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

Did COVID-19 influence fruit and vegetable consumption? Explaining and comparing pandemic peak and post-peak periods

The COVID-19 pandemic, one of the worst global health crises in the last century, impacted nearly every aspect of people's lives, including their dietary choices and food consumption patterns. It arrived during a long shift in American diets featuring increasingly large portions of processed foods as well as fruit and vegetable consumption that is well below recommended levels. Improving the latter has been a key part of policymakers' efforts to improve consumers' diets. This study surveyed individuals in the US South to determine the factors influencing their consumption of fruit and vegetables during the pandemic peak and how these have changed post-peak. During the peak, food venue, demographics, and concerns about diet and the seriousness of the virus heavily affected consumption. Greater amounts of fresh fruit and vegetables were consumed post-peak pandemic. Changes post-peak were predicted by food venue. Cooking meals at home was the main positive predictor for consumption. US policymakers should try and leverage the changes since the peak to promote greater consumption of fruit and vegetables.

Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic

Importance: Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). Objective: To investigate the trends in the incidence of GDM before and during COVID-19 pandemic (2016-2021) among the Louisiana Medicaid population. Design, Setting, and Participants: This study included 111,936, Louisiana Medicaid pregnant women of age 18-50 between January 1, 2016, to December 31, 2021. Main Outcomes and Measures: Pregnancies, GDM, and pre-pregnancy diabetes cases were identified by using the Tenth Revisions of the International Classification of Disease code. The annual incidence of GDM and annual prevalence of pre-pregnancy diabetes were calculated for each age and race subgroup. Results: The age-standardized incidence of GDM increased from 10.2% in 2016 to 14.8 in 2020 and decreased to 14.0% in 2021. The age-standardized prevalence of pre-pregnancy diabetes increased from 2.8% in 2016 to 3.4% in 2018 and decreased to 2.3% in 2021. The age-standardized rate of GDM was the highest among Asian women (23.0%), then White women (15.5%), and African American women (13.9%) (p for difference <0.001). The COVID-19 pandemic saw an increase in the incidence of GDM, with a rise in prominent GDM risk factors, such as obesity and sedentary behaviors, suggesting an association. Conclusion and Relevance: The incidence of GDM significantly increased during the COVID-19 pandemic. Potential reasons might include increased sedentary behavior and increased prevalence of obesity. GDM is a major public health issue, and the prevention of GDM is particularly essential for the Louisiana Medicaid population owing to the high prevalence of GDM-related risk factors in this population.

The Impact of COVID-19 on Health Behavior Engagement and Psychological and Physical Health Among Active Duty Military Enrolled in a Weight Management Intervention: An Exploratory Study

INTRODUCTION

The COVID-19 pandemic profoundly affected the health and well-being of people globally. Some studies suggest individuals with overweight or obesity may have been more adversely impacted by pandemic restrictions. Additionally, military personnel may have been more vulnerable to stress during the pandemic because of job demands (e.g., work in close quarters). Our research group was conducting a randomized clinical trial of a weight management intervention in active duty military personnel with overweight or obesity when the COVID-19 pandemic struck. Thus, we collected additional pandemic-related data from participants enrolled during the COVID-19 pandemic and conducted exploratory analyses to understand how the pandemic affected their stress levels and perceived abilities to engage in health behaviors like exercise and healthy eating. The aims of this exploratory study were to: (1) assess associations between pandemic-related stress and health behaviors with body fat percentage (BF%) and psychological and physical health, and (2) explore how pandemic-related stress and health behaviors affected BF% during and after the intervention.

MATERIALS AND METHODS

A total of 29 active duty Navy personnel (55% female, 69% White) were enrolled after the onset of pandemic restrictions and completed measures assessing pandemic-related stress and health behaviors as well as measures of general psychological and physical health before the intervention. BF% was collected at 5 timepoints, including baseline, during, and following the intervention. Bivariate correlations assessed associations at baseline. Linearmixed-effects longitudinal models explored how pandemic-related stress and health behaviors affected BF%. Post-hoc analyses evaluated the effects of pandemic factors on BF% at each timepoint.

RESULTS

Most participants perceived of the pandemic as increasing stress and detracting from their abilities to engage in health behaviors (i.e., exercise and healthy eating). Higher pandemic stress was significantly associated with reporting exercise and healthy eating as more difficult, worse overall health, and more anxiety and general stress. Reporting exercise as harder during the pandemic also was associated with more psychological distress at baseline. A linearmixed- effects model controlling for age, sex, and number of intervention sessions attended revealed endorsing "exercise as harder" was associated with higher BF%. Post-hoc regression analyses revealed rating "exercise as harder" significantly predicted higher BF% 3 months post-intervention (B = 0.65, P = .01), whereas pandemic stress was not significantly associated with higher BF% at 3 month (B =0.14, P = .08) or 6 month (B = 0.21, P = .09) follow-up.

CONCLUSIONS

As expected, most participants perceived of the pandemic as heightening stress and interfering with engagement in health behaviors. It is possible that pandemic-related stress may have exacerbated weight gain-promoting behaviors and/or interfered with achievement of desired weight management outcomes. Outside the context of the pandemic, it may be beneficial for healthcare providers to screen individuals for stress and perceptions of ease of engagement in health behaviors before enrollment in a weight management intervention. Further, tailoring interventions to mitigate stress and promote perceptions of ease in engaging in health behaviors may promote better weight management outcomes.

COVID-19-related liver injury: Mechanisms, diagnosis, management; its impact on pre-existing conditions, cancer and liver transplant: A comprehensive review

AIMS

This review explores the mechanisms, diagnostic approaches, and management strategies for COVID-19-induced liver injury, with a focus on its impact on patients with pre-existing liver conditions, liver cancer, and those undergoing liver transplantation.

MATERIALS AND METHODS

A comprehensive literature review included studies on clinical manifestations of liver injury due to COVID-19. Key areas examined were direct viral effects, drug-induced liver injury, cytokine storms, and impacts on individuals with chronic liver diseases, liver transplants, and the role of vaccination. Data were collected from clinical trials, observational studies, case reports, and review literature.

KEY FINDINGS

COVID-19 can cause a spectrum of liver injuries, from mild enzyme elevations to severe hepatic dysfunction. Injury mechanisms include direct viral invasion, immune response alterations, drug toxicity, and hypoxia-reperfusion injury. Patients with chronic liver conditions (such as alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma) face increased risks of severe outcomes. The pandemic has worsened pre-existing liver conditions, disrupted cancer treatments, and complicated liver transplantation. Vaccination remains crucial for reducing severe disease, particularly in chronic liver patients and transplant recipients. Telemedicine has been beneficial in managing patients and reducing cross-infection risks.

SIGNIFICANCE

This review discusses the importance of improved diagnostic methods and management strategies for liver injury caused by COVID-19. It emphasizes the need for close monitoring and customized treatment for high-risk groups, advocating for future research to explore long-term effects, novel therapies, and evidence-based approaches to improve liver health during and after the pandemic.

Weight gain, new-onset overweight or obesity, and their influencing factors during the social distancing era of the COVID-19 pandemic

The prevalence of obesity is gradually increasing in South Korea, and the coronavirus disease 2019 (COVID-19) pandemic has accelerated the weight gain. In response to COVID-19, South Korea implemented targeted distancing measures based on the number of COVID-19 cases, rather than a full lockdown. This study focused on two subgroups that influence the rise in obesity prevalence during the early stages of the COVID-19 pandemic and explored the factors contributing to rapid weight gain in this group during this period. This cross-sectional study involved 3,462 participants recruited through the MicroEmbrain Inc. Online survey panel. Participation emails were sent by the research company to the online survey panel, and individuals who voluntarily agreed to participate responded to the survey. The participants consisted of residents aged 19 and above from Seoul, with sample distribution taking considering sex, age, and region. Height, and weight before and during the COVID-19 pandemic were self-reported. The analysis revealed that compared with that of pre-COVID-19 statistics, 11 % of all participants entered the overweight or obese categories post COVID-19, and among those who were overweight or obese before COVID-19, 42.5 % reported weight gain. Both groups had relatively younger individuals, higher stress levels, spent more time alone, and had increased usage of online platforms including online food purchasing. Post-COVID-19 wt gain among individuals with pre-existing overweight or obesity status was associated with a higher frequency of solitary drinking (odds ratio [OR] = 1.407, 95 % confidence interval [CI] = 1.024-1.932), increased online leisure time (OR = 1.336, 95 % CI = 1.063-1.678), and increased use of meal delivery services (OR = 1.307, 95 % CI = 1.026-1.664). The prevalence of obesity has continued to rise after COVID-19 pandemic, highlighting the need for interventions that mitigate the negative impact of the pandemic on health behavior.

