Clinical Nutrition in Covid-19 Patients-A Systematic Review

Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.

The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia

Background: COVID-19-related olfactory dysfunction is an emerging problem with a significant impact on the quality of life of affected individuals. Different lines of treatment have been used with varying results. This study aimed to assess the potential therapeutic effect of PRP in the treatment of post-COVID olfactory dysfunction. This work aimed to assess the potential therapeutic effect of platelet-rich plasma (PRP) in treating post-COVID-19 parosmia. A pilot study was conducted on 60 patients with post-COVID parosmia without responding to a 3-month course of olfactory training, topical corticosteroids, omega-three, vitamin B12, and zinc supplementation. The patients were distributed randomly and equally among 2 groups. The case group was subjected to three PRP injections in the olfactory cleft at 3 weeks intervals. The control group continued the pre-study treatment protocol for 6 weeks. The degree of parosmia was assessed before and after treatment subjectively using a visual analog scale (VAS) from 0 to 10. Reaching 0-1 on the visual analog scale was a complete improvement. The primary outcome was assessing the post-treatment score for parosmia 1 month after the third injection in the case group. The second outcome was the comparison between both groups regarding the degree of improvement 1 month after cessation of treatment. Result(s): There was a highly significant improvement in VAS for parosmia (p < 0.00001) in the case group and a significant improvement in VAS for parosmia in the control group (p = P = 0.00148). There was a significant difference between both groups regarding the degree of improvement favoring the case group (p = 0.002). Conclusion(s): Platelet-rich plasma injection in the olfactory cleft offers a therapeutic option for treating patients with post-COVID-19 olfactory parosmia who failed to respond to traditional conservative treatment.Copyright © 2022, The Author(s).

Self-medication Practices for COVID-19 Prevention: A Study among Medical Students in Yogyakarta, Indonesia

The corona virus disease 2019 (COVID-19) pandemic has increased the interest in self-care strategies, including self-medication. Medical students, as future health practitioners, learn more about medications than other students. This study aimed to describe self-medication practices for preventing COVID-19 among medical students at Universitas Islam Indonesia. This observational study used a cross-sectional design and was undertaken in November- December 2020. The study sample included 336 undergraduate medical students determined using a consecutive sampling technique based on inclusion and exclusion criteria. Data were collected using an online questionnaire about self-medication practices in the preceding 3 months. Among a total of 336 students, 137 (41%) reported using self-medication intending to prevent COVID-19, and 126 (92%) of these 137 took preventive supplements, mainly vitamins C, D, and E, and omega-3. Seven students reported the use of zinc, mainly in combination with other vitamins. Students who practiced self-medication lived closer to people confirmed with COVID-19, washed their hands more often, and desinfected their belongings more frequently than their counterparts (p<0.05). The mean duration for consuming vitamins was 11-16 days. Forty students (29%) used herbal medicine to prevent COVID-19;ginger, turmeric, honey, black seed, cutcherry, and Curcuma were the most often consumed herbal remedies. Fourteen students (10%) reported taking over-the-counter medications to relieve symptoms related to COVID-19, including antipyretic, analgesic, antiseptic, antihistamine, decongestant, antitussive, and expectorant medications. Most respondents (82%) purchased their medications at pharmacies, and 11 (9%) obtained them from online shops. These findings show the high rate of self-medication using vitamins and herbal remedies for COVID-19 prevention among university medical students. Further studies are needed to explore students' knowledge about the risks of self-medication including the use of herbal medicines.Copyright © 2022 Marmara University Press.

A systematic review on immunity functionalities and nutritional food recommendations to develop immunity against viral infection

Immunity plays a fundamental role in the maintenance and protection of the human body from infectious and pathogenic microorganisms. It requires regular intake of nutrients for proper functioning of the immune system. Due to an unbalanced lifestyle and consumption of ready-to-eat foods, immunity is being affected negatively. Inflammation and immunity are influenced by diet and nutrition. Simple sugars, trans fats, refined carbs, and processed meat, among other meals, may induce inflammation while simultaneously counteracting the anti-inflammatory benefits of omega-3 fatty acids. As a result, unhealthy food intake may enhance systemic inflammation in individuals, boosting the generation of IL-6. Dietary nutrition is a well-known aspect of immune system maintenance, with the significance of micronutrients prominently featured in a variety of scientific literary works. Currently, global population is susceptible viral infection such as COVID-19. This viral strain is directly attacking the immunity of the individual and bringing it at risk. When a patient's immune system isn't operating correctly, COVID-19 is thought to raise the harshness of the infection or make it more vulnerable to contagious diseases. This review paper will help in understanding the immune responses mechanism along with diet balance and maintaining the sufficiency of vitamins and minerals to fight against COVID-19 infection.Copyright © 2023 The Author(s)

