The main causes of death in patients with COVID-19.

By March 21, 2022, 6.1 million deaths from COVID-19 were reported, most of them in the United States, Brazil, and India. Between January 1, 2020, and December 31, 2021, the global estimated mortality due to the COVID-19 pandemic was 120.3 deaths (113.1-129.3) per 100,000 of the population for all ages. So far, many of the potentially fatal mechanisms of COVID-19 have been reported. In this manuscript, we analyzed the available data on the causes of deaths from COVID-19. This analysis suggests that the primary attributable cause of death from COVID-19 is multiple organ failure resulting from numerous pathological mechanisms, including genetic predisposition to the severe inflammatory response. Increased inflammatory response affects the lungs locally as well as systemic thrombotic microangiopathy. It seems that many comorbidities associated with an increased mortality rate among patients with COVID-19 per se predispose them to an increased risk of thrombotic changes. Furthermore, the role of inflammation in the lungs and the changes that lead to hypoxia cannot be overlooked. However, the thrombotic changes in microcirculation seem to be the most dominant.

The endocrine system function disturbances during and after SARS-CoV-2 infection.

Several receptors for the angiotensin-converting enzyme 2 (ACE2), essential for the penetration of SARS-CoV-2 into cells, are located in the tissues of the endocrine glands. Therefore, it has been suggested that SARS-CoV-2 infection results in the development of hormonal disturbances. To date, several cases of endocrine disturbances related to the dysfunction of all endocrine glands during and after SARS-CoV-2 infection have been described. In this review, we discuss the endocrine system disturbances in patients with COVID-19 and post-COVID-19 syndrome. Based on the case reports described in the literature, patients with COVID-19 may develop endocrine disturbances that are immediately life-threatening. In addition, patients with post-COVID-19 syndrome may develop chronic endocrine disturbances. In summary, the diagnostics of endocrine system disturbances based on clinical symptoms should be taken into account in both patients with COVID-19 and post-COVID-19 syndrome.

COVID-19 and obesity: the confrontation of two pandemics.

In 2009, obesity was identified for the first time as a risk factor for increased disease severity and mortality in patients infected with the H1N1 influenza A virus. During the current COVID-19 pandemic, overweight and obesity have been described as independent risk factors of disease severity and mortality due to COVID-19. Excess visceral fat is associated with systemic chronic microinflammation, changes in adipokine release, and oxidative stress. These disturbances result in an impaired immune response, including dysfunction in lymphocyte action and antibody production. Moreover, obesity is a cause of endothelial dysfunction, pro-coagulation state, and enhanced expression of angiotensin-converting enzyme 2 (ACE-2), which contributes to the infection itself and the severity of the disease. We analyzed both the impact of obesity on the severity of COVID-19 and the potential mechanism that influences this severity. Moreover, we discuss the effect of obesity complications on the severity of disease and mortality of patients with COVID-19. Furthermore, we summarize the effectiveness of COVID-19 vaccination in patients with obesity. Finally, we analyzed the effect of the COVID-19 pandemic on mood disturbances and emotional eating and, as a consequence, the development of obesity or an increase in its severity. In summary, the studies conducted during the COVID-19 pandemic indicate that effective obesity treatment should be initiated at once. In addition, the data confirm the need to organize efficient obesity treatment systems for the sake of not only the individual but also society.

“Superfoods” during COVID-19 pandemic

Introduction: Recently there has been a significant increase in interest in so-called “superfoods, a natural, unprocessed products that contain ingredients profoundly beneficial for humans' health (ex. goi berries or avocado). The aim of the study was to analyse use of superfoods and other food supplements before and during COVID-19 pandemic in Polish population. Methods: The survey was performed nation-wide by Internet among adult Poles between November 2020 and January 2021. Study questionnaire included 43 questions concerning consumed superfoods and use of drugs and dietary supplements during COVID-19 pandemic. Results: A total of 496 respondent (299 women), mean age 34.5 ± 14.5 years were included. Among study group 6.3% was diagnosed with underweight, 61.1% with normal weight, 23.8% with overweight and 8.9% with obesity. 72,0% of responders use food supplements during a pandemic COVID-19, and before 72,4%. The most popular used food supplements were: vitamin C and multivitamin preparations. There was a significant increase in vitamin D supplementation during COVID-19 pandemic (from 48.8% to 61.5%, p<0.01). No difference in inosine pranobex use was observed. 42.7% of respondents were not familiar with superfood definition. Garlic, broccoli, oranges, parsley, and Cruciferae vegetables were the most popular superfoods indicated by respondents. Among herbal preparations the most popular s were Sambuccus nigra and chamomile. Conclusion: During COVID-19 pandemic in Polish population significantly increased supplementation of vitamin D.

