Available online: http://journal.ipb.ac.id/index.php/jgizipangan J.

Gizi Pangan, November 2022, 17(3):139-148

ISSN 1978-1059 EISSN 2407-0920 DOI: https://doi.org/10.25182/jgp.2022.17.3.139-148

Systematic Review Article

Effects of COVID-19 Pandemic on Changes in Nutritional Status and Physical

Activities of School-Age Children: A Scoping Review
Fajar Ari Nugroho1*, Annisa Nafilata Ruchaina2, Angga Galih Luhur Wicaksono2
Department of Nutrition, Faculty of Health Sciences, Universitas Brawijaya, Malang 65145, Indonesia
1

Dietitian Professional Study Program, Department of Nutrition, Faculty of Health Sciences, Universitas
2

Brawijaya, Malang 65145, Indonesia

ABSTRACT

This study's objective is to review the consequence of the COVID-19

epidemic on physical activities, sedentary lifestyles, screen time, and
Article History: changes in the nutritional status of school-age children. The outcomes of
Received 08-06-2022 this study are intended to be applicable to obesity management in children.
Revised 07-08-2022 This study reviewed full-text articles and open-access publications on
Accepted 07-09-2022 the sedentary lifestyle of children during the pandemic. and the data were
Published 30-11-2022 analyzed using cohort, case-control, and cross-sectional designs. The
results of reviewing 17 articles show that school-age children’s physical
Keywords: activities and nutritional status have decreased, but their sedentary
COVID-19, nutritional lifestyle and screen time have increased due to social restrictions during
status, physical activities, the COVID-19 pandemic. Children’s decreased physical activities are
school-age children, caused by the absence of a comparable replacement mechanism as that
sedentary lifestyle before the pandemic. Meanwhile, the increasingly sedentary lifestyle
highly influences children’s physical and mental health. Screen time
*
Corresponding Author: has also increased and is unavoidable during the pandemic because
tel: +6281330736005 children’s activities were limited and their learning systems are switched
email: fajar_arinugroho.fk@ to online learning; as a result, their supporting sedentary lifestyle
ub.ac.id increases while physical activities decrease. These factors have changed
the nutritional status of children during the pandemic. These results
support the idea that the pandemic will impact the health of school-age
children, especially their nutritional status. This review concludes that
it is important to establish policies that prevent children’s further health
effects, such as obesity, caused by COVID-19.

INTRODUCTION problem, particularly in low socioeconomic

groups (Sahoo et al. 2015).
Obesity has become a world health World Health Organization (WHO) has
problem, and it is estimated that 39% of people declared the COVID-19 outbreak a global
are overweight and obese (Chooi et al. 2019). pandemic in early 2020 (Cucinotta & Vanellli
The prevalence of overweight in women is lower 2020). All authorities respond by stipulating
than in men; on the contrary, obesity prevalence several policies to reduce the transmission rate,
in women is higher than in men (Chooi et al. such as social restriction, social distancing,
2019). The national data show that 10.3% of the temporary school closure, restrictions on public
prevalence of adult obesity is found in women, places, restrictions on mass gatherings or crowds,
and 7.5% of the prevalence of adult obesity is and the obligation to wear masks (Cucinotta &
found in men; these numbers are higher than Vanellli 2020). In the end, these policies directly
those of the regional data (GNR 2022). impact society, including school-age children
The Indonesian Baseline Health Research (Arum & Susilaningsih 2020).
reports that the percentage of overweight school A study has reported that school-age
children (6‒14 years old) has increased from children perform a lack of physical activities
2007 to 2013 (Megawati et al. 2021). Obesity during the COVID-19 pandemic (Moore et
in children has become a major public health al. 2020). Approximately 70% of school-age

This is an open access article under a Creative Commons Attribution-ShareAlike 4.0 International License
(https://creativecommons.org/licenses/by-sa/4.0/)
J. Gizi Pangan,Volume 17, Number 3, November 2022 139
Nugroho et al.

