The coronavirus disease 2019 (COVID-19) pandemic has led to significant shifts in dietary behaviors worldwide, influenced by socioeconomic factors such as income and education. This study examines the impact of these factors on dietary changes in urban middle-aged and older adults in the United States during the pandemic. A cross-sectional survey was conducted with 10,050 participants aged 40–100 years who were stratified by income and education levels. Dietary habits were assessed using the 25-item Dietary Screening Tool (DST), with scores being calculated pre- and post-pandemic. Nutritional risk was evaluated based on the DST scores, and binary logistic regression models were used to assess associations between socioeconomic factors and changes in food consumption. During the pandemic, lower-income individuals were more likely to reduce their consumption of nutrient-dense foods, including fruits, vegetables, and lean proteins, while processed meat intake showed mixed trends across income levels. Interestingly, individuals with higher education levels demonstrated increased nutritional vulnerability, potentially due to stress-related changes and disrupted access to preferred foods. Educational level was a stronger predictor of nutritional risk than income level, with higher education being unexpectedly associated with greater vulnerability to dietary disruption. These findings highlight the need for public health interventions that address nutritional challenges across all socioeconomic levels during crises, rather than focusing solely on income or educational disparities. By improving food access, promoting affordable healthy options, and addressing stress-related eating, future policies can better support equitable dietary resilience. This study’s insights can inform strategies for mitigating nutritional risk and promoting dietary stability in future public health emergencies.
| [1] | Janssen, M., Chang, B. P., Hristov, H., Pravst, I., Profeta, A., and Millard, J., “Changes in food consumption during the COVID-19 pandemic: Analysis of consumer survey data from the first lockdown period in Denmark, Germany, and Slovenia.” Frontiers in Nutrition, 8, 635859. July 2021.View Article PubMed |
| [2] | Bennett, G., Young, E., Butler, I., and Coe, S., “The impact of lockdown during the COVID-19 outbreak on dietary habits in various population groups: A scoping review.” Frontiers in Nutrition, 8, 626432. July 2021.View Article PubMed |
| [3] | Bakaloudi, D. R., Jeyakumar, D. T., Jayawardena, R., and Chourdakis, M., “The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: A systematic review of the evidence.” Clinical Nutrition, 41 (7), 3038–3045. April 2022.View Article PubMed |
| [4] | AlMughamis, N., AlAsfour, S., and Mehmood, S., “Poor eating habits and predictors of weight gain during the COVID-19 quarantine measures in Kuwait: A cross-sectional study.” F1000Research, 9, 914. August 2020.View Article |
| [5] | Deschasaux-Tanguy, M., Druesne-Pecollo, N., Esseddik, Y., De Edelenyi, F. S., Allès, B., Andreeva, V. A., Baudry, J., Charreire, H., Deschamps, V., Egnell, M., et al., “Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March–May 2020): Results from the French NutriNet-Santé cohort study.” American Journal of Clinical Nutrition, 113 (5), 924–938. December 2021.View Article PubMed |
| [6] | Husain, W., and Ashkanani, F., “Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: A community-based cross-sectional study.” Environmental Health and Preventive Medicine, 25, 61. October 2020.View Article PubMed |
| [7] | Zeigler, Z., Forbes, B., Lopez, B., Pedersen, G., Welty, J., Deyo, A., and Kerekes, M., “Self-quarantine and weight gain related risk factors during the COVID-19 pandemic.” Obesity Research and Clinical Practice, 14 (3), 210–216. May 2020.View Article PubMed |
