Diet and lifestyle behaviour disruption related to the pandemic was varied and bidirectional among US and UK adults participating in the ZOE COVID Study

Patient activation and psychological coping strategies to manage challenging circumstances during the COVID-19 pandemic in people with kidney disease

BACKGROUND

Coping with health problems requires some degree of self-management; however, an individual's ability to self-manage can be threatened during challenging times, such as the COVID-19 pandemic. Exploring differences and changes in psychological well-being and coping strategies between those with low and high patient activation may inform appropriate interventions to support psychological coping.

METHODS

People with chronic kidney disease (CKD) (non-dialysis and transplant) were recruited from 11 hospital sites across England between August and December 2020. Participants responded to an online survey study, including the Brief Coping Orientation to Problem Experienced (COPE) Inventory, Depression, Anxiety and Stress Scale (DASS-21), Short Health Anxiety Index (SHAI), and Patient Activation Measure (PAM-13). A follow-up survey was conducted 6-9 months later. Paired t tests assessed within-group changes, and chi-squared tests compared coping strategies utilised by low- and high-activated participants. General linear modelling was performed to determine the relationship between patient activation and coping strategies, and covariates.

RESULTS

Two hundred and fourteen participants were recruited (mean age: 60.7, 51% male, mean eGFR: 38.9 ml/min/1.73 m2). Low-activated participants were significantly more anxious than high-activated participants (P = 0.045). Health anxiety significantly decreased (i.e., got better) for high-activated participants (P = 0.016). Higher patient activation scores were associated with greater use of problem-focused strategies (β = 0.288, P < 0.001). Age (β = - 0.174, P = 0.012), sex (β = 0.188, P = 0.004), and education level (β = 0.159, P = 0.019) significantly predicted use of problem-focused strategies.

DISCUSSION

Those with higher activation had lower levels of anxiety, and more frequently used adaptive coping strategies during the pandemic. Targeted support and interventions may be required for people with CKD to enhance patient activation, encourage more positive adaptive coping strategies, and mitigate maladaptive coping strategies.

The impact of COVID-19 lockdowns on the body mass index of people living with obesity: A UK retrospective cohort study using the UK Clinical Practice Research Datalink

BACKGROUND

Restrictions implemented by governments during the coronavirus disease 2019 (COVID-19) pandemic affected people's eating habits and physical activity. We investigated the effect of COVID-19 lockdowns and restrictions on body mass index (BMI) and weight in a UK population, according to BMI class, sex, age and ethnicity.

METHODS

This retrospective observational cohort study used the Clinical Practice Research Datalink AURUM database. Baseline spanned from 22 March 2017-22 March 2020, and the follow-up lockdown period was from 23 March 2020 (start of the lockdown in the UK) to 13 March 2021. The descriptive analysis included individuals with ≥ 1 valid BMI/weight measurements during both the baseline and follow-up periods, while the model-based analysis comprised individuals with ≥ 1 valid measurement(s) during baseline. Results were stratified by baseline BMI category, sex, age and ethnicity.

RESULTS

In the descriptive analysis (n = 273,529), most individuals did not change BMI category post-lockdown (66.4-83.3%). A greater proportion of women (12.6%) than men (9.5%) moved up BMI categories post-lockdown. Compared with older groups, a higher proportion of individuals < 45 years old increased post-lockdown BMI category. The model-based analysis (n = 938,150) revealed consistent trends, where changes in body weight and BMI trajectories pre- and post-lockdown were observed for women and for individuals < 45 years.

CONCLUSION

During COVID-19 restrictions, women and young individuals were more likely than other groups to increase BMI category and weight post-lockdown.

Use and efficacy of dry-mouth interventions in Sjögren's disease patients and possible association with perceived oral dryness and patients' discomfort

OBJECTIVES

Sjögren's disease (SjD) patients use various interventions to relief their oral dryness. However, the use and efficacy of these interventions have only partially been evaluated. The present study aims to investigate whether there is an association between the perceived oral dryness and discomfort of SjD patients and their use of specific interventions.

