COVID-19: Is there a role for immunonutrition in obese patient?

Abstract

On December 12, 2019 a new coronavirus (SARS-CoV-2) emerged in Wuhan, China, triggering a pandemic of severe acute respiratory syndrome in humans (COVID-19). Today, the scientific community is investing all the resources available to find any therapy and prevention strategies to defeat COVID-19. In this context, immunonutrition can play a pivotal role in improving immune responses against viral infections. Immunonutrition has been based on the concept that malnutrition impairs immune function. Therefore, immunonutrition involves feeding enriched with various pharmaconutrients (Omega 3 Fatty Acids, Vitamin C, Arginine, Glutamine, Selenium, Zinc, Vitamin, E and Vitamin D) to modulate inflammatory responses, acquired immune response and to improve patient outcomes. In literature, significant evidences indicate that obesity, a malnutrition state, negatively impacts on immune system functionality and on host defense, impairing protection from infections. Immunonutrients can promote patient recovery by inhibiting inflammatory responses and regulating immune function. Immune system dysfunction is considered to increase the risk of viral infections, such as SARS-CoV-2, and was observed in different pathological situations. Obese patients develop severe COVID-19 sequelae, due to the high concentrations of TNF-α, MCP-1 and IL-6 produced in the meantime by visceral and subcutaneous adipose tissue and by innate immunity. Moreover, leptin, released by adipose tissue, helps to increase inflammatory milieu with a dysregulation of the immune response. Additionally, gut microbiota plays a crucial role in the maturation, development and functions of both innate and adaptive immune system, as well as contributing to develop obese phenotype. The gut microbiota has been shown to affect lung health through a vital crosstalk between gut microbiota and lungs, called the “gut-lung axis”. This axis communicates through a bi-directional pathway in which endotoxins, or microbial metabolites, may affect the lung through the blood and when inflammation occurs in the lung, this in turn can affect the gut microbiota. Therefore, the modulation of gut microbiota in obese COVID-19 patients can play a key role in immunonutrition therapeutic strategy. This umbrella review seeks to answer the question of whether a nutritional approach can be used to enhance the immune system’s response to obesity in obese patients affected by COVID-19.

The Implications of Zinc Therapy in Combating the COVID-19 Global Pandemic

“…[272][273][274] Moreover, research studies reported that the immune physiology could be restored to the normal level by consuming a balanced diet and, if necessary, supplementing micronutrients and trace elements. 274,275 In this manner increases resistance to infection and supports quicker recovery from infectious diseases by reducing both inflammation and oxidative stress triggered by several reasons. 255,272,274,275 By this means, micronutrient insufficiencies have been identified as an international public health concern.…”

“…274,275 In this manner increases resistance to infection and supports quicker recovery from infectious diseases by reducing both inflammation and oxidative stress triggered by several reasons. 255,272,274,275 By this means, micronutrient insufficiencies have been identified as an international public health concern. 258,276,277 A recent study by Darnton-Hill reported that selenium, iron, potassium, sodium, calcium, magnesium, folic acid, copper, and zinc play an important role in improving the immune physiology and patient recovers earlier and decrease hospital stay among COVID-19 patients.…”

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

“…It is possible that stay-at-home policies in conjunction with social distancing may exacerbate weight gain via their effects on physical activity and diet patterns. Current data and expert opinion highlight the significance of vitamins D and C, minerals such as zinc, nutraceuticals such as curcumin, and the maintenance of adequate hydration, proposing also moderate consumption of fat, preferably unsaturated fats, and avoidance of salt and sugar intake [ 94 , 185 , 186 ]. The Mediterranean diet represents one of the healthiest dietary approaches globally, recognized for its demonstrated preventive actions in T2DM and cardiometabolic disorders in a plethora of trials [ 187 ].…”

“…It is possible that stay-at-home policies in conjunction with social distancing may exacerbate weight gain via their effects on physical activity and diet patterns. Current data and expert opinion highlight the significance of vitamins D and C, minerals such as zinc, nutraceuticals such as curcumin, and ✓ HbA1c should be assessed in patients with COVID-19 with hyperglycemia and/or ketoacidosis to identify potential undiagnosed DM ‡ Position statement by the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the Heart Failure Society of America ACE, angiotensin-converting enzyme; AKI, acute kidney injury; ALT, alanine aminotransferase; ARBs, angiotensin receptor blocker; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein; CV, cardiovascular; DIC, disseminated intravascular coagulation; DKA, diabetic ketoacidosis; DM, diabetes mellitus; DPP-4, dipeptidyl peptidase 4; eGFR, estimated glomerular filtration rate; ESR, erythrocyte sedimentation rate; GLP-1R, glucagon-like peptide 1 receptor; IL, interleukin; MERS, Middle East respiratory syndrome; PPAR-γ, peroxisome proliferator-activated receptors-γ; SGLT2: sodium glucose co-transporter 2; TCZ, tocilizumab the maintenance of adequate hydration, proposing also moderate consumption of fat, preferably unsaturated fats, and avoidance of salt and sugar intake [94,185,186]. The Mediterranean diet represents one of the healthiest dietary approaches globally, recognized for its demonstrated preventive actions in T2DM and cardiometabolic disorders in a plethora of trials [187].…”

Fasting: How to Guide

“…Starting with and maintaining an adequate LM is compulsory to reach all the benefits of the fasting state in terms of body composition. Maintaining a correct nutrition status is crucial, especially in a period when the immune system is stimulated and involved in internal reset [ 128 , 129 ]. Water intake is also important.…”