The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: A systematic review of the evidence

Published:April 16, 2021DOI:https://doi.org/10.1016/j.clnu.2021.04.020

      Summary

      The pandemic of coronavirus disease 2019 (COVID-19) and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide. In this study we aimed to investigate the impact of the first COVID-19 lockdown period (March–May 2020) on snacking behavior, fast-food and alcohol consumption. A systematic search in PubMed®, Scopus® and Web of Science® databases was conducted and 32 studies were included. Changes in snacking, in fast-food and ordered food consumption and in alcohol intake were examined. Snacking was found to be increased for a significant portion of the population examined (18.9–45.1%), whereas fast food (15.0–41.3%) and ordered food (33.9%) showed a tendency towards decrease. As per alcohol consumption, an upward trend was observed in a significant part (10.4–51.0%) of the participants examined. The increased snacking and alcohol consumption observed for almost a third of the examined population could be alarming because long-term health problems could arise in cases of repeated lockdowns in the future. The observed downward trend in fast-food consumption and in frequency of ordered food could be an encouraging sign of turning to home-prepared foods, but further research is needed in this field.

      Keywords

      Abbreviations:

      COVID-19 (Coronavirus Disease 2019), CVD (Cardiovascular Diseases), Τ2DM (Diabetes Mellitus Type 2), MENA (Middle East and North Africa), NOS (Newcastle Ottawa Scale), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), QoL (Quality Of Life), UK (United Kingdom), USA (United States of America), WHO (World Health Organization)

      1. Introduction

      The coronavirus disease 2019 (COVID-19), a severe acute respiratory syndrome, was first reported in Wuhan, China and on March, 11th 2020 the World Health Organization (WHO) declared a pandemic due to its rapid spread throughout the world [
      • Baloch S.
      • Baloch M.A.
      • Zheng T.
      • Pei X.
      The coronavirus disease 2019 (COVID-19) pandemic.
      ]. In order to combat the pandemic, many governments enforced preventive measures of self-isolation and nationwide lockdowns of several degrees, so as by April 2020 more than a third of the global population was under lockdown [
      • Koh D.
      COVID-19 lockdowns throughout the world.
      ]. People were forced to stay at home and practice online working and/or online learning and were allowed to leave their homes only for prespecified occasions, such as medical reasons, essential work, physical activity, purchasing food and in emergencies [
      • Koh D.
      COVID-19 lockdowns throughout the world.
      ]. Such sudden changes in people's life can have a negative impact both on their mental health and their lifestyle behaviors, such as alcohol consumption [
      • Clay J.M.
      • Parker M.O.
      Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?.
      ] and dietary habits [
      • Anton S.D.
      • Miller P.M.
      Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults?.
      ]. Moreover, shifts in the daily routine and abstention from work, which can be associated with stress and boredom could lead to a greater energy intake and/or overeating [
      • Moynihan A.B.
      • van Tilburg W.A.
      • Igou E.R.
      • Wisman A.
      • Donnelly A.E.
      • Mulcaire J.B.
      Eaten up by boredom: consuming food to escape awareness of the bored self.
      ]. During the first COVID-19 lockdown a high prevalence of sleep disorders was reported [
      • Janati Idrissi A.
      • Lamkaddem A.
      • Benouajjit A.
      • Ben El Bouaazzaoui M.
      • El Houari F.
      • Alami M.
      • et al.
      Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco.
      ,
      • Pinto J.
      • van Zeller M.
      • Amorim P.
      • Pimentel A.
      • Dantas P.
      • Eusébio E.
      • et al.
      Sleep quality in times of Covid-19 pandemic.
      ], which could also be linked to imbalanced dietary patterns [
      • Crispim C.A.
      • Zalcman I.
      • Dáttilo M.
      • Padilha H.G.
      • Edwards B.
      • Waterhouse J.
      • et al.
      The influence of sleep and sleep loss upon food intake and metabolism.
      ]. Overeating is directly related to an increased risk of developing obesity [
      • Muscogiuri G.
      • Pugliese G.
      • Barrea L.
      • Savastano S.
      • Colao A.
      Commentary: obesity: the "achilles heel" for COVID-19?.
      ] and subsequently the risk for cardiovascular diseases (CVD) [
      • Van Gaal L.F.
      • Mertens I.L.
      • De Block C.E.
      Mechanisms linking obesity with cardiovascular disease.
      ] and type-2 diabetes mellitus (T2DM) [
      • Chobot A.
      • Górowska-Kowolik K.
      • Sokołowska M.
      • Jarosz-Chobot P.
      Obesity and diabetes-Not only a simple link between two epidemics.
      ] is increased. In addition, identification of the alcohol consumption pattern during the lockdown period is important, as this is related to an increased prevalence of negative health outcomes and also negatively influences the quality of life (QoL) for both the consumer and his/her family members [
      Health risks and benefits of alcohol consumption.
      ].
      Undoubtedly, there is inadequate information about related changes in eating behaviors as well as alcohol consumption during this global health crisis, although several studies have been conducted at national level. This systematic review aims to investigate changes in specific dietary habits (snacking, fast-foods, ordered food) and alcohol consumption during the COVID-19 lockdown period compared to pre lockdown time.