Nutritional Supplement Use Influencing by Cyberchondria and E-Health Literacy During the COVID-19 Outbreak in Turkey

Aim: "We're not just fighting an epidemic;we're fighting an infodemic," said World Health Organization Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference. In this context, we examined vitamin-mineral use frequency as influenced by cyberchondria, or E-health literacy level, and related factors during the coronavirus disease-2019 outbreak. Method(s): In this cross-sectional study, participants who were admitted to the outpatient clinics in a tertiary hospital between March 2021 and April 2021 were asked questions on socio-demographic data, the presence of vitamin and mineral use, and knowledge. The cyberchondria scores by the cyberchondria severity scale and the E-health literacy scores by the electronic health literacy scale were assessed based on nutrition type choice. The use of vitamins and minerals was compared between regular and non-regular supplement users. Factors related to the presence of nutritional supplement use were assessed through logistic regression analysis. Result(s): A total of 417 participants, including those aged 39.3+/-12.09 years, were found to be regular nutritional supplement users at a rate of 52.99% during the outbreak. The most commonly used supplements were vitamin D (62.8%), vitamin C (54.4%), vitamin B12 (39.6%), zinc (37.9%), magnesium (35.7%), and iron (33.60%). The least used supplement was melatonin (5.30%). Iron, calcium, and vitamin A users had a higher cyberchondria score than non-users (p=0.002, p=0.044, and p=0.030, respectively). However, zinc, selenium, magnesium, calcium, vitamin B6, vitamin C, omega-3 fish oil, and probiotic users had a higher E-health literacy score than non-users (p<0.001, p=0.018, p<0.001, p=0.009, p=0.047, p=0.018, p=0.002, p=0.002, respectively). Logistic regression analyses identified higher E-health literacy [odds ratio (OR)=1.077;95% confidence interval (CI): 1.042-1.115;p<0.001], female sex (OR=1,659;95% CI: 1,005-2,737;p=0.048), graduated from university (OR=2,536;95% CI: 1,009-6,374;p=0.048), presence of health professional's advice (OR=3,716;95% CI: 2,260-6,119;p<0.001) and chronic disease presence (OR=2,755;95% CI: 1,420-5,347;p=0.003) were predictors of supplement usage during the outbreak. Conclusion(s): Higher E-health literate women with comorbidities were likely nutritional supplement users during the outbreak, regardless of cyberchondria severity or age generation differences.Copyright © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

Polysaturated fatty acids and their derivatives regulate respiratory infections.

The regulation of inflammation is a complex pathophysiological process that depends on the production of oxygenated lipid derivatives essential polyunsaturated fatty acids, like omega-3 and omega-6, among which are the lipoxins resolvins and protectins, called specialized pro-resolving lipid mediators (SPM). Their activity is associated with the control of respiratory infection processes to modulate the production of proinflammatory cytokines, avoiding damage due to inflammation-associated necrosis, reducing microbial loads, and promoting tissue remodeling. Therefore, we review some of the biochemical, physiological and immunological aspects of SPM in the regulation of inflammation in respiratory infections.Copyright © 2022, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

Omega-3 Fatty Acid Supplementation for the Treatment of COVID-19-Related Olfactory Dysfunction

