الفهرس 
Aim of studyOnly 14 pages are availabe for public view
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Abstract
A novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, on December 12, 2019, leading to the onset of a global pandemic characterized by acute respiratory syndrome in humans, commonly referred to as COVID-19. Based on data from the COVID-Case Tracker of Johns Hopkins University, the global COVID-19 death toll on April 24, 2020, was recorded at 195, 313, with a corresponding total of 2, 783, 512 confirmed COVID-19 cases. The COVID-19 pandemic has had a profound impact on human health, leading to significant alterations in lifestyle, the implementation of social distancing measures, and the necessity of home isolation. These changes have had wide-ranging social and economic consequences. Enhancing public health within the ongoing epidemic necessitates medical and biological scientific knowledge and a comprehensive grasp of many human sciences about lifestyle, social dynamics, and behavioral patterns. This encompasses study including aspects such as dietary habits and overall way of life.
The infection caused by SARS-CoV-2 can manifest as either asymptomatic or symptomatic, with a wide range of symptoms observed, including mild upper respiratory tract infection and severe sepsis, which can be life-threatening.
The nutritional condition of individuals may be affected by changes in food habits and lifestyle resulting from quarantine and social isolation. The presence of obesity and its accompanying comorbidities is linked with physiological anomalies that increase an individual’s vulnerability to infection, pathogenicity, and transmission of the COVID-19 virus. Furthermore, in light of the ongoing and indefinite nature of the pandemic, individuals had to demonstrate resilience by making necessary adjustments to their lifestyles to mitigate the risks associated with the present and predicted future surges of COVID-19. Cultivating healthy behaviors is crucial to facilitate sufficient immunological response and prevent or manage conditions such as undernutrition, obesity, and comorbidities in individuals affected by COVID-19. Therefore, it is imperative to provide comprehensive information regarding the impact of nutritional status on the outcomes of Covid-19 in order to raise awareness among the general population. Hence, it is imperative to underscore the significance of incorporating nutritional status as a crucial factor in health initiatives that seek to mitigate the repercussions of COVID-19.
Due to the absence of definitive therapeutic and preventive strategies for Covid-19, nutrition and exercise are considered preventive approaches.
The field of nutrition plays a crucial role in determining an individual’s overall health. Additionally, it is crucial to note that nutrition has a significant role in the management of both acute and chronic illnesses. This holds particularly true for medical conditions lacking a proven causal treatment. This observation could also be extended to the ongoing global epidemic caused by SARS-CoV-2, called COVID-19.
The food industry commonly utilizes chemicals to prolong the shelf life of products and enhance or restore particular qualities often diminished during the production of specific foods. Throughout the course of modern history, the food business has extensively employed many additives. Despite their extensive utilization, these substances, like other pharmaceuticals, can elicit adverse reactions. Various entities, such as the Food Safety Act, the Codex Alimentarius, the European Union, the United States, and Japan, present divergent interpretations regarding the classification of food additives.
Food additives typically possess the following features in a general sense:
Food additives are substances not intended to be ingested as standalone food items but are included in food products.
The composition of these substances encompasses both synthetic ingredients and natural components.
The objective of including additives is to enhance the overall characteristics of the food, including its quality, color, scent, and flavor, while also fulfilling the demands for preservation, freshness, and processing.
Food additives can elicit acute adverse effects or offer long-term risks when individuals are consistently exposed to them. Headache occurrences, alterations in energy levels, as well as shifts in mental focus, behavioral patterns, and immunological responses.
