nutrients

Article
Relationship between Dietary Habits, Food Attitudes
and Food Security Status among Adults Living within
The United States Three Months Post-Mandated
Quarantine: A Cross-Sectional Study
Aljazi Bin Zarah , Juliana Enriquez-Marulanda and Jeanette Mary Andrade *
Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA;
[email protected] (A.B.Z.); [email protected] (J.E.-M.)
* Correspondence: [email protected]; Tel.: +1-352-294-3975




Received: 28 September 2020; Accepted: 5 November 2020; Published: 12 November 2020


Abstract: COVID-19 has disrupted The lives of many and may have influenced dietary habits through
factors such as food security status and attitudes. The purpose of this study was to identify dietary
habits and their associations with food insecurity and attitudes among adults living in The United
States within three months post-mandated quarantine. An online cross-sectional study was conducted
from April to June 2020. Participants (n = 3133) responded to a 71-item questionnaire regarding
demographics (n = 7), health information (n = 5), lifestyle habits (n = 8), dietary habits (n = 37), food
attitudes (n = 8), and food security status (n = 6). Frequency counts and percentages were tabulated,
and multivariate linear regression was conducted to examine associations using STATA v14 at a
statistical significance level of p < 0.05. Results showed that most participants indicated no change
in dietary habits (43.6–87.4%), yet participants reported increased consumption of sweets (43.8%)
and salty snacks (37.4%). A significant positive association for food attitude scores (1.59, 95% CI
1.48 to 1.70; p < 0.001) and food security scores (1.19, 95% CI 0.93 to 1.45; p < 0.001) on total dietary
habit scores was found. Future extensive population studies are recommended to help public health
authorities frame actions to alleviate The impact that mandated quarantine has on dietary habits.

Keywords: COVID-19; adults; dietary habits; food attitudes; food security

1. Introduction
Coronavirus, also known as SARS-CoV-2 or COVID-19, is a severe acute respiratory syndrome in
which more than 40 million global cases and more than 1.1 million deaths have been identified [1].
In The United States (U.S.), there have been more than 8.2 million cases and 221 thousand reported
deaths [2]. During March, The U.S. federal government mandated that all residents and citizens remain
in quarantine. Only essential workers such as medical professionals and grocery store personnel
were allowed to be physically present at The workplace [3]. In April, The federal government
eased restrictions; however, several states, businesses, schools, and other organizations continued
to encourage adults to remain in their homes and limit The time spent at establishments to reduce
The spread of The virus. As a result of limited economic activity, many businesses closed their doors,
which resulted in 14.7% of adults being unemployed in April [4,5]. Projections are that food insecurity
will increase by as much as 5.2% due to The rates of unemployment [5–7].
Even though these preventative measures were necessary to reduce The virus’s spread, it may
have unwillingly shifted dietary habits based on food security status. As models have shown,
during a pandemic, individuals reduce their consumption of animal protein, fruits, and vegetables
due to The increased cost and availability of these foods [8,9]. Additionally, during high-stress times,

Nutrients 2020, 12, 3468; doi:10.3390/nu12113468 www.mdpi.com/journal/nutrients

Nutrients 2020, 12, 3468 2 of 14

attitudes such as boredom or anxiety may also influence dietary habits as foods typically consumed
are considered snacks or comfort foods that are typically high in sodium, added sugars, and total
fats [10]. This is further observed by The recent COVID-19 studies that have focused on dietary
habits [11–16] or The influence that attitudes [17–20] had on dietary habits. Notably, an Italian study
showed that participants decreased their consumption of fruits and vegetables (8.7%), with 33.5% of
participants stating that this was due to The lower availability of these foods. Additionally, around
46% of participants reported an increase in snacking, 42.5% reported an increase in their consumption
of sweetened snacks such as chocolate, ice cream, and desserts, while 23.5% reported an increase in
their intake of salty snacks. Furthermore, these dietary habits occurred due to feelings of boredom,
fear, anxiety, and stress [16].
The effects of COVID-19 on adults’ dietary habits are likely due to food security status and
attitudes. However, there is limited evidence that has associated these factors with dietary habits.
Therefore, this study identified dietary habits and their associations with food security status and
attitudes among adults living in The U.S. within three months post-mandated quarantine.

