The Role of Nutrition in the COVID-19 Pandemic

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

The effect of macronutrient and micronutrient supplements on COVID-19: an umbrella review

BACKGROUND AND AIMS

A healthy diet play an important role in the prevention and even treatment of various diseases. Proper nutrition plays an important role in boosting of immune system. These include the consumption of macronutrients such as proteins, lipids, carbohydrates, and also micronutrients including vitamins. Here, we aimed to systematically review the effects of macronutrients and micronutrients on the prevention and treatment of COVID-19.

METHODS

We searched the databases of PubMed, Scopus, Embase, and Web of Science on December 23, 2023. The records were downloaded into an EndNote file, the duplicates were removed, and the studies underwent a two-phase screening process based on their title/abstracts and full texts. The included articles were screened and underwent inclusion and exclusion criteria. We included the English systematic reviews and meta-analyses that concurred with the aim of our study. The selected articles were assessed by Cochrane's Risk of Bias in Systematic Reviews for the quality check. The data of the eligible studies were extracted in a pre-designed word table and were used for the qualitative synthesis.

RESULTS

A total of 28 reviews were included in this study. Most studies have shown that micronutrients are effective in morbidity and mortality controlling in viral respiratory infections such as COVID-19 but some studies have shown that micronutrients are sometimes not effective in controlling severity. On the other hand, calcifediol was by far the most successful agent in reducing intensive care needs and mortality between studies.

CONCLUSION

Individuals without malnutrition had a reduced risk of SARS-CoV-2 infection and severe disease. The administration of Vitamin D is effective in reducing the morbidity and mortality of COVID-19 patients. Patients with vitamin D deficiency were more prone to experience severe infection, and they were at higher risk of morbidities and mortality. Other micronutrients such as Vitamin A, Vitamin B, and Zinc also showed some benefits in patients with COVID-19. Vitamin C showed no efficacy in COVID-19 management even in intravenous form or in high doses.

COVID-19 and diet: efforts towards a balanced diet and sustainable nutrition among university students in Pakistan

Nutrition is an important aspect of a healthy lifestyle for all individuals, including adolescents. The objective of this cross-sectional descriptive survey study was to investigate university students' awareness of immunity enhancing foods, food nutritive values, and eating practices during the COVID-19 pandemic. A total of 839 university students from four different universities in Pakistan participated in the study from October 2021 to January 2022, 397 of which were male and 442 were female. A total of 419 students were studying in medical disciplines while 420 were non-medical students. The students had significant knowledge (p < 0.05) about COVID-19, and nutritional habits were seen in both medical and non-medical students. Results showed that medical students (n-201) were slightly more aware of immunity-enhancing foods and the nutritive values of foods compared to engineering students (n-79). However, eating practices were generally poorly adopted by all of the university students. Male and female students were not significantly different in their mean replies to questions on the nutritive value of food or in their eating habits. Healthy eating practices will aid university students in preventing illnesses connected to nutrition as well as enhancing their immune systems and nutritional well-being both during and post-pandemic. In light of these results, suggestions and implications for nutritional advice and education were explored.

Epidemiology, clinical profiles, and prognostic value of COVID-19-related cutaneous manifestations in African populations: a rapid narrative review

BACKGROUND

Skin manifestations' true prognostic value, and clinical and epidemiological pictures in SARS-CoV-2 infection in African populations are poorly described and understudied. More familiarity with COVID-19 cutaneous manifestations may aid in early clinical diagnosis or guide prognosis.

METHODS

In this literature review, we looked for potential studies published from December 2019 to March 2023 on COVID-19 cutaneous lesions in African populations. Our key questions were focused on the prognostic values of cutaneous manifestations related to COVID-19.

RESULTS

Our findings show that cutaneous manifestations of COVID-19 vary by country and severity of COVID-19, primarily multisystem inflammatory syndrome (MIS). Significant differences were also found between various dermatological lesions, primarily MIS, erythema multiforme-like, livedoid, vesicular, or varicella-like rashes, urticarial, maculopapular or morbilliform rashes, and chilblain-like or pernio-like rashes. There were 47.5% (115/242) of MIS cases reported in nine published African studies. Our findings also revealed that MIS may be diagnosed in 2-7 days due to early onset rash. Advanced age, obesity, diabetes, cardiovascular disease, HIV, tuberculosis, asthma, atopic disease, underweight, malnutrition, and malignancy were found to be associated with COVID-19 cutaneous manifestations in African populations.

