Comorbidities (Table
1
)
After lockdown the number of diabetic subjects with elevated value of glycated hemoglobin increased from 23 subjects to 42 (P = 0.01) (M:F = 25:17, P = 0.1). After lockdown there was no difference in the percentage of males with hyperinsulinemia (2% vs. 5%, P = 0.21), while the percentage of females significantly increased (45% vs. 5%, P < 0.0001).
HDL cholesterol levels lower than the cut-off was detected in a higher percentage in females, when compared to baseline (78% vs. 97%, P < 0.0001), with no significant difference according to the value (P = 0.22), while any difference in male subjects was detected according to the percentage of subjects and value of HDL (P = 0.55). Triglycerides levels increased after the lockdown in male and female subjects, showing significant higher values in females than in males (P = 0.03).
According to liver function, ALT levels significantly increased in both sexes (M, P = 0.001; F, P < 0.0001), and was significant higher in females than in males (P = 0.029), while there was no difference in percentage of affected individuals intra-sexes (M 85% vs. 86%, F 72% vs. 79%, P = 0.32).
AST levels were higher than normal value in 4 females (98 (range 90–102)) and in one male subject (88) U/L.
GGT levels were increased in 3 male and in 2 female subjects (M 113 range (M: 102–124), F 98.5 (range 89–108)) U/L.
The grading of liver steatosis is reported in Table
2. Fifteen subjects (
M:
F = 6:9,
P = 0.5) had normal liver at ultrasound at the ultrasound examination, 53 subjects showed grade I (mild), 83 subjects showed grade II (moderate), and 94 subjects showed grade III (severe). The number of subjects with normal liver at ultrasound, mild steatosis, and moderate steatosis decreased after lockdown compared to baseline, while the number of subjects with severe steatosis remarkably increased after lockdown (from 29 to 94 subjects,
P < 0.0001). The decrease in mild/moderate steatosis and the consecutive increase of severe steatosis were more pronounced in female group (Table
2).
Impact of work activities and social/familial status
Regarding work activities during COVID-19 lockdown, subjects were divided as “home work” (63 subjects), “remote work” (126 subjects), and “essential activities” (56 subjects). Therefore, BMI, MD adherence, junk score, and aspects of psychological profile were evaluated at baseline and after lockdown. The BMI for “home work” group (all females) significantly increased from 29.4 (range 25.6–32.8) at baseline to 31.9 (range 26.3–35.8) Kg/m2 (P < 0.0001) after lockdown. The BMI for “remote work” groups significantly increased in all subjects (28.7 (range 25.2–32.3) vs. 30.3 (range 24.5–34.6) Kg/m2 (P < 0.0001)), in the males group (28.7 (range 26.3–30.8) vs. 29.8 (range 25.7–33.3) Kg/m2 (P < 0.0001)), and in the females group (29 (range 25.2–32.4) vs. 31.5 (range 24.5–34.6) Kg/m2 (P < 0.0001)), with a greater increase of BMI (calculated as delta BMI) in females than in males (2.2 (range –0.77 to 4.9) vs. 1.6 (range –1.9 to 2.7) Kg/m2, P < 0.0001)).
The BMI for essential worker group significantly increased in all subjects (28.1 (range 25.1–31.2) vs. 28.4 (range 25.1–32.8) Kg/m2 (P = 0.009)). Also, in the males group BMI significantly increased (28.4 (range 25.7–31.2) vs. 29 (range 25.6–32.8) Kg/m2 (P = 0.0005)), while no difference was detected in the females group (26.3 (range 25.1–30.4) vs. 27.3 (range 25.1–29.4) Kg/m2 (P = 0.75)), as well as according to delta BMI between males and females (0.32 (range –0.7 to 2.9) vs. 0.34 (range –1.2 to 1.5) Kg/m2, P = 0.23)).
Moreover, changes in MD adherence score were also observed in different work sub-groups before and after lockdown. In details, the MD score for “home work” group significantly decreased from 13 (range 10–17) at baseline to 10 (range 7–18) (P < 0.0001) after lockdown.
MD adherence score for “remote work” groups significantly decreased in all subjects (14 (range 10–18) vs. 11 (range 6–18) (P < 0.0001)), in the males group (14 (range 10–17) vs. 13 (range 8–18) (P < 0.0001)), in the females group (13 (range 10–18) vs. 10 (range 6–18) (P < 0.0001)), with a greater decrease (calculated as delta MD adherence score) in females than in males (1 (range –8 to 7) vs. 3 (range –5 to 7), P < 0.0001)).
