The Nutrition-COVID-19 Interplay: a Review

Abstract

Purpose of Review Nutritional status is affected by the COVID-19 pandemic, directly or indirectly. Even with the recent rollout of the coronavirus disease 2019 (COVID-19) vaccines and availability of medicines such as remdesivir, and monoclonal antibodies, host nutritional status is pivotal in the fight against the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and outcomes. The purpose of this review is to discuss the effects of COVID-19-related lockdown on lifestyle behaviors, and the nutritional consequences, and the direct sequelae of the infection on nutrition including potential nutritional interventions. Recent Findings The COVID-19-related lockdown imposed radical changes in lifestyle behaviors with considerable short-term and long-term health and nutritional consequences including weight gain and obesity and increased cardiometabolic risk, consistently linked to worsened prognosis. The extent of the impact was dependent on food insecurity, overall stress and disordered eating, physical inactivity, and exposure to COVID-19-related nutrition information sources. COVID-19 could directly induce inflammatory responses and poor nutrient intake and absorption leading to undernutrition with micronutrient deficiencies, which impairs immune system function with subsequent amplified risk of infection and disease severity. Nutrition interventions through nutrition support, dietary supplementation, and home remedies such as use of zinc, selenium, vitamin D, and omega-3 fatty acids showed the most significant promise to mitigate the course of COVID-19 infection and improve survival rates. Summary The nutrition-COVID-19 relationship and related dietary changes mimic a vicious cycle of the double burden of malnutrition, both obesity and undernutrition with micronutrient deficiencies, which promote infection, disease progression, and potential death.

Malnutrition Increases Hospital Length of Stay and Mortality among Adult Inpatients with COVID-19

“…These comorbidities have in common chronic systemic inflammation, a higher prevalence of sarcopenia, loss of lean body mass, and protein-calorie malnutrition, which impairs immunity to infectious agents, such as SARS-CoV-2 [ 4 , 5 , 6 , 7 , 8 ]. The COVID-19 pandemic has heightened the risks of sarcopenia and protein-calorie malnutrition due to restrictions in physical activity from lockdowns, inaccessibility to exercise facilities, limited public transportation, and food insecurity from supply chain disruptions [ 9 ]. Symptomatic infection by SARS-CoV-2 results in a catabolic inflammatory response coupled with inherent physical immobility, poor nutrient intake from dysgeusia and anosmia, and frequent gastrointestinal involvement [ 10 ].…”

Pandemic Preparedness: Maintaining Adequate Immune Fitness by Attaining a Normal, Healthy Body Weight

“…Additionally, diet can significantly prevent or induce low-grade inflammation [ 60 , 61 ]. Eating a high amount of ultra-processed energy-dense and other unhealthy food with a low amount of healthy nutrients can cause low-grade inflammation and increase the risk of infections and other immune-related disorders [ 62 , 63 ]. In this context, it has been shown that a lifestyle switch to no exercise and consuming an unhealthy diet for only two weeks has already resulted in reduced insulin sensitivity, a higher level of body fat, and low-grade inflammation [ 64 ].…”

“…In addition, it is important to note that only attaining a normal, healthy bodyweight will likely not be sufficient to promote adequate immune fitness. Mental health (e.g., stress reduction), healthy nutrition, and adequate and regular physical activity are factors that can directly improve immune fitness [ 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. Therefore, in terms of pandemic preparedness, attaining a normal, healthy BMI should be viewed as one of several measures that could be adopted by individuals.…”

Higher Adherence to the Mediterranean Dietary Pattern Is Inversely Associated With Severity of COVID-19 and Related Symptoms: A Cross-Sectional Study

“…Besides advanced pharmacological treatments, non-pharmacological interventions have gained attention to assist in combating primary and secondary events of COVID-19 ( 9 , 10 ). In this regard, dietary habits are critical due to their long-term physiological necessity ( 11 ).…”