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Berger MM, Amrein K, Barazzoni R, Bindels L, Bretón I, Calder PC, Cappa S, Cuerda C, D'Amelio P, de Man A, Delzenne NM, Forbes A, Genton L, Gombart AF, Joly F, Laviano A, Matthys C, Phyo PP, Ravasco P, Serlie MJ, Shenkin A, Stoffel NU, Talwar D, van Zanten ARH. The science of micronutrients in clinical practice - Report on the ESPEN symposium. Clin Nutr 2024; 43:268-283. [PMID: 38104489 DOI: 10.1016/j.clnu.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND & AIMS The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium. METHODS Current evidence was discussed, the first day being devoted to clarifying the biology underlying the guidelines, especially regarding the definition of deficiency, the impact of inflammation, and the roles in antioxidant defences and immunity. The second day focused on clinical situations with high prevalence of MN depletion and deficiency. RESULTS The importance of the determination of MN status in patients at risk and diagnosis of deficiencies is still insufficiently perceived, considering the essential role of MNs in immune and antioxidant defences. Epidemiological data show that deficiencies of several MNs (iron, iodine, vitamin D) are a global problem that affects human health and well-being including immune responses such as to vaccination. Clinical conditions frequently associated with MN deficiencies were discussed including cancer, obesity with impact of bariatric surgery, diseases of the gastrointestinal tract, critical illness, and aging. In all these conditions, MN deficiency is associated with worsening of outcomes. The recurrent problem of shortage of MN products, but also lack of individual MN-products is a worldwide problem. CONCLUSION Despite important progress in epidemiology and clinical nutrition, numerous gaps in practice persist. MN depletion and deficiency are frequently insufficiently searched for in clinical conditions, leading to inadequate treatment. The symposium concluded that more research and continued education are required to improve patient outcome.
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Affiliation(s)
- Mette M Berger
- Lausanne University, Faculty of Biology & Medicine, 1005 Lausanne, Switzerland.
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Laure Bindels
- Faculty of Pharmacy and Biomedical Sciences, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.
| | - Irene Bretón
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Stefano Cappa
- IUSS Cognitive Neuroscience (ICoN) Center, University School for Advanced Studies (IUSS-Pavia), 27100 Pavia, Italy.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Patrizia D'Amelio
- Service de gériatrie et réadaptation gériatrique, Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Angélique de Man
- Department of Intensive Care Medicine, Research VUMC Intensive Care, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.
| | - Nathalie M Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.
| | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
| | - Laurence Genton
- Clinical Nutrition Unit, Department of Endocrinology, Geneva University Hospitals, Geneva, Switzerland.
| | - Adrian F Gombart
- Linus Pauling Institute, Department of Biochemistry and Biophysics, Oregon State University, Corvallis, OR 97331, USA.
| | - Francisca Joly
- Beaujon Hospital, APHP, Clichy, University of Paris VII, France.
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, University La Sapienza, Rome, Italy.
| | | | - Pyi Pyi Phyo
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Paula Ravasco
- Coordinator of the Curricular Units Diabetes, Obesity and Lifestyle, Digestion and Defence, University of Lisbon - Católica Medical School, Lisbon, Portugal.
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| | - Dinesh Talwar
- Department of Biochemistry, Glasgow Royal Infirmary, Glasgow, UK.