The effect of the COVID-19 pandemic lockdown on the distribution of fat tissue and skinfold thickness in adolescents from Kraków (Poland)

BACKGROUND

The COVID-19 pandemic has significantly changed the lifestyle and dietary habits of societies worldwide. The aim of the study was to assess changes in the distribution of fat tissue and skinfold thickness in adolescents (aged 11-15) from Kraków during the COVID-19 pandemic period.

METHODS

Two cross-sectional studies conducted in 2020 and 2022 (before and after the pandemic) involved 1662 adolescents from the Kraków population. Skinfold thickness measurements were taken. The trunk adiposity index, limbs-to-trunk fat ratio and limbs-to-total skinfold ratio were calculated. Statistical analysis employed a two-way ANOVA, Tukey's HSD test and the Kruskal-Wallis test, depending on the normality of the distribution.

RESULTS

Higher skinfold thicknesses were observed in the majority of age groups in both sexes from the 2022 cohort in comparison with the 2020 cohort. Additionally, higher values of the trunk adiposity index and the limbs-to-total skinfold ratio in most age groups were observed. However, an inverse trend was observed in the limbs-to-trunk fat radio.

CONCLUSIONS

The introduced restrictions such as lockdown, remote learning, reduced physical activity and changes in dietary habits could have influenced the distribution of fat tissue and skinfold thickness amongst adolescents from Kraków.

Body Composition and Dietary Intake Profiles of Elite Iranian Swimmers and Water Polo Athletes

BACKGROUND

This study aimed to conduct a detailed and comparative analysis of body composition and dietary habits in elite swimming and water polo athletes. Through the examination of these key parameters, this study seeks to compare the dietary intake of these two distinct aquatic sports disciplines.

METHODS

A total of 10 top-level swimmers and 13 water polo athletes participated in anthropometric and body composition assessments, as well as a detailed analysis of nutritional intake. To compare the two groups, an independent samples t-test was used, and variance homogeneity was checked using Levene's test. The effect size of the group differences was evaluated using Hedges' g.

RESULTS

Water polo athletes showed significantly greater height (189.4 ± 2.9 vs. 186.5 ± 2.0 cm, p = 0.013), body mass index (24.3 ± 1.4 vs. 22.1 ± 0.5 kg/m2, p < 0.001), fat-free mass (62.9 ± 1.4 vs. 61.1 ± 1.38 kg, p < 0.001), skeletal muscle mass (47.1 ± 1.3 vs. 43.9 ± 1.6 kg, p < 0.001), and overall weight (86.9 ± 6.9 vs. 76.7 ± 2.2 kg, p < 0.001) in comparison to swimmers. Swimmers consumed greater amounts of mean daily energy (60.0 ± 1.0 vs. 39.0 ± 1.0 kcal/kg, p < 0.001), carbohydrate (7.8 ± 0.3 vs. 4.4 ± 0.5 g/kg, p < 0.001), protein (1.7 ± 0.5 vs. 1.4 ± 0.5 g/kg, p < 0.001), and fat (2.4 ± 0.5 vs. 1.7 ± 0.5 g/kg, p < 0.001) compared to water polo athletes.

CONCLUSION

Our findings highlight the need for differentiated targeted nutritional interventions to enhance athletic performance in different types of water sports. Compared to water polo athletes, swimmers consumed significantly higher amounts of calories, matching their increased calorie demand from their specific training regime. However, this is an observational study and the differential needs of energy and macronutrients in water sports should be confirmed by studies with energy expenditure measurements.

Unveiling the lockdown effects: exploring behavior, dietary habits and weight changes in rural Egypt during COVID-19 lockdown: a cross-sectional retrospective study

BACKGROUND

The COVID-19 lockdown significantly impacted dietary habits and body weights globally, particularly in Egypt, where 57.03% of the population resides in rural areas, despite lack of information. The study examines the impact of COVID-19 lockdown on the weight changes of the rural Egyptian population through behavioral, physical, and dietary changes.

METHODS

A cross-sectional online survey using Microsoft Forms was distributed in Delta regions in Egypt. The questionnaire used a modified version of the validated 14- items PREDIMED MedDiet Adherence Screener (MEDAS). The first part of the questionnaire addressed sociodemographic variables whereas the second one included questions related to dietary, behavioral and weight changes of participants. These changes were statistically tested for significance in relation to BMI, gender, home living, current job and family history of obesity.

RESULTS

A total of 306 participated in the study (70% females, 13% obese, 95% living with family, 56% university students, and 36% with family history of obesity). Obese showed a significant increase in sweet intake whereas underweight and normal weight people displayed a significant decrease in eating desire. Both females and males showed significant increase in consumption of fruits and vegetables with significant decrease in soft drink. However, women showed a significant decrease in sport activity relative to men. Participants living with family showed an increase in sweet intake while those living alone explored an increase in meal frequency. Employers revealed a significant decrease in sport activities and people with family history of obesity reported more sleeping times than those without family history of obesity.

CONCLUSION

During Covid-19 quarantine, Egyptians' eating habits improved, but daily routines were disrupted. Raising awareness about obesity and providing guidance on maintaining activity, energy, and mood is crucial for future quarantine situations.

Effects of Changes in Frequency of Going Out during the COVID-19 Pandemic on ikigai (Sense of Purpose in Life) and Mental Health in Middle-Aged and Older Adults in Japan

To clarify whether changes in frequency of going out due to the COVID-19 pandemic affect ikigai (sense of purpose in life) and mental health in Japanese middle-aged and older adults. In a questionnaire survey mailed to 16,866 adults aged > 40 years in Japan in September 2020, 7,973 responses were received (response rate, 47.3%) in October 2020. Following exclusions, data from 6,978 individuals (50.6% female, mean age 67.8 ± 12.2 years) were available for analysis. Respondents were categorized based on changes in frequency of going out, reflecting changes in social and/or physical activity, during the pandemic compared with before it: the previously active group went out often before but less often during the pandemic; the remained active group continued going out often; and the inactive group continued not going out often. Whether these changes affected the respondents' ikigai and mental health was investigated. The previously active group had a significantly higher proportion of individuals with decreased ikigai during the pandemic than the other groups. Mental health score decreased in all groups during the pandemic, but more so in the previously active group (-3.21), followed by the inactive and then the remained active groups (-1.45 and -1.28, respectively). Previously active individuals showed the greatest decline in ikigai and mental health among the three groups. These findings suggest that continuing to engage in appropriate physical and social activities, including going out, while following appropriate infection control measures, even under restrictions, can help people maintain ikigai and mental health.

Critical appraisal of how COVID-19 infection and imposed lockdowns have impacted gastroesophageal reflux: A review

Previous literature has demonstrated that COronaVIrus Disease of 2019 (COVID-19) impacts an individual gastrointestinal tract (GIT), causing symptoms like nausea, diarrhea, and loss of appetite. Severe acute respiratory syndrome coronavirus RNA has been discovered in the stool of infected individuals in earlier research. It was discovered that severe acute respiratory syndrome coronavirus was significantly expressed in the GIT, indicating that the virus can also infect the digestive system. Angiotensin-converting enzyme 2 functions as the viral receptor. The chronic illness known as gastroesophageal reflux disease (GERD) is typified by frequent reflux of stomach acid into the esophagus. By triggering the sensitized esophageal-bronchial neuronal circuit or aspirating into the airways (microaspiration), GER exacerbates respiratory diseases. Aspiration is a well-known risk to be considered when treating patients in intensive care units. Strong genetic correlations have been identified between COVID-19 infection and GERD susceptibility, suggesting a shared genetic basis for both conditions. Nonetheless, even though GERD, extraesophageal reflex, and COVID-19 have a number of significant risk factors and exhibit similar symptoms, the relationship between these illnesses has not yet been examined in depth. This review is the first of its kind to critically examine the association between the COVID-19 epidemic and GER and its associated diseases. The key objective of this work is to promote the creation of prevention plans, treatment plans, and guidelines while also enhancing and optimizing our understanding of the relationship between COVID-19 and GERs.

Type 2 diabetes-related health measures during the initial COVID-19 surge at an academic internal medicine practice

The COVID-19 pandemic disrupted chronic disease management in the United States and across the world. This study reports minimal effects of the initial COVID-19 surge on body mass index, blood pressure, cholesterol, and blood glucose control in ambulatory general internal medicine patients with Type 2 diabetes at a single academic center.

