Impacts on dietary habits and health of Indian population during COVID-19 lockdown

.


Introduction
Good diet is an important part of leading a healthy lifestyle.Combined with physical activity, diet can help to reach and maintain a healthy weight and promote your overall health.CoViD-19, is a severe acute respiratory syndrome caused by SARS coronavirus 2 (SARS-CoV-2).In December 2019 from Huanan seafood market Wuhan City of Hubei, Province of China SARS-CoV-2 transit from animals to humans, and spread to the rest of the world [1 ].On the 30 January 2020, due to the growing infection rates at Chinese and international locations the WHO Emergency Committee declared a global health emergency [2].
In India, in the state of Kerala on 30 January 2020 the first confirmed COVID-19 case was reported (WHO 2020a) and 22 new cases were recognized on 4 March 2020 due to spread to the other parts of the country.On 12 March 2020, the COVID-19 first death was reported in India (WHO 2020a).On 22 March 2020, prime minister of India announced 14 hours' public curfew.To handle the worsening of pandemic in country on 24 March 2020, the prime minister suddenly ordered a complete nationwide lockdown for 21 days (https://www.mha.gov.in/).During the sudden lockdown in India, all places of public gatherings such as schools, cinemas, restaurants, shopping complexes, higher educational institutions were closed.To avoid crowds and control the spread of CoViD19 employees and students were being asked to work from home.All types of transportation services, including rail, road and air, were suspended with exceptions for essential services were closed.
In particular, after almost 4 months of lockdown, India is the third world's worst-affected country in the CoViD- 19 pandemic [4].Due to sudden lockdown various changes has occurred in the habits and lifestyles of the public, with a complete reduction of any form of socialization.Physical distancing and self-isolation strongly impacted people lives, affecting in particular eating habits and everyday behaviors.
Further, the disturbance of the routine work caused by the lockdown could result in monotonous life style that leads to consumption of higher calories [6].Moreover watching television and reading social media news of adverse situation due to lockdown leading increases stress and consecutively increases overeating of readily available food that rich in sugar such as chocolates and biscuits [7,8].
These ready to eat food are rich in carbohydrates, thus tiger enhance happy hormone serotonin production [9].Thus higher consumption of rich in sugar and fat foods associated with the health complication like hypertension and cardiovascular diseases, obesity, diabetes which leading to risk factor in COVID-19 completion [10,11].
The limited access to daily groceries may lead to reduce the consumption of fresh foods, especially fruit, vegetables and meat or fish, only the highly processed food available such as, junk foods, snacks, and ready-to-eat cereals, which tend to be high in fats, sugars, and salt.This crisis leading to change emotional responses of individual that a negative effect in human psychology [12,13], the availability also changes human food habit leading to stress eating or "emotional eating" [14,15].Quarantine and self isolation even changes people satiety and hunger, hence leading overeating [16,17].
In order to prevent the transmission of virus and maintained all containment measures this "Lockdown" was introduces.But this lockdown led to crisis of work and resources.This crisis was adversely affecting sedentary behaviors of individual; it does modify in smoking and sleeping habits.Sleep disturbances and food habit changes the circadian rhythm in most of us [19,20].In a study it was proven that good Mediterranean diet (MD) and good sleep lower body mass index (BMI) in middle-aged adults [21].
In addition smoking have a significant association with SARS-CoV-2 infection, unlike air pollution, and thus smokers shows severe COVID-19 symptoms [22].Eating habits and lifestyle modification effect our health and taking correct nutrition not at only choice but depends on finical status is crucial, in one side migrant labour and worker can't afford good food.But in the same tine booting immune system is time in need.The Ministry of AYUSH gives guideline to boot immunity by incorporation of specific vegetables, herbs and spices in daily diet [23].As the overweight people and obese people are in high risk if infected with COVID-19 and can develop secondary complication [24].The produces cytokines and proinflammatory milieu observed in adipose tissue, of obsess people which one of the risk factor in viral infection [25].Moreover, patients with high abdominal fat have constricted pulmonary physiology thus facing more difficult ventilation thus increase complication after respiratory viral infection [26].Participants have presented their response in order to compare their overall health before and during pandemics.Few participants (2) said that their overall health downgrades due to pandemics, while most of participants (24) agreed their physical health became poor rather than good or fair.

