Nutrition

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trader32176
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Nutrition

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Nutritional status may impact susceptibility to COVID-19, study says

10/22/20


https://www.news-medical.net/news/20201 ... -says.aspx


Nutrition plays an integral role in maintaining a healthy body, including the immune system to ward off diseases. Amid the coronavirus disease (COVID-19) pandemic, nutritional status has been tagged as a risk factor for developing severe illness, including obesity and malnutrition.

Now, a team of researchers at the London School of Hygiene & Tropical Medicine and the University of Oxford wanted to provide a systematic review of the latest evidence on how malnutrition across all forms, including undernutrition, obesity, and micronutrient status, may influence the susceptibility and severity of COVID-19.

Nutrition and COVID-19


The continuous spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has resulted in a global pandemic, with infections topping more than 41.5 million cases and the death toll reaching more than 1.13 million.

As the pandemic evolves, studies have linked risk factors related to nutrition and the progression of COVID-19. Meanwhile, the pandemic has also exacerbated the risk factors for malnutrition in all its forms. The reasons include alteration in agricultural production and market linkages, which have led to food price increases, and lack of nutritious food items.

Understanding the link between nutritional status and COVID-19 risk is important to produce evidence-based recommendations.

The study


In the study, published on the preprint journal medRxiv*, the researchers synthesized information on 13 nutrition-related components and their relationship with COVID-19 – overweight, obesity, and diabetes, protein-energy malnutrition, vitamins A, C, D, and E, anemia, iron, selenium, zinc, poly-unsaturated fatty acids, antioxidants, and nutritional support.

Of the 13 searches, there were a total of 2,732 articles from EMBASE and PubMed, 4,164 articles from preprint servers, and 433 trials were returned. A total of 288 published and 278 preprint articles were considered for full-text assessment.

Of all the articles, the team arrived at 22 published articles, 39 preprint articles, and 79 trials. The team has found that the studies cover a wide array of mechanistic and observational evidence to underline nutrition's role in the susceptibility and progression of COVID-19. Yet, there is still limited proof that high-dose supplementation of these micronutrients can help prevent infection.

The current study synthesizes the information to add to existing reviews, bringing 13 systematic reviews into one. However, the team said that up to date, there is no conclusive evidence supporting novel nutritional therapies in battling COVID-19. The team said that public health strategies to reduce micronutrient deficiencies and undernutrition are still essential. Further, preventing obesity and type 2 diabetes can also markedly reduce the risk of severe COVID-19.


"To date, there is no evidence supporting the adoption of novel nutritional therapies, although results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies, undernutrition, and over-nutrition remain of critical importance, drawing on the numerous lessons learned from other viral diseases," the team concluded in the study.

COVID-19 global toll

Understanding ways to prevent and potentially curb the current COVID-19 pandemic is crucial as the virus wreaks havoc across the globe. The total case toll has now reached more than 41.47 million, while the deaths rose to more than 1.13 million.

The United States also reports high numbers of cases, with more than at least 8.4 million cases and more than 222,000 deaths. India follows with more than 7.70 million infections and more than 116,000 deaths.

Other countries who report a high number of cases include Brazil, with more than 5.29 million, Russia, with more than 1.45 million, and France, with more than 1.04 million cases.

As the number of active cases increases and some countries are reporting their second waves, it is crucial always to remember to wash the hands, practice social distancing and wear a mask at all times, especially when outdoors.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information

Source:

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) - https://gisanddata.maps.arcgis.com/apps ... 7b48e9ecf6

Journal reference:

James, P.T., Ali Z., Armitage, A. et al. (2020). Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review. medRxiv. https://www.medrxiv.org/content/10.1101 ... 20214395v2
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Re: Nutrition

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Immunonutrition may improve COVID-19 patients' recovery

11/26/20

https://www.news-medical.net/news/20201 ... overy.aspx

Researchers duo Emma Derbyshire and Joanne Delange from the Nutritional Insight, Surrey, United Kingdom, explore the role of immunonutrition – nutrition that boosts or influences the immune system for those over 65 years of age in COVID-19. Their study titled, “COVID-19: is there a role for immunonutrition, particularly in the over 65s?,” was released in the latest issue of the BMJ Nutrition, Prevention and Health.

Background


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), since its emergence in late December 2019 in the city of Wuhan, Hubei Province, China, has infected over 60 million people worldwide, with over 1.43 million succumbing to severe COVID-19 disease. The World Health Organisation (WHO) declared a pandemic on the 11th of March this year, and since then, the pandemic remains one of the most significant public health problems in recent human memory.

Public health strategies to prevent the spread of this highly infective virus include social distancing, prevention of gatherings, wearing masks, and hand hygiene. The focus has not been on the immune system and foods that could help boost the immune system, write the researchers.

This review attempted to gather the present evidence in favor of immune-nutrition or nutrition and diet that helps boost the immune system, especially among the elderly who are more susceptible to the SARS CoV-2 infection and its complications.

The researchers call immunonutrition a form of prevention of disease or “prehabilitation,” which could help the “body to cope with potentially lethal viruses such as coronavirus.”

Prehabilitation

The researchers explain that the definition of prehabilitation in scientific literature says these are “interventions that can help improve patient’s health in advanced of being exposed to a physiological stressor, so they are then better able to cope with that stress.”
Nutrition and disease

The researchers say that there is ample evidence that poor nutrition, protein-energy malnutrition as well as deficiencies of micronutrients such as vitamins and minerals are part of “related lifestyle factors” which can contribute to a suboptimally functioning immune system.

Certain components of the diet, including fruit, vitamin C, antioxidants, vitamins, minerals, and probiotics, are termed as immunonutrition that could help boost immunity and have a possible role in “resisting respiratory viruses and diseases,” write the researchers.

