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Modest effects of dietary supplements during the COVID-19 pandemic: Insights from 445 850 users of the COVID-19 Symptom Study app

Modest effects of dietary supplements during the COVID-19 pandemic: Insights from 445 850 users of the COVID-19 Symptom Study app
Modest effects of dietary supplements during the COVID-19 pandemic: Insights from 445 850 users of the COVID-19 Symptom Study app

Objectives Dietary supplements may ameliorate SARS-CoV-2 infection, although scientific evidence to support such a role is lacking. We investigated whether users of the COVID-19 Symptom Study app who regularly took dietary supplements were less likely to test positive for SARS-CoV-2 infection. Design App-based community survey. Setting 445 850 subscribers of an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in the UK (n=372 720), the USA (n=45 757) and Sweden (n=27 373). Main exposure Self-reported regular dietary supplement usage (constant use during previous 3 months) in the first waves of the pandemic up to 31 July 2020. Main outcome measures SARS-CoV-2 infection confirmed by viral RNA reverse transcriptase PCR test or serology test before 31 July 2020. Results In 372 720 UK participants (175 652 supplement users and 197 068 non-users), those taking probiotics, omega-3 fatty acids, multivitamins or vitamin D had a lower risk of SARS-CoV-2 infection by 14% (95% CI (8% to 19%)), 12% (95% CI (8% to 16%)), 13% (95% CI (10% to 16%)) and 9% (95% CI (6% to 12%)), respectively, after adjusting for potential confounders. No effect was observed for those taking vitamin C, zinc or garlic supplements. On stratification by sex, age and body mass index (BMI), the protective associations in individuals taking probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts. Conclusion In women, we observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2. We found no clear benefits for men nor any effect of vitamin C, garlic or zinc. Randomised controlled trials are required to confirm these observational findings before any therapeutic recommendations can be made.

COVID-19, nutritional treatment
149-157
Louca, Panayiotis
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Murray, Benjamin
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Klaser, Kerstin
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Graham, Mark S
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Mazidi, Mohsen
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Leeming, Emily R
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Thompson, Ellen
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Bowyer, Ruth
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Drew, David A
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Nguyen, Long H
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Merino, Jordi
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Gomez, Maria
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Mompeo, Olatz
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Costeira, Ricardo
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Sudre, Carole H
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Gibson, Rachel
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Steves, Claire J
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Wolf, Jonathan
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Franks, Paul W
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Ourselin, Sebastien
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Chan, Andrew T
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Berry, Sarah E
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Valdes, Ana M
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Calder, Philip
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Spector, Tim D
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Menni, Cristina
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Louca, Panayiotis
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Murray, Benjamin
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Klaser, Kerstin
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Graham, Mark S
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Mazidi, Mohsen
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Leeming, Emily R
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Thompson, Ellen
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Bowyer, Ruth
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Drew, David A
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Nguyen, Long H
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Merino, Jordi
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Gomez, Maria
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Mompeo, Olatz
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Costeira, Ricardo
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Sudre, Carole H
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Gibson, Rachel
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Steves, Claire J
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Wolf, Jonathan
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Franks, Paul W
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Ourselin, Sebastien
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Chan, Andrew T
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Berry, Sarah E
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Valdes, Ana M
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Calder, Philip
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Spector, Tim D
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Menni, Cristina
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Louca, Panayiotis, Murray, Benjamin, Klaser, Kerstin, Graham, Mark S, Mazidi, Mohsen, Leeming, Emily R, Thompson, Ellen, Bowyer, Ruth, Drew, David A, Nguyen, Long H, Merino, Jordi, Gomez, Maria, Mompeo, Olatz, Costeira, Ricardo, Sudre, Carole H, Gibson, Rachel, Steves, Claire J, Wolf, Jonathan, Franks, Paul W, Ourselin, Sebastien, Chan, Andrew T, Berry, Sarah E, Valdes, Ana M, Calder, Philip, Spector, Tim D and Menni, Cristina (2021) Modest effects of dietary supplements during the COVID-19 pandemic: Insights from 445 850 users of the COVID-19 Symptom Study app. BMJ Nutrition, Prevention & Health, 4 (1), 149-157. (doi:10.1136/bmjnph-2021-000250).

Record type: Article

Abstract

Objectives Dietary supplements may ameliorate SARS-CoV-2 infection, although scientific evidence to support such a role is lacking. We investigated whether users of the COVID-19 Symptom Study app who regularly took dietary supplements were less likely to test positive for SARS-CoV-2 infection. Design App-based community survey. Setting 445 850 subscribers of an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in the UK (n=372 720), the USA (n=45 757) and Sweden (n=27 373). Main exposure Self-reported regular dietary supplement usage (constant use during previous 3 months) in the first waves of the pandemic up to 31 July 2020. Main outcome measures SARS-CoV-2 infection confirmed by viral RNA reverse transcriptase PCR test or serology test before 31 July 2020. Results In 372 720 UK participants (175 652 supplement users and 197 068 non-users), those taking probiotics, omega-3 fatty acids, multivitamins or vitamin D had a lower risk of SARS-CoV-2 infection by 14% (95% CI (8% to 19%)), 12% (95% CI (8% to 16%)), 13% (95% CI (10% to 16%)) and 9% (95% CI (6% to 12%)), respectively, after adjusting for potential confounders. No effect was observed for those taking vitamin C, zinc or garlic supplements. On stratification by sex, age and body mass index (BMI), the protective associations in individuals taking probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts. Conclusion In women, we observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2. We found no clear benefits for men nor any effect of vitamin C, garlic or zinc. Randomised controlled trials are required to confirm these observational findings before any therapeutic recommendations can be made.

