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*Corresponding author: E-mail: akibul433@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
3(1): 269-277, 2020; Article no.AJI.58128 
 

 
 

 

 

Role and Effects of Micronutrients Supplementation 
in Immune System and SARS-Cov-2(COVID-19) 

 
Akibul Islam Chowdhury1* 

 
1
Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, 

Sonapur-3814, Bangladesh. 
 

Author’s contribution 
 

The sole author designed, analyzed and interpreted and prepared the manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Tania Mara Pinto Dabés Guimarães, Federal University of Minas Gerais, Brazil. 

Reviewers: 
(1) Ghada Mostafa Lofty El Ashy, Egypt. 

(2) Ritu Ghosh, Rabindranath Tagore University, India. 
(3) Hanchu Dai, University of Illinois, USA. 

Complete Peer review History: http://www.sdiarticle4.com/review-history/58128 

 
 
 
 

Received 31 May 2020  
Accepted 21 June 2020 
Published 30 June 2020 

 
 

ABSTRACT 
 

COVID-19 is a serious disease caused by the virus SARS-CoV-2 which is easily transmitted to 
humans. There are no vaccines or drugs discovered yet to control its transmission and prevent the 
disease. In that case, it is important to find the methods of preventing and controlling it. To fight 
against the virus a well-functioning immune system is necessary. The immune system is always 
active but if an individual becomes infected then the activity of immune system is enhanced to fight 
against the virus and recover the body from infection. Adequate intake of micronutrients through 
diet (vitamins A, B-complex, C, D and zinc, selenium, copper, iron) can help to boost up the 
immune system as each of the nutrients named above has roles in supporting antiviral and 
antibacterial defense. Although the supplementation of micronutrients can be given, it is necessary 
to provide the right amount of supplements after assessing the nutritional status of each individual 
as supplementation of micronutrient have some adverse effects. Therefore, it is recommended to 
follow a healthy diet to prevent COVID-19 and also assess the nutritional status of COVID-19 
patients before prescribing treatments. 
 

 
Keywords:  Micronutrients; immune system; micronutrient supplementation; respiratory tract infection; 

SARS-CoV-2; COVID-19. 

Review Article 



 
 
 
 

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ABBREVIATIONS 

 
IL : Interleukin 
CD : Cluster of Differentiation 
COVID-19 : Corona Virus Disease 2019 
SARS CoV-2 :Severe Acute Respiratory       

Syndrome 
WHO : World Health Organization 
PMNL : Polymorphonuclear Leukocytes 
DTH : Delayed-Type Hypersensitivity 
 

1. INTRODUCTION 
 
COVID-19, a severe acute respiratory syndrome 
is caused by the virus SARS-CoV-2 and WHO 
declared this as a global pandemic [1]. Previous 
epidemics related to CoV included that severe 
acute respiratory syndrome (SARS)-CoV was 
started in China in 2002 [2] and the Middle East 
respiratory syndrome (MERS)-CoV in the Middle 
East, first reported in 2012 [3]. Not all types of 
people are suffering from this virus. People with 
weak immune system are much exposed to SAS-
Cov-2 [4]. There are many recommendations to 
prevent the spread of COVID-19 from the WHO 
[5], the UK [6], USA [7] governments and the 
European Commission [8] as well as public 
health agencies including the key direction of 
self-isolation [9]. Some potential treatment 
options (anti-viral, anti-malarial, herbals) are also 
introduced to treat COVID-19 patients [10]. 
Nutrition especially micronutrients play a vital 
role to alleviate both mortality and morbidity in 
COVID-19 as micronutrients boost up our 
immunity system. Nutritional status is an 
important factor influencing the outcome of 
patients with COVID-19 [11]. In a study, a list of 
nutrients were identified with possible 
anticoronavirus effects based on in vitro and 
clinical studies [11]. Several micronutrients have 
antioxidants feature such as Vitamin C, Vitamin 
E, and beta-carotene. Antioxidants increase 
response to influenza virus vaccine compared 
with placebo and also increase the number of T-
cell subsets, enhance lymphocyte response to 
mitogen [12]. The activity of the immune system 
in our body is accompanied by an increasing rate 
of metabolism, requiring energy sources, 
substrates for biosynthesis, and regulatory 
molecules that are derived from the diet. 
Adequate supply of essential nutrients is required 
in this pandemic situation [13,14]. This review is 
based on published data and information and 
major searches were done using Google scholar 
and PubMed. This review aims to describe the 
role of specific micronutrients in supporting the 
immune system and also describes the effect of 

micronutrients supplementation in this pandemic 
situation. 
 

