Food Consumption and COVID-19 Risk Perception of University Students

Round 1

Reviewer 1 Report

The article touches on interesting issues, especially important in recent times, namely the problem of consumption from the perspective of COVID-19.

It is an interesting analysis, supported by primary data, i.e. surveys of students. I think that such works are worth publishing, pending minor corrections.

Comments:

1. There is a lack of a clearly outlined purpose to the paper. The intended reader should know at the outset what the authors intend to prove, what they are aiming at.
2. It is difficult to determine what new contribution this research adds to the literature. Perhaps it is worth detailing and adding a section on what existing research it complements.
3. The conclusions are too general. They should be expanded and detailed.
4. It is also worth referring to other research on COVID, such as these very interesting deliberations by Michał Dudek and Ruta Śpiewak https://doi.org/10.3390/agriculture1201006. Such research is conducted all over the world, so maybe it should be mentioned in the introduction, with references to selected examples.
5. Recommendations are missing. It is absolutely necessary to include them.
6. The concepts of proinflammatory diet and non-proinflammatory diet should be explained to the readers in detail.
7. It would also be useful to state in the summary to what extent the studies are comparable to those in other countries.

Author Response

Rev 1

 

The article touches on interesting issues, especially important in recent times, namely the problem of consumption from the perspective of COVID-19.

It is an interesting analysis, supported by primary data, i.e. surveys of students. I think that such works are worth publishing, pending minor corrections.

Comments:

There is a lack of a clearly outlined purpose to the paper. The intended reader should know at the outset what the authors intend to prove, what they are aiming at.

 Thank you for your comment. We have expanded the aim of the study from line 106 to line 114.

 

It is difficult to determine what new contribution this research adds to the literature. Perhaps it is worth detailing and adding a section on what existing research it complements.

 Thank you. We added in line 323 how our study complements the existing research.

 

The conclusions are too general. They should be expanded and detailed.

Thank you. We have expanded the conclusions.

 

It is also worth referring to other research on COVID, such as these very interesting deliberations by Michał Dudek and Ruta Śpiewak 

https://doi.org/10.3390/agriculture12010061. Such research is conducted all over the world, so maybe it should be mentioned in the introduction, with references to selected examples.

 Thank you! We have added this reference in the item [8].

 

Recommendations are missing. It is absolutely necessary to include them.

 Thank you. We have included the practical application.

 

The concepts of proinflammatory diet and non-proinflammatory diet should be explained to the readers in detail.

 Thank you. Definitions for both concepts have been included in the lines 108 to 112.

 

It would also be useful to state in the summary to what extent the studies are comparable to those in other countries.

 Thank you very much. Your appreciation has been added as a future line of research.

Author Response File: Author Response.docx

Reviewer 2 Report

 “Food consumption and COVID-19 danger perception of university students”

 

Summary

-Diet may play an important role in overall health and immune system functioning. This study compared various health outcomes between college students who consumed high proinflammatory diets (PDG; currently defined in the manuscript as consuming 3-7 inflammatory food groups per week) and low proinflammatory diets (NPDG; currently defined in the manuscript as consuming 0-4 inflammatory food groups per week). College students (N = 513) completed an online survey during the COVID-19 pandemic. Compared to the NPDG, the PDG reported significantly greater levels of perceived danger, work impacts, and confinement compliance all related to COVID-19. The PDG also lived with significantly more people, consumed more proinflammatory food groups, and displayed more openness to experience than the NPDG. The NPDG reported significantly greater loneliness and depression compared to PDG. There were no significant differences on extraversion, agreeableness, conscientiousness, neuroticism, acceptance and action, anxiety, physical activity outcomes, sleep, academic performance perceptions related to COVID-19, or personal impacts of COVID-19 between the groups. The results from this study could provide information about the role of diet on health outcomes for college students during the COVID-19 pandemic.

 

Overall Comments

-It might be useful to add references about the connection between diet and danger perception. Have other studies examined an association between the two? If so, what were the outcomes? If not, then it is still important to state because this study would be the first to explore such connections.

-Similarly, do all the constructs measured in this study truly measure “danger”? There might be a better way to refer to the outcomes of this study.

-It is recommended to add some references regarding the psychometric properties of the measures that were used to demonstrate established validity and reliability and perhaps add internal consistency metrics for the present study.