SARS CoV-2 and immune system

The COVID-19 pandemic raging around the world is caused by the SARS-CoV-2, which is part of the coronavirus family. At present, there are no safe and effective treatments against this virus nor vaccines to prevent infection. SARS-CoV-2, in some vulnerable individuals, especially the elderly, may lead to atypical viral pneumonia. Some may even need oxygen or artificial ventilation and ICU care. Elderly with other health problems such as heart disease, obesity, diabetes, etc., may have a greater risk of developing complications such as acute respiratory distress syndrome (ARDS), leading to multiple organ failure and even deaths.

The immune system has four components - T cells, B cells, the complement system, and phagocytes. There are two arms of the immune system – innate and adaptive immunity. These protect the body against infections. A healthy diet and nutrition boost the immune system.

The team writes that Professor Philip Calder, an expert on immune nutrition, says in his paper, “Feeding the Immune System,” that the immune system functions by acting as a barrier against incoming infections.

Age and immune system

With age, the immune function declines. This is called ‘immunosenescence.’ Both innate and acquired immune systems decline with age. The reasons for this decline include:

Reducing functions of the T cells due to involution of the thymus gland and also reduced production of new naïve T cells
“Inflammaging” or inflammation associated with aging processes
Poor nutritional status associated with age. There is typically micronutrient deficiencies seen in the elderly
Menopause and andropause can also contribute to nutritional deficiencies

Immunonutrition and COVID-19

Some of the main findings from the scientific literature search by the researchers were:

A healthy immune system requires vitamins A, D, C, E, B6, B12, folate, copper, iron, zinc, and selenium. There is an interplay of these nutrients in a healthy immune system
Immunonutrients of considerable importance are vitamin C, D, and zinc.
Vitamin C helps in the development of the epithelial barrier functions of the respiratory system that prevents invasion by pathogens. It can help prevent pneumonia.
Vitamin D is a powerful immunoregulator. B and T lymphocytes, macrophages, and monocytes are some of the immune cells that have vitamin D receptors on their surface. Vitamin D has a protective role in respiratory infections
Authors write, “Zinc is regarded as a ‘gatekeeper’ of immune function.”

Recommendations

The researchers wrote, “The general public and indeed the aging population should be encouraged to follow guidance from Public Health England and continue taking supplements containing 10 μg of vitamin D daily...”. They recommend foods rich in vitamin C (broccoli (60 mg/100 g), blackcurrants (130 mg/100 g), fortified breakfast cereals (up to 134 mg/100 g) and oranges (37–52 mg/100 g). They recommend foods rich in natural zinc such as “canned crab (5.7 mg/100 g), canned shrimps (3.7 mg/100 g), canned adzuki beans (≈2.3 mg/100 g) and boiled eggs (1.3 mg/100 g)”. The recommendations are for vitamin D supplementation with an upper limit of 50 µg/day and an upper limit of daily zinc at 25 mg/day.

Future directions

There is a dearth of studies that examine the effects of immune nutrients on “vulnerable groups such as those aged >65, with underlying health conditions, such as asthma, chronic obstructive pulmonary disease, diabetes, and heart disease, or who are immunosuppressed”.

The research duo feels that public health strategies should also focus on immunonutrition as a form of prehabilitation to prevent the spread of the infection, boost recoveries and reduce the burden on the healthcare systems due to an increase in hospital admissions.

Journal reference:


Derbyshire E, Delange JCOVID-19: is there a role for immunonutrition, particularly in the over 65s? BMJ Nutrition, Prevention & Health 2020;3, doi: 10.1136/bmjnph-2020-000071, https://nutrition.bmj.com/content/3/1/100
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Re: Nutrition

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Healthy diet plays vital role in warding off COVID-19

11/29/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


The COVID-19 pandemic continues to spread globally, with over 62.26 million people infected. With the rapid spread of its causative agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is crucial to determine ways to prevent infection.

The immune system protects the host from pathogenic organisms, including viruses, bacterial, fungi, and parasites. To deal with a broad range of threats, the immune system has evolved to include many specialized cell types that communicate and work in tandem to fight off infections.

Since the immune system is active in carrying out surveillance throughout the day, it needs adequate nutrients. Several vitamins and trace elements have been shown to reduce the risk of infections.

A researcher at the School of Human Development and Health, Faculty of Medicine, University of Southampton, explored nutrition's role in boosting the immune system to combat COVID-19 infection.

The study published in the BMJ Nutrition, Prevention & Health highlights the importance of nutrition in boosting the immune system's ability to fight off infection.

The immune system

The immune system is a complex network of cells and proteins that defends the body against infection. It keeps a record of every pathogen it has ever encountered to recognize and kill it if it enters the body again.

Immunological memory refers to the immune system's ability to quickly recognize an antigen that the body has previously encountered and initiated a corresponding immune response.

Many factors could alter the body's immune response. Aging can be tied to a loss of immune system competence, called immunosenescence.

Immunosenescence is characterized by reduced immune cells, including T lymphocytes, B lymphocytes, dendritic cells, neutrophils, monocytes, macrophages, and natural killer cells.

One factor associated with immunosenescence is a reduction of immune cells from the bone marrow, where these cells come from. All these processes that occur in old age could predispose older people to more severe COVID-19.

Obesity is also tied to a reduced immune response. Usually, obese people experience impairments in the activity of helper T lymphocytes, cytotoxic T lymphocytes, B lymphocytes, and natural killer cells. They also have reduced antibody and interferon-gamma (IFN-y) production. This predisposes them to develop severe COVID-19.

Also, obese people may have a poorer response to vaccination. Obesity has also been linked to increased blood concentrations of many inflammatory mediators, a state of chronic low-grade inflammation. When infected, the immune system may mount an excessive inflammatory response like a cytokine storm, making them vulnerable to severe COVID-19.

Nutrition and immunity

The immune system functions at all times, but specific cells become activated by the presence of pathogens. The activation leads to a marked increase in the immune system's demand for energy-yielding substrates, including fatty acids, glucose, and amino acids.

