bims-covind Biomed News
on COVID-19 and Immunology: nutrition and diet
Issue of 2021‒01‒24
eleven papers selected by
Aimee Cook
Newcastle University


  1. Int J Environ Res Public Health. 2021 01 16. pii: E740. [Epub ahead of print]18(2):
    Abraham J, Dowling K, Florentine S.
      The foremost mortality-causing symptom associated with COVID-19 is acute respiratory distress syndrome (ARDS). A significant correlation has been identified between the deficiency in vitamin D and the risk of developing ARDS. It has been suggested that if we can reduce or modify ARDS in COVID-19 patients, we may significantly reduce the severity of COVID-19 symptoms and associated mortality rates. The increased mortality of dark-skinned people, who have a reduced UV absorption capacity, may be consistent with diminished vitamin D status. The factors associated with COVID-19 mortality, such as old age, ethnicity, obesity, hypertension, cardiovascular diseases, and diabetes, are all found to be linked with vitamin D deficiency. Based on this review and as a precautionary measure, it is suggested that the adoption of appropriate and safe solar exposure and vitamin D enriched foods and supplements should be considered to reduce the possible severity of COVID-19 symptoms. Safe sun exposure is deemed beneficial globally, specifically in low and middle-income countries, as there is no cost involved. It is also noted that improved solar exposure and vitamin D levels can reduce the impact of other diseases as well, thus assisting in maintaining general human well-being.
    Keywords:  SARS-CoV-2; acute respiratory distress syndrome (ARDS); acute respiratory tract infection (ARTI); calcifediol; calcitriol; coronavirus; environment; human health; infectious disease; pandemic
    DOI:  https://doi.org/10.3390/ijerph18020740
  2. Br J Nutr. 2021 Jan 20. 1-26
    Stephensen CB, Lietz G.
      SARS-CoV2 infects respiratory epithelial cells via its cellular receptor angiotensin-converting enzyme 2 (ACE2), causing a viral pneumonia with pronounced inflammation resulting in significant damage to the lungs and other organ systems, including the kidneys, though symptoms and disease severity are quite variable depending on the intensity of exposure and presence of underlying conditions that may affect the immune response. The resulting disease, COVID-19, can cause multi-organ system dysfunction in patients requiring hospitalization and intensive care treatment. Serious infections like COVID-19 often negatively affect nutritional status and the resulting nutritional deficiencies may increase disease severity and impair recovery. One example is the viral infection measles, where associated vitamin A (VA) deficiency increases disease severity and appropriately timed supplementation during recovery reduces mortality and hastens recovery. VA may play a similar role in COVID-19. First, VA is important in maintaining innate and adaptive immunity to promote clearance of a primary infection as well as minimize risks from secondary infections. Second, VA plays a unique role in the respiratory tract, minimizing damaging inflammation, supporting repair of respiratory epithelium and preventing fibrosis. Third, VA deficiency may develop during COVID-19 due to specific effects on lung and liver stores caused by inflammation and impaired kidney function, suggesting that supplements may be needed to restore adequate status. Fourth, VA supplementation may counteract adverse effects of SARS-CoV2 on the angiotensin system as well as minimizing adverse effects of some COVID-19 therapies. Evaluating interactions of SARS-COV2 infection with VA metabolism may thus provide improved COVID-19 therapy.
    Keywords:  COVID-19; SARS-CoV2; angiotensin converting enzyme II (ACE2); immunity; inflammation; kidney function; lipofibroblasts; pulmonary fibrosis; retinoic acid; vitamin A
    DOI:  https://doi.org/10.1017/S0007114521000246
  3. J Leukoc Biol. 2021 Jan 19.
    Kalia V, Studzinski GP, Sarkar S.
