EFFECT OF MICRONUTRIENT SUPPLEMENTS ON COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT

TOPIC Chest Infections TYPE Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a worldwide pandemic and leading cause morbidity and mortality globally. Due to their immunomodulatory functions, micronutrient supplements such as vitamin D, vitamin C, and zinc have been used for the management of viral illnesses. Furthermore, recent studies have shown low serum vitamin C, vitamin D, and zinc levels in critically ill patients with COVID-19. However, the role of these micronutrients in reducing mortality in patients with COVID-19 remains unclear. Therefore, we conducted this meta-analysis to provide a quantitative assessment of the effect of vitamin D, vitamin C, and zinc on mortality in COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021. All the studies that compared adding micronutrient supplements such as vitamin C, vitamin D, and zinc versus standard-of-care (SOC) in patients with COVID-19 were included. The outcome of interest was the mortality rate. All statistical analyses were performed using the Review Manager software (RevMan 5.3). Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. RESULTS: Four studies evaluated vitamin C in 390 patients (201 in vitamin C and 189 in SOC). Seven studies assessed vitamin D in 1251 patients (457 in vitamin D and 794 in SOC). Five evaluated zinc in 1506 patients (776 in zinc and 730 in SOC). Both vitamin C (RR 0.60, 95% CI 0.27-1.36, P = 0.22) and vitamin D (RR 0.94, 955 CI 0.46-1.94, P = 0.87) did not significantly reduce mortality. However, zinc was associated with an 33% reduction in mortality compared to SOC (RR 0.67, 95% CI 0.54-0.84, P = 0.0005). CONCLUSIONS: Our meta-analysis demonstrated that zinc reduced mortality in COVID-19 patients. However, vitamin C and D did not show significant improvemnt in mortality. CLINICAL IMPLICATIONS Micronutrient supplements, especially zinc, may play a role in the treatment of COVID-19. However, it is unclear whether the magnitude of the effects of these micronutrients are clinically meaningful. Further research is needed to better evaluate the utility of these micronutrient supplements in the management of COVID-19. DISCLOSURES No relevant relationships by Waleed Abdulsattar, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Wasef Sayeh, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by Jamie Stewart, source=Web Response