CONCLUSIONS

COVID-19-related skin manifestations in African populations are important as a driving force in COVID-19 prognosis.

Neutrophil heterogeneity and aging: implications for COVID-19 and wound healing

Neutrophils play a critical role in the immune response to infection and tissue injury. However, recent studies have shown that neutrophils are a heterogeneous population with distinct subtypes that differ in their functional properties. Moreover, aging can alter neutrophil function and exacerbate immune dysregulation. In this review, we discuss the concept of neutrophil heterogeneity and how it may be affected by aging. We then examine the implications of neutrophil heterogeneity and aging for COVID-19 pathogenesis and wound healing. Specifically, we summarize the evidence for neutrophil involvement in COVID-19 and the potential mechanisms underlying neutrophil recruitment and activation in this disease. We also review the literature on the role of neutrophils in the wound healing process and how aging and neutrophil heterogeneity may impact wound healing outcomes. Finally, we discuss the potential for neutrophil-targeted therapies to improve clinical outcomes in COVID-19 and wound healing.

Early oral nutritional supplement improves COVID-19 outcomes among hospitalized older patients during the Omicron wave

OBJECTIVES

The effect of and optimal timing for initiating an oral nutritional supplement(ONS) in hospitalized older patients with the Omicron variant infection remain unclear. The aim of this study was to explore the associations between the ONS and clinical outcomes.

METHODS

This study used a retrospective cohort design as primary analysis and a case-control design as sensitivity analysis. We collected data from patients with confirmed coronavirus disease 2019 (COVID-19) between April 2022 and June 2022 at Shanghai Fourth People's Hospital, one of the designated medical centers for COVID-19 in Shanghai, China. Patients were identified as ONS users or non-ONS users, with the former defined as early ONS (ONS initiated within 48 h from hospital admission), and late ONS (ONS initiated after 48 h) users.

RESULTS

The study included 1181 hospitalized patients ≥60 y of age. The mean age of the cohort was 78 y, and most patients were women (57.7%). Mortalities after propensity-score matching were 1.2% and 4.3% in the ONS group and non-ONS groups, respectively (P = 0.032). Subgroup analysis results showed that median (IQR) hospital length of stay and the median (IQR) length from symptom onset to viral clearance were shorter for the early ONS than for the late ONS group (9 [6-13] d versus 14 [11 -18] d; P < 0.001, and 11 [8-17] d versus 17 [13-22] d; P < 0.001, respectively). The findings from the case-control analysis supported those from the primary analysis.

CONCLUSIONS

Early ONS might have significantly lowered risk for in-hospital death, as well as reduce hospital length of stay and days of viral clearance in older patients with COVID-19 during the Omicron wave.

Potential Benefits of Omega-3 Polyunsaturated Fatty Acids (N3PUFAs) on Cardiovascular Health Associated with COVID-19: An Update for 2023

The accumulating literature demonstrates that omega-3 polyunsaturated fatty acid (n-3 polyunsaturated fatty acid, N3PUFA) can be incorporated into the phospholipid bilayer of cell membranes in the human body to positively affect the cardiovascular system, including improving epithelial function, decreasing coagulopathy, and attenuating uncontrolled inflammatory responses and oxidative stress. Moreover, it has been proven that the N3PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of some potent endogenous bioactive lipid mediators that mediate some favorable effects attributed to their parent substances. A dose-response relationship between increased EPA and DHA intake and reduced thrombotic outcomes has been reported. The excellent safety profile of dietary N3PUFAs makes them a prospective adjuvant treatment for people exposed to a higher risk of cardiovascular problems associated with COVID-19. This review presented the potential mechanisms that might contribute to the beneficial effects of N3PUFA and the optimal form and dose applied.

A qualitative study of Covid-19 effects on nutrition associated problems in recovered patients

BACKGROUND

World is currently challenging with Covid-19 pandemic. Nutritional status is a determinant factor in the treatment process and recovery for patients with Covid-19. Although a limited data is available about the effects of nutrition on this disease. Therefore, the aim of this study was to identify nutritional problems in patients recovering from Covid-19 before, during and after the disease.

METHODS

This qualitative descriptive study was carried out based on the specified inclusion criteria through targeted sampling of 45 patients recovered from Covid-19, 2021-2022. In-depth semi-structured individual interviews were used to collect data. Interviews were recorded, transcribed and analyzed using qualitative content analysis method and MAXQDA Software.

