Nutritional Behavior in European Countries during COVID-19 Pandemic—A Review
Abstract
:1. Introduction
2. Methods
3. General Population of Adults
3.1. Central and Eastern European Countries
3.2. Scandinavian Countries
3.3. Western European Countries
4. Specific Populations
5. Limitations and Biases
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Activity | Immune-Mechanism | Dietary Source | |
---|---|---|---|
Zinc | - prevents SARS-CoV-2 invasion and directly suppresses viral replication | - zinc-finger protein ZCCHC3 binds RNA and helps to recognize viral RNA in the host cell by activating retinoic acid-inducible gene-I [20] | Meat, liver, rennet cheese, dark bread, buckwheat, and eggs |
- through RIG-1-like receptors, zinc upregulates the interferon type 1 response, which results in the synthesis of antiviral proteins [21] | |||
- inhibits Viral RNA-dependent RNA polymerase (RdRp) [22] | |||
- upregulates NK cell activity and IL-2 secretion, promoting antiviral immune response [23,24] | |||
- limits oxidative stress and normalizes excessive cytokine release | - stimulates the synthesis of glutathione [25] | ||
- inhibits pro-inflammatory transcription nuclear factor κB (NF-κB) [26] | |||
- inhibits IL-6 production; Zn level correlates positively with IFN-γ [27] | |||
- reduces TNF-α, IL-1β, IL-6, MCP-1, vascular cell adhesion molecule (VCAM), and CRP [28] | |||
- is required for B and Th cell maturation, number, and function | - facilitates antiapoptotic signaling and cell survival in early B-cell development in the bone marrow [29] | ||
- activity of biologically active form of thymulin, which mediates maturation of T helper cells, requires the presence of Zn2+ in its molecule [30,31] | |||
- regulates CD4+/CD8+ T cell count [32] | |||
- reduces oxidative stress, which limits uncontrolled inflammatory response and cytokine release | - maintains the redox balance via superoxide dismutase that contains zinc and copper and affects the expression of glutamate–cysteine ligase [33] - stimulates glutathione biosynthesis [34] | ||
Iron | - iron overload and high ferritin is associated with iron toxicity | - pro-inflammatory IL-6 stimulates ferritin and the synthesis of hepcidin, which leads to intracellular iron excess, oxidative stress, and ferroptosis [35,36] | Heme iron: giblets, meat, and eggs; nonheme iron: parsley, pulses, and dark bread |
- mild to moderate iron deficiency mitigates viral infection | - SARS-CoV-2 is highly dependent on iron, and iron deficiency might be protective from ferroptosis and viral spread [37,38,39] | ||
- iron deficiency negatively affects cell-mediated immunity in children | - iron deficiency in children is related to a reduction in the CD4+ count, decreased CD4:CD8 ratio, and decreased maturation of T cells [40] | ||
Copper | - neutralizes RNA viruses | - causes RNA damage through the generation of lethal hydroxyl radicals [41] - exposure to copper destroys the viral genome via premature virus uncoating and degradation of the exposed vRNA [42,43] - cold-sprayed copper coatings exhibit a virucidal activity [44] | Wheat bran, oat flakes, offal meat (liver), nuts, cocoa, and sunflower seeds |
Selenium | - stimulates cellular and humoral immunity, and innate immune cell functions | - stimulates proliferation of T cells and increases antiviral cytokines like IFN-γ [45] | Offal meat (kidney), shellfish, fish, legume seeds, garlic, and mushrooms |
- increases NK cell cytotoxic effects [45] | |||