      2. Material and methods

      An electronic search was conducted in PubMed®, Scopus® and Web of science® databases (up to 28 November 2020) using the index terms “junk food”, “fast food”, “take away”, “alcohol”, “ethanol”, “covid-19”, “Sars-Cov-2” and the final search string as well as more info about our search strategy can be found in Supplementary File 1.
      Total records identified through database searching were 1485 and were added in a reference database. (EndNote X7 for Windows, Thomson Reuters). After removal of duplicates studies were screened independently by two reviewers DB and MC. Any disagreements regarding selection of the included studies and data extraction were solved by consensus. Inclusion criteria were adolescent (≥16 years old) and adult populations who were under lockdown restrictions due to the COVID-19. Studies in which included children (<16 years old) or symptomatic COVID-19 patients were excluded. Studies not in English language were also excluded.
      This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [
      • Liberati A.
      • Altman D.G.
      • Tetzlaff J.
      • Mulrow C.
      • Gøtzsche P.C.
      • Ioannidis J.P.A.
      • et al.
      The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
      ] (Supplementary Table 1). The quality of the eligible studies was assessed using the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies (Supplementary Table 2) [
      • Herzog R.A.-P.M.
      • Diaz C.
      • Del Barrio J.L.
      • Estrada J.M.
      • Gil A.
      Newcastle-Ottawa Scale adapted for cross-sectional studies.
      ]. Due to the fact that this is a rapid systematic review as COVID-19 is an emerging, rapidly evolving situation, a protocol for this systematic review was not written.
      Data extraction of the included studies was independently conducted by two reviewers (DB and MC) using a previous standardized excel form. All disagreement were solved by consensus. Data extracted from each study were country origin, sex and number of participants, period and type of the survey. Moreover, we examined dietary changes and we extracted information regarding changes in snacking habit, fast-food and ordered food as well as alcohol consumption. Variables referred to dietary and alcohol changes were presented as percentages. Statistical significance of each study's results was stated by p-values where this data was available.

      3. Results

      3.1 Search results

      The process for the studies selection is presented as a flow diagram in Fig. 1. A total of 1489 studies were identified through databases and reference searching and after removal of 642 duplicates, 847 studies were screened. Hence, 32 studies [
      • Alhusseini N.
      • Alqahtani A.
      COVID-19 pandemic's impact on eating habits in Saudi Arabia.
      ,
      • Ammar A.
      • Brach M.
      • Trabelsi K.
      • Chtourou H.
      Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19.
      ,
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Błaszczyk-Bębenek E.
      • Jagielski P.
      • Bolesławska I.
      • Jagielska A.
      • Nitsch-Osuch A.
      • Kawalec P.
      Nutrition behaviors in polish adults before and during COVID-19 lockdown.
      ,
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ,
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ,
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ,
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ,
      • Panagiotidis P.
      • Rantis K.
      • Holeva V.
      • Parlapani E.
      • Diakogiannis I.
      Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece.
      ,
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ,
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ,
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ] (all cross-sectional) were included in this systematic review. Characteristics of the 32 cross-sectional included studies can be found in Table 1.
      Fig. 1
      Fig. 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of eligibility process of included studies.
      Table 1Characteristics of Included studies (All online surveys).
      Study ID (Country)SubjectsPeriod survey conducted (already time spent in lockdown)
      Allhuseini et al., 2020 [
      • Alhusseini N.
      • Alqahtani A.
      COVID-19 pandemic's impact on eating habits in Saudi Arabia.
      ]

      (Saudi Arabia)
      2706 (Μ:1240, F:1466)5–15 May (NA)
      Ammar et al., 2020 [
      • Ammar A.
      • Brach M.
      • Trabelsi K.
      • Chtourou H.
      Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19.
      ] (International)
      1047 (Μ:484, F: 563)1–11 April (NA)
      Avery et al., 2020 [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ] (USA)
      3871 (Μ:1125, F:2746)26 March-5 April (NA)
      Błaszczyk-Bębenek et al., 2020 [
      • Błaszczyk-Bębenek E.
      • Jagielski P.
      • Bolesławska I.
      • Jagielska A.
      • Nitsch-Osuch A.
      • Kawalec P.
      Nutrition behaviors in polish adults before and during COVID-19 lockdown.
      ] (Poland)
      312 (Μ:112, F:200)29 April-19 May (NA)
      Cheikh Ismail et al., 2020 [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ]

      (UAE)
      1012 (Μ:244, F:768)April–May (NA)
      Cheikh Ismail et al., 2020 [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ] (International)
      2970 (Μ:844, F:2126)15–29 April (NA)
      Chodkiewicz et al., 2020 [
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ] (Poland)
      443 (Μ:95, F:348)10–22 April (1 month)
      Constant et al., 2020 [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ]

