Improved nutrition – A tool for resilience in COVID-19 pandemic

Dr Lokesh Kumar Mishra *

As India celebrates the grand success of 100 crore vaccine doses against coronavirus disease (COVID-19) it still has to be emphasized that appropriate social distancing, regular handwashing and use of good quality face masks are the most efficient and clinically established methods to reduce the risk and spread of the coronavirus disease (COVID-19).

Since the dreaded COVID-19 pandemic spread across the world, common citizens have been curious to know about ways to prevent infection by the coronavirus. These include questions related to daily routine work such as ways to shop safely, preparation of food safely. Most of us are also curious to know about the specific role of diet and nutrition during this pandemic.

It has been known for a long time that nutrition is intricately linked to immunity and to the risk and severity of infections. The interlink between nourishment of an individual and his chances of risk of bacterial, viral or other infections is evident from the fact that poorly nourished individuals are at a greater risk of various bacterial, viral, and other infections and vice-versa chronic or severe infections lead to nutritional disorders or worsen the nutritional status of affected people.

In view of this fact it is crucial for all to pay attention to our diet and nutritional status during the ongoing COVID-19 pandemic. This fact is further validated by evidence which shows that the clinical course of COVID-19 disease tends to be more severe among older individuals and among people with chronic conditions, such as diabetes, hypertension and cancer that are partly related to nutrition.

As a matter of fact, it is always desirable to consume good quality diets, and this is particularly important during the COVID-19 pandemic. A healthy diet, as depicted by a model plate designed by the ICMR-National Institute of Nutrition. recommends sourcing of macronutrients and micronutrients from a minimum of 8 food groups per day with vegetables, fruits, green leafy vegetables forming essentially half the plate of the recommended foods per day. The other major portion is occupied by cereals and millets, followed by pulses and milk/curd.

The amount of pulses and milk in the menu provides good quality protein and supply of all essential amino acids. Milk and milk products represented in a glass as a part of the model plate help to achieve the required protein, calcium, and are the sole source of Vitamin B12 in a vegetarian diet.

A balanced diet should provide around 50-60% of total calories from carbohydrates, preferably from complex carbohydrates, about 20-30% from total fats/oils and a minimum of 10-15% from proteins. 'My Plate for the Day' provides typically 13.5% calories or energy (E) from protein, 29 %E from fat and 56%E from carbohydrates required to meet the 2000 calories need in a day.

The plate has been designed on the basis of Recommended Dietary Allowances (RDA) guidelines for Indians. The cost of the 'My plate for the day' has been estimated based on commonly consumed foods. The cost of each food group has been estimated taking into consideration the different types of foods consumed in a particular food group from different parts of the country as on December, 2019 (agmarknet.in/price Trends).

For the non-vegetarian menu, pulses are replaced with meat/chicken for estimating the price. Fuel and spices required for cooking have also been considered for estimating the total day's menu cost. The cost of the non-vegetarian menu works out to approximately Rs.78 and vegetarian menu is Rs.66 per person per day.

Such a diet will provide appropriate amounts of healthy macronutrients and essential minerals and vitamins. Eating high-quality sources of protein, fat, and carbohydrate can help maintain a healthy weight and good metabolic state. It is strongly suggested that this is not a time for highly restrictive, crash diets for rapid weight loss.

If someone does develop a COVID-19 infection, eating enough of these healthy calories' adequate amounts of minerals and vitamins in these diet helps to ensure sufficient numbers of immune cells and antibodies, which are important as our body mounts a response to infections employing various options.

Despite the scarcity of data regarding nutritional factors with respect to risk and severity of coronavirus infection there are few well established evidence on nutrition and infection that may potentially help the body in efficiently defending against the infections. For example

o Vitamin C plays a role in controlling infections and healing wounds, and is a powerful antioxidant that can neutralize harmful free radicals. Vitamin C is a cofactor for many enzymes. It enhances the function of many enzymes all over the body.

Clinical studies have shown that vitamin C supplementation significantly reduces the incidence of respiratory tract infections, reduces the duration of stay in the intensive care unit and the need for mechanical ventilation among patients. The dose of vitamin C can be from 1-3 g/day, and dose does not appear to be the main driver of effectiveness. Doses of vitamin C above 2 g/day should be avoided and any medication should be taken under professional medical care only.

o Zinc is a component of many enzymes and transcription factors in cells all over the body, and inadequate zinc levels limit the individual's ability to mount an adequate immune response to infections. Multiple studies have shown that oral zinc supplementation reduces the incidence rate of acute respiratory infections by 35%, shortens the duration of flu-like symptoms by approximately 2 days, and improves the rate of recovery.

