La nutrition/supplémentation contre le COVID?

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The Role of Nutrition in the COVID-19 Pandemic
by Maria Chiara Mentella Nutrients 2021, 13(4), 1093;

SARS-CoV-2, the cause of the COVID-19 disease, is posing unprecedent challenges. In the literature, increasing evidence highlights how malnutrition negatively affects the immune system functionality, impairing protection from infections. The current review aims to summarize the complex relationship between SARS-CoV-2 infection and nutritional status and the effects of malnutrition in terms of disease severity, patients’ recovery time, incidence of complications and mortality rate. Current studies evaluating the possibility of modulating nutrition and supplementation in combination with pharmacological treatments in the clinical setting to prevent, support, and overcome infection are also described. The discussion of the most recent pertinent literature aims to lay the foundations for making reasonable assumptions and evaluations for a nutritional “best practice” against COVID-19 pandemic and for the definition of sound cost-effective strategies to assist healthcare systems in managing patients and individuals in their recovery from COVID-19.

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The Benefits of Supplementation in the COVID-19 Pandemic

The current evidence on the infection suggests that it causes a generalized status of enhanced inflammation due to the release of a “cytokine storm”. The patient is hospitalized and, if needed, admitted to an ICU to enable overcoming the “inflammatory storm”. According to Ferrara et al. [48], combining anti-inflammatory and antiviral drug treatment seems effective in inhibiting the release of cytokines, for the prevention of lung collapse, and for a radical reduction in the SARS-Cov-2-related death rate.
Combining pharmacological treatments with nutritional interventions and amino acid supplementation with the aim of preventing, supporting, and overcoming the infection is under evaluation. The hypothesis is that the association of clinical nutrition and adequate supplementation might support the immune system, enhancing its preventive action against infection and ensuring that inflammation is controlled. Above all, amino acids seem to provide a relevant contribution to those affected by the disease and hospitalized in an ICU: on one side, it regulates inflammation; and on the other, it promotes the healing phase with consequent indirect and intangible cost savings [46,49].

The utilization of probiotics (i.e., microorganisms that, when administered in adequate amounts, provide a health benefit on the host) is also under evaluation, which is recognized to be useful for improving immunity. Probiotics, in fact, modulate the activity of host immune cells in the intestinal epithelium and mucosa [50,51]. Nevertheless, in order to obtain the most appropriate immunomodulatory/stimulatory effects, probiotics should be rationally selected among mono-strain, multi-strain and multi-species, considering the specific disease [24]. In particular, probiotics containing Lactobacillus may help prevent viral infections such as influenza, as reported by Berggren et al. [25] in a, parallel, double-blind randomized controlled study.

Considering the current pandemic scenario, Zuo et al. [26] analyzed 15 fecal samples from as many COVID-19 cases through shotgun metagenomic sequencing analyses, and observed notable alterations in their microbiomes compared to controls, with an increased presence of opportunistic and pathogenic bacteria and depleted commensal flora, at the hospital entrance and during the whole stay. Although an unreasoned intake of probiotics against COVID-19 may not be recommended until the SARS-CoV-2 pathogenesis and its consequences on the gut microbiota will become clearer, it is possible that a targeted approach aimed at modulating the gut microbiota will soon become a possible additional or adjuvant treatment option to manage the disease and its related comorbidities. Several clinical investigations are currently being undertaken to study the safety and effectiveness of probiotics in the current pandemic scenario, as summarized by Baindara et al. [52].

As reported by Pecora et al. [53], in vitro tests and observational studies highlight the importance of omega-3 fatty acids, vitamins A, C, D, and zinc for immune response modulation. Supplementing them within the context of a well-balanced diet and not exceeding the quantity limits defined by medical experts to support immune system functionality seems a low-priced and safe option, potentially helping to prevent the infection, or to limit its consequences.