| | - Arthur R H van Zanten
- Gelderse Vallei Hospital, Ede and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
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Alomran AA, Althubaiti KA, Alabdullah HA, Al Bisher HB, Awadh A, Al Shankiti HA, Almazyad L, Aljandul LA, Aljohani AT, Dhafar OW, Alzahrani ZA, Kharaba AM. Body Mass Index as a Predictor of COVID-19 Severity in ICU Patients in Saudi Arabia: A Retrospective Analysis. Cureus 2024; 16:e52470. [PMID: 38371162 PMCID: PMC10873537 DOI: 10.7759/cureus.52470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction The global coronavirus disease 2019 (COVID-19) pandemic has prompted research into various risk factors, including the role of body mass index (BMI) in disease severity. This study specifically examines the correlation between BMI and the severity of COVID-19 among intensive care unit (ICU) patients in Saudi Arabia, addressing a gap in region-specific data. The study aims to assess the impact of BMI on the severity of COVID-19 in a Saudi Arabian ICU patient cohort, providing insights into how this relationship varies in different demographic contexts. Materials and methods Employing a retrospective cohort design, the study analyzed data from adult ICU patients in Saudi Arabia diagnosed with COVID-19. It focused on variables like BMI at admission, demographic information, and COVID-19 outcomes including severity, recovery, and mortality. Statistical analysis involved regression models, adjusting for age, gender, and comorbidities. Results Unlike global observations, the study found no significant correlation between BMI and COVID-19 severity in the Saudi Arabian context. This suggests that in this specific demographic, other factors may be more critical in determining the severity of the disease. Conclusion Our findings challenge the global consensus on BMI as a key factor in COVID-19 severity, highlighting the importance of regional differences in disease dynamics. They underscore the need for localized healthcare strategies and further research into diverse demographic factors affecting COVID-19. This study contributes to a broader understanding of the pandemic and encourages region-specific approaches in both clinical and public health spheres.
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Affiliation(s)
| | | | | | - Heba B Al Bisher
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Atheer Awadh
- College of Medicine, Taif University, Taif , SAU
| | | | - Laura Almazyad
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Leen A Aljandul
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abrar T Aljohani
- Family Medicine, Faculty of Medicine, Ibn Sina National College for Medical Sciences, Jeddah, SAU
| | - Obay W Dhafar
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Ayman M Kharaba
- Internal Medicine Intensive Critical Care Unit, King Fahad Hospital, Madinah, SAU
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3
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Anghel L, Manole C, Nechita A, Tatu AL, Ștefănescu BI, Nechita L, Bușilă C, Zainea P, Baroiu L, Mușat CL. Calcium, Phosphorus and Magnesium Abnormalities Associated with COVID-19 Infection, and Beyond. Biomedicines 2023; 11:2362. [PMID: 37760804 PMCID: PMC10525362 DOI: 10.3390/biomedicines11092362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has had a profound impact on global health, leading to a surge in research to better understand the pathophysiology of the disease. Among the various aspects under investigation, disruptions in mineral homeostasis have emerged as a critical area of interest. This review aims to provide an overview of the current evidence linking calcium, phosphorus and magnesium abnormalities with COVID-19 infection and explores the potential implications beyond the acute phase of the disease. Beyond the acute phase of COVID-19, evidence suggests a potential impact of these mineral abnormalities on long-term health outcomes. Persistent alterations in calcium, phosphorus and magnesium levels have been linked to increased cardiovascular risk, skeletal complications and metabolic disorders, warranting continuous monitoring and management in post-COVID-19 patients.
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Affiliation(s)
- Lucreția Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Aurel Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Alin Laurențiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800010 Galati, Romania
| | - Bogdan Ioan Ștefănescu
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
- Clinical Surgery Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Camelia Bușilă
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Pușica Zainea
- Clinical Emergency County Hospital Braila, 810318 Braila, Romania;
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Carmina Liana Mușat
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
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Kahar LA, Yusrawati Y, Jamsari J, Maskoen T. Association between Vitamin D Levels and Mortality in Sepsis Patients Admitted to an Intensive Care at General Hospital Dr. M. Djamil, West Sumatera, Indonesia. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND: Vitamin D deficiency is associated with an increased risk and progression of the disease, especially sepsis. Low serum Vitamin D levels when patients enter the Intensive Care Unit (ICU) can affect patient care outcomes.
AIM: This study aims to determine the relationship between Vitamin D levels and sepsis patients’ treatment outcomes in the Intensive Care Unit.
METHODS: We analyzed 80 sepsis patients admitted from July 2022 to September 2022. This study used a cohort design. Sampling and collection were carried out from July 2022 to September 2022 in the Intensive Care Unit of Dr. M. Djamil Hospital, Padang. This study was conducted on 40 case samples and 40 control samples. The relationship between Vitamin D levels and treatment outcomes for sepsis patients was analyzed using the Chi-Square/Fisher Exact Test.
