Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19.

Background: Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors. Methods: This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters. Results: In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters. Conclusion: Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study.

BACKGROUND: In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS: INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS: We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION: COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING: None.

Food safety knowledge among pregnant women in the United Arab Emirates amid the COVID-19 pandemic.

Studies have indicated shortcomings in food safety knowledge and practices among pregnant women in the Arab region. A high-risk group for having severe outcomes from foodborne illnesses. This study aimed to assess self-reported food safety knowledge and practices among pregnant women in the UAE during the COVID-19 pandemic. A total of 354 pregnant women residing in the UAE completed an online survey between October 2021 and January 2022. The questionnaire included socio-demographic information, food safety knowledge, and food practices during the COVID-19 pandemic. Correct answers for food safety knowledge were scored out of 50 and the total score was compared by sociodemographic characteristics. The total mean score for the study population was 26.7 ± 4.6 out of 50. Participants had good knowledge about foodborne diseases (81.3%) and personal hygiene practices (61.8%). While they were least knowledgeable about cross-contamination (43.3%) and temperature control practices (35.8%). Significantly higher knowledge scores were observed with higher levels of education and primigravida women (p<0.05). Knowledge about the COVID-19 virus and its relation to food safety was adequate for most participants. This study infers the need for food safety-related education and training programs to reduce the risk of foodborne disease among this vulnerable group. It also highlights the need to enhance the role of healthcare professionals as trusted sources of information in improving food safety during pregnancy.

Sex disparities in food consumption patterns, dietary diversity and determinants of self-reported body weight changes before and amid the COVID-19 pandemic in 10 Arab countries.

Background: The COVID-19 pandemic along with its confinement period boosted lifestyle modifications and impacted women and men differently which exacerbated existing gender inequalities. The main objective of this paper is to assess the gender-based differentials in food consumption patterns, dietary diversity and the determinants favoring weight change before and amid the COVID-19 pandemic among Arab men and women from 10 Arab countries. Methods: A cross-sectional study was conducted based on a convenience sample of 12,447 households' family members (mean age: 33.2 ± 12.9; 50.1% females) and information from participants aged 18 years and above was collected about periods before and during the pandemic. Results: Findings showed that, during the COVID-19 period, the dietary diversity, declined by 1.9% among females compared to males (0.4%) (p < 0.001) and by 1.5% among overweight participants (p < 0.001) compared to their counterparts. Conclusions: To conclude, gender-sensitive strategies and policies to address weight gain and dietary diversity during emergent shocks and pandemics are urgently needed in the region.

The Impact of COVID-19 on Physical (In)Activity Behavior in 10 Arab Countries.

Insufficient physical activity is considered a strong risk factor associated with non-communicable diseases. This study aimed to assess the impact of COVID-19 on physical (in)activity behavior in 10 Arab countries before and during the lockdown. A cross-sectional study using a validated online survey was launched originally in 38 different countries. The Eastern Mediterranean regional data related to the 10 Arabic countries that participated in the survey were selected for analysis in this study. A total of 12,433 participants were included in this analysis. The mean age of the participants was 30.3 (SD, 11.7) years. Descriptive and regression analyses were conducted to examine the associations between physical activity levels and the participants' sociodemographic characteristics, watching TV, screen time, and computer usage. Physical activity levels decreased significantly during the lockdown. Participants' country of origin, gender, and education were associated with physical activity before and during the lockdown (p < 0.050). Older age, watching TV, and using computers had a negative effect on physical activity before and during the lockdown (p < 0.050). Strategies to improve physical activity and minimize sedentary behavior should be implemented, as well as to reduce unhealthy levels of inactive time, especially during times of crisis. Further research on the influence of a lack of physical activity on overall health status, as well as on the COVID-19 disease effect is recommended.

Camel milk consumption patterns and perceptions in the UAE: a cross-sectional study.