RESULTS

Based on the participants' description of this stage, it can be reported that most of the individuals who were infected had no specific symptoms. Nutrition-linked problems in the main stage of the disease included troubles in tolerating foods and nutrition (e.g., fatty and solid foods), highly consumed foods in the main stage of the disease (e.g., beverages), individuals' approaches to improve nutritional challenges (e.g., consumption of herbal teas and soft texture foods) and using supplements. The patients stated fewer nutritional problems after recovering from the disease. The most significant change included their desire to eat solid foods such as rice, bread, pasta and fast foods.

CONCLUSION

appropriate nutrition with medication can help accelerate the recovery process of the patients, especially hospitalized patients with further severe degrees of the illness.

OBESITY AND OUTCOME AMONG PATIENTS HOSPITALIZED FOR SARS-COV-2: A HOSPITAL-BASED STUDY IN INDONESIA

Background

Patients with obesity who have SARS-CoV-2 are at significant risk for developing serious clinical problems that need intensive care and have a bad prognosis.

Aim

The aim of this study was to determine obesity and outcome among patients hospitalized for SARS-CoV-2 at the Indonesia's national referral hospital.

Methods

This study used a retrospective cohort. The study samples were SARS-CoV-2 patients who were treated by pulmonary specialists in the intensive room of Dr. M. Djamil Hospital Padang. The number of samples in this study was 106 subjects. Data analysis was performed using the Chi-square test, Kaplan-Meier, and Cox regression. P < 0.05 was significant, and the data were analyzed using the SPSS version 21.0 program.

Results

The results of this study found obesity was associated with the outcome of SARS-CoV-2 patients treated at Indonesia's national referral hospital (p<0.05, OR=3.55 (95% CI 1.44-8.71)). The mortality rate among patients hospitalized with SARS-CoV-2 at Indonesia's national referral hospital with obesity was higher than non-obese; 82.7% and 57.4% respectively. The length of stay in patients with obesity was also shorter; 12 days compared to 19 days in non-obese.

Conclusion

There was an association between obesity with mortality of SARS-CoV-2 patients in a national referral hospital in Indonesia. This study can provide input in the therapeutic management of patients with obesity so as to reduce the poor prognosis.

Social Capital Promotes a Healthier Diet among Young Adults by Reducing Psychological Distress

Studies have revealed the links between social capital and diet. However, the mediating role of psychological distress in this relationship has been understudied. This study aims to identify direct and indirect relationships between social capital and adherence to the Mediterranean diet among Lithuanian young adults and identify the mediating role of psychological distress in this relationship. Data were collected from 1336 young adults, aged 18-36 years; 40.5% were males. MEDAS was used to measure adherence to a healthy diet. Social capital was measured by eight separate items in terms of family support, social support, social cohesion, social trust, communication, collaboration, participation, and distant communication. Kessler's six-item scale was used to assess psychological distress. Higher family support (β = 0.105), higher social participation (β = 0.294), and lower psychological distress (β = 0.073) directly predicted higher adherence to the Mediterranean diet. Social capital was indirectly related to adherence to the Mediterranean diet, with standardized effect sizes of 0.02-0.04, indicating small effect sizes. Thus, psychological distress mediates the relationship between social capital and a healthy diet. Given that social capital is related to psychological health and both directly and indirectly predicts healthy behavior in young adults, further longitudinal and experimental research is required to measure the effects of the intervention on incorporating, facilitating, encouraging, and implementing measures to strengthen the social connection between people and groups of people within the community, neighborhood, and organizations.

Proper Dietary and Supplementation Patterns as a COVID-19 Protective Factor (Cross-Sectional Study-Silesia, Poland)

BACKGROUND

The COVID-19 pandemic has become a challenge for the world today, so it is very important to create healthy eating habits in society to support immunity and raise awareness of the benefits of supplementation.

OBJECTIVE

The purpose of this study is to evaluate diet and dietary supplementation, since previous studies indicate the protective nature of these in building immunity during the pandemic and post-pandemic period (COVID-19). The hypothesis of the study is whether the dietary regimen presented by the COVID-19 respondents can be considered protective in building immunity against SARS-CoV-2.

MATERIAL AND METHODS

The study included 304 subjects, with an average age of 39.04 ± 23.59. The main criteria for inclusion in the study were that the respondent was ≥18 years old and participated voluntarily. The study was conducted using an original questionnaire.

