Is nutrition the forgotten risk factor in COVID-19 infection?

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Un aspecto más desconocido es la interrelación entre estado nutricional y salud no solo a escala individual, sino también comunitaria y global. Varios factores contribuyen al estado nutricional, entre ellos, estabilidad económica, enfermedades coexistentes, racismo u otros tipos de discriminación e inseguridad alimentaria, determinada por un acceso desigual a nutrientes esenciales o alimentos saludables. Todos ellos condicionan el estado de salud comunitario e individual de manera que, a través de una alteración de la inmunidad innata y adquirida o de una microbiota intestinal poco saludable, predisponen a las personas a contraer enfermedades infecciosas, así como una COVID-19 más agresiva y grave." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juana Carretero Gómez, Jose Pablo Miramontes González, Carlos Dueñas Gutiérrez, Jose Carlos Arévalo Lorido" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juana" "apellidos" => "Carretero Gómez" ] 1 => array:2 [ "nombre" => "Jose Pablo" "apellidos" => "Miramontes González" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Dueñas Gutiérrez" ] 3 => array:2 [ "nombre" => "Jose Carlos" "apellidos" => "Arévalo Lorido" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887421000242" "doi" => "10.1016/j.rceng.2020.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000242?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521000035?idApp=WRCEE" "url" => "/00142565/0000022100000005/v1_202105061437/S0014256521000035/v1_202105061437/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887421000412" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.11.004" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "1939" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2021;221:312-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Correspondence" "titulo" => "COVID-19 myopericarditis: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "313" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miopericarditis por COVID-19: A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 1743 "Tamanyo" => 236122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A) Chest radiography. 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"apellidos" => "Arévalo Lorido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Zafra, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Instituto de Investigación Biológica de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Universitario de Valladolid, Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es la nutrición el factor de riesgo olvidado en la infección por COVID-19?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2071 "Ancho" => 2925 "Tamanyo" => 460394 ] ] "descripcion" => array:1 [ "en" => "The interrelationship between nutritional status, health, and COVID-19 progress. Several mechanisms have been implicated in COVID-19 progress. Host-related factors include sex, age, and lung and metabolic diseases. A more unknown aspect is the interrelationship between nutritional status and health at not only the individual, but also the community and global levels. Several factors contribute to nutritional status, including economic stability; medical comorbidities; racism or other discrimination; and food insecurity, as determined by unequal access to essential nutrients or healthy food. All condition community and individual health status such that, through impaired innate and acquired immunity or unhealthy gut microbiota, they predispose individuals to infectious diseases as well as more aggressive and severe COVID-19 disease." ] ] ] "textoCompleto" => "We read the articles by Casas-Rojo<a class="elsevierStyleCrossRef" href="#bib0030">1</a> and Suarez<a class="elsevierStyleCrossRef" href="#bib0035">2</a> with interest. It is curious that multiple risk profiles for infection, hospital or intensive care unit admission, and death from COVID-19 have been published since the beginning of the pandemic. In all of them, age, hypertension, male sex, diabetes mellitus, and obesity have been included as risk factors. On the other hand, the recommended therapeutic strategies have changed. Notably, nutritional status is not included in these risk profiles. We strongly agree that several nonmedical factors and conditions can influence health.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> It is a no-brainer to say that nutritional status is considered both a health status indicator and an element of resistance against intercurrent diseases.Evidence has been reported on the influence that diet has on the immune system and susceptibility to disease. It has been shown that a deficit in specific nutrients affects the immune system through cell activation, changes in the production of signaling molecules, and gene expression. Nutritional deficiencies in energy, protein, and micronutrients have been associated with depressed immune function and increased susceptibility to infection.<a class="elsevierStyleCrossRef" href="#bib0045">4</a> In addition, dietary components are significant determinants of gut microbiota composition and, consequently, can shape the characteristics of immune responses in the body. Nutritional support therapies form part of the care for patients with a high degree of comorbidity and advanced age, factors related to a higher probability of presenting with poor progress (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Just a few small studies have reported on the nutritional status of patients with COVID-19, and, in those works, it was clear that patients with nutritional deficiencies had poor progress.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> We have not found any recommendations regarding treatment and prevention strategies in this regard, only opinion articles. If the nutritional status is a decisive factor in the progress of patients with infectious diseases, it leads us to ask ourselves, Is nutrition the forgotten risk factor in COVID-19 infection?" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "Please cite this article as: Carretero Gómez J, Miramontes González JP, Dueñas Gutiérrez C, Arévalo Lorido JC. ¿Es la nutrición el factor de riesgo olvidado en la infección por COVID-19? Rev Clín Esp. 2021;221:311–312." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2071 "Ancho" => 2925 "Tamanyo" => 460394 ] ] "descripcion" => array:1 [ "en" => "The interrelationship between nutritional status, health, and COVID-19 progress. Several mechanisms have been implicated in COVID-19 progress. Host-related factors include sex, age, and lung and metabolic diseases. A more unknown aspect is the interrelationship between nutritional status and health at not only the individual, but also the community and global levels. Several factors contribute to nutritional status, including economic stability; medical comorbidities; racism or other discrimination; and food insecurity, as determined by unequal access to essential nutrients or healthy food. All condition community and individual health status such that, through impaired innate and acquired immunity or unhealthy gut microbiota, they predispose individuals to infectious diseases as well as more aggressive and severe COVID-19 disease." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of patients hospitalized with COVID-19 in Spain: results from the SEMI-COVID-19 Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Casas-Rojo" 1 => "J.M. Antón-Santos" 2 => "J. Millán-Núñez-Cortés" 3 => "C. Lumbreras-Bermejo" 4 => "J.M. Ramos-Rincón" 5 => "E. 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