| [8] | Sidor, A., and Rzymski, P., “Dietary choices and habits during COVID-19 lockdown: Experience from Poland.” Nutrients, 12 (6), 1657. June 2020.View Article PubMed |
| [9] | Pellegrini, M., Ponzo, V., Rosato, R., Scumaci, E., Goitre, I., Benso, A., Belcastro, S., Crespi, C., De Michieli, F., Ghigo, E., et al., “Changes in weight and nutritional habits in adults with obesity during the 'lockdown' period caused by the COVID-19 virus emergency.” Nutrients, 12 (7), 2016. July 2020.View Article PubMed |
| [10] | Gallo, L. A., Gallo, T. F., Young, S. L., Moritz, K. M., and Akison, L. K., “The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students.” Nutrients, 12 (6), 1865. June 2020.View Article PubMed |
| [11] | Di Renzo, L., Gualtieri, P., Pivari, F., Soldati, L., Attinà, A., Cinelli, G., Leggeri, C., Caparello, G., Barrea, L., Scerbo, F., et al., “Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey.” Journal of Translational Medicine, 18, 229. June 2020.View Article PubMed |
| [12] | Ruiz-Roso, M. B., de Carvalho Padilha, P., Mantilla-Escalante, D. C., Ulloa, N., Brun, P., Acevedo-Correa, D., Arantes Ferreira Peres, W., Martorell, M., Aires, M. T., de Oliveira Cardoso, L., et al., “COVID-19 confinement and changes of adolescent’s dietary trends in Italy, Spain, Chile, Colombia and Brazil.” Nutrients, 12 (6), 1807. June 2020.View Article PubMed |
| [13] | Bracale, R., and Vaccaro, C. M., “Changes in food choice following restrictive measures due to COVID-19.” Nutrition, Metabolism & Cardiovascular Diseases, 30 (7), 1423–1426. May 2020.View Article PubMed |
| [14] | Scarmozzino, F., and Visioli, F., “COVID-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.” Foods, 9 (5), 675. May 2020.View Article PubMed |
| [15] | González-Monroy, C., Gómez-Gómez, I., Olarte-Sánchez, C. M., and Motrico, E., “Eating behaviour changes during the COVID-19 pandemic: A systematic review of longitudinal studies.” International Journal of Environmental Research and Public Health, 18, 11130. November 2021.View Article PubMed |
| [16] | Bonfanti, R. C., Sideli, L., Teti, A., Musetti, A., Cella, S., Barberis, N., Borsarini, B., Fortunato, L., Sechi, C., Micali, N., et al., “The impact of the first and second wave of the COVID-19 pandemic on eating symptoms and dysfunctional eating behaviours in the general population: A systematic review and meta-analysis.” Nutrients, 15 (8), 3607. August 2023.View Article PubMed |
| [17] | Monroe-Lord, L., and Ardakani, A., “How COVID-19 Pandemic Changed Consumption of Fruits and Vegetables by Older Adults.” Innovation in Aging, 5 (Suppl. 1), 726. 2021.View Article PubMed |
| [18] | Souza, T. C. M., Oliveira, L. A., Daniel, M. M., Ferreira, L. G., Della Lucia, C. M., Liboredo, J. C., and Anastácio, L. R., “Lifestyle and eating habits before and during COVID-19 quarantine in Brazil.” Public Health Nutrition, 25, 65–75. 2022.View Article PubMed |
| [19] | Monroe-Lord, L., Harrison, E., Ardakani, A., Duan, X., Spechler, L., Jeffery, T. D., and Jackson, P., “Changes in food consumption trends among American adults since the COVID-19 pandemic.” Nutrients, 15 (7), 1769. April 2023.View Article PubMed |
| [20] | Monroe-Lord, L., Ardakani, A., Jackson, P., Asongwed, E., Duan, X., Schweitzer, A., Jeffery, T., Johnson-Largent, T., and Harrison, E., “Dietary Shifts since COVID-19: A Study of Racial Differences.” Nutrients, 16 (8), 3164. August 2024.View Article PubMed |
| [21] | Caso, D., Guidetti, M., Capasso, M., and Cavazza, N., “Finally, the chance to eat healthily: Longitudinal study about food consumption during and after the first COVID-19 lockdown in Italy.” Food Quality & Preference, 95, 104275. 2022.View Article PubMed |
