Diet and COVID-19

Nutrition is pivotal to supporting our immune systems and protecting us from infections. However, the level of evidence investigating the links between COVID-19 risk and dietary consumption remains insufficient. In this study by Zhou et al. (2022), the authors evaluate the link between consuming ultra-processed foods (UPF) and COVID-19 risk using data from a population of 41.012 participants in the UK Biobank study (number of available 24-hour dietary evaluations 2 ≤ n ≤ 5). Dietary evaluations were submitted online by the participants, which helped divide their consumed foods according to processing degree following the NOVA classification criteria, while COVID-19 infection included participants who tested positive for or suffered mortal outcomes from COVID-19. Analysis of the results revealed that consuming UPF was linked to a substantial increase in the risk of suffering from COVID-19 infection, an association that was observed when comparing participants at the lowest levels of UPF consumption compared to the rest of their peers. This association was not found to be related to participant education level, age, body mass index, or existing comorbidities. The authors conclude that increased UPF consumption leads to an elevated risk of COVID-19 infection and that more research is necessary to fully outline the dynamics of this relationship. [NPID: Nutrition, immunity, ultra processed food, COVID-19 risk]

This 2022 study aimed to find out how eating processed, or unprocessed foods can affect symptoms of depression and anxiety in Brazil during the COVID-19 pandemic. Past studies have already shown that eating high-nutrient diets is correlated with a lower risk of developing these psychological disorders. A household survey was firstly conducted in two cities in Brazil. Food consumption was evaluated using a qualitative food frequency questionnaire that refers to what the respondents ate in the last 3 months. The foods consumed by these participants were then categorized according to the NOVA classification for fresh/minimally processed food and ultra-processed food. The data ultimately demonstrated that eating fresh or minimally processed foods more frequently than the average person every week was associated with lower prevalence of depression. But conversely, consuming ultra-processed foods above the weekly average frequency was related to higher prevalence of depression as well as anxiety. Thus, this study recommends eating fresh or minimally processed foods.[NPID: processed foods, diet, unhealthy diets, anxiety, depression, Brazil, COVID-19, pandemic, ultra-processed foods]

the COVID-19 pandemic. The aim of this study was to evaluate the relationship between lifestyle and emotional aspects of food consumption during the pandemic COVID-19. These teachers were working in primary education (kindergarten, elementary and high school). Various questionnaires were distributed to these participants to determine their diet and lifestyle profiles. The greater adherence to the healthy consumption profile was strongly linked with lower body weight, being less physically active, having lower income, consuming less alcohol, and changes in mental health. On the other hand, the unhealthy consumption profile was associated with weight gain, consuming more alcohol, being more physically active, being a younger adult, and smoking more cigarettes. In addition, those individuals with unhealthy dietary profiles were more likely to have started drinking alcohol during the pandemic. The study concluded that the COVID-19 pandemic influenced the food profiles of basic education teachers in the Minas Gerais state education system in two completely opposite ways (promoting the consumption of either healthy or unhealthy foods). [NPID: COVID-19, pandemic, teachers, Brazil, diet, lifestyle, alcohol, mental health, body weight, obesity, weight gain, smoking]

Since the COVID-19 disease affects people’s psychological well-being, this 2021 study explored its potential threat to body image. The overall aim of this study was to investigate the relationship between depressive symptoms, dietary intake, and body image during the COVID-19 quarantine in Peru. The participants were Peruvian adults aged between 18 and 59 years. These 589 Peruvians completed 3 questionnaires, including a food frequency questionnaire, the Body Shape Questionnaire, and the Patient Health Questionnaire-9. Around 38% of women reported depressive symptoms, while 43.6% of them also expressed their dissatisfaction with body image. It was discovered that depressive symptoms were strongly associated with dietary intake and dissatisfaction with body image. Furthermore, dissatisfaction with body image was linked with dietary consumption. In conclusion, depressive symptomatology plays an influential role in the dietary intake and body image of Peruvian adults during the COVID-19 pandemic. These factors can be addressed through a roll-out of health campaign programs and personalized therapeutic interventions. [NPID: COVID-19, pandemic, mental health, body image, depression, diet, quarantine, Peru, Peruvians]

