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Introduction

In December 2019 in the city of Wuhan, China, in the province of Hubei, medical authorities classified several cases of pneumonia of unknown etiological origin. This alerted health authorities worldwide, warning about the possible spread of this microorganism of unknown origin and with a remarkably aggressive symptomatology, causing the death of those infected. Due to the need of knowledge about the outbreak of this microorganism, some investigations were oriented, generated that they were undertaken, so they managed to have more knowledge and therefore a new classification; new Coronavirus, which, if not properly treated, was the cause of severe acute respiratory syndrome. This is how they managed to identify the Coronavirus 2 (SARS CoV-2), causal agent of the new respiratory disease, COVID-19 (1, 2, 3).

In March 2020, the World Health Organization (WHO) declared COVID-19 as a pandemic. Some countries decided to follow health recommendations, such as confinement and social distancing (4).

Since then, and until now, joint efforts have been generated that contribute to the decrease in the incidence rate and spread of the various variants of COVID-19. This had an impact on several productive sectors of the countries, including the education sector (5). These efforts and, specifically, the confinement had an important impact on education and eating habits in students of all educational levels. Psychological factors are related to overweight or obesity, according to a study conducted on university students (6).

Confinement as a preventive measure brought not only reassurance that COVID-19 would not spread, but it also reduced the perceived anxiety about the development of SARS-COV2 in its new variants over time (7).

It is considered that confinement can result in a decrease in physical activity, an increase in unhealthy eating patterns, for example, consumption of saturated fats and ultra-processed foods (pastries, cookies, packaged bread, desserts), thus generating unhealthy lifestyle habits that put at risk the quality of life of individuals and also a possible development of Chronic Non-Communicable Diseases (NCDs) (8).

It is known that NCDs have a close relationship with eating patterns and behaviors in adults, free and conscious in the choice of food they decide to eat. Some NCDs are type II diabetes mellitus, hypertension, dyslipidemia, overweight and obesity, protein-energy malnutrition, folate or iron-dependent anemias. These diseases are related to unhealthy eating patterns, adopted by the community, and it is known that there is a significant deterioration in people living with them, when they are not controlled or attended by the medical-nutritional team. It is for this reason that the implementation of an adequate nutrition and health orientation should be considered (9).

According to the National Health and Nutrition Survey, 2018 (5) (ENSANUT, 2018) applied to 126.5 million Mexican people, there was a combined prevalence of obesity of 75.2% in adults over 20 years old, in addition, 19.5% of the sample presented high levels in triglycerides and serum cholesterol, while 6.7% of Mexicans reported knowing their diagnosis about diabetes mellitus type II, while 12 % of Mexicans claimed to live with arterial hypertension. There is an increase and, in the same sense, a greater concern for the development of ENTCAN in the Mexican adult population over 20 years of age.

The data obtained from the ENSANUT show that Mexico belongs to one of the countries with a high rate for the development of NCDs. There is also concern about the development of these diseases, it also requires adequate guidance for the acquisition of healthy lifestyle habits (HLHs) that provide attitudes and skills for the improvement of dietary patterns and habits. On the other hand, the system leaves disease prevention in the background (10). Regarding healthy lifestyle habits, the following was reported: 63.8% of Mexicans stated that they consumed alcohol, 29% consumed tobacco. In another sense, only 29% of Mexican respondents performed less than 150 minutes of physical activity at the time of the survey during the day. This is the minimum recommended amount of physical activity per week, according to the WHO. High alcohol consumption, combined with low levels of physical activity, could be relevant factors in the early development of ENTCAN in the Mexican population over 20 years of age (11).

Regarding eating habits in the frequencies of food consumption, applied to Mexicans older than 20 years, at the time of the survey, the following was observed in consumption of healthy foods: it was highlighted a low consumption of fruits and vegetables (49.7% and 44.9%), respectively, in addition, a high consumption of sugary drinks (85.8%), (5). A low consumption of fruits and vegetables can cause an increase in metabolic fats, resulting in heart problems, in addition, due to the proliferation of firmicutes and bacteroidetes (constituents of the intestinal microbiota), a development of chronic gastrointestinal problems (12).

In another sense, it is known that the consumption of excessive sugar, contained in sugar-sweetened beverages (fruit juices, processed juices, processed flavored waters) and carbonated, sugar-sweetened beverages (soft drinks with syrups), are precursors in the early development of ETCAN. However, despite various public policies [increase in Value Added Tax (VAT)] to decrease the consumption of these liquids in the Mexican population, significant changes have been seen in the decline of consumption. Leaving the consumption of drinking water in the background (13).

