Systematic review of the effects of pandemic confinements on body weight and their determinants

Sex differences in prevalence of metabolic syndrome components and contributing factors among psychiatric patients in Saudi Arabia

Background/objectives

The purpose of this study was to detect sex differences in metabolic syndrome (MS) features and risk variables among Saudi participants.

Methods

For this study, 144 patients (52.08% males, 47.92% females) aged 19 to 59 signed a written consent form based on the Declaration of Helsinki, either as a patient or a family member. A cross-sectional survey was used to collect data on family disease history, health, and eating habits. MS components included waist circumstance (WC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), fasting glucose (FG), and blood pressure. A chi-square test was used to compare categorical data within and across sexes.

Results

The associations between variables were found using Spearman correlation coefficients and simple regression analysis. Anthropometric indices were significantly (p ≤ 0.01) varied between sexes as well as family history, health behaviors, and eating behaviors. Sex variations in MS components that contributed to an MS diagnosis were discovered and were significantly varied between sexes. The most common components in males were low HDL-C (90.67%), high WC (85.33), and elevated TG levels (76.0%). In females, the most typically recognized components were high WC (86.96%), followed by high FG (69.57%) and high blood pressure and TG (63.77%). Sex differences in other risk variables for MS, such as family history, health, dietary habits, sedentary lifestyle, and smoking, were found to be associated with high anthropometric indices.

Conclusion

Sex-specific public health policies and management techniques for preventing MS in the older adult population should be created for Saudis who are aging physiologically.

The impact of the COVID-19 pandemic shelter in place on glycemic control, blood pressure control, and body mass index among diabetic patients at Kaiser Permanente Northern California: a retrospective cohort study

BACKGROUND/ INTRODUCTION

Regional shelter-in-place (SiP) mandates had a substantial impact on physical health and access to care. The impact of SiP on chronic disease management, specifically diabetes mellitus, is unknown. We sought to quantify the impact of California's 2020 SiP order on various health parameters in the Kaiser Permanente Northern California (KPNC) diabetic population.

METHODS

This retrospective cohort study included 168,621 diabetic patients, stratified by pre-pandemic HbA1c level. Our primary outcome was the difference in HbA1c, systolic blood pressure (SBP), and diastolic blood pressure (DBP) comparing the pre- (September 1, 2019, to March 31, 2020) to post-SiP period (June 1, 2020, to December 31, 2020). Our secondary endpoints included use of insulin or oral hypoglycemic agents (OHAs) during the post-SiP period and change in body mass index (BMI). This study utilized a paired t-test and chi-squared testing in order to assess for statistically significant differences in pre- versus post-SiP values.

RESULTS

Patients in this cohort were 52.29% male with 37.68% White, 22.35% Hispanic, 9.30% Black and 23.54% Asian and a mean age of 63 years. In this cohort, 44.02% of patients had a HbA1c < 7%, while 29.17%, 13.67%, 6.34% and 6.81% had an HbA1c of 7-7.9%, 8-8.9%, 9-9.9% and ≥ 10%, respectively (range 4.10 to 19.50%). Mean HbA1c, SBP, and DBP increased significantly across all groups; OHA use and insulin utilization also increased overall. Patients with lower pre-SiP HbA1c demonstrated larger increases in HbA1c and OHA utilization, while patients with higher pre-SiP HbA1c demonstrated increased rates of insulin initiation and decreases in their post-SiP HbA1c. Notably, mean BMI decreased in every HbA1c subgroup. Due to the large sample size, all p-values were < 0.0001.

CONCLUSIONS

Among the KPNC diabetic population, several metrics for diabetes health management were significantly worsened after California's SiP. However, diabetic patients with the highest HbA1c values showed clinically significant improvement in their HbA1c, indicating a differential effect of the SiP on diabetes management. Our study helps identify higher-risk diabetic patients who require more intensive monitoring in the setting of the recent pandemic and highlights the importance of considering long-term implications of policy decisions on diabetes care.

Reduced Physical Activity and Increased Weight Status in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review

BACKGROUND/OBJECTIVES

The COVID-19 pandemic has impacted the lifestyles of children and adolescents because of the restrictions imposed to contain the infection. This systematic review examined the possible reduction in children's and adolescents' physical activity and changes in their BMI and weight status.

METHODS

A systematic review (PROSPERO: CRD42024589208) of English-language studies published up to 1 October 2024 in individuals with a mean age between 6 and 18 years that investigated physical activity data before and during or after the pandemic and focused on their BMI and weight status according to age, sex, and country making use of PubMed, Web of Science, and Scopus, identified 1040 possible articles.

RESULTS

Following the PRISMA statement, 26 articles with a whole set of 138,737 children and adolescents were enclosed in the review. The majority of included articles were of moderate quality, as determined by the Newcastle-Ottawa Scale adapted for observational studies. The studies found a decrease in PA, an increase in sedentary activities during/after the lockdown, and an increase in BMI and prevalence of overweight and obesity, especially in males and 8-11-year-olds.

CONCLUSIONS

The interruption or restriction of outdoor physical activities and sports during the COVID-19 pandemic resulted in a more sedentary lifestyle among children and adolescents, contributing to an overall increase in BMI and obesity, with alarming implications for related health risks and other noncommunicable diseases. Therefore, the adverse effects of restrictive measures should be assessed when implementing public health strategies during pandemics.

Factors associated with individual-level changes in BMI as a result of COVID-19 in the general- and migrant-origin populations in Finland

AIMS

There is limited information on changes in body mass index (BMI) due to the COVID-19 pandemic among persons of migrant origin. The aim of the present study was to examine factors associated with changes in BMI among the general- and migrant-origin populations in Finland.

METHODS

Longitudinal data to explore individual-level changes in self-reported BMI among migrant-origin persons (N = 3313) were obtained from the FinMonik Survey conducted in 2018 and the MigCOVID Survey conducted 2020-2021. Data for the general population reference group were obtained from the FinHealth 2017 Study conducted 2017-2018 and its follow-up conducted in 2020 (N = 2982). Logistic regression was applied to examine whether age, sex, education, economic activity, length of residence in Finland, language skills, smoking, alcohol usage, sleep, physical activity, snacking, and fruit and vegetable consumption were associated with an increase or decrease in BMI. A change in BMI was defined as a 5% or greater increase or decrease.

RESULTS

Twenty-seven per cent of the migrant-origin population experienced an increase in BMI, while 14% had a decrease in BMI. These results corresponded to figures observed among the general population in Finland (27% and 14%). Persons of migrant origin who were other than students or employed faced greater odds of an increase in BMI of at least 5% (OR = 1.71). In the general population, an increase in BMI of at least 5% had greater odds of occurring among women (OR = 1.61), those who were other than students or employed (OR = 1.68), those who increased their alcohol intake (OR = 1.64), those who increased their snacking (OR = 1.40) and decreased their fruit and vegetable intake (OR = 1.85).

CONCLUSIONS

Most examined factors applied differently to general- and migrant-origin populations and by migrant-origin group. These differences must be considered when planning future public health promotion efforts, particularly those during crisis situations.

Trends in Gestational Weight Gain and Prepregnancy Obesity in South Carolina, 2015-2021

Introduction

We examined trends in prepregnancy obesity and gestational weight gain, with a focus on racial and ethnic differences, before and during the COVID-19 pandemic in South Carolina.

Methods

Hospital and emergency department discharge codes were linked to birth certificates. Prepregnancy obesity was defined as a body mass index (kg/m2) of 30 or higher. Gestational weight gain was defined as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. A generalized linear model with a multinomial distribution and glogit link estimated the risk of inadequate weight gain and excessive weight gain with adequate weight gain as the reference group. The generalized linear model with a modified Poisson distribution and log link estimated prepregnancy obesity risk with nonobese as the reference group.

Results

Our study included 306,344 full-term, singleton live births among 239,597 mothers from 2015 through 2021. The prevalence of inadequate weight gain increased across all racial and ethnic groups prepandemic (relative risk [RR] = 1.02; 95% CI, 1.01-1.02) and attenuated during the pandemic (RR = 0.99; 95% CI, 0.96-1.01). The prevalence of excessive weight gain was high and remained stable across all races and ethnicities before and during the pandemic. The prevalence of prepregnancy obesity increased across all racial and ethnic groups prepandemic; the prevalence after the start of the pandemic increased only among women of "other" races and ethnicities (RR = 1.12; 95% CI, 1.05-1.19) while attenuating among Hispanic, non-Hispanic Black, and non-Hispanic White women.

Conclusion

The COVID-19 pandemic did not alter trends of gestational weight gain; however, it did have a small effect on trends in prepregnancy obesity, with differential effects across racial and ethnic groups. The prevalence of prepregnancy obesity, inadequate weight gain, and excessive weight gain remains high among pregnant women in South Carolina. Obesity and weight gain are risk factors for many adverse maternal and infant pregnancy outcomes. Their high prevalence indicates the importance of developing effective weight management programs for women of childbearing age and pregnant women.