MATERIALS AND METHODS

A cross-sectional study was performed among SjD patients, who completed several questionnaires to assess the severity of their oral dryness and an inventory of dry-mouth interventions. The perceived efficacy of each intervention was reported on a 5-point Likert-scale.

RESULTS

The questionnaires were returned by 92 SjD patients. For relief of oral dryness, they mostly used "eating fruit", "drinking tea", "moistening the lips", "drinking water, and "drinking small volumes" (> 50%). Three interventions had a frequency of use ranging from 2-6 times/day, whereas, "drinking water" and "drinking small volumes" showed higher frequencies (> 14). The highest overall efficacy (≥ 3.5) was reported for "chewing gum" and "using a mouth gel". Furthermore, various dry-mouth interventions showed significant associations with oral dryness scores and/or patients' discomfort. For example, "drinking small volumes" and "using XyliMelts" were associated with the Bother Index score.

CONCLUSION

Great variation was found in the use of dry-mouth interventions by the participants and the severity of the oral dryness and/or patients' discomfort seemed to affect their choice of intervention. Notably, the mostly used interventions did not show the highest reported efficacy.

CLINICAL RELEVANCE

These findings might help SjD patients and clinicians in their choice of effective dry-mouth interventions.

Associations between comfort eating and weight change during the COVID-19 pandemic among U.S. adults

Objective

To examine associations between comfort eating in response to loneliness or stress and weight change during the COVID-19 pandemic among U.S. adults.

Design

Quantitative, cross-sectional study.

Setting

The 2021 SummerStyles survey data.

Subjects

U.S. adults (≥18 years; N = 4068).

Measures

The outcome was reported weight changes since the start of the COVID-19 pandemic with four responses: lost weight, weight remained the same, gained weight, and don't know. The exposure variable was frequency of comfort eating in response to loneliness or stress during the past year with three responses: never/ rarely, sometimes, or often/always.

Analysis

We used chi-square analysis to examine the independence of survey variables related to weight changes, and comfort eating in response to loneliness or stress during the COVID-19 pandemic. Next, we used a multinomial logistic regression to estimate adjusted odds ratios for weight changes by comfort eating in response to loneliness or stress frequency.

Results

Overall, 20.1% of adults reported losing weight, 39.9% remained about the same weight, 30.4% gained weight, and 9.4% did not know about their weight change during the COVID-19 pandemic. Taking comfort by eating in response to loneliness or stress was reported by over 33% of participants (often/always = 8.3%; sometimes = 25.3%). Weight change and comfort eating during the COVID-19 pandemic significantly varied by sociodemographic factors. Respondents that sometimes or often/always reported taking comfort by eating in response to loneliness or stress were more likely to report losing weight (Adjusted Odds Ratio ranges: 1.62-2.99) or gaining weight (Adjusted Odds Ratio ranges: 3.10-4.61) than those who never/rarely took comfort by eating in response to loneliness or stress.

Conclusions

Taking comfort by eating when stressed/lonely was significantly associated with reported weight changes during the COVID-19 pandemic. Weight changes may lead to additional health complications. Implementing evidence-based strategies to reduce loneliness or stress and support healthy eating during the COVID-19 pandemic may benefit weight management and future well-being.

Daily step counts before, during, and after COVID-19 pandemic: a smartphone-tracking study of university students in Egypt and Saudi Arabia

BACKGROUND

COVID-19 pandemic has drastically changed people's lifestyles and daily routines around the world. This study aimed to investigate changes in daily step counts - as an indicator of physical activity - before, during, and after the pandemic among university students in Egypt and Saudi Arabia and to identify regional and gender factors that may have influenced physical activity during these periods.

METHODS

A total of 1273 university students from Egypt (Assiut University and Zagazig University) and Saudi Arabia (Taif University, King Faisal University, and Imam AbdulRahman Bin Faisal University) provided valid data on their daily step counts recorded by a smartphone application (iPhone Health App) from January 2019 to December 2021. The data was divided and averaged based on three periods: the pre-pandemic year (January to December 2019), the first pandemic year (January to December 2020), and the second pandemic year (January to December 2021).

