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1: Association between consumption of fermented vegetables and COVID-19 mortality at a country level in Europe
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Posted 07 Jul 2020

Association between consumption of fermented vegetables and COVID-19 mortality at a country level in Europe
13,655 downloads medRxiv nutrition

Susana Fonseca, Ioar Rivas, Dora Romaguera, Marcos Quijal, Wienczyslawa Czarlewski, Alain Vidal, Joao Fonseca, Joan Ballester, Josep Anto, Xavier Basagana, Luis M Cunha, Jean Bousquet

Background Many foods have an antioxidant activity and nutrition may mitigate COVID-19. Some of the countries with a low COVID-19 mortality are those with a relatively high consumption of traditional fermented foods. To test the potential role of fermented foods in COVID-19 mortality in Europe, we performed an ecological study. Methods The European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database was used to study the country consumption of fermented vegetables, pickled/marinated vegetables, fermented milk, yoghurt and fermented sour milk. We obtained the COVID-19 mortality per number of inhabitants from the Johns Hopkins Coronavirus Resource Center. EuroStat data were used for data on potential confounders at the country level including Gross Domestic Product (GDP) (2019), population density (2018), percentage of people older than 64 years (2019), unemployment rate (2019) and percentage obesity (2014, to avoid missing values). Mortality counts were analyzed with quasi-Poisson regression models - with log of population as an offset - to model the death rate while accounting for over-dispersion. Results Of all the variables considered, including confounders, only fermented vegetables reached statistical significance with the COVID-19 death rate per country. For each g/day increase in the average national consumption of fermented vegetables, the mortality risk for COVID-19 decreased by 35.4% (95% CI: 11.4%, 35.5%). Adjustment did not change the point estimate and results were still significant. Discussion The negative ecological association between COVID-19 mortality and consumption of fermented vegetables supports the a priory hypothesis previously reported. The hypothesis needs to be tested in individual studies performed in countries where the consumption of fermented vegetables is common.

2: Diet and physical activity during the COVID-19 lockdown period (March-May 2020): results from the French NutriNet-Sante cohort study
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Posted 05 Jun 2020

Diet and physical activity during the COVID-19 lockdown period (March-May 2020): results from the French NutriNet-Sante cohort study
7,725 downloads medRxiv nutrition

Melanie Deschasaux-Tanguy, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Benjamin Alles, Valentina A Andreeva, Julia Baudry, Helene Charreire, Valerie Deschamps, Manon Egnell, Leopold K Fezeu, Pilar Galan, Chantal Julia, Emmanuelle Kesse-Guyot, Paule Latino-Martel, Jean-Michel Oppert, Sandrine Peneau, Charlotte Verdot, Serge Hercberg, Mathilde Touvier

Background: Since December 2019, the coronavirus disease (COVID-19) has massively spread, with overwhelming of health care systems and numerous deaths worldwide. To remedy this, several countries, including France, have taken strict lockdown measures, requiring the closure of all but essential places. This unprecedented disruption of daily routines has a strong potential for disrupting nutritional behaviours. Nutrition being one of the main modifiable risk factors for chronic disease risk, this may have further consequences for public health. Our objective was therefore to describe nutritional behaviours during the lockdown period and to put them in light of individual characteristics. Methods: 37,252 French adults from the web-based NutriNet-Sante cohort filled lockdown-specific questionnaires in April-May 2020 (nutritional behaviours, body weight, physical activity, 24h-dietary records). Nutritional behaviours were compared before and during lockdown using Student paired t-tests and associated to individual characteristics using multivariable logistic or linear regression models. Clusters of nutritional behaviours were derived from multiple correspondence analysis and ascending hierarchical classification. Results: During the lockdown, trends for unfavourable nutritional behaviours were observed: weight gain (for 35%; +1.8kg on average), decreased physical activity (53%), increased sedentary time (63%), increased snacking, decreased consumption of fresh food products (especially fruit and fish), increased consumption of sweets, biscuits and cakes. Yet, opposite trends were also observed: weight loss (for 23%, -2kg on average), increased home-made cooking (40%), increased physical activity (19%). These behavioural trends related to sociodemographic and economic position, professional situation during the lockdown (teleworking or not), initial weight status, having children at home, anxiety and depressive symptoms, as well as diet quality before the lockdown. Modifications of nutritional practices mainly related to routine change, food supply, emotional reasons but also to voluntary changes to adjust to the current situation. Conclusion: These results suggest that the lockdown led, in a substantial part of the population, to unhealthy nutritional behaviours that, if maintained in the long term, may increase the nutrition-related burden of disease and also impact immunity. Yet, the lockdown situation also created an opportunity for some people to improve their nutritional behaviours, with high stakes to understand the leverages to put these on a long-term footing.

