Higher Adherence to the Mediterranean Dietary Pattern Is Inversely Associated With Severity of COVID-19 and Related Symptoms: A Cross-Sectional Study

Abstract

Background and AimsAdherence to the Mediterranean diet (MD) has been associated with a decreased risk of developing a variety of chronic diseases that are comorbidities in COVID-19 patients. However, its association to the severity and symptoms of COVID-19 are still unknown. This study aimed to examine the association between adherence to the MD pattern and COVID-19 severity and symptoms in Iranian hospitalized patients.MethodsIn this cross-sectional study, 250 COVID-19 patients aged 18 to 65 were examined. We employed a food frequency questionnaire (FFQ) to obtain data on dietary intake of participants in the year prior to their COVID-19 diagnosis. COVID-19 severity was determined using the National Institutes of Health's Coronavirus Disease 2019 report. Additionally, symptoms associated with COVID-19, inflammatory markers, and other variables were evaluated. The scoring method proposed by Trichopoulou et al. was used to assess adherence to the MD.ResultsThe participants' mean age was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients who adhered more closely to the MD had lower serum C-reactive protein levels (7.80 vs. 37.36 mg/l) and erythrocyte sedimentation rate (14.08 vs. 42.65 mm/h). Those with the highest MD score were 77% less likely to have severe COVID-19 after controlling for confounding variables. The MD score was also found to be inversely associated with COVID-19 symptoms, including dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat.ConclusionHigher adherence to the MD was associated with a decreased likelihood of COVID-19 severity and symptoms, as well as a shorter duration of hospitalization and convalescence, and inflammatory biomarkers.

Relevance of Mediterranean diet as a nutritional strategy in diminishing COVID-19 risk: A systematic review

“…Four studies reported the association between Mediterranean diet adherence and COVID-19 symptoms [20,21,24,25] with a sample size of 53,069 patients. Differing comparison of Mediterranean diet adherence score was reported across studies with one each of, continuous variable of 1-point increment, categorical variable in a cut-off determined by the authors of the study, categorical variable in tertiles, and as both categorical variable in quartiles and continuous variable of 1-SD increment, as detailed in Table 3.…”

“…The study by Zagarzadeh et al [25] found that higher Mediterranean diet adherence significantly decrease the odds for all reported COVID-19 symptoms, with OR varied between 0.06–0.34 for each symptom. Three studies reported insignificant association, with OR of each study ranging between 0.84–0.992, and p value >0.05, although the result from Yue et al [24] did reach the limit of statistical significance (OR= 0.89, 95% CI: 0.80–0.99; P-trend= 0.0549).…”

“…Various comparison of Mediterranean diet adherence score was reported, with one study as a categorical variable in a cut-off determined in the study, one study as a categorical variable in tertiles, and one study as a continuous variable of 1-SD increment. Self-report of hospitalization due to The study by Zagarzadeh et al [25] found that participants with top tertile Mediterranean diet score were less likely to have severe COVID-19 (OR= 0.23; 95% CI: 0.11-0.50, P <0.001). than the bottom tertile.…”

“…All 6 articles were observational studies, published in 2020-2023 [20][21][22][23][24][25]. The total sample was 55,489 patients, with study location across 5 countries.…”

“…All studies depended on self-report for the presence of COVID-19 symptoms, and analyzed the odds ratio using logistic regression with yes/no type outcome. Two studies analyzed for symptomatic COVID-19 outcome [21,24], one study for moderate COVID-19 burden (defined as presence of 5-10 symptoms) [20], and one study analyzed for each COVID-19 symptom [25].…”