Diet quality and risk and severity of COVID-19: a prospective cohort study
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Abstract
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 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.
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SciScore for 10.1101/2021.06.24.21259283: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: At enrollment, we obtained informed consent to the use of volunteered information for research purposes and shared relevant privacy policies and terms of use agreements.
IRB: 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).Sex as a biological variable We also excluded participants younger than 18 years old, pregnant, and participants who logged only one daily assessment during follow-up. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing …
SciScore for 10.1101/2021.06.24.21259283: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: At enrollment, we obtained informed consent to the use of volunteered information for research purposes and shared relevant privacy policies and terms of use agreements.
IRB: 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).Sex as a biological variable We also excluded participants younger than 18 years old, pregnant, and participants who logged only one daily assessment during follow-up. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:We acknowledge several limitations. First, as an observational study, we are unable to confirm a direct causal association between diet and COVID-risk or infer specific mechanisms. Second, our study population was not a random sampling of the population. Although this limitation is inherent to any study requiring voluntary provision of information, we recognize our participants are mainly white participants and less likely to live in low deprived areas and are less ethnically diverse than the general population.19 Thus, generalizability of our finding even to the wider British and American population is uncertain. Third, our results could be biased due to the time lapse between the dietary recalls, administered a few months after the relevant period of exposure (pre-pandemic). However, our sensitivity analyses in which we censored cases that had occurred before the administration of the diet survey showed consistent results. Fourth, the self-reported nature of the diet questionnaire is prone to measurement error and bias, and the use of a short food frequency survey could have further reduced the resolution of dietary data collected. More accurate dietary intake assessment methods such as the use of dietary intake biomarkers would be valuable in future studies,32 but also difficult to implement in large-scale and time-sensitive investigations. Fifth, we defined risk of severe COVID-19 according to reports of hospitalization with oxygen support, which may not have captured mor...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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