Changes in Body Mass Index during the COVID-19 Pandemic among Indonesian Adolescents: The Role of Sex, Urban Area, Baseline BMI, and Appetitive Traits

INTRODUCTION

Little is known about how the COVID-19 situation affected weight development among Indonesian adolescents. This longitudinal study examined whether, and for whom, the COVID-19 situation affected weight outcomes over time among adolescents from private schools and higher socio-economic positions in Indonesia, where being overweight is a rather prevalent characteristic. This study specifically examined whether appetitive traits (i.e., emotional overeating, food responsiveness) as well as baseline zBMI, sex, and urban area could explain changes in zBMI.

METHODS

At baseline, 411 adolescents from 5 private schools in Indonesia (53.3% males, Mage = 12.02 years, SD = 0.45) filled out questionnaires on appetitive traits and background characteristics. In addition, their height and weight were measured. Of these, 336 adolescents (81.8%) also participated at follow-up. At follow-up, height and weight were measured or reported. We used linear regression to analyze the association between predictors and interactions with zBMI.

RESULTS

The results showed a significant decrease in zBMI over time, with a lower average zBMI during COVID-19 compared to before COVID-19. Female adolescents and adolescents with higher baseline zBMI values particularly tended to show this zBMI decreasing pattern. We did not find statistically significant main effects of baseline emotional overeating, food responsiveness, and urban area or any interactions.

CONCLUSIONS

Indonesian adolescents appeared to decrease in terms of zBMI during COVID-19, particularly females and adolescents with higher pre-COVID-19 zBMI. Our findings suggest that (culturally-specific) contextual changes (i.e., less exposure to the Indonesian food environment at schools and more exposure to the home environment) might have a beneficial impact in terms of preventing overweight among Indonesian adolescents, particularly among those being more vulnerable (i.e., having higher baseline zBMI).

The Impact of the COVID-19 Pandemic: A Longitudinal Analysis of Body Weight Variations and Their Implications for Daily Habits

Assessing changes in lifestyle, dietary habits, eating behaviors, and stress during the pandemic and their impact on weight is crucial for developing effective interventions. This study investigated weight variations among Brazilians and associated habit changes over nine months during the COVID-19 pandemic. An online questionnaire was applied (T0/T1, T2). Weight variation classifications were determined from T0 to T1 and evaluated longitudinally for changes in lifestyle, dietary habits, food consumption, eating behavior, and perceived stress using generalized estimating equations (p < 0.05). Out of 453 participants, 23.6% lost weight, 18.1% maintained their weight, 26.0% gained up to 2.4 kg, and 32.2% gained ≥ 2.5 kg. Weight loss was associated with decreased food consumption and increased stress at T2. The group that gained up to 2.4 kg reported reduced food intake, snacking, meal preparation, and candy consumption but increased stress at T2. Those gaining ≥ 2.5 kg initially increased food consumption, snacking, meal preparation, hamburgers/canned products, sugary drinks, instant meals/snacks, candies, and fast food consumption at T1, all of which were reduced at T2, along with a decrease in uncontrolled and emotional eating. Although the pandemic initially affected daily habits differently based on weight changes, participants-especially those who gained more weight-tended to revert to pre-pandemic habits.

Sleep Patterns, Social Media Usage, and Dietary Habits during COVID-19 Lockdown in Mexico: A Cross-Sectional Study

During the COVID-19 lockdown, a high prevalence of disruption in lifestyle habits was reported, especially concerning sleep habits. The present study aimed to explore the relationship between lifestyles and the COVID-19 lockdown on subjects living in Mexico. A cross-sectional survey was conducted. An online questionnaire was administered to survey participants. A clustering procedure was performed to identify groups of survey respondents with similar characteristics. There were 155 survey respondents. Most of them were women (83%) of young age. The clustering identified two distinct groups of subjects, i.e., Cluster 1 and 2. The subjects in Cluster 2 were younger, more likely to use social media, and spent much more time watching TV/surfing the internet than subjects in Cluster 1. Furthermore, the prevalence of problems with falling and staying asleep during the lockdown was higher in Cluster 2 than in Cluster 1 (14% in Cluster 2 vs. 4% in Cluster 1) even though nobody from Cluster 2 had sleep problems before the lockdown. The study showed that younger respondents were those more affected by lockdown measures.

The association between excess weight and COVID-19 outcomes: An umbrella review

This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death.

Socioeconomic status and the effect of prolonged pandemic confinement on anthropometric and glycaemic outcomes in adults with type 2 diabetes mellitus

AIM

This systematic review and meta-analysis aimed to investigate the impact of COVID19 lockdown on the anthropometric and glycaemic outcomes of adults with type 2 diabetes mellitus (T2DM) and assess whether socioeconomic status (SES) was relevant to these changes.

METHODS

A search of three databases was conducted. Meta-analyses using random effects models were undertaken to combine anthropometric and glycaemic measures pre- and post-confinement. Subgroup analyses according to SES were also conducted.

RESULTS

This systematic review of 19 articles demonstrated that prolonged pandemic-related confinement is associated with a deterioration in both anthropometric and glycaemic outcomes among adults with T2DM. Furthermore, SES was found to be relevant to these changes. Specifically, BMI (kg/m2) showed an increase in mean difference of 0.72 (95% CI; 0.13, 1.31; p<0.05) between pre and post lockdown cohorts. High income countries displayed a greater increase in BMI compared to their lower middle-income counterparts. Regarding, fasting blood glucose (FBG), a statistically significant difference was observed in the upper middle-income group (mean difference: 5.10; 95% CI: 2.92, 7.27), and high-income group (mean difference: 6.03; 95% CI: 0.04, 12.02). There were no significant changes to weight, waist circumference, or HbA1C over the lockdown period.

CONCLUSION

Our findings suggest adults with T2DM may have received less effective care over the lockdown period, particularly in high income countries. Clinics and care providers may need to adopt more intensive contact and treatment plans in the post lockdown period to prevent lasting impacts on disease progression and metabolic sequelae.

Influence of Religiosity on Youths' Attitudes Towards People with Disabilities in the United Arab Emirates

This cross-sectional survey investigates the influence of youths' religiosity on their attitude towards people with disabilities. The Muslim religiosity questionnaire and multidimensional attitudes scale towards persons with disabilities were used to survey 733 youths from the federal university in the United Arab Emirates. The results indicated that the youths were religious and had positive attitudes towards people with disabilities. An increase in religiosity is associated with a positive attitude towards disability, and both religiosity and total family income positively impacted the attitude towards people with disabilities. Reducing inequalities by including persons with disabilities is one of the UN 2030 Agenda for Sustainable Development objectives. Policies should aim to enhance curriculum, improvise public guidelines and partner with associated faith-based leaders to build an inclusive society for people with disabilities, thus helping to achieve sustainable development goals.

Long-lasting effects of the COVID-19 pandemic on lifestyle and body weight: results of representative cross-sectional surveys in adults in Germany

BACKGROUND

The COVID-19 pandemic severely affected people's daily lives and health. Few studies have looked into the persistence of these changes. In the current study, we investigated to what extent changes in lifestyle and body weight were sustained after two years of restrictions.

METHODS

We performed two representative online surveys among adults living in Germany. The first survey (S1) was performed in April 2021; the second survey (S2) in June 2022. The questionnaire focused on changes in physical activity, dietary habits, body weight, and mental stress levels. The data were weighted to optimally represent the general population of Germany. Using Chi-square tests, results were compared between the two surveys, and - per survey - between subgroups based on sociodemographic factors and mental stress levels. Furthermore, binomial logistic regression was performed to identify factors associated with weight gain.

RESULTS

A total of 1,001 (S1) and 1,005 (S2) adults completed the survey, of which 50.4% were men and 49.6% were women in both surveys. Mean body mass index (BMI) at the time of the survey was 27.4 ± 6.0 kg/m2 (S1) and 27.1 ± 5.5 kg/m2 (S2). Reduced physical activity was reported by 52% of the participants in S1 and by 40% in S2 (p < .001). Moderate to severe stress was reported by 71% of the participants in S1 and by 62% in S2 (p < .001). Less healthy eating compared to before the pandemic was reported by 16% of the participants in S1 and by 12% in S2 (p = 0.033). Weight gain was reported by 40% of the participants in S1 and by 35% in S2 (p = 0.059). Weight gain was associated with higher BMI, reduced physical activity levels, less healthy nutrition and increased consumption of energy-dense food.

CONCLUSIONS

Our results indicate that two years and three months after the start of the COVID-19 pandemic, the adverse effects on health-related lifestyle factors and body weight still existed, albeit to a lesser degree than directly after the first year of the pandemic. Targeted strategies are needed to better support the population subgroups most likely to change their lifestyle in unfavorable ways when faced with disruptions of their everyday lives.

