Nutritional therapy in patients with COVID-19: some considerations and scientific evidence
DOI:
https://doi.org/10.33448/rsd-v10i3.13400Keywords:
COVID-19; Nutrition; Imunonutrition; Nutritional biomarkers.Abstract
The present study aimed to review the literature on nutritional therapy in patients with COVID-19, highlighting some nutrients with functional potential that can benefit patients in responding to infection and recovery from the disease. It is a simple narrative review, developed from a bibliographic survey, reading of original articles and other reviews on the theme. The articles were retrieved from the PubMed, Scielo and Web of Science databases. The main elevated findings are that malnutrition is a frequent feature in patients infected with SARS-CoV-2, associated with increased morbidity and mortality. Scientific evidence confirms nutritional therapy as a determinant in the prognosis of patients with COVID-19, with recommendations for hyperprotein supply and adequate content of nutrients with functional potential, such as those considered immunomodulatory and anti-inflammatory. It is concluded that a nutritional therapy with an increased supply of protein and rich in immunonutrients, can improve the clinical prognosis of patients with COVID-19.
References
Alwarawrah, Y., Kiernan, K., & MacIver, N. J. (2018). Changes in Nutritional Status Impact Immune Cell Metabolism and Function. Frontiers in immunology, 9, 1055. doi:org/10.3389/fimmu.2018.01055
Beck, M. A., Handy, J., & Levander, O. A. (2004). Host nutritional status: the neglected virulence factor. Trends in Microbiology, 12 (9), 417–423. doi:10.1016/j.tim.2004.07.007
Berggren, A., Lazou Ahrén, I., Larsson, N., & Önning, G. (2011). Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. European Journal of Nutrition, 50 (3), 203–210. doi:org/10.1016/j.tim.2004.07.007
Biasebetti, M. D. B. C., Rodrigues, I. D., & Mazur, C. E. (2018). Relação do consumo de vitaminas e minerais com o sistema imunitário: uma breve revisão. Visão Acadêmica, 19 (1), 130-136. doi:10.5380/ACD.V19I1.57737
Caccialanza, R., Laviano, A., Lobascio, F., Montagna, E., Bruno, R., Ludovisi, S., Corsico, A. G., Di Sabatino, A., Belliato, M., Calvi, M., Iacona, I., Grugnetti, G., Bonadeo, E., Muzzi, A., & Cereda, E. (2020). Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition, 74, 110835. doi.org/10.1016/j.nut.2020.110835
Calder, P. (2010). Rationale and use of n-3 fatty acids in artificial nutrition. Proceedings of the Nutrition Society, 69 (4), 565-573. doi:10.1017/S0029665110000157
Calder, P. C., Carr, A. C., Gombart, A. F., & Eggersdorfer, M. (2020). Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients, 12 (4), 1181. doi:10.3390/nu12041181
Clerkin, K. J., Fried, J. A., Raikhelkar, J., Sayer, G., Griffin, J. M., Masoumi, A., Jain, S. S., Burkhoff, D., Kumaraiah, D., Rabbani, L., Schwartz, A., & Uriel, N. (2020). COVID-19 and Cardiovascular Disease. Circulation, 141 (20), 1648–1655. doi:org/10.1161/CIRCULATIONAHA.120.046941
Costa, F. F et al. (2020). Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14 (5), 809-814. doi:10.1016/j.dsx.2020.06.016
De Lucena, T., Silva Santos, A. F., Lima, B. R., de Albuquerque Borborema, M. E., & de Azevêdo Silva, J. (2020). Mechanism of inflammatory response in associated comorbidities in COVID-19. Diabetes & Metabolic Syndrome, 14 (4), 597–600. doi:org/10.1016/j.dsx.2020.05.025
Dellalibera-Joviliano, R., Alves, N. P., Dellalibera, E., & Fujita, A. T. (2020). Perfil celular imunológico e o papel na resposta inflamatória frente ao SARS-CoV-2. Revista Interdisciplinar de Saúde e Educação, 1 (2), 192-207.