Introduction: Olfactory dysfunction (OD) is a prevalent and characteristic symptom among individuals with COVID-19 infection. Although most patients with COVID-19-related OD experience a significant recovery, there exists a substantial population of patients with persistent OD with limited therapeutic options. Method(s): Patients with laboratory-confirmed or clinically suspected COVID-19 infection and self-reported new onset OD from March 2020 to October 2021 were prospectively recruited for a randomized, placebo-controlled, doubleblinded clinical trial. Patients with evidence of quantitative OD, defined as a Brief Smell Identification Test (BSIT) score of 9 or less, were eligible for study inclusion. The experimental group received 2 g of omega-3 fatty acid (O3FA) supplementation, including 1366-mg eicosapentaenoic acid and 504-mg docosahexaenoic acid, while the control group received an identical placebo, each to be taken daily for 6 weeks. The primary outcome was change in BSIT score from initial test to a 6-week follow-up BSIT. Result(s): A total of 117 patients were included in analysis, including 57 patients in the O3FA group and 60 in the placebo group. The mean duration of OD prior to study enrollment was 200.1 days with no significant difference between groups (P=.685). Patients receiving O3FA supplementation demonstrated a mean BSIT improvement of 1.12+/-1.99 compared with 0.68+/-0.86 in the placebo group (P=.385). Among those with severe hyposmia, defined as a BSIT score of 7 or less, patients in the O3FA group (n=23) demonstrated a BSIT improvement of 2.30+/-0.77 compared with 1.63+/-1.82 among those in the placebo group (n=16, P=.255). Conclusion(s): Our study showed a trend toward improved olfactory recovery among COVID-19-related OD patients receiving high doses of O3FA supplementation at a 6-week follow-up time point. Future work will be needed to better define the effectiveness and durability of O3FA supplementation as a treatment for COVID-19-related OD.

The central role of neutrophil extracellular traps in SARS-CoV-2-induced thrombogenesis and vasculitis

Objective: Severe acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) seen in SARs-CoV-2 infection has been attributed to the disruption of the immune response in COVID-19 patients. Neutrophilia and marked lymphocyte reductions are associated with disease severity and seem predictive of disease outcome in moderate and severe COVID-19 patients. Herein, we aim to decipher possible mechanisms involved in extensive tissue injury observed in COVID-19 patients, accompanied by vasculopathy, coagulopathy, and a high incidence of thrombotic complications in severe patients. Method(s): We searched PubMED for keywords including COVID-19 pathogenesis, thrombosis, and vasculities. Result(s): Neutrophils can undergo a specialized form of apoptosis to yield thread-like extracellular structures termed neutrophil extracellular traps (NETs), termed NETosis, which form web-like scaffolds of DNA, histones, and toxic protein granules and enzymes, whose primary function is to trap and eliminate microbes. However, uncontrolled NET production can lead to ALI and ARDS, coagulopathy, multiple organ failure, and autoimmune disease. Dysregulation of NETs promotes production of anti-neutrophil cytoplasmic antibodies (ANCA) which affects small vessels through ANCA-associated vasculitis (AAV). Furthermore, NETs can also induce thrombosis via formation of scaffolds that trap platelets, RBCs, fibronectin, and other proteins, which can also induce coagulation. Conclusion(s): We suggest that NET production is central during SARS-CoV-2 infection and COVID-19 pathogenesis, associated with alveolar damage accumulation of edema, endothelial injury and coagulopathy, elevated platelet activation and thrombogenesis forming a NET production feed-forward loop, causing diffuse small vessel vasculitis in the lungs and other organs. Copyright © 2020 FSG Communications Ltd. All rights reserved.

Impact of the COVID-19 Pandemic on Cardiometabolic Health Parameters in Children

Background: The COVID-19 pandemic has raised concerns for worsening cardiometabolic health in children. Methods: Retrospective chart review to analyze patients who had visits to a pediatric lipid clinic in both the year prior to (3/18/2019- 3/17/2020) and during (3/18/2020-3/17/2021) the COVID-19 pandemic. Laboratory markers of cardiometabolic health (lipid panel, insulin resistance, and transaminases), physical exam findings (BMI, waist circumference (WC), and blood pressure), self-reported exercise time, and lipid-lowering medications (LLM) were compared via paired t-tests. Results: 303 patients met inclusion criteria. Among patients prescribed no LLM (metformin, statin, omega-3 fatty acids, fenofibrate) or on stable doses of LLM (n=244), there was a significant increase in BMI and WC (see Table). All changes in lipid panels were statistically, but likely not clinically, significant. Among patients with changes in prescribed LLM between pre-pandemic and pandemic intervals (n=62), there was an increase in HgbA1c and TG, a trend towards increased fasting insulin and ALT, and no changes in LDL-C or HDL-C. During the pandemic, patients showed increased BMI and trended towards increased WC (see Table). Neither group had a statistically significant change in exercise time. The incidence of newly prescribed LLM increased during the pandemic. This included statistically significant increases in prescriptions for statins (P= 0.003), metformin (P= 0.001), and omega-3 fatty acids (P= 0.001). Conclusion: Pediatric patients in a lipid clinic demonstrated increases in BMI and WC in the year of the COVID-19 pandemic compared to the year prior, despite few clinically significant changes in their lipid panels. In patients who required changes in LLM, increases in HgbA1c, TG, ALT and fasting insulin are consistent with reports of higher rates of pediatric type 2 diabetes during the pandemic. The increase in medication prescriptions further supports this, and indicates the need to diagnose and treat new onset dyslipidemia, insulin resistance, and diabetes in children.

