University of Navarra, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Navarra, Spain.
University of Navarra, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Navarra, Spain; CIBER Fisiopatología de La Obesidad y Nutrición, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008 Pamplona, Navarra, Spain; Department of Nutrition, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
Clin Nutr. 2022 Dec;41(12):3061-3068. doi: 10.1016/j.clnu.2021.04.001. Epub 2021 Apr 15.
BACKGROUND & AIMS: A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.
We assessed 9,677 participants from the SUN Project, a prospective cohort of middle-aged university graduates in Spain. We inquired about a positive result in a COVID-19 diagnostic test during the months of February to December 2020. After excluding health professionals (HP), 5,194 participants were included in the statistical analyses (mean age: 52.6, SD: 12.4; 55.2% women). Food habits were assessed at baseline using a previously validated semiquantitative 136-item food frequency questionnaire. Adherence to the Mediterranean diet (cumulative average of 2 repeated measurements 10 years apart) was assessed using the 0-to-9 Mediterranean Diet Score (MDS). We used multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for incident COVID-19 according to the MDS.
Among 5,194 non-HP participants, 122 reported to have received a positive COVID-19 diagnostic test. Participants with intermediate adherence to the Mediterranean diet (3 < MDS ≤ 6) had a significantly lower odds of developing COVID-19 (multivariable-adjusted OR = 0.50, 95% CI: 0.34-0.73), and those with the highest adherence (MDS > 6) exhibited the lowest risk (multivariable-adjusted OR = 0.36, 95% CI: 0.16-0.84, p for trend < 0.001) as compared with participants with MDS ≤ 3. This inverse association remained robust within subgroups and in sensitivity analyses. Notwithstanding, no significant associations were observed for health professionals (p for interaction = 0.06).
In conclusion, better adherence to the Mediterranean diet may be associated with a lower risk of COVID-19. Our results are applicable only to persons who are not health professionals.
鉴于充足的饮食摄入对免疫系统有益的生物学原理，人们期望高质量的饮食模式能预防 COVID-19。然而，关于长期维持健康的饮食模式（如地中海饮食）与 SARS-CoV-2 感染风险之间的关系，人们的了解仍然很少。我们在一个著名的地中海队列中对此进行了纵向评估。
我们评估了来自西班牙 SUN 项目的 9677 名中年大学毕业生作为前瞻性队列的参与者。我们询问了他们在 2020 年 2 月至 12 月期间 COVID-19 诊断检测的阳性结果。排除卫生专业人员（HP）后，有 5194 名参与者纳入了统计分析（平均年龄：52.6，SD：12.4；55.2%为女性）。使用先前验证的半定量 136 项食物频率问卷在基线时评估饮食习惯。地中海饮食的依从性（10 年内重复测量 2 次的累积平均值）使用 0 至 9 地中海饮食评分（MDS）进行评估。我们使用多变量逻辑回归模型根据 MDS 估计 COVID-19 发生率的比值比和 95%置信区间。
在 5194 名非 HP 参与者中，有 122 名报告接受了 COVID-19 阳性诊断检测。地中海饮食中度依从者（3 < MDS ≤ 6）发生 COVID-19 的可能性明显较低（多变量调整后的 OR = 0.50，95%CI：0.34-0.73），而依从性最高者（MDS > 6）的风险最低（多变量调整后的 OR = 0.36，95%CI：0.16-0.84，p 趋势 < 0.001）与 MDS ≤ 3 的参与者相比。这种反比关联在亚组和敏感性分析中仍然稳健。然而，对于卫生专业人员，没有观察到显著的关联（p 交互作用 = 0.06）。
总之，更好地遵守地中海饮食可能与 COVID-19 的风险降低有关。我们的结果仅适用于非卫生专业人员。
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