The MD adherence score for “essential worker” group significantly decreased in all subjects (15 (range 9–17) vs. 15 (range 8–18) (P = 0.0004)). Also, in the males group MD adherence score significantly decreased (15 (range 9–17) vs. 14 (range 8–18) (P = 0.0002)), while no difference was detected in the females group (15 (range 12–17) vs. 16 (range 12–18) (P = 0.27)), as well as according to delta MD adherence score between males and females (0 (range –6 to 5) vs. –3 (range –4 to 2), P = 0.2)).
Junk food score for “home work” group (only females) was 70 (range 0–90). Junk food score for “remote work” group was 55 (range 0–85), and significantly greater in the females (65 range 0–85) than in males (45 range 0–85) (P < 0.0001), while Junk food score for “essential worker” group was 0 (range 0–60), and comparable between the two groups (M 0 range 0 – vs. F 0 range 0–35) (P = 0.8). Overall, Junk food score significantly decreased from “home work” to “remote work” to “essential work” (P < 0.0001).
The scores of depression, anxiety, and tension/stress for “home work” group (only females) were 14 (7–29), 18 (8–20), and 27 (15–32), respectively.
The scores of depression, anxiety, and tension/stress for “essential worker” group were 9 (range 6–21), 12 (range 5–20), and 18 (10–33), respectively. Moreover, all the scores were significantly greater in the female group (13 range 7–21; 16 range 9–20; 27 range 15–33) than in males (8 range 6–16; 10 range 5–18; 17 range 10–25) (P < 0.0001), respectively. The three scores for “remote work” group were 8 (range 5–14), 13 (range 7–18), and 24 (range 13–29), respectively. The scores of depression, and anxiety for “remote work” group were significantly greater in the females group (10 range 8–14; 14 range 13–17) than in males (8 range 5–12; 12 range 7–18) (P = 0.0002; P = 0.006, respectively), while no significant difference was detected according to the score of tension/stress (F 25 range 19–26 vs. M 22 range 13–29) (P = 0.1). Overall, depression score decreased significantly from “home work” to “remote work” to “essential work” (P < 0.0001), while the anxiety and tension/stress scores were significantly higher (P < 0.0001) in “home work” group than in other two groups without any significant change between “remote group” and “essential group”.
Then, participants were sub-divided by subjects with children (129 subjects) and without children (116 subjects). The BMI of subjects without children was 28.5 (range 25.1–32.8), and comparable between males and females (M 28.4 (range 25.7–31.2) vs. F 28.6 (range 25.1–32.8) Kg/m2) (P = 0.5) at baseline, increased significantly after lockdown (29.1 (range 24.5–35.1) Kg/m2 (P < 0.0001), and was significantly greater in females than in males (F 29.4 (range 24.5–35.1) vs. M 28.4 (range 25.6–32.2) Kg/m2)) (P = 0.02).
The BMI of subjects with children was 29.1 (range 25.5–32.5), and was significantly higher in females than in males (F 29.4 (range 25.5–32.5) vs. M 29 (range 26.5–30.8) Kg/m2) (P = 0.01) at baseline, increased significantly after lockdown (31.2 (range 25.4–35.8 kg/m2) (P < 0.0001), and was significantly greater in females than in males (F 31.9 (range 25.4–35.8) vs. M 30.3 (range 26.9–33.3) Kg/m2) (P < 0.0001). The increase in BMI (delta BMI) was significantly greater in the subjects with children than in those without children (2.2 (range –1 to 4.9) vs. 0.7 (range –1.9 to 5.4) Kg/m2, P < 0.001).
At baseline, the MD score of subjects without children was higher in males than females (P = 0.005), after lockdown decreased significantly (P < 0.0001), and the MD score was significantly greater in males than females (P = 0.01) (Table 3S).
At baseline, the MD score of subjects with children was significantly higher in males than in females (P = 0.0005). After lockdown the MD score decreased significantly (P < 0.0001) and was significantly greater in males than in females (P < 0.0001). The decrease in MD score (delta MD) was significantly greater in the subjects with children than in those without children (P < 0.0001) (Table 3S).
Junk food score for subject was significantly greater in females than in males both in the groups without children (P < 0.0001), and with children (P < 0.0001), Overall, Junk food score increased significantly from subjects without children to subject with children (P < 0.0001) (Table 3S).
According to the psychological profile, all the scores were significantly greater in the female group than in males (P < 0.0001), respectively. Overall, depression, anxiety, and tension/stress scores were significantly higher (P = 0.008; P = 0.001, P < 0.0001, respectively) in subjects without children than subjects with children, and the changes in psychological scores were more remarkable in females than males (Table 3S).