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

OBJECTIVES: The massive spread of the novel coronavirus SARS-CoV2 (COVID-19) and subsequent restrictive measures caused disruptions in daily routines and behaviors, including changes in diet that may have consequences on immediate health and longer term risk of chronic disease. Our objective was to assess two-year changes in diet quality among subgroups of the Cancer Prevention Study-3 (CPS-3) cohort. METHODS: In August 2020, an online COVID-19 survey that assessed food group intakes, meal sources, and COVID-related questions was completed by a subgroup of 2,335 CPS-3 participants. Paired t-tests evaluated reported change in behaviors from 2018 to 2020. A diet quality score assigned higher points for greater frequency of foods recommended by cancer prevention guidelines, and lower points for foods that are not recommended. RESULTS: While diet quality improved slightly, on average, from 2018 to 2020, consumption of component food groups decreased (P < 0.001), with the greatest decreases in vegetables and whole grains. The greatest decrease in vegetable intake occurred in Black participants, as well as participants who gained weight. On average, Asian/Pacific Islander participants increased fruit consumption. Participants who lost ≥20 pounds had the greatest decrease in refined grain consumption and greatest improvements in diet quality. Low diet quality scores during the pandemic were associated with being male, current smoking, less education, lower physical activity, higher BMI, and weight gain of ≥20 pounds since 2018. Participants who worried about food insecurity, were at high risk of COVID-19 complications, and reported more COVID-related stressors also had lower scores. Changes in diet quality did not appear to vary by other demographic factors. On average, total alcohol intake decreased in most groups examined. Frequency of meals from all sources decreased (P < 0.001), and the greatest decreases were observed in full-service restaurants and prepared ready-to-eat meals. CONCLUSIONS: Undesirable changes in diet during the pandemic, particularly decreases in vegetables and whole grains, may contribute to weight gain, poor metabolic health, and subsequent higher risk of chronic disease. FUNDING SOURCES: The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 Cohort.