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Psychological Aspects and Eating Habits during COVID-19 Home Confinement: Results of EHLC-COVID-19 Italian Online Survey

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Nutrients
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Abstract and Figures

The COVID-19 pandemic has had a huge impact on the population with consequences on lifestyles. The aim of the study was to analyse the relationship between eating habits, mental and emotional mood. A survey was conducted online during social isolation, from 24 April to 18 May 2020, among the Italian population. A total of 602 interviewees were included in the data analysis. A high percentage of respondents experienced a depressed mood, anxious feelings, hypochondria and insomnia (61.3%, 70.4%, 46.2% and 52.2%). Almost half of the respondents felt anxious due to the fact of their eating habits, consumed comfort food and were inclined to increase food intake to feel better. Age was inversely related to dietary control (OR = 0.971, p = 0.005). Females were more anxious and disposed to comfort food than males (p < 0.001; p < 0.001). A strength of our study was represented by the fact that the survey was conducted quickly during the most critical period of the Italian epidemic lockdown. As the COVID-19 pandemic is still ongoing, our data need to be confirmed and investigated in the future with larger population studies.
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nutrients
Article
Psychological Aspects and Eating Habits during
COVID-19 Home Confinement: Results of
EHLC-COVID-19 Italian Online Survey
Laura Di Renzo 1, Paola Gualtieri 1, Giulia Cinelli 2, 3, * , Giulia Bigioni 4, Laura Soldati 5,
Alda Attinà2, Francesca Fabiola Bianco 2, Giovanna Caparello 2, Vanessa Camodeca 2,
Elena Carrano 2, Simona Ferraro 2, Silvia Giannattasio 2, Claudia Leggeri 2, Tiziana Rampello 2,
Laura Lo Presti 6, Maria Grazia Tarsitano 7and Antonino De Lorenzo 1
1Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of
Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; laura.di.renzo@uniroma2.it (L.D.R.);
paola.gualtieri@uniroma2.it (P.G.); delorenzo@uniroma2.it (A.D.L.);
2School of Specialization in Food Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome,
Italy; alda.attina@gmail.com (A.A.); kikafabiola@gmail.com (F.F.B.); caparello.giovanna@gmail.com (G.C.);
vanessacamodeca@libero.it (V.C.); elena_carrano@libero.it (E.C.); ferrarosimona@hotmail.it (S.F.);
silviagiannattasio85@gmail.com (S.G.); claudialeggeri@gmail.com (C.L.); tizianarampello1@gmail.com (T.R.)
3Predictive and Preventive Medicine Research Unit, Bambino GesùChildren’s Hospital IRCCS,
00165 Rome, Italy
4Department of Physic, University of Rome Sapienza, P.zza Aldo Moro 5, 00185 Rome, Italy;
bigionigiulia@gmail.com
5Department of Health Sciences, University of Milan, Via A. Di Rudinì, 8, 20142 Milan, Italy;
laura.soldati@unimi.it
6Unitelma Sapienza, University of Rome Sapienza, Via Regina Elena, 295, 00161 Rome, Italy;
la.lopre@gmail.com
7Department of Experimental Medicine, University of Rome Sapienza, Rome 00161, Italy;
mariagrazia.tarsitano@uniroma1.it
*Correspondence: giuliacinelli88@gmail.com; Tel.: +39-329-185-8289
Received: 19 June 2020; Accepted: 16 July 2020; Published: 19 July 2020


Abstract:
The COVID-19 pandemic has had a huge impact on the population with consequences on
lifestyles. The aim of the study was to analyse the relationship between eating habits, mental and
emotional mood. A survey was conducted online during social isolation, from 24 April to 18 May
2020, among the Italian population. A total of 602 interviewees were included in the data analysis.
A high percentage of respondents experienced a depressed mood, anxious feelings, hypochondria
and insomnia (61.3%, 70.4%, 46.2% and 52.2%). Almost half of the respondents felt anxious due to
the fact of their eating habits, consumed comfort food and were inclined to increase food intake to
feel better. Age was inversely related to dietary control (OR =0.971, p=0.005). Females were more
anxious and disposed to comfort food than males (p<0.001; p<0.001). A strength of our study
was represented by the fact that the survey was conducted quickly during the most critical period
of the Italian epidemic lockdown. As the COVID-19 pandemic is still ongoing, our data need to be
confirmed and investigated in the future with larger population studies.
Keywords:
SarsCoV2; COVID-19; lockdown; psychological eects; emotional eating; lifestyle;
eating behaviours
Nutrients 2020,12, 2152; doi:10.3390/nu12072152 www.mdpi.com/journal/nutrients
Nutrients 2020,12, 2152 2 of 14
1. Introduction
The new form of coronavirus (Sars-CoV-2) has triggered a worldwide state of emergency [
1
].
In this pandemic scenario, the experts involved [
2
] are increasingly concerned by the psychological
implications that the epidemic has brought with it, especially for elderly people with compromised
immune systems and for the health of the workers employed on the front lines against this virus [
3
].
Previous studies have revealed a wide range of psychosocial impacts on individuals and on the overall
community during outbreaks of infections [
4
]. On a personal level, people experienced fear of getting
sick or dying, feelings of helplessness and stigma [
4
]. In particular, the fear of one’s own health and of
their loved ones, social distancing and the quarantine obligations have put a strain on the aective
and emotional sphere of every individual. This situation has severely undermined the psychological
stability of Italians as well as the worldwide population, causing adverse psychological eects.
The lockdown measures have had a great impact on everyday life [
2
], often associated with a
negative influence on psychological well-being. These circumstances have exasperated a series of
psychological and psychopathological conditions, including emotional exhaustion, irritability, anxiety,
increased anger, depressive symptoms as well as a post-traumatic stress disorder [
5
]. Psychological
theories, such as the behaviour immune system (BIS), argue that these emotional and cognitive
responses support proactively the immune system in the fight against the pathogen agents [6].
Until now, the information on psychological impact of the COVID-19 pandemic on the population
continues to be limited. Researchers, in fact, have mainly focused on identifying epidemiology
and clinical features of infected patients [
7
], virus genomics characterizations [
8
] and governmental
challenges in the healthcare and economic fields [
9
]. Besides these priorities, it is important not to
downplay the contribution of social and behavioural sciences in shaping and optimizing individual
and collective response to the crisis [
10
]. During an epidemic, people can react to ocial information
in an irrational way and, thus, governments should make people aware of the situation without raising
alarms [11].
Several studies have highlighted how a significant number of individuals have manifested a
series of psychological eects and the diculties in adapting to the new lifestyle of the quarantine. In
China, the psychological impact and the state of mental health during the first phase of COVID-19
pandemic were assessed through the Event Scale (IES-R), while the impact of depression, anxiety
and stress were assessed by the Depression Anxiety and Stress Scale (DASS-21) [
12
]. Similarly, an
Italian study assessed the general population’s psychological distress during the pandemic through
an online survey. This showed that 38% of the population was aected by significant psychological
indispositions [
13
]. Further, many studies have compared the psychological outcomes between
quarantined and non-quarantined people [
14
]. One in particular demonstrated that the quarantine
eect could be a predictor of post-traumatic stress symptoms, even years after the event [
15
]. In Poland,
a significant percentage of individuals changed dietary habits and started eating and snacking more,
leading to weight gain in overweight and obese subjects [
16
]. Therefore, as widely demonstrated by
these studies, negative eects of post-traumatic stress symptoms, confusion and anger were reported.
The stress factors included uncertainty about the duration of the quarantine, fear of possible infections,
the ban on going to hospitals unless strictly necessary, frustration, boredom, infodemic, overall
uncertainty of the future, fear of significant financial losses and long-term repercussions that the
country will face.
It is pivotal to highlight how containment measures, including self-isolation and social distancing,
may have had a strong impact on the everyday life of the population and how the population’s
psychological well-being may have been negatively aected.
The “Eating Habits and Lifestyle Changes in COVID-19 lockdown” (EHLC-COVID19) project
on the Italian population has started to explore and analyse, in a diachronic perspective, the
multi-dimensional lifestyle behaviours, eating habits and mental and emotional responses during
home confinement [16].
Nutrients 2020,12, 2152 3 of 14
The first survey launched with the EHLC-COVID19 and focused on eating habits, adherence to the
Mediterranean Diet (MD) and the changes in the lifestyle faced during the COVID-19 lockdown of the
Italian population [
17
]. This paper presents data from the second part of the EHLC-COVID19 survey
that aimed to analyse the psychological status during the COVID-19 pandemic and its correlation with
the eating habits in the Italian population.
