HEALTHY HABITS IN CSIC WORKERS DURING COVID-19 LOCKDOWN IN SPAIN

INTRODUCTION

The current pandemic situation caused by SARS-CoV-2 has caused a deep change in citizen’s lifestyle. Measures focused on the protection of public health have been implemented worldwide. In particular, the Spanish government imposed a national lockdown on March 14^th, 2020, due to the severity of the situation. For nearly 3 months, Spanish population had to adapt their lifestyles to the new situation of staying at home, in a context where outdoor activities are an essential part of their cultural habits. In addition to this, the stressful environment created by the rising of COVID-19 cases and deaths (Lima et al. 2020Lima, Carlos Kennedy Tavares; de Medeiros Carvalho, Poliana Moreira de Medeiros; de Araújo Araruna Silva Lima, Igor; de Oliveira Nunes, José Victor Alexandre; Saraiva, Jeferson Steves; de Sousa, Ricardo Inácio; daSilva, Claúdio Gleidiston Lima; Neto, Modesto Leite Rolim (2020). The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Research 287, 112915. ), the fear of infection, the uncertainty about the near future and the possible socio-economic consequences of the pandemic (Balluerka et al. 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Garre-Olmo et al. 2020Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214.), are just some factors that have a psychological impact on the population (Brooks et al. 2020Brooks, Samantha; Webster, Rebecca; Smith, Louise; Woodland, Lisa; Wessely, Simon; Greenberg, Neil; Rubin, Gedeon James (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395 (10227): 912-920.).

Indeed, in the previous outbreaks of Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), psychological symptoms like anxiety (Jeong et al. 2016Jeong, Hyunsuk; Yim, Hyeon; Song, Yeong-Jun; Ki, Moran; Min, Yung-Ah; Cho, Juhee; Chae, Jeong-Ho (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health 38.), depression, and post-traumatic stress disorder (PTSD) (Ko et al. 2006Ko, Chih-Hung; Yen, Cheng-Fang; Yen, Ju-Yu; Yang, Ming-Jen (2006). Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry and Clinical Neurosciences 60 (4): 397-403.; Reynolds et al. 2008Reynolds, Donna L.; Garay, Jason Robert; Deamond, Sherri L.; Moran, Maura K.; Gold, Wayne.; Styra, ima. (2008). Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology & Infection 136 (7): 997-1007.; Lam et al. 2009Lam, Marco Ho Bun; Wing, Yun-Kwok; Yu, Mandy, Wai Man; Leung, Chi-Ming; Ma, Ronald C. W.; Kong, Alice P. S.; So, W. Y.; Fong, Samson Yat-Yuk; Lam, Siu-Ping (2009). Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Archives of Internal Medicine 169 (22): 2142-2147.; Mak et al. 2009Mak, Ivan Win Chi; Chu, Chung Min; Pan, Pey Chyou; Gar Chung Yiu, Michael; Lee Chan, Veronica (2009). Long-term psychiatric morbidities among SARS survivors. General Hospital Psychiatry 31 (4): 318-326.; Yoon et al. 2016Yoon, Mi-Kyung; Kim; Soon-Young; Ko, Hye-Sun; Lee, Myung-Soo (2016). System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. International Journal of Mental Health Systems 10 (1), 51.) were detected in individuals who were isolated, and those symptoms remained for some time (Wu et al. 2008Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Jonhui; Lu, Jin; Litvak, Iva J. (2008). Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol & Alcoholism 43 (6): 706-712.; Jeong et al. 2016Jeong, Hyunsuk; Yim, Hyeon; Song, Yeong-Jun; Ki, Moran; Min, Yung-Ah; Cho, Juhee; Chae, Jeong-Ho (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health 38.). Regarding COVID-19 pandemic, a study comparing the Spanish and Greek populations during the first outbreak showed that living in Spain was associated with increased anxiety symptoms. Authors attributed these differences to the severe situation and stricter lockdown measures in Spain (Papandreou et al. 2020Papandreou, Christopher; Arija, Victoria; Aretouli, Eleni; Tsilidis, Kostantinos; Bulló, Mònica (2020). Comparing eating behaviours and symptoms of depression and anxiety between Spain and Greece during the COVID-19 outbreak: Cross-sectional analysis of two different confinement strategies. European Eating Disorders Review 28 (6): 836-846.).