The studies were conducted in the US as well as in multiple low- and middle-income countries including India, South Africa, and Peru. These studies have recommended variable doses of zinc supplementation but dose does not appear to be the main driver of the effectiveness of zinc supplementation.

o Vitamin D supplementation lowers the odds of developing acute respiratory tract infections (most of which are assumed to be due to viruses). The beneficial effect of supplementation was seen in patients across all ages, and individuals with pre-existing chronic illnesses.

Studies published by Harvard School of Public health indicate that among those who were infected with coronavirus, flu symptoms were fewer and recovery was earlier if they had received doses of vitamin D greater than 1000 IU. The benefits were relatively greater in individuals with vitamin D deficiency than in those who had adequate levels of vitamin D. Any medication should be taken under professional medical care only.

Dietary surveys across the globe indicate that most people are consuming diets that do not meet national guidelines—often because of availability or cost—and such diets may not provide optimal quantities of essential vitamins and minerals. Currently, the ongoing COVID-19 pandemic is likely to put many more individuals at risk of food insecurity and make consuming a healthy diet even more difficult.

This becomes increasingly likely if the infection risk-mitigation strategies do not include approaches to ensure essential supplies are effectively distributed and accessible, or if the pandemic affects productivity of the agricultural sector.

In the current scenario, COVID-19 has posed a new set of challenges for the individuals to maintain a healthy diet.The state of isolation, targeted lockdowns, social distancing and most importantly vaccination are important measures to restrict the surge of the disease. Some of these measures have severe repercussions on an individual's life.

The act of confining to one's home has significant impacts on one's health, including changes in eating patterns, sleeping habits, and physical activity. It would promote sedentary behaviours that affect mental and physical health and lead to an increased risk of obesity.Fear and anxiety may also cause changes in dietary habits leading to unhealthy dietary patterns and less desire to eat or with lessened enjoyment during eating.

A balanced diet in these situations can potentially help in maintaining a strong immune system that can help withstand any assault by the virus.

In the current situation, it is necessary to be aware of the specific types of food that can improve our immune system in order to combat COVID-19. Here are authentic dietary guidelines to withstand COVID-19:

o Eat fruits daily (guava, apple, banana, strawberry, cantaloupe melon, grapefruit, pineapple, papaya, orange, Longman fruit, blackcurrant, pummelo) with a serving size of two cups (4 servings).
o Eat fresh vegetables (green bell peppers, garlic, ginger, kale, lime, coriander (dried), broccoli, green chili pepper) 2.5 cups of vegetables (5 servings) , legumes (beans and lentils).
o Eat whole grains and nuts, 180 g of grains (unprocessed maize, oats, wheat, millet, brown rice or roots such as yam, potato, taro or cassava)
o Use nuts like almonds, coconut, and pistachio.
o Red meat can be eaten once or twice per week, and poultry 2"3 times per week. Use foods from animal sources (e.g. fish, fish, eggs, and milk) and 160 g of meat and beans.
o Choose fresh fruits and raw vegetables for snacks rather than foods that are high in sugar, salt or fat.
o Overcooking of vegetables should be avoided as it leads to the loss of important nutrients such as vitamins and minerals.
o When using dried or canned fruits and vegetables, choose varieties without added sugar or salt.
o A Strict "NO" to HFSS food (high fat/salt/sugar foods). Consume healthy unsaturated fats (found in avocado, fish, nuts, soy, olive oil, canola, corn oil, and sunflower) having a good amount of polyunsaturated fatty acids (PUFA) or monounsaturated fatty acids (MUFA). Saturated fats (found in butter, fatty meat, coconut and palm oils, cheese, ghee, and cream) should be avoided.
o Drink 8–10 glasses of water every day. Optimal hydration helps the body system to transport nutrients in the blood, gets rid of waste, and regulates the body temperature much more efficiently.
o Fizzy, carbonated, concentrated juices, and all drinks which contain sugar should be restricted.
o Healthy lifestyle with judicious exercise, meditation, and regular sleep should be adopted. Adequate sleep helps to support immune functioning.
o Preferably eat at home to avoid contact with other people and try to reduce the chance of being exposed to COVID-19 and maintain optimal hand and oral hygiene.

(Note: The information given in the article is for general information only and does not intend to provide medical advice.)


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