Comment on "Western Dietary Pattern Antioxidant Intakes and Oxidative Stress: Importance during the SARS-CoV-2/COVID-19 Pandemic".

Dear Editor:

In an article published in Advances in Nutrition, Trujillo-Mayol et al. (1) present their argument for increasing dietary antioxidant intake to improve coronavirus disease 2019 (COVID-19) outcomes. In it, they conclude: “Although evidence remains scarce, there is some indication that a healthy diet, along with supplemental antioxidant intake, is beneficial to COVID-19 patients.” Although there is strong consensus favoring diets high in vegetables, and it makes sense that people might have better outcomes from COVID-19 if well-nourished, this is a troubling statement. Without direct evidence, a more circumspect conclusion than “is beneficial” would have been more appropriate. Moreover, the authors do not include in the balance of their analysis the aggregate data on antioxidant supplementation, which include reports of harm, and which have led the NIH National Center for Complementary and Integrative Health to issue cautions such as “high-dose supplements of antioxidants may be linked to health risks in some cases” (2).

Statements that concern public health interventions should always be made scrupulously, even if they are consistent with the general consensus. This is particularly acute at a time when we are dealing with a pandemic that has much of the population quite scared, searching for ways to control their susceptibility to COVID-19 infection, and hence they may be more likely to feel betrayed when it is divulged that the theory about which they were excited did not represent hard science.

It should also be noted that the authors reference numerous narrative reviews as fact citations throughout the article. Fact references should be primary research, ideally, or meta-analysis, or at least systematic review. Narrative reviews may be cited for the conclusions of the authors when the inclusion of opinion is desired. But then the text should reflect this. Given the likelihood that the casual reader will not be checking the references, it is the responsibility of the authors, the reviewers, and the editors to take extreme care to properly reference and to call out the strength of the studies cited.

The credibility of science has been under attack for decades. We strongly defend the publication of theoretical arguments that can educate and spur research, but these should be clearly labeled as such. They should be described as potentially making for interesting further study, and not serve as news during a terrifying pandemic as has happened with other COVID-related nutrition reporting (3–5). Derivative theory, presented as truth, or even as suggestive of possible effect, may only serve to diminish trust in science, and may cause harm to those whom we hope to help. Editorial and peer review should include assessment of use of proper citation. We applaud the desire to take action; however, doing so without recognizing the limitations of science increases the risk of introducing bias.