key: cord-0923382-jfmspoo1 authors: Grant, Federica; Scalvedi, Maria Luisa; Scognamiglio, Umberto; Turrini, Aida; Rossi, Laura title: Eating Habits during the COVID-19 Lockdown in Italy: The Nutritional and Lifestyle Side Effects of the Pandemic date: 2021-06-30 journal: Nutrients DOI: 10.3390/nu13072279 sha: c498f280903aeb75f1a2cf375aaa1254ed4c65ed doc_id: 923382 cord_uid: jfmspoo1 To limit the spread of coronavirus SARS-CoV-2, a nationwide lockdown started in Italy in March 2020. In this unpredictable situation, a cross-sectional study using an online questionnaire was carried out by the Observatory on Food Surplus, Recovery and Waste of CREA Food and Nutrition Centre. The aim of this work was to evaluate how Italian habits changed during this period, the determinants of changes, and the effect on food waste prevention. In a sample of 2678 respondents, 62% showed low Adherence to the Mediterranean Diet (AMD). During lockdown many of participants improved the quality of their diet, increasing their consumption of fruit (24.4%), vegetables (28.5%), legumes (22.1%), nuts (12%), and fish or shellfish (14%). Unfavorable changes were observed with the excessive consumption of sweets or pastries (36.9%) and comfort foods (22.7%), and a lack of physical activity (37.2%). The main novelty of this study was the examination of dietary changes identified by a cluster analysis. Respondents with generally high AMD improved their eating habits, while the habits of the respondents with generally low AMD remained unchanged. In addition, nearly 80% of respondents were sensitive to food waste. The study provides a useful contribution to the debate on nutritional recommendations in case of further lockdown. In December 2019, the new coronavirus SARS-CoV-2 broke out in China and spread rapidly around the world, leading the WHO to declare it a pandemic in March 2020. As a response, several governments established measures of physical restrictions to contain the virus; in Italy, an emergency law imposing a complete lockdown in the whole country from 8 March 2020 was passed (Legislative Decree 06/2020). Under this law, people were not allowed to leave their homes except for essential activities such as buying food and medicines or for medical reasons. People were encouraged to work from home whenever possible limiting out-of-home activities to essentials. Such a situation had never occurred in Italy as well as in the rest of the world, where similar lockdowns were imposed. The lockdown period has had significant socio-economic and psychological impacts. In fact, it has been reported that many people suffered from anxiety, depression, and insomnia [1, 2] . At the same time, changes in food habits occurred with an increased consumption of unhealthy food [3] [4] [5] and more time dedicated to cooking [6] . Public health nutrition experts started to emphasize the importance of eating a balanced diet and maintaining an active lifestyle in order to promote adequate dietary habits during the lockdown [7] [8] [9] . The Mediterranean Diet (MD) principles were recommended [10] given its effectiveness in protecting health [11] [12] [13] [14] [15] and promoting an appropriate performance of the immune system [16, 17] . Recommendations also included physical exercise, an important determinant of health [18] . Considering the strong connection between nutrition and the immune The participants came from all regions of Italy, with a prevalence of respondents from Northern regions (46.1%). Men and women were equally distributed (48.2% and 51.8% respectively), with ages mainly ranging from 30 to 69 (65.1%), and with high educational level (69%). The details of the sociodemographic characteristics of the sample are reported in Table S2 . More than half of the sample (62%) showed lower AMD (low 34.5%; low to moderate 27.1%). Moderate to high AMD (19.1%) and high AMD (19.3%) were reported by the rest of respondents with the same proportion. In our sample, dietary habits in line with the Mediterranean Diet recommendations were frequently observed, as far as concerning the frequency of the consumption of vegetables and nuts, whole grain cereals (i.e., bread, pasta, rice), and legumes. Sugary drink consumption was reported by one fourth of respondents, and most participants declared not using butter and margarine as added fat, preferring to use olive oil. The consumption of wine in this sample was generally very low. Eating habits different from Mediterranean Diet recommendations were reported by nearly half of the sample, who consumed red meat more than once a week and did not follow the correct consumption of whole grain cereals. In addition, adding sugar to drinks was a common habit and eating sweets and pastries was frequently reported, three or more times per week (Table S3 ). To evaluate the effect of the lockdown on Italian food habits, changes in the consumption of typical Mediterranean Diet food were asked, and the results were reported in Figure 1 . For several items, the dietary changes during the confinement led to a consumption pattern more in line with the Mediterranean Diet principles, given the increase in the consumption of vegetables (28.5%), fruit (24.4%), water (19.9%), legumes (22.1%), olive oil (18.9%), nuts (12%), whole grain cereals (13.1%), and fish or shellfish (14%). Other elements in line with the Mediterranean Diet principles were the reduction in consumption of red meat (22.2%), sugary drinks (16.3%), and butter and margarine (12.9%). The confinement Nutrients 2021, 13, 2279 5 of 19 period was also characterized by changes in consumption patterns that worsened the dietary profile of the respondents. In fact, the intake of sweets and pastries (36.9%) and