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Association of Periodic Fasting with Lower Severity of COVID-19 Outcomes in the SARS-CoV-2 Pre-Vaccine Era: An Observational Cohort from the INSPIRE Registry (preprint)
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.03.17.22272577
ABSTRACT

Objectives:

Intermittent fasting boosts some mechanisms of host defense against infection while modulating the inflammatory response. Lower-frequency periodic fasting is associated with greater survival and lower risk of comorbidities that exacerbate COVID-19. This study evaluated the association of periodic fasting with COVID-19 severity and, secondarily, initial diagnosis of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Design:

Prospective longitudinal observational cohort study.

Setting:

Single-center secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system.

Participants:

Patients enrolled in the INSPIRE registry in 2013-2020 were studied if they had SARS-CoV-2 testing in March 2020-February 2021 and either tested positive (N=205) for the primary outcome evaluation or had a positive or negative test result for evaluation of the secondary outcome (n=1,524).

Interventions:

No treatment assignments were made; individuals provided information about their personal practice and history of engaging in routine periodic fasting across their lifespan. Main outcome

measures:

The association of periodic fasting with a composite of mortality or hospitalization as the primary outcome was evaluated by Cox regression through February 2021 and multivariable adjustments considered 36 covariables in INSPIRE patients diagnosed with COVID-19. Secondary analysis evaluated the association of fasting with testing positive for SARS-CoV-2 in INSPIRE patients evaluated for COVID-19 (n=1,524).

Results:

Subjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4{+/-}20.6 years (max 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI=0.42, 0.90) favoring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalization/mortality were age, Hispanic ethnicity, prior MI, prior TIA, and renal failure, with trends for race, smoking, hyperlipidemia, coronary disease, diabetes, heart failure, and history of anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51).

Conclusions:

Routine periodic fasting was associated with a lower risk of hospitalization or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic. Trial registration clinicaltrials.gov, NCT02450006 (the INSPIRE registry)
Subject(s)

Full text: Available Collection: Preprints Database: medRxiv Main subject: Anxiety Disorders / Coronavirus Infections / Coronary Disease / Diabetes Mellitus / Renal Insufficiency / COVID-19 / Heart Failure / Hyperlipidemias / Myocardial Infarction Language: English Year: 2022 Document Type: Preprint

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Full text: Available Collection: Preprints Database: medRxiv Main subject: Anxiety Disorders / Coronavirus Infections / Coronary Disease / Diabetes Mellitus / Renal Insufficiency / COVID-19 / Heart Failure / Hyperlipidemias / Myocardial Infarction Language: English Year: 2022 Document Type: Preprint