Nutrition amid the COVID-19 pandemic: a multi-level framework for action

Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants-shortened version

BACKGROUND

The diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation's health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States.

METHODS

250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants-Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students' REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher's Exact Tests.

RESULTS

Medical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet.

CONCLUSION

Our data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.

Wrestling injuries during the 2016 Rio and 2020 Tokyo Olympic Games

OBJECTIVES

To evaluate and compare the injuries of Olympic wrestlers during the 2016 Rio and 2020 Tokyo Olympic Games held in August 2021 due to the COVID-19 pandemic.

METHODS

In this descriptive epidemiological study, injury report forms were used to collect and analyse injury data during the competitions.

RESULTS

During 410 matches in the Rio Olympic Games, 21 injuries were recorded among 346 wrestlers (112=women), a rate of 5.1 injuries/100 bouts and 6.1 injuries/100 athletes. During 322 matches in the Tokyo Olympic Games, 28 injuries were recorded among 287 wrestlers (96=women), with 8.7 injuries/100 bouts and 9.8 injuries/100 athletes. However, these apparent differences in injury rates between Tokyo and Rio were not statistically significant (injuries/bout: p=0.057, 95% CI: 0.31 to 1.02; injuries/athlete: p=0.087, 95% CI: 0.33 to 1.08). Mild injuries comprised the greatest proportion of injuries in both Olympic Games. Severe injuries accounted for 0%, 16.7% and 36.4% of injuries in Greco-Roman, Freestyle and Women's wrestling, respectively.

CONCLUSION

Most wrestling injuries in the 2016 Rio and 2020 Tokyo Olympic Games were mild skin injuries in the head and face regions due to direct body contact during standing positions in the 1/8-final round of wrestling competitions. No critical injury was observed during the recent Olympic Games. Attention should be drawn to preventing upper limb joint dislocations as common severe injuries in both Olympic Games. While not statistically significant, the Tokyo Games, after the COVID-19 pandemic, witnessed a higher injury occurrence than the Rio Games.

Determining the Mental Status, Sleep Quality, and Eating Behaviors of University Students During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic has resulted in adverse effects on individuals' physical and mental health worldwide, with university students also being adversely affected by this process.

OBJECTIVES

This research aimed to determine the mental condition, sleep quality, and eating behaviors of university students during the COVID-19 process.

METHOD

This cross-sectional study was conducted with 1,065 university students. Study data were collected with an online questionnaire including a personal information form, the Depression Anxiety Stress Scale, the Pittsburgh Sleep Quality Index, and the Dutch Eating Behavior Scale.

RESULTS

Students' poor sleep quality was determined to be 69.5%. It was also determined that students' depression and stress levels were moderate that their anxiety levels were low, their eating behaviors were generally problematic, and more than half had poor sleep quality. In addition, eating disorders and poor sleep quality increased as depression, anxiety, and stress levels increased, and eating disorders increased as poor sleep quality increased (p < .05).

CONCLUSIONS

The results emphasize the importance of the strengthening of students' mental health, particularly by improving their sleep quality and eating habits. Evidence-based interventions regarding the effects of the pandemic should be made for students under the leadership of a psychiatric nurse, and effective strategies must be developed accordingly.

Older Adults' Exposure to Food Media Induced Unhealthy Eating during the COVID-19 Omicron Lockdown? Exploring Negative Emotions and Associated Literacy and Efficacy on Shanghainese

The COVID-19 pandemic, propelled by the highly transmissible Omicron variant, had a global impact and significantly affected Shanghai, a major city in China. This study investigates how food media exposure influenced unhealthy eating habits among older adults during the COVID-19 lockdown in Shanghai, focusing on the roles of negative emotions, food literacy, health consciousness, and eating self-efficacy. The random sample comprised 400 individuals aged ≥50 years who lived in Shanghai from March to June 2022. A path and correlation analysis was performed. The exposure of older adults to food media resulted in the acceleration of unhealthy eating. The relationship was significantly exacerbated by food literacy and negative emotions. In contrast, eating self-efficacy and health consciousness effectively countered the media. The enhanced pathway from food-related media influence to eating habits through negative emotions or self-efficacy towards health awareness and food literacy showed significant effects. The findings provide insights for future research and public health strategies. Importantly, this study has practical significance for media professionals, public health decision-makers, and healthy food businesses regarding how to enhance older adults' cognition to respond to unhealthy eating crises.

The impact of inactivity during the COVID-19 pandemic on the physical performance of high school athletes

BACKGROUND/OBJECTIVE

This study was conducted during the 2019-2020 academic year to evaluate the impact of participation in school sports on students' Body Mass Index (BMI) and Assessing Levels of Physical Activity (ALPHA) test scores. Interrupted by the COVID-19 pandemic, which led to a suspension of in-person education, the study resumed in September 2021, refocusing on the effects of pandemic-induced inactivity on the physical fitness levels of the same cohort.

METHODS

The study included twenty-nine male high school students (age: 17,24 ± 0,73 years), divided into thirteen athletes (participating in sports such as football, basketball, and track) and sixteen non-athletic counterparts. They underwent reassessment using the ALPHA test battery, evaluating cardiorespiratory, musculoskeletal, and motor skills fitness. Data were analyzed using independent and paired samples t-tests and a two-way repeated measures ANOVA to assess changes over time and between groups. Discriminant function analysis evaluated the ALPHA test's ability to classify students based on their athletic status pre- and post-pandemic.

RESULTS

Initially, athlete students exhibited significantly better BMI, 20 m shuttle run, and 4 × 10 m speed run scores compared to their non-athlete peers. After the pandemic, only the 20 m shuttle run scores remained significantly higher for athletes, with diminished distinctions in other fitness areas. The classification accuracy of the ALPHA test battery decreased from 89.7 to 75.9% post-pandemic.

CONCLUSION

The enforced sedentary lifestyle due to the COVID-19 pandemic adversely affected all students, particularly diminishing health-related fitness parameters such as body composition, cardiorespiratory and musculoskeletal strength, and motor skills. Students previously engaged in regular physical activity, notably school athletes, experienced significant fitness declines. This highlights the urgent need for targeted interventions to encourage active lifestyles among youth in the post-pandemic phase, aiming to avert long-term adverse health outcomes.

Community health information needs assessment in the mid-south region of the United States indicates new roles for public libraries

BACKGROUND

Libraries provide public access to information that may be used to inform healthcare decisions. Exploring the health information needs of library-users could improve community health outcomes, especially during times of crisis like the COVID-19 pandemic.

OBJECTIVE

The purpose of this study was to identify the health information needs of library-users to explore the potential role of libraries in advancing community health.

METHODS

A quantitative, descriptive, cross-sectional survey was employed.

RESULTS

One hundred and fifty participants in the (Memphis) Tennessee metropolitan area, ranging from 18 to 84 years of age, completed the survey between September 2020 and April 2021. Most respondents reported seeking physical and mental health-related information from libraries. In addition, nearly half of respondents reported delaying medical care due to risk of exposure to COVID-19, cost or appointment issues.

DISCUSSION

Study results indicated that there were urgent health information needs among library-users in this community, that COVID-19 further limited or delayed access to information, and that library-users accessed health information during library visits.

CONCLUSION

Public libraries have the potential to serve as information hubs to improve community health outcomes. Additional research should be conducted to collect qualitative community health information needs and the ways in which public library systems can address them.

A Case Report Highlighting the Significance of COVID-19 Unveiling Megaloblastic Anemia and Worsening Dementia in the Elderly

The COVID-19 pandemic has resulted in substantial lifestyle changes with significant implications for nutritional health. Factors such as movement restrictions and disruptions in food supply chains led to the restricted availability of primary sources of essential micronutrients. To highlight this, we present the case of an elderly woman with an underlying subclinical cobalamin deficiency who developed symptomatic megaloblastic anemia, requiring hospital admission under lockdown conditions. This exemplifies how changes in diet during the COVID-19 lockdown have hastened the onset of B12 deficiency symptoms. Adverse outcomes can be avoided by identifying people at high risk of poor nutritional status and implementing policy initiatives that enhance their nutritional condition. This case report showed how important the B12 shortage was during the COVID-19 lockdown, especially for older people. They are more likely to be malnourished during COVID-19 for several reasons.

