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Healthy lifestyle for the prevention of post-COVID-19 multisystem sequelae, hospitalization, and death: a prospective cohort study

Wang et al., medRxiv, doi:10.1101/2024.01.30.24302040
Jan 2024  
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Prospective study of 68,896 UK Biobank participants with COVID-19 showing adherence to a healthy lifestyle prior to infection, characterized by 10 factors including adequate physical activity and sleep, not smoking, and a healthy BMI, was associated with a significantly lower risk of mortality, hospitalization, and post-COVID multisystem sequelae. Risk decreased monotonically for increasing numbers of healthy lifestyle factors from 5-10. Reduced risks were evident across cardiovascular, metabolic, neurologic, respiratory, and other disorders over 210 days following infection, during both acute and post-acute phases, regardless of age, sex, ethnicity, test setting, vaccination status, or SARS-CoV-2 variant.
Study covers exercise, sleep, and diet.
Wang et al., 31 Jan 2024, prospective, United Kingdom, preprint, 10 authors.
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Healthy lifestyle for the prevention of post-COVID-19 multisystem sequelae, hospitalization, and death: a prospective cohort study
BSMed, MSc Yunhe Wang, PhD Binbin Su, PhD Marta Alcalde-Herraiz, PhD Nicola L Barclay, PhD Yaohua Tian, Chunxiao Li, PhD Nicholas J Wareham, PhD Roger Paredes, PhD Junqing Xie, Daniel Prieto-Alhambra
Background Post-COVID complications are emerging as a global public health crisis. Effective prevention strategies are needed to inform patients, clinicians and policy makers, and to reduce their cumulative burden. We aimed to investigate whether a habitual healthy lifestyle predated pandemic is associated with lower risks of multisystem sequelae and other adverse outcomes of COVID-19, and whether the potential protective effects are independent of pre-existing comorbidities. Methods The prospective population-based cohort study enrolled participants with SARS-CoV-2 infection confirmed by a positive polymerase chain reaction test result between March 1, 2020, and March 1, 2022. Participants with no history of the related outcome one year before infection were included and followed up for 210 days. Exposures included ten modifiable healthy lifestyle factors including past or never smoking, moderate alcohol intake (≤4 times week), body mass index <30 kg/m 2 , at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week, less sedentary time (<4 hours per day), healthy sleep duration (7-9 hours per day), adequate intake of fruit and vegetables (≥400 g/day), adequate oily fish intake (≥1 portion/week), moderate intake of red meat (≤4 portions week) and processed meat (≤4 portions week). Outcomes included multisystem COVID-19 sequelae (consisting of 75 diseases/symptoms in 10 organ systems), death, and hospital admission following SARS-CoV-2 infection, confirmed by hospital inpatient and death records. Risk was reported in relative scale (hazard ratio [HR]) and absolute scale (absolute risk reduction [ARR]) during both the acute (the first 30 days) and post-acute (30-210 days) phases of infection using Cox models. Findings A total of 68,896 participants (mean [SD] age, 66.6 [8.4]; 32,098 women [46.6%]) with COVID-19 were included. A favorable lifestyle (6-10 healthy lifestyle factors; 46.4%) was associated with a 36% lower risk of multisystem sequelae of COVID-19 (HR, 0.64; 95% CI, 0.58-0.69; ARR, 7.08%; 95% CI, 5.98-8.09), compared with unfavorable lifestyle (0-4 factors; 12.3%). Risk reductions were observed across all 10 prespecified organ systems including cardiovascular, coagulation, metabolic and endocrine, gastrointestinal, kidney, mental health, musculoskeletal, neurologic, and respiratory disorders, and general symptoms of fatigue and malaise. This beneficial effect was largely attributable to direct effects of healthy lifestyle, with mediation proportion ranging from 44% to 93% across organ systems. A favorable lifestyle was also associated with lower risk of post-COVID death (HR, 0.59; 95% CI, 0.52-0.66; ARR, 1.99%; 95% CI, 1.61-2.32) and hospitalization (HR, 0.78; 95% CI, 0.73-0.84; ARR, 6.14%; 95% CI, 4.48-7.68). These associations were observed after accounting for potential misclassification of lifestyle factors, and during acute and post-acute infection, in those tested positive in the hospital and..
Author contributions Drs Wang and Xie had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. Concept and design: Wang and Xie. Acquisition, analysis, or interpretation of data: Wang, Xie, and Prieto-Alhambra. Drafting of the manuscript: Wang. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Xie. Obtained funding: Prieto-Alhambra. Administrative, technical, or material support: Prieto-Alhambra. Supervision: Nicholas J. Wareham and Prieto-Alhambra. Competing interests Dr Prieto-Alhambra's department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. His research group has received consultancy fees from Astra Zeneca and UCB Biopharma. Amgen, A, qualitative sensitivity analyses. B, quantative sensitivity analysis accounting for potential misclassification of lifestyle factors over time. a Odds ratios were used to quantify associations and assumed a sensitivity and specificity of 90% for each lifestyle component.
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