With regard to omega-3 fatty acids, Vivar-Sierra et al. [54], in an in silico simulation study, found that fatty acids high in omega-3 from a marine origin are correlated with lower COVID-19 mortality rates, and that those molecules could contribute to the reduction in COVID-19 medical complications by reducing virus entry into human cells, through a mechanism involving fatty acids binding to viral spike proteins.
Hathaway et al. [55] hypothesized that supplementing omega-3 fatty acids might add to the prevention of the virus entry by changing the lipid composition in the bilipid membrane of cells. Moreover, omega-3 is key in mediating inflammatory processes, modulating both innate and acquired immune responses. However, future research should be carried out to clarify whether the supplementation of omega-3 fatty acids may play a pivotal role in SARS-CoV-2 treatment.

Recent published evidence consistently shows a strong association between vitamin D deficiency and severe COVID-19 manifestations [56]. Moreover, current hypotheses on the role played by vitamin D in immunity do provide support for an increasing number of clinical trials that are being undertaken to investigate how supplementing vitamin D may affect the COVID-19 outcomes [56]. Until these studies provide further evidence, guaranteeing sufficient vitamin D levels seems to be a reasonable and conscious measure.
Interestingly, a controlled, double-blind, parallel arm randomized clinical trial is currently ongoing to evaluate if supplementing curcumin–piperine may be effective to manage the COVID-19 infection severity, duration, clinical manifestations and inflammatory mediators [27]. Similarly, a controlled, double-blind, parallel arm randomized trial will study the effects of propolis supplementation [28].
Future results from these trials will shed light on possible benefits of these options on COVID-19 infection. Existing clinical evidence regarding the possible effects of supplementation on COVID-19 infection is still limited. Most of the investigations, to date, are retrospective, and observational; thus, data should be interpreted with caution. However, medical nutrition therapy is one of the pillars of COVID-19 management and represents a key tool in the panorama of the possible therapeutic interventions [48]. As discussed, malnourished people with impaired immune response and chronic diseases present a worse prognosis and higher fatality rates. Healthy nutrition not only supports the immune systems reaction against diseases, including COVID-19, but it also represents undoubted support promoting recovery from the disease.

Conclusions
Here, we discussed the relevance of nutritional status in COVID-19 patients, confirming the existing relationship between nutrition status, immune response, and disease clinical manifestations severity. In COVID-19, this relationship has shown to be crucial across the disease phases, particularly in people at risk for a poor prognosis, including obese, undernourished, and older patients. Malnutrition is largely recognized to be both a cause and a consequence of immune system dysfunction. Even prolonged stay in an intensive care unit is a known risk factor for malnutrition, often causing dramatic muscle mass loss and physical function impairment. The altered inflammatory response consequent to the SARS-CoV-2 infection may aggravate catabolic processes and cachexia. These aspects may, in turn, worsen malnutrition and contribute to slow recovery, loss of independence in the daily life, depression, disability, and generally to a decreased quality of life after ICU discharge.
According to ESPEN recommendations, programs addressing the care of COVID-19 patients should integrate nutritional screening, assessment, and therapy. Obesity is a negative prognostic risk factor in COVID-19 disease progression, its effect also being independent of patient age or gender, or the presence of comorbidities. Underfeeding in individuals with COVID-19 should be carefully avoided, and ad hoc nutrition protocols and practical indications should be largely adopted in hospitals. Moreover, research will soon shed light on the possible benefits that ad hoc nutrient supplementation may provide to patients. In this pandemic scenario, community efforts should focus on promoting healthy eating and active living habits, thus preventing overweight, obesity or nutrient deficiency. In this respect, following guidelines for a healthy diet is highly recommended to prevent malnutrition in all its forms. Healthcare services should define and implement cost-effective strategies focused on increasing population awareness on the importance of balanced nutrition regimens, also considering the no imminent end of pandemic.
A multidisciplinary approach is likely to bring the highest benefit to patients. Unfortunately, most of the current knowledge is based on evidence that is mainly retrospective and observational or on previous investigations concerning other populations affected by infectious diseases; thus, it is not possible to draw robust conclusions and further recommendations. Future research should focus on investigating how malnutrition relates to the COVID-19 course and prognosis through rigorous, ad hoc clinical studies.

