The Association Between COVID-19 Infection Severity and Micronutrient Deficiencies in Children
Haleh Pashaei, Fahimeh Ehsanipour, Samileh Noorbakhsh, Behnam Sobouti, Sara Minaeian, Morteza Haghighi Hasanabad, Zahra Sadr
Journal of Comprehensive Pediatrics, doi:10.5812/jcp-149127
Background: Coronavirus disease 2019 (COVID-19) can cause pulmonary and systemic inflammation in both children and adults. Investigating the potential impact of micronutrient deficiencies on COVID-19 infection is of great importance. Objectives: This case-control study was designed to compare the serum levels of vitamins D and C and zinc between healthy children and children with mild or severe COVID-19 infection, as well as to investigate the impact of micronutrient deficiencies on the clinical symptoms of patients. Methods: This case-control study was conducted at a teaching hospital in Tehran, Iran. Control subjects were recruited from healthy children, and cases were included from children with mild and severe symptoms of COVID-19. Blood samples were obtained from participants to measure the levels of micronutrients and were analyzed using statistical software. Results: A total of 85 subjects were included (33 controls, 25 cases with mild symptoms, and 27 cases with severe symptoms). We found no differences in the means of serum vitamin D and vitamin C levels between the studied groups. However, the mean serum zinc level was significantly lower in severe patients compared to the controls (P < 0.01). Moreover, no significant difference was observed in the frequency of patients with micronutrient deficiencies based on their clinical conditions. Conclusions: Our findings revealed zinc deficiency in children with severe COVID-19 infection, while no significant differences were found in the mean serum levels of vitamins D and C between healthy children and patients. More studies are necessary to provide more robust evidence.
References
Arroyo-Diaz, Julve, Vlacho, Corcoy, Ponte et al., Previous Vitamin D Supplementation and Morbidity and Mortality Outcomes in People Hospitalised for COVID19: A Cross-Sectional Study, Front Public Health,
doi:10.3389/fpubh.2021.758347
Azadeh, Hedayatizadeh-Omran, Saeedi, Vahedi-Larijani, Mehravaran et al., Serum Vitamin D Concentrations in CoVID19 Patients, J Mazandaran Univ Med Sci
Bayramoglu, Akkoc, Agbas, Akgun, Yurdakul et al., The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: single-center experience from a pandemic hospital, Eur J Pediatr,
doi:10.1007/s00431-021-04030-1
Beran, Mhanna, Srour, Ayesh, Stewart et al., Clinical significance of micronutrient supplements in patients with coronavirus disease 2019: A comprehensive systematic review and meta-analysis, Clin Nutr ESPEN,
doi:10.1016/j.clnesp.2021.12.033
Cole, Grant, Swaby-Ellis, Smith, Jacques et al., Zinc and iron deficiency and their interrelations in low-income African American and Hispanic children in Atlanta, Am J Clin Nutr,
doi:10.3945/ajcn.2009.28089
Esteghamati, Badamchi, Naghdalipoor, Faramarzi, Hasanabadi et al., Prevalence of Mycoplasma genitalium and Ureaplasma urealyticum in pregnant women, Tehran Univ Med J
Gao, Xu, Wang, Lv, Ma et al., The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study, J Aging,
doi:10.18632/aging.202557
Gombart, Pierre, Maggini, A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection, Nutrients,
doi:10.3390/nu12010236
Grant, Lahore, Mcdonnell, Baggerly, French et al., Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths, Nutrients,
doi:10.3390/nu12040988
Guo, Wei, Zhang, Wu, Li et al., Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score, Front Microbiol,
doi:10.3389/fmicb.2019.02752
Hastie, Mackay, Ho, Celis-Morales, Katikireddi et al., Vitamin D concentrations and COVID-19 infection in UK Biobank, Diabetes Metab Syndr,
doi:10.1016/j.dsx.2020.04.050
Kakodkar, Kaka, Baig, A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19), Cureus,
