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Dolati S, Hariri Far A, Mollarasouli Z, Imani A. The Impact of the COVID-19 Pandemic on Changes in Food Choice, Purchase, and Consumption Patterns in the World: A Review Study. JNFS 2022; 7 (3) :388-397
URL: http://jnfs.ssu.ac.ir/article-1-481-en.html
Department of Nutrition, Ministry of Health, Tehran, Iran.
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The Impact of the COVID-19 Pandemic on Changes in Food Choice, Purchase, and Consumption Patterns in the World:  A Review Study
Sepideh Dolati; MSc *1, Alemeh Hariri Far; MSc 2, Zahra Mollarasouli; MSc 2 & Ali Imani; PhD 3
1 Department of Nutrition, Ministry of Health, Tehran, Iran.
2 Department of Community Nutrition, School of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
ARTICLE INFO ABSTRACT
REVIEW ARTICLE Background: The COVID-19 pandemic has caused serious disruption to food security in the world. Declining incomes, purchasing power, and food production and rising prices in the food supply and consumption chain have affected and increased the risk of food insecurity, the most important consequence of which is the worsening of world hunger and malnutrition. The outbreak of the COVID-19 pandemic since December 2019 in Wuhan, and its spread around the world has caused major changes in people's lives; one of the most important affected areas is the food and nutrition sector. This study aims to evaluate the effect of the COVID-19 pandemic on changes in food choice, purchase, and consumption. Methods: Keywords "food", "nutrition", "choice or select", "buy or purchase", "consumption" and "behavior" in combination with the word "COVID-19" were used to search for English articles in Google Scholar, PubMed, and Scopus. All articles from the beginning of the pandemic to the end of May 2021 were included in this study. After deleting some studies due to non-English language, duplication, inconsistency with the intended purpose, and being reviewed, 25 articles entered the final phase. Results: The results indicate that forced quarantine and travel restrictions with the formation of new nutritional behaviors have affected the quality of nutrition of different populations. It has positive consequences, such as reducing ready meals and fast foods, increasing attention to nutrients to promote and maintain health and reduce food waste. The negative consequences include increased intake of snacks, high-calorie foods, canned foods, and processed meats in some countries. Conclusion: Decreased nutritional quality from this pandemic can have adverse effects on public health. More detailed studies are needed to examine the impact of quarantine on food choice, purchase, and consumption during the COVID-19 pandemic.
Keywords: COVID-19; Food; Purchase; Nutrition
Article history:
Received: 15 Sep 2021
Revised: 3 Dec 2021
Accepted: 1 Jan 2022
*Corresponding author:
sd.dolati@gmail.com
Department of Nutrition, ministry of health, Tehran, Iran.

Postal code: 1986755882
Tel: +98-9106759828

Introduction
In December 2019, the corona virus started in Wuhan, the center of Hubei Province china. It spread rapidly, infected individuals, and engaged health-related organizations (Singhal, 2020 ). In March 2020, COVID-19 was known as an infectious disease by the world Health Organization (WHO) (Matsuo et al., 2021).
At the end of that month, more than 100 countries around the world announced that they had adopted "Lockdown" measures (Snuggs and McGregor, 2021). These sudden changes in people's lives have had negative impacts on their mental health and behaviors, such as eating habits (Bakaloudi DR et al., 2021).
It should be noted that diseases not only affect people's health, but also change their economic, social, agricultural, food security, and dietary status. Agriculture is one of the most important sectors of human development and is related to food security (Obayelu et al., 2021), and this pandemic has created serious challenges for the stable and sustainable functioning of food markets (Jámbor et al., 2020).
Transportation, commerce economy, subsistence, food supply chain, and food production sector
have been all affected and damaged as a result
of this worldwide pandemic and the due
lockdown regulations
(Gopinath, 2020). The COVID-19 pandemic has led to a limit on the number of specific food items that consumers could already buy easily (Sim et al., 2020). In addition to the psychological and emotional problems of to the coronavirus outbreak, limited access to daily food purchase may lead to a reduction in consuming fresh foods, especially fruits, vegetables and fish, and increase in consuming  processed foods, such as snacks, ready-to-eat foods, junk foods, snacks, and cereals (Di Renzo et al., 2020).

Recent studies have reported changes in food shopping behaiors during this period. For example, a study in Italy showed that people are buying more foods with long-term food storage, such as pasta, frozen foods, and ultrahigh temperature (UHT) milk than before. On the other hand, the purchase of fresh foods, such as fruits, dairy products with short expire dates and fresh vegetables has decreased during this period (Bracale and Vaccaro, 2020).
