Consumption of Commercial Dietary Products over Natural Diet – Impact in COVID Pandemic

Background: An adequate intake of essential minerals like selenium, iron, and zinc and the vitamins A, C, D, E, B6, and B12 are crucial to maintaining a healthy immune function. Commercial dietary products containing a mixture of some of the above-mentioned; nutrients may suffice the specific requirements in definitive groups of populations. The comprehensive impact on the Indian population with consumption of commercial dietary products in addition to natural dietary products; during the Corona Virus Disease (COVID) pandemic was assessed in this study. Methods: A cross-sectional & observational study was conducted in a group of 3699 subjects, who attended the COVID OP Department at Sri Venkateswara RamaNarayana Ruia Government General Hospital, Tirupati from the period of August and September 2020. The subjects were randomly selected and a questionnaire was posed. The data collected were analyzed using Microsoft Excel and SPSS software. Results: The percentage of the population consuming commercial dietary products in addition to natural dietary products was 15.865%. Commonly used natural dietary products by the population were egg& milk products, vegetables followed by fruits. In our study, a significant association between gender and consumption of commercial dietary products was noted. Conclusions: The usage of commercial dietary products in addition to natural dietary products can be recommended in specified population groups. The consumption of commercial dietary products in addition to natural dietary products was significant concerning the female gender.


Introduction
Diet and immunity have an age-old link, as the deficiencies in the natural diet may impact the immune system to a greater extent. An adequate intake of essential minerals like selenium, iron, and Malnutrition is associated with defective immune function. Assessment of immunity is not a practical method in routine clinical practice. [8].
The immune system helps in discrimination of self from non-self. This discrimination is governed by natural or innate immunity and adaptive or acquired immunity. [9]. Dietary influence over the causation of chronic inflammatory disorders which disrupt innate immunity was familiar from age-old. Avoiding malnutrition is the basic goal in nutrition therapy as malnutrition increase morbidity and mortality of the disease process and delays recovery.

Results
The present article covered the nutritive value of common natural dietary products in contrast with commercial dietary products. The details of the study were analyzed and shown in terms of statistical tables, percentages, and bar diagrams.
Gender specificity to consumption of commercial dietary products was studied.     Table 4 shows that there was a significant   They were outstanding sources of Vitamin A, Folic acid, and rich sources of Selenium, vitamin B12.

Grains
Consumption of fruits mentioned in Fig. 3  An adequate intake of zinc, iron, and vitamins A, B 12, B6, C, and E is essential for the maintenance of immune function, as they impact the immune system through gene expression, cell activation, and signaling molecules modification. In addition, various dietary ingredients are determinants of gut microbial composition and subsequently shape the immune responses in the body. [11]. Both the immune impairments and the susceptibility to infection can be reversed by correcting the deficiency showing a causal relationship between the availability of specific nutrients and immune defenses.