3: The effect of the COVID-19 induced lockdown on nutrition, health and lifestyle patterns among adults in Zimbabwe
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Posted 19 Jun 2020

The effect of the COVID-19 induced lockdown on nutrition, health and lifestyle patterns among adults in Zimbabwe
6,123 downloads medRxiv nutrition

Tonderayi M Matsungo, Prosper Chopera

Background: The 2019 coronavirus disease (COVID-19) is a global public health emergency resulting in lockdowns, associated diet and lifestyle changes and constraint public health delivery. Objective: To investigate the impacts of the COVID-19 induced lockdown in Zimbabwe on nutrition, physical activity, alcohol consumption and smoking among Zimbabwean population aged [&ge;]18years. Methods: A cross-sectional online survey was conducted using a structured questionnaire to collect information on demographics (age, gender, place of residence, current employment), food system dimensions, diet and physical activity patterns, stress and anxiety, body image perceptions, lifestyle behaviours like smoking, alcohol intake, screen time, and ease of access to health services. The study obtained ethical clearance from the Medical Research Council of Zimbabwe (MRCZ/B/1920). Results: The participants (n=507) were mostly female (63.0%) between the ages of 31-40 years (48.1%) and had tertiary education (91.3%). The lockdown resulted in increase in food prices (94.8%) and decrease in availability of nutritious foods (64%). Most (62.5%) of the participants reported a reduction in their physical activity levels. The prevalence of Generalised Anxiety Disorder (GAD) was 40.4% and mostly affecting females [63.5%, P=0.909), 31-40 years age group (49.6%, P=0.886). Based on the BMI-based Silhouette Matching Test (BMI-SMT) 44.5% gained weight, 24.3% lost weight and 31.2% did not have weight change. The paired samples T test showed that there was a significant increase in perceived body weight (P<0.001). More than half (59.6%) reported having difficulties accessing medicinal drugs and 37.8% growth monitoring services. Conclusions: The lockdown period was associated with increase in food prices, decrease in dietary diversification, elevated stress, disrupted diet and consumption patterns. There were low levels of physical activity and perceived weight gained during the lockdown period, thus increasing the risk of overweight and obesity. Further studies incorporating participants of different socio-economic status are warranted to get more conclusive results.

4: Prevalence of vitamin D is not associated with the COVID-19 epidemic in Europe. A critical update of the existing evidence.
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Posted 07 Mar 2021

Prevalence of vitamin D is not associated with the COVID-19 epidemic in Europe. A critical update of the existing evidence.
4,124 downloads medRxiv nutrition

Dimitra Rafailia Bakaloudi, Michail Chourdakis

BackgroundCOVID-19 has emerged as a global pandemic, affecting nearly 104 million people worldwide as of February 4th 2021. In previous published studies, the association between the mean Vit D status of each country and COVID-19 infection rate, and mortality among the adult population in European countries was examined. The aim of this study was to re-examine the relationship between the Vit D status of each country and COVID-19 infection, recovery, and mortality using updated data and a different methodological approach. MethodsInformation only form the last decade on Vit D concentration/deficiency for each country was retrieved through literature search on PubMed(R) database. As of February, 4th 2021, COVID-19 infections and mortalities per one million population as well as total recoveries were extracted from the Worldometer website. The association between vitamin D deficiency and COVID-19 infection, recovery, and mortality were explored using correlation coefficients and scatterplots. FindingsThe prevalence of vitamin D deficiency among European countries ranged from 6.0 (Finland) to 75.5% (Turkey), with several countries facing more than 50% of vitamin D deficiency among their population. Non-significant correlations were observed between the number of COVID-19 infections (r=0.190; p=0.374), recoveries (rs=0.317, p=0.131), and mortalities (r=0.129; p=0.549) per one million population, with the prevalence of vitamin D deficiency. InterpretationPrevalence of vitamin D deficiency was not significantly associated with either number of infections, recoveries or mortality rate of COVID-19 among European countries. Thus, it is an important parameter to be considered when implementing preventive measures to face COVID-19. FundingNone

5: Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review
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Posted 21 Oct 2020

Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review
2,440 downloads medRxiv nutrition