- increases the expression of IL-2 receptors on B cells [46] | |||
- exhibits antioxidant effects and limits inflammation | - maintains the redox balance via selenoproteins that contain selenium, mainly glutathione peroxidases (GPx) and thioredoxin reductases [47] - modulates inflammatory responses, limits pulmonary lipid peroxidation and lung injury in patients with ARDS [48] | ||
Magnesium | - possibly prevents SARS-CoV-2 invasion | - possibly inhibits transmembrane protease serine protease 2 (TMPRSS2) and the pre-protein convertase furin, the two enzymes involved in the cleavage of S protein and cellular invasion of SARS-CoV-2 [49] | Cereal products, legume seeds, nuts, cocoa, dark chocolate, rennet cheese, fish, potatoes, bananas, and green vegetables |
- affects innate immunity by preventing excessive release of inflammatory mediators and oxidative stress | - stabilizes the membranes of mast cells; limits the production of reactive oxygen species by neutrophils and macrophages [50] - inhibits the production of pro-inflammatory cytokines and stimulates anti-inflammatory cytokines secretion by inducing the conversion of macrophages from M0 to M2 phenotype [51] | ||
- regulates adaptive immunity | - is necessary for the expression of the natural killer activating receptor (NKG2D) in NK and CD8+ T cells [52] | ||
Vitamin A (Retinol) | - plays a role in maintaining first-line defense | - supports the formation and functional maturation of epithelial cells [53] | In the form of beta carotene: carrot, parsley, pulses, spinach, curly kale, broccoli, apricots, peaches, milk, eggs, and butter. In the form of retinol: offal meat (liver), butter, eggs, sea fish, and rennet cheese |
- affects second-line defense (inflammation) of the innate immunity - affects adaptive immunity | - retinoic acid (RA), a metabolite of Vitamin A, decreases the production of IL-12 and TNF-α by macrophages and increases the level of anti-inflammatory IL-10 [54] | ||
- RA modulates T cell phenotype and mucosal-homing molecules on lymphocytes [54] | |||
- RA modulates the maturation and activity of antigen-presenting cells (APCs) [54] | |||
- RA promotes the generation of Treg cells and suppresses Th17 cells [54] | |||
- enhances Th2 and inhibits Th1 differentiation [54] | |||
- RA promotes the generation of CD8+ effector memory T cells and inhibits central memory CD8+ T cells [54] | |||
- depending on type of antigen stimulation, RA enhances IgG and IgA production [54] | |||
- AM580, a retinoid derivative, demonstrates direct antiviral activities | - AM580 directly inhibits SREBP-related pathways and replication of coronaviruses in host cells [55,56] | ||
Vitamin B1 (Thiamine) | - affects innate immunity as an antioxidant and anti-inflammatory vitamin | - limits mast cell degranulation [57] | Pork, meat preparations, legume seeds, wholegrain products, and nuts |
- in macrophages and microglial cells, it down-regulates the expression of inflammatory prostaglandin E2, thromboxane 2, prostacyclin, leukotrienes, NF-κB, iNOS, COX-2, IL-1, IL-6, TNFα, and increases anti-inflammatory IL-10 [57,58] | |||
- affects adaptive immunity | - as a cofactor for the tricarboxylic acid cycle (TAC), thiamine controls the activity and number of naive B cells in the Peyer’s patches [59] | ||
