The impact of COVID-19 on diet quality, food security and nutrition in low and middle income countries: A systematic review of the evidence

The prevalence of overweight among 4-year-olds during and after the COVID-19 pandemic was associated with socioeconomic burden

AIM

To assess the prevalence of overweight among Swedish 4 year olds in 2018, 2020 and 2022, taking socioeconomic variables into account.

METHODS

Aggregated regional data on children's body mass index were collected. The socioeconomic Care Need Index (CNI), foreign background, low education, being a single parent, low income and childhood poverty, were assessed. The differences in overweight, including obesity, were tested for Sweden and for regions.

RESULTS

Data were available for 303 843 children, representing 87% of children born in 2014, 2016 and 2018. Overweight or obesity were found in 11 177 (11.4%) of children in 2022, decreasing from 2020 (13.3%, p < 0.001) but at the same level as in 2018. Regional low CNI, low level of foreign background, education and income as well as being a single parent were associated with a higher prevalence of overweight or obesity in all cohorts (p < 0.001). In regions with high levels of childhood poverty, overweight or obesity were more prevalent during (p = 0.009) and after the pandemic (p < 0.001).

CONCLUSION

Three national cohorts demonstrate that the increase in overweight during the COVID-19 pandemic has returned to pre-pandemic levels, but the inequalities in health associated with socioeconomic vulnerability of the regions remained.

A qualitative exploration of the COVID-19 pandemic on health and nutrition behaviours during the first 1000 days in Sri Lanka

This study sought to understand reported impacts of the COVID-19 pandemic on maternal and child health and nutrition behaviours during the first 1000 days of life. This qualitative and participatory substudy was embedded within mixed methods formative research conducted during 2020-2022 across two urban, three rural and one estate sector site in Sri Lanka. Semi-structured interviews among caregivers of children aged 6-23 months (n = 34), influencers of caregivers, such as health workers (n = 37), leaders (n = 10) and pregnant women (n = 20) were conducted. Participatory workshops (n = 14) triangulated interview findings. Interview data were analyzed to identify salient themes using Dedoose. Numerical data from voting conducted in workshops were summed and triangulated with interview data. Findings suggest that the COVID-19 pandemic and imposed restrictions shaped maternal and child health and nutrition behaviours through a complex interplay of factors. Imposed restrictions and changes to the food system contributed to temporary unemployment for wage workers and reduced purchasing power to maintain food security for vulnerable households. While deciding whether to seek care, fears of infection prevented usual care-seeking decisions. Also, reduced incomes and disrupted public transportation made transport to health care facilities for antenatal care services difficult. Once women reached facilities, medical services and quality of care were negatively impacted. Implementing expanded community-based services during home visits focused on the first 1000 days and beyond was one effective strategy to maintain maternal and child health and nutrition during the early pandemic in Sri Lanka.

Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial

BACKGROUND

Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction.

METHODS

DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality.

RESULTS

After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study.

CONCLUSION

Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259-8105.

Food Insecurity and Nutritional Inadequacy in Children and Adolescents of Basic Education Schools of Cantagalo District in São Tomé and Príncipe, Central Africa

Food insecurity (FI) is a critical socioeconomic and public health problem globally, particularly affecting children's nutritional status and development. This cross-sectional study aimed to assess the prevalence of nutritional inadequacy among children and adolescents in the Cantagalo district of São Tomé and Príncipe (STP), in Central Africa. It also assessed their households' FI situation and examined sociodemographic, anthropometric, and nutritional characteristics associated with severe FI. Data included 546 children/adolescents (51.8% males, aged 9-15 years) from the eight public basic education schools. A structured questionnaire provided sociodemographic data, while anthropometric measurements assessed nutritional status. Dietary intake data were gathered using a single 24 h dietary recall, and the adjusted prevalences of nutritional inadequacy were obtained using version 2.0 of the PC-Software for Intake Distribution Estimation (PC-SIDE®). The Household Food Insecurity Access Scale was used to assess FI, and households were classified as severely or non-severely food insecure. Multivariable binary logistic regression models adjusted for potential confounders identified factors related to FI. Children's/adolescents' thinness was exhibited in 34.1% of participants, and over 95% had inadequate intake of essential micronutrients, including iron. Notably, 73.7% were severely food insecure. A higher severity of FI was positively associated with a lower intake of iron and certain household head characteristics, such as being female or older, and negatively associated with having a home garden.

Soy Peptide Supplementation Mitigates Undernutrition through Reprogramming Hepatic Metabolism in a Novel Undernourished Non-Human Primate Model

In spite of recent advances in the field of undernutrition, current dietary therapy relying on the supply of high protein high calorie formulas is still plagued with transient recovery of impaired organs resulting in significant relapse of cases. This is partly attributed to the inadequacy of current research models in recapitulating clinical undernutrition for mechanistic exploration. Using 1636 Macaca fascicularis monkeys, a human-relevant criterion for determining undernutrition weight-for-age z-score (WAZ), with a cutoff point of ≤ -1.83 is established as the benchmark for identifying undernourished nonhuman primates (U-NHPs). In U-NHPs, pathological anomalies in multi-organs are revealed. In particular, severe dysregulation of hepatic lipid metabolism characterized by impaired fatty acid oxidation due to mitochondria dysfunction, but unlikely peroxisome disorder, is identified as the anchor metabolic aberration in U-NHPs. Mitochondria dysfunction is typified by reduced mito-number, accumulated long-chain fatty acids, and disruption of OXPHOS complexes. Soy peptide-treated U-NHPs increase in WAZ scores, in addition to attenuated mitochondria dysfunction and restored OXPHOS complex levels. Herein, innovative criteria for identifying U-NHPs are developed, and unknown molecular mechanisms of undernutrition are revealed hitherto, and it is further proved that soypeptide supplementation reprogramed mitochondrial function to re-establish lipid metabolism balance and mitigated undernutrition.

'Whatever we have is what we eat': How marginalised urban populations in the Philippines and Thailand experienced their food environments, food security and diets through COVID-19

This qualitative cross-country comparative study investigated the lived experience of marginalised urban populations (unemployed, daily wage earners/street vendors, and internal/external migrants) in Manila (Philippines) and Bangkok (Thailand) on food environments, food security and diets during COVID-19. Semi-structured interviews were conducted with individuals (n = 59) in April-May 2022. Thematic analysis revealed loss of income and strict mobility restrictions (Philippines) as key drivers of dietary changes and hunger. Common narratives included financial hardship, loss of personal agency, and daily survival. Coping strategies included drawing on social networks, cash and food aid, and 'scheming' around restrictions. Contextualised crisis policy planning should explicitly consider the lived experience of marginalised populations for future shocks.

Analysis of anthropometric outcomes in Indian children during the COVID-19 pandemic using National Family Health Survey data

BACKGROUND

Disruptions in food, health, and economic systems during the COVID-19 pandemic may have adversely affected child health. There is currently limited research on the potential effects of the COVID-19 pandemic on stunting, wasting, and underweight status of young children.

