Eating habits of children and adolescents during the COVID-19 era: A systematic review

Factors shaping adolescent snack choices in urban Bangladeshi schools: a mixed methods study

Research on adolescents' snack choices in school food environments has predominantly focused on high-income countries, leaving gaps in low- and middle-income contexts. This study addresses these gaps by examining snack choices and their individual, social and environmental influencing factors among adolescents in 20 urban high schools in Bangladesh using a mixed-methods approach guided by a conceptual model informed social cognitive theory (SCT) and an ecological perspective. Quantitative data were collected through surveys with 975 adolescents (ages 11-17), while qualitative data included focus group discussions with 60 adolescents. Adolescents frequently purchased energy-dense, non-nutritious snacks during school breaks, spending 10-20 Bangladeshi Taka (0.1-0.2 USD) daily. Individual factors such as taste were not widely prioritised in the quantitative survey but emerged as a central influence in the qualitative FGDs, often overriding health or hygiene considerations. While health considerations were frequently reported across both data sources, adolescents typically defined healthy food in terms of safety from contamination and chemical adulteration, rather than nutritional content. Many viewed home-cooked meals as compensating for less healthy snacks. Social peer influences were perceived as secondary in the survey data, yet qualitative findings revealed that peers exerted a significant influence through shared routines, group preferences, and subtle conformity. Environmental factors, including cost, availability, and hygiene, were cited less frequently in the survey but featured prominently in the FGDs. Adolescents often selected snacks based on affordability, accessibility, and perceived cleanliness, highlighting the influence of the school food environment on their choices. Interventions should generate demand for nutritious snacks, address food safety concerns, challenge compensatory health beliefs, and consider adolescents' psycho-emotional stressors. Policies must reshape school food environments to ensure safe, affordable, and nutritious snacks.

Impact of Covid-19 on children and adolescents with type 1 diabetes: lifestyle, telecommunication service, and quality of life

OBJECTIVES

The COVID-19 pandemic brought about major changes, such as lifestyle changes, modification in telecommunication, as well as increased mental and psychological burden. This has raised concerns regarding its impact on the quality of life of children and adolescents with type 1 diabetes. To detect the impact of COVID-19 pandemic on children and adolescents with type 1 diabetes in terms of lifestyle changes and telecommunication service using a predesigned questionnaire, as well as quality of life using the Pediatric Quality of Life Inventory (PedsQL).

METHODS

A cross-sectional study including 286 participants with type 1 diabetes at the Pediatrics and Adolescent Diabetes Unit was conducted from March to August 2022. A predesigned questionnaire was used to collect data about lifestyle, telecommunication service, and quality of life using PedsQL.

RESULTS

Results show that most of the participants (62.2 %) food consumption increased during the lockdown period. Moreover, results also reveal that 79.7 % of the participants were informed about the telecommunication service, 93.4 % of them actually used it, and 88.6 % thought it was simple. As regards the quality of life, there was a statistically significant difference in PedsQL total score between the younger and older groups, with a p-value=0.009 indicating a better quality of life in the older group.

CONCLUSIONS

The COVID-19 pandemic influenced the lifestyle of children and adolescents with type 1 diabetes. Their food consumption increased, the telemedicine service was easy to use and appealed to the majority, and the quality of life of older participants was better.

Changes in health behaviour of medical students during and after the COVID-19 pandemic-focus on physical activity, screen time, sleep duration, unhealthy foods, alcohol, and tobacco

Introduction

The COVID-19 pandemic and the preventive measures led to a change in the health behaviour among the population. Medical students were particularly affected by this. Previous studies primarily focused on few health behaviours, were mostly conducted in 2020-2021, and did not assess the persistence of these behaviours post-pandemic.

Methods

A combined cross-sectional and longitudinal approach were applied to examine changes in physical activity, screen time, sleep duration and consumption of unhealthy foods, alcohol and of tobacco. Data from Medical Students at the Technical University of Dresden were collected online as part of the multicenter study "Medical Student Health Survey" in 2020 and 2022. Descriptive and inferential statistical methods were applied.

Results

Medical students (N = 575) reported reduced physical activity and increased screen time due to the COVID-19 pandemic, citing lockdown and changed habits as main reasons. Longitudinal analysis of medical students (N = 66) between 2020 and 2022 revealed increased physical activity (p = 0.018) and decreased unhealthy food consumption (p = 0.009) after the end of the pandemic. Screen time, sleep duration and consumption of alcohol and of tobacco products remained unchanged. Changes in health behaviours were not intercorrelated.

Discussion

The COVID-19 pandemic led to change in health behaviour of medical students. However, intra-pandemic changes differing from pre-post pandemic changes and interindividual variations in health behaviour change were found. The rise in physical activity, the decreased consumption of unhealthy foods, and the low tobacco use reflect a health-aware cohort. The findings should inform the development of future preventive measures and further research is needed to understand the sustainability and broader impact of these health behaviour changes.