      Vitamin D, a key nutrient/prohormone classically associated with skeletal health, is also an important immunomodulator, with pleotropic effects on innate and adaptive immune cells. Outcomes of several chronic, autoimmune, and infectious diseases are linked to vitamin D. Emergent correlations of vitamin D insufficiency with coronavirus-induced disease 2019 (COVID-19) severity, alongside empirical and clinical evidence of immunoregulation by vitamin D in other pulmonary diseases, have prompted proposals of vitamin D supplementation to curb the COVID-19 public health toll. In this review paper, we engage an immunological lens to discuss potential mechanisms by which vitamin D signals might regulate respiratory disease severity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections, vis a vis other pulmonary infections. It is proposed that vitamin D signals temper lung inflammatory cascades during SARS-CoV2 infection, and insufficiency of vitamin D causes increased inflammatory cytokine storm, thus leading to exacerbated respiratory disease. Additionally, analogous to studies of reduced cancer incidence, the dosage of vitamin D compounds administered to patients near the upper limit of safety may serve to maximize immune health benefits and mitigate inflammation and disease severity in SARS-CoV2 infections. We further deliberate on the importance of statistically powered clinical correlative and interventional studies, and the need for in-depth basic research into vitamin D-dependent host determinants of respiratory disease severity.
    Keywords:  immunoregulation; vitamin D
    DOI:  https://doi.org/10.1002/JLB.4COVR1020-698R
  4. Sci Rep. 2021 Jan 21. 11(1): 1981
    Walrand S.
      To determine the factor triggering the sudden surge of daily new COVID-19 cases arising in most European countries during the autumn of 2020. The dates of the surge were determined using a fitting of the two last months of reported daily new cases in 18 European countries with latitude ranging from 39° to 62°. The study proves no correlation between the country surge date and the 2 weeks preceding temperature or humidity but shows an impressive linear correlation with latitude. The country surge date corresponds to the time when its sun UV daily dose drops below ≈ 34% of that of 0° latitude. Introducing reported seasonal blood 25-hydroxyvitamin D (25(OH)D) concentration variation into the reported link between acute respiratory tract infection risk and 25(OH)D concentration quantitatively explains the surge dynamics. Several studies have already substantiated a 25(OH)D concentration impact on COVID-19 severity. However, by comparing different patient populations, discriminating whether a low 25(OH)D concentration is a real factor underlying COVID-19 severity or only a marker of another weakness that is the primary severity factor can be challenging. The date of the surge is an intrapopulation observation and has the benefit of being triggered only by a parameter globally affecting the population, i.e. decreases in the sun UV daily dose. The results indicate that a low 25(OH)D concentration is a contributing factor to COVID-19 severity, which, combined with previous studies, provides a convincing set of evidence.
    DOI:  https://doi.org/10.1038/s41598-021-81419-w
  5. J Food Biochem. 2021 Jan 17. e13604
    Oyagbemi AA, Ajibade TO, Aboua YG, Gbadamosi IT, Adedapo ADA, Aro AO, Adejumobi OA, Thamahane-Katengua E, Omobowale TO, Falayi OO, Oyagbemi TO, Ogunpolu BS, Hassan FO, Ogunmiluyi IO, Ola-Davies OE, Saba AB, Adedapo AA, Nkadimeng SM, McGaw LJ, Kayoka-Kabongo PN, Oguntibeju OO, Yakubu MA.
      The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent for the Coronavirus Disease 2019 (COVID-19). The COVID-19 pandemic has created unimaginable and unprecedented global health crisis. Since the outbreak of COVID-19, millions of dollars have been spent, hospitalization overstretched with increasing morbidity and mortality. All these have resulted in unprecedented global economic catastrophe. Several drugs and vaccines are currently being evaluated, tested, and administered in the frantic efforts to stem the dire consequences of COVID-19 with varying degrees of successes. Zinc possesses potential health benefits against COVID-19 pandemic by improving immune response, minimizing infection and inflammation, preventing lung injury, inhibiting viral replication through the interference of the viral genome transcription, protein translation, attachment, and host infectivity. However, this review focuses on the various mechanisms of action of zinc and its supplementation as adjuvant for vaccines an effective therapeutic regimen in the management of the ravaging COVID-19 pandemic. PRACTICAL APPLICATIONS: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent for the Coronavirus Disease 2019 (COVID-19), has brought unprecedented untold hardship to both developing and developed countries. The global race for vaccine development against COVID-19 continues with success in sight with attendant increasing hospitalization, morbidity, and mortality. Available drugs with anti-inflammatory actions have become alternative to stem the tide of COVID-19 with attendant global financial crises. However, Zinc is known to modulate several physiological functions including intracellular signaling, enzyme function, gustation, and olfaction, as well as reproductive, skeletal, neuronal, and cardiovascular systems. Hence, achieving a significant therapeutic approach against COVID-19 could imply the use of zinc as a supplement together with available drugs and vaccines waiting for emergency authorization to win the battle of COVID-19. Together, it becomes innovative and creative to supplement zinc with currently available drugs and vaccines.