Change in body weight of older adults before and during the COVID-19 pandemic: longitudinal results from the Berlin Aging Study II

OBJECTIVES

Change in body weight during the COVID-19 pandemic as an unintended side effect of lockdown measures has been predominantly reported for younger and middle-aged adults. However, information on older adults for which weight loss is known to result in adverse outcomes, is scarce. In this study we describe the body weight change in older adults before, during, and after the COVID-19 lockdown measures and explore putative associated factors with a focus on the period that includes the first six months of the COVID-19 containment measures.

DESIGN

Prospective cohort study with three follow-up examinations over the course of 10 years.

SETTING AND PARTICIPANTS

In this study, we analyzed the longitudinal weight change of 472 participants of the Berlin Aging Study II (mean age of 67.5 years at baseline).

MEASUREMENTS

Body weight was assessed at four time points. Additionally, differences between subgroups characterized by socio-economic, cognitive, and psychosocial variables as well as morbidity burden, biological age markers (epigenetic clocks, telomere length), and frailty were compared.

RESULTS

On average, women and men lost 0.87% (n = 227) and 0.5% (n = 245) of their body weight per year in the study period covering the first six months of the COVID-19 pandemic. Weight loss among men was particularly pronounced among groups characterized by change in physical activity due to COVID-19 lockdown, low positive affect, premature epigenetic age (7-CpG clock), diagnosed metabolic syndrome, and a more masculine gender score (all variables: p < 0.05, n = 245).

CONCLUSION

During the COVID-19 pandemic, older participants lost weight with a 2.5-times (women) and 2-times (men) higher rate than what is expected in this age.

Association of COVID-19 pandemic societal closures with gestational weight gain among women in South Carolina, 2018-2021

PURPOSE

During the early COVID-19 pandemic, an increase in weight gain among the general population was observed; however, gestational weight gain (GWG) was not thoroughly evaluated. We evaluated changes in GWG during the pandemic closures in South Carolina.

METHODS

We used live, singleton birth records to compare GWG outcomes among three pregnancy groups occurring before (January 2018-February 2020), during (March-May 2020), and after (June 2020-December 2021) pandemic closures. GWG categories were defined by the Institute of Medicine (IOM) recommendations. We used multinomial logistic regression models to calculate prevalence ratios (PRs) of GWG categories stratified by prepregnancy body mass index (BMI) category.

RESULTS

We analyzed 177,571 birth records. Women with normal weight (n = 64,491, 36%) had a slightly lower prevalence of excessive GWG during and after the pandemic closures (PR 0.94; 95% CI: 0.91-0.98 and PR 0.95; 95% CI: 0.93-0.98, respectively). We observed no changes in GWG patterns for women with overweight and obesity.

CONCLUSIONS

We found limited changes in GWG patterns for a subset of pregnant women during and after pandemic closures, compared with prepandemic period in South Carolina, countering findings of weight changes among the general population.

Determining factors of physical activity and sedentary behaviour in university students during the COVID-19 pandemic: A longitudinal study

INTRODUCTION

Historically, university students demonstrate poor movement behaviours that could negatively impact current and future health. Recent literature has focused on identifying determinants of physical activity (PA) and sedentary behaviour (SB) in this population to inform the development of intervention strategies. However, the COVID-19 pandemic substantially restricted movement behaviours in this population, meaning findings of previous research may no longer be applicable within the current societal context. The present study explored the longitudinal relationships between pre-pandemic psychological, behavioural and anthropometric factors, and the movement behaviours of UK university students nine months following the outbreak of COVID-19.

METHODS

Mental wellbeing (MWB), perceived stress (PS), body mass index (BMI), SB, and PA were assessed using an online self-report survey in 255 students prior to (October 2019) and nine months following (October 2020) the first confirmed case of COVID-19 in the UK. Path analysis was utilised to test relationships between pre-COVID mental wellbeing, perceived stress and BMI, and movement behaviours during the pandemic.

RESULTS

The fit of the path analysis model was good (χ2 = 0.01; CMIN = 0.10, CFI = 1.00, RMSEA = 0.00). Pre-covid MWB and PS positively influenced PA (β = 0.29; β = 0.24; P < 0.01) but not SB (β = -0.10; β = 0.00; P = 0.79) during the pandemic. Additionally, pre-pandemic SB and PA positively influenced SB and PA during the pandemic respectively (SB: β = 0.26; P < 0.01) (PA: β = 0.55; P < 0.01). Pre-pandemic BMI did not influence any measured variable during the pandemic (PA: β = 0.03 and P = 0.29; SB: β = 0.06 and P = 0.56), and there was no mediating effect of PA on SB during the pandemic (β = -0.26; P = 0.14).

CONCLUSION

These findings indicate that pre-covid mental health and movement behaviours had a direct positive influence on PA during the pandemic, but not SB. This longitudinal study demonstrates the influence that prior psychological and behavioural factors have in determining university students' response to periods of elevated stress and uncertainty, furthering our understanding of determinants of health-related behaviours in students.

Determinants of body weight changes during Ramadan fasting in India amid COVID-19: A cross-sectional study

Ramadan intermittent fasting (RIF) presents unique challenges and opportunities for public health and clinical practice, especially in populations with a high prevalence of non-communicable diseases. This study aims to investigate the impact of RIF on weight change among Indian Muslims and explore the associated demographic, dietary, and behavioral factors. A cross-sectional survey was conducted with a sample of Indian Muslim adults who observed RIF. Participants were asked to report their demographic information, family and personal health history, and dietary and lifestyle behaviors before and during Ramadan month. The primary outcome was body weight change, with secondary outcomes including changes in dietary patterns, physical activity, and other health-related lifestyle behaviors. The study found that during Ramadan, nearly half of the participants (48.5%) self-reported a retained initial weight, while a significant fraction (30.9%) self-reported a modest weight reduction between 0.5 to 2.5 kg at the end of Ramadan. Additionally, self-reported eating practices demonstrated moderately altered by about half (48.4%) of the study participants, with 32.2% reporting minor changes and 8.2% indicating substantial changes. An urban residence was associated with a higher likelihood of weight gain, where urban residents showed 3 times the odds of increased weight compared to rural inhabitants. Employment status emerged as a significant determinant for weight fluctuation, influencing both weight gain and loss. During Ramadan, there was a significant rise in snacking frequency, increasing from 21.7% to 32.6% in comparison with pre-Ramadan. The consumption of large quantities of food more frequently grew from 14.9% to 36%, and the incidence of eating despite not being hungry went up from 17.4% to 33.2%. The study demonstrates that RIF is associated with variable changes in body weight among adult Indian Muslims, influenced by urbanization, employment status, and dietary changes. The findings suggest that clinicians should provide tailored advice about body weight regulation during Ramadan and consider integrating community-based health initiatives within religious settings to improve health outcomes.

Physical Activity in Patients with Neuromuscular Disease Three Years after COVID-19, a Longitudinal Survey: The After-Effects of the Quarantine and the Benefits of a Return to a Healthier Life-Style

BACKGROUND

Quarantine was one of the strategies adopted by governments against the spread of COVID-19. This restriction has caused an increase in sedentary behaviors and a decrease in the practice of physical activity (PA), with a consequent negative impact on lifestyle both in healthy people and in those who need constant practice of PA to combat diseases, such as patients suffering from neuromuscular diseases (NMDs). Hence, this study aimed to compare PA levels among patients with NMD during and after quarantine.

METHODS

An adapted version of the International Physical Activity Questionnaire Short-Form and the Short-Form Health Survey were administered during COVID-19 quarantine (T0) and after 3 years (T1) to 91 Italian patients with NMDs.

RESULTS

We found a significant increase in the total PA level at T1, with no significant changes in vigorous-intensity PA. Moreover, a significant decrease in the PA level was found among the patients with different NMDs. No significant changes in physical component scores and mental component scores were detected.

CONCLUSIONS

Our results suggest that it would be necessary to provide alternative indoor exercise settings to prevent the adoption of sedentary behaviors.

Eating behaviors and physical activity during the COVID-19 pandemic lockdown: Experiences of breast cancer patients on adjuvant hormonal therapy

Background/Aim. Since the coronavirus disease 2019 (COVID-19) pandemic led to a strict lockdown in Serbia, the population has experienced drastic lifestyle changes. Physical distancing, self-isolation, limited availability of essential food products, and the stress related to the availability of therapy during the pandemic particularly affected the lives of vulnerable groups, such as breast cancer (BrC) patients. The aim of this study was to examine the changes in eating behaviors and physical activity of postmenopausal BrC patients on adjuvant hormonal therapy under the COVID-19 lockdown conditions. Methods. This observational retrospective pre-post cohort study included 32 women treated with aromatase inhibitors (AIs) who responded to telephone interviews using a structured questionnaire. The questionnaire aims to collect data on eating habits (intake of certain foods on a daily/weekly basis, as well as changes in the usual choice of food), intake of supplements, changes in weight, and physical activity before and during the lock-down. Results. The results showed that, due to problems in obtaining groceries, the patients cooked and consumed homemade sweets and fruit more often (47% of the respondents), while fewer (31%) consumed fresh fish. Nearly 41% of patients reported increased food intake, and 88% reported decreased physical activity, which led to an in-crease in body weight in as many as 47% of subjects. The intake of supplements was doubled. Conclusion. The COVID-19 lockdown with home confinement exacerbated health risks and affected dietary patterns and physical activity, which may have had a negative impact on the long-term health of BrC patients treated with AIs.

