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The Impact of COVID-19 Stay-At-Home Orders on Health Behaviors in Adults.
Flanagan, EW, Beyl, RA, Fearnbach, SN, Altazan, AD, Martin, CK, Redman, LM
Obesity (Silver Spring, Md.). 2021;29(2):438-445
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In response to the global outbreak of COVID-19, a wave of quarantine and stay-at-home mandates were issued to attenuate the rapid worldwide spread. The aim of this study was to quantify changes in habitual dietary behaviours, physical activity, sleep, sedentary behaviours, and mental health before and during the initial peak of the COVID-19 pandemic. This study is based on an anonymous survey via paid advertisements on the social media platform Facebook. A total of 7,753 completed the first COVID-19 question and were thus included in the analysis. Results indicate that: - declines in healthful eating behaviours were coincident with reductions in physical activity. These negative behaviours were characteristic of individuals reporting weight gain in response to the pandemic outbreak. - anxiety scores nearly doubled in response to the pandemic and 20% of the sample reported that symptoms were severe enough to interfere with daily routines. - home confinement led to shifts in daily work and household responsibilities which resulted in mental health declines alongside some positive and many negative changes to health behaviours. Authors conclude that with increased cases of weight gain and significant declines to mental health, COVID-19 may impact clinical practice for years to come.
Abstract
OBJECTIVE Stay-at-home orders in response to the coronavirus disease 2019 (COVID-19) pandemic have forced abrupt changes to daily routines. This study assessed lifestyle changes across different BMI classifications in response to the global pandemic. METHODS The online survey targeting adults was distributed in April 2020 and collected information on dietary behaviors, physical activity, and mental health. All questions were presented as "before" and "since" the COVID-19 pandemic. RESULTS In total, 7,753 participants were included; 32.2% of the sample were individuals with normal weight, 32.1% had overweight, and 34.0% had obesity. During the pandemic, overall scores for healthy eating increased (P < 0.001), owing to less eating out and increased cooking (P < 0.001). Sedentary leisure behaviors increased, while time spent in physical activity (absolute time and intensity adjusted) declined (P < 0.001). Anxiety scores increased 8.78 ± 0.21 during the pandemic, and the magnitude of increase was significantly greater in people with obesity (P ≤ 0.01). Weight gain was reported in 27.5% of the total sample compared with 33.4% in participants with obesity. CONCLUSIONS The COVID-19 pandemic has produced significant health effects, well beyond the virus itself. Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionally affected individuals with obesity.
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Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study.
Sun, Y, Liu, B, Snetselaar, LG, Wallace, RB, Shadyab, AH, Kroenke, CH, Haring, B, Howard, BV, Shikany, JM, Valdiviezo, C, et al
Journal of the American Heart Association. 2021;10(5):e015553
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Dietary recommendations for human health focusing on total protein intake without considering specific protein sources may be simplistic and insufficient. The aim of this study was to investigate whether different dietary protein sources would be differentially associated with mortality risk. The study is based on data from a large prospective cohort study with up to 18-years of follow-up to investigate the risks of all-cause and cause-specific mortality in relation to animal and plant protein intake, and major sources of dietary protein. Results indicate that intake of plant protein and substitution of animal protein with plant protein, were associated with lower risk of all-cause, cardiovascular disease, and dementia mortality. Furthermore, substitution of red meat, eggs, dairy products, or legumes with nuts was associated with lower risk of all-cause mortality. Authors conclude that their findings support the need for consideration of protein sources, in addition to the amount of protein intake, in future dietary guidelines.
