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BACKGROUND: Diet plays an important role in management of gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). Restrictive diets have gained popularity as treatment for IBS, but no studies have examined the patients' experiences of implementing such diets. Thus, the present study aimed to explore the experience of patients with IBS undergoing a structured dietary intervention. METHODS: Using inductive content analysis, semi-structured interviews were conducted in 19 patients with IBS, who were recruited from a randomised controlled trial evaluating two different restrictive diets for 4 weeks: a diet low in total carbohydrates; and a diet low in fermentable oligo-, di- and monosaccharides and polyols (i.e., FODMAP) combined with traditional IBS dietary advice. RESULTS: Three main themes developed from the qualitative analysis and together they describe the dietary intervention as supportive, as well as the dietary changes as challenging and contributing to reflection. Patients found the dietary support effective in both initiating and adhering to their dietary changes. Despite the support, the implementation of the diet was perceived as challenging when it interfered with other important aspects of their lives. However, going through the dietary change process, the patients began to reflect on their eating behaviours, which enabled individual dietary adjustments. The adjustments that patients maintained were not only a result of alleviation of GI symptoms, but also based on personal preferences. CONCLUSIONS: Patients with IBS undergoing restrictive diets appear to benefit from structured support. However, considering the individual patient's life situation and personal preferences, individualised dietary options should be encouraged to achieve long-term dietary changes.

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The animal gut microbiota is strongly influenced by environmental factors that shape their temporal dynamics. Although diet is recognized as a major driver of gut microbiota variation, dietary patterns have seldom been linked to gut microbiota dynamics in wild animals. Here, we analysed the gut microbiota variation between dry and rainy seasons across four Sceloporus species (S. aeneus, S. bicanthalis, S. grammicus and S. spinosus) from central Mexico in light of temporal changes in diet composition. The lizard microbiota was dominated by Firmicutes (now Bacillota) and Bacteroidota, and the closely related species S. aeneus and S. bicanthalis shared a great number of core bacterial taxa. We report species-specific seasonal changes in gut microbiota diversity and composition: greater alpha diversity during the dry compared to the rainy season in S. bicanthalis, the opposite pattern in S. aeneus, and no seasonal differences in S. grammicus and S. spinosus. Our findings indicated a positive association between gut bacterial composition and dietary composition for S. bicanthalis and S. grammicus, but bacterial diversity did not increase linearly with dietary richness in any lizard species. In addition, seasonality affected bacterial composition, and microbial community similarity increased between S. aeneus and S. bicanthalis, as well as between S. grammicus and S. spinosus. Together, our results illustrate that seasonal variation and dietary composition play a role in shaping gut microbiota in lizard populations, but this is not a rule and other ecological factors influence microbiota variation.

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OBJECTIVE: To explore how university students' dietary intakes changed during COVID-19, and whether these changes differed by food security status. PARTICIPANTS: Six hundred students attending a New Jersey public university. METHODS: A cross-sectional online survey asked about student intake. Food security status was measured using the 18-item US Household Food Security Survey. Open-ended questions were content analyzed and themes were compared between food secure (FS) and food insecure (FI) students. RESULTS: The most frequently reported dietary changes for FI students were food source/sourcing (22.7%), food variety (19.7%), and food/meal properties (19.7%). For FS students, themes differed: no change (31.5%), food source/sourcing (31.3%), and health/nutrition (13.7%). CONCLUSIONS: Students indicated dietary changes during the pandemic regardless of food security status, although FI students more frequently reported smaller, less healthy, and less varied meals. Colleges and universities can provide support through enhanced outreach and assistance during emergencies or extended periods of disruption.

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@#Introduction: Cancer diagnosis may shift an individual’s food choices as well as self-esteem mainly due to the side effects of treatment, which will influence their nutritional status and perception about themselves. The aim of this study was to explore the association between dietary changes and self-esteem among cancer patients. Methods: A cross-sectional study was conducted among 113 cancer patients in Hospital Universiti Sains Malaysia. Among the data collected were socio-demographic background, clinical characteristics, Karnofsky Performance Status Scale, dietary changes questionnaire before and after cancer diagnosis, self-esteem. Spearman correlation was employed for determining the relationship between dietary changes and self-esteem. Results: Out of 113 subjects, 98 subjects (86.7%) made changes in their dietary intake after being diagnosed with cancer. A total of 58.4% and 45.1% of the subjects reported a decrease in their intake of sugar and condensed milk, while 52.2% stopped consuming red meat. The mean self-esteem score was reported to be average (29.33 ± 3.52). However, no statistically significant association was found between socio-demographic, clinical parameters, and self-esteem with dietary changes. Conclusion:The findings of this study demonstrated that cancer patients had made drastic dietary changes following cancer diagnosis especially consumption of red meat and food high in sugar. Most cancer patients had average self-esteem level. Although no association had been found between dietary changes and self-esteem level, it is suggested for more studies should be carried out to provide clear understanding of the factors affecting dietary changes among cancer patients.