Nutritional health of the Rohingya refugees in Bangladesh: Conceptualizing a multilevel action framework focusing the COVID-19

The Rohingya refugees are among the most vulnerable victims of COVID-19 pandemic in Bangladesh. In refugee camps, they frequently lack access to safe and nutritious foods, drinking water, and a healthy environment. Despite the fact that numerous national and international organizations are sincerely collaborating to meet their nutritional and medical needs, the pace of work has slowed due to COVID-19. Combating COVID-19 demands a robust immune system, which relies heavily on a nutritious diet. The development of strong immunity to protect Rohingya refugees, particularly children and women, through the provision of nutrient-dense foods is thus highly necessary. Consequently, the current commentary focused on the nutritional health status of Rohingya refugees in Bangladesh during COVID-19. In addition, we provided a multilevel implementation framework that could assist stakeholders and policymakers in taking effective measures to recover their nutritional health.

Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19

BACKGROUND & AIMS

The South Korean government established the multidisciplinary nutritional support teams (NST) system for enhancing the evaluation and adequate supply of nutritional support to patients at high risk of malnutrition. However, the impact of the NST on clinical outcomes in critically ill patients with coronavirus disease 2019 (COVID-19) remains unclear. We aimed to investigate whether NST implementation affects survival outcomes in patients with COVID-19 requiring intensive care unit (ICU) admission.

METHODS

Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients with COVID-19 admitted to the ICU between October 8, 2020, and December 31, 2021, were included. The NST comprised four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). Patients admitted to ICUs with and without the NST system were assigned to the NST and non-NST groups, respectively.

RESULTS

A total of 13,103 critically ill adult patients were included in the final analysis; among them, 10,103 (77.1 %) and 3,000 (22.9 %) patients were included in the NST and non-NST groups, respectively. In the NST group, 2,803 (27.7 %) critically ill patients with COVID-19 were prescribed enteral or parenteral nutrition by the NST. In a covariate-adjusted multivariable model, the NST group showed a 40 % lower in-hospital mortality rate than the non-NST group (odds ratio: 0.60, 95 % confidence interval: 0.51, 0.71; P < 0.001). In subgroup analyses, compared with the non-NST group, the NST group showed significantly lower in-hospital mortality rates at 2, 3, 4, and 5 points on the World Health Organization clinical progression scale among patients with acute respiratory distress and mechanical ventilatory support.

CONCLUSIONS

NST implementation was associated with improved survival outcomes in critically ill patients with COVID-19; accordingly, it may be recommended for improving adequate nutritional support and evaluation in critically ill patients.

COVID-19 and diet: efforts towards a balanced diet and sustainable nutrition among university students in Pakistan

Nutrition is an important aspect of a healthy lifestyle for all individuals, including adolescents. The objective of this cross-sectional descriptive survey study was to investigate university students' awareness of immunity enhancing foods, food nutritive values, and eating practices during the COVID-19 pandemic. A total of 839 university students from four different universities in Pakistan participated in the study from October 2021 to January 2022, 397 of which were male and 442 were female. A total of 419 students were studying in medical disciplines while 420 were non-medical students. The students had significant knowledge (p < 0.05) about COVID-19, and nutritional habits were seen in both medical and non-medical students. Results showed that medical students (n-201) were slightly more aware of immunity-enhancing foods and the nutritive values of foods compared to engineering students (n-79). However, eating practices were generally poorly adopted by all of the university students. Male and female students were not significantly different in their mean replies to questions on the nutritive value of food or in their eating habits. Healthy eating practices will aid university students in preventing illnesses connected to nutrition as well as enhancing their immune systems and nutritional well-being both during and post-pandemic. In light of these results, suggestions and implications for nutritional advice and education were explored.

Nutrition fact label (NFL) use is related to meeting the requirements for vitamins and minerals not listed on NFLs: Data from the Korea National Health and Nutritional Examination Survey VIII (2019-2021) for the prepandemic and pandemic periods

The credibility and wide usability of nutrition fact labels (NFLs) have increased due to the pandemic, which may lead to healthier nutritional choices. This cross-sectional study aimed to evaluate the association between NFL use and meeting the estimated average requirements (EARs) for vitamins and minerals not listed on NFLs during the prepandemic (2019, n = 6606) and pandemic periods (2020 and 2021, n = 12085) using KNHANES data. Household surveys, health behavior interviews, and health checkup examinations were conducted for all participants. Subjects were included in the unAware+noUse, Aware+noUse, and Aware+Use groups according to NFL usage, and nutritional intake was analyzed by the 24-hour recall method. Complex-sample multiple logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for meeting the EARs according to NFL usage in the crude and adjusted (including metabolic conditions) models. The primary finding was that awareness and NFL use were associated with adequate intake above the EARs for vitamin A, vitamin B2, niacin, folate, Ca, Fe, and P; this association was more evident during the pandemic. After adjusting for covariates, during the pandemic, the ORs of meeting the EARs in the Aware+noUse group and Aware+Use group were 1.25 (CI 1.06-1.47) and 1.36 (CI 1.05-1.75) for vitamin A, 1.26 (CI 1.06-1.50) and 1.54 (CI 1.19-2.00) for vitamin B2, 1.32 (CI 1.13-1.56) and 1.46 (CI 1.15-1.85) for folate, and 1.46 (CI 1.06-2.00) and 1.73 (1.09-2.75) for P, respectively. Additionally, the ORs for niacin (1.21, 1.02-1.43) and Fe (1.29, 1.08-1.54) were significant in the Aware+noUse group, and that for Ca (1.39, 1.08-1.78) was significant in the Aware+Use group (all p <0.05). In conclusion, NFL awareness and use are associated with meeting the EARs for vitamins and minerals not listed on NFLs. For future recurring health crises, effective NFL use is necessary for healthy dietary practices.

Association of weight changes with SARS-CoV-2 infection and severe COVID-19 outcomes: A nationwide retrospective cohort study

BACKGROUND

Obesity is a risk factor for COVID-19. However, it is unknown whether weight changes can alter this risk. We investigated the association of weight changes with SARS-CoV-2 infection and acute severe COVID-19 outcomes occurring within two months of the infection.

METHODS

We used 6.3 million nationwide cohort. The body weight was classified as follows: (1) underweight, body mass index (BMI) < 18.5 kg/m2; (2) normal, BMI 18.5-22.9 kg/m2; (3) overweight, BMI 23-24.9 kg/m2; (4) obese, BMI≥ 25 kg/m2. Weight changes were defined by comparing the classification of body weight during the health screening period I and II. The outcomes were SARS-CoV-2 infection and severe COVID-19 outcomes within two months after the infection. The association was evaluated using multivariable-adjusted logistic regression. The following covariates were adjusted: age, sex, household income, cigarette smoking, alcohol consumption, physical activity, hypertension, diabetes mellitus, dyslipidemia, Charlson comorbidity index score, and dose of all COVID-19 vaccinations prior to SARS-CoV-2 infection.

RESULTS

Of the 2119,460 study participants, 184,204 were infected with SARS-CoV-2. Weight gain showed a higher risk of SARS-CoV-2 infection in underweight to normal and normal to overweight groups. Conversely, weight loss showed a lower risk of SARS-CoV-2 infection in normal to underweight, overweight to underweight, overweight to normal, obese to normal, and obese to overweight groups. In addition, weight gain revealed a higher risk of severe COVID-19 outcomes, whereas weight loss showed a lower risk of severe COVID-19 outcomes.

CONCLUSION

This study found that weight loss and gain are associated with a lower and higher risk of both SARS-CoV-2 infection and severe COVID-19 outcomes, respectively. Healthy weight management may be beneficial against the risk of COVID-19.

