scholarly journals Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003371
Author(s):  
Hyunju Kim ◽  
Kyueun Lee ◽  
Casey M. Rebholz ◽  
Jihye Kim
Keyword(s):  
Metabolic Syndrome ◽  
Dietary Intake ◽  
Lower Risk ◽  
Density Lipoprotein ◽  
Vegetarian Diet ◽  
Healthy Plant ◽  
Potential Measurement ◽  
Plant Foods ◽  
Asian Populations

Background Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time. Methods and findings Analyses were based on a community-based cohort of 5,646 men and women (40–69 years of age at baseline) living in Ansan and Ansung, South Korea (2001–2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31–1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%–46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70–0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding. Conclusions In this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

scholarly journals Association between Different Types of Plant-Based Diets and Risk of Dyslipidemia: A Prospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 220
Author(s):  
Kyueun Lee ◽  
Hyunju Kim ◽  
Casey M. Rebholz ◽  
Jihye Kim
Keyword(s):  
Density Lipoprotein ◽  
Dietary Intakes ◽  
Food Frequency ◽  
Plant Foods ◽  
Lipid Disorders ◽  
Asian Populations ◽  
Hazard Ratios ◽  
Different Types

We evaluated the associations among different types of plant-based diet indices, risk of dyslipidemia, and individual lipid disorders in Asian populations with different dietary patterns from Western populations. Participants included 4507 Korean adults aged ≥40 years without dyslipidemia and related chronic diseases at baseline (2001–2002). Dietary intakes were assessed using an average of validated food frequency questionnaires measured twice. We calculated three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 14 years, 2995 incident dyslipidemia cases occurred. Comparing the highest with lowest quintiles, the multivariable-adjusted hazard ratios (HRs) for incident dyslipidemia were 0.78 (95% CI, 0.69–0.88) for PDI, 0.63 (95% CI, 0.56–0.70) for hPDI, and 1.48 (95% CI, 1.30–1.69) for uPDI (P-trend < 0.0001 for all). Associations between PDI and individual lipid disorders differed by sex. The PDI was inversely associated with risk of developing hypertriglyceridemia in men and with risk of developing low high-density lipoprotein cholesterol in women. The hPDI was inversely associated with risk of all lipid disorders, whereas the uPDI was positively associated with individual lipid disorders. The quality of plant foods is important for prevention of dyslipidemia in a population that consumes diets high in plant foods.

scholarly journals Plant-Based Diets and Incident CKD and Kidney Function

2019 ◽  
Vol 14 (5) ◽  
pp. 682-691 ◽  
Author(s):  
Hyunju Kim ◽  
Laura E. Caulfield ◽  
Vanessa Garcia-Larsen ◽  
Lyn M. Steffen ◽  
Morgan E. Grams ◽  
...  
Keyword(s):  
Kidney Function ◽  
Proportional Hazards ◽  
Population Based ◽  
Vegetarian Diet ◽  
Cox Proportional Hazards ◽  
Healthy Plant ◽  
Atherosclerosis Risk In Communities ◽  
Plant Foods ◽  
Cox Proportional Hazards Models ◽  
Middle Aged Adults

Background and objectivesThe association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk varied by different types of plant-based diets.Design, setting, participants, & measurementsAnalyses were conducted in a sample of 14,686 middle-aged adults enrolled in the Atherosclerosis Risk in Communities study. Diets were characterized using four plant-based diet indices. In the overall plant-based diet index, all plant foods were positively scored; in the healthy plant-based diet index, only healthful plant foods were positively scored; in the provegetarian diet, selected plant foods were positively scored. In the less healthy plant-based diet index, only less healthful plant foods were positively scored. All indices negatively scored animal foods. We used Cox proportional hazards models to study the association with incident CKD and linear mixed models to examine decline in eGFR, adjusting for confounders.ResultsDuring a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).ConclusionsHigher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.

