The Impact of Nutrition on the COVID-19 Pandemic and the Impact of the COVID-19 Pandemic on Nutrition

The coronavirus disease 2019 (COVID-19) pandemic has had significant morbidity, mortality, social and financial implications for the global population. Despite this knowledge, we still know very little about how COVID-19 infection affects quality of life resulting from changes in nutritional behaviour and, conversely, how nutrition could modulate the epidemiology of COVID-19. In addition, the social isolation most have experienced due to the regulations imposed by governments during the COVID-19 pandemic may have also had effects on our nutritional behaviour. It is possible that nutritional interventions may have effects on the incidence of COVID-19 infection and mortality rates. The purpose of this review is to evaluate the current status of research on the topic of nutrition as it relates to the COVID-19 pandemic.     

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

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

Food Habits and Lifestyle of Romanians in the Context of the COVID-19 Pandemic

The pandemic caused by the SARS-CoV-2 virus has produced significant changes in socio-cultural life, diet, and interpersonal relationships across the world’s population. The present study aims to identify changes in lifestyle and diet among the Romanian population one year after the onset of the COVID-19 pandemic. An online questionnaire with 58 items (addressing the following aspects: socio-demographic and anthropometric data, current eating habits, and lifestyle changes) was distributed using institutional mailing lists and social media. A total number of 2040 respondents participated in the study, of whom 1464 were women, and 576 men. Among the respondents, 1598 came from urban areas and 442 from rural areas. The processing of the collected data showed significant changes in the behavior of the respondents caused by the pandemic situation with psycho-affective changes in some cases. The number of people who had anxiety, depression and nervousness increased by up to 20%. The majority of respondents (over 57%) were up to 30 years old, either students (43.50%) or employees going to workplaces (33.20%). Analyzing eating habits, we found that diet modification was needed to increase the daily consumption of fruits, vegetables, fish, and seafood. Regarding weight status during the pandemic, we noticed that 34.7% of normal-weight respondents said that they gained weight while 49.7% of overweight people and 52.5% of obese people said that they gained weight (p < 0.0001). Regarding psycho-emotional behavior, 11.81% of the surveyed women stated that they frequently had depressive states during the pandemic period and 11.63% of the men stated that they frequently presented depressive states during the pandemic (p = 0.005).     

The Impact of the COVID-19 Epidemic on the Mood and Diet of Patients Undergoing Bariatric Surgery

Limited social contacts, lack of professional activities, economic insecurity, and a sense of threat, as well as boredom during the COVID-19 pandemic, contributed to tension and stress. All of these increase the risk of an inappropriate diet. The aim of this cross-sectional study was to assess the impact of the COVID-19 pandemic on the mood and nutrition of patients undergoing bariatric surgery. A group of 312 patients (both before and after bariatric surgery) completed a questionnaire about their diet and mood during COVID-19 lockdown. About 70% of all respondents reacted to the epidemiological situation: irritability, anxiety about their own health, and eating without being hungry. A total of 74% of all of the subjects snacked between meals (especially sweets). The respondents who believed that obesity and its complications had a negative impact on the prognosis of the coronavirus infection had a statistically significant higher prevalence of health anxiety, feeling that important life issues were out of control, irritability, need for psychological support, and need for dietary consultation. Patients after bariatric surgery had e.g., a statistically significant lower incidence of feeling hungry, eating after meals, and eating fatty foods. The COVID-19 pandemic has been shown to negatively affect the mood and diet of bariatric patients, which may affect their health status and worsen the prognosis of COVID-19.     

Associations of Nutritional Behavior and Gut Microbiota with the Risk of COVID-19 in Healthy Young Adults in Poland

The numerous consequences of the coronavirus disease 2019 (COVID-19) pandemic in healthy young people and the lack of clarity as to the long-term disease outcomes have spurred the search for risk factors for SARS-CoV-2 infection. We aimed to evaluate the associations of nutritional behaviors, gut microbiota, and physical activity with the risk of COVID-19 in healthy young nonobese people. Data on body composition, anthropometric measurements, physical activity, dietary intake, and gut microbiota were obtained from 95 adults (mean age, 34.66 ± 5.76 years). A balanced diet rich in vegetables and fruit, including nuts, wholegrain cereal products, and legumes, covers the need for vitamins and minerals. Such a diet can be an effective measure to reduce the risk of COVID-19 in nonobese healthy physically active young people with normal immune function. People with balanced diet and an average daily consumption of >500 g of vegetables and fruit and >10 g of nuts had an 86% lower risk of COVID-19 compared with those whose diet was not balanced and who consumed lower amounts of these products. It is well documented that proper nutrition, physical activity, and maintenance of normal weight facilitate good health by ensuring optimal immune function. The beneficial effects of these interventions should be strongly emphasized during the COVID-19 pandemic.     