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Introduction: Endometriosis is characterized by ectopic endometrial tissue and severe pain; frequently, women afflicted by this condition resort to non-medical interventions, such as dietary modifications. The aim of this study is to assess the impact of endometriosis on dietary patterns and quality of life. Methods: An online survey was conducted among Italian women with endometriosis to gather self-reported demographic, clinical, dietary habit, and daily life data post-diagnosis. Results: A total of 4,078 participants were included. Following an endometriosis diagnosis, 66% reported changes in eating habits, and 92% experienced a decline in daily life. Respondents chose dietary interventions: gluten-free (15%), anti-inflammatory (8%), Mediterranean (7.1%), or ketogenic (4%) diets, to improve health and reduce symptoms. The study revealed a shift in eating habits, with increased consumption of vegetables, fruits (10%), cereals, legumes (6.6%), and fish (4.5%), while reducing dairy products (18.4%), soy-containing foods (6.7%), and high saturated fats (8%). Eating habit changes correlated with endometriosis stages and worsened daily life. Educational level, endometriosis stages, years of symptoms, and eating habit changes linked to changes in daily life. Conclusion: Our findings emphasize the importance of monitoring eating behaviors to prevent unhealthy habits and malnutrition in women with endometriosis. Further studies are needed to evaluate how different diets impact symptoms and enhance daily life for these individuals.

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Background: COVID-19 outbreak and quarantine measures clearly had an impact on the population's eating habits-related behavior. Objective: This study aimed to explore the long-term impact of the COVID-19 pandemic and physical quarantine on eating habits after quarantine among Riyadh city residents, Saudi Arabia. Methods: A cross-sectional study was conducted through an online survey between December 2022 and April 2023 on a convenient sample of Saudi adults in Riyadh, Saudi Arabia. A valid questionnaire was used to measure study outcomes. A comparison between dietary habits before and after COVID-19 was performed to identify the changes in dietary habits. Results: 1,451 Saudi adults residing in Riyadh completed the online survey. The majority (88.6%) of the respondents reported changes in dietary habits after COVID-19. About 50% had 1-3 dietary habits changes and slightly more than one-third had 4-7 dietary habits change. About 33.8% of the participants reported stable weight during the COVID-19 pandemic. However, 40.9% reported weight gain, and 20.7% reported weight loss. The participants reported several unhealthy dietary changes most commonly eating fast food (33%), eating junk food/fast food due to boredom/distress/disappointment (29.8%), and high sugar such as sweet porridge, pastry, sweets, and chocolate (28.5%). On the other side, the participants showed healthy dietary habits such as having a balanced healthy ingredients diet (34.4%), an increase in the consumption of fruits and vegetables, and a decrease in the intake of junk foods (28.9%). Males were more likely to exhibit unhealthy dietary habits than females (Odd Ratio:1.43, p = 0.038, CI: 1.02-2.02). Increasing age was associated with a reduction in the likelihood of exhibiting unhealthy dietary habits (OR: 0.98, p = 0.011, CI: 0.96-0.99). Moreover, participants who reported stable weight or weight loss during COVID-19 were 0.29 (p = 0.043, 0.09-0.96) and 0.34 (p = 0.020, 0.07-0.79), respectively, less likely to have unhealthy dietary habits. Conclusion: Although healthy dietary habits have been reported in this study, such as consumption of fruits and vegetables, COVID-19 confinement has also led to negative dietary behaviors reflected by high consumption of fast/junk food and sugar intake resulting in weight gain, a potential adverse impact on the population wellbeing.

