Effect of educational intervention on knowledge and attitude about the role of vitamins, minerals and nutraceuticals in COVID-19 and other disorders among medical and nursing undergraduates of a tertiary care teaching hospital.

Shruti Singh: Conceptualization, Methodology, Software, Validation, Investigation, Data Curation, Writing - Original Draft, Writing - Review & Editing, Visualization, Supervision, Project administration Soni: Methodology, Software, Validation, Investigation, Resources, Pallavi Lohani: Methodology, Software, Validation, Formal analysis, Resources, Data Curation, Writing - Review & Editing, Visualization, Project administration Aakanksha Priya:Software, Investigation Alok Ranjan: Conceptualization, Methodology, Validation, Nirav Nimavat: Software, Formal analysis, Writing - Review & Editing, Visualization.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The study was conducted on 415 participants. Of 415 participants, 265 (63.8%) were medical undergraduates, and the remaining 150 (36.1%) were nursing undergraduates. Their mean age was 21.08 years (±1.70). There was an unequal distribution of study participants based on gender, as all the nursing students were female. Thus, almost three-a fifth (57.8%,240) of the participants were females compared to (175, 42.2%) males. Of the total study participants, 108 (26%), 110 (26.5%), 107 (25.8%) and 90 (21.7%) belonged to Ist, IInd, IIIrd and IVth year, respectively ( Table 1 ). Table 1 Knowledge of undergraduates about vitamins, minerals and DS in COVID-19 and other disorders before and after webinar [N = 415]. Table 1 Knowledge- based questions Pre-webinar n (%) Post-webinar n (%) P- value a Vitamins and minerals are included among nutraceuticals 219 (52.8) 320 (77.1) <0.00 Probiotics and Yoghurt are included among nutraceuticals 177 (42.6) 278 (67.0) <0.00 Phytoestrogens, Carotenoids, and Flavonoids are included among nutraceuticals 160 (38.5) 207 (49.9) 0.002 There are specific vitamins, minerals and DS that boost immunity against cough and cold 234 (56.3) 400 (96.4) <0.00 Vit C boosts immunity 341 (82.2) 371 (89.4) 0.002 Zinc boosts immunity 115 (27.7) 232 (55.9) <0.00 Vit D boosts immunity 21 (5.1) 175 (42.2) <0.00 Vit A boosts immunity 42 (10.1) 207 (49.9) <0.00 Vit E boosts immunity 22 (5.3) 197 (47.5) <0.00 Probiotics boost immunity 29 (7.0) 168 (40.5) <0.00 The dose of vitamins and minerals should be increased during infection 326 (78.6) 364 (87.7) <0.00 Nutraceuticals and herbal medicines are different 361 (87.0) 301 (72.5) <0.00 a Chi-square test was used to calculate P- value. Knowledge of undergraduates about vitamins, minerals and DS in COVID-19 and other disorders before and after webinar [N = 415]. Chi-square test was used to calculate P- value. Significant improvement in the knowledge of the participants regarding DS was noted post-webinar. The knowledge that not just vitamins and minerals but probiotics and yoghurt, phytoestrogen carotenoids and flavonoids are also included among nutraceuticals improved significantly among the participants. Before the webinar, only around half of the participants (219, 52.8%) knew the components of nutraceuticals, which increased significantly post-webinar. A more significant proportion of participants became aware that vitamins and minerals (320, 77% p < 0.00) are included among nutraceuticals. An increased number of participants (234, 56.3% vs 400, 96.4%, p < 0.00) gained knowledge that some specific vitamins and minerals boost immunity against cough and cold. Almost 326 (78.6%) participants out of 415 knew that the dose of Vitamins, Minerals, and DS needs to be increased during infection before the webinar. However, the proportion still improved to around 364 (87.7%) after the webinar (p < 0.00). ( Table 2 ). Table 2 Comparison of mean knowledge score before and after webinar [N = 415]. Table 2 Background Characteristics Pre-webinar mean score Post- webinar mean score Difference in mean score t/F value (df) P- value mean (+SD) mean (+SD) mean (+SD) Overall 4.95 (1.45) 7.76 (1.69) 2.80 (2.07) 27.59 (414)∗ <0.00∗ Course  Medical 5.21 (1.40) 8.23 (1.60) 3.02 (2.06) 8.25 (1413) # 0.0043 #  Nursing 4.51 (1.43) 6.93 (1.54) 2.42 (2.03) Gender  Female 5.21 (1.44) 8.19 (7.96) 2.98 (2.01) 2.24 (1413) # 0.1349 #  Male 4.77 (1.43) 7.44 (1.71) 2.67 (2.41) Year- wise  1st 4.27 (1.28) 7.33 (1.68) 3.06 (2.10) 2.41 (3, 411) # 0.066 #  2nd 4.78 (1.37) 7.74 (1.64) 2.95 (2.17)  3rd 5.18 (1.23) 7.97 (1.59) 2.79 (1.71)  4th 5.72 (1.55) 8.04 (1.82) 2.32 (2.25) ∗paired t- test, T- statistics, # One-way ANOVA, F- statistics. Comparison of mean knowledge score before and after webinar [N = 415]. ∗paired t- test, T- statistics, # One-way ANOVA, F- statistics. Before the webinar, the overall score was 4.95 (SD ± 1.45, 95% CI 4.814327–5.094107), which improved significantly to 7.76 (SD ± 1.69, 95% CI 7.595448–7.922624) after the webinar (p < 0.00). The positive impact of the webinar was evident through an improvement in knowledge score of approximately 3 points. Significant improvement in post-webinar score was observed across all traits. Table 2 shows that the increase in knowledge score was more notable for medical students (3.02) than nursing students (2.42, p = 0.0043). Although insignificant, the mean pre- and post-webinar scores and the improvement in scores were better for female students than male students. The pre-and post-webinar scores of final-year students were the best of all years (5.72 (±1.55) vs (8.04 (±1.82)). The improvement of knowledge following the webinar was the greatest for the 1st year students (3.06 (±2.10). ( Table 3 ). Table 3 Attitude of undergraduates about vitamins, minerals and DS in COVID-19 and other disorders before and after webinar [N = 415]. Table 3 Attitude based questions related to Nutraceuticals, vitamins and minerals Pre-webinar n (%) Post-webinar n (%) P-value Agree Neutral Disagree Agree Neutral Disagree Vitamin D has a role in COVID 19 41 (9.9%) 141 (34.0%) 233 (56.1%) 188 (45.3%) 43 (10.4%) 184 (44.3%) <0.00 Vitamin C has a role in COVID-19 290 (69.9%) 51 (12.3%) 74 (17.8%) 369 (88.9%) 29 (7.0%) 17 (4.1%) <0.00 Zinc has a role in COVID-19 85 (20.5%) 56 (13.5%) 274 (66.0%) 226 (54.5%) 68 (16.4%) 121 (29.2%) <0.00 Adequate intake of vitamins and minerals has a positive role in protecting against various disorders (unrelated to COVID-19) 330 (79.5%) 12 (2.9%) 73 (17.6%) 380 (91.6%) 6 (1.4%) 29 (7.0%) <0.00 Adequate intake of vitamins and minerals has a positive role in protecting against COVID-19 306 (73.7%) 09 (2.2%) 100 (24.1%) 372 (89.6%) 06 (1.4%) 37 (8.9%) <0.00 Need for events educating people about the role of vitamins and minerals in various disorders (Not related to COVID-19) 363 (87.5%) 01 (0.2%) 51 (12.3%) 379 (91.3%) 04 (1.0%) 32 (7.7%) 0.052 Favourable changes in views regarding the role of dietary supplements in various COVID_ 19/non-COVID_ 19 related conditions due to the current pandemic 304 (73.2%) 17 (4.1%) 94 (22.6%) 352 (84.8%) 09 (2.2%) 54 (13.0%) <0.00 More likely to invest in research about the potential of vitamins and minerals and their appropriate usage because of the current pandemic? 287 (69.16%) 11 (2.6%) 117 (28.2%) 361 (87.0%) 08 (1.9%) 46 (11.1%) <0.00 Dietary supplements cannot substitute nutrients from natural food 175 (42.2%) 119 (28.7%) 121 (29.2%) 208 (50.1%) 92 (22.2%) 115 (27.7%) 0.049 Need for more events educating people about the role of vitamins and minerals and their appropriate usage in COVID-19 367 (88.4%) 03 (0.7%) 45 (10.8%) 382 (92.0%) 02 (0.5%) 31 (7.5%) 0.056 The safety of vitamins and minerals is an important consideration 259 (62.4%) 13 (3.1%) 143 (34.5%) 299 (72.0%) 31 (7.5%) 85 (20.5%) 0.001 Attitude of undergraduates about vitamins, minerals and DS in COVID-19 and other disorders before and after webinar [N = 415]. Similarly, the participants’ attitudes regarding the role of Vitamins, Minerals and DS in COVID-19 and other disorders were ascertained. The improvement in their attitudes was compared before and after the webinar. Significant improvement in positive attitude was noted across all the categories. Before the webinar, only (41)9.9% and (85)20.5% of participants respectively agreed to the fact that Vitamin D and Zinc have a role in COVID- 19, which improved to (188)45.3%, p < 0.00 and (226)54.5% p < 0.00 respectively, post-webinar. A more