Prevalence of Obesity and Lifestyle Risk Factors Following Two Years' COVID-19 Related Service Closure at Wellness Center, Primary Health Care

Background

COVID-19 lockdown has affected health behaviors and daily life in unprecedented ways. This study aimed to assess (i) the prevalence of lifestyle behaviors including physical activity, sedentary behavior, sleep, and stress levels during the COVID confinement, and (ii) evaluate anthropometric measures, body composition, cardiopulmonary and muscular endurance among regular Wellness Center attendees, following two years' service closure.

Methods

A cross-sectional study was undertaken between 1st June 2022 and 30th January 2023. A structured validated questionnaire was utilized to retrospectively collect data related to the closure period, and quantitative objective measurements were obtained at the time of data collection.

Results

A total of 100 adults with a mean age of 49.6 ± 10.5 years, mostly female (80%) and Qatari (76%) participated in the study. The results revealed high rates of low physical activity (47%), sedentary behavior (62%), poor sleep (58%), and stress levels (61% moderate and 5% high). Results also confirmed high prevalence of obesity (57%) marked by BMI and body circumferences, fat mass (34 ± 10.5 kg)/fat percentage (42.7 ± 7.2%) and muscle mass (20.6 ± 5.4 kg)/muscle percentage (25.4 ± 3.9%) above and below normal levels, respectively. The average cardiopulmonary (mean VO2 MAX was 15.5 ± 11 mL O2kg-1min-1) and muscular endurance (pushups per min 19 ± 8.9, L-sit 46 ± 35 secs, plank 42.7 ± 27.8 secs) were distinctly below normal levels for age and sex.

Conclusion

The findings indicate that physically active adults have experienced adverse lifestyle behaviors during the COVID-19 lockdown. Obesity, unfavorable body composition, low cardiopulmonary and muscular endurance were evident. More emphasis should be put on the development of targeted intervention strategies to promote positive lifestyle behaviors during any potential future crises.

COVID-19 and the Liver: A Complex and Evolving Picture

Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, other organs, such as the liver, are also affected. In this overview, the effects of SARS-CoV-2 infection on the liver in both healthy people and in those with pre-existing liver disease are documented; the relationship between coronavirus disease 19 (COVID-19) vaccination and liver injury is examined; the mechanism of SARS-CoV-2-associated liver injury is explored; and the long-term consequences of COVID-19 are delineated, both in people with and without pre-existing liver disease.

Attitudes and practices toward COVID-19 precautionary measures: A comparative study of health professionals and public

BACKGROUND

Containment of the COVID-19 pandemic has been impaired by the denial and defiance of preventive recommendations.

AIMS

We aimed to study the attitudes toward COVID-19 social measures among laypersons and healthcare professionals.

METHODS

We conducted a cross-sectional study in the United Arab Emirates using a self-administered online questionnaire. Both healthcare workers and laypersons were actively recruited. In addition to sociodemographic variables, the questionnaire included questions on anxiety, knowledge, and defiance related to COVID-19.

RESULTS

A total of 615 individuals with a mean age of 32 years (SD, 12) participated. Females comprised 69% and healthcare workers constituted 60% of the study sample. Among laypersons, over 42% reported having social gatherings at home, and 44% admitted to visiting crowded places. More than half of the respondents felt increased anxiety. Previous COVID-19 infection did not affect attitudes or anxiety levels. Knowledge about COVID-19 was higher among those who were more educated (r = .21). Healthcare workers had lower anxiety than laypersons (p = .002). COVID-19 anxiety was higher among older persons and did not decrease with more knowledge. COVID-19 defiance was higher among younger male respondents from larger households and did not correlate with knowledge. Multivariate analysis showed more defiant attitudes at younger ages.

CONCLUSIONS

Anxiety-related to the COVID-19 pandemic is more common in older individuals, whereas younger persons were more likely to deny and defy prevention recommendations despite having knowledge of viral transmission. Voluntary compliance by young individuals requires an engaging communication strategy to generate more compassionate attitudes.

The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak.

METHOD

We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria.

RESULTS

The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms.

CONCLUSION

This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

Eighteen-Month Changes in Physical Activity, Body Weight, Quadriceps Strength, and Gait Biomechanics during the COVID-19 Pandemic

PURPOSE

This study assessed the effects of the COVID-19 pandemic restrictions/lockdowns on physical activity levels, body mass, quadriceps strength, and gait biomechanics over 18 months.

METHODS

Ten healthy men were assessed at baseline (~14 wk before first lockdown) and 17.9 ± 0.3 months later (<1 wk after second lockdown). At both times, physical activity levels, body mass, and quadriceps strength were acquired using the International Physical Activity Questionnaire, a force plate, and a dynamometer, respectively. Gait data were also acquired using a motion capture system and force plates during self-paced walking, from which spatiotemporal parameters, knee angles, and external moments were computed. Baseline and follow-up measurements were compared using two-tailed paired t -tests ( α = 0.05).

RESULTS

At follow-up, participants spent less time doing vigorous physical activity (∆ = -76 ± 157 min·wk -1 , P = 0.048), exhibited a tendency toward increased sedentary time (∆ = +120 ± 162 min·d -1 , P = 0.056), weighed more (∆ = +2.5 ± 2.8 kg, P = 0.021), and showed a trend toward reduced quadriceps strength (∆ = -0.29 ± 0.45 (N·m)·kg -1 , P = 0.071) compared with baseline. At follow-up, participants walked slower (∆ = -0.09 ± 0.07 m·s -1 , P = 0.005), had greater knee flexion angles at heel strike (∆ = +2.2° ± 1.8°, P = 0.004) and during late stance (∆ = +2.2° ± 1.8°, P = 0.004), had reduced knee extension moments (∆ = -0.09 ± 0.09 (N·m)·kg -1 , P = 0.012) and knee internal rotation moments (∆ = -0.02 ± 0.02 (N·m)·kg -1 , P = 0.012) during late stance.

CONCLUSIONS

Healthy men exhibited reduced physical activity levels, increased body weight, a tendency toward reduced quadriceps strength, and altered gait biomechanics over the initial 18 months of the COVID-19 pandemic-alterations that could have far-reaching health consequences.

The correlations between food security, diet quality and weight change among working women of reproductive age during the endemic phase of COVID-19

Aim

This cross-sectional study aims to investigate the correlations between food security, diet quality and weight change among working women during the endemic phase of COVID-19 in the Klang Valley of Malaysia.

Methods

Working women aged 18-49 years were required to self-report their socio-demographics and pre-pandemic body weight (body weight during February 2020). Body height and current body weight were measured using a SECA stadiometer and TANITA weighing scale. Food security was assessed using the Food Insecurity Experience Scale (FIES); the diet quality was determined with the Diet Quality Questionnaire (DQQ) for Malaysia.

Results

The prevalence of moderate-to-severe food insecurity was 19.9%. It is noted that 64.3% of working women gained weight throughout the pandemic, with an average weight gain of 4.36 ± 3.19 kg. Concerning diet quality, the majority (82.5%) achieved the Minimum Dietary Diversity for Women (MDD-W). Findings from linear regression revealed that food security was not significantly correlated with weight change. However, working women who failed to achieve the MDD-W gained, on average, 1.853 kg more than those who did (p = 0.040). On the other hand, no significant correlation was observed between food security status and diet quality in weight change of working women.

Conclusion

The current study shall provide an impetus to develop intervention strategies for promoting healthy eating among working women.

Risk of body weight changes among Danish children and adolescents during the COVID-19 pandemic

BACKGROUND

Knowledge of COVID-19 and the pandemic's effects on Danish children's body weight is limited.

OBJECTIVE

Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS-CoV-2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre- and post-pandemic.

METHODS

A national survey was administered to all Danish children aged 0-18 years, with prior COVID-19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID-related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre-pandemic database.

RESULTS

In all, 17 627 cases and 54 656 references were included. The 4-18-year-old cases had lower odds of unintended weight gain. The 2-3-year-old cases had higher odds and the 15-18-year-old cases lower odds of weight loss compared to references. Regardless of COVID-19 status, any reported long COVID-related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post-pandemic.

CONCLUSION

COVID-19 was associated with higher odds of weight loss in 2-3-year-olds and lower odds of unintended weight gain in 4-18-year-olds. Any long COVID-related symptom was associated with higher odds of weight changes regardless of COVID-19 status.

Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities

Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as 'COVID-19', 'pandemic', 'lockdowns', 'mental health', 'physical activity', and 'obesity'. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.