2. ROLE OF IMMUNITY IN VIRAL 
INFECTION 

 
When an individual exposed to viral infection, the 
immunity system becomes vital. First of all, the 
innate immunity system of the body such as 
macrophages, monocytes and dendritic cells 
recognize the foreign particles or pathogens. The 
presence of pattern recognition receptors (PRRs) 
and microbe-associated molecular patterns 
(MAMPs) help in the identification of the 
pathogens. TLR7 and TLR8 of innate immune 
system are more important for recognition of 
corona virus. After viral infection some cells 
release IFN-α and IFN-β. Natural killer cells are 
directly activated after viral infection to kill the 
infected cells. The maturation of dendritic cells is 
induced by PRRs signaling which functions to 
precess and present viral antigen. The 
presentation of viral antigens is resulted by 
upregulation of MHC I on virally infected cells 
which kill the virally affected cells releasing the 
pore forming protein like perforin. The production 
of IL-2 by CD4+ helper T lymphocytes and T 
helper 1 phenotype promotes cytotoxic T 
lymphocytes activity which produce antival 
antibodies by the differentiation of B lymphocytes 
to plasma cells. Then these antibodies can bind 
to the viruses and destroy them [15-18]. 
 

3. ROLE OF VITAMIN A IN IMMUNITY 
 

The roles of vitamin A in the immunity system 
and host susceptibility to infection are identified 
in many studies [19-23]. The main functions of 
vitamin A are helping in visions, providing 
immunity, contributing in gene expression, etc. 
Vitamin A is required for immune cell maturation 
and functioning as boosting the immune system 
is the main focus to prevent the spread of 
COVID-19. Deficiency of vitamin A may impair 
barrier functions and immune response. Vitamin 
A and its metabolites help to modulate innate 
immunity along with barrier function and also 
control neutrophil maturation. The functions of 
neutrophil are to ingest and kill bacteria. Vitamin 
A also supports in phagocytic activity to promote 
bacteria killing. Vitamin A helps to increase the 
activity of natural killer cells which have antiviral 
defenses. Other functions of vitamin A are to 
control dendritic cell, CD4+ T lymphocyte 
maturation and maintaining the balance between 
T helper 1 and T helper 2 lymphocytes. There 
are various chemical forms of vitamin A and each 



 
 
 
 

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271 

 

of the form has different activity in immune 
system. Movements of T lymphocyte to the gut-
associated lymphoid tissue is promoted by 
retinoic acid and it is also required for CD8+ T 
lymphocyte survival and proliferation [24]. Many 
systemic reviews supported that vitamin A could 
reduce the rate of mortality and mobility from 
measles and improved symptoms in acute 
pneumonia. A systemic review study is 
conducted by Imdad et al. [25] found that vitamin 
A decreased all causes of mortality and morbidity 
from diarrhea and measles and decreased the 
incidence of diarrhea and measles. Another 
study found that vitamin A decreased morbidity 
and mortality with pneumonia and also increased 
the clinical response and shortened length of 
hospital stay [26]. Common sources of vitamin A 
are Liver, eggs, oily fish, fortified margarine, dairy 
products, carrots, orange fruits, green and yellow 
vegetables and tomato juice and the 
recommendation of vitamin A intake for adults is 
3000-5000IU [27]. The adverse effects of vitamin 
A supplementation are identified in Table 2. 
 

4. ROLE OF VITAMIN D IN IMMUNITY 
 
Vitamin D is an important micronutrient for health 
because of its function in bone, immune etc. 
Several studies included the role of vitamin D in 
immune system [28-30]. The active form of 

vitamin D is 1, 25-dihydroxyvitamin D3 which has 
important immune-regulatory properties. 
However, the functions of vitamin D on the 
cellular components of immunity are rather 
complex. Vitamin D improves antimicrobial 
peptide synthesis in epithelial tissue [31] and 
also inhibits the proliferation of T cell, and 
production of cytokines by T helper 1 
lymphocyte. It also has little impact on CD8+ T 
lymphocyte. Low level of vitamin D in the body 
has been associated with upper respiratory tract 
infections [32,33] including influenza [34], chronic 
obstructive pulmonary disease [35] and allergic 
asthma [36]. Many studies showed that 
supplementation of vitamin D can reduce the risk 
of viral respiratory tract infection [37] and many 
meta-analysis studies have been concluded this 
subjects. According to Bergman et al. and 
Martineau et al., vitamin D decreases the risk of 
respiratory tract infections [38,39]. A systematic 
review and meta-analysis conducted by Zhou et 
al. [40] concluded that risk of pneumonia had 
been increased with deficiency of vitamin D. So, 
vitamin D can be important micronutrients to treat 
COVID-19 patients. The common sources of 
vitamin D are sunlight, Liver, eggs, oily fish, 
fortified margarine and dairy products and 
recommendation of vitamin D intake for adults is 
400-1000IU [27]. The adverse effects of vitamin 
D supplementation are identified in Table 2. 

