Vitamin D and Zinc Supplementation to Improve Treatment Outcomes among COVID-19 Patients in India: Results from a Double-Blind Randomized Placebo-Controlled Trial

Partap, Uttara; Sharma, Kamal Kant; Marathe, Yogesh N.; Wang, Molin; Shaikh, Sanaa; D’Costa, Pradeep; Gupta, Gaurav; Bromage, Sabri; Hemler, Elena C; Mistry, Nerges; Kain, Kevin C.; Dholakia, Yatin; Fawzi, Wafaie W.

doi:10.1016/j.cdnut.2023.101971

Cited by 2 publications

(1 citation statement)

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“…In a separate clinical trial conducted as a randomly assigned 2 × 2 factorial placebo-controlled study with a 1:1:1:1 allocation ratio, which included nonpregnant adults with COVID-19 from hospitals in Mumbai and Pune, India, no significant impact of zinc supplementation alone was observed. This included its effect on the duration of specific symptoms, the requirement for mechanical ventilation, length of hospital stay, all-cause mortality, as well as various blood biomarkers encompassing nutritional, inflammatory, and immunological markers [244]. A completed RCT in Tunisia has not posted results yet.…”

Section: Completed Rcts With Clinical Outcomementioning

confidence: 99%

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

Briassoulis,

Ilia

et al. 2023

Antioxidants

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Zinc is a structural component of proteins, functions as a catalytic co-factor in DNA synthesis and transcription of hundreds of enzymes, and has a regulatory role in protein–DNA interactions of zinc-finger proteins. For many years, zinc has been acknowledged for its anti-oxidative and anti-inflammatory functions. Furthermore, zinc is a potent inhibitor of caspases-3, -7, and -8, modulating the caspase-controlled apoptosis and necroptosis. In recent years, the immunomodulatory role of zinc in sepsis and COVID-19 has been investigated. Both sepsis and COVID-19 are related to various regulated cell death (RCD) pathways, including apoptosis and necroptosis. Lack of zinc may have a negative effect on many immune functions, such as oxidative burst, cytokine production, chemotaxis, degranulation, phagocytosis, and RCD. While plasma zinc concentrations decline swiftly during both sepsis and COVID-19, this reduction is primarily attributed to a redistribution process associated with the inflammatory response. In this response, hepatic metallothionein production increases in reaction to cytokine release, which is linked to inflammation, and this protein effectively captures and stores zinc in the liver. Multiple regulatory mechanisms come into play, influencing the uptake of zinc, the binding of zinc to blood albumin and red blood cells, as well as the buffering and modulation of cytosolic zinc levels. Decreased zinc levels are associated with increasing severity of organ dysfunction, prolonged hospital stay and increased mortality in septic and COVID-19 patients. Results of recent studies focusing on these topics are summarized and discussed in this narrative review. Existing evidence currently does not support pharmacological zinc supplementation in patients with sepsis or COVID-19. Complementation and repletion should follow current guidelines for micronutrients in critically ill patients. Further research investigating the pharmacological mechanism of zinc in programmed cell death caused by invasive infections and its therapeutic potential in sepsis and COVID-19 could be worthwhile.

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Section: Completed Rcts With Clinical Outcomementioning

confidence: 99%

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

Briassoulis,

Ilia

et al. 2023

Antioxidants

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Vitamin D deficiency and the need to replenish it in COVID-19

Krivosheev,

Kozlovsky,

Nikitina

et al. 2024

Sanitary Doctor

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More than five years have passed since the beginning of the COVID-19 pandemic, but although the fundamental role of vitamin D’s effect on the immune system is quite obvious to the vast majority of specialists, there are publications expressing a sharply negative attitude towards the use of vitamin D preparations for the treatment of patients infected with SARSCoV- 2. The purpose of the work: «generalization of international experience on the issue of vitamin D deficiency in COVID-19 patients and the need to replenish it.» From the archive of the National Library of Medicine of the USA, containing 15,768 full versions of articles on the effect of vitamin D on the incidence of coronavirus in the population, we selected 49 articles presenting the results of clinical use of vitamin D preparations for the treatment of patients with a confirmed diagnosis of COVID-19. Of these, the results of 38 studies involving more than 3,800 patients infected with SARS-CoV-2 showed positive results of using vitamin D preparations as a therapeutic agent for the treatment of patients with a confirmed diagnosis of COVID-19 (improvement of inflammation markers, reduction of the need for artificial ventilation, reduction of the length of stay in the clinic, reduction of hospital mortality). In three more articles, the authors conclude that the use of vitamin D preparations for the treatment of patients with COVID-19 is ineffective, but they contain information about the usefulness of such use, although the differences in results in the intervention groups and control groups are not statistically significant. Seven articles indicate zero results from the use of vitamin D preparations, and one article says that taking vitamin D worsened the condition of critically ill patients. The ratio of positive, positive, but statistically insignificant, zero and negative results of clinical trials of vitamin D preparations for the treatment of patients with a confirmed diagnosis of COVID-19 (38:3:7:1) It is significantly biased towards the usefulness of vitamin D supplements to reduce the severity of the disease and reduce hospital mortality from coronavirus infection. The most common type of vitamin D drug used in COVID-19 therapy is cholecalciferol, calcidiol is less often used, and calcitriol and ergocalciferol are used even less often (isolated cases have been described). To date, calcidiol has demonstrated the greatest effectiveness in the complex therapy of COVID -19.

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Vitamin D and Zinc Supplementation to Improve Treatment Outcomes among COVID-19 Patients in India: Results from a Double-Blind Randomized Placebo-Controlled Trial

Cited by 2 publications

References 50 publications

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

Vitamin D deficiency and the need to replenish it in COVID-19

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