Composition and Nutritional Quality of the Diet in Spanish Households during the First Wave of the COVID-19 Pandemic

In Spain, the health crisis caused by the COVID-19 pandemic led to the declaration of a state of alarm in the whole country in 2020; in this context, a nationwide lockdown was implemented, potentially altering the dietary habits of the population. The aims of this study were to describe the diet and its nutritional quality in Spanish households during the first COVID-19 epidemic wave and to compare them with the same period in 2019. Data on monthly foods and beverages household purchases in 2019 and 2020 were obtained from the nationwide Food Consumption Surveys. In April, there was an average increase, compared with 2019, of more than 40% for all food groups, with significant peaks in: alcoholic beverages (75%), appetizers (60%), eggs (59%), sugar and sweets (52%), and vegetables (50%). In March, the greatest peak was for pulses, with a 63% increment. The mean energy value of purchased foods in April was 2801 kcal/person/day, corresponding to an increase of 771 kcal/person/day (+38%), compared to the same month of 2019 (March and May: +520 kcal (+26%), June: +343 kcal (+18%)). Regarding nutrient density, there was a reduction in calcium, iodine, zinc, selenium, riboflavin, vitamins B₁₂, D, A, especially retinol, and an increase in fibre, sodium, folic acid, carotenes and vitamin E. Alcohol content per 1000 kcal increased by more than 20% from April to July. Food purchase patterns in Spanish households changed during lockdown and after it, with no appreciable improvement in the quality of the diet.     

Telehealth Management and Risk Stratification of Older Patients With Chronic Heart Failure During COVID-19 Pandemic: Prognostic Evaluation of the TeleHFCovid19-Score

ObjectivesTo evaluate 6-month risk stratification capacity of the newly developed TeleHFCovid19-Score for remote management of older patients with heart failure (HF) during the coronavirus disease 2019 pandemic.DesignMonocentric observational prospective study.Setting and ParticipantsOlder HF outpatients remotely managed during the first pandemic wave.MethodsThe TeleHFCovid19-Score (0-29) was obtained by an ad hoc developed multiparametric standardized questionnaire administered during telephone visits to older HF patients (and/or caregivers) followed at our HF clinic. Questions were weighed on the basis of clinical judgment and review of current HF literature. According to the score, patients were divided in progressively increasing risk groups: green (0-3), yellow (4-8), and red (≥9).ResultsA total of 146 patients composed our study population: at baseline, 112, 21, and 13 were classified as green, yellow, and red, respectively. Mean age was 81±9 years, and women were 40%. Compared to patients of red and yellow groups, those in the green group had a lower use of high-dose loop diuretics (P < .001) or thiazide-like diuretics (P = .027) and had reported less frequently dyspnea at rest or for basic activities, new or worsening extremity edema, or weight increase (all P < .001). At 6 months, compared with red (62.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization (P < .001). Moreover, receiver operating characteristic curve analysis showed a high sensibility and specificity of our score at 6 months (area under the curve = 0.789, 95% CI 0.682-0.896, P < .001) with a score <4.5 (very close to green group cutoff) that identified lower-risk subjects.Conclusions and ImplicationsThe TeleHFCovid19-Score was able to correctly identify patients with midterm favorable outcome. Therefore, our questionnaire might be used to identify low-risk chronic HF patients who could be temporarily managed remotely, allowing to devote more efforts to the care of higher-risk patients who need closer and on-site clinical evaluations.     

