Abstract
Purpose
The present work investigated dietary changes amongst individuals living with and beyond cancer (LWBC) from before to during the pandemic. To identify those at greatest risk of unhealthy changes, it was further examined whether patterns varied by sociodemographic, health-related, and COVID-19-related characteristics.
Methods
This longitudinal cohort study analysed data from 716 individuals LWBC participating in the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Using data provided before and during the pandemic, changes in fruit and vegetable, snack, and alcohol intake were tested using mixed-effect regression models.
Results
Fruit and vegetable (95%CI: − 0.30; − 0.04) and alcohol consumption (95%CI: − 1.25; − 0.31) decreased, whilst snacking increased (95%CI: 0.19; 0.53). Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, poorer mental health, and regular social contact were more likely to decrease alcohol consumption during the pandemic.
Conclusions
Findings suggest decreased intake for fruit, vegetable, and alcohol consumption and increased snack intake in response to the pandemic amongst individuals LWBC. These changes appear to differ across various characteristics, suggesting the pandemic has not equally impacted everyone in this population. Findings highlight the need for targeted post-COVID strategies to support individuals LWBC most adversely affected by the pandemic, including women and socially isolated individuals. This encourages resources to be prioritised amongst these groups to prevent further negative impact of the pandemic. Whilst the findings are statistically significant, practically they appear less important. This is necessary to acknowledge when considering interventions and next steps.
Similar content being viewed by others
Introduction
The COVID-19 pandemic has negatively impacted people’s lives, including their physical and mental health, financial security, and social relationships [1]. Research also indicates an impact of the pandemic on health behaviours [2], including diet [3]. Changes in diet may be due to increased stress resulting in emotional eating [4], restricted access to fresh foods [5], changing working environments [6], and fear of the virus [7]. Since the pandemic started, studies exploring dietary changes suggest the consumption of fruits and vegetables [8,9,10,11,12], snacks [8, 10,11,12,13], and alcohol [8, 11, 13] has both increased and decreased. These mixed findings suggest a need to investigate factors associated with the differences in dietary change, as certain groups of individuals may have changed their behaviours in different ways [14].
Identifying factors associated with dietary change generally, and during the pandemic, is important for identifying those at greatest risk. Several sociodemographic variables associated with diet across the life course have been identified. Diet quality appears to follow a socioeconomic gradient; one study observed that higher baseline education levels predicted increased healthier dietary patterns over 4 years [15]. This observed gradient may be due to lack of nutritional education [16] or financial resources [17]. Contrastingly, during the COVID-19 lockdown, research observed that those with a high education level ate less healthily and purchased more snacks compared to those with low education levels [18]. This may be due to individuals with higher education being more likely to work from home during lockdown which likely influenced eating behaviours [19]. Research has also established differences between males and females regarding their health behaviours and motivations for adhering to positive health behaviours [20]. For example, females generally place greater importance on healthy eating than males [21]. During the COVID-19 pandemic, one study using data from 5 British cohort studies observed that men had higher alcohol consumption than women and reported lower fruit and vegetable intake both before and during the pandemic [22].
Health-related factors also influence dietary intake. Short sleep duration and poor sleep quality are associated with increased snacking and preference for energy-dense foods [23]. Mental health conditions have also been associated with poorer diet quality. One study of 1634 adults from the Netherlands observed diet quality to be worse amongst participants with a current anxiety or depressive disorder than amongst healthy controls [24]. Research conducted during the pandemic identified an association between higher stress and unhealthy eating practices [25]. These health factors are important as sleep [26] and mental health [27] have been impacted by the pandemic.
The pandemic has led to increased social isolation due to imposed social restrictions. Individuals at greater risk from the virus due to existing health conditions were advised to ‘shield’, which furthered isolation. Evidence suggests that social factors such as frequency of social contact and social engagement are important influences on diet [28, 29]. Socially isolated older adults appear to be especially vulnerable to dietary inadequacy, including minimal consumption of fruit and vegetables, due to a lack of social support [30]. Considering the increase in social isolation during the pandemic [31], it is critical to understand how this change has impacted diet.
A key population for whom health behaviours are particularly important are individuals living with and beyond cancer (LWBC). Currently, 2.5 million people are estimated to be LWBC in the UK, rising to 4 million by 2030 [32]. Cancer survivorship benefits from healthy lifestyle factors; adopting the healthiest lifestyle is associated with a 52% lower cancer mortality risk compared with having the least healthy lifestyle [33]. The World Cancer Research Fund (WCRF) has provided a set of dietary recommendations for those LWBC including to (a) eat at least 30g of fibre and 400g of fruit and vegetables every day, (b) limit fast foods and other processed foods high in fat, starches, or sugars, (c) limit red meat consumption to 500g per week and avoid processed meat, and (d) not drink alcohol. Research has suggested that dietary behaviours may improve following a cancer diagnosis, including increased fruit and vegetable consumption and reduced intake of sugar and sweets [34,35,36]. A recent systematic review observed that a better overall diet may improve survival and quality of life after a breast cancer diagnosis and a Mediterranean diet may be protective for overall mortality following a colorectal cancer diagnosis [37]. Inflammation may act as a potential pathway for these associations as higher quality diets post-diagnosis were associated with lower C-reactive protein levels in cancer patients [38] and both a Mediterranean diet and lower Healthy Eating Index diet scores are considered to have low inflammatory potential [39]. This demonstrates the beneficial effects of a healthy dietary pattern on cancer survival in terms of mortality but also for quality of life. However, the dietary impact of the pandemic amongst individuals LWBC and the individuals LWBC most vulnerable to unhealthy dietary changes is unknown. It is important to identify those most likely to experience dietary change during the pandemic as this can inform the development of post-COVID targeted strategies to support those most adversely affected by the pandemic.
