2020 has indeed been an extraordinary year for all. The team at Nutritional Insight, like most of us, has been adapting to change and now, approaching a year on we would like to share some of our journey progressions and insights for 2021. In March, we were very proud to write a paper detailing the role of immunonutrition in the COVID-19 pandemic, which was subsequently published in the British Medical Journal. Furthermore, scientists at Nutritional Insight were one of the first to bring this subject to the attention of the media and general public.
Throughout the year we have published ten scientific articles, with topics ranging from aronia berries and health, choline and neurodevelopment, the role of fungal protein in future diets and the health implications of drinking different teas.
We have also actively participated in Webinars – disseminating educational and continuing professional development insights and are also driving the way forward and raising the awareness of important links between nutrition and public health. A particularly important field, in light of the COVID-19 pandemic, is the links between diet, nutrition and respiratory health – which led Nutritional Insight to editing a special edition on this very topic for both Frontiers Nutrition and Frontiers Immunology.
So, What does 2021 have in store? Here are Predictions from Nutritional Insight:
An End to Vitamin D Controversies?
At Nutritional Insight we have been driving the importance of vitamin D all year, particularly given the COVID-19 pandemic. The Scientific Advisory Committee on Nutrition published a report in 2016 on vitamin D and health, which remains inconclusive. Yet now in 2020, there has been an accumulation of new studies strongly implying that vitamin D could have played a key role in helping to manage COVID-19 risk and severity. In September 2020, a paper published in Frontiers collates the most recent evidence on this topic.
We hope that the UK Government will be updating the vitamin D guidance in the UK in light of the evidence emerging throughout 2020, beyond the 10µg/day, which is largely inadequate for large proportions of the population. The advice ideally needs to be extended beyond those who are sheltering.
This is particularly the case for people with a higher body weight, of certain ethnicities minority, and those who spend an increased time indoors. It is our hope that 2021 may see an end to this controversy and the public are educated, through governmental guidance, to intake an adequate level of vitamin D, which we believe should be higher than present guidance, particularly for these at risk groups.
Time to Tackle Obesity Properly
It’s time to start taking obesity seriously, not only for its health ramifications but also its planetary effects. Official statistics have been published by the NHS on obesity, physical activity and diet in England in 2020. Alarmingly, the majority of adults are now overweight or obese – 67% of men and 60% of women, with 26% or men and 29% of women who are obese. Yet, what is even more concerning is that 20% of year 6 (age 10-11) children are now classified as obese.
A concerning new report from the World Health Organisation has shown that the percentage of the UK population who are obese is the third highest in Europe, with only Malta and Turkey having higher obesity rates.
Obesity is an epidemic, and one of the greatest public health challenges of the time. Being overweight increases an individual’s risk of developing a number of diseases, such as cancer, diabetes and cardiovascular disease. It has also come to light in a number of studies that obesity increases a person’s risk of developing a severe illness from COVID-19.
Obesity also has a huge environmental footprint. On a global scale obesity results in + 49 megatons of carbon dioxide (CO2) from oxidative metabolism due to higher metabolic demands, + 361 megatons per year of CO2 from food production processes due to increased food intake and + 290 megatons per year of CO2 from vehicle and air travel due to a greater body weight.
It is thus imperative that policies need to be developed to curb the obesity epidemic across the whole of the UK. People need to be encouraged and informed – and we hope that 2021 we will see the start of this reform.
Slow Living, Smart Living and Low-Carbon Lifestyles
During the COVID-19 pandemic, and in particular during lockdown, most people were working from home, with many still doing so. During this time lower levels of air pollution were observed, which has had a knock on effect in improving crop production. This change in our pace of life has impacted most of us and, with this, a reflection and enlightenment regarding the way we live our lives and the impact that has on our natural world.
Whilst we are all eager to see an end to the COVID-19 pandemic, we at Nutritional Insight also hope that some changes that have been implicated in our lives will have lasting effects, particularly the importance of understanding the role of green production and consumption.
Our post-COVID-19 lifestyle is likely to be more sustainable focusing on existing as a community, caring more for others, having a greater concern for the environment and adopting sustainable development.
A recent review published in Elsevier states that if people do not change their habits, changes in our ecosystems will become irreversible and it will be impossible to live in such environment.
Therefore, we believe that one positive result from the COVID-19 pandemic is that responsible consumers will begin to more firmly adopt sustainable lifestyles, slower living, smart living and low-carbon-lifestyles in the future.
A Refocus on Planetary Health
2020 began with ambition and optimism regarding a strong emphasis on planetary health. In fact, as published in the Lancet, 2020 was dubbed a ‘super year’ for the environment and our relationship with nature. The belief, at the start of the decade, was that a turning point was imminent and that major headway would be made in developing and maintaining sustainability.
However, as COVID-19 emerged, the emphasis began to shift and the sole focus of the world’s politicians and scientists became dominated by COVID-19 and the management and control of the global pandemic.