Abstract
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women's Health Initiative between 1993 and 1998, and followed them through February 2017. During 1 876 205 person-years of follow-up, 25 976 deaths occurred. Comparing the highest with the lowest quintile, plant protein intake was inversely associated with all-cause mortality (hazard ratio [HR], 0.91 [0.86, 0.96]), cardiovascular disease mortality (HR, 0.88 [0.79, 0.97]), and dementia mortality (HR, 0.79 [0.67, 0.94]). Among major protein sources, comparing the highest with the lowest quintile of consumption, processed red meat (HR, 1.06 [1.01, 1.10]) or eggs (HR, 1.14 [1.10, 1.19]) was associated with higher risk of all-cause mortality. Unprocessed red meat (HR, 1.12 [1.02, 1.23]), eggs (HR, 1.24 [1.14, 1.34]), or dairy products (HR, 1.11 [1.02, 1.22]) was associated with higher risk of cardiovascular disease mortality. Egg consumption was associated with higher risk of cancer mortality (HR, 1.10 [1.02, 1.19]). Processed red meat consumption was associated with higher risk of dementia mortality (HR, 1.20 [1.05, 1.32]), while consumption of poultry (HR, 0.85 [0.75, 0.97]) or eggs (HR, 0.86 [0.75, 0.98]) was associated with lower risk of dementia mortality. In substitution analysis, substituting of animal protein with plant protein was associated with a lower risk of all-cause mortality, cardiovascular disease mortality, and dementia mortality, and substitution of total red meat, eggs, or dairy products with nuts was associated with a lower risk of all-cause mortality. Conclusions Different dietary protein sources have varying associations with all-cause mortality, cardiovascular disease mortality, and dementia mortality. Our findings support the need for consideration of protein sources in future dietary guidelines.
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The effects of intensive dietary weight loss and exercise on gait in overweight and obese adults with knee osteoarthritis. The Intensive Diet and Exercise for Arthritis (IDEA) trial.
Messier, SP, Beavers, DP, Mihalko, SL, Miller, GD, Lyles, MF, Hunter, DJ, Carr, JJ, Eckstein, F, Guermazi, A, Loeser, RF, et al
Journal of biomechanics. 2020;98:109477
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Obesity is a common contributor to knee joint arthritis. In a previous trial, called the Intensive Diet and Exercise for Arthritis (IDEA) trial, it was demonstrated that 18 months of weight loss via a combination of diet and exercise was superior to diet alone for improved clinical outcomes in 454 individuals with knee joint arthritis. This sub analysis of the original randomised control trial, aimed to determine if weight loss due to diet plus exercise was more beneficial than weight loss due to diet or exercise alone to the way a person walked with knee joint arthritis. The results showed that weight loss was greatest amongst the diet and exercise group, then the diet group, and finally the exercise group. The diet and exercise group walked faster than either the diet or exercise alone groups. Dietary weight loss resulted in improved pressure upon the hip, knee and ankle joints, which was attenuated with a combination of diet and exercise. It was concluded that dietary weight loss was more beneficial for knee joint arthritis, however dietary weight loss combined with exercise is still superior to exercise alone. This study could be used by healthcare professionals to recommend a dietary weight loss regime for individuals with knee arthritis in order to improve their ability to walk.
Abstract
The Intensive Diet and Exercise for Arthritis (IDEA) trial was an 18-month randomized controlled trial that enrolled 454 overweight and obese older adults with symptomatic and radiographic knee osteoarthritis (OA). Participants were randomized to either exercise (E), intensive diet-induced weight loss (D), or intensive diet-induced weight loss plus exercise (D + E) interventions. We previously reported that the clinical benefits of D + E were significantly greater than with either intervention alone (e.g., greater pain reduction, and better function, mobility, and health-related quality of life). We now test the hypothesis that D + E has greater overall benefit on gait mechanics compared to either intervention alone. Knee joint loading was analyzed using inverse dynamics and musculoskeletal modeling. Analysis of covariance determined the interventions' effects on gait. The D + E group walked significantly faster at 18-month follow-up (1.35 m s-1) than E (1.29 m s-1, p = 0.0004) and D (1.31 m s-1, p = 0.0007). Tibiofemoral compressive impulse was significantly lower (p = 0.0007) in D (1069 N s) and D + E (1054 N s) compared to E (1130 N s). D had significantly lower peak hip external rotation moment (p = 0.01), hip abduction moment (p = 0.0003), and peak hip power production (p = 0.016) compared with E. Peak ankle plantar flexion moment was significantly less (p < 0.0001) in the two diet groups compared with E. There also was a significant dose-response to weight loss; participants that lost >10% of baseline body weight had significantly (p = 0.0001) lower resultant knee forces and lower muscle (quadriceps, hamstring, and gastrocnemius) forces than participants that had less weight loss. Compared to E, D produces significant load reductions at the hip, knee, and ankle; combining D with E attenuates these reductions, but most remain significantly better than with E alone.
