High association of COVID-19 severity with poor gut health score in Lebanese patients

Abstract

Background Coronavirus disease 2019 (COVID-19) has affected millions of lives globally. However, the disease has presented more extreme challenges for developing countries that are experiencing economic crises. Studies on COVID-19 symptoms and gut health are scarce and have not fully analyzed possible associations between gut health and disease pathophysiology. Therefore, this study aimed to demonstrate a potential association between gut health and COVID-19 severity in the Lebanese community, which has been experiencing a severe economic crisis. Methods This cross-sectional study investigated SARS-CoV-2 PCR-positive Lebanese patients. Participants were interviewed and gut health, COVID-19 symptoms, and different metrics were analyzed using simple and multiple logistic regression models. Results Analysis of the data showed that 25% of participants were asymptomatic, while an equal proportion experienced severe symptoms, including dyspnea (22.7%), oxygen need (7.5%), and hospitalization (3.1%). The mean age of the participants was 38.3 ±0.8 years, and the majority were males (63.9%), married (68.2%), and currently employed (66.7%). A negative correlation was found between gut health score and COVID-19 symptoms (Kendall’s tau-b = -0.153, P = 0.004); indicating that low gut health was associated with more severe COVID-19 cases. Additionally, participants who reported unhealthy food intake were more likely to experience severe symptoms (Kendall’s tau-b = 0.118, P = 0.049). When all items were taken into consideration, multiple ordinal logistic regression models showed a significant association between COVID-19 symptoms and each of the following variables: working status, flu-like illness episodes, and gut health score. COVID-19 severe symptoms were more common among patients having poor gut health scores (OR:1.31, 95%CI:1.07–1.61; P = 0.008), experiencing more than one episode of flu-like illness per year (OR:2.85, 95%CI:1.58–5.15; P = 0.001), and owning a job (OR:2.00, 95%CI:1.1–3.65; P = 0.023). Conclusions To our knowledge, this is the first study that showed the impact of gut health and exposure to respiratory viruses on COVID-19 severity in Lebanon. These findings can facilitate combating the pandemic in Lebanon.

The indelible toll of enteric pathogens: Prevalence, clinical characterization, and seasonal trends in patients with acute community-acquired diarrhea in disenfranchised communities

“…medicines, widespread pollution, and a severe economic collapse and inflation [43][44][45][46][47][48]. This study is also unique in terms of the diagnostic technology, patient population (rural and urban), and assessment of patients with acute diarrhea of all ages in the community, while many of the previous studies only targeted hospitalized individuals.…”

Associação entre adesão à Dieta Mediterrânea e sintomas COVID-19

“…Apenas um trabalho de investigação estudou os hábitos alimentares e a gravidade dos sintomas, tendo encontrado uma probabilidade maior de desenvolvimento de sintomas severos entre os participantes que reportaram hábitos alimentares menos saudáveis, caracterizados pela ingestão excessiva de fast-food ou açúcares (37).…”

COVID-19: Reducing the risk via diet and lifestyle

“…Many patients with COVID-19 additionally experience gastrointestinal upset, with SARS-CoV-2 present in the stool samples of some patients [214] , [218] . The SARS-CoV-2 virus uses ACE2 receptors for entry into host cells; ACE2 receptors are found in the lungs, kidneys and heart, but also in the gastrointestinal tract [214] , [219] , [220] . This suggests a role of the gut-lung axis [214] which may be of particular significance for individuals with poor gut health, as unbalanced or reduced microbiota (dysbiosis) and “leaky gut” may contribute to more severe disease [219] .…”

“…The SARS-CoV-2 virus uses ACE2 receptors for entry into host cells; ACE2 receptors are found in the lungs, kidneys and heart, but also in the gastrointestinal tract [214] , [219] , [220] . This suggests a role of the gut-lung axis [214] which may be of particular significance for individuals with poor gut health, as unbalanced or reduced microbiota (dysbiosis) and “leaky gut” may contribute to more severe disease [219] . In individuals with dysbiosis (such as the elderly and those with chronic disease), impaired gut barrier integrity and reduced mucus may allow SARS-CoV-2 to not only bind to ACE2 on the intestinal cells, but also to exit the gastrointestinal tract and enter the bloodstream, allowing access to various organs expressing ACE2 throughout the body [220] .…”

“…Firmicutes have previously been shown to either up- or down-regulate ACE2 expression; here, one of the species found to most strongly correlate with severe disease is known to greatly up-regulate colonic ACE2 expression in mice [218] . Further work by Al Kassaa et al [219] addressed the gut health in COVID-19-positive individuals with severity ranging from asymptomatic to severe disease. Recording gut health as a score between one and five (based on healthy food, unhealthy food, overweight/obesity, chronic medication, and gut symptoms), they found a strong association between gut health and the severity of COVID-19 symptoms, with the likelihood of worse symptoms being reduced by 33% for each level increase in gut health.…”