Research has shown that men are twice as likely to become seriously ill from COVID-19 as women. Nutritionist Rob Hobson explores why this is the case and what men can do to reduce the risk.
Who is more at risk from COVID-19?
It is understood that older people and those with certain underlying health conditions such as diabetes and heart disease are at greater risk of serious illness from COVID-19. However, whether you are male or female could also play a role.
According to one recent study published in the journal Frontiers in Public Health1 the number of deaths among men with COVID-19 was shown to be twice that of women. This same pattern has also been shown in data reported by the World Health Organisation (WHO), which shows that 63% of deaths from COVID-19 in Europe have been among men.
Why are men more likely to suffer a serious case of COVID‑19?
Research has suggested a number of reasons why men may be more susceptible to poorer outcomes from COVID-19, and these relate to both lifestyle and genetic makeup.
Body weight
Body mass index (BMI) appears to play a role in both severity and death risk for COVID-19: something highlighted by Prime Minister Boris Johnson in a televised briefing after his recovery from the virus. In a UK study of nearly 17,000 hospital patients with COVID-19, it was found that those who were obese (BMI greater than 30) had a 33% greater risk of dying than those who were not obese.2
This is particularly relevant to men, as they have been shown to have higher rates of obesity and being overweight compared to women, according to findings from the Health Survey for England.3
How is body weight linked to COVID-19?
Being overweight or obese means that you are carrying more fat and are likely to be less fit, which lowers your lung capacity. Having a higher body weight also increases the demand for oxygen, but makes it more of a struggle to get oxygen into the blood and around the body, so putting greater pressure on the system.
Research has also discovered an enzyme called ACE2 in cells, which appears to be the main way for the COVID-19 virus to infect those cells. Higher levels of ACE2 are thought to be found in fatty tissue, which could be one reason why people who have a high BMI are at greater risk of a severe case of COVID-19.4
What can men do?
The obvious approach is to reduce your energy intake and to exercise, in order to create a calorie deficit that supports weight loss. According to a report published by the Men's Health Forum in collaboration with Public Health England, men respond differently to messaging around weight loss.5 It seems that men are more likely to lose weight when supported by their partner or family, but when those close to them do not take their attempts seriously, their motivation appears adversely affected.
Setting weight-loss goals is important for men, as is taking a fact-based approach to weight loss: a clear regime telling them what to eat, and when. Gadgets also appeal to men, and even using a simple pedometer as part of a weight-loss strategy seems to motivate men to build more exercise into their daily lives.6
Immune differences
Another reason put forward for the disparity is that women may have naturally stronger immune defences. This is due to the fact that there are substantial differences in the immune system between males and females, and these have a significant impact on outcome from a wide range of infectious diseases.
One such difference is that women have two X chromosomes per cell, while men have only one. This is relevant because a number of critical immune genes are located on the X chromosome; in particular the gene for a protein called TLR7, which detects single-stranded RNA viruses like the coronavirus that causes COVID-19. This means that this protein is expressed at twice the dose on many immune cells in females compared to males, and the immune response to coronavirus is therefore amplified in females.7
What can men do?
There is little that can be done to amplify immunity in men, but they can ensure their immune system is functioning properly by eating a balanced diet, sleeping well and tackling stress.
Immune system nutrients
There are also several nutrients involved in the normal functioning of the immune system.
Selenium is a mineral found in foods such as Brazil nuts, salmon, mushrooms and wholemeal pasta. This mineral is required for the synthesis of antibodies, and also stimulates the production and activity of the T lymphocytes and natural killer cells that help to fight viral and bacterial infections.
Iron is another mineral found in foods such as lean red meat, eggs, kale and legumes. This mineral is involved in the production of antibodies, which are cells of the immune system required to fight infection.
Vitamin A is also important as it supports the body's innate immunity by maintaining the integrity of mucosal cells in the digestive tract, eyes and respiratory system; these cells act as a first line of defence against infection. Vitamin A is also required for the normal function of immune cells and the production of antibodies that respond to infection.
Vitamin D is also needed for the normal function of the immune system. It's particularly tricky to get from diet alone and the body needs sunlight to make vitamin D itself. In accordance with advice from the National Institute for Health and Care Excellence (NICE), all adults in the UK should take a daily supplement containing 400IU (10mcg) of vitamin D throughout the year.
Diet
The prevalence among men of disease in later life seems to be another reason why they may be more susceptible to severe COVID-19. Rates of conditions such as type 2 diabetes and heart disease are higher in men than women, and these underlying health conditions put them at greater risk of infection and poor health outcomes from the virus.
What can men do?
The risk of diseases such as type 2 diabetes and heart disease are significantly reduced by the adoption of a balanced diet. Research has shown how the Mediterranean diet, which is predominantly plant-based, is particularly effective in the prevention of type 2 diabetes and heart disease.8
Start with the basics
Forget complicated 'on-trend' regimes, or the advice of your mate on what they did to lose weight, and instead concentrate on adopting a healthy way of eating that you can fit into your lifestyle. Rather than seeing your new approach to eating well as a short-term solution to lose weight after potentially gaining a few pounds in lockdown, use this as an opportunity to adopt behaviour changes that you can stick to for the long term.
Take it slow and don't try to do everything at once. Small changes such as eating more vegetables with every meal, watching your portion size or limiting the amount of sugar in your diet can have a big impact on your long-term health and your waistline.
Take action now
Although it seems men may be at greater risk of serious cases of COVID-19, there are clear ways in which they can reduce their chances of contracting the virus. Men are notoriously slow to respond to health advice, so the key is to address diet and lifestyle habits head-on, rather than wait for an unwanted diagnosis of disease before taking action.
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