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1.
Int J Med Sci ; 18(2): 314-324, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33390800

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is the largest health crisis ever faced worldwide. It has resulted in great health and economic costs because no effective treatment is currently available. Since infected persons vary in presentation from healthy asymptomatic mild symptoms to those who need intensive care support and eventually succumb to the disease, this illness is considered to depend primarily on individual immunity. Demographic distribution and disease severity in several regions of the world vary; therefore, it is believed that natural inherent immunity provided through dietary sources and traditional medicines could play an important role in infection prevention and disease progression. People can boost their immunity to prevent them from infection after COVID-19 exposure and can reduce their inflammatory reactions to protect their organ deterioration in case suffering from the disease. Some drugs with in-situ immunomodulatory and anti-inflammatory activity are also identified as adjunctive therapy in the COVID-19 era. This review discusses the importance of COVID-19 interactions with immune cells and inflammatory cells; and further emphasizes the possible pathways related with traditional herbs, medications and nutritional products. We believe that such pathophysiological pathway approach treatment is rational and important for future development of new therapeutic agents for prevention or cure of COVID-19 infection.


Assuntos
/tratamento farmacológico , Interações Hospedeiro-Patógeno , Medicina Tradicional , /prevenção & controle , Quimioterapia Combinada , Humanos , Imunomodulação , Terapia de Alvo Molecular , Fitoterapia , Extratos Vegetais/uso terapêutico , Vitaminas/uso terapêutico , Zinco/uso terapêutico
2.
Toxicol Appl Pharmacol ; 410: 115355, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33271250

RESUMO

Coenzyme Q10 (CoQ10), which is a key cofactor of the electron transport chain in the mitochondria has shown many beneficial effects on liver diseases. However, the mechanisms of CoQ10 protective role on the acetaminophen (APAP)-induced liver injury are elusive and unclear. In this study, we further investigated the CoQ10 therapeutic effects on APAP-overdose liver injury. C57BL/6 J mice were intraperitoneally treated with APAP to induce liver injury. CoQ10 (5 mg/kg) was given to mice at 1.5 h after APAP treatment. The results showed that hepatic CoQ10 levels were decreased during the APAP-induced hepatotoxicity and preceded serum ALT elevation. Treatment of CoQ10 significantly improved the liver injury induced by APAP. Moreover, CoQ10 treatment decreased the ROS levels and promoted the antioxidative related gene expression in APAP overdose mice. Importantly, results showed that even though CoQ10 had no effects on the mtDNA copy number and the expression of genes related to mitochondrial biogenesis, it significantly improved the mitochondrial complex I and V activities and promoted the mitophagy in APAP-overdose mice. To further authenticate mitophagy role in CoQ10-mediated improved liver injury in vivo, we administrated APAP-overdose mice with chloroquine 1 h prior to APAP treatment and found that chloroquine treatment functionally abrogated the CoQ10 protective role on APAP overdose mice. To conclude, this study provides evidence that CoQ10 activates mitophagy to protect against APAP-induced liver injury. Therefore, CoQ10 may represent a novel therapeutic option for the prevention and treatment of drug-induced liver injury.


Assuntos
Acetaminofen/toxicidade , Analgésicos não Entorpecentes/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Mitofagia/efeitos dos fármacos , Ubiquinona/análogos & derivados , Vitaminas/uso terapêutico , Animais , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Mitofagia/fisiologia , Ubiquinona/farmacologia , Ubiquinona/uso terapêutico , Vitaminas/farmacologia
3.
Maturitas ; 143: 1-9, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308613

RESUMO

The world is currently in the grips of the coronavirus disease (COVID-19) pandemic, caused by the SARS-CoV-2 virus, which has mutated to allow human-to-human spread. Infection can cause fever, dry cough, fatigue, severe pneumonia, respiratory distress syndrome and in some instances death. COVID-19 affects the immune system by producing a systemic inflammatory response, or cytokine release syndrome. Patients with COVID-19 have shown a high level of pro-inflammatory cytokines and chemokines. There are currently no effective anti-SARS-CoV-2 viral drugs or vaccines. COVID-19 disproportionately affects the elderly, both directly, and through a number of significant age-related comorbidities. Undoubtedly, nutrition is a key determinant of maintaining good health. Key dietary components such as vitamins C, D, E, zinc, selenium and the omega 3 fatty acids have well-established immunomodulatory effects, with benefits in infectious disease. Some of these nutrients have also been shown to have a potential role in the management of COVID-19. In this paper, evidence surrounding the role of these dietary components in immunity as well as their specific effect in COVID-19 patients are discussed. In addition, how supplementation of these nutrients may be used as therapeutic modalities potentially to decrease the morbidity and mortality rates of patients with COVID-19 is discussed.