METHODS

We examine the short-term associations between the pandemic and anthropometric outcomes of under-5 children (n = 232,920) in India, using data from the National Family Health Survey (2019-2021). Children surveyed after March 2020 are considered as the post-COVID group, while those surveyed earlier are considered as pre-COVID. Potential biases arising from differences in socioeconomic characteristics of the two groups are mitigated using propensity score matching methods.

RESULTS

Post-COVID children surveyed in 2020 and 2021 have 1.2% higher underweight rates, 1.2% lower wasting rates, 0.1 lower height-for-age z-scores (HAZ), and 0.04 lower weight-for-height z-scores as compared with matched pre-COVID children. Post-COVID children surveyed in 2020 have 1.6%, 4.6%, and 2.4% higher stunting, underweight, and wasting rates, respectively, and 0.07 lower HAZ, as compared with matched pre-COVID children. Reductions in nutritional status are largest among children from households in the poorest wealth quintiles.

CONCLUSIONS

These findings indicate a trend towards a recovery in child anthropometric outcomes in 2021 after the initial post-pandemic reductions. The resilience of health and food systems to shocks such as COVID-19 should be strengthened while immediate investments are required to decrease child malnutrition and improve broader child health outcomes.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension.

METHODS

NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up.

RESULTS

In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes.

CONCLUSION

There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Food Resource Management and Healthy Eating Focus Associates with Diet Quality and Health Behaviors in Low-Income Adults

Nutrition education and food resource management (FRM) can assist food-insecure individuals in acquiring healthy and affordable food. We aimed to assess the relationships between FRM skills and healthy eating focus with diet quality and health-related behaviors in low-income adults during the COVID-19 pandemic. This cross-sectional study was conducted using an online survey of 276 low-income adults living in a low-food-access community in Northeast Connecticut. Through analysis of covariance, adults who usually or always had a meal plan, considered reading nutrition labels important, made a grocery list, were concerned about their food healthiness, and rated their diet quality as very good/excellent reported higher diet quality (frequency-based and liking-based scores) (p < 0.05 for all). Individuals who considered reading food labels very important and reported having a good diet reported less frequent pandemic-related unhealthy behaviors (consumption of candy and snack chips, soda or sugary drinks, weight gain, smoking) (p < 0.001). Furthermore, higher-frequency-based diet quality was associated with lower risk of overweight or obesity (OR: 0.37; 95% CI: 0.18, 0.76; p-trend < 0.01). Thus, FRM skills and healthy eating focus were associated with higher diet quality and healthier self-reported changes in diet, weight, and smoking behaviors during the pandemic.

Evidence for Policies and Practices to Address Global Food Insecurity

Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability, imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale.

Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico

BACKGROUND

The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic.

RESEARCH DESIGN AND METHODS

A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated.

RESULTS

A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%).

CONCLUSIONS

A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.

The effects of COVID-19 on agriculture supply chain, food security, and environment: a review

COVID-19 has a deep impact on the economic, environmental, and social life of the global population. Particularly, it disturbed the entire agriculture supply chain due to a shortage of labor, travel restrictions, and changes in demand during lockdowns. Consequently, the world population faced food insecurity due to a reduction in food production and booming food prices. Low-income households face food security challenges because of limited income generation during the pandemic. Thus, there is a need to understand comprehensive strategies to meet the complex challenges faced by the food industry and marginalized people in developing countries. This research is intended to review the agricultural supply chain, global food security, and environmental dynamics of COVID-19 by exploring the most significant literature in this domain. Due to lockdowns and reduced industrial production, positive environmental effects are achieved through improved air and water quality and reduced noise pollution globally. However, negative environmental effects emerged due to increasing medical waste, packaging waste, and plastic pollution due to disruptions in recycling operations. There is extensive literature on the effects of COVID-19 on the environment and food security. This study is an effort to review the existing literature to understand the net effects of the pandemic on the environment and food security. The literature suggested adopting innovative policies and strategies to protect the global food supply chain and achieve economic recovery with environmental sustainability. For instance, food productivity should be increased by using modern agriculture technologies to ensure food security. The government should provide food to vulnerable populations during the pandemic. Trade restrictions should be removed for food trade to improve international collaboration for food security. On the environmental side, the government should increase recycling plants during the pandemic to control waste and plastic pollution.

Impact of the second wave of COVID-19 pandemic on food security among Ho indigenous community of Jharkhand, India

Background

Food insecurity and hunger are global concerns further exacerbated by the unprecedented COVID-19 pandemic. There is a need to understand the depth of this impact, especially among smallholder farmers, and recognize specific coping strategies that offered resilience to inform preparedness in future. The present cross-sectional study assessed the impact of the second wave of COVID-19 pandemic on different dimensions of food security among smallholder farmers of Ho indigenous community of Jharkhand, India. It also explored potential resilient attributes of their food systems.

Results

Most of the respondents (67.2%) reported reduced food consumption at the household (HH) level. Majority faced difficulty in accessing food from different food sources; however, easier access to government food security programmes was highlighted. Around 40% reported change in their ability to purchase farming inputs. Market vendors reported disruptions in food procurement owing to travel restrictions; however, no change was reported for home-produced foods in agricultural lands/kitchen gardens. Prices of indigenous foods produced locally decreased/remained same; however, for cereals, pulses, and other HH staples, prices increased during second wave. Difficulty in accessing wild food environment (OR: 1.7, CI 0.40, 7.75), change in food prices (OR: 19.9, CI 5.25, 76.02), decrease in HH income (OR: 9.2, CI 2.99, 28.60) were found to be significantly associated with reduction in HH food consumption (p < 0.01). The coping strategies adopted by the community included sale of cultivated and wild produce in local weekly markets to ensure additional income.

Conclusions

The findings highlight the need to reinforce the traditional ecological knowledge of the Ho community and focus on practices around their food systems, engrained into their socio-cultural ecosystems that may offer resilience against future stresses. In addition, the need of systemic support to ensure the social and economic well-being of the community needs to be prioritized.

Three years into the pandemic: Insights of the COVID-19 impacts on food security and nutrition in low and middle-income countries

The COVID-19 pandemic triggered a global crisis with unanticipated and diverse consequences. Moreover, the pandemic has considerably impacted food dynamics in low- and middle-income countries (LMICs), where food systems have already been challenged. These countries also have the highest share of the world's malnourished and food insecure. Therefore, this paper aims to analyze the pandemic's impact on food security dimensions (availability, accessibility, utilization, and stability), with a special emphasis on LMICs. According to the results, the pandemic immediately impacted food security by limiting food production and availability. It also had an indirect impact when lockdowns and other confinement measures (e.g., social distancing, movement restrictions) made it more difficult for individuals to access food and maintain a healthy, balanced diet (cf. food utilization). Indeed, with rising unemployment and poverty, access to food has been the most critically undermined aspect of food security. At the utilization level, COVID-19 adversely influences the nutritional state of both individuals and countries, leading to an increase in all forms of malnutrition. Finally, the impact of COVID-19 on the stability dimension is dependent on the length of the pandemic as well as the effectiveness with which recovery plans are followed to ensure universal vaccine availability, among other factors. As a result, including agricultural and food systems in recovery strategies is crucial to mitigating the pandemic's long-term effects on food security.

Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial

BACKGROUND

The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care.

OBJECTIVE

This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers.

METHODS

Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ≤3% weight gain in each arm at 24 months after randomization-our primary outcome-using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point.

RESULTS

We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non-Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ≤3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI -4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI -12.1 to 11.0 percentage points).

CONCLUSIONS

In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-019-6926-7.

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

A Qualitative Investigation on Chronic Disease Management and Prevention Among Older Adults During the COVID-19 Pandemic

PURPOSE

To qualitatively describe experiences of chronic disease management and prevention in older adults (age ≥65 years) during COVID-19.

APPROACH

Qualitative descriptive approach.

SETTING

Data collected online via telephone and video-conferencing technologies to participants located in various cities in British Columbia, Canada. Data analyzed by researchers in the cities of Vancouver and Kelowna in British Columbia.

PARTICIPANTS

Twenty-four community-living older adults (n = 24) age ≥65 years.

METHODS

Each participant was invited to complete a 30-to-45-minute virtual, semi-structured, one-on-one interview with a trained interviewer. Interview questions focused on experiences managing health prior to COVID-19 and transitioning experiences of practicing health management and prevention strategies during COVID-19. Audio recordings of interviews were transcribed verbatim and analyzed thematically.

RESULTS

The sample's mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (12.5% none, 12.5% one). Three themes described participants' strategies for chronic disease management and prevention: (1) having a purpose to optimize health (i.e., managing health challenges and maintaining independence); (2) internal self-control strategies (i.e., self-accountability and adaptability); and (3) external support strategies (i.e., informational support, motivational support, and emotional support).

CONCLUSION

Helping older adults identify purposes for their own health management, developing internal control strategies, and optimizing social support opportunities may be important person-centred strategies for chronic disease management and prevention during unprecedented times like COVID-19.

The spatial effects of the household's food insecurity levels in Ethiopia: by ordinal geo-additive model

Background

Food insecurity and vulnerability in Ethiopia are historical problems due to natural- and human-made disasters, which affect a wide range of areas at a higher magnitude with adverse effects on the overall health of households. In Ethiopia, the problem is wider with higher magnitude. Moreover, this geographical distribution of this challenge remains unexplored regarding the effects of cultures and shocks, despite previous case studies suggesting the effects of shocks and other factors. Hence, this study aims to assess the geographic distribution of corrected-food insecurity levels (FCSL) across zones and explore the comprehensive effects of diverse factors on each level of a household's food insecurity.

Method

This study analyzes three-term household-based panel data for years 2012, 2014, and 2016 with a total sample size of 11505 covering the all regional states of the country. An extended additive model, with empirical Bayes estimation by modeling both structured spatial effects using Markov random field or tensor product and unstructured effects using Gaussian, was adopted to assess the spatial distribution of FCSL across zones and to further explore the comprehensive effect of geographic, environmental, and socioeconomic factors on the locally adjusted measure.

Result

Despite a chronological decline, a substantial portion of Ethiopian households remains food insecure (25%) and vulnerable (27.08%). The Markov random field (MRF) model is the best fit based on GVC, revealing that 90.04% of the total variation is explained by the spatial effects. Most of the northern and south-western areas and south-east and north-west areas are hot spot zones of food insecurity and vulnerability in the country. Moreover, factors such as education, urbanization, having a job, fertilizer usage in cropping, sanitation, and farming livestock and crops have a significant influence on reducing a household's probability of being at higher food insecurity levels (insecurity and vulnerability), whereas shocks occurrence and small land size ownership have worsened it.

Conclusion

Chronically food insecure zones showed a strong cluster in the northern and south-western areas of the country, even though higher levels of household food insecurity in Ethiopia have shown a declining trend over the years. Therefore, in these areas, interventions addressing spatial structure factors, particularly urbanization, education, early marriage control, and job creation, along with controlling conflict and drought effect by food aid and selected coping strategies, and performing integrated farming by conserving land and the environment of zones can help to reduce a household's probability of being at higher food insecurity levels.

Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper

INTRODUCTION

The COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where insults acting on maternal environment have far-reaching consequences, the pandemic has had a significant impact on prenatal outcomes, intrauterine and postnatal development of infants. This research will investigate both the direct and indirect impacts of the COVID-19 pandemic during pregnancy on prenatal outcomes, growth and development in early childhood.

METHODS AND ANALYSIS

Community and hospital data in Hyderabad and Gujarat, India will be used to recruit women who were pregnant during the COVID-19 pandemic and contracted SARS-CoV-2 infection. In comparison with women who were pregnant around the same time and did not contract the virus, the study will investigate the impact of the pandemic on access to healthcare, diet, nutrition, mental health and prenatal outcomes in 712 women (356 per study arm). Children born to the women will be followed prospectively for an 18-month period to investigate the impact of the pandemic on nutrition, health, growth and neurocognition in early childhood.

ETHICS AND DISSEMINATION

Ethics approval was granted from the institutional ethics committees of the Indian Institute of Public Health Gandhinagar (SHSRC/2021/2185), Indian Council of Medical Research-National Institute of Nutrition (EC/NEW/INST/2021/1206), and London School of Hygiene and Tropical Medicine (72848). The findings of the study will be disseminated to policy and research communities through engagements, scientific conferences, seminars, and open-access, peer-reviewed publication.

Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output

Background

In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries.

Methods

The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals.

Results

Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences.

Conclusions

Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia

INTRODUCTION

Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs.

METHODS

We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period.

RESULTS

Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period.

CONCLUSION

The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A.

Effect of a Center-Based Early Childhood Care and Education Program on Child Nutritional Status: A Secondary Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial in Rural Sindh, Pakistan

BACKGROUND

High-quality early childhood care and education (ECCE) programs can positively impact children's development. However, as an unintended consequence, ECCE attendance may also affect children's nutritional status.

OBJECTIVE

We evaluated the effect of a center-based ECCE intervention on child nutritional outcomes in rural Pakistan.

METHODS

This study utilized data from a stepped-wedge cluster randomized controlled trial of a center-based ECCE program that trained female youth to run high-quality preschools for children aged 3.5-5.5 y (Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) program) in rural Sindh, Pakistan. The program did not include any school meals. A total of 99 village clusters were randomized to receive the LEAPS intervention in 3 steps, and repeated cross-sectional surveys were conducted to assess the impact on children (age: 4.5-5.5 y) at 4- time points. ITT analyses with multilevel mixed-effect models were used to estimate the effect of the intervention on child anthropometric outcomes.

RESULTS

The analysis included 3858 children with anthropometric data from 4 cross-sectional survey rounds. The LEAPS intervention was found to have a positive effect on child height-for-age z score (mean difference: 0.13 z-scores; 95% confidence interval [CI]: 0.02, 0.24). However, there was a negative effect on weight-based anthropometric indicators, -0.29 weight-for-height z score (WHZ) (95% CI: -0.42, -0.15), -0.13 BMI z score (BMIZ) (95% CI: -0.23, -0.03), and -0.16 mid-upper arm circumference-for-age z score MUACZ (95% CI: -0.25, -0.05). An exploratory analysis suggested that the magnitude of the negative effect of LEAPS on WHZ, BMIZ, and weight-for-age z score (WAZ) was greater in the survey round during the COVID-19 lockdown.