      (France)
      4005 (Μ:1954, F:2051)8 and 20 April (3–4 weeks)
      Gerritsen et al., 2020 [
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ]

      (New Zealand)
      3028 (Μ:314, F:2682, O:32)24 April-13 May (31–51 days)
      Górnicka et al., 2020 [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ]

      (Poland)
      2381 (F:2138, Μ:243)30 April-23 May (NA)
      Husain et al., 2020 [
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ]

      (Kuwait)
      415 (Μ:130, F:285)30 March-15 April (NA)
      Ingram et al., 2020 [
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ]

      (UK)
      399 (M:168, F:226, O:5)NA (NA)
      Knell et al., 2020 [
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ]

      (USA)
      1809 (Μ:589, F:1220)15 April-5 May (NA)
      Kriaucioniene et al., 2020 [
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ] (Lithuania)
      2447 (Μ:198, F:2149)14–28 April (1 month)
      Malta et al., 2020 [
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ]

      (Brazil)
      45161 (Μ:20956, F:24205)NA (NA)
      Mehta, 2020 [
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ]

      (India)
      50 (Μ:25, F:25)23–29 March (NA)
      Panagiotidis et al., 2020 [
      • Panagiotidis P.
      • Rantis K.
      • Holeva V.
      • Parlapani E.
      • Diakogiannis I.
      Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece.
      ] (Greece)
      705 (Μ:177, F:528)25–28 April (36 days)
      Pellegrini et al., 2020 [
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ]

      (Italy)
      Online and via telephone survey.
      150
      Obese subjects.
      (Μ:34, F:116)
      14–21 April (NA)
      Robinson et al., 2020 [
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ]

      (UK)
      723 (Μ:235, F:488)19–22 April (28–32 days)
      Rodríguez-Pérez et al., 2020 [
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ] (Spain)
      7509 (Μ:2204, F:5305)20 March-10 April (1–3 Weeks)
      Rolland et al., 2020 [
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ]

      (France)
      11391 (M:2557, F:8782, O:52)18–25 March (NA)
      Rossinot et al., 2020 [
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ]

      (France)
      1454 (Μ:530, F:924)23 April-27 May (NA)
      Sánchez-Sánchez et al., 2020 [
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ] (Spain)
      1065 (Μ:290, F:775)May (NA)
      Scarmozzino et al., 2020 [
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ]

      (Italy)
      1929 (Μ:637, F:1292)15 April (NA)
      Sharma et al., 2020 [
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ]

      (USA)
      542 (Μ:106, F:436)April (NA)
      Sidor et al., 2020 [
      • Sidor A.
      • Rzymski P.
      ]

      (Poland)
      1097 (Μ:54, F:1043)17 April-1 May (NA)
      Stanton et al., 2020 [
      • Stanton R.
      • To Q.G.
      ] (Australia)
      1483 (Μ:484, F:999)9–19 April (NA)
      Sun et al., 2020 [
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ]

      (China)
      6416 (Μ:3015, F:3401)24–31 March (NA)
      Tran et al., 2020 [
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ]

      (Australia)
      13829 (NA)3 April-2 May (4–32 days)
      Vanderbruggen et al., 2020 [
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ] (Belgium)
      3624 (M:1083, F:2541)9–29 April (NA)
      Yan et al., 2020 [
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ]

      (China)
      8431 (M:3486, F:4945)15 April-11 May (NA)
      Zajacova et al., 2020 [
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]

      (Canada)
      4319 (M:2116, F:2203)29 March-3 April (NA)
      F: Female, M: Male, O: Other.
      NA: Not available.
      a Online and via telephone survey.
      b Obese subjects.

      3.2 Snacking habits

      Several studies had examined changes in snacking behavior during the period of lockdown [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ,
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ] and the results are shown in Table 2. In these studies 34.0–62.2% stated no changes in either frequency or portion of snacking consumption throughout the day [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ]. Regarding the subjects who reported changes in snacking a tendency towards increase can be observed [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ]. The highest increase (~45%) for snacking consumption compared to the pre-lockdown period was reported among the Lithuanian population [
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ].
      Table 2Changes in snacking during lockdown.
      Study ID (Country)IncreasedDecreasedNo changesP value
      Constant et al., 2020 [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ]

      (France)
      24.0%18.2%57.9%NA
      Gornicka et al., 2020 [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ]

      (Poland)
      The total from those studies is not 100%.
      32.0%18.8%62.2%<0.001
      Kriaucioniene et al., 2020 [
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ] (Lithuania)
      45.1%9.8%45.1%NA
      Malta et al., 2020 [
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ]

      (Brazil)
      aNANANA
      Mehta, 2020 [
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ]

      (India)
      38.0%28.0%34.0%NA
      Pellegrini et al., 2020 [
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ]

      (Italy)
      32.7%11.3%56.0%NA
      Rodríguez-Pérez et al., 2020 [
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ] (Spain)
      37.6%15.7%46.7%<0.001
      Sánchez-Sánchez et al., 2020 [
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ] (Spain)
      bNANA<0.001
      Scarmozzino et al., 2020 [
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ]

      (Italy)
      The total from those studies is not 100%.
      18.9%23.5%57.6%NA
      NA not available.
      a before lockdown: snacks more than 2 days: 9.5%/during lockdown snacks more than 2 days: 13.2%.
      b before lockdown: 2 or less portions per week: 72.2%, 3 or more portions per week: 27.8%/After lockdown: 2 or less portions per week: 55.6%, 3 or more portions per week: 44.4%.
      a The total from those studies is not 100%.

