Nutrition amid the COVID-19 pandemic: a multi-level framework for action
Nutrition amid the COVID-19 pandemic: a multi-level framework for action
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DOI：
10.1038/s41430-020-0634-3
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发表时间：
2020-04-20
影响因子：
4.7
通讯作者：
Hamadeh, Rena
中科院分区：
文献类型：
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作者：
Naja, Farah;Hamadeh, Rena
COVID-19是一种由新型冠状病毒引起的疾病，已成为全球人类的主要威胁，并已演变为大流行病。冠状病毒是主要针对人类呼吸系统的主要病原体之一。2019年12月下旬，一群患者入院，初步诊断为不明病因的肺炎[1]。早期的报告预测可能会爆发一种名为SARS-CoV-2的冠状病毒疫情，导致COVID-19疾病。世界卫生组织（WHO）已宣布该流行病为全球公共卫生紧急事件[2]。以往暴发的经验表明，随着流行病的演变，迫切需要将公共卫生活动扩大到直接临床管理之外，并扩大到包括管理和优化资源利用的基本原则[3]。自COVID-19爆发以来，个人和社区的复原力成为主要资源，同时仍然是应急准备的第一道防线。事实上，个人和社区的心理和行为应对措施是提高应对能力和提高公共卫生方法维斯类似COVID-19的大流行病的有效性的重要决定因素[4]。个人的营养状况长期以来一直被认为是对不稳定的恢复力的指标[5]。逆境和复原力的生态学表明，营养不足等重大压力因素可能导致与健康相关的长期影响[6]。事实上，不良的饮食质量不仅与身体健康有关，还与心理健康有关[7]。最佳营养和饮食摄入是超越个人、社区影响全球的资源[8]。为了增强个人维斯COVID-19大流行中的身心健康，本评论提出了一个行动框架，以保持个人、社区、社区和社区的最佳营养，国家和全球层面使用的健康行为的生态模型的改编版本（图1）。在个人层面上，推动大多数营养和饮食建议以对抗病毒感染（包括COVID-19）的共同点在于饮食和免疫力之间的联系。事实上，现有的证据表明，饮食对人们的免疫系统和疾病易感性有着深远的影响。已经证明，特定的营养素或营养素组合可能会通过激活细胞、改变信号分子的产生和基因表达来影响免疫系统[9]。此外，膳食成分是肠道微生物组成的重要决定因素，因此可以塑造体内免疫反应的特征[10]。能量、蛋白质和特定微量营养素的营养缺乏与免疫功能低下和感染易感性增加有关。摄入足够的铁，锌和维生素A，E，B6和B12对维持免疫功能至关重要[11]。因此，维持有效免疫系统的关键是避免营养素的缺乏，这些营养素在免疫细胞的触发、相互作用、分化或功能表达中起着至关重要的作用。
COVID-19, a disease caused by a novel coronavirus, became a major global human threat that has turned into a pandemic. Coronavirus is one of the major pathogens that mainly targets the human respiratory system. In late December 2019, a cluster of patients were admitted to hospitals with an initial diagnosis of pneumonia of an unknown etiology [1]. Early reports predicted the onset of a possible coronavirus outbreak called SARS-CoV-2, causing the disease COVID-19. The ongoing epidemic has been declared by the World Health Organization (WHO) as a global public health emergency [2]. Experiences from previous outbreaks have shown that as an epidemic evolves, there is an urgent need to expand public health activities beyond direct clinical management and extend to cover basic principles of management and optimization of resource utilization [3]. Since the outbreak of the COVID-19, individual and community resilience emerged as a main resource while remaining the first line of defense in emergency preparedness. In fact, psychological and behavioral countermeasures of both the individual and the community are vital determinants to improve resilience and enhance the efficacy of public health approaches vis a vis a pandemic of a magnitude similar to that of COVID-19 [4]. The nutritional status of individuals has for long been considered as an indicator of resilience against destabilization [5]. The ecology of adversity and resilience demonstrates that substantial stressors, such as inadequate nutrition, can lead to long-lasting effects that are linked to health [6]. In fact, poor diet quality has been associated not only with physical but also mental health [7]. Optimal nutrition and dietary intake is a resource that transcends the individual, the community to reach global influence [8].In order to enhance the physical and mental health of individuals vis a vis the COVID-19 pandemic, this commentary presents a framework for action to maintain optimal nutrition at the individual, community, national and global levels using an adapted version of the ecological model of health behavior (Fig. 1). At the individual level, the common denominator that drives most of the nutrition and dietary recommendations to combat viral infections, including COVID-19, lies within the link between diet and immunity. In fact, existing evidence highlights that diet has a profound effect on people’s immune system and disease susceptibility. It has been demonstrated that specific nutrients or nutrient combinations may affect the immune system through the activation of cells, modification in the production of signaling molecules, and gene expression [9]. Furthermore, dietary ingredients are significant determinants of gut microbial composition and consequently can shape the characteristics of immune responses in the body [10]. Nutritional deficiencies of energy, protein, and specific micronutrients are associated with depressed immune function and increased susceptibility to infection. An adequate intake of iron, zinc, and vitamins A, E, B6, and B12 is predominantly vital for the maintenance of immune function [11]. Therefore, the key to maintaining an effective immune system is to avoid deficiencies of the nutrients that play an essential role in immune cell triggering, interaction, differentiation, or functional expression.