Deficiências de vitamina A e D no prognóstico de infecções respiratórias: Uma revisão sistemática com perspectivas para a Covid-19 e uma análise crítica sobre a suplementação

Autores

DOI:

https://doi.org/10.21527/2176-7114.2022.46.11026

Palavras-chave:

Nutritional Deficiency”, “Vitamin A”, “Vitamin D'', ''influenza'', ''coronavirus''

Resumo

Considerando a rápida disseminação da Covid-19, a comunidade científica tem buscado formas de reconhecer fatores que possam interferir no desfecho da infecção viral. Apesar da escassez de estudos com o novo coronavírus, sabe-se que níveis séricos adequados de micronutrientes são essenciais para a resposta orgânica às doenças infecciosas. Assim, objetivamos revisar os efeitos da vitamina A, D, deficiência de ferro, zinco ou folato no prognóstico de pacientes com infecções respiratórias com manifestações semelhantes à Covid-19 e discutir sobre a suplementação dos nutrientes analisados nesta revisão. A busca foi realizada nas bases de dados PubMed, Lilacs, e SciELO, incluindo estudos observacionais publicados entre 2010-2020, com resultados para indivíduos com infecções do trato respiratório com manifestações semelhantes à Covid-19. Seis artigos preencheram os critérios de inclusão, todos relacionados a deficiências das vitaminas A e D. Em geral, a deficiência de vitamina A esteve associada a tosse, febre e maior resistência respiratória total. A respeito de vitamina D, a carência desse nutriente levou a maiores taxas de internação em UTI, necessidade de ventilação mecânica e mortalidade. Evidência vincular relações específicas entre deficiências nutricionais e Covid-19 permanecem inexistentes devido ao pequeno número de estudos e heterogeneidades em subgrupos populacionais. Em conclusão, as deficiências de vitaminas A e D parecem afetar negativamente o prognóstico de infecções do trato respiratório. Suplementação desses nutrientes para prevenção ou tratamento de pacientes diagnosticados com Covid-19 deve respeitar os níveis séricos, o estado nutricional e as condições de moradia (por exemplo, localização endêmica) dos indivíduos.

Referências

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med.2020;382:727-733.

World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 84; 2020.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Zhu L, Wang J, Huang R, Liu L, Zhao H, Wu C et al. Clinical characteristics of a case series of children with coronavirus disease 2019. Pediatr Pulmonol. 2020;55(6):1.430-1.432.

Dong XC, Li JM, Bai JY, Liu ZQ, Zhou PH, Gao L et al. Epidemiological characteristics of confirmed COVID-19 cases in Tianjin. Zhonghua liu Xing Bing xue za zhi= Zhonghua Liuxingbingxue Zazhi. 2020;41(5):638-642.

Huang Y, Lu Z, Li R, Wang B. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6.049-6.057.

Saghazadeh A, Rezaei N. Immune-epidemiological parameters of the novel coronavirus–a perspective. Expert Rev Clin Immunol. 2020;6:1-6.

Gombart AF, Pierre A, Maggini S. A Review of Micronutrients and the Immune System–Working in Harmony to Reduce the Risk of Infection. Nutrients. 2020;12(1):236.

Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 2020;12(4):1.181.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W-65.

Preferred Reporting Items for Systematic Reviews. International prospective register of systematic reviews. https://www.crd.york.ac.uk/PROSPERO/ (accessed in 10 Apr. 2020).

Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Methodological guideline: how to conduct a systematic review and meta-analysis of observational comparative studies of risk factors and prognosis. Normas e Manuais Técnicos. 2014.

Ministério da Saúde. Secretaria de Vigilância em Saúde. Centro de Operações em Emergência em Saúde Pública. New Coronavirus Disease 2019 – COVID-19. 2020:1-18.

World Health Organization. Nutritional anemias: tools for effective prevention and control. Geneva, 2017.

World Health Organization. Assessing the iron status of populations: report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. Geneva, Switzerland, 6-8, Apr. 2004.

Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP da. STROBE initiative: guidelines on reporting observational studies. Rev Saude Publica. 2010;44(3):559-565.

Cebey-López M, Pardo-Seco J, Gómez-Carballa A, Martinón-Torres N, Rivero-Calle I, Justicia A et al. Role of vitamin D in hospitalized children with lower tract acute respiratory infections. J Pediatr Gastroenterol Nutr. 2016;62(3):479-485.

Brance ML, Miljevic JN, Tizziani R, Taberna ME, Grossi GP, Toni P et al. Serum 25‐hydroxyvitamin D levels in hospitalized adults with community‐acquired pneumonia. Clin Respir J. 2018;12(7):2.220-2.227.

Thornton KA, Mora-Plazas M, Marín C, Villamor E. Vitamin A deficiency is associated with gastrointestinal and respiratory morbidity in school-age children. J Nutr. 2014;144(4):496-503.

Amaral CT, Pontes NN, Maciel BLL, Bezerra HS, Triesta AN, Jeronimo SM et al. Vitamin A deficiency alters airway resistance in children with acute upper respiratory infection. Pediatr Pulmonol. 2013;48(5):481-489.