Neurodevelopmental Programming of Adiposity: Contributions to Obesity Risk

This review analyzes the published evidence regarding maternal factors that influence the developmental programming of long-term adiposity in humans and animals via the central nervous system (CNS). We describe the physiological outcomes of perinatal underfeeding and overfeeding and explore potential mechanisms that may mediate the impact of such exposures on the development of feeding circuits within the CNS-including the influences of metabolic hormones and epigenetic changes. The perinatal environment, reflective of maternal nutritional status, contributes to the programming of offspring adiposity. The in utero and early postnatal periods represent critically sensitive developmental windows during which the hormonal and metabolic milieu affects the maturation of the hypothalamus. Maternal hyperglycemia is associated with increased transfer of glucose to the fetus driving fetal hyperinsulinemia. Elevated fetal insulin causes increased adiposity and consequently higher fetal circulating leptin concentration. Mechanistic studies in animal models indicate important roles of leptin and insulin in central and peripheral programming of adiposity, and suggest that optimal concentrations of these hormones are critical during early life. Additionally, the environmental milieu during development may be conveyed to progeny through epigenetic marks and these can potentially be vertically transmitted to subsequent generations. Thus, nutritional and metabolic/endocrine signals during perinatal development can have lifelong (and possibly multigenerational) impacts on offspring body weight regulation.

Hepatic steatosis and skeletal muscle alterations during the COVID-19 lockdown in a cohort of patients with chronic liver disease in Japan

AIM

Following the coronavirus disease outbreak, a state of public emergency was declared worldwide, which enforced lifestyle changes. This study therefore aimed to investigate the changes in lifestyle, body composition, hepatic steatosis, and fibrosis in patients with chronic liver disease (CLD) under lockdown.

METHODS

During the lockdown period, 1344 patients with CLD answered a lifestyle questionnaire. In 298 patients, body composition and liver stiffness measure (LSM)/controlled attenuation parameter (CAP) were analyzed by InBody and FibroScan, respectively, and serial data were obtained in 137 patients.

RESULTS

More than half of the CLD patients answered decreases in physical activity and frequency of outings during lockdown, while diet was less affected. Overall, 58% of patients showed elevations in CAP values, which were not different statistically over time. Women, but not men, were more likely to increase CAP values during lockdown. Neither LSM nor serum fibrosis markers were elevated chronologically during lockdown. In men, body mass index (BMI), body fat percentage, and visceral fat area (VFA) were significantly increased, whereas in women, lower-limb muscle mass was significantly decreased. Patients with decreased SMI showed elevations in CAP and VFA values, and patients who exercised less showed increases in BMI.

CONCLUSION

In response to lockdown, men tended to increase body fat but the degree of hepatic steatosis was less affected, while women were more likely to exacerbate hepatic steatosis with skeletal muscle loss among CLD patients. Gender-specific approaches need to be established for management of CLD patients to avoid exacerbation or comorbidity of steatotic liver disease.

Work- and mental health-related events and body mass index trajectories during the Covid-19 lockdown. Evidence from the lifelines cohort study in the Netherlands

BACKGROUND

The aim of this study was to identify heterogeneity in trajectories of body mass index (BMI) during the Covid-19 pandemic in the Netherlands. Moreover, we aimed to investigate whether work- and mental health-related disruptive events experienced during the pandemic, such as job insecurity or depression, were associated with such BMI trajectories.

METHODS

Longitudinal data from the Lifelines Covid Questionnaire was used (21 waves between April 2020 and July 2021; n = 64,630). Different trajectories were identified using group-based trajectory models. Multinomial regression models were fitted to analyse the main determinants of experiencing changes in BMI during the pandemic.

RESULTS

Trajectories of increased BMI, and, to a lesser extent also trajectories of decreased BMI, were more common among those who experienced disruptive work-related events (e.g., being laid-off or having a temporary contract) and mental health-related events (e.g., anxiety or depression) during the pandemic. Those experiencing multiple events were particularly likely to show trajectories of increased or decreased BMI.

CONCLUSIONS

During the Covid-19 pandemic, strong heterogeneity was observed in BMI trajectories. This was partially related to work- and mental health-related events.

Weight Gain in Overweight and Obese People with HIV-The OBHIV Cohort

BACKGROUND

HIV and non-HIV-related factors have been related to weight gain (WG); however, their specific impact on people with HIV (PWH) who are overweight or obese remains unclear.

METHODS

This is a single-center observational study enrolling PWH with a BMI > 25 kg/m2. A generalized linear model was used to assess variables related to greater WG during 12 years of observation.

RESULTS

A total of 321 PWH were enrolled, 67% overweight and 33% obese, who gained an average of 0.2 ± 1.3 and 1.7 ± 1.5 kg/year, respectively (p < 0.0001). Years since HIV infection were the only variable significantly associated with WG (β -0.048, 95% CI -0.083; -0.013) during the study period, while type of ART did not influence the outcome. Narrowing the observation to the period of the SARS-CoV-2 pandemic, PWH with a longer duration of infection (β 0.075, 95% CI 0.033; 0.117) and a greater increase in triglycerides (β 0.005; 95% CI 0.000; 0.011) gained more weight, while higher BMI (β -0.256, 95% CI -0.352; -0.160), obesity (β -1.363, 95% CI -2.319; -0.408), diabetes mellitus (β -1.538, 95% CI -2.797; -0.278), and greater abdominal circumference (β -0.086, 95% CI -0.142; -0.030) resulted in protection.

CONCLUSION

Among overweight and obese PWH, the amount of WG was higher in the first years after diagnosis of HIV and decreased thereafter, despite aging, regardless of the type of ART.

Changes in weight status during the COVID-19 pandemic: impact of educational level and mental health

BACKGROUND

The COVID-19 pandemic has resulted in a disruption of daily routines and changes in health behaviors leading to widespread concerns about unfavorable changes in weight status and a potential increase in the prevalence of obesity. This study examined the long-term impact of the COVID-19 pandemic on changes in weight status and its possible dependency on educational level and mental health.

METHODS

The study utilizes the Danish Health and Well-being Survey with repeated self-reported information on weight status collected before the COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 2020 and 2021). Information on educational level was derived from registers, whereas mental health was measured using validated scales. Generalized estimating equations were performed to investigate changes in mean weight and body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and to investigate potential differences in changes in weight status by pre-pandemic educational level and mental health.

RESULTS

Mean weight significantly increased by 0.34 kg [95% confidence interval (CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared with pre-pandemic weight status. The increase was greater among individuals with lower educational levels and poorer mental health. There were no significant changes in BMI category during the pandemic.

CONCLUSION

The results showed a significant increase in mean weight among the Danish population, particularly among individuals with lower educational levels and poorer mental health, but without detectable differences in obesity, supporting a long-term but minor impact of the COVID-19 pandemic on weight status.

Assessment of lifestyle changes related to quarantine among Saudi population during the early COVID-19 pandemic: pre- and post-analysis

BACKGROUND

The escalating emergence of the COVID-19 pandemic interrupted human life due to the ever-increasing morbidity, containment measures, and the associated emotional distress. This study examined the influence of COVID-19-related measures on the lifestyle behaviors of adults living in the Kingdom of Saudi Arabia (KSA).

METHODS

The study recruited 638 participants through convenience sampling in Jeddah and Taif cities, Saudi Arabia. Demographic characteristics and COVID-19-related information were collected through an anonymous self-reported electronic questionnaire. Lifestyle behaviors were assessed before and during the quarantine using the Healthy Dietary Habits Index (HDHI)-A and the International Physical Activity Questionnaire (IPAQ-SF).

RESULTS

The study revealed significant changes in the dietary pattern: a reduction in fish intake and increased consumption of French fries and candies. Vegetables and fruit intake increased significantly. Sedentary time > 6 h per day increased from 36.7% pre to 60.8% during the pandemic. Healthy dietary index score and physical activity MET-minutes/week values were respectively 3.5% and 37.9% significantly higher before compared to the full quarantine period.

CONCLUSION

The pandemic detrimentally influenced eating habits and physical activity levels that led to weight gain, and hence higher vulnerability to COVID-19 infection and negative outcomes. This analysis provides public health agencies with data to tailor nutrition interventions that mitigate the observed adverse lifestyle behaviors.

Assessment of clinical impact of SARS-CoV-2 in people with type 1 diabetes: A cohort study

OBJECTIVES

During the coronavirus 2019 pandemic, there had been more than 758 million COVID-19 cases as of February 13, 2023, and it is the main cause of death in many countries. Due to the variation in disease presentation, scientists determined that people living with type 2 diabetes mellitus were at higher risk of mortality. However, people living with type 1 diabetes have not been thoroughly studied, especially in extreme regions of developing countries. The objective of this study was to analyze the effects of SARS-CoV-2 pandemic restrictions on different variables in a cohort with type 1 diabetes.