children decreased their physical activities due topics. Therefore, 2,075 articles were excluded. In
to social restrictions during the pandemic (Zheng the next stage,the abstracts of 44 selected articles
et al. 2020). This fact is against school-age were examined by considering the inclusion
children’s natural characteristics, such as playing, and exclusion criteria; this examination resulted
moving, interacting in groups (Chusna & Utami in 28 articles. The next step was examining
2020), and more actively exploring many things the full texts of the 28 remained articles. This
(Rachmawati et al. 2021). Another study has examination resulted in seven articles for review.
reported that the Body Mass Index (BMI) of The seven articles consisted of six cohort studies
children aged 2‒19 years and obesity prevalence and one cross-sectional study. The whole process
have increased by 16.1% during the COVID-19 of the article selection is presented in Figure 1.
pandemic (Lange et al. 2021). Children’s limited
mobility during the pandemic could lead to a lack RESULTS AND DISCUSSION
of physical activities, a sedentary lifestyle, and
changes in the nutritional status (Zheng et al. 2020). Seven selected articles were reviewed
Exploring the effects of the COVID-19 and presented descriptively. The impacts of the
pandemic on school-age children’s physical COVID-19 pandemic on children are grouped
activities, sedentary lifestyle levels, screen time, into physical activities, sedentary activities,
and changes in nutritional status are pivotal and screen time, and nutritional status
relevant to current conditions. This review aims
to review the latest research results on decreased Physical activities of children during the
physical activities, sedentary lifestyle levels, COVID-19 pandemic
screen time, and changes in nutritional status The effects of COVID-19 on children’s
of school-age children during the pandemic. physical activities are reported by five of the
The results of this study are expected to bring seven articles reviewed. These five articles
important information to create a strategic mention that children’s physical activities have
solution and combat the effects of COVID-19 on significantly decreased during the pandemic; all
the obesity in school-age children. p values are <0.01 with a negative association
direction (Table 1).
METHODS

This scoping review was carried out by

involving articles, full-texts, and open access
articles on the sedentary lifestyle of children
published in 2020‒2021. This study employed
cohort, case-control, and cross-sectional designs.
This study excluded investigation on non-child
subjects, review studies, and studies without the
cohort, case-control, and cross-sectional designs.
The keywords were sedentary, sedentary lifestyle,
sedentary behavior, sedentary behavior AND
pandemic, COVID-19, COVID AND obesity,
obese AND children, child, and school age. The
search process was carried out using the Boolean
technique on four journal databases: PubMed,
ProQuest, ResearchGate, and Sciencedirect. The
PRISMA flow diagram was used to ensure the
best process of the article selection.
A total of 2,119 articles were identified
through a database search. Most of the articles
are published by ProQuest for 1,404 articles,
followed by Science Direct, Research Gate, and
Pubmed. Furthermore, all articles were examined Figure 1. The PRISMA flow article selection
in more detail based on the relevant titles and diagram