wine (16%) increased. In addition, although a small percentage of respondents increased their fish and shellfish consumption, almost a quarter (23.8%) reduced the intake of these foods. Nutrients 2021, 13, x FOR PEER REVIEW 5 of 20 olive oil (18.9%), nuts (12%), whole grain cereals (13.1%), and fish or shellfish (14%). Other elements in line with the Mediterranean Diet principles were the reduction in consumption of red meat (22.2%), sugary drinks (16.3%), and butter and margarine (12.9%). The confinement period was also characterized by changes in consumption patterns that worsened the dietary profile of the respondents. In fact, the intake of sweets and pastries (36.9%) and wine (16%) increased. In addition, although a small percentage of respondents increased their fish and shellfish consumption, almost a quarter (23.8%) reduced the intake of these foods. In Table 1 , the results of a set of questions aimed to describe the behavioral changes during the restriction period are reported. Regarding food purchasing and cooking, 28 .8% of the sample paid attention to food prices and around 50% of respondents did not change their usual cooking habits. However, for approximately one third of them, the lockdown led to an improvement in their cooking abilities and their willingness to try new foods. In this sample, an awareness of food surplus and waste was reported by nearly 80% of participants who claimed to consume all the food they cooked and reported to have had the capacity to store surplus and consume the leftovers. In terms of the perceived quality of the diet, 45.5% of respondents did not report an improvement in their eating habits, with 22.6% of people increasing their consumption of comfort food, 19 .2% that increased the consumption of snacks, and 35.3% reporting the need to go on a diet to lose weight. A very high proportion of the sample (85%) did not find any difficulties in doing a separate collection of waste. Finally, 66% of the participants believed that the elderly experienced problems in buying food and suffered from isolation. In Table 1 , the results of a set of questions aimed to describe the behavioral changes during the restriction period are reported. Regarding food purchasing and cooking, 28 .8% of the sample paid attention to food prices and around 50% of respondents did not change their usual cooking habits. However, for approximately one third of them, the lockdown led to an improvement in their cooking abilities and their willingness to try new foods. In this sample, an awareness of food surplus and waste was reported by nearly 80% of participants who claimed to consume all the food they cooked and reported to have had the capacity to store surplus and consume the leftovers. In terms of the perceived quality of the diet, 45.5% of respondents did not report an improvement in their eating habits, with 22.6% of people increasing their consumption of comfort food, 19 .2% that increased the consumption of snacks, and 35.3% reporting the need to go on a diet to lose weight. A very high proportion of the sample (85%) did not find any difficulties in doing a separate collection of waste. Finally, 66% of the participants believed that the elderly experienced problems in buying food and suffered from isolation. Physical activity levels and perceived body weight changes are reported in Figure 2 . A sedentary lifestyle was very common with most of respondents that did not perform exercises as recommended (64.5%) (Figure 2a ). This reflects the perception of an increased body weight reported by more than 30% of participants at different levels Figure 2b . This result is line with Q12 of Table 1 in which around one third of respondents declared the need to go on a diet to lose weight. As a conviviality indicator and considering the changes in household practices because of the lockdown, breakfast habits and children's involvement in cooking activities were specifically investigated. A large proportion of respondents did not change the breakfast habits, while 12.1% of them declared to have had more time for breakfast with whole family (Figure 3a ). One third of the families reported an increased involvement of As a conviviality indicator and considering the changes in household practices because of the lockdown, breakfast habits and children's involvement in cooking activities were specifically investigated. A large proportion of respondents did not change the breakfast habits, while 12.1% of them declared to have had more time for breakfast with whole family (Figure 3a ). One third of the families reported an increased involvement of children in the kitchen activities with a specific interest in learning new things on food and nutrition ( Figure 3b ). These results are paired with the answers of Q15 of Table 1 in which 47% of respondents reported having increased the occasion of conviviality during the lockdown. As a conviviality indicator and considering the changes in household practices because of the lockdown, breakfast habits and children's involvement in cooking activities were specifically investigated. A large proportion of respondents did not change the breakfast habits, while 12.1% of them declared to have had more time for breakfast with whole family (Figure 3a ). One third of the families reported an increased involvement of children in the kitchen activities with a specific interest in learning new things on food and nutrition (Figure 3b ). These results are paired with the answers of Q15 of Table 1 in which 47% of respondents reported having increased the occasion of conviviality during the lockdown. Firstly, to evaluate the magnitude of food habit changes during the lockdown in relation to the usual AMD, an