2. Materials and Methods

2.1. Study Design and Participants

This cross-sectional study was conducted online through QualtricsXM (Qualtrics, Provo, UT, USA),
an online survey platform, from April to June 2020. Recruitment was voluntary and anonymous
and occurred through social media platforms and ResearchMatch (NIH CTSA, Nashville, TN, USA).
ResearchMatch is a national health volunteer registry created by several academic institutions and
supported by The National Institutes of Health as part of The Clinical Translational Science Award
(CTSA) program [21]. Adults were eligible to participate if they were above The age of 18 and were
able to read in The English language and lived in The U.S. during COVID-19. All subjects gave their
informed consent for inclusion before they participated in The study. A total of 3155 adults initially
participated; after excluding non-responses regarding dietary habits and food security, The final
dataset included 3133 participants (see Figure 1). All study protocols were granted ethical approval by
The University of Florida Institutional Review Board # 202001147.

n = 3155

n = 3133

Figure 1. Sample collection chart.

Nutrients 2020, 12, 3468 3 of 14

2.2. Questionnaire
Participants responded to a 71-item questionnaire regarding demographics (n = 7), health
information (n = 5), lifestyle habits (n = 8), dietary habits (n = 37), food attitudes (n = 8), and food
security status (n = 6). The researchers (ABZ and JMA) developed this questionnaire with The use
of adapted validated instruments. The instrument was assessed for face validity by five adults and
modifications were made to enhance clarity (Supplementary File). The total length of time to complete
The questionnaire was estimated at 10 minutes. The demographic questions (n = 7) included age,
sex, race/ethnicity, education level, employment status, geographic location of residence, and time
spent at home since COVID-19. Health information questions (n = 5) that were self-reported by
The participants included current height reported in feet and inches and weight reported in pounds
for The researchers to calculate body mass index (BMI) (body mass (kg)/height (m2 )) and interpreted
according to The criteria of The Centers for Disease Control and Prevention [22]. Seven categories were
identified: underweight (BMI < 18.5 kg/m2 ), normal weight (18.5 kg/m2 –< 25.0 kg/m2 ), overweight
(25.0 kg/m2 –BMI < 30.0 kg/m2 ), obesity class 1 (BMI 30.0 kg/m2 –< 35.0 kg/m2 ), obesity class 2 (BMI 35.0
kg/m2 –< 40 kg/m2 ), and obesity class 3 (BMI > 40 kg/m2 ) [22]. Additional health questions were about
weight changes, health conditions, supplement use, and if participants followed a diet since COVID-19.

2.2.1. Lifestyle Habits

Lifestyle habit statements (n = 8) focused on participants’ physical and social activities during
COVID-19. For physical and social activities, participants indicated whether The behaviors increased,
decreased, or did not change during COVID-19. To determine total scores, no change resulted in a score
of 0. An increase in eating, watching TV, or smoking or a decrease in exercising, physical activity, sleep
amount/quality, reading/studying, or socialization resulted in a score of 1 as these were considered
unfavorable to health [13,19,23]. If participants indicated a decrease in these activities (e.g., eating)
or an increase in these activities (e.g., exercising), it resulted in a score of 2 as these activities were
considered favorable to health [13,19,23]. Total scores ranged from 0 to 16.

