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Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review

BMC Public Health volume 24, Article number: 1661 (2024) Cite this article

Abstract

Background

COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition.

Methods

This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria.

Results

Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D.

Conclusion

This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.

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Introduction

The significance of nutrition cannot be overstated when it comes to its impact on respiratory diseases. It is well-documented that nutrition has a profound influence on the immune system, which in turn affects the respiratory system [1]. This relationship has been confirmed by numerous studies conducted over the years [2,3,4]. Given the critical role of nutrition, it is imperative to further investigate its effects on respiratory health. This study aims to contribute to this body of knowledge and underscore the necessity of continued research in this area.

The role of nutrition in modulating the immune and respiratory systems and influencing the susceptibility and severity of COVID-19 has been a topic of interest for many researchers. Nutrition may affect the host response to viral infections, as well as the viral replication and transmission [5]. Dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns may have an impact on the prevention, progression, and recovery of COVID-19, as well as on the long-term complications and sequelae of the infection [6,7,8,9,10]. However, the evidence on the relationship between nutrition and COVID-19 is still emerging and inconclusive, and there are many gaps and challenges in the existing research.

The research on the relationship between food intake and serum levels of nutrients with coronavirus is limited. The observations regarding dietary intake and nutrient serum levels in relation to other respiratory infections, such as SARS, Middle East Respiratory Syndrome (MERS), influenza, seasonal colds and lung infections may be like those between dietary intakes and nutrient serum levels and COVID-19 [11]. Six review articles have been conducted in this area. One of these articles focused on clinical trials related to viral infections [12]. Another review summarized management strategies for critically ill patients [13]. Additionally, one review gathered information on effective pharmaceutical and nutritional treatments [14]. Furthermore, a study investigated the therapeutic effects of nutrients in boosting the immune system [15]. Moreover, another review provided guidance on hygiene and nutritional principles [16]. Finally, a systematic review encompassed all studies evaluating the role of dietary patterns and nutrients in immune system function and viral infections (Corona and MERS) [17].

Micronutrients play a crucial role in supporting the immune system, especially in the context of COVID-19 [18]. A balanced diet rich in essential nutrients like vitamin D, vitamin A, B vitamins (folate, vitamin B6 and vitamin B12), vitamin C, and minerals such as iron, copper, selenium, and zinc contribute to the normal functions of the immune system [18]. Deficiencies or even suboptimal intakes of these micronutrients in targeted groups of patients and in distinct and highly sensitive populations could potentially weaken the immune system, thereby increasing susceptibility to COVID-19 [18]. For instance, zinc and vitamins C and D are micronutrients with robust evidence of their immunomodulating activity, such that their deficiency, even if marginal, can compromise metabolism and, consequently, their action on the immune system [19]. It is important to note that while a balanced diet can help strengthen the immune system, it will not prevent or cure COVID-19 infection. Frequent handwashing and social distancing remain critical to reduce transmission. The relationship between micronutrients and COVID-19 is still being explored, and further research is needed to fully understand this complex interaction.

The COVID-19 pandemic has significantly impacted dietary patterns across various population groups [20]. The lockdown measures implemented in many countries have restricted access to fresh food and limited physical activity, leading to changes in eating habits [20]. For instance, a study conducted in Saudi Arabia found that the quarantine measures affected dietary patterns, with changes observed in the type and frequency of snack consumption, the main meal-type, and a significant increase in fluids consumption [21]. Moreover, a dietary pattern characterized by healthy plant-based foods was associated with a lower risk and severity of COVID-19 [22]. The relationship between dietary patterns and COVID-19 is complex and multifaceted, warranting further exploration. It is crucial to maintain a balanced diet rich in essential nutrients to support the immune system and potentially mitigate the impact of COVID-19.

The scope of this study is to explore the relationship between dietary intake, micronutrient serum levels, malnutrition, dietary patterns, and respiratory infections, with a particular focus on COVID-19. The need for this study arises from the ongoing COVID-19 pandemic and the increasing evidence suggesting a link between nutrition and immune response, particularly in relation to respiratory-related symptoms, which are the most common cause of COVID-19 mortality. This study aims to fill a gap in the current literature by examining a wide range of dietary factors, including specific micronutrients (vitamins A, E, D, and C, zinc, magnesium, iron, omega-3 fatty acids, probiotics), malnutrition, and overall dietary patterns. It also seeks to address the limited research on the impact of certain dietary components, such as omega-3 and fiber, on COVID-19 prevention. The findings of this study could potentially inform dietary recommendations for the prevention of COVID-19 and other respiratory infections, contribute to the development of public health strategies during the pandemic, and guide future research in this area. This study is therefore both timely and necessary in the face of the ongoing global health crisis.

Therefore, we conducted a narrative review to summarize and present the available literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We aimed to provide a comprehensive overview of the topic, and to track the development of the scientific and clinical concepts related to nutrition and respiratory infections. We also aimed to identify the strengths and weaknesses of literature, and to suggest some directions for future research.

Methods

Study framework

We aimed to review the current literature on the association between dietary intake and serum levels of micronutrients, respiratory infections, influenza, pneumonia, acute respiratory syndrome, and corona viruses, with a focus on COVID-19. We searched for relevant articles in various scientific databases and selected those that met our inclusion criteria.

Search strategy

We used MeSH terms (medical subject headings) and other related keywords: “Novel coronavirus 2019” or “2019 nCoV” or “COVID-19” or “Wuhan coronavirus” or “Wuhan pneumonia” or “SARS-CoV-2” or “severe acute respiratory syndrome coronavirus 2” or “respiratory disease” or “respiratory infection” or “acute lower respiratory tract infections” or “lung infection” or “influenza” or “COPD” or “inflammatory response” or “pneumonia” or “common cold” or “sepsis” or “acute respiratory distress syndrome” or “severe acute respiratory syndrome-related coronavirus” or “bronchitis” or “chronic obstructive pulmonary disease” or “obstructive pulmonary disease” AND “vitamin D” or “vitamin A” or “carotenoids” or “zinc” or “vitamin” or “selenium” or “folic acid” or “vitamin B” or “vitamin E” or “vitamin B12” or “cobalamin” or “thiamine” or “riboflavin” or “niacin” or “pantothenic acid” or “pyridoxine” or “biotin” or “folic acid” or “cobalamin” or “amino acid” or “omega 3” or “water” or “malnutrition”.

Inclusion and exclusion criteria

The inclusion criteria for the study were: 1) examination of the relationship between dietary intake and serum levels of nutrients with respiratory infections, influenza, pneumonia, or acute respiratory syndrome with a focus on coronavirus, and 2) all observational studies. The review excluded other types of human and animal studies, in vitro studies, irrelevant sources, and studies not published in English.

Data extraction

Database searches as well as reference extraction were performed by two separate investigators. In prospective studies, dietary intake and serum levels of nutrients measured at the beginning of the study were considered exposure variables, while respiratory infections, influenza, pneumonia, and acute respiratory syndrome were defined as outcome variables. Information was extracted on the first author’s name, year of publication, location of the study, age range of participants (in cohort studies at the start or in cross-sectional studies), gender, sample size, follow up duration (in prospective studies), number of participants who developed respiratory infections, influenza, pneumonia and acute respiratory syndrome during the study, person-years, and any adjustments made for confounding variables.

Results

A total of 292 studies were included in the review.

Dietary patterns

Healthy dietary patterns have been shown to activate the immune system through the gut microbiota [23,24,25,26]. A meta-analysis showed that a healthy dietary pattern was associated with lower prevalence of chronic obstructive pulmonary disease (COPD) [27]. To the best of our knowledge, there are no original research articles that have examined the causal effect of dietary pattern on COVID-19 prevention, symptoms, or mortality using rigorous methods such as randomized controlled trials.

Vitamin D

Several studies have indicated a relationship between vitamin D deficiency and an increased susceptibility to respiratory viral infections [28,29,30]. A meta-analysis of eight observational studies in adults found an association between vitamin D deficiency (VDD) and an increased risk of community-acquired pneumonia (CAP) [31]. Subsequently, seven original articles produced similar results [32,33,34,35,36,37,38]. A meta-analysis of six observational studies showed vitamin D deficiency was prevalent in patients with recurrent tonsillitis [39].

A meta-analysis of ten cohort studies in pregnant women showed no strong association between early life vitamin D status and the risk of developing respiratory tract infections (RTIs) in infants [40]. Of the 15 original studies published since then, four produced similar results while the rest produced conflicting conclusions [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. There is currently a meta-analysis on vitamin D in relation to acute viral airway infections in healthy adults which analyzed individual participant data from randomized controlled trials (RCTs). It found that vitamin D supplementation reduced the risk of acute respiratory tract infections among all participants [56]. However, a prospective cohort study found that serum concentration of 25- hydroxyvitamin D was associated with the incidence of acute viral respiratory infections [57]. Vitamin D deficiency in elite swimmers was also associated with increased acute upper respiratory tract infections [58]. Serum levels of vitamin D were also found to be a predictor of bronchitis [59] and an association was seen between symptoms of upper respiratory tract illness (URTI) and vitamin D deficiency in adults [60] and between low 25OHD levels and acute respiratory infections (ARI) in children [29]. No association was found between vitamin D and COPD [61]. There is currently no available meta-analysis on this topic.

A prospective study found that children with active tuberculosis had significantly lower vitamin D levels [62] but there has been no meta-analysis on this topic to date.

A meta-analysis of critically ill children with sepsis found that vitamin D deficiency was linked to increased mortality [63]. Seven subsequent articles confirmed these findings [54, 64,65,66,67,68,69]. Two original articles have found a significant association between low 25 (OH) D levels and mortality in critically ill patients [70] and a link between high vitamin D levels and reduced organ dysfunction [71]. No meta-analysis has been performed on vitamin D and subclinical interstitial lung disease (ILD) in adults, but Kim et al. found an association between vitamin D deficiency and subclinical ILD [72]. No meta-analysis has been performed for the relationship between cystic fibrosis in children and vitamin D, but Oliveira et al. (2019) found no connection between the severity of lung disease in cystic fibrosis group and vitamin D levels [73]. There has been meta-analysis on the relationship between respiratory disease and vitamin D in adults but low serum levels of 25 (OH) D were found to be associated with respiratory disease in the elderly [74].

Vitamin D deficiency has been identified as a risk factor for COVID-19 [75,76,77,78,79] With mean level of vitamin D being inversely associated with SARS-CoV-2 infection and fatality in the Indian population [80]. Studies have linked vitamin D deficiency to mortality from COVID-19 [81,82,83]. Vitamin D deficiency also impacted the severity and hospitalization of COVID-19 in China [84] and was associated with COVID-19 patient outcomes [85]. However, a study found no association between 25 (OH) D concentration and chronic inflammation, impaired pulmonary function tests, pathological outcomes on CT scans, or persistent symptoms [86]. Vitamin D deficiency was more prevalent in critically ill ICU patients infected with coronavirus [87] and several studies reported lower levels of vitamin D in hospitalized COVID-19 patients [88,89,90,91,92,93,94,95,96,97,98,99]. However, one study found no potential association between vitamin D concentrations and COVID-19 infection risk [100].

Vitamin E

Vitamin E supports the immune system through antioxidant activity [101, 102]. Regarding recurrent respiratory infection (RRI) in children, no meta-analysis on Vitamin E and RRI has been conducted. However, one study found a positive association between vitamin E deficiency and RRI [45]. No meta-analysis on the relationship between antioxidants and COPD has been published. In terms of serum levels, several studies have found that people with COPD had lower antioxidant status [103,104,105]. The benefits of higher serum concentration s of antioxidants on lung health have been shown in men [106, 107]. An imbalance between oxidants and antioxidants has been found in patients with COPD [108] but not in all studies [109]. There was no significant relationship between plasma Vitamin E levels and COPD severity [110]. A positive association between tocopherols and pulmonary gas diffusion was observed only in patients with lung disease [111]. Adherence to high antioxidant dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet, was found to be lower in lower in patients with COPD [112]. Vitamin E and olive oil intake were linked to reduced oxidative stress in current smokers with COPD [113]. A positive association was observed between a high intake of three antioxidants (vitamin C, vitamin E, and â-carotene) and pulmonary function, but this disappeared after adjusting for energy intake [114]. Other studies have shown an inverse association between diet and serum antioxidant levels and COPD [115,116,117,118].

Vitamin A

Vitamin A has been shown to have anti-infection properties in several studies [119,120,121,122]. A meta-analysis of 62 observational studies in children, supports the beneficial effects of vitamin A on infection [123]. However, subsequent research has produced conflicting results [124,125,126,127,128,129,130,131,132,133,134,135].

Studies have shown a positive association between vitamin A deficiency and respiratory infection in children [136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154]. Three studies showed an association between infection severity and vitamin A deficiency [45, 149, 155, 156]. Importance of vitamin A has been indicated in several studies [130, 157, 158] but some research has produced conflicting results [159,160,161].

No meta-analysis has been published on the relationship between vitamin A and pneumonia in children. Two studies have shown an association between lower serum vitamin A level and increased risk of pneumonia [162, 163]. Some studies have found that children with pneumonia experience a temporary decrease in vitamin A levels [146,147,148,149, 152]. The relationship between serum retinol levels and increased risk of pneumonia has produced conflicting results in different studies [160, 164].

Iron

Iron is necessary for the function of the immune system [165]. Iron deficiency can impair host immunity and excess iron can cause oxidative stress, which increases the risk of harmful viral mutations [166, 167]. A meta-analysis of 41 cohort studies found that anemia is prevalent among tuberculosis (TB) patients [168].

There is no meta-analysis on the relationship between viral infection and iron in children. However, there have been four individual studies on this topic. Two studies found that during viral infection, serum hepcidin levels increased and iron levels decreased [169, 170]. Blood plasma transferrin saturation by iron was significantly reduced in patients with severe forms of influenza stomatitis [171]. The mean hemoglobin level in infants and toddlers decreased with increasing numbers of infectious episodes [172].

Several studies have shown that ferritin is an indicator of severity and outcome of the disease. Serum ferritin levels are elevated in severe cases of COVID-19 [173,174,175,176,177]. Two cross-sectional studies found similar results, including one study on diabetic people with coronavirus [178]. Ferritin is closely related to disease severity, along with D-dimer [179].