Philip T James, Zakari Ali, Andrew E. Armitage, Ana Bonell, Carla Cerami, Alexander Drakesmith, Modou Jobe, Kerry S Jones, Zara Liew, Sophie E Moore, Fernanda Morales Berstein, Helen M. Nabwera, Behzad Nadjm, Sant-Rayn Pasricha, Pauline Scheelbeek, Matt J. Silver, Megan R. Teh, Andrew M Prentice

BackgroundMany nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to COVID-19 infection, progression to symptoms, likelihood of severe disease and survival. The pandemic has fostered many nutrition-related theories, sometimes backed by a biased interpretation of evidence. ObjectivesTo provide a systematic review of the latest evidence on how malnutrition across all its forms (under- and over-nutrition and micronutrient status) may influence both susceptibility to, and progression and severity of, COVID-19. MethodsWe synthesised information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity and diabetes; protein-energy malnutrition; anaemia; vitamins A, C, D, and E; poly-unsaturated fatty acids; iron; selenium; zinc; anti-oxidants, and nutritional support. For each section we provide: a) a landscape review of pertinent material; b) a systematic search of the literature in PubMed and EMBASE databases, including a systematic search of a wide range of pre-print servers; and c) a screen of six clinical trial registries. Two reviewers were assigned per section for data extraction. All original research was considered, without restriction to study design, and included if it covered: 1) SARS-CoV-2, MERS-CoV or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16th May and 11th August, 2020. PROSPERO registration CRD42020186194. ResultsAcross the 13 searches, a total of 2732 articles from PubMed and EMBASE, 4164 articles from the pre-print servers, and 433 trials were returned. A total of 288 published articles and 278 pre-print articles were taken to full text screening. In the final narrative synthesis, we cover 22 published articles, 39 pre-print articles and 79 trials. The review highlights a range of mechanistic and observational evidence to highlight the role nutrition can play in susceptibility and progression of COVID-19. However, to date, there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery, although results of clinical trials are eagerly awaited. ConclusionsTo date there is no conclusive evidence supporting adoption of novel nutritional therapies. However, given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. There is strong evidence that prevention of obesity, and its consequent type-2 diabetes, will reduce the risk of serious COVID-19 outcomes.

6: Vitamin C for the treatment of COVID-19: A living systematic review
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Posted 08 May 2020

Vitamin C for the treatment of COVID-19: A living systematic review
2,261 downloads medRxiv nutrition

Eduard Baladia, Ana Beatriz Pizarro, Gabriel Rada

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of vitamin C in the treatment of patients with COVID-19. Data sources We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L OVE (Living OVerview of Evidence). L OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomised trials evaluating the effect of vitamin C, as monotherapy or in combination with other drugs, versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating vitamin C in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case no direct evidence from randomised trials is found, or if the direct evidence provides low- or very low-certainty for critical outcomes. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media. PROSPERO Registration Submitted to PROSPERO (awaiting ID allocation). Keywords COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus Infections, Systematic review, vitamin c, ascorbic acid.

7: Is vitamin D deficiency associated with the COVID-19 epidemic in Europe?
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Posted 29 Jan 2021

Is vitamin D deficiency associated with the COVID-19 epidemic in Europe?
1,974 downloads medRxiv nutrition

Dimitra Rafailia Bakaloudi, Michail Chourdakis

ObjectiveCOVID-19 has emerged as a global pandemic, affecting nearly 80 million people from 218 countries as of December 2020. At the same time, vitamin D deficiency seems to be prevalent among COVID-19 patients. Hence, the association between the prevalence of vitamin D deficiency and COVID-19 infection and mortality among European countries was examined. DesignA case series and recent literature review study SettingsInformation on prevalence of vitamin D deficiency in each country was retrieved through literature searching on PubMed(R) database. As of December, 23rd 2020, COVID-19 infections and mortalities per million population were extracted from the Worldometer website, whereas the latitude of each country was taken from the CSGNetwork website. The association between both vitamin D deficiency and COVID-19 infection and mortality were explored using correlation coefficients and scatterplots. ParticipantsEuropean Countries-Populations ResultsThe range of prevalence of vitamin D deficiency among European countries was 6.9-75.1%, with most countries facing more than 50% of vitamin D deficiency among their population. Significant positive correlations were observed between COVID-19 infections (r=0.82; p<0.001) and mortalities (r=0.53; p=0.05) per million population with the prevalence of vitamin D deficiency. Most of the high latitude countries showed lower rates of COVID-19 infections and mortalities compared to middle latitude countries. ConclusionPrevalence of vitamin D deficiency was significantly associated with both infection and mortality rate of COVID-19 among European countries. Thus, it is an important parameter to be considered when implementing preventive measures to mitigate the mortality rate of COVID-19.