This is recognized by the European Food Safety
Authority which permits claims of 'maintenance of functions of the immune system' for vitamins A, B6, B12, C, D, and folate (vitamin B9) and for the trace elements zinc, iron, selenium, and copper. [12].
Zinc deficiency may affect both humoral and cellmediated immunity. Zinc deficiency may result in decreased Natural Killer cells activity, T Lymphocyte proliferation, InterLeukin 2 (IL2) production, which can be corrected with supplementation. [13].
Hence, daily intake of Zinc at low doses <25mg/day on a long-term basis was recommended. [14].
Selenium works as an antioxidant through enzymes like Glutathione peroxidase, Thioredoxin reductase. Alexander et al, suggested that adequate preinfectious selenium status may protect against hyper inflammation during COVID infection. [14].
Studies have shown that Selenium deficiency may increase the virulence of certain viruses through mutations like poliovirus, murine influenza virus, and coxsackievirus. [13]. This aspect has yet to be studied in the case of COVID. Copper deficiency decreases the lymphocyte proliferation and IL2 production which can be reversed by supplementation. [13].
The precedence of natural diet over commercial products was notable regarding phytonutrients. The fruits, vegetables, and legumes rich in phytonutrients like flavonoids and polyphenol can exert anti-inflammatory effects. [15]. Jovic et al analyzed varied food samples and noted that spices, nuts like ground cloves, turmeric powder, ground ginger ground cinnamon, walnuts, ground mustard seeds were rich in antioxidants while meat and poultry products were poor sources of antioxidants. [15].
The production of InterLeukin -1β (IL-1β) and InterLeukin-1 (IL-1) receptor antagonist by alveolar macrophages, in turn, neutrophilic infiltration was modulated by Retinoic acid which was implicated in the pathogenesis of Acute Respiratory Distress Syndrome (ARDS). [16]. The role of Vitamin C, to interfere with the COVID pathogenesis was the maintenance of alveolar barrier function through regulation of alveolar fluid clearance. Expression of protein channels like Aquaporin 5, Cystic Fibrosis Transmembrane Conductance Regulator, Epithelial Sodium Channel, etc over alveolar-capillary membrane was promoted by Vit C supplementation. [16]. Epidemiological studies suggested an inverse association between blood levels of 25(OH)-D3 and inflammatory biomarkers like InterLeukin-6 (IL6) and C-Reactive Protein (CRP). [14]. Two Ecological studies concluded that the rate of COVID infection was high in countries at higher latitudes due to their lower Vitamin D status. [14].
Vitamin D promotes the differentiation of monocytes to macrophages and increases phagocytosis, superoxide production, and bacterial killing by innate immune cells. [13]. Vitamin D upregulates the expression of antioxidant genes, such as glutathione reductase thereby reducing free radicalinduced pulmonary damage and ARDS. [16].  [14]. Vitamin E supplementation reduces the production of superoxides thereby maintaining the balance between oxidants and antioxidants. Failure of biological membranes due to excessive lipid peroxidation may result in diffuse alveolar damage and ARDS. [16]. Vitamin K is an essential "switch" in balancing the coagulation and anti-coagulation process. The anticoagulant role of Vitamin K can be recognized through the activation of protein C, S and Z. Vitamin K-dependent protein C activation can inhibit clotting factors V and VIII which were responsible for clot generation. K2 acts as an immunosuppressive compound to modulate the expression of a multitude of pro-inflammatory cytokines such as TNF, InterLeukin-1α (IL-1α), IL-1β and suppresses IL-6 release which was implicated in the pathogenesis of COVID.
Thus, vitamin K administration may reduce the risk for ARDS development in COVID-19 patients. [17]. As stated by Heiman and Greenway, "The more diverse the diet, the more diverse the microbiome and the more adaptable it will be to perturbations." This suggests the dietary intake of varieties of plant-based foods to modify the gut microflora, in turn, affects immunity. [15]. When fecal samples of COVID patients were collected and compared to that of healthy individuals, opportunistic pathogens and depleted commensals were observed in COVID patient samples while healthy subjects maintained a higher prevalence of Eubacterium, Roseburia, Lachnospiraceae Eubacterium, Faecalibacterium prausnitzii, Roseburia, and Lachnospiraceae. [18]. Indeed, the consumption of foods that are a source of fiber has been related to lower levels of inflammatory cytokines (CRP, TNF-α, and IL-6), as well as enhanced levels of short-chain fatty acids (SCFAs).SCFAs (acetate, propionate, and butyrate) exert their anti-inflammatory effect by inhibiting the release of pro-inflammatory molecules and by decreasing the expression of nuclear factor-kB (NF-kB). [18].

Limitations:
The complete composition of proteins present in commercial dietary products in comparison to natural dietary products was not studied in detail.
Only the essential ailments given COVID pandemic were studied and many other contents of natural dietary products were not included in the study. The study population might not represent that of the community

Conclusions
The What does the study add to existing knowledge?
Various combinations of natural food products may be used to meet the community's nutritional and, thus, immunological needs during the COVID pandemic. During the COVID pandemic, improving knowledge, attitudes, and practises (KAP) on nutritional patterns of natural dietary products at the population level through the digital platform may be encouraged.The female gender used a substantial amount of commercial dietary products in addition to natural dietary products. When necessary, such as among specified groups of the population, the use of commercial dietary products in addition to natural dietary products was encouraged.