Some nutrients, such as vitamin A and D, are direct regulators of the gene expression in immune cells. They play essential roles in the maturation, differentiation, and responsiveness of immune cells.

Antioxidants also play critical roles in protecting the body against oxidative stress. Classic antioxidant vitamins include vitamin C and E, including antioxidant enzymes such as catalase, glutathione peroxidase, and superoxide dismutase.

Hence, keeping the body well-nourished is crucial to combat the coronavirus pandemic. Good nutrition provides an environment where the immune system can respond quickly and appropriately to infection. Meanwhile, nutrient deficiency makes the body and the immune system unable to work correctly.

In a nutshell, keeping the body nourished with vitamins and minerals is essential in the fight against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In some cases, even if a person gets infected, the body's immune system can readily fight off the pathogen, reducing the risk of developing severe illness.

Vitamin A, B6, folate, C, D, and E, including trace elements like zinc, copper, iron, and selenium, have been demonstrated to play key roles in supporting the immune system and reducing the risk of infections.


"It would seem prudent for individuals to consume sufficient amounts of essential nutrients to support their immune system to help them to deal with pathogens should they become infected," the researchers explained.

"Consumption of a diet of diverse and varied plant-based and animal-based foods that are consistent with current healthy eating guidelines would be best to support the immune system," they encouraged.

Journal reference:


Philip C Calder (2020). Nutrition, immunity, and COVID-19. BMJ Nutrition, Prevention & Health. https://nutrition.bmj.com/content/3/1/74
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Re: Nutrition

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Research suggests importance of vitamin D for good health in the context of COVID-19

11/29/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


As the coronavirus disease (COVID-19) pandemic continues to spread globally, proactive measures to reduce the risk of infection are vital since there is still no approved vaccine to block severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nor drug approved for the safe treatment of COVID-19 disease.

Vitamin D deficiency has been tied to developing severe COVID-19. Correcting deficiency vitamin D status may be a good target in the battle against the pandemic.

A researcher at the UNC Nutrition Research Institute, University of North Carolina revealed that avoiding vitamin D deficiency may help reduce the risk of severe COVID-19.

Further, older, obese, and dark-skinned people are likely to need extra vitamin D, especially during the dark months of winter and spring.

Vitamin D deficiency and COVID-19


The SARS-CoV-2 outbreak first emerged in Wuhan City, China, in late December 2019. From there, it has spread to over 191 countries and territories. At present, more than 62.6 million individuals globally have been infected, with over 1.45 million lives lost.

The current study published in the BMJ Nutrition, Prevention, and Health, highlights the factors that can influence vitamin D status and how these are related to COVID-19.

Recent studies have shown the benefit of vitamin D in fighting respiratory infections. The active vitamin D metabolite, 1,25-dihydroxyvitamin D (1,25D), is produced in immune cells and triggers the expression of several genes tied to a healthy immune response.

The metabolite is also linked to the maturation and recruitment of macrophages, increased production of cathelicidin and other antibacterial peptides, and phagocytosis promotion.

However, in some areas worldwide, especially in places at a latitude greater than 40° and includes the United Kingdom, Central and Northern Europe, Canada and the northern half of the United States, and similarly some regions in the southern hemisphere, vitamin D deficiency is a common problem during the winter and spring seasons.

People with low vitamin D status are more likely to develop respiratory infections. Hence, amid the coronavirus pandemic, health experts believe boosting vitamin D levels is crucial to avert contracting COVID-19.

Further, a recent editorial noted that countries below the latitude of 35° North and across the southern hemisphere appear to have lower COVID-19 mortality rates than countries further to the North. The study author believes that a lower capacity to produce vitamin D at higher northern latitudes impairs vitamin D status during the cold season, contributing to high mortality rates.

Key modulators of vitamin D status

Several factors can influence vitamin D status. First, dietary intake plays a significant role in determining one's vitamin D status. Only a few foods, mainly fatty coldwater fish such as sardines, herring, mackerel, and salmon, contain naturally significant amounts of vitamin D.

Some doctors recommend vitamin D3 supplementation to boost vitamin D levels in the body. From the diet, most people get no more than very modest amounts of vitamin D.

Another key modulator of vitamin D status is ultraviolet B (UVB) light exposure. Most of the vitamin D in blood comes from skin exposure to ultraviolet light with wavelengths between 280 and 313 nm, commonly called ultraviolet B (UVB).

Getting adequate exposure to the sun will help boost vitamin D levels. However, spending too much time indoors, prolonged cloud cover, severe air pollution, covering skin with garments, and sunscreen can limit vitamin D production in the skin.

Aging can also affect how much vitamin D a person has in the body. Older age can lead to a lower vitamin D status. Older adults have progressive skin thinning, decreasing the amount of the 7-dehydrocholesterol precursor available for vitamin D conversion.

People who have excess weight may also suffer from low vitamin D status. In one study, the scientists found that the resulting decreased vitamin D status is reversible when excess weight is shed.

Further, some genetic variations may also influence vitamin D status. For example, skin tone can affect the body's capacity to produce vitamin D in the skin. In a study, nearly all non-Hispanic blacks and most Mexican-Americans had vitamin D insufficiency.

Now, in the context of the current COVID-19 pandemic, renewed attention to the very high prevalence of severe vitamin D deficiency there and elsewhere is in order," the researcher concluded in the study.

"Advanced age, obesity, dark skin tone, and risk-related genotypes, particularly in combination, are alarm signs that should prompt corrective action, typically with a moderate, individually tailored dose of supplemental vitamin D," he added.

The study author emphasizes that while vitamin D supplements' preventive potential should not be exaggerated, preventing vitamin D deficiency should be a widely shared goal. Since COVID-19 severity has also been associated with low vitamin D status, it is crucial for people who are at high-risk to monitor their vitamin D levels.