Camel milk has been consumed for centuries due to its medicinal and healing properties. The present study aims to investigate the consumption patterns of camel milk and perceived benefits and risks among adults in the United Arab Emirates. A self-administered online questionnaire was developed in English and Arabic languages and was completed online by 852 adults. Socio-demographic characteristics, camel milk consumption patterns and perceived knowledge of the benefits and risks of camel milk were investigated. About 60 % of the participants have tried drinking camel milk, but only a quarter (25⋅1 %) were regular consumers. The most consumed camel milk products after fresh milk were yoghurt and flavoured milk. The most popular additions to camel milk were honey, turmeric and sugar. Most consumers had less than one cup of camel milk per day (57⋅0 %). Camel milk consumers preferred it over other types of milk due to its nutritional value (66⋅4 %) and medicinal properties (39⋅3 %). Among consumers, 58⋅4 % reported consuming unpasteurised camel milk. Reasons included the belief that it is fresher (87⋅2 %), better for the immune system (41⋅6 %), and higher in nutrients (39⋅2 %). Overall, participants had inadequate knowledge about the health benefits of camel milk (7⋅11 ± 5⋅3 out of 25). Males and camel milk consumers had a significantly higher knowledge about the health benefits of camel milk compared to females and non-consumers (P < 0⋅05). Although positive perceptions were common, misperceptions appear to be prevalent among non-consumers. Consuming unpasteurised camel milk is a major public health concern, thus national regulations are essential.

Impact of coronavirus 2019 pandemic on post-traumatic stress disorder symptoms among pregnant women in Jordan.

OBJECTIVE: To examine the prevalence of psychological symptoms of the coronavirus disease 2019 outbreak among pregnant women and its association with gestational age and post-traumatic stress disorder symptoms. METHODS: A cross-sectional study was conducted between June and November 2020 to assess the impact of the COVID-19 pandemic on mental health in pregnancy using the Impact of Event Scale-Revised. Pregnant women 18 years and older were recruited from antenatal and obstetrics clinics in Jordan. A total of 481 pregnant women participated in an online survey developed on Google Forms. A self-administered structured questionnaire was used to collect sociodemographic data, mental health information, and lifestyle changes. The Impact of Event Scale-Revised, the Perceived Support Scale, and the Mental Health Lifestyle Scale were administered. Variables related to sociodemographic information and dietary behavior and perception during the COVID-19 pandemic were also assessed. RESULTS: The results showed that 58.6% of pregnant women reported the presence of post-traumatic stress disorder symptoms and women in the second trimester were more likely to show post-traumatic stress disorder symptoms compared with the first and third trimesters (p = 0.001). Moreover, a higher level of education, employment, poor dietary habits, and changes due to the pandemic were significantly associated with the Impact of Event Scale-Revised score and the presence of post-traumatic stress disorder symptoms. CONCLUSION: The COVID-19 pandemic was associated with high rates of psychological distress among pregnant women. Identifying mothers at risk of post-traumatic stress disorder symptoms may help improve maternity services and prevent adverse child outcomes.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries.

Background: The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries. Methods: A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics. Results: Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores. Conclusion: Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.

Dietary Diversity in the Eastern Mediterranean Region Before and During the COVID-19 Pandemic: Disparities, Challenges, and Mitigation Measures.

The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragility posing severe challenges to maintaining healthy sustainable lifestyle. The aim of this cross-sectional study (N = 13,527 household's family members, mean age: 30.3 ±11.6, 80% women) is to examine the impact of the COVID-19 pandemic on food consumption patterns and household's dietary diversity in 10 Eastern Mediterranean countries. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping and food stock explore the community mitigation measures. In the overall population, before and during the pandemic, most food groups were consumed less or equal to 4 times per week. As evident from our findings and considering that the pandemic may be better, but it's not over, small to moderate changes in food consumption patterns in relatively short time periods can become permanent and lead to substantial poor dietary diversity over time. While it is a priority to mitigate the immediate impact, one area of great concern is the long-term effects of this pandemic on dietary patterns and dietary diversity in Eastern Mediterranean households. To conclude, the COVID-19 crisis revealed the region's unpreparedness to deal with a pandemic. While the aggressive containment strategy was essential for most countries to help prevent the spread, it came at a high nutritional cost, driving poor dietary diversity.