The impact of the COVID-19 pandemic on dietary behaviors among school-age children, adolescents, and young adults: a systematic review and meta-analysis

CONTEXT

The COVID-19 pandemic has had a global impact on food security and nutrition, both in the short and long term. The influence on school-age children, adolescents, and young adults may be particularly significant and long-lasting.

OBJECTIVE

This systematic review and meta-analysis aimed to quantify the impact of the COVID-19 pandemic on dietary habits among school-age children, adolescents, and young adults worldwide.

DATA SOURCES

PubMed, Web of Science, and Embase were searched from inception to October 5, 2023.

DATA EXTRACTION

We included observational studies published in English that reported dietary quality scores and dietary intake quantities during and before the COVID-19 pandemic among school-age children, adolescents, and young adults. We included a total of 22 cohort studies and 20 cross-sectional studies of high or moderate quality.

DATA ANALYSIS

We conducted a meta-analysis, expressing dietary quality scores and dietary intake quantities as standardized mean differences (SMD) with 95% confidence intervals (CIs). For studies with low heterogeneity, we used a fixed-effects model; otherwise, we applied a random-effects model. The Newcastle-Ottawa Scale was employed by 2 reviewers independently to evaluate methodological quality. The analysis indicated that, overall, juice intake increased (SMD = 0.12, 95% CI: 0.04 to 0.20), while alcohol consumption reduced during the COVID-19 pandemic (SMD = -0.28, 95% CI: -0.47 to -0.08). However, the age-stratified results varied. Among school-age children, intake of fruit, dairy products, sugar, and juice increased. Adolescents showed an increase in meal frequency and vegetable intake. Young adults showed reduced carbohydrate and alcohol intakes, while protein and dairy product intakes increased, based on limited included studies.

CONCLUSION

Dietary changes in school-age children from before to during the pandemic were mixed, while dietary behavior changes in adolescents and young adults tended to be more positive. Considering the lasting effects of negative dietary behaviors, attention should be given to addressing the increased sugar and juice intakes. It is also crucial that caregivers and researchers monitor whether positive dietary behaviors will rebound after returning to normal study and life.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023420923.

The Mediating Effect of Concurrent Changes in Dietary Behaviors on the Associations Between Intervention and Changes in Adiposity Outcomes: Evidence from a Cluster-Randomized Controlled Trial

Behavioral interventions have been shown to be effective in improving dietary behavior and reducing childhood obesity. There is limited evidence on how concurrent changes in dietary behavior from intervention studies affect childhood obesity. The present study aimed to evaluate the mediating effect of concurrent changes in dietary behaviors between the intervention and changes in adiposity indicators. This study included 1180 children from the DECIDE-Children study, which was conducted across three areas in China, aiming to promote children's healthy diet and physical activity, while also engaging schools and families to support children's behavioral changes. Dietary behaviors were collected by a revised version of the Food Frequency Questionnaire and a self-designed questionnaire. Adiposity outcomes were objectively measured by trained personnel. Generalized linear mixed models were used to estimate the association between scores of dietary behavioral changes and adiposity indicator changes. Mediation analyses were used to evaluate how scores of dietary behavioral changes mediated the effect of intervention on adiposity indicator changes. Six hundred children in the intervention group and five hundred and eight in the control group with both baseline and follow-up data were included. Each increase in dietary behavioral change score was associated with a 0.06 (p = 0.016) decrease in changes in BMI and other adiposity indicators. Scores of dietary behavioral changes mediated 13.87% (p < 0.001), 11.81% (p < 0.001), 17.60% (p = 0.024), and 16.78% (p = 0.032) of the association between intervention and changes in body mass index (BMI), BMI z-score, body fat percentage, and waist circumference, respectively. Scores of dietary behavioral changes mediated the intervention effect on adiposity indicator changes. Future interventions targeting childhood obesity should incorporate promoting multiple dietary behaviors simultaneously.

Stress, physical activity, and mindfulness practices among youth amidst COVID-19

Introduction

The COVID-19 pandemic has exacerbated stress and anxiety among young people, particularly university students, impacting their mental well-being and daily life. Given the rise in social isolation and economic uncertainty, the adoption of mindfulness practices such as sophrology, meditation, and yoga becomes essential for improving their mental health. This study aims to evaluate the impact of these practices on stress levels and their effect on engagement in physical activities among youths.

Method

This study employed a mixed methods design to assess the impact of different wellness and mindfulness practices on stress levels and physical activity (PA) engagement among university students. Quantitative data were gathered electronically from 218 students at the University of Rouen and the university of Paris-Cité through validated questionnaires, including custom tools on sports and mindfulness practices and the Perceived Stress Scale (PSS). The sample consisted mainly of young adults aged 18 to 35, with a majority of 170 female and 48 male participants. Qualitative insights were gathered through semi-structured interviews with three directors of the university's sports and physical activities department (SUAPS), as well as four wellness program instructors. Data analysis involved statistical techniques using Statistical Analysis System (SAS) software for quantitative data, while qualitative data were analyzed thematically using Sphinx software, a tool for textual analysis. Ethical approval for the study was obtained, and confidentiality of all participants was maintained throughout the research.