140 J. Gizi Pangan,Volume 17, Number 3, November 2022

 COVID-19 and children: A scoping review

A cohort study in Czech children in 2021 the girls, the greater the decline (Treuth et al.
has found children’s activities more severely 2009). During the pandemic, another study cites
decrease during the pandemic than before children could not fulfil their basic physical
(Stverakova et al. 2021). The study reported activities due to social restrictions (Moore et al.
that the children experienced a decline not only 2020). Moore et al. (2020) explain that genders
in total physical activities but also in spare time, showed differences in physical activities; boys
before–school-activities, sports class activities, are physically more active than girls. The data
and rest activities (Stverakova et al. 2021). on age denote that older children experienced a
Another study in the Netherlands compared data bigger impact of changes in their activity patterns
from two cohorts and report non-converging than younger children do (Moore et al. 2020).
results (Ten Velde et al. 2021). One of the cohort
results mentioned that children’s total physical Sedentary activities of children during the
activities (p<0.01) decrease. However, this COVID-19 pandemic
result disagrees with another cohort study (Ten The sedentary lifestyle was reviewed from
Velde et al. 2021). Children’s decreased physical three selected articles (Table 1). An increased
activities have also been recorded by a previous sedentary lifestyle was reported by Ten Velde
study which reveals a p-value of 0.002 (Alonso- et al. (2021) from two cohort results. Moreover,
Martinez et al. 2021). This result was supported they report that the children’s physical activities
by another study although it was not significant have lightly, moderately, and vigorously
(Cachon-Zagalaz et al. 2021). increased during the pandemic (p<0.01). The
Children’s physical activities decrease same result was reported by Alonso-Martinez
because they do not have alternative substitute et al. (2021) with a p-value of 0.006. Whereas
activities during the pandemic (Stverakova a study has found two types of significant
et al. 2021). Children’s organized indoor and sedentary lifestyles in children: playing computer
outdoor activities decline; organized physical or video games by boys and talking on the
activities in distance learning encounter various phone or texting by girls (Dunton et al. 2020).
challenges so that decreased physical activities of Keeping children from experiencing a
children cannot be optimally prevented (Vilchez sedentary lifestyle during the pandemic was proven
et al. 2021; Gobbi et al. 2020). Another study to protect children’s mental well-being (Gilbert et
also reported that returning children’s physical al. 2021). Children were the age group who are
activity levels to the same level as before the affected the most by the pandemic (Runacres et
pandemic was probably difficult due to lack of al. 2021). Runacres et al. (2021) stated that the
parental support, amount of sleep time, lower increased sedentary lifestyle negatively impacts
energy, and lower time (Moore et al. 2020). children’s mental health, depression, anxiety, and
This review notes that several selected quality of life. These problems are influenced by
studies analyse age and gender with mixed several factors, such as socioeconomic (the main
results. A recent study states that neither age factor), education levels of parents, overweight
nor gender was significantly associated with or obese parents, and parents’ high anxiety about
decreased physical activities during the pandemic COVID-19 (Runacres et al. 2021). Runacres et al.
(Stverakova et al. 2021). Another study by Ten (2021) have found that gender was not related to
Velde et al. (2021) agrees that children’s age was an increasingly sedentary lifestyle; however, girls
not associated with decreased physical activities, were consistently reported to be more sedentary
but data on gender show that girls’ physical than boys.
activities decrease more significantly than boys’.
The next cohort study reported that physical Screen time of children during the COVID-19
activities decrease along with the increasing age; pandemic
moreover, the study has found that girls’ leisure This review has found two articles reporting
time greatly increases (Dunton et al. 2020). A changes in screen time of children during the
weaker cross-sectional study by Cachon-Zagalaz COVID-19 pandemic (Table 1). Ten Velde et al.
et al. (2021) reported that children’s daily (2021) report several results of screen time. They
activities increased as they got older. investigated two cohorts and have found that
A longitudinal study has found that girls’ screen time for school purposes has significantly
physical activities have decreased; the older increased on weekdays and weekends (Ten Velde
et al. 2021).

J. Gizi Pangan,Volume 17, Number 3, November 2022 141

Nugroho et al.

Table 1. Extraction results of articles on the impact of the COVID-19 pandemic on physical activity,
sedentary lifestyle, screen time, and changes in nutritional status in school-age children
Title Country Type of Association
Variable Result
(Author; Year) (Participant) study Significancy Type Direction
Physical activity
The impact Czech Republic Cohort Pre COVID The mean PAQ-C Significant Decreased (-)
of COVID-19 (Children aged vs during (physical activity) (p<0.001)
on physical 8‒12 years COVID total score
activity of (n=98) during Spare time Significant Decreased (-)
Czech lockdown (activities during (p=0.001)
children and (n=206) leisure time)
(Stverakova pre-COVID)
Activities before Significant Decreased (-)
et al. 2021)
school (p=0.003)
Activities during Significant Decreased (-)
sports learning (p<0.001)

Activity at Rest Significant Decreased (-)

(p<0.001)
Pre COVID The PAQ-C scores No data n/a n/a
vs during between gender mentioned
COVID
by gender
Pre COVID The PAQ-C scores Not n/a n/a
vs during between age significant
COVID (p=0.217)
by age

