Nutritional status of patients with COVID-19

Selenium supplementation may improve COVID-19 survival in sickle cell disease

Sickle cell disease is associated with lower selenium levels, and the serum selenium level is inversely associated with haemolysis in SCD. The SCD population is more vulnerable to adverse COVID-19 outcomes. SARS-CoV-2 infection lowers the serum selenium level and this is associated with severity of COVID-19. Selenium supplementation is proposed to improve COVID-19 outcomes in the sickle cell disease population.

Circulating trace elements status in COVID-19 disease: A meta-analysis

Trace elements are a group of essential metals or metalloids, which are necessary for life, and present in minute amounts. Despite substantial researches highlighting the importance of trace elements in Coronavirus disease 2019 (COVID-19) diseases, a thorough evaluation of the levels of circulating trace elements is lacking. Therefore, we conducted a systematic review and meta-analysis to evaluate the trace element status (Zn, Fe, Cu, Mg, and Se) in COVID-19 disease. We also assessed the relationship between circulating trace elements and COVID-19 disease severity and survival status during follow-up. We searched comprehensively MEDLINE, Web of Science, CNKI, and WangFang databases without language restriction, between November 1, 2019 and April 1, 2022. The search identified 1,566 preliminary references. A total of 49 studies met the eligibility criteria and were included in the review, and 42 studies were included in the final meta-analysis. Meta-analysis showed that COVID-19 patients had significantly lower circulating Zn (SMD: -0.83, 95% CI: -1.19 to -0.46, P < 0.001), Fe (SMD: -1.56, 95% CI: -2.90 to -0.21, P = 0.023), and Se (SMD: -0.75, 95% CI: -0.94 to -0.56, P < 0.001) levels than healthy controls, and circulating Zn (SMD: -0.47, 95% CI: -0.75 to -0.18, P = 0.002), Fe (SMD: -0.45, 95% CI: -0.79 to -0.12, P = 0.008), and Se (SMD: -0.27, 95% CI: -0.49 to -0.04, P = 0.020) levels were associated with the presence of severity status in COVID-19 patients. Moreover, circulating Fe levels in non-survivors were significantly lower than survivors in COVID-19 (SMD: -0.28, 95% CI: -0.44 to -0.12, P = 0.001). However, there was no significant difference in Cu and Mg levels between COVID-19 patients and controls, severity and non-severity status, and survivors and non-survivors (all P > 0.05). Taken together, COVID-19 patients displayed lower circulating levels of Zn, Fe, and Se, and their levels were associated with severity status. Moreover, circulating Fe levels may provide part of the explanation for the unfavorable survival status. Therefore, we presumed optimistically that supplements of trace elements might provide an adjutant treatment in the early stages of COVID-19.

Systematic review registration

[https://www.crd.york.ac.uk/prospero], identifier [CRD42022348599].

A Crisis within a Crisis: COVID-19 and Hidden Hunger

The coronavirus (Covid-19), which was recognized in December 2019 and quickly became a worldwide pandemic, has become a significant public health problem. When it comes to the immune and infectious diseases, effects of nutrition on the inflammatory system cannot be ignored. Micronutrients, including vitamins and minerals, are critical to a well-functioning immune system and vital in supporting nutritional and health well-being. However, there are serious vitamin and mineral deficiencies worldwide known as "Hidden Hunger". It is thought that need for micronutrients in nutrition may increase especially during Covid-19 pandemic process. Therefore, it is essential to take precautions regarding the formation of hidden hunger. While the underlying determinants and complexity of malnutrition have been better understood through years of research, these researches have been limited in scaling, developing and implementing nutrition and food system approaches closely related to sustainable agriculture targeting food diversity and livelihoods.. In this review, the Covid-19 pandemic and its interactions with health, environment, food and their relationship to chronic micronutrient deficiencies, known as 'hidden hunger,' which affected more than two billion people worldwide, are evaluated.

The Prevalence of Dietary Supplement Use for the Purpose of COVID-19 Prevention in Japan

COVID-19 is still the biggest issue worldwide. Many dietary supplements on the market claim to have anti-COVID-19 effects without scientific evidence. To elucidate the prevalence of dietary supplement usage for the prevention of COVID-19, we conducted an online cross-sectional questionnaire survey among Japanese adults in January 2022. The prevalence of dietary supplement use for the prevention of COVID-19 was 8.3%, and there was no gender difference. We also conducted additional research on these dietary supplement users (1000 males and 1000 females). The most popular ingredient used was vitamin C (61.0%), with vitamin D (34.9%) and probiotics (33.4%) following. Half of these participants reported using supplements for more than one year. The information sources that reportedly led them to start using dietary supplements for the prevention of COVID-19 were the Internet (44.0%), television and radio (29.9%), and family or friends (26.0%), and these information sources differed among generations. In conclusion, some of the population used vitamin/mineral supplements for the prevention of COVID-19 that might be beneficial for their health, but some used ingredients with no scientifically proven effects against the virus at this time. Therefore, information-based scientific evidence is important to prevent the inappropriate use of dietary supplements by consumers.

Immunomodulatory roles of selenium nanoparticles: Novel arts for potential immunotherapy strategy development

Current chemotherapy strategies used in clinic appear with lots of disadvantages due to the low targeting effects of drugs and strong side effects, which significantly restricts the drug potency, causes multiple dysfunctions in the body, and even drives the emergence of diseases. Immunotherapy has been proved to boost the body’s innate and adaptive defenses for more effective disease control and treatment. As a trace element, selenium plays vital roles in human health by regulating the antioxidant defense, enzyme activity, and immune response through various specific pathways. Profiting from novel nanotechnology, selenium nanoparticles have been widely developed to reveal great potential in anticancer, antibacterial, and anti-inflammation treatments. More interestingly, increasing evidence has also shown that functional selenium nanoparticles can be applied for potential immunotherapy, which would achieve more effective treatment efficiency as adjunctive therapy strategies for the current chemotherapy. By directly interacting with innate immune cells, such as macrophages, dendritic cells, and natural killer cells, selenium nanoparticles can regulate innate immunity to intervene disease developments, which were reported to boost the anticancer, anti-infection, and anti-inflammation treatments. Moreover, selenium nanoparticles can also activate and recover different T cells for adaptive immunity regulations to enhance their cytotoxic to combat cancer cells, indicating the potential of selenium nanoparticles for potential immunotherapy strategy development. Here, aiming to enhance our understanding of the potential immunotherapy strategy development based on Se NPs, this review will summarize the immunological regulation effects of selenium nanoparticles and the application of selenium nanoparticle-based immunotherapy strategies. Furthermore, we will discuss the advancing perspective of selenium nanoparticle-based potential immunotherapy as a kind of novel adjunctive therapy to enhance the efficiency of current chemotherapies and also introduce the current obstacles for the development of selenium nanoparticles for potential immunotherapy strategy development. This work is expected to promote the future research on selenium nanoparticle-assisted immunotherapy and finally benefit the more effective disease treatments against the threatening cancer and infectious and chronic diseases.

Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review

Background and Objectives: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. Material and Methods: In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. Results: The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. Conclusions: While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.

Effects of nutrients on immunomodulation in patients with severe COVID-19: Current knowledge

Recent research has demonstrated that critically ill patients with coronavirus disease 2019 (COVID-19) show significant immune system dysregulation. Due to that, some nutrients that influence immunomodulation have been suggested as a form of treatment against the infection. This review collected the information on the impact of vitamins on the prognosis of COVID-19, with the intention of facilitating treatment and prevention of the disease risk status in patients. The collected information was obtained using the PubMed electronic database by searching for articles that relate COVID-19 and the mechanisms/effects of the nutrients: Proteins, glucose, lipids, vitamin B12, vitamin D, calcium, iron, copper, zinc, and magnesium, including prospective, retrospective, and support articles. The findings reveal an optimal response related mainly to omega-3, eicosapentaenoic acid, docosahexaenoic acid, calcium, and iron that might represent benefits in the treatment of critically ill patients. However, nutrient supplementation should be done with caution due to the limited availability of randomized controlled studies.