Assuntos
/tratamento farmacológico , Vitaminas/uso terapêutico , Ácido Ascórbico/imunologia , Ácido Ascórbico/uso terapêutico , Suplementos Nutricionais , Ácidos Graxos Ômega-3/imunologia , Ácidos Graxos Ômega-3/uso terapêutico , Humanos , Sistema Imunitário/efeitos dos fármacos , Selênio/imunologia , Selênio/uso terapêutico , Vitamina D/imunologia , Vitamina D/uso terapêutico , Vitamina E/imunologia , Vitamina E/uso terapêutico , Vitaminas/imunologia , Zinco/imunologia , Zinco/uso terapêutico
4.
Am J Physiol Endocrinol Metab ; 320(1): E2-E6, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33174766

RESUMO

The use of vitamin D to reduce the severity of COVID-19 complications is receiving considerable attention, backed by encouraging data. Its purported mode of action is as an immune modulator. Vitamin D, however, also affects the metabolism of phosphate and Mg, which may well play a critical role in SARS-CoV-2 pathogenesis. SARS-CoV-2 may induce a cytokine storm that drains ATP whose regeneration requires phosphate and Mg. These minerals, however, are often deficient in conditions that predispose people to severe COVID-19, including older age (especially males), diabetes, obesity, and usage of diuretics. Symptoms observed in severe COVID-19 also fit well with those seen in classical hypophosphatemia and hypomagnesemia, such as thrombocytopenia, coagulopathy, dysfunction of liver and kidneys, neurologic disturbances, immunodeficiency, failure of heart and lungs, delayed weaning from a respirator, cardiac arrhythmia, seizures, and, finally, multiorgan failure. Deficiencies of phosphate and Mg can be amplified by kidney problems commonly observed in patients with COVID-19 resulting in their wastage into urine. Available data show that phosphate and Mg are deficient in COVID-19, with phosphate showing a remarkable correlation with its severity. In one experiment, patients with COVID-19 were supplemented with a cocktail of vitamin D3, Mg, and vitamin B12, with very encouraging results. We, thus, argue that patients with COVID-19 should be monitored and treated for phosphate and Mg deficiencies, ideally already in the early phases of infection. Supplementation of phosphate and Mg combined with vitamin D could also be implemented as a preventative strategy in populations at risk.


Assuntos
/complicações , Deficiência de Magnésio/tratamento farmacológico , Magnésio/uso terapêutico , Deficiência de Vitamina B 12/tratamento farmacológico , Vitamina B 12/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , /tratamento farmacológico , Suplementos Nutricionais , Humanos , Deficiência de Magnésio/etiologia , Deficiência de Magnésio/metabolismo , Deficiência de Vitamina B 12/etiologia , Deficiência de Vitamina B 12/metabolismo , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/metabolismo
5.
Curr Opin Clin Nutr Metab Care ; 24(1): 18-24, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32941186

RESUMO

PURPOSE OF REVIEW: Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D. RECENT FINDINGS: The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely. SUMMARY: There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.


Assuntos
Envelhecimento , Estado Nutricional , Obesidade/epidemiologia , Índice de Gravidade de Doença , Deficiência de Vitamina D/complicações , Vitamina D , Tecido Adiposo , Idoso , /epidemiologia , Comorbidade , Suplementos Nutricionais , Humanos , Pandemias , Sistema Renina-Angiotensina , Fatores de Risco , Luz Solar , Vitamina D/metabolismo , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/epidemiologia , Vitaminas/metabolismo , Vitaminas/uso terapêutico
6.
Curr Opin Clin Nutr Metab Care ; 24(1): 102-107, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33003119

