Adherence to healthy lifestyle prior to infection and risk of post-covid-19 condition

Few modifiable risk factors for post-COVID-19 condition (PCC) have been identified. A study investigated the association between healthy lifestyle factors prior to SARS-CoV-2 infection and risk of PCC.
In a prospective cohort study, 32,249 women in the Nurses’ Health Study II cohort reported pre-infection lifestyle habits in 2015 and 2017. Healthy lifestyle factors included healthy body mass index (BMI, 18.5-24.9) never smoking, at least 150 minutes per week of moderate to vigorous physical activity, moderate alcohol intake (5 to 15 g/d), high diet quality (upper 40% of Alternate Healthy Eating Index-2010 score), and adequate sleep (7 to 9 h/d).
SARS-CoV-2 infection (confirmed by test) and PCC (at least 4 weeks of symptoms) were self-reported on 7 periodic surveys administered from April 2020 to November 2021. Among participants with SARS-CoV-2 infection, the relative risk (RR) of PCC in association with the number of healthy lifestyle factors (0 to 6) was estimated, adjusting for demographic factors and comorbidities.
A total of 1,981 women with a positive SARS-CoV-2 test over 19 months of follow-up were documented. Among those participants, mean age was 64.7 years (SD, 4.6; range, 55-75); 97.4% (n = 1929) were White; and 42.8% (n = 848) were active health care workers. Among these, 871 (44.0%) developed PCC. Healthy lifestyle was associated with lower risk of PCC in a dose-dependent manner. Compared with women without any healthy lifestyle factors, those with 5 to 6 had 49% lower risk (RR, 0.51; 95% CI, 0.33-0.78) of PCC. In a model mutually adjusted for all lifestyle factors, BMI and sleep were independently associated with risk of PCC (BMI, 18.5-24.9 vs others, RR, 0.85; 95% CI, 0.73-1.00, P = .046; sleep, 7-9 h/d vs others, RR, 0.83; 95% CI, 0.72-0.95, P = .008). The authors say that if these associations were causal, 36.0% of PCC cases would have been prevented if all partici-pants had 5 to 6 healthy lifestyle factors (population attributable risk percentage, 36.0%; 95% CI, 14.1%-52.7%). Results were comparable when PCC was defined as symptoms of at least 2-month duration or having ongoing symptoms at the time of PCC assessment.
In this prospective cohort study, pre-infection healthy lifestyle, which included moderate alcohol consumption, was associated with a substantially lower risk of PCC. The authors comment that future research should investigate whether lifestyle interventions may reduce risk of developing PCC or mitigate symptoms among individuals with PCC or possibly other postinfection syndromes.
Source: Wang S, Li Y, Yue Y, Yuan C, Kang JH, Chavarro JE, Bhupathiraju SN, Roberts AL. Adherence to Healthy Lifestyle Prior to Infection and Risk of Post-COVID-19 Condition. JAMA Intern Med. 2023 Feb 6.