This issue of Topics in Clinical Nutrition highlights 2 articles on COVID-19, as well as several articles focusing on the pediatric population. The association between serum selenium levels and mortality rate and inflammatory factors in patients with COVID-19, as well as vitamin D levels in pediatric patients with COVID-19, is examined. Sports nutrition knowledge and practices of regular exercisers are also described. Four articles discuss malnutrition identification in various populations and disease states, such as outpatients with chronic obstructive pulmonary disease (COPD), elderly inpatients, pediatric patients with celiac disease (CD), and adolescents in an outpatient pediatric gastroenterology clinic. The second of a 2-part review on the microbiome, with a focus on infants and children, is also presented.

Keshani et al of Iran conducted a cross-sectional study investigating the association of serum selenium levels with mortality rate and inflammatory and immunity factors in 179 individuals with COVID-19 since selenium is an antioxidant that can play a role in immunity. Serum selenium levels were found to be significantly correlated with white blood cell, neutrophil, and lymphocyte levels, as well as erythrocyte sedimentation rate. No significant association was found with mortality rate, although morality rate was lower in those with higher levels of selenium. Similarly, no significant association was seen with inflammatory markers interleukin-6 and interferon-[gamma]. Since many study subjects were found to be selenium deficient, potentially influencing the findings, larger studies are needed to further describe the association of selenium levels with COVID-19.

Ekemen Keles and colleagues evaluated serum 25-hydroxy vitamin D levels in 98 children with COVID-19 and 2112 healthy controls and found that serum vitamin D levels were significantly lower in children with COVID-19 than in controls. Although the majority of both groups were found to have inadequate vitamin D status, almost 65% of patients with inadequate vitamin D had symptomatic COVID-19 compared with 30% with adequate vitamin D levels. While acute illness may lead to low serum vitamin D, the association of vitamin D status in COVID-19 severity requires further study.

Hillman and Green of Ohio University investigated the sports nutrition knowledge and breakfast habits and beliefs of 404 regularly exercising adults, including current athletes, former athletes, and nonathletes through a cross-sectional, validated, 46-item Internet-based survey. Sports nutrition knowledge was found to be inadequate in regular exercisers. Although breakfast consumption was high, breakfast consumption prior to exercise was low. The Internet was found to be the primary source of sports nutrition information, which may contribute to misinformation, and only 4% of exercisers consulted registered dietitians. Education on macronutrient composition and timing of meals around exercise were identified as possible areas of focus for sports nutrition professionals.

Uzunlar et al of Turkey conducted a study of 80 male individuals with COPD to identify the relationship between disease severity and nutrition status using subjective global assessment (SGA). Twenty patients were included in each of the 4 classifications of the Global Initiative for Chronic Obstructive Lung Disease. The majority of patients with severe malnutrition were noted to be in the severe disease group (group D). The SGA was found to be a useful method to identify malnutrition in a timely manner. Since malnutrition may exacerbate respiratory impairment in this population, addressing malnutrition early in the disease may improve prognosis.

Naaman and colleagues of King Abdulaziz University in Saudi Arabia investigated the prevalence of malnutrition and the ability of nurses to identify malnutrition in hospitalized patients older than 60 years. Nurses were asked whether a patient was malnourished, and their answers were compared with the Mini Nutritional Assessment-Short Form completed on the same patient. More than 25% of the 100 patients were found to be malnourished, and almost half were at risk for malnutrition. Nurses recognized only 11% of patients with poor nutritional status. The findings highlight the importance of dietitians in malnutrition screening as well as the need for nutrition education of other health care professionals.

Guennouni et al of Morocco conducted a longitudinal study comparing the nutritional status at diagnosis and at follow-up after following a gluten-free diet (GFD) of 127 children with CD and 127 controls. Median body mass index (BMI) was significantly lower in children with CD than in controls. A decrease in thinness and an increase in obesity were noted during GFD follow-up. These findings support the importance of nutrition follow-up in children with CD to promote consumption of a balanced GFD.

Dogan and colleagues of Ankara University in Turkey conducted a cross-sectional study in 62 adolescents from an outpatient pediatric gastroenterology clinic in order to identify the ability of handgrip strength (HGS) to determine malnutrition. BMI, triceps/biceps skinfold, neck, waist, and wrist circumference, and arm muscle area were correlated with HGS. Both dominant and nondominant HGS measures were found to be possible predictors of malnutrition. Although the sample size was small, the findings suggest that HGS may be a useful tool in identifying malnutrition in this population.

Finally, Abad-Jorge and Comess of Norfolk State University provide the second of their 2-part narrative review of the microbiome. This review focuses on the development of the microbiome in prenatal life and genetic, epigenetic, nutrition, and environmental contributors that impact its diversity. The microbiome's role in pediatric obesity, allergy, and various gastrointestinal disorders is highlighted.

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-Kelly Kane, MS, RD

Editor