A healthy lifestyle key to mitigating long COVID

In a study assessing the correlation between modifiable lifestyle factors and post-COVID-19 outcomes, the risk of post-COVID-19 multisystem sequelae, death, and hospitalization decreased across healthy lifestyle categories during both the acute and post-acute phases of infection.

The 10 modifiable lifestyle factors included smoking, alcohol consumption, BMI, physical activity, TV watching/sedentary time, sleep duration, fruit and vegetable consumption, oily fish intake, red meat intake, and processed meat consumption.

“Adherence to a healthy lifestyle that predated the pandemic was associated with substantially lower risks of sequelae across organ systems, death, and hospitalization following COVID-19, regardless of phases of infection, vaccination status, test setting, and SARS-CoV-2 variants, and independent of relevant comorbidities,” the investigators said.

Compared with participants who had an unfavourable lifestyle (0–4 factors), those with a favourable lifestyle (6–10 healthy factors) were at lower risk of multisystem COVID-19 sequelae (hazard ratio [HR], 0.64; absolute risk reduction [ARR] at 210 days, 7.08 percent). The trends were similar in both the acute (HR, 0.57) and post-acute (HR, 0.69) phases of COVID-19.

Participants with a favourable lifestyle were also at lower risks of death (HR, 0.59; ARR at 210 days, 1.99 percent) and hospitalization following COVID-19 (HR, 0.78; ARR at 210 days, 6.14 percent) than those with an unfavourable lifestyle. [Nat Commun 2024;15:6363]

Long COVID prevention strategies crucial

Evidence-based strategies for the prevention or treatment of long COVID have yet to become available, and non-pharmaceutical management approaches is also lacking. [Nature 2022;608:258–260; Proc Natl Acad Sci USA 2022;119:e2213524119] “Effective prevention [and intervention] strategies for post-COVID complications are crucial for patients, clinicians, and policymakers to mitigate their cumulative burden,” the researchers said.

A total of 68,896 participants from the UK Biobank cohort (mean age 66.6 years, 53.4 percent men) who had a positive SARS-CoV-2 test result between March 1, 2020 and March 1, 2022 were included in the study. Over 40 percent followed an intermediate (41.3 percent) or favourable (46.4 percent) lifestyle, while 12.3 percent had an unfavourable lifestyle. The median number of healthy lifestyle factors that participants engaged in was seven.

In summary, the study showed that a favourable lifestyle was associated with a 36-percent lower risk of multisystem sequelae, a 41-percent lower risk of death, and a 22-percent lower risk of hospitalization as opposed to an unhealthy one. These corresponded to ARRs of 7.08, 1.99, and 6.14 fewer cases per 100 people at 210 days after infection, respectively.

These associations were notably greater than those seen in studies on therapeutic interventions in nonhospitalized patients, reporting a 14-percent reduction in the risk of post-acute sequelae at 180 days with vaccination prior to infection, and 14-percent and 26-percent risk reductions at 180 days with molnupiravir and nirmatrelvir, respectively, during the acute phase of infection. [Nat Med 2022;28:1461–1467; JAMA Intern Med 2023;183:554–564; BMJ 2023;381:e074572]

However, generalizability of the findings may be limited, as most UK Biobank participants are older than the general UK population and are mostly of European descent. Some participants may have also been classified as uninfected but may have had undiagnosed or untested COVID-19.

Most participants also fell under the intermediate or favourable lifestyle categories, implying that they may be healthier than the general population, they added. “[The ARRs] should thus be interpreted with caution. Nevertheless, the relative associations of risk factors with disease outcomes in the UK Biobank were tested to be generalizable and comparable to those from other representative cohort of general population.”

“[Overall,] these findings underscore the clinical and public health importance of adhering to a healthy lifestyle in mitigating long-term COVID-19 adverse impacts and enhancing future pandemic preparedness,” they concluded.