RESULTS: Patients with the most Vitamin D deficiency were women (77.5%), obese (57.5%), with the most comorbid Chronic Kidney Injury (12.5%), the mean APACHE II score was 21, and SOFA score of 7. Patients with non-deficiency Vitamin D most was male (7%), obese (52.5%), with the most comorbid Cardiovascular Disease (15.0%), the mean APACHE II score was 19, and SOFA score of 5. In 40 patients with Vitamin D deficiency, 24 patients (57.1%) non-survived, and 16 patients (42.1%) survived (RR = 1.833).
CONCLUSION: Vitamin D deficiency increases the risk of death in septic patients, so further intervention is needed.
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Barazzoni R, Breda J, Cuerda C, Schneider S, Deutz NE, Wickramasinghe K, Abbasoglu O, Meijerink JB, Bischoff S, Pelaez RB, Cardenas D, Cederholm T, Cereda E, Chourdakis M, Toulson Davisson Correia MI, Schuren MDVD, Delzenne N, Frias-Toral E, Genton L, Cappellari GG, Cakir BK, Klek S, Krznaric Z, Laviano A, Lobo D, Muscaritoli M, Ockenga J, Pirlich M, Serlie MJM, Shi HP, Singer P, Soop M, Walrand S, Weimann A. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers. Clin Nutr 2022; 41:2858-2868. [PMID: 36075815 PMCID: PMC9365508 DOI: 10.1016/j.clnu.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.
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Affiliation(s)
- Rocco Barazzoni
- Corresponding author. Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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Bandeira L, Lazaretti-Castro M, Binkley N. Clinical aspects of SARS-CoV-2 infection and vitamin D : COVID-19 and the endocrine system: special issue for reviews in endocrine and metabolic disorders (Felipe Casaneuva, Editor in Chief) A. Giustina and JP Bilezikian, Guest Editors. Rev Endocr Metab Disord 2022; 23:287-291. [PMID: 34559361 PMCID: PMC8460842 DOI: 10.1007/s11154-021-09683-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/19/2022]
Abstract
In December 2019, the first cases of severe acute respiratory syndrome due to a new coronavirus (SARS-Cov-2), later designated as Covid-19, were described in China. With rapid advance of the infection to several continents, in March 2020, WHO declared this to be a pandemic. In April 2020, the first papers suggesting a possible role of Vitamin D deficiency in the severity of this infection began to appear and dozens of articles evaluating a potential relationship of vitamin D with COVID have emerged subsequntly. This possibility was raised based on pre-existing evidence of the effects of Vitamin D on the immune system, and more specifically on acute respiratory viral infections. In addition, most Covid-19 victims belong to groups at risk for vitamin D deficiency such as the elderly, obese, chronically ill, and specific ethnic groups. Although with some contradictory reports exist, most observational and cohort studies find a relationship of low vitamin D status with greater Covid severity, others, including the few interventional studies available show inconsistent results. This paper aims to present the rapidly expanding literature to date regarding the clinical relevance of vitamin D in Covid-19 and, consequently, the reasonableness of avoiding its deficiency to keep the immune system able to respond in the best way to this acute viral infection. In the meantime, we wait for publication of several prospective randomized controlled studies that are underway, evaluating the effects of treatment with vitamin D or metabolites on the severity of Covid-19 outcomes.