| [22] | Marmot, M., “Social determinants of health inequalities.” Lancet, 365, 1099–1104. 2005.View Article PubMed |
| [23] | Monroe-Lord, L., and Ardekani, A., “COVID-19 Pandemic-Related Changes in Nutrition Behaviors of Older Adults.” Current Developments in Nutrition, 5 (Suppl. 1), 39. 2021.View Article PubMed |
| [24] | Ardakani, A., Monroe-Lord, L., and Spechler, L., “P070 COVID-19 pandemic changes in fruit and vegetable consumption among various demographic populations.” Journal of Nutrition Education & Behavior, 54, S50–S51. 2022.View Article PubMed |
| [25] | Loopstra, R. Vulnerability to Food Insecurity Since the COVID-19 Lockdown. The Food Foundation: London, UK, 2020. |
| [26] | Power, M., Doherty, B., Pybus, K., and Pickett, K., “How COVID-19 has exposed inequalities in the UK food system: The case of UK food and poverty.” Emerald Open Research, 2, 11. 2020.View Article |
| [27] | Laborde, D., Martin, W., Swinnen, J., and Vos, R., “COVID-19 risks to global food security.” Science, 369, 500–502. 2020.View Article PubMed |
| [28] | Darmon, N., and Drewnowski, A., “Does social class predict diet quality?” American Journal of Clinical Nutrition, 87, 1107–1117. 2008.View Article PubMed |
| [29] | McKey, K., “Socioeconomic status and health: The challenge of the gradient.” American Psychologist, 61, 103–116. 2006. |
| [30] | Lesser, I. A., and Nienhuis, C. P., “The impact of COVID-19 on physical activity behavior and well-being of Canadians.” International Journal of Environmental Research & Public Health, 17, 3899. 2020.View Article PubMed |
| [31] | Cosgrove, K., Vizcaino, M., and Wharton, C., “Predictors of COVID-19-related perceived improvements in dietary health: Results from a US cross-sectional study.” Nutrients, 13, 2097. 2021.View Article PubMed |
| [32] | Ordoñez-Araque, R., and Caicedo-Pineda, L., “Impacts of COVID-19 on the dietary habits of low- and high-income households in Ecuador.” Current Research in Food Science, 4, 44–51. 2021. |
| [33] | World Health Organization. A Conceptual Framework for Action on the Social Determinants of Health. Geneva, Switzerland, 2010. |
| [34] | Qualtrics. Provo, UT., 2020. Available online: https://www.qualtrics.com (accessed on 13 August 2020). |
| [35] | United States Census Bureau. The Urban and Rural Classifications. Suitland, MD, USA, 2013. |
| [36] | U.S. Department of Agriculture. What is MyPlate? 2020. Available online: https://www.myplate.gov/eat-healthy/what-is-myplate (accessed on 22 November 2021). |
| [37] | Malik, V. S., Popkin, B. M., Bray, G. A., Després, J.-P., Willett, W. C., and Hu, F. B., “Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: A meta-analysis.” Diabetes Care, 33, 2477–2483. 2010.View Article PubMed |
| [38] | Micha, R., Michas, G., and Mozaffarian, D., “Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes: An updated review of the evidence.” Current Atherosclerosis Reports, 14, 515–524. 2012.View Article PubMed |
| [39] | Bailey, R. L., Miller, P. E., Mitchell, D. C., Hartman, T. J., Lawrence, F. R., Sempos, C. T., and Smiciklas-Wright, H., “Dietary screening tool identifies nutritional risk in older adults.” American Journal of Clinical Nutrition, 90, 177–183. 2009.View Article PubMed |
| [40] | Bailey, R. L., Mitchell, D. C., Miller, C. K., Still, C. D., Jensen, G. L., Tucker, K. L., and Smiciklas-Wright, H., “A dietary screening questionnaire identifies dietary patterns in older adults.” Journal of Nutrition, 137, 421–426. 2007.View Article PubMed |
| [41] | Marra, M., Thuppal, S. V., Johnson, E. J., and Bailey, R. L., “Validation of a dietary screening tool in a middle-aged Appalachian population.” Nutrients, 10, 345. 2018.View Article PubMed |
| [42] | Davitt, E. D., Heer, M. M., Winham, D. M., Knoblauch, S. T., and Shelley, M. C., “Effects of COVID-19 on university student food security.” Nutrients, 13, 1932. 2021.View Article PubMed |