Using longitudinal data from the Advancing Survivorship Cancer Outcomes Trial (ASCOT), we evaluated whether diet (fruit and vegetable, snack, and alcohol consumption) was different during the COVID-19 pandemic compared with before the pandemic. We also investigated whether dietary patterns varied with sociodemographic (gender, education), health-related (sleep quality, anxiety, and depression), and COVID-19-related factors (shielding, social contact). Two research questions were constructed: (1) Has the intake of fruit and vegetables, snacks, and alcohol changed for individuals LWBC from before to during the pandemic? (2) What sociodemographic, health-related, and COVID-19-related predictors influenced dietary change amongst individuals LWBC during the pandemic?
Methods and materials
Design and procedure
This study is part of ASCOT, a 2-arm randomised controlled trial that tested a brief habit-based health behaviour intervention for individuals LWBC [40]. The trial included 1348 patients diagnosed with non-metastatic (stages I–III) breast, prostate, or colorectal cancer, recruited from seven NHS trusts across London and Essex. Surveys were completed on paper, online, or via telephone with a researcher at baseline, 3 months, 6 months, and 2 years post-recruitment with the addition of a COVID-19 follow-up. The current research used the participants from ASCOT as a cohort rather than assessing intervention effectiveness. The sample included participants who, before the pandemic began, had completed all main trial assessments (3 months, 6 months, and 2 years) and those who had completed the 6-month assessment but were not yet due for the 2-year assessment. Questionnaire data was used from two timepoints: participant’s most recent assessment before the pandemic and during the pandemic. The most recent questionnaires completed before the pandemic were collected between April 2018 and March 2020, and the COVID-19 follow-up was completed between September 2020 and May 2021.
Sample
The participants were adult non-metastatic breast, prostate, or colorectal cancer patients who received their diagnosis between 2006 and 2016, had completed primary curative treatment, and expressed interest in participating in a lifestyle programme. Participants were excluded at baseline if they were receiving active treatment for cancer or were not able to consent due to severe cognitive impairment. Included in the current analyses were participants with valid data for fruit and vegetable, snack, and alcohol consumption at both the before pandemic and during pandemic assessment points (N = 716).
Measures
Outcome variables
Fruit and vegetable consumption was measured using a 2-item measure requiring participants to separately state how many portions of fruit and vegetables they usually ate over the past month, with possible responses ranging from 1 (‘less than one per week’) to 7 (‘3 or more per day’). These two responses were converted into a number that reflected the number of portions per day and then summed to create a combined daily fruit and vegetable score (range 0–7) [41] which has been validated against biomarkers [42].
Snack food consumption was measured using an item from the Dietary Instrument for Nutrition Education (DINE) [43]. Participants stated how many times a week they ate a serving of biscuits, chocolate, or savoury snacks (e.g. crisps, nuts). Possible responses ranged from 1 (‘less than once a week’) to 4 (‘6 or more per week’). Answers were converted into a number that reflected the number of portions per week.
Finally, alcohol consumption was measured using 2 items adapted from the AUDIT-C. Firstly, how often do you have a drink containing alcohol with the responses of ‘never’, ‘monthly or less’, ‘2–4 times per month’, ‘2–3 times per week’, ‘4–5 times per week’, or ‘everyday’. Secondly, how many units of alcohol do you drink on a typical day when you are drinking with the responses ‘I never drink alcohol’, ‘1–2’, ‘2–4’, ‘5–6’, ‘7–9’, or ‘10 + ’ units. These two responses were then converted to numbers and multiplied to create weekly units of alcohol, ranging from 0 to 70 units per week.
Exposure variables
Several exposure variables were assessed, including sociodemographic, health-related, and COVID-19-related variables. The sociodemographic variables included were gender (male (reference category) versus female) and education (higher education (reference category) versus no higher education).
