Changes in Adults' Eating Behaviors During the Initial Months of the COVID-19 Pandemic: A Narrative Review

Exploration of Food Attitudes and Management of Eating Behavior from a Psycho-Nutritional Perspective

BACKGROUND/OBJECTIVES

This study investigates the relationship between food attitudes and the management of eating behavior from a psycho-nutritional perspective, with a focus on the Health Belief Model (HBM). The objective was to explore how emotional food cravings influence different aspects of eating behavior and dietary attitudes, and to identify indirect pathways through which these cravings affect attitudes toward dieting behaviors.

METHODS

Data were collected from 659 participants using validated scales that assessed dieting tendencies, bulimia and food preoccupation, culinary behaviors, food preoccupation, expectations of positive outcomes, and emotional food cravings. Descriptive statistics, Pearson's correlations, and network analysis were employed to uncover significant associations among these variables. A sequential mediation analysis was conducted using SPSS PROCESS Macro Model 6 to identify indirect pathways.

RESULTS

The analysis revealed significant associations among the variables. Emotional food craving had a negative indirect effect on dieting attitudes through bulimia tendencies (effect size: -0.523) and a positive indirect effect through food preoccupation (effect size: 0.1006). These results highlight the complex interplay between emotional food cravings, bulimia tendencies, and food preoccupation in shaping dieting attitudes.

CONCLUSIONS

The findings emphasize the complex dynamic between emotional food cravings, bulimia tendencies, and food preoccupation, and their collective impact on dieting attitudes. This study provides insights into potential intervention strategies aimed at improving eating habits by addressing emotional food cravings and their indirect effects on dietary behavior.

Environmental study and stress-related biomarkers modifications in a crew during analog astronaut mission EMMPOL 6

PURPOSE

Human presence in space is increasingly frequent, but we must not forget that it is a hostile environment. We aimed to study the characteristics of experimental scenarios, to obtain data on human response to isolation, disruption of circadian rhythm and high levels of psychophysical stress.

METHODS

In these experiments, we evaluated stress response in five young healthy subjects inside an earth-based moon-settlement-like habitat during a 1-week long analog astronaut mission. Wearable devices were used to monitor daily step count of the subjects, physical activity, heart rate during physical exercise and at rest, and sleep parameters. From saliva and urine samples collected every day at awakening, we studied oxy-inflammation biomarkers and hormones (stress and appetite) were studied too.

RESULTS

At the end of the week, all subjects revealed an increase in oxidative stress and cortisol levels but no inflammation biomarkers variations, in conjunction with increasing time/daily exercise. Furthermore, a significant decrease in hours of sleep/day, sleep quality, and REM phase of sleep was recorded and correlated with the increase of reactive oxygen species.

CONCLUSION

Oxidative stress increased in a short period of time and may be attributed to the influence of psychological stress during confinement, as well as increased exercise and decreased amount of sleep. On a long-term basis, this could impact performance.

Validity and reproducibility of food group intakes in a self-administered food frequency questionnaire for genomic and omics research: the Tohoku Medical Megabank Project

BACKGROUND

The Tohoku Medical Megabank Project (TMM) was established to realize personalized healthcare and medicine using genomic and omics data. This study evaluated the validity and reproducibility of food group intakes derived from a self-administered food frequency questionnaire (TMM-FFQ) that included the response option "constitutionally unable to eat/drink it" among community-dwelling Japanese adults.

METHODS

Participants comprised 89 men and 124 women aged ≥20 years from Miyagi Prefecture. Participants completed weighed food records (WFRs) for 3 consecutive days per season as reference intake and FFQs in 2019 (FFQ1) and 2021 (FFQ3). Spearman's rank correlation coefficients (CCs) were calculated for correlations between food group intakes estimated from the 12-day WFR and FFQ3 (validity), and for correlations between those estimated from the FFQ1 and FFQ3 (reproducibility). Cross-classification according to quintiles using FFQ and WFR data was also performed.