 

Detailed Comments

Abstract:

-Please provide the mean and standard deviation for age. That would be helpful given that the minimum and maximum ages listed appear to be outside of traditional college age in the United States (typically 18-21)

-Please denote which findings were statistically significant 

-Please briefly operationally define “affected in work,” as it could relate to mood states at work. Reading through the method section, it seems as though the authors mean changes in work hours or shifts in work status.

 

Introduction:

-Lines 29-31 are confusing and could be interpreted as COVID-19 was no longer spread worldwide after the World Health Organization declared it a pandemic. The COVID-19 virus is continuing to spread regardless of society’s recognition of a global health pandemic. Also, please reconsider the usage of the term “forced,” which sounds as though the WHO was coerced into naming it as a pandemic.

-Line 47 What kind of impact on health? Positive or negative?

-Line 56 Please clarify what increase in daily intake is being referred to

-Line 62 It would be helpful to note the age group of the Spaniards in the study, as the next paragraph contrasts the Spaniards study with one of adolescents in Spain. So, the reader is left wondering what the sociodemographic contrast is if both samples are Spaniard.

-Line 73 How does an increase of legume and fruit sale possibly lead to greater increase of consumption? Please revise to clearly connect this reference to explain the increase in food groups by adolescents. I imagine that adolescents consuming legume and fruit is related to increased sale of those foods, not that the latter caused the former (as currently phrased).

-Lines 82-88 Please add the reference when the study is introduced rather than seven lines later. Also, reconsider the term “people mood,” as that is a somewhat unfamiliar phrase to me in psychology. Perhaps the authors mean “people’s mood” or simply “mood.”

-Lines 94-95 Please add a reference to support this claim.

 

Methods:

-Lines 110-111 I am uncertain what the phrase < “refuse the realization of the questionnaire” means. Perhaps try rephrasing to simplify.

-Lines 116-118 Please explicitly state the name of the questionnaire.

-Lines 123-126 How can the proinflammatory diet group range include consumption of 3-7 food groups per week and the non-proinflammatory diet group range be 2-4 groups or less per week? Wouldn’t 3 and 4 groups fall within the proinflammatory range? Also, should the non-proinflammatory start at 0 considering the < “or less” added after 2-4?

-Line 127 212 + 298 does not seem to add up to 513 total participants. Please clarify.

-Line 186 Rather than p less than or equal to 0.05, might the authors mean alpha less than .05, per conventions?

 

Results:

-Tables: I suggest noting the p-values as < .001 rather than .000 since p-values cannot technically be nill.

-Line 192 I believe an item is missing after “and”

-Lines 210-212 It might be beneficial to state that these outcomes were statistically significant.

 

Discussion:

-Line 230 Please state what is meant by < “special” or provide examples to clarify

-Line 241 The study results do not appear to look at the associations between age/class year and food consumption. So, I do not believe the authors can say that those are results of their research unless the data are presented.  

-Line 248 “These consumption patterns also vary according to gender, age or people with whom the person lives” > See comment above. The results compare PDG v. NPDG, but don’t seem to compare these covariates.

-Lines 252-256 Since the two groups (proinflammatory diet designated by consumption of 3-7 high inflammatory food groups per week and non-proinflammatory designated by those who consumed less of these foods groups), wouldn’t it be expected that these groups significantly differ in the amount of proinflammatory food groups consumed per week? Please explain why it is believed that this finding is noteworthy.

-Lines 271-272 seem contradictory. It should be stated which group had significantly higher levels of depression. Likewise, please report on other studies related to depression and proinflammatory food groups and how this study fits in with them. However, the second half of the sentence may lead readers to believe that the significant difference was not important. It might be useful to state the size of the effect instead, if that is what is being referred to here. Perhaps the authors mean that these groups were statistically different from each other regarding depressive symptoms, but the effect size between the two was small. Indicating the effect size would be helpful to make this statement appear less contradictory

-Lines 297-298 How can this cross-sectional study be considered a causal relationship to confirm? This phrasing may not be appropriate. Perhaps the authors mean that a causal relationship needs to be tested in future studies.

-Line 315 This study did not report on significant differences between diet groups on the outcome of stress. Therefore, < “student mental health” or < “depression” might be alternatives here that connect the final sentence to the study outcomes that were measured.

