PERAN VITAMIN DAN

SUPLEMEN MAKANAN Yoga Devaera

DALAM MENGHADAPI FKUI-RSCM-RSUI
“NEW NORMAL”
PANDEMI COVID-19
Disclosure
• I have no current or past relationships with commercial entities
• I have received a speaker’s fee from IDAI Jaya for this learning activity
Pokok bahasan
• Sekilas perkembangan sistem
imun
• Pengaruh malnutrisi terhadap
imunitas
• Efektivitas suplementasi
• Anjuran diet selama “new normal”
INTRODUCTION Overview of immune
system
 Influenza
death related
to age group

Simon AK, Hollander GA, McMichael A.

Evolution of the immune system in humans from infancy to old age.
Proc. R. Soc. B. 2015;282: 20143085.
Development of innate immunity

Front. Immunol. doi: 10.3389/fimmu.2017.00957

Development of immune system

Environmental
exposures

Feeding practices:

• Breastfeeding

WHO on Covid 19:

Continue breastfeeding
No data on transmission via breast
milk

Nutrients 2020, 12(4),1039; https://doi.org/10.3390/nu12041039

NUTRITION How do nutritional
AND status affect
immunity?
IMMUNITY
 Apakah obesitas meningkatkan risiko
terhadap infeksi virus influenza?

Quiz 1 A.

B.
Ya
Tidak
 Overview of antiviral
immunity
• Substrates for biosynthesis
and regulatory molecules,
which are all ultimately
derived from the diet

• A 1°C rise in body

temperature requires a 10–
12.5% increase in metabolic
rate

Calder PC. Nutrition,immunity and COVID-19.

BMJ Nutrition,Prevention &Health 2020
 Calorie, protein, lipid and
micronutrient deficiencies
impact the hematopoietic
and lymphoid organs and
compromise both innate and
adaptive immune functions.

Nutrients 2020, 12(1), 236; https://doi.org/10.3390/nu12010236

 Undernutrition
Inadequate nutrition and infectious
diseases are major problems in
developing countries
Pneumonia
• RR with WAZ < -1 SD:
• > -3 SD 8 (4.3 – 15.1)
• -2 to -3 SD 4(2.6-6)
• -1 to -2 SD 2(1.6-2.4)

Caulfield, Laura E et al. Undernutrition as an underlying cause of child

deaths associated with diarrhea, pneumonia, malaria, and measles.
Am J Clin Nutr.2004: 801;193-8 .
 Obesity
2009 H1N1 influenza A virus pandemic: • Low grade chronic inflammation
• a risk factor for increased disease
severity and mortality • Higher expression of ACE2 in adipose
tissue
• increases the duration of virus
shedding by 42% • Adipose tissue can serve as a
• delayed and blunted antiviral reservoir for human influenza A virus,
responses. COVID-19 might also infect adipose
• efficacy of antivirals and vaccines is tissue and then spread to other organ
reduced
• Decreased vitamin D availability

Obesity Reviews. 2020;21:e13034

Honce R and Schultz-Cherry S (2019)
Impact of Obesity on Influenza A Virus Pathogenesis, ImmuneResponse, and Evolution.
Front. Immunol. 10:1071. doi: 10.3389/fimmu.2019.01071
Obesity
Limited data on children

A case series of 50 children with COVID 19:

Obesity (11 [22%]) was the most prevalent comorbidity and significantly
associated with mechanical ventilation in children 2 years or older (6 of 9
[67%] vs 5 of 25 [20%]; P = .03

Zachariah P, et al. Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in
New York City, New York.
JAMA Pediatr. Published online June 03, 2020. doi:10.1001/jamapediatrics.2020.2430
Obesity and micronutrient deficiencies
• Obese children are at risk of vitamin A, D, E, folate, iron, zinc and selenium
deficiencies:
• low intakes and less sun exposure
• fat as reservoir
• increased requirements
• low grade inflammation have impacts on some proteins transport

Frelut, ML. ebook.ecog-obesity.eu/chapter-clinics-

complications/nutritional-deficiencies-obese-child-adolescent
VITAMIN AND
FOOD What are the best
available evidence?

SUPPLEMENT
Calder PC. Nutrition,immunity and COVID-19.
BMJ Nutrition,Prevention &Health 2020
Calder PC. Nutrition,immunity and COVID-19.
BMJ Nutrition,Prevention &Health 2020
Vitamin D and sun exposure
• Age
• Skin color
• Season
• Latitude
• Time

Hollick rule:
1/4 of a minimal erythemal dose (MED) over 25% of a
body (face, arms, hand) is equivalent to 1000 IU oral
vitamin D3
How long?

Bekasi at 9 am:
0.25 x 1/0.8 MED x 60
= 25 min

North Jakarta at 10 am
= 12.5 min
Molecules 2018, 23, 2778; doi:10.3390/molecules23112778
Antiviral activities of curcumin

S. Z. Moghadamtousi, et al. A review on antibacterial, antiviral, and antifungal activity of curcumin. BioMed Research International 2014, Article ID 186864
System biology tools were applied to explore the potential of VCG Plus in modulating targets and
pathways relevant to immune and inflammation responses.
The results show that VCG Plus can act on 88 hub targets which are closely connected and associated with
immune and inflammatory responses. All these biological processes and pathways have been well
documented in CoV infections studies.
Therefore, our findings suggest that VCG Plus may be helpful in regulating immune response to combat
CoV infections and inhibit excessive inflammatory responses to prevent the onset of cytokine storm.
However, further in vitro and in vivo experiments are warranted to validate the current findings with
system biology tools

Nutrients 2020, 12, 1193; doi:10.3390/nu12041193

 • Continue breastfeeding
• Eating foods from a variety of food groups will often be
sufficient to meet energy, protein and micronutrient
requirements
Take home massage • Supplementation should not be considered as a
replacement, but instead as an addition to good
dietary practices
• Prevention of virus transmission is crucial
THANK YOU