    Keywords:  SARS-CoV-2; antioxidant; antiviral; immunomodulatory; zinc supplementation
    DOI:  https://doi.org/10.1111/jfbc.13604
  6. Endocr Pract. 2020 Oct;pii: S1530-891X(20)48220-5. [Epub ahead of print]26(10): 1186-1195
    Barengolts E, Smith ED.
      OBJECTIVE: To review data implicating microbiota influences on Coronavirus Disease 2019 (COVID-19) in patients with diabetes.METHODS: Primary literature review included topics: "COVID-19," "SARS," "MERS," "gut micro-biota," "probiotics," "immune system," "ACE2," and "metformin."
    RESULTS: Diabetes was prevalent (~11%) among COVID-19 patients and associated with increased mortality (about 3-fold) compared to patients without diabetes. COVID-19 could be associated with worsening diabetes control and new diabetes diagnosis that could be linked to high expression of angiotensin-converting enzyme 2 (ACE2) receptors (coronavirus point of entry into the host) in the endocrine pancreas. A pre-existing gut microbiota imbalance (dysbiosis) could contribute to COVID-19-related complications in patients with diabetes. The COVID-19 virus was found in fecal samples (~55%), persisted for about 5 weeks, and could be associated with diarrhea, suggesting a role for gut dysbiosis. ACE2 expressed on enterocytes and colonocytes could serve as an alternative route for acquiring COVID-19. Experimental models proposed some probiotics, including Lactobacillus casei, L. plantarum, and L. salivarius, as vectors for delivering or enhancing efficacy of anti-coronavirus vaccines. These Lactobacillus probiotics were also beneficial for diabetes. The potential mechanisms for interconnections between coronavirus, diabetes, and gut microbiota could be related to the immune system, ACE2 pathway, and metformin treatment. There were suggestions but no proof supporting probiotics benefits for COVID-19 infection.
    CONCLUSION: The data suggested that the host environment including the gut microbiota could play a role for COVID-19 in patients with diabetes. It is a challenge to the scientific community to investigate the beneficial potential of the gut microbiota for strengthening host defense against coronavirus in patients with diabetes.
    DOI:  https://doi.org/10.4158/EP-2020-0336
  7. J Korean Med Sci. 2021 Jan 18. 36(3): e21
    Kang HM, Jeong DC, Suh BK, Ahn MB.
      BACKGROUND: The risk of weight gain as a consequence of school closure in children during the coronavirus disease-2019 (COVID-19) pandemic has been recognized. This study was performed to investigate changes in anthropometric and metabolic parameters in children following a 6-month period of social distancing and school closure due to the pandemic.METHODS: This retrospective cohort study was conducted in school-aged children that were on routine follow-up at the Growth Clinic of Seoul St. Mary's Hospital. Changes in body mass index (BMI) standard deviation scores (z-scores), lipid profiles, and vitamin D levels were investigated. The 1-year period prior to school closure was defined as "pre-COVID-19 period," and the subsequent 6-month period as "COVID-19 period."