Vitamin B2 (Riboflavin) | - affects innate immunity as an antioxidant and anti-inflammatory vitamin | - in macrophages, it decreases the formation of pro-inflammatory cytokines IL-1 and TNF-α, high-mobility group box 1 (HMGB1) protein, iNOS, NO, heat shock protein 72, and monocyte chemoattractant protein-1 (MCP-1), and increases the expression of anti-inflammatory IL-10 [57] | Milk, rennet cheese, cottage cheese, eggs, and offal meat |
- inhibits viral replication | - together with UV radiation, damages viral nucleoid acids in MERS-CoV (Middle East Respiratory Syndrom Coronavirus) and SARS-CoV-2 [60,61] | ||
Vitamin B3 (Niacin, vitamin PP) | - affects innate immunity as an anti-inflammatory and antiviral vitamin | - activates nicotinic acid receptor (GPR10) that is present in immune cells (e.g., macrophages), leading to decreased levels of pro-inflammatory cytokines (IL-6, TNF-α), MCP-1, and NF-κB and reduced monocyte chemotaxis [57] - regulates signaling pathways, including the NF-κB, p53, HIF-1 and IL-17, and Th17 cell differentiation [62] | Liver, meat, meat preparations, fish, wholegrain products, and peanuts |
Vitamin B5 (Pantothenic acid) | - affects innate and adaptive immunity | - stabilizes the membranes of mast cells and controls the number of macrophages [63] | Food of animal origin, wholegrain products, dry legume seeds, and milk |
- promotes the generation of INFγ and IL-17 by CD4+ [63] | |||
- inhibits the production of pro-inflammatory IL-6 and TNF-α in acute lung injury [64] | |||
- exhibits paradoxical effect on cytokines | - inhibits neutrophils in producing anti-inflammatory cytokines in early bacterial infection and stimulates them in late infection [63] | ||
Vitamin B6 (Pyridoxine) | - limits cytokine storm and inflammation | - upregulates IL-10 production that inhibits cytokine release by macrophages [65] | Fish, meat (poultry and pork), offal meat (liver), seeds, nuts, brown rice, bananas, dried apricots, potatoes, red pepper, and tomato juice |
- affects B and T cell function | - deficiency of B6 reduces antibody production, IL-2 level, inhibits T cell proliferation, and increases IL-4 levels [57] | ||
Vitamin B9 (Folic acid, folate) | - prevents SARS-CoV-2 invasion | - inhibits furin activity and prevents sequence-specific cleavage of the spike protein into S1 and S2 domains [66] - inhibits S1-glycoprotein/NRP-1 complex formation [67] | Legume seeds, kale, spinach, lettuce, eggs, offal meat (liver), and rennet cheese |
- normalizes excessive cytokine release - affects the number and function of T cells - affects humoral immunity | - inhibits pro-inflammatory transcription nuclear factor κB (NF-κB) [68] | ||
- folate deficiency reduces T cell proliferation and increases the CD4+/CD8+ ratio [68] | |||
- is necessary for the survival and differentiation of Treg cells [68] | |||
- deficiency of folic acid indirectly affects the proper formation of antibodies [68] | |||
Vitamin B12 (Cobalamin) | - prevents SARS-CoV-2 invasion and replication | - inhibits furin activity [69] - possibly inhibits viral replication by suppression of the RNA-dependent-RNA polymerase activity of the SCV2-nsp12 enzyme [70] | Meat, fish, eggs, offal meat, and shellfish |
- regulates cytokine release - affects innate immunity - affects humoral immunity | - deficiency of B12 upregulates the synthesis of TNF-α by macrophages and downregulates IL-6 levels [68] | ||
- supports NK-cell activity [71] | |||
- supports antibody production [71] | |||
- affects T cell count and function | - increases CD8+ cell count, reduces CD4+/CD8+ ratio, and stimulates NK cell activity [72] | ||