Journal reference:

Martin Kohlmeier. (2020). Avoidance of vitamin D deficiency to slow the COVID-19 pandemic. BMJ Nutrition, Prevention, and Health. https://nutrition.bmj.com/content/3/1/67
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Re: Nutrition

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Could the keto diet help prevent or mitigate severe COVID-19?

11/30/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


There is much evidence that obesity, hypertension and cardiovascular disease contribute significantly to adverse outcomes following coronavirus disease 2019 (COVID-19). It is rational to apply the principles of primary prevention in the attempt to contain this pandemic, by mitigating these risk factors. A new study published in the journal of Translational Medicine reports that the ketogenic diet (KD) may be useful in this area, with its track history of effectual reduction of fat mass, anti-inflammatory and immunomodulatory effects, and consequent improvement of cardiovascular health.

The current pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unique in that the virus is not an especially lethal pathogen, compared to Ebola, SARS, MERS or Lassa fever, with an overall case fatality ratio of 2.3%. However, it has led to the global imposition of lockdown measures, because of the rapid spread of the virus. Since this leads to thousands of new infections every day, even this small proportion of critical infection rapidly causes hospitals and intensive care units to fill up with patients requiring constant and multidisciplinary care. The outcome is that many patients are denied care, in the worst-case scenario as happened in Italy, while the healthcare system undergoes massive overwhelm, both due to overwork and the fact that many healthcare workers are infected or even die.

High-risk state of excessive fat mass


While obesity and cardiovascular risk factors predispose towards a poorer outcome, it is also important to note that the lockdown period in many cases led to a more sedentary lifestyle, which in itself may have worsened the health conditions of society as a whole. This results from insulin resistance, increased fat deposition, and low-grade inflammation, associated with obesity. Such individuals show an overall poor metabolic profile.

The state of sarcopenic obesity is a combination of poor muscle mass with high fatty tissue mass, and involves poor nutrition, reduced antiviral immunity, as well as dysregulated metabolism and inflammatory pathways. The authors note that this state in patients with critical COVID-19 is more commonly associated with a poor outcome than obesity without sarcopenia. Secondly, obesity is known to shift the individual to a high-risk COVID-19 group at a relatively younger age.

This relationship could be explained by the effect of fat deposition on the vertical movement of the diaphragm, restricting the lung capacity, as well as the immune and metabolic effects, and the low-grade inflammation induced by obesity. Fat cells also express ACE at high levels, which might indicate that the virus is harbored within these cells and that they act strategically to magnify the cytokine cascade to dangerous or dysregulated levels.

Potential for drugs to affect inflammatory and immune response

Dietary interventions are important in reducing this risk, most importantly by restricting junk food consumption, while substituting foods with high antioxidant and anti-inflammatory properties. Such lifestyle interventions are all the more crucial in view of the fact that several pharmacological therapies for diabetes or hypertension also play a key role in the homeostasis of glucose – in inflammation, and in renal activity as well as in cardiovascular health.

For instance, dipeptidyl peptidase-4 (DPP-4) inhibitors are used to lower glucose levels and influence the activity of many immunomodulatory molecules. ACE2 is the most widely recognized SARS-CoV-2 receptor in human host cells, and in mouse models, it has been found to be present at higher levels in the tissues of diabetic mice, though corresponding findings in humans are not available. Though this does not warrant discontinuation of such drugs as angiotensin receptor blockers (ARBs) or ACE inhibitors, two important anti-hypertensive classes, the authors say, "The possibility to avoid or interrupt potentially harmful pharmacological therapies with a lifestyle intervention should be carefully taken into consideration."

Adverse effects of diabetes on susceptibility

People with diabetes are more prone to acute viral respiratory infections such as H1N1 influenza, and high glucose levels have an immunosuppressive effect. Chinese research suggests a higher mortality associated with high plasma glucose levels in COVID-19 patients, which agrees with earlier studies in H1N1 and SARS patients.

People with diabetes appear to have poor lung function, thickening of the vascular membrane and alveolar epithelium, and an increased risk of acute respiratory distress syndrome (ARDS) is associated with a high glucose level at admission. The high glucose levels may also affect the immune and inflammatory pathways that drive the pathogenesis of pneumonia in these individuals. This may also increase the levels of glycosylated virus and glycosylated receptors, perhaps boosting up the susceptibility to the virus or to the severity of the illness.

Earlier studies have shown a link between hyperglycemia and high glucose concentrations in lung tissue, which, in turn, promotes infection and replication of the flu virus. In fact, with SARS-CoV-2, the virus is known to increase the production of reactive oxygen species (ROS), which, through a chain of processes, favors highly glycolytic metabolism of monocytes and macrophages, thus increasing the rate of replication markedly. The authors suggest that inhibitors of aerobic glycolysis could correct metabolism and thus suppress viral replication.

Inflammation, fat mass and severe COVID-19

Dysregulated inflammation also plays a major role in severe COVID-19, initiated by a delayed interferon-gamma response, with a lymphopenic state and prolonged inflammation. Hyperglycemia is a known immunosuppressant and pro-inflammatory state, with diabetics showing high M1 macrophages and low NK cell activity. In addition, they have a Th1/Th2 imbalance, with Th17 cells predominating over Treg cells.

The low-grade inflammation that accompanies excessive adipose tissue deposition is due to gut-derived dietary metabolites, fat cell-derived factors and cytokines related to cell death. These signals are amplified by recruited monocytes and macrophages that remove cell debris. Many inflammatory markers are correlated with the percentage of fat in the body, supporting the existence of this connection.

Keto diet – multiple mechanisms of benefit

Ketogenic diets (KDs) are a lifestyle intervention that aims at changing the metabolic state in the host from one that utilizes primarily carbohydrates to ketone-based metabolism, by a high-fat, low-carbohydrate dietary pattern. Interestingly, one researcher has previously suggested using intermittent fasting along with supplementary medium-chain triglycerides as a possible method to prevent or reduce the severity of SARS-CoV-2 infection. The expected benefits are increased mitochondrial resistance to stress, better antioxidant activity, greater DNA repair and autophagy of damaged cells, and insulin sensitivity. These chime in with the health benefits of keto diets.

