Was diet quality related to COVID-19 depression and fear states in adults during the COVID-19 pandemic in Turkey?

Erdogan, Bilge; Avci, Hanife; Pinar, Aylin Acikgoz

doi:10.1590/1678-9865202437e230134

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Original - Clinical Nutrition • Rev. Nutr. 37 • 2024 • https://doi.org/10.1590/1678-9865202437e230134 linkcopy

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Was diet quality related to COVID-19 depression and fear states in adults during the COVID-19 pandemic in Turkey?

A qualidade da dieta estava relacionada aos estados de depressão e medo da COVID-19 em adultos durante a pandemia de COVID-19 na Turquia?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective This study was designed to examine diet quality among adults in Turkey, and it’s association to depression and fear states concerning COVID-19.

Methods A total number 105 volunteers participated, 56 (53.3%) females and 49 (46.7%) males aged between 19 and 64 years old, in an online-based cross-sectional study. The questionnaire was prepared to determine information about participant’s demographic characteristics, dietary habits, fear of COVID-19 (FCV-19S), depression, anxiety, stress levels (DASS-21) and diet quality (Healthy Eating Index, HEI-2015).

Results It was observed that 42.9% of participants increased home cooking and 51.4% of those decreased ready meal consumption during COVID-19 (p<0.05). The mean FCV-19S and DASS-21 scores of females were higher than males (F/M:20.3±6.40/16.9±6.78, p=0.012; 36/16, p=0.036; respectively). Also 19.6% of females had moderate depression, while 16.3% of males had extremely severe depression in anxiety subscales. A statistically significant correlation was found between FCV-19S and DASS-21 (r=0.416, p<0.001). No significant correlation was found between HEI-2015 and neither FCV-19S nor DASS-21. The mean HEI-2015 scores of females and males identified respectively 64.0±13.07 and 55.3±11.62 (p<0.001). Daily energy intake, carbohydrate and fat intake were negatively correlate with HEI-2015 (0.000). Daily carbohydrate intake was negatively correlate between DASS-21 (r=-0.209; p=0.033).

Conclusion Reducing depression, stress, anxiety, and fear levels during the pandemic will ensure a good level of diet quality by affecting the nutritional habits of individuals. For this reason, it will be essential for individuals to receive support from a multidisciplinary team of dietitians and psychologists.

Keywords:
Covid-19; Depression; Diet quality; Dietary habits

Demographic and anthropometric characteristics	Female (n=56)	Male (n=49)	Total (n=105)	Test value	p-value
Age	27 (16.0%) [²⁰-⁵³]	36 (22.5%) [²²-⁶⁰]	30 (20.0%) [²⁰-⁶⁰]	3.217	0.001^a
Marital Status
Single	34 (60.7%)	21 (42.9%)	55 (52.4%)	2.663	0.103^b
Married	22 (39.3%)	28 (57.1%)	50 (47.6%)	2.663	0.103^b
Education Status
Primary school	2 (3.6%)	2 (4.1%)	4 (3.8%)	3.121	0.571^c
Secondary school	2 (3.6%)	0	2 (1.9%)
High school	14 (25.0%)	18 (36.7%)	32 (30.5%)
Graduate	30 (53.5%)	22 (44.9%)	52 (49.5%)
Postgraduate	8 (14.3%)	7 (14.3%)	15 (14.3%)
Occupation
Housewife	8 (14.3%)	0	8 (7.6%)	15.429	0.012^c
Officer	13 (23.2%)	16 (32.7%)	29 (27.6%)
Employee	12 (21.4%)	18 (36.7%)	30 (28.6%)
Self-employment	1 (1.8%)	3 (6.1%)	4 (3.8%)
student	13 (23.2%)	5 (10.2%)	18 (17.1%)
Retired	4 (7.2%)	5 (10.2%)	9 (8.6%)
Unemployment	5 (8.9%)	2 (4.1%)	7 (6.7%)
Body mass index (kg/m²)	21.7 (5.1) [15.8-31.2]	25.3 (3.6) [18.6-34.5]	24.2 (5.7) [15.>9-34.5]	2054.5	0.001^a
Underweight	6 (10.7%)	0	6 (5.7%)	15.522	0.001^c
Normal	38 (67.8%)	23 (46.9%)	61 (58.1%)
Overweight	9 (16.1%)	23 (46.9%)	32 (30.5%)
Obese	3 (5.4%)	3 (6.2%)	6 (5.7%)

