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 ::  Abstract
  ::  Introduction
Materials and Me...
  ::  Results
  ::  Discussion
 ::  References
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  Table of Contents     
BRIEF REPORT
Year : 2022  |  Volume : 68  |  Issue : 3  |  Page : 148-151

Impact of COVID-19 pandemic on eating styles: A population based-survey during the first lockdown in Italy


1 Cognitive Rehabilitation Center, Messina, Italy
2 Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
3 Relational Psychotherapy and Cognitive Rehabilitation Center, Messina, Italy
4 Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Brain Injury Center, Messina, Italy

Date of Submission20-Sep-2021
Date of Decision20-Jan-2022
Date of Acceptance20-Jan-2022
Date of Web Publication20-Aug-2022

Correspondence Address:
R S Calabrò
Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Brain Injury Center, Messina
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.jpgm_919_21

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 :: Abstract 


Background: The Coronavirus disease (COVID-19) pandemic has had a strong impact on eating behavior. To maintain health and well-being, correct nutrition is essential, especially when the immune system is under pressure.
Objective: The aim of this study was to evaluate the correlation between emotional aspects and the eating behavior of a group of people living in Sicily during the lockdown due to COVID-19.
Methodology: We used a cross-sectional survey design with an anonymous online questionnaire, administered through technological means.
Results: During the COVID-19 pandemic, 91 participants experienced high stress (PSS = 18.14 ± 4.1), and eating was associated with emotional behaviors (DEBQ EM = 41.74 ± 10.9). Stress correlated positively with the emotional and external aspects of eating behaviors.
Conclusion: The present study showed that the COVID-19 lockdown caused high stress with a worsening in eating behaviors. The study participants had difficulty in adequately coping with some emotions and feelings, developing an 'addiction' to food.


Keywords: Eating behavior, lockdown, nutritional habits, SARS-CoV-2


How to cite this article:
Andaloro A, Maggio M G, Stagnitti M C, Marchese D, Calabrò R S. Impact of COVID-19 pandemic on eating styles: A population based-survey during the first lockdown in Italy. J Postgrad Med 2022;68:148-51

How to cite this URL:
Andaloro A, Maggio M G, Stagnitti M C, Marchese D, Calabrò R S. Impact of COVID-19 pandemic on eating styles: A population based-survey during the first lockdown in Italy. J Postgrad Med [serial online] 2022 [cited 2022 Oct 4];68:148-51. Available from: https://www.jpgmonline.com/text.asp?2022/68/3/148/354323





 :: Introduction Top


Italy was among the countries most affected by the COVID-19 pandemic, entering into quarantine as of March 10, 2020.[1] The new emergency condition has highlighted the need to create new and innovative care pathways, not only in hospitals but especially at home.[2],[3] In the general population, especially the elderly and the chronically ill, physical inactivity and stress resulting from social distancing and confinement are among the most risk factors for the morbidity of various diseases.[4] In particular, the closure of all activities during the lockdown period has had a strong relevance on eating behavior.[5] To maintain health and well-being, correct nutrition is essential, especially when the immune system is under pressure. In addition, travel and commerce restrictions have reduced access to food, so this may adversely affect overall physical and mental health. For many people, quarantine has been a cause of anxiety and worry, being the main cause of the consumption of larger quantities of food, even of poor quality. Finally, the sedentariness resulting from home confinement, in combination with altered eating habits, has led to an increase in weight.[5] The context of social isolation has inevitably led to an imbalance in daily habits, including food. It has been therefore essential to assess the changes in disorderly eating behaviors that have occurred as a result of the COVID-19 pandemic. In the literature, few studies have evaluated the link between stress and eating behaviors during the lockdown,[6],[7] considering the peculiarity characteristic of this new condition due to COVID-19. For this reason, in this study, we sought to evaluate the correlation between emotional aspects and nutritional habits of a group of people living in Sicily, during the COVID-19 quarantine.


 :: Materials and Methods Top


Study population, design, and setting

We used a cross-sectional survey design with an anonymous online questionnaire, administered through the technological means offered by smartphones (i.e. WhatsApp, Facebook) or by email. To be included in the study, participants had to be at least 18 years of age. They were excluded if they were diagnosed with psychiatric or medical disorders and/or if they were taking psychoactive drugs or substance of abuse, including alcohol. Medical information were verified from the records of participants' family physician. Potential study participants were identified through the medical records of general practitioners working in the province of Messina, Sicily, who had previously contacted their clients to obtain consent for our screening.

Of the 200 contacted participants, just under half (i.e. 91 individuals) entered the study.

Then, participants completed the self-administered questionnaires in Italian, using an online survey platform (“Google Form”, Google LLC).