Physical Netherland Cohort Before The total time of physical activity

activity (Cohort COVID - Cohort A Significant Decreased (-)
behaviour A=children vs during (p<0.01)
and screen aged 4‒18 COVID
time in Dutch years based on - Cohort B Not n/a n/a
children participating subjective significant
during the in children measurement School activities
COVID-19 obesity and - Cohort A Significant Decreased (-)
pandemic: lifestyle (p<0.01)
Pre-, during- during
and COVID-19 - Cohort B Not n/a n/a
post-school (COLC) significant
closures (n=102)
Sport activities
(Ten Velde
- Cohort A Significant Decreased (-)
et al. 2021) Cohort
(p<0.01)
B=children
ages 7‒12
- Cohort B Significant n/a n/a
years from
(p<0.01)
clinicatrial.gov
study: Leisure activities
NCT03440580 - Cohort A Significant n/a n/a
(n=131) (p<0.01)

- Cohort B Not n/a n/a

significant

Before Total physical Not n/a n/a

COVID vs activity significant
during
COVID by
age
Before Light physical Significant Decreased (-)
COVID vs activity between (p<0.02) (girls>boys)
during boys and girls
COVID by
gender

142 J. Gizi Pangan,Volume 17, Number 3, November 2022

 COVID-19 and children: A scoping review
Continue from Table 1

Title Country Type of Association

Variable Result
(Author; Year) (Participant) study Significancy Type Direction
Screen time
Physical activity Netherland Cohort Before COVID Screen time
behaviour and (Cohort A= vs during CO- related to school
screen time in children aged VID
4‒18 years - Cohort A Significant Increased (+)
Dutch
(p=0.04)
children during participating in
the COVID-19 Children Obesity
- Cohort B No data n/a n/a
pandemic: pre-, and Lifestyle
during-and post- during COVID-19
school closures (COLC) (n=102); Weekday screen
(Ten Velde et al. time
Cohort B=
2021)
children ages 7‒12 - Cohort A Not n/a n/a
years from significant
clinicatrial.gov
study: - Cohort B Significant Increased (+)
NCT03440580 (p<0.01)
(n=131)

Physicalactivity Spain (Children Cross- Screen time Screen time Significant Increased (+)
and Daily aged 0‒12 years sectional during (p=0.013) (boys>girls)
Routine among (n=837), 50.2% COVID-19
Children Aged boys (n=420) Screen time Daily screen Significant Increased (+)
0‒12 during and 49.8% during time (p=0.000) (older>younger)
the COVID-19 girls (n=417)) COVID-19
Pandemic in by age
Spain (Cachon- Screen time The highest Significant n/a n/a
Zagalaz et al. during screen time was (p=0.043)
2021) COVID-19 by in children with
family type single parents
compared to
other children
Screen time The more active Significant Decreased (-)
during children, the (p=0.018)
COVID-19 by screen time will
children’s level decrease
of active
Nutritional status
Paediatric BMI United State of Cohort BMI changes Children aged Significant Increased Potentially
changes during America (Children (∆BMI) vs age 6‒9 years (p=0.002) (+)
COVID-19 aged 6‒17 years group
pandemic: An (n=191,846) with
electronic health details taken from
Children aged Significant Increased Potentially
record-based the results of the
10‒13 years (p=0.003) (+)
retrospective WCC U.S
cohort study Electronic Health
(Brooks et al. Record (EHR)
Children aged Not n/a n/a
2021) data from
14‒17 years significant
Optum 2017‒2019
(n=144,714)
and 2020 data
(n=47,132)

Projecting the United State of Cohort BMI and BMI in girls in Significant Increased (+)
impact of the America (Children Childhood the group of (p<0.05)
coronavirus who come from Obesity children with
disease various Prevalence COVID-19
(continue) (continue) compared to the
control

J. Gizi Pangan,Volume 17, Number 3, November 2022 143

Nugroho et al.