Zinc

Zinc plays a significant role in the protecting immune function [180]. A meta-analysis of 32 observational studies in pregnant women found a protective effect of zinc against childhood wheezing [181]. Two later studies also found similar protective effects [182, 183].

Although no meta-analysis exists for the connection between zinc and acute lower respiratory tract infections in children, two original articles suggest that zinc plays a role in these infections [184, 185]. Though no meta-analysis has been performed, one study discovered that zinc levels in children can aid in diagnosing and predicting the outcome of pneumonia [186].

Selenium

Selenium has both antioxidant and anti-inflammatory properties [14, 187]. The level of maternal selenium exposure experienced by the fetus may impact the risk of wheezing [188]. The concentration of selenium in cord blood has been linked to the occurrence of allergic rhinitis in children [183]. Prenatal exposure to selenium has been linked to wheezing in childhood [189]. To the best of our knowledge, no study has investigated the relationship between selenium and coronavirus.

Magnesium

Magnesium has a significant impact on immune function [190]. No meta-analysis has been conducted in the fiend of nutrition to examine the relationship between magnesium and respiratory diseases using observational studies. In adults with COPD, serum magnesium levels have been found to be directly associated with quality of life (QOL) [61].

Maternal dietary magnesium intake during pregnancy may reduce the risk of eczema in children [191]. Childhood dietary habit have a crucial role in the development of wheezing disease [192]. Two studies have found that low magnesium intakes is associated with an increased risk of hyperreactivity during seasonal allergies [193, 194].

Beta-carotene

Beta-carotene is a precursor for vitamin A synthesis, which is derived from plants [14]. No further studies on this topic have been published to date.

Malnutrition

Nutrition is a critical factor affecting the immune response [195]. A meta-analysis based on 54 observational studies on children under 5 years old showed that malnutrition is linked to increased deaths from ALRI [196]. A 2020 meta-analysis of 12 observational studies found a direct association between malnutrition and pneumonia in children [197].

We could not find any meta-analysis examining the relationship between malnutrition and adult pneumonia. However, nutritional care after general and digestive surgery may prevent postoperative pneumonia in malnourished patients [198] as shown by several studies that associate malnutrition with incidence of pneumonia, including in hospitalized patients [199,200,201,202,203,204,205,206,207,208,209,210]. Some studies have indicated that the mortality rate increases with higher degree of malnutrition among patients with pneumonia [211,212,213,214]. Two studies demonstrated the importance of nutritional status in the prevention and treatment of pneumonia [214, 215]. However, malnutrition did not play a significant role in the incidence of pneumonia in hospitalized elderly patients [216]. A study by Kelaiditi et al. in 2014 found that 58.7% of elderly participants were at risk of malnutrition [217].

This information suggests that there is limited research available on the relationship between malnutrition and RNA viruses in children, with only five studies found. One of these studies found a connection between underweight children and lower serum antibody titers [218]. In another study, malnutrition was initially associated with acute respiratory infection; but after adjusting for covariates that could have affected the results, this association was no longer present [219]. In another study, the prevalence of viral infections increased as the severity of malnutrition increased [220]. A study of premature infants showed that malnutrition was not a significant contributor to respiratory failure (RF) [221]. However, malnutrition was found to be risk factor for mortality in children hospitalized due to respiratory influenza A H1N1 virus infections [222]. There has not been meta-analysis on the relationship between sepsis and malnutrition in adults, however, there are conflicting results [223].

There has not been no meta-analysis on the relationship between antiviral immunity and malnutrition in children. In a study, higher mortality was observed in children with TB-HIV co-infection and severe malnutrition [224]. Additionally, there has not been a meta-analysis on the relationship between tuberculosis and adult malnutrition, but 44 studies have been conducted on this topic. Several studies have shown that malnutrition is highly prevalent among patients with active pulmonary tuberculosis [225,226,227,228,229,230,231,232,233,234]. Undernutrition was found to be one of the most common comorbidities among young tuberculosis patients [235]. Two studies indicated that a majority of patients with pulmonary tuberculosis (PTB) were suffering from nutritional deficiencies at the onset of treatment ([236, 237]. Serum albumin levels were negatively associated with C-Reactive-Protein (CRP) levels [238]. In some studies malnutrition has been found to be associated with an increased risk of developing pulmonary tuberculosis (PTB) [239,240,241,242,243,244,245,246]. Several studies have indicated that low body mass index (BMI) and malnutrition to be associated with tuberculosis [247,248,249,250,251,252,253,254,255,256,257,258,259,260,261,262,263,264]. There has been no meta-analysis on the association between tuberculosis and malnutrition in children. However, one study did not find an increased risk of mortality from tuberculosis in severely malnourished children [265]. Several studies have shown an association between malnutrition and TB [266,267,268,269,270,271,272].

Patients with both COVID-19 and malnutrition had a higher inflammatory response, greater acute heart damage and weaker immune functions. Malnutrition was significantly related to poor outcomes in COVID-19 outcomes, while patients with normal nutritional status had better prognosis in terms of white blood cell count, inflammatory status, and mortality [273].

Omega 3 fatty acids

Long-chain polyunsaturated fatty acids (PUFAs) play important roles as both pro-inflammatory and anti-inflammatory factors [274]. A meta-analysis of 23 observational studies in children found that consuming fish had a beneficial effect in reducing wheezing [275]. No meta-analysis has been published for adults, but there has been one case–control study which showed that regular dietary intake of fish oil did not effectively suppress a special bronchial response [276].

Cobalamin

Cobalamin plays an essential role in supporting the immune system by aiding in the production of white blood cells [277, 278]. A meta-analysis of nine observational studies in adults did not support the hypothesis that vitamin B12 and folate levels are causally linked to hay fever or allergy biomarkers [279].

Fiber

Dietary fibers can enhance immune function primarily by producing Short Chain Fatty Acids (SCFA) [279,280,281]. Currently, no meta-analysis exists on the relationship between COPD and fiber. In a cross-sectional study, Butler et al. found that a diet high in fiber from fruits (and possibly soy foods) may decrease the incidence of acute respiratory symptoms [282]. Hirayama et al. observed an inverse relationship between vegetable intake and the risk of COPD in Japanese adults [283]. Two studies found that high fiber consumption was inversely associated with the incidence of COPD in men who were current or former smokers [284, 285]. A study indicated that dietary fiber was independently linked to better lung function and reduced prevalence of COPD [286]. Another study suggested that a diet high in fiber, especially cereal fiber, may lower the risk of developing COPD [287]. In a case control study, the medium intake of dietary fiber in the COPD group was notably lower than the average intake (6.14 vs. 8.45 g / day, p < 0.001) [288].

Discussion

This review aimed to understand the association between dietary intake, serum levels of micronutrients, malnutrition, dietary patterns, and respiratory infections, with a specific emphasis on COVID-19. The results indicate that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may play a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is inconsistent and inconclusive, necessitating further research to clarify the mechanisms and optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been primarily studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D. These inconsistencies may be due to the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet. We are not aware of any other reviews that have addressed this specific question, although there are some reviews that have examined the effects of nutrition on other respiratory infections or on COVID-19 outcomes.

Fish and seafood are excellent sources of fatty acids [289] that have anti-inflammatory effects through the G protein-coupled receptor 120 (GPR 120) [290] and resolvin E1 (RvE1) [291]. These foods are rich in zinc, copper, and selenium, which play a role in antioxidant enzymatic mechanisms [292,293,294,295]. Whole grains have anti-inflammatory and antioxidant properties [292, 293]. In addition, fruits, vegetables, and whole grains rich in fiber can have antioxidant effects through the production of SCFAs, including butyrate, by gut microbiota through fiber fermentation [294].

One of the mechanisms connecting the high prevalence of low levels of vitamin D in critically ill patients with sepsis is frequent reduction in serum concentrations of vitamin D-transporting proteins [296]. Vitamins are involved in regulating the production of antimicrobial peptides (AMPs) such as β-defensin and catalystidine [297, 298]. Vitamin D increases AMP production, which is effective against a wide range of fungi and bacteria [299, 300].

The results regarding vitamin D and respiratory tract infections in infants have been contradictory. Vitamin D seems to be crucial for the responses of interferon-g dependent T cells to infection and important for activating TLR and antimicrobial responses [301].

Regarding the association between vitamin D and COPD in adults, contrary to cross-sectional studies, a cohort study found this association [302]. Vitamin D status has been shown to be inversely related to inflammatory biomarkers [303,304,305] which may have a pathogenesis role in COPD [306]. Vitamin D directly regulates epithelium function as several types of epithelium express vitamin D receptors and to respond to vitamin D. Vitamin D may also indirectly modulate the epithelial cell function in the lung by acting on inflammatory cells [307, 308].

In a study that investigated the link between vitamin E and recurrent respiratory infections in children, it was found that vitamin E levels was significantly lower in both the active and stable recurrent respiratory infection groups and significantly lower in the active cohort compared to the stable group [45]. Vitamin E stabilizes the cell membrane structure of the and its supplementation enhances cellular immunity [56].

Regarding pneumonia, seven studies found negative associations between vitamin A and pneumonia in children [146,147,148,149, 151, 162, 163]. One study found a positive association [164], while another found no association [160]. A study showed that increased concentrations of serum retinol were significantly correlated with increased pneumonia risk [164]. Several studies conducted in lower- and middle-income countries have identified poor zinc and vitamin A status as risk factors for pneumonia and lower respiratory tract infections [137, 309].Vitamin A has a significant pleiotropic role in protecting the normal mucosal barrier [310].

In existing studies of viral infections and iron in children, decreased levels of serum hemoglobin, iron and plasma transferrin saturation were observed during infection [169,170,171,172]. The decrease in serum iron levels during infection may be due to increased hepcidin [311,312,313,314,315,316].

Additionally, zinc deficiency affects the survival, reproduction and maturation of immune cells that plays a role in both innate and adaptive immunity [317].

One study found an association between serum selenium levels and childhood wheezing but found no association between dietary selenium intake and wheezing. The estimates of dietary intake of selenium are not entirely reliable when using the food frequency questionnaires (FFQ), because food nutrient tables that use both FFQs and weighted records do not account for the wide diversity in the selenium content of foods due to geographical differences in soil selenium [189].

Since magnesium causes relaxation in smooth muscle and restricts its ability to contract, it may impact COPD-related quality of life by improving respiratory symptoms [318, 319]. Findings from studies on pneumonia and malnutrition in children showed a direct association [197]. It appears that malnutrition weakens the respiratory muscles making it unable to clear the airways of secretions and weakens the immune system [320].

Studies in adults have also supported the effect of malnutrition on pneumonia [198, 199, 210, 211, 214, 215, 217, 321, 322] with only one study showing results to the contrary [217]. In addition, hypoalbuminemia and low BMI are correlated with mortality in senile pneumonic patients [323]. Albumin influences the host’s defense mechanisms against bacterial infection through the complement function and defensin production [324, 325]. Therefore, nutritional therapy may partially reduce risk factors associated with malnutrition and help improve defense mechanisms against bacterial infection, reducing the development of pneumonia [203].

In Hong et al.’s study, inadequate nutrition and an impaired immune system did not have a synergistic impact on mortality in acute septic patients. Caloric restriction, by regulating inflammatory pathways, has been shown to increase cell survival in mammals [326]. Caloric restriction during the acute phase of infection may reduce the inflammatory response and damage by regulating hormonal, inflammatory, and metabolic pathways. Caloric restriction has also been linked to better glycemic control [326, 327], because short-term hyperglycemia can disrupt the body’s natural immune responses to infection [328].

Regarding the consumption of fiber and COPD, a diet rich in fiber has been found to be inversely associated with the incidence and symptoms of COPD [282,283,284,285,286,287,288]. This might be due to fiber’s antioxidant and anti-inflammatory properties [329,330,331,332,333,334,335,336,337]. Fiber consumption has been linked to decreased C-reactive protein level, a marker of systemic inflammation. Fiber may modulate inflammation through several mechanisms, including by slowing glucose absorption [338] and reducing lipid oxidation [329], or affecting the production of anti-inflammatory cytokines in the gut flora [339]. Some components of fiber, such as trace elements or related nutrients like flavonoids, may have a positive impact on the lungs [340], however, the fiber sources in different studies have varied, which may be due to limited diversity of fiber sources in some populations, for example, white rice is the main grain in Asian diets whereas whole grains are found in some Western diets [341].

Observational studies on SARS-CoV-2 are limited, with most of them focusing on vitamin D [342]. Dysregulation of the renin-angiotensin system is also one of the early mechanisms of lung damage in COVID-19 [343, 344]. Vitamin D upregulates anti-inflammatory intermediates, which is critical when considering the excessive inflammatory response triggered by COVID-19 in the immune system [345]. However, A cohort study [346], found that low levels of vitamin D in most COVID-19 patients may be due to insulin resistance diabetes, overweight, or obesity, as these are of risk factors for both low vitamin D levels and for COVID-19 [347, 348].

Poor nutritional status may contribute to the increased mortality in COVID-19 patients [349]. Most COVID-19 patients have elevated CRP levels [349, 350]. Inflammation and malnutrition often occur simultaneously because malnutrition can increase susceptibility to infection, while infections can lead to malnutrition by increasing nutrient needs and reducing appetite [351].

Strengths and limitations

We found that the literature on the association between dietary intake and serum levels of micronutrients, respiratory infections, influenza, pneumonia, acute respiratory syndrome and COVID-19 was varied and rich, but also faced some methodological and conceptual limitations. Most of the articles we reviewed had an acceptable to good quality, but they differed in their study designs, populations, interventions, and outcomes, which made it difficult to compare and synthesize their results. Therefore, we were unable to conduct a meta-analysis on this topic, and we had to rely on a narrative synthesis to present the main findings and trends. Another limitation of our study was that we focused only on viral infections related to the respiratory tract, as COVID-19 primarily affects the respiratory system. This may have excluded some relevant studies that examined the effects of nutrition on other types of viral infections, such as gastrointestinal or systemic infections. Future studies should consider these limitations and aim to provide more comprehensive and robust evidence on the relationship between nutrition and COVID-19, by using more standardized and rigorous methods, exploring the mechanisms and the dose–response relationships of dietary components, and including a wider range of viral infections and outcomes.