Results and conclusion

The COVID-19 pandemic had significant effects on French university students' PA, mental health, and stress levels. Lockdowns led to a decline in sports practices for many, while others adapted by increasing their engagement in fitness and wellness practices. The majority of participants (64.68%) reported moderate levels of stress. A significant correlation was found between motivations for mental health support and stress management, and higher levels of stress (p = 0.0000 and p = 0.0024, respectively). Regular participation in wellness activities was associated with lower stress (p = 0.0193). The findings reinforce the idea that incorporating wellness practices into educational environments can strengthen students' mental resilience and overall well-being, equipping them with essential tools to effectively cope with future stressors.

Modelling the cost differential between current and healthy diets according to household education level in Belgium

This study aims to estimate the cost differential between current and healthy diets, overall and by household education level. Data from the 2014-2015 Belgian National Food Consumption Survey and food prices from the 2014 GfK ConsumerScan panel were linked. The DIETCOST programme was used to model healthy, isocaloric healthy and current diets. For the reference household, the average daily diet cost was 20.1€ (95%CI: 19.9-20.4) for current diets, 20.9€ (95%CI: 20.6-21.2) for healthy isocaloric diets (+3.9% vs. the current diets) and 22.5€ (95%CI: 22.3-22.8) for healthy diets (+12.0%). In low-educated households, the cost of current and of healthy isocaloric diets was similar (19.2€ (95%CI: 19.0-19.5) vs. 19.3€ (95%CI: 19.0-19.6)), whereas in high-educated households, the cost of healthy isocaloric diets (22.0€; 95%CI: 21.8-22.3) was higher than the cost of current diets (21.2€; 95%CI: 20.9-21.4)). Though needing validation, this finding is valuable for interventions aimed at improving dietary habits in disadvantaged populations.

Changes in unhealthy food consumption among vulnerable elementary-aged children in the United States during the COVID-19 pandemic: a serial cross-sectional analysis

Objective

Several studies suggest that during the early pandemic, amidst socioeconomic instability, children from underserved families were more likely to resort to consuming cheaper, lower-quality foods with longer shelf lives. This study investigated the change in unhealthy food consumption across different phases (pre, early, mid) of the COVID-19 pandemic, and whether the strength of association between unhealthy food consumption and household socioeconomic disadvantage (HSED) varied across phases of the pandemic.

Methods

This study utilized serial cross-sectional data collected from low-income families enrolled in a school-based food co-op, Brighter Bites. Secondary data analysis included 5,384 surveys from families who had complete data: 3422 pre-pandemic, 944 from the early pandemic, and 1,018 mid-pandemic. Outcome measures included sugary food intake and convenience/fast food intake, each of which was operationalized as a scale using pre-validated items from the surveys. HSED was operationalized as a composite of parent employment, parent education, food insecurity, and participation in government programs; responses were categorized into low, medium, and high HSED groups for analysis. We examined the interaction between HSED and time period to explore how HSED and its association with dietary measures changed over the course of the pandemic.

Results

A significant linear negative trend, i.e., a decrease in consumption from pre-to-mid-pandemic period was seen in sugary food intake (p < 0.001), but not in convenience food intake. In data pooled across time-periods, both sugary food and convenience/fast food consumption were inversely associated with HSED, and low unhealthy food consumption was observed among high-disadvantage groups. No significant interaction between time period and HSED was observed on either scale. However, the post-regression estimates from the adjusted interaction model showed a significant association between convenience/fast food consumption and HSED in pre- and mid-pandemic periods.

Conclusion

The study highlights the nuances of socioeconomic dynamics on the diet behaviors of children from low-income families during a natural disaster.

COVID-19 lockdown effects on adolescent brain structure suggest accelerated maturation that is more pronounced in females than in males

Adolescence is a period of substantial social-emotional development, accompanied by dramatic changes to brain structure and function. Social isolation due to lockdowns that were imposed because of the COVID-19 pandemic had a detrimental impact on adolescent mental health, with the mental health of females more affected than males. We assessed the impact of the COVID-19 pandemic lockdowns on adolescent brain structure with a focus on sex differences. We collected MRI structural data longitudinally from adolescents prior to and after the pandemic lockdowns. The pre-COVID data were used to create a normative model of cortical thickness change with age during typical adolescent development. Cortical thickness values in the post-COVID data were compared to this normative model. The analysis revealed accelerated cortical thinning in the post-COVID brain, which was more widespread throughout the brain and greater in magnitude in females than in males. When measured in terms of equivalent years of development, the mean acceleration was found to be 4.2 y in females and 1.4 y in males. Accelerated brain maturation as a result of chronic stress or adversity during development has been well documented. These findings suggest that the lifestyle disruptions associated with the COVID-19 pandemic lockdowns caused changes in brain biology and had a more severe impact on the female than the male brain.