-Line 320 Similar to the comment regarding the abstract, please briefly operationally define “affected in work.”

 

Style Comments

-Line 148 Parenthesis is missing

-I encourage the authors to read through to examine their usage of the word “thus.” “Thus” usually means “because x is true, then y follows.” However, it does not seem as though the word “thus” is the most apt term for all the instances used.

Author Response

 “Food consumption and COVID-19 danger perception of university students” 

 

Summary

-Diet may play an important role in overall health and immune system functioning. This study compared various health outcomes between college students who consumed high proinflammatory diets (PDG; currently defined in the manuscript as consuming 3-7 inflammatory food groups per week) and low proinflammatory diets (NPDG; currently defined in the manuscript as consuming 0-4 inflammatory food groups per week). College students (N = 513) completed an online survey during the COVID-19 pandemic. Compared to the NPDG, the PDG reported significantly greater levels of perceived danger, work impacts, and confinement compliance all related to COVID-19. The PDG also lived with significantly more people, consumed more proinflammatory food groups, and displayed more openness to experience than the NPDG. The NPDG reported significantly greater loneliness and depression compared to PDG. There were no significant differences on extraversion, agreeableness, conscientiousness, neuroticism, acceptance and action, anxiety, physical activity outcomes, sleep, academic performance perceptions related to COVID-19, or personal impacts of COVID-19 between the groups. The results from this study could provide information about the role of diet on health outcomes for college students during the COVID-19 pandemic.

 

Overall Comments

-It might be useful to add references about the connection between diet and danger perception. Have other studies examined an association between the two? If so, what were the outcomes? If not, then it is still important to state because this study would be the first to explore such connections.

In line 232 it is explained that another study analyzed the perception of danger, however, no references have been found that related the perception of danger to diet.

-Similarly, do all the constructs measured in this study truly measure “danger”? There might be a better way to refer to the outcomes of this study.

Thank you. We have changed the term danger to risk, in relation to previous studies. (Rodriguez-Besteiro, S., Tornero-Aguilera, J. F., Fernández-Lucas, J., & Clemente-Suárez, V. J. Gender differences in the covid-19 pandemic risk perception, psychology and behaviors of spanish university students. International Journal of Environmental Research and Public Health 2021, 18(8), 3908.)

-It is recommended to add some references regarding the psychometric properties of the measures that were used to demonstrate established validity and reliability and perhaps add internal consistency metrics for the present study.

Thank you. We have added these properties in the Materials and Methods section.

 

 

 

 

Detailed Comments

Abstract:

-Please provide the mean and standard deviation for age. That would be helpful given that the minimum and maximum ages listed appear to be outside of traditional college age in the United States (typically 18-21).

Thank you for your indication. We have added it in line 15 of the abstract.

-Please denote which findings were statistically significant. 

We have added information on line 19 and the statistically significant results are shown from line 19 onwards.

-Please briefly operationally define “affected in work,” as it could relate to mood states at work. Reading through the method section, it seems as though the authors mean changes in work hours or shifts in work status.

 Added in line 25.

 

Introduction:

-Lines 29-31 are confusing and could be interpreted as COVID-19 was no longer spread worldwide after the World Health Organization declared it a pandemic. The COVID-19 virus is continuing to spread regardless of society’s recognition of a global health pandemic. Also, please reconsider the usage of the term “forced,” which sounds as though the WHO was coerced into naming it as a pandemic.

Thank you for your appreciation. We have changed the sentence to avoid confusion. (lines 33-34)

-Line 47 What kind of impact on health? Positive or negative?

Thank you, we have added it in line 51

-Line 56 Please clarify what increase in daily intake is being referred to.

It has been added in line 63, thank you.

-Line 62 It would be helpful to note the age group of the Spaniards in the study, as the next paragraph contrasts the Spaniards study with one of adolescents in Spain. So, the reader is left wondering what the sociodemographic contrast is if both samples are Spaniard.

Sorry for the inconvenience. These studies do not indicate the age range of the population, as they speak of a general consumption in the population.

-Line 73 How does an increase of legume and fruit sale possibly lead to greater increase of consumption? Please revise to clearly connect this reference to explain the increase in food groups by adolescents. I imagine that adolescents consuming legume and fruit is related to increased sale of those foods, not that the latter caused the former (as currently phrased).

