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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 3-7

COVID-19 pandemic: Impacts of social lockdown on nutritional health and beyond


1 Department of Physiology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
2 Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA

Date of Submission11-Nov-2020
Date of Decision15-Nov-2020
Date of Acceptance22-Nov-2020
Date of Web Publication06-Feb-2021

Correspondence Address:
Mohammed S Razzaque
Department of Pathology, Lake Erie College of Osteopathic Medicine, 2000 West Grandview Boulevard, Erie, PA 16509
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_130_20

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How to cite this article:
Abukabda AB, Razzaque MS. COVID-19 pandemic: Impacts of social lockdown on nutritional health and beyond. Adv Hum Biol 2021;11:3-7

How to cite this URL:
Abukabda AB, Razzaque MS. COVID-19 pandemic: Impacts of social lockdown on nutritional health and beyond. Adv Hum Biol [serial online] 2021 [cited 2021 Oct 17];11:3-7. Available from: https://www.aihbonline.com/text.asp?2021/11/1/3/308856





The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) causes the coronavirus disease 2019 (COVID-19). A balanced diet accompanied by a healthy lifestyle is the key to good health and always desirable; the importance of a balanced diet is even more apparent during the ongoing COVID-19 pandemic. Maintaining an adequate balance of vitamins, minerals and other nutrients through healthy eating habits and active lifestyles can help sustain the immune system's essential role in combatting the invading SARS-CoV-2 virus. Outdoor activity is an integral part of a healthy lifestyle and has been markedly impaired by the total or partial lockdowns occurring during the COVID-19 pandemic. Similarly, access to healthy food is also becoming an issue during the lockdown. Safeguarding and expanding access to healthy food for vulnerable communities, including children and the elderly, should be a priority during the pandemic lockdown. In order to mitigate this situation, community and government involvement is required to protect vulnerable populations and maintain nutritional health. Governmental intervention in the form of cash aid can also empower affected communities to meet their requirements during the lockdown in the COVID-19 pandemic. In many places, markets are still functioning, and providing e-vouchers and cash programming may be more useful and meaningful for the affected communities to maintain their nutritional needs. Of note, combating nutritional impairment is challenging during the COVID-19 pandemic with various degrees of lockdown in places, which disproportionately affects women, children and the elderly. Undernutrition could diminish children's overall development, partly because of the lack of essential vitamins and minerals. One of the consequences of the lockdown is the decrease in time spent doing outdoor activities, leading to less sunlight exposure, which may likely be reflected as reduced Vitamin D.


  Impact of Lockdown on Vitamin D Top


Vitamin D is a fat-soluble vitamin, and its synthesis can be partly initiated in the skin following the exposure to ultraviolet B (UVB) rays from sunlight which are necessary to convert cutaneous 7-dehydrocholesterol pre-Vitamin D3 to its active form. To produce the physiologically active form of 1,25-dihydroxyvitamin D (1,25(OH)2D), the dermal Vitamin D requires two hydroxylations in the liver and kidneys [Figure 1]. Cutaneous Vitamin D synthesis by UVB sunlight supplies >80% of the required Vitamin D in humans.[8],[9],[10],[11] For adults, the Institute of Medicine estimates a daily requirement of around 600 IU/day. The recommended daily intake stratified by various age groups is shown in [Table 1]. The US Preventive Services Task Force found that the currently available evidence does not justify the daily recommendation of >400 IU of Vitamin D supplement and >1000 mg of calcium supplement.[12],[13] Of note, it is estimated that full-body exposure to UVB sunlight for around 30 minutes can generate as much as 10,000 units of Vitamin D.[14] Aging skin cannot synthesize as much Vitamin D as younger skin following sunlight exposure and this factor likely contributes to Vitamin D deficiency. During the ongoing COVID-19 pandemic lockdown, lack of outdoor activities and subsequent low sunlight exposure are likely to affect elderly individuals as a result of reduced Vitamin D levels.
Figure 1: Simplified diagram showing the sources and stages of Vitamin D synthesis. For simplicity, only the essential steps of vitamin synthesis are included. VDR: vitamin D receptor (modified from earlier publications).[1],[2],[3],[4],[5],[6],[7]