How Distressed Are Adolescent Students? A Mix-Method Study on High School Students in Northern Italy, Two Years after the Beginning of the COVID-19 Pandemic

Adolescence is a central phase for the development of a person's identity, involving complex multidimensional changes and increasing vulnerability to distress. This study aimed to investigate the psychological well-being of adolescent students in Brescia (Northern Italy), two years after the beginning of the COVID-19 pandemic. An online survey investigated the extent and the reasons reported by high school students (13-21 years) for their emotional distress (ED), also considering other factors such as physical activity, nutrition, sleep and smartphone overuse. The main reasons for ED were classified through a qualitative analysis of the free-text answers. A total of 1686 students agreed to participate, and 50% showed a presence of ED. According to a multiple logistic analysis, adolescents were more at risk of ED if they were female (AdjOR 2.3), older (AdjOR 1.6), slept less than 8 h (AdjOR 1.5), perceived increased anxiety (AdjOR 3.4), and adopted certain eating behaviors, e.g., comfort food consumption (AdjOR 2.0). According to free-text answers, the main reasons for ED were "school pressure", "relationships with family and peers", "negative emotional states" and "the pandemic". The results show a high level of ED among adolescents, and the reported reasons may help to better address their psychological needs after the pandemic.

Food Neophobia in Children: A Case Study in Federal District/Brazil

A reluctance to eat and/or avoidance of novel foods is characterized as food neophobia (FN). FN restricts the diet to familiar foods when, in fact, it should be much more varied. FN can be a barrier to healthy foods, affecting the quality of diet, and impairing children's growth and development. Therefore, according to their caregivers' perceptions, this study aimed to evaluate FN in children from Federal District/Brazil. The Brazilian Children's Food Neophobia Questionnaire (BCFNeo), a specific instrument developed and validated in Brazil, was answered by caregivers of children aged 4 to 11 y/o. Sampling occurred through snowball recruitment, being convenient and non-probabilistic. The Health Sciences Ethics Committee approved the study. The analysis evaluated FN in total (BCFNeoTot) and in the following domains: general (FNgen), for fruits (FNfru), and for vegetables (FNveg). FN scores were compared between sex and child's age and categorized according to three ordinal levels. FN levels were compared using the Mann-Whitney U test. The Friedman test, followed by the Wilcoxon test with Bonferroni correction, was performed to analyze differences in FN according to the environment. Of the caregivers' answers for their children, 595 answers were included, because 19 were out of age. The prevalence of high FN was 42.9%. The domain with the highest prevalence of high FN was vegetables (48.6%). Children aged 8 to 11 y/o had a higher mean FN in two domains (FNgen p = 0.047 and FNveg p = 0.038) when compared to children aged 4 to 7 y/o. Boys were more neophobic in all domains (FNgen p = 0.017; FNfru p = 0.010; FNveg p = 0.013; BCFNeoTot p = 0.008), and FN tends not to decrease with age. The results showed that the children of the FD are more neophobic than Brazilian children in general, highlighting the importance of additional studies in FN determinants in this population and nutritional education interventions to reduce FN among FD children.

Family Dynamics, Socioeconomic Hardships, and Health Risk Behaviours of Bulgarian Adolescents during the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

This study aims to explore family dynamics and the economic hardships experienced by families during the COVID-19 pandemic and their associations with adolescents' health risk behaviours (HRBs).

METHODS

Based on a representative study of adolescents aged 11-16 conducted in Bulgaria during the COVID-19 pandemic and HBSC data from the pre-pandemic period, logistic regression models were applied, assessing cigarette smoking, vaping, alcohol use, drunkenness, and cannabis use. The independent variables included demographics, Family Affluence Scale (FAS III), family structure, ease of communication with parents, and the authors' developed questions on parents' income and economic status change, family conflicts, and missing contact with extended family due to the pandemic.

RESULTS

Material status of the family showed increasing differentials in adolescents' HRBs during the pandemic. Parental unemployment, income reduction, and temporary lay-offs were associated with a higher risk of substance use. Family conflicts, missing contact with extended family, and difficulties in communication with the mother were related to a higher risk of substance use. Communication with the father was significantly associated with alcohol use and drunkenness. Boys had lower odds of vaping and higher odds of alcohol use, drunkenness, and cannabis use. Higher age and minority status were associated with an increase in adolescents' HRBs.

CONCLUSIONS

This study highlights the need for special family-focused interventions in times of health and economic crises.