Functional Food Consumption and Its Associated Factors among University Students in Malaysia during COVID-19 Pandemic

Background

In the current situation of COVID-19, dietary intake that incorporates functional foods may potentially be a preventive measure for defence against viral infection. This study aimed to determine the consumption of functional foods and its associated factors among university students during COVID-19.

Methods

This was a cross-sectional study conducted among 284 Malaysian university students in Kuala Lumpur, Malaysia. An online self-administered questionnaire was employed to assess subjects' nutrition knowledge, dietary habits, attitude towards functional foods, recognition and consumption of functional food products.

Results

Out of 284 respondents, 41.9% had poor level of nutrition knowledge and 57% had moderate level of functional food-related attitude, with seven types of functional foods consumed on average (57.0%). Binary logistic regression showed that university students who consumed fruits at least three times per day (aOR = 11.18; 95% CI: 1.46, 80.17), salty snacks (aOR = 2.90; 95% CI: 1.43, 5.86), soft drinks/sugar-sweetened beverages (SSB) (aOR = 3.12; 95% CI: 1.53, 5.26) and pure juice (aOR = 2.80; 95% CI: 1.48, 5.30) were more likely to consume functional foods during COVID-19 (P < 0.05).

Conclusion

The findings could provide information to public and private sectors in terms of creating a supportive environment to encourage and promote the awareness and consumption of functional foods and their associated health benefits.

Examining the relationship between sleep quality and depressive symptoms in Korean women engaged in soccer during the coronavirus pandemic

Introduction

The COVID-19 pandemic has caused sudden changes to daily lives, such as self-isolation and social distancing, and has negatively affected sleep quality and patterns. The resulting psychological discomfort has caused many Korean women to experience depressive moods. Vigorous physical activity is considered effective in improving sleep quality and alleviating depressive symptoms. As a form of vigorous physical activity, soccer could be used to improve women's mental health. This study aimed to ascertain the effects of playing soccer on sleep quality and depressive symptoms in women.

Methods

Non-face-to-face questionnaires were administered using Pittsburgh Sleep Quality Index to measure sleep quality and Patient Health Questionnaire-9 to measure depressive symptoms, targeting 200 of 297 soccer-playing Korean women aged 20-50 years, from October 13, 2022, to January 15, 2023. A total of 172 questionnaires administered to soccer participants were used, while 28 with insincere and double or no-responses were excluded. Additionally, 124 samples of non-exercise participants were collected, with the help of "EMBRAIN," a Korean research and survey company. This study analyzed differences in sleep quality and depressive symptoms, and correlations and multiple regression analysis were performed.

Results

The soccer group was shown to have a high quality of sleep. In relation to the effect of sleep quality on depressive symptoms, subjective sleep quality, sleep latency, sleep disturbance, use of sleeping pills, and daytime functional disorder had a significant effect. In the relation to the effect of sleep quality on depressive symptoms, significant effect was found in subjective sleep quality, sleep latency, sleep disturbance, and daytime functional disorder of soccer participants, and non-exercise participants displayed significant effect in subjective sleep quality, sleep disturbance, and the use of sleeping pills.

Discussion

This study examined the effect of soccer participation on sleep quality and depressive symptoms among women. Soccer, which requires high activity and teamwork levels, improves sociability in women by enhancing their sense of belonging, self-confidence, and team spirit.

Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities

OBJECTIVES

To quantify the number and type of students failing to secure basic needs.

PARTICIPANTS

Students attending 22 postsecondary schools in the United States in Fall 2019.

METHODS

The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities.

RESULTS

Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen.

CONCLUSIONS

High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

The Indicator of Emotional Eating and Its Effects on Dietary Patterns among Female Students at Qassim University

Emotional eating (EE) is considered as the inclination to eat in response to emotions and is associated with certain syndromes. In this sense, we explored the indices of EE and its association with dietary patterns among female students at Qassim University in Saudi Arabia. A cross-sectional study of 380 participants (aged 18-29 years, female students) was performed. Anthropometric measurements of the participants were taken, such as height, body mass index, fat mass and hip-waist circumference as well as the Emotional Eating Scale (EES). The classification of the ESS included the thresholds of 44.7, 43.9 and 11.3% for low, moderate and high EE, respectively. Linear regression after adjustment showed that fat intake was a significant predictor of EE (p = 0.031) as well as feelings of enthusiasm. We also observed an interesting indication: fat intake (p = 0.011) and educational level (p < 0.05) were significantly associated with, and could be significant predictors of, EE. The results highlight the importance of emotional eating, its relationship with the consumption of foods that contain fat and understanding how it develops by raising awareness of the importance of healthy food for a healthy lifestyle.

Effect of COVID-19 pandemic on eating habits and lifestyle of college students in Tabriz, Iran: a cross-sectional study

Background

The pandemic of coronavirus disease (COVID-19) has influenced lifestyle behaviors and the health of populations worldwide. The purpose of this study was to determine the effects of the COVID-19 pandemic on the eating habits and lifestyle behaviors of Tabriz University of Medical Sciences students in Tabriz, Iran.

Methods

This cross-sectional study was conducted on 220 college students selected using a convenience sampling method in May-June 2022. Data were collected by the questionnaire, which included information on eating habits, physical activity, smoking, watching television, social media use, sleep, anxiety and stress, and smoking before and during the pandemic. The Chi-square test was used to analyze the association of COVID-19 with lifestyle behaviors.

Results

The median age of participants was 22.00 (IQR: 3.00) years old. The median BMI was 21.69 (IQR: 3.82) kg/m2, and 74.5% of participants had a BMI of 18.5 to 25 kg/m2. Around 34.5% of participants reported a weight gain during the pandemic. During the pandemic, students' eating habits improved by maintaining a regular meal pattern, eating a balanced diet, consuming 2-3 servings of milk or its products, consuming one or more servings of pulses, eggs, or meat per day, decreasing consumption of fast food, fried, and junk foods, adding less sugar to meals and beverages, and consuming fewer sugar-sweetened beverages and foods with high sugar (all p = 0.000). They also reported less physical activity and more sitting and screen time. Sleep time and poorer quality of sleep increased during the pandemic (p = 0.000). Feeling stress or anxiety in a day increased, and 2.2% of our participants decided to smoke. The biggest reasons for eating habits changes were less eating out, fear of coronavirus spreading through food, preferring home-cooked food, and improved knowledge about nutrition.

Conclusion

The results indicated that the eating habits of university students improved; however, participants stated increased weight gain, screen, sitting, and sleep time, declined physical activity, worse sleep quality, and feeling stress or anxiety during the COVID-19 pandemic. The findings can help to develop nutritional and behavioral recommendations for maintaining adults' health during and after the pandemic.

Diet Quality and Its Association with Lifestyle and Dietary Behaviors among Croatian Students during Two COVID-19 Lockdowns

The present study aims to assess the diet quality, the relationship between diet quality and lifestyle, and the association of diet quality with body mass index and students' field of study during COVID-19 lockdown periods (spring and winter) in 2020. Datasets were collected via an anonymous online self-reported questionnaire distributed during two time periods using social media. A total of 1939 Croatian students (82.4% women and 17.6% men) completed the questionnaire. Diet quality was assessed using the pro-healthy diet index (pHDI) and non-healthy diet index (nHDI). An increase in diet quality was noted during both lockdown periods but was lower during the winter lockdown. Cooking for oneself was associated with a high level of pHDI, while ordering or buying ready-to-eat food was linked to a low level of pHDI. Additionally, a decrease in screen time and increased physical activity was associated with high pHDI values. Furthermore, during both lockdown periods, students with a BMI above 30 kg/m² had the highest nHDI values compared to other students. Although positive changes were found during both lockdown periods, they were less pronounced throughout the winter lockdown. Further studies are needed to elucidate the real impact of these changes in the post-COVID period.