To ensure a good response rate we used a clear and easy-to-access platform and interview, increased motivation by briefly explaining the importance of the topic during pandemics with the help of the participants' family doctors, and also sent gentle reminders.

Data collection took place from April 1 to May 20, 2020, that is, during the first Italian lockdown. The survey consisted of a structured interview regarding the sociodemographic data of the subject, and the administration of specific tests in order to assess how the quarantine resulting from the COVID-19 outbreak has affected their nutritional habits and psychological status. The questionnaire administered were: the Dutch Eating Behavior Questionnaire Italian version (DEBQ)[8] to measure eating styles and the Perceived Stress Scale (PSS)[9] to measure the perception of stress. In addition, participants were asked to report whether they had changed eating habits since the pre-COVID period and what the change in habits consisted of.

The present study complied with the principles of the Helsinki Declaration, and all participants provided written informed consent to participate in the study and publication of the data. The study was approved by the Local Ethics Committee (i.e. the IRCCS Centro Neurolesi; approval number: IRCCS-ME 23/2021).

Statistical analysis

The descriptive statistics were analyzed and expressed as mean ± standard deviation or as median ± first third quartile for continuous variables, as appropriate; frequencies (%) were used for categorical variables. Clinical scale scores were expressed as a mean and standard deviation. We used linear regressions to calculate the univariate associations between socio-demographic characteristics and the scoring of the scales. All tests were two-tailed, with a significance level of P < 0.05. Statistical analysis was performed using SPSS Statistic 22.0 (IBM SPSS Statistics, New York, United States).


 :: Results Top


The final sample consisted of 91 participants living in the province of Messina, Italy [Table 1]. One hundred and nine, did not answer depite attempts made to ensure their participation.
Table 1: Sociodemographic characteristics of the participants

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We observed that the majority (86.7%) of the sample reported having a drastic change in eating habits during the pandemic. In particular, they had a consumption of more caloric foods (homemade desserts, pizzas, chips), and in greater quantities than in the pre-COVID period. Moreover, the results showed that during the COVID-19 pandemic, the participants experienced high stress (18.14 ± 4.1, mean ± SD) [Table 2]. Also their eating behavior was associated with their emotional behaviors (DEBQ EM – 41.74 ± 10.9, mean ± SD). In the present study stress correlated positively with the emotional (P < 0.001) and external (P = 0.003) aspects of eating (Cronbach's alpha were 0.65 and 0.45, respectively) [Table 3].
Table 2: Scores obtained by the study sample

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Table 3: Pearson's correlations coefficient (r) between the scores of the two administered scales

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 :: Discussion Top


The present study focused for the first time on the correlation between stress and eating during the first lockdown in Italy by using specific tools, and we found high stress levels related to an increase in both emotional and external eating. In other words, food was seen as a way to cope with psychological problems, with reduced sensitivity to internal cues of hunger and satiety. The subject also paid more attention to external cues, such as the sight and smell of food. These results are in line with various studies.[6],[7],[10],[11],[12] In fact, it has been shown that the main consequence of the quarantine is a change in eating habits, characterized above all by a shift towards unhealthy foods and reduced sports activity. Bracale et al.[7] carried out an analysis on the trend of consumption during the first period of the spread of the coronavirus, on 10769 stores. The authors noted that there was an increase in the consumption of pasta, flour, eggs, long-life milk, and frozen foods, compared to a reduction in fresh food products, as reported by our sample. Indeed, as demonstrated by Torres and Nowson,[10] stress can alter overall food intake, leading to insufficient, or excessive nutrition with a preference for foods that are high in sugar and fat. Mattioli et al.[6] emphasize that during quarantine, there is a regression toward junk foods versus fresh foods. In response to stress, people tend to consume high-energy foods. Moreover, Genis-Mendoza[13] performed an online survey to assess the effect of the pandemic on 1,011 adults. Changes in eating habits were reported in 38.51% of the participants, 67.80% reported having distorted their physical perception of themselves or starting a calorie-restricted diet. Additionally, 2.27% of individuals presented with post-traumatic stress symptoms.[13] Thus, in situations of high stress caused by the pandemic the subject may have higher stress, with possible difficulty in adequately coping with some emotions and feelings such as anger, sadness, loneliness, emptiness, indecision, and confusion.[14] Eating in these situations can be a distraction or “anesthesia” to face the emotional sensations.[15] For this reason, people begin to have an “addiction” to food in order to manage their emotional state. Recent studies carried out in Italy have observed that psychological distress decreased with the relaxation of restrictions, and it was also observed that stress predicted binge eating.[14],[15]

Nonetheless, as a novelty, we used specific psychometric tools to better define the eating style to understand the prevailing type of diet and the level of stress in order to more objectively demonstrate a direct correlation between these two variables. Furthermore, the use of online forms for the evaluation of psycho-eating dimensions can be considered an innovative means of investigastion especially during pandemics.