KDs have been widely used to reduce body mass in severe obesity, metabolic disorders, migraine, and cancers, with adjustments in the composition of the overall pattern. In one particular group of very obese individuals who are at risk of cardiovascular disease, a very-low-calorie ketogenic diet (VLCKD) has been found to be very useful, supplying adequate nutrition while restricting carbohydrates to 30 g/day, making up the energy deficit by fat and protein. The daily caloric intake is reduced to 800kcal/day or less. These individuals have been shown to regain insulin sensitivity, good glycemic control and normal blood pressure, as they lose primarily fat mass, preserving muscle mass.

Metabolic correction

KD also treats metabolic (dysfunction) associated fatty liver disease (MAFLD), with a healthy reduction in the liver fat content and insulin resistance in the liver within a week of treatment. Short VLCKD regimens also improve glycemic control in type 2 diabetes mellitus, since the very low carbohydrate intake not only promotes weight loss, and prevents blood sugar spikes, but promotes hepatic insulin sensitivity, thus preventing the synthesis of glucose in the liver. These changes cause a marked improvement in beta-cell function. The extremely rapid pace of change requires such diets be followed under strict medical supervision.

Muscle-sparing and immunomodulatory effects


KDs also increase ketone body levels in plasma, including acetoacetate and betahydroxybutyrate. These can provide fuel for energy as well as upregulating genes that control oxidative stress. They also prevent muscle cell breakdown and reduce inflammation, in addition to immunomodulatory effects, thus exhibiting a broad spectrum of action in different tissues.

Ketone bodies inhibit inflammasome activation in response to viral infections, and could thus prevent the hyperinflammatory reaction associated with the cytokine storm in severe and critical COVID-19. Interestingly, M1 macrophages are known to be dependent on a supply of glucose for aerobic glycolysis. KDs could prevent their activation by drastically reducing the carbohydrate supply, while simultaneously sustaining M2 anti-inflammatory macrophages that use free fatty acids instead.

KD also promotes expansion of a specific type of T cell bearing γδ receptors. These γδ T cell receptor-bearing cells have immunomodulatory and anti-inflammatory activity. Perhaps they may be important in sustaining the lung epithelial barrier against this infection in the lung and in fat tissue. But only endogenous ketone bodies were able to protect mice against influenza, indicating the potential of KD to increase ketone bodies in a physiological manner and thus enhance the capacity of adaptive immune cells to prevent SARS-CoV-2 infection.

What are the implications of a keto diet in COVID-19?

VLCKD also helps lower blood pressure via increased sodium losses through urine in combination with ketonuria. Physical exercise would further increase the favorable effects of such a diet. Attention should be paid to setting up properly customized KDs to produce a permanent lifestyle modification in obese patients, reducing multiple risk factors for severe COVID-19 through multiple mechanisms. A study comparing severe COVID-19 incidence among obese patients on a KD versus those on an ordinary diet may throw more light on the validity of this hypothesis.

Journal reference:

Paoli, A. et al. (2020). The dark side of the spoon - glucose, ketones and COVID-19: a possible role for ketogenic diet? Journal of Translational Medicine. https://doi.org/10.1186/s12967-020-02600-9, https://translational-medicine.biomedce ... 20-02600-9
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Re: Nutrition

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Which dietary supplements can help prevent COVID-19?

12/1/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) agent, has infected over 63.47 million people worldwide and has killed over 1.47 million. The World Health Organization (WHO) declared the global spread of COVID-19 a pandemic on March 11, 2020. The pandemic has been dubbed by many as the largest public health and economic crisis of a generation.

Since the first case of the infection was detected late in 2019 in Wuhan, China, numbers have risen exponentially. Nearly a year on since COVID-19’s detection, advice regarding healthy diets and dietary supplements that can prevent infection or help alleviate symptoms has been flooding social and other media. Researchers collaborating from the United Kingdom, Sweden and the United States conducted a recent study surveying population use of dietary supplements over the past few months. Their study, titled “Dietary supplements during the COVID-19 pandemic: insights from 1.4M users of the COVID Symptom Study app: A longitudinal app-based community survey,” was released in the preprint server medRxiv* on November 30, 2020.

Dietary supplements and the immune system

Since the pandemic’s beginnings, several studies have shown that micronutrients such as vitamins C and D and zinc have been known to boost the immune system and reduce the risk of respiratory infection. With SARS-CoV-2 being a respiratory infection, these nutrients have been prescribed and advised by health care professionals since the beginning of the pandemic. The authors of this study wrote that these nutrients could be obtained from diets and dietary supplements, taken alone or as part of a multinutrient or multivitamin tablet.

Several other dietary supplements are also known to benefit health and the immune system. These include omega-3 fatty acids (“fish oil”), probiotics and plant isolates like garlic, wrote the researchers. They added, “The use of specific dietary supplements in both prevention and acute treatment of infection with SARS-CoV-2 has been promoted since the beginning of the current coronavirus pandemic”.

Increasing sales and consumption

The researchers wrote that the market sales of the dietary supplements rose by 19.5 percent in the UK in the time before March 2020 when the pandemic and nationwide “lockdown” was declared. Sales of vitamin C rose by 110 percent, and multivitamin supplement sales rose by 93 percent. Zinc supplement sales rose by 415 percent over just 7 days between 2-8 March 2020 in the US. Similar rises in sales were seen with Vitamin D supplements as well.

Study objective and design

This study was a longitudinal app-based community survey. It tested participants who had subscribed to a COVID-19 symptoms based app (COVID Symptom Study app). Self-reported regular dietary supplement usage was checked. This included, “probiotics, garlic, omega-3 fatty acids (“fish oils”), multivitamins, vitamin D, vitamin C or zinc.”