METHODS

This cohort-type study included pediatric and adult patients with type 1 diabetes at Regional Hospital Dr. Juan Noé Crevani in Arica, Chile. Biosocial and anthropometric factors, clinical history, self-care activities, and biochemical parameters were assessed and compared using analysis of variance and paired t tests between March 2020 and March 2021.

RESULTS

A total of 150 patients were assessed during the SARS-CoV-2 pandemic in Arica, Chile. One year after the pandemic struck, the main causes for metabolic deterioration were a reduction of carbohydrate counting by an average of 8.67% (P = 0.000), a reduction of adherence to treatment by an average of 25% (P = 0.000), and a shift to telemedicine as a main health care service (P = 0.023); these factors raised hemoglobin A1c (HbA1c) levels by 1.81%, 1.78% and 0.075%, respectively. The participants' average body mass index (BMI) increased by 1.26 kg/m2 and HbA1c levels increased by 0.16% during the first year of the pandemic. Also, hospitalizations increased about 2% (P = 0.984), and there was a significant increase in carbohydrate and snack intake (P = 0.330 and P = 0.811, respectively). Children's linear growth decreased by a standard deviation of 0.035 (P = 0.648), and their physical activity decreased by 12.67% (P = 0.383).

CONCLUSIONS

This study found that adherence to diabetes care was reduced during the pandemic owing to a variety of behavioral reasons and environmental changes (e.g., quarantines and food security). This affected this population's HbA1c levels, BMI, linear growth, and number of hospitalizations as main consequences. Telemedicine remains an important tool, but it must be reconsidered among all different age groups.

Outcomes of the combined lifestyle intervention CooL during COVID-19: a descriptive case series study

BACKGROUND

The main objective of this nationwide study was to investigate changes in outcomes between baseline and eight months of participation regarding anthropometrics, control and support, physical activity, diet attentiveness, perceived fitness, sleep, and stress of participants in Coaching on Lifestyle (CooL), a Combined Lifestyle Intervention (CLI). Since the study took place when the COVID-19 pandemic emerged, we defined a subobjective, i.e., to address changes in intervention outcomes over time while participants were exposed to pandemic-related restrictions and uncertainties.

METHODS

Data were collected from November 2018 until October 2021 at different locations across the Netherlands from 1824 participating adults, meeting the CLI inclusion criteria. We collected a broad set of data on anthropometrics (weight, body mass index (BMI), waist circumference), control and support (self-mastery, social support), physical activity (sedentary time on least/most active days, physical active minutes), diet attentiveness (attentiveness to meal composition, awareness to amounts of food and attentiveness to consuming), alcohol consumption, smoking, perceived fitness (perceived health, fitness when waking, fitness during daytime, impact daily stress), sleep and stress.

RESULTS

All outcomes showed improvements after eight months compared to baseline except for social support and smoking. Large effect sizes were found on weight (0.57), waist circumference (0.50) and perceived health (0.50). Behaviour patterns showed small to large effect sizes, with the largest effect sizes on diet attentiveness (i.e., attentiveness to meal composition (0.43), awareness to amounts of food (0.58) and attentiveness to consuming (0.39)). The outcomes of participants pre COVID-19 versus during COVID-19 showed differences on self-mastery (p = 0.01), sedentary time (all underlying constructs p < 0.02), perceived fitness (all underlying constructs p < 0.02) and stress (p < 0.01).

CONCLUSION

The results show that small changes in multiple behaviours go along with a large positive change in perceived health and health-related outcomes in line with the lifestyle coaching principles. In addition, participating in CooL may have protected against engaging in unhealthier behaviour during the pandemic.

TRIAL REGISTRATION

As the CLI is considered usual health care that does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act, this study was exempt from trial registration.

COVID-19 Lockdown and Impact on 2-Year Weight Loss in a Bariatric Center

INTRODUCTION

The COVID-19 pandemic has led to a worldwide lockdown, which affected physical exercise habits, as well as having a detrimental effect on psychological health and follow-up visits of patients submitted to bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 lockdown on the 2-year weight loss of patients submitted to bariatric surgery in our center.

METHODS

This was an observational study comparing the weight loss of patients who underwent bariatric surgery from January to March 2020 with a control group submitted to surgery between January and March 2017. Percentage of total weight loss (% TWL) and excess weight loss (% EWL) were assessed 6, 12, and 24 months after surgery.

RESULTS

A total number of 203 patients were included in this study, 102 had bariatric surgery during the selected period in 2020 and 101 underwent surgery during the same period in 2017. There was no statistically significant difference in weight loss between the 2017 and 2020 groups which was reported as % TWL (mean 27.08 ± 7.530 vs. 28.03 ± 7.074, 33.87 ± 8.507 vs. 34.07 ± 8.979 and 34.13 ± 9.340 vs. 33.98 ± 9.993; p = 0.371) and % EWL (mean 66.83 ± 23.004 vs. 69.71 ± 17.021, 83.37 ± 24.059 vs. 84.51 ± 21.640 and 83.47 ± 24.130 vs. 84.27 ± 23.651; p = 0.506) at 6, 12, and 24 months post-surgery.

CONCLUSION

Despite social limitations imposed by the COVID-19 lockdown, we found no significant difference between weight loss at 2 years postoperatively in the 2020 group when compared with a control group who underwent bariatric surgery in 2017. These results show that the outcomes of bariatric surgery during the COVID-19 lockdown were comparable with those recorded before the pandemic, supporting the efficacy of bariatric procedures' metabolic effects during the first 2 years after surgery, regardless of lifestyle habits.

Impact of a randomized controlled trial of discounts on fruits, vegetables, and noncaloric beverages in NYC supermarkets on food intake and health risk factors

The objective of this study was to observe the effects of a multi-level (30%, 15%, and 0%) randomized discount on fruits, vegetables, and non-caloric beverages on changes in dietary intake. This randomized controlled trial (RCT) comprised an 8-week baseline, a 32-week intervention, and a 16-week follow-up. 24-hour dietary recalls were conducted during the baseline period and before the intervention midpoint. In-person clinical measures were analyzed from Week 8 (end of baseline) and 24 (midpoint). This report is from an interim analysis up to the intervention period midpoint at Week 24, as the study is still ongoing. Participants with BMIs of 24.5-50 kg/m2 and ages 18-70 years old who were the primary household shoppers were recruited from several New York City supermarkets, starting in September 2018. Of these, we analyzed 20 in the 30% discount group, 25 in the 15% discount group, and 19 in the 0% discount group. The 30% discount group reported greater intake of vegetables (+98.4 g ± 48.9 SD, P = 0.049) and diet soda (+63.3 g ± 29.3, P = 0.035) relative to the baseline period, compared to the 0% discount group. The clinical measures including body weight remained unchanged. The participants who experienced the COVID-19 pandemic had a marginal increase in body weight of 1.5 kg, P = 0.053. In conclusion, we observed a significant increase in intake of vegetables and diet soda in the 30% discount group relative to the 0% discount group.

Impact of COVID-19 restrictions on health and well-being in the United Arab Emirates

Background

Restrictions during the COVID-19 pandemic are thought to have impacted both the physical health and well-being of individuals where lockdown was applied. The United Arab Emirates (UAE) was one of the leading countries in implementing the international guidelines to limit the intensely contagious nature of the outbreak.

Aim

To identify the impact of COVID-19 on changes to exercise and general physical activity habits, changes to the consumption of various foods and potential weight gain, as well as any differences in smoking habits among individuals residing in the UAE during the COVID-19 quarantine.

Methods

This is a cross-sectional analytical study that used a quantitative electronic questionnaire sent by the Ministry of Health and Prevention to individuals on its platform in order to collect data on the physical health and well-being of a UAE sample population. A total of 2,362 responses were received to specific questions on physical activity, eating habits, and tobacco use for the period before, during, and after the COVID-19 lockdown. Descriptive statistical analysis was used to display the sample's demographic data and the changes in physical health and well-being. Paired t-test was used to show the changes in dietary habits.

Results

This study reveals concerning changes in health risk behaviors during the COVID-19 lockdown in the UAE. Physical activity levels declined across mild, moderate and vigorous ranges in most participants. Alarmingly, sedentary behavior dramatically increased with 71% of participants spending an average of 4-8 h per day sitting and over 54% of participants spending more than 4 h watching TV on an average day during lockdown. Fast-food consumption and snacking rose, hence weight gain was observed in over 53% of participants. Smoking habits, especially among cigarette smokers, may have worsened, with 45.2% reporting an increase in cigarette smoking, 16.8% declaring an increase in shisha smoking and 35.3% reporting an increase in smoking other tobacco products. These unfavorable behaviors during confinement could have serious long-term health consequences.