 
Table 1. Effects of vitamin and mineral supplementation on immunity 

 

Immune 
system 

Vitamins and minerals Models Effects 

Macrophages C supplementation [41] Human Stimulation of chemotaxis and 
phagocytosis 

E dietary supplementation [42] Rat Inhibited glomerular sclerosis  
Zinc supplementation [43] human Increased IL-1, IL-6, TNF-α, INF-γ 

Natural killer 
cell 

C dietary supplementation [44] Human Enhance activity 
E dietary supplementation [45] Human Enhance activity 
Zinc [46] Human Enhance activity 
Selenium [47] Mouse Enhance activity and IL-2 protein 
Iron [48] Mouse Decreased activity 

PMNL B12 supplementation [49] Human Increased bacterial killing 
C supplementation [50] Human Enhanced phagocytosis, decreased 

superoxide production 
C,E supplementation [51] Human Suppressed production of oxygen 

free radical 
Copper, Zinc and Iron 
supplementation [52-54] 

Human Increased neutrophil function 

DTH 
 

C supplementation [55] Human Increased  
E supplementation [56] Human Increased  

T cell C, E and A supplementation [57] Human Increased 
Zinc supplementation [58] Human Increased T lymphocyte 

Abbreviations: PMNL: Polymorphonuclear Leukocytes, DTH: Delayed-Type Hypersensitivity 

 



 
 
 
 

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Table 2. Adverse effects of vitamin and mineral supplementation [27,59-61] 
 

Vitamin and minerals Adverse effects associated with supplements 

Vitamin A Hepatotoxic effects, visual change, hair and skin change, risk of lung 
cancer among smokers, diarrhea 

Vitamin B6 Sensory neuropathy, ataxia 
Vitamin B12 No upper limit unknown 
Vitamin D Hypocalcaemia, soft tissue calcifation 
Vitamin C Diarrhea, gastric  
Vitamin E Nausea, vomiting, diarrhea, headache, fatigue, blurred vision 
Zinc Nausea and vomiting, immune-suppression and impaired copper uptake 
Selenium Brittle hair and nails, peripheral neuropathies and gastrointestinal upset 
Iron Nausea, vomiting, reduced zinc uptake and constipation  

 

5. ROLE OF VITAMIN C IN IMMUNITY 
 
Vitamin C is a water soluble vitamin which has 
antioxidant properties. It plays a major role in the 
immune system of the human body. It is required 
for collagen biosynthesis and also helps in the 
migration of leucocytes to the sites of infection 
[62]. Other roles of vitamin C in immunity are 
phagocytosis, bacteria killing, and natural killer 
cells activity [62,63]. Vitamin C supplementation 
enhances the activity of natural killer cells [44]. 
Variety of studies stated that the severity of 
upper respiratory tract infections can be lowered 
by vitamin C supplementation. A meta-analysis 
stated that vitamin C decreased the incidence of 
pneumonia as well as reduced severity and 
morbidity from pneumonia [64]. For its functional 
properties, many doctors and researchers 
suggested to increase the intake of vitamin C to 
boost up the immunity and to fight against the 
corona virus. The common sources of vitamin C 
are Citrus fruits, broccoli, kiwi, yams, 
strawberries, melons and recommendation of 
vitamin C intake for adults is 60-90mg [27]. The 
adverse effects of vitamin C supplementation are 
identified in Table 2. 
 

6. ROLE OF VITAMIN B-COMPLEX IN 
IMMUNITY 

 
B vitamins are mainly involved in intestinal 
immune regulation and help in the gut-barrier 
functions. Folic acid increases the number of 
circulating T lymphocyte, but the activity of 
neutrophils appears unchanged. Vitamin B12 
increases the phagocytic and bacteria killing 
capacity of neutrophils while vitamin B6 helps in 
the lymphocyte proliferation and increases the 
number of T lymphocyte in the blood. Folic acid, 
vitamin B6 and B12 enhanced the activity of 
natural killer cells which would be important in 
antiviral defense [65,66]. A study found that 
deficiency of vitamin B6 decreased the T 

lymphocyte and B lymphocyte proliferation and 
IL-2 production [67]. The common sources of 
vitamin B complex are Poultry, fish, meat, nuts, 
legumes, whole grains, potatoes, meat, egg, 
seaweed etc and the recommendation of vitamin 
B6 and B12 for adults are 1.3-2 mg and 2.4-6 μg 
respectively [27]. The adverse effects of vitamin 
B complex supplementation are identified in 
Table 2. 
 