      3.3 Fast-food and ordered food consumption

      Changes in fast-food consumption were reported in eight studies [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ,
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ] and changes in ordered food were examined in three studies [
      • Alhusseini N.
      • Alqahtani A.
      COVID-19 pandemic's impact on eating habits in Saudi Arabia.
      ,
      • Błaszczyk-Bębenek E.
      • Jagielski P.
      • Bolesławska I.
      • Jagielska A.
      • Nitsch-Osuch A.
      • Kawalec P.
      Nutrition behaviors in polish adults before and during COVID-19 lockdown.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ], whereas relevant results are summarized in Table 3, Table 4 respectively. In four studies, more than 50% of the participants’ fast-food consumption remained unchanged during lockdown [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. In studies where consumption of fast food had changed during the lockdown restrictions, a downward trend was identified [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ,
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. Less than 10% of the participants examined reported an increase in junk food consumption [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ], in contrast to one study by Zajacova et al., in which an increased consumption was stated by 25.0% of the survey participants [
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. Regarding the frequency of food ordering and having food delivered at home, results varied as can be seen in Table 4, with two studies showing a decline [
      • Alhusseini N.
      • Alqahtani A.
      COVID-19 pandemic's impact on eating habits in Saudi Arabia.
      ,
      • Błaszczyk-Bębenek E.
      • Jagielski P.
      • Bolesławska I.
      • Jagielska A.
      • Nitsch-Osuch A.
      • Kawalec P.
      Nutrition behaviors in polish adults before and during COVID-19 lockdown.
      ], and one showing an increase [
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ] (see Table 5).
      Table 3Changes in consumption of fast-food during lockdown.
      Study ID (Country)IncreasedDecreasedNo changesP value
      Cheikh Ismail et al., 2020 [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ] (UAE)
      NAbNA<0.001
      Cheikh Ismail et al., 2020 [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ] (International)
      NAaNA<0.001
      Górnicka et al., 2020 [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ]

      (Poland)
      8.1%36.6%55.3%<0.001
      Husain et al., 2020 [
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ]

      (Kuweit)
      NAcNANA
      Kriaucioniene et al., 2020 [
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ] (Lithuania)
      6.7%41.3%71.1%NA
      Rodríguez-Pérez et al., 2020 [
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ] (Spain)
      5.1%34.9%60.0%<0.001
      Rolland et al., 2020 [
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ]

      (France)
      NAdNANA
      Zajacova et al., 2020 [
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]

      (Canada)
      25.0%15.0%60.0%NA
      NA not available.
      a Before lockdown: 28.8%/After lockdown 5.3%.
      b Before lockdown: 26.7%/After lockdown 7.9%.
      c Before lockdown: Other: 2.7%, 1–2 times per week: 49.4%, 3–4 times per week: 17.3%, 5 or more times per week: 5.3%/After lockdown: Other: 0.2%, 1–2 times per week: 13.7%, 3–4 times per week: 2.2%, 5 or more times per week: 1.9%.
      d Before lockdown: >1 time per day: 1.5%, once per day: 6.3%, few times per week: 22.6%, once per week: 25.3%, once per month: 19.8%, occasionally: 13.7%, never: 10.8%/After lockdown: >1 time per day: 0.3%, once per day: 0.7%, few times per week: 6.7%, once per week: 12.8%, once per month: 27.8%, occasionally: 28.3%, never: 23,4%.
      Table 4Changes in frequency of ordered food during lockdown.
      Study ID (Country)IncreasedDecreasedNo changesP value
      Allhuseini et al., 2020 [
      • Alhusseini N.
      • Alqahtani A.
      COVID-19 pandemic's impact on eating habits in Saudi Arabia.
      ]

      (Saudi Arabia)
      NAaNA<0.001
      Błaszczyk-Bębenek et al., 2020 [
      • Błaszczyk-Bębenek E.
      • Jagielski P.
      • Bolesławska I.
      • Jagielska A.
      • Nitsch-Osuch A.
      • Kawalec P.
      Nutrition behaviors in polish adults before and during COVID-19 lockdown.
      ] (Poland)
      NAbNA<0.0001
      Gerritsen et al., 2020 [
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ]