RESULTS

The percentage of participants who chose the "constitutionally unable to eat/drink it" option was non-negligible for some food groups. In the validity analysis, CCs were >0.40 for many food groups; the median across 21 food groups was 0.49 in men and 0.45 in women. The median percentages of cross-classification into exact plus adjacent quintiles were 73.0% in men and 66.9% in women. In the reproducibility analysis, CCs were >0.50 for many food groups; the median across 21 food groups was 0.60 in men and 0.51 in women.

CONCLUSIONS

The validity of the TMM-FFQ compared with 12-day WFR and the reproducibility of the TMM-FFQ were reasonable for food groups in the TMM cohort studies.

The Link between Inflammation, Lipid Derivatives, and Microbiota Metabolites in COVID-19 Patients: Implications on Eating Behaviors and Nutritional Status

Extreme inflammation that continues even after infections can lead to a cytokine storm. In recent times, one of the most common causes of cytokine storm activation has been SARS-CoV-2 infection. A cytokine storm leads to dysregulation and excessive stimulation of the immune system, producing symptoms typical of post-COVID syndrome, including chronic fatigue, shortness of breath, joint pain, trouble concentrating (known as "brain fog"), and even direct organ damage in the heart, lungs, kidneys, and brain. This work summarizes the current knowledge regarding inflammation and the cytokine storm related to SARS-CoV-2 infection. Additionally, changes in lipid metabolism and microbiota composition under the influence of inflammation in COVID-19, along with the possible underlying mechanisms, are described. Finally, this text explores potential health implications related to changes in eating behaviors and nutritional status in COVID-19 patients. Although research on the cytokine storm is still ongoing, there is convincing evidence suggesting that severe immune and inflammatory responses during the acute phase of COVID-19 may lead to long-term health consequences. Understanding these links is key to developing treatment strategies and supporting patients after infection.

Altered Body Composition and Cytokine Production in Patients with Elevated HOMA-IR after SARS-CoV-2 Infection: A 12-Month Longitudinal Study

Altered body composition and cytokine production due to SARS-CoV-2 antigens may affect homeostasis model assessment for insulin resistance (HOMA-IR) after SARS-CoV-2 infection. To elucidate this phenomenon, we conducted a longitudinal study involving 47 COVID-19 patients, who were followed up for 12 months. During recruitment, body composition and glucose indices were measured, and heparin blood samples were collected for measuring cytokine production. HOMA-IR was considered an elevated or non-elevated group based on the ratio between HOMA-IR at 12 months and 1 month of convalescence. Those with elevated HOMA-IR had a significantly higher body mass index, body fat percentage, and visceral fat rating and had a lower lean mass and lean/fat mass ratio than their counterparts. During the convalescent period, the elevated HOMA-IR group had lower TNFα, IFNγ, IL-2, IL-10, and granzyme B expression levels but had higher TNFα/IL-10, IFNγ/IL-10, IL-2/IL-10, and granzyme B/IL-10 ratios than the other group. The reduced cytokine production and pro-/anti-inflammatory imbalance in patients with elevated HOMA-IR may suggest immune cell dysfunction toward SARS-CoV-2. Patients with elevated HOMA-IR after SARS-CoV-2 infection may experience an increase in BMI and body fat percentage, leading to increased immune dysfunction and chronic inflammatory condition. A nutritional approach and promotion of physical activity may help reduce HOMA-IR and ameliorate glucose indices in these patients.

Australian adults cooked more and tried new recipes during COVID-19 restrictions and lockdowns

The lockdowns and restrictions due to COVID-19 caused changes in both food accessibility and availability for people around the globe resulting in changes in food habits and behaviours. To enable a better public health response to the next pandemic, lessons must be learnt from this most recent emergency. This study aimed to examine self-reported changes in food habits and behaviours, of Australian adults during COVID-19 restrictions in 2020. A cross-sectional, convenience, Australia-wide survey, with open-ended and closed-ended questions was conducted online. Respondents were asked to report their demographic characteristics, positive food habit development, worst food-related experiences, changes in food habits and behaviours and cooking and food preparation practices during the COVID-19 restriction period. Adult Australian residents, recruited through social media advertising of the survey. Respondents (n = 764) were mostly female (86%), over 55 years of age (57%, mean age (SD) 53.4 (18.1) years), and half (51%) were not in paid employment. Nearly two-thirds (63%) developed positive food habits, including trying new recipes (54%), eating less take-away (53%) and cooking from scratch (46%) during the COVID-19 restrictions. Furthermore, respondents reported including family members in food preparation and eating together as a family. Negative experiences included being unable to buy certain foods (due to lack of stock and store limits), cooking at home, and being unable to access some food outlets. Australians experienced both positive and negative food experiences during the COVID-19 pandemic and associated lockdown periods, with most experiencing positive changes such as cooking at home from scratch and trying new recipes and relying on less take-away. Females and those who experienced a change in employment status were more likely to develop positive new food habits.

