International Journal of Community Medicine and Public Health Verma AK et al. Int J Community Med Public Health. 2023 Dec;10(12):4755-4761 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040
DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20233775
Original Research Article
Food consumption behavior and lifestyle changes among rural older
adults before and during the COVID-19 pandemic in
northern India: a cross-sectional study
Ashish Kumar Verma, Annapurna, Richa Panchgaur, Alok Kumar*
Department of Statistics, Banaras Hindu University, Varanasi, Uttar Pradesh, India Received: 12 September 2023 Revised: 12 November 2023 Accepted: 16 November 2023 *Correspondence: Dr. Alok Kumar, E-mail: alokkumar@bhu.ac.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT Background: Due to COVID-19, the lockdown was imposed throughout the nation on 24 march 2020 and COVID- 19 is not over yet, cases are still coming. Food insecurity was already a problem but it became even more challenging during the pandemic. Especially rural older adult people have had to deal with the problem of food and health-related issues due to the pandemic. This study aimed to assess food consumption behavior and lifestyle changes among rural older adults before and during the COVID-19 pandemic. Methods: A retrospective cross-sectional study has been conducted in rural areas of the Varanasi district, Uttar Pradesh through personal interviews; a multistage random sampling technique was used to select the participants. 450 participants were taken aged 60 and above for final analysis. The McNemar and Wilcoxon sign rank tests were used to examine differences before and during the COVID-19 pandemic, adopting the statistical significance of p<0.05. Results: 66.0% of people faced a shortage of food. 40.9% of people reported that they had reduced their food intake. 27.6% of participants reported a reduction in body weight. There was a significant percentage decrease in consumption of milk products, pulse, and green vegetables (p<0.001), a percentage decrease in initiating and maintaining sleep (p<0.001), and worse health conditions (p<0.001). Conclusions: Food consumption behavior and lifestyles have changed significantly during the COVID-19 pandemic among rural older adults. Keywords: Before and during, COVID-19, Eating habit, Food consumption, Lifestyle
INTRODUCTION
The COVID-19 pandemic, which is present in more than 180 nations worldwide, is a serious threat to humankind.1 In addition to negatively impacting people’s physical health, this pandemic also resulted in profound changes in their lifestyles.
In India, the lockdown was imposed on 24 March 2020 due to COVID-19 and lessened after 2 months, but COVID-19 is not over yet, cases are still coming.2 As a result of this pandemic, the general public had to deal
with problems like a lack of food supplies, a lack of fresh fruit and vegetables, financial concerns, and mental stress, all of which contribute to emotional and mental breakdowns.3 The threat of the pandemic, might also lead to reduced income, job losses, and worry about an unknown future, which could cause people to curtail overall spending, especially on food and healthcare.4 Some studies, however, have shown trends toward unfavorable food consumption behaviors due to COVID-19 such as reduced consumption of fresh vegetables and fruits, and reduced weight.5 Also, studies conducted in various communities have previously
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shown that the lockdown and home quarantine security measures used to combat the novel coronavirus promoted numerous changes, interfered with routines and lifestyle, decreased physical activity, and altered dietary patterns and food purchases.6-8
According to the LASI report India 2020, there are 46% of persons over the age of 60 and above in India, and 68% of them reside in villages. Moreover, another study showed that older adult people have faced more problems with food and health-related issues due to the COVID pandemic.9 That is why we included village older adults in our survey and attempted to study about the consequences of the COVID epidemic on them. We have noticed from numerous studies that COVID-19 has an impact on people of all ages and social groups. Additionally, we have observed that issues such as food insecurity, changes in daily routine, and many others have emerged due to the pandemic.4,5 Therefore, this is the driving force behind our investigation.
The study aimed to determine how the coronavirus pandemic (COVID-19) affected older adults living in rural areas in terms of their daily routines, including changes in eating and sleeping patterns.
METHODS
A retrospective cross-sectional survey was conducted from March 1 to April 30, 2022, in 30 villages of the Varanasi District, Uttar Pradesh. Using multistage random sampling techniques older adult samples were selected from the Varanasi district. The selection of villages, segments, households, and individuals from the villages of the Varanasi district formed different stages of sampling. In the final analysis, 450 older adult samples were taken.