Continue from Table 1

Title Country Type of Association

Variable Result
(Author; Year) (Participant) study Significancy Type Direction
Physical The highest Significant n/a n/a
activity during sleep time per (p=0.025)
COVID-19 day was
by family type recorded in
children living
with several
families
The highest Significant n/a n/a
daily activity (p=0.010)
was recorded in
children with
divorced parents
Physical The more active
activity during children, the
daily physical Significant
COVID-19 by (p=0.000) Increased (+)
children’s level activity will
of active increase
Sedentary lifestyle
Physical activity Netherland Cohort Before Sedentary time Significant Increased (+)
behaviour and COVID vs (p<0.01)
(Cohort A=
screen time children aged during COVID
in Dutch 4‒18 years based on
children during participating in objective
the COVID-19 Children Obesity measurement Light physical Significant Decreased (-)
pandemic: pre-, & Lifestyle during activity (p<0.01)
during-and post- COVID-19
school closures (COLC) (n=102);
(Ten Velde et al. Cohort B=children
2021) ages 7‒12 years Moderate to Significant Decreased (-)
from vigorous (p<0.01)
clinicatrial.gov physical activity
study:
NCT03440580
(n=131)
Early effects of USA (211 children Cohort Type of Playing Significant Increased (+)
the COVID-19 aged 5‒13 years sedentary computer or (0.006) (boys>girls)
pandemic on through an online lifestyle by video games
physical activity survey reported by gender
and sedentary parents)
behaviour in Talking on Significant Increased (+)
children living phone/texting (0.008) (girls>boys)
in the US
(Dunton et al.
2020)

Physical Spain (Children Cohort Children Sedentary time Significant Increased (+)
activity, aged 4 to 6 years experience (p=0.006)
sedentary from 3 (three) during lockdown
behaviour, different schools
sleep, and sleep- (n=268). The data
regulation in comes from the
Spanish initial assessment
pre-schoolers (September‒
during the December 2019)
COVID-19 and the second
lockdown evaluation in
(Alonso- March‒April
Martinez et al. 2020)
2021)

144 J. Gizi Pangan,Volume 17, Number 3, November 2022

 COVID-19 and children: A scoping review
Continue from Table 1

Title Country Type of Association

Variable Result
(Author; Year) (Participant) study Significancy Type Direction
Screen time
Physical activity Netherland Cohort Before COVID Screen time
behaviour and (Cohort A= vs during related to school
screen time in children aged COVID
Dutch 4‒18 years - Cohort A Significant Increased (+)
children during (p=0.04)
participating in
the COVID-19 Children Obesity
pandemic: pre-, - Cohort B No data n/a n/a
and Lifestyle
during-and post- during COVID-19
school closures (COLC) (n=102); Weekday screen
(Ten Velde et al. time
2021) Cohort B=
children ages 7‒12 - Cohort A Not n/a n/a
years from significant
clinicatrial.gov
study: - Cohort B Significant Increased (+)
NCT03440580 (p<0.01)
(n=131)

Physicalactivity Spain (Children Cross- Screen time Screen time Significant Increased (+)
and Daily aged 0‒12 years sectional during (p=0.013) (boys>girls)
Routine among (n=837), 50.2% COVID-19
Children Aged boys (n=420) Screen time Daily screen Significant Increased (+)
0‒12 during and 49.8% during time (p=0.000) (older>younger)
the COVID-19 girls (n=417)) COVID-19
Pandemic in by age
Spain (Cachon-
Screen time The highest Significant n/a n/a
Zagalaz et al.
during screen time was (p=0.043)
2021)
COVID-19 by in children with
family type single parents
compared to
other children
Screen time The more active Significant Decreased (-)
during children, the (p=0.018)
COVID-19 by screen time will
children’s level decrease
of active
Nutritional status
Paediatric BMI United State of Cohort BMI changes Children aged Significant Increased Potentially
changes during America (Children (∆BMI) vs age 6‒9 years (p=0.002) (+)
COVID-19 aged 6‒17 years group
pandemic: An (n=191,846) with
electronic health details taken from
Children aged Significant Increased Potentially
record-based the results of the
10‒13 years (p=0.003) (+)
retrospective WCC U.S
cohort study Electronic Health
(Brooks et al. Record (EHR)
Children aged Not n/a n/a
2021) data from
14‒17 years significant
Optum 2017‒2019
(n=144,714)
and 2020 data
(n=47,132)

Projecting the United State of Cohort BMI and BMI in girls in Significant Increased (+)
impact of the America (Children Childhood the group of (p<0.05)
coronavirus who come from Obesity children with
disease various Prevalence COVID-19
(continue) (continue) compared to the
control.

J. Gizi Pangan,Volume 17, Number 3, November 2022 145

Nugroho et al.