Vitamin C (Ascorbic acid) | - affects innate and adaptive immunity | - potentiates differentiation and proliferation of phagocytes and B and T cells [73] | Parsley, black currant, kiwi, red pepper, cabbage vegetables, strawberries, and citrus fruits |
- supports antibody production [73] | |||
- supports the development of NK cells and stimulates their activity [73,74] | |||
- increases the production of IFN-α/β in viral infections [73] | |||
- inhibits pro-inflammatory NFκB pathway and modulates cytokine production [73] | |||
- reduces IFN-γ, TNF-α, and IL-6, and increases anti-inflammatory IL-10 production [73] | |||
- limits oxidative stress | - scavenges reactive oxygen species (superoxide and peroxyl radicals, hydrogen peroxide, and hypochlorous acid) [73] | ||
Vitamin D | - plays a role in maintaining first-line defense | - upregulates genes that encode proteins maintaining membrane integrity [75] | Only 20% of vitamin D in the organism comes from the diet, mainly from fatty fish and eggs |
- stimulates maturation of monocytes and phagocytosis [75] | |||
- affects second-line defense (inflammation) of the innate immunity and limits cytokine storm - affects B and T cells and limits inflammation | - inhibits monocytes to produce pro-inflammatory IL-1α, IL-1β, IL-6, IL-8, IL-12, and TNFα [76] | ||
- suppresses proliferation of B cells and antibody production [77] | |||
- inhibits proliferation of T cells and supports a shift from Th1 to Th2 development, which results in reduced pro-inflammatory cytokines production (IFN-γ, TNF-α, IL-2, and IL-12), and increased formation of anti-inflammatory cytokines (IL-10, IL-4, and IL-5) [77] | |||
- inhibits Th17 cells and formation of IL-6, IL-17, and IL-23 [77,78] | |||
- induces Treg cells [77] | |||
Vitamin E (Tocopherol) | - directly suppresses SARS-CoV-2 replication | - water-soluble derivatives of α-tocopherol inhibit SARS-CoV-2 RNA-dependent RNA polymerase [79] | Vegetable oils, grain products, nuts, vegetables, meat products, and dairy products |
- affects effector cells of innate immunity | - inhibits COX2 activity and PGE2 production by macrophages [80,81] | ||
- increases the cytotoxicity of NK cells, possibly by modulating NO levels [80,81] | |||
- inhibits klotho sensitive NF-κB-mediated dendritic cell maturation, migration, and function [82] | |||
- stimulates proliferation of naïve T cells and their secretion of IL-2 [82] | |||
- affects adaptive immunity | - enhances Th1 response [82] | ||
- limits oxidative stress and normalizes excessive cytokine release | - decreases the production of reactive oxygen species by monocytes and dendritic cells [83] | ||
- downregulates IL1, IL-6, and TNF secretion by monocytes and macrophages [81] | |||
- inhibits pro-inflammatory eicosanoids (PGE2, LTB4, and 8-isoprostane) formation [81] |
Ref. | Type of Study | Dates of the Study | Pandemic Restrictions | N | Mean Age ± SD [Years] | Country | Type of Survey |
---|---|---|---|---|---|---|---|
[85] | cross-sectional | 17.04–01.05.2020 | lockdown | 1097 | 27.7 ± 9.0 | Poland | online |
[86] | cross-sectional | 03–04.2020 | lockdown | 183 | 33 ± 11 | Poland | online |
[87] | longitudinal retrospective | 29.04–19.05.2020 | pre-lockdown and lockdown | 312 | 42.1 ± 12.0 M 40.6 ± 13.7 F | Poland | online |
[88] | cross-sectional | 30.04–23.05.2020 | lockdown | 2381 | not reported | Poland | online |
[89] | cross-sectional | 14.04–28.04.2020 | lockdown | 2447 | not reported | Lithuania | online |