Association between unhealthy plant-based diets and the metabolic syndrome in adult men and women: a population-based study in South Korea

2020 ◽  
pp. 1-14 ◽  
Author(s):  
Hyunju Kim ◽  
Kyueun Lee ◽  
Casey M. Rebholz ◽  
Jihye Kim
Keyword(s):  
Metabolic Syndrome ◽  
Metabolic Diseases ◽  
Population Based ◽  
Healthy Plant ◽  
Dietary Intakes ◽  
Plant Foods ◽  
Logistic Regression Models ◽  
Korean Adults ◽  
The Metabolic Syndrome ◽  
Potential Risk Factors

Abstract No studies have investigated the associations between established plant-based diet indices and the metabolic syndrome (MetS). We evaluated the associations between an overall plant-based diet index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI) and the MetS in a nationally representative sample using data from 14 450 Korean adults (≥19 years) in the Korea National Health and Nutrition Examination Survey 2012–2016. Dietary intakes were assessed by a semi-quantitative FFQ. In the PDI, all plant foods received positive scores. In the hPDI, only healthy plant foods received positive scores. In the uPDI, only unhealthy plant foods received positive scores. All indices reverse scored animal food intake. Multivariable logistic regression models were used to examine the associations between three PDI and the MetS by sex, adjusting for potential risk factors. A total of 23·3 % of Korean adults had the MetS. In the overall study population, individuals in the highest quintile of uPDI had greater odds (OR 1·54, 95 % CI 1·28, 1·86, Ptrend < 0·001) of the MetS than those in the lowest quintile. Higher uPDI score was associated with higher odds of hypertriacylglycerolaemia in men and abdominal obesity, high fasting glucose and hypertriacylglycerolaemia in women. No significant associations were observed between PDI, hPDI and the MetS. Greater adherence to unhealthy plant-based diets was associated with greater odds of the MetS and its components suggesting the importance of the quality of plant-based diet in South Korean adults. Sex differences may be considered when recommending plant-based diets for the prevention and management of metabolic diseases.

scholarly journals THE ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND METABOLIC SYNDROME IN OLDER ADULTS WITH OBESITY

2018 ◽  
pp. 1-6
Author(s):  
F. Xu ◽  
S.A. Cohen ◽  
I.E. Lofgren ◽  
G.W. Greene ◽  
M.J. Delmonico ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Metabolic Syndrome ◽  
Lower Risk ◽  
Density Lipoprotein ◽  
Activity Levels ◽  
Cross Sectional ◽  
Physical Activity Levels ◽  
Physical Activity Recommendations ◽  
Activity Recommendations

Background: Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. Methods: This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture’s Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. Results: Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. Conclusions: Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.

scholarly journals The relation between dietary phytochemical index and metabolic syndrome and its components in a large sample of Iranian adults: A population-based study

2020 ◽  
Author(s):  
Aazam ahmadi Vasmehjani ◽  
Zahra Darabi ◽  
azadeh Nadjarzadeh ◽  
masoud Mirzaei ◽  
Mahdieh Hosseinzadeh
Keyword(s):  
Metabolic Syndrome ◽  
Energy Intake ◽  
Lower Risk ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Protective Role ◽  
Food Sources ◽  
Health Study ◽  
Plant Foods ◽  
Logistic Regression Models

Abstract Background: Phytochemicals are natural non-nutritive bioactive compounds in plant foods. There is growing agreement that plant foods-based phytochemicals have a protective role against chronic diseases. The purpose of current study was to appraise Dietary Phytochemical Index (DPI) with the risk of metabolic syndrome (MetS) and its components.Methods: This study was conducted on 2326 participants (1097 men and 1220 women), aged 20-70 years of the recruitment phase of Yazd Health Study (YaHS), a population-based cohort study on Iranian adults. Dietary intake was prepared using a validated and reliable food frequency questionnaire. DPI is calculated based on dietary energy derived from phytochemical-rich food sources (kcal)/ total daily energy intake (kcal). The odds ratio of MetS and its components were assessed across DPI quartiles by binary logistic regression models.Results: After adjustment for all potential confounders, the risk of MetS (OR=0.63, 95% CI=0.41-0.96, P=0.03) and elevated blood pressure (OR=0.62, 95% CI=0.40-0.96, P=0.03) in second category of DPI compared to the first significantly decreased. After full adjustment for confounders, women in the highest quartile of DPI compared with the lowest, had 59% lower risk of MetS (OR=0.41, 95% CI=0.22-0.76, P=0.005). In second quartiles of DPI, the risk of MetS decreased by 62% (OR=0.38, 95% CI=0.16-0.90, P=0.02) in participants with normal BMI and 29% in subjects with high BMI (OR=0.71, 95% CI=0.52-0.99, P=0.04), and also 57% in men (OR=0.43, 95%CI=0.23-0.83, P=0.01). Independent of variables including age, sex and total energy intake, subjects in second and fourth quartiles of DPI had 30% and 25% lower risk of abdominal obesity, respectively.Conclusions: Greater adherence to phytochemical-rich diet could reduce odds of MetS and some components especially in women. Further studies with intervention approaches are required to discover causal relations and relevant underlying mechanisms.

