A University of Oxford-led study links a healthy pre-infection lifestyle to a 36% lower risk of long COVID, a 41% lower odds of death, and 22% lower chance of hospitalization.
The researchers assessed the association of modifiable lifestyle factors (eg, smoking, alcohol use, body mass index, physical activity, time spent in sedentary activities, sleep duration, diet) with long COVID, death, and hospitalization among 68,896 adults in the UK Biobank cohort who tested positive for COVID-19 from March 2020 to March 2022.
The average participant age was 66.6 years, 53.4% were men, and 82.1% were White. A total of 12.3% followed an unfavorable lifestyle (0 to 4 healthy habits), 41.3% had an intermediate lifestyle (5 healthy habits), and 46.4% adhered to a favorable lifestyle (6 to 10). Participants adhered to a median of 7 healthy lifestyle factors.
The results were published today in Nature Communications.
71% of benefits attributed to lifestyle
A total of 5.5% and 7.8% had long-COVID signs or symptoms in at least one studied organ system during and after infection, respectively. A healthy lifestyle was tied to a 36% lower risk of long COVID (absolute risk reduction [ARR] at 210 days, 7.1%) compared with an unfavorable lifestyle. And an intermediate lifestyle was linked to a 20% lower risk of long COVID, compared with an unhealthy lifestyle (ARR, 3.9%). The number of favorable lifestyle factors was tied to the risk of long COVID in a dose-dependent manner.
Adherence to a healthy lifestyle that predated the pandemic was associated with substantially lower risk 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.
Risk reductions affected all organ systems studied (cardiovascular, coagulation, metabolic, gastrointestinal, kidney, mental health, musculoskeletal, and respiratory, as well as fatigue). The benefits were primarily driven by lifestyle, independent of pre-infection illnesses (proportion of direct effect on any sign or symptom, 71%).
A healthy lifestyle was linked to a 41% lower risk of post-COVID death and a 22% lower odds of hospital admission. These association were seen regardless of pre- or post-infection status, hospitalization status, vaccination status, or SARS-CoV-2 variant. Pre-COVID medical conditions—especially cardiovascular disease, diabetes, and mental illness—were linked to a substantially increased risk of long COVID.
The study authors said that a healthy lifestyle may lower the risk of severe COVID-19 and death by protecting against inflammation, abnormal immune responses (autoimmunity), and abnormal clotting.
"Adherence to a healthy lifestyle that predated the pandemic was associated with substantially lower risk 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 study authors wrote. "These findings suggest the benefit of population adhering to a healthy lifestyle to reduce the potential long-term adverse health consequences of COVID-19."