DISCUSSION

The LEAPS intervention positively affected child linear growth but had negative effects on multiple weight-based anthropometric measures. ECCE programs in low- and middle-income country settings should evaluate the integration of nutrition-specific interventions (eg school lunch, counseling on healthy diets) and infection control strategies to promote children's healthy growth and development.

CLINICAL TRIAL REGISTRY

clinicaltrials.gov, NCT03764436, https://clinicaltrials.gov/ct2/show/NCT03764436.

Prevalence of food insecurity amid COVID-19 lockdowns and sociodemographic indicators of household vulnerability in Harar and Kersa, Ethiopia

BACKGROUND

The COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in resource-limited countries, we examine food insecurity during the pandemic period.

METHODS

We conducted a cross-sectional study and used logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. The study is set in two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and included a random sample of 880 households.

RESULTS

Roughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income.

CONCLUSIONS

After taking individual and household level sociodemographic characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings suggest a need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.

Effect of Gut Microbiota-Directed Complementary Food Supplementation on Fecal and Plasma Biomarkers of Gut Health and Environmental Enteric Dysfunction in Slum-Dwelling Children with Moderate Acute Malnutrition

Dietary supplementation with a gut microbiota-directed complementary food (MDCF-2) significantly improved weight gain and repaired gut microbiota, as reported in a recent randomized controlled trial on Bangladeshi children with moderate acute malnutrition (MAM). Environmental enteric dysfunction (EED) is a small bowel disorder, and recent evidence shows that it is linked to growth failure in children. Therefore, we intended to investigate whether supplementation with MDCF-2 has any role in modifying gut health by changing the levels of biomarkers of EED and gut inflammation in children with MAM. We randomly assigned 124 children aged 12-18 months to one of two intervention diets, either MDCF-2 or ready-to-use supplementary food (RUSF). Approximately 50 g of the diet was administered in two feeding sessions daily for 12 weeks. Stool and plasma biomarkers were assessed to evaluate intestinal health. Results showed that the average change in citrulline concentration (µmol/L) significantly increased among children who consumed MDCF-2 compared to those who consumed RUSF (mean difference-in-differences: 123.10; 95% CI: 3.60, 242.61; p = 0.044). The research findings demonstrated that MDCF-2 might have a beneficial effect on improving the gastrointestinal health of malnourished children.

Food Insecurity and Perceived Effects of COVID-19 on Livelihoods in Rural Sri Lanka

BACKGROUND

Little is known about how the COVID-19 pandemic has affected food security and livelihoods in Sri Lanka.

OBJECTIVE

This article aims to assess food insecurity, perceived effects of COVID-19, and coping mechanisms among agriculture-based households in rural Sri Lanka.

METHODS

We used 2 rounds of panel data from phone surveys (n = 1057 households) conducted in 5 districts. Food insecurity (30-day recall), perceived impacts of COVID-19 (6-month recall), and coping mechanisms (6-month recall) were assessed using a household questionnaire. To assess food insecurity, we used the 8-item Food Insecurity Experience Scale. We tested for differences between T1 (baseline: December 2020-February 2021) and T2 (follow-up: July 2021-September 2021) and explored the association between food insecurity and the perceived effect of COVID-19 on income using a logistic regression model.

RESULTS

Food insecurity was highly prevalent (T1: 75%, T2: 80%) but varied across districts. Most respondents were affected by COVID-19 and/or COVID-19-associated mitigation measures (T1: 84%, T2: 89%). Among affected households, commonly reported impacts included those on income (T1: 77%, T2: 76%), food costs (T1: 84%, T2: 83%), and travel (∼90% in both rounds). Agricultural activities were also adversely affected (T1: 64%, T2: 69%). About half of COVID-19-affected households reported selling livestock or assets to meet basic needs. Households whose income was impacted by COVID-19 were more likely to be food insecure (adjusted odds ratio: 2.56, P < .001).

CONCLUSIONS

Households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic. Additional surveys are needed to assess recovery post-COVID-19 and to understand if programs that support livelihoods have been protective.

A systematic review of the direct and indirect COVID-19's impact on food security and its dimensions: pre-and post-comparative analysis

BACKGROUND

Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and to identify which, if any, food security dimensions were specifically compromised.

METHODS

Primary research articles were initially identified through four online databases (Scopus, PubMed, Google Scholar, and Web of Science), with the references of each paper then also reviewed for additional article. The food security status of individuals and the wider community, both before and after the emergence of COVID-19, were examined.

RESULTS

Of the 2,057 studies initially identified, a total of ten were included in the final review. The included studies confirmed that COVID-19 had substantially impacted food security, with individuals, households and the wider community experiencing food insecurity. Nine of the included studies aruged that the food accessibility dimension was the most compromised.

CONCLUSION

To address the identified direct and indirect food security issues associated with COVID-19, it is proposed that a combination of prevention practices and proactive food security activities is required. Integrating food security interventions, supporting and facilitating food security resilience, and conducting further studies on the food security of COVID-19 are also recommended.

Nutrition transition, double burden of malnutrition, and urbanization patterns in secondary cities of Bangladesh, Kenya and Rwanda

BACKGROUND

By 2050, approximately 68% of the global population will live in cities, but nutrition data on urban populations of low- and middle-income countries are scarce. Fast growing secondary cities, combining characteristics and hurdles of urban and rural settings, are hotspots for the double burden of malnutrition. The Nutrition in City Ecosystems (NICE) project focuses on 6 secondary cities in Bangladesh, Kenya and Rwanda, to improve health and nutrition, and reduce poverty. To assess the baseline situation and guide future interventions, food insecurity, dietary diversity, nutrition status, and food production and purchasing patterns were explored.

METHODS

In a cross-sectional study design, data were collected from urban and peri-urban households of Dinajpur and Rangpur in Bangladesh, Bungoma and Busia in Kenya, and Rubavu and Rusizi in Rwanda. Approximately 1200 households, in neighborhoods prone to malnutrition, were involved from April to June 2021. We assessed Household Food Insecurity Access Score (HFIAS), both current and before COVID-19, Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity for Women (MDD-W), anthropometric measurements, household and socioeconomic information, and questions related to food production and consumer behavior. Further we collected secondary data on low birthweight and anemia during pregnancy.

RESULTS

All cities experienced a substantial increase in food insecurity during the COVID-19 pandemic. Stunting rates in children under 5 years varied among the cities and ranged from 7.8% in Busia to 46.6% in Rubavu, while half of adult women were overweight (between 42.1% in Rusizi and 55.8% in Bungoma). Furthermore, many women did not consume an adequately diverse diet (MDD-W < 5 for 29.3% in Bangladesh, 47.5% in Kenya, and 67.0% in Rwanda), however many of the urban and peri-urban households were engaged in farming (58-78%).