It has been well established that food choices are associated with mental and physical health. Some groups may be more vulnerable to the changes of diet and meals during the lockdown. For example, evidences suggest that pandemic anxiety may contribute to greater weight gain in obese adults (Sarlio-Lähteenkorva et al., 2004, Steptoe et al., 1995). Therefore, due to the new conditions created in terms of food access and the mentioned limitations, this review study was conducted to investigate the effect of the COVID-19 pandemic on changes in food choice, purchase, and consumption.
Materials and Methods
Eligibility criteria and search strategy: Manuscripts that assessed the effect of the COVID-19 on purchase, choice or consumption of food and nutrition or eating behavior during the pandemic in the world, were included. The inclusion criteria were non-review articles and articles in English language.
Information sources: Keywords, including "food", "nutrition", "choice or select", "buy or purchase", "consumption", and "behavior", in combination with the word "COVID-19" were used for searching English articles in Google Scholar, PubMed, and Scopus.  All related articles from the beginning of the pandemic to the end of May 2021 were included in this study.
Study design: The observational, prospective or retrospective, and case reports were used in this study. In this validity review study, articles were searched by one author and repeated. The citations were saved in EndNote x9 (produced by Clarivate Analytics. PA. USA), and after removing duplicate articles, titles and abstracts were evaluated. The non-English, without full text, and review articles were excluded from the study. Then, a final selection was conducted.
Data extraction: Data extraction was performed in duplicate by 2 authors and included the following attributes. They included country of origin, author(s), aims, purpose, or objective; population characteristics; sample size; methodology or methods, outcomes and description of measuring; and related findings.
Results
In searching, 97 articles were extracted. After reviewing the abstracts, 37 articles due to inconsistency with the purpose of the review, 21 articles due to duplication, 8 articles due to lack of abstract or non-English language, and 6 articles due reviewing methodology were excluded. Finally 25 articles were included. In this way, the review stage was finalized. Figure 1 shows the steps of performing the survey. Table 1 summarizes the findings of the studied survey.


 
Table 1. Results of changes in food selection, purchase, and consumption during the COVID-19 pandemic.
Results Method Gender and age Country(region)/ sample size Authors and date NO
Attention to choosing healthy foods in order to control their weight and improve their mood Online questionnaire Male and female > 18 years uk/ 240 Snuggs et al. (Snuggs and McGregor, 2021) 1
Significant reduction in consumption of fresh fish as the main food of the people of this country due to rising prices, reduction of food purchases, change of shopping direction to online Online and phone interview  with questionnaire Male and female, > 18 years Bangladesh/
397
Mandal et al. (Mandal et al., 2021) 2
Significant reduction in food consumption outside the home compared to before the pandemic, increase in consumption of stored and canned foods in exchange for fresh foods Online questionnaire Male and female, > 18 years Italy /
456
Cavallo et al. (Cavallo et al., 2020) 3
Clear changes in consumption and purchases, changes from unhealthy foods to healthy foods, increased online food purchases, no frightened purchases to store food Online questionnaire Male and female, > 18 years Qatar /
579
Ben Hassen et al. (Ben Hassen et al., 2020) 4
Significant increase in consumption of vegetables, increase in consumption of meat and starchy vegetables Online questionnaire Male and female, > 18 years New York /
381564
Mitchell et al. (Mitchell et al., 2020) 5
Most respondents cooked at home, increasing online food purchases Online questionnaire Girl and boy, 15-25 years Indonesia /
157
Widayat et al. (Widayat and Arifin, 2020) 6
Reducing expend for foods outside the home, increase the share of payments for food purchases, increase dry food purchases, taste was  the most important factor in food selection Online questionnaire Male and female, > 18 years America/
1370
Ellison et al. (Ellison et al., 2020) 7
Increase in food purchases more than usual, avoidance of in-person purchases and increase in online purchases Online questionnaire female, > 18 years Arizona America/861 Chenarides et al. (Chenarides et al., 2020) 8
Further increase in food purchases and consumption, 53% reduction in food waste, less acceptance of online food shopping and reduced sales of bakery products, fresh fish, and salty snacks Online questionnaire Male and female, > 18 years Italy /
