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LitCovid-PubTator

Id Subject Object Predicate Lexical cue tao:has_database_id
1 76-84 Disease denotes COVID-19 MESH:C000657245
12 1199-1205 Gene denotes OR 1.3 Gene:128360
13 914-926 Species denotes participants Tax:9606
14 239-256 Disease denotes distress symptoms MESH:D004421
15 288-312 Disease denotes coronavirus disease 2019 MESH:C000657245
16 314-322 Disease denotes COVID-19 MESH:C000657245
17 334-340 Disease denotes Stress MESH:D000079225
18 630-647 Disease denotes distress symptoms MESH:D004421
19 653-661 Disease denotes COVID-19 MESH:C000657245
20 790-798 Disease denotes COVID-19 MESH:C000657245
21 1417-1425 Disease denotes COVID-19 MESH:C000657245
28 2257-2265 Species denotes patients Tax:9606
29 1537-1561 Disease denotes coronavirus disease 2019 MESH:C000657245
30 1563-1571 Disease denotes COVID-19 MESH:C000657245
31 1809-1822 Disease denotes viral disease MESH:D001102
32 2245-2256 Disease denotes psychiatric MESH:D001523
33 2359-2367 Disease denotes COVID-19 MESH:C000657245
41 2558-2564 Disease denotes Stress MESH:D000079225
42 2625-2631 Disease denotes stress MESH:D000079225
43 2661-2692 Disease denotes loss of appetite and hypophagia MESH:D001068
44 2766-2772 Disease denotes stress MESH:D000079225
45 2844-2850 Disease denotes Stress MESH:D000079225
46 3299-3309 Disease denotes depression MESH:D000275
47 3315-3334 Disease denotes adverse weight gain MESH:D015430
49 4764-4772 Disease denotes COVID-19 MESH:C000657245
52 4811-4816 Chemical denotes sugar MESH:D000073893
53 4898-4906 Disease denotes COVID-19 MESH:C000657245
55 4997-5005 Disease denotes COVID-19 MESH:C000657245
65 3573-3579 Species denotes people Tax:9606
66 4347-4352 Species denotes women Tax:9606
67 3503-3511 Disease denotes COVID-19 MESH:C000657245
68 3775-3781 Disease denotes stress MESH:D000079225
69 3854-3862 Disease denotes COVID-19 MESH:C000657245
70 4217-4226 Disease denotes depressed MESH:D000275
71 4230-4237 Disease denotes anxious MESH:D001007
72 4371-4379 Disease denotes COVID-19 MESH:C000657245
73 4547-4555 Disease denotes COVID-19 MESH:C000657245
76 5575-5587 Species denotes Participants Tax:9606
77 5276-5284 Disease denotes COVID-19 MESH:C000657245
80 6287-6295 Disease denotes COVID-19 MESH:C000657245
81 6402-6410 Disease denotes COVID-19 MESH:C000657245
86 6546-6558 Species denotes participants Tax:9606
87 7080-7092 Species denotes participants Tax:9606
88 7315-7327 Species denotes Participants Tax:9606
89 6817-6825 Disease denotes COVID-19 MESH:C000657245
92 8562-8570 Disease denotes COVID-19 MESH:C000657245
93 8617-8625 Disease denotes COVID-19 MESH:C000657245
95 9311-9323 Species denotes Participants Tax:9606
97 9619-9631 Species denotes participants Tax:9606
102 9947-9959 Species denotes participants Tax:9606
103 10126-10138 Species denotes participants Tax:9606
104 10469-10481 Species denotes participants Tax:9606
105 10214-10222 Disease denotes COVID-19 MESH:C000657245
107 11001-11006 Chemical denotes Sugar MESH:D000073893
111 11204-11216 Species denotes participants Tax:9606
112 11333-11345 Species denotes participants Tax:9606
113 11466-11478 Species denotes participants Tax:9606
115 11626-11650 Disease denotes COVID-19-Related Worries MESH:C000657245
123 11754-11760 Gene denotes OR 1.9 Gene:391110
124 12138-12144 Gene denotes OR 1.3 Gene:128360
125 12035-12041 Gene denotes OR 1.3 Gene:128360
126 11685-11697 Species denotes participants Tax:9606
127 11722-11725 Species denotes men Tax:9606
128 11815-11827 Species denotes participants Tax:9606
129 11958-11970 Species denotes participants Tax:9606
137 12571-12579 Disease denotes COVID-19 MESH:C000657245
138 12820-12828 Disease denotes COVID-19 MESH:C000657245
139 13019-13027 Disease denotes COVID-19 MESH:C000657245
140 13160-13166 Disease denotes stress MESH:D000079225
141 13183-13191 Disease denotes COVID-19 MESH:C000657245
142 13303-13309 Disease denotes stress MESH:D000079225
143 13679-13685 Disease denotes stress MESH:D000079225
149 13720-13732 Species denotes participants Tax:9606
150 13769-13772 Species denotes men Tax:9606
151 14032-14037 Species denotes women Tax:9606
152 14076-14079 Species denotes men Tax:9606
153 14166-14172 Disease denotes stress MESH:D000079225
159 14693-14705 Species denotes participants Tax:9606
160 14479-14487 Disease denotes COVID-19 MESH:C000657245
161 15199-15209 Disease denotes depression MESH:D000275
162 15474-15482 Disease denotes COVID-19 MESH:C000657245
163 15630-15638 Disease denotes COVID-19 MESH:C000657245
178 16575-16584 Species denotes chocolate Tax:3641
179 16596-16605 Species denotes chocolate Tax:3641
180 16644-16653 Species denotes chocolate Tax:3641