It is good to consider the following, the development of HLHs depends on strategies planned punctually by governments, state, and federal; however, sometimes Mexico is far from them. In addition, it is necessary to bet on the training of professionals in preventive health, in addition, in the designation of this attention to the collectivities, with the intention of generating a correct orientation habit. Mexican nutritionists are the professionals to guide the task of guiding in preventive health and HLHs management.

The confinement by COVID-19 brought with it an important psychological impact on people all over the world (14), investigations carried out in Western countries: (Australia, Canada, China, Hong Kong, etc.). Composed by the review of 25 scientific articles, they managed to highlight the following: it could be observed how people developed problems at a psychological level, affecting their mood derived from: uncertainty, little information, and fear of contagion by COVID-19, to mention a few (14). 

In another sense, Romero-Díaz, and Matamoros (2020) conducted a study composed of 214 students in Nicaragua, where they evaluated, through the scale "Satisfaction with life scale" (SWLS), the satisfaction that the students perceived during the confinement. The descriptive data obtained in the psychological factor of the students considered the following (15): "to feel fear during the pandemic," evident data due to the little information that existed at the beginning and during the confinement derived from the COVID-19. This research allows us to recognize how, in general, the population and university students perceived greater uncertainty, depending on the lack of knowledge about the pandemic and the COVID-19 confinement.

Taking into account the above, it is necessary to know what is the impact and its possible relationships with eating behaviors and eating habits, in addition, if these are related (6) with school performance and learning of college students, focusing on the following educational theories: ecology of human development, constructivist, and sociocultural. These theories will help to look with a broad approach, in addition, in the understanding of the possible that they keep in the relationship of behavior and eating habits in college students.

Method

The present work was retrieved from a review of scientific articles, whose objective was to determine if the eating behaviors during the pandemic and confinement derived from COVID-19 have an impact on school performance and learning of university students. To do this, a search for scientific articles related to the topic was conducted. The search was composed of original articles and review articles, using the following search engines: "Google Academic," "Redalyc," and "Pubmed." The search for articles began in February 2022 and ended in March 2022.

To locate articles that will be related to eating behavior, school performance, and learning, the filter no older than five years was applied; the different search strategies were used: ("Learning" [MeSH] or "Learning" [in title and abstract]) and ("Eating behavior" [MeSH] or "Eating behavior" [in title and abstract] and "School performance" [MeSH] or "School performance" [in title and abstract] and "Healthy lifestyle habits" [MeSH] or "healthy lifestyle habits" [in title and abstract] or "learning styles" [in title and abstract] or "risky eating behaviors" [in title and abstract]).

Once the titles and summaries of the different articles were obtained, we discarded those articles that did not fit the topic; they would be carried out in preschoolers, schoolchildren, and adolescents or were very short interventions. In another sense, we discarded all those in which it was impossible to read beyond the title/summary.

Finally, a total of fifteen articles were selected and included in the review, six referring to eating behavior and COVID-19 confinement, four referring to healthy lifestyle habits in university students and COVID-19 confinement, and five referring to performance/learning in university students and COVID-19 confinement.

Results

Educational theories: ecology of human development, constructivist, and sociocultural

The ecological theory of human development, postulated by Bronferbrenner, 1987 (16), "It comprises the scientific study of the progressive mutual accommodation between an active, developing human being and the changing properties of the immediate environments in which the developing person lives" (p.729). It is possible to emphasize the importance of the surroundings and the environment on the development of the human beings; an adequate environment will bring benefits for the integral health of the people. Therefore, the care of the systems for the development of the human being: macrosystem, microsystem, and mesosystem, will have as an objective the acquisition of HLHs that contribute to a better quality of life (16). 

In the same sense, nutrition is implicit in the development of these spheres, which will have an impact on adequate growth, for example, adults with smaller stature tend to suffer from food insecurity in their childhood. This forces us to question the need to adequately inform about the importance of the structure of these systems and their relationship with the HLHs for communities, with the intention that these are key to proper development at different stages of life (16). 

The duality that exists between food scarcity and excess weight in the population worldwide is not fully understood (17). Considering the contributions of Stuckler and Nestle (2012), the system of food distribution in the population must be improved. It is clear that this distribution becomes a problem and this inequitable distribution dictated by the macrosystem will directly affect the microsystem, which will affect the possibility of acquiring healthy food and the possibility of having recreational times that contribute to a quality of life shaped by HLHs (17).