[90] | cross-sectional | 03.05–06.06.2021 | post-lockdown | 2040 | not reported | Romania | online |
[91] | cross-sectional | 29.04–19.05.2020 | lockdown | 312 | 41.12 ± 13.05 | Poland | online |
[92] | longitudinal prospective | 03.2020 and 10.2020 | lockdown and post-lockdown | 200 | 19.5 ± 0.6 | Poland | online |
[93] | longitudinal retrospective | 24.03–11.04.2020 | pre-lockdown and lockdown | 506 | 24.67 ± 4.23 | Poland | online |
[94] | cross-sectional | 10–11.02.2021 | post-lockdown | 108 | 46.3 ± 10.5 | Poland | paper |
[95] | longitudinal retrospective | 01.06–01.08.2020 | post-lockdown | 171 | 22.53 ± 2.48 | Serbia | online and paper |
[96] | cross-sectional | 05.05–30.06.2020 | lockdown | 689 | not reported | Kosovo | online |
[97] | cross-sectional | 10.2019–06.2020 and 11.2020–03.2021 | pre-lockdown and post-lockdown | 6369 and 2392 | 37.9 ± 11.8 and 38.4 ± 12.6 | Lithuania | online |
[98] | cross-sectional | 20.03–30.05.2020 | lockdown | 926 | not reported | Poland | online |
[99] | cross-sectional | 04–05.2020 | lockdown | 1082 | 31.6 ± 11.98 | Poland | online |
[100] | cross-sectional | 01.01–20.06.2021 | post-lockdown | 1022 | 33.18 ± 11.86 | Poland | online |
[101] | cross-sectional | 01.05–15.05.2021 | post-lockdown | 145 | not reported | Poland | online |
[102] | cross-sectional | 04–12.2020 | lockdown | 9936 | 31.0 ± 12.16 | Russia | online |
[103] | cross-sectional | 04–05.2020 and 11.2020 | lockdown and post-lockdown | 978 | not reported | Poland | online |
[104] | cross-sectional | 01.11.2020–31.01.2021 | post-lockdown | 1101 | not reported | Poland | online |
[105] | cross-sectional | 01–03.2021 | post-lockdown | 1447 | 31.34 ± 11.05 | Poland | online |
[106] | cross-sectional | 22.02–03.04.2021 | post-lockdown | 1323 | 22 ± 4 | Poland | online |
[107] | cross-sectional | 20.03–15.12.2021 | post-lockdown | 894 | 20.73 ± 1.81 | Poland | paper |
[108] | longitudinal retrospective | 11.2020–01.2021 | pre- and post-lockdown | 435 | not reported | Poland | online |
[109] | cohort | 08.2019–03.2020, 03–06.2020, and 06–08.2020 | pre-lockdown, lockdown, and post-lockdown | 1877 | 26.5 ± 6.8 | Sweden | online |
[110] | cross-sectional | 24.04–05.05.2020 | lockdown | 2462 | not reported | Denmark | online |
[111] | cross-sectional | 15–30.04.2020 | lockdown | 24,968 | not reported | Norway | online |
[112] | cross-sectional | 03–04.2020 | lockdown | 1964 | 23.3 ± 4.0 | Germany | online |
[113] | cross-sectional | 12.03–03.05.2020 | lockdown | 827 | not reported | Germany | online |
[114] | cross-sectional | 12.04–03.05.2020 | lockdown | 2103 | 40 ± 14 | Germany | online |
[115] | longitudinal retrospective | 11.2020 | lockdown and post-lockdown | 1694 | 47.6 ±14.8 | France | online |
[116] | cross-sectional | 25–30.03.2020 | lockdown | 11,391 | 47.47 ± 17.28 | France | online |
[117] | longitudinal retrospective | 30.04–01.05.2020 | pre-lockdown and lockdown | 938 | 38.7 ± 11.6 | France | online |
[118] | cross-sectional | 09–30.06.2020 | lockdown | 2422 | not reported | France | online |
[119] | cross-sectional | 2009, 2012, 2015, 2018, and 05.2021 | pre- and post-lockdown | 8981 | 20.4 ± 1.8 | France | online |
[120] | cross-sectional | 22–28.04.2020 | lockdown | 1030 | 49.9 ± 17.0 | Netherlands | online |
[121] | cross-sectional | 9–22.04.2020 | lockdown | 1129 | 34.9 ± 14.3 | Belgium | online |
[122] | cross-sectional | 16–23.04.2020 | lockdown | 28,029 | not reported | Belgium | online |