Dias, V.M.C.H., Carneiro, M., Vidal, C.F.L., Corradi, M.F.D.B., Brandão, D., Cunha, C.A., Chebabo, A., Oliveira, P.R.D.O., Michelin, L., Rocha, J.L.L., Waib, L.F., Carrilho, C.M., Lobo, S.M.A., Oliveira, M.C.O., Nunes, R.R., Diego,. L.A.S., Santos, A.S., Muglia, V., Jr Souza, A.S., Escuissato, D., Neto, C.A., Chatkin, J.M., Martins, R., Maurici, R., Costa, S.F., Alves, J.S., Nascimento, M.M., Moura-Neto, J. (2020). Orientações sobre diagnóstico, tratamento e isolamento de pacientes com COVID-19. J. Infect. Control, 9 (2), 56-75. https://jic-abih.com.br/index.php/jic/article/view/295
Dumas, A., Bernard, L., Poquet, Y., Lugo-Villarino, G., & Neyrolles, O. (2018). The role of the lung microbiota and the gut-lung axis in respiratory infectious diseases. Cellular Microbiology, 20 (12), 12966. doi:org/10.1111/cmi.12966
El Beitune, P., Duarte, G., Nunes de Morais, E., Quintana, S. M., & Vannucchi, H. (2003). Deficiência da vitamina a e associações clínicas: revisão. Archivos Latinoamericanos de Nutricion, 53 (4), 355-363. Recuperado en 28 de septiembre de 2020, de http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0004 06222003000400004&lng=es&tlng=pt
Elmadfa, I., & Meyer, A. L. (2019). The Role of the Status of Selected Micronutrients in Shaping the Immune Function. Endocrine, Metabolic & Immune Disorders Drug Targets, 19 (8), 1100–1115. doi:org/10.2174/1871530319666190529101816
Farhadi, S., & Ovchinnikov, R.S. (2018). The relationship between nutrition and infectious diseases: A review. Biomedical and Biotechnology Research Journal, 2, 168 - 172. doi:org/10.4103/bbrj.bbrj_69_18
Feiber, L. T. (2015). Associação entre parâmetros nutricionais e inflamatórios e o tempo em ventilação mecânica de pacientes pediátricos graves com insuficiência respiratória (Dissertação de mestrado). Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brasil.
Francisco, P. M. S. B., Donalisio, M.R., Barros, M.B.A., César, C.L.G., Carandina, L., & Goldbaum, M. (2006). Fatores associados à vacinação contra a influenza em idosos. Rev Panam Salud Publica. 19 (4), 259–64. URI: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000400006
Girão, M. M. F., Paiva Coelho, N., Barroso, B. S., & Gadelha, M. D. S. V. (2020). Perfil Epidemiológico dos Pacientes de SARS-COV-2 no Brasil. Revista de Psicologia, 14 (51), 646-658.
Guan W-Jie., Ni, Z-yi., Hu Y, Liang W-hua., Ou, J. He, L. Liu, H. Shan, C. Lei, D.S.C. Hui, Guo, T., Fan, Y., Chen, M., Wu, X., Zhang, L., He, T., Wang, H., Wan, J., Wang, X., & Lu, Z. (2020). Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5 (7), 811–818. doi:org/10.1001/jamacardio.2020.1017
Gutiérrez, S., Svahn, S. L., & Johansson, M. E. (2019). Effects of Omega-3 Fatty Acids on Immune Cells. International Journal of Molecular Sciences, 20 (20), 5028. doi:org/10.3390/ijms20205028
Handu, D., Moloney, L., Rozga, M., & Cheng, F. (2020). Malnutrition Care during the COVID-19 Pandemic: Considerations for Registered Dietitian Nutritionists Evidence Analysis Center. Journal of the Academy of Nutrition and Dietetics. doi:10.1016/j.jand.2020.05.012