181 16792-16804 Species denotes participants Tax:9606
182 17404-17412 Species denotes patients Tax:9606
183 16212-16217 Chemical denotes sugar MESH:D000073893
184 16126-16145 Disease denotes depressive symptoms MESH:D000275
185 16357-16363 Disease denotes Stress MESH:D000079225
186 16902-16908 Disease denotes stress MESH:D000079225
187 17101-17107 Disease denotes stress MESH:D000079225
188 17216-17235 Disease denotes adverse weight gain MESH:D015430
189 17240-17247 Disease denotes obesity MESH:D009765
190 17310-17317 Disease denotes obesity MESH:D009765
191 17395-17403 Disease denotes COVID-19 MESH:C000657245
195 17647-17655 Disease denotes COVID-19 MESH:C000657245
196 17999-18005 Disease denotes stress MESH:D000079225
197 18681-18691 Disease denotes depression MESH:D000275
201 19769-19781 Species denotes participants Tax:9606
202 20151-20157 Species denotes people Tax:9606
203 19584-19592 Disease denotes COVID-19 MESH:C000657245
209 21230-21235 Chemical denotes sugar MESH:D000073893
210 20623-20631 Disease denotes COVID-19 MESH:C000657245
211 20903-20911 Disease denotes COVID-19 MESH:C000657245
212 21021-21029 Disease denotes COVID-19 MESH:C000657245
213 21441-21460 Disease denotes adverse weight gain MESH:D015430
289 23895-23907 Species denotes participants Tax:9606
292 24221-24233 Species denotes participants Tax:9606
293 24375-24383 Disease denotes COVID-19 MESH:C000657245
296 26626-26634 Species denotes children Tax:9606
297 26767-26772 Species denotes Euros Tax:9319
299 26982-26990 Disease denotes COVID-19 MESH:C000657245

LitCovid-PD-HP

Id Subject Object Predicate Lexical cue hp_id
T1 345-360 Phenotype denotes negative affect http://purl.obolibrary.org/obo/HP_0031467
T2 3299-3309 Phenotype denotes depression http://purl.obolibrary.org/obo/HP_0000716
T3 3323-3334 Phenotype denotes weight gain http://purl.obolibrary.org/obo/HP_0004324
T4 3919-3937 Phenotype denotes increased appetite http://purl.obolibrary.org/obo/HP_0002591
T5 4306-4317 Phenotype denotes weight gain http://purl.obolibrary.org/obo/HP_0004324
T6 15199-15209 Phenotype denotes depression http://purl.obolibrary.org/obo/HP_0000716
T7 17224-17235 Phenotype denotes weight gain http://purl.obolibrary.org/obo/HP_0004324
T8 17240-17247 Phenotype denotes obesity http://purl.obolibrary.org/obo/HP_0001513
T9 17310-17317 Phenotype denotes obesity http://purl.obolibrary.org/obo/HP_0001513
T10 18681-18691 Phenotype denotes depression http://purl.obolibrary.org/obo/HP_0000716
T11 21449-21460 Phenotype denotes weight gain http://purl.obolibrary.org/obo/HP_0004324

LitCovid-sentences

Id Subject Object Predicate Lexical cue
T1 0-94 Sentence denotes Emotional Eating in Relation to Worries and Psychological Distress Amid the COVID-19 Pandemic:
T2 95-140 Sentence denotes A Population-Based Survey on Adults in Norway
T3 142-150 Sentence denotes Abstract
T4 151-333 Sentence denotes Population-based studies have revealed a high occurrence of self-reported psychological distress symptoms during the early phases of the coronavirus disease 2019 (COVID-19) pandemic.
T5 334-442 Sentence denotes Stress and negative affect can lead to emotional eating, which in turn can have negative outcomes on health.
T6 443-678 Sentence denotes In this population-based study, 24,968 Norwegian inhabitants participated in an electronic questionnaire including structured questions on dietary habits, emotional eating, psychological distress symptoms, and COVID-19-related worries.
T7 679-808 Sentence denotes The study took place during April 2020 after around six weeks of interventions to tackle the first wave of the COVID-19 pandemic.
T8 809-927 Sentence denotes Overall, emotional eating was reported in 54% of the population and was markedly more frequent in female participants.
T9 928-1222 Sentence denotes Worries related to consequences of the pandemic were associated with increased emotional eating, and the association was stronger for worries related to personal economy—odds ratios (OR) 1.7 (95% confidence interval (CI95%) 1.5–1.9)—compared to worries related to health—OR 1.3 (CI95% 1.2–1.5).
T10 1223-1316 Sentence denotes Psychological distress had a strong association with emotional eating—OR 4.2 (CI95% 3.9–4.4).
T11 1317-1515 Sentence denotes Correspondingly, the intake of high-sugar foods and beverages was higher for those with substantial COVID-19-related worries and those with psychological distress compared to the overall population.
T12 1517-1519 Sentence denotes 1.
T13 1520-1532 Sentence denotes Introduction
T14 1533-1666 Sentence denotes The coronavirus disease 2019 (COVID-19) pandemic constitutes a worldwide state of emergency that is unparalleled in recent times [1].
