Pneumonia Associated with Low Vitamin C Levels and Elevated Oxidative Stress

by | Jun 30, 2020 | 2020, COVID-19, Lung Health, Respiratory Health, Vitamin C

Written by Angeline A. De Leon, Staff Writer. This study suggests that patients with pneumonia have depleted vitamin C levels and increased oxidative stress and would benefit from additional vitamin C supplementation.

lung healthPneumonia is a lower respiratory tract infection accounting for over 60 million hospitalizations each year and over 2 million deaths worldwide 1. For young children, the elderly, and certain ethnic groups with lower socioeconomic status, this lung disease is particularly concerning, in terms of mortality rate and prevalence 2,3. Vitamin C plays a vital role in supporting healthy immune function 4, and epidemiological research has linked lower respiratory tract infections with low vitamin C status 5. One longitudinal study reported that among almost 20,000 subjects, those in the top quartile of vitamin C status had a 30% lower risk of pneumonia 5. Case-control studies have also demonstrated an inverse association between vitamin C status and severity of pneumonia 6,7. Although controlled trials using vitamin C supplementation for pneumonia have been scarce, findings appear promising. For example, one intervention study observed that vitamin C intake at a dose of 200 mg per day was able to restore vitamin C status within 2 weeks and significantly diminish respiratory symptoms in patients with severe pneumonia and bronchitis 8. To further elucidate the link between vitamin C and pneumonia, a 2020 study 9 published in Nutrients investigated vitamin C status in patients with community-acquired pneumonia.

A total of 50 healthy controls (50% male, mean age = 57 years) and 50 hospital patients with community-acquired pneumonia (pneumonia acquired outside of hospitals or health care settings) (54% male, mean age = 68 years) who were admitted for hospital treatment were enrolled in an observational study. Non-fasting blood samples were collected within the first 24 hours of hospitalization and analyzed for plasma vitamin C levels and biomarkers of oxidative stress (protein carbonyl) using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Disease severity scores (Confusion Urea Respiratory Rate Blood Pressure, CURB-65 score) were calculated from admission records.

Results indicated a significantly lower vitamin C status among patients with pneumonia, compared to healthy controls (24 +/- 14 µmol/L vs. 56 +/- 24 µmol/L, respectively, p < 0.001), with about 96% of pneumonia patients showing inadequate vitamin C status (< 50 µmol/L).  Within the pneumonia cohort, those who were admitted to the ICU had significantly lower vitamin C status than those admitted to the acute medical assessment unit (11+/- 3 µmol/L vs. 24 +/- 14 µmol/L, respectively, p = 0.02). Protein carbonyl concentrations were also significantly elevated in pneumonia patients vs. healthy controls (468 +/- 305 pmol/mg protein vs. 159 +/- 39 pmol/mg protein, respectively, p < 0.001). Correlational analyses indicated a significant relationship between vitamin C status and systolic blood pressure (R = 0.33, p = 0.02) and between protein carbonyl concentration and CURB-65 score (R = 0.4, p = 0.006).

Overall findings provide evidence to support the association between vitamin C deficiency and pneumonia. In the current study, lower vitamin C status was apparent among patients with pneumonia, with lower levels associated with increased disease severity. Patients with pneumonia also exhibited elevated concentrations of protein carbonyl, confirming increased levels of oxidative stress. It is probable, based on findings, that patients diagnosed with pneumonia associated with COVID-19 would demonstrate similar deficiencies in vitamin C status and elevated levels of oxidative stress. Additional testing is needed to verify this, and intervention trials are warranted to evaluate the benefits of vitamin C supplementation in patients with pneumonia. Limitations of the current study relate to the use of non-fasting plasma samples to test for vitamin C levels, as well as a relatively small sample size and the measurement of only one biomarker to assess oxidative stress.

Source: Carr AC, Spencer E, Dixon L, et al. Patients with community acquired pneumonia exhibit depleted vitamin C status and elevated oxidative stress. Nutrients. 2020; 12: 1318. DOI: 10.3390/nu12051318.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/)

Click here to read the full text study.

Posted June 29, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

  1. Khang Y-H, and GBD 2016 Lower Respiratory Infections Collaborators. . Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious diseases. 2018;18(11):1191-1210.
  2. Burton DC, Flannery B, Bennett NM, et al. Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health. 2010;100(10):1904-1911.
  3. Chambers S, Laing R, Murdoch D, et al. Māori have a much higher incidence of community-acquired pneumonia and pneumococcal pneumonia than non-Māori: findings from two New Zealand hospitals. The New Zealand medical journal. 2006;119(1234):U1978.
  4. Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11).
  5. Myint PK, Wilson AM, Clark AB, Luben RN, Wareham NJ, Khaw KT. Plasma vitamin C concentrations and risk of incident respiratory diseases and mortality in the European Prospective Investigation into Cancer-Norfolk population-based cohort study. Eur J Clin Nutr. 2019;73(11):1492-1500.
  6. Chakrabarti B, Banerjee S. Dehydroascorbic acid level in blood of patients suffering from various infectious diseases. Proceedings of the Society for Experimental Biology and Medicine Society for Experimental Biology and Medicine (New York, NY). 1955;88(4):581-583.
  7. Bakaev VV, Duntau AP. Ascorbic acid in blood serum of patients with pulmonary tuberculosis and pneumonia. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2004;8(2):263-266.
  8. Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. International journal for vitamin and nutrition research Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung Journal international de vitaminologie et de nutrition. 1994;64(3):212-219.
  9. Carr AC, Spencer E, Dixon L, Chambers ST. Patients with community acquired pneumonia exhibit depleted vitamin C status and elevated oxidative stress. Nutrients. 2020;12(5):1318.