estimation was made summing up the number of changes in line with Mediterranean Diet recommendations. The higher the score of classes of changing, the higher the improvement in the usual dietary habits, measured with AMD. The results are shown Table 2 (Total column). For 26.4% of participants the lockdown had no impact on dietary habits (no changes, score 0), 30.6% experienced small changes (score 1-2), while 20.7% and 22.4% showed a progressive improvement in dietary habits in line Firstly, to evaluate the magnitude of food habit changes during the lockdown in relation to the usual AMD, an estimation was made summing up the number of changes in line with Mediterranean Diet recommendations. The higher the score of classes of changing, the higher the improvement in the usual dietary habits, measured with AMD. The results are shown Table 2 (Total column). For 26.4% of participants the lockdown had no impact on dietary habits (no changes, score 0), 30.6% experienced small changes (score 1-2), while 20.7% and 22.4% showed a progressive improvement in dietary habits in line with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage). while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. or while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. and while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. A further analysis showed how the AMD groups changed food consumption (Table 3 ) nd lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed r the consumption of some foods either in term of intake increasing or decreasing. As eported in detail in Table 3 , respondents with high AMD reported an increase in the conumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable eduction in consumption of red meat, sweets and pastries, and sugar added to beverages, hile sugary drinks intake remained unchanged. In addition, during the assessed period, e group with high AMD respect to that with low AMD, followed closely the recommenations drinking more water than usually and reducing the intake of wine with statistially significant differences. On the other hand, respondents who have a low AMD did ot change consumption of whole grain cereals, and legumes, and 7.9% of them reduced e consumption of vegetables compared to respondents with the highest index. Moreoer, the low AMD respondents increased the consumption of pasta and rice, and white read, red meat, butter and margarine, sweet and pastries, and sugary drinks more than igh AMD category. In addition to this, people with low AMD decreased wine consumpon less than the others. sumption during the lockdown by the AMD before the lockdown (percentage).  or  demption changes, =describes unchanged food consumption,  and  describes unfavourable p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. tively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  ded consumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage ignificant differences among high and low AMD groups were observed on of some foods either in term of intake increasing or decreasing. As in Table 3 , respondents with high AMD reported an increase in the conwhole grain cereals, fish or shellfish, and legumes and a considerable mption of red meat, sweets and pastries, and sugar added to beverages, s intake remained unchanged. In addition, during the assessed period, h AMD respect to that with low AMD, followed closely the recommenore water than usually and reducing the intake of wine with statistiifferences. On the other hand, respondents who have a low AMD did ption of whole grain cereals, and legumes, and 7.9% of them reduced f vegetables compared to respondents with the highest index. Moreorespondents increased the consumption of pasta and rice, and white utter and margarine, sweet and pastries, and sugary drinks more than y. In addition to this, people with low AMD decreased wine consumpthers. he lockdown by the AMD before the lockdown (percentage).  or  dedescribes unchanged food consumption,  and  describes unfavourable Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. further analysis showed how the AMD groups changed food consumption (Table 3) estyle (Table 4) . atistically significant differences among high and low AMD groups were observed consumption of some foods either in term of intake increasing or decreasing. As ed in detail in Table 3 , respondents with high AMD reported an increase in the conion of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable ion in consumption of red meat, sweets and pastries, and sugar added to beverages, ugary drinks intake remained unchanged. In addition, during the assessed period, up with high AMD respect to that with low AMD, followed closely the recommens drinking more water than usually and reducing the intake of wine with statistiignificant differences. On the other hand, respondents who have a low AMD did ange consumption of whole grain cereals, and legumes, and 7.9% of them reduced sumption of vegetables compared to respondents with the highest index. Moreoe low AMD respondents increased the consumption of pasta and rice, and white red meat, butter and margarine, sweet and pastries, and sugary drinks more than MD category. In addition to this, people with low AMD decreased wine consumpss than the others. further analysis showed how the AMD groups changed food consumption (Table 3 ) festyle (Table 4) . tatistically significant differences among high and low AMD groups were observed e consumption of some foods either in term of intake increasing or decreasing. As ted in detail in Table 3 , respondents with high AMD reported an increase in the contion of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable tion in consumption of red meat, sweets and pastries, and sugar added to beverages, sugary drinks intake remained unchanged. In addition, during the assessed period, oup with high AMD respect to that with low AMD, followed closely the recommens drinking more water than usually and reducing the intake of wine with statistisignificant differences. On the other hand, respondents who have a low AMD did ange consumption of whole grain cereals, and legumes, and 7.9% of them reduced nsumption of vegetables compared to respondents with the highest index. Moreoe low AMD respondents increased the consumption of pasta and rice, and white , red meat, butter and margarine, sweet and pastries, and sugary drinks more than MD category. In addition to this, people with low AMD decreased wine consumpss than the others. ption during the lockdown by the AMD before the lockdown (percentage).  