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Affiliation(s)
- Leonardo Bandeira
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Grupo Fleury, Recife, Brazil
| | | | - Neil Binkley
- School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
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Influence of exercise and vitamin D on the immune system against Covid-19: an integrative review of current literature. Mol Cell Biochem 2022; 477:1725-1737. [PMID: 35258807 PMCID: PMC8902492 DOI: 10.1007/s11010-022-04402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/23/2022] [Indexed: 10/26/2022]
Abstract
Respiratory infections of viral origin have become the leading cause of infectious diseases in the world. In 2020, the World Health Organization (WHO) declared a pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Coronavirus Disease 2019 (Covid-19). The pandemic caused by the new coronavirus has challenged the entire global health system, since Covid-19 has a high rate of morbidity and mortality. The immune response to the virus depends on factors such as age, genetics, nutritional status, physical status, as well as environmental factors. Despite scientific advances, so far, there is still no specific therapy for the disease. Thus, this study aims to analyze the contribution of physical exercise and maintenance and/or supplementation of vitamin D to the strengthening of the immune system against viral infections, among them, Covid-19. Regular practice of moderate-intensity physical activity is responsible for promoting a reduction in the concentrations of pro-inflammatory cytokines (IL-6, TNF-α and IL-1β), as well as triggering the increase in the production of anti-inflammatory cytokines (IL-4 and IL-10). In addition, hypovitaminosis D predisposes to the development of chronic diseases and infections. Therefore, in patients affected by Covid-19, the maintenance of vitamin D levels contributes significantly to the 0prevention of the cytokine storm. Thus, the association between maintaining vitamin D levels and performing moderate-intensity physical exercise is responsible for strengthening the immune system and, therefore, triggering a defense mechanism against infections by intracellular microorganisms, in which SARS -CoV-2.
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Arazo-Rusindo MC, Zúñiga RN, Cortés-Segovia P, Benavides-Valenzuela S, Pérez-Bravo F, Castillo-Valenzuela O, Mariotti-Celis MS. Nutritional Status and Serum Levels of Micronutrients in an Elderly Group Who Participate in the Program for Complementary Food in Older People (PACAM) from the Metropolitan Region, Santiago de Chile. Nutrients 2021; 14:nu14010003. [PMID: 35010878 PMCID: PMC8746835 DOI: 10.3390/nu14010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/10/2023] Open
Abstract
The increase in the Chilean elderly population has promoted public policies to favor an adequate nutrition in later life. This study evaluated the nutritional status, micronutrients intake and serum micronutrients levels of an elderly group beneficiary of the PACAM from the Metropolitan Region, Santiago de Chile. Anthropometric and dietary survey (24 h food recalls) were assessed in 182 elderly individuals (60 and 80 years old). Blood serum collection was used to measure the micronutrient status. The sample was comprised by 12.6%, 46.1%, 28.0% and 13.2% of underweight, normal weight, overweight and obese subjects, respectively. Women presented 11% of underweight, 45% of normal weight and 44% of overweight and obese, while men—18%, 50% and 32%, respectively. Only the 63% of the elderlies consumed PACAM foods, reaching average daily intakes below (50%) the recommended daily serving. Serum deficiencies of 25-hydroxyvitamin D (88%), vitamin B12 (33%) and calcium (36%) were observed, being the highest ones in the PACAM foods women (60–75 years old). Chilean elderlies presented mainly a normal weight; however, an important proportion of overweight/obese subjects was observed. Although PACAM foods consumption significantly increased the micronutrient intake, it was not enough to ensure an adequate serum micronutrient levels in the elderly.
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Affiliation(s)
- Migdalia Caridad Arazo-Rusindo
- Department of Biotechnology, Universidad Tecnológica Metropolitana, Las Palmeras 3360, Ñuñoa, Santiago 7800003, Chile; (M.C.A.-R.); (R.N.Z.)
| | - Rommy N. Zúñiga
- Department of Biotechnology, Universidad Tecnológica Metropolitana, Las Palmeras 3360, Ñuñoa, Santiago 7800003, Chile; (M.C.A.-R.); (R.N.Z.)
| | - Pablo Cortés-Segovia
- Faculty of Medicine, Nutrition and Dietetics School, Universidad Finis Terrae, Pedro de Valdivia 1509, Providencia, Santiago 7501015, Chile;
| | - Sergio Benavides-Valenzuela
- Núcleo de Investigación en Agroalimentos y Nutrición Aplicada, Universidad Adventista de Chile, Camino a las Mariposas s/n, Chillan 3780000, Chile;
| | - Francisco Pérez-Bravo
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7830489, Chile
- Nutrigenomics Laboratory, Nutrition Department, Faculty of Medicine, University of Chile, Santiago 7830489, Chile
- Correspondence: (F.P.-B.); (O.C.-V.); (M.S.M.-C.)
| | - Oscar Castillo-Valenzuela
- Faculty of Medicine, Nutrition and Dietetics School, Universidad Finis Terrae, Pedro de Valdivia 1509, Providencia, Santiago 7501015, Chile;
- Correspondence: (F.P.-B.); (O.C.-V.); (M.S.M.-C.)
| | - María Salomé Mariotti-Celis
- Faculty of Medicine, Nutrition and Dietetics School, Universidad Finis Terrae, Pedro de Valdivia 1509, Providencia, Santiago 7501015, Chile;
- Correspondence: (F.P.-B.); (O.C.-V.); (M.S.M.-C.)