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Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study.
Pietrobelli, A, Pecoraro, L, Ferruzzi, A, Heo, M, Faith, M, Zoller, T, Antoniazzi, F, Piacentini, G, Fearnbach, SN, Heymsfield, SB
Obesity (Silver Spring, Md.). 2020;28(8):1382-1385
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The coronavirus disease 2019 (COVID-19) pandemic has had far reaching health, social, and economic implications. Among them is the abrupt cessation of school programs for children and adolescents in Italy. The aim of this study was to test the hypothesis that factors contributing to weight gain among children and adolescents with overweight and obesity are exacerbated during a pandemic-associated lockdown. This study is a longitudinal clinical trial which enrolled non-adult participants (n=41) with obesity as controls in the ongoing longitudinal observational OBELIX Study in Verona, Italy. Results indicate that eating, activity, and sleeping behaviours changed in an unfavourable direction just after three weeks into their confinement during the national lockdown. Thus, findings support the hypothesis that lockdown appears to create an unfavourable environment for maintaining healthy lifestyle behaviours Authors conclude that recognition of the lockdown phenomenon is the first step in taking preventive measures.
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the coronavirus disease 2019 pandemic, will display unfavorable trends in lifestyle behaviors. METHODS The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors was collected at baseline and 3 weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t tests. RESULTS There were no changes in reported vegetable intake; fruit intake increased (P = 0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (P value range, 0.005 to < 0.001). Time spent in sports activities decreased by 2.30 (SD 4.60) h/wk (P = 0.003), and sleep time increased by 0.65 (SD 1.29) h/d (P = 0.003). Screen time increased by 4.85 (SD 2.40) h/d (P < 0.001). CONCLUSIONS Recognizing these adverse collateral effects of the coronavirus disease 2019 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child's or adolescent's adult adiposity level.
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Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors.
Heo, M, Jimenez, CC, Lim, J, Isasi, CR, Blank, AE, Lounsbury, DW, Fredericks, L, Bouchard, M, Faith, MS, Wylie-Rosett, J
BMC pediatrics. 2018;18(1):7
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Adolescent obesity is a major public health concern that affects health status not only during adolescence but also during adulthood. The aim of this study was to test whether the HealthCorps program would improve weight status represented by body mass index (BMI; kg/m2) z-score and obesity class. A secondary aim was to identify knowledge and health behaviour domains that would be increased with the program. The study design was a two parallel arm quasi-experimental pre-post comparison design. A total of 2279 students from 62 schools participated in the HealthCorps program. Results indicate that HealthCorps program participation resulted in BMI z-score improvement among overweight/obese female students. Participation also resulted in increased knowledge in most domains regardless of sex and improved a few behaviour domains. However, it did not improve weight status among male students. Authors conclude that the HealthCorps was effective for BMI z-score improvements among female students in addition to significant positive effects on knowledge and a few behaviors in both sexes.