Impact of food insecurity and its influencing factors on the risk of malnutrition among COVID-19 patients

INTRODUCTION

Few studies focused on the impact of food insecurity severity on the risk of malnutrition among COVID-19 patients in Saudi Arabia.

OBJECTIVES

This study described the prevalence of food insecurity among COVID-19 patients, its severity, and its associated factors. Additionally, the impact of the severity of food insecurity on the risk of malnutrition was determined. It is hypothesized that food insecurity is associated with an increased risk of malnutrition among COVID-19 patients.

METHOD

A cross-sectional study was conducted in Al Madinah Al Munawarah in Saudi Arabia. Patients with confirmed COVID-19 and acute severe or nonsevere illness were enrolled. The Food Insecurity Experience Scale was used to determine the severity of food insecurity, and risk of malnutrition was assessed using the Malnutrition Screening Tool. Demographic characteristics, history of medical conditions, food intake, and body mass index (BMI) were assessed.

RESULTS

A total of 514 patients were enrolled, with 391 (76%) having acute nonsevere COVID-19 symptoms. A total of 14.2% of patients suffered from food insecurity. Of these, 17% had severe symptoms. The severity of food insecurity was influenced by patients' education (P = 0.02, 95% CI 0.019-0.225), weight loss (P = 0.0001, 95% CI 0.252-0.752), and loss of appetite (P = 0.0001, 95% CI 0.293-0.604). Fifteen percent of patients were at risk of malnutrition. Many obese patients suffered from severe COVID-19 symptoms (P = 0.029, 95% CI 0.02-0.539). The risk of malnutrition was associated with the severity of food insecurity (P = 0.001, 95% CI -0.056- -0.014), BMI (P = 0.049, 95% CI 0.000-0.042), and employment status (P = 0.034, 95% CI 0.002-0.048).

CONCLUSION

Food insecurity and the risk of malnutrition among COVID-19 patients should be assessed to prevent adverse health outcomes.

Physical exercise practice was positively associated with better dietary practices of aged people during COVID-19 social distance: A cross-sectional study

BACKGROUND & AIMS

COVID-19 is a respiratory syndrome caused by SARS-CoV-2. In the absence of effective treatment and vaccines, social distance (SD) is essential to reduce the spread of the virus. However, SD generates several behavioral changes, especially in psychological (i.e., emotions and depressive symptoms) and lifestyle-related parameters (i.e., diet, physical activity, and sleep), and the aged people could be more susceptible to COVID-19 SD-related effects (i.e., loneliness, stress, fear, concerns about life, etc.). As such, we aimed to explore the relationship between lifestyle- (physical exercise practice and sleep quality) and psychological-related factors with the dietary practices derived from the Brazilian National Food Guide of older adult during the COVID-19 SD.

METHODS

A web-based survey was conducted in São Paulo, Brazil. Data were collected between August and December 2020 (a period of social isolation due to the COVID-19 pandemic). The questions were extracted from validated questionnaires to verify dietary practices (score of adhesion to the food guide for the Brazilian population), sleep quality (by Pittsburgh questionnaire), emotional food-related dimensions (by Three-factor Eating Questionnaire), and depression symptoms (by Beck's questionnaire).

RESULTS

Results were from 229 aged people (mean age 66.5 ± 6.02 years old; mean BMI 27.5 ± 4.32 kg/m²; mean sleep duration 8.23 ± 1.41 h; Pittsburg sleep quality score 6.55 ± 4.83; dietary practice score 42.5 ± 6.47). In the adjusted-linear regression model, we verified that physical exercise practice at home (β = 2.179; 95% CI: 0.599 to 3.758; p = 0.007) during COVID-19 SD was positively associated with better dietary practices in aged people. In contrast, emotional eating was negatively associated with dietary practices (β = -0.051; 95% CI: -0.092 to - 0.009; p = 0.015).

CONCLUSION

We conclude that in aged people, physical exercise practice at home during COVID-19 SD was positively associated with better dietary practices, while emotional eating was negatively associated.

Food Insecurity, the Food Environment, and COVID-19 in Rural South Carolina

In this study, we explored the relationship between the food environment and food security among rural adults during the COVID-19 pandemic. Researchers, with assistance from community partners, conducted a cross-sectional survey assessing the impact of COVID-19 on food access, food security, and physical activity in 9 rural South Carolina (SC) counties. This survey was administered to a purposive sample (N = 587) from August 2020 to March 2021. The dependent variable was a binary indicator of food insecurity (past 3 months), in accordance with the USDA Household Food Security Survey Module. Independent variables were sociodemographic characteristics, food environment factors (eg, shopping at grocery stores, partial markets, and farmers' markets), and shopping behaviors during the pandemic. Overall, 31% of respondents were food insecure. Food security status differed by income and household composition. Results indicate that the odds of food insecurity were higher for respondents who shopped frequently at partial markets (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI]: 1.01-2.56) and shopped more for food before the pandemic than during the pandemic (AOR = 1.68, 95% CI: 1.07-2.64). Findings underscore the importance of examining the relationship between the food environment and food insecurity during COVID-19 in rural settings.

Tuberculosis and malnutrition: The European perspective

Tuberculosis (TB) is a leading infectious cause of death worldwide, despite ongoing efforts to limit its incidence and mortality. Although the European Region has made gains in TB incidence and mortality, it now contends with increasing numbers of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). Malnutrition is a major contributor to the burden of TB and may also be directly caused or enhanced by the onset of TB. The presence of malnutrition may worsen TB and MDR/RR-TB related treatment outcomes and contribute to growing TB drug-resistance. Preventing and treating all forms of malnutrition is an important tool to limit the spread of TB worldwide and improve TB outcomes and treatment efficacy. We carried out a scoping review of the existing evidence that addresses malnutrition in the context of TB. Our review found malnutrition increased the risk of developing TB in high-burden settings and increased the likelihood of developing unfavorable treatment outcomes, including treatment failure, loss to follow-up, and death. The potential impact of nutritional care and improved nutritional status on patient prognosis was more difficult to evaluate due to heterogeneity of patient populations, treatment protocols, and treatment durations and goals. High-quality trials that consider malnutrition as a major risk factor and relevant treatment target when designing effective strategies to limit TB spread and mortality are needed to inform evidence-based practice. In TB patients, we suggest that widespread and regular nutritional screening, assessment, and counselling, has the potential to increase effectiveness of TB management strategies and improve patient quality of life, overall outcomes, and survival.

Malnutrition in older adults

Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.

Exposure to Healthy Weight Information on Short-Form Video Applications to Acquire Healthy Weight-Control Behaviors: A Serial Mediation Model

This study explored the effects of Chinese college students' (20-34 years old) exposure to healthy weight information on short-form video applications on their intention to acquire healthy weight-control behaviors (reducing high-fat diet intake, accessing physical activity to control body weight, etc.). Specifically, this study investigated the direct and mediated effect on such a relationship via healthy weight awareness, the first-person effect, and perceived herd. The data were collected using a web-based survey and thoroughly tested questionnaire with a sample of 380 Chinese college students. Hierarchical regression, parallel mediation, and serial mediation analysis were applied to test the hypotheses. The results indicated that healthy weight awareness, first-person effect, and perceived herd all played mediator roles that induced the relationship between Chinese college students' exposure to healthy weight information and their intention to acquire healthy weight-control behaviors. In addition, healthy weight awareness and the first-person effect sequentially mediated this relationship.

Exploring the Longitudinal Stability of Food Neophilia and Dietary Quality and Their Prospective Relationship in Older Adults: A Cross-Lagged Panel Analysis

Poor dietary quality is a major cause of morbidity, making the promotion of healthy eating a societal priority. Older adults are a critical target group for promoting healthy eating to enable healthy aging. One factor suggested to promote healthy eating is the willingness to try unfamiliar foods, referred to as food neophilia. This two-wave longitudinal study explored the stability of food neophilia and dietary quality and their prospective relationship over three years, analyzing self-reported data from N = 960 older adults (M_T1 = 63.4, range = 50-84) participating in the NutriAct Family Study (NFS) in a cross-lagged panel design. Dietary quality was rated using the NutriAct diet score, based on the current evidence for chronic disease prevention. Food neophilia was measured using the Variety Seeking Tendency Scale. The analyses revealed high a longitudinal stability of both constructs and a small positive cross-sectional correlation between them. Food neophilia had no prospective effect on dietary quality, whereas a very small positive prospective effect of dietary quality on food neophilia was found. Our findings give initial insights into the positive relation of food neophilia and a health-promoting diet in aging and underscore the need for more in-depth research, e.g., on the constructs' developmental trajectories and potential critical windows of opportunity for promoting food neophilia.