The impact of lockdown during the COVID-19 pandemic on changes of eating habits and body mass

Introduction: The introduction of lockdown measures to limit the spread of the COVID-19 widely affected the lifestyle. The strict rules of social distancing and decreased individual mobility resulted in psychosocial implications. The aim of this study is to analyse the impact of the COVID-19 pandemic on eating habits, physical activity and body mass. Methods: The survey was performed nation-wide by Internet among adult Poles between November 2020 and January 2021. Study questionnaire included 50 questions concerning anthropometric and social parameters as well as questions related to eating habits and dietary choices. The exclusion criteria were eating disorders and pregnancy. Results: Total of 1164 responders (74.5% females) in mean age 23.2 ± 7.5 years were included. 11.4%, was diagnosed with underweight, 66.1% with normal weight, 16.8% with overweight and 5.7% with obesity. In 86.2% of participants there was a change in study/work character during COVID-19 pandemic. 38.6% of participants gained weight and 26.5% of the study group loosed weight during lockdown. There was a significant increase in mean number of meals during time of COVID-19 pandemic (4.1 ± 1.3 vs. 3.7 ± 1.0 meals/day, p<0.001). 51.6% of the participants declared more frequent snacking between meals, similarly 52.6% started to cook more often and 29.3% of the group used sugar more often compared to the time before pandemic. Conclusion: The lockdown during the COVID-19 pandemic resulted in unfavorable changes in eating habits and weight gain a significant part of Polish population.

The prevalence of sleep disturbances and physical activity during the lockdown due to COVID-19 pandemic in Polish population

Introduction: Sleep disturbances are linked to significant adverse behavioural and health consequences. It is well known that insomnia is associated with an increase of ACTH and cortisol secretion. Presence of sleep disorders, which may have worsened over time of COVID-19 pandemic, in a combination with improper lifestyle habits, may lead to the increase of overweight and obesity prevalence. The aim of the study was to analyse sleep disturbances during lockdown due to COVID-19 pandemic. Methods: The survey was performed nation-wide by Internet among adult Poles between November 2020 and January 2021. Study questionnaire included 46 questions concerning sleep habits and Athenian sleep scale. Results: Total of 703 responders (537 females) in mean age 28.9 ± 10.4 years were included to the analysis. Mean duration of sleep during and before COVID-19 pandemic was similar (7.06 ± 1.53 vs. 7.09 ± 1.12 hours respectively, p=NS). The insomnia was diagnosed in 28.4%. During the pandemic a significant increase in the screen time (7.9 ± 3.4 vs. 5.1 ± 2.8 hours respectively, p<0.01) and a significant decrease of weekly physical activity (3.1 ± 5.2 vs. 5.4 ± 13.6 respectively, p<0.01) as well as daily outdoor activity (1.6 ± 2.2 vs. 3.0 ± 2.3 hours respectively, p<0.01) was observed. Conclusion: Insomnia and reduced physical activity may be a risk factors overweight and obesity development during COVID-19 pandemic in Polish population.

The impact of stress on the regularity of menstrual cycle during COVID-19 pandemic

Introduction: Regular menstrual cycle is one of the factors of woman's health. All of menstrual cycle disturbances are a manifestation of anatomical an physiological pathologies affecting female fertility. Stress is one of factors affecting of menstrual cycles regularity. Aim of study: The aim of the study was to analyse the association between levels of stress and regularity of menstrual cycle in women of reproductive age. Material-Methods: The study group included 271 menstruating women. The survey was performed nation-wide by Internet among adult Poles. Study questionnaire included 41 questions. The level of stress was assessed on the basis of the 4-grade scale. The exclusion criteria were hyperthyroidism and hypothyroidism, Polycystic Ovary Syndrome, hyperprolactinemia, hyperandrogenism, congenital adrenal hyperplasia and depression. For statistical analysis authors used Statistica 12.0. Results: A correlation between subjective level of stress and regularity of menstrual cycle was showed (p<0.05). As many as 80% of women which reported irregular menstruation suffered from high or medium level of stress. Conclusion: High levels of stress is associated with irregular menstrual cycle.