This 2020 study examined the eating behaviors, and depressive and anxiety symptoms of people in Spain during the COVID-19 pandemic and compared the outcomes with the residents of Greece. These two countries have different confinement strategies and infection severities. The method of data collection was a web-based survey, which was completed by 1002 inhabitants of Spain and 839 residents in Greece. These surveys were administered during and shortly after the COVID-19 lockdown in Spain and Greece. The data showed lower mean scores of restraint and external eating in the Spanish participants, compared with Greek respondents, although there was no difference in emotional eating scores between the two countries. Moderate to severe depressive and anxiety symptoms were reported in 13.6% and 12.3% of respondents in Spain, respectively. Whereas 18.8% of Greek participants showed moderate-severe depressive signs and 13.2% had moderate or severe anxiety symptoms. But regarding anxiety symptoms in general, there was a higher prevalence in Spain compared with Greece. No difference was seen for depressive symptoms. To summarize, the people living in these 2 Mediterranean countries demonstrated high scores of inappropriate eating behaviors and a high frequency of depressive and anxiety symptoms during the COVID-19 outbreak. Compared to Greek participants, the Spanish respondents encountered more severe pandemic and stricter lockdown measures, and were associated with lower restraint and external eating, and increased anxiety symptoms. [NPID: depression, anxiety, COVID-19, pandemic, Spain, Greece, eating behaviors, lockdown]

This randomized clinical trial published in 2021 assessed the effect of culinary interventions on home cooking practices, coping strategies, and resiliency during the first wave of the COVID-19 pandemic in March/April 2020. The participants, aged 25-70 years with a BMI of 27.5–35, were either assigned to the intervention or control group. The intervention consisted of 12 weekly one-on-one remote culinary coaching sessions each lasting 30 minutes. More of the intervention group were found to use self-care as a coping strategy than the control group. Moreover, the individuals that took part in the cooking sessions showed greater resiliency than those that did not, although the differences were not found to be statistically significant. During the pandemic, these subjects in the intervention group utilized their home cooking skills such as meal planning and time-saving techniques. To summarize these findings, remote culinary coaching may be effective in teaching home cooking skills and promoting the use of self-care as a coping strategy during stressful periods, including the COVID-19 pandemic. [NPID: COVID, pandemic, mental health, stress, cooking, coaching, culinary, self-care, meal planning, meal plans]

The aim of this 2020 study was to analyze how dietary patterns changed during COVID-19 confinement in adolescents aged 10 to 19 years, and to determine variables that may have influenced these alterations. Ruiz-Roso et al. believe that the confinement may affect diet and nutrition, particularly in adolescents who are susceptible to acquiring bad eating habits. Poor dietary habits can then put some people at risk of degenerative diseases such as obesity and diabetes. After collecting the data of 820 adolescents from Spain, Italy, Brazil, Colombia, and Chile (through online questionnaires), the COVID-19 confinement was not found to affect dietary habits in this sample. The team of researchers looked at changes in intakes of fried food, sweet food, legumes, vegetables, and fruits. Furthermore, there were no significant correlations between adequate nutrition with gender, family members at home, watching TV during mealtime, country of residence, or maternal education. Better understanding of adolescents' nutrition behavior during the COVID-19 lockdown would allow public health authorities to be more prepared, on their nutritional recommendations, for another pandemic. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, degenerative diseases, obesity, diabetes, TV, maternal education]

Since it is known that social isolation can influence one’s dietary behaviors, Elmacıoğlu et al. (2021) decided to explore the possible effects of the COVID-19 pandemic and social isolation process on individuals' nutritional behaviours and body weight changes. The 827 women and 209 men (18 years +) who volunteered for this experiment were administered with the Three Factor Nutrition Questionnaire (evaluates nutritional behaviors) during the social isolation process. These results were then compared with answers obtained before the pandemic. Although there was no significant change in cognitive restriction behaviour, there was an increase in emotional eating and uncontrolled eating behaviours during the pandemic and social isolation process. Through monitoring of the volunteers’ weights throughout the study, the researchers found that 35% of the participants gained weight during the isolation. These findings indicate that dietary behaviors may be modified as a result of the self-isolation process practiced during this COVID-19 pandemic. It is vital that the public take precautions to prevent this modification in nutritional behavior as it could lead to further negative impacts in the future. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, social isolation, cognitive restriction, emotional eating]

Since people confined to their homes during the COVID-19 pandemic may alter their dietary behaviors due to the stressful nature of the situation, this 2020 study aimed to examine the association between quarantine/confinement stressors with dietary behaviors, comparing the group of subjects who attend diet clinics and those who don’t (general population). Haddad et al. recruited 407 participants from the Lebanese population and provided them with web-based online surveys and Eating Disorder Examination - Questionnaires (to assess behavioral features of eating disorders). According to the surveys, 53% of the subjects abided by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. The surveys also revealed higher fears of COVID-19 in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Greater fear of this disease, higher BMI, and physical activity were significantly associated with a higher restraint score, while variables such as higher anxiety levels, higher fear of COVID-19, higher BMI, practicing physical exercise, and a greater number of adults living in the quarantine/confinement were significantly linked with increased shape and weight concerns. This study provides evidence that fear of the COVID-19 is correlated with elevated eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, Lebanese, eating disorders, boredom, anxiety, fear]

