COVID-19 Recovery: Nutrition Considerations in Older Adults​

COVID-19 Recovery:

Nutrition Considerations in Older Adults

Table of Contents

Presentation of Material

At-risk Population

Adults 65 to 74 years of age are 5 times more likely to be hospitalized if they contract COVID-19 and 90 times more likely to die compared to younger adults. Those 75 to 84 years of age are 8 times more likely to be admitted to hospital and 220 times more likely to die. Over the age of 85, a person who gets COVID-19 is 13 times more likely to be hospitalized and 630 times more likely to die than a younger adult.1 Residents in long-term care are especially vulnerable given the communal setting, as many have underlying chronic medical conditions.2

Common Nutritional Deficiencies

Older adults are more likely to be deficient in several vitamins and minerals due to poor intake, hormonal changes, cognitive status, gastrointestinal issues, and side effects of medications. In addition to these factors, chronic medical conditions have a profound affect on both nutrient needs and nutritional status in older adults.3 Common vitamin deficiencies include vitamin B6, B12, C, D, E, and folate. Mineral deficiencies common in older adults include zinc, calcium, magnesium, and potassium.3 Vitamins and minerals play a critical role in metabolic function, prevention of oxidative damage, immunity, regulation of body functions, utilization of nutrients, wound healing, and maintenance of tissues.

COVID-19 Treatment

Current CDC COVID-19 Treatment Guidelines outline a course of medications for varying severity of the illness. Along with medications, antiviral and immune-based therapies are approved treatments.4 Adjunctive therapies are used in addition to antiviral and immune therapies, and they include antithrombotic therapy and treatment with vitamin and mineral supplements. Ongoing studies are evaluating vitamin and mineral supplement use for treatment and prevention of COVID-19. The CDC cites vitamin C, vitamin D, and zinc as having possible benefit in treating COVID-19.5 However, other minerals and vitamins have benefits which can enhance recovery from respiratory illnesses such as COVID-19.

Vitamin D

Synthesized with the help of sunlight, the body uses vitamin D for many functions including bone and brain health, but vitamin D is a lesser known factor in immune health.6 Vitamin D deficiency is linked to respiratory diseases,7 autoimmune problems,8 and decreased lung function.9 A study conducted by Northwestern University culled data from COVID -19 cases worldwide and found that patients with severe vitamin D deficiency suffered a hyperinflammatory response which lead to acute respiratory distress and death.10 Researchers noted that populations most often deficient in vitamin D are most vulnerable.10 To date, dosage of vitamin D for the prevention and treatment of COVID-19 is unclear.10 A great deal of research is conducted on vitamin D. Evaluation of vitamin D’s precise role in fighting COVID-19 remains an ongoing priority.11

DRI for Adults over the age of 70: 800 IU / day vitamin D.
Tolerable Upper Intake: 4000 IU / day

Vitamin C

Found in many vegetables and fruits, vitamin C is a powerful antioxidant vitamin which has important roles in wound healing and maintenance of skin as well as fighting inflammation and fending off disease.12 Vitamin C supports the immune system by enhancing the proliferation and differentiation of both T cells and B cells, the body’s immune memory lymphocytes.13 Infections increase inflammation and usage of vitamin C. In turn, more is needed to meet metabolic requirements.13 Research on vitamin C intake as it relates to incidence of the common cold found that supplemental vitamin C did not consistently prevent illness.14 However, regular supplementation trials found that vitamin C reduced the duration and severity of respiratory illness.14 This means that regular adequate intake of vitamin C may bolster immunity to COVID-19: patients who are sick may have less severe symptoms as well as recover more quickly. Megadosing vitamin C is not recommended, as it may cause or contribute to diarrhea, nausea, and GI distress. High intake of vitamin C is also not recommended for those in cancer treatment or those who take statin drugs.12

DRI for Adults over the age of 19: 90 mg men, 75 mg women / day
Smokers require an additional 35 mg / day vitamin C.
Tolerable Upper Intake: 2000 mg / day

Zinc

This trace mineral is commonly found in red meat, poultry, nuts, beans, and fortified foods.15 Like vitamin C, zinc is needed for proper wound healing as well as immune cell function and response to inflammation.16 For many reasons, zinc deficiency is common in older adults; low intake, reduced ability to chew, intestinal malabsorption, and medication interactions are common causes of zinc deficiency. In fact, a study conducted in a long term care setting found that those in cognitive decline, with low body mass index, bedridden, or with low ability to perform activities of daily living had lowest levels of serum zinc.16 Past meta-analysis has found that zinc lozenges can reduce the severity and duration of the common cold.17 Current literature reviews on the use of zinc to fight acute respiratory infections conclude that zinc intake in fighting COVID-19 is most beneficial in at-risk populations.18 Assessment of zinc status as part of a SARS-CoV-2 clinical work-up is recommended,18 and is a cost-effective therapy for COVID -19 patients with minimal side effects.19 Zinc works in concert with other vitamins and minerals to achieve best possible outcomes when combatting COVID-19.20