Conclusion

In this systematic review, we examined the relationship between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, with a focus on COVID-19. We found that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber play a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, we also identified some limitations and gaps in the existing literature, such as the lack of randomized controlled trials, the heterogeneity of study designs and populations, the confounding effects of other factors, and the scarcity of studies on the specific effect of dietary components on COVID-19 outcomes. Therefore, we suggest that future research should conduct more rigorous and comprehensive studies to test the causal effect of dietary patterns on COVID-19 prevention, symptoms, or mortality, and to explore the underlying mechanisms and pathways of how nutrition influences the immune and respiratory systems. Adopting a healthy and balanced diet, rich in certain micronutrients and fiber, may be a feasible and effective strategy to protect against respiratory infections, including COVID-19, and to improve the overall health and well-being of individuals and populations.

Availability of data and materials

Not applicable.

Abbreviations

TUMS:

Tehran University of Medical Science

COVID-19:

Coronavirus disease 2019

SARSr-CoV-2:

Severe Acute Respiratory Syndrome Related Coronavirus 

MERS:

Middle East Respiratory Syndrome

ICU:

Intensive Care Unit

RCT:

Randomized Controlled Trials

MeSH:

Medical Subject Headings

COPD:

Chronic Obstructive Pulmonary Disease

RSV:

Respiratory Syncytial Virus

VDD:

Vitamin D Deficiency

CAP:

Community Acquired Peumonia

RTI:

Respiratory Tract Infection

URTI:

Upper Respiratory Tract Illness

ILD:

Interstitial Lung Disease

RRI:

Recurrent Respiratory Infection

DASH:

Dietary Approaches to Stop Hypertension

ALRI:

Acute Lower Respiratory Tract Infection

TB:

Tuberculosis

QOL:

Quality of Life

FEF:

Forced Expiratory Flow

PTB:

Pulmonary Tuberculosis

PUFA:

Polyunsaturated Fatty Acid

SCFA:

Short Chain Fatty Acid

IL:

Interleukin

GPR 120:

G Protein-coupled Receptor 120

RvE1:

Resolvin E1

VDR:

Vitamin D Receptor

TLR:

Toll-like receptor

AMP:

Antimicrobial Peptide

Mtb:

Mycobacterium tuberculosis

FEV1:

Forced Expiratory Volume1

CCSP:

Club Cell Secretory Protein

BMI:

Body Mass Index

RDS:

Respiratory Distress Syndrome

PICU:

Pediatric Intensive Care Unit

GSHPx:

Glutathione peroxidase

Th:

T-helper

FFQ:

Food Frequency Questionnaire

EPA:

Eicosapentaenoic Acid

DHA:

Docosahexaenoic Acid

CRP:

C-Reactive-Protein

AST:

Aspartate Transaminase

LDH:

Lactate Dehydrogenase

CK-MB:

Creatine Kinase- Myoglobin Binding

References

  1. Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr. 1997;66(2):460S-S463.

    Article  CAS  PubMed  Google Scholar 

  2. Munteanu C, Schwartz B. The relationship between nutrition and the immune system. Front Nutr. 2022;9:1082500.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Klasing KC. Nutrition and the immune system. Br Poult Sci. 2007;48(5):525–37.

    Article  CAS  PubMed  Google Scholar 

  4. Venter C, Eyerich S, Sarin T, Klatt KC. Nutrition and the immune system: A complicated tango. Nutrients. 2020;12(3):818.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis. 2000;182(Supplement_1):S93–6.

    Article  CAS  PubMed  Google Scholar 

  6. McAuliffe S, Ray S, Fallon E, Bradfield J, Eden T, Kohlmeier M. Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus on high-risk groups and preventative healthcare. BMJ Nutr Prevent Health. 2020;3(1):93.

    Article  Google Scholar 

  7. Aljadani H. Impact of Different Dietary Patterns and Micronutrients on the Immune System and COVID-19 Infection. Curr Res Nutr Food Sci. 2021;9(1):127–38.

  8. Cámara M, Sánchez-Mata MC, Fernández-Ruiz V, Cámara RM, Cebadera E, Domínguez L. A review of the role of micronutrients and bioactive compounds on immune system supporting to fight against the COVID-19 disease. Foods. 2021;10(5):1088.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lockyer S. Effects of diets, foods and nutrients on immunity: Implications for COVID-19? Nutr Bull. 2020;45(4):456–73.

    Article  Google Scholar 

  10. Foolchand A, Ghazi T, Chuturgoon AA. Malnutrition and dietary habits alter the immune system which may consequently influence SARS-CoV-2 virulence: a review. Int J Mol Sci. 2022;23(5):2654.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Peiris J, Lai S, Poon L, Guan Y, Yam L, Lim W, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. The lancet. 2003;361(9366):1319–25.

    Article  CAS  Google Scholar 

  12. Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: a review. Diabetes Metab Syndr. 2020;14(4):367–82.

    Article  PubMed  PubMed Central  Google Scholar 

  13. González-Salazar LE, Guevara-Cruz M, Hernández-Gómez KG, Serralde Zúñiga AE. Nutritional management of the critically ill inpatient with COVID-19. A narrative review. Nutr Hospitalaria. 2020;34(3):622–30.

    Google Scholar 

  14. Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol. 2020;92(5):479–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Taghdir M, Sepandi M, Abbaszadeh S, Parastouei K. A review on some nutrition-based interventions in Covid-19. J Military Med. 2020;22(2):169–76.

    Google Scholar 

  16. Ramezani A, Amirpour M. Nutritional care in the prevention and treatment of coronavirus disease 2019: a simple overview. J Health Res Commun. 2020;6(1):74–82.

    Google Scholar 

  17. BourBour F, Mirzaei Dahka S, Gholamalizadeh M, Akbari ME, Shadnoush M, Haghighi M, et al. Nutrients in prevention, treatment, and management of viral infections; special focus on Coronavirus. Arch Physiol Biochem. 2023;129(1):16–25.

    Article  CAS  PubMed  Google Scholar 

  18. Richardson DP, Lovegrove JA. Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective. Br J Nutr. 2021;125(6):678–84.

    Article  CAS  PubMed  Google Scholar 

  19. Souza ACR, Vasconcelos AR, Prado PS, Pereira CPM. Zinc, vitamin D and vitamin C: perspectives for COVID-19 with a focus on physical tissue barrier integrity. Front Nutr. 2020;7:606398.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bennett G, Young E, Butler I, Coe S. The impact of lockdown during the COVID-19 outbreak on dietary habits in various population groups: a scoping review. Front Nutr. 2021;8:626432.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Al-Mana N, Awney H, Zareef T, Albathi F, Baeshen F, AlZahrani S, Abdullah R. The impact of COVID-19 pandemic on the dietary patterns and eating behaviour in Saudi adults. Proceed Nutr Soc. 2022;81(OCE1):E58.

    Article  CAS  Google Scholar 

  22. Merino J, Joshi AD, Nguyen LH, Leeming ER, Mazidi M, Drew DA, et al. Diet quality and risk and severity of COVID-19: a prospective cohort study. Gut. 2021;70(11):2096–104.

    Article  CAS  PubMed  Google Scholar 

  23. Wu D, Lewis ED, Pae M. Nutritional modulation of immune function: analysis of evidence, mechanisms, and clinical relevance. Front Immunol. 2019;9:431237.

    Article  Google Scholar 

  24. Casas R, Sacanella E, Estruch R. The immune protective effect of the mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14(4):245–54.

    Article  CAS  PubMed  Google Scholar 

  25. Zhang C, Björkman A, Cai K, Wang C, Xia H, Kristiansen K, et al. Impact of a 3-months vegetarian diet on the gut microbiota and immune repertoire. Front Immunol. 2018;9:343888.

    Google Scholar 

  26. Hooper LV, Littman DR, Macpherson AJ. Interactions between the microbiota and the immune system. Science. 2012;336(6086):1268–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Parvizian MK, Dhaliwal M, Li J, Satia I, Kurmi OP. Relationship between dietary patterns and COPD: a systematic review and meta-analysis. ERJ Open Res. 2020;6(2):00168–2019.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Monlezun DJ, Bittner EA, Christopher KB, Camargo CA Jr, Quraishi SA. Vitamin D status and acute respiratory infection: cross sectional results from the United States National Health and Nutrition Examination Survey, 2001–2006. Nutrients. 2015;7(3):1933–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zdrenghea MT, Makrinioti H, Bagacean C, Bush A, Johnston SL, Stanciu LA. Vitamin D modulation of innate immune responses to respiratory viral infections. Rev Med Virol. 2017;27(1):e1909.

    Article  Google Scholar 

  31. Zhou YF, Luo BA, Qin LL. The association between vitamin D deficiency and community-acquired pneumonia: a meta-analysis of observational studies. Medicine. 2019;98(38):e17252.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Georgakopoulou VE, Mantzouranis K, Damaskos C, Karakou E, Melemeni D, Mermigkis D, et al. Correlation between serum levels of 25-hydroxyvitamin D and severity of community-acquired pneumonia in hospitalized patients assessed by pneumonia severity index: an observational descriptive study. Cureus. 2020;12(7):e8947.

    PubMed  PubMed Central  Google Scholar 

  33. Uzer F, Ozbudak O. Are 25 (OH) D concentrations associated with asthma control and pulmonary function test? Caspian J Intern Med. 2019;10(4):377.

    PubMed  PubMed Central  Google Scholar 

  34. 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):2220–7.

    Article  CAS  PubMed  Google Scholar 

  35. Huang GQ, Cheng HR, Wu YM, Cheng QQ, Wang YM, Fu JL, et al. Reduced vitamin D levels are associated with stroke-associated pneumonia in patients with acute ischemic stroke. Clin Interv Aging. 2019;31:2305–14.

    Article  Google Scholar 

  36. Park S, Lee MG, Hong S-B, Lim C-M, Koh Y, Huh JW. Effect of vitamin D deficiency in Korean patients with acute respiratory distress syndrome. Korean J Intern Med. 2018;33(6):1129.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lu D, Zhang J, Ma C, Yue Y, Zou Z, Yu C, Yin F. Link between community-acquired pneumonia and vitamin D levels in older patients. Zeitschrift für Gerontologie und Geriatrie. 2018;51(4):435–9.

    Article  PubMed  Google Scholar 

  38. Talebi F, Yaseri M, Hadadi A. Association of vitamin D status with the severity and mortality of community-acquired pneumonia in Iran during 2016–2017: a prospective cohort study. Rep Biochemist Mol Biol. 2019;8(1):85.

    CAS  Google Scholar 

  39. Mirza AA, Alharbi AA, Marzouki H, Al-Khatib T, Zawawi F. The association between vitamin D deficiency and recurrent tonsillitis: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2020;163(5):883–91.

    Article  PubMed  Google Scholar 

  40. Mustapa Kamal Basha MA, Majid HA, Razali N, Yahya A. Risk of eczema, wheezing and respiratory tract infections in the first year of life: a systematic review of vitamin D concentrations during pregnancy and at birth. PLoS One. 2020;15(6):e0233890.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lu M, Litonjua AA, O’Connor GT, Zeiger RS, Bacharier L, Schatz M, et al. Effect of early and late prenatal vitamin D and maternal asthma status on offspring asthma or recurrent wheeze. J Allergy Clin Immunol. 2021;147(4):1234–41 (e3).

    Article  CAS  PubMed  Google Scholar 

  42. Chinratanapisit S, Sritipsukho P, Satdhabudha A, Matchimmadamrong K, Deerojanawong J, Suratannon N, Chatchatee P. Outcomes of young children hospitalized with acute wheezing. Asian Pac J Allergy Immunol. 2023;41(2):127–32.

    PubMed  Google Scholar 

  43. Dinlen N, Zenciroglu A, Beken S, Dursun A, Dilli D, Okumus N. Association of vitamin D deficiency with acute lower respiratory tract infections in newborns. J Matern Fetal Neonatal Med. 2016;29(6):928–32.

    Article  CAS  PubMed  Google Scholar 

  44. Binks MJ, Smith-Vaughan HC, Marsh R, Chang AB, Andrews RM. Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory. Med J Australia. 2016;204(6):238-.

    Article  PubMed  Google Scholar 

  45. Zhang J, Sun R, Yan Z, Yi W, Yue B. Correlation of serum vitamin A, D, and E with recurrent respiratory infection in children. Eur Rev Med Pharmacol Sci. 2019;23(18):8133–8.

    CAS  PubMed  Google Scholar 

  46. Ahmed P, Babaniyi I, Yusuf K, Dodd C, Langdon G, Steinhoff M, Dawodu A. Vitamin D status and hospitalisation for childhood acute lower respiratory tract infections in Nigeria. Paediatr Intern Child Health. 2015;35(2):151–6.

    Article  Google Scholar 

  47. Kaaviyaa A, Krishna V, Arunprasath T, Ramanan PV. Vitamin D deficiency as a factor influencing asthma control in children. Indian Pediatr. 2018;55:969–71.

    Article  CAS  PubMed  Google Scholar 

  48. Li W, Cheng X, Guo L, Li H, Sun C, Cui X, et al. Association between serum 25-hydroxyvitamin D concentration and pulmonary infection in children. Medicine. 2018;97(1):e9060.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. 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):479–85.

    Article  PubMed  Google Scholar 

  50. Woon FC, Chin YS, Ismail IH, Abdul Latiff AH, Batterham M, Chan YM, Group MR. Maternal vitamin D levels during late pregnancy and risk of allergic diseases and sensitization during the first year of life—a birth cohort study. Nutrients. 2020;12(8):2418.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Khakshour A, Farhat AS, Mohammadzadeh A, Zadeh FK, Kamali H. The association between 25-dehydroxy vitamin D and lower respiratory infection in children aged less than" 5" years in Imam Reza hospital, Bojnurd. Iran JPMA J Pakistan Medic Assoc. 2015;65(11):1153–5.

    Google Scholar 

  52. Carroll KN, Gebretsadik T, Larkin EK, Dupont WD, Liu Z, Van Driest S, Hartert TV. Relationship of maternal vitamin D level with maternal and infant respiratory disease. American J Obstet Gynecol. 2011;205(3):215 (e1-. e7).

    Article  CAS  Google Scholar 

  53. Dabbah H, Yoseph RB, Livnat G, Hakim F, Bentur L. Bronchial reactivity, inflammatory and allergic parameters, and vitamin D levels in children with asthma. Respir Care. 2015;60(8):1157–63.