2.2.2. Dietary Habits

Participants completed a section about dietary habits based on foods/beverages consumed.
The foods and beverages listed were based on Dana-Farber’s Cancer Institute Eating Habits
Questionnaire [24]. The Cancer Institute questionnaire originally included five food categories—dairy,
fruits, vegetables, meats, sweets, baked goods, and beverages—with a total of 61 food/beverage items
based on The frequency of consuming those items over The past year. The instrument was modified
to reflect six food/beverage categories with 37 items, to reduce potential survey exhaustion from
participants [25,26]. For example, instead of listing specific fruits (e.g., oranges, bananas), information
was grouped into fresh/frozen or canned fruit. For dietary habits, total scores were determined based
on whether The participant selected increased, decreased, or no change in these habits since COVID-19.
Selecting no change resulted in a score of 0. Selecting increased from The following food/beverage
items resulted in a score of 2 for each item or by selecting decreased results in a score of 1 for each
item as these were considered nutrient-dense foods (i.e., low in sodium, added sugars and total fat):
milk and yogurt, fresh/frozen/canned fruits and vegetables, chicken and fish, whole grains (e.g., whole
wheat/brown bread/rice), water, non-carbonated no added sugar beverages, immune-enhancing
beverages, coffee/tea, and protein shakes [27,28]. Selecting increased in The following food/beverage
items resulted in a score of 1 for each item or selecting decreased resulted in a score of 2 for each item
as these foods were considered energy-dense foods (i.e., high in sodium, added sugars and total fat):
cheese, butter/margarine, fruit juice, vegetable/tomato juice, processed meats, red meats, refined grains
(e.g., white bread/rice), chips, sweets, alcohol (e.g., beer, wine, spirits), and carbonated added sugar
beverages [27,28]. The total scores ranged from 0 to 74 points.
Nutrients 2020, 12, 3468 4 of 14

2.2.3. Food Attitudes

The second section of The survey asked participants to indicate an increase, decrease, or no
change (never had these thoughts) in eight statements regarding food attitudes since COVID-19.
These statements included eating much more than planned, over-eating, lethargy after eating, and stress
behaviors derived from The Yale Food Addiction Scale [29]. The original addiction scale has 16
statements based on a response from 1 (never) to 5 (4 or more times daily) over The past 12 months.
This instrument has internal reliability for a single-factor of ∝ = 0.75 based on Kuder–Richardson.
It has been validated through convergent, divergent, and incremental methods based on a sample of
1440 participants [29]. Total scores were determined through The identification of increased/decreased
or no change reports. If participants had no change in their food attitudes, a score of 0 was provided.
An increase in these thoughts was given a score of 2. For a decrease in these thoughts, a score of 1 was
provided. Thus, the total scores ranged from 0 to 16.

2.2.4. Food Security

Household food security was measured using The validated USDA Food Security Module.
The short module includes six questions, ordered by The severity of food insecurity, that ask about
a household’s experiences with food insufficiency during The previous twelve months. The survey
in this study was adapted to The COVID-19 circumstances. This short-item survey has been
validated to represent 97.7% of households and is intended to be answered by a representative
of The household [30,31]. This 6-item survey is scored on a scale from 0 to 6, with 0–1 representing
high or marginal food security, 2–4 representing low food security, and a score of 5–6 representing
even lower food security [30]. The scoring system has been validated by previous studies [30,31].

2.3. Statistical Analysis

Frequency counts and percentages were tabulated for demographic variables and dietary habits,
food attitudes, and food security scores similarly to a previous study [11]. Multivariate linear regression
was conducted to examine The impact of associations of food insecurity and attitudes on dietary
habits. This analysis examined The confounding factors (food attitudes and food security status) and
isolated The relationship of interest (dietary habits). An additional regression was conducted that
focused on The impact of The confounding variables, demographics and lifestyle, on dietary habits [32].
The average dietary habits score was regressed onto demographics, lifestyle habits, food security status,
and food attitudes as shown in Table 1. The effect size classification suggested by Cohen [33] was used
to present The strength of R2 , which was classified as small, medium, and large when R2 = 0.01, 0.09,
and 0.25, respectively [34,35]. Statistical significance was determined at p < 0.05. All statistical analyses
were conducted using STATA (version 14.0, StataCorp, College Station, TX, USA).

Table 1. Model for regression analysis.

Y1 = b0 + b1 X1 + b2 X2 + . . . + bk Xk
where
Y1 represents Dietary habits
b0 , b1 and bk represent Estimate regression parameters
X1 X2 and Xk represent k predictors (demographics, lifestyle habits, food attitudes, and food security status)

3. Results

3.1. Study Population

The sample consisted of 3133 respondents, although not all participants responded to demographic
or health statements. For those who responded to these statements, The majority were white (84.5%),
female (79.4%), held a bachelor’s or master’s degree (34.2% and 30.3%, respectively), and were
employed full-time (43.0%). The sample’s age range varied, with a slight majority between The ages of
Nutrients 2020, 12, 3468 5 of 14

30 to 49 years old (30.5%). Half of The participants were married (50.5%), lived in The South Atlantic
region (22.9%), lived with at least one person (42.2%), and had stayed in their homes 75% to 95% of
The time during The three months within post-quarantine measures (79.4%) (see Table 2).