The long-term effects of food additives have been associated with an increased risk of cancer. Several food additives commonly used include sodium benzoate (E211), tartrazine (E102), quinoline yellow (E104), sunset yellow (E110), carnosine (E122), and Allura red (E129). According to various testing methodologies, it has been observed that tartrazine has an impact on a range of 10-40% of individuals who are sensitive to aspirin. The effects experienced by these individuals include asthma, rhinitis, and pediatric hyperactivity. The artificial food coloring known as Sunset Yellow (E110), commonly used in the production of cookies, has been found to induce renal and adrenal harm in laboratory animals based on experimental studies. The presence of benzoates (E210-E219) in various food products such as marinated fish, fruit-based fillings, jam, salad cream, soft drinks, and beer has been associated with the development of angioedema and asthma. Sulfites falling within the E220-E227 range have demonstrated mutagenic properties when present in animal feed. Monosodium glutamate (MSG) is a commonly utilized flavor enhancer in various savory food items, including snacks, soups, sauces, and meat products. The Food and Drug Administration (FDA) has compiled an extensive list of about 3000 components, several commonly employed in domestic settings daily, such as sugar, baking soda, salt, vanilla, yeast, spices, and colors.
Food preservatives maintain the flavor, texture, edibility, and nutritional composition of food products by impeding the proliferation of microbes or the process of spoilage. Various natural preservatives, such as salt, sugar, alcohol, vinegar, and other similar substances, are commonly employed in food preservation. Using chemical food additives has significantly increased in popularity over the past few decades. According to the FDA (2010), these methods have demonstrated superior efficacy in prolonging the shelf life of products and are usually considered reliable for preservation purposes. Sodium Nitrate (251), Benzoic acid (210), Sodium Benzoate (211), and Sodium Sulphite are illustrative instances of chemical additives employed as food preservatives (221).
A color additive refers to a substance, such as a dye, pigment, or chemical, that can impart color to a food, drug, or cosmetic, alone or by interacting with other components. Non-edible substances are not typically consumed as food or regularly used as a specific ingredient, irrespective of their nutritional worth. Food colors are incorporated into food products to counteract the degradation of color resulting from exposure to light, air, moisture, and fluctuations in temperature, as well as to intensify the existing natural colors. Food colors are present in various food items, such as snack foods, margarine, cheese, jams, jellies, candies, and beverages. These food colors consist of specific color additives, such as curcumin (110), brilliant blue FCF (133), tartrazine (102), sunset yellow FCF, and orange-yellow S.
Taste enhancers are employed in savory food products to augment the sensory perception of their flavor profiles. Although lacking in flavor alone, they enhance the taste of food products. The utilization of natural flavor enhancers has been shown to boost the stability of food products. Salt is a commonly utilized natural substance that enhances the flavor of culinary products. The flavor enhancers most frequently utilized include Monosodium Glutamate (E621), Calcium Glutamate (623), Disodium 5′-ribonucleotides (635), Ethyl Maltol (637), Monosodium Glutamate (E621), Monopotassium Glutamate (E623), Calcium Diglutamate (626), Guanylic acid (E627), Sodium Guanylate (E630), and Inosinic acid. Taste enhancers can be identified in diverse food products, including savory snacks, pre-packaged meals, and condiments. Monosodium glutamate is the sodium salt derived from the naturally occurring amino acid glutamic acid.
The present investigation employed a sample of adult individuals of both genders who had received a diagnosis of COVID-19 and were subsequently placed under quarantine within hospital settings until achieving full recovery. In conjunction with the severe symptoms outlined by the National Institutes of Health, it is worth noting that all participants in this study experienced typical manifestations of COVID-19, encompassing cough, fever, sore throat, and anosmia. The severity of COVID-19 was determined using the definitions provided in the National Institutes of Health (NIH) COVID-19 Treatment Guideline (National Institutes of Health, 2021). The patients in the study met the criteria of being positive for COVID-19 as determined by RT-PCR testing, having a SpO2 level of less than 30 breaths per minute, or exhibiting lung infiltrates of more than 50%.
The present investigation enlisted adult individuals infected with the Coronavirus from Menoufia Governorate. Individuals afflicted with the Coronavirus were recruited randomly from outpatient clinics and hospitals in the Menoufia Governorate of Egypt. The study included individuals who satisfied the following eligibility criteria: (1) A confirmed diagnosis of COVID-19. (2) Patients receiving hospital care or home care. (3) Express consent to partake in the study and affix one’s signature on the consent form.
In contrast, the researchers excluded certain patient groups from the study. These groups included
• Individuals with end-stage pneumonia, cancer, and other similar conditions,
• Individuals with significant exposure to COVID-19 infection, and
• Individuals who have recently undergone heart or lung surgery.