T15 1667-1888 Sentence denotes Countries all over the world have implemented unprecedented non-pharmaceutical interventions (NPIs) in order to limit the spread of the novel viral disease, including regional- and national-level lockdowns and quarantine.
T16 1889-2047 Sentence denotes As communities were closing down, concerns were raised about the impact of these interventions on other aspects of public health, including mental health [2].
T17 2048-2148 Sentence denotes In the wake of the first phase of the pandemic, evidence of its impact on mental health is emerging.
T18 2149-2381 Sentence denotes Although limited, most current studies show an increased burden of mental health symptoms among psychiatric patients and healthcare workers and lower psychological well-being in the general population amid the COVID-19 outbreak [3].
T19 2382-2557 Sentence denotes Population-based studies have also revealed a high occurrence of self-reported psychological distress during the early phases of the pandemic in different populations [4,5,6].
T20 2558-2615 Sentence denotes Stress and emotional state influence the eating behavior.
T21 2616-2699 Sentence denotes To many, stress and negative mood can induce loss of appetite and hypophagia [7,8].
T22 2700-2843 Sentence denotes However, for a major subset of individuals, negative emotions and stress cause them to eat more—a type of eating known as emotional eating [9].
T23 2844-3051 Sentence denotes Stress is known to induce a shift in individuals, making them favor hyperpalatable foods, i.e., calorie-dense foods high in fat and/or sugar content, and this tendency is stronger in emotional eaters [7,10].
T24 3052-3172 Sentence denotes Even under habitual circumstances, emotional eaters consume more energy-dense and sweet snack foods than others [11,12].
T25 3173-3343 Sentence denotes There is evidence emerging that points to the role of emotional eating as a behavioral mechanism mediating the association of depression with adverse weight gain [13,14].
T26 3344-3502 Sentence denotes Thus, emotional eating may pose an additional health burden to those vulnerable to eating more, and more unhealthily, during moments of hardship and distress.
T27 3503-3598 Sentence denotes COVID-19 represents a major disruption on the day-to-day life of most people in affected areas.
T28 3599-3811 Sentence denotes There is reason to believe that the pandemic has an impact on the eating habits not only due to the practical effects of the lockdown, but also through its effect on perceived stress and psychological well-being.
T29 3812-4026 Sentence denotes Current studies on eating habits amid the COVID-19 outbreak reveal a shift in self-reported eating towards increased appetite and overall food consumption, as well as increased snacking in-between meals [15,16,17].
T30 4027-4242 Sentence denotes A study regarding the most critical phase of the first Italian lockdown shows a substantial prevalence of emotional eating in the population, in particular among those that reported feeling depressed or anxious [4].
T31 4243-4420 Sentence denotes Similarly, a Chinese study on emotional eating and gestational weight gain amid the pandemic found that women who worried about COVID-19 had higher emotional eating scores [18].
T32 4421-4636 Sentence denotes Our aim was to assess the prevalence of emotional eating and its association with worries and psychological distress amid the COVID-19 lockdown through a large-scale population-based study in a major city in Norway.
T33 4637-4782 Sentence denotes Our main research questions were:How prevalent was emotional eating among females and males in different age groups during the COVID-19 lockdown?
T34 4783-4949 Sentence denotes Did the consumption of high-sugar foods and beverages differ between the overall population and those experiencing COVID-19-related worries or psychological distress?
T35 4950-5048 Sentence denotes Was emotional eating associated with levels of COVID-19-related worries or psychological distress?
T36 5050-5052 Sentence denotes 2.
T37 5053-5074 Sentence denotes Materials and Methods
T38 5076-5080 Sentence denotes 2.1.
T39 5081-5099 Sentence denotes Survey Methodology
T40 5100-5329 Sentence denotes A random selection of 81,170 individuals from a total of 224,000 adult inhabitants in Bergen, Norway, were invited to participate in a survey assessing the consequences of the COVID-19 outbreak and the NPIs that were implemented.
T41 5330-5574 Sentence denotes NPIs included social distancing and quarantine, travel restrictions, closing of schools and universities, mandated use of home office, restrictions on the use of public space and closed social arenas for sports, leisure, and culture activities.
T42 5575-5667 Sentence denotes Participants were drawn from a contact register through the Norwegian Digitalization Agency.
T43 5668-5768 Sentence denotes The questionnaire was sent to invitees by email through the web-based questionnaire tool SurveyXact.
T44 5769-5819 Sentence denotes Data were collected between 15 April and 30 April.
T45 5820-5930 Sentence denotes During the study period, restrictions and policies regarding the lockdown remained mainly unaltered in Norway.
T46 5931-6085 Sentence denotes In total, 29,535 (36%) individuals agreed to participate in the study, and among these, 24,968 (84%) completed questionnaire items relevant to this study.
T47 6087-6091 Sentence denotes 2.2.
T48 6092-6105 Sentence denotes Questionnaire
T49 6106-6305 Sentence denotes The questionnaire contained items collecting demographic information and self-reported weight and height and items that focused on various aspects of life and health amid the first COVID-19 lockdown.
T50 6306-6535 Sentence denotes Survey items relevant to this study include those assessing eating habits and emotional eating, COVID-19-related worries and symptoms of psychological distress—all of which are included in detail in the Supplementary Document S1.
T51 6536-6760 Sentence denotes In brief, participants were asked to express their level of worry concerning health-related and economic consequences of the pandemic and the lockdown on a three-point scale ranging from not worried to substantially worried.