The role of nutrition knowledge in dietary adjustments during COVID-19 pandemic

Knowledge/awareness significantly influences people's dietary choices, lifestyle, and inadvertently their health outcomes; hence it is imperative that people have correct information with regards to food and health. This study was undertaken to establish the role of nutrition knowledge on dietary choices and habits of people in Calabar, especially after the hard COVID-19 lockdown, and to ascertain if there was any positive or negative effect on the lifestyle of the people. It consisted of a cross-sectional survey in Calabar, Cross River State - Nigeria. An online questionnaire was prepared after sample size determination and its content validated. The questionnaire was designed to obtain data on the socio-economic status, participants' lifestyle, and changes in dietary intake/health before and during the COVID-19 lockdown, while the questionnaire link was in circulation for 6 weeks (April/May 2021). Descriptive statistics was used to define the proportion of responses for each question and Pearson's correlation was used to check for association between variables. Most participants were undergraduates depending on parents/sponsors. Financial decline appeared to have contributed to a post lockdown decrease in food consumption. Many (82.6%) respondents recorded high nutrition knowledge scores (NKS) and 83.1% of the respondents had high health scores. The results show that NKS influenced the kind of foods the respondents consumed frequently and there was a positive correlation between NKS consumption of fruits/vegetables. NKS had effect on their access to healthy foods and it varied significantly with respondent's total health score. No association existed between NKS and the reason for skipping meal - 'lack of time to prepare meals'. Nutrition knowledge and proper awareness, contributed significantly in dietary choices (regardless of limited resources), thus ensuring adequate nutrition and reduced health problems (most respondents recorded high health scores) during a pandemic. This study affirms the effectiveness of adequate nutrition education and awareness in ensuring healthy dietary choices, promoting optimal health, and reducing risks of diseases.

The effect of Augmented-Reality media-based health education on healthy lifestyle knowledge, attitude, and healthy lifestyle behaviors among pregnant women during COVID-19 pandemic in Jakarta, Indonesia

Pregnancy is a critical period. Pregnant women need to perform healthy lifestyle behavior in order to ensure good fetal development. During COVID-19 pandemic, Augmented-Reality (AR) media may be used in pregnant women health education. However, there is a lack of research that investigated the effect of AR media use in pregnant women health education. Therefore, this research aimed to investigate the impact of AR media use on healthy lifestyle knowledge, attitude, and behaviors among pregnant women during COVID-19 pandemic. This cohort-longitudinal study involved 86 pregnant women aged 18-45 years. The subjects who participated in this research received health education interventions using AR media for 5 months. The data collection was performed at the pre-post-intervention through a survey with questionnaire. Changes in subjects' healthy lifestyle knowledge, attitude, and behaviors were analyzed by using t-test. The research results show that the AR media use in health education significantly improved the subjects' scores for healthy lifestyle knowledge (5.0 ± 10.9; p < .05) and behaviors (9.7 ± 17.5; p < .05). However, the subject score for attitude was not significantly improved (0.3 ± 7.1; p ≥ .05). This research results provide evidence of the importance of using AR media in health education for pregnant women during COVID-19 pandemic.

The Association between Dietary Inflammatory Index with Risk of Coronavirus Infection and Severity: A Case-Control Study

Background

Recently, several have evaluated the association between the components of the dietary inflammatory index (DII) score with the risk and severity of Coronavirus Disease 2019 (COVID-19). For the first time, we examined the association between DII^® with risk of coronavirus infection and symptom severity through a case-control study in Iran.

Methods

The present case-control study was conducted on COVID-19 cases (n = 100) and healthy control (n = 100) volunteer, aged from 18 to 65 years. Dietary intake, DII, body mass index, COVID-19 infection, and the severity of its symptoms were assessed for each participant. A multivariable logistic regression analysis test was used to estimate the odds ratio and 95% confidence interval.

Results

Our results demonstrated that COVID-19-infected patients were significantly older and had longer history of diabetes as compared to the healthy control group (P <.05). Furthermore, the participants with COVID-19 had a significantly greater intake of total fat (P =0.259), saturated fat (P =0.005), and dietary fiber (P = .004). In contrast, individuals in the healthy control group had a higher intake of carbohydrate (P = .005), sodium (P <.001), and iron (P <.001). However, there was no significant difference in DII score between COVID-19 and healthy controls (P =.259). In addition, we did not detect any specific association between DII score and risk of COVID-19 infection (odds ratio = 1.08, 95% confidence interval: 0.92 to 1.27; P =.294) and the severity of its symptoms (P >.05).

Conclusions

There appears to be no specific association between DII score and risk of COVID-19 infection and the severity of its symptoms. More prospective cohort studies are necessary to confirm the veracity of our results.

Disordered eating in female Indian students during the Covid-19 pandemic: The potential role of family

BACKGROUND

Within a paternalistic culture where weight is socially important and parental pressures are strong, 10 female Indian university students across various countries faced particular problems when living with their parents during the Covid-19 lockdowns.

OBJECTIVE

The current interview study examines why cultural and familial factors during the Covid-19 lockdown had such an impact on female Indian university students' food and exercise behaviors and self-view.

METHOD

Semi-structured, online (Microsoft Teams) interviews were conducted with 10 female Indian university students aged 20-23, who had moved back in with their parents during lockdown. The recorded and transcribed interviews were analyzed using reflexive thematic analysis with a contextualist orientation.

RESULTS

Five themes were generated. Set within a context where eating and exercise habits are regulated by cultural and familial factors (Theme 1), lockdown living situations amplified these factors (Theme 2), severely impacting students' cognitions and affect (Theme 3), and relationships with their parents (Theme 4) even after lockdown was over. Participants' experiences led to greater awareness and motivation to confront their issues regarding body image and mental health (Theme 5).

CONCLUSIONS

These findings have practical implications for counseling and eating disorder (ED) therapy in universities: Improved understanding of cultural and familial factors that affect female Indian students likely leads to better support. Our findings also emphasizes the need for research into the role of family and the impacts of family dynamics in the development of disordered eating habits.

PUBLIC SIGNIFICANCE

In Indian culture, eating and exercise habits tend to be regulated by cultural and familial factors. When female university students moved back in with their parents during the Covid-19 lockdowns, their living situation amplified these factors, severely impacting students' thoughts and feelings about their body, and relationships with their parents even after lockdown was over. The study has strong practical implications for university counseling settings and adds to research on the role of culture in how ED develops.