In the same vein, maldistribution during the COVID-19 pandemic may have had an impact on HLHs improvement; furthermore, this distribution was mostly limited by confinement and border closures between different countries, it could be attributed that such government mandates may have been the causes of lower HLHs attachment, Stuckler and Nestle (2012).

The constructivist theory. In an epistemological sense, constructivism considers that (18): 

"The problem of the construction of knowledge is one of the most mysterious and enigmatic problems facing human beings... What men and women are essentially is the product of their ability to acquire knowledge that has enabled them to anticipate, explain, and control the workings of nature" (pg. 354). 

Emphasizing bases on the above, it can be perceived as food has an important role since this should be seen as a construction. This construction will give rise to a healthy or unhealthy eating pattern, linked to beliefs, attitude, and social aptitude towards the preparation, choice, etc.

Humans build from the learning and experiences lived during our lives. These constructions of knowledge can range from uses and customs, and some very particular ones such as hygiene habits, dietary habits, free time management, and incorporation of physical activity into their lives. These constructions will give rise to bodily practices, in this sense, these practices will sometimes dictate relevant scenarios in the life of the human being, the construction of a food pattern and HLHs. Seen from this approach, these turn out to be bodily practices that will allow to potentiate the quality of life of human beings. Therefore, it is possible to notice the need to evoke the HLHs construction during the confinement by COVID-19 since it could be observed how many people were victims of greater complications related to the NCDs, with which they lived previously (18). 

Returning to Vygotsky and the development of his sociocultural theory (19), the following can be observed: 

"Through coexistence, human beings tend to build knowledge that will allow them to have a better quality of life, together with the development of new learning, without leaving behind their previous experiences" (pg. 42). 

Eating patterns are established during life from early childhood, are key in the growth and eating behavior that will be acquired as adults. The proper development of these patterns, established in the family, will be carried into practice for the rest of one's life. In contrast, during the pandemic, people were forced to improve their HLHs, and this change could be attributed to fear of getting sick or dying. Although there is an opportunity to change them, sometimes the context is not conducive to changing these HLHs.

An example in the establishment of unhealthy HLHs is "the use of lard by Mexican matrons in the 20th century to flavor food." It is clear that generations in the 21st century sometimes continue to carry these unhealthy practices with them, but some others question the possible impact on their health and seek alternatives that are beneficial in preventing the early development of NCDs (19).

The above allows us to understand the importance of building and developing or, sometimes, maintaining HLHs during the adult stage, with the intention of generating greater quality of life, and in the COVID-19 context, we sought the maintenance or improvement of health, improving HLHs, which were put in less practice before it and the impact on people's lives.

Bourdieu defines lifestyle as "the routine actions product of a knowledge originated in social structures and reproduced through concrete acts and actors" (1998). The impact of non-formal education oriented to the development of HLHs, within the family, such as, the culture in each kitchen, the belief system about healthy or unhealthy food, the ways of preparation, the preference in consumption of certain foods, and other culinary practices have been the product of collective knowledge and social structure and its adoption throughout life (culinary heritage); (16, 19).

It is known in clinical nutrition that the stages of human development will demand specific nutritional requirements (kilocalories, macronutrients, micronutrients, water, and fiber); therefore, attention should be paid to the importance of building healthy eating patterns (Table 1), which will contribute to have a better quality of life and not only put into practice the improvement of healthy eating patterns in unfavorable contexts as COVID-19. In another sense, these patterns will conceive the eating behaviors of people. On the other hand, eating behaviors (Table 1) as well as patterns will contribute to the preservation of metabolic health and, therefore, the prevention of the development of NCDs through the practice of HLHs. It is worth mentioning that during the COVID-19 pandemic there may have been changes in eating behavior linked to the emotional state of individuals (9).

Table 1

Difference between eating behavior and eating pattern (20)

Food pattern	"Strong attachment to the products that make it up in the eating habits of the population, along with a marked territorial rootedness in time; it also represents a constant of traditions and a socially segmented consumption structure, an expression of national and regional culture."
Feeding behavior	"The set of actions that establish the relationship between human beings and food."

Note: Taken from: Torres-Torres, F. Changes in the dietary pattern in Mexico City. 2007; Oyarce-Merino K, Valladares-Vega M, Elizondo-Vega R, Obregón A. Eating behavior in children. 2016.

