Diet quality and risk and severity of COVID-19: a prospective cohort study

DOI record: { "DOI": "10.1136/gutjnl-2021-325353", "ISSN": [ "0017-5749", "1468-3288" ], "URL": "http://dx.doi.org/10.1136/gutjnl-2021-325353", "abstract": "<jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 (P<jats:sub>interaction</jats:sub>=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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>", "alternative-id": [ "10.1136/gutjnl-2021-325353" ], "author": [ { "ORCID": "http://orcid.org/0000-0001-8312-1438", "affiliation": [], "authenticated-orcid": false, "family": "Merino", "given": "Jordi", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0001-7581-6934", "affiliation": [], "authenticated-orcid": false, "family": "Joshi", "given": "Amit D", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-5436-4219", "affiliation": [], "authenticated-orcid": false, "family": "Nguyen", "given": "Long H", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-0531-4901", "affiliation": [], "authenticated-orcid": false, "family": "Leeming", "given": "Emily R", "sequence": "additional" }, { "affiliation": [], "family": "Mazidi", "given": "Mohsen", "sequence": "additional" }, { "ORCID": 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