Changes in Weight and Nutritional Habits in Adults with Obesity during the "Lockdown" Period Caused by the COVID-19 Virus Emergency

Mediterranean Diet and SARS-COV-2 Infection: Is There Any Association? A Proof-of-Concept Study

The aim of this observational study was investigating the possible correlation between adherence to the Mediterranean diet (MeD) and SARS-COV-2 infection rates and severity among healthcare professionals (HCPs). An online self-administrated questionnaire (evaluating both MeD adherence and dietary habits) was filled out by HCPs working in Piedmont (Northern Italy) from 15 January to 28 February 2021. Out of the 1206 questionnaires collected, 900 were considered reliable and analyzed. Individuals who reported the SARS-COV-2 infection (n = 148) showed a significantly lower MeD score, with a lower adherence in fruit, vegetables, cereals, and olive oil consumption. In a logistic regression model, the risk of infection was inversely associated with the MeD score (OR = 0.88; 95% CI 0.81–0.97) and the consumption of cereals (OR = 0.64; 0.45–0.90). Asymptomatic individuals with SARS-COV-2 infection reported a lower intake of saturated fats than symptomatic; individuals requiring hospitalization were significantly older and reported worse dietary habits than both asymptomatic and symptomatic individuals. After combining all symptomatic individuals together, age (OR = 1.05; 1.01–1.09) and saturated fats intake (OR = 1.09; 1.01–1.17) were associated with the infection severity. HCPs who reported a SARS-COV-2 infection showed a significantly lower MeD score and cereal consumption. The infection severity was directly associated with higher age and saturated fat intake.

Impact of the COVID-19 Pandemic on Seasonal Variations in Childhood and Adolescent Growth: Experience of Pediatric Endocrine Clinics

Background: Children experience seasonal variations in growth whereby height increases most in spring and least in autumn, and weight increases least in spring and most in autumn. We hypothesized that activity restriction caused by efforts to contain the spread of coronavirus disease 2019 (COVID-19) would result in increased body mass index (BMI) in children, differing from conventional seasonal growth variations. Methods: We included 169 children who visited endocrine clinics of three hospitals in Korea at regular intervals under the same conditions for two years. Visit dates were D1 (January, 2019), D2 (July, 2019), D3 (January, 2020) before the COVID-19 outbreak, and D4 (July, 2020) during the pandemic. Differences in the z-score for height (HT), weight (WT), and BMI among time points and between spring seasons (i.e., S1–S3) were compared. Results: There were significant differences in BMIz among time points, which decreased from D1–D2 and increased from D2–D3 and D3–D4. WTz significantly increased from D2–D3 and D3–D4. BMIz values of S1 (spring 2019) and S3 (spring 2020) were −0.05 and 0.16, respectively, showing significant differences. WTz values between S1 and S3 were significantly different (−0.02 vs. 0.13). Conclusions: In 2019, there were conventional seasonal variations in BMIz, which declined in spring and increased in autumn, while in 2020, BMIz increased even in spring. The COVID-19 pandemic may have affected seasonal variations in the growth of children attending endocrine clinics.

Poor Eating Habits and Selected Determinants of Food Choice Were Associated With Ultraprocessed Food Consumption in Brazilian Women During the COVID-19 Pandemic

Background: The aim of this study was to investigate possible associations between food consumption and eating habits and food choice determinants in women during COVID-19 pandemic. Methods: This is a cross-sectional survey conducted in Brazil between June and September, 2020, during which time social distancing measures were in place. Results: Participants (n = 629) were aged 34.0 years and mostly within normal weight according to BMI (60.4%). "Snacking" and "liking" associated with increased energy (β = 164.27 and β = 110.24) and carbohydrate intake (β = 1.97 and β = 1.80), and with reduced protein intake (β = -1.54 and β = -1.18). In contrast, "dieting" and "weight control" associated with reduced energy (β = -162.57 and β = -111.49) and carbohydrate intake (β = -2.78 and β = -2.07), and with increased protein intake (β = 3.78 and β = 1.65). "Dieting" (β = 7.27), "need and hunger" (β = 3.34), and "health" (β = 4.94) associated with an increased consumption of unprocessed and minimally processed foods, whereas "replacing main meals with snacks" (β = -8.98), "snacking" (β = -6.92) and binge eating symptoms (β = -0.34) associated with reduced consumption of foods within this processing level. In contrast, "use of delivery services" (β = 3.39), "replacing main meals with snacks" (β = 5.49), "visual appeal" (β = 2.17), "social norms" (β = 2.19) and "affect regulation" (β = 2.01) associated with increased ultraprocessed food consumption. Overall, associations were more frequent and pronounced when analyzing food consumption by processing level rather than by macronutrient intake. Conclusion: Some eating habits and food choice determinants ("snacking," "replacing meals with snacks," "use of delivery services") observed during the COVID-19 pandemic were associated with an unhealthy diet (high energy and carbohydrate consumption, increased ultraprocessed food consumption and reduced unprocessed/minimally processed foods consumption) in Brazilian women.

COVID-19 lockdown and lifestyles: A narrative review

Background: The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic has been controlling disease transmission. However, lockdown measures used to mitigate transmission have affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature has emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances. Methods: We comprehensively searched PubMed and the World Health Organization’s global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed. Results: Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes. Conclusions: The COVID-19 pandemic provides an opportunity to better understand the negative impact of strict lockdown measures on lifestyles. At the same time, it helps us identify and initiate positive behavioral changes, which, if consolidated, could improve chronic disease outcomes. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Selection and Characterization of Probiotic Bacteria Exhibiting Antiadipogenic Potential in 3T3-L1 Preadipocytes

Abnormal adipocyte growth, distinguished by an increase in cell numbers and cellular differentiation, is regarded as a major pathological characteristic of obesity. Thus, inhibition of adipogenic differentiation in adipocytes could prevent obesity. Recently, certain probiotic stains have been reported to regulate lipid metabolism in vitro and/or in vivo. In this backdrop, this study aimed to investigate basic probiotic properties and potential antiobesity characteristics of mouse 3T3-L1 preadipocytes. Six lactic acid bacteria (LAB) strains were prescreened for their cholesterol-lowering activity, antioxidant activity, and survival at low pH and in a solution containing bile salts. These six strains were investigated for antiadipogenic activity by employing 3T3-L1 mouse preadipocytes. 3T3-L1 cells were treated with selected strains during the differentiation process. Lactobacillus johnsonii 3121 and Lactobacillus rhamnosus 86 were found to be more capable of reducing triglyceride and lipid accumulation, as compared to control group, which are fully differentiated 3T3-L1 adipocytes. These strains also inhibited adipocyte differentiation by downregulating the adipogenic transcription factor in 3T3-L1 adipocytes. Taken together, these results indicate that L. johnsonni 3121 and L. rhamnosus 86 could potentially act as probiotic bacteria and prevent fat accumulation by regulating adipogenesis-related markers.

Eating Behavior Changes of People with Obesity During the COVID-19 Pandemic

OBJECTIVE

The precautions taken during the pandemic period may cause stress-related eating behavior disorders. It was aimed to test this hypothesis, and the study was carried out to examine pandemic measures the effect of on the nutritional, depression and stress conditions of people with obesity.

METHODS

The individuals who participated in the study were people with obesity who received follow-up dietary therapy in a private hospital. Three separate scales were applied to the individuals, which measured the desire to overeating request, depression status and stress-fighting status.

RESULTS

This study was conducted on 368 individuals. Women had lower values of BMI (28.57±3.89 kg/cm2) than men (30.64±2.87 kg/cm2). When the scores of the excessive eating request scale mean scores before and during the pandemic were examined, it was seen that the scores of the individuals increased during the pandemic. In the multivariate regression model, it was seen that the increase of stress and BMI increased the FCQ score (p<0.001). Multiple regression models were created by taking into account the criteria that caused the score increase. Each variable can predict the FCQ score separately. The predictor significance order of variants on FCQ score β values is as follows: the Patient Health Questionnaire-9 (PHQ-9) (β=0.774), before pandemic FCQ (β=0.601), the Perceived Stress Scale (PSS) (β=-0.268), before pandemic BMIa (β=-0.223), during pandemic BMIb (β=0.073), and age (β=-0.013).