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The Impact of COVID-19-Related Lockdown on Diet and Serum Markers in Healthy Adults
by Nives Bogataj Jontez, Nutrients 2021, 13(4), 1082;

Due to limited data about the impact of lockdown on health status, the present study aimed to investigate the impact of COVID-19-related lockdown on changes in dietary habits, physical activity and serum markers in healthy adults. A total of 38 asymptomatic adults aged from 23 to 59 with a normal BMI (22.5 kg/m2) participated in baseline and post-lockdown measurements that included dietary and physical activity assessment, anthropometric measurements and blood samples; and the lockdown survey which included dietary assessment and questionnaires about changes in lifestyle and physical activity.

A decreased diet quality during lockdown was observed (Healthy Eating Index reduced from 64.59 to 61.08), which returned to near baseline post-lockdown. Energy intake decreased during lockdown (p = 0.002) and returned to baseline post-lockdown. Despite lower physical activity levels during lockdown (p = 0.035), we observed no significant changes in body composition.

However, we observed a significant increase in serum glucose (p = 0.005), total cholesterol (p = 0.003), and low-density lipoprotein (LDL) (p = 0.049) post-lockdown. Increase in serum glucose levels was pronounced in subjects with higher increase in energy intake (p = 0.039), increased omega-6 fatty acids intake (p = 0.016), those who were exposed to several risky contacts (p = 0.018, compared to those with less risky contacts) and those who were not active in nature (p = 0.008, compared to those active in nature). Increased serum LDL was correlated to decreased monounsaturated fatty acids intake (p = 0.028). Within the limits of this preliminary report, changes in serum markers observed among healthy subjects point to a possible impact of COVID-19-related lockdown on adults’ health to be confirmed in larger groups.

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The impact of the COVID-19 pandemic on the diet, training habits and fitness of Masters cyclists
Keely A Shaw, Nutrition and Health Nutrition and Health March 24, 2021

Background:
The number of Masters-level athletes (≥ 35 years of age) taking part in cycling has increased in the past years which may have beneficial effects on their health. The restrictions brought on by the COVID-19 pandemic has the potential to negatively impact the diet, training and fitness of these individuals due to restrictions in place to slow the spread of the virus.

Aim:
To investigate how the COVID-19 pandemic impacted the diet, training and fitness of Masters-level cyclists.

Methods:
32 Masters cyclists (12 males, 20 females; mean age 47 ± 10 years) completed two incremental exercise tests one month apart during the pandemic to assess sport-specific fitness. Participants also completed online questionnaires to report their sedentary behavior and dietary intake before and during the pandemic, and their training volume and intensity for a specified week in February (before the pandemic) and each of March, April and May (during the pandemic).

Results:
No differences were seen in fitness (p = 0.6), training volume (p = 0.24) or intensity (p = 0.79) and sedentary behavior (p = 0.14) during the pandemic. Energy intake was unchanged (p = 1.0) during the pandemic, but participants consumed lower amounts of key nutrients such as fiber, vitamin A, omega-3 fatty acids and potassium (p < 0.05) while consuming more alcohol (p = 0.008) and vitamin C (p = 0.03).

Conclusions:
Our data shows that the COVID-19 pandemic has undesirable effects on nutrient and alcohol intake of Masters cyclists without impacting their training regimes, which may have adverse effects on their overall health and fitness in the long term.

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Traduction de l'étude

L'impact de la pandémie COVID-19 sur l'alimentation, les habitudes d'entraînement et la forme physique des maîtres cyclistes
Keely A Shaw, Nutrition et santé Nutrition et santé 24 mars 2021

Contexte:
Le nombre d'athlètes de niveau Master (≥ 35 ans) pratiquant le cyclisme a augmenté ces dernières années, ce qui peut avoir des effets bénéfiques sur leur santé. Les restrictions apportées par la pandémie COVID-19 ont le potentiel d'avoir un impact négatif sur le régime alimentaire, l'entraînement et la forme physique de ces personnes en raison des restrictions en place pour ralentir la propagation du virus.