The health-related variables included were mental health and sleep quality during the pandemic. Mental health was assessed using a single item from the EQ-5D developed by the Euroqol Group [44]. The validity and reliability of this measure amongst cancer patients have been supported [45]. Participants selected 1 of 5 responses that best describes their health today. For anxiety and depression, responses ranged from ‘I am not anxious or depressed’ to ‘I am extremely anxious or depressed’. Due to a small number of participants in certain groups, responses were categorised into ‘no symptoms’ (reference category), ‘minimal symptoms’, and ‘high symptoms’. It has been suggested that a single question on depressed mood can detect 85–90% of patients with major depressive disorder [46]. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a 19-item self-report questionnaire that assesses sleep quality and quantity and ranges from 0 to 21 (higher scores indicating worse sleep quality). The questionnaire yields 7 component scores: subjective sleep quality, sleep latency, duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Items 5d and 5j and 10a–e of the PSQI were omitted for the present survey and scoring was adjusted accordingly. Psychometric evaluation supports its internal consistency, reliability, and construct validity amongst cancer patients [47].
The COVID-19-related variables included were the requirement to shield and social contact during the pandemic. For shielding, participants were asked whether they received a letter from the government stating they were required to shield as they were at high risk from the virus. Responses were ‘yes’ or ‘no’ (reference category). Social contact during the pandemic was assessed by asking participants the activities they were completing outside of their house at the time they completed the questionnaire. Possible responses included ‘not leave home at all’, ‘only leave for exercise or medical appointments’, ‘only leave for exercise, medical appointments, food shopping or to collect medication’, ‘only leave for exercise, medical appointments, food shopping, collect medication, or work’, ‘not restrict where you went but socially distanced when near others’, or ‘not restrict where you went or how far away you were from others’. Due to a small number of participants in certain groups, these were categorised into limited (responses 1–3) or regular social contact (4–6) (reference category).
Statistical analyses
Main analyses
Statistical analyses were conducted in R and separate analyses were conducted for each of the dietary components. Descriptive statistics are reported as means (M) and standard deviations (SD) or n (%). Missing data for all included exposure and outcome variables was below 5%. Linear mixed-effect models were conducted using the lme4 package to estimate changes in fruit and vegetable, snack, and alcohol intake during the COVID-19 pandemic. To address the first research question, changes in the dietary outcomes were estimated using a binary predictor variable that indicated whether the outcome was measured before or during the pandemic, which we shall name the time indicator. To address the second research question, interaction effects between the time indicator and the sociodemographic, health-related, and COVID-19-related variables were examined in separate models to understand whether and how the change in dietary outcomes might vary across different characteristics. The covariates that were included in the analyses were based on previous research and included age, gender, ethnicity, and education.
Sensitivity analyses
Subgroup analyses were conducted to understand whether the participants excluded from the current sample, due to the diet-related exclusion criteria, differed meaningfully from those included.
Results
A total of 716 participants out of 1348 at baseline (53.1%) were included in the current analyses. Participant characteristics are presented in Table 1. Participants had a mean age of 66 years at the COVID-19 follow-up, 62.3% were female, 94.1% were of white ethnicity, and 37.7% had higher education. Regarding mental health, 54.6%, 33%, and 12.4% of participants reported feeling no, low, and strong feelings of anxiety and/or depression. Average sleep quality score was ~ 6.82 (± 3.49; range = 0–19). For COVID-19-related factors, only 17.7% of participants were sent a letter saying they needed to shield and 49.9% had limited social contact during the pandemic. Average intake for each of the dietary outcomes is presented in Table 2. Before the pandemic, average daily portions of fruits and vegetables were ~ 4.20 (± 2.07; range = 0–7) compared to ~ 4.02 (± 2.01; range = 0–7) during the pandemic. Before the pandemic, average weekly portions of snacks were ~ 2.45 (± 2.13; range = 0–7) compared to ~ 2.78 (± 2.23; range = 0–7) during the pandemic. Finally, average weekly alcohol consumption before the pandemic was ~ 6.24 (± 10.11; range = 0–70) compared to ~ 5.52 (± 9.22; range = 0–70) during the pandemic.
Mixed effect individual models
The independent mixed effect models are summarised in Table 3. Fruit and vegetable consumption decreased from before to during the pandemic by 0.17 portions per day (95%CI: − 0.30; − 0.04). Snack intake increased from before to during the pandemic by 0.36 portions per week (95%CI: 0.19; 0.53). Alcohol intake decreased from before to during the pandemic by 0.78 units (95%CI: − 1.25; − 0.31).
Mixed effect interaction models
The mixed effect interaction models are summarised in Table 4. The interaction with gender suggests that males did not change their fruit and vegetable intake from before to during the pandemic, whereas females decreased their intake by 0.27 portions (interaction effect = − 0.27; 95%CI: − 0.54; 0.00). Likewise, snack intake for males increased from before to during the pandemic by 0.07 portions per week compared to 0.52 portions for females (interaction effect = 0.45; 95%CI: 0.10; 0.80). Individuals with higher education increased their snack intake by 0.12 portions per week from before to during the pandemic, compared to a 0.50 increase for those without higher education (interaction effect = 0.38; 95%CI: 0.03; 0.73).