Conclusion

This study demonstrates that long periods of home quarantine may have led to unhealthy consequences that increase the risk of developing disease. This study therefore aims to highlight these health impacts, and recommend strategies and policies that can encourage healthy habits.

Physical activity as a mediator of the association of body mass index change with anxiety/depression symptoms in Brazilian adults during COVID-19

BACKGROUND

the COVID-19 pandemic has impacted people's behaviors and mental health around the world.

AIM

to verify the mediating role of physical activity (PA) level in the relationship between body mass index (BMI) and anxiety and depression symptoms.

METHODS

this is a cross-sectional study with Brazilian adults aged ≥ 18 years (n = 2,000, 59.6 % women) selected by the nonprobabilistic snowball method through digital means of communication (WhatsApp®, Telegram®, Facebook®, Twitter®, e-mails). Linear regression models were fitted for PA level mediation analyses in the relationship between BMI and anxiety/depression symptoms.

RESULTS

significant differences were found between the active/not overweight group and the other three groups (active/overweight, insufficiently active/not overweight and insufficiently active/overweight [p < 0.001]) for anxiety/depression after adjusting for age, gender, chronic diseases, alcohol consumption, and smoking. When testing the mediating role of daily PA in the association between BMI and anxiety/depression symptoms, BMI was negatively associated with daily PA in the first regression equation (p < 0.001); in the second, BMI was positively related to anxiety/depression symptoms (p < 0.001); and in the third, daily PA showed an inverse relationship with anxiety/depression symptoms (p < 0.001), and although BMI remained negatively associated with anxiety/depression symptoms, these associations maintained their statistical significance.

CONCLUSIONS

the results suggest that the effect of BMI on anxiety and depression was partially mediated by daily PA.

Social Disparities in Lifestyle and Body Weight Changes during COVID-19 Quarantine and Post-Quarantine Persistence of Changes among Lithuanian Adult Population

The role of social factors on changes in lifestyle habits during the COVID-19 quarantine and their maintenance post-quarantine is underexamined. This study aimed to assess sociodemographic differences in nutrition, physical activity and body weight changes during the quarantine and their persistence post quarantine. The study included a random sample of Lithuanian residents aged 20 to 64. The questionnaires were filled in during the face-to-face interview within households countrywide in 2023. In total, 1500 individuals (742 men and 758 women) participated in the survey. Up to 34.9% of the respondents reported changes in eating habits, mostly increased consumption, 29.5% indicated reduced physical activity, and 22.7% gained weight. Multivariate logistic regression analysis revealed that highly educated individuals were more likely than poorly educated individuals to increase healthy and decrease unhealthy food consumption and increase physical activity during the quarantine. The city inhabitants reported unfavourable changes in nutrition habits more often than those living in villages did. The proportion of respondents who reported the maintenance of the quarantine changes in lifestyle depending on the habit varied from 23.2% to 71.4% in the post-quarantine period. Highly educated individuals were less likely to maintain the decreased consumption of fresh fruits and increased body weight than less-educated individuals were. Our study provides evidence that the targeted interventions are needed to help less-educated individuals and city residents develop and maintain healthy lifestyle habits, even in times of crisis.

Changes in Nutrition, Physical Activity, and Body Weight among Lithuanian Students during and after the COVID-19 Pandemic

The long-term effect of the COVID-19 pandemic on lifestyle changes remains understudied. This cross-sectional study aimed to assess changes in nutrition, physical activity, and body weight among Lithuanian students during the pandemic and their post-pandemic persistence. Data were collected from 1430 first-year students (325 males, 1105 females) through an online self-administered questionnaire. The students indicated an increase in the consumption of snacks, fast food, home-made confectionery, and sweets. A decrease in physical activity during the pandemic was reported by 34.9% of males and 33.2% of females. Lifestyle changes during the pandemic were associated with post-pandemic habits. A higher proportion of females (38.7%) than males (31.1%) indicated an increase in BMI, which was more pronounced among students with overweight. A multivariate logistic regression analysis revealed that reduced physical activity; the increased consumption of red meat, snacks, fast food, and home-made confectionery during the pandemic; and post-pandemic BMI were linked with weight gain. After the pandemic, weight gain persisted in 40.9% of students who continued to follow unhealthy nutrition habits and had reduced physical activity. The study emphasizes that the promotion of a healthy diet and regular physical activity among university students is essential for developing lifelong habits that contribute to a healthy body weight and overall well-being.

Stress during Home Confinement Is Associated with Eating Misalignment among Adults during COVID-19 Lockdown

BACKGROUND

The COVID-19 pandemic forced Saudi Arabia to implement several measures including mandatory home confinement, banning entry to many cities, and suspending religious activities. Studies have reported inconsistent findings of the effect of home confinement on lifestyle factors. This study aims to assess the psychological impact of COVID-19 during home confinement and explore its association with dietary habits and weight change.

METHODS

A cross-sectional study was conducted among Saudi adults using an online survey between May and June 2020. Data on dietary habits, sleep quality, and stress were collected.

RESULTS

A total of n = 503 participants responded. Of 254 analyzed, 87% were females, 49% were overweight/obese (body mass index (BMI) ≥ 25 kg/m2), and 79% were under lockdown for >40 days. In multiple linear regression, higher stress scores during confinement were associated with higher stress scores before confinement and poorer sleep quality. In multiple logistic regression, those who did not eat at the same time had higher stress scores compared to those who always ate at the same time, whereas consuming ≥three meals was associated with lower stress scores than consuming one-two meals. The odds of gaining weight during confinement were higher among married adults, those with lower sleep quality, and consuming ≥three meals.

CONCLUSIONS

Stress during home confinement was associated with eating misalignment and the number of meals consumed. Although this study was limited by its cross-sectional design and reliance on self-reported data, it provides valuable insights into the dietary habits and weight-gain associated factors that need to be further explored and addressed in any future restrictions for improved well-being.

Changes in health behaviours during the COVID-19 pandemic and effect on weight and obesity among older people in England

During COVID-19 lockdown, negative changes in health behaviours have been reported in European older adults. However, less is known about the consequences of these changes on weight gain and obesity, especially in older adults living in England. This study explored the association of health behaviour changes with weight and obesity in English older adults aged 50 years and older, during lockdowns in 2020. We included 4182 participants of the English Longitudinal Study of Ageing COVID-19 sub-study in June/July and Nov/Dec 2020 who also had pre-pandemic data. Perceived changes in health behaviours were regressed on weight and obesity, adjusted for pre-pandemic weight or obesity, and several covariates. Results suggested that less exercise, more sedentariness, eating more and alcohol drinking were associated with a significant increase in weight at both timepoints. Meanwhile, less sedentariness and eating less significantly reduced weight in Nov/Dec 2020. A higher risk of obesity at both timepoints was found in adults sitting, eating, or sleeping more than usual. To conclude, during UK lockdown, older people who engaged in risky health behaviours were at higher risks of weight gain and obesity both in the short run and long term. Considering potential health risks associated with obesity and disruptions in routine lifestyle in the older population even after the pandemic, improved weight management interventions are necessary nationwide.

Changes in Body Mass Index and Their Associations with Psychological Distress, Worries, and Emotional Eating during the COVID-19 Pandemic: A Norwegian Cohort Study

In 2020, the COVID-19 pandemic highlighted obesity's long-term rise. Some of the impacts of the pandemic were increased psychological distress, emotional eating, higher consumption of high-sugar foods and drinks, and a more sedentary lifestyle. This study examined BMI changes over time and their associations with psychological distress and lifestyle changes. This population-based cohort study had 24,968 baseline participants and 15,904 and 9442 one- and two-year follow-ups, respectively. Weight, height, psychological distress, high-sugar foods and drinks, physical activity, and emotional eating were assessed. These factors and BMI were examined at baseline and over time. We used mediation analyses and structural equation modeling to determine how psychological distress affects BMI. The mean BMI was 25.7 kg/m2 at baseline and 26.2 kg/m2 at two years. High psychological distress, daily emotional eating, and low physical activity were associated with higher BMI at baseline and higher yearly increases in BMI compared to reference levels. Emotional eating mediated 33% of the psychological distress BMI effect. Overall, BMI increased during the pandemic. Psychological distress during the pandemic was linked to weight gain partly through emotional eating. This association remained strong over time during different stages of the pandemic.

