Author: Fatima Tazegun
Since the first reports of coronavirus disease 2019 (COVID-19) and identification of the novel coronavirus that causes it – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – the infection has spread to include more than 150 million confirmed cases worldwide. The global spread of SARS-CoV-2 and the thousands of deaths caused by coronavirus disease (COVID-19) led the World Health Organization to declare a pandemic on 12 March 2020. To date, the world has paid a high toll on this pandemic in terms of human lives lost, economic repercussions, and increased poverty. [1,2] The pandemic period has had significant socio-economic and psychological impacts. In fact, it has been reported that many people suffered from anxiety, depression, and insomnia. At the same time, changes in food habits occurred with increased consumption of unhealthy food and more time dedicated to cooking. Public health nutrition experts started to emphasize the importance of eating a balanced diet and maintaining an active lifestyle to promote adequate dietary habits during the pandemic. .
Another thing that came into our lives after the start of the pandemic is lockdown. Worldwide governments considered social isolation as the most successful way to limit the infection spread, so many countries enacted lockdown strategies, limiting access to only essential services to flatten the curve of new infections and to prevent the collapse of health care systems. The COVID-19 lockdown deeply changed lifestyles of communities, thus having considerable impact on physical and mental health, and on social and economic aspects. Limited access to food due to restricted store opening hours, as well as reduced availability of goods and more time spent at home, could have had effects on food purchasing and preparation and as a result on diet quality. Moreover, boredom and feelings of anxiety, triggered by such an adverse scenario, could have impacted food choices, leading to irregular eating and more frequent snacking. .
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. Thirty-five research organizations from Europe, North Africa, Western Asia, and the Americas promoted survey.
Questions were presented in a differential format, with questions related to responses “before” and “during” confinement conditions. The result of research is, 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%), and others (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA (physical activity) 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 unhealthier during confinement, with only alcohol binge drinking decreasing significantly. As a conclusion, while isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviors in a health-compromising direction. 
An Italian study Mediterranean Diet Adherence Screener (MEDAS) highlighted a medium Mediterranean diet adherence in 73.5% of responders, which principally included the younger population, aged 18–30 years (p < 0.05). Regarding changes in eating habits, 33.5% of responders declared an influence of the pandemic period on nutritional practice. A decrease in alcohol consumption was reported by 81% of responders, while an increase in frozen food consumption was reported by 81.3% of responders . Another survey from Kuwait shows that both genders reported increased consumption of vegetables, fruits, and carbohydrates and a decreased consumption of fish and sugary drinks. Compared to males, females reported eating more during the outbreak than their pre-pandemic eating behaviors (32.3% vs. 35.9%, p <0.05). Approximately one-third of respondents (33.1%) reported performing less than 30 min of physical activity or exercise in a week .
Research that included data from several European countries shows that the COVID-19 confinement period influenced eating behavior and physical activity in a group of adult residents of Poland, Austria, and the United Kingdom. The general shopping frequency decreased, regardless of the place and manner. However, there was an increased interest in online grocery shopping. The resulting data revealed an increased frequency of the daily consumption of food products such as dairy, grains, fats, vegetables, and sweets (p <0.05). A rise in the frequency of purchasing frozen goods and food with long shelf life has also been observed. The changing workplace as a homeoffice and working conditions or unemployment probably affected a perceptible rise in alcohol consumption .
Another survey from Spain shows that the number of subjects that practice exercise decreases (29.4% versus 28.8%; p = 0.004) and the time spent exercising (more than an hour, 26.6% versus 14.7%, p = 0.001). Mediterranean Diet (MD) adherence slightly increases during confinement, although consumption of 'unhealthy’ food also increases. Moreover, the number of subjects that practice physical activity and the time spent on it weekly decreases . The survey from Italy, which provided for the first-time data on the Italian population, shows that the population group aged 18–30 years resulted in higher adherence to the MD when compared to the younger and the elderly population .
Lifestyle habits and a balanced diet play a crucial role in the prevention of some of the most common diseases in industrialized countries, such as diabetes, gastrointestinal disorders, obesity, hypertension, and pathologies related to metabolic syndrome . A comprehensive report from the World Obesity Federation highlighted linear correlations among COVID-19 mortality and the proportion of overweight adults. COVID-19 death rates were ten times higher in countries where more than half of the population was classified as overweight. A healthy diet is essential in modulating inflammation and oxidative stress processes . It is no surprise then, that in Turkey during the pandemic healthy eating awareness starts to increase as the number of organic food shops begin to grow.
If we look at the studies from Turkey, which country I was in during pandemic and lockdown period, according to the national data, Ca, Vitamin B1, Zn, Vitamin C, Vitamin B6, Vitamin A, Vitamin B2, and folate deficiencies mostly seem to affect the adult population in Turkey . Before vaccines against the coronavirus were developed, Turkish people focused more on strengthening immunity. There has been an increased interest in functional foods and supplement use. Although During the COVID-19 Pandemic, national research has not assessed the nutritional status of the adult population in Turkey yet, various studies have been conducted on the change in dietary habits. Sabri Ulker Foundation, the research from different regions of cities in Turkey with 600 participants, had shown that the number of people who prepared and consumed lunch at home before the COVID-19 Pandemic was 17.2%, increasing to 42.5% during the Pandemic. .
Furthermore, 48.3% of the participants stated that their food shopping increased. The number of those who preferred organic food in their shopping increased by 40%. In addition, 15% of the participants stated that their food stocks rose . In another study, 68.9% of 360 participants believed that foods could be beneficial in preventing the epidemic; these foods mainly were garlic (76.1%), ginger (53.1%), kefir (42%), and vinegar (41.2%). Almost half of the respondents (49.9%) use nutritional supplements. The most used nutritional supplements included vitamin C (19.6%), vitamin D (15.6%), multivitamin (13.9%), probiotic-prebiotic (10.5%) and fish oil (7.4%) .
There are some recommendations following the reviewed studies:
In conclusion, the effect of COVID-19 lockdown both negatively and positively affected dietary practices in Turkey and worldwide. Negative diet habits were associated with other poor lifestyle outcomes, including weight gain, mental health issues, and limited physical activity. The dietary patterns in the studied countries have changed due to the epidemic situation. They contribute to the aggravation of excess body weight and its health consequences. However, as the COVID-19 Pandemic is continued we must monitor the situation especially in nutritional status and habits.
Author: Fatima Tazegun,
Institute of Public Health, Faculty of Health Sciences, Yeditepe University,
Internship under the Erasmus program at the Department of Nutrition and Drug Research,
Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College
Supervisor: Beata Piórecka
Blog Zdrowia Publicznego, red. M. Zabdyr-Jamróz, Instytut Zdrowia Publicznego UJ CM, Kraków: 9 kwietnia 2022