Thank you, the paragraph has been reworded in line 79.

-Lines 82-88 Please add the reference when the study is introduced rather than seven lines later. Also, reconsider the term “people mood,” as that is a somewhat unfamiliar phrase to me in psychology. Perhaps the authors mean “people’s mood” or simply “mood.”

Modifications have been made.

-Lines 94-95 Please add a reference to support this claim.

The corresponding reference has been added.

 

Methods:

-Lines 110-111 I am uncertain what the phrase < “refuse the realization of the questionnaire” means. Perhaps try rephrasing to simplify.

Sentence has been rephrased in line 121.

-Lines 116-118 Please explicitly state the name of the questionnaire.

It has been added in the text in line 128.

-Lines 123-126 How can the proinflammatory diet group range include consumption of 3-7 food groups per week and the non-proinflammatory diet group range be 2-4 groups or less per week? Wouldn’t 3 and 4 groups fall within the proinflammatory range? Also, should the non-proinflammatory start at 0 considering the < “or less” added after 2-4?

It has been modified according to your instructions.

-Line 127 212 + 298 does not seem to add up to 513 total participants. Please clarify.

Total n -3 (who did not complete all questions) were analysed.

-Line 186 Rather than p less than or equal to 0.05, might the authors mean alpha less than .05, per conventions?

It has been modified. 

 

Results:

-Tables: I suggest noting the p-values as < .001 rather than .000 since p-values cannot technically be nill.

Thank you, it has been changed in the tables.

-Line 192 I believe an item is missing after “and”

Thank you very much for the appreciation, it has been added.

-Lines 210-212 It might be beneficial to state that these outcomes were statistically significant.

Thank you, the sentence has been reworded to state that these results were statistically significant.

 

Discussion:

-Line 230 Please state what is meant by < “special” or provide examples to clarify.

Thank you. This paragraph has been modified

-Line 241 The study results do not appear to look at the associations between age/class year and food consumption. So, I do not believe the authors can say that those are results of their research unless the data are presented.  

Thank you for your appreciation, we have removed this association.

-Line 248 “These consumption patterns also vary according to gender, age or people with whom the person lives” > See comment above. The results compare PDG v. NPDG, but don’t seem to compare these covariates.

Thank you. We have removed this relationship as well.

-Lines 252-256 Since the two groups (proinflammatory diet designated by consumption of 3-7 high inflammatory food groups per week and non-proinflammatory designated by those who consumed less of these foods groups), wouldn’t it be expected that these groups significantly differ in the amount of proinflammatory food groups consumed per week? Please explain why it is believed that this finding is noteworthy.

Thank you. This may be since the combination of proinflammatory elements may make a difference in each of the subjects and for that reason the results may not be significant.

-Lines 271-272 seem contradictory. It should be stated which group had significantly higher levels of depression. Likewise, please report on other studies related to depression and proinflammatory food groups and how this study fits in with them. However, the second half of the sentence may lead readers to believe that the significant difference was not important. It might be useful to state the size of the effect instead, if that is what is being referred to here. Perhaps the authors mean that these groups were statistically different from each other regarding depressive symptoms, but the effect size between the two was small. Indicating the effect size would be helpful to make this statement appear less contradictory.

The requested information has been added.

-Lines 297-298 How can this cross-sectional study be considered a causal relationship to confirm? This phrasing may not be appropriate. Perhaps the authors mean that a causal relationship needs to be tested in future studies.

Thank you. It has been modified.

-Line 315 This study did not report on significant differences between diet groups on the outcome of stress. Therefore, < “student mental health” or < “depression” might be alternatives here that connect the final sentence to the study outcomes that were measured.

Thank you, the sentence has been reworded.

-Line 320 Similar to the comment regarding the abstract, please briefly operationally define “affected in work.”

 Changed as in the abstract.

 

Style Comments

-Line 148 Parenthesis is missing.

Thank you, it has been added.

-I encourage the authors to read through to examine their usage of the word “thus.” “Thus” usually means “because x is true, then y follows.” However, it does not seem as though the word “thus” is the most apt term for all the instances used.

Thank you for your appreciation, changes have been made at the beginning of the paragraphs.

Author Response File: Author Response.docx