Vitamin D and SARS-CoV2 infection, severity and mortality: A systematic review and meta-analysis

To assess the evidence on SARS-CoV2 infection and Covid-19 in relation to deficiency and supplementation of vitamin D, we conducted a systematic review up to April 2021. We summarised data from 38 eligible studies, which presented risk estimates for at least one endpoint, including two RCT and 27 cohort-studies: 205565 patients with information on 25OHD status and 2022 taking vitamin D supplementation with a total of 1197 admitted to the ICU or who needed invasive mechanical ventilation or intubation and hospital stay, and more than 910 Covid-19 deaths. Primary outcomes were severity and mortality and the main aim was to evaluate the association with vitamin D supplementation. Random effects models showed that supplementation was associated with a significant lower risk of both Covid-19 severe disease (SRR 0.38, 95% CI 0.20-0.72, 6 studies) and mortality (SRR 0.35, 95% CI 0.17-0.70, 8 studies). There were no statistically significant dose differences between studies: summary estimates with regular doses remain statistically significant, suggesting that higher doses are not necessary. For patients on vitamin D supplementation, a greater reduction in mortality risk emerged in older individuals and at higher latitudes. Regarding the quality of studies, assessed using the New Castle-Ottawa quality scale, the analysis revealed in most cases no statistically significant differences between low, medium or high quality studies. We found significant associations of vitamin D supplementation with Covid-19, encompassing risks of disease worsening and mortality, especially in seasons characterized by 25OHD deficiency and with not severe patients. Dedicated randomized clinical studies are encouraged to confirm these results.

COVID-19 and Nutrition: Summary of Official Recommendations

Medical nutrition therapy may have a key role in the COVID-19 pandemic. Given the spread of misinformation, the present review organizes and summarizes nutrition recommendations regarding COVID-19, serving as a reference guide for health professionals. Nineteen official recommendations were included of international, US, Asian, European, Canadian, and Australian origin on (i) lactation, (ii) nutrition during quarantine, (iii) nutrition in high-risk groups, (iv) nutrition for recovery at home, and (v) nutrition in hospital. Breastfeeding is encouraged, and the role of hydration and the adoption of a healthy diet during quarantine are emphasized. Older people and/or people with comorbidities should be checked for malnutrition and follow a healthy diet. For patients recovering at home, hydration, protein, and energy intake should be ensured. For hospitalized patients, early feeding with a priority on enteral route is recommended.

Dietary supplements and nutraceuticals in the recovery of COVID-19: A systematic review and meta-analysis

The outbreak of nSARS-CoV2 in December 2019 turned into a global pandemic and is still underway. Infection with nSARS-CoV2 resulted in severe acute respiratory distress syndrome and was named COVID-19. COVID-19 requires the intervention of a series of therapeutics, including antiviral, anti-inflammatory, and immune-modulating molecules. Additionally, studies have demonstrated that nutraceuticals offer a promising impact in fast recovery and boosting immunity. Here, the study aimed to provide a comprehensive synthesis of the scientific evidence examining the effectiveness of nutraceuticals. A detailed search of scientific literature was conducted utilizing the most relevant scientific studies published during 2019–2022 on the intervention of nutraceuticals in the management of COVID-19. PubMed, Cochrane Central Register of Controlled Trials and Scielo databases were explored for the most relevant studies. Meta-analysis was carried out using the MedCalC tool as per PRISMA guidelines for odds ratio among the studies along with risk factor analysis and relative risk. A total of 1,308 original records were identified, where 1,268 studies were collected from different databases, and 40 additional records were obtained from non-pre-defined sources. Odds ratio, risk analysis, and risk difference analysis showed nutraceuticals intervention reported effective (P < 0.001) in COVID-19 patient over control. Nutraceuticals-based interventions had improved immunity, short-term duration, and fast recovery of COVID-19 patients.

Menstrual changes following COVID-19 infection: A cross-sectional study from Jordan and Iraq

Purpose

COVID-19 infection is normally followed by several post-COVID effects. This study aimed to investigate to evaluate menstrual changes in females following COVID-19 infection, and to evaluate female perception about the effect of COVID-19 on their menstrual cycles.

Methods

During this cross-sectional survey-based study, a convenience sample of 483 women from Jordan and from Iraq, who had infected with COVID-19 were invited to fill-out the study questionnaire.

Results

The study was conducted on the females, with a median age 31 years old. Results showed that 47.2% of them (n = 228) suffered from a change in the number of days between two consecutive periods, as well as from a change in the amount of blood loss. Also, more than 50% of them believed that COVID-19 infection may cause changes in the amount of blood loss during the cycle (n = 375, 56.9%), and changes in the number of days between the two consecutive periods (n = 362, 54.2%).

Regression analysis showed that participants with higher educational level (bachelor or higher) (Beta = -0.114, P = 0.011), and those living in Iraq (Beta = -0.166, P<0.001) believed that COVID-19 has lower tendency to cause menstrual changes. In addition, non-married females (Beta = 0.109, P = 0.017), and those who are current smokers (Beta = 0.091, P = 0.048) believed that COVID-19 has higher tendency to cause menstrual changes.

Conclusion

his study revealed that COVID-19 infection could affect the menstrual cycle for the females. Further prospective studies should be done to confirm these findings and evaluate how long these menstrual irregularities lasted.

The Perception of Minerals and Their Prevalence in Fortified Foods and Supplements in Japan

People’s intake of some minerals does not meet the nutrient reference values even in high-income countries. Recently, the deficiency of zinc and/or selenium has been considered to cause greater risk of COVID-19 infection and severity. To investigate consumer awareness, we conducted a cross-sectional questionnaire online survey among Japanese people (7500 males and 7500 females) concerning their perceptions of each mineral and the prevalence of mineral-fortified foods and/or mineral supplements. People’s perception of each mineral varied: the highest was for calcium (91.8%) and the lowest was for selenium (44.7%). In addition, only a portion of participants believed that they consumed a sufficient amount of each mineral; the highest was sodium (23.7%), and the lowest was manganese (5.2%). In addition, 18.2% of them felt that they could not consume enough sodium, even though most of the Japanese’s intake is excessive. Among mineral-fortified-food and/or mineral-supplement users, the purposes for these products were to maintain health (80.6%), supplement nutrients (48.0%), and prevent infectious diseases (23.2%). Only 18.4% of participants knew what amount they took. In conclusion, education is needed to prevent not only the insufficiency/deficiency of each mineral but also an excess intake of sodium.

Distinct gut microbiota and health outcomes in asymptomatic infection, viral nucleic acid test re-positive, and convalescent COVID-19 cases

Gut microbiota composition is suggested to associate with coronavirus disease 2019 (COVID-19) severity, but the impact of gut microbiota on health outcomes is largely unclear. We recruited 81 individuals from Wuhan, China, including 13 asymptomatic infection cases (Group A), 24 COVID-19 convalescents with adverse outcomes (Group C), 31 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-positive cases (Group D), and 13 non-COVID-19 healthy controls (Group H). The microbial features of Groups A and D were similar and exhibited higher gut microbial diversity and more abundant short-chain fatty acid (SCFA)-producing species than Group C. Group C was enriched with opportunistic pathogens and virulence factors related to adhesion and toxin production. The abundance of SCFA-producing species was negatively correlated, while Escherichia coli was positively correlated with adverse outcomes. All three groups (A, C, and D) were enriched with the mucus-degrading species Akkermansia muciniphila, but decreased with Bacteroides-encoded carbohydrate-active enzymes. The pathways of vitamin B6 metabolic and folate biosynthesis were decreased, while selenocompound metabolism was increased in the three groups. Specifically, the secondary bile acid (BA) metabolic pathway was enriched in Group A. Antibiotic resistance genes were common among the three groups. Conclusively, the gut microbiota was related to the health outcomes of COVID-19. Dietary supplementations (SCFAs, BA, selenium, folate, vitamin B6) may be beneficial to COVID-19 patients.

