Socioeconomic differences in nutrition in Italy before and during COVID-19 pandemic: a nationwide cross-sectional study (preprint)

Background: Several socioeconomic conditions may influence subjects’ adherence to healthy eating habits. Food consumption may be influenced by external stress during crisis periods; however, the effects of these events on food habits are difficult to predict. Also, a pandemic crisis like the recent COVID-19 pandemic may have influenced dietary habits and food consumption. The objective of this study was to compare dietary habits in Italian people one year before the COVID-19 pandemic with those belonging to the year 2020 in a nationwide population sample. Materials and methods: Information on dietary habits has been obtained from the multi-purpose survey on families “Aspects of daily life”, carried out in Italy by the Italian National Statistics Institute (ISTAT). We analyzed data coming from 2016 and 2020 editions of the survey (43000 subjects each year). We used population attributable factor (PAF) adjusted for age, defined as the proportional reduction in unhealthy diet that would occur if all participants had had a  higher education, assuming higher educated individuals as more socially advantaged. Prevalence association for each dietary exposition has been calculated through logistic regression. Results: both men and women show high prevalence of unhealthy dietary habits. Regarding men, excessive consumption of eggs, pork meat, and bovine meat is characterized by a PAF attributable to socioeconomic conditions to an extent greater than 30%. Women show the same trend. During COVID-19 pandemic men and women show unhealthy profiles of food consumption since men increased consumption of eggs, cooked fats, snacks, sweets, and reduced consumption of fruits and vegetables. Both sexes registered an increase in overweight and obese subjects in 2020. Conclusions: To our knowledge, this study is the first in our country to use a validate yearly questionnaire to analyze dietary habits looking at single kind of different foods at nationwide level and to put in relationship these habits with COVID-19 pandemic. Our results show unbalanced dietary habits of Italian population. Socioeconomic differences influence food choices but in a complex way. Outside stressors like a crisis period as COVID-19 pandemic seem to have an important role in both men and women regarding assumption of so-called “junk food”.

Tocilizumab in Covid-19 Interstitial Pneumonia: A Phase II Pilot Study (preprint)

Background: Multiple studies have been conducted to investigate Tocilizumab in patients with cOVID-19 pneumonitis. However, published reports show conflicting results, largely due to weak retrospective designs and heterogeneity in critical methodological issues. Methods: : This open-label trial was structured according to the Simon’s optimal two-stage design in order to clarify which patients could really benefit from anti-IL6 strategies and how a future randomized trial should be designed to provide reliable and unequivocal results. 46 patients received a single infusion of Tocilizumab. Inclusion criteria were: SARS-CoV2 infection diagnosed by rt-PCR, multifocal interstitial pneumonia, need of oxygen therapy (FiO2 50%) to maintain SO2 >93%, recent (within the last 24 hours) worsening of lung function. Clinical outcomes were established a priori to assess whether a patient responded to treatment. A low number of carefully chosen clinical and biological markers was measured in order to test their predictive values. Primary end point was early and sustained clinical response. Results: : Twenty-one (46%) patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 hours after tocilizumab infusion (p=0.049) and higher baseline values of PaO2/FiO2 (p=0.008) predicted a favorable clinical response. Patients not improving at 72 hours were also non-responder at day 7. 11/25 of non-responder patients were intubated and 7 died. High levels of vWF were detected in all sera, with a tendency towards higher concentrations in the non-responder group. Conclusions: : Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in selected patients with severe COVID-19 pneumonitis warrants investigations in randomized trials. Trial registration: NCT 04315480