    Article  PubMed  Google Scholar 

  54. Eroglu C, Demir F, Erge D, Uysal P, Kirdar S, Yilmaz M, Omurlu IK. The relation between serum vitamin D levels, viral infections and severity of attacks in children with recurrent wheezing. Allergol Immunopathol. 2019;47(6):591–7.

    Article  Google Scholar 

  55. Aierken A, Yusufu B, Xu P. Correlation between asthmatic infants with rickets and vitamin D, inflammatory factors and immunoglobulin E. Exp Ther Med. 2020;20(3):2122–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS ONE. 2010;5(6):e11088.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Umarov J, Kerimov F, Toychiev A, Davis N, Osipova S. Association the 25 (OH) vitamin D status with upper respiratory tract infections morbidity in water sports elite athletes. biorxiv. 2019;59:559278.

    Google Scholar 

  59. Ferri S, Crimi C, Heffler E, Campisi R, Noto A, Crimi N. Vitamin D and disease severity in bronchiectasis. Respir Med. 2019;148:1–5.

    Article  CAS  PubMed  Google Scholar 

  60. He CS, Handzlik MK, Fraser WD, Muhamad AS, Preston H, Richardson A, Gleeson M. Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of winter training in endurance sport athletes. 2013.

    Google Scholar 

  61. Hussein SHA, Nielsen LP, Dolberg MKB, Dahl R. Serum magnesium and not vitamin D is associated with better QoL in COPD: a cross-sectional study. Respir Med. 2015;109(6):727–33.

    Article  Google Scholar 

  62. Buonsenso D, Sali M, Pata D, Masiello E, Salerno G, Ceccarelli M, et al. Vitamin D levels in active TB, latent TB, non-TB pneumonia and healthy children: a prospective observational study. Fetal Pediatr Pathol. 2018;37(5):337–47.

    Article  CAS  PubMed  Google Scholar 

  63. Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open. 2019;9(5):e027666.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kawashima H, Kimura M, Morichi S, Nishimata S, Yamanaka G, Kashiwagi Y. Serum 25-hydroxy vitamin D levels in japanese infants with respiratory syncytial virus infection younger than 3 months of age. Jpn J Infect Dis. 2020;73(6):443–6.

    Article  CAS  PubMed  Google Scholar 

  65. Wani WA, Nazir M, Bhat JI, Ahmad QI, Charoo BA, Ali SW. Vitamin D status correlates with the markers of cystic fibrosis-related pulmonary disease. Pediatr Neonatol. 2019;60(2):210–5.

    Article  PubMed  Google Scholar 

  66. Science M, Maguire JL, Russell ML, Smieja M, Walter SD, Loeb M. Low serum 25-hydroxyvitamin D level and risk of upper respiratory tract infection in children and adolescents. Clin Infect Dis. 2013;57(3):392–7.

    Article  CAS  PubMed  Google Scholar 

  67. Bilgin BS, Gonulal D. Association between vitamin D level and community-acquired late-onset neonatal sepsis. Arch Argent Pediatr. 2020;118(4):265–72.

    Google Scholar 

  68. Mandlik R, Chiplonkar S, Kajale N, Khadilkar V, Khadilkar A. Infection status of rural schoolchildren and its relationship with Vitamin D concentrations. Indian J Pediatr. 2019;86:675–80.

    Article  PubMed  Google Scholar 

  69. Bodin J, Mihret A, Holm-Hansen C, Dembinski JL, Trieu M-C, Tessema B, et al. Vitamin D deficiency is associated with increased use of antimicrobials among preschool girls in Ethiopia. Nutrients. 2019;11(3):575.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Amrein K, Zajic P, Schnedl C, Waltensdorfer A, Fruhwald S, Holl A, et al. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care. 2014;18:1–13.

    Article  Google Scholar 

  71. Alves FS, Freitas FGR, Bafi AT, Azevedo LCP, Machado FR. Serum concentrations of vitamin D and organ dysfunction in patients with severe sepsis and septic shock. Revista Brasileira De Terapia Intensiva. 2015;27:376–82.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lindley VM, Bhusal K, Huning L, Levine SN, Jain SK. Reduced 25 (OH) vitamin D association with lower alpha-1-antitrypsin blood levels in type 2 diabetic patients. J Am Coll Nutr. 2021;40(2):98–103.

    Article  CAS  PubMed  Google Scholar 

  73. Oliveira MS, Matsunaga NY, Rodrigues ML, Morcillo AM, de Oliveira Ribeiro MA, Ribeiro AF, et al. Lung disease and vitamin D levels in cystic fibrosis infants and preschoolers. Pediatr Pulmonol. 2019;54(5):563–74.

    Article  PubMed  Google Scholar 

  74. Hirani V. Associations between vitamin d and self-reported respiratory disease in older people from a nationally representative population survey. J Am Geriatr Soc. 2013;61(6):969–73.

    Article  PubMed  Google Scholar 

  75. Ye K, Tang F, Liao X, Shaw BA, Deng M, Huang G, et al. Does serum vitamin D level affect COVID-19 infection and its severity?-A case-control study. J Am Coll Nutr. 2021;40(8):724–31.

    Article  CAS  PubMed  Google Scholar 

  76. Mendy A, Apewokin S, Wells AA, Morrow AL. Factors associated with hospitalization and disease severity in a racially and ethnically diverse population of COVID-19 patients. MedRxiv. 2020;2020:20137323.

    Google Scholar 

  77. Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Net Open. 2020;3(9):e2019722-e.

    Article  Google Scholar 

  78. Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D deficiency and treatment with COVID-19 incidence. MedRxiv. 2020;2020:20095893.

    Google Scholar 

  79. Merzon E, Tworowski D, Gorohovski A, Vinker S, Golan Cohen A, Green I, Frenkel-Morgenstern M. Low plasma 25 (OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study. FEBS J. 2020;287(17):3693–702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Padhi S, Suvankar S, Panda VK, Pati A, Panda AK. Lower levels of vitamin D are associated with SARS-CoV-2 infection and mortality in the Indian population: An observational study. Int Immunopharmacol. 2020;88:107001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D deficiency and outcome of COVID-19 patients. Nutrients. 2020;12(9):2757.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS ONE. 2020;15(9):e0239799.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Lansiaux É, Pébaÿ PP, Picard J-L, Forget J. Covid-19 and vit-d: disease mortality negatively correlates with sunlight exposure. Spatial Spatio-temporal Epidemiol. 2020;35:100362.

    Article  Google Scholar 

  84. Luo X, Liao Q, Shen Y, Li H, Cheng L. Vitamin D deficiency is associated with COVID-19 incidence and disease severity in Chinese people. J Nutr. 2021;151(1):98–103.

    Article  CAS  PubMed  Google Scholar 

  85. Abrishami A, Dalili N, Mohammadi Torbati P, Asgari R, Arab-Ahmadi M, Behnam B, Sanei-Taheri M. Possible association of vitamin D status with lung involvement and outcome in patients with COVID-19: a retrospective study. Eur J Nutr. 2021;60:2249–57.

    Article  CAS  PubMed  Google Scholar 

  86. Pizzini A, Aichner M, Sahanic S, Böhm A, Egger A, Hoermann G, et al. Impact of vitamin D deficiency on COVID-19—a prospective analysis from the CovILD Registry. Nutrients. 2020;12(9):2775.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Gonçalves TJM, Gonçalves SEAB, Guarnieri A, Risegato RC, Guimarães MP, de Freitas DC, et al. Prevalence of obesity and hypovitaminosis D in elderly with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinl Nutr ESPEN. 2020;40:110–4.

    Article  Google Scholar 

  88. Hernández JL, Nan D, Fernandez-Ayala M, García-Unzueta M, Hernández-Hernández MA, López-Hoyos M, et al. Vitamin D status in hospitalized patients with SARS-CoV-2 infection. J Clin Endocrinol Metab. 2021;106(3):e1343–53.

    Article  PubMed  Google Scholar 

  89. Panagiotou G, Tee SA, Ihsan Y, Athar W, Marchitelli G, Kelly D, et al. Low serum 25-hydroxyvitamin D (25 [OH] D) levels in patients hospitalized with COVID-19 are associated with greater disease severity. Clin Endocrinol. 2020;93(4):508.

    Article  CAS  Google Scholar 

  90. Carpagnano GE, Di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinol Invest. 2021;44(4):765–71.

    Article  CAS  PubMed  Google Scholar 

  91. Cereda E, Bogliolo L, Klersy C, Lobascio F, Masi S, Crotti S, et al. Vitamin D 25OH deficiency in COVID-19 patients admitted to a tertiary referral hospital. Clin Nutr. 2021;40(4):2469–72.

    Article  CAS  PubMed  Google Scholar 

  92. Mardani R, Alamdary A, Nasab SM, Gholami R, Ahmadi N, Gholami A. Association of vitamin D with the modulation of the disease severity in COVID-19. Virus Res. 2020;289:198148.

    Article  CAS  PubMed  Google Scholar 

  93. Arvinte C, Singh M, Marik PE. Serum levels of vitamin C and vitamin D in a cohort of critically ill COVID-19 patients of a North American community hospital intensive care unit in May 2020: a pilot study. Medicine in drug discovery. 2020;8:100064.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Kaufman HW, Niles JK, Kroll MH, Bi C, Holick MF. SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLoS ONE. 2020;15(9):e0239252.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Im JH, Je YS, Baek J, Chung M-H, Kwon HY, Lee J-S. Nutritional status of patients with COVID-19. Int J Infect Dis. 2020;100:390–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. D’Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, et al. 25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients. 2020;12(5):1359.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Macaya F, Espejo Paeres C, Valls A, Fernández-Ortiz A, Gonzalez del Castillo J, Martínsánchez FJ, et al. Interaction between age and vitamin D deficiency in severe COVID-19 infection. Nutr Hosp. 2020;37:1039–42.

    CAS  PubMed  Google Scholar 

  98. Brenner H, Holleczek B, Schöttker B. Vitamin D insufficiency and deficiency and mortality from respiratory diseases in a cohort of older adults: potential for limiting the death toll during and beyond the COVID-19 pandemic? Nutrients. 2020;12(8):2488.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Yılmaz K, Şen V. Is vitamin D deficiency a risk factor for COVID-19 in children? Pediatr Pulmonol. 2020;55(12):3595–601.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Hastie CE, Mackay DF, Ho F, Celis-Morales CA, Katikireddi SV, Niedzwiedz CL, et al. Vitamin D concentrations and COVID-19 infection in UK Biobank. Diabetes Metab Syndr. 2020;14(4):561–5.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Lewis ED, Meydani SN, Wu D. Regulatory role of vitamin E in the immune system and inflammation. IUBMB Life. 2019;71(4):487–94.

    Article  CAS  PubMed  Google Scholar 

  102. 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):1181.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Rodríguez-Rodríguez E, Ortega RM, Andrés P, Aparicio A, González-Rodríguez LG, López-Sobaler AM, et al. Antioxidant status in a group of institutionalised elderly people with chronic obstructive pulmonary disease. Br J Nutr. 2016;115(10):1740–7.

    Article  PubMed  Google Scholar 

  104. Gosker HR, Bast A, Haenen GR, Fischer MA, van der Vusse GJ, Wouters EF, Schols AM. Altered antioxidant status in peripheral skeletal muscle of patients with COPD. Respir Med. 2005;99(1):118–25.

    Article  PubMed  Google Scholar 

  105. Agacdiken A, Basyigit I, Özden M, Yildiz F, Ural D, Maral H, et al. The effects of antioxidants on exercise-induced lipid peroxidation in patients with COPD. Respirology. 2004;9(1):38–42.

    Article  PubMed  Google Scholar 

  106. Joshi P, Kim WJ, Lee SA. The effect of dietary antioxidant on the COPD risk: the community-based KoGES (Ansan–Anseong) cohort. Int J Chron Obstruct Pulmon Dis. 2015;10:2159–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  107. McKeever TM, Lewis SA, Smit HA, Burney P, Cassano PA, Britton J. A multivariate analysis of serum nutrient levels and lung function. Respir Res. 2008;9:1–10.

    Article  Google Scholar 

  108. Rai RR, Phadke MS. Plasma oxidant-antioxidant status in different respiratory disorders. Indian J Clin Biochem. 2006;21:161–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Kodama Y, Kishimoto Y, Muramatsu Y, Tatebe J, Yamamoto Y, Hirota N, et al. Antioxidant nutrients in plasma of Japanese patients with chronic obstructive pulmonary disease, asthma-COPD overlap syndrome and bronchial asthma. Clin Respir J. 2017;11(6):915–24.

    Article  CAS  PubMed  Google Scholar 

  110. Pirabbasi E, Najafiyan M, Cheraghi M, Shahar S, Manaf ZA, Rajab N, Manap RA. What are the antioxidant status predictors’ factors among male chronic obstructive pulmonary disease (COPD) patients? Global J Health Sci. 2013;5(1):70.

    Google Scholar 

  111. Førli L, Pedersen J, Bjørtuft Ø, Blomhoff R, Kofstad J, Boe J. Vitamins A and E in serum in relation to weight and lung function in patients with advanced pulmonary disease. Int J Vitam Nutr Res. 2002;72(6):360–8.

    Article  PubMed  Google Scholar 

  112. Ahmadi A, Haghighat N, Hakimrabet M, Tolide-ie H. Nutritional evaluation in chronic obstructive pulmonary disease patients. Pakistan J Biolog Sci. 2012;15(10):501–5.

    Article  Google Scholar 

  113. De Batlle J, Barreiro E, Romieu I, Mendez M, Gómez FP, Balcells E, et al. Dietary modulation of oxidative stress in chronic obstructive pulmonary disease patients. Free Radical Res. 2010;44(11):1296–303.

    Article  Google Scholar 

  114. Tabak C, Smit HA, Räsänen L, Fidanza F, Menotti A, Nissinen A, et al. Dietary factors and pulmonary function: a cross sectional study in middle aged men from three European countries. Thorax. 1999;54(11):1021–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Lin YC, Wu TC, Chen PY, Hsieh LY, Yeh SL. Comparison of plasma and intake levels of antioxidant nutrients in patients with chronic obstructive pulmonary disease and healthy people in Taiwan: a case-control study. Asia Pac J Clin Nutr. 2010;19(3):393–401.

    CAS  PubMed  Google Scholar 

  116. Hu G, Cassano PA. Antioxidant nutrients and pulmonary function: the third national health and nutrition examination survey (NHANES III). Am J Epidemiol. 2000;151(10):975–81.

