Role of nutrient supplements in children with post-COVID condition: a retrospective preliminary observation and narrative review, 2025, Morello et al

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Role of nutrient supplements in children with post-COVID condition: a retrospective preliminary observation and narrative review

Rosa Morello, Cristina De Rose, Laura Martino, Francesca Raffaelli, Giuseppe Zampino, Piero Valentini & Danilo Buonsenso

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Background
Post-COVID Condition (PCC), emerging as a significant long-term consequence of SARS-CoV-2 infection, affects not only adults but also the pediatric population. Despite ongoing research, the precise pathophysiology of PCC remains elusive. However, several putative mechanisms have been identified, leading to the exploration of various therapeutic strategies.

Notably, in the adult population, there has been substantial interest in the potential efficacy of nutritional supplements. Regrettably, information regarding the use of such supplements in the pediatric population is currently lacking.

Methods
The present study was conducted to assess the impact of nutritional supplements on alleviating long COVID symptoms in children. To achieve this, we conducted a retrospective analysis of nutrient supplements administered by parents to children with Post-COVID Condition (PCC) between February 2020 and October 2022. Statistical analyses were employed to determine associations between categorical variables.

Results
A total of 1243 children were enrolled following documented SARS-CoV-2 infection, with 940 (76.2%) diagnosed as recovered and 294 (23.8%) diagnosed with Long COVID.

Among Long COVID patients experiencing disabling symptoms, treatment with oral lactoferrin and/or a Multi-Element Product (MEP) with antioxidant and anti-inflammatory properties was initiated.

The correlation analysis between the use of supplements and persistence of long COVID at the next follow-up showed that the use of MEP alone (OR 5.7, 95% CI 3.8–8.5), or the combination of MEP and lactoferrin (OR 5.06, 95% CI 3.3–7.6) three months after the initial infection and for the following three months, were associated with a lower risk having long covid at six months following initial infection, when compared with the use of lactoferrin alone (OR 7.6 95% CI 5.1–11.4).

Conclusions
This proof-of-concept study revealed that MEP and lactoferrin, when administered three months after initial infection in patients with a new diagnosis of long covid, may have a positive impact on improving Long COVID symptoms in children during follow-up evaluations. This positive trend toward reducing Post-COVID Condition (PCC) exhibited by MEP and lactoferrin suggested a potential benefit worthy of exploration in future randomized controlled trials.

Link | PDF (Italian Journal of Pediatrics) [Open Access]
 
Initially in our Post-COVID Unit, in patients with persistent and disabling symptoms, oral lactoferrin and/or Multi-Element Product (MEP) were recommended (chewable tablets once a day for 90 days), based on the assessing physician decision.

Lactoferrin’s complete composition is: Lactoferrin; corn maltodextrin; anticaking agents (magnesium salts of fatty acids, silicon dioxide.); capsule in hydroxypropyl methylcellulose.

MEP’s complete composition is: magnesium 200 mg, quercetin 150 mg, curcumin Meriva®100 mg, resveratrol 20 mg, vitamin E 15 mg, zinc 5 mg, folic acid 90 µg, selenium 55 µg, cholecalciferol 20 µg in one tablet.
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The main limitation of this study is its retrospective nature. which limits the ability to establish causality, and the potential impact of selection bias, recall bias and other biases that may have affected results. In addition, all patients with persistent, disabling symptoms were treated, without a control group. Therefore, we cannot define if the improving trend observed with MEP is due to medication or spontaneous improvement of symptoms over time. Another consideration might be that lactoferrin was used as a therapeutic strategy already in children infected with the pre-omicron variant, which was an independent risk factor for persistent symptoms. In addition, multivitamins were given as supportive treatment, but the patients’ initial vitamin levels are unknown. The effect obtained may be due to baseline vitamin insufficiency, either pre-existing or triggered by the initial viral infection. Last, not a sufficiently high number of patients were treated with one of the different pharmacological approaches at the other timepoints, therefore we could limit our analyses only to patients diagnosed and treated at 3 months following initial infection.
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Additionally, would parents keen on giving more supplements also be more likely to facilitate and optimise a child's rest and recovery?
 
I may be getting confused but to me it makes no sense to evaluate the effect of supplementation without actually measuring the subjects’ levels before and after.

They discuss potential deficits and possible benefits of extra supplementation beyond minimal requirements without knowing if any of the subjects had any deficits or if their regimen increased levels of the target supplement in the body.

As with ME/CFS we need good data on whether there are any deficits present and are such deficits following a different pattern than we would expect in a non ME/CFS or non Covid population. Does supplementation reverse any such deficits, is ongoing supplementation required to prevent return to deficit and does this correction impact the relevant condition/symptoms. For example I suffer from B12 deficiency the symptoms of which when in deficit overlap with my ME symptoms, so reversing any deficit has the short term effect of apparently improving my ME, however once out of deficit supplements don’t subjectively have any further impact other than preventing return to deficit.

We need good data to be able to say if people with ME/CFS or in this case Long Covid are more likely to experience deficits than others, and if so is this directly related to their condition or an indirect consequence of such as being unable to access appropriate nutrition. And these questions need answering prior to or alongside asking if higher than normally required levels have any therapeutic impact on the target condition(s).

I wonder if this study design was largely to take advantage of existing circumstances as even the authors seem to agree it is less than satisfactory. I think, especially given the resources so many patients expend on supplements we need to know if we are looking at just good nutrition giving a good basis for people to live well with their condition when practical support to eat well may be what is required or if there are as often asserted any real condition specific therapeutic effects of going beyond this.
 
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