Vlieg-Boerstra Berber, de Jong Nicolette, Meyer Rosan, Agostoni Carlo, De Cosmi Valentina, Grimshaw Kate, Milani Gregorio Paolo, Muraro Antonella, Oude Elberink Hanneke, Pali-Schöll Isabella, Roduit Caroline, Sasaki Mari, Skypala Isabel, Sokolowska Milena, van Splunter Marloes, Untersmayr Eva, Venter Carina, O'Mahony Liam, Nwaru Bright I
Department of Paediatrics, OLVG Hospital, Amsterdam, The Netherlands.
Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Allergy. 2022 May;77(5):1373-1388. doi: 10.1111/all.15136. Epub 2021 Oct 27.
It remains uncertain as to whether nutrient supplementation for the general population considered healthy could be useful in the prevention of RTIs, such as COVID-19. In this systematic review and meta-analysis, the evidence was evaluated for primary prevention of any viral respiratory tract infection (RTI) such as SARS-CoV-2, through supplementation of nutrients with a recognized role in immune function: multiple micronutrients, vitamin A, folic acid, vitamin B12, C, D, E, beta-carotene, zinc, iron and long-chain polyunsaturated fatty acids. The search produced 15,163 records of which 93 papers (based on 115 studies) met the inclusion criteria, resulting in 199,055 subjects (191,636 children and 7,419 adults) from 37 countries. Sixty-three studies were included in the meta-analyses, which was performed for children and adults separately. By stratifying the meta-analysis by world regions, only studies performed in Asia showed a significant but heterogeneous protective effect of zinc supplementation on RTIs (RR 0.86, 95% CI 0.7-0.96, I = 79.1%, p = .000). Vitamin D supplementation in adults significantly decreased the incidence of RTI (RR 0.89, 95% CI 0.79-0.99, p = .272), particularly in North America (RR 0.82 95% CI 0.68-0.97), but not in Europe or Oceania. Supplementation of nutrients in the general population has either no or at most a very limited effect on prevention of RTIs. Zinc supplementation appears protective for children in Asia, whilst vitamin D may protect adults in the USA and Canada. In 10/115 (8.7%) studies post-hoc analyses based on stratification for nutritional status was performed. In only one study zinc supplementation was found to be more effective in children with low zinc serum as compared to children with normal zinc serum levels.
对于健康的普通人群而言，补充营养素是否有助于预防呼吸道感染性疾病（RTIs），如新型冠状病毒肺炎（COVID-19），目前仍不确定。在这项系统评价和荟萃分析中，通过补充在免疫功能中具有公认作用的营养素：多种微量营养素、维生素A、叶酸、维生素B12、C、D、E、β-胡萝卜素、锌、铁和长链多不饱和脂肪酸，评估了对任何病毒性呼吸道感染（RTI）如严重急性呼吸综合征冠状病毒2（SARS-CoV-2）进行一级预防的证据。检索共产生15163条记录，其中93篇论文（基于115项研究）符合纳入标准，涉及来自37个国家的199055名受试者（191636名儿童和7419名成年人）。63项研究纳入了荟萃分析，分别对儿童和成年人进行了分析。通过按世界区域对荟萃分析进行分层，只有在亚洲进行的研究显示补充锌对呼吸道感染性疾病具有显著但异质性的保护作用（风险比RR=0.86，95%置信区间CI 0.7-0.96，I²=79.1%，p=0.000）。在成年人中补充维生素D显著降低了呼吸道感染性疾病的发病率（RR=0.89，95%置信区间CI 0.79-0.99，p=0.272），特别是在北美（RR=0.82，95%置信区间CI 0.68-0.97），但在欧洲或大洋洲则不然。在普通人群中补充营养素对预防呼吸道感染性疾病要么没有作用，要么作用非常有限。补充锌似乎对亚洲儿童有保护作用，而维生素D可能对美国和加拿大的成年人有保护作用。在115项研究中的10项（8.7%）中，进行了基于营养状况分层的事后分析。仅在一项研究中发现，与血清锌水平正常的儿童相比，补充锌对血清锌水平低的儿童更有效。