Correlation of vitamin D level with the clinical-radiological severity of COVID-19 in geriatric patients

Objective: This study was planned to investigate the effect of 25-OH-Vitamin D (Vit D) deficiency on clinical and radiological findings of coronavirus disease-2019 (COVID-19) in geriatric patients hospitalized due to COVID-19. Material and Method: Seventy-five patients who were treated for COVID-19 were reviewed retrospectively, and grouped in relation with their ages [(1) 65-74, (2) 75-84, (3) >84 years] and the severity of Vit D deficiency [(1) severe deficiency: 30 ng/mL]. The complaints on admission, comorbidities, intensive care unit (ICU) need, length of hospital stay, laboratory data, and mortality of the ones who had and did not have Vit D replacement (n=18/75) were recorded. The patients were analyzed for COVID-19 severity using radiological and clinical markers. Results: Moderate Vit D deficiency (10-20 ng/mL) was frequently detected. When the disease severity and Vit D levels were analyzed, it was found that the disease was more severe (46.6%) in the Vit D 30 ng/ml group, but there was no statistically significant difference among the groups. Low or high Vit D levels did not show any significant correlations with the severity of pneumonia or the thorax CT findings. The intensive care unit (ICU) admission rate was significantly lower in those who had Vit D replacement (p

Genetically Predicted Circulating Concentrations of Micronutrients and COVID-19 Susceptibility and Severity: A Mendelian Randomization Study

Background

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which since 2019 has caused over 5 million deaths to date. The pathogenicity of the virus is highly variable ranging from asymptomatic to fatal. Evidence from experimental and observational studies suggests that circulating micronutrients may affect COVID-19 outcomes.

Objectives

To complement and inform observational studies, we investigated the associations of genetically predicted concentrations of 12 micronutrients (β-carotene, calcium, copper, folate, iron, magnesium, phosphorus, selenium, vitamin B-6, vitamin B-12, vitamin D, and zinc) with SARS-CoV-2 infection risk and COVID-19 severity using Mendelian randomization (MR).

Methods

Two-sample MR was conducted using 87,870 individuals of European descent with a COVID-19 diagnosis and 2,210,804 controls from the COVID-19 host genetics initiative. Inverse variance-weighted MR analyses were performed with sensitivity analyses to assess the impact of potential violations of MR assumptions.

Results

Compared to the general population, nominally significant associations were noted for higher genetically predicted vitamin B-6 (Odds ratio per standard deviation [OR_SD]: 1.06; 95% confidence interval [CI]: 1.00, 1.13; p-value = 0.036) and lower magnesium concentrations (OR_SD: 0.33; 95%CI: 0.11, 0.96; P = 0.042) with COVID-19 infection risk. However, the association for magnesium was not consistent in some sensitivity analyses, and sensitivity analyses could not be performed for vitamin B-6 as only two genetic instruments were available. Genetically predicted levels of calcium, folate, β-carotene, copper, iron, vitamin B-12, vitamin D, selenium, phosphorus, or zinc were not associated with the outcomes from COVID-19 disease.

Conclusion

These results, though based only on genetically predicated circulating micronutrient concentrations, provide scant evidence for possible associations of micronutrients with COVID-19 outcomes.

Evaluation of zinc, copper, and Cu:Zn ratio in serum, and their implications in the course of COVID-19

BACKGROUND

The dynamics of essential metals such as Copper (Cu) and Zinc (Zn) may be associated with the novel coronavirus disease 2019 (COVID-19) that has spread across the globe.

OBJECTIVES

The aim of this study is to investigate the relationship between serum levels of Cu and Zn, as well as the Cu:Zn ratio in the acute phase of COVID-19 along with the assessment of their connection to other laboratory parameters (hematological, biochemical, hemostatic).

METHODS

Serum levels of Cu and Zn were measured by atomic absorption spectrometry in 75 patients in the acute COVID-19 phase and were compared with those of 22 COVID-19 patients evaluated three months after the acute phase of the disease ('non-acute' group) and with those of 68 healthy individuals.

RESULTS

In comparison with both the non-acute patients and the healthy controls, the acute patients had lower levels of hemoglobulin and albumin, and higher levels of glucose, creatinine, liver transaminases, C-reactive protein (CRP), and higher values of the neutrophils to lymphocytes ratio (NLR) at the hospital admission. They also exhibited increased levels of Cu and decreased of Zn, well represented by the Cu:Zn ratio which was higher in the acute patients than in both non-acute patients (p = 0.001) and healthy controls (p < 0.001), with no statistical difference between the last two groups. The Cu:Zn ratio (log scale) positively correlated with CRP (log scale; r = 0.581, p < 0.001) and NLR (r = 0.436, p = 0.003).

CONCLUSION

Current results demonstrate that abnormal dynamics of Cu and Zn levels in serum occur early during the course of COVID-19 disease, and are mainly associated with the inflammation response.

Trace element homeostasis in the neurological system after SARS-CoV-2 infection: Insight into potential biochemical mechanisms

BACKGROUND

Several studies have suggested that COVID-19 is a systemic disease that can affect several organs, including the brain. In the brain, specifically, viral infection can cause dyshomeostasis of some trace elements that promote complex biochemical reactions in specialized neurological functions.

OBJECTIVE

Understand the neurovirulence of SARS-CoV-2 and the relationship between trace elements and neurological disorders after infection, and provide new insights on the drug development for the treatment of SARS-CoV-2 infections.

METHODS

The main databases were used to search studies published up September 2021, focusing on the role of trace elements during viral infection and on the correct functioning of the brain.

RESULTS

The imbalance of important trace elements can accelerate SARS-CoV-2 neurovirulence and increase the neurotoxicity since many neurological processes can be associated with the homeostasis of metal and metalloproteins. Some studies involving animals and humans have suggested the synapse as a vulnerable region of the brain to neurological disorders after viral infection. Considering the combined evidence, some mechanisms have been suggested to understand the relationship between neurological disorders and imbalance of trace elements in the brain after viral infection.

CONCLUSION

Trace elements play important roles in viral infections, such as helping to activate immune cells, produce antibodies, and inhibit virus replication. However, the relationship between trace elements and virus infections is complex since the specific functions of several elements remain largely undefined. Therefore, there is still a lot to be explored to understand the biochemical mechanisms involved between trace elements and viral infections, especially in the brain.

Prevalence of Micronutrient Deficiencies in Patients Hospitalized with COVID-19: An Observational Cohort Study

BACKGROUND

A higher risk for severe clinical courses of coronavirus disease 2019 (COVID-19) has been linked to deficiencies of several micronutrients. We therefore studied the prevalence of deficiencies of eight different micronutrients in a cohort of hospitalized COVID-19-patients.

METHODS

We measured admission serum/plasma levels of vitamins A, B12, D, and E, as well as folic acid, zinc, selenium, and copper in 57 consecutively admitted adult patients with confirmed COVID-19 and analyzed prevalence of micronutrient deficiencies and correlations among micronutrient levels. Further, we studied associations of micronutrient levels with severe disease progression, a composite endpoint consisting of in-hospital mortality and/or need for intensive care unit (ICU) treatment with logistic regression.