COVID-19 Salgınında Sağlık Personelinin Beslenme Alışkanlıklarındaki Değişikliklerin Değerlendirilmesi

Amaç: Bu çalışma COVID-19 salgını sürecinde çalışan sağlık personelinin beslenme alışkanlıklarındaki değişiklikleri değerlendirmek amacıyla yapılmıştır.Yöntem: Çalışmaya Ankara ilinde çalışan, çalışmaya katılmayı kabul eden, soruları eksiksiz yanıtlayan 200 sağlık personeli dâhil edilmiştir. Çalışmada bireylerin sosyo demografik özellikleri, genel sağlık durumları, beslenme alışkanlıkları ve antropometrik ölçümleri sorgulanmıştır. İstatistiksel analizler SPSS adlı paket program kullanılarak yapılmıştır.Bulgular: Bireylerin %84,5’i kadın, %15,5’i erkektir. Çalışmaya katılan erkeklerin yaş ortalaması 29,68±6,75 yıl, kadınların ise 31,31±8,95 yıldır. Erkeklerde Beden Kütle İndeksi (BKİ kg/m2) ortalaması 25,60±3,00kg/m2; kadınlarda 23,03±3,40’kg/m2’dir. Bireylerin %56,5’inin günlük ana öğün tüketimi üç öğündür. Stres durumunda, erkeklerin %54,8’inin, kadınların %61,5’inin yemek tüketiminin azaldığı belirlenmiştir. Bireylerin %19,5’i bitkisel ürün kullanmaktadır. En sık kullanılan ürünlerin, D vitamini (%40,4) ile C vitamini (%26,6) olduğu belirlenmiştir. COVID-19 pandemisinde bireylerin gece yeme ve dışarıdan yemek yeme alışkanlığının sırasıyla %51,0 ve %56,5 oranında arttığı saptanmıştır.Sonuç: Pandemi döneminde bireylerin yeterli ve dengeli beslenmelerinin sağlanması ve bağışıklık sistemi normal fonksiyonlarını sürdürebilmesi için sağlıklı beslenme farkındalığının artırılması gerekmektedir. Pandemi döneminin beslenme alışkanlıklarındaki etkileri hakkında daha fazla çalışmaya ihtiyaç duyulmaktadır. 

Association between Vitamin D Status and Secondary Infections in Patients with Severe COVID-19 Admitted in the Intensive Care Unit of a Tertiary-Level Hospital in Turkey

There are several studies showing that the vitamin D status can determine risk of COVID-19 infections, severity and mortality from coronavirus disease 2019 (COVID-19). However, the association between vitamin D (25(OH)D) and secondary infections in the prognosis of COVID-19 patients has not been reported yet. The aim was to investigate whether the vitamin D status affects the rates of secondary infections in patients with severe COVID-19 hospitalized in the intensive care unit (ICU) of a tertiary-level hospital in Turkey. The data of 194 patients with diagnosis of severe COVID-19 who were admitted to the ICU from March 2020 to June 2021 and older than 18 years were evaluated in this retrospective study. The patients were divided into two groups according to total serum 25(OH)D level as normal group (≥20 ng/mL) and low group (<20 ng/mL). The 25(OH)D level was low in 118 (60.8%) and normal in 76 (39.2%) patients. The mean age of the low group was significantly higher than that of the normal group (67.02 ± 14.47 vs. 61.70 ± 14.38; p = 0.013). The systolic and diastolic blood pressure as well as the Glasgow coma scale score of the low group were significantly lower than that of the normal group (p = 0.004, 0.002 and 0.001, respectively). The intubation rate and APACHE (Acute Physiology and Chronic Health Evaluation) score of the low group was significantly higher than that of the normal group (p = 0.001). The platelets number and blood pH decreased, and the neutrophil/lymphocyte ratio, procalcitonin, lactate, urea, creatinine and lactate dehydrogenase concentrations increased significantly in the low group (p < 0.05). The mortality rate was 79.7% in the low group and 22.4% in the normal group (p < 0.001). Microbiological growth was observed in 68.6% of the normal group and 52.6% of the normal group (p = 0.025). The number of cultures with resistant bacteria was significantly higher in the low group (25.9%) than that in the normal group (17.5%) (p = 0.035). The severe COVID-19 patients hospitalized with vitamin D deficiency may have increased risks of poor prognosis and mortality due to secondary infections in the ICU.

Quality of the diet during the COVID-19 pandemic in 11 Latin-American countries

Background and objectives

The confinement by COVID-19 has affected the food chain and environments, which added to factors such as anxiety, frustration, fear and stress have modified the quality of the diet in the population around the world. The purpose of this study was to explore diet quality during the COVID-19 pandemic in 11 Latin American countries.

Methodology

Multicentric, cross-sectional study. An online survey was applied to residents of 11 Latin-American countries, during April and May 2020, when confinement was mandatory. Diet quality was evaluated using a validated questionnaire.

Result

10,573 people participated in the study. The quality of the food by country shows that Colombia presented the best quality, while Chile and Paraguay presented the lowest. When comparing the overall results of diet quality by gender, schooling and age, women, people with more schooling and people under 30 years of age, presented better diet quality. The regression model showed that the variables associated with diet quality were: age (df = 3, F = 4. 57, p < 0.001), sex (df = 1, F = 131.01, p < 0.001), level of education (df = 1, F = 38.29, p < 0.001), perception of weight change (df = 2, F = 135.31, p < 0.001), basis services (df = 1, F = 8.63, p = 0.003), and quarantine (df = 1, F = 12.14, p = 0.001).

Conclusion

It is necessary for governments to intervene to reverse these indicators, considering that inadequate feeding favors the appearance of no communicable diseases, which favor a higher risk of infection and worse prognosis with COVID-19.

The Effect of Pomegranate Juice and Sumac Consumption in the Treatment of Outpatients with COVID-19

Introduction

COVID-19, an epidemic of coronavirus infection, has become a major global threat. The coronavirus mainly targets the human respiratory system, followed by cytokine storm, and altered immune responses associated with disease progression and adverse outcomes. Sumac and pomegranate juice are rich in bioactive compounds, which potentially have antiviral activities. This study is aimed at investigating the effect of a diet based on the use of sumac and pomegranate juice on the treatment of outpatients with COVID-19.

Methods

In this study, 182 outpatients with COVID-19 were randomly divided into two groups receiving a diet containing pomegranate juice and sumac along with standard treatment and the control group (group 2) receiving standard treatment.

Results

Consumption of a diet containing pomegranate juice and sumac in outpatients with COVID-19, who were receiving standard-of-care treatment, led to a significant decrease in fever, chills, cough, weakness, smell and taste disorders, shortness of breath, diarrhea, nausea and vomiting, and abdominal pain compared with outpatients with COVID-19 who received only standard treatment.

Conclusion

Clinical trials of outpatients have limitations such as patients' resilience to post-COVID-19 follow-up. However, the use of pomegranate juice and sumac can be efficacious in reducing COVID-19 symptoms. This trial is registered with IRCT20190406043175N3.

Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis

Objective

This study was designed to assess and analyze nutritional status (NS) and immune status in patients with tuberculosis.

Methods

A retrospective analysis was conducted on 93 TB patients hospitalized in the tuberculosis ward of the West China Hospital of Sichuan University. Subgroup comparisons were made according to age (<65 years and ≥65 years), nutritional risk score 2002 (NRS 2002 <3 and ≥3), tuberculosis location [pulmonary tuberculosis and extrapulmonary tuberculosis (including pulmonary tuberculosis complicated with extrapulmonary tuberculosis)], and prognostic nutrition index (PNI) (<45 vs ≥45).

Results

Significantly increased weight loss was associated with extrapulmonary tuberculosis (P =0.0010). Serum albumin (P =0.0214), total lymphocyte count (P = 0.0009) and PNI (P = 0.0033) were significantly decreased in older patients. Neutrophils/lymphocytes (NLR) (P =0.0002), monocytes/lymphocytes (MLR) (P < 0.0001), and platelets/lymphocytes (PLR) (P =0.0107) were higher. According to NRS 2002, higher nutritional risk was associated with lower body weight and body mass index (BMI) (P < 0.0001), higher weight loss (P = 0.0012), longer duration of hospitalization (P =0.0100), lower serum albumin level and hemoglobin concentration (P <0.01), lower creatinine level, and lower PNI (P < 0.01). 0.0001), lower total lymphocyte count (P = 0.0004), higher neutrophil and monocyte counts (P <0.05), and higher NLR (P = 0.0002), MLR (P = 0.0006), and PLR (P = 0.0156). Lower PNI was associated with lower body weight (P = 0.0001) and BMI (P =0.0074), lower total protein, albumin, and hemoglobin concentrations (P < 0.0001), and lower total lymphocyte count (P < 0.0001) and creatinine levels (P = 0.0336), higher age (P =0.0002) and NRS 2002 score, P < 0.0001), longer hos-pital stay (P = 0.0003), higher neutrophil count (P = 0.0042), and NLR, MLR, and PLR (P <0.0001) were significantly correlated. In multivariate logistic regression analysis, weight loss (OR: 0.209, 95% CI: 0.060-0.722; p =0.013) was significantly associated with higher nutritional risk (NRS 2002≥3). In multiple linear regression analysis, the NRS 2002 score was higher (B=2.018; p =0.023), and extrapulmonary tuberculosis (B=-6.205; p =0.007) was linked with a longer duration of hos-pitalization.