The study initially attempted to examine the rate of SARS-CoV-2 infection among 327,720 UK participants and their supplement use rate. To this was added data from 45,757 US and 27,373 Swedish participants using the app. They also checked self-reported loss of smell (anosmia) in 993,365 regular app users on dietary supplements who had not been tested for the infection. Anosmia remains one of the strongest predictors of COVID-19, the researchers explained.

Findings

Overall, the researchers found that:

Probiotics reduced the risk of SARS-CoV-2 by 14 percent (8 to 19 percent range)
Omega-3 fatty acids reduced the risk of SARS-CoV-2 by 12 percent (8 to 16 percent range)
Multivitamins reduced the risk of SARS-CoV-2 by 13 percent (10 to 16 percent range)
Vitamin D reduced the risk of SARS-CoV-2 by 9 percent (6 to 12 percent range)
Vitamin C, zinc or garlic supplements did not significantly reduce the incidence of SARS CoV-2 infection

Next the team broke down the participant population into gender, age and body mass index (BMI) classes and found that probiotics, omega-3 fatty acids, multivitamins and vitamin D protected females of all ages and BMI from SARS-CoV-2. The same protection was not seen among men. Similar protective effects were noted for the American and Swedish populations as well. The next part of the study, which checked for protective effects of the supplements and anosmia among 993,365 regular app users, also showed a similar protective effect.

Conclusions and implications

The researchers outlined the protective roles of the supplements as follows:

Vitamin D – the immune cells express the vitamin D receptor, and so it plays a role in the function of antigen-presenting cells, T-cells and B-cells. The team writes, “It [vitamin D] also promotes production of cathelicidin, a microbicidal component of the innate immune system.”
Multivitamins – the components of these have antioxidant properties, and studies have shown they may reduce the risk of respiratory infections
Omega-3 fatty acids – these play a role in the function of T-cell and B-cells and are anti-inflammatory.
Probiotics can alter gut microbiota and may generate anti-viral metabolites that strengthen the host immune system.
Zinc, Vitamin C and garlic – Studies have shown that they may play a role in reducing symptoms. Similar findings were not seen in this study.

This study revealed that there is a significant protective effect of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements against SARS-CoV-2 infection. The team wrote, “No clear benefits for men were observed nor any effect of vitamin C, garlic or zinc for men or women.”

The researchers called for further randomized trials with these supplements and their combinations to check for the protective efficacy of these agents against SARS-CoV-2.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Louca, Panayiotis (2020). Dietary supplements during the COVID-19 pandemic: insights from 1.4M users of the COVID Symptom Study app - a longitudinal app-based community survey. medRxiv preprint server. doi: https://doi.org/10.1101/2020.11.27.20239087,
https://www.medrxiv.org/content/10.1101 ... 20239087v1
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Re: Nutrition

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Low-income families have high awareness of healthy diets but can't afford good quality food

2/24/21


https://www.news-medical.net/news/20210 ... -food.aspx


Low-income families have a high awareness of healthy diets but can't afford good quality and nutritious food, new research shows.

The University of York study, in partnership with N8Agrifood, showed that participants tried to eat as much fruit and vegetables as they could within financial constraints, avoiding processed food wherever possible. But there was widespread acknowledgement that processed food was often more accessible than healthy options because of its lower cost.

The researchers said that while the diets of low-income households have been subject to much scrutiny and debate, there is currently limited evidence in the UK on the diet quality and food practices of households reporting food insecurity and food bank use.

" This research explores lived experiences of food insecurity, the notion of individual 'choice' and the underlying drivers of diet quality among low income families."

- Dr Maddy Power, Department of Health Sciences, University of York

"The findings suggest that educational interventions are likely to be less effective in tackling food insecurity and poor nutrition among people living on a low income, as the people who took part in our study had good knowledge about healthy diets, but quite simply couldn't afford to buy what was needed to maintain a recommended healthy diet."

Participants reported that access to healthy and fresh food was further constrained by geographic access. The availability of fresh and healthy food in local shops was perceived to be poor, but the cost of travelling to large supermarkets, where the quality and diversity of food may be better, was considered prohibitively expensive.

Awareness of being priced out of nutritious and fresh food because of low income reinforced the stigma of living with poverty and was a very visible and everyday example of socio-economic inequality particularly for parents and caregivers, who were keen to ensure their children had access to a healthy diet.

One respondent said, "It's not nice to feel you can't buy food that is healthy or better because it's more expensive."

Other participants acknowledged that processed food was often more accessible than 'healthy' options because of its lower cost with one person saying: "Healthy food is expensive and unhealthy food is cheap."

Researchers say policies focusing on addressing structural drivers, including poverty and geographical access to food, are needed.

The research also suggested a relationship between higher processed food consumption and having used a food bank.

Researchers say that the pandemic and the associated economic fallout has precipitated a sharp increase in food insecurity in the UK. In July 2020, roughly 16 per cent of adults - equivalent to 7.8 million people - reduced meal sizes or skipped meals due to insufficient income for food. This figure, which remained stable between April and July 2020, is roughly double rates of food insecurity before Covid-19

The study took place between 2018 and 2020 and involved participatory research conducted with families of primary school age children.

Dr Katie Jayne Pybus and Professor Kate Pickett from the Department of Health Sciences and Professor Bob Doherty from The York Management School also contributed to the research. The paper called, "The reality is that on Universal Credit I cannot provide the recommended amount of fresh fruit and vegetables per day for my children": Moving the conversation from a behavioural to a systemic understanding of food practices and purchases is published in Emerald Open Research as part of the N8Agrifood Collection.

