Impact of ultra-processed food intake on the risk of COVID-19: a prospective cohort study
Lihui Zhou, Huiping Li, Shunming Zhang, Hongxi Yang, Yue Ma, Yaogang Wang
European Journal of Nutrition, doi:10.1007/s00394-022-02982-0
Purpose Nutrition plays a key role in supporting the human immune system and reducing the risk of infections. However, there is limited evidence exploring the relationship between diet and the risk of COVID-19. This study aimed to assess the associations between consumption of ultra-processed foods (UPF) and COVID-19 risk. Methods In total, 41,012 participants from the UK Biobank study with at least 2 of up to 5 times 24-h dietary assessments were included in this study. Dietary intakes were collected using an online 24-h dietary recall questionnaire and food items were categorized according to their degree of processing by the NOVA classification. COVID-19 infection was defined as individuals tested COVID-19 positive or dead of COVID-19. Association between average UPF consumption (% daily gram intake) and COVID-19 infection was assessed by multivariable logistic regression adjusted for potential confounders. Results Compared to participants in the lowest quartile of UPF proportion (% daily gram intake) in the diet, participants in the 2nd, 3rd, and highest quartiles were associated with a higher risk of COVID-19 with the odds ratio (OR) value of 1.03 (95% CI: 0.94-1.13), 1.24 (95% CI: 1.13-1.36), and 1.22 (95% CI: 1.12-1.34), respectively (P for trend < 0.001), after adjusting for potential confounders. The results were robust in a series of sensitivity analyses. No interaction effect was identified between the UPF proportions and age groups, education level, body mass index, and comorbidity status. BMI mediated 13.2% of this association. Conclusion Higher consumption of UPF was associated with an increased risk of COVID-19 infection. Further studies are needed to better understand the underlying mechanisms in such association.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s00394-022-02982-0. Author contributions LZ and HL designed the study and drafted the statistical analysis plan. LZ compiled the data, did the statistical analysis, interpreted the data, and drafted the manuscript. HL and SZ interpreted the data, and critically revised the manuscript. HY critically revised the manuscript. YM compiled the data. YW conceived the study, critically revised the manuscript, and acquired the data and funding. All authors gave final approval and agree to be accountable for all aspects of the work ensuring integrity and accuracy. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding This study was funded by the National Natural Science Foundation of China (No. 71910107004, 91746205). The funding sources had no role in the design, execution, analyses, and interpretation of the data or decision to submit the results of this study.
Declarations Conflict of interest The authors declare that there is no conflicts of interest.
Ethical approval The ethical approvals of UK Biobank were obtained from the North West Multi-Centre Research Ethics Committee, as a Research Tissue Bank (RTB) approval. This study was approved under the UK Biobank application number 45676. Consent to participate Informed consent was obtained from all individual..
References
Armstrong, Rudkin, Allen, Dynamic linkage of COVID-19 test results between public health England's second generation surveillance system and UK Biobank, Microbial genomics,
doi:10.1099/mgen.0.000397Bandt, Monin, Obesity, nutrients and the immune system in the era of COVID-19, Nutrients,
doi:10.3390/nu13020610Belanger, Hill, Angelidi, Dalamaga, Sowers et al., Covid-19 and disparities in nutrition and obesity, N Engl J Med,
doi:10.1056/NEJMp2021264Beslay, Srour, Mejean, Ultra-processed food intake in association with BMI change and risk of overweight and obesity: a prospective analysis of the French NutriNet-Sante cohort, Plos Med,
doi:10.1371/journal.pmed.1003256Briguglio, Pregliasco, Lombardi, Perazzo, Banfi, The malnutritional status of the host as a virulence factor for new coronavirus SARS-CoV-2, Front Med,
doi:10.3389/fmed.2020.00146Buckley, Kim, Wong, Rebholz, Ultra-processed food consumption and exposure to phthalates and bisphenols in the US National health and nutrition examination survey, 2013-2014, Environ Int,
doi:10.1016/j.envint.2019.105057Bycroft, Freeman, Petkova, Ultraprocessed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study, Eur Heart J,
doi:10.1093/eurheartj/ehab783Deschasaux-Tanguy, Srour, Bourhis, Nutritional risk factors for SARS-CoV-2 infection: a prospective study within the NutriNet-Santé cohort, BMC Med,
doi:10.1186/s12916-021-02168-1Fardet, Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods, Food Funct,
