Comment on "Western Dietary Pattern Antioxidant Intakes and Oxidative Stress: Importance during the SARS-CoV-2/COVID-19 Pandemic".

Dear Editor:

We have read with great interest the article “Western Dietary Pattern Antioxidant Intakes and Oxidative Stress: Importance during the SARS-CoV-2/COVID-19 Pandemic” by Trujillo-Mayol et al. (1) and we found it significant in the context of clinical prevention.

The relevant point explored by this review is the importance of balanced dietary habits including appropriate amounts of antioxidants to maintain the immune system during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) pandemic. Viral infections are characterized by high oxidative stress and an appropriate intake of antioxidants would help to fight against the virus. The authors suggested that lifestyle factors could influence the impact of the disease.

With reference to the findings reported in the article, we would like to make the following contribution to the discussion. The review analyzes in depth the potential beneficial effects of a healthy diet, including a Mediterranean Diet, on viral infection. In recent articles we also supported the idea that a healthy lifestyle could contribute to a higher immune response to the virus and would therefore be beneficial in the fight against the pandemic (2, 3). It has been suggested that there would be a synergy among the antioxidant-rich foods that would foster favorable changes in inflammatory pathways (4). Humans do not consume 1 type of food but a wide variety of combinations of different foods forming a dietary pattern. Consequently, in analyzing eating habits it is mandatory to take the interactions between different foods and their components into consideration. Moreover, it is known that plant-derived phenolic compounds could differently influence the health of males and females (5). The recent COVID-19 pandemic strongly affected women owing to increased psychological distress leading to unhealthy lifestyles, and women were specifically more likely to develop food cravings (2, 6, 7). Food cravings are characterized by a high intake of fat- and sugar-rich foods and by a low intake of fruit and vegetables. In a previous article (2) we hypothesized that vitamin D prophylaxis can help reduce the severity of the disease caused by SARS-CoV-2, particularly in contexts where hypovitaminosis D is common, i.e., women currently living in Northern countries (8). Several factors may have contributed to the widespread infection in Italy, despite the strong adherence to the Mediterranean diet. Lifestyle and diet can influence our inflammatory response to the virus and therefore it is important that both are optimized. The review by Trujillo-Mayol et al. (1) emphasizes these aspects of prevention but does not emphasize the potential increased risk in women. Women's health is strongly influenced by lifestyle, which includes dietary pattern and nutritional status, physical activity, and socioeconomic stress. A healthy lifestyle is mandatory to prevent chronic diseases and to fight infections. Women are less likely to adopt a healthy lifestyle owing to the high social pressures that oblige women to play numerous roles in the family, in society, and at work, all of which are debilitating and time consuming (9, 10). We need educational programs and prevention measures specifically dedicated to women's health.