Basic human values drive food choice decision-making in different food environments of Kenya and Tanzania

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as part of prior studies on food choice. A priori coding based on Schwartz's theory of basic human values was conducted, followed by a narrative comparative analysis, which included review by original principal investigators. Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence-dependability and -caring) were prominent drivers of food choice in both settings. Participants described how values were negotiated and highlighted existing tensions. For example, the value of tradition was cited as important in both settings but changing food contexts (e.g., new foods, diverse neighborhoods) increased prioritization of values like stimulation, indulgence, and self-directed thought and action. The application of a basic values framework was useful for understanding food choice in both settings. A focused understanding of how values drive food choice decision-making in the context of changing food availability in LMICs is essential for the promotion of sustainable healthy diets.

Impact and management of COVID-19 in liver transplant candidates and recipients

The COVID-19 outbreak has had severe consequences for global public health, medical communities, and the socioeconomic status of a considerable number of countries. The emergence of COVID-19 has also significantly impacted the world of liver transplantation (LT). Studies from transplantation centers around the world have shown that LTs during the COVID-19 pandemic have been restricted because of the high risk of serious COVID-19 infection in this population. According to the Centers for Disease Control and Prevention, patients with liver disease are considered at higher risk for severe COVID-19 infection. In March 2020, the American Association for the Study of Liver Diseases recommended that LT should be limited to emergency cases. The COVID-19 treatment guidelines published by the National Institutes of Health are being constantly updated according to new epidemiology trends and treatment regimens. Immunocompromised patients have a higher risk of developing severe disease or death from COVID-19 compared with the general population. In this review, we summarize the available evidence regarding treatment guidelines and considerations for the evaluation and management of LT candidates and recipients in the era of COVID-19. In addition, we present data regarding COVID-19 among LT patients in our local transplantation center.

[Diet and body weight at the beginning of the COVID-19 pandemic in Mexico]

Background

Weight changes in adults have strong repercussions on people's health status. During the COVID-19 pandemic, these changes could be more evident due to the mandatory confinement, as well as eating habits and lifestyle. In this study, changes in diet and body weight in Mexican population at the beginning of COVID-19 lockdown period (weeks 4-7) were evaluated using an online survey.

Objective

To identify the characteristics of the diet and the perceived change in body weight at the beginning of the COVID-19 pandemic in Mexico.

Material and methods

Descriptive, cross-sectional study of 1281 people over 18 years of age, electronic survey in weeks 4-7 of confinement with sociodemographic data, food consumption and perception of body weight.

Results

The change in food consumption was 53.9%, finding differences according to gender in beverages (carbonated, juices, alcoholic), coffee/tea, fruits, legumes (p < 0.05). The perception of body weight increases by 3.4 (increased) and 2.1 (lowered) times more than the risk of change in diet.

Conclusions

The dietary differences refer to a tendency to the type of food consumed, mainly sugary drinks, with the perception of changes in positive body weight in women.

The Impact of Greenspace, Walking, and Cycling on the Health of Urban Residents during the COVID-19 Pandemic: A Study of London

Vulnerability to COVID-19 has been linked to public health issues like obesity and physical fitness, which consecutively can be linked to access to urban greenspace. However, the value of greenspaces remains contentious in the literature and unclear in practice. In view of very high COVID-19 mortality rates, we use data from London boroughs to explore the impact of green infrastructure in terms of the size, accessibility, and support of physical activity and healthy lifestyles (e.g., walking and cycling). Results show no significant relationship between the availability of greenspace and the probability of being obese or dying from COVID-19. Cycling once, thrice, or five times weekly was found to improve healthy weight, as does cycling once a month. However, the probability of dying from COVID-19 during lockdowns is correlated to the frequency of walking or cycling as a result of decreased social distancing, while the frequency of walking and cycling is determined by availability and access to greenspace.

Mediating Effects of Neural Targets on Depression, Weight, and Anxiety Outcomes of an Integrated Collaborative Care Intervention: The ENGAGE-2 Mechanistic Pilot Randomized Clinical Trial

Background

Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated.

Methods

In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care (n = 35) or an integrated behavioral intervention (n = 71). Changes at 6 months in body mass index and Depression Symptom Checklist-20 scores were co-primary outcomes, and Generalized Anxiety Disorder Scale-7 score was a secondary outcome. Changes at 2 months in the activation and functional connectivity of regions of interest in the negative affect circuit were primary neural targets, and secondary targets were in the cognitive control, default mode, and positive affect circuits.

Results

Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs).

Conclusions

Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication.

Gastroesophageal reflux in lockdown

Aim

This study examines the changes in gastroesophageal reflux disease (GERD) symptom frequency among patients with GERD throughout the COVID-19 pandemic.

Methods

A structured questionnaire was distributed among 198 GERD patients. The questionnaire consisted of a demographic characteristic assessment, the GerdQ questionnaire, and a reflux symptom index (RSI) questionnaire.

Result & conclusion

A statistically significant increase in GerdQ score was identified among participants during the COVID-19 pandemic (t = 7.055, df = 209, p < 0.001), who had experienced an increase in the frequency of positive predictors of GERD and a decrease in the frequency of negative predictors of GERD. The COVID-19 pandemic and its related lockdown countermeasures may have led to exacerbating and worsening GERD symptoms.

Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance Use

Primary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.'s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today's full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.

The Influence of Lockdown Due to the COVID-19 Pandemic on Weight Management in Patients With Obesity in Portugal

INTRODUCTION

Obesity is a chronic and multifactorial disease, and the COVID-19 pandemic and lockdown have led to changes in the lifestyle habits of those patients. This study aimed to compare compliance with dietary and lifestyle measures, physical activity, mental health status, and motivation to lose weight during the pandemic in these patients.

METHODS

An observational study was conducted, which included 63 patients over 18 years old who were followed in the outpatient setting through obesity medical appointments and who agreed to answer a questionnaire.

RESULTS

We found that the majority of patients lost weight during the pandemic (61.7%), associating it with a 68% change in dietary habits. Regarding physical activity, there was a 34.9% reduction in its practice among those who used to exercise before the pandemic. Moreover, 52.4% felt more anxious and 44.4% felt sadder during the lockdown.

DISCUSSION

The weight loss reported in our study seems to be related to a decrease in the consumption of carbohydrates and snacks and a lower percentage of those who relied on takeaways. Additionally, we hypothesize a greater number of home-cooked meals. Regarding exercise, the closure of gyms and the limitations imposed on daily life appear to have contributed unfavorably to this matter. Home confinement, loneliness, and a lack of social activities had harmful effects on the mental health of our sample.

CONCLUSION

Overall, the hostile influence of the pandemic on mental well-being and exercise habits was evident. Nevertheless, contrary to our expectations, we observed weight loss during the lockdown.

A clinically managed weight loss program evaluation and the impact of COVID-19

Introduction

With the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute.

Methods

This was a prospective evaluation of a newly established program between January 2019-August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio.

Results

Greater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p < 0.001 vs. 1.75 ± 4.43 kg n = 9, p = 0.02). Completers pre-COVID-19 demonstrated improvements in waist circumference, Framingham risk score, blood pressure, hemoglobin A1C, and body fat percentage.

Conclusions and implications

Though the sample size was small to show definitve evidence, the results may suggest the program worked well prior to the pandemic but the pandemic created barriers to weight-loss for participants.

COVID-19 and severity of liver diseases: Possible crosstalk and clinical implications

COVID-19-infected individuals and those who recovered from the infection have been demonstrated to have elevated liver enzymes or abnormal liver biochemistries, particularly with preexisting liver diseases, liver metabolic disorders, viral hepatitis, and other hepatic comorbidities. However, possible crosstalk and intricate interplay between COVID-19 and liver disease severity are still elusive, and the available data are murky and confined. Similarly, the syndemic of other blood-borne infectious diseases, chemical-induced liver injuries, and chronic hepatic diseases continued to take lives while showing signs of worsening due to the COVID-19 crisis. Moreover, the pandemic is not over yet and is transitioning to becoming an epidemic in recent years; hence, monitoring liver function tests (LFTs) and assessing hepatic consequences of COVID-19 in patients with or without liver illnesses would be of paramount interest. This pragmatic review explores the correlations between COVID-19 and liver disease severity based on abnormal liver biochemistries and other possible mechanisms in individuals of all ages from the emergence of the COVID-19 pandemic to the post-pandemic period. The review also alludes to clinical perspectives of such interactions to curb overlapping hepatic diseases in people who recovered from the infection or living with long COVID-19.