University students' perception of their dietary behavior through the course of the COVID-19 pandemic: a phenomenological approach

PURPOSE

The COVID-19 pandemic mandates that were imposed to curb the spread of disease may have triggered unhealthy dietary behaviors among university students. The current study aims at exploring university students' perception of their dietary behaviors through the course of the pandemic.

METHODS

The qualitative study is designed using a phenomenological framework. Using convenience and snowball sampling, nine university students were recruited in southeast Texas. Interviews were conducted using an interview guide after receiving verbal consent. The data were analyzed by thematic analysis.

RESULTS

Three themes were identified. Initially, an increase in consumption of home-cooked meals and frequency of snacking were reported which were associated with emotions including boredom, stress, and homesickness. However, as the students adapted to the pandemic, the frequency of dining and restaurant food consumption increased.

CONCLUSION

The findings highlight the urgency for educational institutions to be well-equipped in terms of nutrition assistance during times of crisis.

Unveiling Lived Experiences: Exploring the Health and Lifestyle Effects of COVID-19 on Healthcare Workers

The COVID-19 pandemic brought about significant life disruptions among healthcare workers (HCWs), including changes in weight, eating habits, and physical activity. This qualitative study sought to evaluate the initial and longitudinal effects of health habits among HCWs throughout the pandemic. Data were collected through Qualtrics surveys at three points over a 2-year period with questions asking participants (n = 234) to describe whether they experienced changes in weight, eating behaviors, and physical activity and why they believe these changes occurred. The open-ended responses were analyzed following the summative content analysis approach. Four key themes emerged: (1) problematic eating patterns and habits, (2) disruptions in physical activity, (3) alterations in work environment and schedule, and (4) declines in mental health. Respondent reflections highlight the immediate and long-term pandemic-related effects on weight status for some, attributed to alterations in routines and health habits. Other HCWs reported a "reset" or indicated their habits may have been initially disrupted but normalized or improved over the 2-year time span. Findings underscore the need for strategies that support the physical and mental health of healthcare workers.

A pharmacist-led community-based survey study: Determining the impact of the Covid-19 pandemic on actionable factors associated with worse cancer outcomes and cancer health disparities

Purpose

The goals of this cross-sectional community-based survey study were to assess the impact of the Covid-19 pandemic on actionable factors which are known to contribute to worse cancer outcomes, and to determine whether race and ethnicity-based differences exist.

Methods

A survey study which captured demographic information and changes in cancer outcomes-related factors since the start of the Covid-19 pandemic, was conducted at a public Covid-19 vaccination clinic over a period of 10 days during March 2021. Surveys were administered in multiple languages. Chi-square tests and ANOVA followed by post-hoc Dunnett testing assessed for race and ethnicity-based differences.

Results

A total of 949 people participated (61.6% participation rate). Ninety-three surveys were removed based on inclusion criteria giving a final participant number of 856. Many participants reported postponing cancer screenings (17.8%) and cancellation of medical appointments (22.8% and 25.8% reported cancelled appointments by providers or themselves, respectively) due to the pandemic. Participants also reported decreased physical activity (44.7%) and increased tobacco and/or marijuana usage (7.0%). Conversely, participants reported consuming more fruits and vegetables (21.4%) and decreasing alcohol consumption (21.4%). Several race-related differences but no ethnicity-related differences were observed.

Conclusion

Our data can be used to help guide pharmacist-led targeted outreach in our community which will help mitigate Covid-19 pandemic-driven changes in behaviors associated with worse cancer outcomes and exacerbation of cancer health disparities. To our knowledge, this is the first cancer outcomes-related study to be conducted at a public Covid-19 vaccination site and is the first pharmacist-led study in this area.