Parental Neglect and Childhood Obesity Amidst COVID-19: A Developmental Psychopathology Perspective on Health and Developmental Risks

The COVID-19 pandemic has profoundly impacted the mental health and developmental trajectories of children and adolescents, catalyzing a range of psychological and behavioral issues due to enforced lockdowns and other restrictions. This text explores these impacts through the lens of developmental psychopathology, which integrates clinical psychology and developmental science to examine the emergence and evolution of psychological disorders across a lifespan. This paper highlights how pandemic-related disruptions have exacerbated conditions such as anxiety and depression and, notably, increased childhood obesity due to changes in lifestyle and reductions in physical activity. The analysis includes a discussion of how isolation has not only restricted access to educational and psychological resources but also increased the risk of parental mental illness and related familial stress, thereby intensifying issues of neglect and their consequent impact on child health. By employing a developmental psychopathology framework, this paper argues for the necessity of targeted interventions that address these complex interplays of genetic, environmental, and psychological factors. Such interventions aim to support children through structured educational and health-oriented strategies, ensuring their well-being amidst the ongoing challenges posed by the pandemic. This approach underscores the importance of early, multifaceted strategies involving parents, educators, and healthcare providers to foster healthier developmental outcomes for children facing unprecedented global health crises.

Pragmatic Adaptations to Kids SIPsmartER's Implementation Protocol Supported Its Delivery During the COVID-19 Pandemic

OBJECTIVE

Describe the adaptation, implementation, and perceptions of Kids SIPsmartER's classroom component during the coronavirus disease-impacted 2020-2021 school year.

DESIGN

Mixed methods process evaluation.

SETTING

Seven rural Appalachian middle schools (US).

PARTICIPANTS

Middle-school teachers (n = 14) and principals (n = 6).

INTERVENTION

Kids SIPsmartER was a multilevel, school-based intervention designed to decrease sugar-sweetened beverage intake. The 12-lesson classroom component was supported by an implementation protocol.

MEASURES

Implementation protocol adaptations, program perceptions, and the school context were assessed using teacher and principal interviews, teacher-completed fidelity checklists, and researcher-maintained field notes. Adaptations were mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME).

ANALYSIS

Qualitative data were content coded. Quantitative data were summarized using descriptive statistics.

RESULTS

All schools maintained Kids SIPsmartER and delivered 100% of lessons. Ten adaptations were made to the implementation protocol. Schools used adapted delivery approaches to meet individual needs. Teachers and principals identified more benefits than barriers to implementing the program.

CONCLUSIONS AND IMPLICATIONS

Using a strategically adapted implementation protocol that was flexible to schools' individual needs allowed all middle schools to deliver Kids SIPsmartER during the 2020-2021 school year. Findings identify adaptation considerations that other school-based evidence-based interventions could incorporate to facilitate delivery during high-stress times.

Associated Factors of Dietary Patterns among Adolescents in the Rural Northern Region of Thailand: A Community-Based Cross-Sectional Study

This cross-sectional study aims to explore the dietary patterns and associated factors of adolescents, which are often overlooked in nutrition data systems. Face-to-face interviews were conducted with 304 participants aged 10 to 19 in rural northern Thailand, utilizing both open recall and list-based 24 h recall techniques, with the data recorded online. Dietary diversity (DD) was assessed using ten food groups as per the Food and Agricultural Organization guidelines. We employed binary logistic regression and multivariable logistic regression analyses. Most participants consumed items from the grains, white roots, and tubers food group, while the nuts, seeds, and pulses food group was the least consumed. The mean number of food groups consumed was 5.23 ± 0.12, with no significant differences across gender and age groups, and participants reporting no influence of mass media on food choices were more likely to have inadequate DD (AOR = 2.94; 95% CI 1.38-6.28). Conversely, those not influenced by social media when choosing food (AOR = 0.45; 95% CI 0.21-0.96), who felt relaxed during meals (AOR = 0.33; 95% CI 0.19-0.59), and with no role in family meal decisions (AOR = 0.55; 95% CI 0.31-0.95) were less likely to have inadequate dietary diversity. We suggest that assisting adolescents with mealtime management and involving them in selecting healthy menus could improve their dietary variety. Moreover, future research should further investigate these mechanisms to inform strategies for improving DD in this age group.

The Relationship Between Fast Food Consumption and Daily Lifestyle Changes During School Closures Following the COVID-19 Pandemic: A Cross-Sectional Study Among Adolescents in Korea

OBJECTIVE

Increased fast food consumption can have adverse effects on health and well-being among adolescents, posing a significant public health concern. The school closures due to the coronavirus disease-2019 (COVID-19) pandemic have led to changes in eating patterns and disrupted a balance diet among adolescents. This study explored the factors associated with fast food consumption among adolescents during school closures due to the COVID-19 pandemic.