Anti-Inflammatory Pantry Kit: Delivering Foods for Chronic Pain to the Patient's Kitchen

Methods: Participants of the 13 week program, Partner's Aligned in Transformative Healing (PATH), receive an Anti-Inflammatory Pantry Kit containing one retail size quantity of extra-virgin olive oil, avocado oil, pumpkin seeds, Brazil nuts, green tea, ground flax seed, dried lentils, maple syrup, ground turmeric, ground ginger, and coconut milk. During week 5 of the program participants spend 90 minutes with the registered dietitian (virtual or in-person, depending on the group) for an interactive education and sensory experiential. Participants leave with the food and knowledge of the ingredients and how to use them. The registered dietitian procures the ingredients and puts together the kits. Food costs are reimbursed by Blue Cross Blue Shield of Vermont as it has been incorporated into the program's bundled payment model for each PATH participant. Results: What emerged from this experimental adjustment to the curriculum is an innovation that has engaged participants to make modifications to their diets to increase whole food sources of omega-3 fatty acids, phytonutrients, dietary fiber, zinc, selenium, plant-based protein, and healthy fat;all of which are evidenced based nutrients that have been demonstrated to impact inflammatory and immune systems in individuals experiencing chronic pain. Background: The Anti-Inflammatory Pantry Kit was designed during the covid-19 pandemic as a way to continue to offer hands-on culinary medicine to participants at the University of Vermont's Comprhensive Pain Program in the comfort and safety of their own home. Conclusion: Culinary medicine at the Comprehensive Pain Program looks different now that it did prior to the pandemic and the changes have been received with enthusiasm. The Anti-Inflammatory Pantry Kit is a dynamic tool for nutrition and culinary medicine education for chronic pain participants. This tool and approach to medical nutrition therapy has been made sustainable by the reimbursement by Blue Cross Blue Shield of Vermont and the engagement of participants.

CACPR 2022 Annual Meeting

The proceedings contain 4 papers. The topics discussed include: daily steps and all-cause mortality: a meta-analysis of 15 international cohorts;1 year HIIT and Omega-3 fatty acids to improve cardiometabolic risk in stage-a heart failure;outpatient pulmonary rehabilitation in patients with long COVID improves exercise capacity, functional status, dyspnea, fatigue, and quality of life;and pulmonary rehabilitation in idiopathic pulmonary fibrosis and COPD: a propensity-matched real-world study.

Potential of Omega 3 Supplementation for Coronavirus Disease 2019 (COVID-19): A Scoping Review.

COVID-19 can cause fever, cough, headache, and shortness of breath but patients with comorbidities can experience worsening and death. An action is needed to treat this condition in COVID-19 patients. Omega 3 fatty acids may be one possibility associated with COVID-19 prevention, management, and treatment. Therefore, this review aimed to identify the existing studies on potency of omega 3 fatty acid supplementation on COVID-19. We searched studies from PubMed, Google Scholar, Springer Link, and Emerald Insight databases published on January 31, 2020, to September 1, 2021. The studies selected were the full-text, non-review ones which focused on the omega 3 fatty acid intervention in COVID-19 with COVID-19 patients and people affected by COVID-19 as their subjects and clinical manifestations or the results of supporting examinations as their outcomes. No quality assessment was performed in this review. Of the 211, there were 4 studies selected for this review. They showed that severe COVID-19 patients have low levels of omega 3 in their blood. Omega 3 was considered to reduce the risk of positive for SARS-CoV-infection and the duration of symptoms, overcome the renal and respiratory dysfunction, and increase survival rate in COVID-19 patients. Omega 3 fatty acid supplementations were thought to have a potential effect in preventing and treating COVID-19. This can be a reference for further research about omega 3 fatty acid supplementation and COVID-19.