RESUMO

PURPOSE OF REVIEW: Vitamin D exerts extraskeletal functions, including immunomodulatory activity, protection against respiratory tract infections and pleiotropic effects on the cardiovascular system. Since the outbreak of the coronavirus disease-2019 (COVID-19) pandemic, several articles have suggested the potential involvement of vitamin D in reducing the risk and severity of the disease. RECENT FINDINGS: Epidemiological and observational studies support the hypothesis of a protective role of vitamin D but most studies are retrospective or based on small samples. However, the pandemic progression and the increased knowledge on the pathogenesis of COVID-19 have challenged the first evidence, suggesting also potential negative consequences derived by adequate vitamin D status. A cautious interpretation of the significance of low vitamin D25OH levels is advisable. The balance between over-activation of innate immunity and the exhaustibility of the adaptive immune response still needs to be clarified. In addition, the modulation of endothelial function, the down-regulation of renin, angiotensin-converting-enzyme (ACE) and angiotensin genes and the up-regulation of ACE2 expression is still an area of research. SUMMARY: Speculative hypotheses and observational data have suggested a protective role of vitamin D in COVID-19. However, many unanswered questions remain, aberrant detrimental effects of adequate vitamin D25OH levels cannot be excluded and whether its adequacy may prevent the infection or improve clinical outcomes needs to be assessed by adequately sized and designed population-based studies and intervention trials.


Assuntos
/complicações , Suplementos Nutricionais , Estado Nutricional , Índice de Gravidade de Doença , Deficiência de Vitamina D/complicações , Vitamina D , Vitaminas , /metabolismo , /prevenção & controle , Endotélio Vascular , Humanos , Pandemias , Peptidil Dipeptidase A/metabolismo , Sistema Renina-Angiotensina , Vitamina D/farmacologia , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/metabolismo , Vitaminas/farmacologia , Vitaminas/uso terapêutico
7.
Nutrients ; 12(12)2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33297491

RESUMO

There are limited proven therapies for COVID-19. Vitamin C's antioxidant, anti-inflammatory and immunomodulating effects make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection, and as an adjunctive therapy in the critical care of COVID-19. This literature review focuses on vitamin C deficiency in respiratory infections, including COVID-19, and the mechanisms of action in infectious disease, including support of the stress response, its role in preventing and treating colds and pneumonia, and its role in treating sepsis and COVID-19. The evidence to date indicates that oral vitamin C (2-8 g/day) may reduce the incidence and duration of respiratory infections and intravenous vitamin C (6-24 g/day) has been shown to reduce mortality, intensive care unit (ICU) and hospital stays, and time on mechanical ventilation for severe respiratory infections. Further trials are urgently warranted. Given the favourable safety profile and low cost of vitamin C, and the frequency of vitamin C deficiency in respiratory infections, it may be worthwhile testing patients' vitamin C status and treating them accordingly with intravenous administration within ICUs and oral administration in hospitalised persons with COVID-19.


Assuntos
Deficiência de Ácido Ascórbico/tratamento farmacológico , Ácido Ascórbico/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Sepse/tratamento farmacológico , Vitaminas/uso terapêutico , Administração Intravenosa , Administração Oral , Anti-Inflamatórios/uso terapêutico , Deficiência de Ácido Ascórbico/complicações , /virologia , Quimioterapia Adjuvante , Cuidados Críticos , Hospitalização , Humanos , Fatores Imunológicos/uso terapêutico , Unidades de Terapia Intensiva , Estado Nutricional , Pandemias , Respiração Artificial , Infecções Respiratórias/etiologia , Infecções Respiratórias/virologia , Sepse/etiologia , Sepse/virologia
8.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323421

RESUMO

Long QT syndrome with Torsades de Pointes (TdP) is a life-threatening polymorphic ventricular arrhythmia. The corrected QT (QTc) prolongation >500 milliseconds (ms) has been associated with TdP. Hypocalcaemia due to severe vitamin D deficiency is an uncommon cause of acquired long QT. We hereby present a case of a 40-year-old woman with sensorineural deafness and having symptoms of palpitations and presyncope. She had a QTc interval of 556 ms (reference range, QTc 451-470 ms in adult healthy woman) on 24-hour Holter analysis. Genetic analysis for congenital long QT syndrome was negative. She was diagnosed with severe hypocalcaemia secondary to severe vitamin D deficiency. After treatment with intravenous calcium gluconate, followed by oral vitamin D and calcium supplementation, the QTc became normalised and no further episode of palpitations or presyncope occurred. The causes of vitamin D deficiency was due to inadequate exposure to sunlight and a strict vegan diet.