2. Materials and Methods
2.1. Survey Methodology and Promotion
The EHLC-COVID19 project conducted research, using an electronic survey in Italian, to collect
data on the Italian population regarding eating habits, lifestyle and the behavioural and emotional
impact related to the COVID-19 pandemic.
The survey was designed by a steering group of scientists at the Section of Clinical Nutrition
and Nutrigenomics at the Department of Biomedicine and Prevention of the University of Rome Tor
Vergata. It was conducted during the lockdown period among the Italian population using an online
platform (Google Form) which was accessible by any device with an Internet connection. The survey
was concluded when the Italian ministerial ordinances started authorising again some public and
private activities. The questionnaire was uploaded and shared through the institutional mailing list,
social networks (Twitter, Instagram and Facebook), and the “PATTO in Cucina Magazine” website [
17
].
The online survey provided statistical collective parameters. The research objectives were entirely
successful, since this method facilitated the wide dissemination of the questionnaire without any type
of limit.
According to the latest Italian Annual Report on Internet Access, the selected methodology
conformed with the actual use of the Internet in Italy. In January 2020, 94% of internet visitors, aged
16 to 64, used their mobile phones to navigate the Web, while 99% of them used specifically social
networks and messaging services [18].
The survey included an introductory page describing the background, the aims and information
on the ethics of the survey. The inclusion criteria for the respondents were: people living in Italy, age
18–79 years, female or male. Individuals living outside of Italy were excluded. These criteria were
verified by answers given to the corresponding survey questions.
The structured questionnaire included 25 questions, divided into three dierent sections: (1)
personal and general data (including 6 questions: age, gender, information on region and province of
residence, level of education, and cohabitation situation at home); (2) anthropometrics information
(including 2 questions reported as weight and height); (3) lifestyle, eating habits changes, psychological
and emotional aspects caused by the social isolation during the pandemic period (including 17 questions
modified from validated tools [
19
23
]), to investigate and assess the emotional aspects such as anxiety,
depressed mood, hypochondria, level of concern, emotional eating, insomnia, dietary changes, as well
as the perception of diet control and appetite. No names or other personal information was requested.
The questions within the last section of the survey were extrapolated from the 14 item Hamilton
Anxiety Rating Scale [
19
,
20
], commonly used in the clinical context to evaluate anxiety symptoms, the
17 item Hamilton Depression Scale [
21
], developed to assess depression and from the 25 item Yale
Food Addiction Scale (YFAS), designed to identify those exhibiting signs of addiction towards certain
types of foods [
22
,
23
]. Only some of the questions, from the Italian version of the scales, were used and
edited by researchers to adapt them to the current period of social isolation, hence, no scoring scale was
calculated. The full version of the questionnaire, translated into English, is available in Appendix A.
The online survey was conducted in full agreement with the national and international regulations
in compliance with the Declaration of Helsinki (2000). All participants were fully informed about the
study requirements and were required to accept the data sharing and privacy policy before taking part
in the study. To maintain and protect the confidentiality of the participants, their personal information
and data were anonymous, according to the provisions of the General Data Protection Regulation
Nutrients 2020,12, 2152 4 of 14
(GDPR 679/2016). The anonymous nature of the web survey did not allow for tracing in any way
sensitive personal data. Therefore, the present web survey study did not require approval by the
Ethics Committee.
The participants completed the questionnaire directly connected to the Google Form, each
questionnaire was sent to the final database and downloaded as a Microsoft Excel sheet. The
participants’ answers were anonymous and confidential according to Google’s privacy policy [
24
]. The
participants would have been able to withdraw their participation in the survey at any stage before the
submission; non-completed responses were not saved.
2.2. Statistical Analysis
Descriptive statistics were employed to explore demographic, personal characteristics and
anthropometric parameters of the study sample. Data are represented as numbers and percentages
in parentheses (%) for categorical variables or mean and standard deviation (SD), as well as median
and interquartile range in square brackets [IQR] for continuous variables. The Shapiro–Wilk test
was carried out to evaluate variables distribution. All the variables had non-normal distribution.
The Spearman correlation coecient was calculated to evaluate the correlation between continuous
variables. The Chi-square test was employed to assess the association of categorical variables. Instead,
Mann–Whitney U and Kruskal–Wallis tests were performed to compare continuous variables among
two or more groups, respectively. Finally, univariable and multivariable binary logistic regression
analyses were conducted to investigate the association between categorical variables (dependent) and
continuous or categorical ones (independent). Results were significant for p-value <0.05. Statistical
analysis was performed using SPSS ver. 21.0 (IBM, Chicago, IL, USA).
3. Results
3.1. Participants
The web survey was launched on the 24 April 2020 and concluded on the 18 May 2020, when the
lockdown in Italy ended (Appendix Bshows the geographical distribution of COVID-19 total positive
cases in Italy on 18 May 2020). Thereafter data were analysed. A total of 700 participants completed the
questionnaire. After the validation of the data, 602 respondents, aged between 18 and 79 years, were
included in the analysis. The female respondents represented the majority of the population (79.7%).
The territorial coverage spread over all Italian regions: 15.6% of respondents lived in Northern Italy,
40.0% in Centre Italy, and 44.4% in Southern Italy and Islands. According to the age distribution, the
sample reflected the population of Italian internet users (i.e., 98.7% of people older than 20 years) [
25
].
General characteristics and anthropometrics of the population are reported in Table 1. A positive
correlation between BMI and age was found (r=0.296, p<0.001). No dierence was found in BMI
when comparing the dierent Italian regions (p=0.078), while males showed a significantly higher
BMI in comparison to females (Mann–Whitney U =20,331.50, p<0.001).
For what concerns cohabitation during the COVID-19 emergency, 192 (31.9%) participants declared
to live with their parents, 157 (26.1%) with their partner and children, 134 (22.3%) with just their partner
and 21 (3.5%) with just their children. Finally, 64 (10.6%) of them declared to live alone and 34 (5.6%)
with flatmates. Furthermore, 196 (31.9%) of the respondents armed to suer from a disease (e.g.,
hypertension, oncological, cardiovascular or autoimmune diseases).
Nutrients 2020,12, 2152 5 of 14
Table 1. Population’s characteristics and anthropometrics.
Whole Sample
(n=602)
Northern Italy
(n=94)
Centre Italy
(n=241)
Southern Italy and
Islands (n=267)
Age 36.0 [20.0] 36.0 [18.0] 33.0 [23.0] 38.0 [17.0]
38.2 ±12.9 38.1 ±12.5 37.3 ±14.1 39.1 ±11.9
Age Groups
18–30 years 212 (35.2%) 33 (35.1%) 107 (44.4%) 72 (27.0%)
31–50 years 279 (46.3%) 45 (47.9%) 86 (35.7%) 148 (55.4%)
51–65 years 91 (15.1%) 13 (13.8%) 37 (15.4%) 41 (15.4%)
>66 years 20 (3.3%) 3 (3.2%) 11 (4.6%) 6 (2.2%)
Gender
Female 480 (79.7%) 82 (87.2%) 182 (75.5%) 216 (80.9%)
Male 120 (19.9%) 12 (12.8%) 58 (24.1%) 50 (18.5%)
Not specified 2 (0.3%) 0.0 (0%) 1 (0.4%) 1 (0.4%)
Educational Level
Compulsory school
44 (7.3%) 9 (9.6%) 11 (4.6%) 24 (9.0%)
High school degree
215 (35.7%) 23 (24.5%) 76 (31.5%) 116 (43.4%)
Graduate school
degree 243 (40.4%) 41 (43.6%) 107 (44.4%) 95 (35.6%)
Post-graduate
school degree 100 (16.6%) 21 (22.3%) 47 (19.5%) 32 (12.0%)
Weight (kg) 66.0 [21.0] 64.5 [16.3] 66.0 [22.0] 67.0 [21.0]
69.6 ±16.4 67.6 ±16.8 70.3 ±16.6 69.6 ±16.2
Height (cm) 165.0 [11.3] 165.5 [9.5] 165.0 [13.0] 165.0 [10.0]
166.4 ±8.6 166.5 ±7.6 167.2 ±8.5 165.8 ±8.9
BMI (kg/m2) 24.0 [6.4] 23.1 [5.6] 24.0 [6.3] 24.6 [6.7]
25.0 ±5.2 24.3 ±5.6 25.1 ±5.3 25.2 ±4.9
Class of BMI
Underweight 13 (2.2%) 2 (2.1%) 7 (2.9%) 4 (1.5%)
Normal weight 344 (57.1%) 62 (66.0%) 137 (56.8%) 145 (54.3%)
Overweight 161 (26.7%) 20 (21.3%) 64 (26.6%) 77 (28.8%)
Obesity I 61 (10.1%) 7 (7.4%) 23 (9.5%) 31 (11.6%)
Obesity II 13 (2.2%) 1 (1.1%) 5 (2.1%) 7 (2.6%)
Obesity III 10 (1.7%) 2 (2.1%) 5 (2.1%) 3 (1.1%)
Values are expressed as median and IQR in square brackets (M [IQR]) as well as mean and standard deviation
(
M±SD
) for continuous variables or as number and percentage (n(%)) for categorical variables. The Shapiro–Wilk
test was performed to evaluate variables distribution. Variables are considered non-normally distributed for
p<0.05
.
