*Article* **Adherence to the Mediterranean Diet Association with Serum Inflammatory Factors Stress Oxidative and Appetite in COVID-19 Patients**

**Mahsa Mohajeri 1,\*, Reza Mohajery <sup>2</sup> and Arrigo F. G. Cicero 3,4,\***


**Abstract:** *Background and Objectives:* The Mediterranean diet's bioactive components are suggested to strengthen the immune system and to exert anti-inflammatory actions. This study investigated the association between adherence to the Mediterranean diet with serum inflammatory factors, total antioxidant capacity, appetite, and symptoms of COVID-19 patients. *Materials and Methods:* This crosssectional study was conducted among 600 Iranian COVID-19 patients selected by a simple random method. The ten-item Mediterranean diet adherence questionnaire was used to assess diet adherence. At the beginning of the study, 5 cc of blood was taken from all patients for measurement of serum interleukin 1β) IL-1β), tumor necrosis factor (TNF-α), malondialdehyde (MDA), high sensitivity Creactive protein (hs-CRP) and total antioxidant capacity (TAC). A human ELISA kit with serial number 950.090.096 produced by the Diaclone Company was used to test this cytokine using the sandwich ELISA method. *Results:* One hundred and five patients presented a high adherence and 495 patients presented a low adherence to the Mediterranean diet. The incidence of fever, cough, diarrhea, taste changes, and pneumonia severity index were significantly lower in patients who adhered to the Mediterranean diet more than other patients. Serum levels of tumor necrosis factor (5.7 ± 2.1 vs. 6.9 ± 2.8 *p* = 0.02), interleukin 1 beta (3.2 ± 0.02 vs. 4.9 ± 0.01 *p* = 0.02), high-sensitivity C-reactive protein (17.08 ± 4.2 vs. 19.8 ± 2.5 *p* = 0.03), and malondialdehyde (5.7 ± 0.2 vs. 6.2 ± 0.3 *p* = 0.02) were significantly lower in patients who adhered more to the Mediterranean diet than other patients. *Conclusion:* The Mediterranean diet can improve the symptoms and elevated serum inflammatory factors in COVID-19 patients, so clinical trial studies are suggested to confirm this effect.

**Keywords:** mediterranean diet; inflammatory factors; stress oxidative; appetite; COVID-19
