Case–control study of serum vitamin D concentrations in hospitalised patients with COVID-19 and hospitalised controls suffering with respiratory tract infections of differing aetiology

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had lower serum vitamin D compared with patients with ARTIs of other aetiology. A case–control study was performed with cases of COVID-19 and controls of non-COVID-19 ARTIs. Patients were enrolled from a single general medical ward in a secondary care hospital between 15 April 2020 and 15 May 2020. Exclusion criteria were an oxygen requirement of >8 L/min. Data collected included serum 25-hydroxyvitamin D concentration, venous plasma glucose concentration and heamoglobin A1c. Outcomes measured were length of hospital stay, deaths, the need for high dependency and intensive care unit involvement. A total of 60 patients of five ethnic groups were enrolled, 85% (n=46) were of White-British ethnicity. The data analysis is based on these 46 patients of which 24 were non-COVID-19 patients with ARTI and 22 were patients with COVID-19. Overall, 80% of the study population had a serum vitamin D concentration below 50 nmol/L with median concentrations of 30 nmol/L and 35 nmol/L for patients with COVID-19 and non-COVID-19 ARTIs respectively. A Mann-Whitney sign-ranked test with respect to serum vitamin D concentration found no statistically significant difference between cases and controls, p=0.09. There was no significant difference in the length of stay, body mass index and rates of various comorbidities such as diabetes mellitus (DM), hypertension and lung disease in both study groups. However, DM was found to be associated with lower serum vitamin D concentrations. The results of this study support published literature showing an association between low serum vitamin D and ARTIs including COVID-19. However, this study did not identify patients with COVID-19 to have a statistically significant lower serum vitamin D concentration than non-COVID-19 patients with ARTI.

The impact of climate change on food systems, diet quality, nutrition, and health outcomes: A narrative review

Many consequences of climate change undermine the stability of global food systems, decreasing food security and diet quality, and exposing vulnerable populations to multiple forms of malnutrition. The emergence of pandemics such as Covid-19 exacerbate the situation and make interactions even more complex. Climate change impacts food systems at different levels, including changes in soil fertility and crop yield, composition, and bioavailability of nutrients in foods, pest resistance, and risk of malnutrition. Sustainable and resilient food systems, coupled with climate-smart agriculture, are needed to ensure sustainable diets that are adequately diverse, nutritious, and better aligned with contextual ecosystem functions and environmental conservation. Robust tools and indicators are urgently needed to measure the reciprocal food systems-climate change interaction, that is further complicated by pandemics, and how it impacts human health. Copyright © 2022 Owino, Kumwenda, Ekesa, Parker, Ewoldt, Roos, Lee and Tome.

There should always be a free lunch: the impact of COVID-19 lockdown suspension of the mid-day meal on nutriture of primary school children in Karnataka, India.

Background: The COVID-19 pandemic lockdown in 2020 resulted in school closures with eventual suspension of the mid-day meal programme, biannual deworming and iron-folic acid supplements. One year into the lockdown, we evaluated the impact of the withdrawal of these programmes on the nutritional status of rural primary-school children, aged 6-12 years, in Karnataka, India. Methods: Anthropometry, haemoglobin, serum ferritin and C reactive protein were measured in 290 children at two time points, 1 year apart, starting from just before the lockdown (February 2020 to February 2021). Results: The prevalence of anaemia doubled from 21% to 40% (p<0.0001) with more pronounced changes in older girls (10%-53%); however, the prevalence of iron deficiency did not change (48.8%-51.9%), despite cessation of deworming and iron/folic acid supplements. Conclusion: The increase in anaemia was due to limiting intakes of other erythropoietic nutrients, possibly due to a lower dietary diversity. The mid-day lunch meal at school (MDM) is an important part of daily food intake in rural school children, and it is important to maintain dietary diversity through the delivery of MDM for such vulnerable groups.

The effect of nutritional micronutrients in immune system against coronavirus disease (COVID-19)

According to preliminary research, recovery from coronavirus disease needs a strong immune response across multiple cell types (COVID-19). The latest coronavirus pandemic is affecting people all over the world. The virus is known to infect several tissues and, in extreme cases, can lead to respiratory failure. The immune system must be healthy to prevent the disease from progressing to this stage and to limit the damage caused by the Coronavirus (SARS-CoV-2). Nutritional health is important for effective immunological defence and, as a result, a good response to SARS-CoV-2. Micronutrients help immune cells conduct functions that are critical for stopping SARS-CoV-2. Their regular intake is part of a non-pharmacological strategy to maintain the immune system in good shape. Various micronutrients play a critical role in the interactions between the host immune system and viruses, like COVID-19, according to a large number of studies. The relationship between micronutrient status, the host immune response, and pathogenic virus virulence is complex and multifaceted. Micronutrients are essential for the coordinated recruitment of innate and adaptive immune responses to viral infections, as well as the regulation of pro- and anti-inflammatory host responses. Furthermore, insufficient micronutrients not only impair the immune system's ability to fight viral infections, but also lead to the development of more virulent strains by altering the viral genome's genetic makeup. The aim of this study was to assess the evidence that indicates micronutrients play a role in COVID-19 transmission, morbidity, and mortality. When considering the use of micronutrients in the prevention and treatment of COVID-19 infection, both the prevalence of micronutrient deficiencies among infected individuals and the impact of micronutrient supplementation on immune responses and overall disease outcome may be of great interest. These studies may be extremely useful in dealing with potential viral outbreaks.