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Table 1: Recommended daily intakes by the Endocrine Society and the Institute of Medicine

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Indoor sunlight exposure during the COVID-19 pandemic lockdown may not be beneficial because UVB rays are unable to penetrate through glass to stimulate dermal Vitamin D synthesis.[15],[16] As hypovitaminosis D status is usually associated with decreased sunlight exposure, the primary mitigation strategy would be to enhance safe UVB sunlight exposure, which has been drastically impacted during this ongoing COVID-19 pandemic. The National Health and Nutrition Examination Survey has reported that serum 25(OH)D levels were higher during the summer (May–October), as compared to the remaining months of the year; such levels may be perhaps associated with a tendency with increased outdoor activities and higher UVB sunlight exposure during the summertime. Again, the lockdown has severely impaired outdoor activities during this summer, and the adverse impact of such reduced sunlight exposure may likely impact the progression of COVID-19.

Moreover, UVB exposure may reduce hypertension, conceivably by increasing 1,25(OH)2D activities and decreasing the ability of the renin–angiotensin–aldosterone system to lower blood pressure.[17],[18] The incidence of breast and prostate tumours has been shown to be inversely proportional to sunlight exposure.[19],[20],[21],[22],[23] Low sunlight exposure has been shown to enhance the risk of developing cardiovascular and neuronal diseases.[24],[25],[26] Humans possess the innate ability to generate Vitamin D following UVB sunlight exposure, and the COVID-19-related lockdown has had an enormous impact on endogenous Vitamin D production.[27] In the uncertainty arising from the COVID-19 pandemic, high Vitamin D-containing fish, including sardines, salmon, herring and mackerel, should be consumed frequently; wild salmon yields the highest levels of Vitamin D, namely 988 IU/Oz ± 524.[28] Of note, cooking style can significantly reduce Vitamin D levels. For instance, baking fish retains a higher amount of Vitamin D, while frying fish can decrease the Vitamin D content by almost 50%.[28] Other significant sources include meat and eggs and fortified foods such as milk, bread and juice. Another useful source of Vitamin D is shiitake mushrooms, providing around 110 IU/100 g. However, when shiitake mushrooms (gills facing up) were placed under sunlight for 6 h, Vitamin D level increased from 110 IU to an astonishing 46,000 IU/100 g, thus representing a super source of naturally obtainable Vitamin D.[29] Consuming 1 g of sun-dried shiitake mushrooms (about one-tenth of a mushroom) would give around 460 IU Vitamin D, which is very close to the recommended daily allowance, as recommended by the Food and Nutrition Board. In this pandemic, with the lockdown still effective, consuming the above-mentioned Vitamin-D-rich foods and drinks would minimize the risk of developing Vitamin D hypervitaminosis. In addition to Vitamin D, magnesium, zinc and Vitamin B12 have also been shown to exert beneficial effects by reducing the disease burden related to the COVID-19 pandemic, perhaps by boosting host immunity.[30],[31],[32] Again, the COVID-19 pandemic-associated lockdown has impacted the food supply chain, perhaps due to labour shortages, with interruptions in transportation and distribution, causing food and nutritional insecurity.[33]