Changes in glycemic control and body weight over the course of the COVID 19 pandemic in an outpatient setting

Objective

The COVID-19 pandemic altered health outcomes in populations through a host of downstream social, economic, and psychological changes, especially among those with chronic non-communicable diseases (NCDs). Some studies reveal worsened glycemic control and weight gain, while others indicate improved glycemic control and weight loss. Thus, evidence demonstrates conflicting results in this context. We aimed to conduct a study to explore changes in these metrics in an outpatient setting providing for an underserved population.

Methods

We conducted a single-site observational study at a Federally Qualified Health Center (FQHC) in New York City to compare glycemic control and body weight, measured by Hemoglobin A1c (HbA1c) and body mass index (BMI) respectively, before and after the onset of the COVID-19 pandemic.

Results

After the pandemic, there was a 103% increase in the annual change in average HbA1c from the years prior to the pandemic versus from early 2020 to 2021 (p < 0.005). Mean BMI increased during the pandemic, although this was not statistically significant. The slope for the change in BMI over five years prior to the pandemic is -0.09, while the slope of change in BMI before and after the onset of COVID-19 is 0.31. The difference between the two slopes is 0.48 (p = 0.37).

Discussion/Conclusion

Our study reveals that the COVID-19 pandemic could have contributed to a worsening in the status of metabolic disorders due to decreased physical activity, worsened dietary habits, psychosocial stressors, and reduced access to healthcare, emphasizing the need for enhanced medical, pharmaceutical and emotional support. Concurrently, many individuals adopted healthier practices through dietary and activity modifications, with a resulting improvement in cardio-metabolic parameters.

Changes in lifestyle, adiposity, and cardiometabolic markers among young adults in Sweden during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has impacted on public health in several ways. The aim of the study was to investigate changes in lifestyle, adiposity, and cardiometabolic markers among young adults in Sweden during the COVID-19 pandemic and their determinants.

METHODS

The study included 1 004 participants from the population-based birth cohort BAMSE. Anthropometrics, body composition (bioelectric impedance analyses), pulse, and blood pressure were measured before (December 2016-May 2019; mean age 22.6 years) and during (October 2020-June 2021; mean age 25.7 years) the COVID-19 pandemic. Lifestyle changes during the pandemic were assessed through a questionnaire.

RESULTS

All measures of adiposity (weight, BMI, body fat percentage, trunk fat percentage) and cardiometabolic markers (blood pressure, pulse) increased during the study period (e.g., body fat percentage by a median of + 0.8% in females, p < 0.001, and + 1.5% in males, p < 0.001). Male sex, non-Scandinavian ethnicity, BMI status (underweight and obesity), and changes in lifestyle factors, e.g., decreased physical activity during the pandemic, were associated with higher increase in BMI and/or adiposity.

CONCLUSION

Lifestyle factors, adiposity and cardiometabolic markers may have been adversely affected among young adults in Sweden during the COVID-19 pandemic compared with the preceding years. Targeted public health measures to reduce obesity and improve healthy lifestyle are important to prevent future non-communicable diseases.

Effect of the COVID-19 pandemic on obesity and it is risk factors: a systematic review

BACKGROUND

Coronavirus disease (COVID-19) is a contagious disease caused by the severe acute new coronavirus called SARS-CoV-2. Devastating social, economic, and health service utilisation-related activities. Increased burden and lifestyle changes due to confinement.

OBJECTIVE

This study aimed to investigate and determine the determinants of obesity during the coronavirus disease (COVID-19) pandemic from 2019 to 2023.

METHODS

Observational studies published between December 2019 and January 2023 were thoroughly searched using a PRISMA flow chart. PubMed, Google Scholar, Web of Science, HINARI, Scopus, and Embase databases were used. Two reviewers independently identified and critically evaluated the relevant literature. Studies that reported weight gain or involved BMI measurements of 25 kg/m2 or BMI z-scores for children during the COVID-19 lockdown were selected for inclusion. The Newcastle-Ottawa Scale (NOS) was used as a quality assessment instrument in nonrandomised studies to evaluate study quality. All the contributing determinants of weight increase were identified, gathered, and synthesised.

RESULTS

This systematic review identified 40 studies with a total population of 5,681,813 from 22 countries, of which 74.6% were male. The sample size from included articles ranged from 37 to 5,315,435. Of the 40 selected articles, 24 focused on adults, five on adolescents, three on children, and eight on children and adolescents. Physical inactivity, sedentary behaviour, bad eating habits, behavioural lifestyle, excessive stress, depression, anxiety, behavioural risk factors, sex, and ethnic minorities were associated with obesity during the COVID-19 pandemic lockdown.

CONCLUSION

During the COVID-19 pandemic, physical inactivity, sedentary lifestyle, and poor eating patterns were the most common risk factors for obesity. Additionally, unhealthy eating habits, excessive behavioural stress, depression, anxiety, low mood, age, gender, and ethnic minorities have been identified as risk factors for obesity during the COVID-19 pandemic.

Lifestyle and Dietary Patterns during the COVID-19 Lockdown in Bahrain: A Web-Based Cross-Sectional Study

Lifestyle factors such as dietary habits, perceived weight, sleep, and physical activity worsened during the COVID-19 pandemic. Through this study, we aimed to understand the impact of COVID-19 on these lifestyle factors in Bahrain. A cross-sectional study was conducted among 1005 adult Bahrainis. Data were collected online using a structured and validated questionnaire for the assessment of eating habits, physical activity, and lifestyle during the COVID-19 pandemic. Participants were snowballed through those who agreed to answer the online questionnaire. There was a higher consumption of fast food, and a higher dependence on takeaways during the COVID-19 pandemic. About 63.5% of the participants consumed >4 meals per day, compared to 36.5% before the COVID-19. About 30% reported consumption of sugar sweetened beverages from two to three times a day. Weight loss was predominantly observed in persons exercising 1-3 times a week. The consumption of sugar-sweetened beverages was also high, with about 19% reporting drinking sweet beverages once every day, 10.6% from two to three times a day, and 40.4% from one to four times a week. A higher proportion of the participants reported poor sleep quality during the pandemic (31.2%) compared to before (12.2%), and 39.7% of the participants reported feeling lazy. Screen time use also doubled during the pandemic, with participants spending more than five hours per day on screens for entertainment, which went from 22.4% before to 51.9% during the pandemic. The lifestyle and dietary habits changed drastically for our study participants during the pandemic. The increased reliance on processed fast food instead of healthier options is a challenge to be tackled in any future pandemic situation. Future research needs to focus on strategies to promote healthier lifestyle modifications during situations such as the COVID-19 pandemic.

Changes in dietary habits during Covid-19 lockdown in Egypt: the Egyptian COVIDiet study

PURPOSE

COVID-19 lockdown changed social habits and lifestyle, including dietary habits, of people worldwide. However, limited information is available about these changes in Egypt. This cross-sectional study investigates the effects of COVID-19 lockdown on dietary habits among the Egyptian populations.

METHODS

An online questionnaire, based on sociodemographic data and dietary adherence in accordance with the validated PREDIMED MedDiet Adherence Screener (MEDAS), was used all over the Egyptian governorates. The dietary changes were statistically evaluated for significance in relation to age, gender, body mass index (BMI), education level and governorates.

RESULTS

A total of 1010 participants (76% aged below 36 years, 77% female, 22% obese, and 62% university-level education) answered the questionnaire. Respondents ≤ 20 years had a significant increase in weight and consumption of carbonated beverages, commercial pastries, fried and fast food. Egyptians > 50 years old had a significant decrease in physical activity. Underweight people (less than 3% of participants) increased their fast food intake with a prominent rise in weight. However, obese people increased cooking frequency and increased eating times with a decrease in physical activity. Male participants reported increased intake of carbonated beverages and fast food, while female participants increased the intake of homemade pastries with a significant decrease in physical activity. Approximately 50% of participants with postgraduate education reported decreased intake of fast food and carbonated beverages as well as decreased body weight. Residents of Cairo showed a significant increase in vegetable intake, and fried food intake with a decrease in seafood consumption. Participants from the Delta region had a significant increase in pastries intake.

