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Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?
Abstract
The world is currently in the grips of the coronavirus disease (COVID-19) pandemic, caused by the SARS-CoV-2 virus, which has mutated to allow human-to-human spread. Infection can cause fever, dry cough, fatigue, severe pneumonia, respiratory distress syndrome and in some instances death. COVID-19 affects the immune system by producing a systemic inflammatory response, or cytokine release syndrome. Patients with COVID-19 have shown a high level of pro-inflammatory cytokines and chemokines. There are currently no effective anti-SARS-CoV-2 viral drugs or vaccines. COVID-19 disproportionately affects the elderly, both directly, and through a number of significant age-related comorbidities. Undoubtedly, nutrition is a key determinant of maintaining good health. Key dietary components such as vitamins C, D, E, zinc, selenium and the omega 3 fatty acids have well-established immunomodulatory effects, with benefits in infectious disease. Some of these nutrients have also been shown to have a potential role in the management of COVID-19. In this paper, evidence surrounding the role of these dietary components in immunity as well as their specific effect in COVID-19 patients are discussed. In addition, how supplementation of these nutrients may be used as therapeutic modalities potentially to decrease the morbidity and mortality rates of patients with COVID-19 is discussed.
... Тому його дефіцит може спричинити порушення імунних функцій та підвищити ризик тяжкого перебігу інфекційних хвороб, зокрема COVID-19 [7]. Інші дослідження підкреслюють важливість вітамінів групи B для належного функціонування імунної системи та зниження запальних процесів [8]. Дослідження ролі таких прозапальних цитокінів, як TNF-α та IL-6, у перебігу COVID-19 у дітей є надзвичайно важливим через їхній вплив на розвиток тяжких ускладнень, зокрема "цитокінового шторму", тобто обидва ці цитокіни відіграють значну роль в імунній відповіді та індукції запальних процесів [9,10]. ...
... ключову роль у формуванні імунної відповіді, однак їх надмірне продукування може призвести до так званого "цитокінового шторму", що є однією з основних причин ускладнень при COVID-19. Дослідження доводять, що високі рівні TNF-α та IL-6 пов'язані з підвищеним ризиком виникнення тяжких форм захворювання у дітей [4,8]. ...
... Такі підходи можуть допомогти вчасно ідентифікувати пацієнтів із високим ризиком і відповідно адаптувати терапію, що може сприяти зниженню смертності та частоти ускладнень серед дітей. Підтримка адекватного рівня вітамінів і моніторинг цитокінів можуть стати ключовими компонентами у плануванні лікувальних і профілактичних заходів, спрямованих на зменшення тяжкості захворювання [8,21]. ...
Мета дослідження – розробка моделі прогнозування, що дозволяє ідентифікувати дітей із високим ризиком розвитку тяжкого перебігу COVID-19 і своєчасно застосовувати профілактичні заходи. Матеріали та методи. Обстежено 112 дітей віком від 1 місяця до 18 років із підтвердженим діагнозом COVID-19. Дослідження проводили на основі даних про рівні вітамінів і цитокінів у сироватці крові з використанням методу імуноферментного аналізу (ІФА). Результати дослідження та їх обговорення. До моделі увійшли ключові предиктори ризику тяжкого перебігу COVID-19: прозапальні цитокіни TNF-α і IL-6, а також вітаміни A, D і B9. Ці показники виявилися значущими для оцінки ризику розвитку тяжких форм хвороби у дітей, дозволяючи ефективно прогнозувати різні рівні ризику та адаптувати профілактичні заходи. Висновки. Дослідження підтвердило важливу роль прозапальних цитокінів TNF-α та IL-6, а також рівнів вітамінів A, D, B9 у прогнозуванні ризику тяжкого перебігу COVID-19 у дітей. Розроблена математична модель на основі множинного регресійного логістичного аналізу дозволяє з високою точністю визначати пацієнтів із підвищеним ризиком тяжкого перебігу хвороби. Це дає можливість своєчасно впроваджувати профілактичні заходи та індивідуалізувати лікування, що, своєю чергою, сприяє зниженню частоти тяжких форм COVID-19 у дітей та оптимізації використання медичних ресурсів.
... [19] Another study showed that moderate amounts of EPA can reduce NK cell activity in healthy individuals, mainly in people over 55 years of age. [20,21] This effect was completely reversed 4 weeks after discontinuation of supplementation. ...
... However, no significant effect was shown for the levels of IL-6 and TNF-α. [16,21] Interesting information on the effect of SPMs on viral diseases comes from studies in animal models. Morita et al. studied the effect of D1-protectin on the course of influenza caused by H5N1 virus in mice. ...
... However, under severe oxidative stress, they can induce mitochondrial dysfunction leading to apoptosis. [21] Oxidised phospholipids may be biomarkers for atherosclerosis and other pathologies. [17,18,20] N-3 PUFA supplementation in COVID-19 patients influenced the competing roles of lipid mediators, suggesting a pathological lipid mediator "storm" in severe COVID pneumonia. ...
Background/Objectives: For years, research has been conducted on the relationship between anti-inflammatory diets and the incidence and risk of various diseases. In recent years, much attention has been paid to the beneficial effects of fish oil (FO) or shark liver oil (SLO) consumption, which is increasingly being used clinically. Health benefits of FO have been asso-ciated mainly with omega-3 polyunsaturated fatty acids (n-3 PUFAs), but also alkylglycerols (AKGs) and squalene. n-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the main components of FO, have been shown interfere with host immunity, but also various stages of viral infection, particularly viral entry and replication. Methods: In this narrative review we tried to answer the question on the role of n-3 PUFAs, AKGs and squalene in modulation of antiviral response based on the available literature from 2001 to 2023, starting from in vitro and ex vivo studies through animal studies coming up to the human studies. Conclusions: In general, DHA and EPA have an inhibitory effect on the activation of both innate and adaptive immune cells, while squalene and AKGs were shown to enhance antimicrobial and antitumor immune response.
... This trace element is known to retard viral replication and attachment in the nasopharyngeal and oral cavity. The anti-viral effect of zinc may be due to its positive effect on natural killer cells, CD8, CD4 and T-cell activity (Shakoor et al., 2021). It has been demonstrated that zinc may reduce the life cycle of the common cold infection by 1.65 days. ...
... Some studies have also shown that Zinc modifies the effects of respiratory infective agents including the SARS-CoV-2 virus, thus limiting their impact (Adams et al., 2020). Zinc deficiency may lead to the dysregulation of all lung barrier functions and an increase in circulating proinflammatory cytokines that may influence remodeling of lung tissue (Shakoor et al., 2021). ...
... It is still not clear whether Vitamin D supplementation affects SARS-CoV-2 infection rates. However, it has been shown that countries with low Vitamin D levels have higher mortality due to Covid-19 (Shakoor et al., 2021). It is postulated that the reason why Nordic countries such as Finland, Norway, ...
A Phenomenological Study on the Use of Diet, Herbs and Supplements for Covid-19 Management
... The most studied immune-supporting agents include vitamins C, D, and E, as well as trace elements, such as zinc and selenium. Vitamins A, C, D, E, K, and B group, and microelements, namely zinc, iron, copper, selenium, and omega-3 fatty acids, exhibit immunomodulatory effects, making them useful in treating viral infectious diseases as they play vital roles in every stage of the immune response [3,[5][6][7][8]. Consumption of higher daily doses than recommended of vitamins D, C, zinc, and omega-3 fatty acids might po-tentially reduce SARS-CoV-2 viral load and hospitalization time [5,9]. ...
... Elevated levels of prooxidants can involve pro-inflammatory transcription factors, such as nuclear factor кB (NF-кB). Inhibition of NF-кB levels can have a therapeutic effect against viral infections [8]. ...
... The most valuable omega-3 PUFAs include docosahexaenoic and eicosapentaenoic acids, which positively affect the immune system and play an important role in preventing inflammation [8]. They also exert antiviral effects by inhibiting the replication of the influenza virus and improving oxygenation in COVID-19 patients [98]. ...
This review summarizes the scientific knowledge concerning the impact of vitamins, magnesium, and trace elements on various mechanisms contributing to the possible treatment and prevention of COVID-19, including its delayed consequences. A search was conducted in various databases, including PubMed, Scopus, ClinicalTrials.- gov, and Web of Science. Among the main mechanisms involved in the effects of the studied micronutrients, immune-boosting, antioxidant and anti-inflammatory effects were also highlighted. The analyzed clinical trials confirmed that supplementation with higher daily doses of some micronutrients can reduce SARS-CoV-2 viral load and hospitalization time. The potential role of most known vitamins in preventing, treating COVID-19, and rehabilitating patients was considered. The most promising agents for combating COVID-19 and its consequences might be the following vitamins: vitamin D, ascorbic acid, polyunsaturated fatty acids (PUFAs), and some B complex vitamins. Inorganic elements deserving attention include magnesium and trace elements, such as zinc, selenium, copper, and iron. Some associations were found between micronutrient deficiencies and COVID-19 severity in children, adults, and older people. Patients can obtain the aforementioned micronutrients from natural food sources or as supplements/- drugs in various dosage forms. The reviewed micronutrients might be considered adjunctive treatment strategies for COVID-19 patients.
... In the liver, cholecalciferol is hydroxylated to 25-hydroxyvitamin D and subsequently converted to the active hormone 1,25-hydroxyvitamin D (1,25(OH)2D) in the kidneys. It is solely the active form, 1,25(OH)2D, that exerts its effects on VDRs [105]. ...
... A study examining the impact of vitamin supplementation during the course of a SARS-CoV-2 infection revealed that vitamin D supplementation may have the potential to reduce the concentration of pro-inflammatory cytokines, thereby reducing mortality rates associated with acute respiratory distress syndrome in patients with SARS-CoV-2 infection. The effects of an overdose may include kidney stones, muscle weakness, or heart problems [105]. ...
The contemporary approach to nutrition increasingly considers the role of non-nutritive bioactive compounds in modulating the immune system and maintaining health. This article provides up-to-date insight into the immunomodulatory effects of selected bioactive compounds, including micro- and macronutrients, vitamins, as well as other health-promoting substances, such as omega-3 fatty acids, probiotics, prebiotics, postbiotics (including butyric acid and sodium butyrate), coenzyme Q10, lipoic acid, and plant-derived components such as phenolic acids, flavonoids, coumarins, alkaloids, polyacetylenes, saponins, carotenoids, and terpenoids. Micro- and macronutrients, such as zinc, selenium, magnesium, and iron, play a pivotal role in regulating the immune response and protecting against oxidative stress. Vitamins, especially vitamins C, D, E, and B, are vital for the optimal functioning of the immune system as they facilitate the production of cytokines, the differentiation of immunological cells, and the neutralization of free radicals, among other functions. Omega-3 fatty acids exhibit strong anti-inflammatory effects and enhance immune cell function. Probiotics, prebiotics, and postbiotics modulate the intestinal microbiota, thereby promoting the integrity of the intestinal barrier and communication between the microbiota and the immune system. Coenzyme Q10, renowned for its antioxidant attributes, participates in the protection of cells from oxidative stress and promotes energy processes essential for immune function. Sodium butyrate and lipoic acid exhibit anti-inflammatory effects and facilitate the regeneration of the intestinal epithelium, which is crucial for the maintenance of immune homeostasis. This article emphasizes the necessity of an integrative approach to optimal nutrition that considers not only nutritional but also non-nutritional bioactive compounds to provide adequate support for immune function. Without them, the immune system will never function properly, because it has been adapted to this in the course of evolution. The data presented in this article may serve as a foundation for further research into the potential applications of bioactive components in the prevention and treatment of diseases associated with immune dysfunction.
... Overall, these findings underscore the importance of continued public health initiatives aimed at reducing smoking prevalence and supporting individuals in maintaining smoke-free lifestyles, especially during times of heightened health risks such as the COVID-19 pandemic [22,37]. Shakoor et al. (2021) emphasize that both vitamin C and vitamin D play complementary roles in supporting the immune system, reducing the risk and severity of respiratory infections, and potentially aiding in the management of viral infections like COVID-19. These nutrients are essential components of immune health and may have a preventive and therapeutic role in mitigating the impact of infections [38]. ...
... Shakoor et al. (2021) emphasize that both vitamin C and vitamin D play complementary roles in supporting the immune system, reducing the risk and severity of respiratory infections, and potentially aiding in the management of viral infections like COVID-19. These nutrients are essential components of immune health and may have a preventive and therapeutic role in mitigating the impact of infections [38]. ...
Background: During the COVID-19 pandemic, people were asked to stay at home. Places where people interacted such as schools, universities, and cafes were closed, and all gatherings were forbidden. Only stores offering fast-moving consumer goods were open, so citizens could purchase all food categories. The aim of this cross-sectional study was to investigate the effect of the COVID-19 lockdown on the eating and buying habits of consumers in Cyprus and Greece, and any changes in their lifestyles. Methods: An online survey including 1011 participants took place using an electronic questionnaire. Results: The results showed that lockdown significantly affected individuals by increasing weight gain (p < 0.01). The explanatory investigation of related lifestyle habits and nutrition traits showed that the dietary patterns behind these changes included increased meal frequency (p < 0.05)—even without an increased appetite—and subsequent increases in both purchases (p < 0.05) and consumption of several food groups (p < 0.05). Moreover, even though exercise per se was not discontinued due to COVID-19, it was apparent that exercise type was altered to adapt to the relevant restrictions (p < 0.05). Conclusions: In conclusion, the COVID-19 lockdown significantly affected Cypriots and Greeks in many aspects like their eating behavior, food purchasing habits, and lifestyle, all resulting in increased weight and potentially adverse health outcomes.
... People with blood group O were found to have a lower risk of COVID-19 compared with those with other blood groups, which might be associated with lower serum iron levels [99]. Cellular iron homoeostasis is important for the invasion and survival of viruses, as shown by the dependence of viral replication on iron and the effect of viruses on modulating host iron metabolism [100]. Further studies are needed to investigate the significance of iron-chelation treatments and its relationship with viral infection. ...
... Administering selenium along with vitamin E in patients with COVID-19 can promote IL-2 production and enhance the CD4 + and CD8 + T-cell activities, thereby decreasing the risk of infection. They can suppress ROS generation through the corresponding antioxidant effects [100]. One case-control study was performed to determine the effectiveness of vitamin E in treating inpatients with COVID-19, but the results have not been published (NCT05946499). ...
Coronavirus disease 2019 (COVID-19) represents the novel respiratory infectious disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is characterized by rapid spread throughout the world. Reactive oxygen species (ROS) account for cellular metabolic by-products, and excessive ROS accumulation can induce oxidative stress due to insufficient endogenous antioxidant ability. In the case of oxidative stress, ROS production exceeds the cellular antioxidant capacity, thus leading to cell death. SARS-CoV-2 can activate different cell death pathways in the context of infection in host cells, such as neutrophil extracellular trap (NET)osis, ferroptosis, apoptosis, pyroptosis, necroptosis and autophagy, which are closely related to ROS signalling and control. In this review, we comprehensively elucidated the relationship between ROS generation and the death of host cells after SARS-CoV-2 infection, which leads to the development of COVID-19, aiming to provide a reasonable basis for the existing interventions and further development of novel therapies against SARS-CoV-2.