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Objective: Endometriosis is a chronic gynaecological condition, often causing gastrointestinal symptoms and misdiagnosed as irritable bowel syndrome (IBS). Endometriosis guidelines do not formally endorse dietary changes and little is known about how they are self-managed. The objective of this study is to understand nutritional practices and management of gut symptoms in people with endometriosis. Study design: Participants were recruited as part of a larger survey study via endometriosis support groups on social media. Eligibility criteria were: a self-reported physician-led diagnosis of endometriosis, over 18 years old and residing in the United Kingdom (UK). Semi-structured interviews were undertaken virtually via Zoom using a predefined interview guide. All interviews were transcribed and analysed using thematic analysis. Results: 10 people with endometriosis were interviewed. All had made individual dietary changes to manage their gut-related endometriosis symptoms. Dietary changes were made based on advice from social media support, books, websites or professionals other than dietitians. Changes included the restriction and exclusion of multiple essential food groups, including dairy, grains (primarily gluten), vegetables, fruits, and animal products. These changes impacted participants' weight, nutritional status and relationship with food. Four strong themes were identified: 1) impact of pain 2) severe and unpredictable gut symptoms 3) dietary changes and their impact 4) seeking support for dietetic intervention. A common thread underlying and linking these four main themes was the feeling of being dismissed, care being delayed and lack of support. Overall the long delay waiting for a diagnosis, surgery and, at times, the re-occurrence of symptoms post-surgery led to unsupported trial and error with modifiable lifestyle factors, including diet. Conclusion: Overall, participants demonstrated some patterns of restrictive eating behaviour and wanted more professional support to help manage their endometriosis-related gut symptoms. This highlights the need for dietitians to be involved in endometriosis care to help alleviate gut symptoms, whilst ensuring nutritional adequacy and offering weight management support where required.

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Seasonal dietary shifts in animals are important strategies for ecological adaptation. An increasing number of studies have shown that seasonal dietary shifts can influence or even determine the composition of gut microbiota. The Turpan wonder gecko, Teratoscincus roborowskii, lives in extreme desert environments and has a flexible dietary shift to fruit-eating in warm seasons. However, the effect of such shifts on the gut microbiota is poorly understood. In this study, 16S rRNA sequencing and LC-MS metabolomics were used to examine changes in the gut microbiota composition and metabolic patterns of T. roborowskii. The results demonstrated that the gut microbes of T. roborowskii underwent significant seasonal changes, and the abundance of phylum level in autumn was significantly higher than spring, but meanwhile, the diversity was lower. At the family level, the abundance and diversity of the gut microbiota were both higher in autumn. Firmicutes, Bacteroidetes, and Proteobacteria were the dominant gut microbes of T. roborowskii. Verrucomicrobia and Proteobacteria exhibited dynamic ebb and flow patterns between spring and autumn. Metabolomic profiling also revealed differences mainly related to the formation of secondary bile acids. The pantothenate and CoA biosynthesis, and lysine degradation pathways identified by KEGG enrichment symbolize the exuberant metabolic capacity of T. roborowskii. Furthermore, strong correlations were detected between metabolite types and bacteria, and this correlation may be an important adaptation of T. roborowskii to cope with dietary shifts and improve energy acquisition. Our study provides a theoretical basis for exploring the adaptive evolution of the special frugivorous behavior of T. roborowskii, which is an important progress in the study of gut microbes in desert lizards.

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Agriculture accounts for 61 % of fresh water consumption in China. Although population and diet have a significant impact on water consumption, little is known about the reasons for and extent of their influence. Changes in the blue and green water footprint of 20 agricultural sectors in 31 Chinese provinces were estimated in 5 scenarios by applying the environmentally expanded multi-regional input-output model. The water footprint network is strongly interconnected, with over 50 % of the provinces characterized as net importers of the blue water footprint, 70 % of the total blue and green water footprint imports in developed provinces, and 65 % of the total blue and green water footprint exports in developing provinces, with the flow distribution driven and dominated by economically developed provinces. The findings also highlighted that the impact of population change on the water footprint is insignificant, contributing 0.51 % and 5.78 % to the reduction of the water footprint in 2030 and 2050, respectively. The impact of simultaneous changes in the population and dietary structure on the water footprint was higher than population changes and lower than dietary structure changes. The main force driving changes in the water footprint was changes in the dietary structure, which resulted in a two-fold effect on the water footprint. First, it has increased the blue and green water footprint by 33 % and 12 %, respectively, thus aggravating the coercive impact on water resources on the production side. Second, it has led to a change in the main contributing sectors for the blue and green water footprint from cereals to fruits, vegetables, and potatoes. Therefore, when the population is changing and optimizing its dietary structures, a greater focus must be placed on threats and pressures to water resources. This will result in better scientific management and more efficient use of water resources.

