The document discusses nutrition and its role in supporting immunity during the COVID-19 pandemic. It recommends increased intake of vitamins C, D, and zinc which have strong evidence for boosting immunity. Other nutrients like vitamin A, E, selenium, omega-3s and plant phytonutrients may also help. Maintaining overall health through adequate hydration, nutrition from whole foods, moderate fat intake and limiting salt and sugar is advised. Specific dietary recommendations are provided.

1. Ms. AT. AGILANDESWARI MSc., Mphil FSN
LECTURER
DEPARTMENT OF CLINICAL NUTRITION
GANGA INSTITUTE OF HEALTH SCIENCE
COIMBATORE

2. NUTRITION AND COVID 19 PANDEMIC

3. Introduction
• The covid-19 pandemic is posing severe threats to international health and the economy. At the moment
there is still no cure for the disease. Alternative methods need to be found to control the spread of the
virus.
• Covid-19 is caused by specific coronavirus (sars-cov 2). Coronaviruses primarily cause enzootic
infections in animals but is capable of transferring to humans and causing infections eg
* Severe acute respiratory syndrome (sars) in 2002
* Middle east respiratory syndrome (mers) in 2012., Both zoonotic diseases.
• The outbreaks of sars, mers and covid-19 demonstrates how lethal coronaviruses can be when they
cross the species barrier and infect humans.
• Interestingly, the genome structure of covid-19 is 82% identical to that of the sars- cov genome. lessons
learned from the sars (2002) outbreak could be applied or tried to apply to covid-19.

4. Symptoms of Covid 19
– Fever, cough, respiratory symptoms, shortness of breath, breathing
difficulties, fatigue and a sore throat.
– A minority group of people will present with more severe
symptoms and will need to be hospitalised, most often
with pneumonia, and in some instances, the illness can
include ARDS, sepsis and septic shock.

5.  Chronic obstructive pulmonary disease (COPD)
 Hypertension
 Bronchitis
 Emphysema
 Lung cancer
 Cystic fibrosis
 Asthma
• Older people (65+ years)
• Diabetes (Type 1 and 2)
• Lung pneumonia
• Pre-diabetes
• Lung disease
• Cardiovascular disease
• Cerebrovascular disease
The world faces unique circumstances in this time, especially with regards to
COVID-19 and the impact it has with regards to outcomes for people living
with pre-existing (comorbid) conditions.

6. + =
have control
today
SOCIAL DISTANCING &
NUTRITION
IMMUNITY YOUR HEALTH
Covid 19 precautions

7. Psychological health of children and
pandemic
– Children may respond to stress in different ways such as being clingier, anxious,
angry, withdrawing, bedwetting, etc. Therefore we should follow the steps to
overcome this
– Listen to their concerns and give them extra love
– Give them more time and attention
– Speak to them kindly and supportively, while reassuring them.
– Keep children close to their parents and family
– Keep to regular routines and schedules as much as possible
– Give them clear information about how to reduce their risk of being infected.

8. Psychological health of adults
and pandemic
Feeling sad, stressed, confused, scared or angry is normal during a crisis like the COVID-19
pandemic.
– Talk to people you trust, such as friends and family.
– Maintain a healthy lifestyle, including proper diet, sleep and exercise.
– Don't smoke, drink alcohol or use other drugs to deal with your emotions.
– Get the facts. Gather information from credible sources that will help you
accurately determine your risk.

