{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T07:12:18Z","timestamp":1768547538508,"version":"3.49.0"},"posted":{"date-parts":[[2020,7,18]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":26,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2020,7,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Many foods have an antioxidant activity, and nutrition may mitigate COVID-19. To test the potential role of vegetables in COVID-19 mortality in Europe, we performed an ecological study.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database was used to study the country consumption of Brassica vegetables (broccoli, cauliflower, head cabbage (white, red and savoy cabbage), leafy brassica) and to compare them with spinach, cucumber, courgette, lettuce and tomato. The COVID-19 mortality per number of inhabitants was obtained from the Johns Hopkins Coronavirus Resource Center. EuroStat data were used for potential confounders at the country level including Gross Domestic Product (GDP) (2019), population density (2018), percentage of people over 64 years (2019), unemployment rate (2019) and percentage of obesity (2014, to avoid missing values). Mortality counts were analyzed with quasi-Poisson regression models to model the death rate while accounting for over-dispersion.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of all the variables considered, including confounders, only head cabbage and cucumber reached statistical significance with the COVID-19 death rate per country. For each g\/day increase in the average national consumption of some of the vegetables (head cabbage and cucumber), the mortality risk for COVID-19 decreased by a factor of 11, down to 13.6 %. Lettuce consumption increased COVID-19 mortality. The adjustment did not change the point estimate and the results were still significant.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>\n                    The negative ecological association between COVID-19 mortality and the consumption of cabbage and cucumber supports the\n                    <jats:italic>a priori<\/jats:italic>\n                    hypothesis previously reported. The hypothesis needs to be tested in individual studies performed in countries where the consumption of vegetables is common.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2020.07.17.20155846","type":"posted-content","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T08:15:12Z","timestamp":1595060112000},"source":"Crossref","is-referenced-by-count":5,"title":["Association between consumption of vegetables and COVID-19 mortality at a country level in Europe"],"prefix":"10.64898","author":[{"given":"Susana C","family":"Fonseca","sequence":"first","affiliation":[]},{"given":"Ioar","family":"Rivas","sequence":"additional","affiliation":[]},{"given":"Dora","family":"Romaguera","sequence":"additional","affiliation":[]},{"given":"Marcos","family":"Quijal-Zamorano","sequence":"additional","affiliation":[]},{"given":"Wienczyslawa","family":"Czarlewski","sequence":"additional","affiliation":[]},{"given":"Alain","family":"Vidal","sequence":"additional","affiliation":[]},{"given":"Joao A","family":"Fonseca","sequence":"additional","affiliation":[]},{"given":"Joan","family":"Ballester","sequence":"additional","affiliation":[]},{"given":"Josep M","family":"Anto","sequence":"additional","affiliation":[]},{"given":"Xavier","family":"Basagana","sequence":"additional","affiliation":[]},{"given":"Luis M","family":"Cunha","sequence":"additional","affiliation":[]},{"given":"Jean","family":"Bousquet","sequence":"additional","affiliation":[]}],"member":"54368","reference":[{"key":"2021011422551079000_2020.07.17.20155846v1.1","doi-asserted-by":"crossref","unstructured":"Bousquet J , Anto J , Iaccarino G , et al. Is diet partly responsible for differences in Covid-19 death rates between and within countries? Clin Transl Allergy 2020.","DOI":"10.1186\/s13601-020-00323-0"},{"key":"2021011422551079000_2020.07.17.20155846v1.2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.2174\/1872213X12666180815144803","article-title":"Prevention of Cardiovascular Diseases with Anti-Inflammatory and Anti-Oxidant Nutraceuticals and Herbal Products: An Overview of Pre-Clinical and Clinical Studies","volume":"12","year":"2018","journal-title":"Recent Pat Inflamm Allergy Drug Discov"},{"key":"2021011422551079000_2020.07.17.20155846v1.3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/dmrr.2665","article-title":"Probiotics as beneficial agents in the management of diabetes mellitus: a systematic review","volume":"32","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"2021011422551079000_2020.07.17.20155846v1.4","doi-asserted-by":"crossref","unstructured":"Serino A , Salazar G. 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