Health Characteristics and Anthropometrics

For participants who responded to these questions, health characteristics and anthropometrics
revealed that based on The calculated body mass index (BMI) kg/m2 , participants were considered
obese (47.0%) or overweight (34.0%). Most participants were not currently on a diet (82.8%), had no
weight changes during The pandemic (43.0%), and did not take any supplements (79.3%). Of those
using supplements, The majority were taking four or more (36.8%). Participants did indicate that they
had at least two medical conditions (30.8%) (see Table 3).

Table 2. Participants’ demographics.

Variables No. of Responses (%)

Sex N = 3101
Male 614 (19.8%)
Female 2462 (79.4%)
Other 25 (0.8%)
Race/Ethnicity N = 3099
African American 158 (5.1%)
Asian 89 (2.9%)
White 2620 (84.5%)
Hispanic 87 (2.8%)
Native American 11 (0.4%)
Other 134 (4.3%)
Age N = 3106
18–24 years 206 (6.6%)
25–29 years 300 (9.7%)
30–49 years 946 (30.5%)
50–59 years 548 (17.6%)
60–69 years 647 (20.8%)
>70 years 459 (14.8%)
Education level N = 3106
No schooling completed 2 (0.1%)
Some high school, no diploma 9 (0.3%)
High school graduate, diploma, or The equivalent (for example, GED) 71 (2.3%)
Some college credit, no degree 351 (11.3%)
Trade/technical/vocational training 63 (2.0%)
Associate degree 189 (6.1%)
Bachelor’s degree 1062 (34.2%)
Master’s degree 942 (30.3%)
Professional degree 137 (4.4%)
Doctorate degree 280 (9.0%)
Current employment status N = 3103
Full time 1333 (43.0%)
Part time 361 (11.6%)
Unemployed 542 (17.5%)
Other 867 (27.9%)
Nutrients 2020, 12, 3468 6 of 14

Table 2. Cont.

Variables No. of Responses (%)

Marital status N = 3103
Married 1567 (50.5%)
Single 908 (29.3%)
Widowed 125 (4.0%)
Divorced 401 (12.9%)
Other 102 (3.3%)
People live in The household besides yourself N = 3114
None 630 (20.2%)
1 1314 (42.2%)
2 525 (16.9%)
3 363 (11.7%)
4 146 (4.7%)
5 or more 104 (3.3%)
Did not respond 32 (1.0%)
Currently staying at home ×% of The time N = 3105
Less than 25% 0 (0%)
25–49% 132 (4.3%)
50–75% 404 (13.0%)
75–95% 2465 (79.4%)
Never left The house 104 (3.3%)
Residence N = 3098
New England (Connecticut, Maine, Massachusetts, Rhode Island,
119 (3.8%)
Vermont)
Mid-Atlantic (New Jersey, New York, Pennsylvania) 393 (12.7%)
South Atlantic (Delaware, Florida, Georgia, Maryland, North Carolina,
710 (22.9%)
South Carolina, Virginia, Washington DC, West Virginia)
East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin) 573 (18.5%)
East South Central (Alabama, Kentucky, Mississippi, Tennessee) 268 (8.7%)
West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska,
242 (7.8%)
North Dakota, South Dakota)
West South Central (Arkansas, Louisiana, Texas) 161 (5.2%)
Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico,
202 (6.5%)
Utah, Wyoming)
Pacific (Alaska, California, Hawaii, Oregon, Washington) 430 (13.9%)
Note. GED = General Educational Development.