Graphical Abstract
... Ayrıca viral replikasyona ve protein sentezine doğrudan müdahale ederek viral enfeksiyonlara karşı faydalı ve terapötik etkiler sağlayabilir . (26) Çinkonun immünomodülatör ve anti-viral özelliklerinden dolayı SARS-CoV-2 enfeksiyonlu hastalarda destekleyici tedavi olma potansiyeli bulunmaktadır (27). Çinko takviyesinin, hidroksiklorokin gibi diğer tedavilerin etkinliğini artırabileceği öne sürülmüştür (28). ...
... Çalışmalar çinko takviyesinin alt solunum yolu enfeksiyonu gibi SARS-CoV-2 enfeksiyonu ile ilişkili semptomları azaltabildiğini göstermiştir. Bu etkilerin viral kaplamanın, bağlanmanın ve replikasyonun inhibisyonundan kaynaklandığı ve COVID-19 ile ilgili olabileceği öne sürülmüştür (27). ...
Amaç: Şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) enfeksiyonu, hastaneye yatışa yol açabilecek solunum semptomları olan bir hastalıktır. İnsanlarda birçok enzim sisteminde katalizör görevi gören eser elementlerin seviyelerinde tespit edilen dengesizlikler, birçok hastalığın başlangıcı ve ilerlemesi ile yakından ilişkilidir. Bu çalışma, SARS-CoV-2 enfeksiyonunun seyri ile eser element seviyelerinde tespit edilen değişiklikler arasındaki ilişkinin araştırılmasını amaçlamıştır. Gereç ve Yöntem: Bu amaçla literatür taraması yapılmıştır. Literatür taraması sonucunda COVID-19 hastalığıyla ilişkili olarak bakır, çinko ve selenyum düzeylerini inceleyen makaleler çalışmaya dahil edildi. Bulgular: SARS-CoV-2 enfeksiyonunun seyri kötüleştikçe çinko ve selenyum seviyelerinin düştüğü, bakır seviyelerinin ise referans değerlerin dışında kaldığı belirtilmiştir. SARS-CoV-2 enfeksiyonu nedeniyle hastaneye yatırılan hastalarda eksikliği bağışıklık sisteminin zayıflamasına neden olan çinko düzeyleri takip edilmeli ve gerekiyorsa çinko takviyesi verilmelidir. SARS-CoV-2 enfeksiyonu nedeniyle hastaneye yatırılan hastalarda eksikliği bireysel bağışıklık fonksiyon bozukluğuna yatkınlığı artıran selenyum düzeyleri izlenmeli ve gerekiyorsa selenyum takviyesi verilmelidir. Kan bakır düzeylerinde gözlenen sapmalar, SARS-CoV-2 enfeksiyonunun seyrinde iyileşme veya kötüleşme olarak kendini gösterebilir. Sonuç: SARS-CoV-2 enfeksiyonunda akciğer hasarından ve sitokin fırtınasından korunmak için virüse karşı bağışıklık savunmasında dengenin korunması gerekiyor. Bu dengenin korunabilmesi için SARS-CoV-2 enfeksiyonu riski taşıyan bireylere çinko ve selenyum takviyesi önerilebilir.
... These results are also supported by Chris et al., who investigated the scavenging effect of antioxidants in COVID-19 infection (37). Shakoor et al. proposed methods for improving the level of these antioxidant vitamins in these patients (38). The decreased serum level of the antioxidant vitamins is accompanied by a great rise of ROS produced by phagocytes in COVID-19 patients (39). ...
... Recent studies have indicated an important cause of mortality in COVID-19 patients is blood coagulopathy, particularly in the kidneys. However, selenium has been shown to impact the formation of blood clots in blood vessels and reduce their occurrence (Fogarty et al., 2020;Shakoor et al., 2021). The Nutritional Prevention of Cancer Trial (NPCT) demonstrated that Se-enriched yeast (200 μg/d Se) led to a significant reduction in the incidence of various cancers, including lung, colorectal, and prostate cancer, as well as a decrease in total cancer incidence and mortality (Davis et al., 2002). ...
... Moreover, vitamin D activates many gene expressions involved in the immune response [166]. It has also been reported that a physiological vitamin D concentration may prevent COVID-19 infection by helping to defend the respiratory epithelium from pathogenic invasion, probably through increased defensin and cathelicidin expression levels [171]. ...
During the COVID-19 pandemic, several observational studies proved a certain efficacy of nutraceuticals, herbal products, and other dietary supplements as adjuvant therapies used alongside antiviral drugs. Although their use has not been widespread in Italy, according to preliminary evidence, many supplements with demonstrated immunomodulatory effects, such as vitamins C and D, herbal medicines and essential oils, might relieve the respiratory symptoms of COVID-19, since SARS-CoV-2 can activate inflammasome-mediated inflammatory signaling pathways. Other observational studies have shown that herbal treatments, such as Echinacea purpurea and ginseng, help alleviate respiratory symptoms and reduce serum levels of inflammatory cytokines, which are typically overexpressed in both adult and pediatric SARS-CoV-2 patients. Further, vitamins C and D can attenuate the immune response thanks to their cytokine suppression ability and to their known antimicrobial activity and potential to modulate T helper cell response. The strong immune response triggered by SARS-CoV-2 infection is responsible for the severity of the disease. Preliminary data have also shown that L-arginine, an endothelial-derived relaxing factor, is able to modulate endothelial damage, which appears to be one of the main targets of this systemic disease. Finally, some essential oils and their isolated compounds, such as eucalyptol, may be helpful in reducing many of the respiratory symptoms of COVID-19, although others, such as menthol, are not recommended, since it can lead to an undervaluation of the clinical status of a patient. In this narrative review, despite the lack of strong evidence in this field, we aimed to give an overview of the current available literature (mainly observational and cross-sectional studies) regarding herbal products and dietary supplements and their use in the treatment of mild disease from SARS-CoV-2 infection. Obviously, dietary supplements and herbal products do not constitute a standardized treatment for COVID-19 disease, but they could represent an adjunctive and useful treatment when used together with antivirals.
... These results are also supported by Chris et al., who investigated the scavenging effect of antioxidants in COVID-19 infection (37). Shakoor et al. proposed methods for improving the level of these antioxidant vitamins in these patients (38). The decreased serum level of the antioxidant vitamins is accompanied by a great rise of ROS produced by phagocytes in COVID-19 patients (39). ...
Background: SARS-CoV-2 infection can cause significant alterations in our lives. Oxidative stress (OS) has been proposed to play a major role in COVID-19 pathogenesis, and the determination of OS biomarkers provides insight into disease severity. Methods: The study was conducted during the second wave of the pandemic in 2020. Fifty blood samples were collected from patients admitted to one of the COVID-19 isolation centers in Baghdad, Iraq. The samples were subdivided into 25 patients admitted to the intensive care unit (ICU) and 25 non-ICU patients, compared to 25 healthy controls. All participants were aged 35-52 years. Results: The study showed that the mean (±SD) serum total oxidant status (TOS) and malondialdehyde (MDA) levels were significantly increased (p< 0.001) in the ICU group compared to the control and non-ICU groups. Conversely, the levels of serum total antioxidant capacity (TAC) and serum antioxidative enzymes superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase, and glutathione (GSH) were significantly decreased (p< 0.001) in the ICU group compared to both the control and non-ICU groups. Serum zinc levels were significantly decreased (p< 0.001) in both ICU and non-ICU groups compared to the control group, while serum selenium (Se), copper (Cu), and vitamins C and E were significantly decreased (p< 0.001) in the ICU group compared to both the control and non-ICU groups. Conclusion: The presence of OS biomarkers in the sera of COVID-19 patients offers a potential new approach for the treatment of this disease.
... 37,38 Specific essential nutrients, including amino acids (such as glutamine), fatty acids (such as omega-3 fatty acids), and micronutrients (such as zinc, vitamin E, and vitamin C), are vital for the immune system to function. 39 The PN solution usually includes lipid emulsions (LEs), complex amino acids, water-soluble vitamins, fat-soluble vitamins, glucose, electrolytes, and trace elements. 40 LEs are an important source of high-density energy, essential fatty acids, and fat-soluble vitamins, 41 while complex amino acids are crucial for tissue repair and physiological functions. ...
Background
Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes.
Aims
We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer.
Methods
PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI).
Results
In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups (p < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group.
Conclusion
Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation.
... According to these reports, the effect of this vitamin on influenza was dose-dependent, and 5 units compared to 2.5 units of vitamin per 100 g of diet resulted in higher protection in mice. Another study revealed that individuals with a deficiency in vitamin D, defined as a serum 25(OH) D level below 35 nmol/l, exhibited a greater vulnerability to H1N1 infection [89]. It has been reported that the occurrence of vitamin D deficit among the Iranian population is largely attributed to clothing practices, skin coverage, and air pollution, which contribute to a reduced intake of this essential vitamin. ...
The COVID-19 epidemic in recent years has been produced by various coronavirus strains that nearly destroyed world health policies and economics. Emerging viral strains exacerbated the pandemic. Huge investments have been made in preventative vaccines to combat the disease, but the genetic instability of these viruses has hampered their usefulness. However, in addition to traditional therapeutic approaches, nutraceuticals have been considered effica-cious in preventing and or treating COVID-19 and post-COVID syndrome. In this context, nutraceuticals such as vitamins or dietary supplements including multiple vitamins and minerals and propolis have been widely studied for their significant impact on viral respiratory diseases like SARS-CoV-2 and COVID-19. Some of these nutraceuticals having antioxidant, anti-inflammatory, and immune-modulatory properties have been highly recommended for use as an adjunct option to moderate the adverse effects associated with the COVID-19 pandemic. In this review, we intend to present the recent understanding and converse scientific implications for the use of nutraceutical antioxidants such as vitamins, minerals, probiotics, and polyphenols like bee propolis, in the management of viral respiratory diseases and post-COVID-19 syndrome. Future challenges and limitations regarding the use and bioavailability of these ingredients , and dose-response studies are further emphasized.
... Individuals suffering from COPD frequently present with clinical malnutrition, particularly protein deficiency, which can precipitate dyspnea or skeletal muscle dysfunction (65)(66)(67). The significance of minerals, such as selenium (Se) and iron (Fe), in respiratory health has been underscored by recent research (68,69), aligning with findings that a deficiency in these minerals in the DII can heighten the inflammatory potential of one's diet. ...
Background
Respiratory health is closely related to immune system function, and diet can also influence immune homeostasis. Diet, an important part of a healthy lifestyle, is also linked to respiratory health. We aimed to explore the relationship between different dietary patterns and the risk of chronic respiratory diseases (CRDs), including chronic bronchitis (CB), emphysema, and asthma.
Method
A total of 23,042 adults from the United States were selected from the National Health and Nutrition Examination Survey (NHANES) dataset between 2007 and 2018. Diet quality was assessed using 2-day, 24-hour dietary recall data and quantified as the Healthy Eating Index-2020 (HEI-2020), the Dietary Inflammation Index (DII), the Mediterranean Dietary Index (MEDI), and the Dietary Approaches to Stop Hypertension Index (DASHI). Binary logistic regression models, restricted cubic splines (RCS), and the weighted quartile sum (WQS) models were used to assess the relationship between diet quality and the risk of CB, emphysema, and asthma.
Results
In logistic regression analyses of the four dietary indices with the three chronic respiratory diseases, it was consistently observed that higher dietary quality scores were linked to a reduced risk of respiratory disease. These consistent trends were also evident in the assessments of the dose–response relationship between dietary quality score and the risk of respiratory disease. Furthermore, evaluations of the combined effects of dietary components across different dietary indices in the risk of chronic respiratory disease yielded results consistent with the logistic regression models. Notably, high-quality protein, minerals, and fiber-rich fruits and vegetables emerged as the food groups making the most significant contributions to health across different dietary indices.
Conclusion
Low-quality diets, lacking in high-quality protein, minerals, and fruits and vegetables rich in dietary fiber, are associated with a higher risk of chronic respiratory disease, regardless of the dietary index used to measure diet quality.
... The effect of vitamin D on SARS-CoV-2 infection has not been conclusively demonstrated, but it has been suggested that it could potentially reduce levels of pro-inflammatory cytokines, helping to reduce mortality among patients. The accumulated research provides a positive outlook for the future [14]. ...
Introduction Vitamin D is one of the most important vitamins in affecting the human body. It turns out that its influence is not limited to its health-promoting effect on the skeletal system, but may also play an important role in the immune system. In our study, we focused precisely on this aspect of vitamin D's action. Review method We used materials from PubMed for this purpose. We focused on articles and research papers published between 2019 and 2024. We reviewed the publications in terms of vitamin D supplementation and its effects on immunity, disease processes, patient recovery, COVID-19 patients, and some autoimmune diseases. Results Some studies show that vitamin D supplementation significantly improves immune function. It also improves prognosis and reduces mortality in COVID-19. The number of complications and severity of the course also decreases. Vitamin D supplementation also has a positive effect on the course of autoimmune diseases, allowing a reduction in the incidence and improving the outcome of some of them. Unfortunately, not all studies prove such beneficial effects of vitamin D. What is important, however, is that vitamin D may have a beneficial effect on the course of diseases, and the low cost of its use and high availability may prove to be the key to medical development. Conclusions Based on the accumulated studies, it can be concluded that vitamin D contributes to the improvement of immune system function. Some studies prove the beneficial effect of vitamin D supplementation on the course of some autoimmune diseases. The potential benefits of vitamin D supplementation, as well as its low cost, should be a key argument for further research and knowledge on this topic.
... Tobacco use in the past 6 months was higher for the directly exposed group. Supplement intake of vitamin D, vitamin C, zinc, and magnesium, known to be protective against COVID-19 (Butters and Whitehouse 2021, Shakoor, Feehan et al. 2021, Mohammadi, Behjati et al. 2022, Argano, Mallaci Bocchio et al. 2023, were all significantly higher in the indirect exposure group versus the direct exposure group, with intakes of 17.3% vs. 13.6% for zinc to 26.1% vs. 22.8% for Vitamin D. Both exposure groups considered themselves to be healthy, with a difference of 96.7% of the indirect exposure group versus 94.4% of the direct exposure group (p <.001). The reported stress level category frequencies followed a somewhat normal distribution, with the indirect exposure group being generally less stressed. ...
