Immunity and COVID

The COVID-19 pandemic has created a state of emergency throughout the world. To stop the spread of infection, restrictions in movement, social distancing, closure of schools and colleges, work from home has largely impacted the daily lifestyle and eating habits of families throughout. 

The key to remaining protected from this COVID-19 infection is to have strong immunity, which comes with a balanced and nutritious diet. But, the ongoing restrictions and social lockdown have created stressful situations, poor mental health due to isolation, fear, anxiety which has given rise to more domestic violence, drinking and poorer eating habits. Children are the worst hit.^1,2,3

Lockdown has resulted in a reduction in physical activity which also affects food intake and eating habits. Obesity has increased, which has also increased the risk of COVID-19 complications. Studies state that stress has been linked to unhealthy eating habits with more interest in food having high energy, fats salts and sugars, which are the cause of so many diseases.⁴

Low physical activity levels have been suggested to interact both with body fat and appetite dysregulation⁵. Obesity enhances the production of cytokines, contributes to a proinflammatory milieu, decreases the expiratory reserve volume, functional capacity and respiratory system compliance and makes ventilation more difficult. Inflammation is responsible for severity in COVID-19, leading to cytokine storm associated with acute respiratory distress syndrome and multiple organ failure⁶. Also, healthy food influences the gene expression levels of all the cytokines and is capable of modulating the processes of inflammation and oxidative stress⁷.

In a study from Brazil, 589 children and 720 adolescents were surveyed during the lockdown period. It showed that isolated families had healthy eating habits containing raw salad, vegetables, beans and soft drinks and salad, vegetables, beans and soft drinks compared to Lower-class isolated families.¹

Further children consumed regularly all the meals (p < 0.001) as compared to adolescents, who frequently opted for snacks rather than whole meals (p < 0.001). The study also revealed in isolated families both children and adolescents consumed breakfast more regularly than other meals, which was a good sign as breakfast is the most neglected by school-age children and adolescents, but is more essential for overall mental and physical health..^8,9

In Jordan, another study was carried out comprising of 477 children and adolescents between 6-17 years of age which involved a validated questionnaire. The study concluded that after lockdown, there was a significant increase (P < 0.001) in the mean body weight and body mass index for age Z-scores (BAZ) compared with before the lockdown. Sedentary Lifestyle and less physical activity was the reason as more than 50% of participants were reported to spend more than 3hrs spending time either watching TV, playing videos or some other screens or involved in using some gadgets during the lockdown. Further, food consumption also increased during the lockdown as compared to before the lockdown.¹⁰

In India, due to the lockdown of the Supplementary Nutrition Programme (SNP) under Anganwadi Services (erstwhile Integrated Child Development Services - ICDS) and Unfortunately, COVID-19 has increased the risk factors for child malnutrition in India. With the disruption of Anganwadi services and Mid-Day Meal (MDM) are two large-scale programmes delivering food entitlements to children in India both services were disrupted extensively. Though few states provided home delivery of dry ration for children, consistency was hampered due to many gaps and irregularities in implementation. Some organizations such as UNICEF in Odisha reported that a young child the lockdown severely affected and disturbed the nutrition levels of children in Odishas tribal-dominated belt. In rural Rajasthan, a survey of 1000 children from tribal migrant families reported that child malnutrition had increased from 68 per cent to 76 per cent during COVID-19.¹¹

Overall, the COVID-19 has adversely affected the dietary and nutrition needs of children, increasing inactivity, obesity and risk of getting infected due to the reduced immunity.

References

1. Michelle Teixeira Teixeira, R. S. V., Julia Holandino da Silva, Letícia Martins Raposo, Luana Azevedo de Aquino, Simone Augusta Ribas. Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation, J Hum Nutr Diet. 2021, 1-9.
2. Jacka, F. N., Pasco, J. A., Mykletun, A., Williams, L. J., Hodge, A. M., O’Reilly, S. L., et al. Association of Western and traditional diets with depression and anxiety in women. Am. J. Psychiatr. 2010, 167, 305–311. doi: 10.1176/appi.ajp.2009.09060881
3. Pietrobelli, A., Pecoraro, L., Ferruzzi, A., Heo, M., Faith, M., Zoller, T., et al. Effects of COVID-19 lockdown on lifestyle behaviours in children with obesity living in Verona, Itlay: a longitudinal study. 2020, Obesity doi: 10.1002/oby.22861 [Epub ahead of print].
4. Wardle, J., Steptoe, A., Oliver, G., and Lipsey, Z. Stress, dietary restraint, and food intake. J. Psychosom. Res. 2000, 48, 195–202. doi: 10.1016/S0022-3999(00)00076-3
5. Panahi S, Tremblay A. Sedentariness and health: is sedentary behaviour  more than just physical inactivity? Front Public Heal. 2018;6: 258.
6. Muscogiuri G, Pugliese G, Barrea L, Savastano S, Colao A. Obesity: the “Achilles heel” for COVID-19? Metabolism. 2020;108: 154251.
7. Di Renzo L, Gualtieri P, Romano L, Marrone G, Noce A, Pujia A, et al. Role of personalized nutrition in chronic-degenerative diseases. Nutrients. 2019;11(8):1707.
8. Joanne Ingram, G. M. a. C. J. H. Changes in Diet, Sleep, and Physical Activity Are Associated With Differences in Negative Mood During COVID-19 Lockdown. Front. Psychol., 2020, 11:588604. .
9. Weight B, Risk C, Monzani A, Ricotti R, Caputo M, Solito A, et al. A systematic review of the association of skipping factors in children and adolescents. what should we better investigate in the future ? Nutrients. 2019; 11: 1– 23.
10. Al Hourani, H., Alkhatib, B., & Abdullah, M.Impact of COVID-19 Lockdown on Body Weight, Eating Habits, and Physical Activity of Jordanian Children and Adolescents. Disaster Medicine and Public Health Preparedness, Cambridge University Press:  2021; 1-9.
11. Shruti Ambast, P. K. a. S. S. Impact of COVID-19 on Child Nutrition in India: What are thec Budgetary Implications? In Centre for Budget and Governance Accountability (CBGA) and Child Rights and You(CRY): 2021; pp 1-18.