Micronutrient status and fatty acid profile of adults with SARS-CoV-2 infection—an observational study
Melanie Bleffgen, Laura Schinhammer, Francesco Giuseppe De Rosa, Silvia Scabini, Beate Brandl, Hans Hauner, Simona Bo, Thomas Skurk
Frontiers in Nutrition, doi:10.3389/fnut.2025.1608300
Introduction: SARS-CoV-2 infection is a complex disease with multiple dimensions, involving factors that promote infection and virus-driven processes in many body organs. The micronutrient status, beyond others, acts as a potential confounder, influencing susceptibility to infection and disease severity. Additionally, the virus appears to alter lipid metabolism, which may serve a dual function, suppor viral replication while simultaneously contributing to the body's defense and repair mechanisms. Methods: This observational study compared micronutrient levels (vitamin D, selenium, zinc, magnesium, and iron) and lipid profiles between 139 SARS-CoV-2 -positive patients (62 hospitalized, 77 home care) and 314 healthy controls, using dried blood spots. We also examined differences by treatment setting (hospitalized vs. home care) as a proxy for disease severity. Results: Patients with SARS-CoV-2 infection exhibited similar micronutrient levels but showed a significantly impaired lipid profile compared to healthy controls. Notably, there was a significant decrease in palmitic (p-value < 0.01) and stearic acid levels (p-value < 0.01) and a significant increase in omega-3 and omega-6 PUFAs, like AA (p-value < 0.01), DHA (p-value < 0.01), and EPA (pvalue < 0.05) were detected. In the SARS-CoV-2 positive cohort, hospitalized patients had significantly lower micronutrient levels (p < 0.01 for all measured micronutrients) compared to those receiving home care. Discussion: These findings suggest that SARS-CoV-2 infection alters lipid metabolism and that lower micronutrient status may be linked to greater disease severity.
Ethics statement The studies involving humans were approved by Ethics committee of the School of Medicine and Health of the Technical University of Munich. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
Conflict of interest MB is currently employed by Biogena GmbH & CoKG, which markets micronutrient products. This employment commenced after the completion of the study and did not influence the study design, conduct, or reporting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
Brandl, Skurk, Rennekamp, Hannink, Kiesswetter et al., A phenotyping platform to characterize healthy individuals across four stages of life-the enable study, Front Nutr
Brindle, Lillis, Barney, Bansil, Lyman et al., Measurement of micronutrient deficiency associated biomarkers in dried blood spots using a multiplexed immunoarray, PLoS One,
doi:10.1371/journal.pone.0210212Broome, An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status, Am J Clin Nutr,
doi:10.1093/ajcn/80.1.154Calder, Carr, Gombart, Eggersdorfer, Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections, Nutrients,
doi:10.3390/nu12041181Cooper, Crofts, Dinicolantonio, Malhotra, Elliott et al., Relationships between hyperinsulinaemia, magnesium, vitamin D, thrombosis and COVID-19: rationale for clinical management, Open Heart,
doi:10.1136/openhrt-2020-001356Dresen, Pimient, Patel, Heyland, Rice et al., Overview of oxidative stress and the role of micronutrients in critial illness, J Parent Ent Nutr,
doi:10.1002/jpen.2421Gombart, Pierre, Maggini, A review of micronutrients and the immune system-working in harmony to reduce the risk of infection, Nutrients,
doi:10.3390/nu12010236Guillin, Vindry, Ohlmann, Chavatte, Selenium, selenoproteins and viral infection, Nutrients,
doi:10.3390/nu11092101Hoeller, Baur, Roos, Brennan, Daniel et al., Application of dried blood spots to determine vitamin D status in a large nutritional study with unsupervised sampling: the Food4Me project, Br J Nutr,
doi:10.1017/S0007114515004298Huang, Rose, Hoffmann, The role of selenium in inflammation and immunity: from molecular mechanisms to therapeutic opportunities, Antioxid Redox Signal,
doi:10.1089/ars.2011.4145Hunter, Arentz, Goldenberg, Yang, Beardsley et al., Zinc for the prevention or treatment of acute viral respiratory tract infections in adults: a rapid systematic review and meta-analysis of randomised controlled trials, BMJ Open,
doi:10.1136/bmjopen-2020-047474Ivory, Prieto, Spinks, Armah, Goldson et al., Selenium supplementation has beneficial and detrimental effects on immunity to influenza vaccine in older adults, Clin Nutr,
doi:10.1016/j.clnu.2015.12.003Jolliffe, Griffiths, Martineau, Vitamin D in the prevention of acute respiratory infection: systematic review of clinical studies, J Steroid Biochem Mol Biol,
doi:10.1016/j.jsbmb.2012.11.017Laird, Rhodes, Kenny, Vitamin D and inflammation: potential implications for severity of Covid-19, Ir Med J
Metherel, Harris, Ge, Gibson, Chouinard-Watkins et al., Interlaboratory assessment of dried blood spot fatty acid compositions, Lipids,