doi:10.7759/cureus.7560
Karimian, Tahami, Sayyahfar, Delavar, Association of vitamin D and severity of COVID-19 in children, Eur J Transl Myol,
doi:10.4081/ejtm.2022.10453
Maggini, Pierre, Calder, Immune Function and Micronutrient Requirements Change over the Life Course, Nutrients,
doi:10.3390/nu10101531
Noorbakhsh, Ehsanipour, Sobouti, Aski, Faranoush et al., Comparison of Antiphospholipid Antibody Levels in Children with and Without COVID-19, J Arch Pediatr Infect Dis,
doi:10.5812/apid-133851
Noorbakhsh, Farhadi, Haghighi, Minaeian, Hasanabad, Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards, Iran J Microbiol
Ramezaninejad, Sohrabi, Alikhani, Badabi, Kasgari, Relationship between Vitamin D, Vitamin C, and Selenium Intake and Disease Severity and Outcomes in Patients Hospitalized with COVID-19: A Retrospective Study, J Mazandaran Univ Med Sci
Rastegar, Hosseini Teshnizi, Khaleghinia, Seddighi, Rajaei, Vitamin D and Zinc Deficiency in Children with Congenital Heart Defects, J Comprehens Pediatr,
doi:10.5812/jcp-145841
Razzaque, COVID-19 Pandemic: Can Maintaining Optimal Zinc Balance Enhance Host Resistance?, Tohoku J Exp Med,
doi:10.1620/tjem.251.175
Sheikhi, Shirzadfar, Sheikhi, A Review on Novel Coronavirus (Covid-19): Symptoms, Transmission and Diagnosis Tests, Res Infect Dis Trop Med,
doi:10.33702/ridtm.2020.2.1.1
Soldevila, Puig-Domingo, Marazuela, Basic mechanisms of SARS-CoV-2 infection. What endocrine systems could be implicated?, Rev Endocr Metab Disord,
doi:10.1007/s11154-021-09678-6
Thomas, Patel, Bittel, Wolski, Wang et al., Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial, JAMA Netw Open,
doi:10.1001/jamanetworkopen.2021.0369
Wintergerst, Maggini, Hornig, Immune-enhancing role of vitamin C and zinc and effect on clinical conditions, Ann Nutr Metab,
doi:10.1159/000090495
Yao, Paguio, Dee, Tan, Moulick et al., The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19: An Observational Study, J Chest,
doi:10.1016/j.chest.2020.06.082
Yilmaz, Sen, Is vitamin D deficiency a risk factor for COVID-19 in children?, Pediatr Pulmonol,
doi:10.1002/ppul.25106
Zheng, Gao, Wang, Song, Liu et al., Functional exhaustion of antiviral lymphocytes in COVID-19 patients, Cell Mol Immunol,
doi:10.1038/s41423-020-0402-2
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'abstract': '<jats:p>Background: Coronavirus disease 2019 (COVID-19) can cause pulmonary and systemic '
'inflammation in both children and adults. Investigating the potential impact of micronutrient '
'deficiencies on COVID-19 infection is of great importance. Objectives: This case-control '
'study was designed to compare the serum levels of vitamins D and C and zinc between healthy '
'children and children with mild or severe COVID-19 infection, as well as to investigate the '
'impact of micronutrient deficiencies on the clinical symptoms of patients. Methods: This '
'case-control study was conducted at a teaching hospital in Tehran, Iran. Control subjects '
'were recruited from healthy children, and cases were included from children with mild and '
'severe symptoms of COVID-19. Blood samples were obtained from participants to measure the '
'levels of micronutrients and were analyzed using statistical software. Results: A total of 85 '
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'between the studied groups. However, the mean serum zinc level was significantly lower in '
'severe patients compared to the controls (P < 0.01). Moreover, no significant difference '
'was observed in the frequency of patients with micronutrient deficiencies based on their '
'clinical conditions. Conclusions: Our findings revealed zinc deficiency in children with '
'severe COVID-19 infection, while no significant differences were found in the mean serum '
'levels of vitamins D and C between healthy children and patients. More studies are necessary '
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