significant proportion (290, 69.9%) of the students agreed that Vitamin C has a role in COVID-19 even before the webinar, and this proportion further increased to (369)88.9% after the webinar (p < 0.00). Before the webinar, more than three-fourths of the participants (330, 79.5%) agreed that adequate intake of vitamins and minerals has a positive role in non-COVID-related disorders as well as in COVID- 19. Post-webinar (380), 91.6% of the undergraduates now agreed to the same (p < 0.00). After the webinar (379), almost 91.3% of the students felt that there was a need for more webinars to impart knowledge about the role of Vitamins and Minerals in COVID- 19 and other disorders. The proportion of students feeling that the pandemic had changed their perception of the part of dietary supplements in COVID-19 and other diseases increased significantly (73.2%–84.8%)) after the webinar. A similar increase could be appreciated in the research orientation of the students, with (361)87% of the students agreeing that they would educate themselves about DS due to the substantial evidence surrounding DS during the c 19 pandemic. The percentage of students who felt that the safety of nutraceuticals was a vital concern increased from 62.4% (259) to 72% (299) as a result of the webinar (p 0.001). ( Table 4 ). Table 4 Difference in mean attitude scores before and after the webinar [N = 415]. Table 4 Background Character istics Pre-webinar mean score Post-webinar mean score Difference in mean score t/F value (df) P- value mean (+SD) mean (+SD) mean (+SD) Overall 31.8 (5.57) 27.7 (4.90) 4.1 (7.10)∗ 11.81 (414)∗ <0.00∗ Course  Medical 32.3 (5.79) 27.7 (4.98) 4.6 (7.39) 3.24 (1, 413) # 0.0727 #  Nursing 30.9 (27.62) 27.6 (4.78) 3.3 (6.49) Gender  Female 31.4 (5.24) 27.6 (4.71) 3.8 (6.47) 1.33 (1413) # 0.2496 #  Male 32.4 (5.97) 27.8 (5.16) 4.6 (7.89) Year- wise  1st 32.1 (5.52) 27.9 (4.17) 4.3 (6.62) 0.47 (3411) # 0.7031 #  2nd 31.1 (5.26) 27.3 (5.16) 3.8 (7.18)  3rd 31.5 (5.36) 27.8 (5.02) 3.7 (6.85)  4th 32.69 (6.17) 27.9 (5.28) 4.8 (7.89) ∗paired t- test, T- statistics, # One-way ANOVA, F- statistics. Difference in mean attitude scores before and after the webinar [N = 415]. ∗paired t- test, T- statistics, # One-way ANOVA, F- statistics. Like the knowledge score, attitude was also scored. Overall, the attitude score decreased significantly from a mean of 31.8(SD ± 5.57, 95% CI 31.27435 32.34974) to 27.7 (SD ± 4.90, 95% CI 27.22083 28.16712, p < 0.00). The decrease in the mean attitude score signifies an increase in a positive attitude towards DS. Similar to knowledge scores, the difference in mean attitude scores of medical students (4.6 (±7.39)) was more compared to nursing students (3.3 (SD ± 6.49)) (p 0.0727). ( Table 5 ). Table 5 Correlation between Knowledge and attitude before and after webinar [N = 415]. Table 5 Background Characteristics Correlation Coefficient Pre test P- value Correlation Coefficient Post- test P- value Overall 0.0054 0.913 −0.0701 0.1542 Course  Medical −0.0875 0.1556 −0.1274 0.0383  Nursing 0.075 0.3618 0.0364 0.6585 Gender  Female −0.0903 0.2345 −0.1433 0.0586  Male 0.0495 0.4448 −0.0225 0.7282 Year- wise  1st −0.043 0.6588 −0.0852 0.3805  2nd −0.0386 0.6886 −0.0224 0.8167  3rd 0.0709 0.468 0.009 0.9264  4th −0.0069 0.9483 −0.2125 0.0443 Correlation between Knowledge and attitude before and after webinar [N = 415]. The correlation between knowledge and attitude scores was compared before and after the webinar. As already stated, a lower attitude score depicts a positive attitude and a higher knowledge score, better knowledge. Thus, a negative correlation was expected between the two scores. Overall, a positive correlation coefficient (0.0054) before the webinar changed to a negative correlation coefficient (−0.0701) following the webinar. Additionally, an increase in the strength of correlation was also observed. A significant change in the strength of correlation coefficient was noted in medical students only (p 0.0383). ( Table 5 ).

N/A.

