Long-term diet and risk of SARS -CoV-2 infection and Coronavirus Disease 2019 (COVID-19) severity
MS Yiyang Yue, ScD Wenjie Ma, PhD Emma K Accorsi, ScD Ming Ding, MD, PhD Frank Hu, MD, PhD Walter C Willett, MD, MPH Andrew T Chan, MD, ScD Qi Sun, ScD Janet Rich Edwards, PhD Stephanie A Smith-Warner, PhD Shilpa N Bhupathiraju
doi:10.1093/ajcn/nqac219/6659183
Background The role of diet on COVID-19 is emerging.
Methods We included 42,935 participants aged 55 to 99 years in two ongoing cohort studies, Nurses' Health Study II and Health Professionals Follow-up Study, who completed a series of COVID-19 surveys in 2020 and 2021. Using data from food frequency questionnaires prior to COVID-19, we assessed diet quality using the Alternative Healthy Eating Index (AHEI)-2010, the alternative Mediterranean Diet (AMED) score, an Empirical Dietary Index for Hyperinsulinemia (EDIH), and an Empirical Dietary Inflammatory Pattern (EDIP). We calculated multivariable adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for SARS-CoV-2 infection and severity of COVID-19 after controlling for demographic, medical, and lifestyle factors.
Results Among 19,754 participants tested for SARS-CoV-2, 1,941 participants reported a positive result. Of these, 1,327 reported symptoms needing assistance and another 109 were hospitalized. Healthier diet, represented by higher AHEI-2010 and AMED scores and lower EDIH and EDIP scores, were associated with lower likelihood of SARS-CoV-2 infection (ORs Q (quartile) 4 vs. Q1 (95%CI) were 0.80 (0.69, 0.92) for AHEI-2010; 0.78 (0.67, 0.92) for AMED; 1.36 (1.16, 1.57) for EDIH; and 1.13 (0.99, 1.30) for EDIP; all p for trend ≤ 0.01). In the analysis of COVID-19 severity, participants with healthier diet had lower likelihood of severe infection and were less likely to be hospitalized due to COVID-19. However, associations were no longer significant after controlling for BMI and pre-existing medical conditions.
P for linear trend across quartiles was calculated using the median of each quartile as a continuous variable. 2 Continuous analyses for a 1 standard deviation increment 3 Non-cases number for model 1-3 4 Model 1 was adjusted for age (continuous), sex (women or men), and race (white or non-white) 5 Model 2 was further adjusted for smoking (never, past, or current), physical activity (continous), total energy intake (continuous), census tract median family income (continuous), census tract median family home value (continuous), census tract population density (continuous), concern about COVID-19 (yes or no), interaction with people other than patients with presumed or documented COVID-19 (yes or no), and frontline healthcare providers and PPE use (not frontline healthcare providers, frontline healthcare providers without adequate PPE, and frontline healthcare providers with adequate PPE). 6 Model 3 was further adjusted for BMI (continuous), history of high cholesterol (yes or no), history of high blood pressure (yes or no), and presence of other pre-existing medical conditions (diabetes, heart attack, cancer; yes or no). 7 IPW: Probability of receiving a COVID-19 test was modeled using the dietary quality score being evaluated, age, sex, race, being frontline healthcare worker, interaction with people other than patients with presumed or documented COVID-19, census tract median family income, census tract median family home value, census tract population density, and..
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>The role of diet on COVID-19 is emerging.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>We included 42,935 participants aged 55 to 99 years in two ongoing '
'cohort studies, Nurses’ Health Study II and Health Professionals Follow-up Study, who '
'completed a series of COVID-19 surveys in 2020 and 2021. Using data from food frequency '
'questionnaires prior to COVID-19, we assessed diet quality using the Alternative Healthy '
'Eating Index (AHEI)-2010, the alternative Mediterranean Diet (AMED) score, an Empirical '
'Dietary Index for Hyperinsulinemia (EDIH), and an Empirical Dietary Inflammatory Pattern '
'(EDIP). We calculated multivariable adjusted odds ratios (ORs) and 95% confidence intervals '
'(95% CIs) for SARS-CoV-2 infection and severity of COVID-19 after controlling for '
'demographic, medical, and lifestyle factors.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>Among 19,754 participants tested for SARS-CoV-2, 1,941 participants '
'reported a positive result. Of these, 1,327 reported symptoms needing assistance and another '
'109 were hospitalized. Healthier diet, represented by higher AHEI-2010 and AMED scores and '
'lower EDIH and EDIP scores, were associated with lower likelihood of SARS-CoV-2 infection '
'(ORs Q (quartile) 4 vs. Q1 (95%CI) were 0.80 (0.69, 0.92) for AHEI-2010; 0.78 (0.67, 0.92) '
'for AMED; 1.36 (1.16, 1.57) for EDIH; and 1.13 (0.99, 1.30) for EDIP; all p for trend\xa0≤\xa0'
'0.01). In the analysis of COVID-19 severity, participants with healthier diet had lower '
'likelihood of severe infection and were less likely to be hospitalized due to COVID-19. '
'However, associations were no longer significant after controlling for BMI and pre-existing '
'medical conditions.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusion</jats:title>\n'
' <jats:p>Diet may be an important modifiable risk factor for SARS-CoV-2 '
'infection, as well as for severity of COVID-19. This association is partially mediated by BMI '
'and pre-existing medical conditions.</jats:p>\n'
' </jats:sec>',
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