The effect of psychological symptoms on lifestyle has been described in traumatic situations, like terrorist attacks (Boscarino, Adams, and Galea, 2006Boscarino, Joseph; Adams, Richard; Galea, Sandro (2006). Alcohol use in New York after the terrorist attacks: a study of the effects of psychological trauma on drinking behavior. Addictive Behaviors 31 (4): 606-621.) or natural disasters (Lebeaut, Tran, and Vujanovic, 2020Lebeaut, Antoine; Tran, Jana K.; Vujanovic, Anka A. (2020). Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity. Addictive Behaviors 106, 106353.), which were associated with an increased risk of addictive behaviors such as alcohol abuse (García-Álvarez et al., 2020García-Álvarez, Leticia; de la Fuente-Tomás, Lorena; Sáiz, Pilar Alejandra; García Portilla, M.ª Paz; Bobes, Julio (2020). ¿Se observarán cambios en el consumo de alcohol y tabaco durante el confinamiento por COVID-19? Adicciones 32 (2): 85-89.). Therefore, it should be considered the potential risk that COVID-19 lockdown may exert on the development of unhealthy habits. Studies conducted during COVID-19 lockdown showed an increase in the consumption of alcohol or comfort foods (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Sidor and Rzymski, 2020Sidor, Aleksandra; Rzymski, Piotr (2020). Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients 12 (6), 1657.). It has been pointed out those negative emotions such as anxiety or depression, may prompt Emotional Eating (EE) behaviors (Matcht, 2008Macht, Michael (2008). How emotions affect eating: a five-way model. Appetite 50 (1): 1-11.; Konttinen et al. 2010Konttinen, Hanna; Silventoinen, Karri; Sarlio-Lähteenkorva, Sirpa; Männistö, Satu (2010). Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. The American Journal of Clinical Nutrition 92 (5): 1031-1039.; Clum et al., 2014Clum, Gretchen A.; Rice, Janet; Broussard, Marsha; Johnson, Carolyn C.; Webber, Larry S. (2014). Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women. Journal of Behavioral Medicine. 37 (4): 577-586.; Ferrel, Watford, and Braden, 2020Ferrell, Emily; Watford, Tanya; Braden, Abby (2020). Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating. Appetite 144, 104450.). EE is defined as the tendency to eat, usually hyper-palatable foods (Macht, 2008Macht, Michael (2008). How emotions affect eating: a five-way model. Appetite 50 (1): 1-11.; Camilleri et al. 2014Camilleri, Géraldine; Méjean, Caroline; Kesse-Guyot, Emmanuelle; Andreeva, Valentina; Bellisle, France; Hercberg, Serge; Péneau, Sndrine (2014). The associations between emotional eating and consumption of energy-dense snack foods are modified by sex and depressive symptomatology. The Journal of Nutrition 144 (8): 1264-1273.; Muscogiuri et al., 2020Muscogiuri, Giovanna; Barrea, Luigi; Savastano, Silvia; Colao, Anna Maria (2020). Nutritional recommendations for COVID-19 quarantine. European Journal of Clinical Nutrition 74 (6): 850-851.), in the response to positive or negative emotions (Cardi, Leppanen, and Treasure, 2015Cardi, Valentina; Leppanen, Jenni; Treasure, Janet (2015). The effects of negative and positive mood induction on eating behavior: a meta-analysis of laboratory studies in the healthy population and eating and weight disorders. Neuroscience & Biobehavioral Reviews 57: 299-309.). Some authors indicate that this eating behavior could mediate between depressive symptoms and body mass index (BMI) (Clum et al., 2014Clum, Gretchen A.; Rice, Janet; Broussard, Marsha; Johnson, Carolyn C.; Webber, Larry S. (2014). Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women. Journal of Behavioral Medicine. 37 (4): 577-586.), waist circumference, and percent body fat (Konttinen et al., 2010Konttinen, Hanna; Silventoinen, Karri; Sarlio-Lähteenkorva, Sirpa; Männistö, Satu (2010). Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. The American Journal of Clinical Nutrition 92 (5): 1031-1039.).

Moreover, physical activity (PA) has become a paramount concern due to the confinement situation. For instance, Spanish citizens were not allowed to exercise outdoor for at least seven weeks, which implied that PA had to be adapted to be practiced at home. This fact may have impaired exercising, as several investigations have recently shown (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Garre-Olmo et al., 2020Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214.; López-Bueno et al., 2020López-Bueno, Rubén; Calatayud, Joaquín; Andersen, Lars L.; Balsalobre Fernández, Carlos; Casaña, José; Casajús, José A.; Smith, Lee; López Sánchez, Guillarmo F. (2020). Immediate impact of the COVID-19 confinement on physical activity levels in Spanish adults. Sustainability 12 (14), 5708.; Rodríguez-Pérez et al., 2020Rodríguez-Pérez, Celia; Molina-Montes, Esther; Verardo, Vito; Artacho, Reyes; García Villanova, Belén; Guerra Hernández, Eduardo Jesús; Ruiz López, María Dolores (2020). Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study. Nutrients. 12 (6), 1730.). Additionally, PA during the lockdown should have compensated for the decrease of the activities of daily living (Jiménez-Pavón, Carbonell-Baeza, and Lavie, 2020Jiménez-Pavón, David; Carbonell-Baeza, Ana; Lavie, Carl J. (2020). Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in Cardiovascular Diseases 63 (3), 386.). Short- term physical inactivity and a positive energy balance can increase risk factors for developing metabolic syndrome, owing to reduced insulin sensitivity, increased total body, central fat and a proinflammatory status (Martínez-Ferrán, Sanchis-Gomar, and Pareja Galeano, 2020Martínez-Ferrán, María; de la Guía-Galipienso, Fernando; Sanchis-Gomar, Fabián; Pareja Galeano, Helios (2020). Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits. Nutrients 12 (6), 1549.). Overall, habit changes have been detected in Spanish population during the lockdown, observing differences in sociodemographic and living conditions (Navas-Martín et al., 2021Navas-Martín, Miguel Ángel; López-Bueno, José Antonio; Oteiza, Ignacio; Cuerdo Vilches, Teresa (2021). Routines, Time Dedication and Habit Changes in Spanish Homes during the COVID-19 Lockdown. A Large Cross-Sectional Survey. International Journal of Environmental Research and Public Health 18 (22), 12176.). In a society where Non-Communicable Diseases (NCDs) are responsible for almost 70% of all deaths in the world (https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1), is necessary to pay attention to these circumstances which could lead to the establishment of unhealthy habits in a long term. In particular, it is interesting to evaluate how citizens adapt their lifestyle to this exceptional situation from a working level perspective, due to the significant changes that the confinement causes in this specific area.

Therefore, the aim of this study was to determine the effect of the COVID-19 lockdown on workers’ lifestyle from Spanish National Research Council (CSIC), the largest public research institution in Spain. In most cases, CSIC workers had to adapt to work from home, which led to a new situation since the telecommuting was not established. Consequently, assessing lifestyle changes under such special situations, especially on dietary patterns, PA practice and emotional changes becomes necessary.

MATERIAL AND METHODS

To investigate the healthy habits of CSIC workers, a survey was sent during the lockdown applied in Spain from March 14^th, 2020. The questionnaire had an online Google docs format, and it was approved by CSIC Ethics Committee. Participation was shared through the CSIC institutional mailing list, reaching only the internal CSIC staff and not external services, and responses were accepted from April 20^th to June 14^th, 2020. Participation in the online questionnaire was voluntary and anonymized, being necessary for a previous acceptance of the participant.

The survey consisted of 39 questions structured into 4 sections: socio-demographic characteristics, dietary patterns, physical activity, and emotional state during confinement (Figure 1).

Socio-demographic characteristics: gender, age, height, weight, training in nutrition and dietetics, current work modality, cohabitants, living conditions, and the presence of COVID-19 symptoms were asked. Body Mass Index of the respondents was also calculated with the self-reported height and weight.