The basic instrument of data collection was a personal interview method. Information on daily habits like hours of sleep, type of work, and eating habits were taken at the time of survey. The context of during COVID-19 pandemic: information was collected for the preceding 2 years at the time of the survey.
Information related to this study was collected for two points of time (before pandemic and during pandemic) at the time of the survey.
Four groups were prepared using the obtained information. The first group contains information regarding their age, gender, educational level, type of family, current occupation, socioeconomic status, and weight. The following sets of questions were used to gather information on food consumption behavior and lifestyle patterns for two points of time.
Concerning lifestyle, questions about substance abuse (no/yes), doing household chores (never/1-2 days in a week/3-4 days in a week/5-6 days in a week/always), sleeping hours
(<6 hours/6-8 hours/>8 hours), initiating and maintaining sleep (good/bad), family and friends support for maintaining a better lifestyle (never/sometimes/always) and health conditions (good/medium/bad) were asked.
To comprehend the nutrition consequences and food insecurity, questions regarding food insecurity (no/yes), changes in food intake (no changes/reduced), and weight loss (no/yes) were also asked during interviews.
To investigate food consumption behavior during the COVID-19 pandemic, questions related to the consumption of milk products, pulses, eggs, meat, fish, and kadha were carried out. Participants could choose their frequency of consumption for each type of food by choosing from: (never/occasionally/1-2 days a week/3-4 days a week/every day).
Kuppuswamy socioeconomic scale 2021 was used to classify the socioeconomic class of the participants.
Data analysis
The data were analyzed using SPSS 25 (Statistical Package for Social Science). To comprehend the responses of the participants, descriptive statistics like frequency and percentage were used. Mean and standard deviation was calculated from data for age, weight, and body mass index (BMI). The McNemar and Wilcoxon sign rank tests were used to investigate the difference between variables (p<0.05).
RESULTS
A total of 450 participants’ responses were analyzed. Table 1 shows comprehensive details about the socio- demographic characteristics of the study population. The most of participants (60.2%) were men, aged 60-69 years (70.0%). The mean age and weight of the participants were found to be (66.72-year), (51.6 kg) respectively. The majority of the participants were found to be of normal weight (60.4%) and mean BMI (21.1 kg/m2). Almost two- thirds of the participants were not working (68.2%). Most of the participants lived in a joint family (73.6%), were illiterate (64.7%), and belonged to the lower class (43.6%) (Table 1).
When questions were asked about food insecurity, most of the participants reported yes (66.0%). However, 40.9% reported a reduction in food intake, and 27.6% reported weight loss during the pandemic (Table 2).
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Table 1: Socio-demographic characteristics of the respondents.
Table 2: Food insecurity and dietary outcomes in rural households during COVID-19 pandemic.
Participants were asked to give the reasons for the reduced food consumption during the pandemic. Figure 1 shows the percentages for each reason and it was found
that most people have attributed the rise in the prices of edible items (39.6%) followed by a lack of fresh fruits and vegetables (35.3%) (Figure 1).
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Figure 1: Percent decrement in food intake due to
various reasons among rural older adults.
Figure 2: Weight loss (self-reported) according to the
age groups of respondents.
From Figure 2, we found that those who belong aged between 60-69 years, reported more weight loss as compared to their counterpart (70.2%) (Figure 2).
Figure 3: Weight loss (self-reported) according to the
socioeconomic status of respondents.
58.1% of participants who belong to the lower class of socioeconomic status have reported more weight loss during the COVID-19 pandemic (Figure 3).
The eating patterns of the study population before and during the pandemic are shown in Figure 4. Food items like milk and dairy products, pulse, green vegetables, and kadha showed significant differences in the percentage of consumption before and after the COVID-19 pandemic. The findings revealed that 71.6% of people who used to eat milk and dairy products daily before COVID-19 had decreased to 28.2% during the COVID-19 pandemic. Also, the percentage of consuming pulse every day decreased from 90.4% to 26%, and the percentage of those consuming green vegetables and fruits every day decreased from 90% to 32.9%. Moreover, the percentage of participants consuming kadha per day increased from 1.8% before COVID-19 to 69.3% during the COVID-19 pandemic (Figure 4).
