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0 0.5 1 1.5 2+ Severe case 81% Improvement Relative Risk Hospitalization 56% Exercise for COVID-19  Li et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective study in the United Kingdom Lower severe cases with higher activity levels (p=0.02) c19early.org Li et al., BMC Medical Genomics, February 2021 Favors exercise Favors inactivity

Modifiable lifestyle factors and severe COVID-19 risk: a Mendelian randomisation study

Li et al., BMC Medical Genomics, doi:10.1186/s12920-021-00887-1
Feb 2021  
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Exercise for COVID-19
9th treatment shown to reduce risk in October 2020
 
*, now known with p < 0.00000000001 from 66 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Mendelian randomization study showing lower risk of severe COVID-19 with physical activity.
risk of severe case, 81.0% lower, OR 0.19, p = 0.02, RR approximated with OR.
risk of hospitalization, 56.0% lower, OR 0.44, p = 0.07, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Li et al., 3 Feb 2021, retrospective, United Kingdom, peer-reviewed, 2 authors, per SD increase. Contact: shuai.li@unimelb.edu.au (corresponding author).
This PaperExerciseAll
Modifiable lifestyle factors and severe COVID-19 risk: a Mendelian randomisation study
Shuai Li, Xinyang Hua
BMC Medical Genomics, doi:10.1186/s12920-021-00887-1
Background: Lifestyle factors including obesity and smoking are suggested to be correlated with increased risk of COVID-19 severe illness or related death. However, whether these relationships are causal is not well known; neither for the relationships between COVID-19 severe illness and other common lifestyle factors, such as physical activity and alcohol consumption. Methods: Genome-wide significant genetic variants associated with body mass index (BMI), lifetime smoking, physical activity and alcohol consumption identified by large-scale genome-wide association studies (GWAS) of up to 941,280 individuals were selected as instrumental variables. Summary statistics of the genetic variants on severe illness of COVID-19 were obtained from GWAS analyses of up to 6492 cases and 1,012,809 controls. Two-sample Mendelian randomisation analyses were conducted. Results: Both per-standard deviation (SD) increase in genetically predicted BMI and lifetime smoking were associated with about two-fold increased risks of severe respiratory COVID-19 and COVID-19 hospitalization (all P < 0.05). Per-SD increase in genetically predicted physical activity was associated with decreased risks of severe respiratory COVID-19 (odds ratio [OR] = 0.19; 95% confidence interval [CI], 0.05, 0.74; P = 0.02), but not with COVID-19 hospitalization (OR = 0.44; 95% CI 0.18, 1.07; P = 0.07). No evidence of association was found for genetically predicted alcohol consumption. Similar results were found across robust Mendelian randomisation methods. Conclusions: Evidence is found that BMI and smoking causally increase and physical activity might causally decrease the risk of COVID-19 severe illness. This study highlights the importance of maintaining a healthy lifestyle in protecting from COVID-19 severe illness and its public health value in fighting against COVID-19 pandemic.
Supplementary Information The online version contains supplementary material available at https ://doi. org/10.1186/s1292 0-021-00887 -1. Additional file 1: Supplementary Tables 1-4 . Summary statistics for genetic instrumental variables of the four lifestyle factors. Additional file 2: Supplementary Table 5 . Parameter values used in statistical power analysis. Additional file 3: Supplementary Table 6 . Sample sizes of participating studies in the COVID-19 Host Genetic Initiative GWAS Release 4 in September 2020. Additional file 4: Supplementary Fig. 1 . Leave-one-out analysis results for body mass index and severe respiratory COVID-19. Additional file 5: Supplementary Fig. 2 . Leave-one-out analysis results for body mass index and COVID-19 hospitalization. Additional file 6: Supplementary Fig. 3 . Leave-one-out analysis results for lifetime smoking and severe respiratory COVID-19. Additional file 7: Supplementary Fig. 4 . Leave-one-out analysis results for lifetime smoking and COVID-19 hospitalization. Additional file 8: Supplementary Fig. 5 . Leave-one-out analysis results for physical activity and severe respiratory COVID-19. Additional file 9: Supplementary Fig. 6 . Leave-one-out analysis results for physical activity and COVID-19 hospitalization. Additional file 10: Supplementary Fig. 7 . Leave-one-out analysis results for alcohol consumption and severe respiratory COVID-19 using all genetic variants. Additional file 11: Supplementary Fig. 8 . Leave-one-out..
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Summary statistics of the genetic variants on severe illness of ' 'COVID-19 were obtained from GWAS analyses of up to 6492 cases and 1,012,809 controls. ' 'Two-sample Mendelian randomisation analyses were conducted.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Both per-standard deviation (SD) increase in genetically predicted ' 'BMI and lifetime smoking were associated with about two-fold increased risks of severe ' 'respiratory COVID-19 and COVID-19 hospitalization (all P\u2009&lt;\u20090.05). Per-SD ' 'increase in genetically predicted physical activity was associated with decreased risks of ' 'severe respiratory COVID-19 (odds ratio [OR]\u2009=\u20090.19; 95% confidence interval ' '[CI], 0.05, 0.74; P\u2009=\u20090.02), but not with COVID-19 hospitalization (OR\u2009=\u2009' '0.44; 95% CI 0.18, 1.07; P\u2009=\u20090.07). No evidence of association was found for ' 'genetically predicted alcohol consumption. 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Int J ' 'Epidemiol. 2017;46(6):1985–98.', 'volume': '46', 'year': '2017'}, { 'DOI': '10.7554/eLife.34408', 'doi-asserted-by': 'crossref', 'key': '887_CR23', 'unstructured': 'Hemani G, Zheng J, Elsworth B, Wade KH, Haberland V, Baird D, Laurin C, ' 'Burgess S, Bowden J, Langdon R, et al. The MR-Base platform supports ' 'systematic causal inference across the human phenome. Elife. 2018, 7.'}, { 'key': '887_CR24', 'unstructured': 'Ellinghaus D, Degenhardt F, Bujanda L, Buti M, Albillos A, Invernizzi P, ' 'Fernández J, Prati D, Baselli G, Asselta R, et al. Genomewide ' 'association study of severe covid-19 with respiratory failure. N Engl J ' 'Med. 2020.'}, { 'DOI': '10.1038/nri1937', 'author': 'H Tilg', 'doi-asserted-by': 'publisher', 'first-page': '772', 'issue': '10', 'journal-title': 'Nat Rev Immunol', 'key': '887_CR25', 'unstructured': 'Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, ' 'inflammation and immunity. 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Nat Rev ' 'Endocrinol. 2020;16(2):81–90.', 'volume': '16', 'year': '2020'}, { 'DOI': '10.3389/fimmu.2020.01441', 'author': 'LF García', 'doi-asserted-by': 'publisher', 'first-page': '1441', 'journal-title': 'Front Immunol', 'key': '887_CR28', 'unstructured': 'García LF. Immune response, inflammation, and the clinical spectrum of ' 'COVID-19. Front Immunol. 2020;11:1441.', 'volume': '11', 'year': '2020'}, { 'DOI': '10.1002/gepi.21998', 'author': 'S Burgess', 'doi-asserted-by': 'publisher', 'first-page': '597', 'issue': '7', 'journal-title': 'Genet Epidemiol', 'key': '887_CR29', 'unstructured': 'Burgess S, Davies NM, Thompson SG. Bias due to participant overlap in ' 'two-sample Mendelian randomization. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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