Changes in dietary patterns: perception of changes in eating and consumption habits during the confinement (shopping activities, availability of food and meals per day) and 14 questions about food group consumption were asked. Participants had to indicate an increase, decrease, or no change in the intake of water, energetic drinks, alcoholic beverages, fruits and vegetables, wholegrain cereals, legumes, fish, dairy products, red and cured meat, pre-cooked products, fast food, savory snacks, sweet snacks and bakery products.

Two score systems were created to evaluate the consumption of food considered a more or less healthy food. For the healthy food score, points addressed to intake of fruits and vegetables, pulses, fish and whole-grain cereals were assigned, obtaining 2 points if the consumption increased, 1 point if it did not change and 0 points if it decreased. Then the total number of points was divided between the highest rating that it could be obtained, resulting in a score from 0 to 1, where 0 meant the participant decreased the consumption of all the considered healthy food, while 1 meant an improvement of its intake. For the unhealthy food score, the following food groups were included: energetic drinks, alcoholic beverages, savory and sweet snacks, bakery products, red and cured meat, pre-cooked products and fast food. The score was calculated using the same procedure, but 2 points were assigned when the intake of these products decreased, and 0 points were assigned if its consumption increased. Thus, the higher the score was the lower intake of these non-recommended products, and vice versa. Therefore, higher scores in both indicators meant better dietary changes.

Changes in physical activity (PA): practice during the confinement, changes in usual routine, motivation and factors that increase motivation were inquired.

Changes in emotional states (ES): anxiety, boredom, sadness, irritability, and sleep disorders were asked through Likert scale questions, rating from 1-5 (1 no change, 5 complete change). Checkbox type questions were used to evaluate the attitudes and strategies adopted to cope with emotional changes.

An Emotional Eating Score (EE score) was created by the inclusion of those items associated with overeating [“It is difficult for me to control the amount of hyper-palatable food (sweets, fried snacks, etc.) that I eat”, “I eat more because of anxiety, boredom, etc.”, “Snacking” ]. One point was assigned when each item was not checked, thus the higher punctuation, the lesser emotional eating behaviors were followed.

Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 26.0. (IBM Corp. Released 2019, Armonk, NY, USA). To explore personal and sociodemographic characteristics, dietary patterns, physical activity and emotional state, frequencies, percentages (%) and means with standard deviations were employed. For the analysis of the variables, Chi-square was applied when comparing categorical variables and ANOVA to test differences between the means of groups. Correlations between continuous variables were calculated using Pearson correlation.

RESULTS

CHANGES IN DIETARY PATTERNS, PHYSICAL ACTIVITY AND EMOTIONAL STATE

During the lockdown, 33% of the participants increase the preparation of traditional meals, 18% increased meal planning and 15% used shopping lists. 70% of the participants did not change the number of meals per day, where the most common behavior was 3 meals per day.

Almost half of the participants (45.3%) perceived changes in their diet during the confinement (Table 2). From those, 35% expressed that their eating habits had worsened, exhibiting a higher BMI average in this group in relation to participants with a different perception (25.1 ±4.61; 23.6±3.73; 24.3±3.59 kg/m² perceived worsening, no change and perceived improvement, respectively; p<0.001). Moreover, women expressed proportionally worse eating habits during the lockdown than men (18.7 and 11.5%, respectively; p<0.001). Concerning age, 21% of the participants under 35 years old expressed that they changed their eating behavior negatively.

Overall, changes in diet were detected (Table 2), observing a rise in the number of participants who increased their consumption of pulses, fruits and vegetables, fish, dairy products, just as no recommended products like savory snacks and bakery goods. Conversely, several participants reduced the intake of red and cured meat, precooked products and fast food.

No significant differences in BMI and nutritional knowledge were detected for healthy and unhealthy scores, result that it should be highlighted. Nevertheless, the group that perceived worse eating habits during the lockdown obtained significant lower marks in the healthy score (0.49 ±0.17; 0.534 ±0.123; 0.651 ±0.157 (perceived worsening, no change and perceived improvement, respectively); p<0.001) and unhealthy score (0.386 ±0168; 0.544 ±0.149; 0.651 ±0.175 (perceived worsening, no change and perceived improvement, respectively; p<0.001). Additionally, a positive correlation between both scores (r=0.205; p<0.001) was found. Moreover, participants who increased their PA were significantly younger than those who reduced it (42.7±12.7 and 45.4±11.8 y, respectively; p<0.001).

Regarding the relationship between dietary patterns and PA, it was observed that, those who had increased their training during the lockdown obtained higher eating scores than those who reduced their PA, for both healthy (0.584 ±0.154 vs. 0.547 ±0.16 (increased vs. decreased PA); p<0.001) and unhealthy scores (0.576 ±0.184 vs. 0.529 ±0.182 (increased vs. decreased PA); p<0.001).

All emotional markers were positively correlated with each other (p<0.001), and a strong correlation between anxiety (anx.), irritability (irr.) and sadness (sad.) was detected (r=0.578 (anx.-irr.), 0.626 (anx.-sad.) and 0.569 (irr.-sad.). Additionally, a negative correlation between age and all emotional indicators was also found (p<0.001).