      (New Zealand)
      52.2%33.9%13.9%
      Not stated in the study. Calculated according to existing results.
      NA
      NA not available.
      a Before lockdown: Never: 15%, 1–2 times per week: 50.6%, 3–6 times per week: 25.8%, daily: 8.6%/After lockdown: never: 74.8%, 1–2 times per week: 17.5%, 3–6 times per week: 4.4%, daily: 3.4%.
      b Before lockdown: Never: 15.7%, 1–3 times per month: 45.5%, 1 time per week: 17.3%, few times per week: 17.3%, 1 time per day: 3.5%, few times a day: 0.6%/After lockdown: Never: 51.6%, 1–3 times per month: 34.6%, 1 time per week: 9.0%, few times per week: 3.50%.
      c time per day: 1.3%, few times a day: 0%.
      a Not stated in the study. Calculated according to existing results.
      Table 5Changes in alcohol consumption during lockdown.
      Study ID (Country)IncreasedDecreasedNo changesP value
      Ammar et al., 2020 [
      • Ammar A.
      • Brach M.
      • Trabelsi K.
      • Chtourou H.
      Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19.
      ] (International)
      NAaNA<0.001
      Avery et al., 2020 [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ]

      (USA)
      14.3%10.9%74.8%NA
      Chodkiewicz et al., 2020 [
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ] (Poland)d
      13.8%17.4%68.4%NA
      Gerritsen et al., 2020 [
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ]

      (New Zealand)
      32.8%9.1%58.1%e<0.001
      Gornicka et al., 2020 [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ]

      (Poland)
      18.1%10.6%71.3%NA
      Ingram et al., 2020 [
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ]

      (UK)
      35.4%25.3%39.3%0.033
      Knell et al., 2020 [
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ]

      (USA)
      38.5%11.9%49.6%0.01
      Kriaucioniene et al., 2020 [
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ] (Lithuania)
      14.2%15.9%69.9%NA
      Malta et al., 2020 [
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ]

      (Brazil)
      17.6%aNANANA
      Panagiotidis et al., 2020 [
      • Panagiotidis P.
      • Rantis K.
      • Holeva V.
      • Parlapani E.
      • Diakogiannis I.
      Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece.
      ] (Greece)
      21.5%45.2%33.3%bNA
      Robinson et al., 2020 [
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ]

      (UK)
      28.0%30.0%41.0%NA
      Rodríguez-Pérez et al., 2020 [
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ] (Spain)
      10.4%57.3%32.3%<0.001
      Rolland et al., 2020 [
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ](France)d
      17.76%12.0%68.05%NA
      Rossinot et al., 2020 [
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ]

      (France)d
      12.2%12.2%61.8%NA
      Scarmozzino et al., 2020 [
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ] (Italy)d
      36.8%7.9%53.1%NA
      Sharma et al., 2020 [
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ]

      (USA)
      23.6%7.9%68.5%NA
      Sidor et al., 2020 [
      • Sidor A.
      • Rzymski P.
      ]

      (Poland)
      14.6%0.01%e85.3%NA
      Stanton et al., 2020 [
      • Stanton R.
      • To Q.G.
      ] (Australia)
      26.6%18.1%55.3%NA
      Sun et al., 2020 [
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ]

      (China)
      51.0%cNANANA
      Tran et al., 2020 [
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ]

      (Australia)
      20.9%10.5%68.6%NA
      Vanderbruggen et al., 2020 [
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ] (Belgium)
      30.3%13.7%56.0%<0.001
      Yan et al., 2020 [
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ]

      (China)
      25.5%39.3%35.2%<0.001
      Zajacova et al., 2020 [
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]

      (Canada)
      14.0%10.0%76.0%NA
      d the total from those studies is not 100%.
      a higher among people aged 30-39.
      b Before lockdown: Never: 87.68%, sometimes: 10.12%, most of time: 1.81%, always: 0.38% / After lockdown: Never: 93.22%, sometimes: 5.35%, most of time: 1.24%, always: 0.19%.
      b Quit: 14.5 %.
      c Relapses to abuse from alcohol: 19% / Increase in regular drinkers: 32%.
      ∗ Not stated. Calculated by the existing results.
      NA: not available.

      3.4 Alcohol consumption

      Changes in alcohol consumption during the lockdown period were reported in 23 cross-sectional studies [
      • Ammar A.
      • Brach M.
      • Trabelsi K.
      • Chtourou H.
      Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19.
      ,
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • Panagiotidis P.
      • Rantis K.
      • Holeva V.
      • Parlapani E.
      • Diakogiannis I.
      Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece.
      ,
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. Results showed that in 17 out of those 23 studies, alcohol consumption remained unchanged during the lockdown for the majority of participants [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. However, a tendency towards increased alcohol consumption has been be observed for the rest of their examined participants (14.2–38.5%) in the majority of these studies (13 of 17) [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. A decline in alcohol consumption for the majority of participants during the lockdown period was reported in four studies [
      • Ammar A.
      • Brach M.
      • Trabelsi K.
      • Chtourou H.
      Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19.
      ,
      • Panagiotidis P.
      • Rantis K.
      • Holeva V.
      • Parlapani E.
      • Diakogiannis I.
      Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ] and an increase of alcohol consumption was reported for the majority of the survey participants in two studies [
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ].