Quality of Life of Vegetarians during the COVID-19 Pandemic in Brazil

Health emergencies such as the COVID-19 pandemic can negatively impact quality of life (QoL) due to higher levels of stress, social isolation, and uncertainties. In this scenario, distinct population groups might react differently. Vegetarians, who follow a non-conventional dietary pattern, could be more vulnerable to the abrupt changes in normal life routine and economic instability. Therefore, this study aimed at evaluating if the current pandemic situation somehow affected vegetarians’ QoL. A cross-sectional study was carried out in Brazil between 28 July and 14 September 2020 to evaluate the QoL in vegetarians during the pandemic period. Vegetarian adults replied to an online survey that included the VEGQOL and WHOQOL-BREF instruments to evaluate QoL and questions related to the COVID-19 pandemic. A total of 1282 individuals participated. Only 3.8% had tested positive for COVID-19, but 39.9% affirmed having a family member who tested positive for the disease. Almost half (46.3%) of the sample had an income drop due to the pandemic. Results of QoL scores in the different subcategories of vegetarians were similar to previously published data. Individuals who had already tested positive for COVID-19 had lower QoL scores than those who did not test positive, but only in the VEGQOL. QoL was lower for the participants who declared that Sars-Cov-2 had already infected a family member for almost all the parameters evaluated. On the other hand, an income drop affected QoL only partially. Studying how vegetarians are influenced by such conditions contributes to the generation of relevant data that can be used to support healthcare and public policies in the future.     

Vitamin D Status in Adolescents during COVID-19 Pandemic: A Cross-Sectional Comparative Study

Vitamin D has been claimed to be effective in the response to infections, including the respiratory syndrome coronavirus 2 (SARS-CoV-2). It is supposed that lockdown measures and fear of SARS-CoV-2 infection might reduce vitamin D levels through the modification of lifestyle. However, very few data exist on the association between lockdown measures and vitamin D status in humans. For this cross-sectional comparative study, adolescents (n = 298) aged 18 to 19 years were enrolled during the compulsory military fitness-for-duty evaluation between July and December 2020 in Southern Switzerland. Beyond anthropometric measurements, participants filled in a structured questionnaire about their lifestyle and a blood specimen was sampled for the determination of total 25-hydroxy-vitamin D. The obtained data were compared with those of 437 adolescents enrolled at the military fitness-for-duty evaluation during the same period of the year in the context of the CENERI study (2014–2016). The anthropometric measures were similar between the two study groups. The levels of vitamin D were also comparable (77 (64–91) vs. 74 (60–92) nmol/L, p = 0.50; median and interquartile range). A total of 38 (13%) and 43 (9.8%) subjects presented insufficient (<50 nmol/L) levels of vitamin D (p = 0.42) during the current pandemic and in the CENERI study, respectively. These data do not support the hypothesis that during the SARS-CoV-2 pandemic, late adolescents are at higher risk of vitamin insufficiency.     

Health Behaviours among Nursing Students in Poland during the COVID-19 Pandemic

(1) Background: An individual’s health status can be perceived as a consequence of their health behaviours. This research aimed to determine the intensity of health-promoting behaviours and to identify factors determining the health behaviours of nursing students during the COVID-19 pandemic. (2) Methods: This study included 894 nursing students from six universities in Poland, and it was conducted between 20 March and 15 December 2021. A diagnostic survey was applied as the research method, and the data were collected using the Health Behaviour Inventory and the Satisfaction With Life Scale. (3) Results: Nearly half of the students participating in the study (48.43%) declared that the intensity of their general health behaviours was low. A positive and significant correlation (r = 0.426) was found between general health behaviours and satisfaction with life. A regression model demonstrated general satisfaction with life to be a predictor of taking up health-related behaviours (18%; β = 0.34), as well as in terms of proper eating habits (4%; β = 0.15), prophylactic behaviours (6%; β = 0.21), positive mental attitudes (26%; β = 0.44) and applied pro-health practices (10%; β = 0.25). (4) Conclusions: Most nursing students showed low levels of health-promoting behaviours. More research is needed on health behaviours and their determinants among nursing students, as it may be important in explaining the mechanisms of health behaviour formation.     