1865
Scacchi et al. (Scacchi et al., 2021) 9
No change in the amount of food consumption (52%), significant reduction in food consumption in restaurants and coffee shops Online questionnaire Male and female, 17-50 years Germany /
1964
Huber et al. (Huber et al., 2021) 10
Increased consumption of processed foods (this increase was more evident in American countries) Online questionnaire Girl and boy, 16-19 years Italy, Spain, Brazil, Colombia, Chile/
726
Ruíz-Roso et al. (Ruíz-Roso et al., 2020) 11
More than 50% increase in food consumption at home, increase in snack consumption during the day Online questionnaire Male and female, > 18 years Poland/
312
Błaszczyk-B et al. (Błaszczyk-Bębenek E et al., 2020) 12
Increasing the frequency of consumption of dairy products, vegetables, fruits and reduce the frequency of consumption of bread, meat products and beverages, and increasing the desire to consume healthy foods Online questionnaire Male and female, > 18 years Turkey/
3017
Başaran et al. (Başaran and Pekmezcİ Purut, 2021) 13
Foods with the most changes in consumption include frozen foods, canned food, cakes and biscuits and foods with the least changes in consumption include bread, alcoholic beverages and dairy products Online questionnaire Male and female, > 18 years Denmark - Germany - Slovenia /
2680
Janssen et al. (Janssen et al., 2021) 14
Increased consumption of pasta, flour, eggs, frozen foods and long life milk, reduced consumption of fresh foods, increased baking of bread, pizza, and homemade cakes
Online questionnaire Stores and supermarkets France /
10796
Bracale et al. (Bracale and Vaccaro, 2020) 15
Preference to buy in person, reduced food waste, paying attention to food prices Online questionnaire Male and female, > 18 years Brazil/
458
Schmitt et al. (Schmitt et al., 2021) 16
Reduced number of times of buying and increased the amount bought of foods, increasing face-to-face shopping and less  online food buying, reduce access to fruits and vegetables and grains due to rising prices Male and female, > 18 years Russia/
1297
Ben Hassen et al. (Ben Hassen et al., 2021) 17
Increasing the purchase of fresh food online, decreasing the popularity of online food buying Online questionnaire Male and female, > 18 years Wuhan, China/
156
Chen et al. (Chen et al., 2021) 18
Increased willingness to use door-to-door food delivery services, reduced food consumption in women compared to men Online questionnaire Male and female, > 18 years Netherlands/
1030
Poelman et al. (Poelman et al., 2021) 19
Changing the first and the second food preferences from red meat and processed foods to fruits and vegetables, changing the first and the second food preferences from food price and health to food quality and health Online questionnaire Male and female, > 18 years Italy/
411
Celik et al. (Celik and Dane, 2020) 20
Sensory attractiveness and price are the most important factors in choosing food before and during the lockdown, increasing the importance of weight control and food health Online questionnaire Girl and boy, 15-20 years Poland/
2448
Głabska et al. (Głąbska et al., 2020) 21
Consumption of more than of  50% of foods, similar to the before, except for  fish, fruits, and sweets Online questionnaire Male and female, > 18 years Spain/600
Romeo-Arroyo et al. (Romeo-Arroyo et al., 2020) 22
Decreased nutritional quality of the diet in the early months of the pandemic, increased consumption of fruits and vegetables, legumes, fish and seafood. Online questionnaire Male and female, > 18 years France /
938
Marty et al. (Marty et al., 2021) 23
Increasing food intake, not consuming vegetables (59%), not consuming raw meat (61%), reducing consumption of nuts and legumes (16%) Phone surveys Male and female, > 18 years Addis Ababa (Ethiopia ) Hirvonen et al. (Hirvonen et al., 2021) 24





Discussion
In this review study, the effect of the COVID-19 pandemic on changes in food selection, purchase, and consumption in the world has been investigated. Reviewing the studies showed that during the COVID-19 pandemic, food selection, purchase, and consumption changed in many populations. Some of these changes have been favorable and some unfavorable.
During the COVID-19 crisis, a series of health practices were provided to populations by responsible organizations at both the international and national levels in the form of health care recommendations. They were replaced the usual methods and events of social relations which naturally have long-term effects and as care behaviors, are frequently recommended and emphasized by relevant authorities. Frequent recommendation of these behaviors by the authorities is led to the formation of new behaviors and social interactions (Shafiee Seifabadi and Bagheri Dolatabadi, 2020).