Conclusions

Older tuberculosis patients are at nutritional risk, and older patients (≥65 years old) need to pay attention to nutritional monitoring and intervention. Older TB patients and those at risk of malnutrition have increased immune ratio and impaired immune function. Management of TB patients using basic diagnostic tools to assess nutritional and immune status and calculate PNI and immunological indexes (NLR, MLR, PLR) to improve treatment outcomes.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study

COVID-19's intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians' practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

Changes in Vitamin D Status in Korean Adults during the COVID-19 Pandemic

The aim of this study was to investigate changes in 25(OH)D (25-hydroxyvitamin D) levels and in the vitamin D status of Korean adults before and during the coronavirus disease (COVID-19) pandemic. This study compared serum 25(OH)D levels before and after the pandemic in 1483 adults aged 19 years and older who were screened at a university hospital. Subjects were selected only from participants tested in the same season before and after the pandemic. The pre-COVID-19 testing period was from 1 March 2018 to 31 November 2019; the testing period in the COVID-19 era was from 1 June 2020 to 31 November 2021. The mean 25(OH)D level for all participants was 21.4 ± 10.2 ng/mL prior to the outbreak of COVID-19, which increased to 23.6 ± 11.8 ng/mL during the COVID-19 lockdown period (p < 0.001). The increase was particularly dramatic in elderly females (28.8 ± 12.3 ng/mL to 37.7 ± 18.6 ng/mL, p = 0.008). The prevalence of vitamin D deficiency decreased in both males (48.4% to 44.5%, p = 0.005) and females (57.0% to 46.0%, p < 0.001). In conclusion, 25(OH)D levels in Korean adults increased during the COVID-19 era, and the prevalence of vitamin D deficiency decreased accordingly.

Students in Turkey During the Early Days of the COVID-19 Pandemic

This study aims to analyse the subjective well-being of university students during the early days of the COVID-19 pandemic process and to examine how students have been affected economically, psychologically and socially. Other subjects included in the scope of the study are the suitability of the physical conditions during the process of online education, the students' motivation, and their expectations towards the future. The study also analyses the connection between these factors and the subjective well-being concepts of happiness and life satisfaction. The study focuses on students of the Faculty of Economics at Marmara University in Turkey. In total, 428 students took part in the survey prepared for the study. Descriptive analyses indicate that students have been negatively affected in terms of psychological and socio-economic factors along with subjective well-being. Ordered probit models show a statistically significant relationship between a major part of these changes and subjective well-being variables.

Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic

PURPOSE

Maladaptive eating behaviors like food addiction (FA) are common among students, and orthorexia nervosa (ON) is being evaluated as a new condition among eating disorders (EDs). Moreover, dietary diversity (DD) is recognized as an important component of a healthy diet. Thus, the current study sought to examine the prevalence of ON and FA as well as the factors associated with ON, FA, and DD among university students in Bangladesh during the COVID-19 pandemic.

METHODS

Four-thousand-and-seventy-six students were recruited and completed an online survey consisting of the Bratman Orthorexia test, the modified Yale Food Addiction Scale, and a questionnaire based on the Food and Agriculture Organizations' guidelines. Inferential statistics, bivariate and multivariable linear regression were used for analyzing data.

RESULTS

ON and FA were observed in 1.7% and 7.5% of participants, respectively, with 43.8% exhibiting Health Fanatic eating attitude. The mean DD score was 5.96 (SD = 1.56). Students with ON consumed more legumes, nuts, seeds, and vegetables including dark green leafy vegetables whereas students with FA consumed more organ meats and eggs. Students who were older-aged, married, formerly smoked, had fitness goals, and had guilty feelings about violating food rules were more likely to have ON, whereas those who were female, were married, actively smoked, and were overweight and obese were more likely to have FA.

CONCLUSIONS

The findings suggest that students from Bangladesh are at risk of FA, and less so for ON. These entities and low DD deserve more research attention in Bangladesh to increase awareness and ensure appropriate interventions.

COVID-19, nutrition, and gender: An evidence-informed approach to gender-responsive policies and programs

In addition to the direct health impacts of COVID-19, government and household mitigation measures have triggered negative indirect economic, educational, and food and health system impacts, hitting low-and middle-income countries the hardest and disproportionately affecting women and girls. We conducted a gender focused analysis on five critical and interwoven crises that have emerged because of the COVID-19 crisis and exacerbated malnutrition and food insecurity. These include restricted mobility and isolation; reduced income; food insecurity; reduced access to essential health and nutrition services; and school closures. Our approach included a theoretical gender analysis, targeted review of the literature, and a visual mapping of evidence-informed impact pathways. As data was identified to support the visualization of pathways, additions were made to codify the complex interrelations between the COVID-19 related crises and underlying gender relations. Our analysis and resultant evidence map illustrate how underlying inequitable norms such as gendered unprotected jobs, reduced access to economic resources, decreased decision-making power, and unequal gendered division of labor, were exacerbated by the pandemic's secondary containment efforts. Health and nutrition policies and interventions targeted to women and children fail to recognize and account for understanding and documentation of underlying gender norms, roles, and relations which may deter successful outcomes. Analyzing the indirect effects of COVID-19 on women and girls offers a useful illustration of how underlying gender inequities can exacerbate health and nutrition outcomes in a crisis. This evidence-informed approach can be used to identify and advocate for more comprehensive upstream policies and programs that address underlying gender inequities.

Association between body image perception with demographic characteristics of physically active individuals during COVID-19 lockdown in Saudi Arabia

Objective

This study aimed to determine the relationship between body image perception and demographic factors among physically active (men and women) during the COVID-19 lockdown in Saudi Arabia.

Methods

A descriptive cross-sectional survey was employed among physically active individuals in Saudi Arabia between June and July 2020. Eligible participants completed a 19-item self-administered questionnaire that covered three areas: demographic questions, reasons for physical activity, and role or perceptions of body image during the COVID-19 pandemic quarantine.

Results

A total of 323 physically active individuals participated in this study. The majority of the participants were female (N=217, 72.7%), were married (66.6%), and living in the Middle region of Saudi Arabia (N= 268, 83%). The analysis shows that majority of the participants were dissatisfied with their current body shape. The analysis also showed a significant association between participants' educational attainment and BMI and body dissatisfaction (p= 0.001). The strongest predictor was BMI level, recording an odds ratio (OR) of 5.99 (CI: 2.15 – 10.54, p=0.001) in obese and an OR of 4.55 (CI: 1.31 – 9.35, p=0.001) in overweight, indicating that compared with normal weight, obese and overweight participants were more likely to be dissatisfied by five and four times, respectively.

Conclusion

This study indicates that physically active individuals are greatly influenced by the confinement period. Programs that promote physical activity in their house or during lockdown may help to encourage, lessen their anxiety, and maintain their health. This may also decrease the anxiety of individuals, particularly those active ones.

Effects of the COVID-19 pandemic on diet and physical activity and the possible influence factors among Saudi in Riyadh

Background/Aim

The COVID-19 pandemic has been spreading throughout the world, having a significant impact on people’s lifestyles and health through social isolation and home confinement. The purpose of this study is to look into the impact of COVID-19 on diet and physical activity, as well as the possible influence factors, among ≥ 13-year-olds in Riyadh, Saudi Arabia.