3.2. Dietary Habits

On average, The total dietary habits score was 14.39 ± 9.78, with a range of scores from 0 to 53.
Most participants indicated no change in dietary habits (43.6–87.4%) for The listed food and beverage
items. Some participants, though, reported increased consumption of sweets, including cakes, cookies,
and pies (43.8%); potato chips or salty snacks (37.4%); water (35.4%); coffee or tea (31.1%); white rice or
pasta (26.8%); alcoholic beverages (23.9% and 15.6%); cold breakfast cereals (22.3%); baked, mashed,
or boiled potatoes (22.2%); starchy vegetables (21.6%); beef, pork, or lamb (20.4%); processed meats
(20.0%); white bread (19.0%); margarine or butter (16.5%); fruit juice (11.7%); vegetable juice (5.3%);
and carbonated beverages with sugar (10.6%). Furthermore, some participants reported decreased
consumption of fruit (33.4%); eggs, chicken, or turkey (31%); non-starchy vegetables (28.2%); dairy
(21.6%); and fish and shellfish (16.6%). Participants also indicated decreased consumption of nutritious
foods such as nut butter (26.0%); nuts or seeds (25.3%); brown rice or whole-grain pasta (15.1%);
whole-grain bread (14.1%); and oils (10.7%) (see Figure 2).
Nutrients 2020, 12, 3468 7 of 14

Table 3. Participants’ general health characteristics and anthropometrics.

Variables No. of Responses (%)

BMI (kg/m2 ) N = 3040
< 18 37 (1.2%)
18.5–24.9 538 (17.7%)
25–29.9 1033 (34.0%)
30–34.9 733 (24.1%)
35–39.9 357 (11.7%)
40–44.9 194 (6.4%)
>45 146 (4.8%)
Weight change N = 3110
No change 1336 (43.0%)
Increased 1182 (38.0%)
Decreased 592 (19.0%)
Activity N = 3103
No change 1102 (35.5%)
Increased 1326 (42.7%)
Decreased 675 (21.8%)
Tried a diet N = 3123
No 2587 (82.8%)
Yes 536 (17.2%)
Nutritional supplement intake N = 3119
No 2474 (79.3%)
Yes 645 (20.7%)
Supplements currently taking N = 646
Multi-vitamin 47 (7.3%)
Vitamin B complex 5 (0.8%)
Vitamin C 22 (3.4%)
Vitamin D 26 (4.0%)
Other 47 (7.3%)
Two supplements 150 (23.2%)
Three supplements 111 (17.2%)
Four or more supplements 238 (36.8%)
Medical conditions N = 1960
Cancer 24 (1.2%)
Depression 274 (13.9%)
Diabetes (high blood sugar) 52 (2.7%)
Diverticulosis/Diverticulitis 10 (0.5%)
Gastric reflux 80 (4.1%)
Heart disease 143 (7.3%)
IBS/D 47 (2.4%)
Liver disease (cirrhosis, fatty liver) 4 (0.2%)
Lung disease 17 (0.9%)
Nausea/Vomiting 9 (0.5%)
Other 294 (15.0%)
2 conditions 604 (30.8%)
3 or more conditions 402 (20.5%)
Note. BMI = Body Mass Index; IBS/D = Irritable Bowel Syndrome/Disease.
Nutrients 2020, 12, 3468 8 of 14

Nutrients 2020, 12, x FOR PEER REVIEW 8 of 14

Diet Habits per Food/Beverage Item

Percentage Reported
Carbonated beverages with sugar
Low calorie carbonated beverages
Hard liquor
Beer or wine
Immune enhancing beverages
Coffee or tea
Water
Oils such as olive, sunflower
Sweets such as candy, cookies, pies
Peanut or other nut butters
Nuts or seeds
Potato chips or other salty snacks
Brown rice or whole-grain pasta
White rice or pasta
Starchy vegetables
Potatoes
French fried potatoes
Dark bread
White bread
Cold breakfast cereals
Fish or Shellfish
Processed meats
Beef, pork or lamb
Eggs, chicken or turkey
Vegetable or tomato juice
Non-starchy vegetables, salad
Fruit juice
Fruit
Margarine or Butter
Dairy and dairy alternatives

0 10 20 30 40 50 60 70 80 90 100

Decreased Increased No Change

Figure2.2.Dietary
Figure Dietaryhabits
habitsreported
reported by
by foods/beverages
foods/beverages consumed.
consumed.Data
Datarepresented
representedasas
percentages of of
percentages
no-change, increased, or decreased.
no-change, increased, or decreased.