Effects of COVID-19 Pandemic on Metabolic Status and Psychological Correlates of a Cohort of Italian NAFLD Outpatients

Non-alcoholic fatty liver disease (NAFLD) is a potentially progressive condition characterized by the presence of fat in more than 5% of hepatocytes, representing the hepatic expression of metabolic syndrome (MetS). A reduction of at least 5–7% in initial body weight improves the metabolic profile underlying NAFLD. The aim of our study was to evaluate the effects of the COVID-19 lockdown on a cohort of non-advanced NAFLD Italian outpatients. We identified 43 patients with 3 available time point visits in our center: first visit (T0) when behavioral indications aimed at controlling MetS were provided, a pre-COVID visit (T1) and a post-COVID visit (T2). During the lockdown, an online compilation of validated psychological tests (SRQ-20, EQ5D, SF-12 and STAI) and a specifically formulated questionnaire for NAFLD was presented to our cohort and completed by 14 consenting patients. Patients who had lost more than 5% of the initial weight at T1 (9 subjects, 21%) maintained the results even at T2, with an overall reduction in BMI and liver stiffness; patients who had not lost the desired weight at T1 (34 subjects, 79%) displayed a further increase in BMI and visceral adiposity at T2. Of interest is that patients in the latter group reported signs of psychological suffering. Our data demonstrated that the setting of good counseling was effective in controlling the metabolic disorder underlying NAFLD in our cohort of outpatients. Given the need for patients to play an active role in the behavioral therapy for NAFLD, we advocate that a multidisciplinary approach be adopted, including a psychological support to obtain the best results over time.

Weight changes during the COVID-19 shutdown in older individuals with type 2 diabetes: the Look AHEAD Study

OBJECTIVE

The aims of this study were as follows: 1) examine weight changes in older adults (mean age = 76 years) with type 2 diabetes and overweight or obesity during the COVID-19 shutdown; and 2) compare the behavioral and psychosocial effects of the shutdown in those who had large weight losses (>5%), those who had small weight losses (2%-5%), those who remained weight stable (±2%), or those who gained weight (>2%).

METHODS

Look AHEAD (Action for Health in Diabetes) participants (N = 2544) were surveyed during the COVID-19 shutdown (2020), and they self-reported their current weight, reasons for weight change, weight-related behaviors, psychosocial measures, and negative and positive effects of the pandemic on their lives.

RESULTS

Comparing self-reported weight during the COVID-19 shutdown with earlier measured weight, Look AHEAD participants lost, on average, 2.2 kg during the COVID-19 shutdown: 47% lost >2%, and only 18% gained >2% (p < 0.0001). Decreases in physical activity and increases in screen time were reported frequently in all weight-change categories. Similarly, there were few differences among the categories on standardized psychosocial measures or self-reported effects of the shutdown on participants' lives. However, when differences were seen, the most negative impact was in those who gained weight.

CONCLUSIONS

Although weight loss appeared more common than weight gain during the shutdown, the weight-change groups did not differ on most psychosocial and behavioral variables.

Impact of COVID-19 Confinement on the Health-Related Habits of People at High Risk of Type 2 Diabetes

The general lockdown decreed in Spain due to the COVID-19 pandemic interrupted the ALAS health promotion intervention aimed at the population at high risk of suffering from type 2 diabetes. We conducted a descriptive study in 2020 through a telephone survey and a comparison with baseline data to determine the impact of confinement on the lifestyles of the participants. We collected sociodemographic variables and conducted assessments before/after confinement on general health status and lifestyle (sleep, physical activity and diet). Additionally, weight, BMI and adherence to a Mediterranean diet were assessed. Descriptive statistical analyses, comparisons of pre-post confinement data and logistic regression were carried out. A total of 387 individuals responded. Among them, 31.8% reported a worse perception of health after confinement, and 63,1% reported no change. Regarding exercise, 61.1% reduced their weekly physical activity time. Regarding diet, 34,4% perceived worse quality, and 53.4% reported no change, despite the fact that 89.4% declared changes in their eating practices. Weight and BMI decreased by 3,1%, and adherence to the Mediterranean diet improved from baseline. Confinement had a negative impact on the general health, diet, sleep and physical activity of this population (at risk of diabetes); however, weight and BMI decreased, and adherence to a Mediterranean diet improved.

Obesity and weight change during the COVID-19 pandemic in children and adults: A systematic review and meta-analysis

Many obesity risk factors have increased during the COVID-19 pandemic, including physical inactivity, poor diet, stress, and poverty. The aim of this systematic review was to evaluate the impact of the COVID-19 pandemic, as well as associated lockdowns or restrictions, on weight change in children and adults. We searched five databases from January 2020 to November 2021. We included only longitudinal studies with measures from before and during the pandemic that evaluated the change in weight, body mass index (BMI) (or BMI z-scores for children), waist circumference, or the prevalence of obesity. Random effects meta-analyses were conducted to obtain pooled estimates of the mean difference in outcomes. Subgroups were evaluated for age groups and diabetes or obesity at baseline. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 74 studies were included (3,213,776 total participants): 31 studies of children, 41 studies of adults, and 2 studies of children and adults. In children, the pooled mean difference was 1.65 kg (95% confidence interval [CI]: 0.40, 2.90; 9 studies) for weight and 0.13 (95% CI 0.10, 0.17; 20 studies) for BMI z-scores, and the prevalence of obesity increased by 2% (95% CI 1%, 3%; 12 studies). In adults, the pooled mean difference was 0.93 kg (95% CI 0.54, 1.33; 27 studies) for weight and 0.38 kg/m² (95% CI 0.21, 0.55; 25 studies) for BMI, and the prevalence of obesity increased by 1% (95% CI 0%, 3%; 11 studies). In children and adults, the pooled mean difference for waist circumference was 1.03 cm (95% CI -0.08, 2.15; 4 studies). There was considerable heterogeneity observed for all outcomes in both children and adults, and the certainty of evidence assessed using GRADE was very low for all outcomes. During the first year of the COVID-19 pandemic, small but potentially clinically significant increases in weight gain, BMI, and increased prevalence of obesity in both children and adults were observed. Increases were greater in children, and targeted prevention interventions may be warranted.

Dietary Habits and Lifestyle, Including Cardiovascular Risk among Vegetarians and Omnivores during the COVID-19 Pandemic in the Polish Population

Background: This study assessed how two food groups—omnivores (OMN) and vegetarians (VEGE)—differ in lifestyle changes, including dietary habits during the COVID-19 pandemic. Materials: A total of 861 persons participated in the survey and were divided into two groups: persons following a mixed diet (n = 489) and vegetarians, including vegans (n = 372). The mean age shows no significant differences. Methods: An online survey was conducted on the Polish population during the COVID-19 pandemic. Data was collected using social media; the survey was intended for adults and included separate sheets for different diets (OMN vs. VEGE). Results: The results in both groups were similar regarding the burden of premature diseases. Most respondents (~90%) did not indicate cardiovascular disease abnormalities. In the OMN group, overweight and obesity occurred more often, and the OMN group also showed a higher percentage of people reporting weight gain (OMN 42.7% vs. VEGE 35.9%). The results disclosed the VEGE group significantly more frequently chose products, i.e., vegetables (p = 0.029), legumes (p < 0.001), and dairy products or their plant substitutes (p = 0.002), compared to the OMN group. Conclusions: The VEGE group revealed the most regularities in dietary habits during the pandemic.

Risk and protective factors for new-onset binge eating, low weight, and self-harm symptoms in >35,000 individuals in the UK during the COVID-19 pandemic

OBJECTIVE

The disruption caused by the COVID-19 pandemic has been associated with poor mental health, including increases in eating disorders and self-harm symptoms. We investigated risk and protective factors for the new onset of these symptoms during the pandemic.

METHOD

Data were from the COVID-19 Psychiatry and Neurological Genetics study and the Repeated Assessment of Mental health in Pandemics Study (n = 36,715). Exposures were socio-demographic characteristics, lifetime psychiatric disorder, and COVID-related variables, including SARS-CoV-2 infection/illness with COVID-19. We identified four subsamples of participants without pre-pandemic experience of our outcomes: binge eating (n = 24,211), low weight (n = 24,364), suicidal and/or self-harm ideation (n = 18,040), and self-harm (n = 29,948). Participants reported on our outcomes at frequent intervals (fortnightly to monthly). We fitted multiple logistic regression models to identify factors associated with the new onset of our outcomes.

RESULTS

Within each subsample, new onset was reported by: 21% for binge eating, 10.8% for low weight, 23.5% for suicidal and/or self-harm ideation, and 3.5% for self-harm. Shared risk factors included having a lifetime psychiatric disorder, not being in paid employment, higher pandemic worry scores, and being racially minoritized. Conversely, infection with SARS-CoV-2/illness with COVID-19 was linked to lower odds of binge eating, low weight, and suicidal and/or self-harm ideation.

DISCUSSION

Overall, we detected shared risk factors that may drive the comorbidity between eating disorders and self-harm. Subgroups of individuals with these risk factors may require more frequent monitoring during future pandemics.