In Spring 2021, MyCycleStorySM launched a secure online survey to which 92.3% of 6049 respondents self-reported menstrual irregularities occurring after the rollout of the COVID-19 injectables. Each respondent served as her own control because prior to the rollout of COVID-19 vaccination, the vast majority had regular menstrual cycles. A subgroup of 3390 respondents were only indirectly exposed to COVID-19 vaccines or the SARS-CoV-2 virus. This subgroup reported 1) being unvaccinated for COVID-19; 2) having had no COVID-19 symptoms; and 3) no positive test for COVID-19, yet a substantial majority of these women, who were only indirectly exposed to COVID-19 injectables or COVID-19 infections still had many of the same menstrual abnormalities as the 2659 women who were directly exposed to a COVID-19 injection (798), or had COVID-19 symptoms (1347), or tested positive for COVID-19 (514). Generalized linear mixed modeling was used to examine the association (not assuming causation) between abnormal menses experienced after the COVID-19 vaccine rollout by respondents who were only indirectly exposed by some degree of proximity to persons. Chi-Square, Student’s t, Kruskal-Wallis or ANOVA tests were used to assess the statistical significance of the similarities of menstrual irregularities reported by the directly exposed and indirectly exposed groups. The mean age of the entire cohort was 37.8 ± 0.1 years. The percentage of the indirectly exposed participants who reported being within 6 feet of a COVID-19 vaccinated person was 85.5%. Of these, 71.7% had irregular menstrual symptoms within one week and 50.1% had irregular menstrual symptoms within ≤3 days after exposure. When comparing daily proximity to a vaccinated person, the categories of “daily within 6 feet outside the household” versus “seldom/sometimes/daily outside 6 feet” had the highest relative risk at 1.34 (p<0.01) for heavier menstrual bleeding, early menses at more than 7 days early with a relative risk at 1.28 (p=0.03), and extended bleeding for more than 7 days with relative risk at 1.26 (p=0.04). Indirect exposure to COVID-19 vaccinated persons was significantly associated with the likelihood of the onset of menstrual irregularities. This study provides additional data to complement a growing body of evidence raising concerns regarding the safety of mRNA vaccines.
... They support lymphocyte functions-key in combating infections and cancer [33]. Vitamins A, C, E, selenium, and zinc are critical in maintaining immune function by enhancing lymphocyte responses, promoting the production and activity of T cells, B cells, and Natural Killer (NK) cells, all of which are essential in both infection control and cancer surveillance [34]. Vitamin A supports the integrity of epithelial barriers and enhances the function of lymphocytes and NK cells, contributing to the prevention of skin, lung, and gastrointestinal cancers by improving the body's defense against malignancies. ...
Cancer remains a leading cause of morbidity and mortality worldwide, necessitating ongoing exploration of effective prevention strategies. Micronutrients, vital for maintaining cellular health, offer promising avenues for cancer prevention. This review delineates the critical roles of micronutrients in cancer prevention, elucidating their mechanisms at the cellular level. Focusing on essential vitamins and minerals like Vitamins A, C, D, E, selenium, and zinc, we explore their profound effects on fundamental cellular processes such as DNA repair, oxidative stress regulation, cellular proliferation, and immune surveillance. These nutrients, characterized by their antioxidative, anti-inflammatory, and immune-enhancing properties, have shown potential in reducing the risk of cancer. The article synthesizes outcomes from a broad spectrum of clinical trials, epidemiological studies, and systematic reviews to evaluate the efficacy of micronutrients in thwarting cancer development. This critical analysis explores significant trials, addresses controversies in nutrient efficacy, and highlights the implications for clinical practice and public health policy. The review underscores the importance of integrating nutritional strategies into comprehensive cancer prevention frameworks and suggests directions for future research to optimize the preventive potentials of micronutrients.
... Higher dietary fiber intake was associated with a reduced risk of cardiovascular diseases [32]. Dietary components such as vitamins C, D, E, and zinc exhibited anti-inflammatory and antioxidant properties, modulated immunity, and were beneficial for preventing infectious diseases like COVID-19 [33,34]. Smoking and lack of physical activity were significantly associated with an increased risk of CVD [35]. ...
Background
The Oxidative Balance Score (OBS) is employed for evaluating the body’s overall level of oxidative stress. This study aimed to investigate the association between OBS and mortality in individuals with chronic kidney disease (CKD) using a cohort study design.
Methods
We used data from adult participants(≥ 20 years old) in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. CKD is diagnosed based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. OBS, which consists of 16 dietary factors and 4 lifestyle factors, categorized into pro-oxidants and antioxidants, with a total score range of 0 to 40 .The OBS was divided into four quartiles (Q1 to Q4), with Q1 (5–12), Q2 (13–18), Q3 (19–24), and Q4 (25–36). We excluded patients with missing data on OBS, CKD, and key covariates.Cox regression analysis were used to examine the relationship between OBS and all-cause mortality in CKD patients. Sensitivity analyses included subgroup analysis and multiple imputation.
Results
We included a total of 3,984 patients with CKD. During an average follow-up period of 103 months, 1,263 cases (31.7%) of all-cause mortality were recorded. In the fully adjusted model, compared to Q1 the hazard ratios (HRs) and 95% confidence intervals (CIs) for Q4 were as follows: OBS 0.80 (0.68, 0.95) (p = 0.012), dietary OBS 0.78 (0.66, 0.92) (p = 0.003), and lifestyle OBS 0.83 (0.70, 0.99) (p = 0.038). Our sensitivity analyses further confirmed the robustness of these results.
Conclusions
Higher OBS was negatively correlated with all-cause mortality risk in American adults with CKD.
... These components, such as vitamins, are essential for maintaining the integrity and functionality of immune cells [21], while polyphenols, such as flavonoids, exert anti-inflammatory and antioxidant effects. Omega-3 fatty acids are particularly beneficial for regulating inflammation, improving immune cell activity, and potentially reducing the risk of autoimmune conditions [22,23]. Furthermore, the gut microbiota, significantly influenced by diet, plays a crucial role in shaping immune responses. ...
The link between diet and immune function is a growing area of interest, recognized not only by the scientific community but also by global health organizations, such as the World Health Organization (WHO) [...]
... The elderly has been considered a risk group and are more likely to develop serious complications and death than the younger population [4]. In the search for ways to protect this population against SARS-CoV-2 while vaccines have been developed, research has been initiated on the influence of vitamins and minerals on the coronavirus through the effect they can have on the immune system through supplementation [5]. Due to the lack of information about effective treatments for COVID-19, and in search of a way to minimize its impact on public health, the COVID-19 Kit was created in Brazil. ...
Immunization is a challenge for the elderly population and can leave this group more vulnerable to opportunistic pathogens such as SARS-CoV-2. Due to this situation, while vaccines were in the development phase, hypotheses were raised about the role of vitamins and minerals in immunization. In Brazil, there was a controversy regarding the well-known COVID-19 Kit, a standardized prescription for positive cases that contained zinc, and vitamin D, and anti-parasitic drugs. There was great controversy in scientific circles, since COVID-19 brought a major challenge for health professionals and public authorities: misleading information. In this study, we evaluated the role of vitamin D and zinc in the production of anti-SARS-CoV-2 neutralizing antibodies (NAbs) in a group of elderly residents in a nursing home in northeastern Brazil. Serum levels of COVID-19 NAbs were assessed, along with vitamin D and zinc, in two phases. The first (T1) was in August 2022 with 26 elderly people, and the second (T2) was in March 2023 with 21, due to the death of five participants. Overall, we observed satisfactory levels for vitamin D, with no participants showing a deficiency in either test, and zinc, with only two participants having a negative result at T1 and three at T2. However, a drop in the average number of NAbs was observed, especially in women (T1 = 89 ± 19 vs. T2 = 57 ± 44), highlighting the importance of monitoring this immunological parameter in the population studied. Based on the results, we suggest that there is no synergism between the micronutrients studied and NAbs (p > 0.05). Further studies are needed to consolidate the findings of an absence of synergism between vitamin D and zinc in the maintenance of NAbs.
... [29][30][31][32][33] Besides climatic aspects that could subserve bacterial growth, the amount of absorbed UV radiation and vitamin D levels, which also underly seasonal oscillations, affect the immune system directly. [34][35][36][37] The findings of this study demonstrate significant summer peaks for wisdom teeth-related search terms in the USA and Canada. Given the populations tendency to google their symptoms shortly after they are affected, the correlation of observed interest peaks with the incidence of symptoms caused by the respective disease should be discussed. ...
Objective: The study aimed to analyze the public interest in wisdom teeth-related search terms as well as regional and seasonal trends based on information from the Google search engine. Methods: With the help of the online search query tool, Google Trends, the public interest in the primary search term “wisdom teeth” for the timeframe between January 1st, 2004 and September 31st, 2021 was analyzed. To do so, a country-specific search was conducted in English-speaking countries (the USA, the UK, Canada, and Australia) in the northern and southern hemispheres. The extracted time series was examined for reliability, and a Cosinor analysis evaluated the statistical significance of seasonal interest peaks. Results: The reliability of averaged time series data on the search term “wisdom teeth” was excellent in all examined countries. In all countries analyzed, “wisdom teeth removal” was one of the most common related search terms. Significant interest peaks for wisdom teeth-related search terms were found in Canada and the USA during summer (p < .001). In Canada and the USA, significant seasonal patterns with the highest interest during the summer months, could be displayed. Conclusion: This phenomenon could be caused by increased wisdom teeth-related complaints induced by seasonal climate changes.
... Vitamin C is generally recognized for its antioxidant and immunomodulating effects [50,51]. Humans cannot synthesize vitamin C, which makes it an essential nutrient. ...
It is well known that during prolonged, high-intensity physical training, athletes experience a state of immunosuppression and that balanced nutrition can help maintain immunity. This review summarizes the effects (amplified by virus infection) of high-intensity, long-term exercise on immunity, critically presenting key micronutrients and supplementation strategies that can influence athletes’ performance and their immune system. The main conclusion is that micronutrient supplementation with diet could help to protect the immune system from the stress effects induced by intense physical activities. The importance of personalized supplementation has been also recommended.
... Recently, research has indicated the potential effects of vitamin D 3 and omega-3 on gut microbiota biodiversity in a separate intake (Mujico et al. 2013, Costantini et al. 2017, Horigome et al. 2019, Singh et al. 2020, Bellerba et al. 2021, Wellington et al. 2022) and there has been extensive research combining both supplements together to test their effect on cardiovascular diseases, autism, diabetes mellitus, and metabolic diseases with positive outcomes so far (Güttler, Zheleva et al. 2012, Manson et al. 2012, Infante et al. 2020, Manson et al. 2020a, 2020b, Shakoor et al. 2021, Refaat et al. 2022. However, no evidence has been reported yet concerning the combined effect of the supplementation of vitamin D 3 and omega-3 together on the performance of the gut region microbiome. ...
Aims
The gut microbiota plays a key role in host health. An intake of omega-3 and vitamin D3 in a separate manner is vital for maintaining good health of gut microbiota and controlling some illness manifestations. The aim of this study is to investigate the potential change in biodiversity of the gut microbiome in healthy rats supplemented with vitamin D3, omega-3 alone and their combination and to reflect onto the triglyceride levels in serum and fecal samples.
Methods
Using the 16S rRNA gene Miseq Illumina NGS, and monitoring triglyceride levels in serum and fecal samples coupled with several clinical parameters, we examined the effect of orally taken combination of omega-3 and vitamin D3 alongside the separate intake of supplements on gut microbiota in 24 healthy white Wistar rats for six weeks.
Results
The study findings showed that combination treatment encouraged the growth of opportunistic Clostridia class during day 21 and 42 of treatment by 7.7 and 7.4 folds, respectively, exhibited incomplete absorption levels for both supplements when used concomitantly, demonstrated a damaging effect on the gut intestinal lining wall thickness (126um) when compared to control group (158um), increasing lumen diameter (400um) and showed higher triglyceride level in fecal samples.
Conclusion
These findings indicate that omega-3 and vitamin D3 supplements as combination intake reveal unfavorable effects, thus, it is advised to conduct further in-depth studies to clarify the presence or absence of any chemical interaction between both supplements’ molecules and to investigate based on human model to attain a superior perspective.
... According to the European Society for Parenteral and Enteral Nutrition, using omega-3 fatty acids might enhance oxygen levels in COVID-19 patients, yet concrete evidence supporting this is currently lacking. [17] Fresh oils with a greater amount of DHA relative to EPA, like fractionated and concentrated fish oil, tuna oil, calamari oil, and microalgae oil, are becoming more prevalent in the market. Additionally, there are expectations for other oils, including those extracted from genetically modified oilseed crops, to soon become available. ...
Introduction: Questioning how we can boost our immunity during the infectious season often arises in the general practicioner’s office. Patients report issues with recurring infections, affecting not only children but also adults, particularly those in professionally exposed groups such as teachers. Therefore, is it worthwhile to recommend over-the-counter (OTC) products available in pharmacies to patients, aiming to strengthen their immunity? This article discusses the most commonly used supplements and immune-boosting preparations by patients and physicians, along with scientific evidence regarding their effectiveness. Material and methods: The basis of the work were medical articles collected in the PubMed database. The research was conducted by analyzing key words such as: vitamin D3, immunity improvement, zinc, bacterial lysates, lactoferrin, fish oil, omega-3 fatty acids, Echinacea purpurea, Spirulina maxima, curcumin, probiotics, ginseng. Results: In the pharmaceutical market, there are many supplements aimed at boosting the immune system. However, most of them lack sufficient scientific evidence regarding their effectiveness. The studies conducted so far are of low quality and limited in number. Further research is necessary to demonstrate the efficacy and safety of immune-boosting supplements.
... [8] Similarly, the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α) levels were shown to be highest in individuals with severe COVID-19 symptoms and pneumonia. [9] To identify the cellular process behind the pathogenesis of coronavirus, it is crucial to compare the levels of these cytokines in COVID-19 patient's sera to those of healthy individuals. In this research, TNF-α and IL-6 levels have been measured using an ELISA in sera from COVID-19 severe patients compared to a control group of healthy volunteers. ...
Background
In 2019’s December, the new COVID-19 coronavirus induced severe lower respiratory tract syndrome in Wuhan, China. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ultimately became responsible for the life-threatening pandemic. The magnitude and outcome of COVID-19 may be related to the overproduction of pro-inflammatory cytokine called “cytokine storm.” Cytokine production besides the age of patients, and comorbidities, all influence the length and severity of SARS-CoV-2.
Objectives
This research was performed to investigate how these factors affect patients who have severe COVID-19 in a sample of Iraqi patients.
Materials and Methods
A total of 82 participants were enrolled in this work, confirmed hospitalized COVID-19 patients ( n = 60) and healthy control ( n = 22) from both sexes of age range 20‐67 years. Tumor necrosis factor-alpha (TNF- α ) and interleukin-6 (IL-6) levels in the serum of COVID-19 patients and HC have been evaluated using an ELISA.
Results
According to our findings, sera from COVID-19 patients had considerably higher levels of IL-6 and TNF- α than those of the control group. Furthermore, most infections were among women (63%), followed by men (37%), the higher number of patients were within 50‐59 years, while the lowest number of patients was found in the group 20‐29 years. Most COVID-19 patients appeared to be overweight and obese. Additionally, those who have diabetes mellitus are also at risk of severe COVID-19.
Conclusion
Serum levels of TNF- α and IL-6 were higher in patients than in the control group, suggesting that they could be used as indicators of the severity of COVID-19 illness. Also, their combined detection provided highest specificity and sensitivity for early prediction of COVID-19 severity, which has significant clinical values.