Assuntos
Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Adulto , Cálcio/uso terapêutico , Gluconato de Cálcio/uso terapêutico , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Síndrome do QT Longo/tratamento farmacológico , Metoprolol/uso terapêutico , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
10.
Bratisl Lek Listy ; 121(12): 870-877, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33300356

RESUMO

The novel coronavirus COVID-19 outbreak quickly spread across many countries and has become a worldwide threat to health, trade and travel. In terms of clinical manifestations, although it starts as an acute respiratory disorder, it could eventually lead to death by causing damage to many organs such as: lung, liver, kidney and heart. It has been shown that COVID-19 pathology is mediated by an excessive inflammation, oxidation and an aggravated immune response. Vitamin D is a an immunomodulator hormone and has receptors in many tissues and organs. In many studies, vitamin D was shown to have antimicrobial and anti-inflammatory properties. In addition, since COVID-19 infection causes a cytokine storm, vitamin D can have a protective effect on many tissues and organs by reducing the production of proinflammatory cytokines. Vitamin D has a high safety profile, and thus could be beneficial against multiple organ damage in COVID-19 patients. This paper aims to highlight the potential benefits of vitamin D against multiple organ damage caused by COVID-19 (Fig. 1, Ref. 109). Keywords: COVID-19, cytokine, inflammation, vitamin D.


Assuntos
/terapia , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , /patologia , Humanos
11.
Eur Rev Med Pharmacol Sci ; 24(22): 11971-11976, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275274

RESUMO

OBJECTIVE: This paper presents a newborn (G2P2, gestational age of 39+6 weeks, birth weight of 3,200 g, with normal fetal amniotic fluid) with suspected coronavirus disease 2019 (COVID-19) admitted to our hospital on February 10, 2020, at the birth age of 16 hours and 34 minutes. The Apgar scores at 1 and 5 min were 9 and 10 points, respectively. PATIENTS AND METHODS: The mother of the newborn was exposed to a patient with COVID-19 five days before delivery. The newborn had nausea and vomiting after birth, with feeding intolerance, and full enteral feeding was given on the 6th day after birth. The newborn was in good general condition during the period of hospitalization. RESULTS: The two 2019-nCoV nucleic acid tests of the newborn were negative on the 5th and 7th days after birth. On the 1st and 8th days after birth, typical pulmonary lesions were detected in the newborn by chest CT. Our study supports that chest imaging examination should be actively performed in the newborn even with a negative 2019-nCoV nucleic acid test in cases where a pregnant woman is exposed to a patient with COVID-19 or is confirmed with 2019-nCoV infection. CONCLUSIONS: For newborns with typical pulmonary lesions, strict quarantine measures are suggested if the possibility of COVID-19 cannot be excluded.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Exposição Materna , Náusea/fisiopatologia , Complicações Infecciosas na Gravidez/diagnóstico , Tomografia Computadorizada por Raios X , Vômito/fisiopatologia , Ambroxol , Antibacterianos/uso terapêutico , Ácido Ascórbico/uso terapêutico , Aleitamento Materno , Proteína C-Reativa/metabolismo , /fisiopatologia , Expectorantes/uso terapêutico , Feminino , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral , Gravidez , Proteína Amiloide A Sérica/metabolismo , Vitaminas/uso terapêutico
12.
Eur Rev Med Pharmacol Sci ; 24(22): 11977-11981, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275275

RESUMO

Researchers have found many similarities between the 2003 severe acute respiratory syndrome (SARS) virus and SARS-CoV-19 through existing data that reveal the SARS's cause. Artificial intelligence (AI) learning models can be created to predict drug structures that can be used to treat COVID-19. Despite the effectively demonstrated repurposed drugs, more repurposed drugs should be recognized. Furthermore, technological advancements have been helpful in the battle against COVID-19. Machine intelligence technology can support this procedure by rapidly determining adequate and effective drugs against COVID-19 and by overcoming any barrier between a large number of repurposed drugs, laboratory/clinical testing, and final drug authorization. This paper reviews the proposed vaccines and medicines for SARS-CoV-2 and the current application of AI in drug repurposing for COVID-19 treatment.