Weekly iron and folic acid supplementation and nutrition education for adolescent girls in Africa and Asia

ASIA & AFRICA. What this article is about: This article outlines the activities carried out by Nutrition International since 2015, providing weekly iron and folic acid (IFA) supplementation to adolescents residing in six separate high-risk countries. Key messages: * Despite regional supply chain challenges and the complications due to the COVID-19 pandemic, weekly programmes were successful in supporting governments to increase IFA supplementation coverage. * There remains a paucity of data on adolescent health outcomes which makes the design, implementation and monitoring of adolescent health projects particularly difficult. * Although school-based delivery models are effective at the population level, reaching adolescents who do not attend school - who are often at higher risk - remains a significant challenge. Governments should prioritise reaching these isolated groups in order to meet public health policy objectives.

Genetically predicted serum vitamin D and COVID-19: a Mendelian randomisation study.

OBJECTIVES: To investigate causality of the association of serum vitamin D with the risk and severity of COVID-19 infection. DESIGN: Two-sample Mendelian randomisation study. SETTING: Summary data from genome-wide analyses in the population-based UK Biobank and SUNLIGHT Consortium, applied to meta-analysed results of genome-wide analyses in the COVID-19 Host Genetics Initiative. PARTICIPANTS: 17 965 COVID-19 cases including 11 085 laboratory or physician-confirmed cases, 7885 hospitalised cases and 4336 severe respiratory cases, and 1 370 547 controls, primarily of European ancestry. EXPOSURES: Genetically predicted variation in serum vitamin D status, instrumented by genome-wide significant single nucleotide polymorphisms (SNPs) associated with serum vitamin D or risk of vitamin D deficiency/insufficiency. MAIN OUTCOME MEASURES: Susceptibility to and severity of COVID-19 infection, including severe respiratory infection and hospitalisation. RESULTS: Mendelian randomisation analysis, sufficiently powered to detect effects comparable to those seen in observational studies, provided little to no evidence for an effect of genetically predicted serum vitamin D on susceptibility to or severity of COVID-19 infection. Using SNPs in loci related to vitamin D metabolism as genetic instruments for serum vitamin D concentrations, the OR per SD higher serum vitamin D was 1.04 (95% CI 0.92 to 1.18) for any COVID-19 infection versus population controls, 1.05 (0.84 to 1.31) for hospitalised COVID-19 versus population controls, 0.96 (0.64 to 1.43) for severe respiratory COVID-19 versus population controls, 1.15 (0.99 to 1.35) for COVID-19 positive versus COVID-19 negative and 1.44 (0.75 to 2.78) for hospitalised COVID-19 versus non-hospitalised COVID-19. Results were similar in analyses using SNPs with genome-wide significant associations with serum vitamin D (ie, including SNPs in loci with no known relationship to vitamin D metabolism) and in analyses using SNPs with genome-wide significant associations with risk of vitamin D deficiency or insufficiency. CONCLUSIONS: These findings suggest that genetically predicted differences in long-term vitamin D nutritional status do not causally affect susceptibility to and severity of COVID-19 infection, and that associations observed in previous studies may have been driven by confounding. These results do not exclude the possibility of low-magnitude causal effects or causal effects of acute responses to therapeutic doses of vitamin D.

Individual risk management strategy for SARS-CoV-2 infection: A step toward personalized healthcare.

Lethal or critical COVID-19 occurs most in infected hosts with certain risk factors such as advanced age or pre-existing disease. Host metabolic status significantly affects the clinical presentations of SARS-CoV-2 infection. Individual risk management is thus crucial for preventing severe COVID-19. Such susceptibility is individual, depending on a multitude of factors. Personalized risk assessment requires the inclusive analysis of big health data to stratify individual risk and derive a customized action plan. Personalized medicine requires shifting from the virology aspect per se to the whole individual's consideration, including dietary pattern, nutritional status, supporting lifestyle, co-existing diseases, and environmental factors. In this short communication, we discuss the individual management strategy for SARS-CoV2 infection as a step towards future personalized healthcare.

Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food.

