This study was completed with a descriptive, cross-sectional, case-controlled and relational screening model. The aim was to determine the correlation between coronavirus anxiety levels and emotional eating status of subjects with MetS diagnosis according to criteria published by the International Diabetes Federation (IDF) in 2005 and healthy individuals with similar BMI to MetS cases. All subjects attended a diet clinic in an education-research hospital in the north of Turkey.
Metabolic Syndrome Diagnostic Criteria published by the International Diabetes Federation (IDF) in 2005
In addition to - abdominal obesity (waist circumference ≥94 cm in men, ≥80 cm in women,
individuals should abide by at least two of the following criteria
- High fasting blood glucose (≥100 mg/dL) or presence of type 2 diabetes
- High triglyceride levels (>150 mg/dL)
- Low HDL level (<40 mg/dL in men, <50 mg/dL in women)
- High blood pressure (≥130/85 mmHg)
The case group for the research included individuals aged over 18 years of age, with metabolic syndrome diagnosis according to IDF-2005 diagnostic criteria, who were not pregnant or breastfeeding, without any psychological disorder diagnosed by psychiatry, without diagnosis of COVID-19 and not using any psychiatric medications.
The healthy control group in the research included healthy individuals aged 18 years and older, who were not pregnant or breastfeeding, without any psychological disorder diagnosed by psychiatry, not using any psychiatric medications, without diagnosis of COVID-19, without any chronic disorder, and with similar BMI to the individuals in the subject group.
The full sampling method was used in the study. Between 20 June 2020 following relaxation of limitations linked to the pandemic in Turkey and before social isolation rules began to be implemented again due to increasing case numbers on 20 November 2020, the study included 105 individuals with metabolic syndrome attending the diet clinic and 109 healthy individuals attending the diet clinic but without MetS diagnosis.
A survey form was applied to metabolic syndrome and healthy individuals included in the study face-to-face. This survey questioned demographic data, anthropometric measurements (body weight, height, waist circumference, hip circumference) and biochemical findings (glucose, HDL, LDL, total cholesterol, triglycerides, CRP, HbA1c, insulin, HOMA-IR). Blood pressure was measured and recorded. The coronavirus anxiety scale (CAS) and emotional eating scale (EES) were applied.
The age, sex, occupation and marital status of individuals was questioned.
The body weight and body composition of participants were measured in bare feet, with thin clothing and no metal accessories on the body using the bioelectrical impedence analysis (BIA) method with a TANITA BC 418 device. When performing measurements, care was taken that individuals had not performed any intense physical activity for 24 hours before measurements, had not used alcohol, had not eaten 2-4 hours before the test and had not drunk water before the test.
The height of participants was measured without shoes, with feet together and head in Frankfort plane with the aid of a meter stick fixed to a wall. Waist circumference measurements were taken by finding the center point between the lowest rib and the crista iliaca and measuring with an inflexible measuring tape. Hip circumference measurements were taken at the highest point of hip circumference while standing beside the participant with the aid of an inflexible measuring tape . BMI calculation divided the body weight in kg by the square of the height in meters .
Some biochemical findings of participants were recorded from the patient files (glucose, HDL, LDL, total cholesterol, triglyceride, CRP, HbA1c, insulin, HOMA-IR, AST and ALT).
Systolic and Diastolic Blood Pressure:
Systolic and diastolic blood pressure was measured by a researcher trained in the topic using an Erka brand sphygmomanometer. Patients had not smoked, drunk tea or coffee, or eaten food or caffeine within 30 minutes before measurements and were questioned about whether antihypertensives were used. After a 3-5 minute rest period, measurements were recorded while patients were in sitting position at cardiac level in the arm.
Coronavirus Anxiety Scale (CAS):
The Coronavirus Anxiety Scale is a Likert-type scale. The scale comprises 5 questions and has a single dimension. Each item is rated from 0 (not at all) to 4 (nearly always) based on experiences during the pandemic. Total points of ≥9 on the scale shows dysfunctional anxiety related to coronavirus. High points for a certain item or high total scale points (≥9) show the individual has problematic symptoms that may require more advanced assessment and/or treatment. Clinical decisions guide interpretation of the scale results .
Emotional Eating Scale (EES):
The emotional eating scale comprises 10 items and three subdimensions. Questions are answered with 4 choices (never, sometimes, generally and all the time) on a Likert-type scale. The scale does not contain inverse items. Minimum “0” points and maximum “30” points can be obtained from the scale. High points on the scale show high levels of emotional eating behavior .
In order to perform the study, institutional permission was granted by Ordu Provincial Directorate of Health and ethics committee permission was obtained from Ordu University Clinical Research Ethics Committee (2020/228). Each individual accepting participation in the study and abiding by the study criteria was given general information about the research and then provided signed consent stating they accepted participation in the study using the “Informed Consent Form For Studies For Research Purposes”.
SPSS 21.0 software was used for the data analysis. For the data, normal distribution was evaluated using the Shapiro-Wilk test. Frequency, percentage, arithmetic mean, standard deviation, minimum value, maximum value, t test, chi-square, and Pearson correlation analysis were used for the evaluation of data. For the assessment of correlations between quantitative variables and for the determination of the type and power of the correlations between CAS and EES, Pearson correlation analysis was performed. The significance limit was chosen as 0.95 (p < 0.05).
The distributions of sex, occupation, marital status, changes in body weight during the pandemic and age of participants are shown in Table 1. Of individuals with metabolic syndrome, 76.2% were female, 81% were married, mean age was 44.08±11.71 years and 49.5% were housewives. During the pandemic, the body weight of 53.3% of participants with metabolic syndrome had increased by mean 3.28±1.64 kg, with 9.5% having mean 4.0±3.23 kg reduction in body weight. For healthy individuals, 80.7% were female, 78% were married, mean age was 40.86±10.70 years and 36.7% were housewives. During the pandemic, 39.4% of healthy individuals did not experience any change in body weight, while 38.5% lost mean 4.66±3.00 kg. The groups were identified to be similar in terms of sex, marital status, gained and lost weight amounts (p>0.05). However, there were statistically significant differences between the groups in terms of occupation, variations in body weight during the pandemic and age (p<0.05).
The mean points for coronavirus anxiety scale and emotional eating scale in the groups are shown in Table 2. When coronavirus anxiety scale points are compared, individuals with metabolic syndrome had coronavirus anxiety scale points of 2.68±3.40, while the healthy control group had points of 1.69±2.44 and the difference between the groups was statistically significant (p<0.05). For the emotional eating scale, points were 13.56±4.41 for the metabolic syndrome group while they were 13.61±4.63 in the healthy control group and the difference between the groups was not identified to be significant (p>0.05).
The data related to blood pressure measurements and some biochemical findings like glucose, HDL, LDL, total cholesterol, triglyceride, CRP, HbA1c, insulin and insulin resistance of participants are shown in Table 3. Comparisons between the groups identified that, apart from HDS, blood pressure and all biochemical parameters were higher in individuals with metabolic syndrome (p<0.05). HDL was identified to be higher in the healthy control group (p<0.05).
The data related to anthropometric measurements for the metabolic syndrome and healthy control groups are shown in Table 4. There were no differences between the groups in terms of BMI, waist circumference, hip circumference, waist/hip ratio and waist/height ratio (p>0.05).
Table 5 investigates the correlation between coronavirus anxiety scale and emotional eating scale points for metabolic syndrome and healthy individuals. There was no significant correlation identified between the two scales (p>0.05).