Dietary Behaviors in the Post-Lockdown Period and Its Effects on Dietary Diversity: The Second Stage of a Nutrition Survey in a Longitudinal Chinese Study in the COVID-19 Era

Abstract

Coronavirus disease 2019 (COVID-19) has imposed enormous challenges on people's lifestyles. People in China have gradually returned to normal life; however, in the protracted pandemic, people may still follow certain dietary behaviors to cope with COVID-19. This study was the second stage of a longitudinal nutritional survey conducted in post-lockdown China that was aimed at exploring post-lockdown dietary behaviors and their effects on dietary diversity. In line with the first stage of the survey, the current dietary behaviors used to cope with COVID-19 and ways of purchasing food were determined. In addition, changes in dietary behavior compared to the same period in 2019 and those behaviors recommended to ensure food safety were also investigated. The Household Dietary Diversity Score (HDDS) was used to assess dietary diversity; this was also used in the first stage of the survey. Linear regression was used to model the associations between the HDDS, participants' characteristics, and dietary behaviors. The data of 1994 participants were included in the analysis. The overall mean HDDS was 9.2 ± 2.0. Compared to the same period in 2019, a substantial proportion of participants self-reported that they had recently decreased eating in restaurants (61.6%) and reduced intakes of seafood (53.1%), imported frozen food (57.1%), and raw food (60.5%), while 64.8% of participants reported increased cooking at home. People with an increased consumption of seafood (adjusted OR (95%CI) = 0.56 (0.07, 1.04)) and raw food (adjusted OR (95%CI) = 0.74 (0.27, 1.21)) had a significantly higher HDDS. Participants who changed their consumption of imported frozen food (both increased and decreased) had a higher HDDS (adjusted OR (95%CI) = 0.56 (0.07, 1.04) and 0.27 (0.09, 0.44), respectively). People who depended more on purchasing food online had a significantly higher HDDS (adjusted OR (95%CI) = 0.29 (0.02, 0.55)). Compared to the data from stage 1, the proportion of people choosing healthy products to cope with COVID-19 did not greatly change and those people had a higher HDDS (adjusted OR (95%CI) = 0.31 (0.19, 0.42)). Although this study found that the proportion of people who chose to use alcohol or vinegar to prevent COVID-19 had decreased substantially compared to during lockdown, there were still 5.3% and 9.8% who followed these irrational behaviors. Regarding the dietary behavior regarding food safety, except for cooking food fully, fewer than half of participants followed the recommended dietary behaviors, including individual food servings (44.2%), using serving chopsticks and spoons (44.8%), and preparing raw and cooked food separately (43.3%). People who followed these behaviors had a better dietary diversity. In conclusion, during the post-lockdown period, people still followed certain dietary behaviors to cope with COVID-19. While some dietary behaviors were adopted to help prevent infection, irrational dietary behaviors were still followed. These behaviors were associated with the dietary diversity in Chinese adults.

Keywords: COVID-19; China; dietary behaviors; dietary diversity; post-lockdown.

Figure 1

Geographical distribution of the studied population in the second nutrition survey wave. Figure legends: The color of the map indicates the cumulative number of confirmed cases in each area by the end of August 31, according to the report from the Chinese Health Commission [16]. A bubble plot was then generated, with the bubble size representing the number of participants at each investigation point.