Hoeger, J., Simon, T. P., Beeker, T., Marx, G., Haase, H., & Schuerholz, T. (2017). Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - A pilot study. PloS one. 12 (5), e0176069. doi:org/10.1371/journal.pone.0176069
Hojsak, I et al. (2010). Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double-blind, placebo-controlled trial. Clinical Nutrition, 29 (3), 312–316. doi:org/10.1016/j.clnu.2009.09.008
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., Xiao, Y., & Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395 (10223), 497–506. doi:org/10.1016/S0140-6736(20)30183-5
Jason, J., Archibald, L. K., Nwanyanwu, O. C., Sowell, A. L., Buchanan, I., Larned, J., Bell, M., Kazembe, P. N., Dobbie, H., & Jarvis, W. R. (2002). Vitamin A levels and immunity in humans. Clinical and diagnostic laboratory immunology, 9 (3), 616–621. doi:org/10.1128/cdli.9.3.616-621.2002
Jin, Y. H., Cai, L., Cheng, Z. S., Cheng, H., Deng, T., Fan, Y. P., Fang, C., Huang, D., Huang, L. Q., Huang, Q., Han, Y., Hu, B., Hu, F., Li, B. H., Li, Y. R., Liang, K., Lin, L. K., Luo, L. S., Ma, J., & Ma, L. L., for the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team, Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM) (2020). A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research, 7 (1), 4. doi:org/10.1186/s40779-020-0233-6
Jordão, K. S. D. L. U., Assumpção, D. D., Barros, M. B. D. A., & Barros Filho, A. D. A. (2021). Consumo de vitamina E e fontes alimentares na dieta de adolescentes: um estudo transversal de base populacional. Revista Paulista de Pediatria, 39.
Kassir R. (2020). Risk of COVID-19 for patients with obesity. Obesity Reviews, 21 (6), 13034. doi:org/10.1111/obr.13034
Kaushik, N., Subramani, C., Anang, S., Muthumohan, R., Shalimar, Nayak, B., Ranjith-Kumar, C. T., & Surjit, M. (2017). Zinc Salts Block Hepatitis E Virus Replication by Inhibiting the Activity of Viral RNA-Dependent RNA Polymerase. Journal of Virology, 91 (21), 754-17. doi:org/10.1128/JVI.00754-17
Khoo, A. L., Chai, L., Koenen, H., Joosten, I., Netea, M., & van der Ven, A. (2012). Translating the role of vitamin D3 in infectious diseases. Critical Reviews in Microbiology, 38 (2), 122–135. doi:org/10.3109/1040841X.2011.622716
Koivisto, O., Hanel, A., & Carlberg, C. (2020). Key Vitamin D Target Genes with Functions in the Immune System. Nutrients, 12 (4), 1140. doi:org/10.3390/nu12041140
Lang, P. O., Samaras, N., Samaras, D., & Aspinall, R. (2013). How important is vitamin D in preventing infections?. Osteoporosis international, 24 (5), 1537–1553. doi:org/10.1007/s00198-012-2204-6
Lima, W. L., Batista, M. C. C., Silvino, V. O., de Moura, R. C., Mendes, I. L., de Moura, M. S. B. ... da Silva Barbosa, A. K. (2020). Importância nutricional das vitaminas e minerais na infecção da COVID-19. Research, Society and Development, 9 (8), e804986103-e804986103. doi:10.33448/rsd-v9i8.6103
Lippi, G., Lavie, C. J., & Sanchis-Gomar, F. (2020). Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Progress in Cardiovascular Diseases, 63 (3), 390–391. doi:org/10.1016/j.pcad.2020.03.001
Mahan, L. K.; Escott-Stump, S.; Raymond, J.L. (2013). Krause: Alimentos, Nutrição E Dietoterapia. 13ª Ed. Rio De Janeiro: Elsevier.
