bims-covind Biomed News
on COVID-19 and Immunology: nutrition and diet
Issue of 2020‒12‒20
eight papers selected by
Aimee Cook
Newcastle University


  1. Maturitas. 2021 Jan;pii: S0378-5122(20)30346-7. [Epub ahead of print]143 1-9
    Shakoor H, Feehan J, Al Dhaheri AS, Ali HI, Platat C, Ismail LC, Apostolopoulos V, Stojanovska L.
      The world is currently in the grips of the coronavirus disease (COVID-19) pandemic, caused by the SARS-CoV-2 virus, which has mutated to allow human-to-human spread. Infection can cause fever, dry cough, fatigue, severe pneumonia, respiratory distress syndrome and in some instances death. COVID-19 affects the immune system by producing a systemic inflammatory response, or cytokine release syndrome. Patients with COVID-19 have shown a high level of pro-inflammatory cytokines and chemokines. There are currently no effective anti-SARS-CoV-2 viral drugs or vaccines. COVID-19 disproportionately affects the elderly, both directly, and through a number of significant age-related comorbidities. Undoubtedly, nutrition is a key determinant of maintaining good health. Key dietary components such as vitamins C, D, E, zinc, selenium and the omega 3 fatty acids have well-established immunomodulatory effects, with benefits in infectious disease. Some of these nutrients have also been shown to have a potential role in the management of COVID-19. In this paper, evidence surrounding the role of these dietary components in immunity as well as their specific effect in COVID-19 patients are discussed. In addition, how supplementation of these nutrients may be used as therapeutic modalities potentially to decrease the morbidity and mortality rates of patients with COVID-19 is discussed.
    Keywords:  COVID-19; Immunomodulation; Omega-3; Pandemic; SARS-CoV-2; Selenium; Vitamin C; Vitamin D; Vitamin E; Zinc
    DOI:  https://doi.org/10.1016/j.maturitas.2020.08.003
  2. Front Physiol. 2020 ;11 564387
    Santaolalla A, Beckmann K, Kibaru J, Josephs D, Van Hemelrijck M, Irshad S.
      Objectives: To assess the association between vitamin D deficiency and increased morbidity/mortality with COVID-19 respiratory dysfunction.Design: Scoping review.
    Data Sources: Ovid MEDLINE (1946 to 24 of April 2020) and PubMed (2020 to 17 of September 2020).
    Eligibility Criteria for Selecting Studies: A search using the search terms: [(cholecalciferol or ergocalciferol or vitamin D2 or vitamin D3 or vitamin D or 25OHD) and (SARS-CoV-2 or coronavirus or COVID or betacoronavirus or MERS-CoV or SARS-CoV or respiratory infection or acute respiratory distress syndrome or ARDS)]m.p. was conducted on the 24/04/2020 (Search A) and 17/09/2020 (Search B).
    Results: 91 studies were identified as being concerned with Acute Respiratory Infection (ARI)/Acute Respiratory Distress Syndrome (ARDS) and vitamin D, and 25 publications specifically explored the role of vitamin D deficiency in the development and progression of SARS-CoV-2/COVID-19 related ARDS. Search "A" identified three main themes of indirect evidence supporting such an association. Consistent epidemiological evidence exists linking low vitamin D levels to increased risk and severity of respiratory tract infections. We also report on plausible biological processes supporting such an association; and present weaker evidence supporting the benefit of vitamin D supplementation in reducing the risk and severity of ARIs. Uncertainty remains about what constitutes an appropriate dosing regimen in relation to reducing risk/severity of ARI/ARDS. More recent evidence (Search B) provided new insights into some direct links between vitamin D and COVID-19; with a number of cohort and ecological studies supporting an association with PCR-positivity for SARS-CoV-2 and vitamin D deficiency. The exact efficacy of the vitamin D supplementation for prevention of, or as an adjunct treatment for COVID-19 remains to be determined; but a number of randomized control trials (RCTs) currently underway are actively investigating these potential benefits.
    Conclusion: Our rapid review of literature supports the need for observational studies with COVID-19 infected populations to measure and assess vitamin D levels in relation to risk/severity and outcomes; alongside RCTs designed to evaluate the efficacy of supplementation both in preventive and therapeutic contexts. The overlap in the vitamin D associated biological pathways with the dysregulation reported to drive COVID-19 outcomes warrants further investigation.
    Keywords:  COVID-19; COVID-19 risk/severity; SARS-CoV-2; association; respiratory dysfunction; scoping review; vitamin D; vitamin D prophylaxis
    DOI:  https://doi.org/10.3389/fphys.2020.564387
  3. Front Cell Infect Microbiol. 2020 ;10 576551
    Donati Zeppa S, Agostini D, Piccoli G, Stocchi V, Sestili P.