CONCLUSION

COVID-19 pandemic, making applications such as quarantine in pandemic processes has successful results in being able to combat its. However, undesirable conditions such as stress can have serious negative consequences on other health measurements. It was observed in the results of this study that excessive eating food desire developed in people with obesity.

COVID-19 and liver disease: mechanistic and clinical perspectives

Our understanding of the hepatic consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its resultant coronavirus disease 2019 (COVID-19) has evolved rapidly since the onset of the pandemic. In this Review, we discuss the hepatotropism of SARS-CoV-2, including the differential expression of viral receptors on liver cell types, and we describe the liver histology features present in patients with COVID-19. We also provide an overview of the pattern and relevance of abnormal liver biochemistry during COVID-19 and present the possible underlying direct and indirect mechanisms for liver injury. Furthermore, large international cohorts have been able to characterize the disease course of COVID-19 in patients with pre-existing chronic liver disease. Patients with cirrhosis have particularly high rates of hepatic decompensation and death following SARS-CoV-2 infection and we outline hypotheses to explain these findings, including the possible role of cirrhosis-associated immune dysfunction. This finding contrasts with outcome data in pharmacologically immunosuppressed patients after liver transplantation who seem to have comparatively better outcomes from COVID-19 than those with advanced liver disease. Finally, we discuss the approach to SARS-CoV-2 vaccination in patients with cirrhosis and after liver transplantation and predict how changes in social behaviours and clinical care pathways during the pandemic might lead to increased liver disease incidence and severity.

Lifestyle changes associated with COVID-19 quarantine among young Saudi women: A prospective study

BACKGROUND

Negative lifestyle behaviors are associated with an increased risk of adverse outcomes from coronavirus disease (COVID-19). This study aimed to assess lifestyle changes affecting weight, sleep, mental health, physical activity, and dietary habits prospectively from before COVID-19 to during lockdown.

METHODS

A total of 297 Saudi women, aged 19-30 years (mean age, 20.7 ± 1.4 years), were interviewed at two time points, before and during the quarantine. The data collected included anthropometrics, sociodemographic data, clinical history, food frequency questionnaire responses, Pittsburgh Sleep Quality Index scores, Global Physical Activity Questionnaire (GPAQ) responses, and Perceived Stress Scale measures. In addition, during quarantine, COVID-19 and nutrition-related information and Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores were collected. Multivariate multinomial logistic regression analysis was used to examine the indicators of weight gain and loss from before COVID-19 (baseline) until during lockdown.

RESULTS

Although approximately half of the participants did not report a weight change, 30% revealed weight loss and 18%, weight gain. The variables associated with increased weight gain were self-quarantine since COVID-19 started (OR: 5.17, 95% CI: 1.57-17.01, p = 0.007), age (OR: 1.53, 1.03-2.28, p = 0.04), and stress at baseline and during lockdown (OR: 1.15, 1.03-1.29, p = 0.01; OR: 1.10, 1.01-1.19, p = 0.03, respectively). The variables associated with a reduced risk of weight gain were the GPAQ score during lockdown (OR: 0.16, 0.04-0.66, p = 0.01), coffee consumption (OR: 0.36, 0.19-0.67, p = 0.01), and total sleep time (OR: 0.70, 0.51-0.97, p = 0.03).

CONCLUSION

While most young Saudi women experienced no weight change during the COVID-19 lockdown, one-third lost weight and a significant proportion gained weight. Factors associated with weight, such as stress, sleep hours, physical activity, and coffee consumption, highlight the need to carefully consider those at risk during future circumstances that may require lockdowns. These factors could also aid in implementing policies for future lockdowns and support those most at risk of gaining weight.

Exploring the Impact of COVID-19 Pandemic on Eating and Purchasing Behaviours of People Living in England

Consumers' eating habits have changed significantly due to the anxiety and boredom from the reported cases and deaths of COVID-19, the change in work patterns, controlled food shopping, and the inability to meet loved ones during the lockdown. The magnitude of these changes in the eating behaviours and purchasing habits of consumers varies across different groups of people. This study provides empirical evidence of the effects of COVID-19 on the eating and purchasing behaviours of people living in England, which was assessed based on sociodemographic variables. A total of 911 participants were recruited by a market research company, while only 792 useable responses were included in this study. The participants, aged between 18 and 91 years, completed an online questionnaire, and the data were analysed using ordinal regression. Data were collected between October and December 2020. Male participants constituted 34.60%, females 63.89%, and others (other gender and those who prefer not to declare their gender) were 0.63%. The majority of participants' ages fell into the ranges of 23-38 and 39-54. Participants aged 23 to 38 years had the greatest effect of COVID-19 on their purchasing decision of healthier foods, while participants in the age groups 55-73 and 74-91 were least affected. The amount of foods purchased during the pandemic decreased with increasing age. The amount of foods purchased by students, people in employment, and people from minority ethnic groups were greatly affected by the pandemic. All participants who stated that taking food supplements is not important during the pandemic were from the White ethnic group. The effects of the pandemic on purchasing healthier foods were greater in younger generations and participants in full- or part-time employment than participants who were retired and who were aged above 55. The participants with higher educational qualifications and those from minority ethnic groups were also more affected by the pandemic. We suggest further studies to monitor any changes in the effects of the ongoing COVID-19 pandemic on the eating and purchasing behaviours of consumers.

Change in eating habits and physical activities before and during the COVID-19 pandemic in Hong Kong: a cross-sectional study via random telephone survey

BACKGROUND

Hong Kong is a densely populated city with a low incidence and mortality of coronavirus disease 2019 (COVID-19). The city imposed different levels of social distancing including, the closure of sports venues and restrictions on eateries. This inevitably affects the eating behaviour and physical activities of the population. We examined the changes in eating behavior and physical activities before and during the COVID-19 pandemic, and identified sociodemographic factors associated with the behavioral changes.

METHODS

This was a cross-sectional study via a random telephone survey of Chinese adults conducted in Hong Kong from May to June, 2020 - a period in which social distancing measures were being imposed. We measured the physical activity habits from four aspects and dietary consumption patterns from seven aspects before and during the pandemic based on the World Health Organization's guidelines and previous publications.

RESULTS

In total, 724 participants were recruited. Individuals were found to cook more frequently at home (p < 0.001) and order take-out (p < 0.001) during the COVID-19 pandemic. While no significant change in the frequency of fast food consumption was observed, we found significant increases in the frequency of eating fruits (p < 0.001) and vegetables (p = 0.004). The frequencies of walking, moderate-intensive sports, and high-intensity sports were significantly reduced (p < 0.001). We found that healthy lifestyle behaviors during the pandemic were negatively associated with participants' economic status.

CONCLUSIONS

Social distancing measures likely provided an opportunity for individuals to stay home and thus eat healthier. However, in a prolonged period of social restrictions, a lower physical activity level poses a risk to public health. Public health officials are thus advised to monitor physical health on a population-wide basis. The findings highlighted the importance of interventions tailored to individuals who have prolonged home stays - particularly for individuals in the low economic group.

Effect of COVID-19 Lockdown on Dietary Habits and Lifestyle of Food Science Students and Professionals from Spain

On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic, forcing countries around the world to confine their population to halt the rapid spread of the virus. This study aimed to evaluate the changes in dietary habits and lifestyle during the COVID-19 lockdown a specific population with academic and professional knowledge in food sciences from Spain. An online questionnaire, based on 41 items, including sociodemographic data, dietary habits, food-related behaviors, and lifestyle were distributed using academic and institutional mailing lists and social media. Results showed a higher intake of fruit and vegetables, legumes, eggs, fish, and yogurt together with a decrease in consumption of alcoholic beverages between before and during the lockdown period. Nevertheless, an increase in consumption of some fruitive foods and an increase in self-reported weight were also observed, although in lower percentages than in other populations. A worse sleep quality and an increase in working hours and sitting time were also reported. Overall, trends towards healthier dietary habits were observed within the study sample during COVID-19 confinement period.

