Nutritional risk factors for SARS-CoV-2 infection: a prospective study within the NutriNet-Santé cohort

Mélanie Deschasaux-Tanguy, Bernard Srour, Laurent Bourhis, Nathalie Arnault, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Julien Allègre, Benjamin Allès, Valentina A Andreeva, Julia Baudry, Leopold K Fezeu, Pilar Galan, Chantal Julia, Emmanuelle Kesse-Guyot, Sandrine Péneau, Serge Hercberg, Nathalie Bajos, Gianluca Severi, Marie Zins, Xavier de Lamballerie, Fabrice Carrat, Mathilde Touvier, SAPRIS-SERO study group, Fabrice Carrat, Pierre-Yves Ancel, Nathalie Bajos, Marie-Aline Charles, Gianluca Severi, Mathilde Touvier, Marie Zins, Sofiane Kab, Adeline Renuy, Stephane Le-Got, Celine Ribet, Emmanuel Wiernik, Marcel Goldberg, Marie Zins, Fanny Artaud, Pascale Gerbouin-Rérolle, Mélody Enguix, Camille Laplanche, Roselyn Gomes-Rima, Lyan Hoang, Emmanuelle Correia, Alpha Amadou Barry, Nadège Senina, Gianluca Severi, Fabien Szabo de Edelenyi, Julien Allègre, Nathalie Druesne-Pecollo, Younes Esseddik, Serge Hercberg, Mathilde Touvier, Marie-Aline Charles, Pierre-Yves Ancel, Valérie Benhammou, Anass Ritmi, Laetitia Marchand, Cecile Zaros, Elodie Lordmi, Adriana Candea, Sophie de Visme, Thierry Simeon, Xavier Thierry, Bertrand Geay, Marie-Noelle Dufourg, Karen Milcent, Clovis Lusivika-Nzinga, Gregory Pannetier, Nathanael Lapidus, Isabelle Goderel, Céline Dorival, Jérôme Nicol, Fabrice Carrat, Cindy Lai, Hélène Esperou, Sandrine Couffin-Cadiergues, Jean-Marie Gagliolo, Hélène Blanché, Jean-Marc Sébaoun, Jean-Christophe Beaudoin, Laetitia Gressin, Valérie Morel, Ouissam Ouili, Jean-François Deleuze, Stéphane Priet, Paola Mariela Saba Villarroel, Toscane Fourié, Souand Mohamed Ali, Abdenour Amroun, Morgan Seston, Nazli Ayhan, Boris Pastorino, Xavier de Lamballerie, Mélanie Deschasaux-Tanguy, Bernard Srour, Laurent Bourhis, Nathalie Arnault, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Julien Allègre, Benjamin Allès, Valentina A Andreeva, Julia Baudry, Leopold K Fezeu, Pilar Galan, Chantal Julia, Emmanuelle Kesse-Guyot, Sandrine Péneau, Serge Hercberg, Nathalie Bajos, Gianluca Severi, Marie Zins, Xavier de Lamballerie, Fabrice Carrat, Mathilde Touvier, SAPRIS-SERO study group, Fabrice Carrat, Pierre-Yves Ancel, Nathalie Bajos, Marie-Aline Charles, Gianluca Severi, Mathilde Touvier, Marie Zins, Sofiane Kab, Adeline Renuy, Stephane Le-Got, Celine Ribet, Emmanuel Wiernik, Marcel Goldberg, Marie Zins, Fanny Artaud, Pascale Gerbouin-Rérolle, Mélody Enguix, Camille Laplanche, Roselyn Gomes-Rima, Lyan Hoang, Emmanuelle Correia, Alpha Amadou Barry, Nadège Senina, Gianluca Severi, Fabien Szabo de Edelenyi, Julien Allègre, Nathalie Druesne-Pecollo, Younes Esseddik, Serge Hercberg, Mathilde Touvier, Marie-Aline Charles, Pierre-Yves Ancel, Valérie Benhammou, Anass Ritmi, Laetitia Marchand, Cecile Zaros, Elodie Lordmi, Adriana Candea, Sophie de Visme, Thierry Simeon, Xavier Thierry, Bertrand Geay, Marie-Noelle Dufourg, Karen Milcent, Clovis Lusivika-Nzinga, Gregory Pannetier, Nathanael Lapidus, Isabelle Goderel, Céline Dorival, Jérôme Nicol, Fabrice Carrat, Cindy Lai, Hélène Esperou, Sandrine Couffin-Cadiergues, Jean-Marie Gagliolo, Hélène Blanché, Jean-Marc Sébaoun, Jean-Christophe Beaudoin, Laetitia Gressin, Valérie Morel, Ouissam Ouili, Jean-François Deleuze, Stéphane Priet, Paola Mariela Saba Villarroel, Toscane Fourié, Souand Mohamed Ali, Abdenour Amroun, Morgan Seston, Nazli Ayhan, Boris Pastorino, Xavier de Lamballerie

Abstract

Background: Nutritional factors are essential for the functioning of the immune system and could therefore play a role in COVID-19 but evidence is needed. Our objective was to study the associations between diet and the risk of SARS-CoV-2 infection in a large population-based sample.