Quarantine and social isolation and the preference for spending less time outside homes, and spending more time with family members, in addition to better health care and nutrition during this period, have led to some positive consequences in the habits and behaviors of food selection and preparation. As a result, more time is spent for cooking at home and consumption of home-cooked food (Ben Hassen et al., 2021, Cavallo et al., 2020, Huber et al., 2021, Scacchi et al., 2021, Widayat and Arifin, 2020). Some studies and surveys in the UK, Italy, Russia, France, and Indonesia have shown that attention to the purchase and supply of healthy and high-quality foods that help control weight and improve mood has increased more than before the pandemic (Ben Hassen et al., 2021, Cavallo et al., 2020, Celik and Dane, 2020, Mandal et al., 2021, Marty et al., 2021, Snuggs and McGregor, 2021). These results were not only observed in the adult and youth groups, but also in adolescents in Poland studies (Głąbska et al., 2020). In a review study by Matsuo et al., increasing the purchase and consumption of fruits and vegetables has been mentioned as a positive outcome during this period (Matsuo et al., 2021). In other studies, the results were similar (Celik and Dane, 2020, Marty et al., 2021, Mitchell et al., 2020, Scacchi et al., 2021). In a study in Turkey, it was observed that during the pandemic, in addition to the increase in the consumption of fruits and vegetables, the consumption of dairy products and dietary supplements has also increased (Başaran and Pekmezcİ Purut, 2021). These results were inconsistent with studies in Germany and the Netherlands, in which the consumption of fruits and vegetables, as well as dairy products, were not significantly different from the pre-pandemic period (Huber et al., 2021, Poelman et al., 2021).
On the other hand, with the spread of the pandemic, although social isolation and forced quarantine are essential measures to protect public health, the results show that physical activity and eating behaviors have changed during this period (Ammar et al., 2020). Being in quarantine and social isolation can lead to less time outside homes, limited recreation, and entertainments and family parties, as well as fear and anxiety caused by the possibility of developing COVID-19 in oneself or loved ones. All of them, lead to less physical activity (Ammar et al., 2020) and an increase in the volume and number of meals (Błaszczyk-Bębenek E et al., 2020) or unhealthy snacks (Ben Hassen et al., 2021, Scacchi et al., 2021). Increasing the number of meals does not necessarily mean that the diet is useful due to its high quality, because it can be done by consuming comfortable foods, such as sweets, sweet drinks, snacks, and sauces (Matsuo et al., 2021). In many studies, participants tended to consume foods with high energy density and high concentrations of sugar and fat (comfortable foods to overcome feelings of fear and anxiety and to improve mood (Marty et al., 2021) or as a way for spending time with family and relatives and holding home parties (Marty et al., 2021). Increasing the consumption of these foods usually leads to negative health consequences (Matsuo et al., 2021). Some participants in various studies have cited the good taste of foods (high-calorie foods high in sugar, other carbohydrates, and/or fats) as dietary preferences during this period (Ellison et al., 2020, Głąbska et al., 2020). According to these surveys, these foods help suppressing negative emotions during this period (Landaeta-Díaz et al., 2021). In some studies, increase in caloric intake has been observed (Hirvonen et al., 2021, Marty et al., 2021).
In many studies, increase in the volume or number of meals consumed by the adolescent age group (Pietrobelli et al., 2020) and increase in the consumption of chips and sugary drinks have been reported (Matsuo et al., 2021).
Many studies have also shown changes in food selection and purchasing behaviors due to quarantine conditions and social isolation. These changes include reduction in the frequency of food purchases (Ben Hassen et al., 2021, Janssen et al., 2021), increase in  the use of home delivery services (Chenarides et al., 2020), change the purchasing method from face-to-face to online shopping (Ben Hassen et al., 2021, Chen et al., 2021, Ellison et al., 2020, Mandal et al., 2021, Poelman et al., 2021, Widayat and Arifin, 2020). These changes are especially among people with higher education levels (Ben Hassen et al., 2021, Poelman et al., 2021), but less among the elderly (Chen et al., 2021). Moreover, the changes consist of increase in  the volume of shopping in each purchase time, increase in food storage (Ben Hassen et al., 2021, Cavallo et al., 2020, Chenarides et al., 2020, Scacchi et al., 2021), increase in purchases from local retailers (Chenarides et al., 2020) instead of hypermarkets and chain stores due to proximity  of local stores and fast delivery of requested items via email or phone (Cavallo et al., 2020). Furthermore they include increase in  the purchase of domestic food due to the  concerns about foods safety of foreign products (Ben Hassen et al., 2021), and selection and purchase of food items that can be stored for a long time, such as legumes, canned vegetables, milk with long shelf life, cooked meat, and  pasta, instead of fresh foods and probiotic dairy products (Ben Hassen et al., 2021, Bracale and Vaccaro, 2020, Cavallo et al., 2020, Chenarides et al., 2020, Ellison et al., 2020, Janssen et al., 2021, Mandal et al., 2021).