Relationship in dietary habits variations during COVID-19 lockdown in Kosovo: The COVIDiet study

Changes in dietary habits and association with lifestyle during the coronavirus disease 2019 (COVID-19) lockdown in the Kosovo population have not been studied yet. Therefore, the intent of the present study was to determine whether if COVID-19 lockdown had any impact in lifestyle, including dietary habits and physical activity (PA) patterns of people from different areas of Kosovo. Dietary habits, PA, body weight and sociodemographic variables were measured through validated online survey started one week after lockdown decision and lasted for next two month (May and June 2020). Six hundred eighty-nine participants (women 79% and men 21%) aged between 20 and 65 years from the Kosovo territory participated in the research. Multivariate models showed that participants in family home residence, participants from Gjilan, participants female and participants with professional educations reported a higher likelihood of turning into a higher adherence to the Mediterranean diet (MedDiet) (OR: 6.09, 5.25, 5.17, 4.19, respectively). The weight gained during the lockdown was positively associated with a higher cooking frequency (OR; 2.90, p < 0.01), lower meat and fish consumption (OR; 1.15, p = 0.02; OR; 1.04, p = 0.04, respectively), higher fast-food consumption (OR; 0.49, p = 0.02) and no physical activity performance (OR; 0.43, p = 0.02) during the COVID-19 lockdown. The dietary habits during COVID-19 lockdown could be related to the improvements in adherence to the MedDiet and physical activities that may minimize related health complications.

Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March-May 2020): results from the French NutriNet-Santé cohort study

BACKGROUND

Since December 2019, coronavirus disease 2019 (COVID-19) has been spreading steadily, resulting in overwhelmed health-care systems and numerous deaths worldwide. To counter these outcomes, many countries, including France, put in place strict lockdown measures, requiring the temporary closure of all but essential places and causing an unprecedented disruption of daily life.

OBJECTIVES

Our objective was to explore potential changes in dietary intake, physical activity, body weight, and food supply during the COVID-19 lockdown and how these differed according to individual characteristics.

METHODS

The analyses included 37,252 adults from the French web-based NutriNet-Santé cohort who completed lockdown-specific questionnaires in April-May 2020. Nutrition-related changes and their sociodemographic, lifestyle, and health-status correlates were investigated using multivariable logistic regression models. Clusters of participants were defined using an ascending hierarchical classification of change profiles derived from multiple correspondence analyses.

RESULTS

During the lockdown, trends of unfavorable changes were observed: decreased physical activity (reported by 53% of the participants), increased sedentary time (reported by 63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (reported by 40%) and increased physical activity (reported by 19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals, 1.8 kg ± SD 1.3 kg) and 23% lost weight (2 kg ± SD 1.4 kg weight loss). All of these trends displayed associations with various individual characteristics.

CONCLUSIONS

These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions. The observed unfavorable changes should be considered in the event of a future lockdown, and should also be monitored to prevent an increase in the nutrition-related burden of disease, should these diet/physical activity changes be maintained in the long run. Understanding the favorable changes may help extend them on a broader scale. This trial was registered at clinicaltrials.gov as NCT03335644.

Food & meal decision making in lockdown: How and who has Covid-19 affected?

The Covid-19 lockdown resulted in all but essential shops closing in many countries, with inevitable and immediate impact on food availability and choice. Reasons for specific food choices influence diet and mealtimes and can affect psychological and physical well-being. The current study aimed first to investigate whether individuals and families in the UK have changed their food choice motivations over lockdown and second to identify sub-groups in particular need of support in the event of future lockdowns. Two hundred and forty adult participants from the UK completed an online survey, consisting of a series of demographic questions, the Food Choice Questionnaire, the Family Mealtime Goals Questionnaire and some short open-ended questions. They were asked to consider their goals and motivations around food and mealtimes at two timepoints: before lockdown and Summer 2020. Results indicated that the sample placed more importance on health, weight control and mood when choosing their food after lockdown than they had before, and less importance on familiarity. A number of sub-groups were identified who may be particularly vulnerable to food-related challenges in future lockdowns including younger adults, parents and carers of children, those self-isolating and individuals who do not live within close proximity to food shops. These results are preliminary and larger sub-group sample sizes will be necessary to draw firm conclusions. Future research should consider the nature and impact of these challenges in more detail across a more varied population.

Behavioral medicine challenges in the shadow of a global pandemic

Health behavior researchers should refocus and retool as it becomes increasingly clear that the challenges of the COVID-19 pandemic surpass the direct effects of COVID-19 and include unique, drastic, and ubiquitous consequences for health behavior. The circumstances of the pandemic have created a natural experiment, allowing researchers focusing on a wide range of health behaviors and populations with the opportunity to use previously collected and future data to study: (a) changes in health behavior prepandemic and postpandemic, (b) health behavior prevalence and needs amidst the pandemic, and (c) the effects of the pandemic on short- and long-term health behavior. Our field is particularly challenged as we attempt to consider biopsychosocial, political, and environmental factors that affect health and health behavior. These realities, while daunting, should call us to action to refocus and retool our research, prevention, and intervention efforts.

Eating habits among primary and secondary school students in the Gaza Strip, Palestine: A cross-sectional study during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has a great impact on the eating habits, dietary intake, and purchasing behaviours of students. At this critical moment, there is an urgent need to identify the eating habits of school students, in particular, who live in low-income countries, during the lockdown period. Therefore, the present study aims to identify the influence of COVID-19 on the eating habits, quality and quantity of food intake among school students in the Gaza Strip, Palestine.

METHODS

A cross-sectional study was carried out among 2398 primary and secondary school students aged 6-18 year old through an online questionnaire which included questions on socio-demographic, eating habits as well as quality and quantity of food intake. Students over the age of 11 years completed the questionnaire on their own, whereas for students under the age of 12 years, the students' guardians were instructed to answer the questionnaire on their behalf. A Wilcoxon Signed-Rank and McNemar tests were applied to perform a comparison between general dietary habits before and during COVID-19. Also, a Wilcoxon Signed Rank test was used to compare the median scores of food quality and quantity before and during the COVID-19 pandemic based on student's sociodemographic.

RESULTS

During the COVID-19 pandemic, there was a significant increase in eating home-cooked foods (91.6%), avoiding ordering food from outside per week (93.3%) and buying groceries online (7.7%) (p < 0.001). There was a marked increase in the students reporting fear about food hygiene outside the home from 20.8% before COVID-19 to 72.9% during the COVID-19 period (p < 0.001). The results showed that the median score for food quality during the COVID-19 pandemic (11.0/6.0) was significantly higher than the before COVID-19 period (10.0, IQR = 8.0) (p < 0.001). The results revealed that the median score for food quantity before the COVID-19 pandemic (15.0, IQR = 5.0) was significantly higher than the during COVID-19 pandemic (14.0, IQR = 7.0) (p < 0.001). The results showed significant differences between the before and during COVID-19 period for food quality and quantity across socio-demographic variables (gender, age group, parent's highest level of education, monthly household income, and household size). During the COVID-19 pandemic, students from a high-income and a small size family had the highest score in terms of food quality and quantity among other counterparts when compared to other counterparts.

CONCLUSION

Eating habits have significantly altered among school students during the COVID-19 pandemic. In spite of some good healthy habits enhanced among students, the quantity and the quality of the food was compromised. Therefore, the responsible officials at the Ministry of Education must focus on enhancing school students' awareness towards increased intake of healthy food and adopting good eating habits during the spread of pandemics and health diseases to avoid its negative effects on students.

The Impact of COVID-19-Related Lockdown on Diet and Serum Markers in Healthy Adults

Due to limited data about the impact of lockdown on health status, the present study aimed to investigate the impact of COVID-19-related lockdown on changes in dietary habits, physical activity and serum markers in healthy adults. A total of 38 asymptomatic adults aged from 23 to 59 with a normal BMI (22.5 kg/m²) participated in baseline and post-lockdown measurements that included dietary and physical activity assessment, anthropometric measurements and blood samples; and the lockdown survey which included dietary assessment and questionnaires about changes in lifestyle and physical activity. A decreased diet quality during lockdown was observed (Healthy Eating Index reduced from 64.59 to 61.08), which returned to near baseline post-lockdown. Energy intake decreased during lockdown (p = 0.002) and returned to baseline post-lockdown. Despite lower physical activity levels during lockdown (p = 0.035), we observed no significant changes in body composition. However, we observed a significant increase in serum glucose (p = 0.005), total cholesterol (p = 0.003), and low-density lipoprotein (LDL) (p = 0.049) post-lockdown. Increase in serum glucose levels was pronounced in subjects with higher increase in energy intake (p = 0.039), increased omega-6 fatty acids intake (p = 0.016), those who were exposed to several risky contacts (p = 0.018, compared to those with less risky contacts) and those who were not active in nature (p = 0.008, compared to those active in nature). Increased serum LDL was correlated to decreased monounsaturated fatty acids intake (p = 0.028). Within the limits of this preliminary report, changes in serum markers observed among healthy subjects point to a possible impact of COVID-19-related lockdown on adults’ health to be confirmed in larger groups.