      4. Discussion

      According to our knowledge, this is the first systematic review which aim was to examine changes in snacking behavior (including both sweet and salty snacks), fast-food, food ordering habits, and alcohol consumption. In total 128292 subjects from 34 different countries around the world (Algeria, Australia, Bahrain, Belgium, Brazil, Canada, China, Egypt, France, Greece, India, Iraq, Italy, Jordan, Kuwait, Lebanon, Libya, Lithuania, Morocco, New Zealand, Oman, Palestine, Poland, Qatar, Saudi Arabia, Spain, Sudan, Syria, Tunisia, UAE, UK, USA, Yemen) were included in our systematic review, aiming to investigate potential changes in snacking and/or alcohol consumption during the first lockdown period of COVID-19.
      The results of our study regarding snacking showed that although for the majority of the population examined (34.0–62.2%) snacking behavior remained unchanged during the lockdown [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ,
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ], an increased consumption of both salty and sugar snacks was reported for a significant part of individuals (18.9–45.1%) [
      • Constant A.
      • Conserve D.F.
      • Gallopel-Morvan K.
      • Raude J.
      Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: results from a cross-sectional study in France.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • V.M.
      The impact of COVID-19 on the dietary habits of middle-class population in mulund.
      ,
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Sánchez-Sánchez E.
      • Ramírez-Vargas G.
      • Avellaneda-López Y.
      • Orellana-Pecino J.I.
      • García-Marín E.
      • Díaz-Jimenez J.
      Eating habits and physical activity of the Spanish population during the covid-19 pandemic period.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ]. It has to be noted that despite the considerable heterogeneity in the definition of “snacks” (including desserts, candy, chips, nuts, crackers, popcorns, etc. [
      • Piernas C.
      • Popkin B.M.
      Snacking increased among U.S. adults between 1977 and 2006.
      ,
      • Wang Z.
      • Zhai F.
      • Zhang B.
      • Popkin B.M.
      Trends in Chinese snacking behaviors and patterns and the social-demographic role between 1991 and 2009.
      ,
      • Johnson G.H.
      • Anderson G.H.
      Snacking definitions: impact on interpretation of the literature and dietary recommendations.
      ]; most of such food items are rich in calories and poor in nutrients.
      Differences in snacking behavior could be seen even within the same country. In particular, in a study lead by Pellegrini including only obese participants, 32.7% stated an increase in their daily snacking consumption during lockdown [
      • Pellegrini M.
      • Ponzo V.
      • Rosato R.
      • Scumaci E.
      • Goitre I.
      • Benso A.
      • et al.
      Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency.
      ], whereas in the study lead by Scarmozzino, in which the population was not limited to obese people, only 18.9% reported increased consumption [
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ]. This could imply that for obese people, it was more difficult to control their snacking consumption during the lockdown period. Moreover, according Leech et al., snack consumption is not necessarily associated with amelioration in the overall quality of diet (especially in micronutrients intake) [
      • Leech R.M.
      • Livingstone K.M.
      • Worsley A.
      • Timperio A.
      • McNaughton S.A.
      Meal frequency but not snack frequency is associated with micronutrient intakes and overall diet quality in Australian men and women.
      ], but increase in adipose tissue had been observed [
      • Leech R.M.
      • Timperio A.
      • Livingstone K.M.
      • Worsley A.
      • McNaughton S.A.
      Temporal eating patterns: associations with nutrient intakes, diet quality, and measures of adiposity.
      ]. Overeating (including mainly snacking) and weight gain during lockdown could lead to “Covibesity” that should not be disregarded, as it can be a potential risk factor for COVID-19 infection [
      • Khan M.A.
      • Moverley Smith J.E.
      Covibesity," a new pandemic.
      ,
      • Jayawardena R.
      • Jeyakumar D.T.
      • Misra A.
      • Hills A.P.
      • Ranasinghe P.
      Obesity: a potential risk factor for infection and mortality in the current COVID-19 epidemic.
      ]. In addition, with respect to COVID-19 disease, due to the fact that a vaccine is not yet available for everyone, a balanced in macro- and micronutrients nutrition could be a method of prevention and management of the disease [
      • Jayawardena R.
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      ]. Therefore, these subjects could be at risk of becoming symptomatic COVID-19 patients compare to those following a balanced diet [
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      • Misra A.
      Balanced diet is a major casualty in COVID-19.
      ].
      Our results regarding fast food habit showed a significant decrease in fast-food consumption during the lockdown period [
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study.
      ,
      • Cheikh Ismail L.
      • Osaili T.M.
      • Mohamad M.N.
      • Al Marzouqi A.
      • Jarrar A.H.
      • Zampelas A.
      • et al.
      Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Husain W.
      • Ashkanani F.
      Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Rodríguez-Pérez C.
      • Molina-Montes E.
      • Verardo V.
      • Artacho R.
      • García-Villanova B.
      • Guerra-Hernández E.J.
      • et al.
      Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ]. Only, in one study conducted in Canada, 25.0% of the participants stated increased consumption of junk food [
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. Similar results emerged after examination of the frequency of ordered food (Table 4). Only in the study from New Zealand an increased trend was observed [