Result and discussion
The life quality of the participants (3) also decreased and became poor while 4 participants faced very poor mental health during pandemic.
The sleeping of the participants also disturbed during pandemic.
People were sleeping very less before but during pandemic participants observed they are Whereas 34% participants had reported less appetite during pandemic.22 % participants described rarely physical activity during pandemic that includes walking, running or yoga.4 % participants notify their alcohol consumption been raised during pandemic.10% participants said they are during less than 1 liter every day.While 37% participants said their skipping breakfast behavior during pandemic.The participants craving, leftover food eating and food ordering percentage is illustrated in figure 6. 27 % participants reported they often crave for food, while 20 % participants said they use to eat leftover food during pandemic.Among 100 participants 58% females and 42% males taken part.10% and 24% participants reported that they are facing under or over weight problem respectively.Whereas, 10% participants observed food quality is getting worse.29% participants denoted that their food quality has reached worst level during pandemic.
Food use in everyday life by participants during pandemic is listed in figure 9.In average 32 participants mental health was very good before lockdown, however 32 participants also have good mental health during the lockdown.In overall study of mental health of the participants seems to be become poor during the lockdown this is may be due to monotonous lifestyle.

Sleeping Habits
The sleeping time (Fig. 3-A) of 70% participants was average of 5-8hrs before lockdown.But during lockdown 31% participant sleeping hours increase more than 8hrs.This may be because most of the participant in this study population are teacher and students, due to lockdown office and education institute are closed thus due to less workload people get more time to sleep.

Smoking Habits
It was observed that the smoking habit in this study population is very less on most of them are nonsmoker.The pandemic situation makes people more health aware and smoker become non-smoker during this lockdown (Fig. 3-B) and around 90% are become non-smoker during lockdown.

Overall Lifestyle Study: Food Habit, Body Weight, Physical Activities
In Fig. 4 (A) the weight gain of the participants were studies.It was observed that 33% participant loss weight during the lockdown, 30% participant does not lose or gain weight, only 11% participant gain weight.It might be because the people eat homemade healthy food thus most of them either loss weight or weight remain same.
In the study of Sense of hunger and satiety in Fig. 4 (B), 46% participant observed no change, 30% participant observed less appetite.This might be because the food and meal were taken in time thus they do not observe any change.Only 20% observed more appetite, might be those people stay outside and due to lockdown came to home and thus homemade food be more delicious to them.In the study of physical activities during the lockdown in Fig. 4(C), it was observed a discrete distribution of date where 28% participant do physical activities everyday and the same 28% of participant do physical activities few times in a week.In contrast 22% of participants rarely or never do physical activities.However, 12% and 10% do physical activities few times or once in a week respectively.This discrete data was observed may be because the age group of the participant are variety in nature.
The study of alcohol consumption in a week in Fig. 4 (D), it was observed that 52% of participant's lockdown does not have any effect and their alcohol intake do not change.This might be because most of the participants are students; they are not in the habit of alcohol consumption.However, 44% participant's alcohol consumption decreases this is might be because of non availability.Only 4% showed increase in alcohol consumption this might be due to stress.
Water drinking study during pandemic in Fig. 4 (E), it was observed that most of the participants 47% drink more than 3liters of water in a day, in average 1-2liters of water drink by 43% participants and only 10% of participants drink less then 1liter of water.
The study of skipping meal in Fig. 4 (F), it was observed that most of the people (34%) during lockdown skip breakfast, where as 37% people does not skip any meal, 20% skip snacks this might be because homemade lunch and dinner is sufficient for fulfill the hunger.Only 6% and 3% people skip lunch and dinner respectively.