Figure 4: Percentages of food consumption before and during the COVID-19 pandemic (n=450).
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Table 3: Lifestyle-related changes among rural older adults.
Note: NS: Not Significant
Questions were asked from the participants to indicate the frequency of doing household chores, sleeping time, initiating and maintaining sleep, family and friend support for maintaining a better lifestyle, health conditions, and substance abuse at the time of the survey. Results showed, no significant percentage changes in doing household chores, sleeping time, family and friends support, and substance abuse during the COVID-19 pandemic in the rural region. But there was a significant percentage change in initiating and maintaining sleep, and in health conditions (p<0.001). The percentage of older adult participants who reported bad in initiating and maintaining sleep increased from 4.4% before COVID-19 to 22.9% during the COVID-19 pandemic. Similarly, the percentage change in bad health conditions was reported from 2.7% before COVID-19 to 16.4% during the COVID-19 pandemic (Table 3).
DISCUSSION
This research focused on how rural older adults’ daily routines, food consumption habits, and lifestyles changed during the COVID-19 pandemic. Our main findings showed that there were issues with food availability, most of which resulted in decreased food consumption and weight loss.
Additionally, eating patterns have changed, and also found that significant decrement in the use of milk and dairy products, pulses, green vegetables, and fruits, while a significant increment was noted in the kadha’s consumption during the COVID-19 pandemic. Moreover, there was a significant percentage change in initiating and maintaining sleep, and health conditions (p<0.001).
While comparing our findings with those of other related research, we found that the pandemic’s effect on home isolation caused changes in food-related behaviors in an American survey (n=484 adult participants), persons who were experiencing food insecurity had decreased their consumption of fruits and vegetables from the beginning of the COVID-19 pandemic.10 Eating behavior patterns changed during COVID-19. Consumption of regular milk, pulses, and green vegetables was decreased but a significant improvement can be seen in routine consumption of more than once a week of protein-rich food such as pulses and green vegetables. There were not much more changes in the consumption of meat, egg, and fish but the study shows that they were taking it more than once a week. Some studies also found a slight improvement in protein-rich food consumption.11 A possible reason for this difference in rural reason due to the lack of fresh
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vegetables and the rise in the price of edible items. During the COVID-19 intake of the herbal drink (Kadha) an ayurvedic home remedy that consists of some immunity booster ingredients such as fennel seed, black paper, cinnamon seed, basil (tulsi), ginger, turmeric, etc. was increased. Additionally, some studies discovered a rise in the use of products that improve immunity.12-14 Slipping time remains unchanged before and during COVID-19 but the quality of bad sleep was increased. Anxiety, fear of novel diseases, and mental stress can cause poor sleep quality. Some studies also reported that the pandemic affected sleep patterns among Indians.11,12,15,16 Bad health conditions significantly increase during COVID-19 and weight loss was also seen in elderly people. Lack of support for adequate public health care during COVID-19 in rural areas may be the reason for the increase in poor health conditions.
The study is limited by its cross-sectional design, which may constrain the ability to establish causation. Furthermore, the generalizability of the results may be affected. Additionally, the study is limited by the inability of investigators to directly observe and assess both the quality and quantity of food consumed by the study population.
CONCLUSION
The present study has highlighted that food consumption behavior and lifestyles have changed significantly. Although some lifestyles haven’t changed significantly, the quantity of food and health conditions were compromised. Moreover, reduced weight loss was also recorded in the participants during COVID-19. Therefore, the findings of this study can help policymakers, public health experts, and the Indian government to launch efficient initiatives to address such types of problems in the future.
Funding: No funding sources Conflict of interest: None declared Ethical approval: The study was approved by the department of statistics, Institute of Science, Banaras Hindu University
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Cite this article as: Verma AK, Annapurna, Panchgaur R, Kumar A. Food consumption behavior and lifestyle changes among rural older adults before and during the COVID-19 pandemic in northern India: a cross-sectional study. Int J Community Med Public Health 2023;10:4755-61.
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