By: Talking Nutrition Editors
We already know that optimal nutritional status helps to fuel an appropriate immune response as it plays a vital role in the development and maintenance of physical barriers, production of antimicrobial proteins, proper functioning of immune cells and mediation of inflammatory processes.1,2,3 We also know that a bidirectional relationship exists between nutrition and infection, whereby poor nutritional status predisposes someone to infection, and infection is also exacerbated by poor nutritional status. This ultimately results in a cycle of deficiency, disease and poor outcomes, and highlights the significant burden malnutrition can place on the care of patients suffering from diseases or infections like COVID-19.
To better understand the role of nutrients in COVID-19 specifically, a range of micronutrients and trace elements – such as vitamins C, D, zinc and selenium – have been explored and observational evidence indicates that they may have an important role to play in the infection.4,5 These insights are now being translated into new nutritional interventions as part of patient care, and are even being considered as part of preventative strategies.6
Below, we outline the key insights from our latest webinar, ‘Raising standards in elder and patient care’, including the significant role vitamin D may play in the nutritional care of COVID-19 patients.
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Currently, no comprehensive micronutrient guidelines – that provide nutritional recommendations in the context of specific disease states – exist. This gap in nutritional guidance has not gone unnoticed during the COVID-19 pandemic. For instance, it led to accelerating the identification and development of new micronutrient-based, patient-oriented ESPEN guidelines that will provide practical advice to clinicians and dieticians to help them recognize the nutritional needs of patients and provide better nutritional care.
During the webinar, Prof. Hon. Mette Berger, Consultant Intensivist at CHUV, Lausanne University Hospital, shared unique insights into the methodology and practicality for the development of the guidelines – which will become available this year – and how exactly they will help medical professionals. She explained that the final document will offer biomarkers for inflammation – which can affect nutritional status – and advice on which micronutrient deficiencies are commonly observed in specific diseases, including cancer cachexia, diabetes and liver disease. It will then provide guidance on the optimal nutritional care based on the nutritional deficiencies present in these patients.
Prof. Sumantra Ray, Founding Chair and Executive Director, NNEdPro Global Centre for Nutrition & Health, also highlighted the importance of knowledge sharing in light of the current health crisis, the challenges faced during the pandemic, and key considerations learned. He advised that the best way to enable rapid, safe and effective decision making concerning the care of patients during a health crisis – like COVID-19 – is through evidence-informed practice (rather than evidence-based practice, which a pandemic does not allow). Evidence-informed practice includes making use of the best available, current, valid and relevant scientific evidence. It involves bringing together expertise from research, clinical practice and public health sectors to collate existing knowledge that will help to develop a range of communication materials and guidelines for the public and medical community. Prof. Sumantra Ray explained how evidence-informed practice was utilized during the COVID-19 pandemic specifically.
merging scientific evidence highlights the potential benefits of good vitamin D status in COVID-19 patients, indicating that it may help individuals defend themselves against the infection and also lower the severity of infection.7,8,9,10,11,12 As well as being more at risk of infection generally due to immunosenescence – the deterioration of immune function that can happen with aging – senior adults are also more likely to be vitamin D deficient.13 This is due to reduced dietary intakes, impaired nutrient absorption, decreased exposure to sunlight and lower ability to synthesize vitamin D if exposed to UV light. The risk of deficiency has also been amplified during the pandemic due to shielding, because of less time outdoors and poorer access to foods. Vitamin D deficiency has also been hypothesized as one of the factors responsible for the disproportionate prevalence of COVID-19 infection in specific ethnic groups, particularly in people with darker skin who live in higher altitudes. So, how can the nutrition and medical communities utilize the benefits of vitamin D to support these populations better?
Prof. Hon. Mette Berger outlined ESPEN’s strategy for vitamin D therapy in acute illness, depending on the level of deficiency and any presenting medical conditions. She summarized the following steps:
It is important to remember that while emerging scientific findings suggest that vitamin D supplementation – in adjunct to other treatment – may help to reduce the severity of a COVID-19 infection, there is no evidence to suggest that adequate vitamin D serum levels prevent or treat COVID-19.
While the current science is promising, further research and carefully designed studies are vital to identify the cause and effect of micronutrients, including vitamin D. This starts by analyzing existing data from both population and patient sources, and conducting micronutrient screening both in public health and clinical settings. The development and findings of new studies will help to further optimize the nutritional management, care and quality of life of patients and the elderly.
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Maggini et al. Immune function and micronutrient requirements change over the life course. Nutrients, vol. 10, no. 10, pg. 1531, 2018.
Carr et al. Vitamin C and immune function. Nutrients, vol. 9, no. 11, pg. 1211, 2017.
Gombart et al. A review of micronutrients and immune system-working in harmony to reduce the risk of infection. Nutrients, vol. 12, no. 1, 2020.
Calder. Nutrition, immunity and COVID-19. BMJ Nutrition, Prevention & Health, 2020.
McAuliffe et al. Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus on high-risk groups and preventative healthcare. BMJ, 2020.
BMJ Nutrition, Prevention & Health. Nutrition Interactions with COVID-19 (BMJ NPH & NNEdPro Co-ordination of Submissions: Martin Kohlmeier, Bryndís Eva Birgisdóttir, Shane McAuliffe, Sumantra Ray). [website], accessed 20th January 2021.
Calder et al. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients, vol. 12, no. 4, pg. 1181, 2020.
Martineau et al. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess, vol. 23, no. 2, pg. 1-44, 2019.
Charogenngam and Holick. Immunologic effects of vitamin D on human health and disease. Nutrients, vol. 12, no. 7, 2020.
Op. Cit. (Calder 2020).
Ali. Role of vitamin D in preventing of COVID-19 infection, progression and severity. J Infect Public Health, vol. 13, no. 10, pg. 1373-1380, 2020.
Lanham-New et al. Vitamin D and SARS-CoV-2 virus/COVID-19 disease. BMJ Nutrition, Prevention & Health, 2020.
Lips. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol., vol. 103, no. 3-5, pg. 620-625, 2007.