[123] | cross-sectional | 08.06–08.10.2020 | lockdown and post-lockdown | 1119 | 74 ± 7 | Netherlands | paper, online, and phone |
[124] | cross-sectional | 03–05.2020 | lockdown | 8122 | not reported | Belgium | online |
[125] | longitudinal prospective | 01.07–18.11.2020 | post-lockdown | 246 | 49.6 ± 17.2 | Netherlands | online |
[126] | longitudinal retrospective | 29.04–13.05.2020 | lockdown | 818 | 47 ± 13 | England | online |
[127] | cross-sectional | 11–12.2020 | lockdown | 792 | not reported | England | online |
[128] | cross-sectional | 15.05–27.06.2020 | lockdown | 588 | 33.4 ± 12.6 | United Kingdom | online |
[129] | cross-sectional | 28.04–22.05.2020 | lockdown | 2002 | 34.74 ± 12.3 | United Kingdom | online |
[130] | cross-sectional | 01–15.09.2020 | post-lockdown | 352 | not reported | United Kingdom | online |
[131] | longitudinal prospective | 10.2019 and 02.2021 | pre-lockdown and lockdown | 230 | 23.9 ± 5.4 | Lithuania | online |
[132] | longitudinal prospective | 28.03–29.05.2020 | lockdown | 22,374 | not reported | United Kingdom | online |
[133] | cross-sectional | 16.03–30.11.2020 | lockdown and post-lockdown | 37,988 | 57.36 ± 8.23 | United Kingdom | not reported |
[134] | cross-sectional | 03–05.2020 | lockdown | 442 | 45 ± 12.7 | Turkey | online |
[135] | longitudinal retrospective | 06–22.07.2020 | post-lockdown | 124 | 23 | Poland | online |
[136] | cross-sectional | 08.04–20.05.2020 | lockdown | 72 | 63 | Spain | phone |
[137] | cross-sectional | 04–07.05.2020 | lockdown | 284 | 60.4 ± 10.8 | Spain | phone |
[138] | cross-sectional | 27.04–27.05.2020 and 07–15.12.2020 | lockdown | 420 | 50.3 ± 12.0 | France | phone and online |
[139] | longitudinal prospective | not reported | pre-lockdown and lockdown | 66 35 | 50.06 ± 10.68 50.80 ± 12.40 | Portugal | phone and online |
[140] | cross-sectional | 08–09.2020 | lockdown | 1626 | 30 ± 11 | Turkey | online |
[141] | cross-sectional | 11–25.05.2020 | post-lockdown | 254 | 35.82 ± 11.82 | Portugal | online |
[142] | cross-sectional | 07.2020 | post-lockdown | 158 | 32 ± 11.88 | United Kingdom | online |
[143] | cross-sectional | 05.2021 | post-lockdown | 3058 | 20.7 ± 2.3 | France | online |
[144] | longitudinal retrospective | 14–19.05.2020 | lockdown and post-lockdown | 365 | 35.09 ± 13.59 | Italy | online |
[145] | cross-sectional | 17.04–15.05.2020 | lockdown | 511 | not reported | Netherlands | online |
[146] | longitudinal prospective | 01–09.2019 11.2019–01.2020, 22.04–03.05.2020 | pre-lockdown and lockdown | 171 | 31.74 ± 12.76 | Italy | online, phone, and direct |
[147] | cross-sectional | 07.05–12.06.2020 | lockdown | 32 | 35.2 ± 10.3 | United Kingdom | online |
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Wiśniewski, O.W.; Czyżniewski, B.; Żukiewicz-Sobczak, W.; Gibas-Dorna, M. Nutritional Behavior in European Countries during COVID-19 Pandemic—A Review. Nutrients 2023, 15, 3451. https://0-doi-org.brum.beds.ac.uk/10.3390/nu15153451
Wiśniewski OW, Czyżniewski B, Żukiewicz-Sobczak W, Gibas-Dorna M. Nutritional Behavior in European Countries during COVID-19 Pandemic—A Review. Nutrients. 2023; 15(15):3451. https://0-doi-org.brum.beds.ac.uk/10.3390/nu15153451
Chicago/Turabian StyleWiśniewski, Oskar Wojciech, Bartłomiej Czyżniewski, Wioletta Żukiewicz-Sobczak, and Magdalena Gibas-Dorna. 2023. "Nutritional Behavior in European Countries during COVID-19 Pandemic—A Review" Nutrients 15, no. 15: 3451. https://0-doi-org.brum.beds.ac.uk/10.3390/nu15153451