{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:58:21Z","timestamp":1790614701280,"version":"4.1.0"},"reference-count":66,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Social containment measures imposed in Europe during the lockdown to face COVID\u201019 pandemic can generate long\u2010term potential threats for metabolic health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 494 non\u2010COVID\u201019 subjects living in 21 EU countries were interviewed by an anonymous questionnaire exploring anthropometric and lifestyle changes during 1\u2010month lockdown. A subgroup of 41 overweight\/obese Italian subjects with previously diagnosed nonalcoholic fatty liver (NAFLD) joined the study following a 12\u2010month follow\u2010up period promoting weight loss by healthy lifestyle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the lockdown, body weight increased in 55% of subjects (average 2.4\u00a0\u00b1\u00a00.9\u00a0kg). Weight change increased with age, but not baseline body mass index. Subjects living in Italy had greater weight gain than those living in other European Countries. Weight gain during the lockdown was highest in subjects reporting no physical activity, and low adherence to Mediterranean diet. In the NAFLD group, weight gain occurred in 70% of cases. Subjects reporting weight loss during lockdown had decreased fatty liver score at 3\u00a0months before the lockdown, as compared with 1\u00a0year before.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Strict measures of social containment\u2014even short\u2010term\u2014pave the way to the increased risk of metabolic abnormalities in the medium\u2010long term. In this context, adherence to Mediterranean diet and regular physical activity play a protective role both in terms of weight gain and fatty liver development\/progression, with implication for primary and secondary prevention. When adopting measures imposing social containment, intensive educational campaigns must increase public awareness about beneficial effects of healthy lifestyles.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13597","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T11:16:26Z","timestamp":1621941386000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Multiplying effects of COVID\u201019 lockdown on metabolic risk and fatty liver"],"prefix":"10.1111","volume":"51","author":[{"given":"Harshitha","family":"Shanmugam","sequence":"first","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5476-7376","authenticated-orcid":false,"given":"Agostino","family":"Di Ciaula","sequence":"additional","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenica Maria","family":"Di Palo","sequence":"additional","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Molina\u2010Molina","sequence":"additional","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7875-7239","authenticated-orcid":false,"given":"Gabriella","family":"Garruti","sequence":"additional","affiliation":[{"name":"Section of Endocrinology Department of Emergency and Organ Transplantations University of Bari \u201cAldo Moro\u201d Medical School Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Felicia","family":"Faienza","sequence":"additional","affiliation":[{"name":"Paediatric Section Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"vanErpecum","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5359-1471","authenticated-orcid":false,"given":"Piero","family":"Portincasa","sequence":"additional","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d Department of Biomedical Sciences and Human Oncology University of Bari \u201cAldo Moro\u201d Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Coronavirus disease 2019 (COVID 19). Situation Report \u2010 72","author":"World Health Organization","year":"2020"},{"issue":"1","key":"e_1_2_7_3_1","first-page":"157","article-title":"WHO declares COVID\u201019 a pandemic","volume":"91","author":"Cucinotta D","year":"2020","journal-title":"Acta Biomed"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12061730"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-020-02399-5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c110025"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13299"},{"key":"e_1_2_7_8_1","first-page":"1","article-title":"The economic cost of Covid lockdowns: an out\u2010of\u2010equilibrium analysis","author":"Mandel A","year":"2020","journal-title":"Econ Disaster Clim Chang"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0240876"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2015.00369"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.03.020"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12958"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2019.04.005"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31150"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04724.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.10.033"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2017.08.003"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2016.3"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28431"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2021.03.036"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100203"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2006.03.021"},{"key":"e_1_2_7_23_1","first-page":"1","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","author":"World Health Organization","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"issue":"2","key":"e_1_2_7_24_1","first-page":"51S","article-title":"Clinical Guidelines on the Identification, Evaluation, and treatment of overweight and obesity in adults\u2010the evidence report. National Institutes of Health","volume":"6","author":"National Institute of Health","year":"1998","journal-title":"Obes Res"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/09637486.2017.1287884"},{"key":"e_1_2_7_26_1","volume-title":"Basic & Clinical Biostatistics","author":"Dawson B","year":"2001"},{"key":"e_1_2_7_27_1","volume-title":"NCSS 2020 Statistical Software (2020)","author":"Hintze J","year":"2020"},{"issue":"4","key":"e_1_2_7_28_1","first-page":"219","article-title":"Increased weight gain of children during the COVID\u201019 lockdown","volume":"23","author":"Vinker\u2010Shuster M","year":"2021","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13030930"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2021.105244"},{"key":"e_1_2_7_31_1","doi-asserted-by":"crossref","first-page":"e12453","DOI":"10.1111\/cob.12453","article-title":"Impact of the COVID\u201019 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts","author":"Mulugeta W","year":"2021","journal-title":"Clin Obes"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114521000921"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020671"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10863-0"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/fsn3.2179"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13041082"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13030970"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/09637486.2021.1895726"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2021.635859"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114520004547"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12113525"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12072152"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12113445"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-017-0603-8"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1746-1561.2004.tb07933.x"},{"issue":"11","key":"e_1_2_7_46_1","first-page":"1442","article-title":"Impact of lifestyle on health","volume":"44","author":"Farhud DD","year":"2015","journal-title":"Iran J Public Health"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.05.016"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-020-0634-3"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13034"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22808"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13338"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.044"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020300"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17249362"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12103084"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2020.104853"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17176287"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.2196\/19630"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.3325\/cmj.2020.61.309"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17114144"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.01.020"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-044474"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2020.105002"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0022-4707.20.11536-6"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020309"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12061583"},{"key":"e_1_2_7_67_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980013003169"}],"container-title":["European Journal of Clinical Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/eci.13597","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/eci.13597","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/eci.13597","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T04:06:46Z","timestamp":1699070806000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/eci.13597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,25]]},"references-count":66,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1111\/eci.13597"],"URL":"https:\/\/doi.org\/10.1111\/eci.13597","archive":["Portico"],"relation":{},"ISSN":["0014-2972","1365-2362"],"issn-type":[{"value":"0014-2972","type":"print"},{"value":"1365-2362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,25]]},"assertion":[{"value":"2021-02-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13597"}}