Nearly one in five American adults who survived the coronavirus disease (COVID-19) are still suffering from post-acute COVID-19 syndrome (PACS),42 a complex systemic disease manifests in fatigue and muscle weakness that substantially limits one or more major life activities.35-41,92 For older adults, having PACS coupled with an inadequate diet may compound their health deterioration and hasten their physical function decline. 43- 44 Nutritional studies demonstrate that a whole diet comprises foods high in anti-inflammatory activities, e.g., whole grains, fruits, vegetables, and omega-3 fatty acid-rich foods substantially reduce disease-related fatigue, likely by reducing inflammation.49-50 U.S. adults who followed the Dietary Guidelines for Americans (DGA) were more likely to preserve muscle grip strength than those who did not.17 Since fatigue and physical function are interrelated, a ‘Whole-Diet Approach’56,61,62 aligned with the DGA60 with a focus on nutrients high anti- inflammatory activities may be an effective strategy to ameliorate recovery from PACS in older adults. This project proposes to examine, in a 16-week randomized-controlled dietary intervention, the effect of the ‘Whole- Diet Approach’ on mitigating symptoms of PACS related to nutrition, e.g., fatigue and muscle weakness and will explore the underlying mechanisms via biomarkers. The sample will comprise men and women aged 50 years or older with PACS, including underrepresented minorities (50% Non-Hispanic-Blacks). At baseline, N=56 eligible participants will be randomized to either: 1) a dietary intervention following the new DGA with a focus on nutrients high in anti-inflammatory activities via foods and or supplements (e.g., vitamin D, omega-3, and whey); or 2) attention control. Aim 1. In a 16-week, randomized-controlled trial, we will examine the effect of the Whole-Diet Approach (WDA) on the Healthy Eating Index (HEI) and fatigue compared to attention control in adults with PACS. Aim 2. To assess the impact of the dietary intervention following the WDA on muscle mass, strength, and physical function compared to attention control in adults with PACS. Aim 3. To explore the mechanism of decreased fatigue and improved muscle and physical function by examining changes in nutritional and inflammatory biomarkers from baseline to 16 weeks. The proposed dietary intervention to attenuate PACS in older adults is a feasible study relevant to public health. The University of Maryland Baltimore provides a unique opportunity to be trained by a multidisciplinary team of mentors who are experts in clinical trials, muscle, physical function, nutrition, geriatrics, statistics, and COVID-19 to conduct this study successfully. The findings can be translated into a new strategy to counteract fatigue and physical function decline following PACS. The K01 Award will provide me with the training I need to become an independent investigator in dietary trials to advance the field of nutrition and aging while gaining the skills and experience in leadership and mentorship to launch my career in academia.

Nearly one in five American adults who survived the coronavirus disease (COVID-19) are still suffering from post-acute COVID-19 syndrome (PACS), a complex systemic disease that manifests in fatigue and muscle weakness that substantially limits one or more major life activities. For older adults, having PACS coupled with an inadequate diet may compound their health deterioration and hasten their physical function decline. To ameliorate recovery, men and women aged 50 years or older with PACS will be randomized to a 16-week dietary intervention group (N=28) following the ‘Whole-Diet Approach’ based on the new Dietary Guidelines for Americans (DGA 2020-2025) with a focus on the intake of nutrients high in anti-inflammatory activities via foods and/or supplements (e.g., vitamin D, omega-3, whey protein) and will be compared to their counterparts who were randomized to the attention control group (N=28).