    Article  CAS  PubMed  Google Scholar 

  117. Dhakal N, Lamsal M, Baral N, Shrestha S, Dhakal SS, Bhatta N, Dubey RK. Oxidative stress and nutritional status in chronic obstructive pulmonary disease. J Clin Diagn Res. 2015;9(2):01.

    Google Scholar 

  118. Hanson C, Lyden E, Furtado J, Campos H, Sparrow D, Vokonas P, Litonjua AA. Serum tocopherol levels and vitamin E intake are associated with lung function in the normative aging study. Clin Nutr. 2016;35(1):169–74.

    Article  CAS  PubMed  Google Scholar 

  119. Stephensen CB. Vitamin A, infection, and immune function. Annu Rev Nutr. 2001;21(1):167–92.

    Article  CAS  PubMed  Google Scholar 

  120. Bishopp A, Sathyamurthy R, Manney S, Webbster C, Krishna MT, Mansur AH. Biomarkers of oxidative stress and antioxidants in severe asthma: a prospective case-control study. Ann Allergy Asthma Immunol. 2017;118(4):445–51.

    Article  CAS  PubMed  Google Scholar 

  121. Özbey Ü, Uçar A, Shivappa N, Hebert JR. The relationship between dietary inflammatory index, pulmonary functions and asthma control in asthmatics. Iranian J Allergy Asthma Immunol. 2019;18:605–14.

    Google Scholar 

  122. Rémen T, Acouetey D-S, Paris C, Zmirou-Navier D. Diet, occupational exposure and early asthma incidence among bakers, pastry makers and hairdressers. BMC Public Health. 2012;12:1–8.

    Article  Google Scholar 

  123. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis. J Allergy Clin Immunol. 2011;127(3):724-33. e30.

    Article  PubMed  Google Scholar 

  124. Hämäläinen N, Nwaru BI, Erlund I, Takkinen HM, Ahonen S, Toppari J, et al. Serum carotenoid and tocopherol concentrations and risk of asthma in childhood: a nested case–control study. Clin Exp Allergy. 2017;47(3):401–9.

    Article  PubMed  Google Scholar 

  125. Rerksuppaphol S, Rerksuppaphol L. Carotenoids intake and asthma prevalence in Thai children. Pediatr Rep. 2012;4(1):e12.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Al Senaidy AM. Serum vitamin A and β-carotene levels in children with asthma. J Asthma. 2009;46(7):699–702.

    Article  CAS  PubMed  Google Scholar 

  127. Andino D, Moy J, Gaynes BI. Serum vitamin A, zinc and visual function in children with moderate to severe persistent asthma. J Asthma. 2019;56(11):1198–203.

    Article  CAS  PubMed  Google Scholar 

  128. Arora P, Kumar V, Batra S. Vitamin A status in children with asthma. Pediatr Allergy Immunol. 2002;13(3):223–6.

    Article  PubMed  Google Scholar 

  129. Bai Y-J, Dai R-J. Serum levels of vitamin A and 25-hydroxyvitamin D3 (25OHD3) as reflectors of pulmonary function and quality of life (QOL) in children with stable asthma: A case–control study. Medicine. 2018;97(7):e9830.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  130. Amaral CT, Pontes NN, Maciel BL, Bezerra HS, Triesta ANA, Jeronimo SM, et al. Vitamin A deficiency alters airway resistance in children with acute upper respiratory infection. Pediatr Pulmonol. 2013;48(5):481–9.

    Article  PubMed  Google Scholar 

  131. Oh S, Chung J, Kim M, Kwon S, Cho B. Antioxidant nutrient intakes and corresponding biomarkers associated with the risk of atopic dermatitis in young children. Eur J Clin Nutr. 2010;64(3):245–52.

    Article  CAS  PubMed  Google Scholar 

  132. Kim SY, Sim S, Park B, Kim J-H, Choi HG. High-fat and low-carbohydrate diets are associated with allergic rhinitis but not asthma or atopic dermatitis in children. PLoS ONE. 2016;11(2):e0150202.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Lee S-Y, Kim B-S, Kwon S-O, Oh S-Y, Shin HL, Jung Y-H, et al. Modification of additive effect between vitamins and ETS on childhood asthma risk according to GSTP1 polymorphism: a cross-sectional study. BMC Pulm Med. 2015;15:1–9.

    Article  Google Scholar 

  134. Samarasinghe AE, Penkert RR, Hurwitz JL, Sealy RE, LeMessurier KS, Hammond C, et al. Questioning cause and effect: children with severe asthma exhibit high levels of inflammatory biomarkers including beta-hexosaminidase, but low levels of vitamin A and immunoglobulins. Biomedicines. 2020;8(10):393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. Seo J-H, Kwon S-O, Lee S-Y, Kim HY, Kwon J-W, Kim B-J, et al. Association of antioxidants with allergic rhinitis in children from Seoul. Allergy Asthma Immunol Res. 2013;5(2):81.

    Article  CAS  PubMed  Google Scholar 

  136. Zhang X, Ding F, Li H, Zhao W, Jing H, Yan Y, Chen Y. Low serum levels of vitamins A, D, and E are associated with recurrent respiratory tract infections in children living in Northern China: a case control study. PLoS ONE. 2016;11(12):e0167689.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Sommer A, Katz J, Tarwotjo I. Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am J Clin Nutr. 1984;40(5):1090–5.

    Article  CAS  PubMed  Google Scholar 

  138. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  139. Cameron C, Dallaire F, Vézina C, Muckle G, Bruneau S, Ayotte P, Dewailly E. Neonatal vitamin A deficiency and its impact on acute respiratory infections among preschool Inuit children. Can J Public Health. 2008;99:102–6.

    Article  PubMed  PubMed Central  Google Scholar 

  140. Qi Y, Niu Q, Zhu X, Zhao X, Yang W, Wang X. Relationship between deficiencies in vitamin A and E and occurrence of infectious diseases among children. Eur Rev Med Pharmacol Sci. 2016;20(23):5009–12.

    PubMed  Google Scholar 

  141. Pandey A, Chakraborty A. Undernutrition, vitamin A deficiency and ARI morbidity in underfives. Indian J Public Health. 1996;40(1):13–6.

    CAS  PubMed  Google Scholar 

  142. Aibana O, Franke MF, Huang C-C, Galea JT, Calderon R, Zhang Z, et al. Impact of vitamin A and carotenoids on the risk of tuberculosis progression. Clin Infect Dis. 2017;65(6):900–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  143. Grubesic RB. Children aged 6 to 60 months in Nepal may require a vitamin A supplement regardless of dietary intake from plant and animal food sources. Food Nutr Bull. 2004;25(3):248–55.

    Article  PubMed  Google Scholar 

  144. Coutsoudis A, Adhikari M, Coovadia H. Serum vitamin A (retinol) concentrations and association with respiratory disease in premature infants. J Trop Pediatr. 1995;41(4):230–3.

    Article  CAS  PubMed  Google Scholar 

  145. Luo ZX, Liu EM, Luo J, Li FR, Li SB, Zeng FQ, et al. Vitamin A deficiency and wheezing. World J Pediatr. 2010;6:81–4.

    Article  CAS  PubMed  Google Scholar 

  146. Velasquez-Melendez G, Okani ET, Kiertsman B, Roncada MJ. Plasma levels of vitamin A, carotenoids and retinol binding protein in children with acute respiratory infections and diarrhoeal diseases. Rev Saude Publica. 1994;28:357–64.

    Article  CAS  PubMed  Google Scholar 

  147. Silva RD, Lopes E Jr, Sarni ROS, Taddei JADAC. Plasma vitamin A levels in deprived children with pneumonia during the acute phase and after recovery. J De Pediatr. 2005;81:162–8.

    Article  Google Scholar 

  148. Barbosa KC, Cunha DF, Jordão AA Jr, Weffort VR, Cunha SF. Transient decreased retinol serum levels in children with pneumonia and acute phase response. J De Pediatr. 2011;87:457–560.

    Google Scholar 

  149. Jiang YL, Peng DH. Serum level of vitamin A in children with pneumonia aged less than 3 years. Zhongguo Dang Dai Er Ke Za Zhi= Chinese J Contemp Pediatr. 2016;18(10):980–3.

    Google Scholar 

  150. Küçükbay H, Yakinci C, Küçükbay F, Turgut M. Serum vitamin A and beta-carotene levels in children with recurrent acute respiratory infections and diarrhoea in Malatya. J Trop Pediatr. 1997;43(6):337–40.

    Article  PubMed  Google Scholar 

  151. Qian L, Lu JR. Serum levels of IgG subclasses and vitamin A in children with recurrent respiratory tract infection. Zhongguo Dang Dai Er Ke Za Zhi= Chinese J Contemp Pediatr. 2007;9(6):557–8.

    CAS  Google Scholar 

  152. Reyes H, Villalpando S, Pérez-Cuevas R, Rodrı́guez L, Pérez-Cuevas M, Montalvo I, Guiscafré H. Frequency and determinants of vitamin A deficiency in children under 5 years of age with pneumonia. Arch Med Res. 2002;33(2):180–5.

    Article  PubMed  Google Scholar 

  153. Büyükgebiz B, Özalp I, Oran O. Investigation of serum vitamin A levels of children who had a history of recurrent diarrhoea and acute respiratory infections in Ankara. J Trop Pediatr. 1990;36(5):251–5.

    Article  PubMed  Google Scholar 

  154. Arroyave G, Calcano M. Decrease in serum levels of retinol and its binding protein (RBP) in infection. Arch Latinoam Nutr. 1979;29(2):233–60.

    CAS  PubMed  Google Scholar 

  155. Dudley L, Hussey G, Huskissen J, Kessow G. Vitamin A status, other risk factors and acute respiratory infection morbidity in children. South African Med J. 1997;87(1):65–70.

    CAS  Google Scholar 

  156. Rahmanifar A, Kirksey A, McCabe G, Galal O, Harrison G, Jerome N. Respiratory tract and diarrheal infections of breast-fed infants from birth to 6 months of age in household contexts of an Egyptian village. Eur J Clin Nutr. 1996;50(10):655–62.

    CAS  PubMed  Google Scholar 

  157. Shenai JP, Chytil F, Parker RA, Stahlman MT. Vitamin A status and airway infection in mechanically ventilated very-low-birth-weight neonates. Pediatr Pulmonol. 1995;19(5):256–61.

    Article  CAS  PubMed  Google Scholar 

  158. Arredondo-García J, Santos-Argumedo L. Blood concentrations of immunoglobulins in children with vitamin A deficiency. Gaceta Medica De Mexico. 1990;126(5):375–81.

    PubMed  Google Scholar 

  159. Agarwal D, Singh S, Gupta V, Agarwal K. Vitamin A status in early childhood diarrhoea, respiratory infection and in maternal and cord blood. J Trop Pediatr. 1996;42(1):12–4.

    Article  CAS  PubMed  Google Scholar 

  160. Moreira E, Valdés A, Rojo M, López I, Pacheco Y, Vitamin A. conjunctival cytology and clinical complications in children hospitalized with pneumonia. Bol De La Oficina Sanit Panam Pan American Sanit Bureau. 1996;121(4):283–90.

    CAS  Google Scholar 

  161. Ünal M, Tamer L, Pata YS, Kilic S, Degˇirmenci U, Akbaş Y, et al. Serum levels of antioxidant vitamins, copper, zinc and magnesium in children with chronic rhinosinusitis. J Trace Elem Med Biol. 2004;18(2):189–92.

    Article  PubMed  Google Scholar 

  162. Xing Y, Sheng K, Xiao X, Li J, Wei H, Liu L, et al. Vitamin A deficiency is associated with severe Mycoplasma pneumoniae pneumonia in children. Ann Transl Med. 2020;8(4):120.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  163. Li Y, Guo Z, Zhang G, Tian X, Li Q, Chen D, Luo Z. The correlation between vitamin a status and refractory Mycoplasma pneumoniae pneumonia (RMPP) incidence in children. BMC Pediatr. 2020;20:1–9.

    Article  Google Scholar 

  164. Coles CL, Fraser D, Givon-Lavi N, Greenberg D, Gorodischer R, Bar-Ziv J, Dagan R. Nutritional status and diarrheal illness as independent risk factors for alveolar pneumonia. Am J Epidemiol. 2005;162(10):999–1007.

    Article  PubMed  Google Scholar 

  165. Núñez G, Sakamoto K, Soares MP. Innate nutritional immunity. J Immunol. 2018;201(1):11–8.

    Article  PubMed  Google Scholar 

  166. Wessling-Resnick M. Crossing the iron gate: why and how transferrin receptors mediate viral entry. Annu Rev Nutr. 2018;38:431–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  167. Jayaweera JAAS, Reyes M, Joseph A. Retracted article: childhood iron deficiency anemia leads to recurrent respiratory tract infections and gastroenteritis. Sci Rep. 2019;9(1):12637.

    Article  PubMed  PubMed Central  Google Scholar 

  168. Barzegari S, Afshari M, Movahednia M, Moosazadeh M. Prevalence of anemia among patients with tuberculosis: a systematic review and meta-analysis. Indian J Tuber. 2019;66(2):299–307.

    Article  Google Scholar 

  169. Kossiva L, Soldatou A, Gourgiotis DI, Stamati L, Tsentidis C. Serum hepcidin: indication of its role as an “acute phase” marker in febrile children. Ital J Pediatr. 2013;39:1–5.

    Article  Google Scholar 

  170. Kossiva L, Gourgiotis DI, Tsentidis C, Anastasiou T, Marmarinos A, Vasilenko H, et al. Serum hepcidin and ferritin to iron ratio in evaluation of bacterial versus viral infections in children: a single-center study. Pediatr Infect Dis J. 2012;31(8):795–8.

    Article  PubMed  Google Scholar 

  171. Gevkaliuk NO, Sydliaruk NI, Posolenyk LY, Vydoinyk OY, Kuchyrka LI. The state of oxidative homeostasis in children with influenza stomatitis. Wiadomosci Lekarskie (Warsaw, Poland: 1960). 2019;72(3):405–8.

    Article  PubMed  Google Scholar 

  172. Cruz A, Parkinson A, Hall D, Bulkow L, Heyward W. Associations of early childhood infections and reduced hemoglobin levels in a historic cohort of Alaska Native infants. Arctic Med Res. 1990;49(4):175–9.