Materials and methods

In the present study data were collected from 2,649 participants via an online survey. The Google online questionnaire was available from April 23 to May 6, 2020. During the COVID-19 lockdown, the survey asked respondents about their demographic characteristics (gender, age, education, economic income, and occupation), anthropometric data, physical activity, and diet habits.

Results

The study included 2,649 respondents, with 23.3% being male and 76.7% female. The majority of them were in good health and ranged in age from 21 to 29 years. 31% of those polled were overweight, and 14.3% were obese. The majority of respondents have a bachelor’s degree, diploma, or the equivalent, and a monthly family income of ≤ 25.000 SR. Those who were following a healthy diet (32.3%) were unable to maintain it during confinement, with males being affected more than females (42.7%, 29.3%, respectively, P = 0.004), and those most impacted were aged 21–29 years (38.0%, P = 0.046). Furthermore, 59.5% of males significantly failed to continue exercising during confinement compared to females who exercised consistently (P = 0.01). In terms of age, females aged less than 40 increased their exercise rate by about 23.4%, while males aged 40 and up decreased their exercise rate by 25.7% (P = 0.000). Moreover, 40.5% of the subjects’ weight increased, according to the findings. However, there was no significant effect on body mass index, despite the fact that 51% of participants were overweight or obese.

Conclusion

The data showed that the COVID-19 lockdown had a negative impact on maintaining a healthy diet (p = 0.023*) and physical activity (p = 0.000^**).

University Students Eating Habits: Normal Semester vs. Lockdown Period Caused by COVID-19 Pandemic

In the face of the COVID-19 pandemic, university students' eating habits may change due to the stress caused by mandatory full lockdown and social isolation, as well as uncertainty about their academic future. An analysis of 332 Portuguese university students from different areas of study was carried out through an online questionnaire to verify if the lockdown period caused by COVID-19 had any influence on the students' eating habits, as well as if this differed among students from health sciences courses and those from other areas. We found that, compared to a normal semester of classes, during the lockdown period, healthier eating habits were adopted, characterized by a decrease in meal delivery platforms used, self-reported consumption of fast-food, pre-cooked meals, foods rich in sugar and salt, and sugar-sweetened and alcoholic beverages, as well as increased self-reported consumption of vegetables, fruit and legumes, and physical exercise. Thus, although the lockdown led to stress and uncertainty, university students were able to take care of their eating habits and lifestyle, probably as a way of feeling stronger and safer against this disease.

Public health shocks, learning and diet improvement

Many governments aim to mitigate health risks by attacking nutritional failures. In this article, we exploit a unique natural experiment, the COVID-19 pandemic as an exogenous public health shock, to estimate the learning effects of intensive health information campaigns on nutrient intake during the pandemic. Using data from nearly-one million food purchases in China, our empirical findings strongly support the learning effect in explaining improvements in nutrient intake in the post-COVID-19 period. We conclude that when public health shocks occur, policy makers can boost relevant learning mechanisms by promoting information and education to improve individuals' awareness of preventive health behaviors of a more permanent nature, which can lead to health improvements in a society.

Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico

BACKGROUND

In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized.

METHODS

We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively.

RESULTS

We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths.

CONCLUSION

Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.

Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review

Home confinement during the COVID-19 pandemic has been accompanied by dramatic changes in household food dynamics that can significantly influence health. This systematic literature review presents parental perspectives of the impact of COVID-19 lockdown (up to 30 June 2022) on food preparation and meal routines, as well as other food-related behaviors, capturing both favorable and unfavorable changes in the household food environment. Themes and trends are identified and associations with other lifestyle factors are assessed. Overall, families enjoyed more time together around food, including planning meals, cooking, and eating together. Eating more diverse foods and balanced home-cooked meals (e.g., fresh fruit and vegetables) was combined with overeating and increased snacking (e.g., high-calorie snacks, desserts, and sweets), as parents became more permissive towards food; however, food insecurity increased among families with the lowest income. Adoption of meal planning skills and online shopping behavior emerged alongside behaviors aimed at self-sufficiency, such as bulk purchasing and stockpiling of non-perishable processed foods. These results are an important first step in recognizing how this pandemic may be affecting the family food environment, including low-income families. Future obesity prevention and treatment initiatives, but also ongoing efforts to address food management, parental feeding practices, and food insecurity, can account for these changes moving forward.

Is time-restricted eating a robust eating regimen during periods of disruptions in daily life? A qualitative study of perspectives of people with overweight during COVID-19

Background

Time-restricted eating (TRE) has been suggested as a feasible dietary strategy in individuals with overweight. Disruptions in daily life e.g., severe illness can affect engagement in lifestyle interventions to obtain healthier body weight. This study examined if and how the engagement with TRE among people with overweight was affected by the Danish COVID-19 lockdowns as an example of disruptions in daily life.

Methods

Fifteen participants with overweight enrolled in a TRE intervention, i.e. restricting all eating and drinking except water to the same daily ten-hour window, were interviewed about their experiences and engagement with TRE during COVID-19 lockdowns. Interviews were semi-structured and conducted by phone or face-to-face with safe social distancing. Data analysis was grounded in a reflexive thematic analysis approach.

Results

Daily life rhythms were disrupted by lockdowns by preventing participants from performing ordinary daily activities such as going to work, socialising, eating out or exercising. For some, this challenged their TRE engagement, while most were able to undertake the TRE eating window but reported increased snacking and consumption of take-away food within their eating window. For all, exercise habits became unhealthier. The negative impact on TRE engagement primarily occurred during daytime, as social distancing made it easier to engage with TRE during evenings.

Conclusions

This study showed that even people highly motivated to obtain healthier lifestyles practices struggled to maintain engagement with healthy behaviours, whereas sticking to the TRE window was manageable during COVID-19. TRE as a weight loss strategy was challenged which calls for more attention to supporting people in daily life to obtain healthier practices, also in case of periods of other disruptions such as divorce, serious illness etc.

Improving Fruit and Vegetable Accessibility, Purchasing, and Consumption to Advance Nutrition Security and Health Equity in the United States

In recent years, national and local efforts to improve diet and health in the United States have stressed the importance of nutrition security, which emphasizes consistent access to foods and beverages that promote health and prevent disease among all individuals. At the core of this endeavor is fruit and vegetable (FV) consumption, a dietary practice that is integral to attaining and sustaining a healthy diet. Unfortunately, significant inequities in FV accessibility, purchasing, and consumption exist, particularly among populations that are socially and economically disadvantaged. To achieve nutrition and health equity in the United States, the field must center the goal of nutrition security and initiatives that aim to increase FV consumption, specifically, in future work. The International Journal of Environmental Research and Public Health (IJERPH) Special Issue titled "Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption" features several scholarly publications from experts conducting timely research on these topics. In this commentary, we (1) summarize the U.S.-based literature on inequities in FV accessibility, purchasing, and consumption, (2) describe how the contributions to this IJERPH special issue can advance nutrition security and health equity, and (3) outline future research questions from our perspective.

Sleep Quality and Mental Health Consequences of COVID-19 Pandemic in the Aviation Community in Greece

OBJECTIVE

The aim of this study was to assess the mental health and sleep quality of aviation workers in Greece during the pandemic.

METHODS

A cross-sectional study of aviation workers in Greece was conducted.

RESULTS

Sleep disturbances were observed in 25.4% of our 548 participants, whereas 8.2% and 5.8% reported at least mild depressive and anxiety symptoms, respectively. The impact of the pandemic on their mental health was their primary concern, which increased for many active pilots according to their workload. Those infected mainly faced daily tiredness and fatigue. Smoking habits and high body mass index were a predisposition for more physical symptoms. Cabin crew and women generally yielded worse scores than the other groups.

CONCLUSION

Fear of infection could explain mental health issues, whereas physical symptoms of those infected could be attributed to long-COVID (coronavirus disease) syndrome. Flight attendants' lower ratings may be due to more occupational exposure.

Impacts of Self-Efficacy on Food and Dietary Choices during the First COVID-19 Lockdown in China

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual’s dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.