Dietary Changes and Anxiety during the Coronavirus Pandemic: Differences between the Sexes

Abstract

The SARS-CoV-2 (COVID-19) pandemic has been associated with both increased anxiety, deterioration in diet and weight gain. These associations may differ by sex. The present report examines differences by sex in diet quality in order to determine whether associations between diet and psychological stress during the initial phase of the COVID-19 pandemic differed by sex. This online study is available internationally in seven languages. The Mediterranean Diet Score was used to measure diet quality, while the General Anxiety Disorder 7-point scale (GAD-7) was used to measure anxiety. Findings were compared by self-reported sex (male vs. female). A total of 3797 respondents provided informed consent and met eligibility criteria, of whom 526 women were omitted due to being pregnant or six months or less post-partum, or due to reproductive status not being reported. Thus, 3271 individuals are included in the present report, of whom 71.2% were women. The median age of women was 30 (interquartile range (IQR) = 16) years vs. 31 (IQR = 19) years, p = 0.079. The median diet quality score was 9 (IQ = 3) in both women and men (p = 0.75). Despite the overall similarity in diet score, several components of the score differed significantly by sex. Women reported consuming significantly more olive oil, daily servings of vegetables, and weekly servings of sweet baked goods. Men reported consuming significantly more sweetened/carbonated drinks, red meat, alcohol, legumes, and hummus/tahini. Women reported a GAD-7 score of 6 (IQR = 8), while men reported 3 (6), p < 0.001. An inverse association was detected between the Mediterranean diet score and the GAD-7 score in both women (rho = −0.166, p < 0.001) and men (rho = −0.154, p < 0.001), and the correlation coefficients did not differ by sex (p = 0.76). Mediterranean diet score and age both reduced the odds of elevated anxiety (GAD-7 ≥ 10), while female sex, deterioration of diet quality during the outbreak, unemployment, and completing the survey in English increased the odds of this outcome. During the COVID-19 lockdowns, overall diet quality did not differ by sex; however, some differences by sex in components of the total score were detected. Moderate to severe anxiety was positively associated with female sex and poorer diet quality even after controlling for age, employment status, and the language in which the survey was performed.

Dietary eating patterns, dairy consumption, and anxiety: A systematic literature review

“…The remaining 18 studies were cross-sectional, including one study conducted among children which reported a statistically significant inverse association between dairy consumption and anxiety; i.e., more dairy intake was associated with lower risk of anxiety [ 107 ]. Among the 17 cross-sectional studies of adult populations, 4 reported a statistically significant inverse association [ 5 , 13 , 110 , 111 ], 11 showed no association [ 6 , 7 , 14 , 16 , 57 , 60 , 106 , 112 – 115 ], and 2 noted mixed associations [ 12 , 104 ]. One study noted a statistically significant inverse association for women, but no association for men [ 12 ], while another study indicated a statistically significant inverse association for low-fat dairy intake and a positive association for high-fat dairy consumption [ 104 ].…”

Anxiety prevalence and its association with physical activity in patients with non-communicable diseases during COVID-19 lockdown: a cross-sectional study in Shanghai, China

“…It is also possible that psychological problems might urge patients to restrict themselves. Several studies found that the pandemic increased people’s substance use due to social isolation and/or psychological problems [ 40 , 42 ]. Louvardi et al [ 43 ] indicated that patients with respiratory diseases worried more during the pandemic, and reduced substance use for fear of COVID-19 and related respiratory diseases and comorbidities.…”

“…Smoking (%) < 0.001* Current smoker 575 ( The negative associations of smoking and drinking with anxiety may be attributed to the released mental distress by the behaviors. However, previous studies indicated improving or worsening mental status due to substance abuse [39][40][41]. It is also possible that psychological problems might urge patients to restrict themselves.…”

Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic

“…Most studies reported negative dietary changes, especially an increase in meals and snacks. A possible explanation could be increased intake and consumption of high-caloric foods to cope with anxiety, sadness, and boredom during lockdown [ 14 , 15 , 46 – 49 ].…”

“…Boaz et al reported women consumed sweet baked goods, vegetables, and olive oil more than men. On the other hand, men consumed red meat and sweetened/carbonated beverages more than women [ 46 ]. Most of the information about dietary changes was obtained from studies on the general population.…”