COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation

Abstract

The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has engulfed the world, affecting more than 180 countries. As a result, there has been considerable economic distress globally and a significant loss of life. Sadly, the vulnerable and immunocompromised in our societies seem to be more susceptible to severe COVID-19 complications. Global public health bodies and governments have ignited strategies and issued advisories on various handwashing and hygiene guidelines, social distancing strategies, and, in the most extreme cases, some countries have adopted "stay in place" or lockdown protocols to prevent COVID-19 spread. Notably, there are several significant risk factors for severe COVID-19 infection. These include the presence of poor nutritional status and pre-existing noncommunicable diseases (NCDs) such as diabetes mellitus, chronic lung diseases, cardiovascular diseases (CVD), obesity, and various other diseases that render the patient immunocompromised. These diseases are characterized by systemic inflammation, which may be a common feature of these NCDs, affecting patient outcomes against COVID-19. In this review, we discuss some of the anti-inflammatory therapies that are currently under investigation intended to dampen the cytokine storm of severe COVID-19 infections. Furthermore, nutritional status and the role of diet and lifestyle is considered, as it is known to affect patient outcomes in other severe infections and may play a role in COVID-19 infection. This review speculates the importance of nutrition as a mitigation strategy to support immune function amid the COVID-19 pandemic, identifying food groups and key nutrients of importance that may affect the outcomes of respiratory infections.

Keywords: COVID-19; SARS-CoV-2; anti-inflammatory; coronavirus; infection; inflammation; noncommunicable diseases; nutrition; vitamin C; vitamin D; zinc.

Figure 1

Images of SARS-CoV-2 obtained by transmission electron microscopy. The images show SARS-CoV-2 isolated from a patient in the United States. The virus particles shown are emerging from the surface of cells cultured in a laboratory. The spikes on the outer edge of the virus particles give coronaviruses their name. Both images were captured, colorized, and reproduced with permission courtesy of the National Institute of Allergy and Infectious Diseases’ Rocky Mountain Laboratories in Hamilton, MT, USA [23].

Figure 2

World Health Organization (WHO) guidelines and information intended for people with noncommunicable diseases [25]. Abbreviations: COPD = Chronic obstructive pulmonary disease.

Figure 3

A representation of the inflammatory molecules involved in infection and how certain dietary components may interact with them. Included are the cytokines, growth factors, and other chemokines that promote the onset and progression of inflammatory manifestations, dysregulation of the immune system, and a diseased state due to the effects of several unmodifiable and modifiable risk factors. Targeted drug treatments and/or healthy lifestyle choices such as balanced diets and physical activity can counterbalance such inflammatory manifestations towards homeostasis.