Objectif:
Étudier comment la pandémie de COVID-19 a eu un impact sur l'alimentation, l'entraînement et la forme physique des cyclistes de niveau Master.

Méthodes:
32 Maîtres cyclistes (12 hommes, 20 femmes; âge moyen 47 ± 10 ans) ont effectué deux tests d'exercice supplémentaires à un mois d'intervalle pendant la pandémie pour évaluer la condition physique spécifique au sport. Les participants ont également rempli des questionnaires en ligne pour rapporter leur comportement sédentaire et leur apport alimentaire avant et pendant la pandémie, ainsi que leur volume et intensité d'entraînement pendant une semaine donnée en février (avant la pandémie) et chacun des mois de mars, avril et mai (pendant la pandémie).

Résultats:
Aucune différence n'a été observée dans la forme physique (p = 0,6), le volume d'entraînement (p = 0,24) ou l'intensité (p = 0,79) et le comportement sédentaire (p = 0,14) pendant la pandémie. L'apport énergétique est resté inchangé (p = 1,0) pendant la pandémie, mais les participants ont consommé moins de nutriments clés tels que les fibres, la vitamine A, les acides gras oméga-3 et le potassium (p <0,05) tout en consommant plus d'alcool (p = 0,008) et vitamine C (p = 0,03).

Conclusions:
Nos données montrent que la pandémie COVID-19 a des effets indésirables sur la consommation de nutriments et d'alcool des cyclistes Masters sans impact sur leurs régimes d'entraînement, ce qui peut avoir des effets néfastes sur leur santé et leur forme physique à long terme.

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Micronutrients Deficiency, Supplementation and Novel Coronavirus Infections—A Systematic Review and Meta-Analysis
by Min Xian Wang, Nutrients 2021, 13(5), 1589;

Background: Micronutrients play roles in strengthening and maintaining immune function, but their supplementation and/or deficiency effects on respiratory tract infections are inconclusive. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. Methods: Systematic literature searches conducted in five electronic databases identified 751 unique studies, of which 33 studies (five supplementation studies, one supplementation and deficiency study, and 27 deficiency studies) were eventually included in this review. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted. Data from 19 studies were pooled in meta-analysis using the generic inverse variance method.

Findings: A total of 360,346 patients across 16 countries, with a mean age between 32 and 87.7 years, were involved across 33 studies. All studies were on COVID-19 infections. In individuals without micronutrient deficiency, there was a significant reduction on odds of COVID-19 incidence (pooled OR: 0.37, 95% CI: 0.18, 0.78), and ICU admissions or severe/critical disease onset when combined as a severity outcome (pooled OR: 0.26, 95% CI: 0.08, 0.89). Insignificant protective effects were observed on other outcome measures, namely mortality, ICU admission, progression to respiratory-related complications, severe/critical disease onset or requiring respiratory support and hospitalization rate.

Conclusion: The absence of micronutrient deficiency significantly reduced COVID-19 incidence and clinical deterioration in hospitalized patients. Usage of micronutrients as prophylaxis and complementary supplement in therapeutic management of COVID-19 patients may be a promising and cost-effective approach warranting in-depth investigation.

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Vitamin D: Three studies reported mixed effects of VDD on COVID-19 associated
hospitalisation rates (Table 5), although pooling of two studies indicated no association
(OR: 0.60, 95%: 0.22, 1.65; Figure S9). While hospitalisation rate was not continuously associated with 25(OH)D levels (per increase by 10 nmol/L) [17], inpatients had significantly
lower mean or median 25(OH)D levels, or a higher VDD prevalence compared to outpatients [33,37]. Similarly, mean 25(OH)D levels eight weeks after disease onset were similar
across severity groups, defined by requiring hospitalisation, respiratory support, or intensive care treatment [36].
When clinical severity was defined by clinical guidelines, a non-significant protective
effect on severity with Vitamin D sufficiency was observed (pooled OR, 0.10, 95% CI: 0.01,
1.15; Figure 6). In addition, patients with VDD or insufficiency consistently reported to
have higher proportions [27,30] or likelihood for severe/critical disease onset (adjusted OR
ranging from 1.59 to 14.18) [30,43]. Correspondingly, mild/moderate patients had significantly higher median 25(OH)D levels than severe/critical patients, and a significantly
lower proportion of COVID-19 patients with sufficient Vitamin D levels were symptomatic [43].