CONCLUSION

The findings of this study explored the need for increasing awareness about healthy lifestyle in future lockdown periods.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

A Retrospective Chart Review Evaluating Changes in 25-Hydroxyvitamin D Levels among Patients Attending the University Healthcare Centre during the COVID-19 Pandemic

COVID-19-pandemic-related home confinement aids in limiting the spread of the virus but restricts exposure to sunlight, thereby possibly affecting 25(OH)D concentrations. This study aimed to investigate the effect of lockdown measures on 25(OH)D levels in outpatients visiting the healthcare centre over a period of two years. In this retrospective chart review, outpatients who visited a university healthcare centre for a health check-up over a period of two years were included. The patients' 25(OH)D serum levels and status were compared before, during, and after the lockdown periods. A total of 7234 patients were included in this study, with a mean age of 34.66 ± 16.78. The overall prevalence of 25(OH)D insufficiency, deficiency and sufficiency was 33.8%, 30.7% and 35.4%, respectively. The proportion of individuals with 25-(OH) D deficiency prior to lockdown was 29% and this proportion increased in the lockdown and post-lockdown periods to 31.1% and 32%, respectively. Although gender was less likely to have an impact on the 25 (OH) D level during the lockdown period (p = 0.630), we found an association between gender and 25 (OH) D status in the pre-lockdown and post-lockdown periods (p < 0.001 and p < 0.001, respectively). Another association between nationality and 25 (OH)D levels was found before, during and after the lockdown periods (p < 0.001). In addition, the youngest population, aged between 1 and 14, was strongly affected by the home confinement. Age had a positive and significant (p < 0.05) effect on 25 (OH) D status regardless of the different periods. Moreover, in the pre-lockdown period, male outpatients had 1.56 chance of having a sufficient level of 25 (OH)D. However, during the lockdown period, this chance decreased to 0.85 and then increased to 0.99 after the lockdown period. We found no statistically significant difference in the mean serum concentrations or in the prevalence of vitamin D insufficiency when we compared values from before, during and immediately after the COVID-19 lockdown period. However, there was a generally increased prevalence of vitamin D insufficiency in our study population. Another association between gender, nationality and age groups with 25(OH) D was found. Regular exposure to UVR is recommended for maintaining adequate vitamin D levels and to prevent vitamin D deficiency. Further research is needed to determine the best indications for vitamin D supplementation if confinement periods are extended and to consider the potential health consequences of prolonged confinement periods not only on vitamin D status but also on overall public health. The findings of this study may be considered by stakeholders for a targeted supplementation approach for risk groups.

Changes in Food Consumption Trends among American Adults since the COVID-19 Pandemic

The quality and quantity of food consumption have changed due to the COVID-19 pandemic. In this study, we examined how the COVID-19 pandemic has changed the consumption of different food groups in order to close the research gap by providing current evidence that reflects a later stage of the pandemic compared to other circulating research conducted at earlier stages. Data collection for this cross-sectional study was performed via an online Qualtrics survey from 10,050 adults aged 40-100 years. Nutritional status was measured using the 24-item short-form Dietary Screening Tool (DST) twice: before and since the COVID-19 pandemic. The DST questions were categorized based on MyPlate items, along with fat, sugar, and sweet items, as well as nutritional supplement intake. In addition, the total DST score was calculated for each participant, which categorized them into one of three groups: "at risk", "possible risk", and "not at risk". The results revealed that the consumption of grains, fruit, lean protein, and dairy decreased significantly, while the consumption of fat, sugar, and sweet items increased significantly due to COVID-19. The biggest decreases in consumption of food subcategories were related to whole grain bread and cereal, followed by fruit as a snack, in comparison with other types of grain and fruit. No changes in the consumption of vegetables, processed meat, or supplement intake were seen. The total DST score showed that, before and since COVID-19, the overall nutrition status of adult Americans has been at risk. In addition, of those participants who were not at risk before COVID-19, 28.5% were either at risk or at possible risk since COVID-19; moreover, of those participants who were at possible risk before COVID-19, 21% were at risk since COVID-19. As a good nutritional status can reduce the risk of severe illness or even mortality rate in times of crisis, the findings of this study can help policymakers and health educators to develop heath-protecting behavior sessions against future pandemics to manage crises.

Supplementation use and diet changes during COVID-19 pandemic according to anxiety level and Mediterranean diet adherence

Aim; This study was planned and conducted to examine the change in food consumption and nutritional supplement use during the COVID-19 pandemic according to individuals' status of anxiety and Mediterranean diet adherence. Methods; This prospective, cross-sectional research was completed online with the participation of 949 people (66.4% women). The Mediterranean Diet Adherence Screener Scale (MEDAS) and Coronavirus Anxiety Scale (CAS) were applied. After this section of the questionnaire was completed, the participants were tasked with answering questions regarding changes in food consumption and use of nutritional supplements during the pandemic. Results; While 50.8% of the participants had low adherence to the Mediterranean diet, 18.2% were considered to have a high adherence. It was observed that legume (p = 0.001), milk and dairy (p = 0.01), and fruit (p < 0.001) consumption of participants with high adherence to the Mediterranean diet increased during the pandemic, and packaged food (p < 0.001) consumption decreased. The increase in the consumption of fruit (p < 0.001) and vegetables (p = 0.018) were significantly higher in the group with anxiety. Age, sex, educational status, positive COVID-19 test, place of residence, CAS score and MEDAS score affect the use of dietary supplements according to binary logistic regression (R² = 0.106 p < 0.001). The three most commonly used supplements were identified as vitamins C, D and B₁₂. Conclusions: These results can shed light on how to prepare for possible future pandemics when it comes to dealing with anxiety through diet.

Effects of 12-week combined training versus high intensity interval training on cardiorespiratory fitness, body composition and fat metabolism in obese male adults

Background

/Objectives: A weekly combination of a high volume of moderate-intensity continuous training (MICT) with a low volume of high-intensity interval training (HIIT) provides important improvements in body composition and physical capacities in individuals with obesity. However, previous studies did not determine the weekly proportions of HIIT and MICT a priori. This study aimed to investigate changes in body composition, physical capacities and the fat oxidation rate in obese male adults by comparing a combination of MICT and HIIT, called combined training (COMB), with HIIT for a 12-week period.

Methods

Thirty-four obese male adults (mean age: 39.4 ± 7.0 y; mean body mass index [BMI] 34.0 ± 4.2 kg m-2) participated in this study (n = 18 for COMB, n = 16 HIIT), attending ∼ 36 training sessions. The COMB group performed 3 repetitions of 2 min at 95% of peak oxygen uptake (V'O2 peak) (e.g., HIIT ≤20%), followed by 30 min at 60% of VO2 peak (e.g., MICT ≥80%). The HIIT group performed 5-7 repetitions of 2 min at 95% of VO2 peak. At baseline (PRE) and at the end of the training period (POST), body composition, VO2 peak, and the fat oxidation rate were measured. The two training programs were equivalent in caloric expenditure.

Results

At POST, body mass (BM) and fat mass (FM) decreased by a mean of 3.09 ± 3.21 kg and 3.90 ± 2.40 kg, respectively (P < 0.05), in both groups and V'O2 peak increased in both groups by a mean of 0.47 ± 0.34 L min-1 (P < 0.05). The maximal fat oxidation rate increased similarly in both groups from 0.32 ± 0.05 to 0.36 ± 0.06 g min-1 (P < 0.05).

Conclusion

COMB training represents a viable alternative to HIIT to improve anthropometric characteristics, physical capacities and fat oxidation in obese male adults.

Obesity, lifestyle behaviours and psychological effects of the COVID-19 lockdown: A survey of patients attending a tertiary weight loss clinic

Lockdown measures due to coronavirus-19 disease (COVID-19) have impacted lifestyle factors. This study aimed to explore whether health and lifestyle behaviours changed during the 2020 COVID-19 lockdown among patients with obesity. A specifically designed online survey and the Depression Anxiety Stress Scale (DASS-21) were administered to patients scheduled to attend a tertiary weight management service between 6 June-12 August 2020. A total of 210 participants completed the survey; mean age (SD) was 52.1 (12.5) years, 69% female and 67% Caucasian. Only 1.4% had tested positive to COVID-19. There was a statistically significant increase in weight pre- and post-COVID-19 lockdown, with no sex differences. Most (61.3%) gained weight, 30.4% lost weight and 8.3% maintained. The majority changed their overall purchasing (88.4%) and eating behaviours (91.6%). Two-thirds (64%) reported they did some form of exercise during the lockdown. Of those, exercise declined in 56.8% and increased in 18%. DASS-21 scores were positively correlated to worry about COVID-19, eating fewer core foods and eating more convenient/treat foods and negatively correlated with exercise. The results provide insights into how and why behaviour change occurs during stressful periods like the COVID-19 pandemic. Although there was variability in individual weight trajectories, on average people with obesity gained weight and changed lifestyle behaviours during the COVID-19 lockdown period. Strategies and support for people with obesity are required at these times.