scholarly journals The Association of Quality of Life and Personality Characteristics with Adolescent Metabolic Syndrome: A Cohort Study

2020 ◽  
Author(s):  
xiaohua liang ◽  
Peng Zhang ◽  
Shunqing Luo ◽  
Guifang Zhang ◽  
Xian Tang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Cohort Study ◽  
Psychological Health ◽  
Protective Factor ◽  
Community Intervention ◽  
Density Lipoprotein ◽  
Personality Score

Abstract Background: Increased prevalence of adolescent metabolic syndrome (MS) is a tracking factor for adulthood cardiovascular diseases. This study aimed to explore the potential relationship of quality of life (QoL) and personality traits with adolescent MS. Methods：1961 participants aged 11.68 years from a cohort study established in 2014 and followed in 2019 was included in Chongqing. Quality of life (QoL) and Eysenck’s personality questionnaire and MS components were collected.Results：The prevalence of adolescent MS is 4.69% (95% confidence interval, 3.84%-5.72%). Higher QoL domain score of physical activity ability (PAA) was a protective factor for both MS and MS score (all P<0.01), which was mainly negatively correlated with central obesity, diastolic blood pressure (DBP) and triglycerides levels, and positively correlated with high density lipoprotein cholesterol (HDL-C) level. Total score of QoL was negatively correlated with triglycerides level and positively correlated with DBP (all P<0.01). High extraversion personality score was a protective factor of adolescent MS (P=0.04) and MS score (P=0.06), which was mainly negatively correlated WC systolic blood pressure and TGs, and positively correlated with HDL-C (all P≤0.01).Conclusions：QoL score and extraversion personality score were independent protective factors for both MS prevalence and MS score, suggesting the community intervention to improve the QoL and psychological health of children is essential.

scholarly journals Plasma Linoleic Acid Is Associated with Less Adiposity and Lower Risk of Metabolic Syndrome: An NHANES Analysis (P08-121-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kristina Petersen ◽  
Valerie Sullivan ◽  
Victor Fulgoni ◽  
Fulya Eren ◽  
Martha Cassens ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Fatty Acids ◽  
Fatty Acid ◽  
Linoleic Acid ◽  
Waist Circumference ◽  
Dietary Intake ◽  
Lower Risk ◽  
Lipid Lowering ◽  
Calorie Intake ◽  
Plasma Fatty Acids

Abstract Objectives To examine relationships between plasma fatty acids, dietary intake of fatty acids, adiposity and risk of metabolic syndrome (MetSyn) in the National Health and Nutrition Examination Survey (NHANES) dataset. Methods Plasma fatty acids levels (n = 24) measured in NHANES 2001–2003 (n = 1674) and dietary intake of fatty acids (n = 19) from NHANES 2001–2014 (n = 9108) were used for these analyses. The association between plasma fatty acid levels, intake of fatty acids and body weight, BMI, waist circumference, and number of criteria for MetSyn was assessed. Backwards stepwise multiple regression analyses adjusted for age, sex, ethnicity, prescription of anti-hypertensive, lipid-lowering of anti-diabetic medication, modified Health Eating Index-2015 score, physical activity, poverty to income ratio, smoking, and calorie intake were conducted to identify fatty acids that were predictive of the outcomes of interest. Logistic regression analysis, adjusted for the aforementioned covariates, was used to assess the odds of MetSyn, and overweight/obesity associated with each fatty acid. Results Higher levels of the plasma saturated fatty acids myristic acid (14:0), stearic acid (18:0), and docosanoic acid (22:0) were associated with greater BMI, waist circumference, and number of MetSyn criteria (P < 0.01). Arachidic acid (20:0) and lignoceric acid (24:0) were inversely associated with BMI, waist circumference, and number of MetSyn criteria. Plasma linoleic acid (18:2) was the only PUFA inversely associated with BMI (β = −0.002), waist circumference (β = −0.005), and number of MetSyn criteria (β −0.0003) (all P < 0.01). Plasma linoleic acid was also correlated with lower risk of being overweight or obese (odds ratio (OR) 0.9995; P < 0.03) and having an elevated waist circumference (OR 0.9992; P < 0.01). These results were not supported by the dietary fatty acid intake data. Conclusions These data from a representative U.S. cohort indicate that plasma medium and longer chain saturated fats were generally associated with greater adiposity and more criteria for MetSyn, whereas these relationships were not detected for MUFA. Linoleic acid was the only PUFA associated with less adiposity and lower risk of MetSyn and, thus also lower risk of cardiometabolic disease. Funding Sources ACH Food Companies, Inc.