Participants with high (~ 1.48 units) (interaction effect = − 1.68; 95%CI: − 3.16; − 0.21) and low (~ 0.91 units) (interaction effect = − 1.11; 95%CI: − 2.14; − 0.08) feelings of anxiety or depression showed greater decreases in alcohol consumption compared to those with no feelings of anxiety or depression (~ 0.2 units). Individuals with poorer sleep quality had a greater increase in snacking compared to those with better sleep quality (interaction effect = 0.06; 95%CI: 0.02; 0.11). For example, participants with a sleep score of 1, indicating good quality sleep, did not change their weekly snack intake from before to during the pandemic, compared to individuals with a sleep score of 19, indicating poor quality sleep, increased their snacking intake by 1.08 portions per week. Individuals with poorer quality sleep have a greater decrease in alcohol consumption compared to those with better quality sleep (interaction effect = − 0.13; 95%CI: − 0.26; − 0.01). For example, participants with a sleep score of 1, indicating good sleep quality, decreased their alcohol consumption by 0.01 units compared to a decrease of 2.35 units for those with a score of 19, indicating poor sleep quality.
Participants who received a letter recommending them to shield showed a greater increase in snacking (~ 0.98 portions per week) compared to those who did not (~ 0.23 portions per week) (interaction effect = 0.75; 95%CI: 0.30; 1.19). Participants with regular social contact showed a greater decrease in fruit and vegetable intake (~ 0.31 portions) compared to those with limited social contact (~ 0.03 portions) (interaction effect = 0.28; 95%CI: 0.02; 0.54). Participants with regular social contact increased their snack intake by 0.09 portions per week from before to during the pandemic, compared to 0.56 portions for individuals with limited social contact (interaction effect = 0.56; 95%CI: 0.23; 0.90). Participants with regular social contact decreased their alcohol consumption by 1.39 units compared to a decrease of 0.12 units for those with limited social contact (interaction effect = 1.27; 95%CI: 0.34; 2.21).
There were no changes in fruit and vegetable consumption from before to during the pandemic by education, mental health, sleep, or shielding. Likewise, mental health was not associated with changes in snacking and gender, education, and shielding were not associated with changes in alcohol consumption.
Sensitivity analyses
The subgroup analyses (Supplementary Table 1) comparing participants that were excluded (N = 632) and included (N = 716) in the current sample suggest that the samples differed by age, ethnicity, education level, and number of comorbidities but not by gender or index of multiple deprivation.
Discussion
The current research observed dietary changes amongst individuals LWBC during the COVID-19 pandemic. Specifically, fruit, vegetable, and alcohol consumption decreased whilst snacking increased. Changes in dietary habits were influenced by sociodemographic, health-related, and COVID-19-related factors. Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, greater anxiety and depression levels, and regular social contact were more likely to decrease alcohol consumption during the pandemic.
The first research question aimed to identify changes in the consumption of fruit and vegetables, snacking, and alcohol amongst individuals LWBC from before to during the pandemic. Within this sample, fruit and vegetable consumption appeared to decrease from before to during the pandemic which is supported by existing research [48]. Possible explanations for this finding include disruption to the food supply chain during the pandemic [49] impacting food availability [50, 51], leading to shifting preferences towards non-perishable foods over fresh foods, including fruit and vegetables [49]. Likewise, the negative economic impact of the pandemic [52, 53] may have encouraged a reduction in purchasing fruit and vegetables as they are perceived as more expensive [54]. Furthermore, increased stress and anxiety levels amongst individuals LWBC [55] may have led to increased snacking and reduced fruit and vegetable consumption [48, 56, 57]. Previous research identifies an association between ‘natural disasters’ and reduced fresh produce consumption [58], explained via a combination of higher anxiety levels, increased food prices, and decreased availability, which could be likened to the pandemic.
Research supports the finding that snacking increased during the pandemic for individuals LWBC. During the pandemic, increased snacking has been observed alongside elevated stress, boredom, and emotional eating [59,60,61]. Given the high palatability of snacks, they may have acted as a comfort mechanism to deal with COVID-19-related stress [60, 62]. Foods high in saturated fat, salt, and sugar (HFSS) also tend to be cheaper and have long shelf lives. Individuals may have ‘stocked-up’ on HFSS foods through less frequent shopping trips [60]. Home confinement appears to have increased sedentary time amongst breast cancer patients during the pandemic up to 54.2% [63], which may have further contributed to increased snacking [64].
The finding that alcohol consumption decreased amongst individuals LWBC during the pandemic is less expected. A systematic review of general and clinical populations observed an overall trend towards increased alcohol consumption [65]. However, alcohol consumption may have decreased due to reduced socialising following restrictions imposed by the government, and the current sample may have been comprised of primarily social drinkers. Furthermore, research suggests that following a cancer diagnosis individuals LWBC reduce overall consumption of alcohol to improve survival chances and reduce likelihood of re-diagnosis [66]. This protective behaviour may therefore have been established before the pandemic which could have limited any negative changes during the pandemic.
The second research question aimed to explore the sociodemographic, health-related, and COVID-19-related factors associated with dietary changes during the pandemic. The current findings observed that females, compared to males, consumed more snacks and less fruit and vegetables during the pandemic compared to before. Women have a higher tendency to increase their snacking in response to negative affect [67, 68] which is suggested to have increased during the pandemic [69]. Therefore, females may be more responsive to COVID-related stressors, resulting in increased snacking. Research showed that men were more likely to adhere to a Mediterranean diet, including intake of fruit and vegetables, during the pandemic compared to women which supports the current findings.