There was a significant improvement in the knowledge and positive attitude of the students after attending the webinar. The pre-webinar scores suggested that very few participants knew the role of probiotics in boosting immunity. Another cross-sectional Knowledge, Attitude and Practice (KAP) study about probiotics in HCPs found a similar trend, with only 15% of participants having good knowledge about their utility. However, the same study did find that a significantly greater proportion of people (89.1%) had a positive attitude towards probiotics. This is clear evidence that people are generally aware of the potential of probiotics and other DS but do not invest in them because they lack appropriate knowledge and clear guidelines [ [21] , [22] , [23] ]. After our webinar, almost 67% of participants became aware that even probiotics are included among nutraceuticals, not just vitamins and minerals. With recent studies finding a positive correlation between gut health and overall quality of life, adding probiotics to the daily diet seems to be a simple and cost-effective strategy for optimising health. Recent studies have concluded that the outcome of patients hospitalized with COVID-19 infection is significantly associated with their nutritional status and supplementation with DS in the deficient population can markedly affect disease incidence and morbidity [ 24 , 25 ]. However, the results of the current study have shown that we need to actively invest in mass education about the role of a balanced diet containing essential micronutrients (vitamins A, D, E and Zinc etc.) in adequate quantities, as appropriate knowledge about these key nutrients seemed lacking before the webinar. The knowledge about the role of vitamin C in boosting immunity was already high before the webinar, but it still increased significantly post-webinar (p = 0.002). After the webinar, almost 88.9% of participants agreed that vitamin C also has a role in COVID-19, which is contrary to the findings of another KAP study conducted in the Lebanese population, where the percentage of participants’ agreeing about the ability of vitamin C supplements to protect them from the flu decreased from 21.6% to 21.3% during the pandemic [ 18 ]. There was a significant improvement in the overall knowledge score of the undergraduates from 4.45 to 7.76 after the webinar. This is a welcome development, as these students will one day be actively involved in patient care and can exert positive change in popular health-related practices. The pre-webinar score of nursing students was less than their medical counterparts, and there was also a significantly greater improvement among medical students in contrast to nursing students as a result of the webinar, exposing the target area where more educational intervention for improving knowledge about DS was required. Nursing officers have the closest relationship with patients. They could motivate their patients to have a healthy diet rich in nutrients and use DS appropriately whenever prescribed. The greatest improvement in the knowledge score could be appreciated in 1st-year students followed by 2nd, 3rd and final-year students. Very few classes are devoted to teaching the physiology and pharmacology of nutrients so early in the curriculum of medical and nursing students. We can incorporate more lectures in the 1st year itself so that by the time the students pass out, a firm understanding of the physiological role, appropriate usage, indications and contraindications of vitamins and minerals, and the need for their supplementation can be expected. It is a surprise that even after so much focus on Zinc and Vitamin D during the COVID-19 pandemic, more than 50% of students disagreed that these nutrients could have a role in COVID-19 and other disorders before the webinar. The webinar greatly impacted the attitude regarding the role of vitamin D and zinc in COVID-19. However, despite the webinar, the proportion of students agreeing and disagreeing that vitamin D had a role in COVID-19 was almost the same, i.e. 45% and 45%. This indicates that information and attitude about the role of vitamin D, zinc, probiotics etc., is seriously lacking among students; an area around which specific learning objectives can be designed. Other recently concluded KAP studies among University students have also found