    CAS  PubMed  Google Scholar 

  173. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan. China Intens Care Med. 2020;46(5):846–8.

    Article  CAS  Google Scholar 

  174. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020;395(10223):507–13.

    Article  CAS  Google Scholar 

  175. Wang F, Hou H, Luo Y, Tang G, Wu S, Huang M, et al. The laboratory tests and host immunity of COVID-19 patients with different severity of illness. JCI Insight. 2020;5(10):e137799.

    Article  PubMed  PubMed Central  Google Scholar 

  176. Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe-or critical-type 2019 novel coronavirus pneumonia. Lab Invest. 2020;100(6):794–800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  177. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62.

    Article  CAS  Google Scholar 

  178. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;36(7):e3319.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  179. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97(6):1076–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  180. Read SA, Obeid S, Ahlenstiel C, Ahlenstiel G. The role of zinc in antiviral immunity. Adv Nutr. 2019;10(4):696–710.

    Article  PubMed  PubMed Central  Google Scholar 

  181. Beckhaus AA, Garcia-Marcos L, Forno E, Pacheco-Gonzalez RM, Celedón JC, Castro-Rodriguez JA. Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta-analysis. Allergy. 2015;70(12):1588–604.

    Article  CAS  PubMed  Google Scholar 

  182. Bédard A, Northstone K, Holloway JW, Henderson AJ, Shaheen SO. Maternal dietary antioxidant intake in pregnancy and childhood respiratory and atopic outcomes: birth cohort study. European Respir J. 2018;52(2):1800507.

    Article  Google Scholar 

  183. Bobrowska-Korzeniowska M, Jerzynska J, Polanska K, Gromadzinska J, Hanke W, Wasowicz W, Stelmach I, editors. The role of antioxidants and 25-hydroxyvitamin D during pregnancy in the development of allergic diseases in early school-age children–Polish Mother and Child Cohort Study. Allergy & Asthma Proceedings; 2020.

  184. Shakur MS, Malek M, Bano N, Islam K. Zinc status in well nourished Bangladeshi children suffering from acute lower respiratory infection. Age (mo). 2004;32(52):30-6.64.

    Google Scholar 

  185. Shakur S, Malek M, Bano N, Rahman M, Ahmed M. Serum and hair zinc in severely malnourished Bangladeshi children associated with or without acute lower respiratory infection. The Indian Journal of Pediatrics. 2009;76:609–14.

    Article  PubMed  Google Scholar 

  186. Saleh NY, Abo El Fotoh WMM. Low serum zinc level: The relationship with severe pneumonia and survival in critically ill children. Int J Clin Pract. 2018;72(6):e13211.

    Article  PubMed  Google Scholar 

  187. Rayman MP. Selenium and human health. The Lancet. 2012;379(9822):1256–68.

    Article  CAS  Google Scholar 

  188. Baïz N, Chastang J, Ibanez G, Annesi-Maesano I. Prenatal exposure to selenium may protect against wheezing in children by the age of 3. Immun Inflamm Dis. 2017;5(1):37–44.

    Article  PubMed  Google Scholar 

  189. Devereux G, McNeill G, Newman G, Turner S, Craig L, Martindale S, et al. Early childhood wheezing symptoms in relation to plasma selenium in pregnant mothers and neonates. Clin Exp Allergy. 2007;37(7):1000–8.

    Article  CAS  PubMed  Google Scholar 

  190. Liang RY, Wu W, Huang J, Jiang SP, Lin Y. Magnesium affects the cytokine secretion of CD4+ T lymphocytes in acute asthma. J Asthma. 2012;49(10):1012–5.

    Article  PubMed  Google Scholar 

  191. Nwaru B, Erkkola M, Ahonen S, Kaila M, Kronberg-Kippilä C, Ilonen J, et al. Intake of antioxidants during pregnancy and the risk of allergies and asthma in the offspring. Eur J Clin Nutr. 2011;65(8):937–43.

    Article  CAS  PubMed  Google Scholar 

  192. Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000;55(9):775–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  193. Soutar A, Seaton A, Brown K. Bronchial reactivity and dietary antioxidants. Thorax. 1997;52(2):166–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  194. Britton J, Pavord I, Richards K, Wisniewski A, Knox A, Lewis S, et al. Dietary magnesium, lung function, wheezing, and airway hyper-reactivity in a random adult population sample. The Lancet. 1994;344(8919):357–62.

    Article  CAS  Google Scholar 

  195. Calder PC, Jackson AA. Undernutrition, infection and immune function. Nutr Res Rev. 2000;13(1):3–29.

    Article  CAS  PubMed  Google Scholar 

  196. Sonego M, Pellegrin MC, Becker G, Lazzerini M. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS ONE. 2015;10(1):e0116380.

    Article  PubMed  PubMed Central  Google Scholar 

  197. Alamneh YM, Adane F. Magnitude and predictors of pneumonia among under-five children in Ethiopia: a systematic review and meta-analysis. J Environ Public Health. 2020;2020:1–9.

    Article  Google Scholar 

  198. Baba H, Tokai R, Hirano K, Watanabe T, Shibuya K, Hashimoto I, et al. Risk factors for postoperative pneumonia after general and digestive surgery: a retrospective single-center study. Surg Today. 2020;50:460–8.

    Article  PubMed  Google Scholar 

  199. Yeo HJ, Byun KS, Han J, Kim JH, Lee SE, Yoon SH, et al. Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis. Korean J Intern Med. 2019;34(4):841.

    Article  PubMed  PubMed Central  Google Scholar 

  200. Riquelme R, Torres A, El-Ebiary M, Mensa J, Estruch R, Ruiz M, et al. Community-acquired pneumonia in the elderly: clinical and nutritional aspects. Am J Respir Crit Care Med. 1997;156(6):1908–14.

    Article  CAS  PubMed  Google Scholar 

  201. Lin LC, Hsieh PC, Wu SC. Prevalence and associated factors of pneumonia in patients with vegetative state in Taiwan. J Clin Nurs. 2008;17(7):861–8.

    Article  PubMed  Google Scholar 

  202. Lunardi AC, Miranda CS, Silva KM, Cecconello I, Carvalho CR. Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery. Respirology. 2012;17(1):108–13.

    Article  PubMed  Google Scholar 

  203. Matsusaka K, Kawakami G, Kamekawa H, Momma H, Nagatomi R, Itoh J, Yamaya M. Pneumonia risks in bedridden patients receiving oral care and their screening tool: malnutrition and urinary tract infection-induced inflammation. Geriatr Gerontol Int. 2018;18(5):714–22.

    Article  PubMed  Google Scholar 

  204. Sopena N, Heras E, Casas I, Bechini J, Guasch I, Pedro-Botet ML, et al. Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study. Am J Infect Control. 2014;42(1):38–42.

    Article  PubMed  Google Scholar 

  205. Mitani Y, Oki Y, Fujimoto Y, Yamaguchi T, Iwata K, Watanabe Y, et al. Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long-term nursing care facilities. Geriatr Gerontol Int. 2017;17(10):1617–22.

    Article  PubMed  Google Scholar 

  206. Byun SE, Shon HC, Kim JW, Kim HK, Sim Y. Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: a multicenter retrospective analysis. Geriatr Gerontol Int. 2019;19(2):119–23.

    Article  PubMed  Google Scholar 

  207. NanZhu Y, Xin L, Xianghua Y, Jun C, Min L. Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction. Medicine. 2019;98(13):e15045.

    Article  PubMed  PubMed Central  Google Scholar 

  208. Lin CJ, Chang YC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan. Aging Clin Exp Res. 2020;32:149–55.

    Article  PubMed  Google Scholar 

  209. Callahan CM, Wolinsky FD. Hospitalization for pneumonia among older adults. J Gerontol A Biol Sci Med Sci. 1996;51(6):M276–82.

    Article  CAS  PubMed  Google Scholar 

  210. Russo A, Picciarella A, Russo R, Sabetta F. Clinical features, therapy and outcome of patients hospitalized or not for nursing-home acquired pneumonia. J Infect Chemother. 2020;26(8):807–12.

    Article  PubMed  Google Scholar 

  211. Rodríguez-Pecci MS, Carlson D, Montero-Tinnirello J, Parodi RL, Montero A, Greca AA. Nutritional status and mortality in community acquired pneumonia. Medicina. 2010;70(2):120–6.

    PubMed  Google Scholar 

  212. Falcone M, Russo A, Silverj FG, Marzorati D, Bagarolo R, Monti M, et al. Predictors of mortality in nursing-home residents with pneumonia: a multicentre study. Clin Microbiol Infect. 2018;24(1):72–7.

    Article  CAS  PubMed  Google Scholar 

  213. Shirado K, Wakabayashi H, Maeda K, Nishiyama A, Asada M, Isse H, et al. Impact of energy intake at one week after hospitalization on prognosis for older adults with pneumonia. J Nutr Health Aging. 2020;24(1):119–24.

    Article  CAS  PubMed  Google Scholar 

  214. Espinoza R, E Silva JRL, Bergmann A, de Oliveira Melo U, Calil FE, Santos RC, Salluh JI. Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study. J Critical Care. 2019;50:82–6.

    Article  Google Scholar 

  215. Yamaya M, Kawakami G, Momma H, Yamada A, Itoh J, Ichinose M. Effects of nutritional treatment on the frequency of pneumonia in bedridden patients receiving oral care. Intern Med. 2020;59(2):181–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  216. Fujiwara A, Minakuchi H, Uehara J, Miki H, Inoue-Minakuchi M, Kimura-Ono A, et al. Loss of oral self-care ability results in a higher risk of pneumonia in older inpatients: a prospective cohort study in a Japanese rural hospital. Gerodontology. 2019;36(3):236–43.

    Article  PubMed  Google Scholar 

  217. Kelaiditi E, Demougeot L, Lilamand M, Guyonnet S, Vellas B, Cesari M. Nutritional status and the incidence of pneumonia in nursing home residents: results from the INCUR study. J Am Med Dir Assoc. 2014;15(8):588–92.

    Article  PubMed  Google Scholar 

  218. Brüssow H, Sidoti J, Dirren H, Freire WB. Effect of malnutrition in Ecuadorian children on titers of serum antibodies to various microbial antigens. Clin Diagnostic Labor Immunol. 1995;2(1):62–8.

    Article  Google Scholar 

  219. Kabego L, Balol’Ebwami S, Kasengi JB, Miyanga S, Bahati YL, Kambale R, de Beer C. Human respiratory syncytial virus: prevalence, viral co-infections and risk factors for lower respiratory tract infections in children under 5 years of age at a general hospital in the Democratic Republic of Congo. J Med Microbiol. 2018;67(4):514–22.

    Article  PubMed  Google Scholar 

  220. Christie CD, Heikens GT, Black FL. Acute respiratory infections in ambulatory malnourished children: a serological study. Trans R Soc Trop Med Hyg. 1990;84(1):160–1.

    Article  CAS  PubMed  Google Scholar 

  221. Ofman G, Pradarelli B, Caballero MT, Bianchi A, Grimaldi LA, Sancilio A, et al. Respiratory failure and death in vulnerable premature children with lower respiratory tract illness. J Infect Dis. 2020;222(7):1129–37.

    Article  PubMed  PubMed Central  Google Scholar 

  222. Gentile Á, Bakir J, Russ C, Ruvinsky S, Ensinck G, Falaschi A, et al. Estudio de las enfermedades respiratorias por virus Influenza A H1N1 (pH1N1) en niños internados durante el año de la pandemia: Experiencia de 34 centros en la Argentina. Arch Argent Pediatr. 2011;109(3):198–203.

    PubMed  Google Scholar 

  223. Hung KY, Chen YM, Wang CC, Wang YH, Lin CY, Chang YT, et al. Insufficient nutrition and mortality risk in septic patients admitted to ICU with a focus on immune dysfunction. Nutrients. 2019;11(2):367.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  224. Buck W, Olson D, Kabue M, Ahmed S, Nchama L, Munthali A, et al. Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection. Int J Tuberc Lung Dis. 2013;17(11):1389–95.

    Article  CAS  PubMed  Google Scholar 

  225. Pakasi TA, Karyadi E, Dolmans W, Van der Meer J, Van der Velden K. Malnutrition and socio-demographic factors associated with pulmonary tuberculosis in Timor and Rote Islands, Indonesia. Int J Tuberc Lung Dis. 2009;13(6):755–9.

    PubMed  Google Scholar 

  226. Baldwin M, Yori PP, Ford C, Moore D, Gilman R, Vidal C, et al. Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon. Int J Tuberc Lung Dis. 2004;8(12):1484–91.

    CAS  PubMed  Google Scholar 

  227. Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulm Med. 2019;19:1–9.

    Article  Google Scholar 

  228. Harries A, Thomas J, Chugh K. Malnutrition in African patients with pulmonary tuberculosis. Hum Nutr Clin Nutr. 1985;39(5):361–3.

    CAS  PubMed  Google Scholar 

  229. Metcalfe N. A study of tuberculosis, malnutrition and gender in Sri Lanka. Trans R Soc Trop Med Hyg. 2005;99(2):115–9.

    Article  PubMed  Google Scholar 

  230. Yu EA, Finkelstein JL, Brannon PM, Bonam W, Russell DG, Glesby MJ, Mehta S. Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India. PLoS ONE. 2020;15(5):e0233306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  231. Piva SGN, Costa MDCN, Barreto FR, Pereira SM. Prevalence of nutritional deficiency in patients with pulmonary tuberculosis. J Brasileiro De Pneumologia. 2013;39:476–83.

    Article  Google Scholar 

  232. Bacelo AC, Ramalho A, Brasil PE, Cople-Rodrigues CDS, Georg I, Paiva E, et al. Nutritional supplementation is a necessary complement to dietary counseling among tuberculosis and tuberculosis-HIV patients. PLoS One. 2015;10(8):e0134785.

    Article  PubMed  PubMed Central  Google Scholar 

  233. da Silva LF, Skupien EC, Lazzari TK, Holler SR, de Almeida EGC, Zampieri LR, et al. Advanced glycation end products (AGE) and receptor for AGE (RAGE) in patients with active tuberculosis, and their relationship between food intake and nutritional status. PLoS ONE. 2019;14(3):e0213991.

    Article  PubMed  PubMed Central  Google Scholar 

  234. Cegielski JP, Arab L, Cornoni-Huntley J. Nutritional risk factors for tuberculosis among adults in the United States, 1971–1992. Am J Epidemiol. 2012;176(5):409–22.