Assuntos
Inteligência Artificial , Desenvolvimento de Medicamentos , Reposicionamento de Medicamentos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Ácido Ascórbico/uso terapêutico , /uso terapêutico , Cloroquina/uso terapêutico , Aprendizado Profundo , Combinação de Medicamentos , Humanos , Hidroxicloroquina/uso terapêutico , Imunossupressores/uso terapêutico , Lopinavir/uso terapêutico , Aprendizado de Máquina , Ribavirina/uso terapêutico , Ritonavir/uso terapêutico , Vitaminas/uso terapêutico
13.
Artigo em Inglês | MEDLINE | ID: mdl-33203106

RESUMO

Antioxidant supplementation, including vitamin E and C supplementation, has recently received recognition among athletes as a possible method for enhancing athletic performance. Increased oxidative stress during exercise results in the production of free radicals, which leads to muscle damage, fatigue, and impaired performance. Despite their negative effects on performance, free radicals may act as signaling molecules enhancing protection against greater physical stress. Current evidence suggests that antioxidant supplementation may impair these adaptations. Apart from athletes training at altitude and those looking for an immediate, short-term performance enhancement, supplementation with vitamin E does not appear to be beneficial. Moreover, the effectiveness of vitamin E and C alone and/or combined on muscle mass and strength have been inconsistent. Given that antioxidant supplements (e.g., vitamin E and C) tend to block anabolic signaling pathways, and thus, impair adaptations to resistance training, special caution should be taken with these supplements. It is recommended that athletes consume a diet rich in fruits and vegetables, which provides vitamins, minerals phytochemicals, and other bioactive compounds to meet the recommended intakes of vitamin E and C.


Assuntos
Antioxidantes , Ácido Ascórbico , Exercício Físico , Vitamina E , Vitaminas , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Suplementos Nutricionais , Humanos , Vitamina E/uso terapêutico , Vitaminas/uso terapêutico
14.
Am Fam Physician ; 102(10): 603-612, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-33179890

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States, affecting up to 30% of adults. There are two forms of NAFLD: nonalcoholic fatty liver (NAFL), defined as 5% or greater hepatic steatosis without hepatocellular injury or fibrosis, and nonalcoholic steatohepatitis (NASH), defined as 5% or greater hepatic steatosis plus hepatocellular injury and inflammation, with or without fibrosis. Individuals with obesity are at highest risk of NAFLD. Other established risk factors include metabolic syndrome and type 2 diabetes mellitus. Although NAFLD is common and typically asymptomatic, screening is not currently recommended, even in high-risk patients. NAFLD should be suspected in patients with elevated liver enzymes or hepatic steatosis on abdominal imaging that are found incidentally. Once other causes, such as excessive alcohol use and hepatotoxic medications, are excluded in these patients, risk scores or elastography tests can be used to identify those who are likely to have fibrosis that will progress to cirrhosis. Liver biopsy should be considered for patients at increased risk of fibrosis and when other liver disorders cannot be excluded with noninvasive tests. Weight loss through diet and exercise is the primary treatment for NAFLD. Other treatments, such as bariatric surgery, vitamin E supplements, and pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues, have shown potential benefit; however, data are limited, and these therapies are not considered routine treatments. NAFL typically follows an indolent course, whereas patients with NASH are at higher risk of death from cardiovascular disease, cancer, and end-stage liver disease.


Assuntos
Dieta Redutora , Exercício Físico , Hepatopatia Gordurosa não Alcoólica/terapia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Cirurgia Bariátrica , Biópsia , Técnicas de Imagem por Elasticidade , Peptídeo 1 Semelhante ao Glucagon/agonistas , Humanos , Hipoglicemiantes/uso terapêutico , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico por imagem , Imagem por Ressonância Magnética , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/patologia , Encaminhamento e Consulta , Medição de Risco , Albumina Sérica/metabolismo , Índice de Gravidade de Doença , Tiazolidinedionas/uso terapêutico , Vitamina E/uso terapêutico , Vitaminas/uso terapêutico
15.
Artigo em Inglês | MEDLINE | ID: mdl-33143369

RESUMO

This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.


Assuntos
Alimentos Fortificados , Leite , Periodontite , Complicações na Gravidez , Vitamina D , Vitaminas , Animais , Brasil , Carbonato de Cálcio , Estudos de Viabilidade , Feminino , Humanos , Periodontite/terapia , Gravidez , Complicações na Gravidez/terapia , Gestantes , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico
16.
Front Immunol ; 11: 574029, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193359