doi:10.1039/c6fo00107fFardet, Rock, Chronic diseases are first associated with the degradation and artificialization of food matrices rather than with food composition: calorie quality matters more than calorie quantity, Eur J Nutr,
doi:10.1007/s00394-021-02786-8Fiolet, Srour, Sellem, Consumption of ultraprocessed foods and cancer risk: results from NutriNet-Sante prospective cohort, BMJ (Clinical research ed,
doi:10.1136/bmj.k322Frasca, Diaz, Romero, Blomberg, Ageing and obesity similarly impair antibody responses, Clin Exp Immunol,
doi:10.1111/cei.12824Galante, Adamska, Young, The acceptability of repeat Internet-based hybrid diet assessment of previous 24-h dietary intake: administration of the Oxford WebQ in UK Biobank, Br J Nutr,
doi:10.1017/S0007114515004821Gibney, Forde, Mullally, Gibney, Ultra-processed foods in human health: a critical appraisal, Am J Clin Nutr,
doi:10.3945/ajcn.117.160440Ha, Jung, Kim, Association between environmental factors and asthma using mendelian randomization: increased effect of body mass index on adult-onset moderate-tosevere asthma subtypes, Front Genet,
doi:10.3389/fgene.2021.639905Hall, Ayuketah, Brychta, Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake, Cell Metab,
doi:10.1016/j.cmet.2019.05.008Honce, Schultz-Cherry, Impact of Obesity on Influenza A virus pathogenesis, immune response, and evolution, Front Immunol,
doi:10.3389/fimmu.2019.01071Leong, Cole, Brenner, Meigs, Florez et al., Cardiometabolic risk factors for COVID-19 susceptibility and severity: a Mendelian randomization analysis, Plos Med,
doi:10.1371/journal.pmed.1003553López-Gil, García-Hermoso, Tárraga-López, Brazo-Sayavera, Dietary patterns, adherence to the food-based dietary guidelines, and ultra-processed consumption during the COVID-19 lockdown in a sample of Spanish young population, Front Pediatr,
doi:10.3389/fped.2021.702731Monteiro, Cannon, Moubarac, Levy, Louzada et al., The UN Decade of nutrition, the NOVA food classification and the trouble with ultra-processing, Public Health Nutr,
doi:10.1017/S1368980017000234Moser, Galindo-Fraga, Ortiz-Hernandez, Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses, Influenza Other Respir Viruses,
doi:10.1111/irv.12618Moubarac, Parra, Cannon, Monteiro, Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment, Curr Obes Rep,
doi:10.1007/s13679-014-0092-0Narula, Wong, Dehghan, Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study, BMJ (Clinical research ed,
doi:10.1136/bmj.n1554Pazoki, Dehghan, Evangelou, Genetic predisposition to high blood pressure and lifestyle factors: associations with midlife blood pressure levels and cardiovascular events, Circulation,
doi:10.1161/circulationaha.117.030898Perez-Cornago, Pollard, Young, Description of the updated nutrition calculation of the Oxford WebQ questionnaire and comparison with the previous version among 207,144 participants in UK Biobank, Eur J Nutr,
doi:10.1007/s00394-021-02558-4Petrakis, Margina, Tsarouhas, Obesity a risk factor for increased COVID19 prevalence, severity and lethality (Review), Mol Med Rep,
doi:10.3892/mmr.2020.11127Poti, Braga, Qin, Ultra-processed food intake and obesity: what really matters for health-processing or nutrient content?, Curr Obes Rep,
doi:10.1007/s13679-017-0285-4Rico-Campa, Martinez-Gonzalez, Alvarez-Alvarez, Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study, BMJ,
doi:10.1136/bmj.l1949Sideleva, Suratt, Black, Obesity and asthma: an inflammatory disease of adipose tissue not the airway, Am J Respir Crit Care Med,
doi:10.1164/rccm.201203-0573OCSingh, Khan, Clinical characteristics and outcomes of coronavirus disease 2019 among patients with preexisting liver disease in the United States: a multicenter research network study, Gastroenterology,
doi:10.1053/j.gastro.2020.04.064Srour, Fezeu, Kesse-Guyot, Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Sante), BMJ,
doi:10.1136/bmj.l1451Statovci, Aguilera, Macsharry, Melgar, The impact of western diet and nutrients on the microbiota and immune response at mucosal interfaces, Front Immunol,
doi:10.3389/fimmu.2017.00838Storm, Den Hertog, Van Oers, Schuit, How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? -a study in sixteen municipalities in the Netherlands, Int J Equity Health,
doi:10.1186/s12939-016-0384-yVu, Rydland, Achenbach, Van Horn, Cornelis, Dietary behaviors and incident COVID-19 in the UK Biobank, Nutrients,
doi:10.3390/nu13062114Wang, Zhou, Li, Baseline vitamin D status, sleep patterns, and the risk of incident Type 2 diabetes in data from the UK Biobank study, Diabetes Care,
doi:10.2337/dc20-1109Wood, Harrison, Judd, Bellis, Hughes et al., The impact of behavioural risk factors on communicable diseases: a systematic review of reviews, BMC Public Health,
doi:10.1186/s12889-021-12148-y