CONCLUSIONS

The double burden of malnutrition is high in secondary cities and the COVID-19 pandemic has exacerbated levels of food insecurity. Demand for, and access to, an affordable healthy diverse diet that comprises local, nutritious, and agroecologically produced foods present a pathway for overcoming the complex challenges of malnutrition.

Household food security access and dietary diversity amidst COVID-19 pandemic in rural Nepal; an evidence from rapid assessment

BACKGROUND

The COVID-19 pandemic led to surging concerns about food insecurity status throughout the world. In response to global and national concerns on food and nutrition security, this study aimed to examine the prevalence and determining factors of household food insecurity and dietary diversity among people from selected rural municipalities of Lalitpur district, Nepal.

METHODS

A community-based cross-sectional study was conducted among 432 households. Pretested structured questionnaires were used to collect socio-demographic characteristics of the participants, household income; influence of COVID-19 on their income and livelihood, household's access to food and dietary diversity. Food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) and the Household Dietary Diversity Score (HDDS). A multivariable analysis was done using binary logistic regression model following a bivariate analysis to assess the association between the dependent and independent variables.

RESULTS

More than one-third (36%) of the households reported some form of food insecurity. The overall mean score for Household Dietary Diversity Score (HDDS) was 6.0 (±1.1). Multivariable logistic regression analysis showed that participants aged 41-64 years (aOR = 0.35, 95% CI: 0.21-0.59), those over 64 years (aOR = 0.22, 95% CI: 0.07-0.66), as well as those in service occupation (aOR = 0.22, 95% CI: 0.06-0.77) were associated with lower odds of HFIAS. Conversely, Participants belonging to a disadvantaged ethnic group (aOR = 2.73, 95% CI: 1.23-6.07), having no education (aOR = 3.70, 95% CI: 1.16-11.71) or primary education (aOR = 3.67, 95% CI: 1.23-9.89), and those suffering from chronic illness (aOR = 3.12, 95% CI: 1.53-6.35) were associated with higher odds of HFIAS. As for HDDS, participants aged 41-64 years (aOR = 0.48, 95% CI: 0.28-0.83) were associated with lower odds of HDDS, while participants having no education (aOR = 10.05, 95% CI: 4.05-24.01) were associated with significantly higher odds of HDDS.

CONCLUSION

Owing to the pandemic, our study showed a substantial prevalence of food insecurity among diverse community residing in rural outskirts of Kathmandu Valley, particularly among disadvantaged ethnic group and people with lower level of education. Interventions targeting these particular groups may help in improving HFIAS and HDDS among them during emergencies.

Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia

BACKGROUND

COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships.

METHODS

We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia.

RESULTS

Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships.

CONCLUSIONS

Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks.

Trajectories of child growth, child development, and home child-rearing quality during the Covid pandemic in rural Nepal

BACKGROUND

Children, especially disadvantaged children in poor countries, were expected to be among the "biggest victims" of the Covid pandemic. Economic burdens, decreased nutritious foods, reduced medical care, school closures, and ill-health or death of family members were predicted to increase child undernutrition and developmental delays, and diminish home child-rearing quality.

METHODS

A planned nutrition intervention could not be implemented due to Covid restrictions. However, three surveys (pre-Covid [December 2019], July 2021, and September 2021) in 280 Nepali households (309 parent-dyads, 368 children, 6-66 months old) collected demographics, child anthropometry and development (Ages and Stages Questionnaire-3 [ASQ-3]), and home child-rearing quality (caregiver engagement, learning resources, adult supervision [UNICEF's Multiple Indicator Cluster Survey]). Mixed-effect regression models adjusted for household (wealth, maternal education) and child factors (age, gender) and survey round.

RESULTS

Height, mid-upper-arm circumference, and head circumference measurements improved over time. The total ASQ-3 score did not change: Communication scores increased while fine motor and personal-social scores declined. Girls' growth and development worsened more than boys. Caregiver engagement (especially mothers') generally declined, but learning resource availability increased. More children were left unsupervised at Round 2 than Round 1 or 3.

CONCLUSIONS

In this sample, some aspects of child growth, development, and home child-rearing quality improved while others declined. Better understanding of these changes in child well-being and the family environment during the pandemic could provide insight on how to protect children during future crises.

Food Insecurity: Is Leagility a Potential Remedy?

In the wake of the COVID-19 pandemic, and Ukraine-Russian conflict, both significant geo-political and socio-economic shocks to the global food system and food insecurity has risen across the world. One potential remedy to reduce the level of food insecurity is to move from a lean just-in-time food system to one where there is more resilience through greater agility both in routine supply operations and also in the event of an emergency situation. The aim of this critical perspectives paper was to firstly reflect on the concepts of lean, agility, and 'leagility'. Then, this study considered the ability of individual organisations and the whole food system to be resilient, adaptive, enable the elimination of waste, reduce inefficiency, and assure the consistent delivery to market requirements in terms of both volume, safety, and quality. Promoting the concept of leagility together with advocating resilient, sustainable practices that embed buffer and adaptive capacity, this paper positions that increasing digitalisation and improving business continuity planning can ensure effective operationalisation of supply chains under both normal and crisis situations, ultimately reducing the risk of food insecurity at personal, household, and community levels.

Sustainable transformation agenda for enhanced global food and nutrition security: a narrative review

The world's population is currently growing at an exponential rate, which is estimated to be over 8 billion inhabitants as reported by United Nations on November 15, 2022. According to FAO, 870 million people out of this population do not have enough food to eat, with the vast majority of hungry people (98%) living in developing countries, where almost 15% of the population is undernourished. Furthermore, the world's population is estimated to come to 9 billion by 2050, which would incur severe food scarcity and would seriously hamper global food security. Food losses, especially post-harvest loss as a result of poor agricultural practices have also been reported to greatly impact the economy, the environment, and the livelihoods of low and medium countries and Sub-Saharan-African. Therefore, realistic options should be established for promoting sustainable agriculture systems, improving nutrition, and achieving food security to end hunger in our nations. This paper elucidates the drivers of food insecurity including food losses, escalating population growth, hunger, and food production, among others, and provided some transformation approaches such as value addition through appropriate and emerging food processing and preservation techniques, application of biotechnological options through genetically modified foods and functional foods consumption and integration of indigenous underutilized nutrient-dense food crops which could serve as all-inclusive and sustainable transformation options for enhanced food and nutrition security, especially in developing countries, which is where the hunger burden and the prevalence of malnutrition and non-communicable diseases are high.

Cost and affordability of a healthy diet for urban populations in Thailand and the Philippines before and during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic severely affected global food security, but analyses of its impact on the cost and affordability of a healthy diet are limited. This study examines the immediate effect of the COVID-19 pandemic on the cost and affordability of a healthy diet among urban households in Bangkok, Thailand and Manila, the Philippines.

METHODS

We used official food price and household income and food expenditure data from the national statistics offices. The cost of recommended diet (CoRD) method was employed to assess the minimum cost of a healthy diet, following the healthy diet recommendations provided in the national food-based dietary guidelines of the specific countries. Regression discontinuity design was estimated to determine the COVID-19 effect on food prices and scenario analysis done to determine the effect of reduced food budgets with and without government relief programs.

