Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
J Nutr. 2021 Jul 1;151(7):1854-1878. doi: 10.1093/jn/nxab059.
BACKGROUND: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE: The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS: We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (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 16 May and 11 August 2020. RESULTS: Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS: Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. 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. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
背景:许多营养素具有强大的免疫调节作用,有可能改变对 2019 年冠状病毒病(COVID-19)感染、症状进展、发生严重疾病和生存的易感性。
目的:本研究旨在综述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 的易感性和进展的最新证据。
方法:我们综合了有关 13 种与营养相关的成分及其与 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,我们提供以下内容:1)相关材料的全景综述;2)在 PubMed 和 EMBASE 数据库中进行系统的文献搜索,包括广泛的预印本服务器;3)筛选 6 个临床试验登记处。考虑了所有原始研究,不受研究设计的限制,如果研究涵盖以下内容,则将其纳入:1)严重急性呼吸综合征冠状病毒(SARS-CoV-2)、中东呼吸综合征冠状病毒(MERS-CoV)或严重急性呼吸综合征冠状病毒(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。搜索于 2020 年 5 月 16 日至 8 月 11 日进行。
结果:在 13 次搜索中,从 PubMed 和 EMBASE 返回了 2732 篇文章,从预印本服务器返回了 4164 篇文章,从 433 项试验中返回了 433 项。在最后的叙述性综合中,我们包括了 22 篇已发表的文章、38 篇预印本文章和 79 项试验。
结论:目前,尚无高剂量补充微量营养素可预防严重疾病或加速康复的证据。然而,临床试验的结果仍在热切期待中。鉴于所有形式的营养不良对免疫系统的已知影响,减少微量营养素缺乏和营养不良的公共卫生策略仍然至关重要。此外,有强有力的证据表明,预防肥胖和 2 型糖尿病将降低 COVID-19 严重后果的风险。本综述已在 PROSPERO 上注册,注册号为 CRD42020186194。
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