Continue from Table 1

Title Country Type of Association

Variable Result
(Author; Year) (Participant) study Significancy Type Direction
(continue) (continue) The prevalence Significant Increased (+)
2019 pandemic economic of obesity in the (p<0.05)
on childhood backgrounds, group of girls
obesity in the races, regions with COVID-19
United States: a (n=15.631), were compared to the
microsimulation taken from data control group
model from the Early
(An 2020) Childhood
Longitudinal
Study,
Kindergaten class
of 2010‒2011
(ECLS-KC:2011)

Another cross-sectional study by Cachon- have experienced an increase in BMI during the
Zagalaz et al. (2021) noted several results. They COVID-19 pandemic. Both studies also reported
reported that screen time significantly increases that obesity prevalence has inclined in girls and
in boys and girls. However, boys experienced a boys.
higher increase in screen time than girls do. An Lange et al. (2021) have found increase in
identical condition has also been found in older children’s BMI values. The BMI of children aged
children compared to younger ones (Cachon- 2-19 years has doubled during the COVID-19
Zagalaz et al. 2021). Children with a single pandemic (Lange et al. 2021). Children who were
parent have more screen time than other children initially overweight or obese before the pandemic
do although the difference was not significant experienced a higher average BMI increase than
(p=0.043). Meanwhile, active children have children with a normal weight do (Lange et al.
shown less screen time than physically not active 2021). The increased BMI is triggered by an
children with a p-value of 0.018 (Cachon-Zagalaz online or hybrid environment which reduces
et al. 2021). children’s opportunities to do physical activities
According to Musa et al. (2021), screen use or obtain healthy food as provided at school
was necessary during the COVID-19 pandemic. (Lange et al. 2021).
Parents are strongly advised to have vigilance of Another study has revealed a change in the
screen-time sedentary behaviour as a precursor of Z-score of children during the pandemic (Weaver
NCDs (Musa et al. 2022). Another study deploys et al. 2021). Weaver et al. (2021) also state that
that increasing screen time in children during the girls have a higher increment of the z-score than
pandemic is unavoidable, but screen time not for boys do. They argue that this change was caused
school purposes or learning activities should be by children’s difficulty to access scheduled
limited (Olive et al. 2021). Olive et al. (2021) regular activities, compulsory physical activities,
mentioned that an increase in screen time can and physical education at school (Weaver et al.
usually be accompanied by sleep disturbances, 2021). Children also experienced food insecurity
mental health problems, and physical activity since they cannot access healthy food usually
issue that strongly urge all families to significantly provided by the school as well as experience
deal with this issue (Olive et al. 2021). changes in sleeping time; both were factors
triggering overweight and obesity (Weaver et al.
Nutritional status of children during the 2021).
COVID-19 pandemic
Two studies reported a significant increase CONCLUSION
in children’s BMI as presented in Table 1. Brooks
et al. (2021) report that children aged 6‒9 years This review has generally shown the
and 10‒13 years significantly increased their advanced risk of overweight and obesity in
BMI; this condition did not occur among children childhood during the pandemic. The results of
aged 14‒17 years. An (2020) reports that girls the review strengthen other studies that underline

146 J. Gizi Pangan,Volume 17, Number 3, November 2022

 COVID-19 and children: A scoping review

a potentially grown prevalence of overweight and Brooks CG, Spencer JR, Sprafka JM, Roehl KA,
obesity. Therefore, the results of this review could Ma J, Londhe AA, He F, Cheng A, Brown
serve as a consideration to determine a better CA, Page J. 2021. Pediatric bmi changes
preventive strategy for dealing with the prevalence during covid-19 pandemic: An electronic
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the pandemic must be immediately addressed Cachon-Zagalaz J, Zagalaz-Sanchez Ma,
to increase children’s physical activities outside Arufe-Giraldez V, Sanmiguel-Rodriguez
school hours at home. All parties must respond A, Gonzalez-Valero G. 2021. Physical
to changes in the nutritional status of children activity and daily routine among children
by suppressing the causative factors, such as aged 0‒12 during the covid-19 pandemic
low physical activities, increased sedentary in Spain. Int J Environ Res Public Health
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