8: Dietary diversity practice and associated factors among pregnant women attending ANC in Kolfe Keranyo sub city health centers, Addis Ababa, Ethiopia.
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Posted 03 May 2020

Dietary diversity practice and associated factors among pregnant women attending ANC in Kolfe Keranyo sub city health centers, Addis Ababa, Ethiopia.
1,901 downloads medRxiv nutrition

Walelgn Tefera, Tsegahun Worku Brhanie, Mamo Dereje

Background: Adequate and healthy diet during pregnancy is essential for the health of both mother and newborn. Dietary diversity is a proxy indicator of maternal nutrient adequacy. However, little is documented on dietary diversity among pregnant women. Objectives: This study was designed to assess the dietary diversity practice and associated factors among pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa, Ethiopia. Methods: Institution based cross-sectional study was conducted on 406 randomly selected pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa from March 2-April 2/ 2018. Data were collected by using interviewer and 24 H dietary recall method. Data had entered and analyzed using SPSS version 21. Multiple logistic regression was run to assess factors associated with the dependent variable at P<0.05. Result: The mean DDS was 5.45{+/-}1.83. About 60.9% of pregnant women had good dietary diversity practice. Pregnant women learned collage and above had more dietary diversity practice than the illiterate one [AOR=2.26, 95% CI: (1.066, 4.808)]. Pregnant women with monthly income more than 5000 ETB had more dietary diversity than income less than 2000 ETB [AOR=2.33, 95% CI: (1.234, 4.416)]. Pregnant women at second ANC visit had more dietary diversity than at the first visit [AOR=2.42, 95% CI: (1.183, 4.952)]. Having nutrition information during pregnancy increases 2 times dietary diversity practice than none informed ones [AOR=2.10, 95% CI: (1.294, 3.422)]. Conclusion and Recommendation: The mean DDS among the pregnant mothers was 5.45. 60.9% of pregnant women had a good dietary diversity score and 39.1 % had poor dietary diversity. Mothers education, monthly income, second and third ANC visit and nutrition information had a positive significant with pregnant mothers dietary diversity (P<0.05. Early initiation of ANC visit and incorporation of nutrition education at each visit should be practiced. Health extension workers should provide nutritional education to every pregnant woman. Key Words: DDS, Pregnant women, Income, ANC, Education and Nutrition information.

9: The Early Food Insecurity Impacts of COVID-19
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Posted 13 May 2020

The Early Food Insecurity Impacts of COVID-19
1,829 downloads medRxiv nutrition

Meredith T Niles, Farryl Bertmann, Emily H. Belarmino, Thomas Wentworth, Erin Biehl, Roni A. Neff

Background COVID-19 has disrupted food access and impacted food insecurity, which is associated with numerous adverse individual and public health outcomes. Methods We conducted a statewide population-level survey in Vermont from March 29-April 12, 2020, during the beginning of a statewide stay-at-home order. We utilized the USDA six-item validated food security module to measure food insecurity before COVID-19 and since COVID-19. We assessed food insecurity prevalence and reported food access challenges, coping strategies, and perceived helpful interventions among food secure, consistently food insecure (pre-and post COVID-19), and newly food insecure (post COVID-19) respondents. Results Among 3,219 respondents, there was a 33% increase in household food insecurity since COVID-19 (p<0.001), with 35.6% of food insecure households classified as newly food insecure. Respondents experiencing a job loss were more likely to experience food insecurity (OR 3.43; 95% CI, 2.45-4.80). Multiple physical and economic barriers, as well as concerns related to food access during COVID-19, are reported, with respondents experiencing household food insecurity more likely to face access challenges (p<0.001). Significant differences in coping strategies were documented between respondents in newly food insecure vs. consistently insecure households. Conclusions Since the declaration of the COVID-19 pandemic, there has been a significant increase in food insecurity in Vermont, accompanied by major food access barriers. These findings have important potential impacts on individual health, including mental health and malnutrition, as well as on future healthcare costs. We suggest proactive strategies to address food insecurity during this crisis.