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ]. Provided that fast food consumption as well as frequency of ordered food tended to decrease, a possible explanation could be that the long time staying at home during lockdown made people to spend more time in cooking and preparing homemade food, as has already be found in some studies [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Di Renzo L.
      • Gualtieri P.
      • Pivari F.
      Eating habits and lifestyle changes during COVID-19 lItal Survockdown: an Italian surve.
      ]. In addition, an Italian study reported an increase of homemade recipes for pizza and/or sweets [
      • Di Renzo L.
      • Gualtieri P.
      • Pivari F.
      Eating habits and lifestyle changes during COVID-19 lItal Survockdown: an Italian surve.
      ]. Another explanation could be the fear of transmission of COVID-19 disease via packets of food and delivery services, but further research is needed in this field.
      Our results with respect to alcohol during the lockdown period showed that for the majority of the population examined the consumption remained stable [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Kriaucioniene V.
      • Bagdonaviciene L.
      • Rodríguez-Pérez C.
      Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet study.
      ,
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. However, a significant portion of the population examined increased its alcohol consumption during the confinement time [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Gerritsen S.
      • Egli V.
      • Roy R.
      • Haszard J.
      • Backer C.D.
      • Teunissen L.
      • et al.
      Seven weeks of home-cooked meals: changes to New Zealanders' grocery shopping, cooking and eating during the COVID-19 lockdown.
      ,
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ,
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Malta D.C.
      • Szwarcwald C.L.
      • Allard S.M.
      • Knight R.
      • Sweeney D.A.
      • Swafford A.D.
      The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020.
      ,
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Scarmozzino F.
      • Visioli F.
      Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ,
      • Sidor A.
      • Rzymski P.
      ,
      • Stanton R.
      • To Q.G.
      ,
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ,
      • Vanderbruggen N.
      • Matthys F.
      • Van Laere S.
      • Zeeuws D.
      • Santermans L.
      • Van den Ameele S.
      • et al.
      Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey.
      ,
      • Zajacova A.
      • Jehn A.
      • Stackhouse M.
      • Denice P.
      • Ramos H.
      Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.
      ]. Heterogeneity in results regarding alcohol consumption can be observed even in the same country. Results from China varied, where in Sun et al. [
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ] more than a half of the included population has increased its alcohol consumption, whereas in Yan et al. around 25% reported an increase [
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ]. However, in both studies the sample was not representative of the country's population. Moreover, the period of survey between these studies was different (24–31 March in Sun et al./and 15 April-11 May in Yan et al.) [
      • Sun Y.
      • Li Y.
      • Bao Y.
      • Meng S.
      • Sun Y.
      • Schumann G.
      • et al.
      Brief report: increased addictive internet and substance use behavior during the COVID-19 pandemic in China.
      ,
      • Yan A.F.
      • Sun X.
      • Zheng J.
      • Mi B.
      • Zuo H.
      • Ruan G.
      • et al.
      Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: findings among adults with and without diabetes in China.
      ]. An explanation of the fact that different results emerged could be that in the beginning of the lockdown the anxiety and the fear of this unknown situation as well as the sudden change of daily life made people more prone to alcohol consumption compared to the end of lockdown.
      Similar assumptions were also made about results from France [
      • Rolland B.
      • Christensen H.
      • Faasse K.
      Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study.
      ,
      • Rossinot H.
      • Fantin R.
      • Venne J.
      Behavioral changes during COVID-19 confinement in France: a web-based study.
      ] and Australia [
      • Stanton R.
      • To Q.G.
      ,
      • Tran T.D.
      • Hammarberg K.
      • Kirkman M.
      • Nguyen H.T.M.
      • Fisher J.
      Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia.
      ], where a tendency towards decrease in alcohol consumption at the end of the lockdown in comparison to the beginning was observed. Results from USA were also differed between the studies [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ,
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ,
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ]. In Avery et al. study, which was started in March, 14.3% of the participants reported increased alcohol consumption [
      • Avery A.R.
      • Tsang S.
      • Seto E.Y.W.
      • Duncan G.E.
      Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: findings among adult twin pairs.
      ], in Sharma et al. study, which was conducted in April, 23.6% of the participants increased their alcohol consumption [
      • Sharma P.
      • Dai J.
      • Shi J.
      • Huang J.
      • Hu C.
      • Wu L.
      • et al.
      Changes in substance use among young adults during a respiratory disease pandemic.
      ], and in Knell et al. study of which the survey ended in May, 38.5% of the participants reported an increase in their alcohol consumption [
      • Knell G.
      • Robertson M.C.
      • Dooley E.E.
      • Burford K.
      • Mendez K.S.
      Health behavior changes during COVID-19 pandemic and subsequent "Stay-at-Home" orders.
      ]. The same pattern was also observed in polish population where 13.8–14.6% of subjects reported increased consumption in April [
      • Chodkiewicz J.
      • Talarowska M.