or  deion changes, =describes unchanged food consumption,  and  describes unfavourable .05. Low A further analysis showed how the AMD groups changed food consumption (Table 3 ) d lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed r the consumption of some foods either in term of intake increasing or decreasing. As ported in detail in Table 3 , respondents with high AMD reported an increase in the conmption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable duction in consumption of red meat, sweets and pastries, and sugar added to beverages, hile sugary drinks intake remained unchanged. In addition, during the assessed period, e group with high AMD respect to that with low AMD, followed closely the recommenations drinking more water than usually and reducing the intake of wine with statistilly significant differences. On the other hand, respondents who have a low AMD did ot change consumption of whole grain cereals, and legumes, and 7.9% of them reduced e consumption of vegetables compared to respondents with the highest index. Moreor, the low AMD respondents increased the consumption of pasta and rice, and white ead, red meat, butter and margarine, sweet and pastries, and sugary drinks more than igh AMD category. In addition to this, people with low AMD decreased wine consumpon less than the others. sumption during the lockdown by the AMD before the lockdown (percentage).  or  demption changes, =describes unchanged food consumption,  and  describes unfavourable p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3) and lifestyle (Table 4 ). Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3) and lifestyle (Table 4 ). Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. ies consumption during the lockdown by the AMD before the lockdown (percentage).  or  deconsumption changes, =describes unchanged food consumption,  and  describes unfavourable nges; * p < 0.05. Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. As shown in Table 4 , respondents with high AMD (moderate to high, and high) improved their eating habits more than those with low AMD who also reported an increased consumption of comfort food and that they needed to go on a diet to lose weight more than respondents with high AMD. Most of the assessed respondents had a BMI corresponding to normal weight (57.1%), whereas 29.1% were overweight and 10.3% obese. A very small proportion of the sample had BMI values corresponding to underweight (3.5%). Normal BMI values were frequently reported by respondents who have higher AMD (64% moderate to high and 60% high). On the other hand, low AMD resulted most common in respondents with BMI corresponding to underweight (5%), overweight (33%), and obese (15%). These data are not shown in the tables below. The relationship between BMI classes and dietary changes during the lockdown period showed that underweight people generally maintained the same eating habits. Details of the food group consumption changes are reported in Table 5 . In general, this group did not change the consumption of 14 items (olive oil, fruit and vegetables, legumes, fish and shellfish, nuts, sofrito sauce, wine, water, beverages with added sugar, white bread, red meat, butter and margarine, sugary drinks). A similar trend was seen for normal weight respondents, with 9 items (olive oil, fruit and vegetables, white bread, legumes, beverages with added sugar, sofrito sauce, non-whole pasta and rice, and water) remaining unchanged. On the other hand, overweight and obese respondents reported significant modifications in their consumption of different types of food. It was observed that overweight and obese respondents declared to have increased the use of olive oil more than underweight and normal weight respondents. Almost all underweight and normal weight respondents did not change their habits related to olive oil use and fruit and vegetables consumption. All groups reported an increase in consumption of vegetables with higher differences only for the group of obese respondents who also increased their intake of legumes and fish or shellfish. Considering foods that were less consumed, obese respondents decreased the intake of sugary drinks and wine and avoided adding sugar to beverages more than the other categories. Finally, although sweet and pastries consumption increased in all categories, there was a percentage of obese respondents which reduced the consumption of these food more than the other categories. high AMD (30.1%) ( Table 2) . Table 2 . Relation between food habits' changes quartiles during the lockdown and AMD classes before the lockdown (percentage). A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. able 3. Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  deribes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable od consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . Table 2 . Relation between food habits' changes quartiles during the lockdown and AMD classes before the lockdown (percentage). A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2 ). A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. with the Mediterranean Diet (moderate-score 3-4 and large changes-score > 4, respectively). Secondly, the usual AMD was compared with the dietary pattern changes during the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2 ). A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. the lockdown, showing that the "no changes" group had a significantly higher proportion of low AMD (32.7%), while in the "large changes" group there was a preponderance of high AMD (30.1%) ( Table 2) . A further analysis showed how the AMD groups changed food consumption (Table 3 ) and lifestyle (Table 4) . Statistically significant differences among high and low AMD groups were observed for the consumption of some foods either in term of intake increasing or decreasing. As reported in detail in Table 3 , respondents with high AMD reported an increase in the consumption of nuts, whole grain cereals, fish or shellfish, and legumes and a considerable reduction in consumption of red meat, sweets and pastries, and sugar added to beverages, while sugary drinks intake remained unchanged. In addition, during the assessed period, the group with high AMD respect to that with low AMD, followed closely the recommendations drinking more water than usually and reducing the intake of wine with statistically significant differences. On the other hand, respondents who have a low AMD did not change consumption of whole grain cereals, and legumes, and 7.9% of them reduced the consumption of vegetables compared to respondents with the highest index. Moreover, the low AMD respondents increased the consumption of pasta and rice, and white bread, red meat, butter and margarine, sweet and pastries, and sugary drinks more than high AMD category. In addition to this, people with low AMD decreased wine consumption less than the others. Table 3 . Food categories consumption during the lockdown by the AMD before the lockdown (percentage).  or  describes favourable food consumption changes, =describes unchanged food consumption,  and  describes unfavourable food consumption changes; * p < 0.05. The results of the NL-PCA led to consider the first 4 components as synthetic indicators of food consumption changes, explaining 47% of variance (data not shown). Cluster analysis applied to the 4 considered components led to identifying 4 groups of individuals (Table 6; Table S4 ). Group 1, the "healthy eaters" and group 4, the "more eaters" included respondents who increased food consumption of all food categories (group 4) and mainly of healthy foods (except for sweets and pastries) (group 1). Group 2, the "less eaters" included respondents who decreased overall food consumption and group 3, the "usual eaters" who included those that did not change their food consumption pattern. The 4 groups were profiled according to the socio-demographics, AMD, BMI, body weight changes, and physical activity (Table 7) , and to lifestyle and eating habits (Table S5) . These groups can be further characterized. All results were statistically significant. The "healthy eaters" were mainly women and elderly, had high AMD and reported an improvement in eating habits. A large proportion of them shared their meals with the whole family (49.4%) and reported difficulties in finding food they needed. Even with predominantly favorable dietary changes, these respondents declared that they had eaten more comfort food, gained weight (3-5 kg), and had been sedentary. Group 1-"healthy eaters" 26.8 increased consumption of legumes, whole grain cereals and non-whole pasta and rice, nuts, sweets and pastries Group 2-"less eaters" 7.5 decreased consumption of olive oil, fish and shellfish, nuts, legumes, white meat, whole grain cereals and non-whole pasta and rice, vegetables, red meat, butter and margarine, sugary drinks, sweets and pastries and sofrito sauce Group 3-"usual eaters" 51.4 unchanged consumption Group 4-"more eaters" 41.4 increased consumption of almost all categories (coexist an increased and a decreased consumption of olive oil, whole grain cereals and adding sugar to beverages) The "less eaters" group included mainly men (66.3%), and respondents with polarized age, including young (18-29 years) (21.5%), and old people (50-69 years) (47.7%). The "less eaters" had low to moderate AMD (41.9%) and reduced physical activity (16.6%, less frequent). Moreover, most of this group respondents found difficulties in finding food that they needed (34.9%) and paid attention to prices (35.7%). A positive characteristic of the "less eaters" group is having shared the meal with the whole family (52.9%). In the "usual eaters" group a high prevalence of women (54.9%) and elderly (26.2%) was observed. The AMD of the "usual eaters" was lower (38.6%) with respect to the other groups. The respondents included in this group declared that they did not need to go on a diet (50%), and a high prevalence of them were sedentary (39.1%). The attitude of not changing the dietary intake of the "usual eaters" was coupled with the similar trend in their habits resulting in not having cooked better (29.4%), not having improved their diet (52.8%), and having always had the same cooking habits (53.6%). In the "more eaters" group there was a preponderance of women (53.1%) and people aged 18-29 (20.3%) and 30-49 years (44.2%). These respondents increased their intake of comfort food (25.7%) and snacks (24.6%) and reported the intention to go on a diet (44.6%), having declared to performing physical activity at an insufficient level (less than 1 