{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:02:35Z","timestamp":1790139755628,"version":"4.0.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81873927"],"award-info":[{"award-number":["81873927"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82072231"],"award-info":[{"award-number":["82072231"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010040","name":"Taishan Scholar Project of Shandong Province","doi-asserted-by":"publisher","award":["tsqn202103165"],"award-info":[{"award-number":["tsqn202103165"]}],"id":[{"id":"10.13039\/501100010040","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","award":["2018M632685"],"award-info":[{"award-number":["2018M632685"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p><jats:bold>Background and Aim:<\/jats:bold> Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (<jats:italic>P<\/jats:italic> &amp;lt; 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5\u20136.19, <jats:italic>P<\/jats:italic> = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, <jats:italic>P<\/jats:italic> = 0.042) were identified as independent risk factors for low TLC.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.<\/jats:p>","DOI":"10.3389\/fnut.2021.739216","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T06:38:29Z","timestamp":1641451109000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Malnutrition Contributes to Low Lymphocyte Count in Early-Stage Coronavirus Disease-2019"],"prefix":"10.3389","volume":"8","author":[{"given":"Kai","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaojiao","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchun","family":"Fei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangdong","family":"Jian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinguo","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuguo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of 2019 novel coronavirus infection in China","author":"Guan WJ Ni","year":"2020","journal-title":"medRxiv."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2020.102763","article-title":"Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients","author":"Liu","year":"2020","journal-title":"medRxiv."},{"key":"B5","volume-title":"Atlas of Hematopathology: Morphology, Immunophenotype, Cytogenetics, and Molecular Approaches.","author":"Naeim","year":"2013"},{"key":"B6","doi-asserted-by":"publisher","first-page":"75","DOI":"10.26800\/LV-142-3-4-13","article-title":"ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection","volume":"142","author":"Barazzoni","year":"2020","journal-title":"Clin Nutr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1016\/j.cgh.2020.03.043","article-title":"Don't overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19)","volume":"18","author":"Luo","year":"2020","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1053\/j.gastro.2020.03.020","article-title":"Effect of gastrointestinal symptoms on patients infected with COVID-19","volume":"158","author":"Zhou","year":"2020","journal-title":"Gastroenterology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1038\/s41430-020-0642-3","article-title":"Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China","volume":"74","author":"Li","year":"2020","journal-title":"Eur J Clin Nutr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"91","DOI":"10.2165\/00002018-199921020-00003","article-title":"Drug-induced lymphopenia: focus on CD4+ and CD8+ cells","volume":"21","author":"Gergely","year":"1999","journal-title":"Drug Saf."},{"key":"B11","unstructured":""},{"key":"B12","unstructured":"Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Internet]"},{"key":"B13","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s40560-020-00453-4","article-title":"Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis","volume":"8","author":"Huang","year":"2020","journal-title":"J Intensive Care."},{"key":"B14","doi-asserted-by":"publisher","first-page":"471","DOI":"10.3390\/cancers13030471","article-title":"Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study","volume":"13","author":"Lee","year":"2021","journal-title":"Cancers (Basel)."},{"key":"B15","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e25287","DOI":"10.1097\/MD.0000000000025287","article-title":"The relationship between nutritional status and the prognosis of COVID-19: A retrospective analysis of 63 patients","volume":"100","author":"Li","year":"2021","journal-title":"Medicine (Baltimore)."},{"key":"B17","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.tim.2004.07.007","article-title":"Host nutritional status: the neglected virulence factor","volume":"12","author":"Beck","year":"2004","journal-title":"Trends Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1016\/j.clnu.2020.03.022","article-title":"ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection","volume":"39","author":"Barazzoni","year":"2020","journal-title":"Clin Nutr."},{"key":"B19","doi-asserted-by":"publisher","first-page":"110835","DOI":"10.1016\/j.nut.2020.110835","article-title":"Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol","volume":"74","author":"Caccialanza","year":"2020","journal-title":"Nutrition."},{"key":"B20","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1002\/eat.20417","article-title":"Malnutrition induces dissociated changes in lymphocyte count and subset proportion in patients with anorexia nervosa","volume":"40","author":"Saito","year":"2007","journal-title":"Int J Eat Disord."},{"key":"B21","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/S0899-9007(99)00251-8","article-title":"Assessment of protein energy malnutrition in older persons, Part II: Laboratory evaluation","volume":"16","author":"Omran","year":"2000","journal-title":"Nutrition."},{"key":"B22","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/S0899-9007(01)00558-5","article-title":"Clinical pictures of malnutrition in ill elderly subjects","volume":"17","author":"Seiler","year":"2001","journal-title":"Nutrition."},{"key":"B23","doi-asserted-by":"publisher","first-page":"624","DOI":"10.7861\/clinmedicine.10-6-624","article-title":"Malnutrition: causes and consequences","volume":"10","author":"Saunders","year":"2010","journal-title":"Clin Med (Lond)."},{"key":"B24","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet."},{"key":"B25","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1111\/liv.14435","article-title":"Liver injury during highly pathogenic human coronavirus infections","volume":"40","author":"Xu","year":"2020","journal-title":"Liver Int."},{"key":"B26","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/s41569-020-0360-5","article-title":"COVID-19 and the cardiovascular system","volume":"17","author":"Zheng","year":"2020","journal-title":"Nat Rev Cardiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1186\/s13054-020-02872-z","article-title":"Acute kidney injury in SARS-CoV-2 infected patients","volume":"24","author":"Fanelli","year":"2020","journal-title":"Crit Care."},{"key":"B28","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1055\/s-0040-1710317","article-title":"Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge","volume":"120","author":"Violi","year":"2020","journal-title":"Thromb Haemost."},{"key":"B29","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1002\/jmv.25915","article-title":"Central Nervous System Involvement by Severe Acute Respiratory Syndrome Coronavirus\u22122 (SARS-CoV-2)","volume":"92","author":"Paniz-Mondolfi","year":"2020","journal-title":"J Med Virol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2021.739216\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T06:38:35Z","timestamp":1641451115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2021.739216\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,6]]},"references-count":30,"alternative-id":["10.3389\/fnut.2021.739216"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2021.739216","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,6]]},"article-number":"739216"}}