T52 6761-6883 Sentence denotes Health-related worries included fear of transmission of COVID-19 to oneself, to closed ones, or to elderly family members.
T53 6884-6987 Sentence denotes Worries related to the economy included fear of being laid off or experiencing poorer personal economy.
T54 6988-7238 Sentence denotes In accordance with a previous Norwegian survey, emotional eating was assessed by asking the participants to recall the number of times, during the past week, they had been comfort eating or eating more in response to feeling down or unsatisfied [19].
T55 7239-7314 Sentence denotes Scoring 5 or higher on the item was defined as “frequent emotional eating”.
T56 7315-7461 Sentence denotes Participants were also asked to recall how often, on average, they had been consuming high-sugar food items and beverages during the past 30 days.
T57 7462-7637 Sentence denotes In the questionnaire, high-sugar food items were defined and exemplified as cakes, biscuits, desserts, and candies, whereas high-sugar beverages included soft drinks and soda.
T58 7638-7728 Sentence denotes A self-reported consumption above three times per week was considered a “frequent intake”.
T59 7729-7987 Sentence denotes Psychological distress was measured using the 10-item version of the standardized questionnaire Hopkins symptom checklist (SCL-10) assessing mental health symptoms during the past 7 days, setting the threshold of distress at a mean SCL-10 score of 1.85 [20].
T60 7989-7993 Sentence denotes 2.3.
T61 7994-8014 Sentence denotes Statistical Analyses
T62 8015-8124 Sentence denotes All statistical analyses were performed using the software Stata SE 16 (StataCorp, College Station, TX, USA).
T63 8125-8216 Sentence denotes Graphic presentations were produced in Microsoft Excel 15.26 (Microsoft, Redmond, WA, USA).
T64 8217-8371 Sentence denotes The Pearson’s chi square test was used in order to determine the statistical significance of contingency tables on which graphic presentations were based.
T65 8372-8683 Sentence denotes An ordered logistic regression model presented with odds ratios (OR) with 95% confidence intervals was used to predict the degree of emotional eating on a scale from 1 to 7 by the variables COVID-19-related worries, work-related consequences of COVID-19 and psychological distress, and sociodemographic factors.
T66 8684-8795 Sentence denotes The odds ratios in ordinal logistic models give the change in odds for a one-unit increase in the Likert scale.
T67 8796-8921 Sentence denotes Assumptions including correlation/collinearity between independent variables in the model and proportional odds were checked.
T68 8922-9013 Sentence denotes The proportionality of odds assumption was assessed for all predictor variables separately.
T69 9014-9128 Sentence denotes Criteria for proportional odds were met, although the assessment revealed small variations for certain predictors.
T70 9129-9223 Sentence denotes For the sake of transparency, a multinomial logistic regression table is presented (Table S1).
T71 9224-9310 Sentence denotes Results were considered statistically significant at p-values < 0.05 for all analyses.
T72 9311-9395 Sentence denotes Participants with missing answers on relevant items were excluded from all analyses.
T73 9396-9492 Sentence denotes Descriptive statistics with percentages and medians (with 25–75 percentiles) are also presented.
T74 9494-9498 Sentence denotes 2.4.
T75 9499-9505 Sentence denotes Ethics
T76 9506-9614 Sentence denotes The study was approved by the Norwegian Regional Committee for Ethics in Medical Research (REK 2020/131560).
T77 9615-9780 Sentence denotes All participants provided electronic informed consent before responding to the emailed survey; confidentiality and the right to withdraw from the study were assured.
T78 9781-9868 Sentence denotes The study conforms with the ethical principles outlined in the Declaration of Helsinki.
T79 9870-9872 Sentence denotes 3.
T80 9873-9880 Sentence denotes Results
T81 9882-9886 Sentence denotes 3.1.
T82 9887-9932 Sentence denotes Demographic Characteristics of the Population
T83 9933-10032 Sentence denotes Of the 24,968 participants, 50% were under the age of 50, and 56% were female, as shown in Table 1.
T84 10033-10100 Sentence denotes The median body mass index (BMI) was 25 (interquartile range (IQR):
T85 10101-10108 Sentence denotes 23–28).
T86 10109-10313 Sentence denotes In total, 45% of participants reported substantial worries concerning health-related consequences of the COVID-19 pandemic, while 17% expressed substantial worries related to outcomes on personal economy.
T87 10314-10408 Sentence denotes Twenty percent of the overall population scored above the threshold of psychological distress.
T88 10409-10592 Sentence denotes As to consequences of the pandemic and lockdown, 16% of the participants were or had been placed in quarantine, 37% were working from home, and 8% were temporarily laid off from work.
T89 10594-10598 Sentence denotes 3.2.
T90 10599-10674 Sentence denotes Prevalence of Emotional Eating in Females and Males in Different Age Groups
T91 10675-10797 Sentence denotes Overall, 62% of females and 43% of males reported episodes of emotional eating during the past week, as shown in Figure 1.
T92 10798-10871 Sentence denotes Frequent emotional eating was reported by 16% of females and 9% of males.
T93 10872-10974 Sentence denotes Emotional eating was least prevalent in the oldest age groups, χ2 (30, N = 24,968) = 1200, p < 0.001).
T94 10976-10980 Sentence denotes 3.3.
T95 10981-11026 Sentence denotes Consumption of High-Sugar Foods and Beverages
T96 11027-11200 Sentence denotes Twenty-two percent of those with substantial worries reported a high weekly intake of high-sugar food items, compared to 19% of those without substantial worries (Figure 2).