The effects of body dissatisfaction and depression levels on the dietary habits of university students in southern China during COVID-19

Introduction

The novel coronavirus disease of 2019 has impacted people's lives greatly. The spread of the pandemic has restricted many everyday social lives. Some studies have shown that strict risk control during the pandemic threatens people's mental health and eating habits. University students vulnerable to mental health problems may have more prominent mental health and eating disorders during the pandemic. This study aims to elucidate the relationship between body dissatisfaction, depression, body mass index, and emotional eating among university students in the context of the pandemic in southern China. It provides a theoretical basis for developing future approaches to improve depression and emotional eating among university students.

Methods

A total of 1,135 university students were recruited for the study. All participants completed anthropometric, body dissatisfaction, eating behavior, and depression level surveys.

Results

The study finds that female students have higher levels of body dissatisfaction, depression, and emotional eating than male students. University students in the high body dissatisfaction group had higher levels of depression. Depression level (β = 0.33, p < 0.01), body dissatisfaction (β = 0.22, p < 0.01), sex (β = 0.16, p < 0.01), and income (β = 0.06, p < 0.01) were significant predictors of emotional eating. Fundamentally, this study highlights the impact of body dissatisfaction on depression and emotional eating.

Discussion

The potential to improve depression and emotional eating among university students by improving their levels of body dissatisfaction was demonstrated.

Stability and longitudinal association between Body Mass Index and maladaptive eating behaviors in older adults: Results from the NutriAct Family Study (NFS)

PURPOSE

Due to the increasing prevalence of overweight and obesity with age and associated health risks, older adults are an important target group to promote healthy weight. Evidence indicates that maladaptive eating behaviors are associated with higher BMI. However, older adults are often neglected in this research field. This prospective study aims to clarify the temporal relationship between BMI and maladaptive eating behaviors among older adults.

METHODS

In total, 964 participants of the NutriAct Family Study (Mage = 63.34 years) completed web-based questionnaires two times (M = 3.33 years apart). BMI was assessed via self-reported height and weight, and maladaptive eating behaviors with the Dutch Eating Behavior Questionnaire (DEBQ). The stability and longitudinal associations were analyzed using cross-lagged models.

RESULTS

Cross-sectional analysis showed positive correlations between BMI and emotional (r = 0.218), external (r = 0.101), as well as restrictive eating (r = 0.160). All maladaptive eating behaviors (β > 0.684) and BMI (β > 0.922) were longitudinally stable. No significant bidirectional relationships were found between BMI and maladaptive eating behaviors over time, except for BMI predicting restrictive eating (β = 0.133).

CONCLUSION

The observed cross-sectional, but not longitudinal associations between BMI and maladaptive eating behaviors underline the need for prospective study designs to deepen the understanding of the role of maladaptive eating behaviors in weight management among the general population. Maladaptive eating behaviors among older adults may have already consolidated and play a smaller role in explaining weight course, compared to early life like childhood.

Comparison of Consumption of Pulses in Two Seasons of the Year in Chile

BACKGROUND

In Chile, the consumption of legumes at least two times per week is promoted. However, there is a low consumption of legumes. Therefore, our objective is to describe legume consumption in two different seasonal periods.

METHODS

Serial cross-sectional study: surveys were distributed during summer and winter using different digital platforms. Frequency of consumption, purchase access, and preparation type were investigated.

RESULTS

In total, 3280 adults were surveyed in summer and 3339 in winter. The mean age was 33 years. Totals of 97.7% and 97.5% of the population reported consuming legumes in both periods; consumption increased to 3 times per week during winter. In both periods, the main reason for their preference is that they are delicious and nutritious, followed by their use as a meat substitute; the main barriers to their consumption in both periods are that they are expensive (29% in summer and 27.8% in winter) and difficult to prepare.

CONCLUSION

A good consumption of legumes was observed, but with a higher frequency of consumption during winter, with an intake of ≥1 per day; additionally, differences were found in purchases according to season, although no differences were found in the method of preparation.

