The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review

Abstract

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. This review is registered at PROSPERO as CRD42020186194.

COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship

“…According to a recent systematic review on the role of nutrition in COVID-19 susceptibility and severity of disease, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. 139 …”

Malnutrition risk as a negative prognostic factor in COVID-19 patients

“…The aim of the literature review was to verify if there were any previous studies that had already examined the association between an alteration of the nutritional state and the severity of the disease. The analysed articles [1,18e23] identify malnutrition as a possible risk factor for COVID-19, but, due to the lack of clinical trials and the lack of homogenous large populations to be sampled, this association needs further research [22,23].…”

The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

“…Old age, male sex, comorbidities, being overweight, obesity and malnutrition are some of the known risk factors for severe COVID-19 cases [3]. Moreover, COVID-19 infection lasting several days or even weeks prior to ICU admission enhances patient malnutrition, which in turn leads to increased pathogenicity of the infecting agent and disease progression [4,5]. Furthermore, published studies show a risk of malnutrition in COVID-19 patients.…”