Eicosapentaenoic acid increases endothelial function and Heme oxygenase-1 in pulmonary inflammation

INTRODUCTION: Endothelial cell (EC) dysfunction results in reduced nitric oxide (NO) bioavailability leading to inflammation and increased susceptibility to infectious agents. Heme oxygenase-1 (HO-1) produces potent antioxidant and anti-inflammatory products including carbon monoxide. SARS-CoV-2 and influenza affect ECs in multiple vascular beds, including pulmonary tissue. The omega-3 fatty acid eicosapentaenoic acid (EPA) and its metabolites preserve EC function in a manner that may contribute to reduced incident cardiovascular events (REDUCE-IT). Currently, EPA is being tested in patients with or at risk for COVID-19. This study tested the effects of EPA on NO and peroxynitrite (ONOO-) release under conditions of inflammation using lipopolysaccharide (LPS) and the cytokine IL-6. We also measured expression of HO-1 after cell challenge with IL-6. METHODS: Human lung microvascular endothelial cells (HMVEC-L) were pretreated with vehicle or EPA (40 μM) in 2% FBS for 2 h, then challenged with either IL-6 (12 ng/ml) or LPS (200 ng/ml) for 24 h. Cells (including untreated controls) were stimulated with calcium ionophore to measure maximum production of NO and peroxynitrite (ONOO-) using tandem porphyrinic nanosensors. Proteomic analysis was performed using LC/MS to assess relative expression levels. Only significant (p< 0.05) changes in protein expression between treatment groups >1-fold were analyzed. RESULTS: HMVEC-L challenged with LPS and IL-6 showed a pronounced loss of NO release by 22% (p< 0.01) and 18% (p< 0.01), respectively, concomitant with an increase in ONOO- by 28% (p< 0.01) and 26% (p< 0.01), respectively. As a result, the [NO]/[ONOO-] ratio, a marker of eNOS coupling efficiency, decreased by 39% (p< 0.001) and 35% (p< 0.001) with LPS and IL-6, respectively. However, EPA increased this ratio by 39% (p< 0.01) in both LPS and IL-6 treated cells. EPA also caused a 5.7-fold (p = 4.4 × 10-38) increase in expression of HO-1 with IL-6. CONCLUSIONS: These findings indicate that EPA improves NO bioavailability and reduces nitroxidative stress in pulmonary ECs during inflammation with LPS or IL-6. These studies indicate a protective effect of EPA on pulmonary ECs that may reduce inflammatory activation during sepsis, influenza, or advanced COVID-19 that may mediate many aspects of multiorgan system failure.

Highlights from Studies Presented at the Virtual American College of Cardiology Scientific Sessions 2021: Staying Updated with the Latest Advancements in Prevention.

PURPOSE OF REVIEW: This review highlights late-breaking science presented at the Virtual American College of Cardiology Scientific Sessions 2021 that demonstrated advancements in preventative cardiology and introduced novel therapeutic modalities for the management of chronic kidney disease, heart failure, and COVID-19. RECENT FINDINGS: The studies reviewed include clinical trials that assessed the use of dapagliflozin in patients with respiratory failure due to COVID-19 (DARE-19 trial); evinacumab for patients with severe hypertriglyceridemia and pancreatitis; effect of genotype-guided oral P2y12 inhibitors vs conventional clopidogrel on long-term ischemic outcomes after percutaneous coronary intervention (TAILOR-PCI trial); anticoagulation in patients hospitalized with COVID-19 (ACTION trial); atorvastatin vs placebo in patients with COVID-19 admitted to the ICU (INSPIRATION-S trial); rehabilitation therapy in older acute heart failure patients (REHAB-HF trial); and aspirin dosing: a patient-centric trial assessing benefits and long-term effectiveness (ADAPTABLE trial). In addition, we review the results of the American College of Cardiology Global Heart Attack Initiative (GHATI). Finally, we discuss the secondary analysis of the STRENGTH trial assessing the association of achieved levels of omega-3 fatty acid levels and major cardiovascular outcomes. The studies presented at the virtual American College of Cardiology Scientific Session 2021 represent remarkable contributions in the field of cardiovascular disease and prevention.

Genetic Variation, Diet, Inflammation, and the Risk for COVID-19.