10: Blood omega-3 fatty acids and death from COVID-19: A Pilot Study
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Posted 08 Jan 2021

Blood omega-3 fatty acids and death from COVID-19: A Pilot Study
1,628 downloads medRxiv nutrition

Arash Asher, Nathan L. Tintle, Michael Myers, Laura Lockshon, Heribert Bacareza, William S. Harris

Very-long chain omega-3 fatty acids (EPA and DHA) have anti-inflammatory properties that may help reduce morbidity and mortality from COVID-19 infection. We conducted a pilot study in 100 patients to test the hypothesis that RBC EPA+DHA levels (the Omega-3 Index, O3I) would be inversely associated with risk for death by analyzing the O3I in banked blood samples drawn at hospital admission. To have adequate power (>80%) in this pilot study, we pre-specified a significance level of 0.10. Fourteen patients died, one of 25 in quartile 4 (Q4) (O3I [&ge;]5.7%) and 13 of 75 in Q1-3. After adjusting for age and sex, the odds ratio for death in patients with an O3I in Q4 vs Q1-3 was 0.25, p=0.07. Thus, we have suggestive evidence that the risk for death from COVID-19 was lower in those with the highest O3I levels. These preliminary findings need to be confirmed in larger studies.

11: The energy balance theory: an unsatisfactory model of body composition fluctuations
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Posted 28 Oct 2020

The energy balance theory: an unsatisfactory model of body composition fluctuations
1,561 downloads medRxiv nutrition

Francisco Arencibia-Albite, Anssi H. Manninen

Currently, obesity treatment rests on the "calories-in, calories-out" rule, formally named the energy balance theory (EBT). It maintains that body weight increases as food calories are greater than expended calories but decreases when the opposite occurs; hence, weight stability is expected at energy balance meaning that over time energy-in equals energy-out.1 It follows that dietary regimens with identical energy content should evoke similar amounts of weight and fat loss with only minor differences that emerge from diets macronutrient composition7, e.g., diet-induced glycogen depletion and water excretion. A vast collection of evidence shows, however, that low-carbohydrate diets typically result in much greater weight and fat loss than isocaloric low-fat diets.7, 8, 9, 10, 11, 12 Furthermore, our recent mathematical analysis demonstrated that weight stability coincides with a persistent energy imbalance and not otherwise.4 As an alternative, the mass balance model (MBM) was proposed that fitted weight loss data and explained the often superior weight loss evoked by low-carbohydrate diets versus low-fat diets.4 Here, we expand on these observations by computationally contrasting the predictions of both models in two scenarios described in the literature3, 16: altering the diets macronutrient composition while energy intake is kept at weight maintenance level; and the weight loss response as diet composition is changed under untreated type 1 diabetes. Our results indicate that MBM predictions are remarkably accurate while those of the EBT are clearly erroneous. These findings may represent the beginning of a paradigm shift in obesity research.

12: The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students
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Posted 15 May 2020

The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students
1,354 downloads medRxiv nutrition

Linda A Gallo, Tania F Gallo, Sophia L Young, Karen M Moritz, Lisa K Akison

Background: The pandemic inflicted by coronavirus disease 2019 (COVID-19) resulted in physical isolation measures in many parts of the world. In Australia, nationwide restrictions included staying at home, unless seeking medical care, providing care, purchasing food, undertaking exercise, or attending work in an essential service. All undergraduate university classes transitioned to online, mostly home-based learning. This disruption to daily life may have consequences for eating and physical activity patterns. Methods: In this observational study, we examined the effect of isolation measures, during the early phase of the COVID-19 pandemic in Australia (March/April), on diet (24-hour diet recall, ASA-24) and physical activity (Active Australia Survey) patterns among third-year biomedical students in Brisbane, Australia. Findings were compared to students enrolled in the same course in the previous two years. Results: In females, energy intake was ~20% greater in 2020 compared with 2018 and 2019, and the frequency of snacking and energy density of consumed snacks were also increased. In males, there was no difference in energy intake or snacking behaviour. Physical activity was impacted for both sexes, whereby fewer students undertook any walking activity and, of those that did, time spent doing so was less compared with 2018 and 2019. The proportion of students reporting any vigorous activity was not different for males or females but, among males who participated in this level of activity, the duration was less in 2020 compared with previous years. The proportion of male and female students achieving sufficient levels of activity, defined by at least 150 mins over at least 5 sessions, was ~30% less in 2020. Indeed, the majority of students reported as having undertaken less physical activity than usual. Conclusions: Increased energy intake for females and reduced physical activity for males and females demonstrate impacts of isolation measures that may have deleterious consequences for physical and mental wellbeing, with the potential to affect long-term nutrition and activity patterns.