• Individuals who suffer from allergies, asthma, and respiratory conditions. (5) The act of withdrawal, non-compliance, or refusal to participate. (6) Individuals who had a family member with an infection (for the control group exclusively)
The study focused on a sample of adult individuals from the Egyptian population who had been infected with COVID-19 and subsequently recovered. The subjects were picked randomly among individuals who were affected. The study consisted of a total sample size of 180 adults, which included 60 cases and 120 controls. Among the cases were 30 infected males and 30 infected females, while the control group consisted of 60 males and 60 females. The COVID-19 patients were categorized based on the severity of their symptoms. The researcher and the healthcare team at the health center or clinic conducted a comprehensive assessment of anthropometric measurements and obtained blood samples. Participants were selected from various sources, including outpatient clinics, staff members, neighbors, coworkers, relatives, and friends.
The present investigation is characterized as a retrospective cross-sectional study. The study enlisted individuals who satisfied the criteria for inclusion and subsequently separated them into two groups: (1) a case group of 60 patients. The individuals affected by the infection were categorized into three groups based on the intensity of their symptoms. Each group consisted of 20 individuals, resulting in 60 participants. The classification was conducted as follows:
1- Individuals exhibiting modest signs of COVID-19
2- Patients exhibiting moderate signs of COVID-19
3- Patients exhibiting significant signs of COVID-19
4- The control group consisted of 120 adult individuals not afflicted with COVID-19 or any associated illnesses.
The data was collected via a designated questionnaire (see Appendix 1). The researchers developed the questionnaire using standardized methodologies, and a panel of ten experts evaluated its appropriateness and validity. Furthermore, the revised version of the questionnaire was implemented after conducting interviews with 20 participants to evaluate the levels of clarity and accuracy exhibited by the questionnaire. The provided questionnaire was employed to gather many data types, including demographic information, health history, lifestyle factors, anthropometric measurements, radiological data, dietary habits, a quantitative food frequency questionnaire (FFQ), and dietary assessments.
The collected data underwent statistical analysis and were provided in frequency, percentage, mean, and standard deviation (SD) utilizing an independent sample test. Statistically significant differences were observed among the numerical variables, with a significance level of less than .05, indicating the presence of significant data.
The entire sample included individuals from various age groups to investigate the impact of additive consumption across different age demographics. This study’s core age group comprises young adults aged 15 to 30 years, comprising 53.3% of the total sample. This particular age group is expected to exhibit the highest levels of additive use.
There exists a significant correlation between the incidence of COVID infection and various degrees of education, as demonstrated by the chi-square test.
The data in the figure indicates a very high prevalence of COVID cases among healthcare workers, with physicians accounting for 36.6% and nurses accounting for 16.7%. In contrast, teachers accounted for a far lower proportion of cases, representing only 1.7% of the total. The likelihood of infection among healthcare workers (HCWs) is 2.4 times higher than individuals in other occupations. This finding is consistent with other prior studies.
The average family size among the participants was 4.8, with a standard deviation of 0.1. The median value was equal to the mean, indicating a robust sample size and a representative sample.
According to the provided data, 56.7% of households consist of four to five individuals, while 27.7% have more than five persons. This observation aligns with the demographic structure depicted in the population pyramid of Egypt for 2020. To mitigate the confounding effect, this element is carefully controlled and ensured to be consistent across both groups.
Within the surveyed population, it was found that 38.9% of individuals possessed an economic income ranging from 2000 to 4000 EPG. Additionally, 22.2% of individuals fell within the income bracket of 4000 to 6000 EPG, while a mere 17.8% of individuals reported an income exceeding 6000 EPG. Additionally, this variable was equated between the two cohorts.
Adopting positive lifestyle choices and behavioral patterns on one’s health is significant. Within our selected sample, it was observed that 44.4% of individuals occasionally engage in practical sporting activities, whereas a mere 30% partake in sports activities daily.