RESUMO

From Pauling's theories to the present, considerable understanding has been acquired of both the physiological role of vitamin C and of the impact of vitamin C supplementation on the health. Although it is well known that a balanced diet which satisfies the daily intake of vitamin C positively affects the immune system and reduces susceptibility to infections, available data do not support the theory that oral vitamin C supplements boost immunity. No current clinical recommendations support the possibility of significantly decreasing the risk of respiratory infections by using high-dose supplements of vitamin C in a well-nourished general population. Only in restricted subgroups (e.g., athletes or the military) and in subjects with a low plasma vitamin C concentration a supplementation may be justified. Furthermore, in categories at high risk of infection (i.e., the obese, diabetics, the elderly, etc.), a vitamin C supplementation can modulate inflammation, with potential positive effects on immune response to infections. The impact of an extra oral intake of vitamin C on the duration of a cold and the prevention or treatment of pneumonia is still questioned, while, based on critical illness studies, vitamin C infusion has recently been hypothesized as a treatment for COVID-19 hospitalized patients. In this review, we focused on the effects of vitamin C on immune function, summarizing the most relevant studies from the prevention and treatment of common respiratory diseases to the use of vitamin C in critical illness conditions, with the aim of clarifying its potential application during an acute SARS-CoV2 infection.


Assuntos
Ácido Ascórbico/imunologia , Ácido Ascórbico/uso terapêutico , Resfriado Comum/tratamento farmacológico , Resfriado Comum/prevenção & controle , Vitaminas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Ascórbico/efeitos adversos , Criança , Pré-Escolar , Estado Terminal , Suplementos Nutricionais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
JAMA Netw Open ; 3(11): e2025850, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33206192

RESUMO

Importance: Epidemiologic and trial data suggest that vitamin D supplementation may reduce metastatic cancer and cancer mortality, reflecting shared biological pathways. Objective: To follow up on the possible reduction in cancer death in the Vitamin D and Omega-3 Trial (VITAL) with an evaluation of whether vitamin D reduces the incidence of advanced (metastatic or fatal) cancer and an examination possible effect modification by body mass index. Design, Setting, and Participants: VITAL is a randomized, double-blind, placebo-controlled, 2 × 2 factorial clinical trial of vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d). This multicenter clinical trial was conducted in the United States; participants included men aged 50 years or older and women aged 55 years or older who were free of cancer and cardiovascular disease at baseline. Randomization took place from November 2011 through March 2014, and study medication ended on December 31, 2017. Data for this secondary analysis were analyzed from November 1, 2011, to December 31, 2017. Interventions: Vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d) supplements. Main Outcomes and Measures: For the present analysis, the primary outcome was a composite incidence of metastatic and fatal invasive total cancer, because the main VITAL study showed a possible reduction in fatal cancer with vitamin D supplementation and effect modification by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for total cancer incidence reduction for individuals with normal BMI, but not for individuals with overweight or obesity. Secondary analyses included examination of BMI (<25, 25 to < 30, and ≥30) as effect modifiers of the observed associations. Results: Among 25 871 randomized VITAL participants (51% female; mean [SD] age, 67.1 [7.1] years), 1617 were diagnosed with invasive cancer over a median intervention period of 5.3 years (range, 3.8-6.1 years). As previously reported, no significant differences for cancer incidence by treatment arm were observed. However, a significant reduction in advanced cancers (metastatic or fatal) was found for those randomized to vitamin D compared with placebo (226 of 12 927 assigned to vitamin D [1.7%] and 274 of 12 944 assigned to placebo [2.1%]; HR, 0.83 [95% CI, 0.69-0.99]; P = .04). When stratified by BMI, there was a significant reduction for the vitamin D arm in incident metastatic or fatal cancer among those with normal BMI (BMI<25: HR, 0.62 [95% CI, 0.45-0.86]) but not among those with overweight or obesity (BMI 25-<30: HR, 0.89 [95% CI, 0.68-1.17]; BMI≥30: HR, 1.05 [95% CI, 0.74-1.49]) (P = .03 for interaction by BMI). Conclusions and Relevance: In this randomized clinical trial, supplementation with vitamin D reduced the incidence of advanced (metastatic or fatal) cancer in the overall cohort, with the strongest risk reduction seen in individuals with normal weight. Trial Registration: ClinicalTrials.gov Identifier: NCT01169259.


Assuntos
Colecalciferol/uso terapêutico , Metástase Neoplásica , Neoplasias/mortalidade , Vitaminas/uso terapêutico , Idoso , Comorbidade , Suplementos Nutricionais , Progressão da Doença , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Modelos de Riscos Proporcionais
18.
Nutrients ; 12(11)2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33147894

RESUMO

BACKGROUND: The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. METHODS: Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. RESULTS: The three groups (n = 77; mean ± SD, 88 ± 5years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p= 0.03). CONCLUSIONS: Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.