BMI, body mass index.
3.2. Emotional State during the COVID-19 Emergency
With regards to the emotional state, a high percentage of the respondents declared to have felt
anxious and depressed during the COVID-19 lockdown. Figure 1shows the percentage of positive
answers to the questions extrapolated from the Hamilton Depression Rating Scale. The figure includes
also the percentage of positive answers concerning insomnia.
Considering the dierent Italian regions, a dierence was found for physical manifestation of
anxiety (p=0.046; percentage of positive answers: North 55.3%, Centre 52.7%, South and Islands
63.3%) and tension (p=0.017; percentage of positive answers: North 84.0%, Centre 71.4%, South and
Islands 79.8%). Moreover, a dierence among age groups was found for depressed mood, anxious
feelings and insomnia (p=0.001, p<0.001 and p=0.014, respectively). In particular, the univariable
binary logistic regression showed that age was inversely correlated to these emotional states (depressed
mood: OR =0.980, p=0.002; anxious feelings: OR =0.966, p<0.001; insomnia: OR =0.980, p=0.001).
With regards to gender, the percentage of females declaring to feel depressed and anxious, to
experience physical manifestations of anxiety, tension and insomnia problems during the COVID-19
Nutrients 2020,12, 2152 6 of 14
emergency was significantly higher than the males one (at the Chi-Square analysis
p<0.001
for
all the variables). Females were also more prone to take drugs or supplements for their anxious
feelings
(p=0.006)
. Surprisingly, a higher percentage of males in comparison to females armed
to have felt breathing diculties and other symptoms such as tachycardia or perception of fainting
(
p=0.028; p=0.035
). No dierence between males and females was found for hypochondria
(p=0.475)
.
Results are shown in Figure 2. Further, 24.1% of the respondents declared to have stopped working
during the pandemic, while 36.9% armed to have had diculties in concentration in their daily work.
Nutrients 2020, 12, x FOR PEER REVIEW 6 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
3.2. Emotional State during the COVID-19 Emergency
With regards to the emotional state, a high percentage of the respondents declared to have felt
anxious and depressed during the COVID-19 lockdown. Figure 1 shows the percentage of positive
answers to the questions extrapolated from the Hamilton Depression Rating Scale. The figure
includes also the percentage of positive answers concerning insomnia.
Figure 1. Percentage of positive answers to the questions extrapolated from the Hamilton Depression
Rating Scale about depressed mood, anxious feelings, the physical manifestations of anxiety
(tachycardia, headache, sweating), hypochondria, tension and fatigability (on alert, ready to cry,
trembling, restless, unable to relax), breathing difficulties (sighing, choking sensation, chest pressure,
dyspnoea), tachycardia and feeling faint (palpitation, chest pain), use of drugs and supplementation
for anxious mood. The figure also includes the percentage of positive answers about insomnia.
Considering the different Italian regions, a difference was found for physical manifestation of
anxiety (p = 0.046; percentage of positive answers: North 55.3%, Centre 52.7%, South and Islands
63.3%) and tension (p = 0.017; percentage of positive answers: North 84.0%, Centre 71.4%, South and
Islands 79.8%). Moreover, a difference among age groups was found for depressed mood, anxious
feelings and insomnia (p = 0.001, p < 0.001 and p = 0.014, respectively). In particular, the univariable
binary logistic regression showed that age was inversely correlated to these emotional states
(depressed mood: OR = 0.980, p = 0.002; anxious feelings: OR = 0.966, p < 0.001; insomnia: OR = 0.980,
p = 0.001).
With regards to gender, the percentage of females declaring to feel depressed and anxious, to
experience physical manifestations of anxiety, tension and insomnia problems during the COVID-19
emergency was significantly higher than the males one (at the Chi-Square analysis p < 0.001 for all the
variables). Females were also more prone to take drugs or supplements for their anxious feelings (p
= 0.006). Surprisingly, a higher percentage of males in comparison to females affirmed to have felt
breathing difficulties and other symptoms such as tachycardia or perception of fainting (p = 0.028; p
= 0.035). No difference between males and females was found for hypochondria (p = 0.475). Results
are shown in Figure 2. Further, 24.1% of the respondents declared to have stopped working during
the pandemic, while 36.9% affirmed to have had difficulties in concentration in their daily work.
52.2%
19.3%
81.2%
83.1%
77.1%
46.2%
57.8%
70.4%
61.3%
0.0% 25.0% 50.0% 75.0% 100.0%
Insomnia
Use of drugs/supplements for anxious feelings
Tachycardia and feeling faint
Breathing difficulties
Tension and fatigability
Hypochondria
Physical manifestations of anxiety
Anxious feelings
Depressed mood
Emotional State during the COVID-19 Emergency
Figure 1.
Percentage of positive answers to the questions extrapolated from the Hamilton Depression
Rating Scale about depressed mood, anxious feelings, the physical manifestations of anxiety (tachycardia,
headache, sweating), hypochondria, tension and fatigability (on alert, ready to cry, trembling, restless,
unable to relax), breathing diculties (sighing, choking sensation, chest pressure, dyspnoea), tachycardia
and feeling faint (palpitation, chest pain), use of drugs and supplementation for anxious mood. The
figure also includes the percentage of positive answers about insomnia.
Nutrients 2020, 12, x FOR PEER REVIEW 7 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
Figure 2. Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p < 0.05; ** p < 0.01; *** p < 0.001.
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3 shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Figure 3. Percentage of positive answers to the questions about emotional eating behaviour. *
Questions extrapolated from the Yale Food Addiction Scale.
0.0%
25.0%
50.0%
75.0%
100.0%
Insomnia***
Use of drugs/supplements for
anxious feelings**
Tachycardia and feeling faint*
Breathing difficulties*
Tension and faticability***Hypochondria
Physical manifestations of
anxiety***
Anxious feelings***
Depressed mood***
Emotional State in Males and Females
during the COVID-19 Emergency
Males Females
20.3%
57.8%
55.1%
48.7%
14.0%
44.0%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Exclusion of foods that lead to anxious feelings*
Anxious feelings due to current eating habits*
Need to increase food intake to feel better*
Use of food to respond to anxious feelings
Control over eating
Dieting before COVID-19
Emotional Eating Behaviour during the COVID-19
Emergency
Figure 2.
Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p<0.05; ** p<0.01; *** p<0.001.
Nutrients 2020,12, 2152 7 of 14
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Nutrients 2020, 12, x FOR PEER REVIEW 7 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
Figure 2. Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p < 0.05; ** p < 0.01; *** p < 0.001.
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3 shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Figure 3. Percentage of positive answers to the questions about emotional eating behaviour. *
Questions extrapolated from the Yale Food Addiction Scale.
0.0%
25.0%
50.0%
75.0%
100.0%
Insomnia***
Use of drugs/supplements for
anxious feelings**
Tachycardia and feeling faint*
Breathing difficulties*
Tension and faticability***Hypochondria
Physical manifestations of
anxiety***
Anxious feelings***
Depressed mood***
Emotional State in Males and Females
during the COVID-19 Emergency
Males Females
20.3%
57.8%
55.1%
48.7%
14.0%
44.0%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Exclusion of foods that lead to anxious feelings*
Anxious feelings due to current eating habits*
Need to increase food intake to feel better*
Use of food to respond to anxious feelings
Control over eating
Dieting before COVID-19
Emotional Eating Behaviour during the COVID-19
Emergency
Figure 3.
Percentage of positive answers to the questions about emotional eating behaviour. * Questions
extrapolated from the Yale Food Addiction Scale.