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Kazemi A, Mohammadi V, Aghababaee SK, Golzarand M, Clark CCT, Babajafari S. Association of Vitamin D Status with SARS-CoV-2 Infection or COVID-19 Severity: A Systematic Review and Meta-analysis. Adv Nutr 2021; 12:1636-1658. [PMID: 33751020 PMCID: PMC7989595 DOI: 10.1093/advances/nmab012] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
This systematic review was conducted to summarize and clarify the evidence on the association between 25-hydroxyvitamin-D [25(OH)D] concentrations and coronavirus disease 2019 (COVID-19) risk and outcomes. PubMed, Scopus, and Web of Science databases and Google Scholar were searched up to 26 November 2020. All retrospective and prospective cohort, cross-sectional, case-control, and randomized controlled trial studies that investigated the relation between 25(OH)D and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity were included. Thirty-nine studies were included in the current systematic review. In studies that were adjusted (OR: 1.77; 95% CI: 1.24, 2.53; I2: 44.2%) and nonadjusted for confounders (OR: 1.75; 95% CI: 1.44, 2.13; I2: 33.0%) there was a higher risk of SARS-CoV-2 infection in the vitamin D deficiency (VDD) group. Fifteen studies evaluated associations between VDD and composite severity. In the studies that were adjusted (OR: 2.57; 95% CI: 1.65, 4.01; I2 = 0.0%) and nonadjusted for confounders (OR: 10.61; 95% CI: 2.07, 54.23; I2 = 90.8%) there was a higher severity in the VDD group. Analysis of studies with crude OR (OR: 2.62; 95% CI: 1.13, 6.05; I2: 47.9%), and adjusted studies that used the Cox survival method (HR: 7.67; 95% CI: 3.92, 15.03; I2: 0.0%) indicated a significant association of VDD with mortality, while in adjusted studies that used logistic regression, no relation was observed (OR: 1.05; 95% CI: 0.63, 1.75; I2: 76.6%). The results of studies that examined relations between VDD and intensive care unit (ICU) admission, pulmonary complications, hospitalization, and inflammation were inconsistent. In conclusion, although studies were heterogeneous in methodological and statistical approach, most of them indicated a significant relation between 25(OH)D and SARS-CoV-2 infection, COVID-19 composite severity, and mortality. With regard to infection, caution should be taken in interpreting the results, due to inherent study limitations. For ICU admission, inflammation, hospitalization, and pulmonary involvement, the evidence is currently inconsistent and insufficient.
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Affiliation(s)
- Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vida Mohammadi
- Department of Nutrition, Sepidan Bagherololoom Health Higher Education College, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Keshtkar Aghababaee
- Department of Nursing, College of Medical Sciences, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Siavash Babajafari
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Dysmagnesemia Is the Most Common Disturbance of the Calcium-Magnesium-Phosphorous Balance among Older Hospitalized People in Warsaw. Nutrients 2021; 13:nu13103395. [PMID: 34684395 PMCID: PMC8540856 DOI: 10.3390/nu13103395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
The elderly are at great risk of developing life-threatening disturbances in calcium–magnesium–phosphate homeostasis because of comorbidities, long-term medication use, and dietary deficiencies, but it is still not known how often they occur in this group of patients. This study aimed to assess the prevalence of these disturbances in a group of hospitalized patients over 65 years of age according to age and sex. The study was conducted between January 2018 and September 2020 at the Central Clinical Hospital in Warsaw. A total of 66,450 calcium, magnesium, phosphate, and vitamin D concentration results were included in the analysis. Dysmagnesemia was present in 33% of the calcium results, dyscalcemia, dysphosphatemia, and dysvitaminosis D—in 23.5%, 26%, and 70% of the results, respectively. The magnesium concentration was found to be age-dependent, and older people were found to be at higher risk of developing abnormal magnesium concentrations (p < 0.001). Sex influenced the occurrence of abnormal magnesium (p < 0.001), vitamin D (p < 0.001), and calcium (p < 0.00001) concentrations, with hypercalcemia and hypervitaminosis D disorders being significantly more common in women (p < 0.0001). In conclusion, disorders of the calcium–magnesium–phosphate metabolism are common in hospitalized patients over 65 years of age, and the concentrations of these substances should be routinely monitored in this group.