Methods: Our analyses were conducted in the French prospective NutriNet-Santé cohort study (2009-2020). Seroprevalence of anti-SARS-CoV-2 antibodies was assessed by ELISA on dried blood spots. Dietary intakes were derived from repeated 24 h dietary records (at least 6) in the two years preceding the start of the COVID-19 pandemic in France (February 2020). Multi-adjusted logistic regression models were computed.

Results: A total of 7766 adults (70.3% women, mean age: 60.3 years) were included, among which 311 were positive for anti-SARS-CoV-2 antibodies. Dietary intakes of vitamin C (OR for 1 SD=0.86 (0.75-0.98), P=0.02), vitamin B9 (OR=0.84 (0.72-0.98), P=0.02), vitamin K (OR=0.86 (0.74-0.99), P=0.04), fibers (OR=0.84 (0.72-0.98), P=0.02), and fruit and vegetables (OR=0.85 (0.74-0.97), P=0.02) were associated to a decreased probability of SARS-CoV-2 infection while dietary intakes of calcium (OR=1.16 (1.01-1.35), P=0.04) and dairy products (OR=1.19 (1.06-1.33), P=0.002) associated to increased odds. No association was detected with other food groups or nutrients or with the overall diet quality.

Conclusions: Higher dietary intakes of fruit and vegetables and, consistently, of vitamin C, folate, vitamin K and fibers were associated with a lower susceptibility to SARS-CoV-2 infection. Beyond its established role in the prevention of non-communicable diseases, diet could therefore also contribute to prevent some infectious diseases such as COVID-19.

Trial registration: ClinicalTrials.gov NCT03335644.

Keywords: Cohort study; Diet; SARS-CoV-2; Seroprevalence; Vitamins.

Conflict of interest statement

Prof Fabrice Carrat reports personal fees from Imaxio and Sanofi, outside the submitted work. All other authors declare no competing interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Nutritional intakes and SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. ELISA-S positive (n=311) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August-September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day; except for energy), alcohol intakes (g/day; except for alcohol) and a composite score reflecting the adherence to recommended protective behaviors when going out. Total vitamin A including retinol and beta-carotene, calculated as retinol equivalent (1 mg retinol = 6 mg beta-carotene)
Fig. 2
Fig. 2
Food group consumption and SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. ELISA-S positive (n=311) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August-September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day), alcohol intakes (g/day; except for alcoholic drinks) and a composite score reflecting the adherence to recommended protective behaviors when going out. Starchy foods: bread, pasta, rice, potatoes, starchy vegetables, etc.; sugary products: chocolate, sweets, honey, sugary desserts, etc.
Fig. 3
Fig. 3
Nutritional intakes and symptomatic SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. Symptomatic ELISA-S positive (n=179) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August–September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day; except for energy), alcohol intakes (g/day; except for alcohol) and a composite score reflecting the adherence to recommended protective behaviors when going out. Total vitamin A including retinol and beta-carotene, calculated as retinol equivalent (1 mg retinol = 6 mg beta-carotene)
Fig. 4
Fig. 4
Food group consumption and symptomatic SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. Symptomatic ELISA-S positive (n=179) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August–September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day), alcohol intakes (g/day; except for alcoholic drinks) and a composite score reflecting the adherence to recommended protective behaviors when going out. Starchy foods: bread, pasta, rice, potatoes, starchy vegetables, etc.; sugary products: chocolate, sweets, honey, sugary desserts, etc.
Fig. 5
Fig. 5
Nutritional intakes and asymptomatic SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. Asymptomatic ELISA-S positive (n=132) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August–September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day; except for energy), alcohol intakes (g/day; except for alcohol) and a composite score reflecting the adherence to recommended protective behaviors when going out. Total vitamin A including retinol and beta-carotene, calculated as retinol equivalent (1 mg retinol = 6 mg beta-carotene)
Fig. 6
Fig. 6
Food group consumption and asymptomatic SARS-CoV-2 infection (ELISA-S), NutriNet-Santé cohort (2009–2020)—SAPRIS-SERO. Asymptomatic ELISA-S positive (n=132) compared to ELISA-S negative (n=7455) participants. Odds ratios and 95% confidence intervals per 1-SD increment obtained from multi-adjusted logistic regression models including sex (men/women), age, educational level (< high-school degree/high-school degree/undergraduate degree/graduate degree), employment status (no professional activity prior to lockdown: unemployed, retired, homemaker/short-time working/working outside home/working from home/student, trainee and other), smoking status (non-smoker, former smoker, smoker), presence of children and/or grandchildren aged under 18 years at home (yes/no), residential area (rural area/city < 20,000 inhabitants/city ≥ 20,000 to 100,000 inhabitants/city > 100,000 inhabitants), frequency of going out over the past week (never/once/2 to 5 times/6 to 10 times/> 10 times), prevalent chronic disease (cancer, cardiovascular disease, high blood pressure, diabetes, dyslipidemia; yes/no), geographical area (Paris Basin/Centre-East/East/Mediterranean/North/West/Paris region/Southwest), BMI and physical activity level (high, moderate, low) prior to the March 2020 lockdown, month of blood draw (May–June/July/August–September–October), number of 24 h dietary records, energy intakes (without alcohol, kcal/day), alcohol intakes (g/day; except for alcoholic drinks) and a composite score reflecting the adherence to recommended protective behaviors when going out. Starchy foods: bread, pasta, rice, potatoes, starchy vegetables, etc.; sugary products: chocolate, sweets, honey, sugary desserts, etc.

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Source: PubMed

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