| [43] | Devereux, S., Béné, C., and Hoddinott, J., “Conceptualising COVID-19’s impacts on household food security.” Food Security, 12, 769–772. 2020.View Article PubMed |
| [44] | Kirkpatrick, S. I., and Tarasuk, V., “Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents.” Journal of Nutrition, 138, 604–612. 2008.View Article PubMed |
| [45] | Drewnowski, A., and Specter, S. E., “Poverty and obesity: The role of energy density and energy costs.” American Journal of Clinical Nutrition, 79, 6–16. 2004.View Article PubMed |
| [46] | Pechey, R., Monsivais, P., Ng, Y. L., and Marteau, T. M., “Why don’t poor men eat fruit? Socioeconomic differences in motivations for fruit consumption.” Appetite, 84, 271–279. 2015.View Article PubMed |
| [47] | Lin, B.-H., Yen, S. T., Huang, C. L., and Smith, T. A., “U.S. demand for organic and conventional fresh fruits: The roles of income and price.” Sustainability, 1, 464–478. 2009.View Article |
| [48] | Malkan Bakhrul Ilmi, I., Nur Hasan Syah, M., Wahyuningsih, U., and Crosita Octaria, Y., “Determinants of fruit consumption in adult women in Indonesia.” F1000Research, 12, 783. 2023.View Article |
| [49] | Hui, L., “Research on impacts given by grain price fluctuation on customers in inflation period.” Research Journal of Applied Sciences, Engineering and Technology, 5, 4118–4122. 2013.View Article |
| [50] | Lu, K., and Yu, B., “The impact of high food prices on poverty in China.” Development Practice, 21, 794–802. 2011.View Article |
| [51] | Aruga, K., Islam, M. M., and Jannat, A., “Effects of the State of Emergency during the COVID-19 Pandemic on Tokyo Vegetable Markets.” Sustainability, 14 (15), 9719. August 2022.View Article |
| [52] | Revoredo-Giha, C., Russo, C., and Twum, E. K., “Purchases of fruit and vegetables for at-home consumption during COVID-19 in the UK: Trends and determinants.” Frontiers in Nutrition, 9, 847996. April 2022.View Article PubMed |
| [53] | Yang, R., Raper, K. C., and Pruitt, J. R., “The influence of recession and income strata on consumer demand for protein sources.” Applied Economics, 51 (42), 4615–4628. 2019.View Article |
| [54] | Andreoli, V., Bagliani, M., Corsi, A., and Frontuto, V., “Drivers of protein consumption: A cross-country analysis.” Sustainability, 13 (13), 7399. July 2021.View Article |
| [55] | Mulik, K., and Haynes-Maslow, L., “The impact of food insecurity on diet quality during the COVID-19 pandemic: The role of government nutrition assistance programs.” Journal of Nutrition Education & Behavior, 53, 203–210. 2021. |
| [56] | Tan, S. T., Tan, C. X., and Tan, S. S., “Changes in dietary intake patterns and weight status during the COVID-19 lockdown: A cross-sectional study focusing on young adults in Malaysia.” Nutrients, 14 (2), 280. January 2022.View Article PubMed |
| [57] | Park, S., Lee, S. H., and Blanck, H. M., “Characteristics associated with being a high consumer of sweet foods and sugar-sweetened beverages among US adults during the COVID-19 pandemic.” Nutrients, 15 (10), 2363. May 2023.View Article PubMed |
| [58] | Niles, M. T., Bertmann, F., Belarmino, E. H., Wentworth, T., Biehl, E., and Neff, R., “The early food insecurity impacts of COVID-19.” Appetite, 149, 104915. 2020.View Article |
| [59] | Béné, C., “Resilience of local food systems and links to food security—A review of some important concepts in the context of COVID-19 and other shocks.” Agricultural Economics, 51, 1076–1100. 2020.View Article PubMed |
| [60] | Dubowitz, T., Dastidar, M. G., Troxel, W. M., Beckman, R., Nugroho, A., Siddiqi, S., and Cantor, J., “Food insecurity in a low-income, predominantly African American cohort following the COVID-19 pandemic.” American Journal of Public Health, 111, 494–497. 2021.View Article PubMed |