Changes in Physical Activity,Healthy Diet,and Sleeping Time during the COVID-19 Pandemic in South Korea

The coronavirus disease 2019 (COVID-19) pandemic and subsequent social distancing orders may have changed health behaviors adversely. This study aims to examine changes in physical activity, diet, and sleep patterns during the pandemic in South Korea and to identify the factors influencing adverse changes in these behavioral indicators. Data from the Community Health Survey conducted in 2020 with a total of 229,269 adults were used, employing multivariate logistic regression and a classification and regression tree model. Participants reported decreased physical activity (49.6%), an increase in unhealthy diet (17.0%), and decreased sleep time (9.4%). Changes in adverse health behaviors were significantly related to being female, being in poor subjective health, not having hypertension or diabetes, engaging in other unhealthy behaviors, and complying with COVID-19 prevention guidelines. While those with adverse physical activity and unhealthy diet changes were younger and concerned about COVID-19 infection, the participants with adverse sleep changes were older, experienced economic stress (unemployed or recipients of basic living benefits), and had other unhealthy behaviors (obesity, severe stress, current smoking, and binge alcohol consumption). Public health efforts to intervene in these adverse health behaviors during the COVID-19 pandemic should target the variables shown to be significant in this study.     

The Influence of Obesity on Nutrition and Physical Activity during COVID-19 Pandemic: A Case-Control Study

Obesity is one of the important risk factors for a severe course of COVID-19. Maintaining a healthy body weight through diet and physical activity is a reasonable approach to preventing a SARS-CoV-2 infection or in alleviating its course. The goal of the study was to determine the influence of obesity on nutrition and physical activity during the COVID-19 pandemic. A total of 964 respondents, including 227 individuals with a body mass index (BMI) ≥30 kg/m² were evaluated in this study. In the case of 482 respondents, including 105 individuals (21.8%) with BMI ≥ 30 kg/m², the data were collected during the pandemic period from 1 June to 31 August 2020. The remaining 482 individuals were the “pre-pandemic” group, selected via propensity score matching (PSM) out of the 723 National Health Program study participants whose data was collected in 2017–2019. The evaluated dietary health factors were quantitatively similar in patients with BMI of either <30 kg/m² or ≥30 kg/m² and showed no significant changes during the pandemic. The diets of those who suffered from obesity prior to the pandemic showed the evaluated unhealthy nutritional factors to be less pronounced in comparison with those of individuals with BMI < 30 kg/m². During the pandemic, the BMI ≥ 30 kg/m² group showed a significant increase in the overall calorie intake (by 319 kcal; p = 0.001) and an increased consumption of total carbohydrates 299.3 ± 83.8 vs. 252.0 ± 101.5; p = 0.000), sucrose (51.7 ± 30.0 vs. 71.6 ± 49.9; p = 0.000), plant protein (26.3 ± 12.1 vs. 29.3 ± 8.3; p = 0.040), total fat (73.1 ± 42.6 vs. 84.9 ± 29.6; p = 0.011) and saturated fatty acids (29.5 ± 16.4 vs. 34.3 ± 13.9; p = 0.014) in comparison with the pre-pandemic period. The energy and nutritional value of the diets of BMI < 30 kg/m² individuals did not change between the pre-pandemic and pandemic period. Before the pandemic, the level of leisure physical activity of the BMI ≥ 30 kg/m² group was significantly lower than of those with BMI < 30 kg/m². Such differences were not observed in the levels of physical activity at work or school. The pandemic did not alter the amount of physical activity either during leisure time or at work/school in individuals with BMI ≥ 30 kg/m². However, respondents without obesity exercised significantly less during the pandemic than before. In conclusion, the pandemic altered the diets and levels of physical activity in the Polish population, with dietary changes observed in individuals with BMI ≥ 30 kg/m² and changes in physical activity observed in those with BMI < 30 kg/m².     

Childhood immunization during the COVID-19 pandemic in Texas

In 2020, the state of Texas implemented coronavirus disease 2019 (COVID-19) social distancing guidelines in order to prevent surges at Texas hospital emergency rooms and in intensive care units. As noted in other states, an unintended consequence of these activities was significant declines in childhood immunizations. After analyzing state-wide immunization register data for Texas, we observed a 47% relative decline in immunization rates between 2019 and 2020 among 5-month-olds and a 58% decline among 16-month-olds. We observed a small decline (5%) among 24-month-olds, and no decline in vaccines received at birth (Hepatitis B). Declines were larger in rural counties compared to urban. These declines are superimposed on increases in state vaccine exemptions over the last five years due to an aggressive anti-vaccine movement in Texas. There are concerns that continued declines in childhood immunization coverage due to COVID-19 could lead to co-endemics of measles and other vaccine preventable diseases.     