Abstract
BACKGROUND Adolescent obesity is a major public health concern. Open to all high school students regardless of weight status, HealthCorps is a nationwide program offering a comprehensive high school-based participatory educational program to indirectly address obesity. We tested a hypothesis that the HealthCorps program would decrease BMI z-scores among overweight or obese students, and reduce obesity rates, and evaluated its effects on health knowledge and behaviors. METHODS HealthCorps aimed to improve student knowledge and behaviors regarding nutrition quality, physical activity, sleep, breakfast intake, and mental resilience. Participating students received through HealthCorps coordinators weekly or bi-weekly classroom lessons either for a semester or a year in addition to various during- and after-school health-promoting activities and mentorship. Self-reported height and weight were collected along with questionnaires assessing knowledge and behaviors during 2013-2014 academic year among 14 HealthCorps-participating New York City high schools. This quasi experimental two-arm pre-post trial included 611 HealthCorps and 221 comparison arm students for the analytic sample. Sex-specific analyses stratified by weight status were adjusted for age and Hispanic ethnicity with clustering effects of schools and students taken into account. RESULTS HealthCorps female overweight/obese and obese student had a significant decrease in BMI z-scores (post-pre delta BMI z-score = -0.16 (95%CI = (-0.26, -0.05), p = 0.004 for the former; and = -0.23 (-0.44, -0.03), p = 0.028, for the latter) whereas comparison female counterparts did not. The HealthCorps students, but not the comparison students, had a significant increase for all knowledge domains except for the breakfast realm, and reported a greater number of significant behavior changes including fruit and vegetable intake and physical activities. CONCLUSIONS The HealthCorps program was associated with reduced BMI z-score in overweight/obese and obese female adolescents, with enhanced health knowledge and behavior for both sexes. With its wide reach, this may be a promising program to help combat adolescent obesity in schools. TRIAL REGISTRATION This study is registered as a clinical trial at the ClinicalTrials.gov registry with trial number NCT02277496 on September 10, 2014 (Retrospectively registered).
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A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis.
Nechuta, S, Chen, WY, Cai, H, Poole, EM, Kwan, ML, Flatt, SW, Patterson, RE, Pierce, JP, Caan, BJ, Ou Shu, X
International journal of cancer. 2016;138(9):2088-97
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Literature shows that women with oestrogen-receptor-positive (ER+) [cells that have a receptor protein that binds the hormone oestrogen] breast cancer have a better prognosis in the first several years after diagnosis but may have higher risk of recurrence in later years after diagnosis. The aim of this study was to evaluate the associations of postdiagnosis lifestyle factors in association with breast cancer prognosis overall with ER+ late breast cancer outcomes among breast cancer survivors. This study is a prospective study based on ‘The After Breast Cancer Pooling Project’ which includes data from several long-term (>10 years), prospective cohorts of breast cancer survivors. This study included breast cancer survivors from the U.S. cohorts only i.e. a pooled analysis of over 6,500 ER+ breast cancer survivors. Results indicate that: • large post-diagnosis weight gain, obesity, and daily alcohol consumption (≥ 1 drink/day) increased the risk of late recurrence (≥5 years after diagnosis); • physical activity reduced the risk of all-cause mortality, but not the risk of late recurrence; and • current and heavy former smoking was associated with increased risk of late recurrence and all-cause mortality. Authors conclude that modifiable lifestyle factors were important predictors of late recurrence and mortality among long-term ER+ breast cancer survivors.
Abstract
Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor-positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all-cause mortality among 6,295 5-year ER+ Stage I-III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre- to post-diagnosis weight change, body mass index (BMI) (kg/m(2)), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q-statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥ 10% weight gain and obesity (BMI, 30-34.99 and ≥ 35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00-1.53), 1.40 (1.05-1.86) and 1.41 (1.02-1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01-1.62). Physical activity was inversely associated with late all-cause mortality (0.81 (0.71-0.93) and 0.71 (0.61-0.82) for 4.9 to <17.4 and ≥ 17.4 metabolic equivalent-hr/week). A U-shaped association was observed for late all-cause mortality and BMI using updated weight (1.42 (1.15-1.74) and 1.40 (1.09-1.81), <21.5 and ≥ 35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long-term ER+ breast cancer survivors.