Monday, March 1, 2021

Nutrition disparities during the COVID-19 pandemic

 - Jennifer Middleton, MD, MPH

A large, multi-year study of nutrition habits in France is yielding interesting findings during the COVID-19 pandemic. Behaviors related to nutrition are no exception to the deep-seated health inequities COVID-19 continues to expose.

The Nutri-Net Sante study began in 2009. Study researchers monitor participants using a sophisticated online survey:

[D]ietary intakes are assessed every 6 months as part of the usual cohort follow-up using three non-consecutive 24 [hour] dietary records randomly assigned over two weeks and including two weekdays and one weekend day. These web-based 24 [hour] dietary records have been validated against dietary records filled during an interview with a dietitian and against biomarkers.

In April 2020, during France's nationwide lockdown, the researchers collected data from participants regarding changes in lifestyle habits. While some participants increased their snacking frequency (an otherwise rarity in French culture) and decreased their physical activity, others instead increased their home cooking of nutritious meals and increased their physical activity. The less healthy behaviors correlated with lower socio-economic status (SES), while the more healthy behaviors correlated with higher SES.

Although these findings have yet to be formally peer-reviewed and published, they are consistent with similar studies across the globe (ItalyPolandChinaLatin America). The Centers for Disease Control and Prevention (CDC) recommends "good nutrition" to build resilience during the pandemic; they acknowledge, however, that achieving this aim is challenging for many by also listing resources regarding food insecurity. Google searches related to food insecurity ("food bank," "free food") have increased world-wide since March 2020. "The health disparities in nutrition and obesity correlate closely with the alarming racial and ethnic disparities related to Covid-19.

During the COVID-19 pandemic, it's more critical than ever that we systematically and universally screen our patients for food insecurity along with other social determinants of health. Several simple screening tools exist, including the AAFP's EveryONE Project's Social Needs Screening Tool. The EveryONE Project website also includes guidance for connecting patients with community resources. This 2018 AFP editorial on "Food Insecurity: How You Can Help Your Patients" also includes a comprehensive list of online tools and resources. 

Post-pandemic, we must support improvements in our social environment that will mitigate long-standing racial biases and provide equitable health for all; this equity cannot be achieved without access to affordable and high-quality nutrition for all persons. The COVID-19 pandemic is a powerful reminder that efforts to improve our patients' health and well-being will always be incomplete if we confine them to the interiors of hospitals, health centers, and physicians' offices.