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11
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Dayaramani C, De Leon J, Reiss AB. Cardiovascular Disease Complicating COVID-19 in the Elderly. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:833. [PMID: 34441038 PMCID: PMC8399122 DOI: 10.3390/medicina57080833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.
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Affiliation(s)
| | | | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (C.D.); (J.D.L.)
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12
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Menshawey E, Menshawey R, Nabeh OA. Shedding light on vitamin D: the shared mechanistic and pathophysiological role between hypovitaminosis D and COVID-19 risk factors and complications. Inflammopharmacology 2021; 29:1017-1031. [PMID: 34185200 PMCID: PMC8239482 DOI: 10.1007/s10787-021-00835-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-COV-2) is the culprit of the Coronavirus Disease (COVID-19), which has infected approximately 173 million people and killed more than 3.73 million. At risk groups including diabetic and obese patients are more vulnerable to COVID-19-related complications and poor outcomes. Substantial evidence points to hypovitaminosis D as a risk factor for severe disease, the need for ICU, and mortality. 1,25(OH)D, a key regulator of calcium homeostasis, is believed to have various immune-regulatory roles including; promoting anti-inflammatory cytokines, down regulating pro-inflammatory cytokines, dampening entry and replication of SARS-COV-2, and the production of antimicrobial peptides. In addition, there are strong connections which suggest that dysregulated 1,25(OH)D levels play a mechanistic and pathophysiologic role in several disease processes that are shared with COVID-19 including: diabetes, obesity, acute respiratory distress syndrome (ARDS), cytokine storm, and even hypercoagulable states. With evidence continuing to grow for the case that low vitamin D status is a risk factor for COVID-19 disease and poor outcomes, there is a need now to address the public health efforts set in place to minimize infection, such as lock down orders, which may have inadvertently increased hypovitaminosis D in the general population and those already at risk (elderly, obese, and disabled). Moreover, there is a need to address the implications of this evidence and how we may apply the use of cheaply available supplementation, which has yet to overcome the near global concern of hypovitaminosis D. In our review, we exhaustively scope these shared pathophysiologic connections between COVID-19 and hypovitaminosis D.
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Affiliation(s)
- Esraa Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Rahma Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Omnia Azmy Nabeh
- Faculty of Medicine, Department of Medical Pharmacology, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
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13
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Güven M, Gültekin H. The effect of high-dose parenteral vitamin D 3 on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study. Eur J Clin Nutr 2021; 75:1383-1388. [PMID: 34302132 PMCID: PMC8299443 DOI: 10.1038/s41430-021-00984-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/24/2023]
Abstract
Background In many studies, vitamin D has been found to be low in COVID-19 patients. In this study, we aimed to investigate the relationship between clinical course and inhospital mortality with parenteral administration of high-dose vitamin D3 within the first 24 h of admission to patients who were hospitalized in the intensive care unit (ICU) because of COVID-19 with vitamin D deficiency. Methods This study included 175 COVID-19 patients with vitamin D deficiency [25(OH) D <12 ng/mL] who were hospitalized in the ICU. Vitamin D3 group (n = 113) included patients who received a single dose of 300,000 IU vitamin D3 intramuscularly. Vitamin D3 was not administered to the control group (n = 62). Results Median C-reactive protein level was 10.8 mg/dL in the vitamin D3 group and 10.6 mg/dL in the control group (p = 0.465). Thirty-nine percent (n = 44) of the patients in the vitamin D3 group were intubated endotracheally, and 50% (n = 31) of the patients in the control group were intubated endotracheally (p = 0.157). Parenteral vitamin D3 administration was not associated with inhospital mortality by multivariate logistic regression analysis. According to Kaplan–Meier survival analysis, the median survival time was 16 d in the vitamin D3 group and 17 d in the control group (log-rank test, p = 0.459). Conclusion In this study, which was performed for the first time in the literature, it was observed that high-dose parenteral vitamin D3 administration in critical COVID-19 patients with vitamin D deficiency during admission to the ICU did not reduce the need for intubation, length of hospital stay, and inhospital mortality.
