Vitamin A and D deficiencies in the prognosis of respiratory tract infections: A systematic review with perspectives for COVID-19 and a critical analysis on supplementation

Authors

DOI:

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

Keywords:

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

Abstract

Considering the rapid spread of COVID-19, the scientific community has been looking for ways to recognize factors that may interfere with the outcome of viral infection. Despite the lack of studies with the new coronavirus, it is known that adequate serum levels of micronutrients are essential for the organic response to infectious diseases. Thus, we aim to review the effects of vitamin A, D, iron, zinc, or folate deficiency on the prognosis of patients with respiratory infections with manifestations similar to COVID-19 and discuss about supplementation of the nutrients analyzed in this review. The search was conducted in the databases PubMed, Lilacs, and SciELO, including observational studies published between 2010-2020, with results for individuals with respiratory tract infections with manifestations similar to COVID-19. Six articles met the inclusion criteria, all of which were related to deficiencies of vitamins A and D. In general, vitamin A deficiency was associated with cough, fever, and greater total respiratory resistance. Regarding vitamin D, the lack of this nutrient led to higher rates of ICU admission, the need for mechanical ventilation, and mortality. Evidence linking specific relationships between nutritional deficiencies and COVID-19 remain lacking due to the small number of studies and heterogeneities in population subgroups. In conclusion, deficiencies of vitamins A and D seem to negatively affect the prognosis of respiratory tract infections. Supplementation of these nutrients for prevention or treatment of patients diagnosed with COVID-19 should respect serum levels, nutritional status and housing conditions (e.g.,endemic location) of individuals.

References

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

Published

2022-11-16

How to Cite

Santos, T. M., Andrade, M. I. S., de Macêdo, P. F. C., Oliveira, T. P., Lima, N. S., & Ribeiro, I. C. (2022). Vitamin A and D deficiencies in the prognosis of respiratory tract infections: A systematic review with perspectives for COVID-19 and a critical analysis on supplementation. Context and Health Journal, 22(46), e11026. https://doi.org/10.21527/2176-7114.2022.46.11026

Issue

Section

Artigos