DISCUSSION

The COVID-19 pandemic has brought about a global health crisis which led to the application of severe restrictive measures on the general population like confinement. Previous outbreaks like SARS o MERS showed that people under isolation can develop psychological disorders (Ko et al., 2006Ko, Chih-Hung; Yen, Cheng-Fang; Yen, Ju-Yu; Yang, Ming-Jen (2006). Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry and Clinical Neurosciences 60 (4): 397-403.; Reynolds et al., 2008Reynolds, Donna L.; Garay, Jason Robert; Deamond, Sherri L.; Moran, Maura K.; Gold, Wayne.; Styra, ima. (2008). Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology & Infection 136 (7): 997-1007.; Lam et al., 2009Lam, Marco Ho Bun; Wing, Yun-Kwok; Yu, Mandy, Wai Man; Leung, Chi-Ming; Ma, Ronald C. W.; Kong, Alice P. S.; So, W. Y.; Fong, Samson Yat-Yuk; Lam, Siu-Ping (2009). Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Archives of Internal Medicine 169 (22): 2142-2147.; Mak et al., 2009Mak, Ivan Win Chi; Chu, Chung Min; Pan, Pey Chyou; Gar Chung Yiu, Michael; Lee Chan, Veronica (2009). Long-term psychiatric morbidities among SARS survivors. General Hospital Psychiatry 31 (4): 318-326.; Jeong et al., 2016Jeong, Hyunsuk; Yim, Hyeon; Song, Yeong-Jun; Ki, Moran; Min, Yung-Ah; Cho, Juhee; Chae, Jeong-Ho (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health 38.; Yoon et al., 2016Yoon, Mi-Kyung; Kim; Soon-Young; Ko, Hye-Sun; Lee, Myung-Soo (2016). System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. International Journal of Mental Health Systems 10 (1), 51.) which may lead to other health problems, as alcohol dependence (Wu et al., 2008Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Jonhui; Lu, Jin; Litvak, Iva J. (2008). Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol & Alcoholism 43 (6): 706-712.), besides the possible effect on physical activity and diet. For this reason, health organizations (https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/food-and-nutrition-tips-during-self-quarantine; Academia Española de Nutrición y Dietética y el Consejo General de Colegios Oficiales de Dietistas-Nutricionistas, 2020Academia Española de Nutrición y Dietética y Consejo General de Colegios Oficiales de Dietistas-Nutricionistas. (2020). Recomendaciones de alimentación y nutrición para la población española ante la crisis sanitaria del COVID-19. Available at https://academianutricionydietetica.org/NOTICIAS/alimentacioncoronavirus.pdf ) specifically established health and nutrition recommendations for a self-quarantine situation during the COVID-19 outbreak.

According to our study conducted with workers telecommuting from CSIC, it seems that these recommendations, in general, were followed, since a tendency for a greater intake of fruits, vegetables, pulses, and a decreased consumption of pre-cooked meals, red and cured meat, and fast food was identified. Our findings correspond with similar studies during the COVID-19 confinement in Spanish adults (Laguna et al., 2020Laguna, Laura; Fiszman, Susana; Puerta, P.; Chaya, C.; Tárrega, A. (2020). The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers. Food Quality and Preference 86, 104028.; López-Moreno et al., 2020López-Moreno, Miguel; Iglesias López, María Teresa; Miguel, Marta; Garcés Rimón, Marta (2020). Physical and Psychological Effects Related to Food Habits and Lifestyle Changes Derived from COVID-19 Home Confinement in the Spanish Population. Nutrients 12 (11), 3445.; Pérez-Rodrigo et al., 2020Pérez-Rodrigo, Carmen; Gianzo Citores, Marta; Hervás Bárbara, Gotzone; Ruiz Litago, Fátima; Casis Sáenz, Luis; Aranceta Bartrina, Javier (2020). Cambios en los hábitos alimentarios durante el periodo de confinamiento por la pandemia COVID-19 en España. Revista Española de Nutrición Comunitaria 26 (2), 28010. ; Rodríguez-Pérez et al., 2020Rodríguez-Pérez, Celia; Molina-Montes, Esther; Verardo, Vito; Artacho, Reyes; García Villanova, Belén; Guerra Hernández, Eduardo Jesús; Ruiz López, María Dolores (2020). Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study. Nutrients. 12 (6), 1730.) and other Mediterranean countries (Scarmozzino and Visioli 2020Scarmozzino, Federico; Visioli, Francesco (2020). COVID-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods 9 (5), 675.). Some authors reported an increase in the consumption of fruits, vegetables and pulses during confinement that was related to motivations of health or weight control, lower price and long shelf-life (in the case of pulses and canned goods), whereas the decrease in non-perishable ready meals was associated its unhealthy profile (Laguna et al., 2020Laguna, Laura; Fiszman, Susana; Puerta, P.; Chaya, C.; Tárrega, A. (2020). The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers. Food Quality and Preference 86, 104028.) and more available time for cooking (Laguna et al., 2020Laguna, Laura; Fiszman, Susana; Puerta, P.; Chaya, C.; Tárrega, A. (2020). The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers. Food Quality and Preference 86, 104028.; Scarmozzino and Visioli, 2020Scarmozzino, Federico; Visioli, Francesco (2020). COVID-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods 9 (5), 675.).

Regarding PA, several studies conducted in Spanish population (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Garre-Olmo et al., 2020Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214.; López-Bueno et al., 2020López-Bueno, Rubén; Calatayud, Joaquín; Andersen, Lars L.; Balsalobre Fernández, Carlos; Casaña, José; Casajús, José A.; Smith, Lee; López Sánchez, Guillarmo F. (2020). Immediate impact of the COVID-19 confinement on physical activity levels in Spanish adults. Sustainability 12 (14), 5708.; Rodríguez-Pérez et al., 2020Rodríguez-Pérez, Celia; Molina-Montes, Esther; Verardo, Vito; Artacho, Reyes; García Villanova, Belén; Guerra Hernández, Eduardo Jesús; Ruiz López, María Dolores (2020). Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study. Nutrients. 12 (6), 1730.) found out that ~50% of the people exercised less during COVID-19 lockdown, results matching with those presented here. It is worth noting that the participants with worse eating scores, women and young people, were the ones who declared an increase in their PA routine during the confinement. This trend was also observed by García-Tascón et al. (2020)García-Tascón, Marta; Sahelices-Pinto, César; Mendaña-Cuervo, Cristina; Magaz González, Ana María (2020). The Impact of the COVID-19 Confinement on the Habits of PA Practice According to Gender (Male/Female): Spanish Case. International Journal of Environmental Research and Public Health 17 (19), 6961., who hypothesized that men are more likely to exercise for social, ludic and competitive reasons, while women prefer non-competitive and relaxed sports and, hence, they were able to adapt exercise at home easily. These statements are in line with the study conducted by Sánchez-Sánchez et al. (2020)Sánchez-Sánchez, Eduardo; Ramírez-Vargas, Guillermo; Avellaneda-López, Ylenia; Orellana Pecino, J. Ignacio; García Marín, Esperanza; Díaz Jiménez, Jara (2020). Eating habits and physical activity of the Spanish population during the COVID-19 pandemic period. Nutrients 12 (9), 2826., who indicated that men invested more time in exercising before the lockdown than women, whereas during confinement, men have decreased more their training routine than women. Therefore, it seems that men adapted worse their PA practice at home.

