{"doi":"10.1101/2021.06.24.21259283","title":"Diet quality and risk and severity of COVID-19: a prospective cohort study","abstract":"Abstract Objective Poor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation. Design We used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively. Results Over 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone ( P interaction =0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively. Conclusions A dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.","journal":"medRxiv","year":2021,"id":213644,"datarank":0.4335557636844247,"base_score":2.8903717578961645,"endowment":2.8903717578961645,"self_citation_contribution":0.4335557636844247,"citation_network_contribution":0.0,"self_endowment_contribution":0.4335557636844247,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6305,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":104560,"name":"Amit D. 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Murray","orcid":"0000-0002-8198-8131","position":10,"is_corresponding":false},{"id":614716,"name":"Christina Hu","orcid":"0000-0002-3586-3506","position":11,"is_corresponding":false},{"id":616614,"name":"Somesh Selvachandran","orcid":null,"position":12,"is_corresponding":false},{"id":104567,"name":"Sohee Kwon","orcid":"0000-0002-4201-9522","position":13,"is_corresponding":false},{"id":104562,"name":"Wenjie Ma","orcid":"0000-0001-9894-7072","position":14,"is_corresponding":false},{"id":21805,"name":"Cristina Menni","orcid":"0000-0001-9790-0571","position":15,"is_corresponding":false},{"id":346963,"name":"Alexander Hammers","orcid":"0000-0001-9530-4848","position":16,"is_corresponding":false},{"id":230956,"name":"Shilpa N Bhupathiraju","orcid":"0000-0001-9910-6777","position":17,"is_corresponding":false},{"id":104615,"name":"Shreela V. Sharma","orcid":"0000-0002-4668-5020","position":18,"is_corresponding":false},{"id":104580,"name":"Carole H. Sudre","orcid":"0000-0001-5753-428X","position":19,"is_corresponding":false},{"id":254537,"name":"Christina M. Astley","orcid":"0000-0002-5063-8470","position":20,"is_corresponding":false},{"id":806219,"name":"Walter C. Willet","orcid":null,"position":21,"is_corresponding":false},{"id":104573,"name":"Jorge E. Chavarro","orcid":"0000-0002-4436-9630","position":22,"is_corresponding":false},{"id":104583,"name":"Sébastien Ourselin","orcid":"0000-0002-5694-5340","position":23,"is_corresponding":false},{"id":104584,"name":"Claire J. Steves","orcid":"0000-0002-4910-0489","position":24,"is_corresponding":false},{"id":104581,"name":"Jonathan Wolf","orcid":"0000-0002-0530-2257","position":25,"is_corresponding":false},{"id":21957,"name":"Paul W. Franks","orcid":"0000-0002-0520-7604","position":26,"is_corresponding":false},{"id":104582,"name":"Tim D. 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