No dierence was found for the emotional eating behaviour in the dierent Italian regions. In the
regression analysis no correlation was found between age and the dierent emotional eating behaviour
(need to increase food intake: p=0.441; use of food to respond to anxious feelings: p=0.441; anxious
feelings due to the eating habits: p=0.327; foods exclusion: p=0.454; dieting before COVID-19: p=
0.495). On the contrary, age resulted to be inversely correlated to the control overfeeding (OR =0.971, p
=0.005).
With regards to gender, in comparison to males, a higher percentage of females was on a diet
before the COVID-19 emergency (p=0.005). Moreover, females declared to be more prone to emotional
eating, needing to increase their food intake to feel better or using food as a response to their anxious
state (p<0.001; p<0.001). Finally, due to the fact of their eating habits, they also felt more anxious
when compared to males during the COVID-19 lockdown (p<0.001). No dierence was found for
the control of over-eating (p=0769) and exclusion of foods that lead to anxious feelings (p=0.096).
Results are shown in Figure 4.
Nutrients 2020,12, 2152 8 of 14
Nutrients 2020, 12, x FOR PEER REVIEW 8 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
No difference was found for the emotional eating behaviour in the different Italian regions. In
the regression analysis no correlation was found between age and the different emotional eating
behaviour (need to increase food intake: p = 0.441; use of food to respond to anxious feelings: p =
0.441; anxious feelings due to the eating habits: p = 0.327; foods exclusion: p = 0.454; dieting before
COVID-19: p = 0.495). On the contrary, age resulted to be inversely correlated to the control
overfeeding (OR =0.971, p = 0.005).
With regards to gender, in comparison to males, a higher percentage of females was on a diet
before the COVID-19 emergency (p = 0.005). Moreover, females declared to be more prone to
emotional eating, needing to increase their food intake to feel better or using food as a response to
their anxious state (p < 0.001; p < 0.001). Finally, due to the fact of their eating habits, they also felt
more anxious when compared to males during the COVID-19 lockdown (p < 0.001). No difference
was found for the control of over-eating (p = 0769) and exclusion of foods that lead to anxious feelings
(p = 0.096). Results are shown in Figure 4.
Figure 4. Percentages of positive answers to questions related to the emotional eating behaviour
during the COVID-19 emergency in males and females. A Chi-square analysis was performed to
compare male and female percentages. ** p < 0.01; *** p < 0.001.
3.4. Eating Control and Emotional State
The multivariable binary logistic regression analysis was performed to evaluate which factors
could have been predictors of the ability to control over-eating during the pandemic. The results of
the univariable analysis are shown in Table S1. The final step of the backward approach is shown in
Table 2. The increased control of over-eating during the lockdown was associated with lower age,
lower BMI, not feeling anxious, dieting before COVID-19 and being less prone to increase food intake
to feel better.
Table 2. Adjusted association between respondents’ characteristics and control over-eating.
Dependent
Variable Independent Variables Coefficient
(B)
95% CI
p OR
Lowe
r
Bound
Uppe
r
Bound
Control over-
eating
Age 0.034 0.945 0.989 0.004 0.967
BMI 0.113 0.833 0.958 0.002 0.893
Dieting before COVID-19 0.830 1.375 3.822 0.001 2.293
0.0%
25.0%
50.0%
75.0%
100.0%
Exclusion of foods that
lead to an anxious feelings
Anxious feelings due to
the current eating
habits***
Need to increase food
intake to feel better***
Use of food to respond to
anxious feelings***
Control over eating
Dieting before COVID-19**
Emotional Eating Behaviour in Males and Females
during the COVID-19 Emergency
Males Females
Figure 4.
Percentages of positive answers to questions related to the emotional eating behaviour during
the COVID-19 emergency in males and females. A Chi-square analysis was performed to compare
male and female percentages. ** p<0.01; *** p<0.001.
3.4. Eating Control and Emotional State
The multivariable binary logistic regression analysis was performed to evaluate which factors
could have been predictors of the ability to control over-eating during the pandemic. The results of the
univariable analysis are shown in Table S1. The final step of the backward approach is shown in Table 2.
The increased control of over-eating during the lockdown was associated with lower age, lower BMI,
not feeling anxious, dieting before COVID-19 and being less prone to increase food intake to feel better.
Table 2. Adjusted association between respondents’ characteristics and control over-eating.
Dependent Variable Independent Variables Coecient (B)
95% CI
pOR
Lower
Bound
Upper
Bound
Control over-eating
Age 0.034 0.945 0.989 0.004 0.967
BMI 0.113 0.833 0.958 0.002 0.893
Dieting before COVID-19 0.830 1.375 3.822 0.001 2.293
Depressed mood 0.549 0.314 1.062 0.077 0.577
Anxious feelings 0.820 0.239 0.812 0.009 0.440
Need to increase food
intake to feel better 1.036 0.206 0.611 <0.001 0.355
Multivariable binary logistic regressions between control over-eating (dependent variable) and respondents
characteristics (independent co-variables). A separate univariable binary logistic regression analysis was conducted
for each characteristic and the final multivariable model was determined through a backward approach. Variables
included in the model: age, BMI, dieting before COVID-19, depressed mood, anxious feelings and need to increase
food intake to feel better. The table shows only the final step of the regression. Statistical significance for p<0.05 (in
bold). BMI, body mass index; OR, odds ratio.
4. Discussion
There are dierent studies and surveys created all over the world that demonstrate that the
COVID-19 lockdown has aected the population’s psychological wellness [
26
28
]. The choice of
quarantine from public health institutions has generated positive eects on the hindrance of the
Nutrients 2020,12, 2152 9 of 14
spread of the virus but contemporarily led to many symptoms of emotional uncomfortableness and
psychological disorders in the population [
29
]. The severe quarantine restrictions, such as social
distancing, school and several work activities closing, the ban on group gatherings and physical
activities in open spaces and dedicated facilities, abruptly turned upside down the traditional lifestyle.
It generated consequences on the psychological and emotional state globally [
2
]. The second part of
the EHLC-COVID19 project [
18
] started in this period of social constrain to evaluate consequences on
mood and nutrition habits of 602 individuals.
The respondents to the questionnaire were mainly females from the dierent Italian regions,
young individuals and a large portion of them cohabiting within their family. The lockdown has
undoubtedly had eects on the mood of the participants of the survey: 61.3% of the respondents said
that they have had, for various reasons, a lowering of their mood. The majority of the participants
in the survey referred to anxious feelings and depressed moods as well as exhaustion and tension
with tachycardia and breath diculties. The low mood was not directly connected to a clinical
diagnosis of a depressive state but to an emotional state. Nonetheless, the symptoms of depression,
besides the evaluation of the mood tone, were also connected to behavioural and cognitive evaluations
(hypersomnia/hyposomnia, hyperphagia/hypophagia, lack of concentration, attention, etc.) [
30
].
Moreover, 36.9% of the interviewees claimed to have reduced their concentration in their working
activity. The majority of respondents (70.4%) reported having experienced anxious feelings, yet it is
unsure whether this state was pathological or simply related to the lockdown. Anxiety is a natural
emotional state that causes people to perceive themselves to be in danger when they can no longer
manage to implement their forecasting system [
31
]. In the time of the COVID-19, anxiety can be
considered a natural consequence and not necessarily an indicator of endogenous disturbance, it is
rather reactive and connected to the perceived danger. The anxious symptomatology, where present,
was expressed with mild or moderate symptoms and nobody claimed to have had crippling/disabling
experiences; when present, rather than appearing with specific physical symptoms and in a somatised
form (tachycardia, tremor, sweating, etc.) it seemed to express itself as an inability to relax and as a
state of nervousness and restlessness. On the other hand, 46.2% had health concerns and a fear of get
sick. In almost all the interviewees, the need to use specific drugs or supplements for the management
of anxiety was not reported. This may be a result of the low intensity of the symptoms as well as the
interpretation of this state as a normal consequence of the situation experienced, not only by the specific
subject but by the overall population. This underlies the belief that, where “collective” emotional states
and situations of shared danger are experienced, there is the perception of being in the “norm”. As
such, individuals feel like they belong to a group which therefore makes them feel less isolated and
capable of being able to count on the protection from others.
However, with regards to the gender, we discovered that the pandemic has caused, in females,
a depressive mood, anxious state, the manifestation of anxiety, tension and insomnia; their use of
drugs and supplements increased significantly contrary to that of males, who instead suered from
psychosomatic eects like tachycardia and breath diculties. This was probably because the anxious
individual has a higher physiological response to stressful stimuli and is more frequent in the female
gender [
32
]. In addition, the results have shown an inverse correlation between the age of respondents
and the presence of depressed mood, anxious feelings and insomnia.