Another relevant possible effect of the COVID-19 pandemic over the population is the emotional changes that this situation may trigger. Psychological symptoms such as anxiety, depression or poor sleep quality, have been described during the COVID-19 outbreak in adults (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Chacón-Fuertes, Fernández Hermida, and García Vera, 2020Chacón-Fuertes, Fernando; Fernández Hermida, José Ramón; García Vera, M.ª Paz (2020). La psicología ante la pandemia de la COVID-19 en España. La respuesta de la organización colegial. Clínica y Salud 31 (2): 119-123.; DiRenzo et al., 2020Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152.; Garre-Olmo et al., 2020Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214.; Ingram, Maciejewski, and Hand, 2020Ingram, Joanne; Maciejewski, Greg; Hand, Christopher (2020). Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Frontiers in Psychology 11, 2328.; Jiménez-Pavón, Carbonell-Baeza, and Lavie, 2020Jiménez-Pavón, David; Carbonell-Baeza, Ana; Lavie, Carl J. (2020). Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in Cardiovascular Diseases 63 (3), 386.; Moccia et al., 2020Moccia, Lorenzo; Janiri, Delfina; Pepe, Maria; Dattoli, Luigi; Molinaro, Marzio; de Martin, Valentina; Chieffo, Daniela; Janiri, Luigi; Fiorillo, Andrea; Sani, Gabriele; di Nicola, Marco (2020). Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: an early report on the Italian general population. Brain, Behavior, and Immunity, 87: 75-79.; Ozamiz-Etxebarria et al., 2020Ozamiz-Etxebarria, Naiara; Idoiaga-Mondragon, Nahia; Dosil-Santamaría, María; Picaza Gorrotxategi, Maitane (2020). Psychological symptoms during the two stages of lockdown in response to the COVID-19 outbreak: an investigation in a sample of citizens in Northern Spain. Frontiers in Psychology 11, 1491.; Rajkumar, 2020Rajkumar, Ravi Philip; (2020). COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry 52, 102066.; Beck et al., 2021Beck, Francois; Léger, Damien; Fressard, Lisa; Peretti-Wattel, Patrick; Verger, Pierre (2021). COVID-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. Journal of Sleep Research 30 (1), e13119.), as well as in previous outbreaks like SARS in 2003 (Hawryluck et al., 2004Hawryluck, Laura; Gold, Wayne; Robinson, Susan; Pogorsky, Stephen; Galea, Sandro; Styra, Sima (2004). SARS control and psychological effects of quarantine, Toronto, Canada. Emerging Infectious Diseases 10 (7), 1206.; Ko et al., 2006Ko, Chih-Hung; Yen, Cheng-Fang; Yen, Ju-Yu; Yang, Ming-Jen (2006). Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry and Clinical Neurosciences 60 (4): 397-403.; Wu et al., 2008Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Jonhui; Lu, Jin; Litvak, Iva J. (2008). Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol & Alcoholism 43 (6): 706-712.; Lam et al., 2009Lam, Marco Ho Bun; Wing, Yun-Kwok; Yu, Mandy, Wai Man; Leung, Chi-Ming; Ma, Ronald C. W.; Kong, Alice P. S.; So, W. Y.; Fong, Samson Yat-Yuk; Lam, Siu-Ping (2009). Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Archives of Internal Medicine 169 (22): 2142-2147.; Mak et al., 2009Mak, Ivan Win Chi; Chu, Chung Min; Pan, Pey Chyou; Gar Chung Yiu, Michael; Lee Chan, Veronica (2009). Long-term psychiatric morbidities among SARS survivors. General Hospital Psychiatry 31 (4): 318-326.) or MERS-CoV in 2012 (Jeong et al., 2016Jeong, Hyunsuk; Yim, Hyeon; Song, Yeong-Jun; Ki, Moran; Min, Yung-Ah; Cho, Juhee; Chae, Jeong-Ho (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health 38.; Yoon et al., 2016Yoon, Mi-Kyung; Kim; Soon-Young; Ko, Hye-Sun; Lee, Myung-Soo (2016). System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. International Journal of Mental Health Systems 10 (1), 51.). Several factors related to the emotional impact caused by COVID-19 pandemic on the population have been described. For instance, the concern for oneself infection or their relatives (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Wang et al., 2020Wang, Cuiyan; Pan, Riyu; Wan, Xiaoyang; Tan, Yiling; Xu, Linkang; Ho, Cyrus S.; Ho, Roger C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health 17, 1729.) or an adverse work situation, especially for those whose economy may be compromised (Garre-Olmo et al., 2020Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214.), could be the origin of emotional alterations. In this sense, CSIC participants did not jeopardize their job during the COVID-19 crisis, but they experienced emotional changes, especially sleep disorders and anxiety. According to Garre-Olmo et al. (2020)Garre-Olmo, Josep; Turró-Garriga, Oriol; Martí-Lluch, Ruth; Zacarías Pons, Lluis; Alves Cabratosa, Lía; Serrano Sarbosa, Domènech; Vilalta Franch, Joan; Ramos, Rafel (2020). Changes in lifestyle resulting from confinement due to COVID-19 and depressive symptomatology: A cross-sectional a population-based study. Comprehensive Psychiatry 104, 152214., changing work conditions, including telecommuting, is associated with depressive symptoms, which was the situation of the majority of our participants. Moreover, young participants experienced more changes in ES than older workers did. Similar results have been reported in other studies (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; ; DiRenzo et al., 2020Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152.; Ozamiz-Etxebarria et al., 2020Ozamiz-Etxebarria, Naiara; Idoiaga-Mondragon, Nahia; Dosil-Santamaría, María; Picaza Gorrotxategi, Maitane (2020). Psychological symptoms during the two stages of lockdown in response to the COVID-19 outbreak: an investigation in a sample of citizens in Northern Spain. Frontiers in Psychology 11, 1491.; Qiu et al., 2020Qiu, Jianyin; Shen, Bin; Zhao, Min; Wang, Zhen; Bin, Xie; Yifeng, Xu (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 33 (2), 100213. ; Beck et al., 2021Beck, Francois; Léger, Damien; Fressard, Lisa; Peretti-Wattel, Patrick; Verger, Pierre (2021). COVID-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. Journal of Sleep Research 30 (1), e13119.). The effect of overload information or infodemic could be a possible explanation to this behavior, which has been pointed out as a cause of anxiety and depression (DiRenzo et al., 2020Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152.; Gao et al., 2020Gao, Junling; Zheng, Pinpin; Jia, Yingnan; Chen, Hao; Mao, Yimeng; Chen, Sohong; Wang, Yi; Fu, Hua; Dai, Juming (2020). Mental health problems and social media exposure during COVID-19 outbreak. PlosOne 15 (4), e0231924.), especially in young people who are usually more exposed to social media (Qiu et al., 2020Qiu, Jianyin; Shen, Bin; Zhao, Min; Wang, Zhen; Bin, Xie; Yifeng, Xu (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 33 (2), 100213. ). Lastly, women have shown more anxiety, sadness, sleep disorders and irritability than men have. Even though, Ozamiz-Etxebarria et al. (2020)Ozamiz-Etxebarria, Naiara; Idoiaga-Mondragon, Nahia; Dosil-Santamaría, María; Picaza Gorrotxategi, Maitane (2020). Psychological symptoms during the two stages of lockdown in response to the COVID-19 outbreak: an investigation in a sample of citizens in Northern Spain. Frontiers in Psychology 11, 1491. described more depressive symptoms in men and similar levels of stress and anxiety in relation to gender. However, other studies reported more emotional changes in women (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; DiRenzo et al., 2020Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152.; López-Moreno et al., 2020López-Moreno, Miguel; Iglesias López, María Teresa; Miguel, Marta; Garcés Rimón, Marta (2020). Physical and Psychological Effects Related to Food Habits and Lifestyle Changes Derived from COVID-19 Home Confinement in the Spanish Population. Nutrients 12 (11), 3445.; Qiu et al., 2020Qiu, Jianyin; Shen, Bin; Zhao, Min; Wang, Zhen; Bin, Xie; Yifeng, Xu (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 33 (2), 100213. ; Wang et al., 2020Wang, Cuiyan; Pan, Riyu; Wan, Xiaoyang; Tan, Yiling; Xu, Linkang; Ho, Cyrus S.; Ho, Roger C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health 17, 1729.; Beck et al., 2021Beck, Francois; Léger, Damien; Fressard, Lisa; Peretti-Wattel, Patrick; Verger, Pierre (2021). COVID-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. Journal of Sleep Research 30 (1), e13119.). For instance, Navas-Martín et al. (2021)Navas-Martín, Miguel Ángel; López-Bueno, José Antonio; Oteiza, Ignacio; Cuerdo Vilches, Teresa (2021). Routines, Time Dedication and Habit Changes in Spanish Homes during the COVID-19 Lockdown. A Large Cross-Sectional Survey. International Journal of Environmental Research and Public Health 18 (22), 12176. highlighted the greater impact on habit changes, especially those related to home care, in women and people living with children. According to Moscoso-Sánchez (2020)Moscoso-Sánchez, David (2020) El contexto del deporte en España durante la crisis sanitaria de la COVID-19. Sociología del Deporte 1 (1): 15-19., this could be related to the women’s triple role (reproductive, housekeeping and work outside the home) that still prevails.

