COVID: it's those french fries!!

An editorial in the Boston Globe highlighted an interesting aspect of Covid-19 deaths: the US is particularly susceptible given our rates of suboptimal nutrition and obesity (see https://www.bostonglobe.com/2020/05/07/opinion/link-between-coronavirus-deaths-those-french-fries/ )

Details:

--the comorbidities associated with coronavirus deaths are associated with obesity. And at least central obesity is associated with a chronic inflammatory state. so the argument is that it is the chronic inflammation from poor nutrition/obesity that leads to poor Covid-19 outcomes (eg see https://www.frontiersin.org/articles/10.3389/fpubh.2020.00135/full , which makes this case.

    --78% of Covid-19 patients admitted to the ICU in China and Italy had chronic conditions; and 94% of hospitalized patients who died had an underlying condition: eg diabetes, cardiovascular disease, chronic lung disease (including asthma, COPD), hypertension, and cancer.

    --those with excess fat may have many immunologic changes: poor T cell and macrophage production, decreased antiviral responses and efficacy, increased viral shedding/transmission. And vaccines seem to work less well in these folks

    --animal studies suggest that obese mice have increased lung permeability during infection (which may be the link to the pulmonary mortality)

--unfortunately only 12.2% of Americans are metabolically healthy (normal waist circumference, a measure of central obesity; normal blood pressure, blood sugar and cholesterol), per the National Health and Nutrition Examination Survey 2009-16 (see https://www.liebertpub.com/doi/10.1089/met.2018.0105).

    --and >75% of Americans are overweight, 42% obese

    --60% of our calories come from ultra-processed foods: for a compelling prospective study, see dm ultraprocessed food jamaintmed2019 in dropbox or doi:10.1001/jamainternmed.2019.5942, which found consumption of ultraprocessed foods being associated with increased diabetes risk in >100K French adults, with 13% increased risk for each 10% increase in the proportion of ultraprocessed foods in diet.

--our modern diet is rich in non-healthy ingredients: starchy, surgary foods

    --globally this leads to 11 million deaths and 244 million disability-adjusted life years attributable to diet (see https://www.thelancet.com/article/S0140-6736(19)30041-8/fulltext). Likely the single most common cause of preventable deaths globally

--so, the concept here is that “cytokine storm” in those with Covid-19 (a huge driver of need for hospitalization, ICU admission, ventilator use, and death) may be worse in those with pre-existing inflammatory states [though increased inflammatory markers are associated with poorer outcomes, this hypothesis has not been rigorously established]

Commentary:

--I think to the minds of most of us, there is no question that a healthy diet and exercise are key components to a healthy life; eg see:

    --http://gmodestmedblogs.blogspot.com/2018/10/cancer-risk-lower-with-organic-foods.html for a prior blog noting decreased cancer risk, and links to others regarding diet and health overall

    --http://gmodestmedblogs.blogspot.com/search?q=mediterranean+diet has an array of blogs on the healthful effects of the Mediterranean diet

    --http://gmodestmedblogs.blogspot.com/2017/08/changing-diet-changes-lifespan.html for a review of several large prospective epidemiologic studies finding that mortality tracks with changing diets

    --http://gmodestmedblogs.blogspot.com/2019/10/healthy-dietantiinflammatories-dec.html finding that a healthy diet decreases systemic inflammation, and in this case is associated with decreased depression

--and, there is no question that in our society, there are many forces leading to the opposite:

    --expensive and sometimes inaccessible healthy foods; and easy access to cheap, calorie-dense and nutrition-sparse foods

    --lack of accessible venues for exercise, and many streets that are dangerous (sidewalks in poor condition, unsafe neighborhoods)

    --very stressful work lives, leading to “vegging out” on coming home after work (but without the veggies), though with TV

    --lack of community, social focus in many areas; feelings of isolation

So,

--there are lots of reasons why the US has such a high per-capita rate of Covid-19, with so many attendant deaths, including the widespread lack of testing and the (rather striking comment in the news yesterday) that we will probably not have enough until the end of the summer

    --see today's NY Times for how effective early testing was in Denmark:  https://www.nytimes.com/2020/05/08/opinion/us-denmark-economy.html?referringSource=articleShare .  which also, by the way, brings up the humane way workers were treated in Denmark, getting up to 90% of their salary if they were to be laid off

--but the logic (unproven) of the above argument is pretty strong: poor quality nutrition/overweight/obesity is associated with chronic inflammation, which is associated with higher morbidities, which is associated with poorer Covid-19 outcomes, which seems to be predicted by increased markers of inflammation (eg IL-6 levels, see https://www.medrxiv.org/content/10.1101/2020.04.01.20047381v2 ).  And, better nutrition seems to be associated with lots of favorable outcomes (as noted above, many commented upon in prior blogs)

--and, i would add exercise into the mix, given that exercise itself seems to lower chronic inflammation.

geoff

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