PUBLIC SIGNIFICANCE

In a sample of 35,000 UK residents, people who had a psychiatric disorder, identified as being part of a racially minoritized group, were not in paid employment, or were more worried about the pandemic were more likely to experience binge eating, low weight, suicidal and/or self-harm ideation, and self-harm for the first time during the pandemic. People with these risk factors may need particular attention during future pandemics to enable early identification of new psychiatric symptoms.

Women's body dissatisfaction, physical appearance comparisons, and Instagram use throughout the COVID-19 pandemic: A longitudinal study

OBJECTIVE

This study aimed to determine the evolution of Instagram use, body dissatisfaction and physical appearance comparisons throughout the coronavirus disease-2019 (COVID-19) pandemic, and to explore whether there was a relationship between the changes in Instagram use throughout the pandemic and body dissatisfaction and physical appearance comparisons.

METHOD

A total of 272 Spanish women (16-70 years old) were followed-up across four waves of assessment between November 2019 (before the pandemic started) and July 2021. Body dissatisfaction, social appearance comparisons, and Instagram use were assessed using the Eating Disorders Inventory-3, the Physical Appearance Comparison Scale-Revised, and an ad hoc questionnaire for Instagram use, respectively.

RESULTS

No statistically significant changes were found in the frequency of Instagram use, nor on the proportion of women following appearance-focused accounts on Instagram, among the data collection periods. Body dissatisfaction significantly increased from T1 to T4, and physical appearance comparisons significantly increased from T1 to T2, T3, and T4. These increases were not found to be significant for those with eating disorder risk. No significant differences were found in body dissatisfaction and physical appearance comparisons depending on whether participants' frequency of Instagram use had changed or remained the same, or whether they had started/stopped/continued following appearance-focused accounts on Instagram during the pandemic.

DISCUSSION

Women's body dissatisfaction and physical appearance comparisons seem to have increased throughout the pandemic. The experiences of individuals with eating disorder risk throughout the pandemic, and the relationship between the pandemic and Instagram use, might be complex and need further research.

PUBLIC SIGNIFICANCE

This study suggests that women's body dissatisfaction and physical appearance comparisons have increased throughout the COVID-19 pandemic. However, this increase might not be as clear for those who had eating disorder risk before the pandemic. Instagram frequency of use, and the percentage of women following appearance-focused accounts on Instagram, do not seem to have significantly increased. More research is needed to explore the impact of the pandemic.

Income precarity and child and parent weight change during the COVID-19 pandemic: a cross-sectional analysis of the Ontario Parent Survey

OBJECTIVES

To describe child and parent weight change during the pandemic, overall and by income precarity.

DESIGN

A cross-sectional online survey was conducted.

SETTING

Caregivers of children 0-17 years of age living in Ontario, Canada, during the COVID-19 pandemic from May 2021 to July 2021.

PARTICIPANTS

A convenience sample of parents (n=9099) with children (n=9667) living in Ontario were identified through crowdsourcing.

PRIMARY OUTCOME MEASURE

Parents recalled, for themselves and their child, whether they lost weight, gained weight or remained the same over the past year. OR and 95% CI were estimated using multinomial logistic regression for the association between income precarity variables and weight loss or gain, adjusted for age, gender and ethnicity.

RESULTS

Overall, 5.5% of children lost weight and 20.2% gained weight. Among adolescents, 11.1% lost weight and 27.1% gained weight. For parents, 17.1% reported weight loss and 57.7% reported weight gain. Parent weight change was strongly associated with child weight change. Income precarity measures, including job loss by both parents (OR=7.81, 95% CI 5.16 to 11.83) and disruption to household food supply (OR=6.05, 95% CI 4.77 to 7.68), were strongly associated with child weight loss. Similarly, job loss by both parents (OR=2.03, 95% CI 1.37 to 3.03) and disruption to household food supply (OR=2.99, 95% CI 2.52 to 3.54) were associated with child weight gain.

CONCLUSIONS

Weight changes during the COVID-19 pandemic were widespread and income precarity was strongly associated with weight loss and weight gain in children and parents. Further research is needed to investigate the health outcomes related to weight change during the pandemic, especially for youth, and the impacts of income precarity.

A Year in the Life of U.S. Frontline Health Care Workers: Impact of COVID-19 on Weight Change, Physical Activity, Lifestyle Habits, and Psychological Factors

Healthcare workers (HCWs) experienced significantly higher burdens and life demands due to the COVID-19 pandemic. This study sought to assess the longitudinal effects among HCWs throughout the pandemic. Qualtrics surveys collected self-reported data on weight changes, eating patterns, physical activity (PA), and psychological factors with data organized by timepoints prior to the pandemic (PP0—prior to March 2020), baseline (M0—January 2021), month 6 (M6—July 2021), and month 12 (M12—January 2022). Eating patterns were negatively impacted at the M0, with reported increases in snacking/grazing (69.7%), fast food/take-out consumption (57.8%), and alcohol (48.8%). However, by M6 and M12 there were no statistically significant differences in eating patterns, suggesting that eating patterns normalized over time. Mean weight increased from PP0 to M0 by 2.99 pounds (p < 0.001, n = 226) and from PP0 to M6 by 2.12 pounds (p < 0.027, n = 146), though the difference in mean weight from PP0 to M12 was not statistically significant (n = 122). PA counts decreased from 8.00 sessions per week PP0 to 6.80 by M0 (p = 0.005) before jumping to 12.00 at M6 (p < 0.001) and 10.67 at M12 (p < 0.001). Psychological factors comparing M0 to M12 found statistically significant differences for depression (p-value = 0.018) and anxiety (p-value = 0.001), meaning depression and anxiety were initially increased but improved by M12. Additionally, higher scores on depression and insomnia scales were associated with lower PA levels. These overall results imply that the COVID-19 pandemic had immediate effects on the eating patterns, weight changes, PA, and psychological factors of HCWs; however, routines and lifestyle habits appeared to have normalized one year later.

Nigerian Muslim's Perceptions of Changes in Diet, Weight, and Health Status during Ramadan: A Nationwide Cross-Sectional Study

The Islamic month of Ramadan is marked by fasting, when Muslims refrain from eating and drinking from dawn to sunset, which has an impact on their dietary habits. The study aimed to assess Nigerian Muslims' dietary modifications during Ramadan and their related changes in body weight and health status. A web-based cross-sectional study was conducted among Nigerian adult Muslims. The survey assessed sociodemographic, dietary habits, eating behaviors, food choices, perceived weight changes, and health status. The logistic regression model was used to assess the predictors of weight change and perceived health status. There were 770 participants, 62.9% of whom were women, ranging in age from 18 to 60 years with a mean age of 27.7 ± 6.4 years. Fruits, palm dates, homemade foods, milk products, and vegetables were more frequently consumed. There were fewer energy drinks, pastries, salty snacks, and carbonated or sugared drinks consumed during Ramadan than before. Over half (54.6%, 95% CI: 51.0-58.9%) of the respondents lost weight during Ramadan, 37.0% (95% CI: 17.4-38.6%) maintained their weight and 8.4% (95% CI: 6.6-10.6%) gained weight during the month. Nearly all (97.3%, 95% CI: 95.8-98.3%) reported having good health during Ramadan, and 2.7% (95% CI: 1.7-4.1%) reported having a poorer health state during Ramadan. There was a significant weight loss and healthy dietary change associated with Ramadan fasting in Nigeria. Public health measures must be in place to impart such positive health behaviors so that such healthy habits continue throughout the year.

Consumed by Boredom: Food Choice Motivation and Weight Changes during the COVID-19 Pandemic

Boredom is an established cause and correlate of eating behavior. Yet, existing work offers a scattered range of plausible motivations for why this is. We examined among 302 people representative of the adult UK population what motivations they had for selecting food during the COVID-19 pandemic and how this related to boredom. As predicted, bored people choose food less for health reasons and more for convenience. Boredom reduced ethical and 'natural content' motivations for selecting food and was not associated with choosing food to regulate one's mood or to experience unfamiliarity. Boredom was also associated with greater absolute changes in weight over the course of the pandemic. Boredom did not predict weight gains or losses overall. These findings offer insights into the role that boredom plays in eating motivations in particular and health-relevant outcomes in general.

