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The new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in. The site is secure. The pandemic of coronavirus disease COVID and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide. In this study we aimed to investigate the impact of the first COVID lockdown period March—May on snacking behavior, fast-food and alcohol consumption.
Changes in snacking, in fast-food and ordered food consumption and in alcohol intake were examined. Snacking was found to be increased for a significant portion of the population examined As per alcohol consumption, an upward trend was observed in a significant part The increased snacking and alcohol consumption observed for almost a third of the examined population could be alarming because long-term health problems could arise in cases of repeated lockdowns in the future.
The observed downward trend in fast-food consumption and in frequency of ordered food could be an encouraging sign of turning to home-prepared foods, but further research is needed in this field. In order to combat the pandemic, many governments enforced preventive measures of self-isolation and nationwide lockdowns of several degrees, so as by April more than a third of the global population was under lockdown [ 2 ].
Such sudden changes in people's life can have a negative impact both on their mental health and their lifestyle behaviors, such as alcohol consumption [ 3 ] and dietary habits [ 4 ]. During the first COVID lockdown a high prevalence of sleep disorders was reported [ 6 , 7 ], which could also be linked to imbalanced dietary patterns [ 8 ].
Overeating is directly related to an increased risk of developing obesity [ 9 ] and subsequently the risk for cardiovascular diseases CVD [ 10 ] and type-2 diabetes mellitus T2DM [ 11 ] is increased. Undoubtedly, there is inadequate information about related changes in eating behaviors as well as alcohol consumption during this global health crisis, although several studies have been conducted at national level.
This systematic review aims to investigate changes in specific dietary habits snacking, fast-foods, ordered food and alcohol consumption during the COVID lockdown period compared to pre lockdown time. Total records identified through database searching were and were added in a reference database. After removal of duplicates studies were screened independently by two reviewers DB and MC.
Any disagreements regarding selection of the included studies and data extraction were solved by consensus. Studies not in English language were also excluded. The quality of the eligible studies was assessed using the modified Newcastle Ottawa Scale NOS for cross-sectional studies Supplementary Table 2 [ 14 ]. Due to the fact that this is a rapid systematic review as COVID is an emerging, rapidly evolving situation, a protocol for this systematic review was not written.
Data extraction of the included studies was independently conducted by two reviewers DB and MC using a previous standardized excel form. All disagreement were solved by consensus.
Data extracted from each study were country origin, sex and number of participants, period and type of the survey. Moreover, we examined dietary changes and we extracted information regarding changes in snacking habit, fast-food and ordered food as well as alcohol consumption.
Variables referred to dietary and alcohol changes were presented as percentages. Statistical significance of each study's results was stated by p-values where this data was available. The process for the studies selection is presented as a flow diagram in Fig. A total of studies were identified through databases and reference searching and after removal of duplicates, studies were screened.
Hence, 32 studies [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ] all cross-sectional were included in this systematic review. Characteristics of the 32 cross-sectional included studies can be found in Table 1.
Several studies had examined changes in snacking behavior during the period of lockdown [ 22 , 24 , [28] , [29] , [30] , 32 , 34 , 37 , 38 ] and the results are shown in Table 2. In these studies Regarding the subjects who reported changes in snacking a tendency towards increase can be observed [ 22 , 24 , 29 , 34 ].
Changes in fast-food consumption were reported in eight studies [ 19 , 20 , 24 , 25 , 28 , 34 , 35 , 46 ] and changes in ordered food were examined in three studies [ 15 , 18 , 23 ], whereas relevant results are summarized in Table 3 , Table 4 respectively. In studies where consumption of fast food had changed during the lockdown restrictions, a downward trend was identified [ 19 , 20 , 24 , 25 , 28 , 34 , 35 , 46 ].
Regarding the frequency of food ordering and having food delivered at home, results varied as can be seen in Table 4 , with two studies showing a decline [ 15 , 18 ], and one showing an increase [ 23 ] see Table 5. Changes in alcohol consumption during the lockdown period were reported in 23 cross-sectional studies [ 16 , 17 , 21 , 23 , 24 , [26] , [27] , [28] , [29] , 31 , [33] , [34] , [35] , [36] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ].
Results showed that in 17 out of those 23 studies, alcohol consumption remained unchanged during the lockdown for the majority of participants [ 17 , 21 , 23 , 24 , [26] , [27] , [28] , 33 , 35 , 36 , [38] , [39] , [40] , [41] , 43 , 44 , 46 ].
However, a tendency towards increased alcohol consumption has been be observed for the rest of their examined participants A decline in alcohol consumption for the majority of participants during the lockdown period was reported in four studies [ 16 , 31 , 34 , 45 ] and an increase of alcohol consumption was reported for the majority of the survey participants in two studies [ 29 , 42 ]. According to our knowledge, this is the first systematic review which aim was to examine changes in snacking behavior including both sweet and salty snacks , fast-food, food ordering habits, and alcohol consumption.