Assuntos
Infecções por Coronavirus/mortalidade , Suplementos Nutricionais , Fragilidade/mortalidade , Pneumonia Viral/mortalidade , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/sangue , Fragilidade/virologia , Hospitalização , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Taxa de Sobrevida
19.
JAMA ; 324(18): 1855-1868, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170239

RESUMO

Importance: The benefits of vitamin D, omega-3 fatty acids, and exercise in disease prevention remain unclear. Objective: To test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults. Design, Setting, and Participants: Double-blind, placebo-controlled, 2 × 2 × 2 factorial randomized clinical trial among 2157 adults aged 70 years or older who had no major health events in the 5 years prior to enrollment and had sufficient mobility and good cognitive status. Patients were recruited between December 2012 and November 2014, and final follow-up was in November 2017. Interventions: Participants were randomized to 3 years of intervention in 1 of the following 8 groups: 2000 IU/d of vitamin D3, 1 g/d of omega-3s, and a strength-training exercise program (n = 264); vitamin D3 and omega-3s (n = 265); vitamin D3 and exercise (n = 275); vitamin D3 alone (n = 272); omega-3s and exercise (n = 275); omega-3s alone (n = 269); exercise alone (n = 267); or placebo (n = 270). Main Outcomes and Measures: The 6 primary outcomes were change in systolic and diastolic blood pressure (BP), Short Physical Performance Battery (SPPB), Montreal Cognitive Assessment (MoCA), and incidence rates (IRs) of nonvertebral fractures and infections over 3 years. Based on multiple comparisons of 6 primary end points, 99% confidence intervals are presented and P < .01 was required for statistical significance. Results: Among 2157 randomized participants (mean age, 74.9 years; 61.7% women), 1900 (88%) completed the study. Median follow-up was 2.99 years. Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years. For instance, the differences in mean change in systolic BP with vitamin D vs no vitamin D and with omega-3s vs no omega-3s were both -0.8 (99% CI, -2.1 to 0.5) mm Hg, with P < .13 and P < .11, respectively; the difference in mean change in diastolic BP with omega-3s vs no omega-3s was -0.5 (99% CI, -1.2 to 0.2) mm Hg; P = .06); and the difference in mean change in IR of infections with omega-3s vs no omega-3s was -0.13 (99% CI, -0.23 to -0.03), with an IR ratio of 0.89 (99% CI, 0.78-1.01; P = .02). No effects were found on the outcomes of SPPB, MoCA, and incidence of nonvertebral fractures). A total of 25 deaths were reported, with similar numbers in all treatment groups. Conclusions and Relevance: Among adults without major comorbidities aged 70 years or older, treatment with vitamin D3, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT01745263.


Assuntos
Colecalciferol/uso terapêutico , Suplementos Nutricionais , Ácidos Graxos Ômega-3/uso terapêutico , Nível de Saúde , Treinamento de Resistência , Vitaminas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/prevenção & controle , Método Duplo-Cego , Feminino , Seguimentos , Fraturas Ósseas/prevenção & controle , Humanos , Hipertensão/terapia , Imunidade , Masculino , Aptidão Física , Resultado do Tratamento
20.
Int Immunopharmacol ; 88: 106995, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33182059

RESUMO

There is recent evidence that interleukin-6 (IL-6) levels are elevated in cases of complicated COVID-19, but it is also possible that this cytokine may have a far more important role in the pathogenesis of viral infection. IL-6 is known to be modulated by Vitamin D, and there is preliminary evidence that deficiency of this vitamin is linked to poorer outcomes. To identify whether IL-6 levels prior to infection might predict outcome, early data on COVID-19 mortality from Italy and the UK were compared with previously published results of mean IL-6 levels from these countries as well as from the USA. There was a highly significant correlation (r = 0.9883; p = 0.00025) between age-stratified mortality rates and IL-6 levels from previously published data on healthy individuals. To determine whether Vitamin D may be beneficial at lowering IL-6 levels in patients, a limited analysis of trials examining the relationship between these entities published since 2015 was undertaken. Eight out of 11 studies described a significant lowering effect of Vitamin D on IL-6. Given that IL-6 likely facilitates viral cell entry and replication, levels prior to infection may predict mortality. This provides a rationale for prophylactic and therapeutic measures directed at lowering IL-6, including Vitamin D prescription.


Assuntos
Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Interleucina-6/sangue , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
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