T97 11201-11289 Sentence denotes In participants with psychological distress, the numbers were 27% and 19%, respectively.
T98 11290-11428 Sentence denotes As to high-sugar beverages, 11% of worried participants had a frequent weekly intake, compared to 7% of those without substantial worries.
T99 11429-11587 Sentence denotes Among the psychologically distressed participants, 15% reported a high weekly intake of high-sugar beverages, compared to 8% of the non-distressed population.
T100 11589-11593 Sentence denotes 3.4.
T101 11594-11677 Sentence denotes Emotional Eating in Relation to COVID-19-Related Worries and Psychological Distress
T102 11678-11799 Sentence denotes Female participants were more inclined than men to report emotional eating (OR 1.9 (CI95% 1.8–2.0)), as shown in Table 2.
T103 11800-11945 Sentence denotes When comparing participants in the age group between 18 and 30 years, those in older age categories predominantly reported less emotional eating.
T104 11946-12059 Sentence denotes Conversely, participants aged 30–39 years were more inclined to report emotional eating (OR 1.3 (CI95% 1.1–1.4)).
T105 12060-12291 Sentence denotes Substantial health-related worry was weakly associated with emotional eating (OR 1.3 (CI95% 1.2–1.5)), whereas substantial worry related to personal economy had a stronger association with emotional eating (OR 1.7 (CI95% 1.5–1.9)).
T106 12292-12405 Sentence denotes The strongest association was found between psychological distress and emotional eating (OR 4.2 (CI95% 3.9–4.4)).
T107 12407-12409 Sentence denotes 4.
T108 12410-12420 Sentence denotes Discussion
T109 12421-12858 Sentence denotes This large population-based study presents data on the prevalence of emotional eating and its association with worries and mental distress during the COVID-19 lockdown in Norway and is the first to explore associations between emotional eating and worries related to health and personal economy during a pandemic—findings that are in line with those presented in a study on eating habits during the COVID-19 lockdown period in Italy [4].
T110 12859-13034 Sentence denotes Due to limited evidence on the baseline levels of emotional eating in the study population, we are unable to directly compare these numbers with those from pre-COVID-19 times.
T111 13035-13178 Sentence denotes However, emotional eating and associated eating behaviors are closely related to stressful life events and to perceived life stress [21,22,23].
T112 13179-13469 Sentence denotes The COVID-19 pandemic and the NPIs that were implemented during the lockdown period could represent a significant source of stress to many, and it is therefore not implausible that the prevalence of emotional eating was in fact increased during the study period compared to habitual levels.
T113 13470-13712 Sentence denotes Literature from another collectively stressful event, namely, an earthquake in New Zealand, showed increased over-eating in subjects that were already prone to emotional eating and who reported high levels of stress related to the event [24].
T114 13713-13826 Sentence denotes Female participants reported more emotional eating than men, consistently with findings in other studies [12,25].
T115 13827-13905 Sentence denotes An interesting hypothesis relates this gender difference to dietary restraint.
T116 13906-14019 Sentence denotes Dietary restraint refers to the cognitive effort to control food and calorie intake, as is the case with dieting.
T117 14020-14085 Sentence denotes In general, women exhibit higher dietary restraint than men [26].
T118 14086-14303 Sentence denotes Moreover, experimental studies have shown that dieters eat more when exposed to stress or negative emotion than non-dieters, suggesting that dieting could in fact be a possible risk factor for emotional eating [9,27].
T119 14304-14439 Sentence denotes Interestingly, di Renzo et al. found that those who had been dieting prior to the study period were more prone to emotional eating [4].
T120 14440-14533 Sentence denotes Worries concerning the consequences of COVID-19 were weakly associated with emotional eating.
T121 14534-14682 Sentence denotes This association was stronger for worries related to personal economy and job security compared to those related to health and disease transmission.
T122 14683-14861 Sentence denotes Possibly, participants with health-related worries could be more conscious of their eating behavior and therefore have some inherent resistance to unhealthy and emotional eating.
T123 14862-15117 Sentence denotes It is also possible that the prospect of negative outcomes on personal economy could have a stronger impact on worriers than the prospect of disease transmission and contraction, i.e., it is possible that the economic worriers were, in fact, more worried.
T124 15118-15333 Sentence denotes A study comparing the mediation effect of emotional eating on the association of depression with BMI in Denmark and Spain highlighted the role of unemployment in explaining this mediation in the latter country [28].
T125 15334-15444 Sentence denotes This was seen in the context of the 2008–2014 Spanish financial crisis, leading to an upsurge in unemployment.
T126 15445-15557 Sentence denotes During our study period, the COVID-19 lockdown led to a more than four-fold rise in unemployment in Norway [29].
T127 15558-15721 Sentence denotes Importantly, there was a social gradient in the loss of work related to COVID-19, where employees with the lowest income were the most at risk of losing their job.
T128 15722-15834 Sentence denotes In Norway, several measures to reduce economic vulnerability were implemented early in the lockdown period [30].
T129 15835-15954 Sentence denotes Thus, it can be assumed that the associations we present could have been even stronger in the absence of such measures.
T130 15955-16024 Sentence denotes Emotional eating was strongly associated with psychological distress.
T131 16025-16181 Sentence denotes This is in line with findings reported in the literature which present positive associations between depressive symptoms and emotional eating [11,12,13,14].