... At this stage, there is a greater demand for the synthesis of FAs. There is also a great need for these molecules for the formation of the viral membrane and because they are necessary for binding to the receptor-binding domain, such as the LA [46]. However, treatment with Vit E may restore these requirements [47]. ...
Citation: Soto, M.E.; Manzano-Pech, L.; Guarner-Lans, V.; Palacios-Chavarría, A.; Valdez-Vázquez, R.R.; Martínez-Memije, R.; El-Hafidi, M.; Rodríguez-Fierros, F.L.; Pérez-Torres, I. Preliminary Study on the Restoration of the Phospholipid Profile in Serum from Patients with COVID-19 by Treatment with Vitamin E. Abstract: SARS-CoV-2 is an obligatory intracellular pathogen that requires a lipid bilayer membrane for its transport to build its nucleocapsid envelope and fuse with the host cell. The biological membranes are constituted by phospholipids (PLs), and vitamin E (Vit E) protects them from oxidative stress (OS). The aim of this study was to demonstrate if treatment with Vit E restores the modified profile of the FA in PLs in serum from patients with coronavirus disease-19 (COVID-19). We evaluated Vit E, total fatty acids (TFAs), fatty acids of the phospholipids (FAPLs), total phospholipids (TPLs), 8-isoprostane, thromboxane B 2 (TXB 2), prostaglandins (PGE 2 and 6-keto-PGF1 α), interleukin-6 (IL-6), and C-reactive protein (CRP) in serum from 22 COVID-19 patients before and after treatment with Vit E and compared the values with those from 23 healthy subjects (HSs). COVID-19 patients showed a decrease in Vit E, TPLs, FAPLs, and TFAs in serum in comparison to HSs (p ≤ 0.01), and Vit E treatment restored their levels (p ≤ 0.04). Likewise, there was an increase in IL-6 and CRP in COVID-19 patients in comparison with HSs (p ≤ 0.001), and treatment with Vit E decreased their levels (p ≤ 0.001). Treatment with Vit E as monotherapy can contribute to restoring the modified FA profile of the PLs in the SARS-CoV-2 infection, and this leads to a decrease in lipid peroxidation, OS, and the inflammatory process.
... They found that physical activity had an OR of 1.79 and a 95% CI of 1.45-2.20. Researchers have registered and are currently conducting several clinical studies to evaluate the effectiveness of specific nutrients in COVID-19 patients [40]. We reported that, among Arabic adults, 32.1% consumed the daily-recommended requirements of protein, 31.4% of vegetables, 17.2% of fruits, and 23.6% of water. ...
Background
Since the onset of the coronavirus (COVID-19) pandemic crisis, the supplement market has consistently grown. Therefore, we conducted this survey during the fourth wave of the COVID-19 pandemic to study the frequency and context of dietary supplement (DS) consumption (vitamins and mineral intake) and explore the consumer’s pharmaceutical buying behaviour; and (3) to study its determinants as regards the demographics, Fatigue Severity Scale (FSS), and healthy eating pyramids.
Methods
We conducted a cross-sectional web-based survey on 1333 Arabic adults aged 18 years or more residing in six Arabic-speaking countries in May 2022, using a validated self-administrated questionnaire . The survey-involved questions about sociodemographic characteristics, physical activity, FSS, healthy eating pyramid, DS consumption, and consumers’ pharmaceutical purchasing behaviour.
Results
Most participants were aged 20 to less than 35 years, and 64.6% used dietary supplements. There was a statistically significant difference between supplement users and nonusers as regards consumers’ pharmaceutical buying behaviour in terms of advertising quality, safety rules, pharmaceutical forms, and packet quality. Arabic adults consumed the following dietary supplements: 63.5% vitamin C, 60.1% vitamin D, 47.1% iron, and 44.4% zinc. Authorised products (76.0%), natural contents (75.0%), and safety rules (68%), were the most common factors influencing Arabic consumers’ pharmaceutical purchasing behavior. Multi-logistic regression analysis showed that being female, having a history of COVID-19, having a positive attitude about the benefits, and being recommended for supplement use were predictors of dietary supplement use.
Conclusion
The dietary consumption of supplements is prevalent, mainly including vitamin C, vitamin D, iron, zinc, vitamin B, and magnesium. In addition, Arabic adults are poorly adherent to healthy eating pyramids . Given the ongoing COVID-19 pandemic, Arabic health authorities should prioritize this issue to minimize the potential for misusing dietary supplements.
... Due to zinc's involvement in the immune system and cell maintenance, as well as its antiviral and anti-inflammatory properties, certain researchers suggest that sufficient zinc consumption could potentially lower the risk and severity of COVID-19. [12][13][14][15][16][17][18][19][20] The management protocol for patients with coronavirus in Iraq is divided into two types: hospitalized patients included (oxygen therapy, dexamethasone ampules, antibiotics, antiviral, Vitamin C, Vitamin D3, and zinc tablets) throughout the hospitalization period and for nonhospitalized patients include (antibiotic, antiviral, Vitamin C, Vitamin D3, and zinc tablet) until the patient is completely curative. The daily human requirement for zinc is 8 mg for females and 11 mg for males, whereas in sick cases that indicate the need for zinc, the dose should not be exceeded 40 mg per day because it will lead to health problems and toxicity represented as acute and chronic symptoms. ...
Background and Objectives
Zinc is an essential trace mineral required by the human body in minute quantities. It plays a crucial role in facilitating around 100 enzymes to perform key chemical reactions. It has a significant role in DNA synthesis, cellular proliferation, protein synthesis, tissue regeneration, and bolstering the immune system. Zinc toxicity primarily arises from the consumption of zinc supplements rather than from dietary sources. The study aimed to evaluate the side effects caused by the misuse of zinc during and after recovery from the coronavirus.
Materials and Methods
A case series study design was used to carry out the study. The constructed checklist was applied to 107 patients who recovered from corona disease to determine the causes of the adverse health consequences they still suffer from after recovery, also, they underwent comprehensive laboratory tests in January 2023.
Results
Nearby 50% of the study sample had zinc tests higher than the normal range, whereas they were suffering from such physical health disorders that were significantly enhanced due to management undertaken.
Conclusions
The misuse of zinc tablets for a long time and in large doses caused such physical problems to be continued for a time among many patients recovering from coronavirus, and when the intake of zinc tablets and multivitamins supplements was stopped for 6 months an obvious improvement in these health symptoms occurred.
... At this stage there is a greater demand in the synthesis of FA. There is also a great need of these molecules for the formation of the viral membrane and because they are necessary for the binding to the receptor-binding domain such as LA [45]. However, the treatment with Vit E may restore these requirements [46]. ...
SARS-CoV-2 is an obligatory intracellular pathogen that requires of a lipid bilayer membrane for its transport, to build its nucleocapsid envelope and to fuse with the host cell. The biological membranes are constituted by phospholipids (PLs) and vitamin E (Vit E) protects them from oxidative stress (OS). The aim of this study was to demonstrate if the treatment with Vit E restores the modified profile of the FA in PLs in serum from patients with coronavirus disease-19 (COVID-19). We evaluated Vit E, total fatty acids (TFA), fatty acid of the phospholipids (FAPL), total phospholipids (TPLs), 8-isoprostane, thromboxane B2 (TXB2), prostaglandins (PGE2 and 6-keto-PGF1α), interleukin-6 (IL-6) and C-reactive protein (CRP) in serum from 22 COVID-19 patients before and after treatment with Vit E and compared the values with those from 23 healthy subjects (HS). COVID-19 patients showed a decrease in Vit E, TPLs, FAPL and TFA in serum in comparison to HS (p≤0.01) and Vit E treatment restored their levels (p≤0.04). Likewise, there was an increase IL-6 and CRP in COVID-19 patients in comparison with HS (p≤0.001) and the treatment with Vit E decreased their levels (p≤0.001). Treatment with Vit E contributes to restore the modified profile of the PLs in the SARS-CoV-2 infection and this leads to a decrease of OS and of the inflammatory process.
... Ключевые диетические компоненты, рассмотренные в обзоре микроэлементы Se и Zn, витамины (А, Е, C) обладают хорошо зарекомендовавшим себя иммуномодулирующим действием, которое помогает при ОРВИ и других инфекционных заболеваниях [79][80][81][82][83]. ...
Acute respiratory viral infections are widespread diseases, poorly controlled infections and are characterized by moderately pronounced constant growth. The use of vitamin-mineral complexes (nutraceuticals) for nonspecific prevention and treatment of acute respiratory viral infections is experiencing a “second youth” thanks to new data accumulated during the novel coronavirus infection (COVID-19) pandemic. As part of the review, we examined the possible impact of deficiency of the microelements selenium and zinc, vitamins A, E and C on various aspects of the course of ARVI: nonspecific prevention, treatment and rehabilitation. We searched for relevant sources in the PubMed and Scopus information databases, including the time period up to 04.07.2024. The presence in the arsenal of a practicing physician of 2 forms of the vitamin-mineral complex Selzinc® at the outpatient stage of medical care will increase the effectiveness of nonspecific prevention of ARVI in the pre-epidemic period, especially in “frequently ill adults with ARVI,” as well as the treatment of ARVI as adjuvant therapy and subsequent rehabilitation.
... This study examined the levels of antioxidants of vitamins (vitamins A, C and E), enzymes (GSH, GPx SOD and Catalase), and some oxidative stress markers (MDA) in COVID19 patients and controls group.The effect of COVID 19 on serum levels of vitamins A, C and E has been investigatedof the current study.Vitamins A, C and E showed significantly lower in COVID 19patients when compared with control group.Vitamin Ashowed the decrease in COVID 19 patients compared to controls;these findings are similar to other reports [18]. Our results showed low levels of vitamin C in COVID-19 patients,this results also supports by other report [19],that antioxidants vitamins levels are decrease in SARS-COV-2 infection due to their scavenging effect on ROS.Also other reported showed the low levels of antioxidant vitamins in COVID 19 patients, and hence suggested the aim lead to improving the levels of these vitamins the useful in these patients [20]. Our study showed lower values of antioxidant vitamins in COVID 19 patients may be due overproduction of the ROS and a deprived antioxidant system. ...
This study is concerned with COVID-19pandemic and subjects were divided into three main groups honey consumed of COVID-19 patients(n = 90),without honey consumed of COVID-19 patients(n = 30) and control group(n = 30). The determine patients in the city of Najaf during the period between July 2020 to august 2020.Patients were identified using a PCR technique, after which a 5 milliliter was withdrawnon the first day to identify(VitaminA,VitaminC,VitaminE,GSH,GPx,SOD,CAT,MDA) and then repeat the process of determining the variables every seven days.In addition to giving COVID-19patients a kilogram of honey divided into different quantities and different times and compere with second group (without honey consumed of COVID-19patients)and examined by PCR technique.These variables measured the concentration by using assay (ELISA) technique and spectrophotometer instrument. All above variables there was a significant difference and correlation in patients (p˂0.05).Also results showed changes in concentrations levels variablesof honey consumed COVID-19 a significant difference between the mean value in patients (p˂0.05)but little changesin concentrations variableswithout honey consumed of COVID-19 patients a significant difference between the mean value in patients (p˂0.05).The results showed the effect of honey consumed of COVID-19 patients over timeon patients three times a day and the patients are examined byPCR test showed Negative which more than 14 days.
Selenium (Se) is a trace element that fulfills vital functions in the organism. Over the past few years, numerous studies have revealed the profound connection between Selenium and its therapeutic potential in addressing various viral infectious diseases. Selenium can boost the activity of immune cells and counteract oxidative damage caused by free radicals to prevent the replication of viruses. Studies have shown that Selenium protects against a wide range of viruses such as DNA viruses, hepatitis B virus, RNA viruses, human immunodeficiency virus and coxsackie virus. Selenium is probably one of the research directions for antiviral drugs in the future. This review summarizes the use of Selenium in antiviral therapy and its research progress.
The appearance of coronaviruses, particularly SARS-CoV-2, had highlighted the significant role of the innate immune system in determining the severity and outcome of viral infections. As the first line of defence, the immune response relies on pattern recognition receptors, such as Toll-like receptors and the NLRP3 inflammasome, to initiate pro-inflammatory responses aimed at combating viral threats. However, an excessive or dysregulated immune response, including hypercytokinemia, can lead to tissue damage and exacerbate disease severity. Recent studies suggest that nutritional immunomodulation can influence the effectiveness of the immune system and potentially mitigate the impact of coronavirus infections. Nutrients like vitamins D, C, and zinc have been shown to modulate immune functions by enhancing immune activity, promoting anti-inflammatory responses, and improving viral clearance. These nutritional interventions may improve the body's response towards viral infections, reduce inflammation, and prevent excessive immune activation. This review explores the intricate relationship between coronaviruses, innate immunity, and nutritional immunomodulation, emphasizing the potential of targeted nutritional strategies to support immune function and manage the impact of coronavirus infections. Understanding the molecular mechanisms behind these interactions may provide new insights for therapeutic interventions in viral diseases like COVID-19.
The SARS-CoV-2 vaccine is an important keystone in fighting against the virus. The vaccination alone could not prevent all SARS-CoV-2 viral infections or even its spread, especially after the emergence of newly mutant strains. The immune response to the SARS-CoV-2 vaccines varies greatly from one person to another. Age, along with adequate micronutrients, especially vitamin D, are major factors influencing immunity. We aimed to analyze SARS-CoV-2 vaccine neutralization potency and the total IgG antibodies along with 25-hydroxy-cholecalciferol concentrations in a cohort of healthy Egyptian vaccinated adults. 196 individuals were included; 145 females and 51 males, with an age range between 22 and 59 years old, from the first time of vaccination and over 16 weeks long. Three blood samples were taken from each individual at three time points; before the 1st dose of vaccination, before the 2nd dose of vaccination, and after 8 weeks of complete vaccination. The samples were analyzed using a chemiluminescent immunoassay to measure vitamin D level and titer of neutralizing and IgG antibodies. A lower level of neutralizing antibodies was detected in deficient and insufficient vitamin D-vaccinated individuals. However, a sufficient titer was detected in individuals with normal vitamin D. Vitamin D deficiency is associated with a suppressed immune response against SARS-CoV-2 despite vaccination. Thus, we made inquiries about using vitamin D as an adjuvant to SARS-CoV-2 vaccination, and its relation with the production of anti-SARS-CoV-2 antibodies.
In recent decades, the prevalence of known but insufficiently treated diseases and disorders has increased significantly. However, there is also the manifestation of disorders whose causes were already known but were not sufficiently controlled. Public health problems are be-coming more frequent and more current. Among the Cur-rent public health problems many symptoms and diseases are linked to certain vitamins, certain unhealthy life-styles, and other contributing factors. Vitamin D is one of the current public health topics that has recently attracted increasing scientific attention. a biologically essential compound that affects many functions in the human body. And the deficiency of this vitamin is widespread throughout the world. Vitamin D can be found in the form of preparations, but it is also recognized as a registered medication in some contexts.