Effect of the COVID-19 Pandemic on Healthy Components of Diet and Factors Associated with Unfavorable Changes among University Students in France

Introduction: The COVID-19 pandemic and the lockdowns have affected many aspects of university students’ daily lives, including their dietary habits. This study aimed to evaluate the change of diet quality of university students before and during the COVID-19 period, and the factors associated with unfavorable changes in diet quality. Methods: An online cross-sectional study was performed in May 2021 among Rouen (France) university students. Socio-demographic characteristics, body mass index, depression, academic stress, risk of eating disorders and food security were collected. The French “Programme National Nutrition Santé-Guidelines Score 2” (PNNS-GS2) was used to access diet quality. Results: A total of 3508 students were included, 74.4% were female, the mean age was 20.7 (SD = 2.3), and 7.0% were in a situation of food insecurity. The PNNS-GS2 score decreased between the pre- and the COVID-19 pandemic period for 33.1% of university students. The associated factors with the decrease in the PNNS-GS2 score were food insecurity, financial insecurity, not living with parents, depression, academic stress, eating disorders, being in the two first years of study and having been infected by COVID-19. Conclusions: Diets with healthy components decreased for one-third of university students since the COVID-19 pandemic, and this was shown to be associated with food insecurity, poor mental health and eating disorder. This study provides important information to help public health authorities and universities give better support to student health feeding programs during pandemics and lockdowns.     

The coronavirus (COVID-19) pandemic's impact on mental health

Throughout the world, the public is being informed about the physical effects of SARS-CoV-2 infection and steps to take to prevent exposure to the coronavirus and manage symptoms of COVID-19 if they appear. However, the effects of this pandemic on one's mental health have not been studied at length and are still not known. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID-19 outbreak, there has been very little concern expressed over the effects on one's mental health and on strategies to prevent stigmatization. People's behavior may greatly affect the pandemic's dynamic by altering the severity, transmission, disease flow, and repercussions. The present situation requires raising awareness in public, which can be helpful to deal with this calamity. This perspective article provides a detailed overview of the effects of the COVID-19 outbreak on the mental health of people.     

Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis

BackgroundAll-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects.ObjectiveThis study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020.MethodsOfficial data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019.ResultsOverall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older.ConclusionsThe reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.     

Proposition of a New POLA Index to Assess the Immunomodulatory Properties of the Diet and Its Relationship with the Gut Microbiota,Using the Example of the Incidence of COVID-19 in a Group of People without Comorbidities

A rise in the incidence of infections with severe acute respiratory syndrome coronavirus 2 has sparked the search for protective strategies against the new pathogen. It is known that individual food components can interact with different immune cells, modulating the immune response of the body. The aim of this study was to develop an index assessing the immunomodulatory potential of diet (POLA index) and to test its utility for the prediction of coronavirus disease 2019 (COVID-19) in a group of healthy young people following a traditional or vegetarian diet. Data on body composition, anthropometric measurements, physical activity, dietary intake, and gut microbiota were obtained from 95 adults (mean age, 34.66 ± 5.76 years). There was a strong correlation between the dietary inflammatory index and the POLA index (r = 0.90; p < 0.0001). Based on Cohen’s kappa statistic, there was a good agreement in qualitative interpretation between the two indices (kappa = 0.61; p < 0.0001). People on a diet with beneficial immunomodulatory effects had a lower risk of COVID-19 of approximately 80%, as compared with those on a diet with highly unbeneficial immunomodulatory effects. In daily practice, the POLA index might serve as a useful tool for dietitians to identify individuals whose diet is deficient in ingredients for optimal immune system function and change their dietary behavior to ensure optimal immune function that reduces the risk of infection.     

Resurgence of Respiratory Syncytial Virus Infections during COVID-19 Pandemic,Tokyo, Japan

More than a year into the coronavirus-19 pandemic, intensified infection control measures have controlled most viral respiratory infections in Tokyo, Japan. As of July 2021, however, an unusually high number of respiratory syncytial virus infections were reported in Tokyo. This resurgence may have resulted from restarting social activities for children.