The year 2019 did not end happily due to the emergence of a new coronavirus infection (COVID-19) that caused countless cases of morbidity and mortality worldwide (1, 2). COVID-19 quickly became a global concern, as almost no one felt immune to it (3, 4). This fear influenced many aspects of people’s lives, including their food choices and dietary patterns (5–8). On the other hand, authorities implemented lockdowns, and health organizations strongly recommended social distancing. The lockdown had a significant impact on the socioeconomic situation, resulting in decreased income and even job loss for many households (9, 10). Consequently, food choices and dietary habits of a significant proportion of the population changed. However, these dietary changes did vary within and between countries. A study conducted on a sample of the Spanish population revealed that during the pandemic, consumption of unhealthy foods increased while physical activity decreased (11). In a similar study involving 1,097 adults from Poland, almost half of the participants reported increased eating and snacking (43 and 52%, respectively), and approximately one-third reported weight gain, which was associated with decreased consumption of fruits, vegetables, and legumes but an increased intake of meat, dairy products, and fast foods. Approximately 15% of the participants increased their alcohol consumption during lockdown (8). In contrast, an Italian survey of dietary changes during the pandemic revealed greater adherence to the healthy Mediterranean diet among 18- to 30-year-old participants compared to both younger and older participants (12). Overall, these findings suggest both positive and negative impacts of the COVID-19 pandemic on dietary habits worldwide (13). In a study conducted by the U.S. Department of Agriculture (USDA) using the Consumer Expenditure Diary Survey to evaluate food-buying behaviors before and during the early onset of the COVID-19 pandemic, a decrease in the consumption of full-service restaurant meals was observed. This was accompanied by an increase in the purchase of food items from grocery stores, primarily for protein foods, fruits, and vegetables (14).

With the development of COVID-19 vaccines in 2020, an undoubtedly remarkable success in medical history, an estimated 14.4–19.8 million deaths were prevented in 185 countries from 8 December 2020 to 8 December 2021 (15). Although the COVID-19 vaccinations provided an opportunity for human life to return to normal, it left unanswered an important question: Did the dietary changes adopted during the lockdown persist afterward? Some studies have examined these changes following the pandemic. For instance, in Saudi Arabia, approximately 41% of participants in an online survey reported weight gain, while 21% reported weight loss after the COVID-19 pandemic. Both healthy and unhealthy dietary changes, which included increased intake of fruits and vegetables and increased consumption of fast foods and sugary snacks, were reported by approximately one-third of the participants (16). In an attempt to evaluate the long-term effects of the pandemic on dietary habits, a cross-sectional study involving 118 adults residing in the region of Lazio, Italy, found that after the COVID-19 pandemic, they consumed more vegetables, whole grains, and water and ate less out (17). Another online survey involving 1,005 adults conducted in Bahrain found an increase in the consumption of sugary drinks and fast food (18). These post-COVID-19 changes in dietary habits will have health implications.

In this review, we evaluated the overall dietary changes in Iranian households during the COVID-19 lockdown period and compared them with the available data on the trends of food consumption since 2016. Briefly, the aim of this review is to: (i) provide an overview of the overall dietary changes in Iranian households during the lockdown period, (ii) evaluate whether these changes are persistent, and (iii) assess their potential health consequences. Finally, some recommendations are provided for policymakers to address pandemic-induced unhealthy dietary changes and enhance the nutritional status of the general population in Iran.

A thorough literature search on dietary changes during or shortly after the coronavirus pandemic lockdown was conducted using electronic databases, such as MEDLINE/PubMed, CINAHL, Embase, and the Cochrane Library. The keywords used were coronavirus OR COVID-19, diet OR nutrition, household, and Iran. The search focused on English-language articles published between 2020 and 2024. To track dietary changes from years before the lockdown, we used and plotted data from the Household Income and Expenditure Survey (HIES), the Statistical Center of Iran. The exclusion criteria included study protocols alone, meta-analyses, systematic reviews, rapid reviews, and narrative reviews. In addition, studies that focused on a specific area, subgroups (such as students), or cities or provinces were also excluded. The selected literature was chosen according to the predefined inclusion criteria, starting with the title, followed by the abstract, and concluding with the full text. The initial search yielded 79 studies, of which 32 were duplicates and 21 were excluded based on their titles. After screening the abstracts of the remaining 26 studies, 18 were excluded for irrelevance, leaving eight studies for inclusion in the review.

Table 1 shows the nutrition surveys conducted in Iran during the pandemic. Studies that focused on a specific subpopulation (such as students), a specific area, city, or province were not included. Nevertheless, the majority of the studies had small sample sizes. The largest survey during the lockdown period was carried out using a web-based, electronic, self-administered questionnaire, the protocol for which has been described elsewhere (19). Data obtained from 21,290 households from 4 to 25 April 2020 were analyzed. The majority of respondents reported decreased consumption of major food groups. Specifically, the consumption of milk, yogurt, and cheese decreased in approximately 29, 26, and 7% of the households, respectively (20). Similarly, the consumption frequency of red meat, white meat, eggs, and rice/bread in a week also showed a decrease in 33, 24, 14.2, and 7% of the households, respectively. In approximately 47% of the households where the weekly consumption of animal protein sources decreased, the intake of rice and bread increased (21). Accordingly, 35 and 44% of the respondents reported decreased consumption frequency of fruits and snacks, respectively. Additionally, 21% of those who reduced their fruit consumption completely removed fruits from their food basket (22). Even fast food consumption significantly decreased in approximately 75% of the responding households (23). Interestingly, the use of dietary supplements, especially vitamin D, vitamin C, zinc, and multivitamins, increased in households, particularly among those with higher incomes (24). Decreased income was a common reason for all these dietary changes.

The impact of economic factors on food choices and dietary patterns has long been documented (25). Meanwhile, the coronavirus pandemic, the biggest threat since World War II, caused significant damage to the global economy. Industry, commerce, business, and agriculture were all adversely affected to varying degrees (26). While the process of post-pandemic economic recovery has begun in many countries (27), the consequences may persist as behavioral changes and affect the dietary patterns of the survivors (28).

The COVID-19 pandemic unleashed unique challenges worldwide, influencing every aspect of human life. Fear of the virus, along with lockdowns and economic downturns, caused significant changes in food choices and dietary patterns.

Dietary alterations observed worldwide during and after the lockdown revealed a complex interplay of socioeconomic factors, health behaviors, and regional circumstances. In Iran, a large-scale survey highlighted a worrying decline in the consumption of key food groups, which has been exacerbated by economic challenges.

The present report rightly emphasizes the long-term consequences of sustained dietary changes. A decrease in animal protein sources and an increase in the consumption of cereals and oils might result in a low-nutrient density diet, potentially resulting in overweight and micronutrient deficiencies. Downward trends in dairy and fruit consumption raise concerns about nutritional adequacy, with potential repercussions for bone health and disease prevention.

To navigate this crisis, policymakers must adopt a multi-faceted approach. Economic support, nutritional education, and price controls on essential foods are crucial short-term measures. Long-term strategies include supporting local agriculture, fostering public–private partnerships, and ensuring easy access to healthcare services. Regular monitoring of dietary changes through an FNS system, investing in research, and fostering international collaborations are essential for evidence-based policymaking. The proposed recommendations provide a roadmap for policymakers to address the challenges posed by these changes, aiming for a healthier and more resilient post-pandemic future.