91 The Association between Home Confinement during the COVID-19 Pandemic and Children’s Consumption of Fruits and Vegetables and Sugar-containing Beverages
Authors: Mortazavi Sepinood , Maguire Jonathon L , Keown-Stoneman Charles D G , Birken Catherine S , Malik Vasanti S 
Published: September 2023

Abstract

Background
Children tend to gain more weight during summer breaks compared to the school year. It has been identified that school routines regulate obesogenic behaviours, as children tend to consume fewer fruits and vegetables (FV) and more sugar-containing beverages (SCB) during periods when they are not in school. During the COVID-19 pandemic, children’s daily routines were disrupted due to public health home confinement recommendations. Given the rise in childhood obesity during the pandemic, particularly among lower-income groups, home confinement may have affected children’s consumption of FV and SCB.

Objectives
The primary objective of this study was to evaluate the association between home confinement during the COVID-19 pandemic and the consumption of FV and SCB among healthy urban children. The secondary objective was to explore whether household income modified these associations.

Design/Methods
A longitudinal cohort study was conducted with repeated measures of outcome and exposure. The cohort consisted of children aged 1-12 years who were recruited during primary care visits, with questionnaire data completed between May 2020 and November 2021. The primary exposure was home confinement (days/week), defined as not going to in-person school or other public areas. The primary outcome was FV consumption (times per day). The secondary outcome was SCB consumption (cups/day), measured as the total consumption of 100% juice, sweetened beverage, and soda. Ordinal and linear mixed effects regression models were used to evaluate associations for FV and SCB outcomes respectively. Models were adjusted for child age, child sex, annual household income, maternal ethnicity, maternal age, and calendar time. An interaction term for household income was added to models and evaluated using ANOVA.

Results
787 children were included in this study (47% female, mean age 5.55 years at baseline). There was evidence of an association between home confinement and SCB consumption (0.02, 95%CI: 0.01-0.02, p&lt;0.001). After accounting for effect modification (p&lt;0.01), this association was stronger among children from families with income &lt;$50,000 CDN (0.04, 95%CI: 0.00-0.08, p=0.04) and $50,000-$99,999 CDN (0.04, 95%CI: 0.02-0.06, p&lt;0.001), compared to those with family income $100,000-$149,999 CDN (0.01, 95%CI: 0.00-0.03, p=0.02) or &gt;$150,000 CDN (0.01, 95%CI: 0.00-0.02, p=0.04). There was insufficient evidence to support an association between home confinement and FV consumption (OR 0.97, 95%CI: 0.94-1.01, p=0.15) or effect modification by household income in this association (p&gt;0.99).

Conclusion
Home confinement during the COVID-19 pandemic was associated with higher SCB consumption among children, which was more pronounced among lower income families.

Potential competing interests
Miss Mortazavi reported receiving award funding from Victoria College within the University of Toronto. Dr Maguire reported receiving grants from the CIHR, Ontario SPOR Support Unit, and The Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto. Dr Birken reported grants from CIHR, Heart and Stroke Foundation of Canada, Physician Services, The Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Centre for Additions and Mental Health, Ontario Child Health Support Unit, Walmart Canada, and SickKids Foundation outside the submitted work. Dr Malik reported receiving grants from the Canada Research Chair program, Canadian Foundation for Innovation, Connaught New Researcher program, and The Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto. No other disclosures were reported.

Figure 1: Association between home confinement and consumption of sugar-containing beverages by annual household income.