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

Merino et al., Gut, doi:10.1136/gutjnl-2021-325353 (date from earlier preprint)

Merino et al., Diet quality and risk and severity of COVID-19: a prospective cohort study, Gut, doi:10.1136/gutjnl-2021-325353 (date from earlier preprint)

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Retrospective 592,571 participants in the UK and USA with 31,815 COVID-19 cases, showing lower risk or COVID-19 cases and severity for higher healthful plant-based diet scores. Notably, the assocation was less evident with higher levels of physical activity.

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risk of severe case, 41.0% lower, HR 0.59, p < 0.001, higher quality diet 148,142, lower quality diet 148,143, adjusted per study, model 3, high vs. low hPDI, multivariable, Cox proportional hazards.

risk of case, 18.0% lower, HR 0.82, p < 0.001, higher quality diet 148,142, lower quality diet 148,143, adjusted per study, model 3, high vs. low hPDI, PCR+, multivariable, Cox proportional hazards.

risk of case, 9.0% lower, HR 0.91, p < 0.001, higher quality diet 148,142, lower quality diet 148,143, adjusted per study, model 3, high vs. low hPDI, multivariable, Cox proportional hazards.

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Merino et al., 25 Jun 2021, retrospective, multiple countries, peer-reviewed, survey, 30 authors, study period 24 March, 2020 - 2 December, 2020.

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

Jordi Merino, Amit D Joshi, Long H Nguyen, Emily R Leeming, Mohsen Mazidi, David A Drew, Rachel Gibson, Mark S Graham, Chun-Han Lo, Joan Capdevila, Benjamin Murray, Christina Hu, Somesh Selvachandran, Alexander Hammers, Shilpa N Bhupathiraju, Shreela V Sharma, Carole Sudre, Christina M Astley, Jorge E Chavarro, Sohee Kwon, Wenjie Ma, Cristina Menni, Walter C Willett, Sebastien Ourselin, Claire J Steves, Jonathan Wolf, Paul W Franks, Timothy D Spector, Sarah Berry, Dr Andrew T Chan

Gut, doi:10.1136/gutjnl-2021-325353

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 (P interaction =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 plantbased 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. INTRODUCTION Poor metabolic health linked to conditions such as obesity, type 2 diabetes or hypertension 1 2 has been associated with increased risk and severity of COVID-19, and excess adiposity or preexisting liver disease might be causally associated with increased risk of death from COVID-19. 3 4 Underlying these conditions is the contribution of a diet, which may be independently associated with COVID-19 risk and severity. Significance of this study What is already known on this subject? ► Poor metabolic health and unhealthy lifestyle behaviours have been associated with higher risk and severity of COVID-19. ► Improved nutrition, especially in the context of socioeconomic deprivation, has been shown to reduce the burden of certain infectious diseases in the past. Evidence on the association of diet quality with susceptibility and progression of COVID-19 is lacking. What are the new findings? ► A dietary pattern characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. ► We found evidence of a synergistic association of poor diet and increased socioeconomic deprivation with COVID-19 risk that was higher than..

Ethics approval The study protocol was approved by the Mass General Brigham Human Research Committee (protocol 2020P000909) and King's College London Ethics Committee (REMAS ID 18210, LRS-19/20-18210). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement The diet quality data used for this study are held by the department of Twin Research at Kings' College London. The data can be released to bona fide researchers using our normal procedures overseen by the Wellcome Trust and its guidelines as part of our core funding (https:// web. www. healthdatagateway. org/ dataset/ fddcb382-3051-4394-8436-b92295f14259). Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. ORCID iDs Jordi Merino http:// orcid. org/ 0000-0001-8312-1438 Amit D Joshi http:// orcid. org/ 0000-0001-7581-6934 Long H..

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