Individuals with no higher education, compared to those with higher education, were found to increase snack consumption during the pandemic. Human capital theory indicates that education increases income [70], suggesting individuals with lower education levels likely have lower income. Considering the financial impact of the pandemic, less socioeconomically advantaged individuals may be more likely to prioritise foods with longer shelf lives including snacks [49]. Likewise, these disadvantaged individuals may be more likely to experience COVID-19-related stress due to financial insecurity [71] which may encourage emotional eating and a preference for HFSS foods [72].
Health-related and COVID-19-related variables were also associated with increased snacking amongst individuals LWBC during the pandemic. Shielding and limited social contact were associated with increased snacking during the pandemic, compared to before. These individuals are likely experiencing higher levels of social isolation compared to others [73]. Various periods of isolation can have long-term effects on health, including psychiatric symptoms [74]. Psychiatric symptoms have been associated with emotional eating which contributes to snack intake [75]. Individuals with worse sleep also consumed more snacks during the pandemic which is supported by a plethora of research highlighting that insufficient sleep increases snacking [23].
Reduced alcohol consumption was predicted by various health-related and COVID-19-related factors. Individuals with poorer mental health consumed less alcohol during the pandemic compared to before. Research usually observes the opposite, with poorer mental health predicting increases in alcohol consumption [76]. Perhaps individuals with poorer mental health may be less likely to be drinking socially compared to those with better mental health during the pandemic. More research is necessary to understand this association. Individuals with poorer sleep quality consumed less alcohol during the pandemic. Research commonly finds an association between worse sleep quality and increased alcohol consumption [77]. However, these individuals may have tried to rectify their poor sleep during the pandemic by reducing their alcohol intake. This potential explanation warrants further longitudinal exploration. Finally, individuals with regular social contact consumed less alcohol during the pandemic. More frequent social contact during the pandemic was associated with lower anxiety [78] which may lead to reduced alcohol consumption. Therefore, stress-related mental health may be a mediator between social contact and alcohol consumption.
To our knowledge, this is the first paper to prospectively investigate the dietary changes amongst individuals LWBC during the COVID-19 pandemic. A strength of the current study is the larger sample size compared to previous similar research which provides greater power to detect differences. The longitudinal design also allows the tracking of behaviour change over time, allowing behavioural patterns and determinants to be identified.
Nonetheless, the findings should be viewed in the context of several limitations. The sample may not be representative of the target population as some subgroups may have been unequally represented. The subgroup analyses comparing participants that were excluded and included in the sample demonstrated differences in age, ethnicity, and education. These differences increase the likelihood of selection bias and question the generalisability of the findings. Considering the outcome measures were self-reported and the sensitive nature of several measurements collected, including mental health, the research may be subject to self-report bias or social desirability bias. Furthermore, as we included only one pre-pandemic timepoint, we cannot determine whether the effects observed were a response to the pandemic or due to a pre-existing behavioural trend. Finally, whilst the changes in dietary intake are statistically significant, this may not translate into practical or clinical significance considering the portion changes are small.
The current results have potential implications for both individuals LWBC and the general population by providing a more detailed understanding of the potential risk factors for dietary change during the pandemic. Specifically, the findings may suggest a need for more targeted interventions post-COVID based on the risk factors identified. This could allow resources to be prioritised amongst these groups to prevent or reduce any further negative impact of the pandemic. In particular, considering the impact of the pandemic on social contact and the suggested greater risk of less healthy dietary changes for the more socially isolated individuals, interventions that promote social support and social contact amongst those LWBC may be important, for example encouraging in-person or online group support sessions for individuals LWBC that perhaps focus on dietary behaviour change.
To conclude, this study suggests that individuals living with and beyond cancer may have decreased their fruit, vegetable, and alcohol intake and increased their snack intake in response to COVID-19. These changes appear to be different based on sociodemographic, health-related, and COVID-19-related factors, which suggests that the pandemic has not equally impacted everyone. Future research should focus on understanding the potential mediators explaining the observed associations to better understand the pathways to unhealthy dietary change.
Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L et al (2020) Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 7:547–560
López-Bueno R, Calatayud J, Casaña J, Casajús JA, Smith L, Tully MA et al (2020) COVID-19 confinement and health risk behaviors in Spain. Front Psychol 11:1426
Naughton F, Ward E, Khondoker M, Belderson P, Marie Minihane A, Dainty J et al (2021) Health behaviour change during the UK COVID-19 lockdown: findings from the first wave of the C-19 health behaviour and well-being daily tracker study. Br J Health Psychol 26:624–643
Bremner J, Moazzami K, Wittbrodt M, Nye J, Lima B, Gillespie C et al (2020) Diet, stress and mental health. Nutrients 12:2428
Mattioli AV, Sciomer S, Cocchi C, Maffei S, Gallina S (2020) Quarantine during COVID-19 outbreak: changes in diet and physical activity increase the risk of cardiovascular disease. Nutr Metab Cardiovasc Dis 30:1409–1417
Murphy B, Benson T, McCloat A, Mooney E, Elliott C, Dean M et al (2020) Changes in consumers’ food practices during the COVID-19 lockdown, implications for diet quality and the food system: a cross-continental comparison. Nutrients 13:20
de Oliveira Campos P, de Mélo LB, de Souza JCV, de Santana PN, Matte J, da Costa MF (2022) Consumer fear and healthy eating during COVID-19 pandemic. MIP 40:227–41
Górnicka M, Drywień ME, Zielinska MA, Hamułka J (2020) Dietary and lifestyle changes during COVID-19 and the subsequent lockdowns among Polish adults: a cross-sectional online survey PLifeCOVID-19 Study. Nutrients 12:2324
Reyes-Olavarría D, Latorre-Román PÁ, Guzmán-Guzmán IP, Jerez-Mayorga D, Caamaño-Navarrete F, Delgado-Floody P (2020) Positive and negative changes in food habits, physical activity patterns, and weight status during COVID-19 confinement: associated factors in the Chilean population. IJERPH 17:5431
Wang X, Lei SM, Le S, Yang Y, Zhang B, Yao W et al (2020) Bidirectional influence of the COVID-19 pandemic lockdowns on health behaviors and quality of life among Chinese adults. IJERPH 17:5575
Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G et al (2020) Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med 18:229
Luo Y, Chen L, Xu F, Gao X, Han D, Na L (2021) Investigation on knowledge, attitudes and practices about food safety and nutrition in the China during the epidemic of corona virus disease 2019. Public Health Nutr 24:267–274
Rodríguez-Pérez C, Molina-Montes E, Verardo V, Artacho R, García-Villanova B, Guerra-Hernández EJ et al (2020) Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet Study. Nutrients 12:1730
Shimpo M, Akamatsu R, Kojima Y, Yokoyama T, Okuhara T, Chiba T (2021) Factors associated with dietary change since the outbreak of COVID-19 in Japan. Nutrients 13:2039
Thorpe MG, Milte CM, Crawford D, McNaughton SA (2019) Education and lifestyle predict change in dietary patterns and diet quality of adults 55 years and over. Nutr J 18:67
Variyam JN, Blaylock J, Smallwood DM (1996) Modelling nutrition knowledge, attitudes, and diet-disease awareness: the case of dietary fibre. Statist Med 15:23–35
Vozoris N, Davis B, Tarasuk V (2002) The affordability of a nutritious diet for households on welfare in Toronto. Can J Public Health 93:36–40
Poelman MP, Gillebaart M, Schlinkert C, Dijkstra SC, Derksen E, Mensink F et al (2021) Eating behavior and food purchases during the COVID-19 lockdown: a cross-sectional study among adults in the Netherlands. Appetite 157:105002
Deschasaux-Tanguy M, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Allès B, Andreeva VA et al (2020) Diet and physical activity during the COVID-19 lockdown period (March-May 2020): results from the French NutriNet-Santé cohort study [Internet]. Nutrition. Available from: http://medrxiv.org/lookup/doi/10.1101/2020.06.04.20121855. Accessed 6 Sep 2022
Poobalan AS, Aucott LS, Precious E, Crombie IK, Smith WCS (2009) Weight loss interventions in young people (18 to 25 year olds): a systematic review: weight loss interventions in young people. Obes Rev 11:580–592
Sharkey T, Whatnall MC, Hutchesson MJ, Haslam RL, Bezzina A, Collins CE et al (2020) Effectiveness of gender-targeted versus gender-neutral interventions aimed at improving dietary intake, physical activity and/or overweight/obesity in young adults (aged 17–35 years): a systematic review and meta-analysis. Nutr J 19:78
Bann D, Villadsen A, Maddock J, Hughes A, Ploubidis GB, Silverwood R et al (2021) Changes in the behavioural determinants of health during the COVID-19 pandemic: gender, socioeconomic and ethnic inequalities in five British cohort studies. J Epidemiol Community Health 75:1136–1142
Chaput J-P (2014) Sleep patterns, diet quality and energy balance. Physiol Behav 134:86–91
Gibson-Smith D, Bot M, Brouwer IA, Visser M, Penninx BWJH (2018) Diet quality in persons with and without depressive and anxiety disorders. J Psychiatr Res 106:1–7
Khubchandani J, Kandiah J, Saiki D (2020) The COVID-19 Pandemic, stress, and eating practices in the United States. Eur J Investig Health, Psychol Educ 10:950–956
