Associations between sampling characteristics, nutritional supplemental taking and the SARS-CoV-2 infection onset in a cohort of Italian nurses

Submitted: 20 October 2022
Accepted: 13 December 2022
Published: 30 December 2022
Abstract Views: 840
PDF: 166
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The aim of the present study was to analyze any relations existed between sampling characteristics and the onset of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, also by considering the number of times that it occurred in a cohort of Italian nurses interviewed. Additionally, by considering the nutritional supplemental taking, this research wanted to assess any differences both in the onset and in the number of times in which the infection occurred among participants. An observational cohort study was carried out thorough all Italian nurses by advertising the questionnaire through some professional Internet pages. Work typology (P=0.021), coronavirus disease 2019 (COVID-19) ward (P=0.002) and regular meal assumption (P=0.019) significantly associated to the onset of the SARS-CoV-2 infection. Most of nurses who contracted the SARS-CoV-2 infection worked during the night shift (53.7%), 44.3% worked in a no-COVID-19 ward and 53% declared to have a regular meals’ assumption. Ward typology significantly associated to the times of the SARSCoV- 2 onset (P=0.003), as most of nurses who contracted almost one time the SARS-CoV-2 infection were employed in a no-COVID-19 ward (55.5%) and 54.1% of them declared to have a regular meals’ assumption. The onset of the SARS-CoV-2 infection seemed to be more present in the most part of the sample collects. The present study could be considered as pilot in this sense and also more studies will be performed in order to better relate the function of supplemental food intakes with a better functioning of the immune system.



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World Health Organization (WHO). WHO coronavirus disease (COVID-19) dashboard; 2021. Available from: Accessed; September 1, 2022.
Lordan R, Rando HM; COVID-19 Review Consortium, et al. Dietary supplements and nutraceuticals under investigation for COVID-19 prevention and treatment. ArXiv 2021;arXiv:2102.02250v1.
Hu D, Kong Y, Li W, Han Q, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClin Med 2020;24:100424.
Liu Q, Shen D, Chen S, et al. Supporting frontline nurses during the fight against COVID-19. J Am Psychiat Nurses Assoc 2020;26:525-6.
Zhan Y, Ma S, Jian X, et al. The current situation and influencing factors of job stress among frontline nurses assisting in Wuhan in fighting COVID-19. Front Public Health 2020;8:579866.
Vitale E, Galatola V, Mea R. Observational study on the potential psychological factors that affected Italian nurses involved in the COVID-19 health emergency. Acta Biomed 2021;92:e2021007.
Joo JY, Liu MF. Nurses’ barriers to caring for patients with COVID-19: a qualitative systematic review. Int Nurs Rev 2021;68:202-13.
Vitale E, Mea R, Di Dio F, et al. Anxiety, insomnia and body mass index scores in italian nurses engaged in the care of COVID-19 patients. Endocr Metab Immune Disord Drug Targets 2021;21:1604-12.
Vitale E, Galatola V, Mea R, et al. The linkage "body mass index-insomnia levels-eating disorder flexibility" in italian nurses during the covid-19 outbreak: a psychoendocrinological employment disease. Endocr Metab Immune Disord Drug Targets 2022;22:490-501.
Vitale E, Magrone M, Galatola V, et al. The role of nutrition during the COVID-19 pandemic: what we know. Endocr Metab Immune Disord Drug Targets 2021;21:1982-92.
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17:259-60.
Wu G. Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health. Amino Acids 2020;52:329-60.
Childs CE, Calder PC, Miles EA. Diet and immune function. Nutrients 2019;11:1933.
World Health Organization (WHO). WHO EMRO - Nutrition advice for adults during the COVID-19 outbreak; 2021. Available from: Accessed: August 15, 2022.
Fiori F, Bravo G, Parpinel M, et al. Relationship between body mass index and physical fitness in Italian prepubertal schoolchildren. PLoS One 2020;15:e0233362.
Costa D, Barbalho MC, Miguel GP, et al. The impact of obesity on pulmonary function in adult women. Clinics (Sao Paulo) 2008;63:719-24.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA 2020;323:1239-42.
Macit MS. COVID-19 salgını sonrası yetişkin bireylerin beslenme alışkanlıklarındaki değişikliklerin değerlendirilmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi 2020;13:277-88.
Lange KW. Food science and COVID-19. Food Sci Hum Wellness 2021;10:1-5 7.
BourBour F, Mirzaei Dahka S, Gholamalizadeh M, et al. Nutrients in prevention, treatment, and management of viral infections; special focus on Coronavirus. Arch Physiol Biochem 2023;129:16-25.