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BACKGROUND: Dietary habit is one of the most important methods to prevent and treat urinary stones. However, only limited evidence of the experiences of dietary management among urinary stone patients in Malaysia is available. This study aimed to explore participants' current dietary practices after the diagnosis of urinary stones and to identify the factors that facilitate their dietary changes. METHODS: A qualitative study with purposive sampling was conducted using face-to-face semistructured interviews. A total of 20 participants from a tertiary general hospital in Kuantan, Malaysia, were recruited in this study. Data were analysed using framework analysis. RESULTS: Two themes emerged from the analysis. The first theme explained the changes in the dietary practice of the participants postdiagnosis. The second theme revealed that the participants' dietary changes were greatly influenced by personal factors and external support from professionals, family and peers. CONCLUSIONS: Urinary stone patients highlighted the fear of complications, self-determination and knowledge of nutrition as the main drivers of their dietary change postdiagnosis. Emphasising proper nutritional care by assessing and evaluating dietary self-management among patients can facilitate effective self-care in stone prevention management.

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Background: After the COVID-19 outbreak, significant changes in lifestyle and dietary patterns were observed. There are many studies indicating lifestyle changes but very few pointing out the intricate changes in consumption of different food groups, so our aim is to analyze the same. Methods: A cross-sectional study was conducted among 450 participants between the age group of 18 and 60 years. A self-developed questionnaire with questions regarding the change in consumption of different food groups during the pandemic was circulated online among the urban population. Results: It was observed that 46% participants turned down their consumption of fish and seafood and 48.2% participants lowered frozen protein consumption. 44.9% respondents increased their milk consumption and 41.8% reduced their intake of ice-creams. It was observed that 42.4% participants turned up their consumption of bread and buns and 47.3% of respondents increased their rice intake. It was further recorded that 39.6% and 40.9% participants raised their intake of sweets and chocolates and biscuits and cookies, respectively. 50% and 61.3% respondents ate more green leafy vegetables and fruits during the pandemic. There was a 53.3%, 46.9%, and 38.7% reduction in the consumption of hamburgers, pizza, and fried foods, respectively. Conclusion: Majority of the participants have increased consumption of healthy foods like milk, fruits, vegetables, and nuts, while reduced the consumption of junk foods, carbonated drinks, and ice-cream. There has been a positive shift in the dietary pattern of the Indian population toward foods that help develop immunity despite its limited availability during the pandemic.

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PURPOSE: As the French West Indies are facing an ongoing nutrition transition with increasing type-2 diabetes mellitus (T2DM) prevalence, our study aimed to evaluate the effect of potential shifts in dietary patterns on T2DM risk in French West Indian adults according to several scenarios. METHODS: We used a cross-sectional multistage sampling survey on dietary intake conducted in 2013 on a representative sample of Guadeloupeans and Martinicans adults (n = 1063). From previously identified current dietary patterns, we used PRIME-Diabetes, a comparative risk assessment model, to estimate the effect of potential shifts from the "transitioning" pattern to the "convenient," the "prudent," and the "traditional" ones on T2DM risks. RESULTS: Potential shift in dietary intakes from the "transitioning" pattern to the "traditional" one reduced the T2DM risk in women (- 16% [- 22; - 10]) and in men - 14% [- 21; - 7]), as the shift in dietary intakes toward the "prudent" pattern (- 23% [- 29; - 17] and - 19% - 23; - 14], respectively). These risk reductions were mostly driven by increased whole grains, fruits, green leafy vegetable intakes, and decreases in potatoes, red meats, processed meats, and sugar-sweetened beverages. The shift in dietary intakes toward the "convenient" pattern did not affect the T2DM risks. CONCLUSION: To curb the increase in T2DM prevalence and reduce this burden, one public health action could be to target transitioning adults and help them to shift towards a diet associated with a reduced risk of T2DM as a prudent or a traditional diet.

