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Diet quality and risk and severity of COVID-19: a prospective cohort study.
Gut. 2021 Nov; 70(11):2096-2104.Gut

Abstract

OBJECTIVE

Poor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation.

DESIGN

We used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively.

RESULTS

Over 3 886 274 person-months of follow-up, 31 815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR 0.91; 95% CI 0.88 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation.

CONCLUSIONS

A diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

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Authors+Show Affiliations

Merino J
Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Department of Medicine, Harvard Medical School, Boston, MA, USA.
Joshi AD
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Nguyen LH
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Leeming ER
Department of Twin Research, King's College London, London, UK.
Mazidi M
Department of Twin Research, King's College London, London, UK.
Drew DA
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Gibson R
Department of Nutritional Sciences, King's College London, London, UK.
Graham MS
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Lo CH
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Capdevila J
Zoe Limited, London, UK.
Murray B
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Hu C
Zoe Limited, London, UK.
Selvachandran S
Zoe Limited, London, UK.
Hammers A
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK. King's College London & Guy's and St Thomas' PET Centre, King's College London, London, UK.
Bhupathiraju SN
Department of Medicine, Harvard Medical School, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Sharma SV
Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Houston, Texas, USA.
Sudre C
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Astley CM
Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Division of Endocrinology & Computational Epidemiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Chavarro JE
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Kwon S
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Ma W
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Menni C
Department of Twin Research, King's College London, London, UK.
Willett WC
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Ourselin S
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Steves CJ
Department of Twin Research, King's College London, London, UK.
Wolf J
Zoe Limited, London, UK.
Franks PW
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Lund, Sweden.
Spector TD
Department of Nutritional Sciences, King's College London, London, UK.
Berry S
Department of Nutritional Sciences, King's College London, London, UK.
Chan AT
Clinical and Translational Epidemiological Unit, Massachusetts General Hospital, Boston, MA, USA achan@mgh.harvard.edu. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

MeSH

AdolescentAdultAgedCOVID-19DietDiet SurveysDiet, HealthyFemaleHumansMaleMiddle AgedProspective StudiesRisk FactorsSeverity of Illness IndexSocioeconomic FactorsSurveys and QuestionnairesYoung Adult

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34489306

Citation

Merino, Jordi, et al. "Diet Quality and Risk and Severity of COVID-19: a Prospective Cohort Study." Gut, vol. 70, no. 11, 2021, pp. 2096-2104.
Merino J, Joshi AD, Nguyen LH, et al. Diet quality and risk and severity of COVID-19: a prospective cohort study. Gut. 2021;70(11):2096-2104.
Merino, J., Joshi, A. D., Nguyen, L. H., Leeming, E. R., Mazidi, M., Drew, D. A., Gibson, R., Graham, M. S., Lo, C. H., Capdevila, J., Murray, B., Hu, C., Selvachandran, S., Hammers, A., Bhupathiraju, S. N., Sharma, S. V., Sudre, C., Astley, C. M., Chavarro, J. E., ... Chan, A. T. (2021). Diet quality and risk and severity of COVID-19: a prospective cohort study. Gut, 70(11), 2096-2104. https://doi.org/10.1136/gutjnl-2021-325353
Merino J, et al. Diet Quality and Risk and Severity of COVID-19: a Prospective Cohort Study. Gut. 2021;70(11):2096-2104. PubMed PMID: 34489306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diet quality and risk and severity of COVID-19: a prospective cohort study. AU - Merino,Jordi, AU - Joshi,Amit D, AU - Nguyen,Long H, AU - Leeming,Emily R, AU - Mazidi,Mohsen, AU - Drew,David A, AU - Gibson,Rachel, AU - Graham,Mark S, AU - Lo,Chun-Han, AU - Capdevila,Joan, AU - Murray,Benjamin, AU - Hu,Christina, AU - Selvachandran,Somesh, AU - Hammers,Alexander, AU - Bhupathiraju,Shilpa N, AU - Sharma,Shreela V, AU - Sudre,Carole, AU - Astley,Christina M, AU - Chavarro,Jorge E, AU - Kwon,Sohee, AU - Ma,Wenjie, AU - Menni,Cristina, AU - Willett,Walter C, AU - Ourselin,Sebastien, AU - Steves,Claire J, AU - Wolf,Jonathan, AU - Franks,Paul W, AU - Spector,Timothy D, AU - Berry,Sarah, AU - Chan,Andrew T, Y1 - 2021/09/06/ PY - 2021/06/07/received PY - 2021/08/19/accepted PY - 2021/9/8/pubmed PY - 2021/10/16/medline PY - 2021/9/7/entrez KW - COVID-19 KW - diet KW - dietary factors KW - infectious disease SP - 2096 EP - 2104 JF - Gut JO - Gut VL - 70 IS - 11 N2 - OBJECTIVE: Poor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation. DESIGN: We used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively. RESULTS: Over 3 886 274 person-months of follow-up, 31 815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR 0.91; 95% CI 0.88 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation. CONCLUSIONS: A diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/34489306/full_citation DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓123 ↑31]

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