RESULTS

In the study group, no change was noticed in the previous diet during the COVID-19 pandemic, while the level of physical activity among the respondents decreased. Too low a percentage of people regularly consumed, among other foods. legume seeds-only 10.5% of respondents consumed them several times a week-and citrus fruits-the largest number of respondents, as many as 39.8%, only consumed them several times a month. The largest percentage of respondents with mild/scanty COVID-19 disease regularly took vitamin C-containing preparations (n = 61; 59.80%). Statistical analysis showed that there was a correlation between the incidence of mild/scanty COVID-19 and the regularity of taking vitamin C-containing preparations (T = 11.374; r = 0.611; p = 0.04603). A statistical significance level was also obtained for the regularity of supplementation of multivitamin preparations, which were taken by 68% (34) of respondents affected by mild/scanty COVID-19 (T = 13.456; r = 0.711; p = 0.02191).

CONCLUSIONS

The study's hypothesis was supported. Respondents characterized by a normal dietary pattern and taking supplements commonly recognized as immune "boosters" were more likely to mildly survive COVID-19. Moreover, it was shown that the pandemic in most of the respondents did not significantly affect their dietary strategy. It is reasonable to conclude that the dietary patterns adopted may be a common way to prevent SARS-CoV-2 infections and their possible complications.

The landscape of potential health benefits of carotenoids as natural supportive therapeutics in protecting against Coronavirus infection

The Coronavirus Disease-2019 (COVID-19) pandemic urges researching possibilities for prevention and management of the effects of the virus. Carotenoids are natural phytochemicals of anti-oxidant, anti-inflammatory and immunomodulatory properties and may exert potential in aiding in combatting the pandemic. This review presents the direct and indirect evidence of the health benefits of carotenoids and derivatives based on in vitro and in vivo studies, human clinical trials and epidemiological studies and proposes possible mechanisms of action via which carotenoids may have the capacity to protect against COVID-19 effects. The current evidence provides a rationale for considering carotenoids as natural supportive nutrients via antioxidant activities, including scavenging lipid-soluble radicals, reducing hypoxia-associated superoxide by activating antioxidant enzymes, or suppressing enzymes that produce reactive oxygen species (ROS). Carotenoids may regulate COVID-19 induced over-production of pro-inflammatory cytokines, chemokines, pro-inflammatory enzymes and adhesion molecules by nuclear factor kappa B (NF-κB), renin-angiotensin-aldosterone system (RAS) and interleukins-6- Janus kinase-signal transducer and activator of transcription (IL-6-JAK/STAT) pathways and suppress the polarization of pro-inflammatory M1 macrophage. Moreover, carotenoids may modulate the peroxisome proliferator-activated receptors γ by acting as agonists to alleviate COVID-19 symptoms. They also may potentially block the cellular receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human angiotensin-converting enzyme 2 (ACE2). These activities may reduce the severity of COVID-19 and flu-like diseases. Thus, carotenoid supplementation may aid in combatting the pandemic, as well as seasonal flu. However, further in vitro, in vivo and in particular long-term clinical trials in COVID-19 patients are needed to evaluate this hypothesis.

Inadequate energy and protein intake, underweight and malnutrition are associated with in-hospital mortality among COVID-19 rehabilitation patients during the omicron outbreak in Hong Kong

Objective

Malnourished COVID-19 patients were prone to higher mortality and longer length of stay (LOS). This study aims to investigate the malnutrition risk prevalence in the COVID-19 patients and how other nutritional indicators are related to the clinical outcomes in a rehabilitation hospital.

Methods

A retrospective cross-sectional study involved 174 COVID-19 patients during the rehabilitation phase. Malnutrition risk, nutritional indicators, mortality, and LOS were compared among different risk groups. Albumin, nutrition intake, and body mass index (BMI) were investigated for their effects on the clinical outcomes.

Results

The prevalence of malnutrition risk was 94.9%; those older were higher in malnutrition risk. BMI, energy and protein intakes decreased as the malnutrition risk increased. Albumin, energy and protein intakes were lower in the death group. The high malnutrition risk group and severely underweight patients had 2.7 times and 2.2 times higher in-hospital death, respectively. For subjects ≥75 years old, the odds ratio to death was 6.2 compared to those <75 years old.

Conclusion

We observed a high malnutrition risk of 94.9% in COVID-19 patients. Patients with malnutrition risk had a lower BMI, lower nutritional intake, and a higher chance of in-hospital death. These results reinforced the importance of nutrition management in COVID-19 patients.