Dietary intake and eating behaviors	Female (n=56)	Male (n=49 )	Total (n=105)	Test value	p-value
Meal Consumption
Main meal	2 (1) [1-3]	2 (1) [1-3]	2 (1) [1-3]	1337.5	0.795^a
Snack	2 (1) [ 0-5]	1 (2%) [0-5]	2 (1) [0-5]	709.0	0.001^a
Total	4 (2) [ 2-6]	3 (1) [ 2-6]	4 (2) [1-7]	953.5	0.004 ^a
In the pandemic
Meal Consumption
Increased	13 (23.2%)	8 (16.3%)	21 (20.0%)	2.362	0.307^b
Decreased	11 (19.6%)	6 (12.2%)	17 (16.2%)
Not changed	32 (57.2%)	35 (71.5%)	67 (63.8%)
Snack Consumption
Increased	27 (48.2%)	10 (20.4%)	37 (35.2%)	9.872	0.007^b
Decreased	6 (10.7%)	5 (10.2%)	11 (10.5%)
Not changed	23 (41.1%)	34 (69.4%)	57 (54.3%)
Home cooking
Increased	30 (53.6%)	15 (30.6%)	45 (42.9%)	5.794	0.062^c
Decreased	3 (5.4%)	3 (6.1%)	6 (5.7%)
Not changed	23 (41.0%)	31 (63.3%)	54 (51.4%)
Fast foods
Increased	5 (8.9%)	10 (20.4)	15 (14.3%)	6.414	0.040^d
Decreased	35 (62.5%)	19 (38.8)	54 (51.4%)
Not changed	16 (28.6%)	20 (40.8)	36 (34.3%)
Body weight change
Increased	21 (37.5%)	17 (34.7%)	38 (36.2%)	0.125	0.940^d
Decreased	7 (12.5%)	7 (14.3%)	14 (13.3%)
Not changed	28 (50.0%)	25 (51.0%)	53 (50.5%)
Daily energy and macronutrient intake
Energy (kcal/d)	1611±58 [868-2717]	1977±62 [1063-3365]	1780±473 [868-3365]	-4.194	0.001^d
Carbohydrate (g/d)	173.5±8.02 [50.6-327.0 ]	223.7±9.05 [80.9-356.9 ]	196.9±66.28 [50.6-356.9]	-4.156	0.001^d
Protein (g/d)	73.5±3.49 [36.2-146.8 ]	86.05±3.44 [32.3-131.4]	79.3±25.80 [32.3-146.8]	-2.538	0.013^d
Fat (g)	66.4 (29.3) [24.3-150.2]	79.2 (30.6) [42.4-195.8]	72.9 (69.9) [24.3-195.8]	989	0.014^a