T132 16182-16356 Sentence denotes Similarly, the intake of high-sugar foods and beverages was markedly higher in those scoring above the threshold of psychological distress compared to the overall population.
T133 16357-16520 Sentence denotes Stress is known to induce a shift in individuals to favor energy-dense foods containing high amounts of fat and/or sugar, especially among emotional eaters [7,10].
T134 16521-16810 Sentence denotes An experimental study on the mood-enhancing effect of chocolate found that chocolate, in particular, highly palatable milk chocolate, had a short-lived effect on improving negative mood, and that this effect was stronger in high-degree emotional eaters than in the other participants [31].
T135 16811-16957 Sentence denotes It is unlikely that eating certain foods has an actual role in enhancing mood and lowering stress other than short-lived reward or relief [21,32].
T136 16958-17131 Sentence denotes Still, these short-term effects, or even the belief that eating certain foods will provide comfort, may potentially support a tendency towards stress-induced (over-) eating.
T137 17132-17248 Sentence denotes This habit could, on the long term, represent an added health burden in the form of adverse weight gain and obesity.
T138 17249-17418 Sentence denotes With regard to the current pandemic, it is worth noting that obesity and related co-morbidities are emerging as risk factors for poor outcomes in COVID-19 patients [33].
T139 17419-17573 Sentence denotes Our study clearly demonstrates that psychological distress is associated with emotional eating and a higher consumption of high-sugar foods and beverages.
T140 17574-17672 Sentence denotes The same is seen, but to a lesser extent, in those reporting substantial COVID-19-related worries.
T141 17673-17862 Sentence denotes Moreover, we found that worries related to personal economy and job security had a stronger association with emotional eating compared to worries related to health and disease transmission.
T142 17863-17924 Sentence denotes To our knowledge, this is the first study demonstrating this.
T143 17925-18130 Sentence denotes This finding raises the question of whether those vulnerable to financial stress, e.g., those with a lower socioeconomic status, are more at risk of emotional eating during periods of economic uncertainty.
T144 18131-18311 Sentence denotes In fact, emotional eating could play a role in the association of low socioeconomic status with higher BMI—a role that is dependent on emotional and psychological distress [34,35].
T145 18312-18562 Sentence denotes Future research, preferably in the form of large-scale longitudinal studies, could further elucidate this and the possible preventive health measures aimed at populations at risk of making adverse food choices during moments of hardship and distress.
T146 18563-18700 Sentence denotes Interestingly, recent randomized controlled trials point to dietary improvement as a promising treatment strategy for depression [36,37].
T147 18701-18907 Sentence denotes Interventions aimed at healthy eating could have a dualistic beneficial effect on improving eating behaviors, while at the same time reducing psychological distress for those vulnerable to emotional eating.
T148 18909-18934 Sentence denotes Strengths and limitations
T149 18935-19115 Sentence denotes Our study provides an overview of the prevalence of emotional eating and its association with worry and psychological distress on a large scale amid a worldwide state of emergency.
T150 19116-19229 Sentence denotes One strength of this study is its large sample size, allowing analyses with high precision and statistical power.
T151 19230-19419 Sentence denotes Moreover, the study period coincided with the most invasive implementation of NPIs in Norway yet, and this offers insight into a phase that exemplifies the impact of a large-scale pandemic.
T152 19420-19516 Sentence denotes One inherent limitation of this study is its cross-sectional design, limiting causal inferences.
T153 19517-19641 Sentence denotes This also prevents us from drawing conclusions about the effect of COVID-19 and related exposures on outcomes, specifically.
T154 19642-19796 Sentence denotes Another limitation of this study is that it relies on self-report and therefore is subject to recall bias and dependent on the participants’ own insights.
T155 19797-19983 Sentence denotes It is also based on relatively few, but validated, questions related to eating habits and could therefore provide a limited range of detail and nuance compared to a larger questionnaire.
T156 19984-20302 Sentence denotes There is also an inherent selection bias in our study due to the questionnaire being written in Norwegian and distributed solely through digital means, which excludes people without access to the internet and with limited proficiency in the Norwegian language—e.g., elderly inhabitants and first-generation immigrants.
T157 20303-20541 Sentence denotes Moreover, the senior citizens that did participate in this study are likely more self-reliant and healthier than those in the same age group that were unable to participate, providing a potentially unbalanced view of the oldest age group.
T158 20543-20545 Sentence denotes 5.
T159 20546-20557 Sentence denotes Conclusions
T160 20558-20717 Sentence denotes Our study has shown associations between psychological distress, COVID-19-related worries, and emotional eating amid the first phase of the pandemic in Norway.
T161 20718-21001 Sentence denotes Emotional eating was reported by more than half of the population during the lockdown period and was especially prevalent among females, those expressing substantial worries concerning COVID-19-related consequences—and, in particular, among those experiencing psychological distress.
T162 21002-21174 Sentence denotes The association of COVID-19-related worries with emotional eating was strongest for individuals concerned about potential consequences on personal economy and job security.
T163 21175-21321 Sentence denotes In addition, we found that the reported intake of high-sugar foods and beverages was higher in the same groups compared to the general population.
T164 21322-21500 Sentence denotes Emotional eating could pose an additional health burden to vulnerable populations in the form of poor food choices and adverse weight gain during this extraordinary global event.