doi:10.1002/lipd.12203Mitra, Paul, Roy, Sutradhar, Emran et al., Exploring the immune-boosting functions of vitamins and minerals as nutritional food bioactive compounds: a comprehensive review, Molecules,
doi:10.3390/molecules27020555Nguyen, Bourredjem, Piroth, Bouhemad, Jalil et al., High plasma concentration of non-esterified polyunsaturated fatty acids is a specific feature of severe COVID-19 pneumonia, Sci Rep,
doi:10.1038/s41598-021-90362-9Pecora, Persico, Argentiero, Neglia, Esposito, The role of micronutrients in support of the immune response against viral infections, Nutrients,
doi:10.3390/nu12103198Pereira, Damascena, Azevedo, De Almeida Oliveira, Da et al., Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis, Crit Rev Food Sci Nutr,
doi:10.1080/10408398.2020.1841090Pérez-Torres, Guarner-Lans, Soria-Castro, Manzano-Pech, Palacios-Chavarría et al., Alteration in the lipid profile and the desaturases activity in patients with severe pneumonia by SARS-CoV-2, Front Physiol,
doi:10.3389/fphys.2021.667024Quilliot, Bonsack, Jaussaud, Mazur, Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors, Magnes Res,
doi:10.1684/mrh.2021.0476Sun, Chatterjee, Ronanki, Ye, Circulating polyunsaturated fatty acids and COVID-19: a prospective cohort study and Mendelian randomization analysis, Front Med,
doi:10.3389/fmed.2022.923746Thomas, Stefanoni, Dzieciatkowska, Issaian, Nemkov et al., Evidence of structural protein damage and membrane lipid remodeling in red blood cells from COVID-19 patients, J Proteome Res,
doi:10.1021/acs.jproteome.0c00606Van Meer, Voelker, Feigenson, Membrane lipids: where they are and how they behave, Nat Rev Mol Cell Biol,
doi:10.1038/nrm2330Veverka, Wilson, Martinez, Wenger, Tamosuinas, Use of zinc supplements to reduce upper respiratory infections in United States air Force academy cadets, Complement Ther Clin Pract,
doi:10.1016/j.ctcp.2009.02.006Vlieg-Boerstra, De, Meyer, Agostoni, De Cosmi et al., Nutrient supplementation for prevention of viral respiratory tract infections in healthy subjects: a systematic review and meta-analysis, Allergy,
doi:10.1111/all.15136Zeng, Yang, Yuan, Wang, Cheng, Associations of essential and toxic metals/metalloids in whole blood with both disease severity and mortality in patients with COVID-19, FASEB J,
doi:10.1096/fj.202002346RRDOI record:
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"abstract": "<jats:sec><jats:title>Introduction</jats:title><jats:p>SARS-CoV-2 infection is a complex disease with multiple dimensions, involving factors that promote infection and virus-driven processes in many body organs. The micronutrient status, beyond others, acts as a potential confounder, influencing susceptibility to infection and disease severity. Additionally, the virus appears to alter lipid metabolism, which may serve a dual function, suppor viral replication while simultaneously contributing to the body’s defense and repair mechanisms.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This observational study compared micronutrient levels (vitamin D, selenium, zinc, magnesium, and iron) and lipid profiles between 139 SARS-CoV-2 -positive patients (62 hospitalized, 77 home care) and 314 healthy controls, using dried blood spots. We also examined differences by treatment setting (hospitalized vs. home care) as a proxy for disease severity.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Patients with SARS-CoV-2 infection exhibited similar micronutrient levels but showed a significantly impaired lipid profile compared to healthy controls. Notably, there was a significant decrease in palmitic (p-value &lt; 0.01) and stearic acid levels (<jats:italic>p</jats:italic>-value &lt; 0.01) and a significant increase in omega-3 and omega-6 PUFAs, like AA (<jats:italic>p</jats:italic>-value &lt; 0.01), DHA (<jats:italic>p</jats:italic>-value &lt; 0.01), and EPA (<jats:italic>p</jats:italic>-value &lt; 0.05) were detected. In the SARS-CoV-2 positive cohort, hospitalized patients had significantly lower micronutrient levels (<jats:italic>p</jats:italic> &lt; 0.01 for all measured micronutrients) compared to those receiving home care.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>These findings suggest that SARS-CoV-2 infection alters lipid metabolism and that lower micronutrient status may be linked to greater disease severity.</jats:p></jats:sec>",
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"article-title": "The role of micronutrients in support of the immune response against viral infections",
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"journal-title": "Nutrients",
"key": "ref4",
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"DOI": "10.1089/ars.2011.4145",
"article-title": "The role of selenium in inflammation and immunity: from molecular mechanisms to therapeutic opportunities",
"author": "Huang",
"doi-asserted-by": "publisher",
"first-page": "705",
"journal-title": "Antioxid Redox Signal",
"key": "ref5",
"volume": "16",
