Association between consumption of vegetables and COVID-19 mortality at a country level in Europe

Fonseca, Susana; Rivas, Ioar; Romaguera, Dora; Quijal-Zamorano, Marcos; Czarlewski, Wienczyslawa; Vidal, Alain; Fonseca, João Almeida; Ballester, Joan; Antó, Josep M.; Basagaña, Xavier; Cunha, Luís Miguel; Bousquet, Jean

doi:10.1101/2020.07.17.20155846

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…Finally, since the reduction in mortality has been related to the consumption of certain foods, the increased presence of different products in Eastern cuisine may have a protective effect on COVID-19 diseases [17].…”

Section: Discussionmentioning

confidence: 99%

Why are Asian countries outperforming the Western world in controlling COVID-19 pandemic?

Landoni

Maimeri

Fedrizzi

et al. 2020

Pathogens and Global Health

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COVID-19 already caused more than 1,260,000 deaths around the world. However, mortality rates are not equal amongst the different countries. Mortality rates are ranging from less than 1 death per million in Taiwan, Vietnam and Thailand to 1,112 deaths per million in Belgium. In the present article, we report a striking difference in mean per million mortality between Asian and European countries (2.7 vs 197 deaths per million population, p < 0.001). In addition, we confirmed that the later a specific country was hit by the epidemic, the milder the impact on mortality during the first 50 days was. We analyzed several factors that may have contributed to this discrepancy including population age, previous experience of epidemics in the modern era, social acceptance of physical distancing and face masks, percentage of active smokers and lastly genetic prothrombotic mutations.

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Section: Discussionmentioning

confidence: 99%

Why are Asian countries outperforming the Western world in controlling COVID-19 pandemic?

Landoni

Maimeri

Fedrizzi

et al. 2020

Pathogens and Global Health

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“…The consumption of fermented vegetables, head cabbage and cucumber was associated with lower death rates. 3,4 Even though these are ecological studies, they support the association between diet and fatality. A healthy diet, rich in antioxidants, has been proposed as a therapeutic strategy to mitigate the cytokine storm that develops in COVID-19.…”

Section: Ecological Studies On Food Consumption and Death Rates In Comentioning

confidence: 97%

Kimchi and Asian fermented vegetables: candidates for the partial control of the COVID-19 pandemic

Bousquet

Antó

Czarlewski³

et al. 2020

Preprint

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To the Editor, A COVID-19 epidemic started in China and then disseminated to other Asian countries before becoming a pandemic. It appears that the pandemic has so far resulted in proportionately fewer deaths in China and most Eastern Asian countries. Many reasons can explain this picture. 1 One of them is the type of diet in the low mortality countries. 2 This paper is the sixth of a series attempting to understand the role of diet in the differences of COVID-19 death rates between and within countries with the aim to identify potential preventive measures against COVID-19. The concept paper 2 was followed by two ecological studies comparing death rates in European countries and the consumption of vegetables or fermented foods. 3,4 We then proposed that sulforaphane from cruciferous vegetables 1 and lactobacilli from fermented foods (submitted) were possibly involved in the reduction of insulin resistance in COVID-19. It is noteworthy that fermented foods are largely used in Asia. 5,6 It is therefore important to check whether some commonly eaten fermented foods in these countries may explain geographic differences in COVID-19. Kimchi will be used as a model of fermented cabbage. Geographic differences in COVID-19 death rates When comparing death rates, large differences exist between and within countries and the evolution of the pandemic differs largely between countries (Figure 1). As the temporal dynamic of the pandemic may have changed the geographical patterns observed in our previous analyses, 2 we focus on the more recent mortality trends. Although there are many pitfalls in analyzing death rates for COVID-19, 2 the evolution of death rates

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“…A second ecological study has analyzed cruciferous vegetables (broccoli, cauliflower, head cabbage (white, red, and savoy cabbage), leafy brassica) and compared them with spinach, cucumber, courgette, lettuce, and tomato 12 . Only head cabbage and cucumber reached statistical significance with the COVID‐19 death rate per country.…”

Section: Is Diet Partly Responsible For Differences Between and Withimentioning

confidence: 99%

Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID‐19

Bousquet

Haahtela

Fonseca

et al. 2020

Allergy

Self Cite

100

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Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS‐Cov‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT 1 R) axis associated with oxidative stress. This leads to insulin resistanceas well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT 1 R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects helpful in mitigating COVID‐19 severity.

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Association between consumption of vegetables and COVID-19 mortality at a country level in Europe

Cited by 12 publications

References 26 publications

Why are Asian countries outperforming the Western world in controlling COVID-19 pandemic?

Why are Asian countries outperforming the Western world in controlling COVID-19 pandemic?

Kimchi and Asian fermented vegetables: candidates for the partial control of the COVID-19 pandemic

Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID‐19

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