B vitamin complex consist of vitamins B1, B2, B5, B6, B9, B12 and is pivotal for overall health, influencing vital functions such as, energy metabolism, DNA maintenance, and healthy immune system. Inadequate B vitamin levels are associated with various health issues, including neurocognitive problems, immune imbalances, and inflammation. In ageing individuals, deficiencies in B vitamins increase the risk of cardiovascular ailments, stroke, cognitive disorders, neurodegeneration, mental health issues, and methylation-related disorders. These result primarily due to changes in glycation, mitochondria, and oxidative stress. Thus, ensuring optimal vitamin B levels in the ageing population may be beneficial in preventing such age-related diseases. In this chapter we discuss the extensive role of B vitamins in the ageing process.
The novel Coronavirus has brought global mortality, disruption, and a significant loss of life. A compromised immune system is a known risk factor for all viral influenza infections. Due to the perceived “immune-boosting” properties of nutraceutical products, sales of dietary supplements have grown globally. In recent years, consumers have increasingly demanded nutraceutical products rather than curative synthetic medicines for preventive therapies for the coronavirus disease outbreak of 2019 (COVID-19). Healthy foods and nutraceuticals have become daily diet plans for consumers. Although there has been an increase in demand, there is no such regulation and harmonized process, which stands as a barrier to the approval of these products. Therefore, many misbranded and spurious products are entering the market, which may harm consumers. This article focuses on the role of functional foods and nutraceutical in the management of COVID-19 also focuses on the different nutraceutical regulations in each country and compare the similarities and differences of the following countries: India, the USA (United States of America), the EU (European Union), and China. The comparative study of nutraceutical regulations in India, the USA, Europe, and China shows that there is a difference regarding the nutraceutical regulations; however, despite the differences, it is observed that it has the same underlying objective, i.e., ensuring the safety of the consumers by maintaining the product quality.
Boosting the immune system has become a crucial aspect in the global battle against the COVID-19 pandemic and other similar infections to protect oneself against symptoms, especially in the prevention of viral infections of the lower respiratory tract. The importance of conducting more studies to create successful herbal formulations as infection prevention measures is emphasized in this review, which looks at the function of immune-boosting nutrients, medicinal plants, and herbal treatments. We reviewed and analyzed 207 studies published from 1946 to the present using reputable databases like Google Scholar, PubMed, and NCBI. The review examined 115 plant species in total and identified 12 key nutrients, including vitamins A, D, C, omega-3 fatty acids, iron, and zinc, while noting that four plant families, Rosaceae, Asteraceae, Amaryllidaceae, and Acanthaceae, show potential against respiratory infections like influenza, RSV, and SARS-CoV. To lower the risk of infection, it is recommended to consume nutritious meals that have immune-modulating qualities. Information on the bioactive components of medicinal herbs, spices, and plants that have been effective in treating respiratory viral infections and related conditions is compiled in this review, which highlights phytoactive substances with antibacterial and antiviral activity as effective modulators to lower the risk of infections. Furthermore, it is highlighted that ancient knowledge systems, like Ayurveda and Naturopathy, should be integrated to help develop new herbal formulations. To improve immunity and lessen vulnerability to serious respiratory infections, the results highlight the need for including immune-modulating foods and plant-based medicines into everyday routines.
In this editorial, we have commented on the article that has been published in the recent issue of World Journal of Clinical Cases. The authors have described a case of unilateral thyroid cyst and have opined that the acute onset of infection may be linked to diabetes mellitus (DM). We have focused on the role of nutrition in the association between DM and infection. Patients with DM are at a high risk of infection, which could also be attributed to nutrition-related factors. Nutritional interventions for patients with diabetes are mainly based on a low-calorie diet, which can be achieved by adhering to a low-carbohydrate diet. However, dietary fiber supplementation is recommended to maintain the diversity of the gut microbiota. Furthermore, high-quality protein can prevent the increased risk of infection due to malnutrition. Supplementation of vitamins C, vitamins A, vitamins D, and folic acid improves blood sugar control and facilitates immune regulation. Mineral deficiencies augment the risk of infection, but the relationship with diabetes is mostly U-shaped and a good intake should be maintained.
Amidst the relentless battle against Coronaviridae, vaccines stand as our beacon of hope, illuminating a path towards an eventual triumph over the pandemic. Through tireless collaboration and scientific ingenuity, researchers have forged ahead, developing a diverse array of vaccines to combat COVID-19 and its variants. Yet, alongside these remarkable achievements, formidable challenges persist. Vaccine hesitancy, fueled by misinformation and cultural complexities, threatens to impede progress, underscoring the need for comprehensive strategies to foster trust and understanding. Moreover, the imperative of global cooperation looms large, demanding equitable vaccine distribution to ensure that no community is left behind in our shared pursuit of health and resilience. As we navigate these uncharted waters, let us draw inspiration from the resilience and compassion that define our collective humanity, forging ahead with determination and unity to overcome this unprecedented crisis.
Background
Viral respiratory infections (VRIs) continue to be among the most common illnesses and are known to be one of the main reasons of medical consultations worldwide.
COVID-19 remains a major public concern and a threat to global health. The current focus lies on the pivotal role of the human host's immunologic response in combating viral threats.
This critical review aims to examine the current evidence on the potential benefit of nutritional supplements in the prevention and treatment of COVID-19 and viral respiratory infections (VRIs).
Methods
The study was performed in the Google-Scholar and PubMed databases with a main emphasis on publications between January 2000 and September 2023. Consequently, a total of 202 articles were included in this literature review, distributed as follows: 62 meta-analyses and systematic reviews, 20 randomized clinical trials, 11 clinical trials, 28 observational cohorts and 81 others. Of these, 44 % were published between 2020 and 2023.
Results
The research indicates that Vitamin C may have a mitigating effect on VRIs, whereas a deficiency in Vitamin D might heighten susceptibility to COVID-19. Understanding the roles of Vitamins A, B, and E is hampered by limited data availability. Zinc supplementation and probiotics emerge as potential preventive measures for both COVID-19 and VRIs, with selenium and magnesium demonstrating promising results in treating VRIs. The recommendation for omega-3 fatty acid supplementation for COVID-19 treatment awaits further evidence.
Conclusion
Currently, there is insufficient clinical evidence to definitively establish the efficacy of vitamin, mineral, probiotic and/or omega-3 supplementation for combating COVID-19 and VRIs.
Purpose of the study: to analyze the influence of dietary habits and the use of biologically active additives (BAAs) as a factor influencing the risk of COVID-19 in medical workers.
Materials and methods : A longitudinal online study was conducted from March to April 2022. Incidence was assessed as the percentage of COVID-19 cases among the total number of respondents. Characteristics of methods for studying actual nutrition were carried out using the method of retrospective recording of nutrition (method of analysis of frequency of consumption).
Results : respondents who took vitamin D in a prophylactic dosage were less likely to get sick with COVID-19 (confirmed SARS-CoV-2) – 35.9% did not get sick with SARSCoV-2; and those who didn’t take it – only 5.85%; p <0. 0001. Taking vitamin D reduced the odds (OR) of developing COVID-19 by 9.011 times (95% CI 4.581–17.710); and the relative risk of developing the disease by 46.5%. Prophylactic use of multivitamin complexes did not affect the risk of COVID-19 (p=0.14). It was found that the use of vegetables in the daily diet reduces the chance (OR) of the occurrence of clinical manifestations of a new coronavirus infection by 1.948 times (95% CI 0.845–4.492); and when consuming more than 400 grams per day – by 2.530 times (95% CI 1.015– 6.306). Daily consumption of green salads reduces the risk of disease by 29.5%.
Conclusion : impaired nutritional status leads to dysregulation of inflammation and oxidative stress; increasing susceptibility to infection and the risk of worsening the disease. The role of proper nutrition should not be overlooked and the use of vitamin D as a non–specific prophylaxis supports the immune system.
Background
Coronavirus disease 2019 (COVID-19) pandemic was also spread during winter time in December from Wuhan the city of China to worldwide. Various studies conducted throughout the world have indicated the possible relationship between Vitamin D and COVID-19 infection.
Aim
This narrative review is designed to support Vitamin D role and its efficacy in managing COVID-19 menace.
Materials and Methods
Latest 50 articles for Vitamin D, and COVID-19 relationship and management were scrutinized to summarize this article from data bases of PubMed and Google scholar in English language. Diagrams were created by biorender.com to summarize pictorial relations.
Conclusions
Higher mortality is associated with countries of high-level Vitamin D deficiencies. Many studies have found a significant relation between Vitamin D deficiency and COVID-19 complications and related comorbidities. It is highly supported by many literature to recommend daily dose of Vitamin D3 10,000 IU/day for a few weeks to rapidly increase 25-hydroxyvitamin D levels above 40–60 ng/mL, in population at higher risk.
ABSTRACT
Chalcones with a C6-C3-C6 backbone are a class of plant-derived polyphenolic metabolites structurally related to flavonoids, of which two phenyl rings are connected via an α- and β-unsaturated carbonyl chain. Indeed, these secondary metabolites are precursors of flavonoids, as they are readily converted to the corresponding flavanones by the action of chalcone isomerase. Chalcones are found in various plant resources and possess a myriad of biological/pharmacological activities, including antioxidant, anticancer, antiviral, anti-inflammatory, and immunomodulatory effects. Given the outbreak of harmful viral diseases like Ebola, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Mother Nature has been recognized as the most beneficial choice to look for potential candidates to target the variety of human viruses. So, the leaves of an Indian medicinal plant containing chalcones inhibited in vitro SARS-CoV-2 replication by blocking viral entry into host cells with high safety and low toxicity. Various researchers have also computationally studied the potency of chalcones as antiviral drugs toward SARS-CoV-2, the virus that caused COVID-19. As previously reported, prenylated chalcones (i.e., xanthoangelols B, D, E, and F) derived from Angelica keiskei inhibited in vitro the key SARS-CoV enzymes, including 3CLpro (chemotrypsin-like protease) and PLpro (papain-like protease), with IC50 ranges of 1.2‒34.1 μM. Another in vitro study reported that synthetic chalcones, for example, a new ciprofloxacin-chalcone hybrid, can dose-dependently inhibit SARS-CoV-2 3CLpro in Vero cells (IC50 value of 0.6 μM). Although chalcones may provide excellent anti-SARS-CoV-2 compounds, further research is required to investigate their efficiency and safety in clinical trials.
This chapter will cover the current knowledge on chalcones and, in some cases, their synthetic derivatives against SARS-CoV-2. Furthermore, the inhibition of different enzymes, which are related to different stages of viral replication and progression of COVID-19, will be discussed.
Introduction
After throwing light on COVID-19 infection, its transmission, available treatment options in Part I, this article has focused on various preventive measures proposed to deal with the disease.
Aim
The Part II of this review article aimed to provide the different measures advocated to prevent COVID-19.
Methods
An electronic search was performed in PubMed and Google Scholar databases with the keywords "Corona virus, COVID-19, World Health Organization, Severe Acute Respiratory Syndrome, SARS-CoV-2, Prevention, Vaccines" from January 2017 to August 2022.
Results
A total of 42 articles were included in the current review.
Conclusion
The theoretical evidence does advocate the use of vaccines to be good candidates, but practically, no guarantee can be given that an individual will never be infected. One needs to take personal precautions such as hand sanitizing, wearing a mask in public places, and maintaining social distancing till a permanent cure is procured.
The COVID-19 pandemic has highlighted the importance of nutrition in maintaining overall health and supporting the immune system's response to viral infections. This review paper provides an overview of the role of diet in controlling COVID-19 associated symptoms and promoting recovery. Through a comprehensive examination of scientific literature and dietary guidelines, this paper explores the potential impact of various nutrients, dietary patterns, and supplementation strategies on mitigating symptoms, enhancing immune function, and improving clinical outcomes in COVID-19 patients. Additionally, practical recommendations for implementing a therapeutic diet to support COVID-19 management are discussed, with a focus on personalized nutrition approaches tailored to individual needs and preference
Introduction
SARS-CoV-2 (COVID-19) has caused an international pandemic of respiratory illness, resulting in significant healthcare and economic turmoil. To date, no robust vaccine or treatment has been identified. Elemental zinc has previously been demonstrated to have beneficial effects on coronaviruses and other viral respiratory infections due to its effect on RNA polymerase. Additionally, zinc has well-demonstrated protective effects against hypoxic injury—a clear mechanism of end-organ injury in respiratory distress syndrome. We aimed to assess the effect of high-dose intravenous zinc (HDIVZn) on SARS-CoV-2 infection. The end of study analyses will evaluate the reduction of impact of oxygen saturations or requirement of oxygen supplementation.
Methods and analysis
We designed a double-blind randomised controlled trial of daily HDIVZn (0.5 mg/kg) versus placebo. Primary outcome measures are lowest oxygen saturation (or greatest level of supplemental oxygenation) for non-ventilated patients and worst PaO 2 /FiO 2 for ventilated patients. Following power calculations, 60 hospitalised patients and 100 ventilated patients will be recruited to demonstrate a 20% difference. The duration of follow-up is up to the point of discharge.
Ethics and dissemination
Ethical approval was obtained through the independent Human Research Ethics Committee. Participant recruitment will commence in May 2020. Results will be published in peer-reviewed medical journals.
Trial registration number
ACTRN126200000454976.
The SARS-CoV-2 epidemic started in late December 2019 in Wuhan, China, and has since impacted a large portion of China and raised major global concern. Herein, we investigated the extent of molecular divergence between SARS-CoV-2 and other related coronaviruses. Although we found only 4% variability in genomic nucleotides between SARS-CoV-2 and a bat SARS-related coronavirus (SARSr-CoV; RaTG13), the difference at neutral sites was 17%, suggesting the divergence between the two viruses is much larger than previously estimated. Our results suggest that the development of new variations in functional sites in the receptor-binding domain (RBD) of the spike seen in SARS-CoV-2 and viruses from pangolin SARSr-CoVs are likely caused by natural selection besides recombination. Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses had two major lineages (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date. We found that L lineage was more prevalent than the S lineage within the limited patient samples we examined. The implication of these evolutionary changes on disease etiology remains unclear. These findings strongly underscores the urgent need for further comprehensive studies that combine viral genomic data, with epidemiological studies of coronavirus disease 2019 (COVID-19).
Patient: Female, 74-year-old
Final Diagnosis: COVID-19
Symptoms: Cough • fever • shortness of breath
Medication: —
Clinical Procedure: —
Specialty: Critical Care Medicine
Objective
Unusual clinical course
Background
Coronavirus disease 2019 (COVID-19) continues to spread, with confirmed cases now in more than 200 countries. Thus far there are no proven therapeutic options to treat COVID-19. We report a case of COVID-19 with acute respiratory distress syndrome who was treated with high-dose vitamin C infusion and was the first case to have early recovery from the disease at our institute.
