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Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis

Abioye et al., BMJ Global Health, doi:10.1136/bmjgh-2020-003176
Jan 2021  
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Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 77 treatments. c19early.org
Systematic review and meta-analysis of 80 randomized controlled trials showing reduced risk of acute respiratory infections with vitamin C and vitamin D, and shorter duration of symptoms with vitamin C, vitamin D, and zinc.
15 meta analyses show significant improvements with vitamin D treatment for mortality1-10, mechanical ventilation1,6,7,11,12, ICU admission1,3,6,7,10-14, hospitalization5, severity2,4,6,15, and cases8,14,15.
Currently there are 122 vitamin D treatment for COVID-19 studies, showing 36% lower mortality [28‑43%], 19% lower ventilation [-3‑36%], 45% lower ICU admission [28‑58%], 19% lower hospitalization [9‑29%], and 17% fewer cases [9‑24%].
Study covers vitamin C, vitamin D, and zinc.
Abioye et al., 19 Jan 2021, peer-reviewed, 3 authors. Contact: iaa551@g.harvard.edu.
This PaperVitamin DAll
Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis
Ajibola Ibraheem Abioye, Sabri Bromage, Wafaie W Fawzi
BMJ Global Health, doi:10.1136/bmjgh-2020-003176
Acute respiratory tract infections (ARIs) are a leading cause of ill-health and death globally. Individual or multiple micronutrients have been shown to modulate immune function and affect the risk and severity of a number of infectious diseases. We systematically reviewed the evidence on the impact of micronutrient supplements to reduce the occurrence of ARIs and shorten the duration of ARI symptoms among adults. Random effects metaanalyses were conducted to estimate the pooled effects of vitamin D, vitamin C, zinc and multiple micronutrient supplementation (MMS) on the occurrence of ARIs and the duration of ARI symptoms. Vitamin D supplementation reduced the risk of ARI (risk ratio (RR)=0.97; 95% CI 0.94 to 1.00; p=0.028) and shortened the duration of symptoms (per cent difference: −6% (95% CI −9% to −2%; p=0.003)). The RR of vitamin D to prevent ARI was farther from the null when diagnosis was based on clinical diagnosis or laboratory testing, compared with self-report and when the loading dose was <60 000 IU. Vitamin C supplementation reduced the risk of ARIs (RR=0.96; 95% CI 0.93 to 0.99; p=0.01) and shortened the duration of symptoms (per cent difference: −9% (95% CI −16% to −2%; p=0.014)). The effect of vitamin C on preventing ARI was stronger among men and in middle-income countries, compared with women and high-income countries, respectively. Zinc supplementation did not reduce the risk of ARIs but shortened the duration of symptoms substantially (per cent difference: −47% (95% CI −73% to −21%; p=0.0004)). Our synthesis of global evidence from randomised controlled trials indicates that micronutrient supplements including zinc, vitamins C and D, and multiple micronutrient supplements may be modestly effective in preventing ARIs and improving their clinical course. Further research is warranted to better understand the effectiveness that individual or multiple micronutrients have on SARS-CoV-2 infection and treatment outcomes. Key questions What is already known? ► Vitamin C and D supplementation reduce the risk of acute respiratory tract infections (ARIs). ► Vitamin C and zinc supplementation shorten the duration of ARI symptoms. What are the new findings? ► The preventive effect of vitamin D against ARIs is greater when the diagnosis is based on clinical diagnosis or laboratory testing, rather than self-report. An optimal dosing regimen would include a daily dose ≥2000 IU vitamin D and a loading dose <60 000 IU. ► Vitamin D supplementation shortens the duration of ARI symptoms mildly, though the effect did not differ by dose. ► The preventive effect of vitamin C against ARIs is greater among men and residents of middle-income countries. ► Zinc supplementation has no effect on the risk of ARIs. What do the new findings imply? ► Micronutrient supplementation may prevent (vitamin D and C) and treat (vitamin D, C and zinc) for ARIs, including SARS-CoV-2 infection. It is unclear whether the magnitude of the effects of these..
