Folate, B12 and Iron Levels in COVID 19 Patients Observational Case-Control Study

Öz

Background: Folic acid, B12 and Iron play an important role in the pathogenesis of viral infections. Aim: The aim of the study is to determine the blood levels of Folate, B12 and Iron and to examine their relationship with prognosis in cases followed up by the COVID 19 pandemic service. Materials and Methods: The study was planned as a retrospective observational case-control study. In a period of approximately 3 months, 140 patients were screened retrospectively, 70 of whom were COVID 19 and 70 control cases. Cases <18 years of age, followed up in the Intensive Care Unit or withdrawn from the Intensive Care Unit to the service, and patients taking drugs or supportive treatment that could affect blood Folate, B12, Iron levels were excluded from the study. p<0.05 was accepted as statistical significance level. Results: 48.6% (68) of the cases were male, 51.4% (72) were female. The mean age (mean±SD) of all cases was 67.3±15.8. No significant difference was observed between the case and control groups in terms of age, gender, presence of comorbid disease, prognosis, Folate and B12 levels. However, the iron level was significantly higher in the case group. Conclusion: As a result, Folic acid and B12 supplementation is needed in the majority of COVID 19 cases. Before supplementing with iron, the iron level should be checked.

Anahtar Kelimeler

• covid 19
• ;b12
• ;folat
• ;iron

COVID 19 Hastalarında Folat, B12 ve Demir Düzeyleri Gözlemsel Vaka Kontrol Çalışması

Öz

Giriş: Folik asit, B12 ve Demir özellikle viral enfeksiyonların patogenezinde önemli rol oynamaktadır. Amaç: Çalışmanın amacı COVİD 19 pandemi servis takibi yapılan vakalarda kanda Folat, B12 ve Demir düzeylerinin belirlenmesi ve prognoz ile ilişkilerinin irdelenmesi. Materyal ve Metot: Çalışma retrospektif gözlemsel olgu-kontrol çalışması olarak planlandı. Yaklaşık 3 aylık süreçte 70 COVİD 19, 70’de kontrol vakası olmak üzere 140 hasta retrospektif tarandı. <18 yaş, Yoğun Bakım Ünitesi’de takipli vakalar veya Yoğun Bakım Ünitesin’den servise çekilen vakalar ve kan Folat, B12, Demir düzeyini etkileyecek ilaçlar veya destek tedavisi alan hastalar çalışma dışı bırakıldı. İstatistiksel anlamlılık düzeyi olarak p<0.05 kabul edildi. Bulgular: Vakaların %48.6’sı (68) erkek, %51.4’ü (72) kadın cinsiyet idi. Tüm vakaların yaş ortalaması (Ort±SS) 67.3±15.8 idi. Olgu ve kontrol grupları arasında yaş, cinsiyet, komorbid hastalık varlığı, prognoz, Folat ve B12 düzeyleri açısından anlamlı fark gözlenmezken, Demir düzeyi olgu grubunda anlamlı oranda yüksekti. Sonuç: Sonuç olarak COVİD 19 vakalarının büyük çoğunluğunda Folik asit ve B12 takviyesine ihtiyaç duyulmaktadır. Demir takviyesi yapmadan önce ise mutlaka demir seviyesi bakılmalıdır.

Anahtar Kelimeler

• covid 19
• ;b12
• ;folat
• ;demir

Kaynakça

1. 1. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med 2020;18:229.
2. 2. Muscogiuri G, Barrea L, Savastano S, Colao A. Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr 2020;74:850–1.
3. 3. Keusch GT. The history of nutrition: malnutrition, infection and immunity. J Nutr 2003;133:336S–40S.
4. 4. Bhaskaram P. Micronutrient malnutrition, infection and immunity: an overview. Nutr Rev 2002;60:S40–5.
5. 5. Hiraoka M, Kagawa Y. Genetic polymorphisms and folate status. Congenital Anomalies 2017; 57, 142–149.
6. 6. Gropper, S.S, Smith, J.L. Advanced Nutrition and Human Metabolism, 7th ed.; Cengage Learning: Belmont, CA, USA, 2017; ISBN 1305627857.
7. 7. Scaglione, F. Panzavolta, G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica 2014, 44, 480–488.
8. 8. Ducker, G.S. Rabinowitz, J.D. One-Carbon Metabolism in Health and Disease. Cell Metab. 2017, 25, 27–42.

9. 9. Jacobson, W., Wreghitt, T.G., Saich, T., Nagington, J. Serum folate in viral and mycoplasmal infections. J. Infect. 1987, 14, 103–111.
10. 10. Strand, T.A., Taneja, S., Bhandari, N., et al. Folate, but not vitamin B-12 status, predicts respiratory morbidity in north Indian children. Am. J. Clin. Nutr. 2007, 86, 139–144.
11. 11. Calder, P., Carr, A., Gombart, A., Eggersdorfer, M. Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients 2020, 12, 1181.
12. 12. Calder, P.C. Nutrition, immunity and COVID-19. BMJ Nutr. Prev. Health 2020, 3, 74–92.
13. 13. Gombart, A.F., Pierre, A., Maggini, S. A Review of Micronutrients and the Immune System–Working in Harmony to Reduce the Risk of Infection. Nutrients 2020, 12, 236.
14. 14. Batista K.S, Cintra V.M, Lucena P.A.F. The role of vitamin B12 in viral infections: a comprehensive review of its relationship with the muscle–gut–brain axis and implications for SARS-CoV-2 infection. Nutrition ReviewsVR Vol. 00(0):1–18.
15. 15. Andreini C, Putignano V, Rosato A, Banci L. The human ironproteome. Metallomics 2018;10:1223–31.
16. 16. Drakesmith H, Prentice A. Viral infection and iron metabolism. Nat Rev Microbiol 2008;6:541–52.
17. 17. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–6.
18. 18. Meisel E, Efros O, Bleier J, Beit Halevi T, Segal G, Rahav G, Leibowitz A, Grossman E. Folate Levels in Patients Hospitalized with Coronavirus Disease 2019. Nutrients. 2021 Mar 2;13(3):812.
19. 19. Itelman E, Wasserstrum Y, Segev A, Avaky C, Negru L, Cohen D, et al. Clinical Characterization of 162 COVID-19 patients in Israel: Preliminary Report from a Large Tertiary Center. Isr Med Assoc J. 2020 May;22(5):271-274.
20. 20. Acosta-Elias J and Espinosa-Tanguma R (2020). The Folate Concentration and/or Folic Acid Metabolites in Plasma as Factor for COVID-19 Infection. Front. Pharmacol. 11:1062.
21. 21. Elmadfa I, Meyer AL. The Role of the Status of Selected Micronutrients in Shaping the Immune Function. Endocr Metab Immune Disord Drug Targets. 2019;19(8):1100-1115.
22. 22. Andrew Kien HanWee. COVID-19’s toll on the elderly and those with diabetes mellitus – Is vitamin B12 deficiency an accomplice? Medical Hypotheses 146 (2021) 110374.
23. 23. Rodriguez RM, Corwin HL, Gettinger A, Corwin MJ, Gubler D, Pearl RG. Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 2001;16:36e41.
24. 24. Weiss, G.; Ganz, T.; Goodnough, L.T. Anemia of inflammation. Blood, 2019, 133(1), 40-50.
25. 25. Ward, R.J.; Crichton, R.R.; Taylor, D.L.; Della Corte, L.; Srai, S.K.; Dexter, D.T. Iron and the immune system. J. Neural Transm. (Vienna), 2011, 118(3), 315-328.