# Beyond Biochemical Markers: Characterizing Malnutrition in COVID-19

## TL;DR

The study shows that hospitalized COVID-19 patients often experience malnutrition, primarily due to fat loss, and standard biochemical markers may not detect this issue.

## Contribution

The study identifies that nutritional deterioration in hospitalized COVID-19 patients is often undetected by traditional biochemical markers.

## Key findings

- 30% of hospitalized COVID-19 patients experienced nutritional deterioration defined by weight loss of more than 3%.
- Weight loss was mainly due to a reduction in adipose tissue, not lean tissue.
- Traditional markers like low albumin or cholesterol were not observed in these patients.

## Abstract

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 ± 13.4 years; 39% female, aged 58.8 ± 12.0 years) were included. Deterioration of nutritional status was observed in 20 (30%) individuals, more likely in men (OR 7.94, 95% CI: 1.28–49.08) and patients with longer hospitalization (OR 1.30 per day, 95% CI: 1.08–1.57). 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.