COVID-19, which is caused by SARS-CoV-2, is characterized by various symptoms, ranging from mild fatigue to life-threatening pneumonia, "cytokine storm," and multiorgan failure. The manifestation of COVID-19 may lead to a cytokine storm, i.e., it facilitates viral replication that triggers a strong release of cytokines, which then modulates the immune system and results in hyperinflammation. Today's diet is high in omega-6 fatty acids and deficient in omega-3 fatty acids; this, along with a high fructose intake, leads to obesity, which is a chronic state of low-grade inflammation. Omega-6 fatty acids are proinflammatory and prothrombotic whereas omega-3 fatty acids are less proinflammatory and thrombotic. Furthermore, omega-3 fatty acids make specialized lipid mediators, namely resolvins, protectins, and maresins, that are potent anti-inflammatory agents. Throughout evolution there was a balance between omega-6 and omega-3 fatty acids with a ratio of 1-2/1 omega-6/omega-3, but today this ratio is 16-20/1 omega-6/omega-3, leading to a proinflammatory state. In addition, genetic variants in FADS1, FADS2, ELOV-2, and ELOV-5 lead to a more efficient biosynthesis of long-chain polyunsaturated fatty acids (PUFAs), e.g., of linoleic acid (LA) to arachidonic acid (ARA), and (alpha-linolenic acid) (ALA) to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), leading to higher ARA levels. Because the US diet is already high in omega-6 fatty acids, the increased biosynthesis of ARA in people with the derived FADS haplotype (haplotype D) leads to an increased production of leukotrienes, thromboxanes, C-reactive protein (CRP), and eventually elevated levels of cytokines, like interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF), which may increase susceptibility to COVID-19. About 80% of African Americans, 50% of Hispanics, and 45% of European Americans have the FADS haplotype D and are thus efficient metabolizers, which could account for the higher vulnerability of these populations to COVID-19. Therefore, another reason that African Americans and Hispanics are more susceptible to COVID-19 is that they have a higher frequency of haplotype D, which is no longer beneficial in today's environment and diet. Genetic variation must be considered in all studies of disease development and therapy because it is important to the practice of precision nutrition by physicians and other health professionals. The objective of this commentary is to emphasize the importance of genetic variation within populations and its interaction with diet in the development of disease. Differences in the frequency of genes and their interactions with nutrients in various population groups must be considered among the factors contributing to health disparities in the development of COVID-19. A balanced omega-6/omega-3 ratio is essential to health. Physicians should measure their patients' fatty acids and recommend decreasing the intake of foods rich in omega-6 fatty acids and increasing the intake of omega-3 fatty acids along with fruits and vegetables.

Letter to the editor: Study Summary - Randomized Control Trial of Omega-3 Fatty Acid Supplementation for the Treatment of COVID-19 Related Olfactory Dysfunction.

OBJECTIVES: To evaluate a therapeutic role for omega-3 fatty acid supplementation in the treatment of olfactory dysfunction associated with COVID-19 infection TRIAL DESIGN: Randomized, double-blinded, placebo-controlled trial PARTICIPANTS: Eligible patients are adults with self-reported new-onset olfactory dysfunction of any duration associated with laboratory-confirmed or clinically suspected COVID-19 patients. Exclusion criteria include patients with pre-existing olfactory dysfunction, history of chronic rhinosinusitis or history of sinus surgery, current use of nasal steroid sprays or omega-3 supplementation, fish allergy, or inability to provide informed consent for any reason. The trial is conducted at Mount Sinai Hospital INTERVENTION AND COMPARATOR: The intervention group will receive 2000 mg daily of omega-3 supplementation in the form of two "Fish Oil, Ultra Omega-3" capsules (product of Pharmavite®) daily. The comparator group will take 2 placebo capsules of identical size, shape, and odor daily for 6 weeks. MAIN OUTCOMES: Each subject will take a Brief Smell Identification Test at study enrolment and completion after 6 weeks. The primary outcome will be change in Brief Smell Identification Test over the 6-week period. RANDOMISATION: Patients will be randomized by the Investigational Drug Pharmacy at the Icahn School of Medicine at Sinai via a computer-generated sequence in a 1:1 allocation to treatment or control arms. BLINDING (MASKING): Both participants and researchers will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): There will be 88 participants randomized to each group. A total of 176 participants will be randomized. TRIAL STATUS: Protocol Version 1, 8/3/2020 Recruitment is ongoing, started 8/5/2020 with estimated completion 11/30/2020. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov with Protocol Identifier: NCT04495816 . TRIAL REGISTRATION: ClinicalTrials.gov, NCT04495816 . Registered 3 August 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1).