The survey also investigated the relationship between the psychological state and emotional
eating. Emotional eating refers to the drive to eat as a reaction to negative feelings or stress. Negative
emotions like anxiety, stress and depression could be a leading cause for the insurgency of emotional
hunger [
33
,
34
]. Almost a half of the respondents (44.0%) followed a dietary diet, before the outbreak
of the pandemic, highlighting a natural predisposition to “dieting” by the female population. The
lockdown seems to have influenced the ability to control the relationship with food. Isolation, lack of
stimuli, boredom and changing food routines had eects on 86.0% of respondents who reported that
they were unable to suciently control their diet. We could suppose that there was a variation of caloric
intake of each meal due to the quantity and quality of food daily consumed in the quarantine period,
Nutrients 2020,12, 2152 10 of 14
and a major number of highly elaborated homemade foods and of superior caloric content [
17
,
35
].
We know that there are no foods or natural remedies that can prevent COVID-19 infections [
36
];
nevertheless, an anti-inflammatory diet could be useful to strengthen the immune system and contrast
inflammatory cascade and oxidative stress [
37
]. Butler et al. [
38
] suggested that the type of diet
can influence both the host’s response and the pathogen’s virulence. In particular, there could be
a correlation between the consumption of high palatable foods, like ultra-processed ones, and an
impairment of the temporal coordination of the innate and adaptive immunity. Such impairment
has been shown to increase the probability of infection by COVID-19, as well as of a more severe
clinical course.
The enhanced exposure to food caused by the increase of boredom and having more time available
to cook and consume the meal, also enhanced by the fact that the only freedom allowed was to go
grocery shopping, induced people who least succeed in managing their diet to amplify the relationship
between food intake and emotions. Despite this awareness, “containment” actions have not been put
into practice. Many individuals have chosen not to limit themselves, except on rare occasions.
It emerges also that there is a dierence in gender regarding emotional hunger. Females display a
higher state of eating anxiety compared to males. The results show that females had more alimentation
anxiety and felt the need to increase food intake in comparison to males. This is probably caused by
the female physiology which is more subject to emotional hunger and to symptoms of depression [
39
].
We could assess a correlation between anxiety, depressive mood and food dependency which could
lead to a food addiction, referring to the idea that in some sensible subjects some highly palatable
edibles foods would generate a process comparable to addiction [
40
]. More specifically the definition
of this condition is complex and highly debated: it encompasses emotional, behavioural, cognitive and
physiological aspects [
41
]. Consumption of palatable food can have positive and strengthening eects.
It can sensibly normalise stress response with the optimizing and comforting eects [
42
]. Specific
nourishments, mainly those rich in fats and/or sugars, may induce behaviour similar to “addiction”
and, in certain conditions, generate neuronal changes. These consumption models are associated to
enhanced risks of comorbidity conditions as obesity, early weight gain, depression, anxiety, substance
abuse as well as relapse and treatment problems [43].
On the one hand, the lockdown has allowed more room for imagination and exploration with
food both in terms of recipes and human relations (for example cooking and eating together more often
than before), on the other hand, some individuals have experienced an increase of boredom, general
inactivity and seeking out new stimuli in food.
Lastly, by analysing dierent variables that include age, BMI and anxiety mood, it was possible
to observe that during the quarantine the younger population with lower BMI had suered less the
increase in food control and decrease of food intake. This should be further investigated with deeper
studies and among a larger sample of people. It should take into consideration whether there are
dierences among the dierent Italian regions, as the COVID-19 infection has had a diverse spread
between Northern, Central and Southern Italy.
From a psychological point of view, resilience is the ability to face and overcome a dramatic event
or a dicult period. The lockdown caused by the COVID-19 pandemic has heavily influenced our life
by completely changing our routines and isolating us from our loved ones. Italians have demonstrated
courage and strong resilience to maintain a normal lifestyle and discreet eating habits, even when
sanitary and economic situations were hard to handle.
A strength of our study was represented by the fact that the survey was conducted quickly in the
most critical period of the lockdown in Italy. As the COVID-19 pandemic is still ongoing, our data need
to be confirmed and investigated in the future with larger population studies. The main limitations of
this study are related to the lack of test scoring and of some data we could have collected which may
have increased the psychological strain, such as COVID-19 diagnosis and economic status. Hence,
further study on psychological status, eating habits and positivity in relation to COVID-19 should
be conducted.
Nutrients 2020,12, 2152 11 of 14
Supplementary Materials:
The following are available online at http://www.mdpi.com/2072-6643/12/7/2152/s1,
Table S1: Univariable logistic regression between respondents’ characteristics and control over feeding.
Author Contributions:
Conceptualization, L.D.R.; Data curation, G.C. (Giulia Cinelli) and G.B.; Formal analysis,
G.C. (Giulia Cinelli); Investigation, F.F.B., V.C., E.C., S.F., S.G., T.R. and L.L.P.; Methodology, L.D.R.; Project
administration, L.D.R.; Software, A.A. and S.G.; Supervision, A.D.L.; Validation, G.C. (Giulia Cinelli), A.A.
and S.G.; Writing—original draft, L.D.R., G.C. (Giulia Cinelli), G.C. (Giovanna Caparello), E.C., S.G. and C.L.;
Writing—review and editing, P.G., G.C. (Giulia Cinelli), L.S., C.L. and M.G.T. All authors have read and agreed to
the published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments:
The authors thank Paola Medde for her help in interpreting the results on the emotional
status. The authors thank Fulvia Mariotti for the editorial and English language revisions.
Conflicts of Interest: The authors declare no conflict of interest.
Appendix A
Table A1. The 28 item structured questionnaire used for the survey.
Questions Answers
Personal Data
1. Age Age in number
2. Gender Female/Male/NS
3. Place of residence Region
4. Hometown Province
5. Educational level
Elementary school diploma/Superior school
diploma/Master Degree
Post degree diploma
6. Who do you live with?
Alone/With roommates/With friends/With
cohabitant/With parents
With children/With spouse/cohabitant
and children
Anthropometrics Data 7. Weight Weight in kg
8. Height Height in cm
Emotional state, eating habits and
emotional eating behaviors
9. In this social isolation period, is your mood depressed?
Yes/No
10. In this social isolation period are you focused on
your work?
Yes/No/At the moment I am not working due to
the pandemia
11. In this social isolation period, are you experiencing
anxious feelings? Yes/No
12. In this social isolation period, are you feeling
“hypochondriac” (afraid of getting sick)? Yes/No
13. In this social isolation period, are you experiencing
manifestations of anxiety (i.e., headache, sweating)? Yes/No
14. In this social isolation period, are you experiencing
manifestations of tension, fatigability, on alert, ready to cry,
trembling, restless, unable to relax?
Yes/No
15. In this social isolation period are you experiencing
breathing diculties, choking sensation, chest
pressure, dyspnea?
Yes/No
16. In this social isolation period are you experiencing
tachycardia, palpitations, chest pain, feelings of fainting? Yes/No
17. In this social isolation period are you taking any
supplements (i.e., valerian, passionflower) and/or
medications (i.e., benzodiazepines) to treat your
manifestations of anxiety?
Yes/No
18. Have you been diagnosed with medical conditions? Yes/No
19. In this social isolation period, are you
experiencing insomnia? Yes/No
20. In this social isolation period, when you experience
manifestations of anxiety, do you comfort yourself
with foods?
Yes/No
21. In this social isolation period, when you experience
manifestations of anxiety did you avoid any food? Yes/No
22. Before this social isolation period, were you on a diet?
Yes/No
23. In this social isolation period, do you continue to
follow your diet? Yes/No
24. In this social isolation period, are you feeling guilty for
your eating habits? Yes/No
25. In this isolation period, are you eating more to get
feeling better, to reduce negative emotions or to increase
pleasant feelings?
Yes/No
Nutrients 2020,12, 2152 12 of 14
Appendix B
Figure A1.
Geographical distribution of COVID-19 total positive cases in Italy on 18 May 2020. Data
derived from the Health Ministry of Italy [44].
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Health Ministry. Available online: http://www.salute.gov.it/imgs/C_17_notizie_4776_0_file.pdf (accessed on
10 June 2020).
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2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
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... In the last quarter of 2019, a virus with unknown aetiology was identified and initially named 2019 novel coronavirus (2019-nCoV virus), later renamed as SARS-CoV-2 (1)(2)(3). In January 2020, the World Health Organization (WHO) called the viral infection coronavirus disease 2019 (COVID- 19) and announced a public health crisis (4,5). In March 2020, COVID-19 was declared a pandemic by the WHO and a disease of global concern (6). ...