The Frequency of Tobacco Smoking and E-Cigarettes Use among Primary Health Care Patients-The Association between Anti-Tobacco Interventions and Smoking in Poland

The aim of this study was to assess the prevalence of smoking and e-cigarette use among primary care patients during the COVID-19 pandemic and to assess the frequency of minimal anti-tobacco interventions by family doctors. A cross-sectional study was conducted from January 2020 to December 2021 encompassing 896 patients over 18 years of age who used primary health care in the city of Lodz, Poland. In total, 21.2% of the respondents were smokers, 11.6% were e-cigarette users, and 7.3% dual users. In addition, 68.4% of smokers had been asked about smoking, while 62.9% of non-smokers and 33.7% of smokers were advised to quit smoking; furthermore, 71.1% of e-cigarette users and 72.3% of dual users were asked about tobacco use, and 17.3% and 21.5%, respectively, had been advised to quit smoking. Multivariate logistic regression analysis found men and alcohol users to receive more minimal anti-tobacco advice than women and non-alcohol users (OR = 1.46; p < 0.05 and OR = 1.45; p < 0.05), socio-demographic and health correlates did not increase the chances of obtaining minimal anti-tobacco interventions among smokers. People with a medium level of education had a higher chance of receiving minimal anti-tobacco intervention from their family doctor when using e-cigarettes and when they were dual users (OR = 2.06; p < 0.05 and OR = 2.51; p < 0.05). Smokers were less likely to receive minimal anti-tobacco interventions than reported in previous studies. Measures should be implemented to increase the minimum interventions provided by GPs in their daily work among all patients, not only those who use tobacco. Non-smokers should be encouraged to abstain.

Global Changes in Child and Adolescent Physical Activity During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

IMPORTANCE

Numerous physical distancing measures were implemented to mitigate the spread of the COVID-19 virus, which could have negatively affected child and adolescent physical activity levels.

OBJECTIVES

To conduct a systematic review and meta-analysis of the literature that used validated measures to document changes in child and adolescent physical activity during the COVID-19 pandemic and to estimate whether changes in physical activity differed between participant-level, contextual, and methodological moderators.

DATA SOURCES

PubMed, PsycInfo, SPORTDiscus, Web of Science, Scopus, CINAHL, and MEDLINE were searched (from January 1, 2020, to January 1, 2022). A total of 1085 nonduplicate records were retrieved.

STUDY SELECTION

Studies were included if they reported (1) changes in the duration of physical activity at any intensity for children or adolescents (age ≤18 years) comparing before and during the COVID-19 pandemic using validated physical activity measurement tools and were (2) from general population samples, (3) peer-reviewed, and (4) published in English.

DATA EXTRACTION AND SYNTHESIS

A total of 126 articles underwent full-text review. Data were analyzed using a random-effects meta-analysis, which was conducted in January 2022.

MAIN OUTCOMES AND MEASURES

Change in the duration of engagement in physical activity at any intensity comparing before and during COVID-19.

RESULTS

Twenty-two studies including 46 independent samples and 79 effect sizes from 14 216 participants (median age, 10.5 years; range, 3-18 years) were included. The percentage change in the duration of engagement in total daily physical activity from before to during COVID-19 was -20% (90% CI, -34% to -4%). Moderation analyses revealed that changes were larger for higher-intensity activities (-32%; 90% CI, -44% to -16%), corresponding to a 17-minute reduction in children's daily moderate-to-vigorous physical activity levels. The reduction in physical activity was also larger for samples located at higher latitudes (37%; 90% CI, -1% to 89%) and for studies with a longer duration between physical activity assessments (25%; 90% CI, -0.5% to 58%).

CONCLUSIONS AND RELEVANCE

Children and adolescents have experienced measurable reductions in physical activity during the COVID-19 pandemic. Findings underscore the need to provide bolstered access to support and resources related to physical activity to ensure good health and social functioning among children and adolescents during pandemic recovery efforts.

Intrahepatic Fat Content and COVID-19 Lockdown in Adults with NAFLD and Metabolic Syndrome

Background: COVID-19 lockdowns had a significant impact on people’s health, triggering levels of anxiety, perceived stress, and changes in food and nutritional status. Objectives: To assess the changes in dietary habits, metabolic syndrome (MetS) and liver parameters before and after the COVID-19 lockdown according to changes in intrahepatic fat content in adults with non-alcoholic fatty liver disease (NAFLD) and MetS. Design: Pre- and post-lockdown observation of the COVID-19 lockdown on fifty-nine 40–60-year-old participants with MetS and NAFLD, in a parallel group, randomised experiment intended to treat NAFLD. Methods: Anthropometrics, liver and MetS biochemical parameters, intrahepatic fat content by abdominal magnetic resonance imaging, and dietary assessment using a validated 148-item Food Frequency Questionnaire were collected pre-COVID-19 lockdown and post-lockdown. Results: COVID-19 lockdown led to negative changes in the liver of patients with NAFLD and MetS, with weight gain and increases in glycemia, ALT and intrahepatic fat content post lockdown. Participants with worsened liver status had low consumption of fibre, cheese, nuts and coffee, and high consumption of sweets and pastries. Participants who improved liver status ameliorated ALT values, waist circumference, and intrahepatic fat content, assessed by magnetic resonance imaging post-lockdown. Conclusions: The maintenance of healthy lifestyle habits is vital, especially for populations with NAFLD and MetS, to reduce unhealthy lifestyle patterns displayed during lockdown.

Impact of COVID-19 Lockdown on Non-Alcoholic Fatty Liver Disease and Insulin Resistance in Adults: A before and after Pandemic Lockdown Longitudinal Study

Background: Non-alcoholic fatty liver disease is a chronic disease caused by the accumulation of fat in the liver related to overweight and obesity, insulin resistance, hyperglycemia, and high levels of triglycerides and leads to an increased cardiovascular risk. It is considered a global pandemic, coinciding with the pandemic in 2020 caused by the “coronavirus disease 2019” (COVID-19). Due to COVID-19, the population was placed under lockdown. The aim of our study was to evaluate how these unhealthy lifestyle modifications influenced the appearance of metabolic alterations and the increase in non-alcoholic fatty liver disease. Methods: A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. Results: Differences in the mean values of anthropometric and clinical parameters before and after lockdown were revealed. There was a statistically significant worsening in non-alcoholic fatty liver disease (NAFLD) and in the insulin resistance scales, with increased body weight, BMI, cholesterol levels with higher LDL levels, and glucose and a reduction in HDL levels. Conclusions: Lockdown caused a worsening of cardiovascular risk factors due to an increase in liver fat estimation scales and an increased risk of presenting with NAFLD and changes in insulin resistance.

Medication Adherence Among Patients with Multimorbidity in the United Arab Emirates

Background

Multimorbidity, defined as having two or more chronic diseases, has a major impact on public health and Sustainable Development Goals (SDG). This study aims to assess the prevalence of medication adherence and associated factors among patients with multimorbidity.

Methods

A questionnaire-based, cross-sectional survey was conducted by a trained interviewer across patients with multimorbidity attending outpatient clinics in two tertiary referral hospitals in the United Arab Emirates (UAE). Demographic and social variables and the outcome (self-reported adherence to long-term medication) were measured using the General Medication Adherence Scale (GMAS). Multiple logistic regression was used to assess medication adherence and associated factors.

Results

From a total of 630 participants included in this study, the estimated prevalence of high medication adherence is 78.57% (±1.63478) with a 95% confidence interval (CI) [75.19, 81.61]. The odds of high medication adherence increased with age. The odds of high medication adherence for patients aged 66 years and older than those aged 19-35 years is adjusted odds ratio (AOR) = 3.880, with a 95% CI [1.124, 13.390]. Patients with income more than 50,000 had the odds, AOR = 5.169 with a 95% CI [1.282, 20.843], compared to those earning less than 10,000 Dirhams (AED). Patients aged 36-65 with health insurance coverage had higher medication adherence than groups on the other end. The number of current medications is significantly (p-value = 0.027) associated with high medication adherence with the odds of high medication adherence, AOR = 4.529 with a 95% CI [1.184, 17.326], the highest for those currently taking four medications.

Conclusion

This study highlights younger population having multimorbidity in the context of an increasing life expectancy and suboptimal therapeutic outcomes. Furthermore, the study highlights multimorbidity is associated with low medication adherence and out-of-pocket payment, and non-availability of insurance is a major hindrance to medication adherence.

COVID-19, body weight and the neighbourhood: food system dimensions and consumption associated with changes in body weight of Peruvian adults during first wave lockdowns

OBJECTIVE

The objective of this study is to assess changes in the dimensions of the food system and consumption associated with body weight variations during the first month's lockdown in Peruvian adults in Metropolitan Lima.

METHODS

A cross-sectional study conducted during the first months of lockdowns in Peru. 694 adults completed a web-based survey about changes experienced in the process of acquiring food during lockdown, changes in their intake and self-perceived body weight. A multinomial logistic regression analysis was conducted to evaluate the factors associated with changes in body weight.

RESULTS

Weight gain was perceived in 38% of the participants and 22.8% perceived weight loss. 39.2% did not perceive changes in their weight. Risk factors for body weight gain were increased alcohol consumption (OR=4.510, 95% CI 1.764 to 11.531) and decreased fruit consumption (OR=2.129, 95% CI 1.290 to 3.515), while decreasing cereal intake (OR=0.498, 95% CI 0.269 to 0.922) and choosing nutritious food as a driver for purchase (OR=0.512, 95% CI 0.320 to 0.821) were found to be protective against gaining weight. Decreasing food intake during the pandemic (OR=2.188, 95% CI 1.348 to 3.550) and having to miss important foods (OR=2.354, 95% CI 1.393 to 3.978), were associated with weight loss.

