(Supplementary Figure 3).

3.3.3. Length of hospital stays

Five studies with 534 participants reported the effect of the immunomodulatory formula on hospital stays. There was non-significant pooled effects of the immunomodulatory supplementation on the length of hospital stays (WMD = -2.12 days, 95% CI: -7.56, 3.31, P=0.44) with high heterogeneity (Q statistic=36.96, Cochrane Q test, P<0.001, I2 =89.2%).

3.3.4. SOFA and MOD score

Three studies with 195 participants showed that the immunomodulatory formula resulted in decreased SOFA and MOD score in the intervention group compared to the control group (Hedge’s g =-0.42; 95%CI: -0.74, -0.11, P=0.008); between-study heterogeneity was low (Q statistic=2.24, Cochrane Q test, P=0.33, I2 =10.8%).

3.3.5. Overall 28 days mortality

Nine studies with 1104 participants showed that immunomodulatory diet was associated with decreased overall 28 days mortality of about 26% (relative risk = 0.74, 95%CI: 0.58, 0.91, P<0.001). The heterogeneity was low (Cochrane Q test=7.77, P=0.46, I2 =0.0%) (Figure 3) . The reduction in ALI and ARDS was more evident compared to other subgroups