METHODS

A total of 1,710 middle and high school students in Gwangju, South Korea participated in a cross-sectional survey. The self-administered questionnaire included items assessing dietary intake, physical activity, sleep, media use, and sociodemographic information. The Patient Health Questonnaire-9, Generalized Anxiety Disorder-7, and three item version of the UCLA Loneliness Scale were also administered. Multivariable logistic regression was used to examine the factors associated with increased fast food consumption.

RESULTS

Approximately 34.6% of the surveyed adolescents reported increased fast food consumption during school closures, as well as increased sleep duration, increased sedentary behaviors including watching TV and using the internet, and reduced physical activity. Multivariable logistic regression analysis revealed that fast food consumption during school closures was associated with irregular patterns of main meals and sleep, decreased physical activity, increased internet use, and a lack of daytime adult supervision.

CONCLUSION

Our results highlight the need for dietary and lifestyle monitoring and guidelines to promote health among adolescents, especially during school closures. In conclusion, nutrition intervention programs aiming to limit fast food consumption and enhance healthy dietary habits among adolescents during long-term school closures are warranted.

Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has taken the lives of millions and disrupted countless more worldwide. Simply living through the pandemic has had drastic effects on the health of citizens. Diet, an important aspect of health, has been uniquely affected by the pandemic, although these changes have not been sufficiently studied among youth.

OBJECTIVES

The objective of this systematic review was to investigate dietary changes of youth during COVID-19.

METHODS

A prespecified literature review was conducted using MEDLINE, EMBASE, Scopus, and CINAHL to identify studies from January 2020 to May 2023 that assessed dietary changes among youth aged ≤20 y compared with before the pandemic. Only quantitative observational studies that were published in English were included. Two authors completed all screening/study selection independently, with disagreements being resolved via discussion. Data extraction was completed by 1 author. Dietary changes were categorized into food groups and habits for analysis purposes.

RESULTS

In total, 67 studies met inclusion criteria. Most studies used recall to assess changes (48/67; 71.6%). Most studies found an increase in fruits and vegetables (24/46; 52.2%), grain products (6/11; 54.5%), meat, poultry, and eggs (4/8, 50.0%), diet quality indices and/or overall dietary assessments (7/13, 53.8%), and the frequency of snacking (9/12; 75.0%), whereas generally finding a decrease in ultraprocessed foods (32/53; 60.4%), compared with before the COVID-19 pandemic. Mixed findings or primarily no changes were found for fish and aquatic products, legumes, beans, seeds and nuts, milk and milk products, breakfast consumption, and nutrient intake.

CONCLUSIONS

Mostly favorable dietary changes appear to have occurred among youth during COVID-19, although there were several mixed findings and unclear takeaways among the foods and habits under study. The heterogeneity of defining food groups was a noted limitation in the current review.

Factors Influencing the Subjective Health and Physical Fitness Perceptions of Korean Adolescents

Background

Adolescence is an important period of growth and development. We aimed to analyz the factors affecting the subjective health and physical fitness perceptions of Korean adolescents.

Methods

This cross-sectional study used data from 2,599 Korean adolescents who participated in the Korea National Life and Sports Surveys during 2020-2022, along with secondary data analysis. The study included frequency analysis of the demographic variables and chi-square tests to examine the relationship between the variables and subjective health and fitness perceptions. Multivariate logistic regression was also used to explore the factors affecting adolescent subjective perceptions.

Results

The study revealed significant factors influencing health perceptions in Korean adolescents, including male gender, lack of regular physical activity, adequate rest, adherence to a consistent diet, and use of nutritional supplements (P<0.05).

Conclusion

Key factors, such as rest, diet, and nutritional supplements should be considered while developing policies that support adolescent health. Unfortunately, there has been a decline in the physical activity of adolescents in Korea. Therefore, a variety of physical activity programs that consider the characteristics of each student need to be developed to address adolescent health issues.

Impact and process evaluation of a primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: pragmatic cluster non-randomized controlled trial

BACKGROUND

Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge.

METHODS

FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation.

RESULTS

Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns.

CONCLUSIONS

This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: [ACTRN12620001347954]- Registered prospectively on 14/12/2020.

Impact of COVID-19 Lockdown on Metabolic/Inflammatory Profile in Adolescents: Cellular Studies and Predictive Biomarkers

CONTEXT

The COVID-19 pandemic and its lockdown restrictions changed people's lifestyles with potential negative impact on health.

OBJECTIVE

This longitudinal study aimed to assess the COVID-19 lockdown influence on the adherence to the Mediterranean diet (MD) pattern and its effects on the metabolic inflammatory profile in a cohort of healthy adolescents.

METHODS

We analyzed anthropometric measurements, body composition, and MD adherence along with serum metabolic and inflammatory profile in 77 healthy adolescents from southern Italy before and after the COVID-19 pandemic lockdown. Additionally, we evaluated the biological properties of prelockdown and postlockdown serum on human HepG2 and HuH-7 hepatic cells.