  Impact of Lockdown on Physical Activities Top


Another consequence of the lockdown is the reduced physical activity around the world, as determined by the reduced overall step count from South Korea, Taiwan and Japan to Italy, Spain, Australia and the United States.[34],[35] The benefits of adequate physical activity in reducing depression symptoms, anxiety, uplifting mood and inducing better sleep are well known.[36],[37],[38],[39],[40],[41] For elderly patients with comorbidities, routine physical activity is essential to sustain good health. Although children and adolescents are relatively less affected by the SARS-CoV-2 virus infection, less physical activity as a result of a prolonged social lockdown might be a long-term risk to growth and development. Furthermore, sedentary behaviours are linked to unhealthy eating behaviours, leading to higher energy intake.[42] For children, during a 3 hours sitting session, a regular 3-min break every 30 min has been shown to reduce insulin response and plasma-free fatty acids as compared to children with uninterrupted sedentary behaviours.[43] Studies have found an adverse impact of the COVID-19-associated lockdown measures on psychological well-being in China and Italy.[44],[45] In a study conducted on 507 adults, the COVID-19-associated lockdown reduced physical activity, with apparent weight gain and risk of obesity.[46] Therefore, the sedentary behaviours associated with social lockdown have long-term health consequences among all age groups of otherwise healthy individuals. In this lockdown, mutual inspiration and support from peers and family should motivate performing indoor physical activities and avoid a sedentary lifestyle.

Of relevance, the availability of remote support systems is one of the positive aspects of the social lockdown. Many free online resources are offered for improving physical activity levels. Similarly, for sustaining mental well-being during the ongoing social lockdown, online interactions through social support groups and audio–visual conferencing services are attainable. Physicians and other healthcare professionals should encourage individuals to be physically active while complying with the local and national regulations and maintaining social distancing during this lockdown. The media should play a role in reminding people of the benefits of physical activity during this lockdown. Regular moderate physical activities can increase the quality of life with reduced morbidity and mortality rates in elderly individuals.[47]


  Summary Top


Nutritional health is sustained by consuming a balanced diet. Impaired nutrient intake leads to malnutrition-related health complications, affecting organ and tissue functions. The association between disease conditions and nutritional health is interdependent; in many diseases, malnutrition is a consequence, while malnutrition can also adversely influence the course of the underlying diseases. Three key factors usually alter the nutritional balance in humans, that is, amount of food consumed, disease-associated stressful conditions and impaired absorption of nutrients. Food and nutrition insecurity are severe consequences of the currently ongoing pandemic. The COVID-19 pandemic is caused by the SARS-CoV-2 virus, which has resulted in prolonged lockdown with restricted outdoor activities. In this pandemic, both inadequate nutrient consumption and disease-associated stress have affected the majority of the population around the globe. Because adequate nutrition is essential for maintaining a healthy immune system to provide a shield against the ongoing viral pandemic, disease burden is likely to be intensified with enhanced morbidity and mortality in the absence of nutritional support, amalgamated with less physical activities.


  Conclusion Top


The COVID-19 patients have the heterogenicity of clinical presentations; it can affect relatively healthy individuals to elderly individuals with comorbidities to pregnant women.[48],[49],[50] While the social lockdown has helped in 'flattening the curve', it has also caused less physical activity and limited access to healthy fresh foods with enhanced emotional stress.[51] Around the globe, the COVID-19 pandemic-associated lockdown has impacted the food supply chain and has started causing food and nutritional insecurity.[33] A lockdown-related sedentary lifestyle may cause a higher undernutrition rate and obesity-associated complications due to the food chain supply disruption. During the COVID-19 pandemic-associated social lockdown, owing to easier accessibility, increased consumption of processed foods and sugar-sweetened beverages containing high fat, sugar and phosphate is likely to increase obesity and other cardiometabolic disorders.[30],[32],[52],[53] Processed and sugary food consumption correlates with poor mental health.[54] Consuming nutritionally deficient food and being physically inactive are directly linked to numerous chronic non-communicable diseases, such as metabolic diseases, hypertension and tumours. Reported studies have shown that sedentary behaviours, such as television-watching time, are related to higher risks of obesity and cardiometabolic diseases in children and adolescents.[55],[56],[57] Quickly identifying the perturbing trends in health behaviours related to social lockdown and providing necessary emotional, financial and nutritional support to vulnerable groups (children, adolescents, pregnant women and the elderly) will reduce the disease burden.

Acknowledgements

We wish to express our sincere gratitude to Dr Nuraly Akimbekov (Al-Farabi Kazakh National University, Kazakhstan) for help in drawing the illustration. We also wish to thank Mr M. Muhit Razzaque and Dr Arafat Tannum for carefully reading the manuscript and providing useful suggestions.



 
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