Abstract
Background: Micronutrients play roles in strengthening and maintaining immune function, but their supplementation and/or deficiency effects on respiratory tract infections are inconclusive. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. Methods: Systematic literature searches conducted in five electronic databases identified 751 unique studies, of which 33 studies (five supplementation studies, one supplementation and deficiency study, and 27 deficiency studies) were eventually included in this review. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted. Data from 19 studies were pooled in meta-analysis using the generic inverse variance method. Findings: A total of 360,346 patients across 16 countries, with a mean age between 32 and 87.7 years, were involved across 33 studies. All studies were on COVID-19 infections. In individuals without micronutrient deficiency, there was a significant reduction on odds of COVID-19 incidence (pooled OR: 0.37, 95% CI: 0.18, 0.78), and ICU admissions or severe/critical disease onset when combined as a severity outcome (pooled OR: 0.26, 95% CI: 0.08, 0.89). Insignificant protective effects were observed on other outcome measures, namely mortality, ICU admission, progression to respiratory-related complications, severe/critical disease onset or requiring respiratory support and hospitalization rate. Conclusion: The absence of micronutrient deficiency significantly reduced COVID-19 incidence and clinical deterioration in hospitalized patients. Usage of micronutrients as prophylaxis and complementary supplement in therapeutic management of COVID-19 patients may be a promising and cost-effective approach warranting in-depth investigation.
Highlights
Coronaviruses are a family of enveloped RNA viruses capable of infecting both humans and animals [1]
Due to an inappropriate scale of exposure measurement for pooling or outcome measure reported, or lack of sufficient studies with similar outcome definitions, only 19 studies were subsequently included in the meta-analysis (Figure 1)
The meta-analysis pooled the following outcomes for studies assessing the effect of micronutrient deficiency: incidence of episodes, mortality, intensive care unit (ICU) admission, progression to respiratory-related complications and clinical severity according to study-specific definitions
Summary
Coronaviruses are a family of enveloped RNA viruses capable of infecting both humans and animals [1]. In the past two decades, three beta coronaviruses—severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019—with epidemic potential have spilled over from animal reservoirs and affected humans worldwide. Outbreaks caused by SARS-CoV and MERS-CoV were relatively contained, compared to the ongoing COVID-19 pandemic by the SARS-CoV-2. During the eight months where SARS-CoV was actively spreading, the disease infected 8437 people across 29 countries, of which 813 died before the outbreak was declared to be contained globally [2,3]. Since outbreak initiation in April 2012, there were 2566 MERS-CoV cases and 882 associated deaths reported from 27 countries globally. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted.
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