    RESULTS: Overall, 226 children between 4 to 14 years old without comorbidities were assessed. On average, their BMI z-scores increased by 0.219 (95% confidence interval [CI], 0.167-0.271; P < 0.001) in the COVID-19 period compared to the pre-COVID-19 period, and the proportion of overweight or obesity increased from 23.9% in the pre-COVID-19 period to 31.4% in the COVID-19 period. The number of days after school closure (P = 0.004) and being in the normoweight category in the pre-COVID-19 period (P = 0.017) were factors associated with an increased BMI in the COVID-19 period. The mean triglyceride (105.8 mg/dL vs. 88.6 mg/dL, P < 0.001) and low-density lipoprotein-cholesterol (100.2 mg/dL vs. 94.0 mg/dL, P = 0.002) levels were higher, whereas the calcidiol level (18.9 mg/dL vs. 23.8 mg/dL, P < 0.001) was lower in the COVID-19 period compared to the pre-COVID-19 period.
    CONCLUSION: Within 6 months, increased childhood obesity and vitamin D deficiencies were observed. The duration of school closure was significantly associated with an increased BMI and being normoweight does not exclude the risks for gaining weight.
    Keywords:  Calcidiol; Overweight; School Closure; Social Distancing
    DOI:  https://doi.org/10.3346/jkms.2021.36.e21
  8. J Med Virol. 2021 Jan 21.
    Finzi E, Harrington A.
      Previous research has shown that zinc can interfere with proteolytic processing of polyproteins in RNA viruses1 , and the RNA polymerase of SARS-CoV-12 . This article is protected by copyright. All rights reserved.
    Keywords:  COVID-19; Retrospective; SARS-Cov-2; Treatment; Zinc
    DOI:  https://doi.org/10.1002/jmv.26812
  9. Endocr Metab Immune Disord Drug Targets. 2021 Jan 14.
    Vitale E, Magrone M, Galatola V, Magrone T.
      BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (COVID-19) infection provokes serious clinical consequences, which in many situations need hospitalization of the patient in Intensive Care Unit. Additionally, SARS-COV-2 infection can indirectly cause deaths in aged individuals as well as in patients with comorbidities.OBJECTIVE: To evaluate the effects of nutrition during the COVID-19 pandemic in both hospitalized patients and in the general population.
    METHODS: Authors searched Medline (PubMed), Web of Science, EMBASE, Cochrane Library, Google, and Institutional websites for medical subheadings terms and free full text referred to "SARS-CoV-2", COVID-19", "nutrition", "immune system", before 31st July 2020.
    RESULTS: A total of 20 articles describing different nutritional interventions for patients with SARS-CoV-2 infection focusing on the general population have been included. Of these, 6 studies are dealing with nutritional interventions for patients with SARS-CoV2 infection and the others are focalized on a potential beneficial effect exerted by a Mediterranean-type diet, related to the supplementation of micronutrients and vitamins.
    CONCLUSION: A correct lifestyle even including the consumption of nutrient largely present in MD, may be beneficial for preventing or improving prognosis in the SARS-CoV-2 infection.
    Keywords:  Immune system; SARS-CoV-2; nutrition; patients; prevention
    DOI:  https://doi.org/10.2174/1871530321666210114154401
  10. Am J Lifestyle Med. 2021 Jan-Feb;15(1):15(1): 60-67
    Smirmaul BPC, Chamon RF, de Moraes FM, Rozin G, Moreira ASB, de Almeida R, Guimarães ST.
      The COVID-19 pandemic has made it challenging for individuals and families to maintain a healthy lifestyle, quality of life, and well-being. Preliminary evidence have suggested that higher odds of both mortality and severity of the COVID-19 are closely associated to unhealthy lifestyle behaviors. Thus, in an effort to contribute to this challenging global situation, we joined a group of lifestyle medicine researchers and/or practitioners to provide scientifically sound information, recommendations, resources, and suggestions related to the main pillars of lifestyle medicine (healthy eating, physical activity, sleep, tobacco/alcohol, stress management, relationships, and planetary health) that may help health practitioners to support clients and patients maintain a healthy lifestyle during (and after) the COVID-19 crisis.
    Keywords:  COVID-19 pandemic; healthy living medicine; lifestyle medicine; quality of life; well-being
    DOI:  https://doi.org/10.1177/1559827620950276