Dietary supplements during the COVID-19 pandemic: insights from 1.4M user study

  

View ORCID ProfilePanayiotis Louca,  View ORCID ProfileBenjamin Murray,  View ORCID ProfileKerstin Klaser,  View ORCID ProfileMark S Graham,  View ORCID ProfileMohsen Mazidi,  View ORCID ProfileEmily R Leeming,  View ORCID ProfileEllen J Thompson,  View ORCID ProfileRuth Bowyer,  View ORCID ProfileDavid Alden Drew,  View ORCID ProfileLong Alden Nguyen,  View ORCID ProfileJordi Merino,  View ORCID ProfileMaria F Gomez,  View ORCID ProfileOlatz Mompeo,  View ORCID ProfileRicardo Costeira,  View ORCID ProfileCarole H Sudre,  View ORCID ProfileRachel Gibson,  View ORCID ProfileClaire Steves,  View ORCID ProfileJonathan Wolf,  View ORCID ProfilePaul W Franks,  View ORCID ProfileSebastien Ourselin,  View ORCID ProfileAndrew T Chan,  View ORCID ProfileSarah E Berry,  View ORCID ProfileAna Valdes,  View ORCID ProfilePhilip Calder,  View ORCID ProfileTim D Spector,  View ORCID ProfileCristina Menni

doi: https://doi.org/10.1101/2020.11.27.20239087

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2020.11.27.20239087v1.full.pdf

Abstract

Objectives: Dietary supplements may provide nutrients of relevance to ameliorate SARS-CoV-2 infection, although scientific evidence to support a role is lacking. We investigate whether the regular use of dietary supplements can reduce the risk of testing positive for SARS-CoV-2 infection in around 1.4M users of the COVID Symptom Study App who completed a supplement use questionnaire. Design: Longitudinal app-based community survey and nested case control study. Setting: Subscribers to an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in three countries. Main Exposure: Self-reported regular dietary supplement usage since the beginning of the pandemic. Main Outcome Measures: SARS-CoV-2 infection confirmed by viral RNA polymerase chain reaction test (RT-PCR) or serology test. A secondary outcome was new-onset anosmia. Results: In an analysis including 327,720 UK participants, the use of probiotics, omega-3 fatty acids, multivitamins or vitamin D was associated with a lower risk of SARS-CoV-2 infection by 14%(95%CI: [8%,19%]), 12%(95%CI: [8%,16%]), 13%(95%CI: [10%,16%]) and 9%(95%CI: [6%,12%]), respectively, after adjusting for potential confounders. No effect was observed for vitamin C, zinc or garlic supplements. When analyses were stratified by sex, age and body mass index (BMI), the protective associations for 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. Results were further confirmed in a sub-analysis of 993,365 regular app users who were not tested for SARS-CoV-2 with cases (n= 126,556) defined as those with new onset anosmia (the strongest COVID-19 predictor). Conclusion: 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 in women. No clear benefits for men were observed nor any effect of vitamin C, garlic or zinc for men or women. Randomised controlled trials of selected supplements would be required to confirm these observational findings before any therapeutic recommendations can be made.

Competing Interest Statement

TDS, AMV, ERL and SEB are consultants to Zoe Global Ltd (Zoe). JW is an employee of Zoe Global Limited. 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 AG, Pfizer, Inc. and Boehringer Ingelheim. Other authors have no conflict of interest to declare.

Funding Statement

This work was supported by Zoe Global Limited. The Dept 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 Guys and St Thomas NHS Foundation Trust in partnership with Kings 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 Alzheimers 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). 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).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).

https://www.medrxiv.org/content/10.1101/2020.11.27.20239087v1