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"DOI": "10.1016/j.abb.2016.03.022",
"article-title": "Zinc and immunity: an essential interrelation",
"author": "Maares",
"doi-asserted-by": "publisher",
"first-page": "58",
"journal-title": "Arch Biochem Biophys",
"key": "ref6",
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"key": "ref17",
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"DOI": "10.1038/s41598-021-90362-9",
"article-title": "High plasma concentration of non-esterified polyunsaturated fatty acids is a specific feature of severe COVID-19 pneumonia",
"author": "Nguyen",
"doi-asserted-by": "publisher",
"first-page": "10824",
"journal-title": "Sci Rep",
"key": "ref18",
"volume": "11",
"year": "2021"
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"DOI": "10.3389/fmed.2022.923746",
"article-title": "Circulating polyunsaturated fatty acids and COVID-19: a prospective cohort study and Mendelian randomization analysis",
"author": "Sun",
"doi-asserted-by": "publisher",
"first-page": "923746",
"journal-title": "Front Med (Lausanne)",
"key": "ref19",
"volume": "9",
"year": "2022"
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"DOI": "10.1021/acs.jproteome.0c00606",
"article-title": "Evidence of structural protein damage and membrane lipid remodeling in red blood cells from COVID-19 patients",
"author": "Thomas",
"doi-asserted-by": "publisher",
"first-page": "4455",
"journal-title": "J Proteome Res",
"key": "ref20",
"volume": "19",
"year": "2020"
},
{
"DOI": "10.1371/journal.pone.0210212",
"article-title": "Measurement of micronutrient deficiency associated biomarkers in dried blood spots using a multiplexed immunoarray",
"author": "Brindle",
"doi-asserted-by": "publisher",
"first-page": "e0210212",
"journal-title": "PLoS One",
"key": "ref21",
"volume": "14",
"year": "2019"
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{
"DOI": "10.1017/S0007114515004298",
"article-title": "Application of dried blood spots to determine vitamin D status in a large nutritional study with unsupervised sampling: the Food4Me project",
"author": "Hoeller",
"doi-asserted-by": "publisher",
"first-page": "202",
"journal-title": "Br J Nutr",
"key": "ref22",
"volume": "115",
"year": "2016"
},
{
"DOI": "10.1002/lipd.12203",
"article-title": "Interlaboratory assessment of dried blood spot fatty acid compositions",
"author": "Metherel",
"doi-asserted-by": "publisher",
"first-page": "755",
"journal-title": "Lipids",
"key": "ref23",
"volume": "54",
"year": "2019"
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"DOI": "10.3389/fnut.2020.582387",
"article-title": "A phenotyping platform to characterize healthy individuals across four stages of life-the enable study",
"author": "Brandl",
"doi-asserted-by": "publisher",
"first-page": "582387",
"journal-title": "Front Nutr",
"key": "ref24",
"volume": "7",
"year": "2020"
},
{
"article-title": "Vitamin D and inflammation: potential implications for severity of Covid-19",
"author": "Laird",
"first-page": "81",
"journal-title": "Ir Med J",
"key": "ref25",
"volume": "113",
"year": "2020"
},
{
"DOI": "10.1136/openhrt-2020-001356",
"article-title": "Relationships between hyperinsulinaemia, magnesium, vitamin D, thrombosis and COVID-19: rationale for clinical management",
"author": "Cooper",
"doi-asserted-by": "publisher",
"first-page": "e001356",
"journal-title": "Open Heart",
"key": "ref26",
"volume": "7",
"year": "2020"
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{
"DOI": "10.3390/nu11092101",
"article-title": "Selenium, selenoproteins and viral infection",
"author": "Guillin",
"doi-asserted-by": "publisher",
"first-page": "9201",
"journal-title": "Nutrients",
"key": "ref27",
"volume": "11",
"year": "2019"
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{
"DOI": "10.3390/medicina59071190",
"article-title": "Hypermagnesemia in clinical practice",
"author": "Aal-Hamad",
"doi-asserted-by": "publisher",
"first-page": "1190",
"journal-title": "Medicina (Kaunas)",
"key": "ref28",
"volume": "59",
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"article-title": "Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors",
"author": "Quilliot",
"doi-asserted-by": "publisher",
"first-page": "114",
"journal-title": "Magnes Res",
"key": "ref29",
"volume": "33",
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"article-title": "Associations of essential and toxic metals/metalloids in whole blood with both disease severity and mortality in patients with COVID-19",
"author": "Zeng",
"doi-asserted-by": "publisher",
"first-page": "e21392",
"journal-title": "FASEB J",
"key": "ref30",
"volume": "35",
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"DOI": "10.1002/jpen.2421",
"article-title": "Overview of oxidative stress and the role of micronutrients in critial illness",
"author": "Dresen",
"doi-asserted-by": "publisher",
"first-page": "538",
"journal-title": "J Parent Ent Nutr.",
"key": "ref31",
"volume": "47",
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