The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review.

BACKGROUND: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE: The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS: We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS: Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS: Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.

Special foods and local herbs used to enhance breastmilk production in Ghana: rate of use and beliefs of efficacy.

BACKGROUND: Inadequate breastmilk production is one of the key factors associated with suboptimal breastfeeding. In most local African homes, special herbs and some food items are commonly used to promote breastmilk production (known as lactogogue/galactogogue). We describe the use and characterize the herbs and food items used to promote breastmilk production in two regions of Ghana. METHODS: We conducted a cross-sectional study in 2018 involving 402 lactating mothers. The range of foods used as lactogogues was obtained from 20 participants through focus group discussions. Quantitative data on demographics, lactogogue use and feeding practices were obtained through questionnaire administration. RESULTS: The mean age of women was 29.2 years and children were 10 months. Breastmilk production problems were low (22.4%) and the majority of lactating mothers felt they had adequate breastmilk (70.4%) but awareness about lactogogues was widespread in both regions (88.8%) and highest in the Brong-Ahafo region (90.0%). Information about lactogogues was mainly from grandparents (24.6%), parents (31.6), health facilities (16.5%) and friends (12.8%), while the media had little influence (< 1%). The majority of the mothers used lactogogues to enhance breastmilk production (67.7%), and a quarter of them used lactogogues because of their tradition (25.2%). Prevalence of lactogogue use was 83.8%, lactogogues were prepared separate from household meals (59.4%) and consumed one to three times a day (89.6%). Users felt the effectiveness within 24 h of use (98.5%). The most common lactogogues included; groundnut/peanut soup prepared with Bra leaves (Hibiscus sabdariffa), hot black tea, Werewere/Agushi (Citrulus colocynthis) prepared with Bra leaves, and Abemudro (a polyherbal formulation). Only 13.2% of lactating mothers also used lactogogues during pregnancy. CONCLUSIONS: Special foods and selected herbs are widely used to enhance breastmilk production in Ghana and constitute an important part of the diet of lactating mothers. These results could contribute to understanding breastfeeding behaviours and stimulate further research into evaluating the safety and scientific efficacy of these products in Ghana.

Use of commercial infant cereals as complementary food in infants and young children in Ghana.

BACKGROUND: Typical complementary foods in developing countries are often inadequate in multiple micronutrients. One way of preventing micronutrient deficiency among infants and young children (IYC) is to feed them a variety of nutrient dense foods. The use of commercial infant cereals (CIC) as complementary food is increasing in Ghana. However, it is unknown whether giving CIC may discourage inclusion of other locally available and nutritious foods as mothers may hold the notion that CIC is superior. This study therefore examined the use of CIC as complementary food, the micronutrient intake from CIC and reasons for its use. METHODS: A cross-sectional study was conducted involving mothers with IYC aged 6-23 months who give CIC as complementary food. Questionnaires were administered to estimate the usual daily frequencies and quantities of CIC. Micronutrient intakes from CIC were calculated. We also calculated the proportion of the recommended nutrient intake (RNI) contributed by micronutrients from CIC. RESULTS: Of the 384 children sampled, 64.6% were aged 13-23 months and 50.3% were females. More than half of the mothers earned income through trading (55.2%) and nearly one quarter of them had senior high school education (24.7%). Majority of the children consumed 3-4 tablespoons (52.3%) of CIC in a feeding moment. Younger children (6-12 months) were served CIC more frequent than older children (13-23 months). The mean ± SD of micronutrients from CIC were 6.76 ± 2.67 mg, 4.79 ± 1.70 mg, 384.12 ± 139.69 mg, 266.70 ± 100.74 mg and 69.11 ± 24.65 µg for the minerals Fe, Zn, Ca, P and I respectively. The vitamin intakes were: 337.17 ± 119.70 µg, 42.88 ± 15.28 mg, 0.84 ± 0.31 µg, 34.24 ± 12.22 µg and 2.70 ± 1.03 mg for vitamin A, vitamin C, vitamin B12, folic acid and niacin respectively. Micronutrients from CIC consumption contributed to at least 70% of the RNIs for Fe, Zn, Ca, I, vitamin A, vitamin C and vitamin B12. Mothers believed that CIC alone could meet the nutritional needs of children and ensure optimal growth and health. CONCLUSION: The results of present study show that use of CIC as complementary food was high among mothers with IYC 6-12 months. Mothers believed that CIC was nutritionally adequate for their children and did not see the need to include or enrich other locally available complementary foods. Mothers should be educated on the need to include other foods with CIC to increase the dietary quality of IYC.