Lockdown is associated with increased symptoms of anxiety, depression, and disordered eating behaviors.[2],[3] It has been shown that people can counteract stress with binges, resulting in physical discomfort, weight gain, and risk of disease.[10],[16] Onal et al.[17] found a trend of weight change associated with sociodemographic variables, dietary habits, and the stress level after one year of the pandemic.

Moreover, lockdown-related physical inactivity leads to an increase in the inflammatory state, especially in the presence of chronic diseases. Therefore, during the quarantine, subjects, especially those with obesity, may have experienced immense stress that has made them more vulnerable to overeating and a sedentary lifestyle, thus predisposing them to further weight gain.[10],[16]

In conclusion, the present study underlines that the first COVID-19 lockdown measures have had an impact on eating habits and emotional stress in an Italian population, supporting the link between stress and pathological eating behaviors, including binge eating and consumption of unhealthy foods.

Declaration of patient consent

The authors certify that appropriate participants consents were obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Remuzzi A, Remuzzi G. COVID-19 and Italy: What next? Lancet 2020;395:1225-8.  Back to cited text no. 1
    
2.
World Health Organization. Be active during COVID-19. Available from: https://www.who.int/news-room/q-a-detail/coronavirus-disease. [Last accessed 2021 Mar 27].  Back to cited text no. 2
    
3.
Calabrò RS, Maggio MG. Telepsychology: A new way to deal with relational problems associated with the COVID-19 epidemic. Acta Biomed 2020;91:e2020140.  Back to cited text no. 3
    
4.
Maggio MG, De Luca R, Manuli A, Calabrò RS. The five 'W' of cognitive telerehabilitation in the Covid-19 era. Expert Rev Med Devices 2020;17:473-5.  Back to cited text no. 4
    
5.
Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 international online survey. Nutrients 2020;12:1583.  Back to cited text no. 5
    
6.
Mattioli AV, Sciomer S, Cocchi C, Maffei S, Gallina S. Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease. Nutr Metab Cardiovasc Dis 2020;30:1409-17.  Back to cited text no. 6
    
7.
Bracale R, Vaccaro CM. Changes in food choice following restrictive measures due to Covid-19. Nutr Metab Cardiovasc Dis 2020;30:1423-6.  Back to cited text no. 7
    
8.
Dakanalis A, Zanetti MA, Clerici M, Madeddu F, Riva G, Caccialanza R. Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age. Appetite 2013;71:187-95.  Back to cited text no. 8
    
9.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 9
    
10.
Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition 2007;23:887-94.  Back to cited text no. 10
    
11.
Cooper M, Reilly EE, Siegel JA, Coniglio K, Sadeh-Sharvit S, Pisetsky EM, et al. Eating disorders during the COVID-19 pandemic and quarantine: An overview of risks and recommendations for treatment and early intervention. Eat Disord 2022;30:54-76.  Back to cited text no. 11
    
12.
Rodgers RF, Lombardo C, Cerolini S, Franko DL, Omori M, Fuller-Tyszkiewicz M, et al. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord 2020;53:1166-70.  Back to cited text no. 12
    
13.
Genis-Mendoza AD, Martínez-Magaña JJ, López-Narváez ML, González-Castro TB, Juárez-Rojop IE, Nicolini H, et al. Mental health problems due to social isolation during the COVID-19 pandemic in a Mexican population. Front Public Health 2021;9:703450.  Back to cited text no. 13
    
14.
Osimo SA, Aiello M, Gentili C, Ionta S, Cecchetto C. The influence of personality, resilience, and alexithymia on mental health during COVID-19 pandemic. Front Psychol 2021;12:630751.  Back to cited text no. 14
    
15.
Cecchetto C, Aiello M, Gentili C, Ionta S, Osimo SA. Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress. Appetite 2021;160:105122.  Back to cited text no. 15
    
16.
Papandreou C, Aria V, Aretouli E, Tsilidis KK, Bullo M. Comparing eating behaviors, and symptoms of depression and anxiety between Spain and Greece during the COVID-19 outbreak: Cross-sectional analysis for two different confinement strategies. Eur Eat Disord Rev 2020;28:836-46.  Back to cited text no. 16
    
17.
Onal HY, Bayram B, Yuksel A. Factors associated with the weight change trend in the first year of the COVID-19 pandemic: The case of Turkey. Nutr Res Pract 2021;15(Suppl 1):S53-69.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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