Source:

University of York

Journal reference:

Power, M., et al. (2021) “The reality is that on Universal Credit I cannot provide the recommended amount of fresh fruit and vegetables per day for my children”: Moving from a behavioural to a systemic understanding of food practices [version 1; peer review: awaiting peer review]. Emerald Open Research. doi.org/10.35241/emeraldopenres.14062.1
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Re: Nutrition

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Family meals, conviviality, and the Mediterranean diet promote healthy eating among adolescents

4/6/21


https://www.news-medical.net/news/20210 ... cents.aspx


Eating together as a family, maintaining the Mediterranean diet's traditional customs of conviviality, influences the eating habits of adolescents and prevents eating behavior disorders, according to a new study prepared by scientists from the Universitat Oberta de Catalunya (UOC) and the Universitat Autònoma de Barcelona (UAB) and published in the open access International Journal of Environmental Research and Public Health.

" At a time when lockdown due to the pandemic has revived family meals, this study indicates one of the possible positive aspects of the situation that we have had to confront."

- Anna Bach-Faig from the Foodlab group, member of the Faculty of Health Sciences and study's researcher

The research establishes that family meal routines, such as sharing food, sitting around a table without digital devices or having a pleasant conversation, are beneficial aspects for adolescents and contribute to their health. In line with other studies it notes that this conviviality, which favors conversation and slower eating, helps adolescents to recognize the feeling of fullness during meals and, indirectly, prevents obesity.

The study, conducted by means of in-depth interviews of families in Catalonia with adolescents from 12 to 16 years old, analyses one of the least studied aspects of the Mediterranean diet: socialization at mealtimes and how the way in which we eat also affects our health.

"A healthy diet is not just what we eat but also how we eat it", explains Bach-Faig. "The Mediterranean diet is much more than a list of foods. It is a cultural model which includes how these foods are selected, produced, processed and consumed."

The importance of conversation

To determine the degree of conviviality in the families studied, the researchers analysed the frequency and duration of family meals, the place where they took place, the use of digital devices, the preparation of the food and the type of communication established in these gatherings.

According to the study, the majority of families only ate the evening meal together and their habits varied depending on whether they ate alone or with their loved ones. The research ascertained that family meals were a place for communication and socialization, and that when families devoted less time to them, did not sit at the table, were distracted by digital devices or did not engage in pleasant conversation during these gatherings, they also followed the Mediterranean diet to a lesser extent.

For the majority of parents, family meals were especially important when they had adolescent children, since they favour conversation and closer family bonds. "It is easier when children are small, but in adolescence there is a disconnect between you and them and, thanks to these conversations, you can gain a little insight into their world", explained one of the mothers interviewed.

Moreover, the majority considered that, through these family gatherings, parents become role models and help to establish healthy patterns for their children. This impression is consistent with the results of other studies in which it is demonstrated that eating together as a family is related to a healthier diet, with more fruit and vegetables, and less sugary drinks.

The Western diet

For nutrition expert Bach-Faig, it is essential to preserve eating traditions in order to maintain the benefits of the Mediterranean diet and promote the health of the younger generations. However, for several decades now, the Mediterranean diet has been losing influence in the face of the so-called "Western diet", characterized by the predominance of processed foods and eating quickly, often in front of the television.

The study stresses that it is crucial to consider these aspects in order to promote a healthy diet among adolescents and to design public health campaigns. One example was the Implica't campaign, carried out in Catalonia with the participation of researchers from this study. "Just as we recommend 5 fruit and veg a day", explains Bach-Fair, "we could also propose at least one family meal a day".

Source:

Universitat Oberta de Catalunya (UOC)

Journal reference:

de la Torre-Moral, A., et al. (2021) Family Meals, Conviviality, and the Mediterranean Diet among Families with Adolescents. International Journal of Environmental Research and Public Health. doi.org/10.3390/ijerph18052499.
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Re: Nutrition

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Americans are consuming poor nutritional quality food everywhere, except at school

4/13/21


https://www.news-medical.net/news/20210 ... chool.aspx


Whether eating out or buying food from the grocery store, Americans of all ages are, for the most part, eating poorly everywhere-;except at school. The information comes from a new dietary trends study, which also reveals persistent or worsening disparities in meal quality from restaurants, grocery stores, and other sources-;but not school-;by race, ethnicity, and income.

Published today in JAMA Network Open and led by researchers at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, the study analyzed all meals (including snacks and beverages) consumed by Americans over 16 years.

By 2018, the most recent year for which national data is available, meals with the lowest nutritional quality came from restaurants, where 65% of adult meals and 80% of children's meals were of poor quality. Entertainment venues and food trucks were next, with 44% of adult meals and 52% of children's meals being of poor nutritional quality. At work sites, 51% of adult meals eaten were of poor dietary quality.

Grocery stores were better sources of food, with 33% of adult meals eaten and 45% of children's meals being of poor quality. Schools were best, where only 24% of meals consumed by children were of poor nutritional quality.

" Schools are now the single healthiest place Americans are eating. This finding is particularly timely given widespread school closures over the last year from COVID-19, and current efforts to safely and fully reopen schools. Our results suggest substantial nutritional harms for millions of kids who have not been consistently receiving meals at school and must rely on other sources. These harms also disproportionately affect low-income, Black and Latinx children."

- Dariush Mozaffarian, Study Senior Author and Dean, Friedman School

Analyzing the diets of about 40,000 adults and 21,000 children between 2003 and 2018, the research team found significant improvements in the nutritional quality of school food consumed over this period, almost all happening after the passage of the federal Healthy, Hunger-Free Kids Act in 2010, which mandated much stronger school and early child care nutrition standards. The findings represent food as actually consumed from different U.S. sources, not what is theoretically available to be purchased.

In U.S. children from 2003 to 2018:

The proportion of poor nutritional quality food consumed from restaurants declined least, from 85% to 80%.
The proportion of poor nutritional quality food consumed from grocery stores declined modestly, from 53% to 45%.
The proportion of poor nutritional quality food consumed from schools was cut by more than half, from 57% to 24%.
Significant disparities were seen in improvements in food consumed from grocery stores, with greater improvements among whites than Blacks or Hispanics, and among children in households with greater family income or heads of household with higher educational attainment than with lower income or education.
In contrast, improvements in food consumed from schools were equitable by race/ethnicity, education, and household income.