moderate to low knowledge and unfavourable attitude about vitamin D and vitamin D supplements [ 26 ]. The study uncovered an unmet need among medical and nursing students for useable nutraceutical information. Almost 90% agreed before and after the webinar that continuing medical education in this area would be highly appreciated. A greater proportion of participants felt motivated to research this field after the webinar, indicating a change in the belief pattern for vitamins, minerals and DS. Almost 85% of students felt after the webinar that their views regarding the potential of vitamins and minerals had changed for the better because of the pandemic; an important contribution of the pandemic, albeit at a great cost [ 27 ]. A recently concluded KAP study also reported an improvement in the participants’ attitude towards the role of DS in supporting good health during the pandemic (p < 0.001). The same study reported a drastic improvement in its participants' belief in the ability of DS to promote immunity, a finding consistent with our study [ 18 ]. A greater proportion of students (72%) agreed post-webinar that the safety of nutraceuticals was an important consideration, and almost 50% agreed that DS could not take the place of a nutrient-rich diet for better health; in contrast to another study where the percentage of participants agreeing to the fact that DS could replace food nutrients increased significantly after the emergence of the COVID- 19 pandemic [ 18 ]. Studies in the past have reported a greater belief among university students of United Arab Emirates on the value of a combination of DS and food together to maintain good health [ 28 ]. Like all other medicines, even DS may cause side effects, modify the effect of other medications and produce idiosyncratic responses due to a person's specific pharmacogenetics and add to the monetary burden of consumers. People need to be educated about their appropriate usage, doses and side effects, e.g. vitamin c that is so commonly self-prescribed, may be associated with oxalate, cysteine and urate kidney stones. Therefore, the need for supplementation to correct micronutrient deficiencies in an individual needs to be carefully evaluated, and self-medication needs to be strongly discouraged. Taking supplements at their RDA should be the standard practice unless otherwise indicated [ 29 , 30 ]. Indeed, multivitamins cannot be a one-stop solution for optimum health. However, an average person's diet is usually unable to fulfil all his RDAs for key nutrients. Also, certain population groups, such as the elderly, might not be able to absorb all the nutrients from their diet. Therefore, the judicious use of nutraceuticals under physician guidance might be beneficial in the long run. Nevertheless, DS come with risks, and a balance must be there between food and dietary supplements [ 31 ]. The strongly negative overall correlation coefficient between knowledge and attitude emphasises that the webinar had an overall positive impact. However, the correlation between knowledge and attitude remained positive among nursing students. Nursing students could benefit from focused teaching and training regarding the potential role of key vitamins, minerals and DS in COVID-19 and other disorders. In conclusion, educating the public about a nutrient-rich diet and the potential of DS should be made a priority by health policymakers. People should be made aware that for maximum benefit, most nutrients should be derived from food, and DS should be used only when indicated, in recommended doses. There needs to be a lot more focus on Nutraceutical research. The role that vitamins, minerals and nutraceuticals play in various diseases and pharmacogenetically diverse populations need to be elucidated. Data regarding factors favouring and deterring appropriate nutraceuticals must be generated. Informed decisions can only be made when evidence-based information regarding the benefits and harms of DS is constantly updated and readily available. KAP studies incorporating educational interventions can help raise awareness and generate comprehensive data that might impact policy decisions and guidelines.