... Additionally, the stress and emotional distress experienced by individuals during the pandemic further influenced their eating habits (12,13,16,17). Although balanced and healthy food habits were paramount to combat the disease, a shift toward unhealthy food patterns and habits was observed, including the consumption of comfort food with high calories and unrestricted eating between major meals (18)(19)(20)(21). ...
... The participants had the following demographic and anthropometric characteristics: a mean height of 160. 19 Table 1 lists the demographic characteristics of the study population. ...
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Background Since the emergence of COVID-19 and the subsequent imposition of lockdown and movement restrictions, the world has witnessed fundamental lifestyle changes including alterations in dietary patterns and food consumption habits. Here, we investigated how the COVID-19 lockdown impacted dietary patterns and eating behaviors in the Saudi population. Methodology This cross-sectional study enrolled 427 participants aged 18 years or more, with 258 of them completing the survey. The survey included questions about demographic and dietary patterns during the COVID-19 lockdown. Data were collected and dietary behaviors before and during the lockdown in Jeddah, Saudi Arabia, were analyzed. Results The number of participants who considered lunch as their primary meal significantly decreased (p < 0.001) during the COVID-19 lockdown (74%), compared to before it (86%). By contrast, the number of participants who considered dinner as their primary meal remained almost unchanged (p = 0.079) during (79.1%) and before (84.1%) the lockdown. However, snack consumption significantly increased (p < 0.001) while fast-food consumption significantly decreased (p < 0.01) during the lockdown period. Our results also revealed a significant increase (p < 0.01) in water and coffee intake during the lockdown, with a significant rise in dessert consumption (p < 0.01). Conclusion Our results demonstrate that the COVID-19 lockdown caused a marked shift in dietary patterns and eating behaviors among the Saudi population. Notable changes were observed in overall food preferences after the lockdowns were imposed, with reduced consumption of fast foods and increased fluid intake.
... Há estudos que avaliaram o BES durante a pandemia 6,9,17 e identificaram mudanças nos hábitos de saúde da população, referentes a exercícios físicos, dieta e sono 13,15,18,19 . No entanto, não existem dados abrangentes sobre a avaliação das esferas do BES afetadas, bem como do índice geral do BES. ...
... O distanciamento social teve um impacto de 86% nos hábitos de saúde, e a diminuição da motivação para praticar exercícios. Mudanças em emoções e em hábitos alimentares levaram a um maior comportamento sedentário 19 . ...
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The COVID-19 pandemic changed people’s lives in ways that affected subjective well-being (SWB) and lifestyle. Objective: To evaluate SWB during the COVID-19 pandemic and its effects on physical exercise, sleep and nutrition. 72 men and women ages 20 to 60 were assessed for lifestyle before and during the pandemic, and SWB was evaluated during the pandemic. The negative affect dimension had the highest score (3.77 ± 0.71) among the SWB spheres. The pandemic has reduce in the practice of physical exercise in 61% of the participants who practiced physical exercise before the pandemic (p = 0.001). An increase in total sleep time (TST) (p = 0.0003) and improvement in sleep quality were observed during the pandemic, and the individuals reported more sleep time said they did so to take care of their health (p = 0.001). Regarding eating habits, 79.12% of the participants considered their diet to be healthy, 34.72% improved their diet and 58.3% increased their appetite. There was a predominance of negative effects in relation to SWB, and these feelings may have been associated with reduced physical exercise. Social distancing resulted in an increase in TST and did not promote changes in eating habits.
... PHSMs can profoundly change the lifestyle behaviors including diet, physical activity, smoking, mealtimes, sleep patterns, and quality of life [6,7]. Poor access to nutritious food and exercise facilities during the COVID-19 pandemic, especially during home confinement has been significant [8], potentially leading to detrimental behaviors like increased media watching and calorie consumption [9]. ...
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Background The pandemic of coronavirus disease–19 (COVID-19) has a profound influence on the health of the population. This study aimed to assess the weight changes and its relation to the dietary habits and physical activity among adult Egyptian population during the second wave of COVID-19 pandemic. Materials and methods This cross–sectional study was conducted using anonymous online questionnaire. The questionnaire was distributed across Egypt via community–based networks, social and institutional emailing lists, and professional organizations to collect data on sociodemographic, clinical history, dietary and lifestyle habits, physical activity, anthropometric measurements, and stressing factors. Results The study participants (n = 1000) had a median (interquartile range) age of 34.0 (23.0–40.0) years, with 18.7% males, 96.6% having university or postgraduate education. Among them, 69.1% reported weight gain, 21.3% no change, and 9.6% weight loss. Weight loss was predicted by following COVID-19 pandemic reports daily [adjusted odds ratio (AOR) = 0.50 (95% CI, 0.27–0.93), p = 0.03], monthly income change [AOR = 2.52 (95% CI, 1.51–4.22), p < 0.001], starting antidepressants [AOR = 3.57 (95% CI, 1.08–11.76), p = 0.03], and increase in social media use [AOR = 1.81 (95% CI, 1.05–3.13), p = 0.03]. Weight gain was predicted by starting a diet during the second wave of COVID-19 pandemic [AOR = 1.57 (95% CI, 1.11–2.21), p = 0.01], physical activity during the second wave of COVID-19 pandemic [AOR = 0.49 (95% CI, 0.35–0.69), p < 0.001], and unhealthy food intake [AOR = 0.40 (95% CI, 0.28–0.57), p < 0.001] Conclusions More intervention programs aiming to improve dietary habits and increase physical activity should be rapidly implemented to reduce the consequences of the pandemic on the Egyptians to keep healthy weight.
... Additionally, changes were observed in sleeping patterns, with greater difficulty falling asleep and a decrease in sleep quality compared to data from the pre-pandemic era [11][12][13]. Furthermore, nutrition and eating habits were highly affected areas by restrictions, experiencing a major impact both in terms of supply and production [14,15], as well as in the intake of highly processed foods, snacks, and sugary drinks [16][17][18], as unhealthy eating behaviors emerged as a way to cope with isolation, stress, or anxiety [9,13,[19][20][21][22]. Studies conducted in various European countries show a widespread increase in the intake of processed products; a reduction in physical exercise; and changes in traditional eating patterns, such as the Mediterranean diet in southern Europe. ...
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The aim of this study was to investigate the changes in habits regarding the health and lifestyle of the Spanish population during and after the COVID-19 pandemic. A cross-sectional design was used. Data were collected during the pandemic from 22,181 participants and after the pandemic from 3907 participants using the NutSo-HH Scale, assessing demographic, nutritional, and lifestyle variables. Key findings reveal a slight increase in exercise duration (+6.61%) post-pandemic, along with reductions in fried food (−3.57%), juice (−6.45%), and alcohol consumption (−9.66%). Conversely, there were notable increases in the consumption of ultra-processed foods (+2.16%), soft drinks (+6.47%), and coffee/energy drinks (+38.95%). Sleep quality, body image, and self-perceived health showed minor declines. These findings indicate that despite some positive behavioral changes, there is still a significant dependence on unhealthy dietary choices, negatively impacting both mental and physical health. The results highlight the need for public health strategies which encourage healthier eating, increased physical activity, and better sleep quality to reduce the long-term effects of lifestyle changes brought on by the pandemic. Fo-cused interventions are necessary to curb the rising consumption of ultra-processed foods and sugary beverages while fostering overall well-being. This study underscores the vital role of ongoing surveillance and customized public health initiatives to enhance general health in the post-pandemic era.
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Background/Objectives: The COVID-19 pandemic has impacted the lifestyles of children and adolescents because of the restrictions imposed to contain the infection. This systematic review examined the possible reduction in children’s and adolescents’ physical activity and changes in their BMI and weight status. Methods: A systematic review (PROSPERO: CRD42024589208) of English-language studies published up to 1 October 2024 in individuals with a mean age between 6 and 18 years that investigated physical activity data before and during or after the pandemic and focused on their BMI and weight status according to age, sex, and country making use of PubMed, Web of Science, and Scopus, identified 1040 possible articles. Results: Following the PRISMA statement, 26 articles with a whole set of 138,737 children and adolescents were enclosed in the review. The majority of included articles were of moderate quality, as determined by the Newcastle–Ottawa Scale adapted for observational studies. The studies found a decrease in PA, an increase in sedentary activities during/after the lockdown, and an increase in BMI and prevalence of overweight and obesity, especially in males and 8–11-year-olds. Conclusions: The interruption or restriction of outdoor physical activities and sports during the COVID-19 pandemic resulted in a more sedentary lifestyle among children and adolescents, contributing to an overall increase in BMI and obesity, with alarming implications for related health risks and other noncommunicable diseases. Therefore, the adverse effects of restrictive measures should be assessed when implementing public health strategies during pandemics.