The results of our study regarding snacking showed that although for the majority of the population examined Differences in snacking behavior could be seen even within the same country. In particular, in a study lead by Pellegrini including only obese participants, This could imply that for obese people, it was more difficult to control their snacking consumption during the lockdown period. Moreover, according Leech et al.
In addition, with respect to COVID disease, due to the fact that a vaccine is not yet available for everyone, a balanced in macro- and micronutrients nutrition could be a method of prevention and management of the disease [ 54 ]. Therefore, these subjects could be at risk of becoming symptomatic COVID patients compare to those following a balanced diet [ 55 ]. Our results regarding fast food habit showed a significant decrease in fast-food consumption during the lockdown period [ 19 , 20 , 24 , 25 , 28 , 34 , 35 ].
Only, in one study conducted in Canada, Similar results emerged after examination of the frequency of ordered food Table 4. Only in the study from New Zealand an increased trend was observed [ 23 ].
Provided that fast food consumption as well as frequency of ordered food tended to decrease, a possible explanation could be that the long time staying at home during lockdown made people to spend more time in cooking and preparing homemade food, as has already be found in some studies [ 24 , 40 , 56 ].
Another explanation could be the fear of transmission of COVID disease via packets of food and delivery services, but further research is needed in this field.
Our results with respect to alcohol during the lockdown period showed that for the majority of the population examined the consumption remained stable [ 17 , 21 , 23 , 24 , [26] , [27] , [28] , 33 , 35 , 36 , [38] , [39] , [40] , [41] , 43 , 44 , 46 ]. However, a significant portion of the population examined increased its alcohol consumption during the confinement time [ 17 , 23 , 24 , 26 , 27 , 29 , 35 , [38] , [39] , [40] , [41] , [42] , [43] , [44] , 46 ].
Heterogeneity in results regarding alcohol consumption can be observed even in the same country. Results from China varied, where in Sun et al. However, in both studies the sample was not representative of the country's population. Moreover, the period of survey between these studies was different 24—31 March in Sun et al. An explanation of the fact that different results emerged could be that in the beginning of the lockdown the anxiety and the fear of this unknown situation as well as the sudden change of daily life made people more prone to alcohol consumption compared to the end of lockdown.
Similar assumptions were also made about results from France [ 35 , 36 ] and Australia [ 41 , 43 ], where a tendency towards decrease in alcohol consumption at the end of the lockdown in comparison to the beginning was observed. Results from USA were also differed between the studies [ 17 , 27 , 39 ].
In Avery et al. The same pattern was also observed in polish population where Therefore, the population in USA and Poland, in contrast to Chinese, French and Australian population, found to consume more alcohol in the end compared to the beginning of the lockdown.
Data regarding the period of the survey conduction was not available in Ingram et al. However, in Ingram et al. In order to cope with this, a significant portion of the population relapsed to previous abuse as reported by Zhao et al.
Nevertheless, subjects who often consume alcohol are not only more prone to viral and bacterial infections including COVID due to their impaired immune system [ 58 , 59 ], to CVD in heavy drinking occasions [ 60 ], liver [ 61 ], and pancreas diseases [ 62 ], but they also affect the quality of life of people living around them e.
However, according to a recent systematic review the evidence is not enough regarding domestic violence and alcohol abuse during COVID [ 64 ], but awareness of reliability of this data is always needed [ 65 ].
Among the strengths of our study is the number of studies included as well as the fact that a significant geographical part of the world was covered. Moreover, this is the first systematic review examining changes in eating patterns snacking, fast-food, and ordered food as well as in alcohol consumption. In addition, all studies included in this review were assessed according to the Newcastle—Ottawa Scale Suppl.
Limitations of our studies include the fact that the sample of some studies was not representative for the population of each country and this could affect the accuracy of our results.
Moreover, p-values were not reported in all our included studies, therefore not allowing us to provide information on the statistical significance of related results. Lastly, in this systematic review studies only in English language were included and therefore related studies published in other languages might have been missed. During the period of lockdown due to the COVID pandemic, changes in lifestyle behaviors were observed for a significant percentage of the global population.
A tendency towards increased in snacking as well as in alcohol consumption should not be disregarded because long-term problems could be arising especially in cases of repeated lockdowns in future. The observed decrease in fast-food consumption and in frequency of ordered food demonstrate an encouraging turn to home-made foods. However, provision and campaigns regarding nutritional information could be useful in order to combat with this pandemic. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
J, and MC revised the manuscript. All authors have read and approved the final version of manuscript. Clin Nutr. Dimitra Rafailia Bakaloudi , a Dhanushya T. Dhanushya T. Author information Article notes Copyright and License information Disclaimer. Received Jan 22; Accepted Apr All rights reserved.
Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1.
Abstract The pandemic of coronavirus disease COVID and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide.
Results 3.
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