The impact of the COVID-19 pandemic on physical activity in Polish population

Introduction: COVID-19 pandemic forced countries all over the world to impose strict restrictions like, among other, closing of gyms, fitness centres and sport objects. This situation may significantly affect overall physical activity. The aim of the study was to analyse the workout routines and general physical condition before and during the COVID-19 pandemic. Methods: The survey was performed nation-wide by Internet among adult Poles. Study questionnaire included 28 questions concerning changes in the workout routines its duration and general physical condition on the basis of 5-point scale before March 2020 and in the period between March and June 2020 the first lockdown time in Poland. Results: A study group included 587 responders in mean age 29.6 ± 10.3 years. A general physical condition significantly decreased during lockdown compared to time before (3.1 ± 1.3 pts vs. 3.5 ± 1.1 pts, respectively, p<0.01). Also the duration of the workout diminished significantly (p<0.01). 50.1% of responders claimed that the lockdown resulted in the decrease in the frequency and duration of training (most commonly due to closing of the sport objects and fitness centres). Only 24.9% responders declared that the frequency and duration of training increased during lockdown time, mostly due to increase of free time. Conclusion: The first lockdown resulted in decrease in physical activity and worsening of general physical condition of Polish population.

Dietary habits during the COVID-19 lockdown in Poland

Introduction: The COVID-19 pandemic and entailed by it lockdown altered the day-to-day routines and food-related behaviour of many people. The aim of this study was to analyse the effect of stay-at-home lifestyle on dietary habits. Methods: The survey was performed nation-wide by Internet among adult Poles from November to January 2021. The subjects diagnosed with eating disorders and treated with diet were excluded. Study questionnaire included 41 questions concerning the quality of the diet and standardized FFQ-6 scale. Results: The study group included 314 responders (249 women) in mean age 29.9 ± 13.6 years. Total of 8.75% respondents were infected with COVID-19 and 15% were in quarantine. 78.5% respondents declared an increase of body mass and 16.3% a decrease during COVID-19 pandemic. Only 19.1% responders had an increased motivation to change dietary habits due to pandemic, and 23.6% of group pay more attention to the food they buy during pandemic. 15.7% often ordered takeaway food (58,7% usually once a week), 18.5% were more likely to buy alcohol and cigarettes. 23.8% of responders declared consumption more diverse meals, 25.8% increased intake of vegetables;and 43.3% of group ate snacks more often. Conclusion: During COVID-19 pandemic only a few respondents had a positive change in their eating habits. COVID-19 pandemic. One of the consequences of the COVID-19 pandemic may be an increase in obesity.

Treatment of overweight and obesity during and after a pandemic. Let's not wait for the development of complications - new guidelines for doctors

The treatment of obesity in the pandemic era has become more important than ever. The current situation is conducive to the worsening of disease and the development of new diseases, mainly as a result of compensating negative emotions with food. Taking into account the data on the impact of obesity and its complications on the severity of the course and the risk of death due to COVID-19, we recommend using the 2016 American Endocrine Society's criteria for the diagnosis of obesity instead of the 1998 WHO criteria. We also recommend diagnosing eating under the influence of emotions and the occurrence of eating disturbances, such as compulsive eating syndrome, night eating syndrome and food addiction, and complications of obesity, in any person with a BMI ≥ 25 kg/m2. The approach to treatment should be individualised and should not be limited to nutritional and physical activity education alone. Each patient should be offered appropriately selected pharmacotherapy, and, if necessary, also psychotherapy. The first-line drug should be a combined preparation containing naltrexone and bupropion (Mysimba®). Liraglutide in a dose of 3 mg (Saxenda®) should be considered as a second-line drug in a situation where eating under the influence of emotions is excluded (reaching for food in situations of experiencing negative and positive emotions and boredom, eating disturbances: compulsive eating syndrome, night eating syndrome, and food addiction) and depressed mood or there are permanent contraindications to the use of the first-line drug. It is unethical not to treat obesity or refer the patient to another doctor for treatment. The use of telemedicine tools can facilitate work in therapeutic teams (doctor, dietitian, psychotherapist), as well as improve patient compliance with pharmacotherapy and changes in eating habits and the level of physical activity recommendations. Copyright © 2020 Via Medica, ISSN 2449-6170