      Infection with the SARS-CoV-2 virus causes cardiopulmonary and vascular complications, ranging in severity. Understanding the pathogenic mechanisms of the novel SARS-CoV2 infection and progression can provide potential novel targets for its prevention and/or treatment. Virus microbiota reciprocal interactions have been studied in a variety of viral infections. For example, the integrity of Coronavirus particles can be disrupted by surfactin, a bacterial surface molecule that targets other viruses, including that of influenza A. In this light, intestinal microbiota likely influences COVID-19 virulence, while from its side SARS-CoV-2 may affect the intestinal microbiome promoting dysbiosis and other deleterious consequences. Hence, the microbiota pre-existing health status and its alterations in the course of SARS-CoV-2 infection, are likely to play an important, still underscored role in determining individual susceptibility and resilience to COVID-19. Indeed, the vast majority of COVID-19 worst clinical conditions and fatalities develop in subjects with specific risk factors such as aging and the presence of one or more comorbidities, which are intriguingly characterized also by unhealthy microbiome status. Moreover, these comorbidities require complex pharmacological regimens known as "polypharmacy" that may further affect microbiota integrity and worsen the resilience to viral infections. This complex situation may represent a further and underestimated risk with regard to COVID-19 clinical burden for the elderly and comorbid people. Here, we discuss the possible biological, physiopathological, and clinical implications of gut microbiota in COVID-19 and the strategies to improve/maintain its healthy status as a simple and adjunctive strategy to reduce COVID-19 virulence and socio-sanitary burden.
    Keywords:  COVID-19; SARS-CoV-2; gut microbiota; gut-lung axis; microbiota manipulating; microbiota-virus interactions; polypharmacy; preventive therapeutic strategies
    DOI:  https://doi.org/10.3389/fcimb.2020.576551
  4. Pediatr Pulmonol. 2020 Dec 14.
    Speeckaert MM, Delanghe JR.
      
    Keywords:  COVID-19; polymorphism; vitamin D binding protein; vitamin D deficiency
    DOI:  https://doi.org/10.1002/ppul.25196
  5. J Med Virol. 2020 Dec 12.
    Abdollahi A, Sarvestani HK, Rafat Z, Ghaderkhani S, Mahmoudi-Aliabadi M, Jafarzadeh B, Mehrtash V.
      BACKGROUND AND OBJECTIVES: The outbreak of COVID-19 has created a global public health crisis. Little is known about the predisposing factors of this infection. The aim of the current study was to explore an association between the serum vitamin D level, obesity and underlying health conditions, and the vulnerability to COVID-19 in the Iranian population.METHODS: We conducted a case-control study of 201 patients with coronavirus infection and 201 controls. Cases and controls were matched for age and gender. The study was carried out for 2 months (February 2020 to April 2020) at Imam Khomeini Hospital Complex, Tehran, Iran. Serum 25(OH) vitamin D was measured using enzyme-linked immunosorbent assay method. Information containing age, gender, clinical symptoms, body mass index (BMI), CT scan findings, and underlying health conditions related to each participant were elicited from health records.
    RESULTS: A significant negative correlation (p = 0.02) was observed between the serum vitamin D level and developing coronavirus infection. Also, the results showed that the COVID-19 cases were more likely to be overweight than the controls (p=0.023). Diabetes mellitus, hypertension, and respiratory infections were found in 20.89%, 9.65%, and 6.96 % of cases, respectively. These underlying health conditions were not significantly different between cases and controls (p= 0.8111).
    CONCLUSIONS: Vitamin D deficiency and obesity are two main predisposing factors associated with the vulnerability to coronavirus infection in Iranian population. This article is protected by copyright. All rights reserved.
    Keywords:  Abdominal obesity; Body mass index; COVID-19; Iran; Vitamin D
    DOI:  https://doi.org/10.1002/jmv.26726
  6. Nutrients. 2020 Dec 09. pii: E3773. [Epub ahead of print]12(12):
    Vassiliou AG, Jahaj E, Pratikaki M, Orfanos SE, Dimopoulou I, Kotanidou A.
      We aimed to examine whether low intensive care unit (ICU) admission 25-hydroxyvitamin D (25(OH)D) levels are associated with worse outcomes of COVID-19 pneumonia. This was a prospective observational study of SARS-CoV2 positive critically ill patients treated in a multidisciplinary ICU. Thirty (30) Greek patients were included, in whom 25(OH)D was measured on ICU admission. Eighty (80%) percent of patients had vitamin D deficiency, and the remaining insufficiency. Based on 25(OH)D levels, patients were stratified in two groups: higher and lower than the median value of the cohort (15.2 ng/mL). The two groups did not differ in their demographic or clinical characteristics. All patients who died within 28 days belonged to the low vitamin D group. Survival analysis showed that the low vitamin D group had a higher 28-day survival absence probability (log-rank test, p = 0.01). Critically ill COVID-19 patients who died in the ICU within 28 days appeared to have lower ICU admission 25(OH)D levels compared to survivors. When the cohort was divided at the median 25(OH)D value, the low vitamin D group had an increased risk of 28-day mortality. It seems plausible, therefore, that low 25(OH)D levels may predispose COVID-19 patients to an increased 28-day mortality risk.
    Keywords:  ICU; SARS-CoV2; mortality; outcomes; vitamin D
    DOI:  https://doi.org/10.3390/nu12123773