RESULTS

Median age was 67.0 years (IQR 60.0, 74.2) and 60% (n = 34) were male. Overall, 79% (n = 45) of patients had at least one deficient micronutrient level and 33% (n = 19) had ≥3 deficiencies. Most prevalent deficiencies were found for selenium, vitamin D, vitamin A, and zinc (51%, 40%, 39%, and 39%, respectively). We found several correlations among micronutrients with correlation coefficients ranging from r = 0.27 to r = 0.42. The strongest associations with lower risk for severe COVID-19 disease progression (adjusted odds ratios) were found for higher levels of vitamin A (0.18, 95% CI 0.05-0.69, p = 0.01), zinc (0.73, 95% CI 0.55-0.98, p = 0.03), and folic acid (0.88, 95% CI 0.78-0.98, p = 0.02).

CONCLUSIONS

We found a high prevalence of micronutrient deficiencies in mostly older patients hospitalized for COVID-19, particularly regarding selenium, vitamin D, vitamin A, and zinc. Several deficiencies were associated with a higher risk for more severe COVID-19 courses. Whether supplementation of micronutrients is useful for prevention of severe clinical courses or treatment of COVID-19 warrants further research.

Modifiable Host Factors for the Prevention and Treatment of COVID-19: Diet and Lifestyle/Diet and Lifestyle Factors in the Prevention of COVID-19

Many studies have shown that the immune system requires adequate nutrition to work at an optimal level. Not only do optimized nutritional strategies support the immune system, but they also reduce chronic inflammation. Nutritional supplements that are recommended for patients with critical illnesses are thought to also be effective for the coronavirus disease 2019 (COVID-19) patients in the intensive care unit. Some studies have recommended fresh fruits and vegetables, soy, nuts, and antioxidants, such as omega-3 fatty acids, to improve immune system activity. Although nutritional status is considered to be an important prognostic factor for patients with COVID-19, there is to date no sufficient evidence that optimal nutritional therapies can be beneficial for these patients. Some have argued that the COVID-19 pandemic is a good opportunity to test the effectiveness of nutritional intervention for infectious diseases. Many researchers have suggested that testing the proposed nutritional approaches for infectious diseases in the context of a pandemic would be highly informative. The authors of other review papers concluded that it is important to have a diet based on fresh foods, such as fruits, vegetables, whole grains, low-fat dairy products, and healthy fats (i.e., olive oil and fish oil), and to limit the intake of sugary drinks as well as high-calorie and high-salt foods. In this review, we discuss the clinical significance of functional food ingredients as complementary therapies potentially beneficial for the prevention or treatment of COVID-19. We believe that our review will be helpful to plan and deploy future studies to conclude these potentials against COVID-19, but also to new infectious diseases that may arise in the future.

Can Selenium Reduce the Susceptibility and Severity of SARS-CoV-2?-A Comprehensive Review

The SARS-CoV-2 infection is a highly contagious viral infection, which has claimed millions of lives in the last two years. The infection can cause acute respiratory distress, myocarditis, and systemic inflammatory response in severe cases. The interaction of the viral spike protein with the angiotensin-converting enzyme in various tissues causes damage to vital organs and tissues, leading to complications in the post-infection period. Vaccines and antiviral drugs have improved patient response to the infection, but the long-term effect on vital organs is still unknown. Investigations are now focused on supportive nutrient therapies, which can mitigate the susceptibility as well as the long-term complications of COVID-19. Selenium is one such micronutrient that plays a vital role in preventing oxidative stress induced by the virus. Further, selenium is important for effective immune response, controlling systemic inflammation, and maintain overall health of humans. We examine the role of selenium in various aspects of SARS-CoV-2 infection and address the importance of selenium supplementation in reducing the susceptibility and severity of infection in this review.

COVID-19 and liver dysfunction: What nutritionists need to know

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.

Telomere length and vitamin B12

Telomeres are non-coding nucleoprotein structures consisting of a highly conserved tandem repeat DNA sequence that caps the ends of chromosomes in eukaryotes. Telomeres confer chromosomal stability, protect the genome from nucleolytic degradation, avoid aberrant recombination and improper repair, and prevent random fusion of chromosomes. The end-replication problem results in telomere shortening with every cell division, eventually leading to cellular senescence and aging. Telomere length (TL) is thereby an ideal candidate for "biological aging." Telomeres possess guanine-rich repeats, which are highly susceptible to oxidative stress. Epidemiological studies have indicated the association of telomere attrition with mortality and various age-related diseases. Micronutrients comprising vitamins and minerals act as potential modulators of stress and can influence TL. Research has indicated that vitamin B12 (B12) regulates oxidative stress and maintains genomic stability, thereby influencing telomere integrity and cellular aging. The deficiency of B12 leads to elevated levels of homocysteine, which reduces the methylation potential and increases oxidative stress, thereby compromising the TL. Telomere shortening and mitochondrial dysfunction are independently linked to aging. However, they are connected through telomerase reverse transcriptase activity, which regulates mitochondrial biogenesis. Further, experimental evidence indicated the positive association of B12 with relative TL and mitochondrial DNA copy number, an indirect index of mitochondrial biogenesis. The present chapter provides some insights into the role of B12 in influencing TL. Exploring their association might open new avenues to understand the pathophysiology of aging and age-related diseases.

Prognostic and Therapeutic Role of Vitamin D in COVID-19: Systematic Review and Meta-analysis

PURPOSE

Vitamin D deficiency/insufficiency may increase the susceptibility to coronavirus disease 2019 (COVID-19). We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality, and role of vitamin D in its treatment.

METHODS

We searched CINAHL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to May 30, 2021, for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease, and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4.1.0). Heterogeneity was determined by I2 and sources were explored through prespecified sensitivity analyses, subgroup analyses, and meta-regressions.

RESULTS

Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n = 1 976 099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (odds ratio [OR] 1.46; 95% CI, 1.28-1.65; P < 0.0001; I2 = 92%), severe disease (OR 1.90; 95% CI, 1.52-2.38; P < 0.0001; I2 = 81%), and death (OR 2.07; 95% CI, 1.28-3.35; P = 0.003; I2 = 73%). The 25-hydroxy vitamin D concentrations were lower in individuals with COVID-19 compared with controls (mean difference [MD] -3.85 ng/mL; 95% CI, -5.44 to -2.26; P ≤ 0.0001), in patients with severe COVID-19 compared with controls with nonsevere COVID-19 (MD -4.84 ng/mL; 95% CI, -7.32 to -2.35; P = 0.0001) and in nonsurvivors compared with survivors (MD -4.80 ng/mL; 95% CI, -7.89 to -1.71; P = 0.002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19, and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis.

CONCLUSION

Multiple observational studies involving nearly 2 million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.

Decreased Serum Selenium Levels of COVID-19 Patients in Comparison with Healthy Individuals

BACKGROUND

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the cause of the COVID-19 pandemic and is the cause of increased mortality, especially among elderly patients and those who have severe complications, such as chronic pulmonary obstruction, hypertension, diabetes, and cancer. Nutrition, especially micronutrients, plays an important role in reducing mortality and complications from COVID-19 because micronutrients strengthen our immune system and nutritional status is an important factor that affects the outcome of patients with COVID-19. Among micronutrients, selenium has an important effect on both intrinsic and acquired immunity. Host selenium deficiency affects the viral genome and increases the virulence of viruses. We have investigated the serum selenium levels in COVID-19 patients and healthy control individuals.

METHODS

A total of 50 patients with COVID-19 infection were included in this study. During hospitalization, 13 patients died (non-survivor group) and 37 patients recovered (survivor group). We assessed the serum selenium levels in 50 COVID-19 patients and 50 healthy individuals by Agilent SpectrAA-240 Z atomic absorption spectrometer.