9. – Be Respectful
– Follow the Rules
– Convey general guidelines to be followed during pandemic
– Rely on Telemedicine to avoid visiting hospital
– Stock-up Medicine
– Avoid Social Isolation
– Ensure Rest, Nutrition, and Activities
– Stay Occupied
– Enjoy Recreational Activities
– Be Positive
Psychological health of elderly
and pandemic

10. Specific Nutritional Needs for Specific
Populations during COVID-19
Vitamin D
– COVID-19 was first identified in Winter of 2019 in the Northern Hemisphere - affects mostly middle-
aged and elderly people
– Vitamin D reduces the risk of acute respiratory infections
– Vitamin D supplementation is safe and protects against acute respiratory tract infection
– In animal studies:
– a decrease Vitamin D status reported in calves had been reported to cause the infection
of bovine coronavirus
– The average daily recommendation is 600 IU
– The tolerable upper limit is 4 000 IU

11. Vitamin A
– Fat-soluble vitamin
– Three active forms of vitamin A in the body - retinol, retinal, and retinoic acid
– Called the “anti-infective” vitamin and many of the body’s defenses against infection depend on
adequate supply.
– An impaired immune response could be due to the deficiency of vitamin A
– Vitamin A supplementation reduced morbidity and mortality in infectious diseases such as measles,
diarrheal disease, measles-related pneumonia, HIV infection and malaria

12. Cont..
In animal studies:
– low vitamin A diets compromise the effectiveness of inactivated bovine coronavirus vaccines
and render calves more susceptible to infectious disease
– The effect of infection with infectious bronchitis virus (IBV), a kind of coronavirus, was more
pronounced in * chickens fed a lower vitamin A diet.
– Recommended daily allowance 900 (males) and 700 (females) ug retinol activity equivalents
– Tolerable upper limit 3 000 ug/day

13. Vitamin C
– Water-soluble vitamin which is also called as ascorbic acid and plays a role in
the synthesis of collagen in connective tissue. It acts as an anti-oxidant and
Supports immune function
– May function as a weak anti-histamine agent to provide relief from flu-like
symptoms such as sneezing, a runny or stuffy nose, and swollen sinuses
– A significantly lower incidence of pneumonia in vitamin C -supplemented
groups, suggests that vitamin C may prevent the susceptibility to lower
respiratory tract infections under certain conditions.

14. Cont..
In animal studies:
– Protects against infection caused by coronavirus
– COVID-19 causes lower respiratory tract infection - vitamin C could be an
effective choice as part of the treatment plan
– Recommended daily allowance 90mg/day
– Tolerable upper limit 2000mg/day

15. B Vitamins
plays a role in energy metabolism of all cells
suspected to present among the elderly (US study)
vitamin B2 and UV light effectively reduced the titer of MERS-CoV in human plasma products
could enhance the killing of Staphylococcus aureus
effective in prophylactic and therapeutic settings
significantly inhibited neutrophil infiltration into the lungs with strong anti-inflammatory effect during ventilator-
induced lung injury, it led, however, to the development of significant hypoxemia
•needed in protein metabolism
•Participates in over 100 reactions in body tissues
•Plays an important role in body immune function
•Shortage of B vitamins may weaken host immune response - recommended to supplement to virus-infected patients to
enhance their immune system
Vitamin B6
Vitamin B3
Vitamin B2

16. Zinc
– Important for the maintenance and development of immune cells of both the innate and adaptive
immune system
– Zinc deficiency results in dysfunction of both humoral and cell-mediated immunity and increases
susceptibility to infectious diseases
– Zinc supplementation given to zinc-deficient children could reduce measles-related morbidity and
mortality caused by lower respiratory tract infections
– Increasing the concentration of intracellular zinc with zinc-ionophores like pyrithione can efficiently
impair the replication of a variety of RNA viruses
– Combination of zinc and pyrithione in at low concentrations inhibits the replication of SARS coronavirus
(SARS-CoV)
– Recommended daily allowance 15 mg
– Tolerable upper limit 40 mg

17. N-acetylcysteine (NAC)
– Powerful anti-oxidant
– Scavenges free oxygen radicals
– Acts as a mucolytic agent that mellows tenacious mucous discharge
– Addition of NAC therapy for community-acquired pneumonia reduced TNF - a and
increased total antioxidant capacity
– Treatment with NAC may help reduce oxidative and inflammatory damage in pneumonia
patients