    Article  PubMed  Google Scholar 

  235. Rashak H, Sánchez-Pérez HJ, Abdelbary B, Bencomo-Alerm A, Enriquez-Ríos N, Gómez-Velasco A, et al. Diabetes, undernutrition, migration and indigenous communities: tuberculosis in Chiapas. Mexico Epidemiol Infect. 2019;147:e71.

    Article  CAS  PubMed  Google Scholar 

  236. Hussien B, Hussen MM, Seid A, Hussen A. Nutritional deficiency and associated factors among new pulmonary tuberculosis patients of Bale Zone Hospitals, southeast Ethiopia. BMC Res Notes. 2019;12:1–6.

    Article  Google Scholar 

  237. Bacelo AC, do Brasil PEAA, dos Santos Cople-Rodrigues C, Ingebourg G, Paiva E, Ramalho A, Rolla VC. Dietary counseling adherence during tuberculosis treatment: a longitudinal study. Clin Nutr ESPEN. 2017;17:44–53.

    Article  PubMed  Google Scholar 

  238. Niki M, Yoshiyama T, Nagai H, Miyamoto Y, Niki M, Oinuma KI, et al. Nutritional status positively impacts humoral immunity against its Mycobacterium tuberculosis, disease progression, and vaccine development. PloS One. 2020;15(8):e0237062.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  239. Bhat J, Rao V, Sharma R, Muniyandi M, Yadav R, Bhondley MK. Investigation of the risk factors for pulmonary tuberculosis: a case–control study among: Saharia: tribe in Gwalior district, Madhya Pradesh India. Indian J Med Res. 2017;146(1):97–104.

    Article  PubMed  PubMed Central  Google Scholar 

  240. Tian P, Wang Y, Shen Y, Chen L, Wan C, Liao Z, Wen F. Different risk factors of recurrent pulmonary tuberculosis between Tibetan and Han populations in Southwest China. Eur Rev Med Pharmacol Sci. 2014;18(10):1482–6.

    PubMed  Google Scholar 

  241. Kubiak RW, Sarkar S, Horsburgh CR, Roy G, Kratz M, Reshma A, et al. Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis. 2019;19:1–9.

    Article  Google Scholar 

  242. Rao VG, Bhat J, Yadav R, Sharma RK, Muniyandi M. A comparative study of the socio-economic risk factors for pulmonary tuberculosis in the Saharia tribe of Madhya Pradesh, India. Trans R Soc Trop Med Hyg. 2018;112(6):272–8.

    Article  PubMed  Google Scholar 

  243. Anuradha R, Munisankar S, Bhootra Y, Kumar NP, Dolla C, Babu S. Malnutrition is associated with diminished baseline and mycobacterial antigen–Stimulated chemokine responses in latent tuberculosis infection. J Infect. 2018;77(5):410–6.

    Article  PubMed  PubMed Central  Google Scholar 

  244. Campos-Góngora E, López-Martínez J, Huerta-Oros J, Arredondo-Mendoza GI, Jiménez-Salas Z. Nutritional status evaluation and nutrient intake in adult patients with pulmonary tuberculosis and their contacts. J Infect Dev Countries. 2019;13(04):303–10.

    Article  Google Scholar 

  245. Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M, et al. Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS ONE. 2013;8(10):e77979.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  246. Gashaw F, Bekele S, Mekonnen Y, Medhin G, Ameni G, Erko B. High helminthic co-infection in tuberculosis patients with undernutritional status in northeastern Ethiopia. Infect Dis Poverty. 2019;8(05):52–62.

    Google Scholar 

  247. Hayashi S, Takeuchi M, Hatsuda K, Ogata K, Kurata M, Nakayama T, et al. The impact of nutrition and glucose intolerance on the development of tuberculosis in Japan. Int J Tuberc Lung Dis. 2014;18(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  248. Kennedy N, Ramsay A, Uiso L, Gutmann J, Ngowi F, Gillespie S. Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania. Trans R Soc Trop Med Hyg. 1996;90(2):162–6.

    Article  CAS  PubMed  Google Scholar 

  249. Kim D, Kim H, Kwon S, Yoon H, Lee C, Kim Y, et al. Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis. Eur Respir J. 2008;32(4):1031–6.

    Article  CAS  PubMed  Google Scholar 

  250. Lee N, White LV, Marin FP, Saludar NR, Solante MB, Tactacan-Abrenica RJ, et al. Mid-upper arm circumference predicts death in adult patients admitted to a TB ward in the Philippines: a prospective cohort study. PLoS ONE. 2019;14(6):e0218193.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  251. Onwubalili J. Malnutrition among tuberculosis patients in Harrow England. European J Clin Nutr. 1988;42(4):363–6.

    CAS  Google Scholar 

  252. Yoneda T. Relation between malnutrition and cell-mediated immunity in pulmonary tuberculosis. Kekkaku:[Tuberculosis]. 1989;64(10):633–40.

    CAS  PubMed  Google Scholar 

  253. Pelly T, Santillan C, Gilman R, Cabrera L, Garcia E, Vidal C, et al. Tuberculosis skin testing, anergy and protein malnutrition in Peru. Int J Tuberc Lung Dis. 2005;9(9):977–84.

    CAS  PubMed  Google Scholar 

  254. Patsche C, Rudolf F, Mogensen SW, Sifna A, Gomes VF, Byberg S, Wejse C. Low prevalence of malnourishment among household contacts of patients with tuberculosis in Guinea-Bissau. Int J Tuberc Lung Dis. 2017;21(6):664–9.

    Article  CAS  PubMed  Google Scholar 

  255. Pizzol D, Veronese N, Marotta C, Di Gennaro F, Moiane J, Chhaganlal K, et al. Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira. Mozambique BMC Res Notes. 2018;11:1–6.

    Google Scholar 

  256. Podewils L, Holtz T, Riekstina V, Skripconoka V, Zarovska E, Kirvelaite G, et al. Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients. Epidemiol Infect. 2011;139(1):113–20.

    Article  CAS  PubMed  Google Scholar 

  257. PrayGod G, Range N, Faurholt-Jepsen D, Jeremiah K, Faurholt-Jepsen M, Aabye MG, et al. Weight, body composition and handgrip strength among pulmonary tuberculosis patients: a matched cross-sectional study in Mwanza, Tanzania. Trans R Soc Trop Med Hyg. 2011;105(3):140–7.

    Article  PubMed  Google Scholar 

  258. Kawai K, Villamor E, Mugusi FM, Saathoff E, Urassa W, Bosch RJ, et al. Predictors of change in nutritional and hemoglobin status among adults treated for tuberculosis in Tanzania. Int J Tuberc Lung Dis. 2011;15(10):1380–9.

    Article  CAS  PubMed  Google Scholar 

  259. Ren Z, Zhao F, Chen H, Hu D, Yu W, Xu X, et al. Nutritional intakes and associated factors among tuberculosis patients: a cross-sectional study in China. BMC Infect Dis. 2019;19:1–8.

    Article  Google Scholar 

  260. Van LH, Phu PT, Vinh DN, Son VT, Hanh NT, Nhat LTH, et al. Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study. BMC Infect Dis. 2020;20:1–10.

    Article  Google Scholar 

  261. White LV, Edwards T, Lee N, Castro MC, Saludar NR, Calapis RW, et al. Patterns and predictors of co-morbidities in tuberculosis: a cross-sectional study in the Philippines. Sci Rep. 2020;10(1):4100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  262. Shafee M, Abbas F, Ashraf M, Mengal MA, Kakar N, Ahmad Z, Ali F. Hematological profile and risk factors associated with pulmonary tuberculosis patients in Quetta, Pakistan. Pakistan J Med Sci. 2014;30(1):36.

    Google Scholar 

  263. Ukibe NR, Ndiuwem CK, Ogbu II, Ukibe SN, Ehiaghe FA, Ikimi CG. Prognostic value of some serum protein fractions as early index of clinical recovery in pulmonary tuberculosis subjects. Indian J Tuber. 2020;67(2):167–71.

    Article  Google Scholar 

  264. Zachariah R, Spielmann M, Harries A, Salaniponi F. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002;96(3):291–4.

    Article  CAS  PubMed  Google Scholar 

  265. Asare H, Carboo J, Nel E, Dolman R, Conradie C, Lombard M, Ricci C. Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0–59 months: an observational study. Br J Nutr. 2021;125(10):1157–65.

    Article  CAS  PubMed  Google Scholar 

  266. Hicks R, Padayatchi N, Shah N, Wolf A, Werner L, Sunkari V, O’Donnell M. Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children. Int J Tuberc Lung Dis. 2014;18(9):1074–83.

    Article  CAS  PubMed  Google Scholar 

  267. Liyew Ayalew M, Birhan Yigzaw W, Tigabu A, Gelaw Tarekegn B. Prevalence, associated risk factors and rifampicin resistance pattern of pulmonary tuberculosis among children at Debre Markos Referral Hospital, Northwest Ethiopia. Infect Drug Resist. 2020;29:3863–72.

    Article  Google Scholar 

  268. Ejaz K, Lone S, Raza SJ. Investment in paediatric tuberculosis prevention in Pakistan: loss or gain. J Pakistan Med Assoc. 2010;60(11):897.

    Google Scholar 

  269. Ramachandran R, Indu P, Anish T, Nair S, Lawrence T, Rajasi R. Determinants of childhood tuberculosis–a case control study among children registered under revised National Tuberculosis Control Programme in a district of South India. Indian J Tuberc. 2011;58(4):204–7.

    PubMed  Google Scholar 

  270. Jubulis J, Kinikar A, Ithape M, Khandave M, Dixit S, Hotalkar S, et al. Modifiable risk factors associated with tuberculosis disease in children in Pune, India. Int J Tuberc Lung Dis. 2014;18(2):198–204.

    Article  CAS  PubMed  Google Scholar 

  271. Simon Schaaf H, Cilliers K, Willemse M, Labadarios D, Kidd M, Donald PR. Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis. Paediatr Int Child Health. 2012;32(2):74–81.

    Article  PubMed  Google Scholar 

  272. Vijayakumar M, Bhaskaram P, Hemalatha P. Malnutrition and childhood tuberculosis. J Trop Pediatr. 1990;36(6):294–8.

    Article  CAS  PubMed  Google Scholar 

  273. Wei C, Liu Y, Li Y, Zhang Y, Zhong M, Meng X. Evaluation of the nutritional status in patients with COVID-19. J Clin Biochemist Nutr. 2020;67(2):116–21.

    Article  Google Scholar 

  274. Cai C, Koch B, Morikawa K, Lange CM. Macrophage-derived extracellular vesicles induce long-lasting immunity against hepatitis C virus which is blunted by polyunsaturated fatty acids. Front Immunol. 2018;9:345500.

    Article  Google Scholar 

  275. Papamichael M, Shrestha S, Itsiopoulos C, Erbas B. The role of fish intake on asthma in children: a meta-analysis of observational studies. Pediatr Allergy Immunol. 2018;29(4):350–60.

    Article  CAS  PubMed  Google Scholar 

  276. Kitz R, Rose MA, Schubert R, Beermann C, Kaufmann A, Böhles HJ, et al. Omega-3 polyunsaturated fatty acids and bronchial inflammation in grass pollen allergy after allergen challenge. Respir Med. 2010;104(12):1793–8.

    Article  PubMed  Google Scholar 

  277. Tamura J, Kubota K, Murakami H, Sawamura M, Matsushima T, Tamura T, et al. Immunomodulation by vitamin B12: augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment. Clin Exp Immunol. 1999;116(1):28–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  278. Romain M, Sviri S, Linton D, Stav I, van Heerden PV. The role of vitamin B12 in the critically ill—a review. Anaesth Intensive Care. 2016;44(4):447–52.

    Article  CAS  PubMed  Google Scholar 

  279. Skaaby T, Taylor AE, Jacobsen RK, Møllehave LT, Friedrich N, Thuesen BH, et al. Associations of genetic determinants of serum vitamin B12 and folate concentrations with hay fever and asthma: a Mendelian randomization meta-analysis. Eur J Clin Nutr. 2018;72(2):264–71.

    Article  CAS  PubMed  Google Scholar 

  280. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67(4):188–205.

    Article  PubMed  Google Scholar 

  281. North C, Venter C, Jerling J. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Eur J Clin Nutr. 2009;63(8):921–33.

    Article  CAS  PubMed  Google Scholar 

  282. Butler LM, Koh W-P, Lee H-P, Yu MC, London SJ. Dietary fiber and reduced cough with phlegm: a cohort study in Singapore. Am J Respir Crit Care Med. 2004;170(3):279–87.

    Article  PubMed  Google Scholar 

  283. Hirayama F, Lee AH, Binns CW, Zhao Y, Hiramatsu T, Tanikawa Y, et al. Do vegetables and fruits reduce the risk of chronic obstructive pulmonary disease? A case–control study in Japan. Prev Med. 2009;49(2–3):184–9.

    Article  PubMed  Google Scholar 

  284. Kaluza J, Harris H, Wallin A, Linden A, Wolk A. Dietary fiber intake and risk of chronic obstructive pulmonary disease: a prospective cohort study of men. Epidemiology. 2018;29(2):254–60.

    Article  PubMed  Google Scholar 

  285. Szmidt MK, Kaluza J, Harris HR, Linden A, Wolk A. Long-term dietary fiber intake and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Eur J Nutr. 2020;59:1869–79.

    Article  CAS  PubMed  Google Scholar 

  286. Kan H, Stevens J, Heiss G, Rose KM, London SJ. Dietary fiber, lung function, and chronic obstructive pulmonary disease in the atherosclerosis risk in communities study. Am J Epidemiol. 2008;167(5):570–8.

    Article  PubMed  Google Scholar 

  287. Varraso R, Willett WC, Camargo CA Jr. Prospective study of dietary fiber and risk of chronic obstructive pulmonary disease among US women and men. Am J Epidemiol. 2010;171(7):776–84.

    Article  PubMed  PubMed Central  Google Scholar 

  288. Jung YJ, Lee SH, Chang JH, Lee HS, Kang EH, Lee S-W. The Effect of Dietary Fiber and Nutrients Intake on the Lung Function and COPD in Korean Adults. Eur Respiratory Soc. 2020.

  289. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Supplement_2):S27–72.

