Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2021; 27(34): 5682-5699
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5682
Liver disease and COVID-19: The link with oxidative stress, antioxidants and nutrition
Danijela Ristic-Medic, Snjezana Petrovic, Aleksandra Arsic, Vesna Vucic
Danijela Ristic-Medic, Snjezana Petrovic, Aleksandra Arsic, Vesna Vucic, Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, National Institute for Medical Research, University of Belgrade, Belgrade 11129, Serbia
Author contributions: Ristic-Medic D designed the review; Ristic-Medic D, Petrovic S and Arsic A analyzed and interpreted the data and drafted the manuscript; Vucic V critically revised the paper.
Supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia, No. 451-03-9/2021-14/200015.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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:
Corresponding author: Danijela Ristic-Medic, MD, Professor, Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, National Institute for Medical Research, University of Belgrade, Tadeusa Koscuska 1, PO Box 102, Belgrade 11129, Serbia.
Received: January 28, 2021
Peer-review started: January 29, 2021
First decision: March 29, 2021
Revised: April 11, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: September 14, 2021

Varying degrees of liver injuries have been reported in patients infected with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). In general, oxidative stress is actively involved in initiation and progression of liver damage. The liver metabolizes various compounds that produce free radicals. Maintaining the oxidative/antioxidative balance is important in coronavirus disease 2019 (COVID-19) patients. Antioxidant vitamins, essential trace elements and food compounds, such as polyphenols, appear to be promising agents, with effects in oxidative burst. Deficiency of these nutrients suppresses immune function and increases susceptibility to COVID-19. Daily micronutrient intake is necessary to support anti-inflammatory and antioxidative effects but for immune function may be higher than current recommended dietary intake. Antioxidant supplements (β-carotene, vitamin A, vitamin C, vitamin E, and selenium) could have a potential role in patients with liver damage. Available evidence suggests that supplementing the diet with a combination of micronutrients may help to optimize immune function and reduce the risk of infection. Clinical trials based on the associations of diet and SARS-CoV-2 infection are lacking. Unfortunately, it is not possible to definitively determine the dose, route of administration and best timing to intervene with antioxidants in COVID-19 patients because clinical trials are still ongoing. Until then, hopefully, this review will enable clinicians to understand the impact of micronutrient dietary intake and liver status assessment in COVID-19 patients.

Keywords: SARS-CoV-2, COVID-19, Liver injury, Antioxidants, Nutrients, Treatment

Core Tip: In this review, we highlight the importance of an optimal micronutrient intake and status to boost the immune system, providing special emphasis on liver injury during the coronavirus disease 2019 (commonly known as COVID-19) crisis and focusing on the most relevant nutrients that reduce oxidative stress.