Iron/Ferritin: Serum ferritin levels were generally higher in patients with more severe
conditions, compared to those with a relatively milder disease onset. This observation was
consistent across outcome definitions, including clinical guidelines and requiring hospitalisation, ICU admission or requiring oxygen support. However, serum iron levels seem
not to be associated with clinical severity, with reportedly similar iron levels between
groups with varying disease severity [40,44].

Zinc: Mixed effects were observed in the two studies reporting the effects of zinc deficiency on clinical severity. Symptom onset was seemingly not associated with zinc deficiency [42], although a significantly higher proportion of inpatients with no zinc deficiency require ICU admission, oxygen therapy or respiratory support, compared to those with zinc deficiency, defined by <70 µg/dL zinc [26].

Calcium: Non-deficiency was not associated to clinical severity as mean total or ionized calcium levels eight weeks after disease onset were similar across the mild, moderate
and severe groups, defined by requiring hospitalisation, respiratory support, or intensive care treatment [36]

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A total of 10 studies assessed and reported the effects of Vitamin D deficiency (eight
studies) and supplementation (one study), and zinc deficiency (one study) on COVID-19
prevention (Table 3), of which findings from five studies were pooled for meta-analysis
(Figure 2). Collectively, non-deficiency in either vitamin D or zinc has a protective effect
on COVID-19 incidence, decreasing the incidence odds by 63% (pooled OR: 0.37, 95% CI:
0.18–0.78; Figure 2). High heterogeneity was observed regardless of the micronutrient being assessed (subgroup I2 = 84.9%, p = 0.01; Figure 2), indicating that the identity of the
micronutrient being assessed did not significantly affect incidence odds.

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Traduction de l'étude

Carence en micronutriments, supplémentation et nouvelles infections à coronavirus: examen systématique et méta-analyse
par Min Xian Wang, Nutrients 2021, 13 (5), 1589;

Contexte: Les micronutriments jouent un rôle dans le renforcement et le maintien de la fonction immunitaire, mais leurs effets de supplémentation et / ou de carence sur les infections des voies respiratoires ne sont pas concluants. Cette revue vise à évaluer systématiquement les associations entre la supplémentation ou la carence en micronutriments, avec l'incidence des nouveaux coronavirus et la gravité de la maladie. Méthodes: Des recherches documentaires systématiques menées dans cinq bases de données électroniques ont identifié 751 études uniques, dont 33 études (cinq études de supplémentation, une étude de supplémentation et de carence et 27 études de carence) ont finalement été incluses dans cette revue. Les proportions d'incidence et de gravité des résultats dans chaque groupe, ainsi que les statistiques récapitulatives ajustées avec leurs intervalles de confiance (IC) à 95% pertinents ont été extraites. Les données de 19 études ont été regroupées dans une méta-analyse en utilisant la méthode générique de variance inverse.

Résultats: Un total de 360 ​​346 patients dans 16 pays, avec un âge moyen entre 32 et 87,7 ans, ont été impliqués dans 33 études. Toutes les études portaient sur les infections au COVID-19. Chez les personnes sans carence en micronutriments, il y a eu une réduction significative de la probabilité d'incidence du COVID-19 (OR combiné: 0,37, IC à 95%: 0,18, 0,78) et des admissions aux soins intensifs ou d'apparition de la maladie grave / critique lorsqu'ils sont combinés en tant que critère de gravité (combiné OR: 0,26, IC à 95%: 0,08, 0,89). Des effets protecteurs insignifiants ont été observés sur d'autres mesures des résultats, à savoir la mortalité, l'admission aux soins intensifs, la progression vers des complications respiratoires, l'apparition d'une maladie grave / critique ou nécessitant une assistance respiratoire et le taux d'hospitalisation.