      • Miniszewska J.
      • Nawrocka N.
      • Bilinski P.
      Alcohol consumption reported during the COVID-19 pandemic: the initial stage.
      ,
      • Sidor A.
      • Rzymski P.
      ] and 18.1% in May [
      • Górnicka M.
      • Drywień M.E.
      • Zielinska M.A.
      • Hamułka J.
      Dietary and lifestyle changes during covid-19 and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid-19 study.
      ]. Therefore, the population in USA and Poland, in contrast to Chinese, French and Australian population, found to consume more alcohol in the end compared to the beginning of the lockdown. Data regarding the period of the survey conduction was not available in Ingram et al. study [
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ] so as to make an assumption for the heterogenous result from UK [
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ,
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ]. However, in Ingram et al. study [
      • Ingram J.
      • Maciejewski G.
      • Hand C.J.
      Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown.
      ], the sample was characterized as representative, whereas in the study led by Robinson as not representative [
      • Robinson E.
      • Gillespie S.
      • Jones A.
      Weight-related lifestyle behaviours and the COVID-19 crisis: an online survey study of UK adults during social lockdown.
      ].
      COVID-19 pandemic, led to several and sudden changes in people’ daily life and the lockdown period was full of stressf and anxiety for unknown duration [
      • Stanton R.
      • To Q.G.
      ]. In order to cope with this, a significant portion of the population relapsed to previous abuse as reported by Zhao et al. [
      • Zhao A.
      • Li Z.
      • Ke Y.
      • Huo S.
      • Ma Y.
      • Zhang Y.
      • et al.
      Dietary diversity among Chinese residents during the COVID-19 outbreak and its associated factors.
      ]. Nevertheless, subjects who often consume alcohol are not only more prone to viral and bacterial infections (including COVID-19) due to their impaired immune system [
      • Rehm J.
      • Parry C.D.
      Alcohol consumption and infectious diseases in South Africa.
      ,
      • Testino G.
      Are patients with alcohol use disorders at increased risk for covid-19 infection?.
      ], to CVD in heavy drinking occasions [
      • Roerecke M.
      • Rehm J.
      Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis.
      ], liver [
      • Osna N.A.
      • Donohue Jr., T.M.
      • Kharbanda K.K.
      Alcoholic liver disease: pathogenesis and current management.
      ], and pancreas diseases [
      • Irving H.M.
      • Samokhvalov A.V.
      • Rehm J.
      Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis.
      ], but they also affect the quality of life of people living around them (e.g. domestic violence, neuropsychiatric disorders) [
      • Rehm J.
      The risks associated with alcohol use and alcoholism.
      ]. However, according to a recent systematic review the evidence is not enough regarding domestic violence and alcohol abuse during COVID-19 [
      • Abdo C.
      • Miranda E.P.
      • Santos C.S.
      • Júnior J.B.
      • Bernardo W.M.
      Domestic violence and substance abuse during COVID19: a systematic review.
      ], but awareness of reliability of this data is always needed [
      • Sacco M.A.
      • Caputo F.
      • Ricci P.
      • Sicilia F.
      • De Aloe L.
      • Bonetta C.F.
      • et al.
      The impact of the Covid-19 pandemic on domestic violence: the dark side of home isolation during quarantine.
      ].
      Among the strengths of our study is the number of studies included as well as the fact that a significant geographical part of the world was covered. Moreover, this is the first systematic review examining changes in eating patterns (snacking, fast-food, and ordered food) as well as in alcohol consumption. In addition, all studies included in this review were assessed according to the Newcastle–Ottawa Scale (Suppl. Table 2) and were characterized from satisfactory (5∗) to very good (9∗) quality. Limitations of our studies include the fact that the sample of some studies was not representative for the population of each country and this could affect the accuracy of our results. Moreover, p-values were not reported in all our included studies, therefore not allowing us to provide information on the statistical significance of related results. Furthermore, it needs to be noted that the fact that only online/or via telephone questionnaires were used as a tool for all the surveys without any verification by other methods such as focused interviews, food diaries etc., can influence the reliability of the collected data. Lastly, in this systematic review studies only in English language were included and therefore related studies published in other languages might have been missed.

      5. Conclusions

      During the period of lockdown due to the COVID-19 pandemic, changes in lifestyle behaviors were observed for a significant percentage of the global population. A tendency towards increased in snacking as well as in alcohol consumption should not be disregarded because long-term problems could be arising especially in cases of repeated lockdowns in future. The observed decrease in fast-food consumption and in frequency of ordered food demonstrate an encouraging turn to home-made foods. However, provision and campaigns regarding nutritional information could be useful in order to combat with this pandemic.

      Funding

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Author distribution

      DB and MC searched the databases; DB, DJ and MC. wrote the paper; , RJ, and MC made the necessary recommendations; and DB, DJ, R.J, and MC revised the manuscript. All authors have read and approved the final version of manuscript.

      Conflict of interest

      The authors declare no conflict of interest.

      Appendix A. Supplementary data

      The following are the Supplementary data to this article:

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