{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T07:59:03Z","timestamp":1766995143205,"version":"3.48.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Military Institute of Medicine\u2014National Research Institute, Warsaw, Poland","award":["591"],"award-info":[{"award-number":["591"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objective: Malnutrition is common in hospitalized patients and worsens clinical outcomes, particularly in coronavirus disease 2019 (COVID-19), in which inflammation and metabolic disruption contribute to nutritional decline. Thus, identifying simple and accessible markers is essential for early detection and intervention to prevent further deterioration. This study aimed to investigate biochemical and body composition changes during COVID-19 hospitalization and identify key features of hospital-acquired nutritional status disorders. Methods: We conducted a prospective, single-center, observational study of 66 patients hospitalized with COVID-19 between December 2020 and June 2021. Biochemical markers and body composition parameters were measured at admission and at discharge. Deterioration of nutritional status was defined as a weight loss of more than 3% during hospitalization. Results: A total of 66 patients (61% male, aged 56.7 \u00b1 13.4 years; 39% female, aged 58.8 \u00b1 12.0 years) were included. Deterioration of nutritional status was observed in 20 (30%) individuals, more likely in men (OR 7.94, 95% CI: 1.28\u201349.08) and patients with longer hospitalization (OR 1.30 per day, 95% CI: 1.08\u20131.57). Weight loss was primarily characterized by a reduction in adipose tissue mass, whereas lean tissue mass did not change significantly. Traditional biochemical markers of malnutrition, including low albumin, prealbumin, or cholesterol levels, were not present in this cohort. Conclusions: Our study highlights the significant burden of nutritional deterioration in hospitalized patients with COVID-19 and demonstrates its atypical presentation, which may limit the effectiveness of standard malnutrition assessment tools.<\/jats:p>","DOI":"10.3390\/nu18010075","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T07:52:59Z","timestamp":1766994779000},"page":"75","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Biochemical Markers: Characterizing Malnutrition in COVID-19"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-2608","authenticated-orcid":false,"given":"Katarzyna","family":"Plewka-Barcik","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"R\u00f3\u017ca\u0144ska-Trzepla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis Therapy, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9629-5680","authenticated-orcid":false,"given":"Krzysztof","family":"K\u0142os","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9487-1744","authenticated-orcid":false,"given":"Marta","family":"Krawczyk","sequence":"additional","affiliation":[{"name":"Department of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland"},{"name":"Doctoral School of Translational Medicine, Mossakowski Medical Research Institute, Polish Academy of Sciences, Centre of Postgraduate Medical Education, 02-106 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6444-4124","authenticated-orcid":false,"given":"Andrzej","family":"Chcia\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-860X","authenticated-orcid":false,"given":"Stanis\u0142aw","family":"Niemczyk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis Therapy, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Matyjek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis Therapy, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"},{"name":"Clinical Trials Support Unit, Medical University of Lodz, 92-213 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"ref_1","first-page":"957","article-title":"Malnutrition Diagnoses and Associated Outcomes in Hospitalized Patients: United States, 2018","volume":"36","author":"Guenter","year":"2021","journal-title":"Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.clnu.2015.01.009","article-title":"Decline in Nutritional Status Is Associated with Prolonged Length of Stay in Hospitalized Patients Admitted for 7 Days or More: A Prospective Cohort Study","volume":"35","author":"Allard","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1016\/j.clnu.2020.10.043","article-title":"COVID-19 Is Associated with Clinically Significant Weight Loss and Risk of Malnutrition, Independent of Hospitalisation: A Post-Hoc Analysis of a Prospective Cohort Study","volume":"40","author":"Sofia","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1038\/s41392-023-01510-8","article-title":"Metabolic Alterations upon SARS-CoV-2 Infection and Potential Therapeutic Targets against Coronavirus Infection","volume":"8","author":"Chen","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gombart, A.F., Pierre, A., and Maggini, S. (2020). A Review of Micronutrients and the Immune System\u2013Working in Harmony to Reduce the Risk of Infection. Nutrients, 12.","DOI":"10.3390\/nu12010236"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Flatby, H.M., Ravi, A., Dam\u00e5s, J.K., Sollig\u00e5rd, E., and Rogne, T. (2023). Circulating Levels of Micronutrients and Risk of Infections: A Mendelian Randomization Study. BMC Med., 21.","DOI":"10.1186\/s12916-023-02780-3"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Calder, P., Carr, A., Gombart, A., and Eggersdorfer, M. (2020). Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients, 12.","DOI":"10.3390\/nu12041181"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Spolidoro, G.C.I., Azzolino, D., Shamir, R., Cesari, M., and Agostoni, C. (2021). Joint Effort towards Preventing Nutritional Deficiencies at the Extremes of Life during COVID-19. Nutrients, 13.","DOI":"10.3390\/nu13051616"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.clnesp.2021.03.021","article-title":"Poor Nutritional Status, Risk of Sarcopenia and Nutrition Related Complaints Are Prevalent in COVID-19 Patients during and after Hospital Admission","volume":"43","author":"Wierdsma","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1007\/s13668-021-00380-2","article-title":"The Nutrition-COVID-19 Interplay: A Review","volume":"10","author":"Antwi","year":"2021","journal-title":"Curr. Nutr. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1017\/cem.2020.420","article-title":"Self-Reported Anosmia and Dysgeusia as Key Symptoms of Coronavirus Disease 2019","volume":"22","author":"Lee","year":"2020","journal-title":"Can. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.clnu.2015.03.001","article-title":"Diagnostic Criteria for Malnutrition\u2014An ESPEN Consensus Statement","volume":"34","author":"Cederholm","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM Criteria for the Diagnosis of Malnutrition\u2014A Consensus Report from the Global Clinical Nutrition Community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Keller, U. (2019). Nutritional Laboratory Markers in Malnutrition. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060775"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1002\/jpen.2585","article-title":"Association between Fat-free Mass and Survival in Critically Ill Patients with COVID-19: A Prospective Cohort Study","volume":"48","author":"Lakenman","year":"2024","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.2147\/IJGM.S286484","article-title":"Nutritional Risk Screening and Body Composition in COVID-19 Patients Hospitalized in an Internal Medicine Ward","volume":"13","author":"Quarenghi","year":"2020","journal-title":"Int. J. Gen. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.clnesp.2021.07.033","article-title":"Hospitalization for COVID-19 Is Associated with Significant Changes in Body Composition","volume":"45","author":"Kellnar","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1038\/s41366-021-00861-y","article-title":"Weight Trajectories and Abdominal Adiposity in COVID-19 Survivors with Overweight\/Obesity","volume":"45","author":"Cinel","year":"2021","journal-title":"Int. J. Obes."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ashman Kr\u00f6\u00f6nstr\u00f6m, L., Lundgren-Nilsson, \u00c5., Kjellby-Wendt, G., and Stibrant Sunnerhagen, K. (2023). Symptoms, Care Consumption, and Healthcare Costs in Hospitalized Patients during the First Wave of the COVID-19 Pandemic. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0291548"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Boaz, M., and Kaufman-Shriqui, V. (2023). Systematic Review and Meta-Analysis: Malnutrition and In-Hospital Death in Adults Hospitalized with COVID-19. Nutrients, 15.","DOI":"10.3390\/nu15051298"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.clnesp.2021.03.002","article-title":"Prevalence and Outcomes of Malnutrition among Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis","volume":"43","author":"Abate","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Feng, X., Liu, Z., He, X., Wang, X., Yuan, C., Huang, L., Song, R., and Wu, Y. (2022). Risk of Malnutrition in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis. Nutrients, 14.","DOI":"10.3390\/nu14245267"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/S0002-8223(00)00373-4","article-title":"Impact of Declines in Nutritional Status on Outcomes in Adult Patients Hospitalized for More Than 7 Days","volume":"100","author":"Braunschweig","year":"2000","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.clnu.2024.03.014","article-title":"Incidence and Outcomes of In-Hospital Nutritional Decline: A Prospective Observational Cohort Study in Adult Patients","volume":"43","author":"Botero","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3032","DOI":"10.1016\/j.clnu.2021.05.001","article-title":"Impact of COVID-19 on Nutritional Status during the First Wave of the Pandemic","volume":"41","author":"Ramos","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.clnu.2020.08.021","article-title":"Malnutrition and Nutritional Therapy in Patients with SARS-CoV-2 Disease","volume":"40","author":"Pironi","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.1007\/s40520-023-02526-4","article-title":"Malnutrition in COVID-19 Survivors: Prevalence and Risk Factors","volume":"35","author":"Tosato","year":"2023","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"eabm9151","DOI":"10.1126\/scitranslmed.abm9151","article-title":"SARS-CoV-2 Infection Drives an Inflammatory Response in Human Adipose Tissue through Infection of Adipocytes and Macrophages","volume":"14","author":"Ratnasiri","year":"2022","journal-title":"Sci. Transl. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1111\/j.1365-2265.2006.02474.x","article-title":"The Endocrine Function of Adipose Tissue: An Update","volume":"64","author":"Ronti","year":"2006","journal-title":"Clin. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"87","DOI":"10.14712\/23362936.2015.49","article-title":"Adipose Tissue as an Endocrine Organ: An Update on Pro-Inflammatory and Anti-Inflammatory Microenvironment","volume":"116","author":"Smitka","year":"2015","journal-title":"Prague Med. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute Skeletal Muscle Wasting in Critical Illness","volume":"310","author":"Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Anghel, L., Manole, C., Nechita, A., Tatu, A.L., \u0218tef\u0103nescu, B.I., Nechita, L., Bu\u0219il\u0103, C., Zainea, P., Baroiu, L., and Mu\u0219at, C.L. (2023). Calcium, Phosphorus and Magnesium Abnormalities Associated with COVID-19 Infection, and Beyond. Biomedicines, 11.","DOI":"10.3390\/biomedicines11092362"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/1\/75\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T07:56:37Z","timestamp":1766994997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/1\/75"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["nu18010075"],"URL":"https:\/\/doi.org\/10.3390\/nu18010075","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]}}}