RESULTS

The results showed a significant decrease in daily steps from pre-pandemic to the first pandemic year, followed by an increase in the second pandemic year. However, daily step counts did not fully recover to pre-pandemic levels in male Egyptian and marginally in male Saudi participants. In both nationalities, female participants did not show a significant difference in daily steps between the pre-pandemic and second-pandemic years. Female Egyptian participants had significantly lower daily step counts than male Egyptian participants, and a gender difference in daily steps was also observed in Saudi female participants in the pre-pandemic and the second pandemic year but not during the first pandemic year.

CONCLUSION

These findings outline the need for strategies in Egypt and Saudi Arabia to promote physical activity and reduce sedentary behavior, especially among young women, to mitigate the negative consequences of COVID-19 and meet physical activity guidelines.

Exploring the Impact of a Global Pandemic (COVID-19) on Factors Impacting the Resilience of Top-Tier London Hockey Players

Introduction

The cessation of all professional and amateur sport due to the COVID-19 pandemic had a dramatic effect on the mental and physical capacity of the United Kingdom populace, but its impact was arguably felt more deeply by the athletic population. Thus, this research explored which limiting factors were experienced by team hockey players during the national lockdowns (1.0-3.0) with the objective of enabling coaches and team management to better support and protect players' physiological and psychological resilience in return to play.

Methods

Data were collected over 12 weeks during the 3rd UK lockdown (March 2021) from two top-tier London clubs. Hockey players (n = 63) completed an online questionnaire that included validated tests for self-compassion, sport motivation, and a custom open-ended style qualitative questionnaire on nutrition and lifestyle behaviour. Mean self-compassion, motivation scores, and common indicative limiting factors were evaluated and ranked according to significance.

Results

High "rebound resilience" was found with low amotivation scores (m = 8.33) and strong affinity for their sport identifying with the statement "because participation in my sport is an integral part of my life" with correspondingly high integrated regulation scores (m = 21.43). Participants' self-compassion showed the highest scores in mindfulness (m = 3.66) and lowest in self-kindness (m = 2.84) indicating a common trait in athletes for self-criticism. The highest limiting factor was cited as "no social outlets, social interactions, or seeing friends and family".

Conclusion

This study revealed the critical role that social connectedness plays in promoting resilience and enhancing motivation in return to play during extremely challenging circumstances. When the social outlet is absent, enhancing resilience factors with mindfulness, self-compassion, and the creation of a more facilitative environment where player welfare takes priority are potential strategies to support players when they are unable to participate in their sport.

The impact of socioeconomic status on changes in cancer prevention behavior during the COVID-19 pandemic

BACKGROUND

The impacts of socioeconomic status (SES) on COVID-19-related changes in cancer prevention behavior have not been thoroughly investigated. We conducted a cohort study to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic.

METHODS

We invited adult participants from previous studies conducted at Ohio State University to participate in a study assessing the impact of COVID-19 on various behaviors. Post-COVID-19 cancer prevention behaviors, including physical activity, daily intake of fruits and vegetables, alcohol and tobacco consumption, and qualitative changes in post-COVID-19 behaviors relative to pre-COVID levels, were used to construct a prevention behavior change index that captures the adherence status and COVID-related changes in each behavior, with higher index scores indicating desirable changes in prevention behaviors. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted regression models were used to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic.

RESULTS

The study included 6,136 eligible participants. The average age was 57 years, 67% were women, 89% were non-Hispanic Whites, and 33% lived in non-metro counties. Relative to participants with high SES, those with low SES had a 24% [adjusted relative ratio, aRR = 0.76 (95%CI 0.72-0.80)], 11% [aRR = 0.89 (95%CI 0.86-0.92)], and 5% [aRR = 0.95 (95%CI 0.93-0.96)], lower desirable changes in prevention behaviors for physical activity, fruit and vegetable intake, and tobacco use, respectively. Low SES had a higher desirable change in alcohol consumption prevention behaviors, 16% [aRR = 1.16 (95%CI 1.13-1.19)] relative to high SES. The adjusted odds of an overall poor change in prevention behavior were adjusted odds ratio (aOR) 1.55 (95%CI 1.27 to 1.89) and aOR 1.40 (95%CI 1.19 to 1.66), respectively, higher for those with low and middle SES relative to those with high SES.

