Liver disease and COVID-19:The link with oxidative stress,antioxidants and nutrition

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.