World Health Organization (WHO). Nutrition advice for adults during the COVID-19 outbreak; 2021. Available from: Accessed: August 15, 2022.
Food and Agriculture Organization (FAO). Maintaining a healthy diet during the COVID-19 pandemic; 2020. Available from: Accessed: August 15, 2022.
Gupta S, Read SA, Shackel NA, et al. The role of micronutrients in the infection and subsequent response to hepatitis C virus. Cells 2019;8:603.
Messina G, Polito R, Monda V, et al. Functional role of dietary intervention to improve the outcome of COVID-19: a hypothesis of work. Int J Mol Sci 2020;21:3104.
Elmadfa I, Meyer AL. The role of the status of selected micronutrients in shaping the immune function. Endocr Metab Immune Disord Drug Targets 2019;19:1100-15.
Romagnani S. T-cell subsets (Th1 versus Th2). Asthma Immunol 2000;85:9-21.
Thevarajan I, Nguyen THO, Koutsakos M, et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med 2020;26:453-5.
Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2013;2013:CD000980.
Ran L, Zhao W, Wang J, et al. Extra dose of vitamin C based on a daily supplementation shortens the common cold: a meta-analysis of 9 randomized controlled trials. Biomed Res Int 2018;2018:1837634.
Grant WB, Lahore H, McDonnell SL, et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients 2020;12:988.
Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. J Med Virol 2020;92:479-90.
McCarty MF, DiNicolantonio JJ. Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus. Progr Cardiovasc Dis 2020;63:383-5.
Bjørklund G, Dadar M, Pivina L, et al. The role of zinc and copper in insulin resistance and diabetes mellitus. Curr Med Chem 2020;27:6643-57.
Farrokhian A, Bahmani F, Taghizadeh M, et al. Selenium supplementation affects insulin resistance and serum hs-CRP in patients with type 2 diabetes and coronary heart disease. Horm Metab Res 2016;48:263-8.
Holmberg S, Rignell-Hydbom A, Lindh C, et al. High levels of vitamin D associated with less ischemic heart disease - a nested case-control study among rural men in Sweden. Ann Agric Environ Med 2017;24:288-93.
Grundy SM. Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol 2006;47:1093-100.
Sanada F, Taniyama Y, Muratsu J, et al. Source of chronic inflammation in aging. Front Cardiovasc Med 2018;5:12.
Vitale E. Work conditions of Italian nurses and their related risk factors: a cohort investigatory study. Diseases 2022;10:50.
Lim RK, Wambier CG, Goren A. Are night shift workers at an increased risk for COVID-19? Med Hypotheses 2020;144:110147.
Wambier CG, Vaño-Galván S, McCoy J, et al. Androgenetic alopecia in COVID-19: Compared to age-matched epidemiologic studies and hospital outcomes with or without the Gabrin sign. J Am Acad Dermatol 2020;83:e453-4.
Goren A, McCoy J, Wambier CG, et al. What does androgenetic alopecia have to do with COVID-19? An insight into a potential new therapy. Dermatol Ther 2020;33:e13365.
Andreani TS, Itoh TQ, Yildirim E, et al. Genetics of circadian rhythms. Sleep Med Clin 2015;10:413-21.
Hansen J. Night shift work and risk of breast cancer. Curr Environ Health Rep 2017;4:325-39.
Barul C, Richard H, Parent ME. Night-shift work and risk of prostate cancer: results from a Canadian case-control study, the prostate cancer and environment study. Am J Epidemiol 2019;188:1801-11.
D’Ettorre G, Pellicani V, Greco M, et al. Metabolic syndrome in shift healthcare workers. Med Lav 2019;110:285-92.
Shan Z, Li Y, Zong G, Guo Y, et al. Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses. BMJ 2018;363:k4641.
Liu Q, Shi J, Duan P, et al. Is shift work associated with a higher risk of overweight or obesity? A systematic review of observational studies with meta-analysis. Int J Epidemiol 2018;47:1956-71.
Almeida CM, Malheiro A. Sleep, immunity and shift workers: A review. Sleep Science (Sao Paulo, Brazil) 2016;9:164-8.
Mohren DC, Jansen NW, Kant IJ, et al. Prevalence of common infections among employees in different work schedules. J Occup Environ Med 2002;44:1003-11.
Prather AA, Carroll JE. Associations between sleep duration, shift work, and infectious illness in the United States: data from the National Health Interview Survey. Sleep Health 2021;7:638-43.
Belingheri M, Paladino ME, Riva MA. Working schedule, sleep quality, and susceptibility to coronavirus disease 2019 in healthcare workers. Clin Infect Dis 2021;72:1676.