Relation among Perceived Weight Change, Sedentary Activities and Sleep Quality during COVID-19 Lockdown: A Study in an Academic Community in Northern Italy

In Italy, COVID-19 lockdown was imposed from 8 March until 3 May 2020 with negative consequences on the lifestyles and health of people. Within this context, the paper aims: (i) to analyse the impact of COVID-19 lockdown on perceived weight changes; (ii) to evaluate factors associated with the perception of weight changes (Body Mass Index (BMI), sleep quality, time spent in sedentary activities), in an Italian academic community of students and workers. A total of 3666 participants took part in this cross-sectional study (2838 students and 828 workers, of whom 73.0% were female). T-test, Chi-square test and the two-way ANOVA were used. Results showed that 43.3% of participants perceived a weight gain. Workers experienced a more substantial increase in body weight (0.7 kg) compared to students (0.3 kg; p = 0.013). A significant difference between preobese/obese workers (0.9 kg) and students (-0.3 kg; p < 0.001) was found. Overall, 57.0% of the sample was characterized by high levels of sedentary activities. Sedentary people noticed a higher weight gain (0.4 kg) compared to less sedentary people (0.3 kg; p = 0.048). More than 45% of participants reported a worsening of sleep quality and showed a perceived increase in body weight (0.5 kg) in comparison to those who improved their sleep quality (no weight change; p = 0.001). Designing tailored interventions to promote health-related behaviours during lockdown periods is essential.

The Impact of COVID-19 Outbreak in Italy on the Sustainable Food Consumption Intention From a "One Health" Perspective

Coronavirus disease (COVID-19) is a transmissible illness that was recognized in December 2019 and World Health Organization (WHO) stated a pandemic on 11 March 2020. As no cure has been developed for COVID-19 disease yet, Italy has adopted restrictive measures to avoid the spread of the virus, causing different psychological reactions (e.g., stress, anxiety) that lead people to change lifestyle and in particular the consumer orientation toward food. In addition, the COVID-19 emergency had also affected the Italian economy, causing an 11.3% decrease in GDP (gross domestic product). All these changes gave rise to a sense of instability, but it is known that new possibilities may arise in these situations. In particular, the pandemic could be the turning point to make consumers aware of the close link between human health and the ecosystems, supporting the "One Health" perspective and enhancing the orientation to consumer sustainable food products. However, little is known about how the psychological reactions to COVID-19 emergency have affected the consumers' intention to purchase sustainable food products. In order to answer these questions, a representative sample of 1,004 Italian citizens, extracted by stratified sampling, answered an online survey between May the 12th and 18th 2020. The data were analyzed using ANOVA and contingency tables. The results show that during phase one of COVID-19 disease about 30% of the sample reported that have frequently (often and always) consumed the certified sustainable food products and about 20% of the sample have intention to increase the consumption of them in the next 6 months, percentages that increase among those who feel more vulnerable regarding the risk contagion. Moreover, the psychological impact of the COVID-19 emergency has led to a change in consumers' attitudes, increasing the interest in animal and environmental issues and in human health. These aspects seem to drive the future intention of purchasing sustainable food products. This research highlights how the psychological reactions to the health emergency have changed the consumers' attitudes toward sustainability issues, leading them to follow a more sustainable diet that is recognized as a way to preserve human health, environmental preservation, and animal welfare for present and future generations.

The Impact of Lockdown During the COVID-19 Outbreak on Dietary Habits in Various Population Groups: A Scoping Review

Background: Since the beginning of the COVID-19 pandemic, access to fresh food has been restricted, and people are spending more time inside and have limited their physical activity. However, more time at home may have resulted in some positive habits including an increase in cooking. The aim of this review was to assess dietary changes during the first lockdown. Themes and patterns were considered and associations with other lifestyle factors were assessed. Methods: Between June and July 2020, the PubMed, Google Scholar, and Science Direct databases were searched, and results were screened for eligibility based on title, abstract, and full text. The inclusion criteria of this search included: papers published (or in pre-print) in the year 2020; studies that investigated the impact of COVID-19 lockdown on diet; papers published in English. Exclusion criteria were as follows: papers examining dietary changes in those following a structured diet based on diagnosed conditions or dietetic advice; literature, systematic, or narrative studies reviewing previous research. Researchers agreed on the study characteristics for extraction from final papers. Results: Four thousand three hundred and twenty-two studies were originally considered with 23 final full-text papers included. Four themes were identified: dietary patterns, dietary habits (favorable), dietary habits (unfavorable), and other (includes physical activity levels, weight gain). A total of 10 studies reported an increase in the number of snacks consumed, while six studies found that participants increased their meal number and frequency during quarantine. Eleven studies reported favorable changes in dietary habits with an increase in fresh produce and home cooking and reductions in comfort food and alcohol consumption. However, nine studies found a reduction in fresh produce, with a further six reporting an increase in comfort foods including sweets, fried food, snack foods, and processed foods. Two studies reported an increase in alcohol consumption. In eight studies participants reported weight gain with seven studies reporting a reduction in physical exercise. Conclusion: The effect of COVID-19 lockdown both negatively and positively impacted dietary practices throughout Europe and globally, and negative diet habits were associated with other poor lifestyle outcomes including weight gain, mental health issues, and limited physical activity. Both in the short term and if sustained in the long term, these changes may have significant impacts on the health of the population.

Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidates are being evaluated, with the goal of conferring immunity on the highest percentage of people who receive the vaccine as possible. It is noteworthy that vaccine efficacy depends not only on the vaccine but also on characteristics of the vaccinated. Over the past 30 years, a series of studies has documented the impact of psychological factors on the immune system's vaccine response. Robust evidence has demonstrated that stress, depression, loneliness, and poor health behaviors can impair the immune system's response to vaccines, and this effect may be greatest in vulnerable groups such as the elderly. Psychological factors are also implicated in the prevalence and severity of vaccine-related side effects. These findings have generalized across many vaccine types and therefore may be relevant to the SARS-CoV-2 vaccine. In this review, we discuss these psychological and behavioral risk factors for poor vaccine responses, their relevance to the COVID-19 pandemic, as well as targeted psychological and behavioral interventions to boost vaccine efficacy and reduce side effects. Recent data suggest these psychological and behavioral risk factors are highly prevalent during the COVID-19 pandemic, but intervention research suggests that psychological and behavioral interventions can increase vaccine efficacy.

Impact of the COVID-19 lockdown on weight status and associated factors for obesity among children in Massachusetts

This study aims to evaluate the impact of the COVID-19 lockdown on weight status, obesity and overweight among US children and identify associated factors.

METHODS

At a large safety net health system in Massachusetts, anthropometric measurements of 701 children were analyzed before and after the COVID-19 lockdown. Chi-square and paired t-test were computed for categorical and continuous variables, respectively. Multivariate analyses were performed to identify factors associated with obesity and overweight.

RESULTS

Post-lockdown, the overall mean body mass index (BMI) increased from 21.07 to 21.57 kg/m² (p < .001). The overall obesity (23.2%-27.4%, p < .001) and overweight (41.1%-44.5%, p < .001) burdens increased after the lockdown period. Obesity (40.5%-46.9%, p < .001) was highest among Spanish speakers. The youngest age group (2-5 years) had the greatest obesity rate increase by 26% (19.7%-24.8%, p < .001). Obesity was associated with younger age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91, 1.00), higher baseline BMI (OR = 1.19, 95% CI = 1.15, 1.23) and Spanish speaking children (OR = 2.19, 95% CI = 1.10, 4.33).

