Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2022; 14(1): 80-97
Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.80
Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2
Rosangela Passos de Jesus, Jozélio Freire de Carvalho, Lucivalda Pereira Magalhães de Oliveira, Carla de Magalhães Cunha, Thaisy Cristina Honorato Santos Alves, Sandra Tavares Brito Vieira, Virginia Maria Figueiredo, Allain Amador Bueno
Rosangela Passos de Jesus, Lucivalda Pereira Magalhães de Oliveira, Carla de Magalhães Cunha, Thaisy Cristina Honorato Santos Alves, Sandra Tavares Brito Vieira, Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
Jozélio Freire de Carvalho, Institute of Health Sciences, Federal University of Bahia, Salvador 40231-300, Bahia, Brazil
Thaisy Cristina Honorato Santos Alves, Institute of Life Sciences, State University of Bahia, Salvador 41.150-000, Bahia, Brazil
Virginia Maria Figueiredo, Department of Gastroenterology, IPEMED, Ipemed Faculty of Medical Sciences, Salvador 40170-110, Bahia, Brazil
Allain Amador Bueno, College of Health, Life and Environmental Sciences, University of Worcester, Worcester WR2 6AJ, United Kingdom
Author contributions: All authors have contributed to conceptualization, literature appraisal, data gathering and original draft preparation; de Jesus RP, de Carvalho JF, Figueiredo VM and Bueno AA contributed to the final considerations, conclusions and final version of the manuscript; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jozélio Freire de Carvalho, MD, PhD, Adjunct Professor, Institute of Health Sciences, Federal University of Bahia, Av. Reitor Miguel Calmon, s/n - Canela, Salvador 40231-300, Bahia, Brazil. jotafc@gmail.com
Received: May 13, 2021
Peer-review started: May 13, 2021
First decision: July 18, 2021
Revised: July 28, 2021
Accepted: December 22, 2022
Article in press: December 22, 2021
Published online: January 27, 2022
Abstract

Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.

Keywords: COVID-19, SARS-CoV-2, Enteral nutrition, Parenteral nutrition, Hepatic failure

Core Tip: Coronavirus disease-associated liver injury may occur in the progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with or without pre-existing liver disease. Patients with cirrhosis-associated immune dysfunction are particularly vulnerable. Strategies for management of sepsis and SARS are suggested in SARS-CoV-2 for intensive care patients, including early enteral nutrition soon after intensive care unit admission. Transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. In outpatient settings, micronutrient and ω-3 fatty acids have shown beneficial effects upon immune function and inflammation modulation and may be beneficial in management for SARS-CoV-2 liver patients.