Silva FRD, Guerreiro RC, Andrade HA, et al. Does the compromised sleep and circadian disruption of night and shiftworkers make them highly vulnerable to 2019 coronavirus disease (COVID-19)? Chronobiol Int 2020;37:607-17.
Fatima Y, Bucks RS, Mamun AA, et al. Shift work is associated with increased risk of COVID-19: Findings from the UK Biobank cohort. J Sleep Res 2021;30:e13326.
Maidstone R, Anderson SG, Ray DW, et al. Shift work is associated with positive COVID-19 status in hospitalised patients. Thorax 2021;76:601-6.
Rowlands AV, Gillies C, Chudasama Y, et al. Association of working shifts, inside and outside of healthcare, with severe COVID-19: an observational study. BMC Public Health 2021;21:773.
Cermakian N, Stegeman SK, Tekade K, et al. Circadian rhythms in adaptive immunity and vaccination. Semin Immunopathol 2022;44:193-207.
Cuesta M, Boudreau P, Dubeau-Laramée G, et al. Simulated night shift disrupts circadian rhythms of immune functions in humans. J Immunol 2016;196:2466-75.
Liu PY, Irwin MR, Krueger JM, et al. Night shift schedule alters endogenous regulation of circulating cytokines. Neurobiol Sleep Circadian Rhythm 2021;10:100063.
Loef B, Nanlohy NM, Jacobi RHJ, et al. Immunological effects of shift work in healthcare workers. Sci Rep 2019;9:18220.
Cena H, Chieppa M. Coronavirus disease (COVID-19-SARS-CoV-2) and nutrition: is infection in italy suggesting a connection?. Front Immunol 2020;11:944.
Yahfoufi N, Alsadi N, Jambi M, et al. The immunomodulatory and anti-inflammatory role of polyphenols. Nutrients 2018;10:1618.
Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018;3:e419-28.
Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966.
Laviano A, Koverech A, Zanetti M. Nutrition support in the time of SARS-CoV-2 (COVID-19). Nutrition 2020;74:110834.
Correia MITD. Nutrition in times of COVID-19, how to trust the deluge of scientific information. Curr Opin Clin Nutr Metab Care 2020;23:288-93.
Budhwar S, Sethi K, Chakraborty M. A rapid advice guideline for the prevention of novel coronavirus through nutritional intervention. Curr Nutr Rep 2020;9:119-28.
López-Varela S, González-Gross M, Marcos A. Functional foods and the immune system: a review. Eur J Clin Nutr 2002;56:S29-33.
Gombart AF, 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.
Valenzano A, Polito R, Trimigno V, et al. Effects of very low calorie ketogenic diet on the orexinergic system, visceral adipose tissue, and ROS production. Antioxidants (Basel) 2019;8:643.
Moscatelli F, Sessa F, Valenzano A, et al. COVID-19: role of nutrition and supplementation. Nutrients 2021;13:976.
Chen L, Hu C, Hood M, et al. A novel combination of vitamin C, curcumin and glycyrrhizic acid potentially regulates immune and inflammatory response associated with coronavirus infections: a perspective from system biology analysis. Nutrients 2020;12:1193.
Carr AC, Rowe S. The emerging role of vitamin C in the prevention and treatment of COVID-19. Nutrients 2020;12:3286.
Cheng RZ. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?. Med Drug Discov 2020;5:100028.
Hiedra R, Lo KB, Elbashabsheh M, et al. The use of IV vitamin C for patients with COVID-19: a case series. Expert Rev Anti Infect Ther 2020;18:1259-61.
Wessels I, Rolles B, Rink L. The potential impact of zinc supplementation on COVID-19 pathogenesis. Front Immunol 2020;11:1712.
World Health Organization. The World Health report 2002. Midwifery 2003;19:72-3.
Wessels I, Maywald M, Rink L. Zinc as a gatekeeper of immune function. Nutrients 2017;9:1286.
Razzaque MS. COVID-19 pandemic: can maintaining optimal zinc balance enhance host resistance? Tohoku J Exp Med 2020;251:175-81.
Xu Y, Baylink DJ, Chen CS, et al. The importance of vitamin D metabolism as a potential prophylactic, immunoregulatory and neuroprotective treatment for COVID-19. J Transl Med 2020;18:322.
Lehtoranta L, Pitkäranta A, Korpela R. Probiotics in respiratory virus infections. Eur J Clin Microbiol Infect Dis 2014;33:1289-302.

How to Cite

Vitale, E., & Mea, R. (2022). Associations between sampling characteristics, nutritional supplemental taking and the SARS-CoV-2 infection onset in a cohort of Italian nurses. Italian Journal of Medicine, 16(1).