CONCLUSIONS

BMI, obesity and overweight increased among children during the COVID-19 lockdown, disproportionately affecting disadvantaged subpopulations. Strategies are needed to counteract the impact of the COVID-19 lockdown on unhealthy weight gain and childhood obesity.

Dietary intake of university students during COVID-19 social distancing in the Northeast of Brazil and associated factors

This study aimed to analyze the influence of COVID-19 social distancing on the dietary pattern of university students in the Northeast of Brazil and associated factors. This is a cross-sectional study of 955 students from four universities carried out via a web survey containing social, economic, demographic, and health information. A food frequency questionnaire was used to evaluate diet. Weight and dietary alterations were reported. Exploratory factor analysis and multivariate logistic regression were used as statistical analyses. The mean age was 26 and 53.7% of the students observed an increase in their weight. Four dietary patterns were identified: (1) a predominantly in natura pattern, (2) a pattern of processed and ultra-processed foods, (3) a protein-based pattern, and (4) an infusion-based pattern. It was observed that students having a darker skin colour (OR 1.8; CI 95% 1.3-2.6) and 19-29 years old and not being a health course student (OR 1.5; CI 95% 1.1-2.1) were associated with greater adhesion to the in natura pattern. Not engaging in physical activity was statistically associated with not adhering (OR 0.5; CI 95% 0.4-0.7) to that pattern. The university students who saw an alteration in their weight during the social distancing period studied presented a greater probability of consuming the processed and ultra-processed foods pattern (OR 1.8; CI 95% 1.2-2.6), while the men (OR 0.7; CI 95% 0.4-0.9) and those not engaging in physical activity (OR 0.7; CI 95% 0.5-0.9) presented less adhesion to that pattern. These findings indicate that social isolation affected the dietary intake of university students, with adhesion to mixed dietary patterns in terms of health. The adhesion to the pattern of processed and ultra-processed foods identified may affect the students' health, especially the occurrence of excess weight and obesity.

Impact of COVID-19 Lockdown on Short-Term Results After Laparoscopic Sleeve Gastrectomy

Background

The recent COVID-19 pandemic has led several countries worldwide to confine the population. Consequently, people’s mobility and physical activity are limited in addition to a negative psychosocial effect. The aim of this study was to assess the impact of COVID-19 crisis on short-term weight loss and the remission of obesity-associated comorbidities in patients undergoing sleeve gastrectomy (SG).

Methods

A case-control study was conducted comparing percentage of total weight loss (%TWL), excess weight lost (%EWL), and the remission rate of obesity-related comorbidities at the first postoperative year between patients who underwent primary SG between June 2019 and October 2019 (1-year postoperative period affected by COVID-19 lockdown; COV-group), and a control group operated between June 2018 and October 2018 (1-year postoperative period not affected by COVID-19 lockdown; CONTROL-group).

Results

In total, 45 patients from COV-group were compared to 57 patients from CONTROL-group. Demographic data were similar between groups. The follow-up rate at 1 year was 100%. The mean %TWL and %EWL was lower at 28.2 ± 12.7% and 67.6 ± 23.5% in COV-group patients compared to 34.3 ± 14.1% and 78.3 ± 27.2% in CONTROL-group patients at 1 year from SG (p=0.025 and p=0.036, respectively). The remission rate of obesity-related comorbidities at 1 year from SG including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea syndrome was 57.1%, 60.0%, 71.4%, and 41.7% in COV-group and 66.7%, 72.4%, 85.3%, and 52.9% in CONTROL-group, respectively, without any statistically significant difference between groups.

Conclusions

The COVID-19 lockdown had a negative effect on weight loss in the first year after SG. Larger studies are needed to confirm these results, and we are expecting for a longer follow-up to evaluate the long-term impact on weight loss and comorbidities.

COVID-19 disease and nutritional choices: How will the pandemic reconfigure our food psychology and habits? A case study of the Italian population

BACKGROUND AND AIMS

In Italy, the spread of the novel coronavirus (SARS-Cov-2) required lifestyle changes that have affected food choices and people's health condition. We explore people's perception of the role of food consumption as a preventive measure and how it reconfigures consumption habits.

METHOD AND RESULTS

We conducted an online survey of a representative sample of 1004 Italian citizens. Around 40% of the population perceive that strengthening the immune defences through nutrition is not important to reduce the risk of coronavirus disease 2019 (COVID-19) infection. People with lower levels of perceived importance are slightly younger and have a less healthy lifestyle. They are less worried about the emergency. During the last months, they have bought less food supplements and also intend to decrease their purchase in the next 6 months.

CONCLUSION

In COVID-19 pandemic, scholars underline the importance of having a strong immune system. However, the Italians who attribute less importance to food that helps the immune system seem to differ negatively in their psychological attitude towards the emergency and food consumption. Today, Italians are asked to engage in preventive food practices to protect against possible chronic diseases; exploring their perceptions is important to orient them towards this change.

Health Benefits of Plant-Based Nutrition: Focus on Beans in Cardiometabolic Diseases

Cardiovascular disease (CVD) is the leading cause of death worldwide, claiming over 650,000 American lives annually. Typically not a singular disease, CVD often coexists with dyslipidemia, hypertension, type-2 diabetes (T2D), chronic system-wide inflammation, and obesity. Obesity, an independent risk factor for both CVD and T2D, further worsens the problem, with over 42% of adults and 18.5% of youth in the U.S. categorized as such. Dietary behavior is a most important modifiable risk factor for controlling the onset and progression of obesity and related disease conditions. Plant-based eating patterns that include beans and legumes support health and disease mitigation through nutritional profile and bioactive compounds including phytochemical. This review focuses on the characteristics of beans and ability to improve obesity-related diseases and associated factors including excess body weight, gut microbiome environment, and low-grade inflammation. Additionally, there are growing data that link obesity to compromised immune response and elevated risk for complications from immune-related diseases. Body weight management and nutritional status may improve immune function and possibly prevent disease severity. Inclusion of beans as part of a plant-based dietary strategy imparts cardiovascular, metabolic, and colon protective effects; improves obesity, low-grade inflammation, and may play a role in immune-related disease risk management.

Eating behavior and food purchases during the COVID-19 lockdown: A cross-sectional study among adults in the Netherlands

On March 15, 2020, the Dutch Government implemented COVID-19 lockdown measures. Although self-quarantine and social-distancing measures were implemented, restrictions were less severe compared to several other countries. The aim of this study was to assess changes in eating behavior and food purchases among a representative adult sample in the Netherlands (n = 1030), five weeks into lockdown. The results show that most participants did not change their eating behaviors (83.0%) or food purchases (73.3%). However, socio-demographic differences were observed among those that reported changes during lockdown. For example, participants with overweight (OR = 2.26, 95%CI = 1.24-4.11) and obesity (OR = 4.21, 95%CI = 2.13-8.32) were more likely to indicate to eat unhealthier during lockdown compared to participants with a healthy weight. Those with a high educational level (OR = 2.25, 95%-CI = 1.03-4.93) were also more likely to indicate to eat unhealthier during lockdown compared to those with a low educational level. Older participants were more likely to indicate to experience no differences in their eating behaviors compared to those of younger age, who were more likely to indicate that they ate healthier (OR = 1.03, 95%CI = 1.01-1.04) as well as unhealthier (OR = 1.04, 95%CI = 1.02-1.06) during lockdown. Participants with obesity were more likely to indicate to purchase more chips/snacks (OR = 2.79, 95%CI = 1.43-5.45) and more nonalcoholic beverages (OR = 2.74, 95%CI = 1.36-5.50) during lockdown in comparison with those with a healthy weight. Of those that used meal delivery services before, 174 (29.5%) indicated to use meal delivery services more frequently during lockdown. Although the results confirm the persistence of dietary routines, profound socio-demographic differences were observed for those that did report changes. Especially for individuals with overweight and obesity, the lockdown has taken its toll on healthy dietary choices. Further research should unravel underlying mechanisms for these observations.

Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review

OBJECTIVE

In March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called 'lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.