Article
Introduction The lockdown to curb COVID-19 pandemic has affected day-to-day life of the public. The people faced many challenges in their daily life and took various measures to overcome them. Objective To explore challenges being faced by the employees of tertiary care centre during the lockdown period due to COVID-19 pandemic and various interventions undertaken by them to overcome those issues. Methods A descriptive cross-sectional study design was adopted in the study. Purposive sampling technique was used to enrol 151 class III and IV employees of a tertiary care hospital. The data was collected using a questionnaire comprising of socio-demographic profile sheet and questions regarding health-related challenges, preventive practices and the effect of lockdown on basic life activities of the employees of tertiary care Institute during COVID-19 pandemic. Ethical clearance was obtained from the Institutional Ethics Committee and written informed consent was taken from each participant. Results During lockdown, there was an increase in food intake, weight, duration of physical activity, frequency of bathing and changing clothes, involvement in household chores and time spent with children. However, there was no significant change in the sleeping patterns and sexual activity of the participants. They faced various difficulties in medical consultation of non-covid issues, could not procure medicines and skipped vaccinations of their children. The findings also show that people practiced various measures such as herbal and home remedies increased their frequency and duration of hand-washing and sanitisation and started wearing personal protective equipment to some extent to prevent transmission of COVID-19 infection. Conclusion and Recommendations The imposition of lockdown to prevent the spread of COVID-19 infection affected the basic lifestyle of people and changed their behaviours. The people faced many difficulties in accessing healthcare services.
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This study aimed to show alterations in body mass index (BMI) and food preferences and their associations with eating behaviors in the early pandemic. Four hundred and forty-three adults participated in this study. Data were collected using a web-based survey within a month after social distancing onset. Self-reported body weight and height were used to obtain the BMI trend. Alterations in eating habits (snacking, eating out, and main meal number) were collected. The mindful eating questionnaire, Mediterranean diet assessment tool, emotional eating scale, and depression inventory were applied. Multiple linear regression models were set to predict factors on BMI. Food preferences were shown according to mindful eating groups. BMI, snacking, and sleep duration increased in both sexes during social distancing. Nearly half of the participants reported weight gain, while one-fifth lost weight. Being overweight (from 36.0 to 38.7% for men, from 17.7 to 18.8% for women, and obese (from 10.7 to 12.7% for men and from 4.4 to 5.8% for women) increased. Eating out and regular sports activities decreased. The mindful eating scores, negative emotional eating, and positive emotional eating were the predictors of BMI after adjustment for age, sex, and regular sports activity. The only significant factor was mindful eating for the altered BMI. Consumption of bread, grains, seeds, sweet, salty, and fatty snacks, canned foods, pastry, milk puddings, bakery goods, jam and honey, sugar-sweetened fruit juices, and carbonated beverages increased in the low- more than the high-mindful eating group. In conclusion, BMI altered even in the early pandemic. Mindful eating was the only significant factor in the BMI increase. High carbohydrate and fat-contained food groups were more frequently preferred among the low-mindful eating group. Therefore, setting mindfulness practices might prevent eating disorder risks and promote public health.
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Introduction Organ donation and transplantation is a life-saving procedure for patients with end-stage organ failure, but it depends on the availability of donor organs. Nurses play a major role to provide care to brain-dead patient potential for organ donation and efficient care to increase the organ’s survival. For years many efforts have been made to create awareness in public regarding organ donation but donors are still very less than demand. Most of the recipients are waiting for organs for more than 6–8 years and many died because of the paucity of donors. Hence, knowledge of nursing personnel is extremely important to the success of organ donation. Objective To assess the knowledge and practices of nursing personnel while caring of brain-dead patients potential for organ donation. Methodology A descriptive research design was adopted to carry out the study. The study was conducted among 30 nursing personnel caring for brain-dead patients from the automatic tube compensation ICU and various units of Nehru Hospital, PGIMER, Chandigarh. Nurses were given questionnaires to fill, including a sociodemographic data sheet and a knowledge questionnaire. The practices of caring for brain-dead patients were observed by using an observation checklist, and a total of 30 observations were made. Results The findings of the study revealed that 50% of nursing personnel had good knowledge about the care of brain-dead patients, 32% had average knowledge, whereas 18% had poor knowledge. There were 42 steps/items of practice regarding care of a brain dead patient. Around one third (38%) of the steps were followed by the participants, some of them followed 57% of the steps. Conclusion Only half of the nursing personnel were possessing good knowledge about the care of brain-dead patients and less than half were doing good practices about the care of brain-dead patients; hence, there is a need to educate the nursing personnel regarding caring of brain-dead patients.
Chapter
This chapter provides brief insights into consumer perceptions of food-related issues and the variability of consumer behavior in response to crisis in the twenty-first century. Crisis effects often impact society for extended periods due to the uncertainties and disruptions associated with perceived risks. Regardless of the crisis type, consumers may react differently, driven by anxiety, pessimism, panic, or even depression, which can affect their attitudes, habits, and consumption patterns. The intensity and duration of these reactions depend on various factors, such as economic, demographic, sociocultural, and situational variables, as well as the crisis type. Three specific crises are considered: those related to food safety issues, the COVID-19 pandemic, and recent wars. Consumers handle risks during crisis in different ways, generally leading to an inclination towards protective behaviours. Changes in consumer behavior are often more closely linked to their perceptions of the crisis rather than its actual effects. Studies have shown that consumers react to food scares with precaution, penalizing attitudes, tolerance, or even indifference. Consumer confidence and food-related behavior depend on their optimistic or pessimistic attitude toward risk, risk perception and adherence to rules (e.g., isolation during the COVID-19 pandemic). Wars affect consumers differently, from those on the frontline to distant populations. For instance, even consumers indirectly affected by the Ukraine war conflict became more price conscious. Some believe that food-related consumer behavior during wartime is similar to the observed during economic crises. In conclusion, food-related consumer perceptions shift under various conditions, and people adapt their behaviours accordingly. Consumption behaviours and eating habits evolve cyclically, as society learns or fails to learn from past mistakes and crises in human history.
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Confinement due to the COVID-19 pandemic can influence dietary profiles, especially those of adolescents, who are highly susceptible to acquiring bad eating habits. Adolescents’ poor dietary habits increase their subsequent risk of degenerative diseases such as obesity, diabetes, cardiovascular pathologies, etc. Our aim was to study nutritional modifications during COVID-19 confinement in adolescents aged 10 to 19 years, compare them with their usual diet and dietary guidelines, and identify variables that may have influenced changes. Data were collected by an anonymous online questionnaire on food intake among 820 adolescents from Spain, Italy, Brazil, Colombia, and Chile. The results show that COVID-19 confinement did influence their dietary habits. In particular, we recorded modified consumption of fried food, sweet food, legumes, vegetables, and fruits. Moreover, gender, family members at home, watching TV during mealtime, country of residence, and maternal education were diversely correlated with adequate nutrition during COVID-19 confinement. Understanding the adolescents’ nutrition behavior during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.
