Abstract: medicina Article Adherence to the Mediterranean Diet Association with Serum Inflammatory Factors Stress Oxidative and Appetite in COVID-19 Patients Mahsa Mohajeri 1, *, Reza Mohajery 2 1 2 3 4 * Citation: Mohajeri, M.; Mohajery, R.; Cicero, A.F.G. Adherence to the Mediterranean Diet Association with Serum Inflammatory Factors Stress Oxidative and Appetite in COVID-19 Patients. Medicina 2023, 59, 227. https://doi.org/10.3390/ medicina59020227 Academic Editors: Yusra Habib Khan, and Arrigo F. G. Cicero 3,4, * Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil 56189-85991, Iran Energy Management Research Center, University of Mohaghegh Ardabili, Ardabil 56199-11367, Iran Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy IRCCS AOU S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy Correspondence: mahsa.mohajeri.93@gmail.com (M.M.); arrigo.cicero@unibo.it (A.F.G.C.); Tel.: +98-9143592794 (M.M.); +39-512142224 (A.F.G.C.) Abstract: Background and Objectives: The Mediterranean diet’s bioactive components are suggested to strengthen the immune system and to exert anti-inflammatory actions. This study investigated the association between adherence to the Mediterranean diet with serum inflammatory factors, total antioxidant capacity, appetite, and symptoms of COVID-19 patients. Materials and Methods: This crosssectional study was conducted among 600 Iranian COVID-19 patients selected by a simple random method. The ten-item Mediterranean diet adherence questionnaire was used to assess diet adherence. At the beginning of the study, 5 cc of blood was taken from all patients for measurement of serum interleukin 1β) IL-1β), tumor necrosis factor (TNF-α), malondialdehyde (MDA), high sensitivity Creactive protein (hs-CRP) and total antioxidant capacity (TAC). A human ELISA kit with serial number 950.090.096 produced by the Diaclone Company was used to test this cytokine using the sandwich ELISA method. Results: One hundred and five patients presented a high adherence and 495 patients presented a low adherence to the Mediterranean diet. The incidence of fever, cough, diarrhea, taste changes, and pneumonia severity index were significantly lower in patients who adhered to the Mediterranean diet more than other patients. Serum levels of tumor necrosis factor (5.7 ± 2.1 vs. 6.9 ± 2.8 p = 0.02), interleukin 1 beta (3.2 ± 0.02 vs. 4.9 ± 0.01 p = 0.02), high-sensitivity C-reactive protein (17.08 ± 4.2 vs. 19.8 ± 2.5 p = 0.03), and malondialdehyde (5.7 ± 0.2 vs. 6.2 ± 0.3 p = 0.02) were significantly lower in patients who adhered more to the Mediterranean diet than other patients. Conclusion: The Mediterranean diet can improve the symptoms and elevated serum inflammatory factors in COVID-19 patients, so clinical trial studies are suggested to confirm this effect. Tauqeer Hussain Mallhi, Tahir Mehmood Khan and Keywords: mediterranean diet; inflammatory factors; stress oxidative; appetite; COVID-19 Muhammad Salman Received: 25 December 2022 Revised: 18 January 2023 Accepted: 22 January 2023 Published: 26 January 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).