DESIGN DATA SOURCES AND ELIGIBILITY CRITERIA

Electronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.

RESULTS

Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.

CONCLUSION

Given the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.

Impact of the COVID-19 pandemic on phase 2 cardiac rehabilitation patients in Japan

This study aimed to clarify the effects of the interruption of cardiac rehabilitation (CR) and refraining from going outside due to the COVID-19 pandemic on hemodynamic response and rating of perceived exertion (RPE) during exercise including differences by age in phase 2 CR outpatients. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the  < 75 years group and  ≥ 75 years group. Fifty-three patients were enrolled in the final analysis. Post-CR interruption, peak heart rate increased significantly (p = 0.009) in the  < 75 years group, whereas in the  ≥ 75 years group, weight and body mass index decreased significantly (p = 0.009, 0.011, respectively) and Borg scale scores for both dyspnea and lower extremities fatigue worsened significantly (both, p < 0.001). CR interruption and refraining from going outside due to the COVID-19 pandemic affected the hemodynamic response, RPE during exercise and body weight in phase 2 CR outpatients. In particular, patients aged  ≥ 75 years appeared to be placed at an increased risk of frailty.

Mediterranean Diet for the Prevention of Gestational Diabetes in the Covid-19 Era: Implications of Il-6 In Diabesity

The aim of this review is to highlight the influence of the Mediterranean Diet (MedDiet) on Gestational Diabetes Mellitus (GDM) and Gestational Weight Gain (GWG) during the COVID-19 pandemic era and the specific role of interleukin (IL)-6 in diabesity. It is known that diabetes, high body mass index, high glycated hemoglobin and raised serum IL-6 levels are predictive of poor outcomes in coronavirus disease 2019 (COVID-19). The immunopathological mechanisms of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include rising levels of several cytokines and in particular IL-6. The latter is associated with hyperglycemia and insulin resistance and could be useful for predicting the development of GDM. Rich in omega-3 polyunsaturated fatty acids, vitamins, and minerals, MedDiet improves the immune system and could modulate IL-6, C reactive protein and Nuclear Factor (NF)-κB. Moreover, polyphenols could modulate microbiota composition, inhibit the NF-κB pathway, lower IL-6, and upregulate antioxidant enzymes. Finally, adhering to the MedDiet prior to and during pregnancy could have a protective effect, reducing GWG and the risk of GDM, as well as improving the immune response to viral infections such as COVID-19.

Childhood Obesity and COVID-19 Lockdown: Remarks on Eating Habits of Patients Enrolled in a Food-Education Program

Childhood obesity is a worldwide health emergency. In many cases, it is directly linked to inappropriate eating habits and a sedentary lifestyle. During lockdown aimed at containing the coronavirus disease (COVID-19) spread, children have been forced to stay at home. The present study aimed at investigating the lifestyles of outpatients (aged 5–17 years) with complicated obesity enrolled in the day-hospital food education program at the Children’s Hospital Bambino Gesù in Rome. A survey was performed based on a structured questionnaire, investigating dietary habits and lifestyles. The questionnaire answers were rated as “yes/no/sometimes” or “often/never/sometimes”. Eighty-eight families correctly completed the questionnaire between March and May 2020. The results highlighted that 85.2% (N = 75) of the patients ate breakfast regularly, and 64.3% (N = 72) consumed fruit as an afternoon snack. However, 21.6% (N = 19) did just “often” home workouts, and 50.0% (N = 44) reported an increase of feeling hungry with “sometimes” frequency. There is a significant relationship of feeling hungry with gender (p < 0.0001) and age (p = 0.048) and, also, between gender with having breakfast (p = 0.020) and cooking (p = 0.006). Living a healthy lifestyle during lockdown was difficult for the outpatients, mainly due to the increase in a sedentary lifestyle and the increase in feeling hungry, but some healthy eating habits were maintained, as advised during the food education program provided before lockdown.

Is there a link between COVID-19 and obstructive sleep apnea?

Although obstructive sleep apnea syndrome (OSAS) is not considered a risk factor for COVID-19, studies have observed that these two conditions have comorbidities in common such as diabetes, cardiovascular diseases, asthma, obesity, hypertension, and chronic obstructive pulmonary disease. Thus, one may question the possible contribution of OSAS to the worsening of hypoxemia in patients with COVID-19 since OSAS and obesity (hypoventilation) are associated with hypoxemia, which can be a worsening factor in the hypoxemia of COVID-19 pneumonia. Moreover, one may question whether sleep deprivation would negatively interfere with the pulmonary condition caused by COVID-19. Another question would be whether sleep deprivation resulting from OSAS would be a favorable condition for the pulmonary inflammatory process in patients with COVID-19. Studies with a more significant number of participants are needed to assess the possible impact of OSAS on the outcomes of patients with SARS-CoV-2 infection, providing a more solid basis for making therapeutic decisions. An important advance in understanding the influence of OSAS on COVID-19 is represented by careful identification of comorbidities and potential pathophysiological mechanisms that may contribute to the favorable outcome of these patients.

Heterogeneity in presentation of hyperglycaemia during COVID-19 pandemic: A proposed classification

Diabetes and hyperglycemia occurring during COVID-19 era have implications for COVID-19 related morbidity/mortality. In this brief review, we have attempted to categorise and classify such heterogenous hyperglycemic states. During COVID-19 pandemic broadly two types of hyperglycemia were seen: one in patients without COVID-19 infection and second in patients with COVID-19 infection. Patients not inflicted with COVID-19 infection and diagnosed with either type 2 diabetes mellitus (T2DM) or type 1 diabetes mellitus (T1DM) show more severe hyperglycemia and more ketoacidosis, respectively. In former, it could be attributed to weight gain, decreased exercise, stress and in both type of diabetes, due to delayed diagnosis during lockdown and pandemic. In patients with COVID-19 and associated pneumonia, altered glucose metabolism leading to hyperglycemia could be due to corticosteroids, cytokine storm, damage to pancreatic beta cells, or combination of these factors. Some of these patients present with diabetic ketoacidosis, hyperglycemic hyperosmolar state or both. We have provided a framework for categorisation of hyperglycemic states, which could be consolidated/revised in future based on new research data.

Stress and Physical Inactivity: Two Explosive Ingredients for the Heart in COVID-19 Pandemic Times

BACKGROUND

Coronavirus disease 2019 (Covid-19) pandemic is a global health crisis that has culminated in thousands of deaths. In order to reduce the spread of the Sars-CoV-2 virus, governments of several countries have adopted social isolation as a strategy. However, social isolation has culminated in deleterious effects on the population's health, including increased physical inactivity, stress and, consequently, adverse changes in body composition, cardiorespiratory capacity, muscle strength, physical functionality, and vascular events, which are increasingly pointed out as the main determinants of cardiovascular health. Staying physically active during lockdown is a challenge, especially for the population with a higher risk of mortality from COVID-19, who are still encouraged to maintain social distance until there is a vaccine available. Strategies to avoid physical inactivity and reduce stress levels can promote cardiovascular protection and must be considered during COVID-19 time.

OBJECTIVE

The aim of this paper is to discuss the risks of physical inactivity and stress for the cardiovascular system during the COVID-19 pandemic and propose strategies to protect cardiovascular health.

CONCLUSION

A home-based training protocol could be an interesting and effective strategy for the population who need to remain physically active and safe at home.

MiRNAs in Gestational Diabetes Mellitus: Potential Mechanisms and Clinical Applications

Gestational diabetes mellitus (GDM) is a common pregnancy complication which is normally diagnosed in the second trimester of gestation. With an increasing incidence, GDM poses a significant threat to maternal and offspring health. Therefore, we need a deeper understanding of GDM pathophysiology and novel investigation on the diagnosis and treatment for GDM. MicroRNAs (miRNAs), a class of endogenic small noncoding RNAs with a length of approximately 19-24 nucleotides, have been reported to exert their function in gene expression by binding to proteins or being enclosed in membranous vesicles, such as exosomes. Studies have investigated the roles of miRNAs in the pathophysiological mechanism of GDM and their potential as noninvasive biological candidates for the management of GDM, including diagnosis and treatment. This review is aimed at summarizing the pathophysiological significance of miRNAs in GDM development and their potential function in GDM clinical diagnosis and therapeutic approach. In this review, we summarized an integrated expressional profile and the pathophysiological significance of placental exosomes and associated miRNAs, as well as other plasma miRNAs such as exo-AT. Furthermore, we also discussed the practical application of exosomes in GDM postpartum outcomes and the potential function of several miRNAs as therapeutic target in the GDM pathological pathway, thus providing a novel clinical insight of these biological signatures into GDM therapeutic approach.