Furthermore, some authors linked psychological behaviors such as emotional eating (Nonogaki, Nozue and Oka, 2007Nonogaki, Katsunori; Nozue, Kana; Oka, Yoshitomo (2007) Social isolation affects the development of obesity and type 2 diabetes in mice. Endocrinology 148 (10): 4658-4666.; Rodríguez-Martín and Meule 2015Rodríguez-Martín, Boris C.; Meule, Adrian (2015). Food craving: new contributions on its assessment, moderators, and consequences. Frontiers in Psychology 6, 21.; Ferrell et al., 2020Ferrell, Emily; Watford, Tanya; Braden, Abby (2020). Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating. Appetite 144, 104450.; Yilmaz and Gökmen, 2020Yılmaz, Cemile; Gökmen, Vural (2020). Neuroactive compounds in foods: occurrence, mechanism and potential health effects. Food Research International 128, 108744.); or alcohol use (Boscarino, Adams, and Galea, 2006Boscarino, Joseph; Adams, Richard; Galea, Sandro (2006). Alcohol use in New York after the terrorist attacks: a study of the effects of psychological trauma on drinking behavior. Addictive Behaviors 31 (4): 606-621.; Wu et al., 2008Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Jonhui; Lu, Jin; Litvak, Iva J. (2008). Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol & Alcoholism 43 (6): 706-712.; Lebeaut, Tran, and Vujanovic, 2020Lebeaut, Antoine; Tran, Jana K.; Vujanovic, Anka A. (2020). Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity. Addictive Behaviors 106, 106353.; Sallie et al., 2020Sallie, Samantha N.; Ritou, Valentin; Bowden-Jones, Henrietta; Voon, Valerie (2020). Assessing international alcohol consumption patterns during isolation from the COVID-19 pandemic using an online survey: highlighting negative emotionality mechanisms. BMJ Open 10 (11), e044276.) as strategies to cope with stressful situations. In fact, after the SARS outbreak Wu et al. (2008)Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Jonhui; Lu, Jin; Litvak, Iva J. (2008). Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol & Alcoholism 43 (6): 706-712. reported an association between individuals who were in quarantine, with later alcohol abuse or dependence symptoms. Our results showed that 23% of the participants decreased their alcohol consumption while 20% increased it during the confinement, in accordance with other recent studies (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; López-Moreno et al., 2020López-Moreno, Miguel; Iglesias López, María Teresa; Miguel, Marta; Garcés Rimón, Marta (2020). Physical and Psychological Effects Related to Food Habits and Lifestyle Changes Derived from COVID-19 Home Confinement in the Spanish Population. Nutrients 12 (11), 3445.; Sallie et al., 2020Sallie, Samantha N.; Ritou, Valentin; Bowden-Jones, Henrietta; Voon, Valerie (2020). Assessing international alcohol consumption patterns during isolation from the COVID-19 pandemic using an online survey: highlighting negative emotionality mechanisms. BMJ Open 10 (11), e044276.). Additionally, the mean age of those who increased their alcohol consumption (45.4±11.3y) was higher than those who decreased it (40.2±13.6y), findings concurring with those presented by Sallie et al. (2020)Sallie, Samantha N.; Ritou, Valentin; Bowden-Jones, Henrietta; Voon, Valerie (2020). Assessing international alcohol consumption patterns during isolation from the COVID-19 pandemic using an online survey: highlighting negative emotionality mechanisms. BMJ Open 10 (11), e044276., who postulated that older individuals, parents with children, essential workrs, people with depressive and anxiety symptoms or an impulsive personality might have a greater risk for alcohol misuse.