RESULTS

The serum selenium level was significantly lower in COVID-19 patients (77. 8 ± 13.9 μg/L) as compared to healthy control individuals (91.7 ± 16.7 μg/L), but there was no significant difference between the survivor and non-survivor groups. Also, there was no significant relationship between serum selenium levels and laboratory findings of COVID-19 patients.

CONCLUSIONS

These results suggest that decreased serum selenium levels may be a risk factor for the COVID-19 infection, but there was no significant relationship between selenium and severity and mortality of COVID-19 disease.

Association of vitamin D deficiency with COVID-19 infection severity: Systematic review and meta-analysis

BACKGROUND

We sought to evaluate the association between vitamin D deficiency and the severity of coronavirus disease 2019 (COVID-19) infection.

METHODS

Multiple databases from 1 January 2019 to 3 December 2020 were searched for observational studies evaluating the association between vitamin D deficiency and severity of COVID-19 infection. Independent reviewers selected studies and extracted data for the review. The main outcomes of interest were mortality, hospital admission, length of hospital stay and intensive care unit admission.

RESULTS

Seventeen observational studies with 2756 patients were included in the analyses. Vitamin D deficiency was associated with significantly higher mortality (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.50-4.05; 12 studies; hazard ratio [HR]: 4.11, 95% CI: 2.40-7.04; 3 studies), higher rates of hospital admissions (OR: 2.18, 95% CI: 1.48-3.21; 3 studies) and longer hospital stays (0.52 days; 95% CI: 0.25-0.80; 2 studies) as compared to nonvitamin D deficient status. Subgroup analyses based on different cut-offs for defining vitamin D deficiency, study geographic locations and latitude also showed similar trends.

CONCLUSIONS

Vitamin D deficiency is associated with greater severity of COVID-19 infection. Further studies are warranted to determine if vitamin D supplementation can decrease the severity of COVID-19.

Perspectives on nano-nutraceuticals to manage pre and post COVID-19 infections

Optimized therapeutic bio-compounds supported by bio-acceptable nanosystems (i.e., precise nanomedicine) have ability to promote health via maintaining body structure, organ function, and controlling chronic and acute effects. Therefore, nano-nutraceuticals (designed to neutralize virus, inhibit virus bindings with receptors, and support immunity) utilization can manage COVID-19 pre/post-infection effects. To explore these approaches well, our mini-review explores optimized bio-active compounds, their ability to influence SARS-CoV-2 infection, improvement in performance supported by precise nanomedicine approach, and challenges along with prospects. Such optimized pharmacologically relevant therapeutic cargo not only affect SARS-CoV-2 but will support other organs which show functional alternation due to SARS-CoV-2 for example, neurological functions. Hence, coupling the nutraceuticals with the nano-pharmacology perspective of higher efficacy via targeted delivery action can pave a novel way for health experts to plan future research needed to manage post COVID-19 infection effect where a longer efficacy with no side-effects is a key requirement.

Immunomodulatory and Anti-Inflammatory Properties of Selenium-Containing Agents: Their Role in the Regulation of Defense Mechanisms against COVID-19

The review presents the latest data on the role of selenium-containing agents in the regulation of diseases of the immune system. We mainly considered the contributions of selenium-containing compounds such as sodium selenite, methylseleninic acid, selenomethionine, and methylselenocysteine, as well as selenoproteins and selenium nanoparticles in the regulation of defense mechanisms against various viral infections, including coronavirus infection (COVID-19). A complete description of the available data for each of the above selenium compounds and the mechanisms underlying the regulation of immune processes with the active participation of these selenium agents, as well as their therapeutic and pharmacological potential, is presented. The main purpose of this review is to systematize the available information, supplemented by data obtained in our laboratory, on the important role of selenium compounds in all of these processes. In addition, the presented information makes it possible to understand the key differences in the mechanisms of action of these compounds, depending on their chemical and physical properties, which is important for obtaining a holistic picture and prospects for creating drugs based on them.

The effectiveness of nutritional interventions on COVID-19 outcomes: A protocol for systematic review and meta-analysis

Background: Despite global efforts to treat and alleviate the outcomes of COVID-19, no consensus has been reached regarding the optimal approach. Some nutrients have been known to be vital for the integrity of the immune system. Although limited interventional studies support this idea, the findings of some cross-sectional and case studies have been encouraging. Aim: The present study will seek to determine the effectiveness of nutritional interventions on the outcomes of COVID-19. Methods: Electronic databases including PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar will be searched for articles published from October 1st, 2019, to January 12th, 2022. Different study designs, both randomized and nonrandomized trials, cross-sectional or cohort studies, and pre and post-interventions will be included. Screening, selection, and extraction of data as well as quality assessment of included studies, will be carried out by two separate reviewers. Any potential conflicts will be resolved through discussion. An appropriate risk of bias assessment tool will be used to appraise the included studies. Then, the results will be synthesized and pooled for meta-analysis. If the meta-analysis is not performed, the reason will be provided. After summarizing the results and providing conclusions, the specific features associated with effective interventions will be presented based on the power of each study.

Clinical Nutrition and the role of hospital pharmacist in the management of covid patient

The nutritional status of everyone represents a fundamental element to maintain a good health and it can be related to infectious agents in some disorders. Prevention, diagnosis and treatment of malnutrition should be included in the management of SARS-CoV-2 patients in order to improve both short- and long-term prognosis.

In Covid patients the choice of route of administration for nutrition is closely related to respiratory autonomy. In subjects who are not mechanically ventilated or with non-invasive ventilation (NIV), spontaneous oral feeding is strongly indicated, while considering the patient's comorbidity, chewing ability and swallowing. If this is not possible or if it is not possible to meet the appropriate nutritional needs, it is necessary to resort to artificial nutrition (enteral or parenteral). Enteral nutrition (EN) is preferred to parenteral nutrition (PN) because it allows to maintain the trophism of the gastrointestinal tract, involving a lower risk of infectious complications and it is easier to manage. PN is usually used in patients in whom NE is not feasible, insufficient or contraindicated, or in patients with invasive total mechanical ventilation. Based on these considerations, it would be necessary to develop a targeted nutritional pathway in order to support the management of Covid patients.

In the nutritional management of these patients, the role of the hospital pharmacists is fundamental. They collaborate with clinicians, nutritionist, dieticians and speech therapists to choose the most appropriate nutrition, based on the clinical characteristics of the patient and on the availability of nutritional formulations in the therapeutic guide.

Nutritional risk of vitamin D, vitamin C, zinc, and selenium deficiency on risk and clinical outcomes of COVID-19: A narrative review

The pathogenicity of the current coronavirus disease (COVID-19) shows postulates that optimal status of essential nutrients is crucial in supporting both the early viraemic and later hyperinflammatory phases of COVID-19. Micronutrients such as vitamin C, D, zinc, and selenium play roles in antioxidant, anti-inflammatory, antithrombotic, antiviral, and immuno-modulatory functions and are useful in both innate and adaptive immunity. The purpose of this review is to provide a high-level summary of evidence on clinical outcomes associated with nutritional risk of these micronutrients observed in patients with COVID-19. A literature search was performed on PubMed and Google Scholar to obtain findings of cross-sectional and experimental studies in humans. The search resulted in a total of 1212 reports including all nutrients, but only 85 were included according to the eligibility criteria. Despite the diversity of studies and the lack of randomized clinical trials and prospective cohorts, there is evidence of the potential protective and therapeutic roles of vitamin C, D, zinc, and selenium in COVID-19. The findings summarized in this review will contribute to guide interventions in clinical practice or in future clinical studies.