In addition to these dietary behaviors that directly affect health, the COVID-19 pandemic and its related resulting forced quarantine have had many other negative consequences. The closure of borders and disruption of the export and import processes has disrupted the supply chain of many essential foods. All these change have led to a decrease in economic and purchasing power of essential items, especially foods (Shafiee Seifabadi and Bagheri Dolatabadi, 2020). Losing jobs and thus reducing the purchasing power of quality foods, along with increasing stress, fear, and anxiety from the pandemic and economic conditions, lead to low-cost, high-energy and cheap foods to control these negative emotions (Landaeta-Díaz et al., 2021). The results of a study by Mandel et al. in Bangladesh showed that during the pandemic, the consumption of fish, which is one of the main food items in the Bangladeshi diet, decreased in all households, regardless of economic status. In their study, 75% of people stated that the increase of fish price was the main reason for the decrease in its consumption. According to the results of this study, if the COVID-19 pandemic continues for a long time, urban residents with low income, reduced income or lost jobs will experience food insecurity (Mandal et al., 2021). In the pre-pandemic period, large numbers of Italians ate their breakfast and lunch outside the home (Cavallo et al., 2020). It indicates the difference in the level of well-being and access of people to high quality and appropriate foods, among the studied population groups.
Béné showed in his review study that most of the food and nutrition insecurity at the local level (households, communities, and regions) in low and middle income countries (LMICs) is the result of two structural problems and shocks and stressors. Thus, local shocks, such as drought or floods, as well as stressors, such as corruption, local insecurity, and the seasonal impassability of roads, severely affect the local food supply chain, as well as food producers, retailers, transportation systems, and others. This generally leads to physical and economic disruptions in food supply-food shortages, food loss or price fluctuations in rural and urban areas and ultimately short-term and long-term consequences, the most important of which are acute and chronic hunger and malnutrition (Béné, 2020).
There are limitations in this study, different methods have been used for sampling and data collection and also various groups and foods have been evaluated, which should be addressed in future studies. Moreover, most of the reviewed studies were conducted in the form of online surveys due to the quarantine condition, which due to the self-report nature of these studies, can lead to errors in the results.
In this review survey, the number of studies conducted in the less developed and low- and middle-income countries (LMICs) was very limited. At the same time, LMIC countries experience more and different problems during the COVID-19 pandemic. Another limitation of this study relates to the participants. Since the study was conducted using online questionnaire, most participants had a relatively high literacy and education, as well as Internet access and online survey tools. Therefore, people of lower socio-economic levels from low income countries are less likely to attend this study.
Therefore, due to the long period of the pandemic, it is better to consider the trend of changes in food selection and food behavior in the future studies based on seasonal changes and the occurrence of different waves of COVID-19 in the world and the start of vaccination in the populations, as well as changes in the mood and feeling of the participants.
Conclusion
Forced quarantine and social isolation resulting from COVID-19, accompanied by the formation of new interactions and behaviors, have had a profound impact on the lives of populations around the world. During this period, various motivations, such as health maintaining and weight control, suppressing negative emotions, enjoying the taste of food, food quality, food safety, access to food due to transportation constraints, price and purchasing power, play a significant role in peoples’ food selection. These motivations have been studied in different populations. These changes are considered as a risk factor for non-communicable diseases, if they lead to a decrease in the quality of nutrition. Therefore, the effect of quarantine and social isolation is very important on the quality of nutrition and prediction of predict health consequences, at the population level.
Conflict of interest
The authors declare that there is no conflict of interest.
Authors' contribution
Dolati S participated to the original idea, designed the project and collected the data. Dolati S and Hariri-Far involved to manuscript draft. Dolati S, Hariri-Far A, Mollarasouli  Z and Imani A participated to manuscript final edition. All authors read and approved the final version of manuscript .

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Type of article: review article | Subject: public specific
Received: 2021/09/15 | Published: 2022/08/19 | ePublished: 2022/08/19

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