Abstract
Background
Mediterranean Diet has been reported to possess immunomodulatory and anti-inflammatory properties. These properties are closely associated with the immunopathogenesis of COVID-19.
Objective
The present systematic review aimed to determine the association between Mediterranean Diet and COVID-19, COVID-19 symptoms, and COVID-19 severity.
Methods
The protocol for this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO) with identification number CRD42023451794. The literature search was conducted through Pubmed, Proquest, and Google Scholar on August 2023. The inclusion criteria were studies with a population of human subjects, reported the association between Mediterranean diet adherence with risk of COVID-19 infection, COVID-19 symptoms, or COVID-19 severity, and full text must be available in English. The exclusion criteria were reviews, editorials, letters, replies, systematic reviews, meta-analyses, studies on animals, and duplicates. Risk of bias in included studies was assessed using Newcastle Ottawa Scale (NOS). Data was synthesized narratively. Each study was compared and a structured summary was developed.
Results
After selection process, 6 articles were included, with a sample size of 55,489 patients. All studies were observational studies and assessed Mediterranean diet adherence using food frequency questionnaires (FFQ), with scoring system varied between each study. Four studies found a significant correlation between increased adherence to Mediterranean Diet and reduced COVID-19 risk, while one study indicated non-significant association. One study reported a significant association between higher adherence to Mediterranean Diet and COVID-19 symptoms, but three studies reported non-significant association. One study found that individuals with higher adherence to Mediterranean Diet had reduced likelihood of developing severe COVID-19, however, two studies yielded inconclusive findings.
Limitations
All studies used self-administrated food frequency questionnaires (FFQs), which were prone to biased responses, such as recall and estimation bias.
Citation: Halim C, Howen M, Fitrisubroto AANb, Pratama T, Harahap IR, Ganesh LJ, et al. (2024) Relevance of Mediterranean diet as a nutritional strategy in diminishing COVID-19 risk: A systematic review. PLoS ONE 19(8): e0301564. https://doi.org/10.1371/journal.pone.0301564
Editor: Nour Amin Elsahoryi, University of Petra (UOP), JORDAN
Received: March 18, 2024; Accepted: July 22, 2024; Published: August 21, 2024
Copyright: © 2024 Halim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Supporting information
S1 Checklist. PRISMA 2020 abstract checklist.
https://doi.org/10.1371/journal.pone.0301564.s001
(DOCX)
S1 File. Detailed search strategies and MeSH.
https://doi.org/10.1371/journal.pone.0301564.s003
(DOCX)
Acknowledgments
We sincerely thank all researchers who have contributed their studies, without whom this systematic review would not be possible.
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