CONCLUSIONS

During confinement, weight gain was mostly associated with food consumption and personal food system factors. Meanwhile, weight loss was associated with external food system factors.

A Qualitative Study Exploring Management of Food Intake in the United Kingdom During the Coronavirus Pandemic

The coronavirus pandemic has impacted dietary quality through increased emotional eating and extended time spent at home, as well as instances of panic buying due to uncertainty over food availability. We recruited an opportunistic sample of 40 adults living in the United Kingdom (Female = 25; Mean age = 41.9 years) (SD = 14.4) without any prior history of eating disorders. Semi-structured interviews were conducted in June 2020 and focused on the impacts of the COVID-19 lockdown on eating habits and experiences of panic buying. The data were transcribed and organized using the softwares Otter and Quirkos, respectively. Reflexive thematic analysis identified positive and negative changes to eating habits. Overall, themes highlighted that effective organization was vital to manage food purchases and consumption due to a reduced shopping frequency. However, overconsumption frequently occurred due to boredom and ease of accessing energy dense foods, which had negative implications for weight and body image. After indulging, participants attempted to revert to prior eating habits and adhere to a nutritious diet. Many also expressed the importance of having enough food to feed families, which was often reported as a reason for buying extra supplies. Understanding the long-term impacts of changes to eating habits that account for the novel coronavirus context is required to preserve health and prevent unintended changes to weight.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

Background

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries.

Methods

A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics.

Results

Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores.

Conclusion

Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.

Complementary feeding practices and the associated risk of childhood obesity among ethnic minority groups living in high-income countries: protocol for a systematic review and meta-analysis

INTRODUCTION

Complementary feeding (CF) is defined as the period from when exclusive breast milk and formula are no longer sufficient for meeting the infant's nutritional needs. The CF period occurs from birth to 23 months of age. Though the recommended guidelines for introducing CF is from around 6 months of age, data indicates that some infants are introduced to food earlier than 6 months which can predispose children to obesity and overweight. Obesity in ethnic minority groups (EMG) is higher than their native counterparts and often tracks into adulthood. Hence, our aim was to conduct a systematic review and meta-analysis on the available literature to identify the risk of childhood overweight/obesity associated with CF practices concerning their timing, as well as the frequency and type of CF food introduced. We focused specifically on EMG children living in high-income countries.

METHODS AND ANALYSIS

A methodological literature search surrounding childhood obesity and overweight (COO) risk associated with CF practices will be conducted in May 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The following academic databases will be methodologically searched: PubMed, EMBASE, PsycINFO, CINAHL, SCOPUS, Cochrane Library and the WHO Global Index Medicus. Three independent researchers will be involved in independent screening and review the included articles based on the predefined inclusion and exclusion criteria. Where conflicts arise during the screening process, it will be resolved through discourse until a consensus is reached. Information on CF practices and anthropometric measurements will be extracted to ascertain the risk of COO. For this study, WHO body mass index for age and sex percentiles, Centers for Disease Control and Prevention classification and other recognised country-specific classifications will be utilised for the outcome.

ETHICS AND DISSEMINATION

Formal ethical approval is not needed as the results will be drawn from currently available published literature. Outcomes of the review will be shared through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42021246029.

Impact of the COVID-19 Pandemic on Diet Behaviour Among UK Adults: A Longitudinal Analysis of the HEBECO Study

COVID-19 pandemic restrictions impacted dietary habits during the initial months of the pandemic, but long-term effects are unclear. In this longitudinal study, self-selected UK adults (n = 1,733, 71.1% female, 95.7% white ethnicity) completed three online surveys (May-June, August-September, and November-December 2020, with a retrospective pre-pandemic component in the baseline survey), self-reporting sociodemographics, lifestyle, and behaviours, including high fat, salt, and sugar (HFSS) snacks, HFSS meals, and fruit and vegetable (FV) intake. Data were analysed using generalised estimating equations. Monthly HFSS snacks portion intake increased from pre-pandemic levels (48.3) in May-June (57.6, p < 0.001), decreased in August-September (43.7, p < 0.001), before increasing back to pre-pandemic levels in November-December (49.2, p < 0.001). A total of 48.5% self-reported increased [25.9 (95% confidence interval: 24.1, 27.8)] and 47.7% self-reported decreased [24.1 (22.4, 26.0)] monthly HFSS snacks portion intakes in November-December compared with pre-pandemic levels. Monthly HFSS meals portion intake decreased from pre-pandemic levels (7.1) in May-June (5.9, p < 0.001), was maintained in August-September (5.9, p = 0.897), and then increased again in November-December (6.6, p < 0.001) to intakes that remained lower than pre-pandemic levels (p = 0.007). A total of 35.2% self-reported increased [4.8 (4.3, 5.3)] and 44.5% self-reported decreased [5.1 (4.6, 5.6)] monthly HFSS meals portion intakes in November-December compared with pre-pandemic levels. The proportion meeting FV intake recommendations was stable from pre-pandemic through to August-September (70%), but decreased in November-December 2020 (67%, p = 0.034). Increased monthly HFSS snacks intake was associated with female gender, lower quality of life, and - in a time - varying manner - older age and higher HFSS meals intake. Increased monthly HFSS meals intake was associated with female gender, living with adults only, and higher HFSS snacks intake. Reduced FV intake was associated with higher body mass index (BMI) and lower physical activity. These results suggest large interindividual variability in dietary change during the first year of the pandemic, with important public health implications in individuals experiencing persistent increases in unhealthy diet choices, associated with BMI, gender, quality of life, living conditions, physical activity, and other dietary behaviours.

Changes in Total Energy, Nutrients and Food Group Intake among Children and Adolescents during the COVID-19 Pandemic-Results of the DONALD Study

The COVID-19 pandemic may have changed the habitual lifestyles of children and adolescents, in particular, due to the closure of kindergartens and schools. To investigate the impact of the pandemic on nutrients and food intake of children and adolescents in Germany, we analyzed repeated 3-day weighed dietary records from 108 participants (3–18 years; females: n = 45, males: n = 63) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. Polynomial mixed-effects regression models were used to identify prospective changes in dietary intake (total energy (TEI), carbohydrates, fat, protein, free sugar, ultra-processed foods, fruits and vegetables, sugar sweetened beverages and juices) before and during the first months of the COVID-19 pandemic. For the current analysis, we have chosen the first months of the pandemic (March 2020–August 2020), as this was the period with the most restrictions in Germany so far (kindergarten, school and restaurant closures; contact and outdoor activity restrictions). No significant changes in either the selected nutrients or food groups were observed. However, children and adolescents recorded a significantly lower TEI during the pandemic (β = −109.65, p = 0.0062). Results remained significant after the exclusion of participants with under-reported records (β = −95.77, p = 0.0063). While macronutrient intake did not change, descriptive data indicate a non-significant decrease in sugar sweetened beverages and ultra-processed foods intake. We suggest that children and adolescents from high socioeconomic families may have adapted lifestyle changes during the pandemic.

Dietary Habits by Income Level during the COVID-19 Pandemic in Indonesia: Results from the IndoNutriLifeCOVID-19 Online Survey

Background: The Coronavirus Disease 2019 (COVID-19) has caused many lifestyle changes, especially in the diet. Policies such as physical distancing and quarantine orders aimed to mitigate to spread of COVID-19 have affected the economy and, therefore, the dietary habits of the people.  Aim: The purpose of this study was to analyze the associations between income levels and dietary habits during the COVID-19 pandemic.  Methods: This cross-sectional study included 697 Indonesian adults from various regions in Indonesia. The study was conducted from June - August 2020. Data were obtained through a self-administered online questionnaire including dietary habits, lifestyles, and quality of life data adapted from MyNutriLifeCOVID-19 Online Survey. To analyze the associations between income levels and dietary habits during the COVID-19 pandemic, a chi square test was used. Data were analyzed using SPSS version 20.   Results: Respondents had mean age of 27.56 ± 8.58 years and the majority were women (83.6%). The percentage of people with large-scale social restrictions was 47.5%. Respondents reported that their dietary habits were healthier during the pandemic (46.2%), with the majority categorized as high and very high-income status (59.1%). From self-reported of the people in Indonesia, there was association between high-income level and self-perceived healthier dietary habits. Higher-income level was also associated with higher frequency of online food/drink delivery, consuming western diet foods, consuming dietary supplements, and probiotic consumption (p<0.05).  Conclusions: The self-reported that during the COVID-19 pandemic, the dietary habits of people with a higher income level had healthier compared to their dietary habits before the pandemic. However, it is also related to higher energy, cholesterol, and saturated fat intakes due to consuming high western diet foods.  Social inequalities in dietary intake should be considered through promoting a healthy balanced diet with affordable price and healthy food processing in the community. 

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters.

OBJECTIVES

To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil.

DESIGN AND SETTING

A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil.

METHODS

The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality.

RESULTS

More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52).

CONCLUSIONS

Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.