13: Adherence to Pakistan dietary guidelines, Findings from major cities of Pakistan
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Posted 07 Jul 2020

Adherence to Pakistan dietary guidelines, Findings from major cities of Pakistan
1,295 downloads medRxiv nutrition

Ibrar Rafique, Muhammad Arif Nadeem Saqib, Nighat Murad, Muhammad Kashif Munir, Aftab Khan, Rabia Irshad, Tayyaba Rahat, Saima Naz

Background: Pakistan dietary guidelines for better nutrition were developed to cater the local need and prevent nutritional deficiency by providing information to public about healthy eating practices. Aims: To assess the level of adherence to Pakistan Dietary Guidelines for Better Nutrition (PDGN) Methods: It was a community based study conducted in five cities with two stage stratified sampling approach. Total of 448 participants were interviewed using Food frequency questionnaire adapted to local context. Five food groups (proteins, cereals, dairy, vegetables and fruits) were taken as per country guidelines. A score point of 1 was given to each food group making a total of 5 scores. Data were analyzed using SPSS. Results: Overall adherence to PDGN was poor as none of the participants had 05 score while only 1% achieved score 04. However, adherence was more in females (B = 0.45, 95%CI = 0.24; 0.66), graduates (B = 0.45, 95% CI = 0.25; 0.64), unmarried (B = 0.30, 95% CI = 0.18; 0.43), unemployed (B = 0.22, 95% CI = 0.01-0.43) and aged >50 years (B = 0.34, 95% CI = 0.08; 0.60) as compared to others. Among food groups, mean intake of cereals (carbohydrates) was high (3.38) followed by other items with fruits was least (0.76). Overall, at least one serving of discretionary food was taken by participants which was more female gender (p= 0.001), graduates (p= 0.003), high socio-economic group (p=0.001) and employed persons (p= 0.04). Conclusion: The adherence to PDGN was poor and there is a need to bring behavior change by information education and communication to the society.

14: Is iron deficiency a major cause of anaemia in Sri Lankan children aged 5-10 years?
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Posted 21 Apr 2020

Is iron deficiency a major cause of anaemia in Sri Lankan children aged 5-10 years?
1,288 downloads medRxiv nutrition

Renuka Jayatissa, Dulitha Fernando, JM Ranbanda, Krishan Hirun De Silva

To assess the iron status among children aged 5 to 10 years. A cross sectional study in Gampaha district. A sample of 704 children aged 5-10 years resident in a sample of households selected using a two-stage sampling method. A pre tested interviewer administered questionnaire was used to collect information on socio demographic characteristics, housing and sanitation facilities and other relevant variables from the households. Anthropometry was performed on all children aged 5 to 10 years using standard procedures. Venous blood samples were taken to assess the haemoglobin (Hb) level, levels of Serum Ferritin and C Reactive Protein. Overall prevalence rate of anaemia, iron deficiency and iron deficiency anaemia in children aged 5 to 10 years in Gampaha district was 22.7%, 22.1% and 13.5% respectively. The prevalence of iron deficiency among the urban children was significantly higher than that among rural children. The source of water to the households in the households with piped water had a higher prevalence of iron deficiency which was different from the others. The prevalence of iron deficiency among stunted and wasted children was higher though not at a significant level. A substantial proportion of children who were not anaemic were iron deficient. Iron deficiency is an important health problem in this population. Only half of iron deficient children were anaemic and anaemia cannot be solely explained by iron deficiency.

15: Higher energy requirement during weight-loss maintenance on a low- versus high-carbohydrate diet: secondary analyses from a randomized controlled feeding study
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Posted 11 Jul 2019

Higher energy requirement during weight-loss maintenance on a low- versus high-carbohydrate diet: secondary analyses from a randomized controlled feeding study
1,162 downloads medRxiv nutrition

Cara B Ebbeling, Lisa Bielak, Paul R Lakin, Gloria L Klein, Julia MW Wong, Patricia K Luoto, William W Wong, David S Ludwig