Variables	Female (n=56)	Male (n=49 )	Total (n=105)	Test value	p-value
FCV-19S	20.3± 6.40 (7-33)	16.9±6.78 (7-33)	18.7±6.76 (7-33)	2.556	0.012^a
DASS-21	36 (42) [3-108]	16 (46) [0-108]	24 (45) [0-108]	1065.5	0.049^b
Depression
Normal	24 (42.9%)	32 (65.3%)	56 (53.3%)	10.259	0.036^c
Mild	9 (16.1%)	3 (6.1%)	12 (11.4%)
Moderate	11 (19.6%)	6 (12.3%)	17 (16.2%)
Severe	5 (8.9%)	0	5 (4.8%)
Extremely severe	7 (12.5%)	8 (16.3%)	15 (14.3%)
Anxiety
Normal	22 (39.4%)	35 (71.4%)	57 (54.3%)	14.566	0.004^c
Mild	6 (10.7%)	2 (4.1%)	8(7.6%)
Moderate	11 (19.6%)	1 (2.0%)	12 (11.4%)
Severe	6 (10.7%)	3 (6.1%)	9 (8.6%)
Extremely severe	11 (19.6%)	8 (16.4%)	19 (18.1%)
Stress
Normal	32 (57.1%)	36 (73.5%)	68 (64.8%)	5.773	0.215^d
Mild	6 (10.7%)	2 (4.1%)	8 (7.6%)
Moderate	10 (17.9%)	5 (10.2%)	15 (14.3%)
Severe	7 (12.5%)	3 (6.1%)	10 (9.5%)
Extremely severe	1 (1.8%)	3 (6.1%)	4 (3.8%)
HEI-2015	64.0±13.07	55.3±11.62	60.0±13.11	3.602	0.001^a
Poor	8 (38.1%)	13 (61.9%)	21 (20.0%)	3.203	0.202^e
Needs improvement	41 (55.4%)	33 (44.6%)	74 (70.5%)
Optimal	7 (70.0%)	3 (30.0%)	10 (9.5%)

Variables	FCV-19S		DASS-21		HEI-2015
FCV-19S	1		0.416		0.085
r_s			0.001*		0.387
p
DASS-21			1		0.087
r_s					0.377
p
HEI-2015					1
r_s
p
Daily energy and macronutrient intake	FCV-19S		DASS-21		HEI-2015	p
Daily energy and macronutrient intake	r_s	p	r_s	p	r_s	p
Energy (kcal/d)	-0.056	0.568	-0.128	0.193	r_p -0.354	0.001*
Carbohydrate (g/d)	-0.117	0.234	-0.209	0.033*	r_p -0.274	0.005*
Protein (g/d)	0.037	0.708	-0.081	0.411	r_p -0.066	0.502
Fat (g/d)	0.071	0.470	0.086	0.383	-0.334	0.001*

Variables	Body Mass Index (n=105)				Test value	p-value
Variables	Underweight (n=6)	Normal (n=61)	Overweight (n=32)	Obese (n=6)	Test value	p-value
FCV-19S	19.7±7.42 (11-33)	19.7±7.10 (7-33)	17.2±5.79 (7-29)	16.3±6.69 (9-25)	1.237	0.300^a
DASS-21	44 (48) [12-108]	30 (48) [0-108]	13 (21) [4-66]	43 (62) [6-96]	10.641	0.014^b
HEI-2015	54 (21) [43-85]	61 (18) [35-92]	56 (21) [30-82]	59 (22) [32-71]	5.008	0.171^b
Energy (kcal/d)	1389 (771) [1061-2100]	1674 (589) [868-2619]	2026 (607) [1029-3365]	1431 (414) [1255-1831]	11.653	0.009^b
Carbohydrate (g/d)	155.9 (106.9) [92.5-264.7]	196.5 (90.0) [50.6-326.9]	236.3 (109.4) [80.9-356.9]	153.8 (78.6) [100.1-213.4]	11.635	0.009^b
Fat (g)	64.1 (40.9) [36.2-92.8]	69.9 (27.0) [24.3-121.5]	72.3 (30.3) [42.1-195.8]	60.5 (46.1) [32.4-99.8]	2.531	0.470^b
Protein (g/d)	65.7 (13.8) [53.8-77.0]	79.3 (44.3) [32.3-146.8]	87.3 (34.6) [40.1-131.4]	62.0 (47.8) [39.2-100.4]	6.534	0.088^b

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[TFN1] Note: * The median (interquartile range) [minimum-maximum] values are given for numerical variables that do not provide normality, and the frequency distribution for categorical variables. a: Mann Whitney-U test, b: chi-square test, c: Fisher's exact test. p<0.05 is significant and is shown in bold.