Concerning EE, our results showed a greater intake of snacks during the lockdown, which is in line with consumer reports from grocery stores (Los españoles confinados picotean hasta un 50% másLos españoles confinados picotean hasta un 50% más. Kantar. https://www.kantarworldpanel.com/es/Noticias/Los-espaoles-confinados-picotean-hasta-un-50-ms. ; El ticket medio recupera la estabilidad. ¿Cómo evolucionan las compras de alimentación y bebidas en el confinamiento?El ticket medio recupera la estabilidad. ¿Cómo evolucionan las compras de alimentación y bebidas en el confinamiento? InfoRetail. Available at https://www.revistainforetail.com/noticiadet/el-ticket-medio-recupera-la-estabilidad/738fe8425e3be42b8b685a0751b23265 ) and other investigations (Laguna et al., 2020Laguna, Laura; Fiszman, Susana; Puerta, P.; Chaya, C.; Tárrega, A. (2020). The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers. Food Quality and Preference 86, 104028.; Naja and Hamadeh, 2020Naja, Farah; Hamadeh, Rena (2020). Nutrition amid the COVID-19 pandemic: a multi-level framework for action. European Journal of Clinical Nutrition 74 (8): 1117-1121.; Ruiz-Roso et al., 2020Ruiz-Roso, María Belén; de Carvalho Padilha, Patricia; Mantilla-Escalante, Diana C.; Ulloa, Natalia; Brun, Paola; Acevedo Correa, Diofanor; Arantes Ferreira Peres, Wilza et al. (2020). COVID-19 confinement and changes of adolescent’s dietary trends in Italy, Spain, Chile, Colombia and Brazil. Nutrients 12 (6), 1807.; Sánchez-Sánchez et al., 2020Sánchez-Sánchez, Eduardo; Ramírez-Vargas, Guillermo; Avellaneda-López, Ylenia; Orellana Pecino, J. Ignacio; García Marín, Esperanza; Díaz Jiménez, Jara (2020). Eating habits and physical activity of the Spanish population during the COVID-19 pandemic period. Nutrients 12 (9), 2826.; Scarmozzino and Visioli, 2020Scarmozzino, Federico; Visioli, Francesco (2020). COVID-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods 9 (5), 675.; Sidor and Rzymski, 2020Sidor, Aleksandra; Rzymski, Piotr (2020). Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients 12 (6), 1657.) during the same situation. This could be related to the fact that negative emotions can trigger the intake of energy-dense food, such as snacks or sweets (Macht, 2008Macht, Michael (2008). How emotions affect eating: a five-way model. Appetite 50 (1): 1-11.; Camilleri et al., 2014Camilleri, Géraldine; Méjean, Caroline; Kesse-Guyot, Emmanuelle; Andreeva, Valentina; Bellisle, France; Hercberg, Serge; Péneau, Sndrine (2014). The associations between emotional eating and consumption of energy-dense snack foods are modified by sex and depressive symptomatology. The Journal of Nutrition 144 (8): 1264-1273.; Clum et al., 2014Clum, Gretchen A.; Rice, Janet; Broussard, Marsha; Johnson, Carolyn C.; Webber, Larry S. (2014). Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women. Journal of Behavioral Medicine. 37 (4): 577-586.; Charbonnier et al., 2015Charbonnier, Lisette; van der Laan, Laura; Viergever, Max A.; Smeets, Paul A. M. (2015). Functional MRI of Challenging Food Choices: Forced Choice between Equally Liked High- and Low-Calorie Foods in the Absence of Hunger. PLoS One 10 (7), e0131727. ). Additionally, women showed an overall greater consumption of these products in our study, as it has been recently reported (Balluerka et al., 2020Balluerka Lasa, Nekane; Gómez Benito, Juana; Hidalgo Montesinos M.ª Dolores, Gostiosaga Manterola, Arantxa; Espada Sánchez, José Pedro; Padilla García, José Luis; Santed Germán, Miguel Ángel (2020). Las consecuencias psicológicas de la COVID-19 y el confinamiento. Informe de investigación. Available at https://www.ub.edu/web/ub/ca/menu_eines/noticies/docs/Consecuencias_psicologicas_COVID-19.pdf ; Pérez-Rodrigo et al., 2020Pérez-Rodrigo, Carmen; Gianzo Citores, Marta; Hervás Bárbara, Gotzone; Ruiz Litago, Fátima; Casis Sáenz, Luis; Aranceta Bartrina, Javier (2020). Cambios en los hábitos alimentarios durante el periodo de confinamiento por la pandemia COVID-19 en España. Revista Española de Nutrición Comunitaria 26 (2), 28010. ). This behavior could be associated with higher anxiety levels experienced in women, who increased their savory and sweet snacks intake during the lockdown. In fact, it seems that emotional changes have a greater influence on eating behaviors in women, as 33% of them in our study declared that emotions exert a negative effect on their diet vs. 25% of men. These findings are supported by the results of López-Moreno et al. (2020)López-Moreno, Miguel; Iglesias López, María Teresa; Miguel, Marta; Garcés Rimón, Marta (2020). Physical and Psychological Effects Related to Food Habits and Lifestyle Changes Derived from COVID-19 Home Confinement in the Spanish Population. Nutrients 12 (11), 3445..