Relationship between Mini Nutritional Assessment Score and Infection in Critical Care Patients

Background: Nutrition and infectious diseases are 2 influential factors. Mini nutritional assessment (MNA) score is one of the indicators for assessing the nutritional status of the patients. The present study aimed to evaluate the relationship between MNA- short form (SF) and the infectious status of patients admitted to the intensive care unit (ICU) of Hazrat-e-Rasoul hospital in Tehran. Methods: This was a cross-sectional study performed at Hazrat-e-Rasoul hospital in Tehran from 2019 to 2020. Each patient completed the MNA-SF questionnaire. The questionnaire has 6 factors with a score range of 0 to 14, with 12 to 14 indicating "normal nutrition," 8 to 11 indicating "at risk of malnutrition," and 0 to 7 indicating "malnutrition." The patients were monitored for clinical and paraclinical signs and symptoms of infectious disease for the first 14 days after being admitted to the ICU. Then, the relationship between infection level and MNA-SF scores were recorded and the chi-square, independent samples t test, and Pearson correlation test were used. Results: In this study, 119 patients (60 men and 59 women), with a mean age of 53.82 ± 19.76 years were selected, and 71 (59.67%) of the patients had an infection. Women without infection were significantly more than men (p=0.021). In the assessment of the MNA-SF questionnaire, we found that 62 (52.1%) patients had "normal nutrition" status, 30 (25.2%), and 27 (22.7%) had "at risk for malnutrition" and "malnutrition" status, respectively. MNA-SF scores were significantly different in different age groups (p=0.040). There was a significant relationship between weight loss, mobility, and neuropsychological problems with age (p<0.001). Also, there was a meaningful relationship between nutritional status and infection (p=0.032). The results determined that noninfected cases among the patients with "normal nutrition" status were more than those "at risk for malnutrition" (p=0.007). The results of this study showed that clinical outcomes had a significant relationship with nutritional status (p=0.043). Conclusion: Based on the present study, good nutritional status can reduce infection and mortality in patients who are admitted to ICU, and the nutritional status assessed with MNA-SF can play an essential role in patients' susceptibility to infection.

Serum Antibodies SARS-CoV-2 Spike (S) Protein Receptor-Binding Domain in OBGYN Residents and Effectiveness 3 Months after COVID-19 Vaccination

BACKGROUND: The health care workers are considered as vulnerable people who had higher infecting dose of SARS-CoV-2 infection compared to other society. Among more than 500 deaths of Indonesians physicians, obstetrics and gynecologist (OBGYN) has become the most specialists who died in this pandemic. AIM: The objective of our study is to evaluate the antibodies of SARS-CoV-2 in serum OBGYN residents post-vaccination as well as the presence of infection 3 months after the vaccination. METHODS: A prospective cohort study was conducted in OBGYN residents Universitas Indonesia. Serum antibodies SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) was measured using electrochemiluminescence immunoassay, 21 days after Sinovac vaccination, with basic characteristics being recorded. Within 3 months follow-up, the participants were monthly checked related to post-vaccination infection. RESULTS: The median antibodies SARS-CoV-2 for all participants were 50.72 (19.09–98.57) U/mL. There were 20 residents (24.1%) who had post-vaccination infection within 3 months and dominated by asymptomatic to mild symptoms. Body mass index (r = –0.221, p = 0.044) and sleep hours (r = –0.225, p = 0.041) were found to be inversely correlated with antibodies SARS-CoV-2 S RBD. CONCLUSION: Antibodies SARS-CoV-2 S RBD found to be correlated with BMI and sleep hours. The 3-month post-vaccine infection among OBGYN residents was almost similar to Jakarta’s positivity rate and the efficacy rate was higher than expected by National Agency of Drug and Food Control.

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.

Changes in Dietary Patterns and Clinical Health Outcomes in Different Countries during the SARS-CoV-2 Pandemic

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to an excess in community mortality across the globe. We review recent evidence on the clinical pathology of COVID-19, comorbidity factors, immune response to SARS-CoV-2 infection, and factors influencing infection outcomes. The latter specifically includes diet and lifestyle factors during pandemic restrictions. We also cover the possibility of SARS-CoV-2 transmission through food products and the food chain, as well as virus persistence on different surfaces and in different environmental conditions, which were major public concerns during the initial days of the pandemic, but have since waned in public attention. We discuss useful measures to avoid the risk of SARS-CoV-2 spread through food, and approaches that may reduce the risk of contamination with the highly contagious virus. While hygienic protocols are required in food supply sectors, cleaning, disinfection, avoidance of cross-contamination across food categories, and foodstuffs at different stages of the manufacturing process are still particularly relevant because the virus persists at length on inert materials such as food packaging. Moreover, personal hygiene (frequent washing and disinfection), wearing gloves, and proper use of masks, clothes, and footwear dedicated to maintaining hygiene, provide on-site protections for food sector employees as well as supply chain intermediates and consumers. Finally, we emphasize the importance of following a healthy diet and maintaining a lifestyle that promotes physical well-being and supports healthy immune system function, especially when government movement restrictions ("lockdowns") are implemented.

