Abstract: Nutrition 91
92 (2021) 111400 Contents lists available at ScienceDirect Nutrition journal homepage: www.nutritionjrnl.com Applied nutritional investigation The association between serum levels of micronutrients and the severity of disease in patients with COVID-19 Mohammad Taghi Beigmohammadi a, Sama Bitarafan M.D., Ph.D. b,*, Alireza Abdollahi c,d, Laya Amoozadeh a, Faeze Salahshour e, Maedeh Mahmoodi ali abadi f, Danesh Soltani b, Zoya Asl Motallebnejad b a Anesthesiology and Intensive Care Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran c Department of Pathology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran d Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran e Iran Advanced Diagnostic and Interventional Research Center, Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran f Department of Laboratory, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran b A R T I C L E I N F O Article History: Received 6 February 2021 Received in revised form 13 June 2021 Accepted 16 June 2021 Keywords: COVID-19 Cytokine Micronutrients Vitamin Mineral A B S T R A C T Objectives: This study aimed to compare the serum level of micronutrients with normal amounts, and assess their association with the severity of disease and inflammatory cytokines in patients with coronavirus disease 2019 (COVID-19). Methods: The present cross-sectional study included 60 patients admitted to the intensive care unit with COVID-19. We recorded data on demographic characteristics, anthropometric information, and medical history. Serum levels of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, interferongamma, tumor necrosis factor-alpha, interleukin-6), vitamins (A, B9, B12, C, D, E), and minerals (magnesium, zinc, iron) were measured. A radiologist assessed the severity of lung involvement according to patient computed tomography scans. The severity of illness was evaluated with the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, oxygen saturation, and body temperature. Independent associations among the serum levels of micronutrients with the severity of COVID-19 were measured. Results: Median patient age was 53.50 years (interquartile range, 12.75 years). Except for vitamin A and zinc, serum levels of other micronutrients were lower than the minimum normal. Patients with APACHE score
25 had a higher body mass index (P = 0.044), body temperature (P = 0.003), erythrocyte sedimentation rate (P = 0.008), C-reactive protein (P = 0.003), and lower oxygen saturation (P = 0.005), serum levels of vitamin D (P = < 0.001), and zinc (P = < 0.001) compared with patients with APACHE score <25. We found that lower serum levels of vitamin D, magnesium, and zinc were significantly and independently associated with higher APACHE scores (P = 0.001, 0.028, and < 0.001, respectively) and higher lung involvement (P = 0.002, 0.045, and < 0.001, respectively). Conclusions: Lower serum levels of vitamin D, zinc, and magnesium were involved in severe COVID-19. © 2021 Elsevier Inc. All rights reserved.