RESULTS

The results show that the average cost of the recommended diet was US$ 1.55 per person/day in Bangkok and US$ 3.76 in Manila (2019 prices in purchasing power parities) immediately before the pandemic. This diet is generally affordable for all households in Bangkok, but only for 37% of households (4.98 million people) in Manila, indicating much higher poverty in the latter. The pandemic and associated government measures decreased the cost of the recommended diet with 6.5% in Bangkok (p = 0.001) but not in Manila (p = 0.167). Assuming contractions in people's food budgets of 15-20%, the recommended diet became unaffordable for 0.08-0.12 million people in Bangkok and 6.32-7.73 million people in Manila during the pandemic. Government relief largely compensated for this loss in Bangkok, but relief payments in Manila were not enough to compensate the effect.

CONCLUSION

These results show that the main effect of the COVID-19 pandemic on the affordability of healthy diets was through the effect on reduced incomes of the poor rather than through prices. Government relief measures should target low-income households to give them the means to purchase healthy food items.

Impact of COVID-19 on Micronutrient Adequacy and Dietary Diversity among Women of Reproductive Age from Selected Households in Bangladesh

Women of reproductive age (WRA) are recognized as a nutritionally sensitive demographic that is vulnerable to micronutrient deficiencies. The purpose of this study is to determine the situation and influencing factors of diet diversity and micronutrient adequacy during the pandemic-induced economic lockdown period among women living in a selected area of Bangladesh. Twenty-four-hour dietary recall was used to measure the nutrient intake and also used for constructing the Minimum Dietary Diversity for Women (MDD-W) and nutrient adequacy ratio (NAR). Household food insecurity and coping strategies were also measured. Multivariate logistic regression was carried out to identify the link between potential risk factors and MDD-W. About two-thirds (59.9%) of the study subjects did not meet the MDD-W threshold. The women's total energy and protein consumptions were 1475.1 kcal and 46.3 g, respectively, with the diversified diet group consuming more than the non-diverse diet group. Except for vitamin C, vitamin A, and vitamin D, all micronutrients evaluated in the diversified diet group had significantly higher NAR values than the non-diverse diet group. The mean adequacy ratio (MAR) of the overall reproductive women was 0.468 ± 0.096, and it was significantly associated with MDD-W. Another notable finding is that attainment of minimal diversity was not sufficient to achieve acceptable nutrient adequacy for women, pertaining to their low-quantity intake. In addition to this, household size, women's education, coping strategy, and the MAR were found to be significant determinants of MDD-W in the multivariate logistic regression analysis. The findings of the present study therefore highlight the impending need for interventions that ensure good dietary quality for women even during crisis periods.

Food insecurity in Piura, Peru, in the context of post-earthquake and the COVID-19 pandemic

Introduction

Piura, located in a seismic zone, faces challenges related to food security. The aim of this study was to analyze aspects related to food insecurity in the region following the 6.1-magnitude earthquake that occurred in 2021, within the context of the COVID-19 pandemic.

Methods

A secondary analysis was performed in 177 people exposed to the earthquake in Piura. Food insecurity was assessed with the Household Food Insecurity Access Scale. Its association with insomnia, resilience, anxiety/depressive symptoms, and general variables were determined using generalized linear models.

Results

Food insecurity was observed in 31.1% (95% CI: 24.3-38.4) of participants. This prevalence was higher in people with mild (PR: 1.73, 95% CI: 1.12-2.70) and moderate (PR: 1.55, 95% CI: 1.09-2.22) anxiety symptoms, severe depressive symptoms (PR: 2.74, 95% CI: 1.24-6.03), and previous exposure to the El Niño Phenomenon (PR: 1.72; 95% CI: 1.06-2.81). An income higher than 5000 Peruvian soles (approximately 1300 US dollars) was associated with a lower prevalence of food insecurity (PR: 0.22, 95% CI: 0.13-0.40).

Conclusions

Overall, three out of 10 individuals experienced food insecurity after the 2021 earthquake in Piura. Food insecurity may be aggravated by mental disorders, previous exposure to the El Niño phenomenon, and the COVID-19 pandemic. Our study contributes to the field by exploring a range of variables related to food insecurity in a unique context: post-earthquake and during the COVID-19 health emergency in Peru. These findings enhance our understanding of food insecurity at the regional level and highlight the need for preventive food security programs in seismic events.

Household food insecurity levels in Ethiopia: quantile regression approach

Introduction

Numerous natural and man-made factors have afflicted Ethiopia, and millions of people have experienced food insecurity. The current cut-points of the WFP food consumption score (FCS) have limitations in measuring the food insecurity level of different feeding patterns due to the diversified culture of the society. The aim of this study is to adapt the WFP food security score cut-points corrected for the different feeding cultures of the society using effect-driven quantile clustering.

Method

The 2012, 2014, and 2016 Ethiopian socio-economic household-based panel data set with a sample size of 3,835 households and 42 variables were used. Longitudinal quantile regression with fixed individual-specific location-shift intercept of the free distribution covariance structure was adopted to identify major indicators that can cluster and level quantiles of the FCS.

Result

Household food insecurity is reduced through time across the quintiles of food security score distribution, mainly in the upper quantiles. The leveling based on effect-driven quantile clustering brings 35.5 and 49 as the FCS cut-points corrected for cultural diversity. This corrected FCS brings wider interval for food insecure households with the same interval range for vulnerable households, where the WFP FCS cut-points under estimate it by 7 score. Education level, employment, fertilizer usage, farming type, agricultural package, infrastructure-related factors, and environmental factors are found to be the significant contributing factors to food security. On the other hand, the age of the head of the household, dependency ratio, shock, and no irrigation in households make significant contributions to food insecurity. Moreover, households living in rural areas and farming crops on small lands are comparatively vulnerable and food insecure.

Conclusion

Measuring food insecurity in Ethiopia using the WFP FCS cut-off points underestimates households' food insecurity levels. Since the WFP FCS cut-points have universality and comparability limitations, there is a need for a universally accepted local threshold, corrected for local factors those resulted in different consumption patterns in the standardization of food security score. Accordingly, the quantile regression approach adjusts the WFP-FCS cut points by adjusting for local situations. Applying WFP cut-points will wrongly assign households on each level, so the proportion of households will be inflated for the security level and underestimated for the insecure level, and the influence of factors can also be wrongly recommended the food security score for the levels. The quantile clustering approach showed that cropping on a small land size would not bring about food security in Ethiopia. This favors the Ethiopian government initiative called integrated farming "ኩታ ገጠም እርሻ" which Ethiopia needs to develop and implement a system that fits and responds to this technology and infrastructure.

The combined consumption of fresh/minimally processed food and ultra-processed food on food insecurity: COVID Inconfidentes, a population-based survey

OBJECTIVE

To investigate whether the combined consumption of fresh/minimally processed and ultra-processed food is associated with food insecurity (FI) during the COVID-19 pandemic.