Practices and resilience of dieticians during the COVID-19 pandemic: a national survey in the United Arab Emirates.

BACKGROUND: The COVID-19 pandemic impacted the practices and resilience of most healthcare workers, including dieticians. In addition to offering critical care to COVID-19 patients, dieticians play a major role in preventing and managing conditions known to affect COVID-19, such as obesity and metabolic disorders. The objective of this study was to examine the conditions and changes in the work environment as well as resilience and its correlates among dieticians during the COVID-19 pandemic in the United Arab Emirates (UAE). METHODS: A cross-sectional national survey was conducted among dieticians practicing in the UAE (n = 371), using a web-based questionnaire. The questionnaire addressed, in addition to the sociodemographic information, the practice-related characteristics and resilience of participants. For the latter the Connor-Davidson Resilience Scale© was used. Descriptive statistics as well as simple and multiple linear regressions were used in the statistical analysis. RESULTS: Of participants, 26.4% reported not having access to personal protective equipment and 50% indicated being concerned for their safety and health. Furthermore, considerable proportions of participants were not satisfied (45%) with the support nor with the appreciation (37.7%) they received during the pandemic. One in four dieticians considered quitting his/her job. While 65.8% of participants reported counseling COVID-19 patients, a third did not use any online platform for counseling. The most cited challenge to dietetic practice during the pandemic was 'maintaining work-life balance' (43.1%). The mean CD-RISC score was 72.0 ± 14.0. After adjustment, working in a hospital or public clinic (as opposed to private clinic), having a condition preventing face-to-face counseling, considering quitting job and feeling neutral or dissatisfied with the appreciation were associated with lower resilience scores, while counseling COVID-19 patients was associated with higher scores. CONCLUSIONS: Despite the fairly high resilience among dieticians practicing in the UAE during the COVID-19 pandemic, the findings of this study highlighted a few challenges, mainly related to safe practice environment, support for online counseling, and maintaining work-life balance. Concerted efforts of policy and decision makers ought to develop targeted programs for dieticians to ensure their retention and wellbeing during the COVID-19 pandemic.

Dietary Habits and Lifestyle During Coronavirus Pandemic Lockdown: Experience From Lebanon.

This study aimed to examine the impact of quarantine on eating habits and lifestyle behaviors among the Lebanese adult population. A cross-sectional study was conducted using an online questionnaire designed on Google Forms between 3 June and 28 June 2020. The survey questions were adapted from the Short Food Frequency Questionnaire, the International Physical Activity Questionnaire Short Form, and the second version of the Copenhagen Psychosocial Questionnaire. A total of 2,507 adults completed the questionnaire. During the lockdown, 32.8% claimed weight gain, 44.7% did not eat fruits daily, 35.3% did not eat vegetables on daily basis, and 72.9% reported drinking less than eight cups of water per day. Moreover, there was a significant increase in the number of meals consumed per day, consumption of homemade meals, sedentary time, stress, and sleeping disturbances during the pandemic compared to before the pandemic (all p < 0.001). However, there was a significant decrease in physical activity engagement, sleep quality, and energy level during the lockdown compared to before the pandemic (all p < 0.001). The study highlights that the COVID-19 lockdown was associated with unfavorable changes in dietary habits and lifestyle behaviors in Lebanon. Sleep and mental health were also negatively impacted by the pandemic.

Impact of coronavirus 2019 on mental health and lifestyle adaptations of pregnant women in the United Arab Emirates: a cross-sectional study.