Changes in sleep phase and body weight of mobile health App users during COVID-19 mild lockdown in Japan

OBJECTIVE AND METHOD

The stay-at-home order during the COVID-19 pandemic has restricted individuals' social behaviors, and therefore, effected their lifestyle including sleep, diet, and physical activity. Using the cross-sectional study design with a large sample size (N = 30,275) from the mobile health App users in Japan, we show age-dependent lifestyle changes during a nonpunitive "mild lockdown" (from April to May 2020).

RESULTS

Sleep onset and offset were delayed on work-days but not on free-days with increased sleep duration and decreased social jetlag, and the changes were more evident in the younger population. Although average weight change was close to none because of the users' characteristic (95% of App users try to lose weight), we investigated an association between lifestyle change and body-weight change. Participants who reported advanced sleep phase during mild lockdown described a weight decrease. In contrast, the delayed sleep phase reported a weight gain. The results were significant after adjustment of confounding factors including physical activity and meal changes.

CONCLUSIONS

Although there is cumulative evidence showing a relationship between late chronotype and obesity, it is still unclear about the potential benefit of the chronotype management to control body weight. Thus, to the best of our knowledge, this is the first study investigating the association between chronotype and weight changes by leveraging a large cohort.

Have Lifestyle Habits and Psychological Well-Being Changed among Adolescents and Medical Students Due to COVID-19 Lockdown in Croatia?

OBJECTIVE

To investigate dietary habits, sleep and psychological well-being of adolescents and medical students during COVID-19 lockdown in Split, Croatia.

METHODS

We surveyed 1326 students during 2018 and 2019, and compared their responses with 531 students enrolled in May 2020. Perceived stress, quality of life (QoL), happiness, anxiety, and optimism were assessed as proxies of psychological well-being, using general linear modelling.

RESULTS

We found no substantial differences in dietary pattern between pre-lockdown and lockdown periods, including the overall Mediterranean diet (MD) adherence. However, the MD pattern changed, showing increased adherence to the MD pyramid for fruit, legumes, fish, and sweets, while cereals, nuts, and dairy intake decreased during COVID-19 lockdown. A third of students reported weight loss during lockdown, 19% reported weight gain, while physical activity remained rather stable. The most prominent change was feeling refreshed after a night's sleep, reported by 31.5% of students during lockdown vs. 8.5% before; median length of sleep duration increased by 1.5 h. Lockdown significantly affected QoL, happiness, optimism (all p < 0.001), and perceived stress in students (p = 0.005). MD adherence was positively correlated with QoL and study time, and negatively with TV and mobile phone use in pre-lockdown period (all p < 0.001). Interestingly, higher MD adherence was correlated with less perceived hardship and greater happiness and QoL during lockdown.

CONCLUSION

These insights provide valuable information for tailored interventions aimed at maintaining healthy lifestyle in young population. Given the numerous beneficial effects associated with MD adherence, modification of lifestyle through application of lifestyle medicine deserves a priority approach.

Dietary Supplements during COVID-19 Outbreak. Results of Google Trends Analysis Supported by PLifeCOVID-19 Online Studies

The use of dietary supplements (DSs) has been steadily increasing all over the world and additionally, the sales of DSs have dynamical increased in the wake of coronavirus disease 2019 (COVID-19) in most of the countries. We investigated DSs phenomenon in 2020 through (1) exploration of Google searches worldwide and in Poland (with Google Trends (GT) tool), and (2) analyses of results of PLifeCOVID-19 Online Studies conducted during the first and second wave of the pandemic. The conducted GT analysis and cross-sectional studies revealed that during the COVID-19 outbreak in March 2020, the interest in immune-related compounds and foods like vitamins C and D, zinc, omega-3, garlic, ginger, or turmeric, as well as their consumption increased. Improving immunity was the main reason behind the supplementation and changes in consumption of pro-healthy foods. GT analysis has shown these interests were positively correlated with the interest in COVID-19, but adversely with cumulative cases or deaths. Respondents tended to start supplementation during the first COVID-19 wave rather than the second one. Except for the role of vitamins D and C, zinc, and selenium in patients with deficiencies of those nutrients, there are no clear and convincing studies that support the role of DSs use in COVID-19 prevention and treatment in healthy, well-nourished individuals. Moreover, as the risk of elevated intake of some nutrients due to the popularity of DSs exists, effective education of consumers in rationale use of DSs and health-protecting behaviors against COVID-19 should be developed.

Changes in Consumers' Food Practices during the COVID-19 Lockdown, Implications for Diet Quality and the Food System: A Cross-Continental Comparison

COVID-19 has led to dramatic societal changes. Differing movement restrictions across countries have affected changes in consumers' food practices, with a potentially detrimental impact on their health and food systems. To investigate this, this research explored changes in consumers' food practices during the initial COVID-19 phase and assessed the impact of location on these changes. A sample of 2360 adults from three continents (Island of Ireland (IOI), Great Britain (GB), United States (USA), and New Zealand (NZ)) were recruited for a cross-sectional online survey (May-June 2020). Participants completed questions in relation to their cooking and food practices, diet quality, and COVID-19 food-related practices. Significant changes in consumers' food practices during the pandemic were seen within and between regions, with fewer cooking practices changes found in the USA. Food practices, which may put added pressure on the food system, such as bulk buying, were seen across all regions. To prevent this, organisational food practices, including planning ahead, should be emphasized. Additionally, while positive cooking-related practices and increases in fruit and vegetable intake were found, an increase in saturated fat intake was also seen. With the additional pressure on individuals' physical and mental health, the essentiality of maintaining a balanced diet should be promoted.

The Effect of "Novelty Input" and "Novelty Output" on Boredom During Home Quarantine in the COVID-19 Pandemic: The Moderating Effects of Trait Creativity

Governments have adopted strict home quarantine measures during the COVID-19 pandemic. A monotonous, barren, and under-stimulating environment can cause state boredom, and people often deal with boredom via novelty-seeking behavior. Novelty-seeking behavior can be divided into "novelty input" and "novelty output." The former refers to obtaining novel information such as browsing the Web; the latter refers to engaging in creative behavior such as literary creation. This study explores the relationship between two types of novelty-seeking behavior and individual state boredom during home quarantine, along with the moderation effect of trait creativity. The study sample consists of 582 Chinese college students who were quarantined at home during the COVID-19 pandemic. Participants completed the Multidimensional State Boredom Scale, the Williams Creativity Aptitude Test, and self-compiled questionnaires of novelty input and novelty output. The results show that there is no significant relationship between novelty input or novelty output and boredom during the COVID-19 quarantine. Trait creativity is found to negatively moderate the relationship between the two means of novelty seeking and boredom. Specifically, novelty output negatively predicts the state boredom of individuals with high creativity, while novelty input positively predicts the state boredom of individuals with low creativity. Our findings suggest that different novelty-seeking behaviors may have different effects on the boredom level of individuals with high versus low creativity during quarantine. During a quarantine period, individuals should avoid excessively engaging in novelty input behaviors aimed at escaping boring situations.

Anthropometric assessment in ambulatory nutrition amid the COVID-19 pandemic: Possibilities for the remote and in-person care

Background and aims

The COVID-19 pandemic has caused many changes in the nutritional care process as a result of the social distancing measures imposed, especially in the assessment of nutritional status, in which obtaining anthropometric measures is necessary.

Methods

Critical review of the international anthropometry literature, in the light of the recent scientific evidence of COVID-19.