DESIGN

Cross-sectional observational study was derived from a survey using a population-based search of a complex sample. FI was assessed using the validated Brazilian Food Insecurity Scale. Food consumption was assessed using a qualitative FFQ and the NOVA classification for fresh/minimally processed food and ultra-processed food. A scoring system was used to evaluate combined food consumption according to the extent and purpose of processing, considering the weekly consumption of the two groups (according to the NOVA classification). Higher punctuation reflects worse diet quality (higher consumption of ultra-processed foods and lower consumption of fresh/minimally processed foods). A theoretical causality model was constructed using a directed acyclic graph, and multivariate analysis was performed using Poisson regression to test the association between FI and food consumption.

SETTING

Ouro Preto and Mariana, Brazil, between October and December 2020.

PARTICIPANTS

An epidemiological household survey was conducted with 1753 individuals selected through a stratified and clustered sampling design in three stages.

RESULTS

Those with food consumption scores in the fourth quartile had a 60 % higher prevalence ratio (PR) for FI (PR: 1·60 and 95 % CI: 1·06 - 2·40). Also, the increased consumption of fresh/minimally processed foods and low consumption of ultra-processed foods presented a 45 % lower prevalence ratio of FI (PR: 0·55 and 95 % CI: 0·40 - 0·80).

CONCLUSION

These results indicate an inverse association between FI and diet quality.

Considerations for vaccinating children against COVID-19

COVID-19 vaccines have been introduced in children and adolescents in many countries. However, high levels of community transmission and infection-derived immunity make the decision to introduce COVID-19 vaccination of children in countries yet to do so particularly challenging. For example, other vaccine preventable diseases, including measles and polio, generally have far higher childhood morbidity and mortality in low-income and middle-income countries (LMICs) than COVID-19, and coverage with these vaccines has declined during the pandemic. Many countries are yet to introduce pneumococcal conjugate and rotavirus vaccines for children, which prevent common causes of childhood death, or human papillomavirus vaccine for adolescents. The Pfizer and Moderna COVID-19 vaccines that have been widely tested in children and adolescents have a positive risk-benefit profile. However, the benefit is less compared with other life-saving vaccines in this age group, particularly in LMICs and settings with widespread infection-derived immunity. The resources required for rollout may also pose a considerable challenge in LMICs. In this paper, we describe COVID-19 in children, with a focus on LMICs, and summarise the published literature on safety, efficacy and effectiveness of COVID-19 vaccination in children and adolescents. We highlight the complexity of decision-making regarding COVID-19 vaccination of children now that most of this low-risk population benefit from infection-derived immunity. We emphasise that at-risk groups should be prioritised for COVID-19 vaccination; and that if COVID-19 vaccines are introduced for children, the opportunity should be taken to improve coverage of routine childhood vaccines and preventative healthcare. Additionally, we highlight the paucity of epidemiological data in LMICs, and that for future epidemics, measures need to be taken to ensure equitable access to safe and efficacious vaccines before exposure to infection.

The COVID-19 pandemic and its impacts on diet quality and food prices in sub-Saharan Africa

BACKGROUND

Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress.

OBJECTIVE

This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania.

METHODS

We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19.

RESULTS

Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS.

CONCLUSION

Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.

Resilience and vulnerabilities of urban food environments in the Asia-Pacific region

Rapid urbanisation in the Asia-Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low- and middle-income country cities. This paper aimed to examine: the risks and opportunities for healthy diets for low income populations offered by modernising urban centres; the concept of food deserts in relation to urban food environments in the Asia-Pacific region and how these could be mitigated; and measures to strengthen the resilience of food environments in the region using a case study of the impact of COVID-19 on informal food vendors. Our findings indicate that the dynamic changes in urban food environments in the Asia- Pacific region need to be understood by examining not only modern retail food outlets but also wet markets and informal food outlets, including street foods. Efforts should be made to ensure both modern and traditional outlets provide complementary platforms for convenient, affordable and accessible nutritious foods for urban populations. The resilience of urban food environments to environmental, physical and socio-economic shocks can be strengthened by shortening food supply chains and maximising food production in cities. Support mechanisms targeting urban informal food outlets and street vendors can also strengthen resilience and improve food security. Further research is needed on the impact of urbanising food environments on consumer choices, preferences, diets and health outcomes.

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

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

Impact of the COVID-19 lockdown on household diet diversity in rural Bihar, India: a longitudinal survey

BACKGROUND

The COVID-19 pandemic disrupted livelihoods and diets across the world. This study aimed to assess changes in household diet diversity and food consumption between the pre-COVID-19 period (December 2019-January 2020) and during the lockdown (March-May 2020), and to identify the socio-economic characteristics that determine these changes in rural Bihar, India.

METHODS

Households that had provided their phone numbers in the pre-COVID-19 household survey (n = 1797) were contacted for interviews during the lockdown telephonic survey in a longitudinal survey in two districts (Gaya and Nalanda) in Bihar. In total, 939 households were interviewed. Using data on food consumption from both surveys, 876 households were included in the analysis. Food and Agriculture Organization's household diet diversity score (HDDS) was used to compare diet diversity between the pre-COVID-19 period and during the lockdown. Logistic regression was used to identify factors affecting household diet diversity and food consumption in the study households.

RESULTS

Low diet diversity increased from 51.6% (95% CI 48.3-54.9) to 75.8% (95% CI 73.0-78.6) from the pre-COVID-19 to the lockdown period. Reduced food consumption was reported across all foods with nearly a quarter of the households reporting reduced consumption of fruits (27%), pulses (25%) and cereals (21%). Nearly 60% and above reported stopping consumption of nutrient-rich foods such as chicken, fish and eggs although the population was predominantly non-vegetarian. Logistic regression analysis revealed that taking a loan from neighbours/relatives (OR = 1.8; 95% CI 1.3-2.5) and belonging to lower social groups (OR = 1.8; 95% CI 1.1-2.9) increased odds of low HDDS. While those possessing ration cards had lower odds of reduced consumption of all food items, it was not associated with stopping consumption of any food item. In an unadjusted analysis, receipt of cash transfer during lockdown was also not associated with diet diversity (OR = 1.2; 95% CI 0.9-1.7).

CONCLUSIONS

COVID-19 has impacted the consumption of nutrient-rich foods among already low-income rural households in India. Maintaining diet diversity among socio-economically vulnerable households during periods when food consumption is most threatened by shocks such as COVID-19 would need sustained government support in terms of social protection coverage and benefit transfers in rural communities.

Hunger in French Guiana's Vulnerable Urban Neighborhoods: A Neglected Consequence of COVID-19

BACKGROUND

In French Guiana, restrictions to control the spread of SARS-CoV-2 were put in place between March 2020 and March 2022. In vulnerable urban neighborhoods, during this period, requests for food assistance increased and fear of hunger overtook fear of being affected by COVID-19.

OBJECTIVE

The objective of this survey was to describe food security during the COVID-19 pandemic in French Guiana and to study the relationship between the socioeconomic conditions of the study households and household hunger.

METHODS

A multicenter survey was therefore conducted in mobile clinics and fixed structures providing care to at-risk urban populations. In a face-to-face interview, a community health worker asked participants questions about the sociodemographic and economic profile of the household, and about household food security (food consumption score, coping strategies in the face of food shortages, and household hunger index). Two hundred and seventy-seven households were recruited in February 2021.