An analytical cross-sectional study was conducted among medical and nursing undergraduates in a tertiary care teaching hospital in North India. All the consenting undergraduates were consecutively enrolled in the study. Their knowledge and attitude about the utility of DS were assessed using a semi-structured, self-administered online-based google form. A webinar immediately followed this. The topics included in the webinar were related to the mechanisms by which vitamins and minerals (vitamin A, E, C, D, Zinc and probiotics) helped in COVID-19 and non-COVID-19 related disorders, their indications, recommended dosages, toxicities and evidence-based guidelines. An assessment that included the same set of questions was repeated, immediately after the webinar, on the same students who had appeared for the pre-test and attended the webinar. The details of the methodology are presented in another paper [ 20 ]. The data was conceived on a google spreadsheet, transferred to an excel sheet and analysis was done on STATA 12.0. The background details of the study participants were asked in the first section; age, gender, course (medical/nursing), year of enrolment in the course, diet preference, addiction to smoking and daily exercise duration. In the second section, the participant's knowledge about the components and benefits of nutraceuticals was assessed using a set of 12 questions. Each question was graded as true or false. The responses were scored as “0” for wrong answers and “1” for correct responses. The difference in pre and post-webinar percentages was analyzed by the chi-square test and fisher's exact test. In the third section, the participant's attitude towards the usage, benefits, and safety of DS was assessed on the Likert scale of strongly agree to disagree, using a set of 11 questions. The attitude was converted to quantitative data by assigning scores; 1 to agree and strongly agree, 2 to neutral, and 3 to disagree and strongly disagree. The lower the attitude score, the higher the probability of a positive attitude. Each individual's score was summed up to get their respective knowledge and attitude score, and with an increase in knowledge score, it was understood that the attitude score should decrease. To calculate significance, the pre-and post-webinar knowledge and attitude scores were compared using the student's t-tests and One-way ANOVA. The findings of the pre-webinar assessment and study details are already presented. Questions and recorded as agree, neutral and disagree. The normality of scores was assessed by visual inspection of the Q- Q plot. The scores had non-normal distribution; therefore, the spearman's correlation coefficient was calculated between knowledge and attitude both before and after the webinar, and the significance of the difference was calculated separately.

The coronavirus disease 2019 (COVID-19) pandemic brought into sharp focus the role of nutrition in the optimal functioning of the human body. Non-pharmacological preventive approaches such as masks, handwashing, sanitisers, and immunity-boosting measures were the mainstay in the battle against the disease. In this scenario, the consumption of DS, defined by the United States Food and Drug Administration (FDA) as non-drug products intended to supplement the diet with vitamins, minerals, herbs, and amino acids, reached an all-time high [ 1 , 2 ]. An increased dependency upon Nutraceuticals (Nutritional pharmaceuticals), that include DS, was observed among the general population despite there being insufficient evidence of a favourable correlation between DS and COVID-19 disease prevention or treatment [ 3 ]. However, the role of certain vitamins and minerals such as vitamin D, vitamin A, zinc and probiotics in COVID-19 and other disorders has recently become better validated. Several well-conducted Randomized Controlled Trials (RCTs) and observational studies comparing the incidence of the disease among vitamin D-deficient and non-deficient populations have concluded that there does seem to be a role of vitamin D in COVID-19. Hypovitaminosis D is strongly predictive of COVID- 19 disease incidence, severity and mortality. Recent evidence also supports the beneficial effect of vitamin D in autoimmune disorders [ [4] , [5] , [6] , [7] ]. Vitamin C, with its antiviral immunomodulatory and antioxidant properties, has been extensively studied in COVID-19, and studies have reported that high dose intravenous vitamin C can reduce the number of ICU days, duration and intensity of septic shock and Acute Respiratory Distress Syndrome (ARDS) and the burden of inflammatory biomarkers in COVID-19 [ [8] , [9] , [10] , [11] , [12] ]. COVID-19 infection-induced microbial dysbiosis and resultant systemic inflammation and decreased adaptive immunity suggest that probiotics may improve outcomes in infected individuals [ 13 , 14 ]. Similarly, curcumin, which is isolated from turmeric, has been identified to have remedial actions against SARS-CoV-2 through the molecular docking method [ 15 ]. Low levels of micronutrients have been associated with adverse clinical outcomes during viral infections. Therefore, to