This 2020 review discusses a few anti-inflammatory treatments that are being investigated to try to mitigate the cytokine storm seen in severe COVID-19 cases (cytokine storm = life-threatening systemic inflammatory syndrome involving high levels of circulating cytokines and immune-cell hyperactivation). Zabetakis et al. look at nutritional status and the role of diet and lifestyle since these factors affect patient outcomes in other severe infections and are suspected to have a function in COVID-19. In fact, the presence of poor nutritional status and pre-existing noncommunicable diseases (NCDs) such as diabetes mellitus, chronic lung diseases, cardiovascular diseases (CVD), and obesity are said to be significant risk factors for catching a severe COVID-19 infection. Since systemic inflammation is a feature in all of the aforementioned diseases, it may influence patient outcomes against COVID-19. This review explores the potential importance of nutrition in COVID-19 infection and identifies food groups and key nutrients that could play a factor in determining the outcomes of respiratory infections. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, cytokine, non-communicable disease, diabetes, lung disease, cardiovascular disease, respiratory infections]

Since COVID-19 can put individuals at high risk of malnourishment due to the debilitating effects of its acute respiratory failure symptoms, this 2021 study aimed to develop an approach to reduce the risk for malnutrition and improve patients' clinical outcomes. Formisano et al. recruited 49 patients from the intensive care unit (ICU) and 94 non-ICU patients of the Giovanni Borea Civil Hospital in Sanremo. The non-ICU patients were given a personalized diet that considered their conditions and included high-protein and high-calorie pureed diet, oral nutritional supplements, and/or artificial nutrition. The ICU patients were considered at risk for malnutrition without screening and were fed with enteral nutrition plus supplemental parenteral nutrition. Although the dietary treatments were well tolerated by all patients, 53.1% of the ICU patients and 19.1% of the non-ICU patients died. The deaths recorded outside of the ICU were mostly women who were older and with higher body mass indices. As a matter of fact, most of the non-ICU patients were greater than 70 years of age. The protein and energy needs of these older patients were not met. This group of older participants had a higher death rate than patients whose needs were met. Apart from age, 72 of the 94 non-ICU patients scored positive on at least one nutritional risk screening item. It was deduced that nutritional strategies need to be developed to prevent worsening of the clinical outcomes of patients with COVID-19. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, respiratory, high protein, ICU, hospital nutrition]

This 2021 study examined whether food choice motives changed following the national lockdown imposed in France between March 17th and May 10th in 2020. The 938 French adult participants completed online questionnaires asking about their food choice motives and food consumption during the month before and in the first month of the lockdown. The study focused on the following nine food choice motives: health; convenience; sensory appeal; natural content; ethical concern; weight control; mood; familiarity; and price. While food intake was measured through a food frequency questionnaire including 110 foods, 12 non-alcoholic beverages and 4 alcoholic beverages. The results showed that the nutritional value of diets dropped during the lockdown compared to before. A significant change in food choice motives was also observed. Other findings included associations between importance of weight control with nutritional quality, and between increased importance of mood with decreased nutritional quality. The lockdown was thus linked with the alterations in food choice motives, especially with regards to mood as a food choice motive (reported by 48% of the respondents). In addition, there was a rise in consideration for ethical concerns, health, and natural contents in connection with the food, suggesting a growing awareness of how crucial sustainable foods are for some French participants. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, France, food convenience, sensory appeal, price]

The COVIDiet Study (2020) utilized social media and snowball sampling to propagate an online questionnaire measuring dietary and socio-demographic data, and evaluated whether eating behaviors changed during the COVID-19 outbreak confinement among a Spanish adult population. A total of 7514 participants (37% aged below 35 years, 70.6% female, 77.9% university-level education or higher) completed the questionnaire, which used the Mediterranean diet (MedDiet) Adherence Screener (MEDAS) to define a healthy diet, and determine processed foods intake, alterations in their usual food choices and weight gain. During the confinement, the overall MEDAS score among the population increased significantly from 6.53 ± 2 to 7.34 ± 1.93. Multivariate logistic regression models adjusted for multiple variables also marked a significant shift towards an increase in adherence to the MedDiet. Rodríguez-Pérez and her team (2020) arrived at the conclusion that the studied Spanish population have adopted healthier dietary behaviors/habits under COVID-19 confinement, a change that, if sustained in the long-term, could benefit the nation in its prevention of chronic diseases and COVID-19-related complications. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, Spain, Med diet, Mediterranean diet, eating behavior]