T165 21502-21517 Sentence denotes Acknowledgments
T166 21518-21591 Sentence denotes The project group Bergen in change (BiE) contributed to the study design.
T167 21592-21816 Sentence denotes The group consists of Silje Mæland, Lars Thore Fadnes, William Hazell, Stine Lehmann, Øystein Vedaa, Jens Christoffer Skogen, Gro Mjeldheim Sandal, Ellen Haug, Ragnhild Bjørknes, Åsgeir Kjetland Rabben and Andreas Roaldsnes.
T168 21817-22168 Sentence denotes We would like to thank Guri Rørtveit and Øystein Hetlevik from the University of Bergen, Kjell Wolff and Trond Egil Hansen from Bergen Municipality for initiating this work in the frame of Alrek Health Cluster, Sverre Littleskare for advice on setting up and cohort during the pandemic, and Stina Johansson at Rambøll Consulting for technical support.
T169 22169-22387 Sentence denotes The data Protection Officers at University of Bergen and Bergen Municipality contributed with important guidance, and the Norwegian Regional Committee for Ethics in Medical Research for fast-tracking COVID-19 projects.
T170 22388-22511 Sentence denotes Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T171 22513-22536 Sentence denotes Supplementary Materials
T172 22537-22631 Sentence denotes The following are available online at https://www.mdpi.com/1660-4601/18/1/130/s1, Document S1:
T173 22632-22662 Sentence denotes Questionnaire items, Table S1:
T174 22663-22720 Sentence denotes Multinomial regression of emotional eating by predictors.
T175 22721-22757 Sentence denotes Click here for additional data file.
T176 22759-22779 Sentence denotes Author Contributions
T177 22780-23060 Sentence denotes Conceptualization, S.M. and L.T.F.; methodology, S.M., L.T.F., M.B. and Å.K.R.; formal analysis, M.B. and L.T.F.; writing—original draft preparation, M.B. and L.T.F.; writing—review and editing, E.K.A., R.B. and J.C.S.; supervision, L.T.F.; project administration, L.T.F. and S.M.
T178 23061-23137 Sentence denotes All authors have read and agreed to the published version of the manuscript.
T179 23139-23146 Sentence denotes Funding
T180 23147-23216 Sentence denotes The study was funded by Bergen Municipality and University of Bergen.
T181 23217-23289 Sentence denotes The first author was funded through Helse Vest on the ATLAS4LAR project.
T182 23291-23327 Sentence denotes Institutional Review Board Statement
T183 23328-23510 Sentence denotes The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Norwegian Regional Committee for Ethics in Medical Research (REK 2020/131560).
T184 23512-23538 Sentence denotes Informed Consent Statement
T185 23539-23609 Sentence denotes Informed consent was obtained from all subjects involved in the study.
T186 23611-23638 Sentence denotes Data Availability Statement
T187 23639-23727 Sentence denotes The data presented in this study are available on request from the corresponding author.
T188 23728-23792 Sentence denotes The data are not publicly available due to privacy restrictions.
T189 23794-23815 Sentence denotes Conflicts of Interest
T190 23816-23860 Sentence denotes The authors declare no conflict of interest.
T191 23862-24054 Sentence denotes Figure 1 Proportions (%) of the participants reporting any degree of emotional eating (EE) and frequent emotional eating (fEE) among females (white) and males (black) in different age groups.
T192 24055-24191 Sentence denotes Differences were determined to be statistically significant by means of a Pearson´s Chi Square test (p < 0.05). fEE = EE ≥ 5 times/week.
T193 24192-24452 Sentence denotes Figure 2 Proportions (%) of participants reporting frequent intake of high-sugar beverages (left) and food items (right), comparing those with psychological distress and substantial COVID-19-related worries with those that were not distressed and not worried.
T194 24453-24564 Sentence denotes Differences were determined to be statistically significant by means of a Pearson’s Chi Square test (p < 0.05).
T195 24565-24646 Sentence denotes Frequent consumption is defined as a self-reported intake above 3 times per week.
T196 24647-24739 Sentence denotes Table 1 Demographic characteristics, worries, and mental distress in the sample population.
