Francisca Castro Mendes

Francisca Castro Mendes

COVID-19 pandemic might affect the development and progression of chronic diseases through food insecurity. Less healthy food choices combined with a potential global economic crisis could lead to an increased incidence and decreased control of chronic diseases, such as obesity, hypertension, and diabetes. It is essential to assess food security during the COVID-19 pandemic to design intervention strategies that reduce food insecurity for the most vulnerable
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Addressing food insecurity during the COVID-19 pandemic: the added risk for the development and progression of chronic diseases

Francisca de Castro Mendes and Vanessa Garcia Larsen

COVID-19 pandemic might affect the development and progression of chronic diseases through food insecurity. Less healthy food choices combined with a potential global economic crisis could lead to an increased incidence and decreased control of chronic diseases, such as obesity, hypertension, and diabetes. It is essential to assess food security during the COVID-19 pandemic to design intervention strategies that reduce food insecurity for the most vulnerable

On March 11, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic. Since then, country-level efforts have focused on the critical need to reduce transmission and support health systems. Despite food insecurity being a major international problem before the COVID-19 pandemic, the measures to tackle the pandemic are having a long-term detrimental impact on the access to basic, essential food in population settings where it is needed the most. Food insecurity is a public health problem and occurs when “people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active, healthy life.” According to the Food and Agriculture Organization of the United Nations, it is difficult to predict the full impacts of the COVID-19 pandemic on food security since they will be specific for each context. However, food insecurity has clinical implications for the control of chronic diseases and the quality of life in vulnerable individuals.

Although the poorest and most vulnerable will be most affected by food insecurity, this is a major problem not only in low- and middle-income countries (LMICs) but also in high-income countries (HICs) due to periods of economic crises. The recent European economic recession resulted in an increased prevalence of food insecurity by 2.71% points, since 2010, compared to what would be expected considering previous years, corresponding to 13.5 million people. Data from the Gallup World Poll (GWP) survey in 2014-15 estimated that 41% of children under the age of 15 lived with a respondent who was moderately to severely food insecure. Similarly, the restriction measures applied to the circulation of people and consequent products as well as the closure of non-mandatory institutions can directly affect food security at the level of food systems with an impact on food supply and demand, and indirectly, by reducing purchasing power and the capacity of food production and distribution. As an example, the closure of schools can contribute to the creation of situations of food insecurity. Daily, in the US, meals from schools or childcare centers feed about two-thirds of children’s nutritional needs. In this context, several children, mainly those who are living in poverty, will see their food insecurity increased.

Food insecurity is associated with less healthy eating habits. It was recently argued that school closure would exacerbate all the risk factors for weight gain and obesity, including the intake of diets with higher total energy intake as a result of increased demand for food with greater durability to reduce the times that people go to the supermarkets. Besides, results from a Portuguese population-based cohort showed that food-insecure households had reduced adherence to the Mediterranean diet and were independently associated with diabetes, rheumatic disease and depression symptoms. In school-aged children from Mexico, food insecurity was associated with lower consumption of fruits and vegetables as with a decreased chance of meeting the recommendations of these foods. Similarly, in Brazil, food-insecure households had decreased consumption of vegetables and fruits compared to the food-secure household. In accordance, food-insecure adults from rural and urban American Indian communities had decreased consumptions of vegetables, while fruit juice, other sugar-sweetened beverages, and fried potatoes were increased. Regarding children, those who were food insecure had a higher intake of fried potatoes, soda, and sports drinks.

Both malnutrition and unhealthy diets are important risk factors for chronic diseases. It was showed that LMIC are being greatly affected by chronic diseases together with a burden of undernutrition and infectious diseases, while in HICs, chronic diseases disproportionally impact those who are more vulnerable. In addition, food insecurity is associated with compensation mechanisms used to prevent hunger that may have implications for the prevention and management of chronic diseases. In the US population, food-insecure adults had higher chances of having hypertension while among older adults with low income, those who had two or more chronic conditions presented a higher risk of food insecurity. In both young and older adults, those who were food insecure had a higher chance of having diabetes, cardiac disease, pulmonary disease, and obesity. Lastly, food insecurity was consistently associated with both prevalence, control, and management of diabetes.

As such, in the context of the COVID-19 pandemic, people might have to reduce the quantity, quality and diversity of the consumed food, especially fresh fruits and vegetables, due to the lack of resources or money to acquire them. Consequently, individuals will buy foods with high energy density, rich in sugar, fat, and sodium because they have more affordable prices. In addition, the pandemic per se is a stressful situation that can lead to changes in the dietary pattern characterized by the search for comfort foods richer in fat and sugar in detriment of fruit and vegetables. The reduction in the consumption of fruits and vegetables due to the impossibility of buying them or activation of the stress response can lead to the development or progression of chronic diseases.

In summary, COVID-19 pandemic might affect the development and progression of chronic diseases through food insecurity. Less healthy food choices combined with a potential global economic crisis could lead to an increased incidence and decreased control of chronic diseases, such as obesity, hypertension, and diabetes. It is essential to assess food security during the COVID-19 pandemic to design intervention strategies that reduce food insecurity for the most vulnerable.

Francisca de Castro Mendes- PhD Student, Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal and EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Fulbright Visiting Student Researcher, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Vanessa Garcia Larsen- Assistant Professor in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Bio

Francisca Castro Mendes obtained a bachelor’s degree in nutrition sciences and a master in Cell and Molecular Biology from the University of Porto (UP). She started her professional activity in 2017 as a research fellow, at the Faculty of Medicine of the UP (FMUP). She is currently a 2nd year student of the PhD in Public Health at FMUP. At the academic year 2019/2020, she was awarded a Fulbright Research Grant to develop a part of her PhD project at the Department of International Health, The Johns Hopkins University Bloomberg School of Public Health in Baltimore.

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