Hesitancy Regarding Medical Advice on COVID-19: An Emergency Department Perspective

Objective:

The rejection of or non-compliance with treatment arises for different reasons by patients who receive treatment recommendations for various diseases. These states are described by various concepts, such as discharge against medical advice (DAMA) and medication nonadherence (MNA). The basis of the study is to determine how these states have arisen during the coronavirus disease (COVID-19) pandemic.

Method:

The data of this study were collected through standardized interviews with 103 volunteer participants who were diagnosed with COVID-19 at different times and who did not use their prescribed medicine during the pandemic in Turkey. The data obtained in the research were analyzed through the MAXQDA qualitative analysis program.

Results:

As a result of the analysis of the data, 4 main themes and sub-codes have been reached: (1) prescribed medicine, (2) an information source for the COVID-19 period/treatment, (3) the reason for medication nonadherence, and (4) treatment of choice. When the approach toward treatment of patients who were diagnosed with COVID-19 and had started treatment by a physician was evaluated, it was revealed that the nonadherence state emerged as a cycle. In the initial period, nonadherence due to the medication itself was observed. The second period is when the patients recognize their disease and collect information from their environment. Although this period begins before the disease, the search for informative sources intensifies, especially once the diagnosis has been received. In the third period, with their diagnosis and the information they had obtained, patients consider the reasons to use the medication and then decide whether or not to use it. In the fourth period, the patients who will not use antivirals consider other medications, such as anti-flu, anticoagulant, supplements, and nutrition.

Conclusion:

Since a specific treatment protocol has not yet been revealed for COVID-19, a new conceptual framework is required. In the current condition, the state of “hesitation for medical advice” arises for non-hospitalized patients.

Associations of Nutritional Behavior and Gut Microbiota with the Risk of COVID-19 in Healthy Young Adults in Poland

The numerous consequences of the coronavirus disease 2019 (COVID-19) pandemic in healthy young people and the lack of clarity as to the long-term disease outcomes have spurred the search for risk factors for SARS-CoV-2 infection. We aimed to evaluate the associations of nutritional behaviors, gut microbiota, and physical activity with the risk of COVID-19 in healthy young nonobese people. Data on body composition, anthropometric measurements, physical activity, dietary intake, and gut microbiota were obtained from 95 adults (mean age, 34.66 ± 5.76 years). A balanced diet rich in vegetables and fruit, including nuts, wholegrain cereal products, and legumes, covers the need for vitamins and minerals. Such a diet can be an effective measure to reduce the risk of COVID-19 in nonobese healthy physically active young people with normal immune function. People with balanced diet and an average daily consumption of >500 g of vegetables and fruit and >10 g of nuts had an 86% lower risk of COVID-19 compared with those whose diet was not balanced and who consumed lower amounts of these products. It is well documented that proper nutrition, physical activity, and maintenance of normal weight facilitate good health by ensuring optimal immune function. The beneficial effects of these interventions should be strongly emphasized during the COVID-19 pandemic.

Inhibition of selenoprotein synthesis by Zika virus may contribute to congenital Zika syndrome and microcephaly by mimicking SELENOP knockout and the genetic disease PCCA

Selenium status plays a major role in health impacts of various RNA viruses. We previously reported potential antisense interactions between viral mRNAs and host mRNAs encoding isoforms of the antioxidant selenoprotein thioredoxin reductase (TXNRD). Here, we examine possible targeting of selenoprotein mRNAs by Zika virus (ZIKV), because one of the most devastating outcomes of ZIKV infection in neonates, microcephaly, is a key manifestation of Progressive Cerebello-Cerebral Atrophy (PCCA), a genetic disease of impaired selenoprotein synthesis. Potential antisense matches between ZIKV and human selenoprotein mRNAs were identified computationally, the strongest being against human TXNRD1 and selenoprotein P (SELENOP), a selenium carrier protein essential for delivery of selenium to the brain. Computationally, ZIKV has regions of extensive (~30bp) and stable (ΔE < -50kcal/mol) antisense interactions with both TXNRD1 and SELENOP mRNAs. The core ZIKV/SELENOP hybridization was experimentally confirmed at the DNA level by gel shift assay using synthetic oligonucleotides. In HEK293T cells, using Western blot probes for SELENOP and TXNRD1, ZIKV infection knocked down SELENOP protein expression almost completely, by 99% (p<0.005), and TXNRD1 by ~90% (p<0.05). In contrast, by RT-qPCR, there was no evidence of significant changes in SELENOP and TXNRD1 mRNA levels after ZIKV infection, suggesting that their knockdown at the protein level is not primarily a result of mRNA degradation. These results suggest that knockdown of SELENOP and TXNRD1 by ZIKV in fetal brain, possibly antisense-mediated, could mimic SELENOP knockout, thereby contributing to neuronal cell death and symptoms similar to the genetic disease PCCA, including brain atrophy and microcephaly.

Impact of Nutrition in the Management of Nutritional Status of Covid-19 Patients

Abstract:

The second outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is of great concern due to its awful mortality and morbidity rate with decreasing nutritional status and poor lifestyle as well as noteworthy food crisis and affected economy of the world. Increasing food prices, food crisis, global hunger and decreasing availability and feasibility of food are the foremost causes of decreasing nutritional status, which increases the risk of susceptibility to infection and, in turn, leads to unfavorable outcomes of the diseases. Although, in times of the Covid- 19 pandemic, nutrition is of potential attention, and there is a requirement for more exploration in the field of nutrition for the prevention of diseases arising from coronavirus infection. Elderly and individuals with co-morbidity, such as respiratory diseases, cardiovascular diseases, diabetes mellitus and metabolic diseases, are more prone towards getting infected with the coronavirus. Good nutrition is mandatory for healthy immune responses, which can be improved by the inclusion of vitamin A, B6, B12, C, D, E, zinc, selenium, iron, copper and an antioxidant-rich diet.

Preventing the Adverse Effects of SARS-CoV-2 Infection and COVID-19 through Diet, Supplements, and Lifestyle

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for the coronavirus disease 2019 (COVID-19) and the ongoing worldwide pandemic, has cost the lives of almost 5 [...].

Role of Selenium in Viral Infections with a Major Focus on SARS-CoV-2

Viral infections have afflicted human health and despite great advancements in scientific knowledge and technologies, continue to affect our society today. The current coronavirus (COVID-19) pandemic has put a spotlight on the need to review the evidence on the impact of nutritional strategies to maintain a healthy immune system, particularly in instances where there are limited therapeutic treatments. Selenium, an essential trace element in humans, has a long history of lowering the occurrence and severity of viral infections. Much of the benefits derived from selenium are due to its incorporation into selenocysteine, an important component of proteins known as selenoproteins. Viral infections are associated with an increase in reactive oxygen species and may result in oxidative stress. Studies suggest that selenium deficiency alters immune response and viral infection by increasing oxidative stress and the rate of mutations in the viral genome, leading to an increase in pathogenicity and damage to the host. This review examines viral infections, including the novel SARS-CoV-2, in the context of selenium, in order to inform potential nutritional strategies to maintain a healthy immune system.

Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes

Background: Several studies suggest an association between serum 25-hydroxyvitamin D (25OHD) and the outcomes of Severe Acute Respiratory Syndrome Corona-Virus-2 (SARS-CoV-2) infection, in particular Coronavirus Disease-2019 (COVID-19) related severity and mortality. The aim of the present meta-analysis was to investigate whether vitamin D status is associated with the COVID-19 severity, defined as ARDS requiring admission to intensive care unit (ICU) or mortality (primary endpoints) and with the susceptibility to SARS-CoV-2 and COVID-19-related hospitalization (secondary endpoints). Methods: A search in PubMed, ScienceDirect, Web of Science, Google Scholar, Scopus, and preprints repositories was performed until March 31th 2021 to identify all original observational studies reporting association measures, or enough data to calculate them, between Vitamin D status (insufficiency <75, deficiency <50, or severe deficiency <25 nmol/L) and risk of SARS-CoV-2 infection, COVID-19 hospitalization, ICU admission, or death during COVID-19 hospitalization. Findings: Fifty-four studies (49 as fully-printed and 5 as pre-print publications) were included for a total of 1,403,715 individuals. The association between vitamin D status and SARS-CoV2 infection, COVID-19 related hospitalization, COVID-19 related ICU admission, and COVID-19 related mortality was reported in 17, 9, 27, and 35 studies, respectively. Severe deficiency, deficiency and insufficiency of vitamin D were all associated with ICU admission (odds ratio [OR], 95% confidence intervals [95%CIs]: 2.63, 1.45-4.77; 2.16, 1.43-3.26; 2.83, 1.74-4.61, respectively), mortality (OR, 95%CIs: 2.60, 1.93-3.49; 1.84, 1.26-2.69; 4.15, 1.76-9.77, respectively), SARS-CoV-2 infection (OR, 95%CIs: 1.68, 1.32-2.13; 1.83, 1.43-2.33; 1.49, 1.16-1.91, respectively) and COVID-19 hospitalization (OR, 95%CIs 2.51, 1.63-3.85; 2.38, 1.56-3.63; 1.82, 1.43-2.33). Considering specific subgroups (i.e., Caucasian patients, high quality studies, and studies reporting adjusted association estimates) the results of primary endpoints did not change. Interpretations: Patients with low vitamin D levels present an increased risk of ARDS requiring admission to intensive care unit (ICU) or mortality due to SARS-CoV-2 infection and a higher susceptibility to SARS-CoV-2 infection and related hospitalization.

Formation of ideas about rational nutrition as an element of student’s environmental education

The aim of the work was to form ideas about rational nutrition as an element of ecological education of students by studying and discussing their eating behavior in relation to foods rich in vitamin D using quantitative descriptor-profile analysis. Quantitative descriptor-profile analysis showed that the “poorest” profiles have foods with the highest vitamin D. Thus, foods with a high vitamin D content do not fall into the circle of students’ dietary preferences. The results of the survey showed that the most frequently consumed foods for young people are fried potatoes, pizza, dumplings and cheese. Products such as cheese, butter, artificial red caviar, mushrooms (chanterelles) can be successfully used as a base for fortification with vitamin D, since they are positively perceived by students and affordable. It was shown that cheese is the only product that, when surveyed by 59 young people, was included both in the list of 5 most favorite and frequently consumed foods, and was selected from the list of 22 foods offered to the respondents containing significant amounts of vitamin D. The research carried out is the basis for forming students’ understanding of the importance of a balanced diet in the context of environmental education.

Decentralized vitamin C & D dual biosensor chip: Toward personalized immune system support

Combating the ongoing COVID-19 pandemic has put the spotlight on nutritional support of the immune system through consumption of vitamins C and D. Accordingly, there are urgent demands for an effective on-the-spot multi-vitamin self-testing platform that monitors the levels of these immune-supporting micronutrients for guiding precision nutrition recommendations. Herein, we present a compact bioelectronic dual sensor chip aimed at frequent on-the-spot simultaneous monitoring of the salivary vitamin C and D dynamics. The new bioelectronic chip combines a new electrocatalytic vitamin C amperometric assay along with competitive vitamin D immunoassay on neighboring electrodes, to perform selective and cross-talk free detection of both vitamins in a 10-μL saliva sample within 25 min. The distinct vitamin C or D temporal profiles obtained for different individuals after vitamin supplementation indicate the potential of the new bioelectronic chip strategy for enhancing personalized nutrition towards guiding dietary interventions to meet individual nutrition needs and promote immune system health.

The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19

Currently available anti-viral drugs may be useful in reducing the viral load but are not providing the necessary physiological effects to reduce the SARS-CoV-2 complications efficiently. Treatments that provide better clinical outcomes are urgently needed. Vitamin C (ascorbic acid, AA) is an essential nutrient with many biological roles that have been proven to play an important part in immune function; it serves as an antioxidant, an anti-viral, and exerts anti-thrombotic effects among many other physiological benefits. Research has proven that AA at pharmacological doses can be beneficial to patients with acute respiratory distress syndrome (ARDS) and other respiratory illnesses, including sepsis. In addition, High-Dose Intravenous Vitamin C (HDIVC) has proven to be effective in patients with different viral diseases, such as influenza, chikungunya, Zika, and dengue. Moreover, HDIVC has been demonstrated to be very safe. Regarding COVID-19, vitamin C can suppress the cytokine storm, reduce thrombotic complications, and diminish alveolar and vascular damage, among other benefits. Due to these reasons, the use of HDIVC should be seriously considered in complicated COVID-19 patients. In this article, we will emphasize vitamin C’s multiple roles in the most prominent pathophysiological processes presented by the COVID-19 disease.

Nutrient modulation of viral infection-implications for COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has put focus on the importance of a healthy immune system for recovery from infection and effective response to vaccination. Several nutrients have been under attention because their nutritional statuses showed associations with the incidence or severity of COVID-19 or because they affect several aspects of immune function. Nutritional status, immune function, and viral infection are closely interrelated. Undernutrition impairs immune function, which can lead to increased susceptibility to viral infection, while viral infection itself can result in changes in nutritional status. Here, we review the roles of vitamins A, C, D, and E, and zinc, iron, and selenium in immune function and viral infection and their relevance to COVID-19.

Vitamin D and COVID-19 - Let's Explore the Relationship!

Introduction:Vitamin D plays a protective role against COVID-19. Patients with deficiency of vitamin D are more prone to severe SARS-CoV-2 infections. It is known to enhance human β-defensin 2 and antimicrobial peptide. Vitamin D can easily stabilise and manage immunological reactions against SARS-CoV-2. It can also suppress the cytokine storm by boosting the innate system. Material and methods: RT-PCR confirmed COVID-19 positive subjects were divided into two groups, one comprising asymptomatic subjects (Group 1) and the other one ICU admitted patients (Group 2). In both groups, various comorbidities such as obesity, diabetes mellitus, hypertension, cardiovascular disease, respiratory disease, renal disease and malignancy were taken into consideration. Vitamin D estimation was performed along with serum levels of interleukin-6 (IL-6) and ferritin using automated immunoassays on Siemens Advia Centaur XP. Results:On acknowledging the cut-off serum concentration level of vitamin D as < 30 ng/mL for establishing vitamin D deficiency the prevalence of vitamin D deficiency was 66.18% in Group 1 and 98.30% in Group 2. Diabetes mellitus, followed by hypertension was associated comorbidity in both groups. In total, 33 patients were found to be severely deficient (<10 ng/mL) in vitamin D, out of which 27 were critically ill and six asymptomatic. In both groups, diabetes mellitus, followed by hypertension were the highest comorbid associations. Fatality rate (discharge vs fatality) was 0% in Group 1 and 16.94% (10 patients died) in Group 2. Conclusion:To conclude, the present study addressed the significant relationship between vitamin D levels and clinical outcomes of COVID-19 patients. Vitamin D deficiency distinctly upswings the chance of disease severity as well as mortality after SARS-CoV-2 infection.

A naturopathic treatment approach for mild and moderate COVID-19: A retrospective chart review

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has led to significant morbidity and mortality. Although COVID-19 vaccination is available, therapeutic options are still needed. The goal of the present manuscript is to report on a treatment strategy used in a naturopathic medical practice for mild and moderate COVID-19.

DESIGN

A retrospective chart review was conducted of 30 consecutive patients diagnosed with mild and moderate COVID-19 who were provided multi-nutrient, herbal, and probiotic treatment in a rural, out-patient, naturopathic primary care setting.