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Affiliation(s)
- Mehmet Güven
- Department of Endocrinology and Metabolism, Şırnak State Hospital, Şırnak, Turkey.
| | - Hamza Gültekin
- Department of İntensive Care Unit, Şırnak State Hospital, Şırnak, Turkey
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14
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Al Kiyumi MH, Kalra S, Davies J, Kalhan A. The Impact of Vitamin D Deficiency on the Severity of Symptoms and Mortality Rate among Adult Patients with Covid-19: A Systematic Review and Meta-Analysis. Indian J Endocrinol Metab 2021; 25:261-282. [PMID: 35136732 PMCID: PMC8793953 DOI: 10.4103/ijem.ijem_115_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION We aimed to study the prevalence of vitamin D deficiency (VDD) in patients with COVID-19 infection and evaluate the impact of vitamin D levels on the severity of symptoms and the case fatality rate. EVIDENCE ACQUISITION A comprehensive literature search was performed up to December 20, 2020, using the following databases: MEDLINE, PubMed, EMBASE, SCOPUS, Web of Science, and preprint databases (BioRxiv and MedRxiv). Any individual observational study related to the prevalence and impact of vitamin D deficiency/insufficiency (VDD/VDI) on the severity of COVID-19 symptoms and mortality rates was included. No language restrictions were applied, and both published and non-published studies were included. EVIDENCE SYNTHESIS Two of the authors independently performed the literature search and assessed the eligibility of studies. The quality of studies included was assessed using the Newcastle-Ottawa Scale. Data were analyzed using the Review Manager Software (version 5) and Comprehensive Meta-analysis Software (version 3). A total of 43 studies were included with a sample size of 254,963 patients with COVID-19. Pooled analysis showed a higher prevalence of VDD and VDI in patients with COVID-19 (59.0% and 40.1%, respectively). Moreover, a significant association was noticed between vitamin D levels and severity of symptoms (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.94-5.87, P < 0.0001), as well as the case fatality rate (OR = 2.30, 95% CI: 1.47-3.59, P < 0.00001). CONCLUSIONS VDD is highly prevalent in patients with COVID-19 infection. Lower vitamin D levels correlate with disease severity and poor prognosis although most of the data have been derived from moderate-quality observational studies.
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Affiliation(s)
- Maisa Hamed Al Kiyumi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - J.S. Davies
- Department of Endocrinology, University Hospital of Wales, Cardiff, Wales, UK
| | - Atul Kalhan
- Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Wales, UK
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15
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Crafa A, Cannarella R, Condorelli RA, Mongioì LM, Barbagallo F, Aversa A, La Vignera S, Calogero AE. Influence of 25-hydroxy-cholecalciferol levels on SARS-CoV-2 infection and COVID-19 severity: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100967. [PMID: 34179737 PMCID: PMC8215557 DOI: 10.1016/j.eclinm.2021.100967] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of coronavirus disease 19 (COVID-19), a respiratory infection that, starting from December 2019, has spread around the world in a few months, becoming a pandemic. The lack of initial knowledge on its management has led to a great effort in developing vaccines and in finding therapeutic weapons capable of improving the clinical outcome of the affected patients. In particular, the possible role of vitamin D status in the management of COVID-19 has been widely analysed, resulting in a great amount of data. This systematic review and meta-analysis aimed to assess whether hypovitaminosis D is a risk factor for developing SARS-CoV-2 infection and whether it affects the worsening of the clinical course of COVID-19. METHODS Data were extracted through extensive searches in the Pubmed, MEDLINE, Cochrane, Academic One Files, Google Scholar, and Scopus databases from December 2019 to January 2021, using the keywords: "Vitamin D", "25 hydroxy Vitamin D", "25 hydroxycholecalciferol", "cholecalciferol", "COVID 19″, "SARS-CoV-2″. We included observational cohort, cross-sectional, and case-control studies that evaluated differences in serum levels of 25‑hydroxy-cholecalciferol [25(OH)D] in patients who were positive or negative for SARS-CoV-2, in patients with