Background Different pathogens can cause community-acquired pneumonia (CAP); however, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has re-emphasized the vital role of respiratory viruses as a cause of CAP. The aim was to explore differences in metabolic profile, body composition, physical capacity, and inflammation between patients hospitalized with CAP caused by different etiology. Methods A prospective study of Danish patients hospitalized with CAP caused by SARS-CoV-2, influenza, or bacteria. Fat (FM) and fat-free mass (FFM) were assessed with bioelectrical impedance analysis. Physical activity and capacity were assessed using questionnaires and handgrip strength. Plasma (p)-glucose, p-lipids, hemoglobin A1c (HbA1c), p-adiponectin, and cytokines were measured. Results Among 164 patients with CAP, etiology did not affect admission levels of glucose, HbA1c, adiponectin, or lipids. Overall, 15.2% had known diabetes, 6.1% had undiagnosed diabetes, 51.3% had pre-diabetes, 81% had hyperglycemia, and 60% had low HDL-cholesterol, with no difference between groups. Body mass index, FM, and FFM were similar between groups, with 73% of the patients being characterized with abdominal obesity, although waist circumference was lower in patients with COVID-19. Physical capacity was similar between groups. More than 80% had low handgrip strength and low physical activity levels. Compared to patients with influenza, patients with COVID-19 had increased levels of interferon (IFN)-γ (mean difference (MD) 4.14; 95% CI 1.36–12.58; p = 0.008), interleukin (IL)-4 (MD 1.82; 95% CI 1.12–2.97; p = 0.012), IL-5 (MD 2.22; 95% CI 1.09–4.52; p = 0.024), and IL-6 (MD 2.41; 95% CI 1.02–5.68; p = 0.044) and increased IFN-γ (MD 6.10; 95% CI 2.53–14.71; p < 0.001) and IL-10 (MD 2.68; 95% CI 1.53–4.69; p < 0.001) compared to patients with bacterial CAP, but no difference in IL-1β, tumor necrosis factor-α, IL-8, IL-18, IL-12p70, C-reactive protein, and adiponectin. Conclusion Despite higher inflammatory response in patients with COVID-19, metabolic profile, body composition, and physical capacity were similar to patients with influenza and bacterial CAP.

As strategies targeting undernutrition and infections become increasingly successful in low- and middle-income countries (LMICs), a second challenge has appeared, namely premature onset of non-communicable diseases (NCDs). In LMICs, NCDs are often related to exposure to undernutrition and infections. As NCDs strike societies and individuals with impaired resistance or a deficient health (care) state, why not label such diseases ‘opportunistic’, in analogy with opportunistic infections attacking individuals with HIV? We propose the concept of opportunistic NCDs, hoping that fighting against infections, and for better maternal and child health, is becoming acknowledged as essential for the early prevention of NCDs.

Background Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level. Methods This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity. Discussion If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP. Trial registration ClinicalTrials.gov NCT04094636. Registered on 1 April 2019

Bioelectrical impedance analysis (BIA) is an inexpensive, quick and non-invasive method to determine body composition. Equations used in BIA are typically derived in healthy individuals of European descent. BIA is specific to health status and ethnicity and may therefore provide inaccurate results in populations of different ethnic origin and health status. The aim of the present study was to test the validity of BIA in Ethiopian antiretroviral-naive HIV patients.BIA was validated against the 2H dilution technique by comparing fat-free mass (FFM) measured by the two methods using paired t tests and Bland–Altman plots. BIA was based on single frequency (50 kHz) whole-body measurements. Data were obtained at three health facilities in Jimma Zone, Oromia Region, South-West Ethiopia. Data from 281 HIV-infected participants were available. Two-thirds were female and the mean age was 32·7 (sd 8·6) years. Also, 46 % were underweight with a BMI below 18·5 kg/m2. There were no differences in FFM between the methods. Overall, BIA slightly underestimated FFM by 0·1 kg (−0·1, 95 % CI −0·3, 0·2 kg). The Bland–Altman plot indicated acceptable agreement with an upper limit of agreement of 4·5 kg and a lower limit of agreement of −4·6 kg, but with a small correlation between the mean difference and the average FFM. BIA slightly overestimated FFM at low values compared with the 2H dilution technique, while it slightly underestimated FFM at high values. In conclusion, BIA proved to be valid in this population and may therefore be useful for measuring body composition in routine practice in HIV-infected African individuals.