The duration of sports exercise is a significant risk factor that impacts health. In the study, 28.9% of participants engaged in around two hours of activity, while 22.2% spent approximately three hours. The average length of athletic activity among the entire group was 3.3 hours, with a standard deviation of 0.16.
The average hours spent watching screens daily was 4.4, with a standard deviation 0.2. Among the participants, 20.0% reported spending precisely two hours, while 72.2% reported spending between three and more than five hours. All relevant variables were carefully controlled for in the study to minimize their potential influence on the observed outcomes in both groups.
The average weight among the individuals diagnosed with COVID-19 was 76.4, with a standard deviation of 12.6, while among the control group, the average weight was 77.2, with a standard deviation of 15.5. The statistical findings suggest that the sample size is sufficient and the data distribution is approximately normal.
The study examined the association between body mass index (BMI) and its distribution across two distinct groups: COVID cases and controls. The mean BMI among COVID cases was 26.9, with a standard deviation (SD) of 4.5. Similarly, the mean BMI among the control group was likewise 26.9. Obesity is a significant risk factor for numerous diseases, and a robust association has been established between COVID-19 infection and other respiratory tract infections. Therefore, the alignment of body mass index (BMI) between the two groups was paramount.
The prevalence of COVID-19 infection among individuals with chronic conditions, including cardiac, hypertension, and liver problems, is reported to be 8.3%, 3.3%, and 25%, respectively. Additionally, asthmatic patients account for 16.7% of COVID-19 cases, while individuals with high cholesterol levels represent 13.3% of the cases.
Within the population of individuals affected by COVID-19, it has been shown that 16.7% have a diminished sense of taste and smell, while 8.3% exhibit symptoms like those of influenza. Additionally, 10% of individuals present with coughing symptoms, while 5% display a low-grade temperature. Notably, a significant proportion of 50% experience a combination of all symptoms above.
Our research aimed to investigate the correlation between specific additives and COVID-19 infection. Our study focused on examining the impact of these substances on overall health and immunity. These additives may serve as risk factors for infection, re-infection, or exacerbation of disease severity.
The present study examines the likelihood of contracting COVID-19 among individuals with a daily intake of 4PCalcium disodium ethylene diamine triacetate over 5 mg. The population with higher intake has an intake that is three times greater than the group with lower intake. This relationship is statistically significant, as indicated by a low p-value, suggesting that it is not due to chance.
The association between Calcium propionate and COVID infection is strongly correlated, with an odds ratio of 4.5 and a statistically significant difference in mean values between the two groups.
Consumption of preservatives is known to significantly impact immune suppression, exhibiting a solid association with COVID-19 infection. This is evident from the odds ratio (OR) of 2.7, indicating that individuals who consume more than 50mg of preservatives daily have at least twice the likelihood of contracting COVID-19 compared to those who consume a lower quantity.
Our study found that daily consumption of 10 mg of 4C-Riboflavins had a significant impact. Specifically, we observed an odds ratio (OR) of 3, indicating a threefold increase in the likelihood of infection among the population under investigation. The confirmation of this link is supported by the t-test and its associated p-value (0.001).
There is a substantial association between the consumption of color agents above 250 mg daily and an odds ratio (OR) of 3. This relationship is highly statistically significant by a t-test. Furthermore, this association has the potential to elucidate several diseases in relation to the specific mechanism of COVID infection.
The inclusion of 5 grams of monosodium L-glutamate (MSG) in our study holds significance, as indicated by an odds ratio (OR) of 2.6. This OR suggests that the likelihood of infection is 2.6 times higher among the population exposed to MSG. This link has been confirmed by a t-test, yielding a p-value of 0.003.
Our investigation demonstrates a significant correlation between the use of flavor compounds over 5 mg per day and the incidence of COVID infection. The odds ratio (OR) is 2.9, indicating a statistically significant difference between the two groups based on the calculated p-value.
In the present investigation, it was observed that individuals who consumed a total quantity of food additives over 150mg per day exhibited a 2.8-fold increased risk of contracting a COVID infection compared to the control group with lower intake. This association was shown to be statistically significant, as evidenced by a t-test value of 2.13 and a p-value below 0.05.