MAIN OUTCOMES MEASURES

The primary outcome was treatment safety; secondary outcomes included changes in symptoms, progression to severe COVID-19, incidence of long COVID, and recovery time.

RESULTS

No side effects or adverse events were reported from treatment and all patients experienced resolution of symptoms presumed to be associated with COVID-19 infection. One patient who had been ill for 28 days prior to presentation was hospitalized. Five patients had an illness duration of more than one month. Time to treatment was correlated with duration of illness post-treatment (r = 0.63, p < 0.001) and more symptoms at presentation was correlated with a longer duration of illness (r = 0.52, p < 0.01).

CONCLUSIONS

In this retrospective chart review, a multi-nutrient, herbal, and probiotic therapeutic approach for mild and moderate COVID-19 appeared to be well-tolerated. Delay in seeking treatment after symptom onset, as well as more symptoms at presentation, were correlated with a longer duration of illness. This treatment strategy may have clinical benefit, warranting prospective clinical trials with confirmed COVID-19 cases.

Food Access, Diet Quality, and Nutritional Status of Older Adults During COVID-19: A Scoping Review

Background: COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. Objective: To examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. Methods: An electronic search was conducted on 3 databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the mean age of participants was 50 years and older. In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. Results: The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n = 5), analytical (n = 6), and correlational (n = 2). Studies were conducted among community-dwelling older adult populations (n = 7) as well as those temporarily residing in hospital settings (n = 6) in 10 countries. None of the in-scope studies examined the impact of food programs or specific public policies or disaggregated data by race/ethnicity. Conclusions: More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

The Nutrition-COVID-19 Interplay: a Review

Purpose of Review

Nutritional status is affected by the COVID-19 pandemic, directly or indirectly. Even with the recent rollout of the coronavirus disease 2019 (COVID-19) vaccines and availability of medicines such as remdesivir, and monoclonal antibodies, host nutritional status is pivotal in the fight against the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and outcomes. The purpose of this review is to discuss the effects of COVID-19-related lockdown on lifestyle behaviors, and the nutritional consequences, and the direct sequelae of the infection on nutrition including potential nutritional interventions.

Recent Findings

The COVID-19-related lockdown imposed radical changes in lifestyle behaviors with considerable short-term and long-term health and nutritional consequences including weight gain and obesity and increased cardiometabolic risk, consistently linked to worsened prognosis. The extent of the impact was dependent on food insecurity, overall stress and disordered eating, physical inactivity, and exposure to COVID-19-related nutrition information sources. COVID-19 could directly induce inflammatory responses and poor nutrient intake and absorption leading to undernutrition with micronutrient deficiencies, which impairs immune system function with subsequent amplified risk of infection and disease severity. Nutrition interventions through nutrition support, dietary supplementation, and home remedies such as use of zinc, selenium, vitamin D, and omega-3 fatty acids showed the most significant promise to mitigate the course of COVID-19 infection and improve survival rates.

Summary

The nutrition-COVID-19 relationship and related dietary changes mimic a vicious cycle of the double burden of malnutrition, both obesity and undernutrition with micronutrient deficiencies, which promote infection, disease progression, and potential death.

Selenium: An Element of Life Essential for Thyroid Function

Selenium (Se), a microelement essential for life, is critical for homeostasis of several critical functions, such as those related to immune-endocrine function and signaling transduction pathways. In particular, Se is critical for the function of the thyroid, and it is particularly abundant in this gland. Unfortunately, Se deficiency is a very common condition worldwide. Supplementation is possible, but as Se has a narrow safety level, toxic levels are close to those normally required for a correct need. Thus, whether the obtaining of optimal selenium concentration is desirable, the risk of dangerous concentrations must be equally excluded. This review addressed the contribution by environment and food intake on Se circulating levels (e.g., geographical factors, such as soil concentration and climate, and different quantities in food, such as nuts, cereals, eggs, meat and fish) and effects related to its deficiency or excess, together with the role of selenium and selenoproteins in the thyroid pathophysiology (e.g., Hashimoto's thyroiditis and Graves' disease).

The effect of vitamin D, magnesium and zinc supplements on interferon signaling pathways and their relationship to control SARS-CoV-2 infection

The concern of today's communities is to find a way to prevent or treat COVID-19 and reduce its symptoms in the patients. However, the genetic mutations and more resistant strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge; the designed vaccines and adjuvant therapies would potentially control the symptoms and severity of COVID-19. The most important complication of this viral infection is acute respiratory distress syndrome, which occurs due to the infiltration of leukocytes into the alveoli and the raised cytokine storm. Interferons, as a cytokine family in the host, play an important role in the immune-related antiviral defense and have been considered in the treatment protocols of COVID-19. In addition, it has been indicated that some nutrients, including vitamin D, magnesium and zinc are essential in the modulation of the immune system and interferon (IFN) signaling pathway. Several recent studies have investigated the treatment effect of vitamin D on COVID-19 and reported the association between optimal levels of this vitamin and reduced disease risk. In the present study, the synergistic action of vitamin D, magnesium and zinc in IFN signaling is discussed as a treatment option for COVID-19 involvement.

Low vitamin D levels and prognosis in a COVID-19 pediatric population: a systematic review

We aim to study the relationship between vitamin D level, risk and severity of Coronavirus disease of 2019 (COVID-19) infection in pediatric population through systematic review. We searched PubMed, CINAHL, EMBASE, Cochrane Library and Google Scholar from December 2019 to June 2021 for retrieving articles studying association between vitamin D deficiencies with COVID-19. Qualitative details were synthesized in evidence table and quantitative data was used for deriving pooled estimate through meta-analysis. After initial search of 2261 articles, eight eligible studies (two reviews) were included in the systematic review. Meta-analysis of the quantitative data (six studies) showed pooled prevalence of vitamin D deficiency as 45.91% (95% CI: 25.148-67.450). In infected pediatric patients, low levels of vitamin D increased the risk of severe disease (odds ratio-5.5; 95% CI: 1.560-19.515; P = 0.008). It was also found that children and adolescents having vitamin D deficiency had greater risk of COVID infection as compared to patients with normal vitamin D levels. Improvement in disease severity with vitamin D supplementation was also noted. The systematic review showed that almost half of the pediatric COVID patients suffer from vitamin D deficiency. It is also clear that the low level of vitamin D is associated with greater risk of infection and poorer outcome in pediatrics.

Vitamin D levels and oxidative stress markers in patients hospitalized with COVID-19

Background

COVID-19 is characterized by the presence of oxidative stress. Vitamin D status has been reviewed as one of the factors that may affect disease severity. The aim of this study was to assess the relationship between serum vitamin D levels, oxidative stress markers and disease severity in hospitalized COVID-19 patients.

Methods

Vitamin D levels were measured in 33 patients with COVID-19. The total antioxidant power and plasma peroxides were determined in serum.

Results

Severe COVID-19 patients have lower vitamin D levels (18.39 ± 2.29 ng/mL vs. 28.47 ± 3.05 ng/mL, p < .05) and higher oxidative stress compared to the moderate group. When divided according to serum vitamin D levels, significantly higher values of LDH (604.8 ± 76.98 IU/mL vs. 261.57 ± 47.33 IU/mL) and D-dimer (5978 ± 2028ng/mL vs. 977.7 ± 172 ng/mL) were obtained in the group with vitamin D below 30 ng/mL, followed with significantly higher levels of plasma peroxides (d-ROMs: 414.9 ± 15.82 U.Carr vs. 352.4 ± 18.77 U.Carr; p < .05) and oxidative stress index (OSI: 92.25 ± 6.60 vs. 51.89 ± 6.45; p < .001).

Conclusion

The presented data provide a justification to consider vitamin D as an important factor that could ameliorate disease severity through its anti-inflammatory and antioxidant effects.