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OBJECTIVE: Malnutrition is often underestimated in the context of cancer therapy: the dietary trends initiated by patients after diagnosis are usually neither known to nor evaluated by the medical staff. Here, we propose a combined screening instrument evaluating malnutrition and dietary trends. METHODS: The validated screening tool NRS-2002 was combined with a four-item questionnaire assessing whether (1) patients preferred certain foods, (2) avoided certain foods, (3) used dietary supplements or followed a special diet since the time of cancer diagnosis. The screening tool was routinely used by cancer patients in the daily practice of three oncological departments. The presented analysis was performed retrospectively and anonymized. RESULTS: Overall, 102 cancer patients undergoing systemic therapy (CP), 97 undergoing radiation therapy (RP), and 36 head-neck cancer patients (HNP) were screened. The CP cohort showed a higher rate of malnutrition (50.00%) than the HNP (28.13%) or RP (26.80%) cohort. Overall, diet changes were observed in 33.63% of all patients. Avoiding meat, stimulants, or hard and edgy food was often mentioned in free text answers, while patients reported a preference for fruit and vegetables. Nutritional supplements were used by 28.76% of the patients. While dietary changes were common, only 6.64% of the patients mentioned adhering to a specific cancer diet. CONCLUSION: Malnutrition is still underestimated nowadays. Diet trends, especially avoiding certain foods, are common in cancer patients, while adhering to a specific cancer diet is an exception. Diet trends should be assessed and addressed to avoid or aggravate malnutrition.

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Overweight, obesity and chronic conditions like diabetes, stroke and heart disease represent a significant burden to public health. Traditional foods and healthy dietary habits can reduce the risk of these conditions. Therefore, this study aimed to explore traditional food patterns and eating habits among Sub-Saharan African migrant mothers of school-aged children in South Australia. The study was a qualitative inquiry that used face-to-face interviews with 15 mothers of school-aged children in South Australia. Snowballing was used to sample participants, and data were audio-recorded, transcribed verbatim, coded, and analysed thematically. Four broad themes described participants' food behaviours and eating habits, including maintaining traditional food patterns, changes in traditional food patterns and eating habits, concerns with food environments in Australia, and challenges with traditional food availability and access in Australia. This study found that although mothers were committed to maintaining their traditional foods, they found it increasingly difficult to continue such habits. Participants reported challenges as their children are increasingly demanding westernised foods. While some parents pushed back against such demands from their children, others felt helpless and relented. Some views showed that food environments, food systems, access, and scarcity of traditional foods in Australia influenced the participants' food patterns and eating habits. Appropriately tailored healthy eating health promotion actions targeting school-aged children and mothers in this population need to consider their food contexts. Promoting the use of traditional foods, their preparation practices, and processing might be helpful in this community when developing healthy eating programs.

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Para atender las necesidades alimentarias y nutricionales de una población creciente y garantizar los recursos naturales y productivos, lossistemas alimentarios deben experimentar cambios adoptando dietas más sostenibles. Diferentes organismos e instituciones recomiendanpatrones de dieta variada y equilibrada, con predominio de alimentos de origen vegetal y menor presencia de alimentos de origen animal, paramejorar el estado de salud y bienestar y reducir el impacto medioambiental. Este tipo de dietas presentan beneficios en la salud, sobre todosi están bien planificadas y los alimentos se combinan adecuadamente. Sin embargo, en algunas etapas de la vida (escolares, adolescentes,ancianos) y en situaciones fisiológicas especiales (embarazadas, deportistas) se debe prestar atención a los requerimientos nutricionales, quepodrían verse comprometidos en caso de no llevar a cabo una correcta planificación dietética, lo que podría derivar en problemas para la salud.Por ello, para facilitar la transición de los consumidores a una dieta sostenible, se deben promover estrategias bien diseñadas que incluyanprogramas de educación nutricional con instrucciones específicas acerca de las elecciones y combinaciones de alimentos más adecuadas paraaumentar el valor nutricional de la dieta. Además, en situaciones fisiológicas específicas en las que alcanzar los requerimientos nutricionalespudiera estar comprometido, podría considerarse el consumo de alimentos enriquecidos y/o la administración de suplementos. (AU)