O’Regan D, Jackson ML, Young AH, Rosenzweig I (2021) Understanding the impact of the COVID-19 pandemic, lockdowns and social isolation on sleep quality. Nat Sci Sleep 13:2053–2064
Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A et al (2020) Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry 7:883–892
Bloom I, Edwards M, Jameson KA, Syddall HE, Dennison E, Gale CR et al (2017) Influences on diet quality in older age: the importance of social factors. Age Ageing 46:277–283
Bloom I, Lawrence W, Barker M, Baird J, Dennison E, Sayer AA et al (2017) What influences diet quality in older people? A qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study. UK Public Health Nutr 20:2685–2693
Kalousova L (2014) Social isolation as a risk factor for inadequate diet of older Eastern Europeans. Int J Public Health 59:707–714
Holt-Lunstad J (2021) A pandemic of social isolation? World Psychiatry 20:55–56
Macmillan Cancer Support. Cancer in numbers - facts and figures [Internet] (2015). Available from: https://www.macmillan.org.uk/_images/cancer-statistics-factsheet_tcm9-260514.pdf. Accessed 6 Sep 2022
Zhang Y-B, Pan X-F, Chen J, Cao A, Zhang Y-G, Xia L et al (2020) Combined lifestyle factors, incident cancer, and cancer mortality: a systematic review and meta-analysis of prospective cohort studies. Br J Cancer 122:1085–1093
Pinto BM, Trunzo JJ (2005) Health behaviors during and after a cancer diagnosis. Cancer 104:2614–2623
Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM et al (2003) Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav 27:246–56
Tan SY, Wong HY, Vardy JL (2021) Do cancer survivors change their diet after cancer diagnosis? Support Care Cancer 29:6921–6927
Castro-Espin C, Agudo A (2022) The role of diet in prognosis among cancer survivors: a systematic review and meta-analysis of dietary patterns and diet interventions. Nutrients 14(2):348. Available from: https://www.mdpi.com/2072-6643/14/2/348. Accessed 6 Sep 2022
McMillan DC (2013) The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 39:534–540
George SM, Neuhouser ML, Mayne ST, Irwin ML, Albanes D, Gail MH et al (2010) Postdiagnosis diet quality is inversely related to a biomarker of inflammation among breast cancer survivors. Cancer Epidemiol Biomark Prev 19:2220–2228
Beeken RJ, Croker H, Heinrich M, Smith L, Williams K, Hackshaw A et al (2016) Study protocol for a randomised controlled trial of brief, habit-based, lifestyle advice for cancer survivors: exploring behavioural outcomes for the Advancing Survivorship Cancer Outcomes Trial (ASCOT). BMJ Open 6:e011646
Cappuccio FP, Rink E, Perkins-Porras L, McKay C, Hilton S, Steptoe A (2003) Estimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers. Nutr Metab Cardiovasc Dis 13:12–19
Steptoe A (2003) Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. BMJ 326:855–855
Roe L, Strong C, Whiteside C, Neil A, Mant D (1994) Dietary intervention in primary care: validity of the DINE method for diet assessment. Fam Pract 11:375–381
Balestroni G, Bertolotti G (2015) EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch Chest Dis 78(3):155–9. https://doi.org/10.4081/monaldi.2012.121. Accessed 6 Sep 2022
Pickard AS, Wilke CT, Lin H-W, Lloyd A (2007) Health utilities using the EQ-5D in studies of cancer. PharmacoEconomics 25:365–84
Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med 12:439–445
Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh sleep quality index in cancer patients. J Pain Symptom Manage 27:140–148
Bennett G, Young E, Butler I, Coe S (2021) The impact of lockdown during the COVID-19 outbreak on dietary habits in various population groups: a scoping review. Front Nutr 8:626432
Revoredo-Giha C, Russo C, Twum EK (2022) Purchases of fruit and vegetables for at home consumption during COVID-19 in the UK: trends and determinants. Front Nutr 9:847996
Yuen KF, Wang X, Ma F, Li KX (2020) The psychological causes of panic buying following a health crisis. IJERPH 17:3513
Naeem M (2021) The role of social media to generate social proof as engaged society for stockpiling behaviour of customers during Covid-19 pandemic. QMR 24:281–301
Bell DNF, Blanchflower DG (2020) US and UK labour markets before and during the COVID-19 crash. NIER 252:R52-69
Mayhew K, Anand P (2020) COVID-19 and the UK labour market. Oxf Rev Econ Policy 36:S215–S224
Chapman K, Goldsbury D, Watson W, Havill M, Wellard L, Hughes C et al (2017) Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption. Appetite 113:310–319
Islam JY, Vidot DC, Camacho-Rivera M (2021) Evaluating mental health–related symptoms among cancer survivors during the COVID-19 pandemic: an analysis of the COVID Impact Survey. JCO Oncol Pract 17:e1258–e1269
Shin Y, Kim Y (2019) Association between psychosocial stress and cardiovascular disease in relation to low consumption of fruit and vegetables in middle-aged men. Nutrients 11:1915
Gardiner CK, Hagerty SL, Bryan AD (2021) Stress and number of servings of fruit and vegetables consumed: buffering effects of monetary incentives. J Health Psychol 26:1757–1763