    Article  CAS  PubMed  Google Scholar 

  290. Talukdar S, Bae EJ, Imamura T, Morinaga H, Fan W, Li P, et al. GPR120 is an omega-3 fatty acid receptor mediating potent anti-inflammatory and insulin-sensitizing effects. Cell. 2010;142(5):687–98.

    Article  PubMed  PubMed Central  Google Scholar 

  291. Aoki H, Hisada T, Ishizuka T, Utsugi M, Ono A, Koga Y, et al. Protective effect of resolvin E1 on the development of asthmatic airway inflammation. Biochem Biophys Res Commun. 2010;400(1):128–33.

    Article  CAS  PubMed  Google Scholar 

  292. Slavin JL, Jacobs D, Marquart L, Wiemer K. The role of whole grains in disease prevention. J Am Diet Assoc. 2001;101(7):780–5.

    Article  CAS  PubMed  Google Scholar 

  293. Ford E, Mokdad A, Liu S. Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988–1994. Eur J Clin Nutr. 2005;59(2):278–83.

    Article  CAS  PubMed  Google Scholar 

  294. Trompette A, Gollwitzer ES, Yadava K, Sichelstiel AK, Sprenger N, Ngom-Bru C, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nat Med. 2014;20(2):159–66.

    Article  CAS  PubMed  Google Scholar 

  295. Shaheen SO, Northstone K, Newson RB, Emmett PM, Sherriff A, Henderson AJ. Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood. Thorax. 2009;64(5):411–7.

    Article  CAS  PubMed  Google Scholar 

  296. Watkins RR, Yamshchikov AV, Lemonovich TL, Salata RA. The role of vitamin D deficiency in sepsis and potential therapeutic implications. J Infect. 2011;63(5):321–6.

    Article  PubMed  Google Scholar 

  297. Liu Z, Brady A, Young A, Rasimick B, Chen K, Zhou C, Kallenbach NR. Length effects in antimicrobial peptides of the (RW) n series. Antimicrob Agents Chemother. 2007;51(2):597–603.

    Article  CAS  PubMed  Google Scholar 

  298. Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med. 2010;88:441–50.

    Article  CAS  PubMed  Google Scholar 

  299. Dürr UH, Sudheendra U, Ramamoorthy A. LL-37, the only human member of the cathelicidin family of antimicrobial peptides. Biochimica Et Biophysica Acta (BBA)-Biomembranes. 2006;1758(9):1408–25.

    Article  PubMed  Google Scholar 

  300. Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009;7:1–9.

    Article  Google Scholar 

  301. Clancy N, Onwuneme C, Carroll A, McCarthy R, McKenna M, Murphy N, Molloy E. Vitamin D and neonatal immune function. J Matern Fetal Neonatal Med. 2013;26(7):639–46.

    Article  CAS  PubMed  Google Scholar 

  302. Berg I, Hanson C, Sayles H, Romberger D, Nelson A, Meza J, et al. Vitamin D, vitamin D binding protein, lung function and structure in COPD. Respir Med. 2013;107(10):1578–88.

    Article  PubMed  Google Scholar 

  303. Timms P, Mannan N, Hitman G, Noonan K, Mills P, Syndercombe-Court D, et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM. 2002;95(12):787–96.

    Article  CAS  PubMed  Google Scholar 

  304. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006;83(4):754–9.

    Article  CAS  PubMed  Google Scholar 

  305. Bellia A, Garcovich C, D’Adamo M, Lombardo M, Tesauro M, Donadel G, et al. Serum 25-hydroxyvitamin D levels are inversely associated with systemic inflammation in severe obese subjects. Intern Emerg Med. 2013;8:33–40.

    Article  PubMed  Google Scholar 

  306. Wong AP, Keating A, Waddell TK. Airway regeneration: the role of the Clara cell secretory protein and the cells that express it. Cytotherapy. 2009;11(6):676–87.

    Article  CAS  PubMed  Google Scholar 

  307. Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, Hunninghake GW. Respiratory epithelial cells convert inactive vitamin D to its active form: potential effects on host defense. J Immunol. 2008;181(10):7090–9.

    Article  CAS  PubMed  Google Scholar 

  308. Hansdottir S, Monick MM, Lovan N, Powers L, Gerke A, Hunninghake GW. Vitamin D decreases respiratory syncytial virus induction of NF-κB–linked chemokines and cytokines in airway epithelium while maintaining the antiviral state. J Immunol. 2010;184(2):965–74.

    Article  CAS  PubMed  Google Scholar 

  309. Black RE, Sazawal S. Zinc and childhood infectious disease morbidity and mortality. Br J Nutr. 2001;85(S2):S125–9.

    Article  CAS  PubMed  Google Scholar 

  310. Sirisinha S. The pleiotropic role of vitamin A in regulating mucosal immunity. Asian Pacific J Allergy Immunol. 2015;33(2):71–89.

    Google Scholar 

  311. Détivaud LNC, Nemeth E, Boudjema K, Turlin B, Troadec MB, Leroyer P, et al. Hepcidin levels in humans are correlated with hepatic iron stores, hemoglobin levels, and hepatic function. Blood. 2005;106(2):746–8.

    Article  PubMed  Google Scholar 

  312. Mena NP, Esparza A, Tapia V, Valdés P, Núnez MT. Hepcidin inhibits apical iron uptake in intestinal cells. American J Physiol Gastrointest Liver Physiol. 2008;294(1):G192–8.

    Article  CAS  Google Scholar 

  313. Yamaji S, Sharp P, Ramesh B, Srai SK. Inhibition of iron transport across human intestinal epithelial cells by hepcidin. Blood. 2004;104(7):2178–80.

    Article  CAS  PubMed  Google Scholar 

  314. Ganz T, Nemeth E. Iron imports. IV. Hepcidin and regulation of body iron metabolism. American J Physiol Gastrointestinal Liver Physiol. 2006;290(2):G199–203.

    Article  CAS  Google Scholar 

  315. Kemna EH, Tjalsma H, Willems J, Swinkels DW. Hepcidin: from discovery to differential diagnosis. 2008.

    Google Scholar 

  316. Chao A, Sieminski PJ, Owens CP, Goulding CW. Iron acquisition in Mycobacterium tuberculosis. Chem Rev. 2018;119(2):1193–220.

    Article  PubMed  PubMed Central  Google Scholar 

  317. Bonaventura P, Benedetti G, Albarède F, Miossec P. Zinc and its role in immunity and inflammation. Autoimmun Rev. 2015;14(4):277–85.

    Article  CAS  PubMed  Google Scholar 

  318. Albarwani S, Robertson BE, Nye PC, Kozlowski RZ. Biophysical properties of Ca 2+-and Mg-ATP-activated K+ channels in pulmonary arterial smooth muscle cells isolated from the rat. Pflugers Arch. 1994;428:446–54.

    Article  CAS  PubMed  Google Scholar 

  319. Landon RA, Young EA. Role of magnesium in regulation of lung function. J Am Diet Assoc. 1993;93(6):674–7.

    Article  CAS  PubMed  Google Scholar 

  320. Wardlaw TM, Johansson EW, Hodge MJ. Pneumonia: the forgotten killer of children: Unicef; 2006.

  321. Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty. 2016;31(1):15–21.

    Article  PubMed  Google Scholar 

  322. Minakuchi H, Wakino S, Hayashi K, Inamoto H, Itoh H. Serum creatinine and albumin decline predict the contraction of nosocomial aspiration pneumonia in patients undergoing hemodialysis. Ther Apher Dial. 2014;18(4):326–33.

    Article  CAS  PubMed  Google Scholar 

  323. Kosai K, Izumikawa K, Imamura Y, Tanaka H, Tsukamoto M, Kurihara S, et al. Importance of functional assessment in the management of community-acquired and healthcare-associated pneumonia. Intern Med. 2014;53(15):1613–20.

    Article  PubMed  Google Scholar 

  324. DMSc MS, Kusuya Nishioka M. Physiologic role of the complement system in host defense, disease, and malnutrition. Nutrition. 1998;14(4):391–8.

  325. Sherman H, Chapnik N, Froy O. Albumin and amino acids upregulate the expression of human beta-defensin 1. Mol Immunol. 2006;43(10):1617–23.

    Article  CAS  PubMed  Google Scholar 

  326. Heart TN. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307(8):795.

    Article  Google Scholar 

  327. Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011;93(3):569–77.

    Article  CAS  PubMed  Google Scholar 

  328. Jafar N, Edriss H, Nugent K. The effect of short-term hyperglycemia on the innate immune system. Am J Med Sci. 2016;351(2):201–11.

    Article  PubMed  Google Scholar 

  329. King DE. Dietary fiber, inflammation, and cardiovascular disease. Mol Nutr Food Res. 2005;49(6):594–600.

    Article  PubMed  Google Scholar 

  330. Eastwood M. Interaction of dietary antioxidants in vivo: how fruit and vegetables prevent disease? QJM. 1999;92(9):527–30.

    Article  CAS  PubMed  Google Scholar 

  331. A Larrauri J, Goñi I, Martín‐Carrón N, Rupérez P, Saura‐Calixto F. Measurement of health‐promoting properties in fruit dietary fibres: antioxidant capacity, fermentability and glucose retardation index. Journal of the Science of Food and Agriculture. 1996;71(4):515–9.

  332. Ajani UA, Ford ES, Mokdad AH. Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. J Nutr. 2004;134(5):1181–5.

    Article  CAS  PubMed  Google Scholar 

  333. Hagander B, Asp N-G, Efendić S, Nilsson-Ehle P, Scherstén B. Dietary fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients. Am J Clin Nutr. 1988;47(5):852–8.

    Article  CAS  PubMed  Google Scholar 

  334. King DE, Egan BM, Woolson RF, Mainous AG, Al-Solaiman Y, Jesri A. Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Arch Intern Med. 2007;167(5):502–6.

    Article  CAS  PubMed  Google Scholar 

  335. King DE, Mainous AG III, Egan BM, Woolson RF, Geesey ME. Fiber and C-reactive protein in diabetes, hypertension, and obesity. Diabetes Care. 2005;28(6):1487–9.

    Article  CAS  PubMed  Google Scholar 

  336. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75(3):492–8.

    Article  CAS  PubMed  Google Scholar 

  337. Ma ZQ, Yi CP, Wu NN, Tan B. Reduction of phenolic profiles, dietary fiber, and antioxidant activities of rice after treatment with different milling processes. Cereal Chem. 2020;97(6):1158–71.

    Article  CAS  Google Scholar 

  338. Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26(5):995–1001.

    Article  CAS  PubMed  Google Scholar 

  339. Poullis A, Foster R, Shetty A, Fagerhol MK, Mendall MA. Bowel inflammation as measured by fecal calprotectin: a link between lifestyle factors and colorectal cancer risk. Cancer Epidemiol Biomark Prev. 2004;13(2):279–84.

    Article  CAS  Google Scholar 

  340. Slavin JL, Martini MC, Jacobs DR Jr, Marquart L. Plausible mechanisms for the protectiveness of whole grains. Am J Clin Nutr. 1999;70(3):459S-S463.

    Article  CAS  PubMed  Google Scholar 

  341. Chen H-L, Huang Y-C. Fiber intake and food selection of the elderly in Taiwan. Nutrition. 2003;19(4):332–6.

    Article  CAS  PubMed  Google Scholar 

  342. Barlow PG, Svoboda P, Mackellar A, Nash AA, York IA, Pohl J, et al. Antiviral activity and increased host defense against influenza infection elicited by the human cathelicidin LL-37. PLoS ONE. 2011;6(10):e25333.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  343. Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251(3):228–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  344. Kong J, Zhu X, Shi Y, Liu T, Chen Y, Bhan I, et al. VDR attenuates acute lung injury by blocking Ang-2-Tie-2 pathway and renin-angiotensin system. Mol Endocrinol. 2013;27(12):2116–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  345. Daneshkhah A, Eshein A, Subramanian H, Roy HK, Backman V. The role of vitamin D in suppressing cytokine storm in COVID-19 patients and associated mortality. MedRxiv. 2020.

  346. Thavagnanam S, Parker JC, McBrien ME, Skibinski G, Heaney LG, Shields MD. Effects of IL-13 on mucociliary differentiation of pediatric asthmatic bronchial epithelial cells. Pediatr Res. 2011;69(2):95–100.

    Article  CAS  PubMed  Google Scholar 

  347. McCartney D, Byrne DG. Optimisation of vitamin D status for enhanced Immuno-protection against Covid-19. 2020.

    Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  349. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Investig. 2020;130(5):2620–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  350. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England J Med. 2020;382(18):1708–20.

    Article  CAS  Google Scholar 

  351. Cohen S, Danzaki K, MacIver NJ. Nutritional effects on T-cell immunometabolism. Eur J Immunol. 2017;47(2):225–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to gratefully acknowledge for the support awarded by the Tehran University of Medical Sciences.

Funding

This work was supported by the Tehran University of Medical Sciences [grant number 46718_212_3_98].

Author information

Author notes

  1. Mohammadreza Askari and Batoul Ghosn contributed equally to this work.

Authors and Affiliations

  1. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran

    Zahra Salehi, Mohammadreza Askari, Alireza Jafari, Batoul Ghosn, Hamed Pouraram & Leila Azadbakht

  2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Pamela J. Surkan

  3. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Javad Hosseinzadeh-Attar

  4. Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, IR, Iran

    Mohammad Javad Hosseinzadeh-Attar

  5. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR, Iran

    Leila Azadbakht

  6. Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR, Iran

    Leila Azadbakht

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  1. Zahra Salehi
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Contributions

ZS: Authored and drafted the manuscript, conducted the primary literature search, and extracted relevant articles. MA: Conducted a thorough review and verification of the articles. AJ: Assessed and validated the articles discovered. BG: Provided critical review and editing of the initial draft, contributed to the manuscript drafting, and participated in the final revision of the manuscript. MjH, HP, and LA: Provided valuable comments on the research, contributed to the study design, and reviewed and commented on the manuscript draft. PS: Undertook the revision of the article, provided insightful comments, and edited the final draft for submission.

Corresponding author

Correspondence to Leila Azadbakht.

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This study was approved by the institutional review board of the Tehran University of Medical Sciences.

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Salehi, Z., Askari, M., Jafari, A. et al. Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review. BMC Public Health 24, 1661 (2024). https://doi.org/10.1186/s12889-024-18760-y

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BMC Public Health

ISSN: 1471-2458

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