3.3.Association
3.3. Associationbetween
betweenFood
FoodSecurity
Security Status and Food
Food Attitudes
Attitudeson
onDietary
DietaryHabits
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Averagescores
Average scoresforfor food
food attitudeswere
attitudes were2.60
2.60± ±2.99
2.99(minimum
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and and forsecurity
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were 0.69 0.69(minimum
± 1.77 ± 1.77 (minimum
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maximum score of 10).score of 10). A
A multivariate
multivariate linear regression showed a significant positive correlation for food
linear regression showed a significant positive correlation for food attitudes score (1.59, 95% attitudes score (1.59,CI
CI95% 1.48 to 1.70; p < 0.001) and food security score (1.19, CI95% 0.93 to 1.45; p < 0.001)
1.48 to 1.70; p < 0.001) and food security score (1.19, 95% CI 0.93 to 1.45; p < 0.001) with total dietary with total
dietary habits score, controlling for demographic cofounding factors and the interaction
habits score, controlling for demographic cofounding factors and The interaction term (Table 4). term (Table
4). A significant negative correlation was found for the female sex (−0.97, CI95% −1.69 to −0.24; p =
A significant negative correlation was found for The female sex (−0.97, 95% CI −1.69 to −0.24; p = 0.009),
0.009), race (−0.74, CI95% −1.1 to −0.37; p < 0.001), and age range (−1.01, CI95% −1.26 to –0.77; p < 0.001)
race (−0.74, 95% CI −1.1 to −0.37; p < 0.001), and age range (−1.01, 95% CI −1.26 to –0.77; p < 0.001)
with total dietary habits score. A significant positive correlation was found for percentage of time
with total dietary habits score. A significant positive correlation was found for percentage of time
Nutrients 2020, 12, 3468 9 of 14

spent at home (−1.25, 95% CI −0.70 to −1.81; p < 0.001) with total dietary habits score. This model had
a large strength, with an R2 of 0.29.

Table 4. Multivariable associations and total dietary habits score.

Total Dietary Habits Score Coef. Std. Err. t p > |t| (95% Conf. Interval)
Food attitudes score 1.07 0.07 15.22 0.000 * 0.93 1.21
Food security score 1.06 0.15 7.22 0.000 * 0.77 1.34
Sex: female 0.97 0.37 −2.62 0.009 * −1.69 −0.24
Ethnicity −0.74 0.19 −3.98 0.000 * −1.10 −0.37
Residence −0.06 0.06 −0.96 0.34 −0.18 0.06
Education 0.07 0.09 0.73 0.46 −0.11 0.25
Employment −0.06 0.14 −0.42 0.67 −0.33 0.21
Marital status 0.26 0.14 1.91 0.06 −0.01 0.53
% of time spent at home 1.26 0.28 4.45 0.000 * 0.70 1.81
Age range −1.02 0.13 −8.08 0.000 * −1.26 −0.77
Household size −0.07 0.12 −0.57 0.57 −0.31 0.17
BMI 0.06 0.02 2.73 0.006 * 0.02 0.11
Weight change 0.60 0.25 2.39 0.017 * 0.11 1.10
Medical conditions −0.01 0.04 −0.35 0.73 −0.09 0.06
Tried a diet 0.88 0.48 1.86 0.06 −0.05 1.82
Nutritional supplement intake 2.16 0.43 5.05 0.000 * 1.32 3.00
Total activity score 1.14 0.07 16.27 0.000 * 1.00 1.28
Food attitudes * Food security −0.10 0.03 −3.58 0.000 * −0.16 −0.05
Note. * p < 0.05.; Coef = coefficient; Std. Err. = standard error; t = coefficient divided by its standard error;
Conf. = confidence; BMI = Body Mass Index.

A second multivariate linear regression revealed a significant positive correlation for BMI
(0.065, 95% CI 0.02 to 0.11; p = 0.006), weight change (0.60, 95% CI 0.11 to 1.09; p = 0.017), use of
supplements (2.16, 95% CI 1.32 to 3.00; p < 0.001), and total activity score (1.14, 95% CI 1.00 to 1.28;
p < 0.001) with dietary habits score. This model had a large strength, with an R2 of 0.37 (see Table 4).