Conclusion: L'absence de carence en micronutriments a réduit significativement l'incidence du COVID-19 et la détérioration clinique chez les patients hospitalisés. L'utilisation de micronutriments comme prophylaxie et complément complémentaire dans la prise en charge thérapeutique des patients atteints de COVID-19 peut être une approche prometteuse et rentable justifiant une enquête approfondi

b]Vitamine D:[/b] Trois études ont rapporté des effets mixtes de la VDD sur le COVID-19 associé
taux d'hospitalisation (tableau 5), bien que la mise en commun de deux études n'indique aucune association
(OR: 0,60, 95%: 0,22, 1,65; Figure S9). Alors que le taux d'hospitalisation n'était pas continuellement associé aux taux de 25 (OH) D (par augmentation de 10 nmol / L) [17], les patients hospitalisés avaient
des niveaux moyens ou médians de 25 (OH) D inférieurs ou une prévalence plus élevée de la DMV par rapport aux patients ambulatoires [33,37]. De même, les taux moyens de 25 (OH) D huit semaines après le début de la maladie étaient similaires
dans tous les groupes de gravité, définis par une hospitalisation, une assistance respiratoire ou un traitement de soins intensifs [36].
Lorsque la sévérité clinique a été définie par des lignes directrices cliniques, un
un effet sur la sévérité avec une suffisance en vitamine D a été observé (OR combiné, 0,10, IC à 95%: 0,01,
1,15; Figure 6). De plus, les patients atteints de MVD ou d'insuffisance rapportaient systématiquement
ont des proportions plus élevées [27,30] ou une probabilité d'apparition de la maladie grave / critique (OR ajusté
allant de 1,59 à 14,18) [30,43]. De même, les patients légers / modérés avaient des niveaux médians de 25 (OH) D significativement plus élevés que les patients sévères / critiques, et un
une proportion plus faible de patients COVID-19 avec des niveaux suffisants de vitamine D étaient symptomatiques [43].

Fer / ferritine: les taux sériques de ferritine étaient généralement plus élevés chez les patients
conditions, par rapport à ceux avec un début de la maladie relativement bénin. Cette observation était
cohérente entre les définitions de résultats, y compris les lignes directrices cliniques et nécessitant une hospitalisation, une admission aux soins intensifs ou nécessitant une assistance en oxygène. Cependant, les taux de fer sérique semblent
ne pas être associé à la gravité clinique, avec des taux de fer apparemment similaires entre
groupes avec une gravité variable de la maladie [40,44].

Zinc: Des effets mitigés ont été observés dans les deux études rapportant les effets d'une carence en zinc sur la gravité clinique. L'apparition des symptômes n'était apparemment pas associée à une carence en zinc [42], bien qu'une proportion significativement plus élevée de patients hospitalisés sans carence en zinc nécessitent une hospitalisation, une oxygénothérapie ou une assistance respiratoire, par rapport à ceux présentant une carence en zinc, définie par <70 µg / dL de zinc [ 26].

Calcium: la non-carence n'était pas associée à la gravité clinique, car les taux moyens de calcium total ou ionisé huit semaines après le début de la maladie étaient similaires dans les
et les groupes sévères, définis par une hospitalisation, une assistance respiratoire ou un traitement de soins intensifs [36]

Au total, 10 études ont évalué et rapporté les effets d'une carence en vitamine D (huit
études) et la supplémentation (une étude), et une carence en zinc (une étude) sur COVID-19
prévention (tableau 3), dont les résultats de cinq études ont été regroupés pour la méta-analyse
(Figure 2). Collectivement, l'absence de carence en vitamine D ou en zinc a un effet protecteur
sur l'incidence du COVID-19, diminuant les probabilités d'incidence de 63% (OR combiné: 0,37, IC à 95%:
0,18-0,78; Figure 2). Une forte hétérogénéité a été observée quel que soit le micronutriment évalué (sous-groupe I2 = 84,9%, p = 0,01; figure 2), indiquant que l'identité du
les micronutriments évalués n'ont pas eu d'incidence significative sur les cotes d'incidence.