The Role of Immunobiotics and Postbiotics in the Recovery of Immune Cell Populations From Respiratory Mucosa of Malnourished Hosts: Effect on the Resistance Against Respiratory Infections

Malnutrition is associated with a state of secondary immunodeficiency, which is characterized by a worsening of the immune response against infectious agents. Despite important advances in vaccines and antibiotic therapies, the respiratory infections are among the leading causes of increased morbidity and mortality, especially in immunosuppressed hosts. In this review, we examine the interactions between immunobiotics-postbiotics and the immune cell populations of the respiratory mucosa. In addition, we discuss how this cross talk affects the maintenance of a normal generation of immune cells, that is crucial for the establishment of protective innate and adaptive immune responses. Particular attention will be given to the alterations in the development of phagocytic cells, T and B lymphocytes in bone marrow, spleen and thymus in immunosuppression state by protein deprivation. Furthermore, we describe our research that demonstrated that the effectiveness of immunobiotics nasal administration in accelerating the recovery of the respiratory immune response in malnourished hosts. Finally, we propose the peptidoglycan from the immunobiotic Lactobacillus rhamnosus CRL1505 as the key cellular component for the effects on mucosal immunity, which are unique and cannot be extrapolated to other L. rhamnosus or probiotic strains. In this way, we provide the scientific bases for its application as a mucosal adjuvant in health plans, mainly aimed to improve the immune response of immunocompromised hosts. The search for safe vaccine adjuvants that increase their effectiveness at the mucosal level is a problem of great scientific relevance today.

Nutritional Status and COVID-19 among Older Persons in Kerala, India

Background and Aims: The COVID-19 pandemic has posed an unprecedented public health crisis globally irrespective of age. There is no doubt that the older population (above the age of 60) is the most vulnerable age category due to multiple co-morbidities, which often is not in their favour. Age category, types of co-morbidities and nutritional levels indeed play a pivotal role in determining mortality rates. This paper focuses on Kerala, a southern Indian state and how it maintained low mortality levels due to COVID-19 during the first wave despite being the state with the highest proportion of the older population. The present study argues although the state possessed a robust health system and had an active engagement of the public health sector with its citizens through local governments, it was the state's meticulous planning, innovative schemes centred around older persons such as reverse quarantine, the prevailing excellent nutritional status among its population and initiatives to ensure good nutrition through food security schemes like 'essential grocery kits' and 'community kitchens' that helped to develop the body's resistance to infection and thus played a significant role in flattening the curve for Kerala's older adult COVID-19 deaths effectively, thereby achieving a high recovery rate and low rates of fatality during the first wave of COVID-19 in Kerala. Methods: Pre-COVID-19 health conditions of older adults in Kerala were analysed through Kerala Ageing Survey (KAS) panel data and Longitudinal Ageing Survey in India (LASI) data. Percentage analysis, Logistic regression method and Cox hazard regression methods were used to analyse the effect of nutritional levels on health and mortality among older adults in Kerala. Publically available COVID-19 data from the Government of Kerala and the Government of India were used to analyse the COVID-19 death rates. In addition, changes in dietary patterns and other preventive measures taken to fight against COVID-19 were investigated through qualitative response. Result: The study found that nutritional status influences mortality and co-morbidities among older adults in Kerala in the pre-COVID situation. Furthermore, the study found that though nutritional indicators, that is, overweight or obese, significantly increases the risk of comorbid conditions among older adults, good nourishment reduces the risk of all-cause mortality. The study also found that Kerala's COVID-19 fatality was much lower when compared to India and developed nations like the US, UK and Italy. Even if Kerala is one of the highly COVID-19 affected states, the effective nutritional intervention by the Government of Kerala through its various schemes to build up the general immunity of the state's citizens, especially high-risk groups; thereby achieving low COVID fatality in the state.Conclusion: Based on Kerala's experience, nutritional factors influence the population in building up the body's resistance to infection against COVID-19. Even though the fatality rate is very low, obesity coupled with non-communicable diseases affects preventive measures of the state. There is an immediate and persuasive need to find new and more efficient clinical studies apart from socio-epidemiological studies, which could play a pivotal role in determining COVID-19 health outcomes.