INTRODUCTION: Daily vitamin D supplements are recommended for elderly care home residents; however, they are rarely given and vitamin D deficiency in care homes is widespread. This study aimed to understand the determinants of current practice and perceived responsibility for the vitamin D status of residents. METHODS: Thirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim. RESULTS: Inductive thematic analysis identified four themes: framing of vitamin D supplements as medicines; professional and sector boundaries whereby GPs are perceived as responsible for the vitamin D status of residents and care home managers felt unable to administer over-the-counter vitamin tablets; low awareness of national guidance; and ethical and practical issues. This results in vitamin D supplements requiring prescription by medical professionals and few residents receiving them. CONCLUSION: The medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. Vitamin D is important for musculoskeletal health. Possible links with COVID-19 are still being investigated. The pandemic has drawn attention to conditions in care homes and there is an opportunity to revise current guidance on vitamin D supplementation which will have lasting benefit for this vulnerable group.

Exploring the implications of COVID-19 on widening health inequalities and the emergence of nutrition insecurity through the lens of organisations involved with the emergency food response.

BACKGROUND: This paper describes the impact of COVID-19 during the first month of containment measures on organisations involved in the emergency food response in one region of the UK and the emerging nutrition insecurity. This is more than eradicating hunger but considers availability of support and health services and the availability of appropriate foods to meet individual requirements. In particular, this paper considers those in rural communities, from lower socioeconomic groups or underlying health conditions. METHODS: Semistructured professional conversations informed the development of a questionnaire which gathered insights from five organisations involved with the emergency food response in the South East, England, UK. Descriptive themes were derived though inductive analysis and are further discussed in relation to UK government food support measures and early published data. RESULTS: Four themes emerged from conversations, including: (1) increasing demand, (2) meeting the needs of specific groups, (3) awareness of food supply and value of supporting local and (4) concerns over sustainability. All organisations mentioned changes in practice and increased demand for emergency food solutions. Positive, rapid and innovative changes helped organisations to adapt to containment restrictions and to meet the needs of vulnerable people. Although concern was raised with regards to meeting the specific needs of those with underlying health conditions and the sustainability of current efforts. CONCLUSION: Considerable gaps in food provision were identified, as well as concerns regarding increased long-term food and nutrition insecurity. The paper makes recommendations to improve nutrition security for the future and considers the lessons learnt from the COVID-19 pandemic. The generalisability of these early insights is unknown but these real-time snapshops can help to direct further research and evaluation.

No evidence that vitamin D is able to prevent or affect the severity of COVID-19 in individuals with European ancestry: a Mendelian randomisation study of open data.

BACKGROUND: Upper respiratory tract infections are reportedly more frequent and more severe in individuals with lower vitamin D levels. Based on these findings, it has been suggested that vitamin D can prevent or reduce the severity of COVID-19. METHODS: We used two-sample Mendelian randomisation (MR) to assess the causal effect of vitamin D levels on SARS-CoV-2 infection risk and COVID-19 severity using publicly available data. We also carried out a genome-wide association analysis (GWA) of vitamin D deficiency in the UK Biobank (UKB) and used these results and two-sample MR to assess the causal effect of vitamin D deficiency on SARS-CoV-2 infection risk and COVID-19 severity. RESULTS: We found no evidence that vitamin D levels causally affect the risk of SARS-CoV-2 infection (ln(OR)=0.17 (95% CI -0.22 to 0.57, p=0.39)) nor did we find evidence that vitamin D levels causally affect COVID-19 severity (ln(OR)=0.36 (95% CI -0.89 to 1.61, p=0.57)). Based on our GWA analysis, we found that 17 independent variants are associated with vitamin D deficiency in the UKB. Using these variants as instruments for our two-sample MR analyses, we found no evidence that vitamin D deficiency causally affects the risk of SARS-CoV-2 infection (ln(OR)=-0.04 (95% CI -0.1 to 0.03, p=0.25)) nor did we find evidence that vitamin D deficiency causally affects COVID-19 severity (ln(OR)=-0.24 (95% CI -0.55 to 0.08, p=0.14)). CONCLUSIONS: In conclusion, we found no evidence that vitamin D is protective against SARS-CoV-2 infection or COVID-19 severity. Our data support the recent statement by the National Institute for Health and Care Excellence that the use of vitamin D supplementation to mitigate COVID-19 is not supported by the available data.

Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus on high-risk groups and preventative healthcare.

