The relationship between Dietary Inflammatory Index, DASH Diet Score, Total Antioxidant Capacity of food with serum levels of TMPRSS-2, inflammatory biomarkers and disease severity in Covid-19 patients: a case-control study

Abstract

Abstract Introduction: Nutritional status is directly related to inflammation and immune response. Evidence shows that diets with anti-inflammatory profiles support the body's immune system to prevent and fight infections, thereby reducing the severity of infectious diseases such as Covid-19. Although there is a lot of evidence about the relationship between food patterns and behaviors in inflammatory, viral and bacterial diseases, the relationship between food patterns and diagnostic and predictive markers in patients with Covid-19 is less known and in fact there is little information in this field. Therefore, this study aimed to investigate the relationship between dietary inflammatory index (DII), DASH diet score (DASH) and dietary total antioxidant capacity (TAC) with the serum level of transmembrane serine protease 2 (TMPRSS-2), inflammatory biomarkers such as C-reactive protein (CRP), white blood cell and erythrocyt sedimentation rate (ESR) and disease severity in covid-19 patients. Materials and methods: This case-control study included 120 adults (60 COVID-19 patients and 60 healthy controls), who were admitted to the hospital. Demographic information, anthropometry and general characteristics questionnaire were completed for participants. Dietary inflammatory index (DII), DASH Diet score and dietary total antioxidant capacity (TAC) were determined by a 138-item semi-quantitative food frequency questionnaire (FFQ). Inflammatory biomarkers including CRP, ESR, WBC TMPRSS-2 were measured. Also, using pulmonary infiltration, respiratory rate and oxygen saturation the severity of the disease was evaluate. dietary intake was analyzed by Nutritionist IV software. Statistical data analyses were run by IBM SPSS statistics 22. Findings: Inflammatory biomarkers (CRP, ESR, and WBC) (P<0.0001), hospital time (P=0.004) and ICU time (P<0.0001) were significantly higher in the second and third tertil of DII than the first tertile. The mean CRP and hospital time were significantly lower in the third tertile of DASH score (P=0.04, P=0.013) and TAC (P=0.037 and P=0.03) than the first tertile. TMPRSS-2 levels in tertiles of DII, DASH score and TAC showed no significant difference. There was a direct significant relationship between DII and the risk of COVID-19 (OR=8.3, 95%CI: 3/22-4/60). In the third tertile of TAC the odds of COVID-19 was lower than the first tertile(OR=06/0, 95%CI: 0.02-0.20). Individuals in the third tertile of DASH diet scores were also at lower risk of COVID-19 than the fist tertile(OR: 0.12, 95%CI; 0.04-0.34). No significant associations were found between dietary TAC and DASH diet scores with severity of COVID-19 disease, inflammatory biomarkers(CRP, ESR, WBC), TMPRSS-2. In contrast there was a significant direct associations between DII with CRP(β=4.30, 95%CI: 2.89-5.72), ESR(β=5.42, 95%CI:3.53-7.30),WBC(β=1072.53,95%CI:731.88-1413.17), hospitalstay(β=63.0,95%CI:0.20-1.05) and ICU stay(β=1.01, 95%CI:0.72-1.29 ). Conclusion: This study showed that there is a significant relationship between DII score, DASh diet scoreo and dietary with odds of Covid-19. Keywords: Covid-19, dietary inflammatory index, DASH diet score, total antioxidant capacity, TMPRSS-2, inflammatory biomarkers, severity of disease