Authors' names for Pubmed indexing: Abioye AI, Bromage S, Fawzi WW BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
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Random effects meta-analyses were ' 'conducted to estimate the pooled effects of vitamin D, vitamin C, zinc and multiple ' 'micronutrient supplementation (MMS) on the occurrence of ARIs and the duration of ARI ' 'symptoms. Vitamin D supplementation reduced the risk of ARI (risk ratio (RR)=0.97; 95% CI ' '0.94 to 1.00; p=0.028) and shortened the duration of symptoms (per cent difference: −6% (95% ' 'CI −9% to −2%; p=0.003)). The RR of vitamin D to prevent ARI was farther from the null when ' 'diagnosis was based on clinical diagnosis or laboratory testing, compared with self-report ' 'and when the loading dose was &lt;60 000 IU. Vitamin C supplementation reduced the risk of ' 'ARIs (RR=0.96; 95% CI 0.93 to 0.99; p=0.01) and shortened the duration of symptoms (per cent ' 'difference: −9% (95% CI −16% to −2%; p=0.014)). The effect of vitamin C on preventing ARI was ' 'stronger among men and in middle-income countries, compared with women and high-income ' 'countries, respectively. Zinc supplementation did not reduce the risk of ARIs but shortened ' 'the duration of symptoms substantially (per cent difference: −47% (95% CI −73% to −21%; ' '<jats:italic>p=</jats:italic>0.0004)). Our synthesis of global evidence from randomised ' 'controlled trials indicates that micronutrient supplements including zinc, vitamins C and D, ' 'and multiple micronutrient supplements may be modestly effective in preventing ARIs and ' 'improving their clinical course. Further research is warranted to better understand the ' 'effectiveness that individual or multiple micronutrients have on SARS-CoV-2 infection and ' 'treatment outcomes.</jats:p>', 'DOI': '10.1136/bmjgh-2020-003176', 'type': 'journal-article', 'created': {'date-parts': [[2021, 1, 20]], 'date-time': '2021-01-20T05:50:17Z', 'timestamp': 1611121817000}, 'page': 'e003176', 'update-policy': 'http://dx.doi.org/10.1136/crossmarkpolicy', 'source': 'Crossref', 'is-referenced-by-count': 29, 'title': 'Effect of micronutrient supplements on influenza and other respiratory tract infections among ' 'adults: a systematic review and meta-analysis', 'prefix': '10.1136', 'volume': '6', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-6632-613X', 'authenticated-orcid': False, 'given': 'Ajibola Ibraheem', 'family': 'Abioye', 'sequence': 'first', 'affiliation': []}, {'given': 'Sabri', 'family': 'Bromage', 'sequence': 'additional', 'affiliation': []}, {'given': 'Wafaie', 'family': 'Fawzi', 'sequence': 'additional', 'affiliation': []}], 'member': '239', 'published-online': {'date-parts': [[2021, 1, 19]]}, 'reference': [ { 'key': '2021011921500986000_6.1.e003176.1', 'unstructured': 'Ritchie H , Roser M . Causes of Death. In: Our world in data, 2018.'}, { 'key': '2021011921500986000_6.1.e003176.2', 'unstructured': 'World Health Organization (WHO) . Influenza (seasonal) Geneva, ' 'Switzerland: World Health organization, 2020. Available: ' 'https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal ' '[Accessed 3 May 2020].'}, { 'key': '2021011921500986000_6.1.e003176.3', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.dsx.2020.04.020'}, { 'key': '2021011921500986000_6.1.e003176.4', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/apa.15270'}, { 'key': '2021011921500986000_6.1.e003176.5', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2020.2648'}, { 'key': '2021011921500986000_6.1.e003176.6', 'doi-asserted-by': 'crossref', 'unstructured': 'Calder PC , Carr AC , Gombart AF , et al . Optimal nutritional status ' 'for a well-functioning immune system is an important factor to protect ' 'against viral infections. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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