RESULTS

According to the household hunger scale, 42.6% of households experienced moderate hunger and 23.8% of households experienced severe hunger in the month preceding the survey. Lack of residence permit, lack of social support, water insecurity, small housing, and lack of access to an urban garden were determinants related to the risk of household hunger.

CONCLUSIONS

Food insecurity have affected a large majority of the households in this survey, and the immediate consequences for children's health were already apparent. These results draw attention to a neglected health problem in a socioeconomically vulnerable population during the COVID-19 pandemic.

The impact of COVID-19 quarantine on lifestyle indicators in the United Arab Emirates

Introduction

COVID-19 is a virus that has spread rapidly and brought economic and social crises all around the world. The current study aimed to investigate the impact of COVID-19 quarantine on dietary habits, physical activity, food purchasing, smoking, and sleeping patterns in the United Arab Emirates.

Methods

A cross-sectional study was conducted using an online questionnaire between November 1st, 2020 and the end of January 2021. Citizens and residents of the UAE aged ≥ 18 years old were asked to complete an anonymous electronic questionnaire created via Google Forms and distributed on various platforms, such as WhatsApp, Twitter, and email. A total of 1682 subjects participated in the study.

Results

The results included that during the COVID-19 lockdown, more participants (44.4%) reported an increase in weight. This gain seems to be linked to increased food consumption [(Adjusted Odd Ratio) AOR = 1.68, 95% (Confidence Interval) CI = 1.12, 2.54, p = 0.022], decreased physical activity (AOR = 2.25, 95% CI = 1.58, 3.21, p < 0.001), and increased smoking (AOR = 1.90, 95% CI = 1.04, 3.50, p = 0.038). The groups that were most likely to gain weight included those who consumed more cereals (AOR = 1.67, 95% CI = 1.08, 2.57, p = 0.011), had an increased desire for sweets (AOR = 2.19, 95% CI = 1.50, 3.19, p < 0.001), and an increased desire for food (hunger) (AOR = 2.19, 95% CI = 1.53, 3.14, p < 0.001). In contrast, those who exercised more were more likely to lose weight (AOR = 0.61, 95% CI = 0.44, 0.86, p < 0.001) as well as those who slept over 9 h a day (AOR = 1.90, 95% CI = 0.45, 0.88, p = 0.006).

Discussion

Overall, it is essential to promote healthy habits and methods of healthy diet maintenance during stressful and unusual times when people might find it difficult to put effort into their health.

Revisiting fruit and vegetable determinants: Evidence from Latin America

Introduction

In the past decade, the public health discussion regarding fruit and vegetable (FV) consumption has been dominated by economic and physical accessibility.

Methods

Using an online survey in four Latin American countries, we applied a set of tobit models to compare the determinants of desirable and current consumption of FV levels for satisfied and unsatisfied respondents.

Results

We found that, even when consuming less than five FV portions a day, most of the respondents were satisfied with their current FV consumption level. Satisfied respondents consumed significantly more FV than unsatisfied ones. In general, the desirable and current consumption of FV levels were associated with different sets of determinants, while years of education were relevant in both cases. Finally, in a hypothetical case where unsatisfied respondents would not face any physical or economic access restrictions, unsatisfied respondents would not reach the goal of five FV portions a day.

Discussion

Assuming that physical and economic access improved, this would automatically increase FV to reach the five-a-day recommendation may be inaccurate in some cases. We also need to take mental access into account. We may ask how to improve the desirable level of FVs and then how to close the gap between the current and desirable FV levels.

COVID-19 experiences of small-scale fishing households: The case of Lake Victoria, Kenya

Introduction

The impact of COVID-19 on small-scale fishing communities is of great concern given the importance of aquatic foods in trade, nutrition and livelihoods. Using a case study of Lake Victoria, augmented by published literature, we examine the socioeconomic dynamics and severity of COVID-19 impacts on Kenyan fishing communities.

Methods

A household level questionnaire was administered through phone interviews on a monthly basis from June 2020 to May 2021, including a focus group discussion in July 2021.

Results

We find that multifold fear of COVID-19 infection and control measures were present and varied across case rates and stringency of control measures. Fishers and traders reported being affected by disease control measures that limited market access and their ability to fish overnight. In spite of these worries, and contrary to what has been reported in the published literature regarding impacts observed in the early months of the pandemic, we see stable participation in fishing and fish trading over time despite the pandemic. Food insecurity was high before and during the COVID-19 pandemic, but did not substantially shift with the pandemic.

Conclusion

Our findings suggest that Kenyan fishing and fish trading households adopted diverse strategies to cope and balance generating income to provide for their families and staying safe. Our results underscore the need to understand ways in which acute pandemic impacts evolve over time given that effects are likely heterogeneous across small-scale fishing communities.

Food Insecurity Is Associated with Dietary Consumption during the COVID-19 Pandemic: Data from the Korea National Health and Nutrition Examination Survey 2019-2020

Coronavirus disease 2019 (COVID-19) has become a pandemic and has affected people's dietary behaviors, including food insecurity. This study aimed to ascertain whether COVID-19 may alter the prevalence of food insecurity, and if such food security status may be associated with dietary intake among Koreans. The general characteristics, dietary intake and food security status data in the Korea National Health and Nutrition Examination Survey VIII (2019~2020) were analyzed. The prevalence of food insecurity and food group and nutrient consumption by food security status were analyzed before (2019) and after the start of the pandemic (2020). Findings suggested 4.3% of Koreans experienced food insecurity during the first year of the pandemic, yet it did not differ from that in the year before the pandemic. Before COVID-19, there was no significant difference in food group or nutrition consumption by food security status. However, in 2020, the fruit and vitamin C intake of the food-insecure group was significantly lower than that of the food-secure group. Additionally, the food-insecure group's ratio of subjects who did not meet the recommended level of fruits and the vitamin was higher compared to that of the secure group. In conclusion, COVID-19 did not affect food insecurity status, but did have a negative influence on dietary intake for food-insecure Koreans.

How Has COVID-19 Affected Mental Health and Lifestyle Behaviors after 2 Years? The Third Step of a Longitudinal Study of Italian Citizens

The COVID-19 pandemic and its protective measures had a tremendous effect on the general population's mental health and deeply affected their lifestyle. The present study carried out a longitudinal analysis to evaluate the long-lasting psychological effects of the pandemic and its impact on the general population's day-to-day routine. Three points in time were considered: the initial period of the lockdown (T1; n = 2766; March 2020), the final period of the lockdown (T2; n = 439; May 2020) and two years after the lockdown (T3; n = 268; July 2022). Frequency analyses were carried out to examine which behavioral changes were maintained following the COVID-19 pandemic and lockdown; furthermore, a repeated measures ANOVA test was run to measure differences in depression, stress, and anxiety levels between the three periods considered; lastly, multivariable ordinal logistic regression analyses were carried out to examine which variables were associated with psychological distress more than two years after the lockdown. The results highlighted that depression at T3 was associated with depression at T2 and negative affect, whereas stress at T3 was associated with stress at T2 and detachment. The psychological effects and lifestyle changes are also discussed.