Case Report
A 74-year-old woman with no recent sick contacts or travel history presented with fever, cough, and shortness of breath. Her vital signs were normal except for oxygen saturation of 87% and bilateral rhonchi on lung auscultation. Chest radiography revealed air space opacity in the right upper lobe, suspicious for pneumonia. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 came back positive while the patient was in the airborne-isolation unit. Laboratory data showed lymphopenia and elevated lactate dehydrogenase, ferritin, and interleukin-6. The patient was initially started on oral hydroxychloroquine and azithromycin. On day 6, she developed ARDS and septic shock, for which mechanical ventilation and pressor support were started, along with infusion of high-dose intravenous vitamin C. The patient improved clinically and was able to be taken off mechanical ventilation within 5 days.
Conclusions
This report highlights the potential benefits of high-dose intravenous vitamin C in critically ill COVID-19 patients in terms of rapid recovery and shortened length of mechanical ventilation and ICU stay. Further studies will elaborate on the efficacy of intravenous vitamin C in critically ill COVID-19.
Vitamin D deficiency is a worldwide pandemic. The aim of this study was to evaluate associations of plasma 25(OH)D levels with the likelihood of coronavirus disease 2019 (COVID‐19) infection and hospitalization. The study population included the 14 000 members of Leumit Health Services, who were tested for COVID‐19 infection from February 1st to April 30th, 2020, and who had at least one previous blood test for the plasma 25(OH)D level. ‘Suboptimal’ or ‘low’ plasma 25(OH)D level was defined as plasma 25‐hydroxyvitamin D, or 25(OH)D, concentration below the level of 30 ng/mL. Of 7807 individuals, 782 (10.02%) were COVID‐19‐positive, and 7025 (89.98%) COVID‐19‐negative. The mean plasma vitamin D level was significantly lower among those who tested positive than negative for COVID‐19 [19.00 ng/mL (95% confidence interval (CI) 18.41–19.59) vs. 20.55 (95% CI: 20.32–20.78)]. Univariate analysis demonstrated an association between the low plasma 25(OH)D level and increased likelihood of COVID‐19 infection [crude odds ratio (OR) of 1.58 (95% CI: 1.24–2.01, P < 0.001)], and of hospitalization due to the SARS‐CoV‐2 virus [crude OR of 2.09 (95% CI: 1.01–4.30, P < 0.05)]. In multivariate analyses that controlled for demographic variables, and psychiatric and somatic disorders, the adjusted OR of COVID‐19 infection [1.45 (95% CI: 1.08–1.95, P < 0.001)] and of hospitalization due to the SARS‐CoV‐2 virus [1.95 (95% CI: 0.98–4.845, P = 0.061)] were preserved. In the multivariate analyses, age over 50 years, male gender and low–medium socioeconomic status were also positively associated with the risk of COVID‐19 infection; age over 50 years was positively associated with the likelihood of hospitalization due to COVID‐19. We concluded that low plasma 25(OH)D levels appear to be an independent risk factor for COVID‐19 infection and hospitalization.
The novel coronavirus disease 2019 (COVID-19) is now officially declared as a pandemic by the World Health Organization (WHO), and most parts of the world are taking drastic measures to restrict human movements to contain the infection. Millions around the world are wondering, if there is anything that could be done, other than maintaining high personal hygiene, and be vigilant of the symptoms, to reduce the spread of the disease and chances of getting infected, or at least to lessen the burden of the disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The National and International health agencies, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the WHO have provided clear guidelines for both preventive and treatment suggestions. In this article, I will briefly discuss, why keeping adequate zinc balance might enhance the host response and be protective of viral infections.
Aim: To evaluate associations of plasma 25(OH)D status with the likelihood of coronavirus disease (COVID-19) infection and hospitalization.
Methods: The study population included the 14,000 members of Leumit Health Services who were tested for COVID-19 infection from February 1st to April 30th, 2020, and who had at least one previous blood test for plasma 25(OH)D level. "Suboptimal" or "low" plasma 25(OH)D level was defined as plasma 25-hydroxyvitamin D, or 25(OH)D, concentration below 30 ng/mL.
Results: Of 7,807 individuals, 782 (10.1%) were COVID-19-positive, and 7,025 (89.9%) COVID-19-negative. The mean plasma vitamin D level was significantly lower among those who tested positive than negative for COVID-19 [19.00 ng/mL (95% confidence interval [CI] 18.41-19.59) vs. 20.55 (95% CI 20.32-20.78)]. Univariate analysis demonstrated an association between low plasma 25(OH)D level and increased likelihood of COVID-19 infection [crude odds ratio (OR) of 1.58 (95% CI 1.24-2.01, p<0.001)], and of hospitalization due to the SARS-CoV-2 virus [crude OR of 2.09 (95% CI 1.01-4.30, p<0.05)]. In multivariate analyses that controlled for demographic variables and psychiatric and somatic disorders, the adjusted OR of COVID-19 infection [1.45 (95% CI 1.08-1.95, p<0.001)], and of hospitalization due to the SARS-CoV-2 virus [1.95 (95% CI 0.98-4.845, p=0.061)] were preserved. In the multivariate analyses, age over 50 years, male gender and low-medium socioeconomic status were also positively associated with the risk of COVID-19 infection; age over 50 years was positively associated with the likelihood of hospitalization due to COVID-19.
Objectives
Vitamin D deficiency (VDD) has been proposed to play a role in Coronavirus Disease 2019 (COVID‐19) pathophysiology. We aim to evaluate our implementation of a local protocol for treatment of VDD among patients hospitalized for COVID‐19; to assess the prevalence of VDD among COVID‐19 inpatients, and examine potential associations with disease severity and fatality.
Design and Participants
We conducted a retrospective interim audit of a local clinical care pathway for 134 inpatients with COVID‐19. Prevalence of VDD, compliance with local treatment protocol and relationship of baseline serum 25(OH)D with markers of COVID‐19 severity and fatality were analysed.
Results
55.8% of eligible patients received Colecalciferol replacement, albeit not all according to the suggested protocol. Patients admitted to ITU were younger than those managed on medical wards (61.1 years ± 11.8 vs. 76.4 years ± 14.9, respectively, p<0.001), with greater prevalence of hypertension, higher baseline respiratory rate, National Early Warning Score‐2 and C‐Reactive protein level. While mean serum 25(OH)D levels were comparable (p=0.3), only 19% of ITU patients had 25(OH)D levels greater than 50 nmol/L vs. 39.1% of non‐ITU patients (p=0.02). However, there was no association with fatality, potentially due to small sample size and prompt diagnosis and treatment of VDD.
Conclusions
Higher prevalence of VDD was observed in patients requiring ITU admission compared to patients managed on medical wards. Larger prospective studies and/or clinical trials are needed to validate and extend our observations.
Background:
We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors.
Methods:
We studied 4510 UK Biobank participants tested for COVID-19 (positive, n = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status.
Results:
There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations.
Conclusions:
In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.
More and more studies are accumulating about COVID-19. Some aspects of the pathogenesis of the disease recall events occurring in Mg deficiency, such as a drop of T cells, increased plasma concentration of inflammatory cytokines, and endothelial dysfunction. We hypothesize that a low Mg status, which is rather common, might foment the transition from mild to critical clinical manifestations of the disease. Epidemiological, clinical, and fundamental research is needed to clarify the potential role of Mg deficiency in COVID-19.
Coronavirus 2019 (COVID-19) is a pandemic with substantial mortality and no accepted therapy. We report here on four consecutive outpatients with clinical characteristics (CDC case definition) of and/or laboratory-confirmed COVID-19 who were treated with high dose zinc salt oral lozenges. All four patients experienced significant improvement in objective and symptomatic disease measures after one day of high dose therapy suggesting that zinc therapy was playing a role in clinical recovery. A mechanism for zinc’s effects is proposed based on previously published studies on SARS- CoV-1, and randomized controlled trials assessing zinc shortening of common cold duration. The limited sample size and study design preclude a definitive statement about the effectiveness of zinc as a treatment for COVID-19 but suggest the variables to be addressed to confirm these initial findings in future trials.
Coronavirus disease (COVID-19) is a major pandemic and now a leading cause of death worldwide. Currently, no drugs/vaccine is available for the treatment of this disease. Future preventions and social distancing are the only ways to prevent this disease from community transmission. Vitamin D is an important micronutrient and has been reported to improve immunity and protect against respiratory illness. This short review highlights the important scientific link between Vit D levels and susceptibility to COVID-19 in patients. This review also discusses recommendations for Vit D dose required for healthy as well as COVID-19 susceptible patients for protection and prevention.
The current COVID-19 pandemic caused by SARS-CoV-2 has prompted investigators worldwide to search for an effective anti-viral treatment. A number of anti-viral drugs such as ribavirin, remdesivir, lopinavir/ritonavir, antibiotics such as azithromycin and doxycycline, and anti-parasite such as ivermectin have been recommended for COVID-19 treatment. In addition, sufficient pre-clinical rationale and evidence have been presented to use chloroquine for the treatment of COVID-19. Furthermore, Zn has the ability to enhance innate and adaptive immunity in the course of a viral infection. Besides, Zn supplement can favour COVID-19 treatment using those suggested and/or recommended drugs. Again, the effectiveness of Zn can be enhanced by using chloroquine as an ionophore while Zn inside the infected cell can stop SARS-CoV-2 replication. Given those benefits, this perspective paper describes how and why Zn could be given due consideration as a complement to the prescribed treatment of COVID-19.
Selenium (Se) is a ubiquitous element akin to sulfur (S) existing in the Earth crust in various organic and inorganic forms. Selenium concentration varies greatly depending on the geographic area. Consequently, the content of selenium in food products is also variable. It is known that low Se is associated with increased incidence of cancer and heart diseases. Therefore, it is advisable to supplement diet with this element albeit in a proper form. Although blood increased concentrations of Se can be achieved with various pharmacological preparations, only one chemical form (sodium selenite) can offer a true protection. Sodium selenite, but not selenate, can oxidize thiol groups in the virus protein disulfide isomerase rendering it unable to penetrate the healthy cell membrane. In this way selenite inhibits the entrance of viruses into the healthy cells and abolish their infectivity. Therefore, this simple chemical compound can potentially be used in the recent battle against coronavirus epidemic.
World Health Organization announced the novel coronavirus disease (COVID-19) outbreak to be a global pandemic. The distribution of community outbreaks shows seasonal patterns along certain latitude, temperature, and humidity i.e. similar to the behavior of seasonal viral respiratory tract infections. COVID-19 displays significant spread in northern midlatitude countries with an average temperature of 5-11 °C and low humidity. Vitamin D deficiency has also been described as pandemic, especially in the Europe.Regardless of age, ethnicity, and latitude; recent data showed that 40% of the Europeans are vitamin D deficient (25(OH)D levels <50 nmol/L), and 13% are severely deficient (25(OH)D <30 nmol/L).A quadratic relationship was found between the prevalences of vitamin D deficiency in most commonly affected countries by COVID-19 and the latitudes. Vitamin D deficiency is more common in the subtropical and midlatitude countries than the tropical and high latitude countries. The most commonly affected countries with severe vitamin D deficiency are from the subtropical (Saudi Arabia; 46%, Qatar; 46%, Iran; 33.4%, Chile; 26.4%) and midlatitude (France; 27.3%, Portugal; 21.2% and Austria; 19.3%) regions. Severe vitamin D deficiency was found to be nearly 0% in some high latitude countries (e.g. Norway, Finland, Sweden, Denmark and Netherlands).
Accordingly, we would like to call attention to the possible association between severe vitamin D deficiency and mortality pertaining to COVID-19. Given its rare side effects and relatively wide safety, prophylactic vitamin D supplementation and/or food fortification might reasonably serve as a very convenient adjuvant therapy for these two worldwide public health problems alike.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), with a clinical outcome ranging from mild to severe, including death. To date, it is unclear why some patients develop severe symptoms. Many authors have suggested the involvement of vitamin D in reducing the risk of infections; thus, we retrospectively investigated the 25-hydroxyvitamin D (25(OH)D) concentrations in plasma obtained from a cohort of patients from Switzerland. In this cohort, significantly lower 25(OH)D levels (p = 0.004) were found in PCR-positive for SARS-CoV-2 (median value 11.1 ng/mL) patients compared with negative patients (24.6 ng/mL); this was also confirmed by stratifying patients according to age >70 years. On the basis of this preliminary observation, vitamin D supplementation might be a useful measure to reduce the risk of infection. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations and to confirm our preliminary observation.
Background and aims
COVID-19 and low levels of vitamin D appear to disproportionately affect black and minority ethnic individuals. We aimed to establish whether blood 25-hydroxyvitamin D (25(OH)D) concentration was associated with COVID-19 risk, and whether it explained the higher incidence of COVID-19 in black and South Asian people.
Methods
UK Biobank recruited 502,624 participants aged 37–73 years between 2006 and 2010. Baseline exposure data, including 25(OH)D concentration and ethnicity, were linked to COVID-19 test results. Univariable and multivariable logistic regression analyses were performed for the association between 25(OH)D and confirmed COVID-19, and the association between ethnicity and both 25(OH)D and COVID-19.
Results
Complete data were available for 348,598 UK Biobank participants. Of these, 449 had confirmed COVID-19 infection. Vitamin D was associated with COVID-19 infection univariably (OR = 0.99; 95% CI 0.99–0.999; p = 0.013), but not after adjustment for confounders (OR = 1.00; 95% CI = 0.998–1.01; p = 0.208). Ethnicity was associated with COVID-19 infection univariably (blacks versus whites OR = 5.32, 95% CI = 3.68–7.70, p-value<0.001; South Asians versus whites OR = 2.65, 95% CI = 1.65–4.25, p-value<0.001). Adjustment for 25(OH)D concentration made little difference to the magnitude of the association.
Conclusions
Our findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection.
The immune system protects the host from pathogenic organisms (bacteria, viruses, fungi, parasites). To deal with this array of threats, the immune system has evolved to include a myriad of specialised cell types, communicating molecules and functional responses. The immune system is always active, carrying out surveillance, but its activity is enhanced if an individual becomes infected. This heightened activity is accompanied by an increased rate of metabolism, requiring energy sources, substrates for biosynthesis, and regulatory molecules, which are all ultimately derived from the diet. A number of vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium, iron) have been demonstrated to have key roles in supporting the human immune system and reducing risk of infections. Other essential nutrients including other vitamins and trace elements, amino acids and fatty acids are also important. Each of the nutrients named above has roles in supporting anti-bacterial and anti-viral defence, but zinc and selenium seem to be particularly important for the latter. It would seem prudent for individuals to consume sufficient amounts of essential nutrients to support their immune system in order to help them deal with pathogens should they become infected. The gut microbiota plays a role in educating and regulating the immune system. Gut dysbiosis is a feature of disease including many infectious diseases and has been described in COVID-19. Dietary approaches to achieve a healthy microbiota can also benefit the immune system. Severe infection of the respiratory epithelium can lead to acute respiratory distress syndrome (ARDS), characterised by excessive and damaging host inflammation, termed a cytokine storm. This is seen in cases of severe COVID-19. There is evidence from ARDS in other settings that the cytokine storm can be controlled by n-3 fatty acids, possibly through their metabolism to specialised pro-resolving mediators.