T197 24740-24754 Sentence denotes Age Total (%)
T198 24755-24793 Sentence denotes 18–29 30–39 40–49 50–59 60–69 ≥70
T199 24794-24868 Sentence denotes N (%) 3414 (14) 4228 (17) 4772 (19) 5262 (21) 4237 (17) 3055 (12) -
T200 24869-24875 Sentence denotes Gender
T201 24876-24952 Sentence denotes Female 2200 (64) 2530 (60) 2768 (58) 2950 (56) 2133 (50) 1363 (45) 44
T202 24953-25027 Sentence denotes Male 1214 (36) 1698 (40) 2004 (42) 2312 (44) 2104 (50) 1692 (55) 56
T203 25028-25066 Sentence denotes BMI median 23 25 25 26 26 25 25
T204 25067-25133 Sentence denotes 25–75 percentiles 21–26 22–28 23–28 24–29 23–28 23–28 23–28
T205 25134-25149 Sentence denotes Education level
T206 25150-25223 Sentence denotes Primary school 414 (13) 150 (4) 182 (4) 272 (5) 358 (9) 375 (13) 7
T207 25224-25318 Sentence denotes High school or trade school 1177 (36) 773 (19) 932 (20) 1604 (31) 1346 (32) 959 (32) 28
T208 25319-25414 Sentence denotes ≤3 years of higher education 866 (26) 1046 (26) 1098 (24) 1243 (24) 938 (22) 692 (23) 24
T209 25415-25511 Sentence denotes ≥4 years of higher education 828 (25) 2109 (52) 2412 (52) 2022 (39) 1531 (37) 969 (32) 40
T210 25512-25522 Sentence denotes Employment
T211 25523-25599 Sentence denotes Employed 2178 (64) 3548 (84) 4175 (87) 4550 (86) 2415 (57) 201 (7) 68
T212 25600-25675 Sentence denotes Student/military duty 1578 (46) 251 (6) 101 (2) 31 (1) 6 (0) 3 (0) 6
T213 25676-25694 Sentence denotes Household income *
T214 25695-25761 Sentence denotes Low 1041 (36) 522 (13) 462 (11) 364 (8) 234 (6) 314 (12) 13
T215 25762-25838 Sentence denotes Medium 1098 (38) 1944 (49) 2259 (51) 1800 (38) 1262 (35) 1204 (50) 44
T216 25839-25911 Sentence denotes High 734 (26) 1464 (37) 1678 (38) 2536 (54) 2109 (59) 886 (37) 43
T217 25912-25933 Sentence denotes Lockdown consequences
T218 25934-26018 Sentence denotes Placed in quarantine 767 (22) 696 (16) 718 (15) 738 (14) 630 (15) 507 (17) 16
T219 26019-26096 Sentence denotes Home office 712 (21) 2069 (49) 2558 (54) 2477 (47) 1243 (29) 70 (2) 37
T220 26097-26174 Sentence denotes Temporarily laid off 505 (15) 394 (9) 358 (8) 411 (8) 216 (5) 18 (1) 8
T221 26175-26240 Sentence denotes Lost employment 76 (2) 60 (1) 38 (1) 39 (1) 23 (1) 5 (0) 1
T222 26241-26258 Sentence denotes Substantial worry
T223 26259-26348 Sentence denotes Related to personal economy 998 (29) 1025 (24) 877 (18) 862 (16) 342 (8) 64 (2) 17
T224 26349-26432 Sentence denotes Health-related 1889 (55) 2089 (49) 2181 (46) 2507 (48) 1559 (37) 887 (29) 45
T225 26433-26523 Sentence denotes Psychological distress ** 1403 (41) 1211 (29) 935 (20) 823 (16) 475 (11) 247 (8) 20
T226 26524-26639 Sentence denotes * Household income was adjusted by family size (first adult with weight 1, additional adults 0.7. and children 0.5.
T227 26640-26878 Sentence denotes Low is Norwegian krone (NOK) < 250 K/year, middle is 250–500 K/year, and high is >500 K/year; these values can be converted to Euros on the basis of the currency rate of 1 May 2020 (11.422). ** Mean symptom checklist (SCL)-10 score ≥1.85.
T228 26879-26900 Sentence denotes BMI, body mass index.
T229 26901-27034 Sentence denotes Table 2 Ordered logistic regression of emotional eating by predictors including COVID-19-related worries and psychological distress.
T230 27035-27070 Sentence denotes Odds Ratio 95% Confidence Interval
T231 27071-27077 Sentence denotes Gender
T232 27078-27104 Sentence denotes Male Reference Reference
T233 27105-27125 Sentence denotes Female 1.9 1.8–2.0
T234 27126-27129 Sentence denotes Age
T235 27130-27157 Sentence denotes 18–29 Reference Reference
T236 27158-27177 Sentence denotes 30–39 1.3 1.1–1.4
T237 27178-27197 Sentence denotes 40–49 1.1 1.0–1.2
T238 27198-27219 Sentence denotes 50–59 0.93 0.85–1.0
T239 27220-27242 Sentence denotes 60–69 0.75 0.69–0.82
T240 27243-27263 Sentence denotes 70+ 0.55 0.50–0.61
T241 27264-27279 Sentence denotes Education level
T242 27280-27316 Sentence denotes Primary school Reference Reference
T243 27317-27352 Sentence denotes High or trade school 1.0 0.93–1.1
T244 27353-27395 Sentence denotes ≤3 years of higher education 1.1 1.0–1.2
T245 27396-27439 Sentence denotes ≥4 years of higher education 1.0 0.94–1.1
T246 27440-27451 Sentence denotes Quarantined
T247 27452-27476 Sentence denotes No Reference Reference
T248 27477-27494 Sentence denotes Yes 1.2 1.1–1.3
T249 27495-27515 Sentence denotes Temporarily laid-off
T250 27516-27540 Sentence denotes No Reference Reference
T251 27541-27559 Sentence denotes Yes 1.0 0.88–1.1
T252 27560-27582 Sentence denotes Health-related worries
T253 27583-27609 Sentence denotes None Reference Reference
T254 27610-27628 Sentence denotes Some 1.3 1.2–1.3
T255 27629-27654 Sentence denotes Substantial 1.3 1.2–1.5
T256 27655-27678 Sentence denotes Economy-related worries
T257 27679-27705 Sentence denotes None Reference Reference
T258 27706-27724 Sentence denotes Some 1.3 1.2–1.4
T259 27725-27750 Sentence denotes Substantial 1.7 1.5–1.9
T260 27751-27773 Sentence denotes Psychological distress
T261 27774-27808 Sentence denotes SCL10 ≤ 1.85 Reference Reference
T262 27809-27835 Sentence denotes SCL10 ≥ 1.85 4.2 3.9–4.4