RESULTS

We did not observe any significant differences in anthropometric and body composition parameters as well as MD adherence score in adolescents between prelockdown and postlockdown COVID-19. Intriguingly, although the metabolic profile of adolescents postlockdown was within the normal range, we evidenced increased levels of fasting glucose, triglycerides, total cholesterol, and low-density lipoprotein (LDL) along with a reduction in high-density lipoprotein (HDL) in postlockdown compared with prelockdown adolescent serum. In addition, elevated levels of tumor necrosis factor (TNF)-α, interleukin-1β, and ferritin were found in postlockdown adolescents compared with their prelockdown counterparts. Consistent with the biochemical parameters, we observed enhanced lipid accumulation with altered mitochondrial functions and increased reactive oxygen species production in HepG2 and HuH-7 cells treated with pooled serum from postlockdown with respect to prelockdown period. Receiver operator characteristic curve analysis identified total cholesterol, LDL, HDL, TNF-α, and ferritin to be predictive serum markers for metabolic and inflammatory profiling after the lockdown period.

CONCLUSION

Our findings highlight that the COVID-19 lockdown, forcing sedentary behavior, had a negative impact on adolescents' metabolic and inflammatory profile which may result in long-term poor health outcomes.

Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity

BACKGROUND

To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents.

METHODS

Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour.

RESULTS

Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020-2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected.

CONCLUSIONS

Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population.

TRIAL REGISTRATION

Not a trial.

Healthism online: 'What I eat in a day' vlogs before and during COVID-19 restrictions

Objective and setting

The COVID-19 pandemic and its restrictions coincide with an increase in body weight and changes in health-related habits worldwide. This study focusses on the way health-related habits are portrayed online in digital food cultures. The study aims to investigate if and how the content of high-profile Dutch 'What I eat in a day' vlogs has changed during the first period of COVID-19 restrictions. We approach changes in digital food culture through the concept of 'healthism' and see vloggers as cultural intermediaries.

Design and participants

We collected the most watched vlogs of almost all high-profile Dutch influencers pre-post corona and analyzed these in a mixed method approach by using summative and thematic content analysis.

Results

Pre-COVID vlogs highlight an explicit consciousness of energy balance-related behavior, focusing on calorie counting, avoidance of unhealthy food and the use of tracking apps. In vlogs uploaded in 2020, these themes are less present. Instead, intuitive eating and listening to one's body are more central themes within the vlogs.

Conclusions

We consider the shift towards intuitive eating as another variant of "wellness diets" rather than a shift away from dieting, furthered by COVID-19 restrictions. The core values of health and self-regulation are upheld within the shift towards intuitive eating. Yet, we nuance the broad claims of healthism in biopolitics and point to relevant cultural changes within foodscapes.

The Impact of Chronic Stress Related to COVID-19 on Eating Behaviors and the Risk of Obesity in Children and Adolescents

During the COVID-19 pandemic, an increase in the incidence of overweight and obesity in children was observed. It appears that unhealthy food choices, an unbalanced diet, and a sedentary lifestyle, as well as experiencing stress related to the pandemic, may be contributing to this disturbing trend. Chronic stress is a significant factor contributing to eating disorders and obesity in youngsters, involving medical, molecular, and psychological elements. Individuals under chronic stress often focus on appearance and weight, leading to negative body image and disrupted relationships with food, resulting in unhealthy eating behaviors. Chronic stress also impacts hormonal balance, reducing the satiety hormone leptin and elevating the appetite-stimulating hormone ghrelin, fostering increased hunger and uncontrolled snacking. Two systems, the hypothalamic-pituitary-adrenal axis and the sympathetic system with the adrenal medulla, are activated in response to stress, causing impaired secretion of noradrenaline and cortisol. Stress-related obesity mechanisms encompass oxidative stress, neuroinflammation, insulin resistance, and neurohormonal and neurotransmission disorders. Stress induces insulin resistance, elevating obesity risk by disrupting blood sugar regulation and fat storage. Stress also affects the gut microbiome, potentially influencing chronic inflammation and metabolic processes linked to obesity. In conclusion, chronic stress is a multifaceted risk factor for eating disorders and obesity in children, necessitating a comprehensive understanding of effective preventive and intervention strategies amid the escalating prevalence of childhood overweight and obesity.

Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Żywienie (JEŻ)

Increasing students' nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7-12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland.