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The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review
Philip T James, The Journal of Nutrition, 12 May 2021

Background
Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival.

Objective
The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19.

Methods
We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020.

Results
Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials.

Conclusions
Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes

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Traduction de l'étude

Le rôle de la nutrition dans la sensibilité au COVID-19 et la gravité de la maladie: un examen systématique
Philip T James, The Journal of Nutrition, 12 mai 2021

Arrière-plan
De nombreux nutriments ont de puissantes actions immunomodulatrices susceptibles de modifier la sensibilité à l'infection à la maladie à coronavirus 2019 (COVID-19), la progression vers les symptômes, la probabilité d'une maladie grave et la survie.

Objectif
L'objectif était de passer en revue les dernières données sur la manière dont la malnutrition sous toutes ses formes (sous-alimentation et suralimentation et statut en micronutriments) peut influencer à la fois la sensibilité et la progression du COVID-19.

Méthodes
Nous avons synthétisé des informations sur 13 composants liés à la nutrition et leurs interactions potentielles avec le COVID-19: surpoids, obésité et diabète; la malnutrition protéino-énergétique; anémie; les vitamines A, C, D et E; AGPI; le fer; sélénium; zinc; les antioxydants; et un soutien nutritionnel. Pour chaque section, nous fournissons: 1) un examen du paysage du matériel pertinent; 2) une recherche systématique de la littérature dans les bases de données PubMed et EMBASE, y compris un large éventail de serveurs de pré-impression; et 3) un écran de 6 registres d'essais cliniques. Toutes les recherches originales ont été prises en compte, sans restriction de la conception de l'étude, et incluses si elles couvraient: 1) le coronavirus du syndrome respiratoire aigu sévère (CoV) 2 (SRAS-CoV-2), le syndrome respiratoire du Moyen-Orient CoV (MERS-CoV) ou le SRAS -Virus CoV et 2) sensibilité à la maladie ou 3) progression de la maladie, et 4) composante nutritionnelle d'intérêt. Les recherches ont eu lieu entre le 16 mai et le 11 août 2020.

Résultats
Parmi les 13 recherches, 2732 articles de PubMed et EMBASE, 4164 articles des serveurs de pré-impression et 433 essais ont été renvoyés. Dans la synthèse narrative finale, nous incluons 22 articles publiés, 38 articles préimprimés et 79 essais.

Conclusions
À l'heure actuelle, il existe des preuves limitées que des suppléments à forte dose de micronutriments empêcheront une maladie grave ou accéléreront la guérison. Cependant, les résultats des essais cliniques sont attendus avec impatience. Compte tenu des impacts connus de toutes les formes de malnutrition sur le système immunitaire, les stratégies de santé publique visant à réduire les carences en micronutriments et la dénutrition restent d'une importance cruciale. En outre, il existe des preuves solides que la prévention de l'obésité et du diabète de type 2 réduira le risque de conséquences graves du COVID-19

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Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS
by Quirin Notz, Nutrients 2021, 13(6), 2113;

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge.

On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = −0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075).

Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.

[Nutrimuscle-Conseils]

The Efficacy of Antioxidant Oral Supplements on the Progression of COVID-19 in Non-Critically Ill Patients: A Randomized Controlled Trial
by Mahmoud M. A. Abulmeaty Antioxidants 2021, 10(5), 804;

Modulation of cytokine production using immunonutrition is a relatively novel concept to improve outcomes among patients with SARS-CoV-2 infection and is now hypothesized to help manage COVID-19, however, clinical evidence is lacking. This prospective, double-blinded, randomized parallel-controlled interventional clinical trial investigated the effect of antioxidant supplements on inflammatory cytokines and disease progression in non-critically ill patients.

