Use of 1-MNA to Improve Exercise Tolerance and Fatigue in Patients after COVID-19

  1. Michał Chudzik
  2. Monika Burzyńska
  3. Joanna Kapusta

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Abstract

COVID-19 is not only a short-term infection, as patients (pts) recovering from SARS-CoV-2 infection complain of persisting symptoms, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2. Methods: The study population was composed of 50 pts who had recovered from symptomatic COVID-19. The selected pts were randomized into two groups: Gr 1 (NO-1-MNA)—without supplementation; Gr 2 (1-MNA) with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment was performed using the Fatigue Severity Scale (FSS). Both FSS and 6MWT were repeated after 1 month. Results: A significant improvement in the mean distance covered in the 6MWT was noted at follow-up in Gr 1-MNA, compared with Gr NO-1-MNA. We also noted that in Gr 1-MNA, the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared with the beginning of the study (515.18 m in Phase 0 vs. 557.8 m in Phase 1; p = 0.000034). In Gr 1-MNA, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 m, compared with Gr NO-1-MNA (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared with the group with supplementation (Gr 1-MNA = 5 pts (20%) vs. Gr NO-1-MNA = 14pts (56%); p = 0.008). Conclusions: 1-MNA supplementation significantly improved physical performance in a 6-min walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.

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  1. Version published to 10.3390/nu14153004
  2. ScreenIT

    SciScore for 10.1101/2021.07.14.21259081: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationThe selected pts were randomized into two groups: At the beginning of the study (Phase 0), pts from both groups were given the following examinations: The FSS is a self-administered questionnaire for assessing the severity of fatigue in different situations over the past week.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The literature thus provides very significant evidence that MNA acts in a complex way, which could make it a valuable clinical adjunct to the treatment of fatigue and exercise limitation after COVID-19. Given the available evidence, the use of MNA to prevent inflammation damage associated with COVID-19 seems rational. The 6MWT has long been used in cardiac and pulmonary rehabilitation as an objective assessment of the physical capacity of patients and the effects of treatment, including training programs [35,36]. The test has also been used to study pts after contracting COVID-19 [37.38]. Numerous studies have shown improvements in the 6MWT walking distance among post-hospital patients [39.40,41]. However, there have been no published studies assessing the results for 6MWT in pts without hospitalization. In our study, population of non-hospitalized pts, the mean distance in the 6MWT of more than 500 meters was much higher than the distances reported for hospitalized patients (333 meters in Ahmed M Abodonya AM et al. [42] or 240 meters in Curci et al. [43]). Of course, this discrepancy may be due to the milder course of COVID-19. In Wonga’s [44] study on pts with mild COVID-19, the mean distance (491 meters) was similar to that in our study. The difference in the average distance we obtained with 1-MNA supplementation was comparable to the results for pulmonary rehabilitation (44 meters) after COVID-19 reported by Abodonya [42]. In a study by Spielmanns et al. [45], a group of...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04961476CompletedUse of 1-MNA to Improve Exercise Tolerance and Fatigue in Pa…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.14.21259081v1 on medRxiv