or 2 times per week) (14.8%). In addition, even though these respondents found difficulties in finding food (30.5%), they claimed to have improved their cooking (46.9%), to have tried new foods (51.7%), and changed their cooking (33.9%). The "more eaters" claimed to have improved their general eating habits (36%) and reported sharing the meal with the rest of the family more than the others (63%). Respondent behaviors concerning food waste was similar in all groups. No differences were found in the assessment related to the ability to store food correctly, and to perform separate collection of food waste, both practices were shared by around 80% of each group respondents. In addition, most of them (around 70%) declared to have consumed all food stored included the leftovers, however, the "healthy eaters" were more keen than other groups in adopting these practices (83.1%). This paper describes the changes in eating habits and lifestyle that occurred during the period of the containment measures which were adopted to limit the impact of the spread of coronavirus Sars-Cov-2 in Italy during spring 2020. The objective of the assessment was to provide a picture of a unique situation, and to evaluate if, and to what extent, consumers, were following the dietary recommendations that experts and institutions provided. This goal was largely accomplished, considering that the present paper has aspects of similarity with other assessments carried out in the same period but also provides new and complementary information on the topic since the lockdown started. In fact, the findings resulting from the data analysis and pooled variables presented here provided additional information and an original vision of the effect of the lockdown on dietary behaviors and lifestyle changes. An important finding that comes from this assessment is that a large prevalence of the participants, during the lockdown period, seems to have followed the dietary recommendations, increasing their consumption of healthy foods such as legumes, fruit and vegetables and whole grain cereals. Thus, the present data do not confirm the worsening of the dietary profile as stated by Ammar et al. [41] in a survey covering Europe, North-Africa, Western Asia, and the Americas carried out during the isolation period. In fact, in Italy, the scenario was different considering that other studies reported an increased adherence to the Mediterranean Diet and a highest intake of healthy foods during the confinement [3] as well as most sustainable food choices with increased consumption of organic and locally grown food [42] . It is interesting to point out that another Mediterranean country, Spain [43] , also reported the adoption of healthier dietary habits and increased adherence to the Mediterranean Diet during the confinement period. Commonly, when dietary changes occur, improvements in the quality of the diet can be counteracted by unhealthy eating behaviors. As observed in other studies [41, 44] , in our sample, an increase in consumption of sweets, pastries, comfort food, and red meat was observed, alongside with a decrease in the consumption of fish and shellfish, as modifications of dietary habits not coherent with the recommendations. The changes observed in the present sample reflected the national trend of food purchasing reported by the Service Institute for the Agri-Food Market (ISMEA) study carried out in Italy during March 2020 showing that, during the first period of the lockdown, there was an increased demand for canned goods, comfort food, and a decrease in the sale of fresh products [22] . On the other hand, the improved eating habits and cooking skills together with the willingness to try new foods and recipes reported by many of our respondents correspond to another research carried out by the same institution that continued to monitor the agri-food purchases system during the pandemic outbreak. In this further study carried out in April 2020, ISMEA highlighted that after an initial period in which consumers bought long-life products, they then changed their purchasing habits mainly towards ingredients for cooking, such as flour, yeast, sugar, eggs, and butter [23] . These results confirmed that consumers became more careful about the quality of food they were cooking, also reducing the purchasing of ready-to-use foods. The fact that our results are in line with these findings represents a methodological reinforcement of the outcomes we obtained, given that, despite using a non-probabilistic sample, we observed the same tendencies showed by a national representative assessment. In brief, we observed an improvement in the quality of the diet considering the reported increased consumption of healthy foods and the reduction in consumption of some foods not in line with the Mediterranean Diet. However, the increase of the frequency of consumption of certain food categories (e.g., olive oil) and the increased consumption of sweets, pastries, and comfort foods coupled with physical activity reduction, could be claimed to be responsible for the perceived increased body weight. The sedentary lifestyle and the weight gain reported in this study are confirmed by others similar studies performed in Italy [3, 42, 45] . In addition to these, our work is in line with the conclusions of a recent scoping review carried out by Bennett et al. [46] which reported that the lockdown had both positive and negative impact on dietary practices across Europe and worldwide, and negative eating habits were associated with other lifestyle outcomes as weight gain and a reduced physical activity. Moreover, findings on physical activity, weight gain, and some dietary changes (sweets, vegetables and fish) are