18. COVID -19 and Nutrition - Recommendations
for Prevention and Immune optimization?
Micro-nutrients with the strongest evidence
for immune support are:
– Vitamin C, Vitamin D, Zinc
Other nutrients that may help include:
– Vitamin A, Vitamin E, Selenium, Omega 3’s,
B vitamins
– Plant Phytonutrients (from plant-based
foods) may have antioxidant, anti-
inflammatory and anti-viral effects

19. Healthy practices to overcome Covid 19
pandemic

20. World Health Organization:
Nutrition Advice during the COVID-
19 outbreak
Good nutrition and hydration are important. A well-balanced
diet keeps you healthy, strengthens the immune system, and reduces
the risk of chronic disease and infectious disease.
It is recommended that a diet with a variety of fresh food and
unprocessed foods is followed daily, to provide the body with the
necessary vitamins, minerals, dietary fibre, protein, and antioxidants.
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21. – Water is essential
– It transports nutrients and compounds in blood, regulates body
temperature, gets rid of waste and lubricates and cushions joints
– Drink 8 - 10 cups of water daily
– Water is the best choice, other drinks can also be consumed such as lemon
juice (diluted in water and unsweetened), tea and coffee. Avoid consuming
too much caffeine, sweetened fruit juices, fizzy drinks and drinks high in
sugar
Drink enough water every day

22. Eat fresh and unprocessed foods
every day
– Include fruits, vegetables, legumes, nuts and whole grains and foods from animal sources
(e.g. meat, fish, etc)
– Daily portion recommendations:
– 2 cups of fruit (4 servings)
– 2.5 cups of vegetables (5 servings)
– 180 g grains
– 160 g meat and beans (red meat 1-2 times/week and poultry or fish 2-3 times/week)
– Snack on raw vegetables and fruit, rather than foods that are high in sugar, fat or salt
– Avoid overcooking vegetables and fruit - to avoid the loss of important vitamins
– If using canned fruit or vegetables - choose wisely, avoid varieties with added salt and sugar

23. Eat moderate amounts of fat and oil
– Eat unsaturated fats rather than saturated fats
– Choose meat that is low in fat
– Avoid processed meats as it is high in salt and fat
– Avoid industrially produced trans fat - fast food, fried food, etc

24. Eat less salt and sugar
– When cooking and preparing food, limit the amount of salt
– Limit daily salt intake to less than 5g (1 teaspoon)
– Avoid foods high in salt and sugar
– Limit intake of soft drinks and sodas that are high in sugar
– Choose fresh fruits instead of sweet snacks such as cookies, cake and chocolate

25. Dietary Recommendations
– Based on your metabolism, ensure you get an adequate daily calorie intake. Normally, the
recommended calorie intake for women is 2,100-2,300 calories per day, and men need 2,400-2,700
calories, according to the Chinese Center for Disease Control and Prevention.
– Eat the right proportion of protein (10-35 percent), carbohydrates (45-65 percent) and fats (20-35
percent). Salmon, eggs, yogurt, cereals, and orange juice could be your sources of vitamin D.
– Try to drink 1.5 to 2 liters of water a day – about eight 8-ounce glasses – which can help boost your
metabolism.
– Ensure adequate intake of fresh vegetables and fruits. Eating 500 grams of vegetables and 200 to 350
grams of fruit per day is suggested.

28.  Try to avoid emergency rooms or urgent care units.
 Maintain a six-foot distance from others in the waiting room.
 Wear surgical or N95 masks.
Use hand sanitizer after touching objects like handrails and table tops.
Don't touch your mouth, nose or eyes with your hands immediately after use.
 Patients with stable but chronic conditions should reduce the number of hospital visits.
Choose a hospital with fewer patients. In the era of the COVID-19 pandemic, fulfilling a
doctor's appointments could carry potential risks of getting infected. So avoiding hospital visits is
better unless necessary. However, in a medical emergency such a heart attack or accidental laceration,
should seek medical advice immediately by following the steps listed below