Martindale, R et al. (2020). Nutrition Therapy in Critically Ill Patients With Coronavirus Disease 2019. Journal of Parenteral and Enteral Nutrition, 44 (7), 1174-1184. doi:org/10.1002/jpen.1930
Poveda, V. D. B., Castilho, A. C. B. A., Nogueira, L. D. S., Ferretti-Rebustini, R. E. L., & Silva, R. D. C. G. (2018). Aferição do volume residual gástrico: retrato da prática clínica de enfermeiros. Revista da Escola de Enfermagem da USP, 52. doi:org/10.1590/s1980-220x2017038803352
Ryan, P. M. D., & Caplice, N. M (2020). Is Adipose Tissue A Reservoir For Viral Spread, Imunne Activation And Cytokine Amplification In Covid-19. Obesity Reviews. 1 (1), 1-15. doi:10.1002/oby.22843
Schaible, U. E., & Kaufmann, S. H. (2007). Malnutrition and infection: complex mechanisms and global impacts. PLoS Medicine, 4 (5), e115. doi:10.1371/journal.pmed.0040115
Scheen, A. J. (2020). Obésité Et Risque De COVID-19 Sévère. Revue Médicale Suisse. 16 (695), 1115-1119. https://www.revmed.ch/RMS/2020/RMS-N-695/Obesite-et-risque-de-COVID1severe#:~:text=Il%20appara%C3%AEt%20de%20plus%20en,intubation%20et%20une%20ventilation%20assist%C3%A9e.
Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., Huang, H., Yang, B., & Huang, C. (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA cardiology, 5 (7), 802–810. doi:org/10.1001/jamacardio.2020.0950
Shittu, M. O., & Afolami, O. I. (2020). Improving the efficacy of Chloroquine and Hydroxychloroquine against SARS-CoV-2 may require Zinc additives - A better synergy for future COVID-19 clinical trials. Le Infezioni in Medicina, 28 (2), 192–197.
Skalny, A. V., Rink, L., Ajsuvakova, O. P., Aschner, M., Gritsenko, V. A., Alekseenko, S. I., Svistunov, A. A., Petrakis, D., Spandidos, D. A., Aaseth, J., Tsatsakis, A., & Tinkov, A. A. (2020). Zinc and respiratory tract infections: Perspectives for COVID 19 (Review). International journal of molecular medicine, 46 (1), 17–26. doi:org/10.3892/ijmm.2020.4575
Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE). Associação Brasileira de Nutrologia (2011). Terapia Nutricional no paciente com Doença Pulmonar Obstrutiva Crônica. Projeto Diretrizes. São Paulo.
Szklo, S.A. (2020). Associação entre Fumar e Progressão para Complicações Respiratórias Graves em Pacientes com COVID-19. Revista Brasileira de Cancerologia, 66 (2), e-03974. doi:org/10.32635/2176-9745.RBC.2020v66n2.974
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., Zhao, Y., Li, Y., Wang, X., & Peng, Z. (2020a). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 323 (11), 1061–1069. doi:org/10.1001/jama.2020.1585
Wang, Y., Chen, Y., & Qin, Q. (2020b). Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. Journal of Medical Virology, 92 (6), 568–576. doi:org/10.1002/jmv.25748
Zhang, L. & Liu, Y. (2020). Potential interventions for novel coronavirus in China: A systematic review. Journal of Medical Virology, 92 (5), 479–490. doi:org/10.1002/jmv.25707
Zheng, Y. Y., Ma, Y. T., Zhang, J. Y., & Xie, X. (2020). COVID-19 and the cardiovascular system. Nature Reviews Cardiology, 17 (5), 259–260. doi:org/10.1038/s41569-020-0360-5
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395 (10229), 1054–1062. doi:org/10.1016/S0140-6736(20)30566-3
Zuo, T., Zhang, F., Lui, G., Yeoh, Y. K., Li, A., Zhan, H., Wan, Y., Chung, A. C. K., Cheung, C. P., Chen, N., Lai, C. K. C., Chen, Z., Tso, E. Y. K., Fung, K. S. C., Chan, V., Ling, L., Joynt, G., Hui, D., Chan, F., Chan, P., & Ng, S. C. (2020). Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology, 159 (3), 944–955. doi:10.1053/j.gastro.2020.05.048
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Beatriz Souza Santos; Camila Santos Marreiros; Fernanda Kassiely de Sousa Veloso; Jardel Alves da Costa; Karine Rodrigues Ferreira; Lídia Ribeiro de Carvalho; Renata Rodrigues Costa Fontinele; Stefany Dourado da Silva; Gilmara Péres Rodrigues
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.