Selenium status is an established factor in the incidence, outcome or virulence of various RNA viral infections. Because China has geographic regions that range from extremely high to extremely low selenium intakes, we hypothesized that selenium status might influence the outcome of COVID-19 in these areas. For our analysis, we used reported cumulative case and outcome data for a snapshot of the COVID-19 outbreak, as of 2-18-2020. We found that in the city of Enshi, which is renown for having the highest selenium intakes in China, the cure rate was 3 times as high as that for all the other cities in Hubei Province, where Wuhan is located (p < 0.0001). In contrast, in Heilongjiang Province, where Keshan is located and extreme selenium deficiency is endemic, the death rate was almost 5 times as high as that for all the other Provinces and Municipalities outside of Hubei (p < 0.0001). Finally, for a set of 17 cities outside of Hubei, using published city data on average levels of selenium in human hair (a reliable measure of dietary intake), a significant linear correlation with the cure rate for COVID-19 was observed (R squared = 0.72, P < 0.0001).
In view of the emerging COVID‑19 pandemic caused by SARS‑CoV‑2 virus, the search for potential protective and therapeutic antiviral strategies is of particular and urgent interest. Zinc is known to modulate antiviral and antibacterial immunity and regulate inflammatory response. Despite the lack of clinical data, certain indications suggest that modulation of zinc status may be beneficial in COVID‑19. In vitro experiments demonstrate that Zn2+ possesses antiviral activity through inhibition of SARS‑CoV RNA polymerase. This effect may underlie therapeutic efficiency of chloroquine known to act as zinc ionophore. Indirect evidence also indicates that Zn2+ may decrease the activity of angiotensin‑converting enzyme 2 (ACE2), known to be the receptor for SARS‑CoV‑2. Improved antiviral immunity by zinc may also occur through up‑regulation of interferon α production and increasing its antiviral activity. Zinc possesses anti‑inflammatory activity by inhibiting NF‑κB signaling and modulation of regulatory T‑cell functions that may limit the cytokine storm in COVID‑19. Improved Zn status may also reduce the risk of bacterial co‑infection by improving mucociliary clearance and barrier function of the respiratory epithelium, as well as direct antibacterial effects against S. pneumoniae. Zinc status is also tightly associated with risk factors for severe COVID‑19 including ageing, immune deficiency, obesity, diabetes, and atherosclerosis, since these are known risk groups for zinc deficiency. Therefore, Zn may possess protective effect as preventive and adjuvant therapy of COVID‑19 through reducing inflammation, improvement of mucociliary clearance, prevention of ventilator‑induced lung injury, modulation of antiviral and antibacterial immunity. However, further clinical and experimental studies are required.
Background
Vitamin D deficiency (serum 25(OH)D<50nmol/l) is common in Ireland, particularly amongst older adults, hospital inpatients and nursing home residents. Vitamin D deficiency is associated with increased risk of acute viral respiratory infection and community acquired pneumonia, with several molecular mechanisms proposed to explain
this association. Vitamin D supplementation has also been shown to reduce the risk of respiratory infection.
Vitamin D and Covid-19
Correction of vitamin D deficiency is thought to suppress CD26, a putative adhesion molecule for Covid-19 host cell invasion. Vitamin D may also attenuate interferon gamma (IFNγ) and interleukin-6 (IL-6) inflammatory responses, both potent predictors of poorer outcome in critically-ill ventilated patients including those with Covid-19.
Vitamin D Requirements
Irish adults require 25-30µg/d of vitamin D3, an intake not achievable by diet alone, to reliably maintain serum 25(OH)D levels >50nmol/l. Supplementation with doses up to 100µg/d has been shown to be safe for adults, and many agencies and expert groups now advocate supplementation in older adults, albeit at lower levels than this.
Conclusions and Recommendations
Vitamin D deficiency is common and may contribute to increased risk of respiratory infection including Covid-19. We recommend that all older adults, hospital inpatients, nursing home residents and other vulnerable groups (e.g. those with diabetes mellitus or compromised immune function, those with darker skin, vegetarians and vegans, those who are overweight or obese, smokers and healthcare workers) be urgently supplemented with 20-50µg/d of vitamin D to enhance their resistance to Covid-19, and that this advice be quickly extended to the general adult population.
The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.
The COVID-19 pandemics is posing unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely older adults and polymorbid individuals and malnourished people in general. ICU stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing per se a relevant risk factor for higher morbidity and mortality in chronic and acute disease. Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may per se directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity. Prevention, diagnosis and treatment of malnutrition should therefore be routinely included in the management of COVID-19 patients. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing concise guidance for nutritional management of COVID-19 patients by proposing 10 practical recommendations. The practical guidance is focused to those in the ICU setting or in the presence of older age and polymorbidity, which are independently associated with malnutrition and its negative impact on patient survival.
Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an estimated 7,000 deaths in approximately 150 countries (1). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic (2). Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19-associated illness and death than are younger persons (3). Although the majority of reported COVID-19 cases in China were mild (81%), approximately 80% of deaths occurred among adults aged ≥60 years; only one (0.1%) death occurred in a person aged ≤19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12-March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups.
Abstract An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
By Feb 27th, 2020, the outbreak of COVID‐19 caused 82623 confirmed cases and 2858 deaths globally, more than Severe Acute Respiratory Syndrome (SARS) (8273 cases, 775 deaths) and Middle East Respiratory Syndrome (MERS) (1139 cases, 431 deaths) caused in 2003 and 2013 respectively. COVID‐19 has spread to 46 countries internationally. Total fatality rate of COVID‐19 is estimated at 3.46% by far based on published data from Chinese Center for Disease Control and Prevention (China CDC). Average incubation period of COVID‐19 is around 6.4 days, ranges from 0‐24 days. The basic reproductive number (R0) of COVID‐19 ranges from 2‐3.5 at the early phase regardless of different prediction models, which is higher than SARS and MERS. A study from China CDC showed majority of patients (80.9%) were considered asymptomatic or mild pneumonia but released large amounts of viruses at the early phase of infection, which posed enormous challenges for containing the spread of COVID‐19. Nosocomial transmission was another severe problem. 3019 health workers were infected by Feb 12, 2020, which accounted for 3.83% of total number of infections, and extremely burdened the health system, especially in Wuhan. Limited epidemiological and clinical data suggest that the disease spectrum of COVID‐19 may differ from SARS or MERS. We summarize latest literatures on genetic, epidemiological, and clinical features of COVID‐19 in comparison to SARS and MERS and emphasize special measures on diagnosis and potential interventions. This review will improve our understanding of the unique features of COVID‐19 and enhance our control measures in the future.
This article is protected by copyright. All rights reserved.
Coronaviruses (CoVs) are by far the largest group of known positive‐sense RNA viruses having an extensive range of natural hosts. In the past few decades, newly evolved Coronaviruses have posed a global threat to public health. Immune response is essential to control and eliminate CoV infections, however, maladjusted immune responses may result in immunopathology and impaired pulmonary gas exchange. Gaining a deeper understanding of the interaction between Coronaviruses and the innate immune systems of the hosts may shed light on the development and persistence of inflammation in the lungs and hopefully can reduce the risk of lung inflammation caused by CoVs. In this review, we provide an update on CoV infections and relevant diseases, particularly the host defense against CoV‐induced inflammation of lung tissue, as well as the role of the innate immune system in pathogenesis and clinical treatment. This article is protected by copyright. All rights reserved.
Background:
A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.
Methods:
All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not.
Findings:
By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα.
Interpretation:
The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies.
Funding:
Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
Immune support by micronutrients is historically based on vitamin C deficiency and supplementation in scurvy in early times. It has since been established that the complex, integrated immune system needs multiple specific micronutrients, including vitamins A, D, C, E, B6, and B12, folate, zinc, iron, copper, and selenium, which play vital, often synergistic roles at every stage of the immune response. Adequate amounts are essential to ensure the proper function of physical barriers and immune cells; however, daily micronutrient intakes necessary to support immune function may be higher than current recommended dietary allowances. Certain populations have inadequate dietary micronutrient intakes, and situations with increased requirements (e.g., infection, stress, and pollution) further decrease stores within the body. Several micronutrients may be deficient, and even marginal deficiency may impair immunity. Although contradictory data exist, available evidence indicates that supplementation with multiple micronutrients with immune-supporting roles may modulate immune function and reduce the risk of infection. Micronutrients with the strongest evidence for immune support are vitamins C and D and zinc. Better design of human clinical studies addressing dosage and combinations of micronutrients in different populations are required to substantiate the benefits of micronutrient supplementation against infection.
Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China’s national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.
Emerging evidence has shown that vitamin D deficiency may be related with community-acquired pneumonia (CAP), but individually published studies showed inconclusive results. The aim of this study was to quantitatively summarize the association between vitamin D and the CAP.
We conducted this meta-analysis though a systematic literature search of PubMed, Medline, and EMBASE up to 31 September 2018 with the following keywords ‘vitamin D’ or ‘cholecalciferol’ or ‘25-hydroxyvitamin D’ or ‘25(OH)D’ in combination with ‘community-acquired pneumonia’ or ‘CAP’ or ‘pneumonia’ with no limitations. This meta-analysis was performed following the guidelines of Meta-analysis of Observational Studies in Epidemiology. The association between vitamin D levels and CAP were measured as odds ratio (OR) and weighted mean difference (WMD). Results were combined using a random-effect or a fix-effect meta-analysis, and sensitivity analyses were conducted to explore potential factors.
Eight observational studies involving 20,966 subjects were included. In this meta-analysis, CAP patients with vitamin D deficiency (serum 25(OH)D levels <20 ng/mL) experienced a significantly increased risk of CAP (odds ratio (OR) = 1.64, 95% confidence intervals (CI): 1.00, 2.67), and an obvious decrease of −5.63 ng/mL (95% CI: −9.11, −2.14) in serum vitamin D was demonstrated in CAP patients. Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect.
The evidence from this meta-analysis indicates an association between vitamin D deficiency and an increased risk of CAP patients. However, well-designed trails are required to determine the explicit effect of vitamin D supplementation.
Background:
Omega-3 fatty acids, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and derivatives, play a key role in the resolution of inflammation. Higher intake has been linked to decreased morbidity in several diseases, though effects on respiratory diseases like COPD are understudied.
Methods:
The National Health and Nutrition Examination Survey (NHANES), with a focus on dietary assessment, provides a unique opportunity to explore relationships between omega-3 intake and morbidity in respiratory diseases marked by inflammation in the United States (US) population. We investigated relationships between ALA or EPA + DHA intake and respiratory symptoms among US adults with COPD, as well as variation in relationships based on personal characteristics or exposures.
Results:
Of 878 participants, mean age was 60.6 years, 48% were current smokers, and 68% completed high school. Omega-3 intake was, 1.71 ± 0.89 g (ALA), and 0.11 ± 0.21 g (EPA + DHA). Logistic regression models, adjusting for age, gender, race, body mass index, FEV1, education, smoking status, pack-years, total caloric intake, and omega-6 (linoleic acid, LA) intake demonstrated no primary associations between omega-3 intake and respiratory symptoms. Interaction terms were used to determine potential modification of relationships by personal characteristics (race, gender, education) or exposures (LA intake, smoking status), demonstrating that at lower levels of LA intake, increasing ALA intake was associated with reduced odds of chronic cough (pint = 0.015) and wheeze (pint = 0.037). EPA + DHA, but not ALA, was associated with reduced symptoms only among current smokers who did not complete high school.
Conclusions:
Individual factors should be taken into consideration when studying the association of fatty acid intake on respiratory diseases, as differential responses may reveal susceptible subgroups.
Acute Lower Respiratory Tract Infections (ALRI) are one of the most common causes of morbidity and mortality in young children. Zinc supplementation has been shown to have a preventive effect against respiratory infections, but little evidence is available on its effect on the treatment of ALRI. This study examined the effect of zinc supplementation on the treatment outcome in children that were hospitalized with ALRI. A randomized, doubleblinded, placebo-controlled trial was conducted on 64 hospitalized children with ALRI, who were aged between 2 and 60 months. Children were randomly allocated to receive zinc (30 mg elemental zinc/day) or placebo. The primary outcome was the time to the cessation of ALRI, while the secondary outcomes were the length of the stay in hospital and the individual features of the disease. The study found that ALRI cessation was faster in children who received zinc supplementation (median (IQR): 3 (2-4) days and 4 (3-5) days, respectively; P=0.008), and that their hospital stay was shorter (mean (SD): 3.8 (1.3) days and 6.1 (3.2) days, respectively; P<0.001) than the placebo group. Zinc supplementation was well-tolerated, and no adverse events were reported. In conclusion, zinc supplementation reduced the number of days of ALRI in Thai children, as well as their stay in hospital.
A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.
Background:
Previous in vitro and in vivo studies indicate that enzymes that synthesize and metabolize vitamin D are magnesium dependent. Recent observational studies found that magnesium intake significantly interacted with vitamin D in relation to vitamin D status and risk of mortality. According to NHANES, 79% of US adults do not meet their Recommended Dietary Allowance of magnesium.
Objectives:
The aim of this study was to test the hypothesis that magnesium supplementation differentially affects vitamin D metabolism dependent on baseline 25-hydroxyvitamin D [25(OH)D] concentration.
Methods:
The study included 180 participants aged 40-85 y and is a National Cancer Institute independently funded ancillary study, nested within the Personalized Prevention of Colorectal Cancer Trial (PPCCT), which enrolled 250 participants. The PPCCT is a double-blind 2 × 2 factorial randomized controlled trial conducted in the Vanderbilt University Medical Center. Doses for both magnesium and placebo were customized based on baseline dietary intakes. Subjects were randomly assigned to treatments using a permuted-block randomization algorithm. Changes in plasma 25-hydroxyvitamin D3 [25(OH)D3], 25-hydroxyvitamin D2 [25(OH)D2], 1,25-dihydroxyvitamin D3, 1,25-dihydroxyvitamin D2, and 24,25-dihydroxyvitamin D3 [24,25(OH)2D3] were measured by liquid chromatography-mass spectrometry.
Results:
The relations between magnesium treatment and plasma concentrations of 25(OH)D3, 25(OH)D2, and 24,25(OH)2D3 were significantly different dependent on the baseline concentrations of 25(OH)D, and significant interactions persisted after Bonferroni corrections. Magnesium supplementation increased the 25(OH)D3 concentration when baseline 25(OH)D concentrations were close to 30 ng/mL, but decreased it when baseline 25(OH)D was higher (from ∼30 to 50 ng/mL). Magnesium treatment significantly affected 24,25(OH)2D3 concentration when baseline 25(OH)D concentration was 50 ng/mL but not 30 ng/mL. On the other hand, magnesium treatment increased 25(OH)D2 as baseline 25(OH)D increased.
Conclusion:
Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. This trial was registered at clinicaltrials.gov as NCT03265483.
