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CORRESPONDENCE
Year : 2020 | Volume
: 22
| Issue : 2 | Page : 269-270
Nutritional prehabilitation in COVID-19 - “Food for Thought”
Neha Singh1, Sougat Ray2, Surbhi Gupta3
1 Phd Scholar, Centre for Community Medicine, AIIMS, New Delhi, India
2 SSO (Health), HQWNC, Mumbai, India
3 Senior Research Officer, National Centre for Excellence and Advanced Research, Centre for Community Medicine, AIIMS, New Delhi, India
Correspondence Address:
Lt Col (Dr) Neha Singh
Scholar Centre for Community Medicine, AIIMS, New Delhi
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jmms.jmms_177_20
The COVID-19 continues to affect the world with its puzzling inflammatory response, ranging from a very mild disease to extremely intense. It has disproportionately impacted the old and those with comorbidities, especially obesity and diabetes. Race, ethnicity, socioeconomic status, access to health care and increased exposure to the virus due to occupation (frontline health-care workers) have been implicated as critical risk factors.[1] Universal masking and social distancing have been the key concepts for the prevention of the disease with Gandhi and Rutherford[2] hypothesizing that masking has caused variolation which has led to increased number of asymptomatic cases. However, masking alone cannot control the pandemic and social distancing has a negative corollary toward economic activity. Evidence exists regarding building up a strong host immunity in the population through vaccination and nutrition, supplementing each other.
Cytokine storm is a hyperactive immune response to the innate immunity[3] and plays a key role in resistance against entry of novel pathogens. A durable innate immunity can be conferred by a vaccine, or by the presence of myeloid cells (monocytes, macrophages, and neutrophils).[4] On the other hand, the adaptive immunity builds up after the invasion of the pathogen and includes antibody formation to neutralize the virus; killer T cells to destroy the infected cells and the helper T cells to help in the production of antibodies and the killer T cells. Ideally, therefore, training the immune system to elicit a strong innate and adaptive immunity can thwart the infection and its severity.[5],[6] An array of micronutrients, particularly Vit C, Vit D, Zinc, Selenium and probiotics, aid in developing optimal immune response by modulating the secretion of cells such as neutrophils, macrophages and monocytes, required for innate immunity; and B and T lymphocytes for the development of the adaptive immunity.[7]
The effect of nutritional immune-modulation has been witnessed in the last 7 months of COVID lockdown. A healthy host immunity developed by resorting to large scale intake of healthy, nonjunk food along with immunity enhancing supplements, possibly has contributed to lessening the severity of the infection.[8] In contrast, consumption of the Western Diet, an ultraprocessed food, high in saturated fatty acids, omega 6/omega 3 ratio; and low in fiber, might have contributed to dysregulation in innate and adaptive immunity and individuals with obesity, diabetes, and heart diseases, who have suffered the most.[9] Moreover, micronutrient deficiencies are known to be associated with low-grade inflammation such as metabolic syndrome, diabetes and heart failure, conditions known to predispose COVID.[10]
Prehabilitation is a highly effective, graded approach to prevent or reduce the effects of a major surgery, by adding immune-nutrients and exercise to patients who are malnourished, suffering from either nutritional deficiency diseases or excess, by modulating the host immunity.[11],[12] Prehabilitated patients are better placed to cope the postoperative recovery period and safeguard the long-term functional status of such patients.[13] A meta-analysis by Osland et al.[14] found a 20% decrease in postoperative morbidity with a balanced preoperative nutrition in malnourished patients and Hughes et al.[15] found a 34% decrease of postoperative morbidity in prehabilitated patients. Targeted prehabilitation has been studied in diabetes patients with a low carbohydrate, high fat dietary approach, with significant improvements in HbA1C (P < 0.001), fasting glucose (P = 0.006), weight (P = 0.002) and body mass index (P = 0.002). Several other multimodal prehabilitation programs are presently underway successfully.[16]
Recent reviews have recommended early supplementation of Zinc, Selenium, Vitamin C, and Vitamin D to relieve escalation of COVID-19 in high-risk areas and/or soon after suspected exposure of SARS-CoV-2. Furthermore, nutritive adjuvant therapy should be prioritized in high-risk groups, which should be started prior to the administration of specific and supportive medical measures.[17] Patel et al.[18] studied the benefit of Vitamin A and D supplements on humoral immune responses following pediatric influenza vaccination and a higher antibody responses was noted among children who entered the study with insufficient or deficient levels of RBP and 25-hydroxyvitamin D. Researchers have also attempted to propose a protocol for the evaluation and extension of prescribed nutritional support to noncritical COVID-positive patients.[19] Another recent publication to evaluate the current evidence base relating to immunonutrition, with a particular focus on respiratory viruses in target population of above 65 years suggests promising evidence for Vitamins C, D, and zinc and their roles in preventing pneumonia and respiratory infections and reinforcing immunity.[10] A tailor-made, nutritional intervention has a strong possibility to reduce or prevent effects of COVID-19 by favorably enhancing the immune response.
Nutritional interventions are difficult to evaluate when combined with other known interventions to prevent diseases. Prehabilitation programs with dietary and exercise interventions have proven to be highly successful in reducing the severity of major surgeries as well as to reduce complications of diabetes. Improving resilience through a prompt, pragmatic nutritional support is an attractive approach to reduce the severity of COVID as well as speed up recovery in those who suffer from it. An enhanced host nutritional status will also add to the immunity response derived from vaccine. Our approach of prehabilitation is debatable, but to cope with the current crisis, immune supporting micronutrient rich food or supplementation, to the old and those with comorbidities, may allow the global community to “live with the virus.”
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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