mild or severe forms of COVID-19, and in patients who died or were discharged from the hospital. Finally, studies that evaluated the risk of developing severe illness or death in patients with vitamin D deficiency (VDD), defined as levels of 25(OH)D <20 ng/ml, were also included. We calculated the mean difference (MD) and the 95% confidence intervals (CI) for quantitative variables such as 25(OH)D levels in patients with or without SARS-CoV-2 infection, in those with mild vs. severe COVID-19, or those who have died vs. those who have been discharged. Instead, we calculated odds ratios and 95% CI for qualitative ones, such as the number of patients with severe illness/death in the presence of VDD vs. those with normal serum 25(OH)D levels. A p-value lower than 0.05 was considered statistically significant. The study was registered on PROSPERO (CRD42021241473). FINDINGS Out of 662 records, 30 articles met inclusion criteria and, therefore, were included in the meta-analysis. We found that the serum levels of 25(OH)D were significantly lower in patients with SARS-CoV-2 infection than in negative ones [MD -3.99 (-5.34, -2.64); p <0.00001; I2= 95%]. Furthermore, its levels were significantly lower in patients with severe disease [MD -6.88 (-9.74, -4.03); p <0.00001; I2=98%] and in those who died of COVID-19 [MD -8.01 (-12.50, -3.51); p = 0.0005; I2=86%]. Finally, patients with VDD had an increased risk of developing severe disease [OR 4.58 (2.24, 9.35); p <0.0001; I2=84%] but not a fatal outcome [OR 4.92 (0.83, 29.31); p = 0.08; I2=94%]. INTERPRETATION This meta-analysis revealed a large heterogeneity of the studies included due to the different enrolment criteria of patient samples (age, body mass index, ethnicity, comorbidities), the country where they live, all factors influencing serum 25(OH)D levels, and the different criteria used to define the severity of COVID-19. Furthermore, the observational nature of these studies does not allow to establish a cause-effect relationship, even taking into account that 25(OH)D represents a marker of acute inflammation. Treatment with vitamin D might be considered for the primary prevention of SARS-CoV-2 infection and the management of patients with COVID-19. However, further intervention studies are needed to prove this hypothesis.
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Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Laura M. Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, Catanzaro, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
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16
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Rodriguez-Leyva D, Pierce GN. The Impact of Nutrition on the COVID-19 Pandemic and the Impact of the COVID-19 Pandemic on Nutrition. Nutrients 2021; 13:nu13061752. [PMID: 34064053 PMCID: PMC8223988 DOI: 10.3390/nu13061752] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had significant morbidity, mortality, social and financial implications for the global population. Despite this knowledge, we still know very little about how COVID-19 infection affects quality of life resulting from changes in nutritional behaviour and, conversely, how nutrition could modulate the epidemiology of COVID-19. In addition, the social isolation most have experienced due to the regulations imposed by governments during the COVID-19 pandemic may have also had effects on our nutritional behaviour. It is possible that nutritional interventions may have effects on the incidence of COVID-19 infection and mortality rates. The purpose of this review is to evaluate the current status of research on the topic of nutrition as it relates to the COVID-19 pandemic.
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Affiliation(s)
- Delfin Rodriguez-Leyva
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada;
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Institute of Cardiovascular Sciences, Albrechtsen Research Centre, St. Boniface Hospital, 351 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Grant N. Pierce
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada;
- Institute of Cardiovascular Sciences, Albrechtsen Research Centre, St. Boniface Hospital, 351 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
- Canadian Centre for Agri-Food Research in Health and Medicine (CCARM), Albrechtsen Research Centre, St. Boniface Hospital, 351 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
- Correspondence:
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