Analysis of Determinants of Food Preferences in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study

For the choices of food products, food preferences are crucial, as they influence the intake of nutrients and the resultant quality of diet, but in Poland, no studies of food preferences were conducted during the COVID-19 pandemic on a population of young adolescents. The aim of this study was to analyze the determinants of food preferences in a Polish population-based sample of primary school adolescents as part of the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study focused on a national sample of a population of primary school adolescents who were recruited based on cluster sampling of participants from counties and schools, yielding a sample of 5039 individuals. Their food preferences were assessed using the Food Preference Questionnaire (FPQ), and they were compared in subgroups stratified by (1) gender: male and female; (2) age: younger (10-13 years) and older (14-16 years); (3) place of residence: urban and rural; (4) Body Mass Index (BMI): underweight, normal body weight, and overweight/obese (assessed based on Polish growth reference values); and (5) physical activity level: low and moderate (assessed using the International Physical Activity Questionnaire for children aged 10-13 (IPAQ-C) and adolescents aged 14-16 (IPAQ-A)). In the population of adolescents, no statistically significant differences in food preferences between subgroups stratified by gender were observed (p > 0.05). For boys, none of the studied factors (age, place of residence, BMI, physical activity level) was statistically significant determinant of food preferences (p < 0.05), while for girls, all of them were statistically significant determinants (p > 0.05). All the assessed factors (age, place of residence, BMI, physical activity level) in girls were associated with preferences for snacks, and older girls, those from a rural environment, those who were underweight and overweight/obese, as well as those having a low physical activity level declared a higher preference for snacks than younger ones (p = 0.0429), those from an urban environment (p = 0.0484), those of a normal body weight (p = 0.0091), and those having a moderate physical activity level (p = 0.0083). Similarly, girls from rural environments declared a higher preference for starches than those from urban environments (p = 0.0103), and girls having a low physical activity level declared a higher preference for fruit than those having a moderate physical activity level (p = 0.0376). Taking this into account, the population of girls, in particular, needs dedicated educational actions to support proper nutritional habits. Additionally, older age, living in a rural environment, being underweight and overweight/obese, and having a low physical activity level may be indicated as factors predisposing one to food preferences potentially promoting unhealthy dietary habits.

Adolescents' Lifestyle Determinants in Relation to Their Nutritional Status during COVID-19 Pandemic Distance Learning in the North-Western Part of Romania-A Cross-Sectional Study

Several studies have examined how the lockdown restrictions enforced to halt the spread of COVID-19 have affected adults' movement behaviors; however, there is limited information regarding the effects on youth. This study aimed to report on the lifestyle habits of adolescents during COVID-19 pandemic remote learning and explore associations between the participants' bodyweight and lifestyle behaviors. We used a cross-sectional study applied to 285 students studying in the gymnasium. The response rate was 74.21%. They completed an online questionnaire regarding lifestyle, eating habits, and nutritional status (assessed by the Body Mass Index-BMI). The study was conducted in January-February 2021. The percentage of overweight and obese was higher among boys (p = 0.001). The mean sleep duration was 8.12 (SD:1.284) hours per night, and was higher in boys than in girls. The respondents met the physical activity (PA) recommendation for their age, based mainly on unorganized PA. The screen time was 4-6 h or more for the majority of the respondents. Dietary habits included a high consumption of comfort food, like cereals, sweets, soft drinks, snacks, and fried food, but a lower consumption of vegetables and fast food. The regression analyses showed that the BMI was correlated with the BMI of the parents and the number of hours spent in front of the computers in free time. The study identified behavioral and environmental factors that can be modified with effective strategies to reduce overweight and obesity among school students and to promote a healthy lifestyle.

Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations

While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies.

School-based intervention on behavioral intention of adolescents regarding healthy diet in India

Introduction

Adolescence is a distinctive period of life when intense physical, psychological, and cognitive development occurs. A healthy diet helps prevent various forms of malnutrition and non-communicable diseases (NCDs) like diabetes, heart disease, stroke, and cancer. The current study aimed to assess the change in behavioral intentions (measured based on the TPB) toward healthy dietary practices through health promotion intervention among adolescents studying in selected schools in an urban area of West Bengal, India.

Methods

The current study was a non-randomized controlled interventional study conducted among adolescents in either seventh, eighth, ninth, or tenth grades and aged between 12 and 16 years. Two-step cluster analysis with maximum likelihood estimation identified the intenders of a healthy diet. The intervention effect was measured using Relative Risk (RR) for being in the higher intention cluster through Generalized Linear Model (GLM) with a log-linear link under Poisson distribution assumptions and robust standard errors. A P-value of 0.05 or lesser was considered statistically significant.

Results

There was no statistically significant difference in the mean score of "Attitude" in both groups. The mean score of "Subjective Norm" among the intervention group increased after intervention, and the difference was statistically significant. The mean score of "Perceived behavioral control" in the intervention group increased after the intervention, but the difference was statistically not significant. The intervention group's post-intervention proportion of intenders increased, and the difference was statistically significant. The relative risk of becoming an intender for healthy diet consumption in the Intervention group compared to the Control group was 2.07 (1.44-2.97).

Conclusions

The intervention package effectively brought about a positive change in behavioral intention toward healthy dietary practices among adolescents. Model-based and construct-oriented intervention packages can be adopted in school-setting to promote behavioral intention toward a healthy diet.

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.