CONCLUSION

The adverse impacts of COVID-19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population

Introduction

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG).

Methods

This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods.

Results

The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods.

Discussion

We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Snacking and anxiety during the coronavirus disease (COVID-19) pandemic: A prospective cohort study

Anxiety and snacking increased during the initial coronavirus disease 2019 (COVID-19) lockdowns, but it remains unknown whether this change in snacking persisted and if it related to anxiety levels. We used prospective data to examine changes in snacking frequency from t1 (eased restrictions in England in May-June 2020) to t2 (national lockdown in December 2020-March 2021), the association of anxiety (assessed by the Generalised Anxiety Disorder-7 questionnaire at t1) with the snacking change, and the mediating and moderating effects of disinhibition and flexible restraint (assessed by the Three Factor Eating Questionnaire in 2016-17). Analyses including 2128 adults (mean age 28.4 y) residing in England from the Avon Longitudinal Study of Parents and Children showed that snacking frequency increased over time (mean change 1.23 (95% CI 0.81, 1.65) snacks/wk). Linear regressions of snacking adjusted for sociodemographic covariates showed that having clinical levels of generalised anxiety at t1, versus not, was associated with 1.22 (95% CI 0.07, 2.37) more snacks/wk at t2. Disinhibition partially mediated the association between Generalised Anxiety Disorder and snacking (βindirect = 0.15, 95% CI 0.01, 0.32), while there was no evidence that flexible restraint moderated the association (β = 0.05, 95% CI -0.57, 0.66). Our longitudinal findings highlight a detrimental anxiety-snacking association partly operating via disinhibition, suggesting future research could target mitigating anxiety and disinhibited eating behaviours to benefit diet-related outcomes following the pandemic.

In Situ Interfacial Super-Assembly of Nanobiohybrids through Plant for Food-Grade Oral Medicine

Developing a next-generation oral drug delivery system with enhanced efficacy and limited side effects is highly desired for refractory diseases treatment such as colitis. The bioinspired assembly of drugs within food-grade plants highlights its potential value of this unique hybrid material. Herein, we report the preparation of drug-encapsulated vegetable nanobiohybrid superassembled frameworks as an oral food-grade drug delivery system (SAF-FGDD). The in situ superassembly of SAF-FGDD driven by natural transpiration from living plants is carried out through a sustainable and low-carbon manner, allowing for the assembly of distinct precursors inside edible living plants. As an example, mesalazine, an anti-inflammatory drug, is encapsulated in the frameworks for colitis treatment. The cell activity and feeding experiments of zebrafish and mice demonstrate the excellent efficacy of this SAF-FGDD. Compared with those of the control groups, the disease activity index scores and histological scores of the SAF-FGDD group were significantly decreased by 80% and 98%, respectively. The improved performance is attributed to the biocompatibility and protective effect of SAF-FGDD, allowing for abundant mesalazine to be released and act at the site of the intestine during the process of food digestion. In combination with mature soilless cultivation technology, plant-based organisms with natural structure-forming abilities possess broad commercial prospects in large-scale production of various food-grade functional materials.

Susceptibility to COVID-19 Nutrition Misinformation and Eating Behavior Change during Lockdowns: An International Web-Based Survey

To understand the susceptibility to nutrition-health misinformation related to preventing, treating, or mitigating the risk of COVID-19 during the initial lockdowns around the world, the present international web-based survey study (15 April-15 May 2020) gauged participants' (n = 3707) level of nutrition-health misinformation discernment by presenting them with 25 statements (including unfounded or unproven claims circulated at the time), alongside the influence of information sources of varying quality on the frequency of changes in their eating behavior and the extent of misinformation held, depending on the source used for such changes. Results revealed widespread misinformation about food, eating, and health practices related to COVID-19, with the 25 statements put to participants receiving up to 43% misinformed answers (e.g., 'It is safe to eat fruits and vegetables that have been washed with soap or diluted bleach'). Whereas higher quality information sources (nutrition scientists, nutrition professionals) had the biggest influence on eating behavior change, we found greater misinformation susceptibility when relying on poor quality sources for changing diet. Appropriate discernment of misinformation was weakest amongst participants who more frequently changed their eating behavior because of information from poor quality sources, suggesting disparities in the health risks/safety of the changes performed.