maximise the nutritional defence against infections, a daily allowance of vitamins and trace elements for malnourished patients at risk of or diagnosed with (COVID-19) may be beneficial. Recent studies on COVID-19 patients have shown that vitamin D and selenium deficiencies are present in patients with acute respiratory tract infections. Vitamin D improves the physical barrier against viruses and stimulates the production of antimicrobial peptides. It may prevent cytokine storm by decreasing the production of inflammatory cytokines. Selenium enhances the function of cytotoxic effector cells. Furthermore, selenium is important for maintaining T cell maturation and functions and for T cell-dependent antibody production. Vitamin C is considered an antiviral agent as it increases immunity. Administration of vitamin C increased the survival rate of COVID-19 patients by attenuating excessive activation of the immune response. Vitamin C increases antiviral cytokines and free radical formation, decreasing viral yield. It also attenuates excessive inflammatory responses and hyperactivation of immune cells. This mini-review discusses the roles of vitamin C, vitamin D, and selenium in the immune system and COVID-19. Several bioactive peptides in yoghurt have ACE inhibitory, bradykinin potentiating, antiviral, anti-inflammatory, antioxidant and anti-thrombotic effects that attenuate the symptoms of COVID-19 [ 16 ]. Similar pieces of evidence with various other micronutrients such as zinc, selenium, omega fatty acids and isoflavones have also started coming up, advocating their role in COVID-19 [ 17 ]. With all this evidence, it is understandable that patients have now started relying more and more on natural supplements rather than diet as quick fixes and viable preventive and therapeutic options. The sale of certain supplements has increased by over 400% [ 18 ]. However, the random consumption of nutraceuticals with little to no information regarding rationale, dosage frequency and side effects can have detrimental effects, e.g. Isoflavone induced endometriosis in women, impaired coagulation profile in patients who are consuming fish oils along with anticoagulants etc., especially in those who are overusing, self-medicating and blindly substituting food with DS. The Dietary Supplement Health and Education Act (DSHEA) of 1994 mandates that DS should be completely devoid of adulteration. However, supplement manufacturers are not required to provide any proof of quality to the FDA. This has led to an overabundance of substandard DS, with false ingredients, heavy metal contamination etc., in the market [ 19 ]. Needless to say, the toxicity of DS is not a subject that can be overlooked. There is no doubt in the fact that vitamins, minerals and other nutrients not only protect against infectious diseases via a variety of mechanisms but are integral for overall holistic health. Recently, several studies have validated the role of vitamins and minerals in COVID-19. DS does help in replenishing these nutrients if taken for appropriate indications and in the right dosages. In this context, educating HCPs and students who have a vital role in creating public awareness and understanding about the role of vitamins and minerals in various disorders has a far-reaching impact on health-related population parameters. Based on a literature search, we concluded that research to assess the impact of a webinar on knowledge and awareness about the usage of dietary supplements among health professionals in the COVID era, specifically in the Northeastern region of the country, has not been done. Therefore, this study was planned to make medical and nursing students of tertiary care teaching hospitals in Bihar, India, aware of the evidence and recommendations surrounding the role of vitamins, minerals and DS in COVID-19 and other disorders. We also aimed to facilitate an attitude change through a webinar so that Nutrition could be prioritised and the detrimental effects of DS attenuated by imparting proper information regarding their indications and side effects. Additionally, to assess the impact of the webinar, Knowledge and Attitude scores were taken both before and after the webinar. Does a webinar on dietary supplements conducted for medical and nursing undergraduates of a tertiary care centre impact their knowledge and attitude about the same? A webinar on dietary supplements conducted for medical and nursing undergraduates of a tertiary care centre impacts their knowledge and attitude about the same. 1. To facilitate an attitude change through a webinar so that Nutrition can be prioritised and the detrimental effects of DS attenuated by imparting helpful information regarding their indications and side effects. 2. To assess the impact of a webinar on the Knowledge and Attitude scores of students. To facilitate an attitude change through a webinar so that Nutrition can be prioritised and the detrimental effects of DS attenuated by imparting helpful information regarding their indications and side effects. To assess the impact of a webinar on the Knowledge and Attitude scores of students.

None.