BACKGROUND: In light of the pandemic, pregnant women are particularly vulnerable to increased psychological distress and in need of imperative preventive measures. This study aimed to investigate the impact of the pandemic on mental health, lifestyle adaptations, and their determinants among pregnant women in the United Arab Emirates. METHODS: A survey was conducted electronically between June and August 2020. Pregnant women were recruited from prenatal clinics in the UAE and invited to participate in an online survey developed on Google Forms. The questionnaire included socio-demographic characteristics, the Impact of Event Scale- Revised, the Perceived Support Scale and lifestyle-related factors. RESULTS: A total of 384 pregnant women completed the questionnaire of whom 20.6% were in their 1st trimester, 46.1% in their 2nd and 33.3% in their 3rd trimester. The mean IES-R score for the respondents was 26.15 ± 13.55, corresponding to a mild stressful impact, which did not differ significantly among trimesters of pregnancy. Pregnant women expressed increased stress from staying home (64%), work (40%), feeling frightened (66%) and apprehensive (59%). Women reported increased support and sharing their feelings with family members (59%), mainly in the 1st and 3rd trimester of pregnancy (P < 0.05). There was a greater attention to mental health (48%), resting time (55.3%), and relaxing time (57.3%); while a decreased amount of time was spent engaging in physical activities (53.6%), which differed significantly between trimesters (P = 0.02). CONCLUSIONS: The COVID-19 pandemic was associated with a mild stressful impact among pregnant women in the UAE, braced by strong family support and self-care mental health behaviors.

Impact of the Coronavirus Pandemic (COVID-19) Lockdown on Mental Health and Well-Being in the United Arab Emirates.

United Arab Emirates (UAE) has taken unprecedented precautionary measures including complete lockdowns against COVID-19 to control its spread and ensure the well-being of individuals. This study investigated the impact of COVID-19 and societal lockdown measures on the mental health of adults in the UAE. A cross-sectional study was conducted using an English and Arabic online questionnaire between May and June 2020. The psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and the social and family support impact was evaluated using questions from the Perceived Support Scale (PSS). A total of 4,426 participants (3,325 females and 1,101 males) completed the questionnaire. The mean IES-R score was 28.0 ± 14.6, reflecting a mild stressful impact with 27.3% reporting severe psychological impact. Over 36% reported increased stress from work, home and financial matters. Also, 43-63% of the participants felt horrified, apprehensive or helpless due to COVID-19. Females, younger participants, part-timers, and college or University graduates were more likely to have a high IES-R score (p < 0.05). The majority of participants reported receiving increased support from family members, paying more attention to their mental health, and spending more time to rest and relax. The results of this study demonstrate the impact of the COVID-19 pandemic on mental health among the UAE residents and highlight the need to adopt culturally appropriate interventions for the general population and vulnerable groups, such as females and younger adults.

Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: a cross-sectional study.

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

Eating Habits and Lifestyle during COVID-19 Lockdown in the United Arab Emirates: A Cross-Sectional Study.

The coronavirus disease is still spreading in the United Arab Emirates (UAE) with subsequent lockdowns and social distancing measures being enforced by the government. The purpose of this study was to assess the effect of the lockdown on eating habits and lifestyle behaviors among residents of the UAE. A cross-sectional study among adults in the UAE was conducted using an online questionnaire between April and May 2020. A total of 1012 subjects participated in the study. During the pandemic, 31% reported weight gain and 72.2% had less than eight cups of water per day. Furthermore, the dietary habits of the participants were distanced from the Mediterranean diet principles and closer to "unhealthy" dietary patterns. Moreover, 38.5% did not engage in physical activity and 36.2% spent over five hours per day on screens for entertainment. A significantly higher percentage of participants reported physical exhaustion, emotional exhaustion, irritability, and tension "all the time" during the pandemic compared to before the pandemic (p < 0.001). Sleep disturbances were prevalent among 60.8% of the participants during the pandemic. Although lockdowns are an important safety measure to protect public health, results indicate that they might cause a variety of lifestyle changes, physical inactivity, and psychological problems among adults in the UAE.