The impact of the COVID-19 pandemic on cardiovascular disease prevention and management

How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.

Inpatient care cost, duration, and acute complications associated with BMI in children and adults hospitalized for COVID-19

OBJECTIVE

This study aimed to assess the association of BMI with inpatient care cost, duration, and acute complications among patients hospitalized for COVID-19 at 273 US hospitals.

METHODS

Children (aged 2-17 years) and adults (aged ≥18 years) hospitalized for COVID-19 during March 2020-July 2021 and with measured BMI in a large electronic administrative health care database were included. Generalized linear models were used to assess the association of BMI categories with the cost and duration of inpatient care.

RESULTS

Among 108,986 adults and 409 children hospitalized for COVID-19, obesity prevalence was 53.4% and 45.0%, respectively. Among adults, overweight and obesity were associated with higher cost of care, and obesity was associated with longer hospital stays. Children with severe obesity had higher cost of care but not significantly longer hospital stays, compared with those with healthy weight. Children with severe obesity were 3.7 times (95% CI: 1.4-9.5) as likely to have invasive mechanical ventilation and 62% more likely to have an acute complication (95% CI: 39%-90%), compared with children with healthy weight.

CONCLUSIONS

These findings show that patients with a high BMI experience significant health care burden during inpatient COVID-19 care.

Weight gain among US adults during the COVID-19 pandemic through May 2021

OBJECTIVE

There have been conflicting reports concerning weight gain among adults during the COVID-19 epidemic. Although early studies reported large weight increases, several of these analyses were based on convenience samples or self-reported information. The objective of the current study is to examine the pandemic-related weight increase associated with the pandemic through May 2021.

METHODS

A total of 4.25 million adults (18 to 84 years) in an electronic health record database who had at least two weight measurements between January 2019 and February 2020 and one after June 2020 were selected. Weight changes before and after March 2020 were contrasted using mixed-effects regression models.

RESULTS

Compared with the pre-pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m² , and younger adults.

CONCLUSIONS

The results indicate that the mean weight gain among adults during the COVID-19 pandemic may be small.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Consumer Attitudes as Part of Lifestyle in the COVID-19 Emergency

The pandemic brought significant changes to the functioning of society. This article examines the opinion of consumers in south-eastern Poland on lifestyle elements such as shopping preferences, physical activity, holiday preferences and others, against the background of the COVID-19 situation. The aim of this study was to identify the relationship between selected components included in the lifestyle of society in the context of the COVID-19 emergency situation. The research was conducted from 9 November 2020 to 17 January 2021. In order to identify the respondents’ attitudes and their perception of the issues discussed in this study, a questionnaire was created containing a number of theses formulations assessed by the respondents in terms of compliance with their beliefs. The evaluation was carried out using a seven-point bipolar Likert scale with a neutral value. The study was not probabilistic, therefore the inference applies only to the studied group. A total of 737 questionnaires meeting the research assumptions were collected. The form was used to identify ecological attitudes, shopping behavior, food preferences, physical activity and tourist preferences in the COVID-19 situation in which the research was conducted. Also identified were holiday destinations in 2019 and 2020, preferred diet type, and socio-demographic background: sex, age, place of residence and approximate per capita income. The research revealed that the purchasing behavior of the respondents was a predictor of their physical activity and tourist preferences. Studies have also shown that the food preferences of the respondents are an important part of their balanced lifestyle and depend on the sex of the person. The respondents preferred an active lifestyle as a form of pro-health activity when living in the situation of COVID-19. During the COVID-19 pandemic, respondents’ interest in domestic tourism also increased.