Micronutrient perspective on COVID-19: Umbrella review and reanalysis of meta-analyses

Micronutrients are clinically important in managing COVID-19, and numerous studies have been conducted, but inconsistent findings exist. To explore the association between micronutrients and COVID-19. PubMed, Web of Science, Embase, Cochrane Library and Scopus for study search on July 30, 2022 and October 15, 2022. Literature selection, data extraction and quality assessment were performed in a double-blinded, group discussion format. Meta-analysis with overlapping associations were reconsolidated using random effects models, and narrative evidence was performed in tabular presentations. 57 reviews and 57 latest original studies were included. 21 reviews and 53 original studies were of moderate to high quality. Vitamin D, vitamin B, zinc, selenium, and ferritin levels differed between patients and healthy people. Vitamin D and zinc deficiencies increased COVID-19 infection by 0.97-fold/0.39-fold and 1.53-fold. Vitamin D deficiency increased severity 0.86-fold, while low vitamin B and selenium levels reduced severity. Vitamin D and calcium deficiencies increased ICU admission by 1.09 and 4.09-fold. Vitamin D deficiency increased mechanical ventilation by 0.4-fold. Vitamin D, zinc, and calcium deficiencies increased COVID-19 mortality by 0.53-fold, 0.46-fold, and 5.99-fold, respectively. The associations between vitamin D, zinc, and calcium deficiencies and adverse evolution of COVID-19 were positive, while the association between vitamin C and COVID-19 was insignificant. <b>REGISTRATION:</b> PROSPERO CRD42022353953.

微量营养素（micronutrients）在新型冠状病毒肺炎（COVID-19）的临床管理中具有重要价值，目前已有诸多相关研究开展，但所得结论并不一致。为探讨微量营养素与新冠病毒病之间的关联，本研究分别于2022年7月30日及2022年10月15日，在PubMed、Web of Science、Embase、Cochrane图书馆及Scopus数据库中开展文献检索。本研究采用双盲分组讨论的形式开展文献筛选、数据提取与质量评价工作。针对存在关联重叠的荟萃分析（Meta-analysis），本研究采用随机效应模型进行重新整合，并以表格形式呈现叙述性证据。最终纳入57篇综述文献与57篇最新原创研究，其中21篇综述及53项原创研究的质量等级为中至高。新冠患者与健康人群的维生素D、B族维生素、锌、硒及铁蛋白水平存在显著差异。维生素D缺乏与锌缺乏分别使新冠病毒感染风险升高0.97倍/0.39倍与1.53倍。维生素D缺乏使新冠病情严重程度升高0.86倍，而低水平B族维生素与硒则可降低病情严重程度。维生素D与钙缺乏分别使患者入住重症监护室（Intensive Care Unit, ICU）的风险升高1.09倍与4.09倍。维生素D缺乏使患者接受机械通气的风险升高0.4倍。维生素D、锌与钙缺乏分别使新冠病毒病的死亡风险升高0.53倍、0.46倍与5.99倍。维生素D、锌及钙缺乏与新冠病毒病的不良转归呈正相关，而维生素C与新冠病毒病之间的关联则无统计学意义。<b>注册信息：</b> PROSPERO CRD42022353953。