Association Of Fruits, Vegetables, And Fiber Intake With Covid-19 Severity And Symptoms In Hospitalized Patients: A Cross-sectional Study

Kiana Tadbir Vajargah, School of Medicine
Nikan Zargarzadeh, School of Medicine
Armin Ebrahimzadeh, Kashan University of Medical Sciences and Health Services
Seyed Mohammad Mousavi, School of Nutritional Sciences and Dietetics
Parnia Mobasheran, LSU Health Sciences Center - New Orleans
Pari Mokhtari, Children's Hospital Los Angeles
Habib Rahban, Cardiovascular Research Foundation of Southern California
Mihnea Alexandru Găman, Universitatea de Medicina si Farmacie Carol Davila din Bucuresti
Camellia Akhgarjand, School of Nutritional Sciences and Dietetics
Mohsen Taghizadeh, Kashan University of Medical Sciences and Health Services
Alireza Milajerdi, Kashan University of Medical Sciences and Health Services


Background and aims: Fruits and vegetables are rich in fiber and a good source of anti-inflammatory and immune-boosting vitamins, minerals, and antioxidants. We investigated the association between fruits, vegetables, and fiber intake and severity of COVID-19 and related symptoms in hospitalized patients. Methods: A total of 250 COVID-19 hospitalized patients aged 18 to 65 years were recruited for this cross-sectional study in Kashan, Iran, between June and September of 2021. Dietary intakes were assessed using an online validated 168-item food frequency questionnaire (FFQ). COVID-19 severity and symptoms were evaluated using the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Moreover, we examined COVID-19 symptoms, inflammatory biomarkers, and additional factors. Results: The mean age of participants was 44.2 ± 12.1 years, and 46% had severe COVID-19. Patients with higher consumption of fruits (OR: 0.28; 95% CI: 0.14-0.58, P-trend <0.001), vegetables (OR: 0.33; 95% CI: 0.16-0.69, P-trend <0.001), and dietary fiber (OR: 0.25; 95% CI: 0.12-0.53, P-trend <0.001) had lower odds of having severe COVID-19. In addition, they had shorter hospitalization and convalescence periods, lower serum C-reactive protein (CRP), and a reduced risk of developing COVID-19 symptoms such as sore throat, nausea and vomiting, dyspnea, myalgia, cough, weakness, fever, and chills. Conclusion: Higher consumption of fruits, vegetables, and fiber was inversely linked with COVID-19 severity, clinical symptoms, hospitalization and convalescence duration, and CRP concentrations. The results should be interpreted with caution in light of the limitations, and prospective cohort studies are required to further evaluate these findings.