Beverage and Non-vegetarian food consume during Lockdown (Dairy, Carbonated drink, Tea/Coffee and Fish/Meat)
The participant's food choice for dairy products was study in Fig. 5 (A), it was observed 43% people used dairy product more during lockdown, this might be it was easy available for them.However, 31% people dairy product consumption reduces, on the other hand 26% people dairy product consumption remain as it is.Dairy is one of the essential commodity thus during lockdown the supply of such product still available.
The study on the intake of carbonated drink in Fig. 5 (B), as the available was less thus it was observed that 60% people consume less carbonated drink.Only 8% people carbonated drink consumption increases, where as 32% people observe no change.
The study on the consumption of tea and coffee in Fig. 5 (C), it was observed that 45% people show increase in consumption, 30% show no change and 25% consumption become less.
The study on non-vegetarian food preference of the consumer in Fig. 5 (D), due to less availability of fresh fish/meat the consumption of 40% people is reduces, 35% observed no changes and 25% fish/meat consumption increases.The study pastries made by the participants in Fig. 9 (G).It was observed 57% make less homemade pastries, 39% observed no changes and 4% it increases.This might be because less availability of ingredient.Similar response observed in homemade piazza Fig. 9 (H); it was observed 55% less consumption of homemade piazza, 38% observed no changes and only 7% it increases.

Conclusion
Total 100 people from 16 different states has taken participated given the answer from 31 different questions and shared their pandemics experience regarding diet and health issue.The overall health was categorized into physical and mental health in that participants share their response based upon before and during pandemic situation.It was noticed that participated life quality and mental health response was not so good during pandemics, where as participants order less food from outside and almost stop going out.This condition leads to develop mental health issue to few participant didn't feel good about it.
In few cases the sleeping nature also observed disturbed, while few participants getting anxiety and stress during pandemic.Few participates crave for non vegetarian food item more since it was not easily available.Few participants observe their eating habit changed and not feeling to eating as usual, while most of people still skipping their food routine.These patterns indicated that the diet of many participants has changed or disturb due to pandemics that affects their overall heath including mental health.One good thing was notice participant having food with the family and eating homemade food during pandemics.
What does this study adds to knowledge ?
The existing knowledge includes the study done in Italy on lifestyle of European people.But the present study is done Indian people, that highlight the uncertain lockdown affect on Indian people lifestyle.The food habit and food preparing pattern of Asian people is quite different then European people.In India the COVID scenario is far more different than other countries as reporting a first COVID19 case Govt.certainly announce complete lockdown that leads a huge problem for daily worker.As a result, lots of people lost job and consequently leading an economic and mental crisis.
Kumar RR. et al: Impacts on dietary habits and health of Indian Public Health Review -International Journal of Public Health Research 2020;7(6) Methodology Objective of the Survey: This survey research study aimed to assess the impact of lockdown on individuals' daily habits such as sleep/got up, social media use, work from home and more selected variables.It was also intended to measure the adjustment made by people about the crisis and how they are maintaining their daily routine.Study Method: Questionnaire (Online) Sampling technique: Probability sampling-Simple random sampling Sample Size: 100 Study population Ethical Permission: Informed all participants about the survey study to be used for publishing Study tool: A self-prepared semi structured anonymous questionnaire was used to record the responses of participants.The questionnaire was prepared after the literature review, focus group discussion and current news information in consultation with experts from different fields to check relevance and make necessary changes according to our study requirements

Figure 1 :
Figure 1: Age of the Participants Total 100 People from 4 different age group were participated this online questionnaire and submitted their response.

Figure 2 :
Figure 2: (A) Overall Health (B) Physical heath (C) Life quality (D) Mental Health participants before and during pandemic

Figure 3 :
Figure 3: (A) Sleeping (B) Smoking Response of participants before and during pandemic

Figure 7 :
Figure 7: Craving, Leftover food, Food order consumption response during pandemics

Figure 8 :
Figure 8: (A) Eating habit (B) Food quality (C) Gender (D) weight of the participants during pandemic recorded

Figure 9 :
Figure 9: Food consumption response during pandemics Kumar RR. et al: Impacts on dietary habits and health of Indian Public Health Review -International Journal of Public Health Research 2020;7(6)