4. Discussion
This cross-sectional study demonstrated that dietary habits and their associations between food
security status and food attitudes among adults living within The U.S. three months post-mandated
quarantine were impacted. For dietary habits, participants reported increased consumption of sweets,
red and processed meats, and refined grains and decreased consumption of whole fruits, vegetables,
and lean proteins. Additionally, participants reported decreased consumption of whole grain bread,
nuts/seeds, and oils. Factors such as female sex, race, and age range had a negative correlation with
dietary habits, whereas time spent at home, BMI, weight change, use of supplements, and total activity
score positively correlated with dietary habits.
Despite COVID-19 being responsible for 10.6 million job losses and a rise in The consumer price
index of food [4], in this study, participants reported high food security during these times, which is
contradictory to other reports [5,36,37]. Results from this study showed that low food security scores
were associated with lower dietary habits scores. Therefore, individuals that were considered food
secure were less likely to change their dietary habits. These results concur with The United States
Department of Agriculture’s (USDA) definition of food security, as food insecurity is characterized by
disrupted standard eating patterns and multiple changes in The diet due to minimal resources to access
food [38]. High food availability could have also contributed to The high food security scores observed
in this study. Even though grocery stores reported less food availability and higher costs of food at
The start of The pandemic due to unpreparedness, demand for food slowly stabilized, and prices for
food items returned to typical figures [39,40]. For instance, The price for a dozen eggs in New York
rose to USD 3.07 by The end of March but gradually decreased to USD 1.97 by mid-April [39].
Nutrients 2020, 12, 3468 10 of 14

Food attitudes and dietary habits score were positively correlated such that, on average,
participants had lower food attitudes and lower dietary habits scores. Lower food attitude scores
conveyed a lack of distress towards dietary habits. These results may conflict with those reported by
Czeisler et al., who indicated elevated levels of impaired mental health during COVID-19, including a
three-fold increase in anxiety disorders and a four-fold increase in depression [41]. However, the results
of this study align with those found by Termorshuizen et al., which reported that 49% of The U.S.
participants indicated an increased connection with family and friends, which led to adaptive coping
skills and positive changes in their mental health during COVID-19 [42]. A study on The changes in
dietary habits amid COVID-19 in Spain reported that participants who lived with their family during
Spain’s confinement displayed higher adherence to The Mediterranean diet [20]. Since a little over
40% of participants in this U.S. study reported living with at least one person during confinement,
it is possible that positive relationships led to better coping skills, which in turn led to fewer impaired
food attitudes.
It was expected that during quarantine, animal protein, fruits, and vegetable consumption would
decrease due to lower availability and financial access [9]. However, this study found that participants
had reported no change in The intake of these commodities. There was no major variation in dietary
patterns aside from increases in The consumption of sweets and salty snacks. Participants were found
to have low dietary habits scores, which did not necessarily reflect poor nutritional behaviors but
rather no change in The intake of most food items amid COVID-19. These findings are similar to
those reported in an Italian sample by Scarmozzino and Visioli, in which most responders (49.6%)
did not modify their diets during quarantine [16]. These results might seem contradictory to those
found by The International Food Information Council (IFIC), which reported that 8 in 10 Americans
changed their dietary habits amid COVID-19 [43]. However, The change in dietary habits in The IFIC’s
study was mainly due to increased cooking at home [43]. Furthermore, The IFIC study did not assess
The individual’s change in consuming different food items. Regardless, The IFIC’s study and multiple
other studies reported an increase in snacking behavior and consumption of comfort foods (e.g., foods
high in sodium, added sugars, and/or total fats) [11,13,14,16,18–20,43,44], which is consistent with
The increased consumption of sweet and salty snacks observed in this study.
Participants reported a decrease in The consumption of fruits, non-starchy vegetables, dairy, fish,
shellfish, eggs, and white meat (chicken or turkey). Additionally, participants consumed more red meat
(beef, lamb, pork), and caffeinated and alcoholic beverages. Laguna et al. found that Spanish consumers
also decreased their purchases of fish and shellfish as these had a reduced shelf-life and had a higher
price [45]. However, in comparison to The results of this study, Laguna et al. revealed that Spanish
consumers increased their intake of fruits, vegetables, eggs, and dairy and decreased their consumption
of alcoholic beverages and sweets [45]. These effects could be explained by The differences in dieting
in Spain compared to The U.S. While multiple Spanish studies found an increase in The adherence to a
Mediterranean diet [14,20], participants in this study reported not following any diet (82.8%).
In this study, participants (38.0%) reported an increase in their weight. This effect could be
attributed to The increased consumption of sweets (43.8%) and salty snacks (37.4%). Furthermore,
most participants were identified to be overweight (34.0%) or obese (47.0%), with two or more medical
conditions (30.8%). BMI had a significant positive correlation with dietary habits, whereas medical
conditions had no effect. These results agree with The findings of another study, which revealed that a
higher BMI was associated with increased weight gain, lower consumption of fruits and vegetables,
and an elevated intake of meat and alcoholic beverages during quarantine [13]. Another factor
found to influence dietary habits was total activity. This study found that while exercise decreased
(34.5%), the use of electronic devices increased (71.9%). Higher technology use was expected as social
distancing orders transitioned most social and work life to a virtual format. Multiple studies have
outlined The relationship between sedentary behaviors and weight gain during COVID-19 [20,23,46].
The decrease in exercise could further contribute to The weight gain which some participants
experienced during confinement.
Nutrients 2020, 12, 3468 11 of 14