BackgroundLonger-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly-labeled water, has been questioned. ObjectiveThe aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low-versus high-carbohydrate diet. MethodsThe study reports secondary outcomes and exploratory analyses from a feeding study in which the primary outcome was total energy expenditure. After attaining a mean Run-in weight loss of 10.5%, 164 adults with pre-weight-loss BMI of [&ge;]25 were randomly assigned to Test diets containing Low (20%), Moderate (40%) or High (60%) carbohydrate for 20 weeks. Calorie content of Test diets was adjusted to maintain individual body weight within 2 kg of the post-weight-loss value. In analyses by Intention-to-Treat (ITT, study completers, n=148) and Per Protocol (PP, those achieving the weight-loss maintenance target, n=110), we compared estimated energy requirement from 10 to 20 weeks on the Test diets using ANCOVA. Insulin secretion was assessed pre-weight-loss as insulin concentration 30 minutes following 75 grams oral glucose (Insulin-30). ResultsEstimated energy requirement was higher in the Low vs High group by models involving ITT (ranging from 181 [CI 8-353] to 223 [40-406] kcal/d; P[&le;]0.04) and PP (ranging from 245 [43-446] to 295 [91-499] kcal/d; P[&le;]0.02). This difference remained significant in sensitivity analyses accounting for change in adiposity and possible non-adherence. In observational analyses, pre-weight loss Insulin-30 predicted adverse change in body composition following weight loss. ConclusionsEnergy requirement was higher on a low-versus high-carbohydrate diet during weight-loss maintenance, commensurate with total energy expenditure. These data are consistent with the carbohydrate-insulin model and lend qualified support for the validity of the doubly-labeled water method with diets varying in macronutrient composition.

16: Self-reported food choices before and during COVID-19 lockdown
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Posted 17 Jun 2020

Self-reported food choices before and during COVID-19 lockdown
1,141 downloads medRxiv nutrition

Ellen Siobhan Mitchell, Qiuchen Yang, Heather Behr, Laura Deluca, Paul Schaffer

Stressful situations can cause changes in individual food choices, most notably, choices of highly rewarding foods that are high in fat or sugar. Few studies have examined how a population's food choices change during a country-wide stress-inducing event such as the beginning of the COVID-19 stay-at-home orders in the United States. Food data from a digital behavior change weight loss program, which includes an interface for logging meals, were analyzed to assess self-reported food choices from March 5-March 11 ("pre-COVID") and during the first week of the COVID-19 lockdown (March 12-March 18; "during-COVID"). The final sample consisted of 381,564 participants: 318,076 (83.4%) females, the majority who were aged 45-65 years (45.2%). Results indicate that self-reported servings of fresh fruit and vegetable intake decreased from pre- to during-COVID, while intake of red meat and starchy vegetables increased. More men than women increased their intake of red meat and processed meat. There was less overall change in fruit and vegetable consumption in participants aged 66 and older, compared to younger participants (aged 18-35). The percentage of older participants who reported lean meat and starchy vegetable intake increased, but these groups had a negligible change in younger subjects. More subjects aged 18-35 years reduced their intake of caffeine, desserts, lean meat and salads compared to older participants. No changes were observed in terms of snack or alcoholic beverage intake logged. In conclusion, this study of 381,564 US participants revealed that intake of particular food groups were altered during the first weeks of COVID lockdown.

17: Dose-response relationship between protein supplementation and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials
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Posted 23 Feb 2020

Dose-response relationship between protein supplementation and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials
1,025 downloads medRxiv nutrition

Ryoichi Tagawa, Daiki Watanabe, Kyoko Ito, Keisuke Ueda, Kyosuke Nakayama, Chiaki Sanbongi, Motohiko Miyachi

BackgroundMuscle mass is essential for health promotion and maintenance; however, consensus regarding the effectiveness of protein interventions in increasing muscle mass is still lacking. ObjectiveTo evaluate the dose-response relationship in the effects of protein on lean body mass (or fat-free mass). Data SourcesPubMed and Ichushi-Web databases were searched. A manual search of the references of the literature included in this study and of that included in other meta-analyses was conducted. Study SelectionRandomized controlled trials evaluating the effect of supplementary protein intake on lean body mass were included. Data ExtractionTwo researchers independently screened the abstracts and five, reviewed the full-texts. ResultsA total of 5411 subjects in 105 articles were included. Dose-response analysis using a multivariate-adjusted spline model showed that lean body mass significantly improved with about 5 g/day of supplementary protein intake; this effect further increased with > 50 g/day supplementary protein intake. ConclusionsIncreasing daily protein intake can help sustain and improve muscle mass in various populations, irrespective of sex, age, and exercise habits.