in line with the results of a study carried out in Austria, Poland, and the United Kingdom by Skotnicka et al. [47] . More than a half of respondents of this survey has low adherence to Mediterranean Diet. In other surveys carried out in Italy or in other Mediterranean countries during the pandemic, the Mediterranean Index was used mainly to evaluate the changes related to lockdown, hence it is difficult to make comparison. However, the proportion of respondents of our sample with low adherence to Mediterranean Diet deserves attention. These results need to be confirmed by other assessments with a sampling that allows a generalization of the outcome. However, in Bonaccio et al.'s [48] study that surveyed a Southern Italy large cohort (113.262 subjects), higher income and education were independently associated with a greater adherence to Mediterranean Diet. Among our sample subjects, the high educational level was overrepresented, so we could speculate that in a comprehensive sample including a greater proportion of low educational level, the low adherence to Mediterranean Diet could be higher than that observed in the present study. A further novelty of this assessment with respect to others published on the same topic, was the cluster analysis that provides an overview on the effects of lockdown on subjects studied and how food consumption changes were related with other variables. The confinement polarized behaviors, with people who already had a high AMD increased their consumption of healthy food (the "healthy eaters"). Consumers with good eating habits were also the keenest to follow the recommendations during the lockdown. On the contrary, respondents that did not change their consumption pattern, the "usual eaters" were those having usual low adherence to the Mediterranean Diet. For this category the lockdown exacerbated a situation that was already unfavorable [44] . However, an increase in the consumption of comfort foods was observed in all groups as a possible compensation for the negative emotions caused by ongoing emergency and the bad news coming from the media or, simply, as consequence of the boredom of staying at home [49, 50] . As mentioned, we observed an increase in body weight and sedentary lifestyle. These findings could be interpreted in the light of the results from the cluster analysis showing that low levels of physical activity were reported frequently by all groups regardless of their consumption patterns. Moreover, the cluster analysis also highlighted many of socioeconomic aspects of the lockdown that deserve comments. The "less eaters" group paid attention to food prices and found difficulties in buying food. These results may be a consequence of the lack and/or loss of job that impacted on the youngest [51, 52] , and the isolation which affected the oldest [53, 54] , considering the high prevalence of these population groups among the "less eaters". Related to this, the results concerning the elderly showed that even though there was a percentage of this population group that followed MD recommendations, they had also the attitude to not change their eating habits and not improve their food consumption, confirming the fact that this population group often needs nutritional intervention to improve the quality of their diet. Children were to some extent involved in the kitchen and food preparation activities during lockdown. Targeting this population group in educational campaigns in this period was an important initiative [55] also considering the high level of childhood obesity in Italy [56] and the worsening of this situation globally due to the pandemic [45, 57] . To conclude the analysis, two other aspects of lifestyle should be noted. Firstly, the habit of eating together increased positively among most of the respondents (groups 1 "healthy eaters", group 3 "usual eaters" and group 4 "more eaters"). Secondly, all the participants to this study were, without relevant differences between the 4 groups, very sensitive to the problem of food waste. These findings are promising since they may be a signal of the increased attention of Italian consumers towards the negative consequences of throwing away food. Other studies confirmed the attention of Italian consumers to food waste both during the lockdown [58, 59] and before the pandemic [60] . In addition to consumers' behavior changes, the coronavirus crisis is causing many problems and is worsening pre-existing conditions. Many people around the world have lost their jobs and inequalities related to wealth, income level and social protection have exacerbated [61] [62] [63] . Moreover, food insecurity [64] increased among who have already suffered from poverty in developing countries [65] but disparities came out also in developed countries [66, 67] . The suggestion that comes from this study is that the food system in Italy at the household level during the first lockdown was an important element to maintain a daily acceptable routine for the whole family in a pandemic situation which had relevant socio-economic impacts. This situation should be the starting point to reorganize the system during the recovery and to be more aware of how to handle a possible similar future crisis. A limitation of this work is related to the bias of the "river sampling", as far as possible limited using weighted data that corrected the sociodemographic structure of the sample since Italian population statistics [35] . The "river sampling" has advantages and disadvantages. The facility to reach a large number of participants at limited costs widespread the application of this method, especially during the lockdown period. This tendency is increasing independently from the