In disease settings, vitamin D may be important for maintaining optimal lung epithelial integrity and suppressing inflammation, but less is known of its effects prior to disease onset. Female BALB/c dams were fed a vitamin D3-supplemented (2280 IU/kg, VitD+) or nonsupplemented (0 IU/kg, VitD−) diet from 3 weeks of age, and mated at 8 weeks of age. Male offspring were fed the same diet as their mother. Some offspring initially fed the VitD− diet were switched to a VitD+ diet from 8 weeks of age (VitD−/+). At 12 weeks of age, signs of low-level inflammation were observed in the bronchoalveolar lavage fluid (BALF) of VitD− mice (more macrophages and neutrophils), which were suppressed by subsequent supplementation with vitamin D3. There was no difference in the level of expression of the tight junction proteins occludin or claudin-1 in lung epithelial cells of VitD+ mice compared to VitD− mice; however, claudin-1 levels were reduced when initially vitamin D-deficient mice were fed the vitamin D3-containing diet (VitD−/+). Reduced total IgM levels were detected in BALF and serum of VitD−/+ mice compared to VitD+ mice. Lung mRNA levels of the vitamin D receptor (VDR) were greatest in VitD−/+ mice. Total IgG levels in BALF were greater in mice fed the vitamin D3-containing diet, which may be explained by increased activation of B cells in airway-draining lymph nodes. These findings suggest that supplementation of initially vitamin D-deficient mice with vitamin D3 suppresses signs of lung inflammation but has limited effects on the epithelial integrity of the lungs.
Aging is associated with significant changes in the immune system, a phenomenon called immunosenescence, which has been implicated in the increased morbidity of, and mortality from, infection in the elderly. While many immune functions are affected by aging, the defects in T cells are the most pronounced and best characterized. Nutritional intervention has been proposed to be helpful in delaying or reversing immunosenescence, which is well exemplified in the case of vitamin E. Studies in several species of animals show that vitamin E deficiency impairs immune function, which can be corrected by vitamin E repletion. Although vitamin E deficiency is rare in humans, increased intake above recommended levels has been shown to enhance T cell function, particularly in aged animals and humans. The mechanisms for this effect of vitamin E involve both a direct effect of enhancing T cell activation and effector function and a suppressing effect on production of prostaglandin E2, a T cell-suppressing lipid mediator known to increase with aging. Vitamin E-induced enhancement of immune functions has significant clinical implications as evidenced by the findings that vitamin E supplementation is associated with increased resistance to respiratory infections in both aged mice and older adults. In this chapter, we review age-related changes in the immune system, evidence for an immunomodulating effect of vitamin E, the underlying mechanisms, and its clinical application in protecting the host against infection in both animal models and humans.
The paper “Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition?” by TC Wallace, which was published in the Journal of the American College of Nutrition highlights the importance of adequate magnesium (Mg) supply in relation to COVID-19. Wallace notes that Mg deficiency is associated with low-grade chronic inflammation. Furthermore, hypokalemia and a lack of active Vitamin D are consequences of a Mg deficit. In this way, Mg deficiency may exacerbate the course of COVID-19. Therefore, in patients with Covid-19 permanent monitoring of the Mg status and, if necessary, supplementation should be carried out. The possible importance of Mg in COVID-19 was only recently discussed also by Iotti et al. and the German Society for Magnesium Research e.V. Considering the meaningful connections between Mg and COVID-19 there are relevant research topics that should be addressed: Does Mg deficiency increase the risk of infection with COVID-19 or the risk of a severe course of the disease? Is there an increased prevalence of Mg deficiency in COVID-19 patients? Could Mg supplementation alleviate the course of the disease in COVID-19 or reduce complications? Does pharmacological induction of hypermagnesemia via intravenous Mg provide clinical benefits for COVID-19 patients in the intensive care unit (for example with regard to lung function or thromboembolism)?
Background
The coronavirus disease 2019 (COVID-19) pandemic has affected almost 2.5 million people worldwide with almost 170 000 deaths reported to date. So far, there is scarce evidence for the current treatment options available for COVID-19. Vitamin C has previously been used for treatment of severe sepsis and septic shock. We reviewed the feasibility of using vitamin C in the setting of COVID-19 in a series of patients.
Methods
We sequentially identified a series of patients who were requiring at least 30% of FiO2 or more who received IV vitamin C as part of the COVID-19 treatment and analyzed their demographic and clinical characteristics. We compared inflammatory markers pre and post treatment including D-dimer and ferritin.
Results
We identified a total of 17 patients who received IV vitamin C for COVID-19. The inpatient mortality rate in this series was 12% with 17.6% rates of intubation and mechanical ventilation. We noted a significant decrease in inflammatory markers, including ferritin and D-dimer, and a trend to decreasing FiO2 requirements, after vitamin C administration.
Conclusion
The use of IV vitamin C in patients with moderate to severe COVID-19 disease may be feasible.
Background
In December 2019, the viral pandemic of respiratory illness caused by COVID-19 began sweeping its way across the globe. Several aspects of this infectious disease mimic metabolic events shown to occur during latent subclinical magnesium deficiency. Hypomagnesemia is a relatively common clinical occurrence that often goes unrecognized since magnesium levels are rarely monitored in the clinical setting. Magnesium is the second most abundant intracellular cation after potassium. It is involved in >600 enzymatic reactions in the body, including those contributing to the exaggerated immune and inflammatory responses exhibited by COVID-19 patients.
Methods
A summary of experimental findings and knowledge of the biochemical role magnesium may play in the pathogenesis of COVID-19 is presented in this perspective. The National Academy of Medicine's Standards for Systematic Reviews were independently employed to identify clinical and prospective cohort studies assessing the relationship of magnesium with interleukin-6, a prominent drug target for treating COVID-19.
Results
Clinical recommendations are given for prevention and treatment of COVID-19. Constant monitoring of ionized magnesium status with subsequent repletion, when appropriate, may be an effective strategy to influence disease contraction and progression. The peer-reviewed literature supports that several aspects of magnesium nutrition warrant clinical consideration. Mechanisms include its “calcium-channel blocking” effects that lead to downstream suppression of nuclear factor-Kβ, interleukin-6, c-reactive protein, and other related endocrine disrupters; its role in regulating renal potassium loss; and its ability to activate and enhance the functionality of vitamin D, among others.
Conclusion
As the world awaits an effective vaccine, nutrition plays an important and safe role in helping mitigate patient morbidity and mortality. Our group is working with the Academy of Nutrition and Dietetics to collect patient-level data from intensive care units across the United States to better understand nutrition care practices that lead to better outcomes.
Studies have shown that infection, excessive coagulation, cytokine storm, leukopenia, lymphopenia, hypoxemia and oxidative stress have also been observed in critically ill Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) patients in addition to the onset symptoms. There are still no approved drugs or vaccines. Dietary supplements could possibly improve the patient's recovery. Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present an anti-inflammatory effect that could ameliorate some patients need for intensive care unit (ICU) admission. EPA and DHA replace arachidonic acid (ARA) in the phospholipid membranes. When oxidized by enzymes, EPA and DHA contribute to the synthesis of less inflammatory eicosanoids and specialized pro-resolving lipid mediators (SPMs), such as resolvins, maresins and protectins. This reduces inflammation. In contrast, some studies have reported that EPA and DHA can make cell membranes more susceptible to non-enzymatic oxidation mediated by reactive oxygen species, leading to the formation of potentially toxic oxidation products and increasing the oxidative stress. Although the inflammatory resolution improved by EPA and DHA could contribute to the recovery of patients infected with SARS-CoV-2, Omega-3 fatty acids supplementation cannot be recommended before randomized and controlled trials are carried out.
Importance: Vitamin D treatment has been found to decrease incidence of viral respiratory tract infection, especially in vitamin D deficiency. It is unknown whether COVID-19 incidence is associated with vitamin D deficiency and treatment.
Objective: To examine whether vitamin D deficiency and treatment are associated with testing positive for COVID-19.
Design: Retrospective cohort study
Setting: University of Chicago Medicine
Participants: Patients tested for COVID-19 from 3/3/2020-4/10/2020. Vitamin D deficiency was defined by the most recent 25-hydroxycholecalciferol <20ng/ml or 1,25-dihydroxycholecalciferol <18pg/ml within 1 year before COVID-19 testing. Treatment was defined by the most recent vitamin D type and dose, and treatment changes between the time of the most recent vitamin D level and time of COVID-19 testing. Vitamin D deficiency and treatment changes were combined to categorize vitamin D status at the time of COVID-19 testing as likely deficient(last-level-deficient/treatment-not-increased), likely sufficient(last-level-not-deficient/treatment-not-decreased), or uncertain deficiency(last-level-deficient/treatment-increased or last-level-not-deficient/treatment-decreased).
Main Outcomes and Measures: The main outcome was testing positive for COVID-19. Multivariable analysis tested whether the most recent vitamin D level and treatment changes after that level were associated with testing positive for COVID-19 controlling for demographic and comorbidity indicators. Bivariate analyses of associations of treatment with vitamin D deficiency and COVID-19 were performed.
Results: Among 4,314 patients tested for COVID-19, 499 had a vitamin D level in the year before testing. Vitamin D status at the time of COVID-19 testing was categorized as likely deficient for 127(25%) patients, likely sufficient for 291(58%) patients, and uncertain for 81(16%) patients. In multivariate analysis, testing positive for COVID-19 was associated with increasing age(RR(age<50)=1.05,p<0.021;RR(age≥50)=1.02,p<0.064)), non-white race(RR=2.54,p<0.01) and being likely vitamin D deficient (deficient/treatment-not-increased:RR=1.77,p<0.02) as compared to likely vitamin D sufficient(not-deficient/treatment-not-decreased), with predicted COVID-19 rates in the vitamin D deficient group of 21.6%(95%CI[14.0%-29.2%] ) versus 12.2%(95%CI[8.9%-15.4%]) in the vitamin D sufficient group. Vitamin D deficiency declined with increasing vitamin D dose, especially of vitamin D3. Vitamin D dose was not significantly associated with testing positive for COVID-19.
Conclusions and Relevance: Vitamin D deficiency that is not sufficiently treated is associated with COVID-19 risk. Testing and treatment for vitamin D deficiency to address COVID-19 warrant aggressive pursuit and study.
Background: COVID-19 is a major pandemic that has killed more than 196,000 people. The COVID-19 disease course is strikingly divergent. Approximately 80-85% of patients experience mild or no symptoms, while the remainder develop severe disease. The mechanisms underlying these divergent outcomes are unclear. Emerging health disparities data regarding African American and homeless populations suggest that vitamin D insufficiency (VDI) may be an underlying driver of COVID-19 severity. To better define the VDI-COVID-19 link, we determined the prevalence of VDI among our COVID-19 intensive care unit (ICU) patients.
Methods: In an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship.
Results: Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Coagulopathy was present in 62.5% of ICU COVID-19 patients, and 92.3% were lymphocytopenic.
Conclusions: VDI is highly prevalent in severe COVID-19 patients. VDI and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction. Thus, we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted.
Proper management of COVID-19 mandates better understanding of disease pathogenesis. The sudden clinical deterioration 7–8 days after initial symptom onset suggests that severe respiratory failure (SRF) in COVID-19 is driven by a unique pattern of immune dysfunction. We studied immune responses of 54 COVID-19 patients, 28 of whom had SRF. All patients with SRF displayed either macrophage activation syndrome (MAS) or very low human leukocyte antigen D related (HLA-DR) expression accompanied by profound depletion of CD4 lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) production by circulating monocytes was sustained, a pattern distinct from bacterial sepsis or influenza. SARS-CoV-2 patient plasma inhibited HLA-DR expression, and this was partially restored by the IL-6 blocker Tocilizumab; off-label Tocilizumab treatment of patients was accompanied by increase in circulating lymphocytes. Thus, the unique pattern of immune dysregulation in severe COVID-19 is characterized by IL-6-mediated low HLA-DR expression and lymphopenia, associated with sustained cytokine production and hyper-inflammation.
Background
Large-scale data show that the mortality of COVID-19 varies dramatically across populations, although the cause of these disparities is not well understood. In this study we investigated whether severe COVID-19 is linked to Vitamin D (Vit D) deficiency.
Method
Daily admission, recovery and deceased rate data for patients with COVID-19 from countries with a large number of confirmed patients (Germany, South Korea (S. Korea), China (Hubei), Switzerland, Iran, UK, US, France, Spain, Italy) as of April 20, 2020 were used. The time-adjusted case mortality ratio (T-CMR) was estimated as the number of deceased patients on day N divided by the number of confirmed cases on day N-8. The adaptive average of T-CMR (A-CMR) was further calculated as a metric of COVID-19 associated mortality in different countries. Although data on Vit D level is not currently available for COVID-19 patients, we leveraged the previously established links between Vit D and C-Reactive Protein (CRP) and between CRP and severe COVID-19, respectively, to estimate the potential impact of Vit D on the reduction of severe COVID-19.
Findings
A link between Vit D status and COVID-19 A-CMR in the US, France, and the UK (countries with similar screening status) may exist. Combining COVID-19 patient data and prior work on Vit D and CRP levels, we show that the risk of severe COVID-19 cases among patients with severe Vit D deficiency is 17.3% while the equivalent figure for patients with normal Vit D levels is 14.6% (a reduction of 15.6%).
Interpretation
Given that CRP is a surrogate marker for severe COVID-19 and is associated with Vit D deficiency, our finding suggests that Vit D may reduce COVID-19 severity by suppressing cytokine storm in COVID-19 patients. Further research is needed to account for other factors through direct measurement of Vit D levels.
Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
Vitamin B contributes to the overall health and wellbeing, including that of energy metabolism, methylation, synthesis and DNA repair and proper immune function. Deficiency in B vitamins has been linked to neurocognitive disorders, mitochondrial dysfunction, immune dysfunction and inflammatory conditions. In ageing populations B vitamin deficiency has been linked to cardiovascular disorders, cognitive dysfunction, osteoporosis and methylation disorders and can increase the risk of developing degenerative diseases, particularly cardiovascular disease, cognitive diseases and osteoporosis. Optimization of B vitamin status in the elderly may prove beneficial in the prevention of degenerative diseases. Here we discuss broadly the role of B vitamins in ageing.
Most older individuals develop inflammageing, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, and premature death. Potential mechanisms of inflammageing include genetic susceptibility, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence, NLRP3 inflammasome activation, oxidative stress caused by dysfunctional mitochondria, immune cell dysregulation, and chronic infections. Inflammageing is a risk factor for cardiovascular diseases (CVDs), and clinical trials suggest that this association is causal. Inflammageing is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia, but whether modulating inflammation beneficially affects the clinical course of non-CVD health problems is controversial. This uncertainty is an important issue to address because older patients with CVD are often affected by multimorbidity and frailty - which affect clinical manifestations, prognosis, and response to treatment - and are associated with inflammation by mechanisms similar to those in CVD. The hypothesis that inflammation affects CVD, multimorbidity, and frailty by inhibiting growth factors, increasing catabolism, and interfering with homeostatic signalling is supported by mechanistic studies but requires confirmation in humans. Whether early modulation of inflammageing prevents or delays the onset of cardiovascular frailty should be tested in clinical trials.