To meet the food and nutritional needs of a growing population and, at the same time, guarantee natural and productive resources, food systemsmust undergo changes in production models and consumption patterns, adopting more sustainable diets. The recommendations of differentorganizations and institutions are aimed at adopting a varied and balanced dietary pattern, with a greater predominance of plant-based food anda lower presence of animal food, to improve the state of health and well-being, while reducing the environmental impact. These types of diets haveimportant health benefits, especially if diets are well planned and foods are properly combined. However, in some stages of life (schoolchildren,adolescents, elders) and in some special physiological situations (pregnancy, athletes), special attention should be paid to the increase of certainnutritional requirements that could compromise the health status if a correct dietary planning is not carried out. Therefore, well-designed strategies should be put in place to facilitate the transition to a sustainable diet, including nutrition education programs for consumers with specificinstructions on the most appropriate food choices to increase the nutritional value of the diet. In addition, in specific physiological situations,where meeting nutritional requirements may be compromised, the consumption of fortified foods and/or supplementation could be considered. (AU)

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BACKGROUND: Experiences of long-term achievement in participants attending programs for changing health habits including diet and physical activity interventions aiming for weight reduction is lacking. This study aimed to explore how participants experienced their own achievement of healthy habits 60 months after attending a Healthy Life Centre programme in the Norwegian primary healthcare. METHODS: An explorative qualitative design with an inductive approach was employed. Individual semi-structured interviews were performed with 20 participants attending a Healthy Life Centre programme 60 months ago. They were aged 30-72 years, and 55% were females. Interviews were transcribed verbatim and analysed thematically using systematic text condensation. RESULTS: Two main themes emerged from the interviews with three subthemes each. The first theme "Changes over time" includes "Nutritional changes", "Physical activities adjusted to own presumptions" and "Health habits incorporated into life with manageable goals". The second theme "Barriers to fulfil changes" includes "Life circumstances with health issues influences the continuity to adjust to changes", "a busy everyday life" and "a lack of external drive when not having commitment to the Healthy Life Centre". CONCLUSIONS: Focusing on changes adjusted to participants' own everyday lives and having an approach with small goals can facilitate long-term changes in health habits.

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Background The COVID-19 pandemic's mandatory quarantine encouraged a sedentary lifestyle, which had detrimental effects on health. The purpose of this study is to evaluate the health effects of the prolonged COVID-19 quarantine. Methods A descriptive cross-sectional study was conducted using an online questionnaire to assess the effects of physical activity and dietary patterns on weight gain and perceived stress. Results Of the 384 participants, the majority (58.6%) experienced stress, while 22.4% saw a dramatic decline in physical activity and only 19.8% performed regular physical activity. Although 64.1% of the participants reported eating healthily, 40.6% gained weight during the quarantine. Insufficient exercise (OR 1.966, 95% CI: 1.001-3.858) and consuming soft drinks frequently (OR 2.363, 95% CI: 1.137-4.910) were the two most important predictors of weight gain. The likelihood of developing psychological stress was increased by consuming more food (OR 2.592, 95% CI; 1.268-5.298), eating few vegetables (OR 3.154, 95% CI: 1.203-8.269), and insufficient exercising (OR 2.211, 95% CI: 1.063-4.600). Conclusion Long quarantines and physical inactivity raise the risk of weight gain and stress, both of which have detrimental effects on general health.

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The COVID-19 pandemic changed the way people acquired food, including increased use of meal-kit delivery services. Investigators analyzed data from a national survey of US adults collected between July 2020 and September 2020, to describe new users of meal-kit services during the pandemic and explore associations between new use of meal-kits and dietary behaviors. Bivariate and multivariate regression analyses were conducted to identify differences in demographic characteristics and reported dietary behaviors between new and never meal-kit users. Nearly all new meal-kit users were under the age of 55 years (92.5%), lived in urban areas (90.1%), and reported having children in their households (82%). A higher proportion of new users were current SNAP participants (32.8%) compared to never users (17.1%). Compared to never users, new users of meal-kit services reported eating more fruits and vegetables (PR: 1.95, 95% CI: 1.42, 2.68), and more red and processed meats (PR: 2.39, 95% CI: 1.49-3.85) since the pandemic began. Results suggest that meal-kit services may have been a useful resource for certain populations during the early months of COVID-19 and are potentially associated with increased consumption of certain foods. Further research examining the continued use and the influence of meal-kit services on diet is needed.

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