7. ROLE OF VITAMIN E IN IMMUNITY 
  
Vitamin E acts as a scavenger of free radical by 
blocking the per-oxidation of polyunsaturated 
fatty acids (PUFA) and also acts as antioxidants. 
It is suggested that vitamin E is an important 
nutrient in the immune system [68]. Due to 
vitamin E deficiency, T-cell mitogenesis, IL-2 
production, PMN phagocytosis, and PMN 
chemotaxis are decreased [56]. It is found that 
there is a positive association between vitamin E 
and cell-mediated immune responses and 
vitamin E supplementation appears to be 
beneficial for adults people [69]. Vitamin E 
supplementation also enhances the activity of 
helper T lymphocyte and improves vaccine 
responses [70]. Several studies identified that 
vitamin E supplementation reduced the risk of 
respiratory tract infections and decreased the 
duration of respiratory tract infections among 
adults [71]. The common sources of vitamin E 
are Plant oils (soya, corn, olive), nuts, seeds, 
wheat germ and the recommendation of vitamin 
E for adults people is 15-20 mg [27]. 
Supplementation of vitamin E also has some 
adverse effects which are identified in Table 2. 
 

8. ROLE OF ZINC IN IMMUNITY 
 
In this COVID-19 situation, zinc is considered as 
a supportive treatment therapy as it has direct 
antiviral effects [72]. It is found that zinc 
supplementation may have positive effects in the 



 
 
 
 

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273 

 

treatment of COVID-19 patient [73]. The role of 
zinc in immunity is explained in many studies 
[74-76]. Zinc deficiency can cause loss of T 
helper cells and also responsible for atrophy of 
thymus and spleen. Zinc increases the IgM 
plaque response and IgG response. Cell 
mediated immunity is also increased with zinc 
supplementation. T lymphocyte proliferation is 
also maintained by proper dietary intake of zinc 
[77]. Some meta-analysis found that zinc 
decreased the prevalence and incidences of 
pneumonia as well as duration of common cold 
[78,79]. The common sources of zinc are meat, 
cheese, cereals and grains, shellfish etc. 
 

9. ROLE OF SELENIUM IN IMMUNITY 
 

Selenium has important effect on both innate and 
acquired immunity. Selenium enhances the 
function of T lymphocyte and B lymphocyte and 
also increases the activity of natural killer cell 
[80,81]. A study found that selenium 
supplementation improved immune function in 
the human body [82]. The common sources of 
selenium are fish, meat, egg and nuts. 
Supplementation of selenium also has some 
adverse effects on the body. 
 

10. ROLE OF COPPER IN IMMUNITY 
 

Some studies described the importance of 
copper in the immune system. Copper has 
antimicrobial properties, and also increases the 
activity of natural killer cell and neutrophils, 
monocyte function [83,84]. Some studies showed 
that lymphocyte proliferation and IL-2 production 
are promoted by copper [85]. A systematic 
review found that respiratory tract infection can 
be reduced by copper supplementation [86]. The 
common sources of copper are nuts, shellfish 
and some vegetables. 
 

11. CONCLUSION 
 

Nutrition is very important for every steps of life 
and proper intake of both micronutrients and 
macronutrients can help to prevent and treat 
several infectious diseases. All nutrients named 
above have special role in immune system of the 
body, and consumption of adequate amount 
nutrients is necessary to boost up our immune 
function. Immune system can also be boosted up 
by supplementation of these nutrients. However, 
there are some adverse effects of micronutrients 
supplementation in case of overdosing. Many 
studies showed both positive and negative 
effects of micronutrients supplementation on 
immune response and human health. However, 

there are no published studies which described 
the function of micronutrients for the prevention 
and treatment of corona-virus but some studies 
showed that intake right amount of micronutrients 
can reduce the duration of the disease severity. 
 

CONSENT 
 

It is not applicable. 
 

ETHICAL APPROVAL 
 

It is not applicable. 
 

COMPETING INTERESTS 
 

Author has declared that no competing interests 
exist. 
 

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