A total of 87 hospitalized COVID-19 patients were randomized using computer-generated-randomization into the supplement group (n = 18) and the placebo group (n = 16) for 10 days. Baseline and final nutritional screening via nutrition risk screening (NRS-2002) and subjective global assessment (SGA), as well as the recording of anthropometric, clinical, biochemical, and functional parameters, were done. Serum ferritin level, cytokine storm parameters such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein 1(MCP-1), C-reactive protein, total leukocyte count, lymphocytic count, and neutrophil-to-lymphocyte ratio were measured. Anthropometric and clinical parameters showed nonsignificant differences between groups. The hematology profile showed improvement in lymphocyte count in the supplement group. However, levels of alkaline phosphatase, IL-6, TNF-α, and MCP-1 were significantly lower in the supplement group.

In conclusion, antioxidant oral supplementation significantly reduced the cytokine storm and led to partial improvements in clinical parameters among patients with non-critical COVID-19.


one capsule of a commercially available oral dietary supplement enriched with vitamins A, E, C, Zinc, and selenium (21st Century Antioxidant, Arizona, AZ, USA) or a cellulose-containing placebo capsule for 10 days.

[Nutrimuscle-Diététique]

Traduction de l'étude

L'efficacité des suppléments oraux antioxydants sur la progression du COVID-19 chez les patients non gravement malades : un essai contrôlé randomisé
par Mahmoud M.A. Abulmeaty Antioxydants 2021, 10(5), 804;

La modulation de la production de cytokines à l'aide de l'immunonutrition est un concept relativement nouveau pour améliorer les résultats chez les patients infectés par le SRAS-CoV-2 et est maintenant supposée aider à gérer le COVID-19, cependant, les preuves cliniques font défaut. Cet essai clinique interventionnel prospectif, en double aveugle, randomisé et contrôlé en parallèle a étudié l'effet des suppléments antioxydants sur les cytokines inflammatoires et la progression de la maladie chez des patients non gravement malades.

Un total de 87 patients COVID-19 hospitalisés ont été randomisés à l'aide d'une randomisation générée par ordinateur dans le groupe supplément (n = 18) et le groupe placebo (n = 16) pendant 10 jours. Un dépistage nutritionnel de base et final via un dépistage des risques nutritionnels (NRS-2002) et une évaluation globale subjective (SGA), ainsi que l'enregistrement des paramètres anthropométriques, cliniques, biochimiques et fonctionnels, ont été effectués. Taux de ferritine sérique, paramètres de tempête de cytokines tels que l'interleukine-6 ​​(IL-6), le facteur de nécrose tumorale-α (TNF-α), la protéine chimiotactique des monocytes 1 (MCP-1), la protéine C-réactive, le nombre total de leucocytes, le nombre de lymphocytes , et le rapport neutrophiles/lymphocytes ont été mesurés. Les paramètres anthropométriques et cliniques ont montré des différences non significatives entre les groupes. Le profil hématologique a montré une amélioration du nombre de lymphocytes dans le groupe supplément. Cependant, les niveaux de phosphatase alcaline, d'IL-6, de TNF-α et de MCP-1 étaient significativement plus faibles dans le groupe supplément.

En conclusion, la supplémentation orale en antioxydants a considérablement réduit la tempête de cytokines et a conduit à des améliorations partielles des paramètres cliniques chez les patients atteints de COVID-19 non critique.


une capsule d'un complément alimentaire oral disponible dans le commerce enrichi en vitamines A, E, C, zinc et sélénium (21st Century Antioxidant, Arizona, AZ, USA) ou une capsule placebo contenant de la cellulose pendant 10 jours.

[Nutrimuscle-Conseils]

Diet quality and risk and severity of COVID-19: a prospective cohort study
Jordi Merino, medRXiv June 25, 2021.

Objective Poor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation.

Design We used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively.

Results Over 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively.

Conclusions A dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.