Yet, the COVID-19 pandemic has highlighted how ongoing urban growth is linked to a disruption in the ecological balance – leading to an increased risk of exposure to new pathogens and the arrival of new diseases. What COVID-19 has demonstrated is that any disruption to the human-ecological balance has serious implications for our health. Transmission of SARS-CoV-2, the virus that causes COVID-19, grew uncontrollably in crowded, dense and polluted areas throughout the globe.
Furthermore, our green spaces became our saviour, and were increasingly appreciated throughout the COVID-19 pandemic. COVID-19 has contributed to shifts in exercise habits, increasing walking, running, cycling and generally enjoying the ‘great outdoors’ – something that clearly needs to be sustained.
Moving forward into 2021, and towards the end of the COVID-19 pandemic, we believe that the complicated, interconnected relationship between humans and the environment will take centre stage. Not only to work towards combating climate change but also to prepare and adapt to new emerging infectious diseases, such as COVID-19. Planetary health will be paramount.
Supporting Mental Health and ‘Psychoneuroimmunity’
Psychoneuroimmunity is the study of the effect of the mind on health and resistance to disease. Preventive strategies include following a healthy lifestyle, regular exercise, balanced nutrition, quality sleep and a strong connection with other people.
The COVID-19 pandemic has shown how all of these strategies have fundamental underpinning roles to play in our mental health. With the onset of the pandemic people experienced heightened anxiety levels when facing the real or perceived threat of the virus. This followed with feelings of isolation and vulnerability when locked down at home, particularly for those who were shielding.
The psychological impacts of the global pandemic have materialised over the months, with one study published in Frontiers in Psychology, identifying associations between socio-demographic factors, COVID-19 induced changes and health behaviours. Changes in health behaviours such as diet, sleep and physical activity have clear links to a negative mood and we hope that moving into 2021 a greater focus will be put on increasing psychoneuroimmunity against COVID-19.
The Development of Drugs and Vaccines Against COVID-19
Finally, we have had some good news this week regarding the Pfizer vaccine. The world’s scientists and global health professionals have been brought together in 2020 for the sole purpose of working towards novel methods of controlling COVID-19 and researching towards diagnostics, therapeutics and vaccines to eradicate this novel coronavirus.
At the very onset of the pandemic, the WHO launched an R&D Blueprint, to improve coordination between the world’s scientists. The aim was to accelerate the research and development process – and it is certainly living up to that aim.
The Solidarity Therapeutics Trial is generating evidence on the effectiveness of repurposed drugs for the treatment of COVID-19. Interim results have unfortunately shown that remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon have little or no effect against COVID-19. Similarly, the UK Recovery Trial is a global effort to discover effective COVID-19 treatments, and has also found that lopinavir/ritonavir has no clinical benefit against COVID-19. However, these global platforms are ready to quickly evaluate potential new therapeutics. Currently antiviral drugs, anti-SARS COV-2 monoclonal antibodies and immunomodulators are being considered for evaluation.
A vaccine normally takes years, if not decade, to develop. However, many experts believe that a vaccine against SARS-CoV-2 will be widely available by mid-2021 – just over a year from the emergence of the novel coronavirus.
Over 200 vaccines are in early development, with 40 in clinical development. In the UK, the University of Oxford is developing a potential vaccine that is already in advanced clinical development, which is hugely promising as findings thus far show it to be safe and effective in producing an immune response. Another potential UK vaccine, developed by Imperial College London, is also in advanced clinical development and human participants are reported to be responding well, with the aim to launch a large 20,000 participant phase III clinical trial by the end of this year and hopefully a human challenge trial in January 2021, where healthy participates will be given the vaccine and purposely infected with SARS-CoV-2. Human challenge trials are important in enhancing our understanding of infectious diseases and speeding up the development of vaccines.
Most recently in the news is the Pfizer and BioNTech vaccine, which has published preliminary results showing the vaccine can prevent more than 90% of people from getting COVID-19. This potential vaccine uses mRNA technology, developed from use in cancer therapies. The vaccine instructs human cells to generate COVID-19 viral protein, which then causes an immune response. However, the requirement of two injections and storage at -80 degrees will hamper the administration of this vaccine worldwide. Further data is required on whether the vaccine protects only against clinical disease or also prevents transmission, plus its effectiveness in the most vulnerable, who are most likely to suffer with severe COVID-19.
In response to this announcement, the Sputnik V vaccine, developed in Russia, has subsequently announced that this potential vaccine has demonstrated 92% efficacy in the first interim analysis. This potential vaccine is based on the human adenoviral vector platform, which has proven safe and effective with no long-term side effects in more than 250 clinical trials worldwide.
These, and other vaccine trials, are an exciting and positive development in tackling COVID-19. The preliminary results of further potential COVID-19 vaccines, such as the Oxford vaccine, are eagerly awaited.
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