Schelleman-Offermans K, Kuntsche E, Knibbe RA (2011) Associations between drinking motives and changes in adolescents’ alcohol consumption: a full cross-lagged panel study: motives and alcohol use: a cross-lagged model. Addiction 106:1270–1278
Coulthard H, Sharps M, Cunliffe L, van den Tol A (2021) Eating in the lockdown during the Covid 19 pandemic; self-reported changes in eating behaviour, and associations with BMI, eating style, coping and health anxiety. Appetite 161:105082
Zhang X, Chen B, Jia P, Han J (2021) Locked on salt? Excessive consumption of high-sodium foods during COVID-19 presents an underappreciated public health risk: a review. Environ Chem Lett 19:3583–3595
Bhutani S, vanDellen MR, Cooper JA (2021) Longitudinal weight gain and related risk behaviors during the COVID-19 pandemic in adults in the US. Nutrients 13:671
Salazar-Fernández C, Palet D, Haeger PA, Román MF (2021) The perceived impact of COVID-19 on comfort food consumption over time: the mediational role of emotional distress. Nutrients 13:1910
Natalucci V, Villarini M, Emili R, Acito M, Vallorani L, Barbieri E et al (2021) Special attention to physical activity in breast cancer patients during the first wave of COVID-19 pandemic in Italy: the DianaWeb Cohort. JPM 11:381
Parekh N, Deierlein AL (2020) Health behaviours during the coronavirus disease 2019 pandemic: implications for obesity. Public Health Nutr 23:3121–3125
Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA et al (2021) Alcohol and other substance use during the COVID-19 pandemic: a systematic review. Drug Alcohol Depend 229:109150
Shi Z, Rundle A, Genkinger JM, Cheung YK, Ergas IJ, Roh JM et al (2020) Distinct trajectories of fruits and vegetables, dietary fat, and alcohol intake following a breast cancer diagnosis: the Pathways Study. Breast Cancer Res Treat 179:229–240
Dubé L, LeBel JL, Lu J (2005) Affect asymmetry and comfort food consumption. Physiol Behav 86:559–567
Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora D et al (2006) Food selection changes under stress. Physiol Behav 87:789–793
Santos E, Ratten V, Diogo A, Tavares F (2021) Positive and negative affect during the COVID-19 pandemic quarantine in Portugal. J Sci Technol Policy Manag 13:195–212
Yang J, Qiu M (2016) The impact of education on income inequality and intergenerational mobility. China Econ Rev 37:110–125
Claes N, Smeding A, Carré A (2021) Mental health inequalities during COVID-19 outbreak: the role of financial insecurity and attentional control. Psychol Belg 61:327–340
Roemmich JN, Lambiase MJ, Balantekin KN, Feda DM, Dorn J (2014) Stress, behavior, and biology: risk factors for cardiovascular diseases in youth. Exerc Sport Sci Rev 42:145–152
Sayin Kasar K, Karaman E (2021) Life in lockdown: social isolation, loneliness and quality of life in the elderly during the COVID-19 pandemic: a scoping review. Geriatr Nurs 42:1222–1229
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N et al (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395:912–920
Kaplan HI, Kaplan HS (1957) The psychosomatic concept of obesity. J Nerv Ment Dis 125:181–201
Murphy JG, Yurasek AM, Dennhardt AA, Skidmore JR, McDevitt-Murphy ME, MacKillop J et al (2013) Symptoms of depression and PTSD are associated with elevated alcohol demand. Drug Alcohol Depend 127:129–136
Hasler BP, Pedersen SL (2020) Sleep and circadian risk factors for alcohol problems: a brief overview and proposed mechanisms. Curr Opin Psychol 34:57–62
Shattuck SM, Kaba D, Zhou AN, Polenick CA (2022) Social contact, emotional support, and anxiety during the COVID-19 pandemic among older adults with chronic conditions. Clin Gerontol 45:36–44
Funding
Katie Taylor is funded by the ESRC-BBSRC Soc-B Centre for Doctoral Training (Grant ref: ES/P000347/1). ASCOT was funded by Cancer Research UK (grant numbers C43975/A27498, C1418/A14133).
Author information
Authors and Affiliations
Contributions
Katie Taylor and Phillippa Lally designed the study. Phillippa Lally, Rebecca Beeken, and Abigail Fisher designed the COVID-19 follow-up survey. Phillippa Lally and Katie Taylor performed data collection for the COVID-19 follow-up survey. Katie Taylor conducted the statistical analyses under the supervision of Phillippa Lally, Rebecca Beeken, and Abigail Fisher. All authors provided substantial scientific input in interpreting the results and drafting the manuscript. Phillippa Lally, Rebecca Beeken, and Abigail Fisher supervised the study. Abigail Fisher and Rebecca Beeken are principal investigators for the ASCOT trial.
Corresponding author
Ethics declarations
Ethics approval
Ethical approval was obtained through the National Research Ethics Service Committee South Central – Oxford B (reference: 14/SC/1369). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Taylor, K.S., Beeken, R.J., Fisher, A. et al. Did the COVID-19 pandemic impact the dietary intake of individuals living with and beyond breast, prostate, and colorectal cancer and who were most likely to experience change?. Support Care Cancer 31, 585 (2023). https://doi.org/10.1007/s00520-023-08032-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00520-023-08032-7