Strengths and Limitations

To our knowledge, this is The first study to focus on identifying The dietary habits of adults living
in The U.S. during COVID-19 post-mandated quarantine. Even though over 3000 participants from
across The U.S. participated in this study, The investigators were unable to generalize The results due
to The limited demographic variability. As this study was conducted online, only individuals with
access to WiFi and a technological device were able to participate. This inadvertently led to selection
bias [25]. Self-reporting bias may have been present in The participants’ responses as participants
were not forced to respond to each question [25,47]. This bias may have been present in one of two
ways: recall bias or social desirability bias. When answering questions regarding dietary habits,
attitude or lifestyle behavior recall bias, or error in recalling a past event, may have inhibited accurate
responses [25,47]. Additionally, questions concerning more sensitive topics such as food security status,
weight, and health conditions may have resulted in social desirability bias or inaccurate reporting due
to desired approval [25,47].

5. Conclusions
The present study was designed to identify dietary habits and their associations with food
insecurity and attitudes among adults living in The United States within three months post-mandated
quarantine. The research has shown a significant correlation between food security status and food
attitudes. Home confinement directly affects lifestyle patterns, including dietary habits, access to food,
and food attitudes. This interruption of a routine lifestyle led to non-nutritious food consumption such
as those high in sodium, added sugars, and total fats.
COVID-19 continues to evolve globally, possibly having a prolonged effect on The relationship
between dietary habits, food security status, and food attitudes, as shown in The current study.
Maintaining consistent dietary habits is difficult during confinement, as The availability of food varies.
Future extensive population studies are recommended in The U.S. to help public health authorities to
frame actions to alleviate The impact that mandated quarantine has on dietary habits.

Supplementary Materials: The following are available online at http://www.mdpi.com/2072-6643/12/11/3468/s1,

File S1: Survey on U.S. Adults’ Dietary habits, Food Attitudes and Food security status during COVID-19.
Author Contributions: Conceptualization of this study was by A.B.Z. and J.M.A.; methodology, J.E.-M., A.B.Z.
and J.M.A.; validation, A.B.Z. and J.M.A.; formal analysis, J.E.-M., A.B.Z. and J.M.A.; investigation, J.E.-M.,
A.B.Z. and J.M.A.; data curation, A.B.Z. and J.M.A.; writing—original draft preparation, J.E.-M. and A.B.Z.;
writing—review and editing, J.E.-M., A.B.Z. and J.M.A.; supervision, J.M.A.; project administration, J.M.A. All
authors have read and agreed to The published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments: We appreciate The consultation from statisticians A. Enriquez-Marulanda and J. Colee.
Conflicts of Interest: The authors declare no conflict of interest.

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