Change in Diet Quality and Meal Sources during the COVID-19 Pandemic in a Diverse Subset of Men and Women in the Cancer Prevention Study-3.

The COVID-19 pandemic resulted in restrictive measures that caused disruptions in behaviors that may have long-term consequences on diet, health, and chronic disease risk. The aim of this study was to assess longitudinal changes in diet quality from before to during the pandemic among 2335 adult participants (816 males and 1519 females; aged 36-78) of the Cancer Prevention Study-3 cohort. We compared dietary screeners conducted in 2018 and 2020 and calculated a diet quality score, which assigned higher points for recommended foods. Overall diet quality slightly improved among all participants from before to during the pandemic, particularly among males (+0.45 points, p < 0.001), White participants (+0.24 points, p < 0.001), and participants reporting weight loss (+0.66 points, p < 0.001 for 2.25 -< 4.5 kg loss; +1.04 points, p < 0.001 for ≥4.5 kg loss); change in diet quality did not differ by other sociodemographic factors. Reported consumption of most food groups decreased, especially whole grains (-0.17 servings/day, p < 0.001) and vegetables (-0.21 servings/day, p < 0.001), primarily among females, Black participants, and participants who gained ≥2.25 kg. The frequency of meals from outside the home decreased, especially in full-service restaurants (-0.47 times/week, p < 0.001) and for ready-to-eat meals (-0.37 times/week, p < 0.001). Declines in whole grain and vegetable consumption raise concerns for weight gain in these populations and increased risk of poor metabolic health and chronic disease.

The High Cost and Unequal Cancer Burden of Poor Diet in the United States

Poor diet is known to increase cancer risk and mortality, both directly and mediated by excess body fatness.1,2 Characterized by higher intakes of red and processed meat and sugar sweetened beverages (SSBs) and a lower intake of whole grains, vegetables, and fruit, poor diet is associated with the risk of multiple cancers, especially colorectal cancer.1,2 The most recent estimates of the proportion of new cancer cases attributable to suboptimal diet range from 4.2%3 to 5.2%,4 equating to approximately 67 000 to 80 000 total cases per year in the United States. ORIGINS OF DISPARITIES The reasons for disparities in dietrelated health outcomes are multifactorial and complex, with major aspects rooted in structural and social marginalization and discrimination, which result in poorer living environments, limited educational and occupational opportunities, and lower incomes among people of color and other historically marginalized populations.7 Consequently, these populations often experience higher levels of unhealthy food marketing and lower access to healthy foods because of a lack of financial and other resources, including transportation insecurity. [...]to inform policy and program efforts, there is a need for more implementation research on interventions that aim to reduce disparities. [...]more research is needed on indirect effects of diet on cancer through body mass index and on any differences in associations between diet and cancer risk by race/ethnicity;in this study, the authors used the same estimates for all racial/ethnic groups.