DRI for Adults over the age of 19: 11 mg men, 8 mg women / day
Tolerable Upper Limit: 40 mg / day

Magnesium

Although not yet listed as an Adjunctive Therapy by the CDC, magnesium is a mineral of critical importance for both activation of vitamin D and energy production. Thus, the most recently published studies are focusing on magnesium intake as an immune system modulator.21 Those with gastrointestinal diseases, type 2 diabetes, alcohol dependance, and those of older age are most at risk for magnesium inadequacy.22 A common link between chronic illnesses identified as a risk factor for COVID-19 is hyperinsulinemia20 or high levels of insulin. Hyperinsulinemia causes increased blood clotting and magnesium depletion. Vitamin D and calcium may mediate the activity of insulin.23 This cascade of magnesium inadequacy leads to increased blood clotting,24 a commonly seen complication of SARS-CoV-2.20 Due to magnesium’s prominent role in homeostasis, magnesium intake can be considered a pivotal mineral in recovering from COVID-19.

DRI for Adults over the age of 51: 420 mg men, 320 mg women / day
Tolerable Upper Limit: 350 mg / day

Conclusion

COVID-19 nutrition research is rapidly emerging in order to identify effective treatment protocols which can be broadly recommended and applied in practice. For the older population, especially those in long term care and assisted living settings, COVID-19 risk is markedly higher for a variety of reasons. The vulnerability of the older population to the most severe symptoms and complications of SARS-CoV-2 cannot be overstated. As we take daily precautions to protect vulnerable populations by appropriate hand washing, social distancing, mask wearing, isolation, and frequent testing, we should consider the role of nutrition in mitigating both the incidence and severity of COVID-19 infection.

Vaccines are rolling out nationally, and in order to support best outcomes for both recovering COVID-19 patients and the newly vaccinated, adequate nutritional intake remains a principal way of bolstering success and achieving immunity. Although continuing research must establish conclusive causal evidence of vitamin benefit in COVID-19 recovery, we must consider risk versus benefit of taking action now. With low cost of implementation and low risk of adverse outcomes, supplementation may be a feasible and effective way to help combat COVID-19 and save lives.

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References

  1. CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 7, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/need-extra-precautions/older-adults.html
  2. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 7, 2021. https:// www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
  3. Common Dietary Deficiencies in Older Adults | West Hartford Health. West Hartford Health & Rehabilitation Center. Published July 15, 2020. Accessed January 7, 2021. https://westhartfordhealth.com/news/senior-health/dietary- deficiencies/
  4. Therapeutic Management. COVID-19 Treatment Guidelines. Accessed January 7, 2021. https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/
  5. Adjunctive Therapy. COVID-19 Treatment Guidelines. Accessed January 7, 2021. https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/
  6. Yin K, Agrawal DK. Vitamin D and inflammatory diseases. Journal of Inflammation Research. doi:10.2147/JIR.S63898
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  8. Office of Dietary Supplements – Vitamin D. Accessed January 20, 2021. https:// ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  9. Zosky GR, Berry LJ, Elliot JG, James AL, Gorman S, Hart PH. Vitamin D Deficiency Causes Deficits in Lung Function and Alters Lung Structure. Am J Respir Crit Care Med. 2011;183(10):1336-1343. doi:10.1164/rccm.201010-1596OC
  10. Morris A. Vitamin D levels appear to play role in COVID-19 mortality rates: Patients with severe deficiency are twice as likely to experience major complications. ScienceDaily. Accessed January 19, 2021. https://www.sciencedaily.com/releases/ 2020/05/200507121353.htm
  11. Biesalski HK. Vitamin D deficiency and co-morbidities in COVID-19 patients – A fatal relationship? NFS Journal. 2020;20:10-21. doi:10.1016/j.nfs.2020.06.001
  12. Office of Dietary Supplements – Vitamin C. Accessed January 19, 2021. https:// ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
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  15. Office of Dietary Supplements – Zinc. Accessed January 26, 2021. https:// ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
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  19. Wessels I, Rolles B, Rink L. The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis. Front Immunol. 2020;11. doi:10.3389/fimmu.2020.01712
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  22. Office of Dietary Supplements – Magnesium. Accessed January 26, 2021. https:// ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
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