Results

This paper presents recommendations for anthropometric assessment of the nutritional status of people in ambulatory settings for both remote and in-person assessment. The most appropriate measures to the current pandemic scenario are also discussed, in order to contribute to the monitoring of nutritional status and to minimize health impacts.results

Conclusion

When sanitary conditions cannot be guaranteed during in-person encounters or when the person cannot attend the office of the professional, the remote anthropometric assessment can be a useful strategy to nutritional surveillance.conclusions

The path ahead: From global pandemic to health promotion

The current COVID-19 pandemic represents an acute threat to the health of adults and children across the globe. In addition, it has the potential to worsen the health of future generations through intergenerational health effects. Examples from history, including the Dutch famine (Hongerwinter), suggest that in utero and early life environments may have significant implications for health outcomes throughout the lifespan and are important in determining risk of chronic disease in adulthood. Parental health status, stress, and nutrition appear to affect offspring health and are all affected by the COVID-19 pandemic. Thus, it is critical that we consider the potential impacts of the current pandemic on pregnant women, infants and children and take public health and medical actions to mitigate risk and promote health in future generations.

The Impact of the COVID-19 Pandemic on Incidences of Atrial Fibrillation and Electrical Cardioversion at a Tertiary Care Emergency Department: An Inter- and Intra-year Analysis

Background: National authorities have introduced measures as lockdowns against spreading of COVID-19 and documented incidences of multiple non-COVID-19 diseases have dropped. Yet, data on workload dynamics concerning atrial fibrillation and electrical cardioversion whilst a national lockdown are scarce and may assist in future planning.

Methods: Documented cases of atrial fibrillation and respective electrical cardioversion episodes at the Emergency Department of the Medical University of Vienna, Austria, from 01/01/2020 to 31/05/2020 were assessed. As reference groups, those incidences were calculated for the years 2017, 2018, and 2019. Inter- and intra-year analyses were conducted through Chi-square test and Poisson regression.

Results: A total of 2,310 atrial fibrillation-, and 511 electrical cardioversion episodes were included. We found no significant incidence differences in inter-year analyses of the time periods from January to May, or of the weeks pre- and post the national lockdown due to the COVID-19 pandemic. However, the intra-year analysis of the year 2020 showed a trend toward decreased atrial fibrillation incidences (rate-ratio 0.982, CI 0.964–1.001, p = 0.060), and significantly increased electrical cardioversion incidences in the post-lockdown period (rate ratio 1.051, CI 1.008–10.96, p = 0.020).

Conclusion: The decreased atrial fibrillation incidences are in line with international data. However, an increased demand of electrical cardioversions during the lockdown period was observed. A higher threshold to seek medical attention may produce a selected group with potentially more severe clinical courses. In addition, lifestyle modifications during isolation and a higher stress level may promote atrial fibrillation episodes to be refractory to other therapeutic approaches than electrical cardioversion.

The burden of type 2 diabetes pre-and during the COVID-19 pandemic - a review

Introduction

Diabetes Mellitus is a chronic disease and a global epidemic. It is a known fact that co-morbidities, including Diabetes Mellitus, pose a higher risk of infection by COVID-19. Additionally, the outcomes following infection are far worse than in people without such co-morbities.Factors contributing to the development of type 2 diabetes mellitus (T2DM) have long been established, yet this disease still bestows a substantial global burden. The aim was to provide a comprehensive review of the burden of diabetes pre-COVID-19 and the additional impact sustained by the diabetes population and healthcare systems during the COVID-19 pandemic, while providing recommendations of how this burden can be subsided.

Methodology

Literature searches were carried out on 'Google Scholar' and 'PubMed' to identify relevant articles for the scope of this review. Information was also collected from reliable sources such as the World Health Organisation and the International Diabetes Federation.

Results

T2DM presented with economic, social and health burdens prior to COVID-19 with an significant 'Disability Adjusted Life Years' impact. Whilst people with diabetes are more susceptible to COVID-19, enforcing lockdown regulations set by the Public Health department to reduce risk of infection brought about its own challenges to T2DM management. Through recommendations and adapting to new methods of management such as telehealth, these challenges and potential consequences of mismanagement are kept to a minimum whilst safeguarding the healthcare system.

Conclusion

By understanding the challenges and burdens faced by this population both evident pre-covid and during, targeted healthcare can be provided during the COVID-19 pandemic. Furthermore, implementation of targeted action plans and recommendations ensures the care provided is done in a safe and effective environment.

Relationship between Dietary Habits, Food Attitudes and Food Security Status among Adults Living within the United States Three Months Post-Mandated Quarantine: A Cross-Sectional Study

COVID-19 has disrupted the lives of many and may have influenced dietary habits through factors such as food security status and attitudes. The purpose of this study was to identify dietary habits and their associations with food insecurity and attitudes among adults living in the United States within three months post-mandated quarantine. An online cross-sectional study was conducted from April to June 2020. Participants (n = 3133) responded to a 71-item questionnaire regarding demographics (n = 7), health information (n = 5), lifestyle habits (n = 8), dietary habits (n = 37), food attitudes (n = 8), and food security status (n = 6). Frequency counts and percentages were tabulated, and multivariate linear regression was conducted to examine associations using STATA v14 at a statistical significance level of p < 0.05. Results showed that most participants indicated no change in dietary habits (43.6-87.4%), yet participants reported increased consumption of sweets (43.8%) and salty snacks (37.4%). A significant positive association for food attitude scores (1.59, 95% CI 1.48 to 1.70; p < 0.001) and food security scores (1.19, 95% CI 0.93 to 1.45; p < 0.001) on total dietary habit scores was found. Future extensive population studies are recommended to help public health authorities frame actions to alleviate the impact that mandated quarantine has on dietary habits.

The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey

BACKGROUND AND AIMS

A national lockdown to prevent the spread of coronavirus disease (COVID-19) in Turkey was introduced in March 2020. We think that lockdowns may lead to weight gain and worsening of glycemic parameters in patients with type 2 diabetes mellitus (DM). The purpose of this study was to investigate how type 2 DM patients were affected by the lockdown.

METHOD

Type 2 DM patients unable to attend regular follow-ups due to lockdown over a 75-day period between March and June 2020 and who again attended polyclinic follow-up when the lockdown was lifted were included in the study. These patients' glycemic control and weight status were compared with the pre-lockdown period. In addition, patients' general habits, and adherence to diet and exercise were evaluated, while their general health was assessed using the Short-Form 36-item survey.

RESULT

The research involved 101 type 2 DM patients, 57 men (56.5%) and 44 women (44.5%), with a mean age of 55 ± 13. Patients' mean pre-lockdown weight was 84.7 ± 16.4 kg, rising to 85.5 ± 16.8 kg post-lockdown, although the increase was not statistically significant (p = 0.781). In terms of glycemic parameters, Hba1c rose from 7.67 ± 1.76 to 8.11 ± 2.48, and fasting glucose from 157.9 (83-645) mg/dl to 163.2 (84-550) mg/dl, none of which were statistically significant (p = 0.253, p = 0.079, respectively).

CONCLUSION

In addition to weight gain among type 2 DM patients during the Covid 19 lockdown, statistically insignificant increases were also observed in such glycemic parameters. This was a small sample and further studies with larger sample are needed.

Associations between Changes in Health Behaviours and Body Weight during the COVID-19 Quarantine in Lithuania: The Lithuanian COVIDiet Study

The COVID-19 quarantine has caused significant changes in everyday life. This study aimed to evaluate the effect of the quarantine on dietary, physical activity and alcohol consumption habits of Lithuanians and the association between health behaviours and weight changes. An online cross-sectional survey was carried out among individuals older than 18 years in April 2020. The self-administered questionnaire included health behaviour and weight change data. Altogether 2447 subjects participated in the survey. Almost half of the respondents (49.4%) ate more than usual, 45.1% increased snacking, and 62.1% cooked at home more often. Intake of carbonated or sugary drinks, fast food and commercial pastries decreased, while consumption of homemade pastries and fried food increased. A decrease in physical activity was reported by 60.6% of respondents. Every third (31.5%) respondent, more often those already with overweight, gained weight. Multivariate logistic regression analysis showed that the higher odds of weight gain were associated with females, older age, increased consumption of sugary drinks, homemade pastries and fried food, eating more than usual, increased snacking, decreased physical activity and increased alcohol consumption. Our data highlighted the need for dietary and physical activity guidelines to prevent weight gain during the period of self-isolation, especially targeting those with overweight and obesity.