Existing micronutrient deficiencies, even if only a single micronutrient, can impair immune function and increase susceptibility to infectious disease. Certain population groups are more likely to have micronutrient deficiencies, while certain disease pathologies and treatment practices also exacerbate risk, meaning these groups tend to suffer increased morbidity and mortality from infectious diseases. Optimisation of overall nutritional status, including micronutrients, can be effective in reducing incidence of infectious disease. Micronutrient deficiencies are rarely recognised but are prevalent in the UK, as well as much more widely, particularly in high-risk groups susceptible to COVID-19. Practitioners should be aware of this fact and should make it a consideration for the screening process in COVID-19, or when screening may be difficult or impractical, to ensure blanket treatment as per the best practice guidelines. Correction of established micronutrient deficiencies, or in some cases assumed suboptimal status, has the potential to help support immune function and mitigate risk of infection. The effects of and immune response to COVID-19 share common characteristics with more well-characterised severe acute respiratory infections. Correction of micronutrient deficiencies has proven effective in several infectious diseases and has been shown to promote favourable clinical outcomes. Micronutrients appear to play key roles in mediating the inflammatory response and such effects may be enhanced through correction of deficiencies. Many of those at highest risk during the COVID-19 pandemic are also populations at highest risk of micronutrient deficiencies and poorer overall nutrition. Correction of micronutrient deficiencies in established COVID-19 infection may contribute to supporting immune response to infection in those at highest risk. There is a need for further research to establish optimal public health practice and clinical intervention regimens.

Zinc as nutritional intervention and prevention measure for COVID-19 disease.

The present spread of severe acute respiratory syndrome coronavirus 2, provoking COVID-19 disease, progresses rapidly worldwide. In current absence of a curative treatment and an effective, safe vaccine, there is a pressing need to focus on identifying and correcting deficits in immune function in order to reduce risk of severe progress of the disease and to lower the number of infections and fatalities. This paper evaluates the most recent literature on zinc status related to antiviral immunity and its possible role in COVID-19. It is concluded that zinc is a critical factor for antiviral immunity. There is ample evidence suggesting that zinc depletion, also prevalent in high-income nations, compromises immune functions. Notably, major risk groups for COVID-19, the elderly, men more than women, obese individuals and patients with diabetes are all at risk of zinc deficiency. Moreover, various widely used antihypertensive drugs and statin therapy have been reported to negatively influence zinc status. As zinc depletion impairs antiviral immunity, it is hypothesised to increase susceptibility for COVID-19. Therefore, dietary preventive measures and prompt implementation of zinc supplementation for risk groups should be considered. Large-scale studies are urgently needed to investigate the role of micronutrients and antiviral immunity, in particular drug-micronutrient immunity interaction.

COVID-19: is there a role for immunonutrition, particularly in the over 65s?

In late December 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in Wuhan, Hubei, China, resulting in the potentially fatal COVID-19. It went on to be officially recognised as a pandemic by the World Health Organisation on 11 March 2020. While many public health strategies have evolved, there has been little mention of the immune system and how this could be strengthened to help protect against viral infections such as SARS-CoV-2. The present paper evaluates the current evidence base relating to immunonutrition, with a particular focus on respiratory viruses. Within the nutrition sector a promising body of evidence studying inter-relationships between certain nutrients and immune competence already exists. This could potentially be an important player in helping the body to deal with the coronavirus, especially among elders. Evidence for vitamins C, D and zinc and their roles in preventing pneumonia and respiratory infections (vitamins C and D) and reinforcing immunity (zinc) appears to look particularly promising. Ongoing research within this important field is urgently needed.

Nutrition, immunity and COVID-19.

The immune system protects the host from pathogenic organisms (bacteria, viruses, fungi, parasites). To deal with this array of threats, the immune system has evolved to include a myriad of specialised cell types, communicating molecules and functional responses. The immune system is always active, carrying out surveillance, but its activity is enhanced if an individual becomes infected. This heightened activity is accompanied by an increased rate of metabolism, requiring energy sources, substrates for biosynthesis and regulatory molecules, which are all ultimately derived from the diet. A number of vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium, iron) have been demonstrated to have key roles in supporting the human immune system and reducing risk of infections. Other essential nutrients including other vitamins and trace elements, amino acids and fatty acids are also important. Each of the nutrients named above has roles in supporting antibacterial and antiviral defence, but zinc and selenium seem to be particularly important for the latter. It would seem prudent for individuals to consume sufficient amounts of essential nutrients to support their immune system to help them deal with pathogens should they become infected. The gut microbiota plays a role in educating and regulating the immune system. Gut dysbiosis is a feature of disease including many infectious diseases and has been described in COVID-19. Dietary approaches to achieve a healthy microbiota can also benefit the immune system. Severe infection of the respiratory epithelium can lead to acute respiratory distress syndrome (ARDS), characterised by excessive and damaging host inflammation, termed a cytokine storm. This is seen in cases of severe COVID-19. There is evidence from ARDS in other settings that the cytokine storm can be controlled by n-3 fatty acids, possibly through their metabolism to specialised pro-resolving mediators.