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Abstract Background On December 12th 2019, a new coronavirus (SARS-Cov2) emerged in Wuhan, China, sparking a pandemic of acute respiratory syndrome in humans (COVID-19). On the 24th of April 2020, the number of COVID-19 deaths in the world, according to the COVID-Case Tracker by Johns Hopkins University, was 195,313, and the number of COVID-19 confirmed cases was 2,783,512. The COVID-19 pandemic represents a massive impact on human health, causing sudden lifestyle changes, through social distancing and isolation at home, with social and economic consequences. Optimizing public health during this pandemic requires not only knowledge from the medical and biological sciences, but also of all human sciences related to lifestyle, social and behavioural studies, including dietary habits and lifestyle. Methods Our study aimed to investigate the immediate impact of the COVID-19 pandemic on eating habits and lifestyle changes among the Italian population aged ≥ 12 years. The study comprised a structured questionnaire packet that inquired demographic information (age, gender, place of residence, current employment); anthropometric data (reported weight and height); dietary habits information (adherence to the Mediterranean diet, daily intake of certain foods, food frequency, and number of meals/day); lifestyle habits information (grocery shopping, habit of smoking, sleep quality and physical activity). The survey was conducted from the 5th to the 24th of April 2020. Results A total of 3533 respondents have been included in the study, aged between 12 and 86 years (76.1% females). The perception of weight gain was observed in 48.6% of the population; 3.3% of smokers decided to quit smoking; a slight increased physical activity has been reported, especially for bodyweight training, in 38.3% of respondents; the population group aged 18–30 years resulted in having a higher adherence to the Mediterranean diet when compared to the younger and the elderly population (p
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The outbreak of coronavirus disease (COVID-19) in late December 2019 in China, which later developed into a pandemic, has forced different countries to implement strict sanitary regimes and social distancing measures. Globally, at least four billion people were under lockdown, working remotely, homeschooling children, and facing challenges coping with quarantine and the stressful events. The present cross-sectional online survey of adult Poles (n = 1097), conducted during a nationwide quarantine, aimed to assess whether nutritional and consumer habits have been affected under these conditions. Over 43.0% and nearly 52% reported eating and snacking more, respectively, and these tendencies were more frequent in overweight and obese individuals. Almost 30% and over 18% experienced weight gain (mean ± SD 3.0 ± 1.6 kg) and loss (−2.9 ± 1.5 kg), respectively. Overweight, obese, and older subjects (aged 36–45 and >45) tended to gain weight more frequently, whereas those with underweight tended to lose it further. Increased BMI was associated with less frequent consumption of vegetables, fruit, and legumes during quarantine, and higher adherence to meat, dairy, and fast-foods. An increase in alcohol consumption was seen in 14.6%, with a higher tendency to drink more found among alcohol addicts. Over 45% of smokers experienced a rise in smoking frequency during the quarantine. The study highlights that lockdown imposed to contain an infectious agent may affect eating behaviors and dietary habits, and advocates for organized nutritional support during future epidemic-related quarantines, particularly for the most vulnerable groups, including overweight and obese subjects.
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The coronavirus-disease 2019 (COVID-19) was announced as a global pandemic by the World Health Organization. Challenges arise concerning how to optimally support the immune system in the general population, especially under self-confinement. An optimal immune response depends on an adequate diet and nutrition in order to keep infection at bay. For example, sufficient protein intake is crucial for optimal antibody production. Low micronutrient status, such as of vitamin A or zinc, has been associated with increased infection risk. Frequently, poor nutrient status is associated with inflammation and oxidative stress, which in turn can impact the immune system. Dietary constituents with especially high anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, and phytochemicals such as carotenoids and polyphenols. Several of these can interact with transcription factors such as NF-kB and Nrf-2, related to anti-inflammatory and antioxidant effects, respectively. Vitamin D in particular may perturb viral cellular infection via interacting with cell entry receptors (angiotensin converting enzyme 2), ACE2. Dietary fiber, fermented by the gut microbiota into short-chain fatty acids, has also been shown to produce anti-inflammatory effects. In this review, we highlight the importance of an optimal status of relevant nutrients to effectively reduce inflammation and oxidative stress, thereby strengthening the immune system during the COVID-19 crisis.
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Background: Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours. Methods: Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions. Results: 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly. Conclusion: While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.
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The coronavirus COVID-19 and the global pandemic has already had a substantial disruptive impact on society, posing major challenges to the provision of mental health services in a time of crisis, and carrying the spectre of an increased burden to mental health, both in terms of existing psychiatric disorder, and emerging psychological distress from the pandemic. In this paper we provide a framework for understanding the key challenges for psychologically informed mental health care during and beyond the pandemic. We identify three groups that can beneit from psychological approaches to mental health, and/or interventions relating to COVID-19. These are (i) healthcare workers engaged in frontline response to the pandemic and their patients; (ii) individuals who will experience the emergence of new mental health distress as a function of being diagnosed with COVID-19, or losing family and loved ones to the illness, or the psychological efects of prolonged social distancing; and (iii) individuals with existing mental health conditions who are either diagnosed with COVID-19 or whose experience of social distancing exacerbates existing vulnerabilities. Drawing on existing literature and our own experience of adapting treatments to the crisis we suggest a number of salient points to consider in identifying risks and ofering support to all three groups. We also ofer a number of practical and technical considerations for working psychotherapeutically with existing patients where COVID-19 restrictions have forced a move to online or technologically mediated delivery of psychological interventions.
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The Covid-19 pandemic led to lockdowns in several parts of the world and, hence, changed some daily habits, including social interactions, the ability to perform sports, and—possibly—diet. The Italian government established and promulgated lockdown policies on 9 March 2020. We aim at assessing the effects of Covid-19-induced confinement policies on self-reported food consumption of self-selected Italians by means of a questionnaire that was created and diffused by the Internet. Nearly half, i.e., 49.6% of responders did not substantially modify their diet during the lockdown; however, 46.1% of them reported that they were eating more during confinement, and 19.5% gained weight. In particular, we report an increase in “comfort food” consumption, notably chocolate, ice-cream, and desserts (42.5%) and salty snacks (23.5%). In addition, 42.7% percent of this cohort attributed this increase to higher anxiety levels. Related to this, 36.8% of responders reported a decrease in alcohol consumption, even though 10.1% of them reported an increase. Interestingly, 21.2% of responders increased their consumption of fresh fruit and vegetables. Only 33.5% of those who declared decreased consumption attributed this change of diet to lower availability and ease of purchasing such items. Equally interesting, over half of responders, i.e., 56.2%, admitted that fruit and vegetables did not appeal to them while in lockdown. Purchases of ready-made meals were reduced by nearly 50%. Future large-scale similar studies should be undertaken worldwide and will help public health authorities shape their reactions to future, unavoidable pandemics.
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The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
Article
The outbreak of COVID-19 is severely affecting mental health worldwide, although individual response may vary. This study aims to investigate the psychological distress perceived by the Italian general population during the early phase of the COVID-19 pandemic, and to analyze affective temperament and adult attachment styles as potential mediators. Through an online survey, we collected sociodemographic and lockdown-related information and evaluated distress, temperament, and attachment using the Kessler 10 Psychological Distress Scale (K10), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire short version (TEMPS-A) and the Attachment Style Questionnaire (ASQ). In our sample (n=500), 62% of the individuals reported no likelihood of psychological distress, whereas 19.4% and 18.6% displayed mild and moderate-to-severe likelihood. Cyclothymic (OR: 1.24; p<0.001), depressive (OR: 1.52; p<0.001) and anxious (OR: 1.58; p=0.002) temperaments, and the ASQ “Need for approval” (OR: 1.08; p=0.01) were risk factors for moderate-to-severe psychological distress compared to no distress, while the ASQ “Confidence” (OR: 0.89; p=0.002) and “Discomfort with closeness” were protective (OR: 0.92; p=0.001). Cyclothymic (OR: 1.17; p=0.008) and depressive (OR: 1.32; p=0.003) temperaments resulted as risk factors in subjects with moderate-to-severe psychological distress compared to mild distress, while the ASQ “Confidence” (OR: 0.92; p=0.039) and “Discomfort with closeness” (OR: 0.94; p=0.023) were protective. Our data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak. Specific affective temperament and attachment features predict the extent of mental health burden. To the best of our knowledge, these are the first data available on the psychological impact of the early phase of the COVID-19 pandemic on a sizeable sample of the Italian population. Moreover, our study is the first to investigate temperament and attachment characteristics in the psychological response to the ongoing pandemic. Our results provide further insight into developing targeted intervention strategies.
Article
While all groups are affected by the COVID-19 pandemic, the elderly, underrepresented minorities, and those with underlying medical conditions are at the greatest risk. The high rate of consumption of diets high in saturated fats, sugars, and refined carbohydrates (collectively called Western diet, WD) worldwide, contribute to the prevalence of obesity and type II diabetes, and could place these populations at an increased risk for severe COVID-19 pathology and mortality. WD consumption activates the innate immune system and impairs adaptive immunity, leading to chronic inflammation and impaired host defense against viruses. Furthermore, peripheral inflammation caused by COVID-19 may have long-term consequences in those that recover, leading to chronic medical conditions such as dementia and neurodegenerative disease, likely through neuroinflammatory mechanisms that can be compounded by an unhealthy diet. Thus, now more than ever, wider access to healthy foods should be a top priority and individuals should be mindful of healthy eating habits to reduce susceptibility to and long-term complications from COVID-19.