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Accepted/In Press date: 4 March 2021
e-pub ahead of print date: 19 April 2021
Published date: 1 June 2021
Additional Information: Funding Information: Funding This work was supported by Zoe Global Limited. The Department of Twin Research receives grant support from the Wellcome Trust (212904/Z/18/Z) and the Medical Research Council (MRC)/British Heart Foundation Ancestry and Biological Informative Markers for Stratification of Hypertension (AIMHY; MR/M016560/1), European Union, Chronic Disease Research Foundation (CDRF), Zoe Global Ltd, NIH and the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. PL is funded by the Chronic Disease Research Foundation; AMV is supported by the National Institute for Health Research Nottingham Biomedical Research Centre. CHS is an Alzheimer’s Society Junior Fellowship AS-JF-17-011; SO is funded by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z), Wellcome Flagship Programme (WT213038/Z/18/Z). ATC is the Stuart and Suzanne Steele MGH Research Scholar and is a Team Leader for the Stand Up to Cancer Foundation. ATC, LHN, JAM and DAD are supported by the Massachusetts Consortium on Pathogen Readiness (MassCPR). CM is funded by the Chronic Disease Research Foundation and by the MRC Aim-Hy project grant. PCC is supported by the National Institute for Health Research Southampton Biomedical Research Centre. MSG is supported by the Wellcome Flagship Programme (WT213038/Z/18/Z). MFG and PWF receive support from the Swedish Research Council, Swedish Heart-Lung Foundation and the Swedish Foundation for Strategic Research (LUDC-IRC 15-0067). Competing interests TDS, AMV, ERL and SEB are consultants to Zoe Global Limited ('Zoe'). JW is an employee of Zoe. PCC has research funding from BASF AS and Bayer Consumer Care; is an advisor/consultant to BASF AS, DSM, Danone/ Nutricia, Cargill, Smartfish, Nutrileads, Bayer Consumer Care and Pfizer (now GSK) Consumer Healthcare and has received travel reimbursement/speaking fees from Danone, Fresenius Kabi, Pfizer (now GSK) Consumer Healthcare, Smartfish, Biogredia and the California Walnut Commission. ATC has received consulting fees from Bayer Pharma, Pfizer and Boehringer Ingelheim. Funding Information: running and supporting the app and service to all users worldwide. The Department of Twin Research is funded by the Wellcome Trust, Medical Research Council, European Union, Chronic Disease Research Foundation (CDRF), Zoe Global Ltd and the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. CM is funded by the Chronic Disease Research Foundation and by the MRC Aim-Hy project grant. PL is funded by the CDRF, SO is funded by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z), Wellcome Flagship Programme (WT213038/ Z/18/Z), and PCC is supported by the National Institute for Health Research Southampton Biomedical Research Centre. We express our sincere thanks to all the participants of the COVID Symptom Study app including study volunteers enrolled in cohorts within the Coronavirus Pandemic Epidemiology (COPE) consortium. We thank the staff of Zoe Global Limited, the Department of Twin Research at King’s College London, the Clinical & Translational Epidemiology Unit at Massachusetts General Hospital, Researchers and staff at Lund University in Sweden for their tireless work in contributing to the running of the study and data collection. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
Keywords: COVID-19, nutritional treatment

Identifiers

Local EPrints ID: 447697
URI: http://eprints.soton.ac.uk/id/eprint/447697
PURE UUID: ff71be8f-4a0c-41e3-8b71-918ded6979dc
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 18 Mar 2021 17:46
Last modified: 17 Mar 2024 06:24

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Contributors

Author: Panayiotis Louca
Author: Benjamin Murray
Author: Kerstin Klaser
Author: Mark S Graham
Author: Mohsen Mazidi
Author: Emily R Leeming
Author: Ellen Thompson
Author: Ruth Bowyer
Author: David A Drew
Author: Long H Nguyen
Author: Jordi Merino
Author: Maria Gomez
Author: Olatz Mompeo
Author: Ricardo Costeira
Author: Carole H Sudre
Author: Rachel Gibson
Author: Claire J Steves
Author: Jonathan Wolf
Author: Paul W Franks
Author: Sebastien Ourselin
Author: Andrew T Chan
Author: Sarah E Berry
Author: Ana M Valdes
Author: Philip Calder ORCID iD
Author: Tim D Spector
Author: Cristina Menni

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