Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review
Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review
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DOI：
10.1101/2020.10.19.20214395
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
P. James;Zaka Ali;A. Armitage;A. Bonell;C. Cerami;H. Drakesmith;M. Jobe;K. Jones;Zara Liew
中科院分区：
文献类型：
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作者：
P. James;Zaka Ali;A. Armitage;A. Bonell;C. Cerami;H. Drakesmith;M. Jobe;K. Jones;Zara Liew
背景资料：许多营养素具有强大的免疫调节作用，有可能改变对COVID-19感染的易感性、症状进展、严重疾病的可能性和生存率。这场大流行催生了许多与营养有关的理论，有时这些理论得到了对证据的偏见解释的支持。目的：对各种形式的营养不良（营养不足和营养过剩以及微量营养素状况）如何影响COVID-19易感性、进展和严重程度的最新证据进行系统性综述。研究方法：我们综合了13种营养相关成分及其与COVID-19潜在相互作用的信息：超重、肥胖和糖尿病;蛋白质-能量营养不良;贫血;维生素A、C、D和E;多不饱和脂肪酸;铁;硒;锌;抗氧化剂和营养支持。对于每个部分，我们提供：a）相关材料的横向审查; B）PubMed和EMBASE数据库中文献的系统性检索，包括广泛的预印本服务器的系统性检索;以及c）6个临床试验登记研究的筛选。每个章节分配两名审查员进行数据提取。所有原始研究均被考虑，不受研究设计的限制，如果其涵盖：1）SARS-CoV-2，MERS-CoV或SARS-CoV病毒和2）疾病易感性或3）疾病进展，以及4）感兴趣的营养成分，则包括在内。会议于2020年5月16日至8月11日举行。PROSPERO注册CRD 42020186194。结果如下：在13次检索中，共返回了来自PubMed和EMBASE的2732篇文章、来自预印本服务器的4164篇文章和433项试验。共对288篇已发表文章和278篇预印本文章进行了全文筛选。在最后的叙述性综合中，我们涵盖了22篇已发表的文章，39篇预印本文章和79项试验。该综述强调了一系列机制和观察证据，以强调营养在COVID-19易感性和进展中的作用。然而，迄今为止，只有有限的证据表明，高剂量的微量营养素补充剂可以预防严重疾病或加速康复，尽管临床试验的结果正在等待。结论：到目前为止，没有确凿的证据支持采用新的营养疗法。然而，鉴于已知各种形式的营养不良对免疫系统的影响，减少微量营养素缺乏和营养不良的公共卫生战略仍然至关重要。有强有力的证据表明，预防肥胖及其导致的2型糖尿病将降低COVID-19严重后果的风险。
Background: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to COVID-19 infection, progression to symptoms, likelihood of severe disease and survival. The pandemic has fostered many nutrition-related theories, sometimes backed by a biased interpretation of evidence. Objectives: To provide a systematic review of the latest evidence on how malnutrition across all its forms (under- and over-nutrition and micronutrient status) may influence both susceptibility to, and progression and severity of, COVID-19. Methods: We synthesised information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity and diabetes; protein-energy malnutrition; anaemia; vitamins A, C, D, and E; poly-unsaturated fatty acids; iron; selenium; zinc; anti-oxidants, and nutritional support. For each section we provide: a) a landscape review of pertinent material; b) a systematic search of the literature in PubMed and EMBASE databases, including a systematic search of a wide range of pre-print servers; and c) a screen of six clinical trial registries. Two reviewers were assigned per section for data extraction. All original research was considered, without restriction to study design, and included if it covered: 1) SARS-CoV-2, 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 16th May and 11th August, 2020. PROSPERO registration CRD42020186194. Results: Across the 13 searches, a total of 2732 articles from PubMed and EMBASE, 4164 articles from the pre-print servers, and 433 trials were returned. A total of 288 published articles and 278 pre-print articles were taken to full text screening. In the final narrative synthesis, we cover 22 published articles, 39 pre-print articles and 79 trials. The review highlights a range of mechanistic and observational evidence to highlight the role nutrition can play in susceptibility and progression of COVID-19. However, to date, there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery, although results of clinical trials are eagerly awaited. Conclusions: To date there is no conclusive evidence supporting adoption of novel nutritional therapies. However, 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. There is strong evidence that prevention of obesity, and its consequent type-2 diabetes, will reduce the risk of serious COVID-19 outcomes.