restrictions of the pandemic. In fact, despite limitations, non-probabilistic online surveys are now frequently used to make claims about the general population in social science and policy research. According to Lehdonvirta et al. [29] , this kind of sampling can be used to describe certain phenomena and their safest use is in examining members of the sample itself. In addition, this sampling could be used to make tentative inferences, but the effect sizes would not be accurate, and could be affected by the selection biases. We perform the analysis of the data in light of these methodological inputs treating the sample as is and considering possible bias. For example, the high educational level of the participants of this survey, could partially explain the increased quality of the dietary patterns observed in our and other opportunistic samples selected with similar methodology. This is a limitation of the studies carried out during the lockdown, but it is also true that to accomplish the objective of providing a picture of that specific moment no more other options were possible, considering the restrictions and, above all, the need to perform the data collection without the appropriate planning. Other limits of this study consist of the self-reported answering that could affect the reliability of the responses and the fact that eating habits were based on participants' perception of food intake that may not reflect true intake during lockdown. However, the large sample size and the confirmation of our results with other similar survey support the quality of the data collected. The results of this study together with the other assessments carried out in the same period and in different population groups, showed that the lockdown in Italy improved the quality of diet but had negative effects both on the quantity of food consumed and on the levels of physical activity. This situation led to a general increase in body weight and to an exacerbation of sedentary lifestyle that was already common in Italy. These conditions should be carefully considered as detrimental changes with potential significant impact across the population groups, in particular, for the most vulnerable, such as the elderly. Nevertheless, the involvement of children in kitchen activities, the increased occasions of conviviality, and the attention on the issue of food waste should be considered important positive habits to highlight. This survey should be considered an important element that allows to consider nutritional aspects in the framework of the pandemic approach, given that the pandemic is still on-going and because also in 2021 people experienced different levels of confinements that exposed them to the same detrimental conditions. An additional value of this assessment is the timing. Having distributed the survey until nearly the end of the first lockdown period, the data collection provided a comprehensive overview about how consumers adapted their habits to this unpredictable situation. Even though the acute phases of Coronavirus disease 2019 are increasingly under control thanks to the ongoing vaccination campaigns that is reducing deaths and severe cases, the overall consequences of the pandemic period would significantly impact on people nutritional status as shown in this paper and at larger extent on the health system. The increase in unhealthy dietary habits and deterioration of nutritional status found in this study may contribute to a general decline of health among population groups, considering that being overweight and obese makes individuals more susceptible to chronic health conditions and diseases. Future public health actions should consider the worsening of people's nutritional status one among other long-term health consequence of the pandemic. Supplementary Materials: The following are available online at https://www.mdpi.com/article /10.3390/nu13072279/s1, Table S1: The Questionnaire; Table S2 : The sample-sociodemographic variables; Table S3 : Food categories consumption before lockdown: frequency or typology; Table S4 : Cluster analysis: food consumption patterns, 4 groups; Table S5 : Cluster analysis, the relation between the 4 groups and eating habits and lifestyle changes. The authors' responsibilities were as follows-The research questions, conceptualization, and design of the study were carried out by L.R., U.S. and M.L.S.; the methodology was revised by M.L.S. and A.T.; database compilation was carried out by U.S.; data were analyzed by M.L.S. and A.T.; data interpretation was undertaken by F.G., L.R., M.L.S., U.S. and A.T.; writing and original draft preparation was carried out by L.R. and F.G.; writing, review, and editing were carried out by L.R., F.G., U.S., M.L.S. and A.T. All authors have read and agreed to the published version of the manuscript. Ethical review and approval were waived for this study because it did not involve any invasive procedure (e.g., fecal samples, voided urine, etc.) or laboratory assessment or induced lifestyle changes or dietary intake modifications. Before starting the data collection, participants were informed about the objective of the research and the consequent statistical analysis. They were free to decide to be involved in the survey and were asked to fill in the self-reported questionnaire in anonymity. Informed consent for participation and for personal data management was obtained asking participants to tick on a dedicated item before starting the questionnaire. The archived data and all the elaboration and analysis generated and used for presentation of results in this study are fully available on request from the corresponding author. 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