MORTALITY FROM COVID-19 INCREASES WITH UNSATURATED FAT, AND MAY BE REDUCED BY EARLY CALCIUM AND ALBUMIN SUPPLEMENTATION

Bara El-Kurdi

Biswajit Khatua

Christopher Rood

Christine Snozek

Shubham Trivedi+6 authors

^{Department of Medicine, East Tennessee State University, Johnson City, TN}

^{Department of Medicine, Mayo Clinic, Scottsdale, AZ}

^{Saint Louis University School of Medicine, Saint Louis, MO}

^{Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ}

^{Department of Cardiovascular Diseases, Biochemistry and Molecular biology, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Scottsdale, AZ}

^{Department of Biostatistics, Mayo Clinic, Scottsdale, AZ}

Vijay P. Singh: ude.oyam@yajiv.hgnis

^{Corresponding Author:} Vijay P. Singh, MD, Division of Gastroenterology and Hepatology Mayo Clinic, Scottsdale, AZ 85259, Phone: 480-301-4286 Fax: 480-301-7017 ude.oyam@yajiv.hgnis

^{contributed equally to the study}

Received 2020 Apr 27; Revised 2020 May 12; Accepted 2020 May 18.

Key words: unsaturated, fatty acid, coronavirus, lipotoxicity

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Footnotes

Contributors:

Bara El-Kurdi^{, Biswajit Khatua}^{, Christopher Rood}^{, Christine Snozek}^{, Sergiy Kostenko}^{, Shubham Trivedi}^{, Clifford Folmes}^{, Katherine Minter Dykhouse}^{, Sumbal Babar}^{, Yu-Hui Chang}^{, Rahul Pannala}^{, Rodrigo Cartin-Ceba}^{, Vijay P. Singh}^*

Author contributions: VPS designed, supervised and conceptualized the study. Acquisition, and analysis of data was facilitated and carried out by BEK, BK, CR, ST, CF, KMD, YHC, SB and VPS. BEK, BK, CR, RP,CF, CS, SK, RCS, ST, SB, VPS critically evaluated the manuscript. Interpretation of data was done by BEK, BK, CR, SK, YHC, ST and VPS. Manuscript was drafted by BK, CR, VPS. Statistical analysis was done by BEK, BK, CR, ST, YHC, and VPS. Funding was obtained by VPS.

Funding: This project was supported by the following findings: R01DK092460, R01DK119646 from the NIDDK and PR151612 from the DOD (VPS), Intramural support from the Mayo Foundation. Intramural funding from the MEGA award (RCC) also contributed to the project.

There are no conflicts of interest for any author.

Lay summary:

Maintenance of a normal serum calcium (e.g. by giving oral over the counter calcium carbonate), and normal serum albumin early during COVID-19 infection, may prevent the disease from becoming severe.

What you need to know:

Background and context: While most COVID-19 patients clear the infection, some develop severe disease with organ failure. Based on patterns associated with severe COVID-19, underlying mechanisms, we propose a simple, low risk supportive intervention.

New Findings: Unsaturated fat intake is associated with increased mortality from COVID-19. Unsaturated fatty acids cause injury, organ failure resembling COVID-19. Early albumin and calcium can bind unsaturated fatty acids, reduce injury.

Limitations: We do not have a clinical trial to support that “keeping a normal serum calcium and albumin all through COVID-19” improved mortality. Such a trial may be helpful in the future.

Impact: Both calcium and albumin are inexpensive, and easily available. If supplemented early during COVID-19 hospitalization, these may reduce organ failure and ICU requirements despite a lack of proven anti-viral therapies.

Footnotes