Hakeem & Sheik (2020) highlight the urgent need for interventions particularly in developing countries in order to manage these COVID-19 infections, and propose several nutrition interventions to optimize quality of life during and after the pandemic. The authors point out the lack/limited evidence of diet being considered as part of current COVID-19 management strategies although it has not been refuted that nutrition has been associated with lowering the infection-related morbidity and mortality. Hazeem & Sheik (2020) accept that the low number of and variability of nutrition-related interventions may be expected but the delay in prioritising these types of interventions may have long-term effects on the economy and people’s quality of life. The authors state that safe and promising interventions are achievable and promote the following: better use of existing resources; quicker augmentation of nutrition status for those high-risk individuals and for non-hospitalized cases by use of supplement and individualized guidance; and nutritional support in severe cases through timely enteral and parenteral feeding. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, quality of life, parenteral feeding]

This 2020 review demonstrates how important optimal intake of the relevant nutrients is to strengthen the immune system during the COVID-19 crisis. Deficiencies in micronutrients such as vitamin A and zinc have been linked to higher infection risk, while sufficient consumption of proteins is required for optimal antibody production. It is also commonly said that poor nutrient status is associated with inflammation and oxidative stress, which in turn can impact the immune system. Iddir et al. (2020) states that vitamins C and E, and phytochemicals such as carotenoids and polyphenols show great anti-inflammatory and antioxidant capacity, while there is also evidence that the short-chain fatty acids that form via the fermentation of dietary fiber by the gut microbiota may possess anti-inflammatory effects. Moreover, vitamin D may be able to disturb viral cellular infection by interacting with cell entry receptors (angiotensin converting enzyme 2). [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, COVID-19, micronutrients, nutrient deficiencies, antibodies, oxidative stress, inflammation, phytochemicals, carotenoids, polyphenols, fiber, vitamin D]

Calder et al. (2020) details the role of nutrition in supporting the immune system, including the important and complementary functions of vitamins A, B6, B12, C, D, E, and folate, trace elements such as zinc, iron, selenium, magnesium, and copper, as well as omega-3 fatty acids like eicosapentaenoic acid and docosahexaenoic acid. It is said that deficiencies in the intakes of these nutrients are widespread and have resulted in decreased resistance to infections and increased disease burden. The researchers close with the following conclusions: supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function; supplementation above the Recommended Dietary Allowance (RDA), but within recommended upper safety limits, for specific nutrients such as vitamins C and D is warranted; and public health officials are encouraged to include nutritional strategies in their recommendations to improve public health. [NPIDs: COVID, coronavirus, pandemic, immunity, the immune system, vitamin A, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, folate, zinc, iron, selenium, magnesium, copper, omega-3s, eicosapentaenoic acid, docosahexaenoic acid, DHA, EPA, COVID-19]

This 2020 study reported the impact of the COVID-19 lockdown on appetite and overeating in Australian adults during the first month of emergency measures (began 22 March 2020). An anonymous self-reported survey was released collecting data on sociodemographic characteristics, symptoms of anxiety and depression, and the effect of COVID-19 and the lockdown. The main outcome measure was an item from the Patient Health Questionnaire 9 asking: ‘Over the past 2 weeks, how often have you been bothered by poor appetite or overeating?’. Of the 13,829 adult Australian residents (aged 18+), 53.6% felt bothered by poor appetite or overeating in the past 2 weeks, and 11.6% reported poor appetite or overeating nearly every day. The risk factors for poor appetite or overeating were high levels of anxiety, concern about contracting COVID-19, being in lockdown with children and reporting a severe impact of the lockdown. Given the widespread prevalence of being bothered by poor appetite or overeating, universal public health interventions addressing emotion-focused or situational eating during periods of lockdown may be appropriate. [NPIDs: COVID, coronavirus, pandemic, appetite, overeating, Australia, March 2020, anxiety, depression, anxiety, lockdown, emotional eating, COVID-19]

While emotional eating and food choices are influenced by the perceived stress of an individual, Shen et al. (2020) investigated the role of emotional eating in the relationship between perceived stress levels and food choice motives (health, mood, convenience, natural content, price, sensory appeal, familiarities, weight control, and ethical concerns) among citizens of the United States, during the coronavirus disease 2019 pandemic. A total of 800 participants were assessed on their perceived stress, emotional eating, and food choice motives using the Perceived Stress Scale, Dutch Eating Behavior Questionnaire, and Food Choice Questionnaire. While moderate to high levels of stress were quite prevalent (73.6%), this perceived stress was found to correlate significantly with emotional eating (r = 0.26) and with five out of nine food choice motives: mood (r = 0.32), convenience (r = 0.28), natural content (r = −0.14), price (r = 0.27), and familiarity (r = 0.15). Emotional eating was also related with four of the food choice motives including mood (r = 0.27), convenience (r = 0.23), price (r = 0.16), and familiarity (r = 0.16). This study uncovered evidence suggesting that emotional eating mediates the associations between perceived stress and the food choice motives: mood, convenience, sensory appeal, price, and familiarity. [NPIDs: COVID, coronavirus, emotional eating, stress, perception, mood, sensory, ethical concerns, food convenience, price, familiarity, pandemic, COVID-19]