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. REGISTRATION: PROSPERO CRD42022353953.

微量营养素（micronutrients）在新冠病毒病（COVID-19）的临床管理中具有重要价值，目前已有大量相关研究开展，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 Library及Scopus数据库中开展文献检索。本研究采用双盲分组讨论的方式完成文献筛选、数据提取与质量评价。针对存在关联重叠的荟萃分析，采用随机效应模型进行重新合并；同时以表格形式呈现叙事性证据综合结果。本研究最终共纳入57篇综述类文献与57篇最新原创研究，其中21篇综述及53篇原创研究的质量为中至高等级。新冠患者与健康人群的维生素D、维生素B族、锌、硒及铁蛋白水平存在显著差异。维生素D与锌缺乏可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缺乏可使新冠病情严重程度升高0.86倍，而低维生素B与硒水平则可降低病情严重程度。维生素D与钙缺乏可使ICU收治风险分别升高1.09倍与4.09倍。维生素D缺乏可使机械通气需求升高0.4倍。维生素D、锌与钙缺乏可分别使新冠病死率升高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不良转归呈正相关，而维生素C与新冠病毒病的关联则无统计学意义。注册信息：PROSPERO CRD42022353953。