key: cord-318892-1vyhsg5k
authors: AbdAllah, Mohamed; Elarab, Hanan Ez; Raslan, Eman; Saber, Lobna; Daoud, Eitedal; Saber, Maha
title: Role of micronutrients in the management of COVID-19
date: 2020-10-10
journal: New Microbes New Infect
DOI: 10.1016/j.nmni.2020.100782
sha: 
doc_id: 318892
cord_uid: 1vyhsg5k

Micronutrients play an important role in enhancing the immune system, therefore, proper nutritional support of micronutrients could have a positive impact on COVID-19 outcome.

virus. It is a single-stranded RNA virus which was identified in China in December 2019 [1] .

The disease has an asymptomatic or mild course in 80% of cases where fever, cough and sore throat are its most common presentations [2] . Host immunological response against SARS-CoV-2 could affect the disease outcome. Higher levels of interleukins 6 -10 and tumor necrosis factor α are associated with poor outcome [3] .

Micronutrients play an important role in the immune system and subsequently could have a positive impact on COVID-19 outcome [4] . Antioxidants enhance natural killer cells and lymphocytic activity and increase interleukin-2 production [5] . Vitamin D is vital for the protection of the respiratory tract through preserving tight junctions, killing enveloped viruses and induction of cathelicidin and defensins. It also reduces the risk of cytokine storm through decreasing the production of pro-inflammatory cytokines but unfortunately, poor sun exposure during hospital stay or home isolation may aggravates vitamin D deficiency [6] . Additionally, Zinc has an inhibitory effect on RNA-dependent RNA polymerase of SARS-CoV-2 virus by binding and elongation in Vero-E6 cells [7] .

Based on the fore-mentioned data, the nutritional state of COVID-19 patients may affects the progression and outcome of illness. Despite the absence of any reports regarding malnutrition inside hospitals or home isolation during COVID-19 pandemic, conditions like chewing problems, physical disabilities and cognitive disturbance may precipitate malnutrition [8] .

According to the Egyptian guidelines for the management of COVID-19, daily supplementation of vitamin C (1gm) and zinc (50mg) is mandatory for all symptomatic cases. Most of the patients receive these requirements through pharmaceuticals. Consequently, drug shortage has been reported. Shifting to the natural sources of these elements has become preferable to ensure delivery of the needed requirements each day. Proper nutrition can also play a role in prophylaxis against COVID19. Some reports recommend Mediterranean diet plan as the most suitable pattern to be followed in quarantine [5, 9] . But unfortunately, lockdown and the other community preventive measures may affect people's diet plan.

Boredom and stress may lead to large caloric intake mainly carbohydrates. Carbohydrates enhance serotonin production which aids in stress relief , therefore, natural sources such as bananas, cherries, J o u r n a l P r e -p r o o f and oats may be a good healthier alternatives [5] . More studies need to be done to improve the nutritional plans as a complementary factor for both prophylaxis and treatment of COVID-19. *These data based on US NIH dietary supplement fact sheet (https://www.federalregister.gov/documents/2017/10/02/2017-21019/food-labeling-revision-of-thenutrition-and-supplement-facts-labels-and-serving-sizes-of-foods-that) ** Daily value(%) describes the ability of a certain amount and type of food to satisfy the recommended daily dietary allowance. In order to satisfy the daily needs of a nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights into Potential Drugs and Its Mechanisms. Pathogens

A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19)

SARS-CoV-2: a storm is raging

Micronutrient status of COVID-19 patients: a critical consideration

Nutritional recommendations for CoVID-19 quarantine

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture

Nutritional status and COVID-19: an opportunity for lasting change