scholarly journals Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US Adults

2018 ◽  
Vol 148 (4) ◽  
pp. 624-631 ◽  
Author(s):  
Hyunju Kim ◽  
Laura E Caulfield ◽  
Casey M Rebholz
Keyword(s):  
Cardiovascular Disease ◽  
Lower Risk ◽  
Effect Modification ◽  
Healthy Plant ◽  
Future Research ◽  
Cardiovascular Disease Mortality ◽  
Plant Foods ◽  
Disease Mortality ◽  
All Cause Mortality ◽  
The Impact

AbstractBackgroundPlant-based diets, often referred to as vegetarian diets, are associated with health benefits. However, the association with mortality is less clear.ObjectiveWe investigated associations between plant-based diet indexes and all-cause and cardiovascular disease mortality in a nationally representative sample of US adults.MethodsAnalyses were based on 11,879 participants (20–80 y of age) from NHANES III (1988–1994) linked to data on all-cause and cardiovascular disease mortality through 2011. We constructed an overall plant-based diet index (PDI), which assigns positive scores for plant foods and negative scores for animal foods, on the basis of a food-frequency questionnaire administered at baseline. We also constructed a healthful PDI (hPDI), in which only healthy plant foods received positive scores, and a less-healthful (unhealthy) PDI (uPDI), in which only less-healthful plant foods received positive scores. Cox proportional hazards models were used to estimate the association between plant–based diet consumption in 1988–1994 and subsequent mortality. We tested for effect modification by sex.ResultsIn the overall sample, PDI and uPDI were not associated with all-cause or cardiovascular disease mortality after controlling for demographic characteristics, socioeconomic factors, and health behaviors. However, among those with an hPDI score above the median, a 10-unit increase in hPDI was associated with a 5% lower risk in all-cause mortality in the overall study population (HR: 0.95; 95% CI: 0.91, 0.98) and among women (HR: 0.94; 95% CI: 0.88, 0.99), but not among men (HR: 0.95; 95% CI: 0.90, 1.01). There was no effect modification by sex (P-interaction > 0.10).ConclusionsA nonlinear association between hPDI and all-cause mortality was observed. Healthy plant-based diet scores above the median were associated with a lower risk of all-cause mortality in US adults. Future research exploring the impact of quality of plant-based diets on long-term health outcomes is necessary.

scholarly journals Diet quality and risk and severity of COVID-19: a prospective cohort study

2021 ◽  
Author(s):  
Jordi Merino ◽  
Amit D Joshi ◽  
Long Nguyen ◽  
Emily Leeming ◽  
David Alden Drew ◽  
...  
Keyword(s):  
Diet Quality ◽  
Lower Risk ◽  
Socioeconomic Deprivation ◽  
Healthy Plant ◽  
Cox Models ◽  
Plant Foods ◽  
Hazard Ratios ◽  
High Deprivation ◽  
Diet Score

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 (Pinteraction=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.

scholarly journals Diet quality and risk and severity of COVID-19: a prospective cohort study

Gut ◽  
2021 ◽  
Vol 70 (11) ◽  
pp. 2096-2104 ◽  
Author(s):  
Jordi Merino ◽  
Amit D Joshi ◽  
Long H Nguyen ◽  
Emily R Leeming ◽  
Mohsen Mazidi ◽  
...  
Keyword(s):  
Diet Quality ◽  
Lower Risk ◽  
Socioeconomic Deprivation ◽  
Healthy Plant ◽  
Unhealthy Lifestyle ◽  
Cox Models ◽  
Plant Foods ◽  
High Deprivation ◽  
Diet Score

ObjectivePoor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of 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 interaction with socioeconomic deprivation.DesignWe used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively.ResultsOver 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 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 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 (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation.ConclusionsA diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

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