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BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on health systems, food supplies, and population health. This is the first study to examine the association between zinc and vitamin C intakes and the risk of disease severity and symptoms among COVID-19 patients. METHODS: This cross-sectional study included 250 recovered COVID-19 patients aged 18-65 years from June to September 2021. Data on demographics, anthropometrics, medical history, and disease severity and symptoms were collected. Dietary intake was evaluated using a web-based, 168-item food frequency questionnaire (FFQ). The severity of the disease was determined using the most recent version of the NIH COVID-19 Treatment Guidelines. Using multivariable binary logistic regression, the association between zinc and vitamin C intakes and the risk of disease severity and symptoms in COVID-19 patients was evaluated. RESULTS: The mean age of participants in this study was 44.1 ± 12.1, 52.4% of them were female, and 46% had a severe form of the disease. Participants with higher zinc intakes had lower levels of inflammatory cytokines, such as C-reactive protein (CRP) (13.6 vs. 25.8 mg/l) and erythrocyte sedimentation rate (ESR) (15.9 vs. 29.3). In a fully adjusted model, a higher zinc intake was also associated with a lower risk of severe disease (OR: 0.43; 95% CI: 0.21, 0.90, P-trend = 0.03). Similarly, participants with higher vitamin C intakes had lower CRP (10.3 vs. 31.5 mg/l) and ESR serum concentrations (15.6 Vs. 35.6) and lower odds of severe disease after controlling for potential covariates (OR: 0.31; 95% CI: 0.14, 0.65, P-trend = <0.01). Furthermore, an inverse association was found between dietary zinc intake and COVID-19 symptoms, such as dyspnea, cough, weakness, nausea and vomiting, and sore throat. Higher vitamin C intake was associated with a lower risk of dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. CONCLUSION: In the current study, higher zinc and vitamin C intakes were associated with decreased odds of developing severe COVID-19 and its common symptoms.
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COVID-19 , Pharyngitis , Humans , Female , Male , Ascorbic Acid , Cross-Sectional Studies , Zinc , COVID-19 Drug Treatment , Cough , Vitamins , Logistic Models , EatingABSTRACT
Background The Coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on health systems, food supplies, and population health. This is the first study to examine the association between zinc and vitamin C intakes and the risk of disease severity and symptoms among COVID-19 patients. Methods This cross-sectional study included 250 recovered COVID-19 patients aged 18-65 years from June to September 2021. Data on demographics, anthropometrics, medical history, and disease severity and symptoms were collected. Dietary intake was evaluated using a web-based, 168-item food frequency questionnaire (FFQ). The severity of the disease was determined using the most recent version of the NIH COVID-19 Treatment Guidelines. Using multivariable binary logistic regression, the association between zinc and vitamin C intakes and the risk of disease severity and symptoms in COVID-19 patients was evaluated. Results The mean age of participants in this study was 44.1±12.1, 52.4% of them were female, and 46% had a severe form of the disease. Participants with higher zinc intakes had lower levels of inflammatory cytokines, such as C-reactive protein (CRP) (13.6 vs. 25.8 mg/l) and erythrocyte sedimentation rate (ESR) (15.9 vs. 29.3). In a fully adjusted model, a higher zinc intake was also associated with a lower risk of severe disease (OR: 0.43;95% CI: 0.21, 0.90, P-trend = 0.03). Similarly, participants with higher vitamin C intakes had lower CRP (10.3 vs. 31.5 mg/l) and ESR serum concentrations (15.6 Vs. 35.6) and lower odds of severe disease after controlling for potential covariates (OR: 0.31;95% CI: 0.14, 0.65, P-trend = <0.01). Furthermore, an inverse association was found between dietary zinc intake and COVID-19 symptoms, such as dyspnea, cough, weakness, nausea and vomiting, and sore throat. Higher vitamin C intake was associated with a lower risk of dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. Conclusion In the current study, higher zinc and vitamin C intakes were associated with decreased odds of developing severe COVID-19 and its common symptoms.
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Background and aims Fruits and vegetables are rich in fiber and a good source of anti-inflammatory and immune-boosting vitamins, minerals, and antioxidants. We investigated the association between fruits, vegetables, and fiber intake and severity of COVID-19 and related symptoms in hospitalized patients. Methods A total of 250 COVID-19 hospitalized patients aged 18 to 65 years were recruited for this cross-sectional study in Kashan, Iran, between June and September of 2021. Dietary intakes were assessed using an online validated 168-item food frequency questionnaire (FFQ). COVID-19 severity and symptoms were evaluated using the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Moreover, we examined COVID-19 symptoms, inflammatory biomarkers, and additional factors. Results The mean age of participants was 44.2 ± 12.1 years, and 46% had severe COVID-19. Patients with higher consumption of fruits (OR: 0.28;95% CI: 0.14-0.58, P-trend <0.001), vegetables (OR: 0.33;95% CI: 0.16-0.69, P-trend <0.001), and dietary fiber (OR: 0.25;95% CI: 0.12-0.53, P-trend <0.001) had lower odds of having severe COVID-19. In addition, they had shorter hospitalization and convalescence periods, lower serum C-reactive protein (CRP), and a reduced risk of developing COVID-19 symptoms such as sore throat, nausea and vomiting, dyspnea, myalgia, cough, weakness, fever, and chills. Conclusion Higher consumption of fruits, vegetables, and fiber was inversely linked with COVID-19 severity, clinical symptoms, hospitalization and convalescence duration, and CRP concentrations. The results should be interpreted with caution in light of the limitations, and prospective cohort studies are required to further evaluate these findings.
