The Remote Diet Intervention to REduce long Covid symptoms Trial (ReDIRECT) – dietary profile of the study participants at baseline

Abstract

Introduction: Long COVID (LC), characterised by a symptom duration of ≥12 weeks after a COVID-19 infection, is a condition affecting multiple organ systems with no proven treatments. Living with obesity is a risk factor for LC, and obesity has symptoms which may overlap with and aggravate LC, such as fatigue, breathlessness, and pain. The ReDIRECT study tested if remotely-delivered weight management improves LC symptoms. Methods: We recruited people with LC and BMI >27kg/m2 (>25kg/m2 South Asians) from the UK between Dec 2021 and July 2022 [1]. The intervention was delivered remotely by dietitians, with online data collection (medical and dietary history, COVID-19 infection and vaccination, body composition, LC history/symptoms, blood pressure, quality of life, and sociodemographic data). Participants self-selected the dominant LC symptoms they most wanted to improve from the intervention. Results: Participants (n=234) in England (64%) and Scotland (30%) were mainly women (85%) of white ethnicity (90%), with 13% living in the 20% most deprived areas, a mean age of 46 (SD 10) years, and median BMI of 35kg/m2 (IQR 32-40). Self-selected dominant LC symptoms included fatigue (54%), breathlessness (16%), pain (12%), anxiety/depression (1%) and other (17%). At baseline, 82% were taking medication, and 57% reported 1+ other medical conditions. Quality of life was poor with a mean EQ-5D-5L health utility score of 0.48 (SD 0.24). Most participants reported moderate or worse problems with activity (77%), pain/discomfort (71%) and mobility (54%). Employment status changed for 36% of participants between becoming ill with COVID-19 and entering the study, with 22% on longterm sick leave or working reduced hours due to LC. Healthcare professionals were the most common occupation group (38%). NHS support for LC was received by most (88%), with GP (81%), specialist LC clinics (50%), hospital specialist services (48%) and physiotherapy (32%) being the most common resources. In addition, 24% paid for private healthcare, and 7% used complementary and alternative medicine to manage LC symptoms. Most (59%) used support networks, including online communities (42%), LC support charities (25%), and local support groups (8%). Most (92%) reported gaining weight since contracting COVID-19 (median weight change +11.5 kg, range -11.5 to +45.3 kg), with 28% moving to a higher body composition category based on BMI cut-offs. Weight change was highest for those with a pre-COVID BMI <25kg/m2 but was not influenced by area deprivation. Weight management was familiar to most participants (83%) before starting the study, with commercial weight loss programmes being the most used method (68%). Other methods included increased physical activity (65%), and self-directed weight management and diet changes (53%). Conclusion: Symptoms linked to LC and overweight are diverse and complex. Remote trial delivery enabled rapid recruitment across the UK yet certain groups (e.g. men and those from ethnic minority groups) were under-represented.