18: Influence of nutritional status on eating habits and food choice determinants among Brazilian women during the COVID-19 pandemic
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Posted 05 Nov 2020

Influence of nutritional status on eating habits and food choice determinants among Brazilian women during the COVID-19 pandemic
947 downloads medRxiv nutrition

Bruna Caruso Mazzolani, Fabiana Infante Smaira, Gabriel Perri Esteves, Heloísa C. Santo André, Milla Cordeiro Amarante, Daniela Castanho, Karen Campos, Fabiana Braga Benatti, Ana Jéssica Pinto, Hamilton Roschel, Bruno Gualano, Carolina Nicolleti Ferreira

We aimed to evaluate the influence of nutritional status on eating habits and food choice determinants among Brazilian women during the COVID-19 outbreak. This cross-sectional survey was conducted between June and September, 2020, period in which social distancing measures were in place. Participants (n=1,183) were classified as normal weight (60.4%), overweight (26.2%) and obese (13.4%). Eating habits changed during quarantine irrespective of nutritional status. The number of women participating in grocery shopping was reduced by 34% during quarantine (p<0.001, OR=0.55, 0.79), whereas participation in cooking and ordering delivery service increased by 28% (p=0.004, OR=1.08, 1.51) and 146% (p<0.001, OR=2.06, 2.95), respectively. The number of participants reporting the habit of snacking (p=0.005, OR=1.07, 1.43) and eating at the table increased by 24% and 40% (p<0.001, OR=1.20, 1.64). Interestingly, the number of participants reporting the habit of dieting decreased by 41% (p<0.001, OR=0.59 [0.50, 0.70]). During the quarantine, "liking", "need and hunger", and "habits" were the most commonly reported determinants of food choice overall. "Health", "natural concerns" and "need and hunger" were less important determinants for participants with overweight/obesity compared to those with normal weight. Regression models showed that (i) "health", "natural concerns" and "affect regulation"; (ii) "health", "pleasure", "convenience", and "natural concerns"; and (iii) "visual appeal" and "pleasure" were the food choice determinants more associated with eating habits among women with normal weight, overweight and obesity, respectively. In conclusion, eating habits were influenced during the pandemic despite nutritional status, whereas food choice determinants differed between overweight/obesity and normal weight women.

19: Nutritional Supplementation during Pulmonary Rehabilitation in COPD: A Systematic Review
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Posted 28 Jun 2019

Nutritional Supplementation during Pulmonary Rehabilitation in COPD: A Systematic Review
788 downloads medRxiv nutrition

Abdulelah M Aldhahir, Ahmed M Al Rajah, Yousef S Aldabayan, Salifu Drammeh, Vanitha Subbu, Jaber S Alqahtani, John R Hurst, Swapna Mandal

BackgroundUptake of nutritional supplementation during pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD) has been limited by an absence of rigorous evidence-based studies supporting use. Our objective were to report and summarise the current evidence supporting use of nutritional supplementation to improve outcomes during pulmonary rehabilitation in stable COPD patients. MethodsA systematic search was conducted up to May 7th, 2019 (registration number CRD42018089142). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Six databases were included: Medical Literature Analysis and Retrieval System Online or MEDLARS Online (Medline), Allied and Complementary Medicine Database (AMED), the Cochrane Database of Systematic Reviews, Excerpta Medica dataBASE (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Science. ResultsThis systematic search generated 580 initial matches, of which 24 studies (1035 COPD participants) met the pre-specified criteria and were included. Our analysis does not confirm an impact of nutritional supplementation during PR, but studies, supplements and PR programmes were heterogeneous in nature. ConclusionThere is currently insufficient evidence on the effect of nutritional supplementation on improving outcomes during PR in patients with COPD. Therefore, controversy remains and further research is needed.

20: Boys are more likely to be undernourished than girls: A systematic review and meta-analysis of sex differences in undernutrition
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Posted 20 Sep 2020

Boys are more likely to be undernourished than girls: A systematic review and meta-analysis of sex differences in undernutrition
756 downloads medRxiv nutrition

susan Thurstans, Charles Opondo, Andrew Seal, Jonathan Wells, Tanya Khara, Carmel Dolan, Andre Briend, Mark Myatt, Michel Garenne, Rebecca Sear, Marko Kerac

Background Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at-risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. Methods We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0-59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random effects model. Results 76 studies were identified: 46/76 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13-1.40). 39 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.31 95% CI 1.24-1.39). 25 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.19, 95% CI 1.07-1.32). There was some limited evidence that the female advantage indicating lower risk of stunting and underweight was weaker in South Asia than other parts of the world. 44/76 (58%) of studies discussed possible reasons for boy/girl differences; 11/76 (14%) cited studies with similar findings with no further discussion; 21/76 (28%) had no sex difference discussion. 6/44 studies (14%) postulated biological causes, 21/44 (48%) social causes and 17/44 (38%) to a combination. Conclusion Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others.

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