"Our results underscore the fact that the nutritional quality of most meals, snacks, and drinks consumed in the U.S. remains poor, and with important differences by where the food is obtained," said Mozaffarian. "Improvement in schools was especially striking, large, and equitable across population subgroups. This is clearly linked to the 2010 Healthy Hunger-Free Kids Act, a powerful lesson on how a single federal policy can improve both nutrition and equity for millions of Americans. These findings are especially timely with the new focus of the presidential administration, USDA, and Congress on nutrition security."

"The nutritional improvements in foods obtained at school came from kids eating more of what's good for them, such as whole grains, total fruits, greens and beans, and less of what's harmful, such as sugary drinks, refined grains, and foods with added sugar," said first author Junxiu Liu, a postdoctoral scholar at the Friedman School at the time of the study, now assistant professor at the Icahn School of Medicine at Mount Sinai. "These were the specific targets of the Healthy Hunger-Free Kids Act."

Despite these improvements, Mozaffarian and Liu pointed out, school meals only provided 9% of calories for the average child over the course of an entire year, highlighting the importance of improving the nutritional quality of food choices from the other sources.

Grocery stores accounted for 65% of calories for children and 67% for adults, followed by restaurants at 19% of calories for children and 22% of calories for adults. Other sources, such as gifts from others, food trucks, and entertainment venues, represented 8% of calories for children and 9% for adults.

Additional results for U.S. adults from 2003 to 2018 include:

The proportion of poor nutritional quality food consumed from restaurants remained relatively stable, at 65%.
The proportion of poor nutritional quality food consumed from workplaces declined modestly, from 56% to 51%.
The proportion of poor nutritional quality food consumed from grocery stores declined modestly, from 40% to 33%.

"COVID-19 has changed the equation for where Americans are getting their food. Grocery stores were the main source before the pandemic, a trend which has only accelerated – including online. Restaurants that have survived the pandemic are now reopening. This is a perfect time to take stock of our food sources and choices as a nation and find policy solutions to put better nutrition on the table for all Americans," Mozaffarian said.

Methodology

This new study is part of a series led by Friedman School researchers investigating patterns and trends in diet quality among U.S. adults and children. The team used data from the nationally representative National Health and Nutrition Examination Survey (NHANES) and assessed nutritional quality using the American Heart Association (AHA) diet score and the Healthy Eating Index (HEI)-2015, which provided similar results. The authors note that self-reported food recall is subject to error, and there is no single, agreed-upon measure of dietary quality.

Source:

Tufts University
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Re: Nutrition

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Study finds correlation between COVID-19 pandemic and six unhealthy eating behaviors

4/12/21


https://www.news-medical.net/news/20210 ... viors.aspx


A new probe into the lingering impacts of the COVID-19 pandemic revealed correlations to six unhealthy eating behaviors, according to a study by the University of Minnesota Medical School and School of Public Health. Researchers say the most concerning finding indicates a slight increase or the re-emergence of eating disorders, which kill roughly 10,200 people every year -- about one person every 52 minutes.

U of M Medical School's Melissa Simone, PhD, a postdoctoral research fellow in the Department of Psychiatry and Behavioral Sciences, collaborated with School of Public Health professor and head of the Division of Epidemiology and Community Health, Dianne Neumark-Sztainer, PhD, MPH, to learn from study participants in Neumark-Sztainer's Project EAT between April and May 2020.

"The COVID-19 pandemic has resulted in the rapid implementation of public health policies to reduce transmission of the virus. While these protections are necessary, the disruptions to daily life associated with the ongoing pandemic may have significant negative consequences for the risk of eating disorders and symptoms," said Simone, who is the lead author of the study. "Eating disorders have one of the highest mortality rates across all psychiatric health concerns, and therefore, it is important to try to make links between the consequences of the pandemic and disordered eating behaviors.

The study aimed to understand potential associations between stress, psychological distress, financial difficulties and changes in eating behaviors during the COVID-19 pandemic through the analysis of both qualitative and quantitative data. Simone's findings, published in the International Journal of Eating Disorders, found six key themes of eating behavior changes:

Mindless eating and snacking;
Increased food consumption;
Generalized decrease in appetite or dietary intake;
Eating to cope;
Pandemic-related reductions in dietary intake;
And, a re-emergence or marked increase in eating disorder symptoms.

Approximately 8% of those studied reported extreme unhealthy weight control behaviors, 53% had less extreme unhealthy weight control behaviors and 14% reported binge eating. The study revealed that these outcomes were significantly associated with poorer stress management, greater depressive symptoms and moderate or extreme financial difficulties.


" There has been a lot of focus on obesity and its connection with COVID-19. It is also important to focus on the large number of people who have been engaging in disordered eating and are at risk for eating disorders during and following the pandemic. The majority of the young adults in our study are from diverse ethnic/racial and lower income backgrounds, who often do not receive the services they need. To ensure health inequities do not increase, we need to meet the needs of these populations."

- Dianne Neumark-Sztainer, Principal Investigator of Project EAT

Simone added, "The economic consequences of the COVID-19 pandemic will likely persist long beyond the dissemination of a vaccine. Because our findings suggest that moderate or severe financial difficulties may be linked with disordered eating behaviors, it is essential that eating disorder preventive interventions and treatment efforts be affordable, easily accessible and widely disseminated to those at heightened risk. As such, online or mobile-based interventions may prove to be effective and accessible modes for targeted intervention efforts."

Source:

University of Minnesota Medical School
Journal reference:

Simone, M., et al. (2021) Disordered eating in a population‐based sample of young adults during the COVID‐19 outbreak. Journal of Eating Disorders. doi.org/10.1002/eat.23505.
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