Relationships between plasma fatty acids in adults with mild, moderate, or severe COVID-19 and the development of post-acute sequelae

Abstract

Background: SARS-CoV-2 has infected millions across the globe. Many individuals are left with persistent symptoms, termed post-acute sequelae of COVID-19 (PASC), for months after infection. Hyperinflammation in the acute and convalescent stages has emerged as a risk factor for poor disease outcomes, and this may be exacerbated by dietary inadequacies. Specifically, fatty acids are powerful inflammatory mediators and may have a significant role in COVID-19 disease modulation.

Objective: The major objective of this project was to pilot an investigation of plasma fatty acid (PFA) levels in adults with COVID-19 and to evaluate associations with disease severity and PASC.

Methods and procedures: Plasma from adults with (N = 41) and without (N = 9) COVID-19 was analyzed by gas chromatography-mass spectrometry (GC-MS) to assess differences between the concentrations of 18 PFA during acute infection (≤14 days post-PCR + diagnosis) in adults with varying disease severity. Participants were grouped based on mild, moderate, and severe disease, alongside the presence of PASC, a condition identified in patients who were followed beyond acute-stage infection (N = 23).

Results: Significant differences in PFA profiles were observed between individuals who experienced moderate or severe disease compared to those with mild infection or no history of infection. Palmitic acid, a saturated fat, was elevated in adults with severe disease (p = 0.04), while behenic (p = 0.03) and lignoceric acid (p = 0.009) were lower in adults with moderate disease. Lower levels of the unsaturated fatty acids, γ-linolenic acid (GLA) (p = 0.03), linoleic (p = 0.03), and eicosapentaenoic acid (EPA) (p = 0.007), were observed in adults with moderate disease. Oleic acid distinguished adults with moderate disease from severe disease (p = 0.04), and this difference was independent of BMI. Early recovery-stage depletion of GLA (p = 0.02) and EPA (p = 0.0003) was associated with the development of PASC.

Conclusion: Pilot findings from this study support the significance of PFA profile alterations during COVID-19 infection and are molecular targets for follow-up attention in larger cohorts. Fatty acids are practical, affordable nutritional targets and may be beneficial for modifying the course of disease after a COVID-19 diagnosis. Moreover, these findings can be particularly important for overweight and obese adults with altered PFA profiles and at higher risk for PASC.

Clinical trial registration: [ClinicalTrials.gov], identifier [NCT04603677].

Keywords: COVID-19; SARS-CoV-2; disease severity; nutritional status; persistent symptoms; plasma fatty acid profiles; post-acute sequelae of COVID-19 (PASC).

Conflict of interest statement

The 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.

Copyright © 2022 Stromberg, Baxter, Dooley, LaVergne, Gallichotte, Dutt, Tipton, Berry, Haberman, Natter, Webb, McFann, Henao-Tamayo, Ebel, Rao, Dunn and Ryan.

Figures

FIGURE 1

Significant differences in fatty acid profiles between disease severity groups and the uninfected adults. (A) Behenic acid lower in moderate adults compared to uninfected. (B) Palmitic acid elevated in adults with severe disease compared to uninfected. (C,E) Lignoceric acid and γ-linolenic acid lower in moderate disease compared to uninfected. (D) Oleic acid lower in moderate disease compared to severe disease. (F) Linolenic acid lower in moderate adults compared to mild disease and uninfected. (G) EPA lower in mild and moderate adults compared to uninfected. Shaded points represent adults who received convalescent plasma. * denotes statistical significance p ≤ 0.05.