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Background and Aims: Adherence 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. Methods: In 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. Results: The 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. Conclusion: Higher 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.
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Background: COVID-19 is a highly transmissible viral infection with high morbidity. Few studies have been done about dietary intakes in patients with COVID-19. This study aimed to evaluate the association between major dietary patterns before COVID-19 diagnosis in recovered patients and the risk of disease severity and symptoms after the disease begins. Methods: Overall, 250 recovered cases with both genders completed study questionnaires providing data on demographic characteristics, self-reported web-based 168-item food frequency questionnaire (FFQ), and COVID-19 outcomes in Shahid Beheshti Hospital, Kashan. PCR was used to determine a positive diagnosis of COVID-19. We used multivariable logistic regression models to assess the association between major dietary patterns and study outcomes. All statistical analyses were done by SPSS version 16. Results: We identified three major dietary patterns-unhealthy, traditional, and healthy dietary patterns. Serum levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly higher in patients with unhealthy and traditional dietary patterns and lower in those with healthy dietary patterns. There was a significant direct relationship between unhealthy and traditional patterns with risk of severe COVID-19 and hospitalization duration and a significant direct association between an unhealthy pattern and the odds ratio (OR) of convalescence duration. A significant inverse relationship was found between healthy pattern and risk of severe COVID-19 and OR of convalescence duration. We found a significant direct association between unhealthy pattern and OR of cough, fever, chilling, weakness, myalgia, nausea and vomiting, and sore throat and between traditional pattern and OR of cough, fever, and chilling. In contrast, a significant inverse association was seen between healthy pattern and OR of dyspnea, weakness, and sore throat. Conclusion: This study showed that high adherence to an healthy pattern was associated with lower CRP and ESR levels and lower risk of severe COVID-19, hospitalization, and convalescence duration in patients who recovered from COVID-19. More adherence to unhealthy or traditional dietary patterns was associated with higher CRP and ESR levels and a higher risk of severe COVID-19 and hospitalization duration. A direct association was found between unhealthy and traditional patterns and the risk of some COVID-19 symptoms, while an inverse association was found for a healthy dietary pattern.
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Background and Aims Adherence 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. Methods In 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. Results The 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. Conclusion Higher 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.
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Background and Aims: Magnesium is an anti-inflammatory mineral that plays a role in the innate immune system, and the relaxation of bronchial smooth muscle warrants additional attention in COVID-19. This study examined the association between magnesium intake and COVID-19 severity and related symptoms in hospitalized patients. Methods: A cross-sectional study was done enrolling 250 COVID-19 patients aged 18 to 65 years. A validated 168-item online food frequency questionnaire (FFQ) was used to assess dietary magnesium intake. COVID-19 Treatment Guidelines were used to determine COVID-19 severity, and symptoms were evaluated using a standard questionnaire. Crude and adjusted analyses were performed (Model 1: age, sex, and energy intake; Model 2: Model 1 + physical activity, supplements, corticosteroids, and antiviral drugs; Model 3: Model 2 + body mass index). Results: The mean age of participants was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients at the highest tertile of dietary magnesium intake had lower serum levels of inflammatory biomarkers, including CRP (11.8 ± 2.2 vs. 29.5 ± 2.1 mg/L, p < 0.001) and ESR (15.8 ± 2.4 vs. 34.7 ± 2.4 mm/hr, p < 0.001), than those at the lowest tertile. After controlling for potential confounders, we observed that a higher dietary magnesium intake was associated with a lower odds of severe COVID-19 (OR: 0.32; 95% CI: 0.15-0.70). Also, we found a significant inverse association between dietary magnesium intake and odds of COVID-19 symptoms. Conclusion: We found that higher intake of dietary magnesium was inversely associated with COVID-19 severity and symptoms.
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Some earlier studies reported higher risk of COVID-19 mortality in patients with vitamin D deficiency, while some others failed to find such as association. Due to inconsistences between earlier meta-analyses and needs for an updated study, we conducted current systematic review and meta-analysis on the association between vitamin D status and risk of COVID-19 in-hospital mortality among observational studies. We searched PubMed, Scopus and Web of Science up to 27 July 2021. We conduct our systematic review and meta-analysis in according to PRISM statement. Two authors independently screened studies and extracted data from the relevant ones. All types of observational studies about the association between vitamin D status and in hospital COVID-19 mortality were included. Data was pooled using a random-effect model. P-values Ë 0.05 was assumed as statistically significant. We identified 13 observational studies. Pooling 9 studies which categorized vitamin D level, a significant positive relationship was found between vitamin D deficiency and risk of COVID-19 in-hospital mortality (Odds Ratio (OR): 2.11; 95% Confidence Interval (CI): 1.03, 4.32). All subgroup analyses also showed significant relationship between vitamin D deficiency and risk of COVID-19 in-hospital mortality. In the other analysis, pooling data from 5 studies in which vitamin D level was entered as a continues variable, we found an inverse significant association between each unit increment in serum vitamin D concentrations and risk of COVID-19 in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99). We found a significant direct association between vitamin D deficiency and elevated risk of COVID-19 in-hospital mortality. Moreover, each unit increment in serum vitamin D levels was associated to significant reduction in risk of COVID-19 mortality. Further prospective studies are needed to confirm our findings.