Diverse hypotheses correlate specific eating behaviors with higher levels of stress and negative emotions. Physiologically, food intake is suppressed under stress-induced psychological changes due to the activation of the sympathetic nervous system, which may interfere with digestion processes such as gastrointestinal transit or by delaying glucose absorption (Tsigos et al., 2000Tsigos, Constantine; Kyrou, Ioannis; Kassi, Eva; Chrousos, George P. (2000). Stress: Endocrine Physiology and Pathophysiology. Available at https://www.ncbi.nlm.nih.gov/books/NBK278995/ ). However, overeating behavior under negative emotions or stress conditions has well been reported. The reason for these mixed behaviors is a complex problem still unresolved and may involve physiological, behavioral, emotional and cognitive mechanisms (Macht, 2008Macht, Michael (2008). How emotions affect eating: a five-way model. Appetite 50 (1): 1-11.; DiRenzo et al., 2020Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152.; Muscogiuri et al., 2020Muscogiuri, Giovanna; Barrea, Luigi; Savastano, Silvia; Colao, Anna Maria (2020). Nutritional recommendations for COVID-19 quarantine. European Journal of Clinical Nutrition 74 (6): 850-851.). Thus, food-induced emotion may affect the control of food choice, where energy-dense foods usually rich in fat and sugar, would evoke positive affective responses causing a greater intake, whereas bitter compounds would provoke the opposite effect (Charbonnier et al., 2015Charbonnier, Lisette; van der Laan, Laura; Viergever, Max A.; Smeets, Paul A. M. (2015). Functional MRI of Challenging Food Choices: Forced Choice between Equally Liked High- and Low-Calorie Foods in the Absence of Hunger. PLoS One 10 (7), e0131727. ). Another class of emotion-induced changes that could trigger overeating is the impairment of cognitive eating controls. Lastly, a learning perspective could be the motive in which eating would be used as a strategy to regulate emotions. In this case, the learning process would involve the negative emotions as the stimuli and eating palatable food as the operant behavior, which would result in a reduction of the negative emotions due to the mood-elevating effect of this kind of food. The repetition of this behavior may reinforce it and might be used to cope with negative emotions (Rodríguez-Martín and Meule, 2015Rodríguez-Martín, Boris C.; Meule, Adrian (2015). Food craving: new contributions on its assessment, moderators, and consequences. Frontiers in Psychology 6, 21.). For instance, in the study of DiRenzo et al. (2020)Di Renzo, Laura; Gualtieri, Paola; Cinelli, Giulia; Bigioni, Giulia; Soldati, Laura; Attinà, Alda; Bianco, Francesca Fabiola et al. (2020). Psychological aspects and eating habits during COVID-19 home confinement: Results of EHLC-COVID-19 Italian Online Survey. Nutrients 12 (7), 2152. about the relationship between eating habits, mental and emotional mood among the Italian population, almost half of the participants claimed that they used food when they felt anxious as a tool to feel better.

Regarding the effect of boredom on EE, Koball et al. (2012)Koball, Afton M.; Meers, Molly R.; Storfer-Isser, Amy; Domoff, Sarah E.; Musher Einzenman, Dara R. (2012). Eating when bored: Revision of the emotional eating scale with a focus on boredom. Health Psychology 31 (4): 521-524. pointed out that boredom should be considered in a separate dimension of EE, since the eating response, which triggers is different from the response activated by other emotions. This may explain why our results did not show gender differences when participants felt bored. Laguna et al. (2020)Laguna, Laura; Fiszman, Susana; Puerta, P.; Chaya, C.; Tárrega, A. (2020). The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers. Food Quality and Preference 86, 104028. suggested that the lockdown forced the population to transfer the usual leisure activities to home, which would raise the intake of snacks and homemade bakery. In fact, higher levels of boredom were associated with the intake of bakery goods and all kinds of snacks (Muscogiuri et al. 2020Muscogiuri, Giovanna; Barrea, Luigi; Savastano, Silvia; Colao, Anna Maria (2020). Nutritional recommendations for COVID-19 quarantine. European Journal of Clinical Nutrition 74 (6): 850-851.). Moreover, according to consumer reports (Cotos 2020Cotos, Carlos (2020). Los españoles llenan más sus cestas en el confinamiento. Kantar. Available at https://www.kantar.com/es/inspiracion/coronavirus/los-espanoles-llenan-mas-sus-cestas-en-el-confinamiento ; https://www.revistainforetail.com/noticiadet/el-ticket-medio-recupera-la-estabilidad/738fe8425e3be42b8b685a0751b23265) the sales of products related to homemade bakery and appetizers remarkably increased, reaching even to be sold out during the confinement.

This study presents some limitations as the possible bias owing to the self-reported data. In addition, this kind of online questionnaires cannot be excessively longer because of the risk of a low engagement level.

Our study was designed to explore the effect of the lockdown during the first and more severe period. For this reason, the data cannot be considered representative, not being possible, for instance, to determine in a deeper level the gender differences regarding the home care. A longer study targeting the same population in different stages of the pandemic, as the inclusion of other variables, would have contribute to establish stronger and additional correlations.

The strength of this study is the large representation of all CSIC centers and the notable number of participants considering the total CSIC workers.

CONCLUSIONS

The COVID-19 health crisis and the ad doc lockdown measures implemented in Spain seem to cause a negative effect on CSIC workers’ lifestyles, especially from a psychological status point of view. This work shows the effects of the lockdown on a specific population, which did not have risk of losing their jobs, but had to change their working conditions to a telecommuting mode.

Despite emotional changes were detected, a general improvement in the dietary patterns was identified, probably owing to an increased health concern and more available time for cooking. However, the intake of unhealthy products such as snacks and bakery goods seem to have increased during the confinement, especially in women. This consumption could be associated with greater emotional changes in women, particularly for anxiety, and the strategies adopted by them to cope with these emotional alterations. In this way, emotional eating behaviors, like snacking, lack of control over the consumption of hyperpalatable food and intake related to emotions, have been associated with greater levels of anxiety. In addition, it should be highlighted that in a context where food is undoubtedly involved in Spanish leisure activities, it is not surprising the link of boredom and a greater intake of snacks and bakery products.

Moreover, the mobility restrictions established during confinement had a great effect on the practice of physical activity that was reduced in almost half of the population. In addition, it seems that men adapted their PA practice worse to the confinement situation, possibly due to the type of sport practiced before the pandemic.

Further investigations are needed to determine the long-term effects of COVID-19 lockdown on the population’s lifestyles. Therefore, our study provides initial information about how the lockdown influenced this specific population and then develop future interventions to mitigate it.