Hurwitz JL, Jones BG, Penkert RR, Gansebom S, Sun Y, Tang L et al. Low retinol-binding protein and vitamin D levels are associated with severe outcomes in children hospitalized with lower respiratory tract infection and respiratory syncytial virus or human metapneumovirus detection. J Pediatr. 2017;187:323-327.

Kim HJ, Jang JG, Hong KS, Park JK, Choi EY. Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia. Int J Tuberc Lung Dis. 2015;19(6):729-734.

Bailey RL, West Jr KP, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(Suppl. 2):22-33.

de Carvalho CA, de Almeida Fonsêca PC, Priore SE, Franceschini S do CC, de Novaes JF. Food consumption and nutritional adequacy in Brazilian children: a systematic review. Rev Paul Pediatr. 2015;33(2):211-221.

Darnton-Hill I. Public Health Aspects in the Prevention and Control of Vitamin Deficiencies. Curr Dev Nutr. 2019;3(9):nzz075.

Naja F, Hamadeh R. Nutrition amid the COVID-19 pandemic: a multi-level framework for action. Eur J Clin Nutr. 2020:1-5.

Guillin OM, Vindry C, Ohlmann T, Chavatte L. Selenium, Selenoproteins and Viral Infection. Nutrients. 2019;11(9). DOI: 10.3390/nu11092101

Childs CE, Calder PC, Miles EA. Diet and Immune Function. Nutrients. 2019;11(8). DOI: 10.3390/nu11081933

ISIN Position Statement on Nutrition, Immunity and COVID-19. 2020;March 2020.

Mawson AR. Role of Fat-Soluble Vitamins A and D in the Pathogenesis of Influenza: A New Perspective. ISRN Infect Dis. 2012;2013.

Qi YJ, Niu QL, Zhu XL, Zhao XZ, Yang WW, Wang XJ. Relationship between deficiencies in vitamin A and E and occurrence of infectious diseases among children. Eur Rev Med Pharmacol Sci. 2016;20(23):5.009-5.012.

Thurnham DI, McCabe GP, Northrop-Clewes CA, Nestel P. Effects of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet. 2003;362(9401):2.052-2.058.

Barbosa KC, Cunha DF, Jordão Jr AA, Weffort VR, Cunha SF. Transient decreased retinol serum levels in children with pneumonia and acute phase response. J Pediatr. 2011;87(5):457-460.

Xu C, Fang VJ, Perera RA, Kam AM, Ng S, Chan YH et al. Serum 25-Hydroxyvitamin D Was Not Associated with Influenza Virus Infection in Children and Adults in Hong Kong, 2009-2010. J Nutr. 2016;146(12):2506-2512. DOI: 10.3945/jn.116.234856

Mamani M, Muceli N, Basir HRG, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: A case-control study. Int J Gen Med. 2017;10:423.

Inamo Y, Hasegawa M, Saito K, Hayashi R, Ishikawa T, Yoshino Y et al. Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children. Pediatr Int. 2011;53(2):199-201.

Xu C, Fang VJ, Perera RA, Kam AM, Ng S, Chan YH et al. Serum 25-Hydroxyvitamin D Was Not Associated with Influenza Virus Infection in Children and Adults in Hong Kong, 2009-2010. J Nutr. 2016;146(12):2506-2512. DOI: 10.3945/jn.116.234856

Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systemic review. J Med Virol. 2020.

Chen H, Zhuo Q, Yuan W, Wang J, Wu T. Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age. Cochrane Database Syst Rev. 2008;(1).

Loeb M, Dang AD, Thiem VD, Thanabalan V, Wang B, Nguyen NB et al. Effect of vitamin D supplementation to reduce respiratory infections in children and adolescents in Vietnam: a randomized controlled trial. Influenza Other Respi Viruses. 2019;13(2):176-183.

Aglipay M, Birken CS, Parkin PC, Loeb MB, Thorpe K, Chen Y et al. Effect of high-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. Jama. 2017;318(3):245-254.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1.255-1.260.

Manaseki‐Holland S, Qader G, Isaq Masher M, Bruce J, Zulf Mughal M, Chandramohan D et al. Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial. Trop Med Int Heal. 2010;15(10):1.148-1.155.

Choudhary N, Gupta P. Vitamin D supplementation for severe pneumonia – a randomized controlled trial. Indian Pediatr. 2012;49(6):449-454.

Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.

Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12(4):988.

Downloads

Publicado

2022-11-16

Como Citar

Santos, T. M., Andrade, M. I. S., de Macêdo, P. F. C., Oliveira, T. P., Lima, N. S., & Ribeiro, I. C. (2022). Deficiências de vitamina A e D no prognóstico de infecções respiratórias: Uma revisão sistemática com perspectivas para a Covid-19 e uma análise crítica sobre a suplementação. Revista Contexto & Saúde, 22(46), e11026. https://doi.org/10.21527/2176-7114.2022.46.11026

Edição

Seção

Artigos