Stress, trauma, and perception of eating behavior changes during the first weeks of the COVID-19 outbreak

OBJECTIVE

The COVID-19 pandemic is one of the largest collective stressors in recent history. Consistent with prior research, this stress has led to impactful eating behavior change. While prior life traumas also impact eating behavior, it is unclear whether the current stress experienced during COVID-19, and prior life traumas (overall, socially relevant, and nonsocially relevant), interact to influence eating behavior changes. Moreover, it is unclear whether current stress and prior traumas impact how eating behavior changes are perceived (i.e., in magnitude, valence, or both) by the individuals experiencing the changes. Therefore, this study sought to examine both the relationship between current stress and perception of eating behavior changes, as well as the moderating impact of prior life traumas on this relationship.

METHODS

Between March and April 2020, participants completed a subjective, self-report online assessment of current stress, prior life traumas, pandemic-related changes in eating behaviors, and the perceived impact of eating behavior changes.

RESULTS

Higher current stress was associated with larger, more negative perceptions of eating behavior changes. This relationship was moderated by prior life traumas. Specifically, the association between current stress and perceived negative impact of eating behavior change was potentiated among those with more prior socially relevant (but not nonsocially relevant) traumas.

DISCUSSION

These results suggest eating behavior changes occurred early in the pandemic and were uniquely impacted by the cumulative effect of present stress and socially relevant prior life traumas.

PUBLIC SIGNIFICANCE

Changes in eating behaviors and pathology have been prevalent during COVID-19. We examined how stress and prior life traumas interacted during the first weeks of COVID-19 to influence perceptions of eating behavior change. As altered perception of eating behaviors is a notable feature of eating pathology, these results will help inform development of intervention targets for those at risk for developing disordered eating during future- and post-pandemic recovery.

Eating Choices—The Roles of Motivation and Health Literacy: A Cross-Sectional Study

Food choices are determined by intrinsic and extrinsic product characteristics, biological and physiological features, psychological factors, and situational and socio-cultural factors. Self-determination theory offers the explanation of health behavior change identifying motivations located along a continuum of autonomy. Another approach to the motivations guiding health behaviors, including food choices, relies on distinguishing thematic categories. Health motivations seem to be an obvious determinant of health behaviors, but final decisions regarding health are also the effect of other types of motivations such as economic, cultural, or emotional. The role of marketing pressure in modern society is perceived to be an important source of motivation for purchasing food and other products. The Motivation–Opportunity–Ability (MOA) framework was initially proposed in order to explain the processing of brand information from advertisements and was later expanded to other areas, including health and nutritional behaviors. The aim of this study was the analysis of determinants of food choices. We have developed a common regression model including six categories of motivations addressed by the Eating Motivations Scale and three health literacy types corresponding with element of ability from the MOA framework, adjusted for socio-demographic factors, health status, and the use of the Internet and TV. The analysis was performed on data from a computer-assisted web-based interviewing (CAWI) survey among 2008 adult Internet users completed in May 2022. The uni- and multivariate linear regression models were developed with the Index of Unhealthy Food Choices (IUFC), calculated based on the responses to items asking about the frequency of the consumption of twelve food categories. Univariate modeling revealed that IUFC is significantly associated with health, food, and e-health literacies and with five out of six eating motivations. However, the multivariate regression model yielded significant associations only for eating motivations but not for the three literacy scores. Health motivation was negatively associated with IUFC (B, standard error (SE): 0.83, 0.07; 95% confidence interval (95% CI): 0.98–0.69), but positively with emotional (B, SE: 0.22, 0.04; 95% CI: 0.14–0.3), economic (B, SE: 0.41, 0.08; 95% CI: 0.25–0.56), and marketing (B, SE: 0.62, 0.08; 95% CI: 0.47–0.78) motivations. Our findings suggest that motivations guiding food choices may prevail over the element of ‘ability’ distinguished in the frameworks and models that explain people’s behaviors, including behaviors relating to health. Thus, it is essential to emphasize development of appropriate motivations and not only to provide knowledge and skills. Furthermore, one should also remember motivations other than health motivations when searching for the determinants of health behaviors.