It is necessary for the nutrition professional to understand how the mentioned educational theories play an important role in human development; and how socio-cultural factors will endow the person with knowledge to make use of informed decisions, thereby building with conscious bases the choice on some foods healthier than on others that are less healthy. In addition, as such sociocultural context in the COVID-19 pandemic, it could have a negative impact on the practice of HLHs. In another sense, that the population have tools that allow to understand their food culture and allow to relearn or transform the HLHs, which do not favor the maintenance in the quality of life, will be determinants in the process of health-disease and, in the future, these could prevent them and provide them with tools that help to improve their quality of life and not be disadvantaged in contingency situations (19).

Eating behaviors in university students

Eating behavior is multifactorial, i.e., it includes psychological, biological, social/cultural and, sometimes, spiritual aspects. For Lazarevich, (2016), eating behavior in college students is key to the preservation of health, in the same sense, it is considered key to incorporate programs to generate spaces for physical activity and dietary guidance, as adjuvants in reducing stress and factors associated with the acquisition of unhealthy or risky eating behaviors. (21)

Findings related to eating behavior in Hispanic students (6) have shown that college students prefer to follow unhealthy HLHs, associated with COVID-19 confinement, binge eating, associated with emotions and food consumption, has been little studied. In a multicenter study of 829 participants, changes in body composition and eating behavior were observed. It is worth mentioning that the multicenter study was conducted in patients with eating disorders during COVID-19 confinement (22).

In review studies, it has been shown that there is a change in eating behavior associated with COVID-19 confinement, motivated by experiencing negative emotions (23). Eating behavior in students could be affected by stress overload (technostress) (24), although it is an existing topic of which little is said, it can be considered that students are affected by these feelings/emotions and the compensation with comfort foods: sweet, energy-dense foods with low nutritional intake during COVID-19 confinement (24).

This could be related to the change in the eating behavior of university students, in addition, this eating behavior may be conditioned to the technostress generated in virtual education spaces, little linked to behavioral changes, such as the eating pattern of university students (23, 24).

In a study conducted in Mexico (25), in 323 students, it was possible to locate two new components for a better understanding of eating behavior: food neophobia (fear of trying new foods) and food neophilia (daring to try new foods). This study was conducted during the COVID-19 pandemic, the data showed that women tend to be more fearful of including new foods in their diet, and they would not try foods they are unfamiliar with. These findings underscore the importance of further research to understand the "dietary variety" that dictates the laws of eating as a healthy behavior and to prevent the development of NCDs (15).

Healthy lifestyle habits in university students

When talking about healthy life habits, the following can be understood (16), "group of attitudes and behaviors that people practice and develop consciously and voluntarily during the course of their lives" (pg. 247), life habits have been altered in university students by the pandemic and the confinement derived from the COVID-19. In cross-sectional research, (Veramendi, NG. 2020) observed that the perception in university students "lifestyle," it was associated with a higher quality of life, in addition, when submitting to the analysis non-grouped data, the food practices were not entirely healthy, preferring ultra-processed foods (26).

It is necessary to return to the importance of access to food due to economic income in university students and how this could potentially affect a varied diet and consumption of foods rich in vitamin D (yogurt, cheese, etc.), animal proteins (beef, fish, seafood, pork, poultry), and fruits. In the Mexican context, these are foods that some households with low incomes have difficulty accessing. An investigation oriented to know the family income and the perception of university students shows how this influenced their emotional stability, derived from the concern of the economic income and its distribution (27). The above could reveal the difficulties and food insecurity in university students, which in turn could modify healthy life habits in them, depending on the economic income, in addition during COVID-19, different scenarios were experienced that were related to unemployment of citizens, having a lower income and, therefore, less access to nutritious food.

Regarding the HLHs that are related to their eating patterns, it was observed in investigations conducted in Latin America a poor adjustment to meal times, a high consumption of ultra-processed foods (cookies, pastries, packaged sweet bread), and a perception of weight different from the real one (real weight less than the perceived), (28). The quality of food in college students may be influenced by poor or no management of free time and procrastination dependent on their ontological stage; however, attention should be focused on the dissemination of information for decision making to generate greater HLHs.

In contrast, current research developed in Spain showed that during the confinement derived from COVID-19, regarding the change of food, habits had favorable repercussions (29); a higher consumption of healthy food was observed. Besides, there was a decrease in the consumption of unhealthy food.

In another sense, it observed an increase in food prepared at home. People acknowledged spending more than nine hours sitting and little physical activity during confinement. In addition, media publicity on the importance and relevance of nutrition and food guidance for the management of healthy HLHs, distributed by the WHO, positioned nutrition as a transversal axis in the improvement of HLHs, conscious choice of food, and home cooking practices.

In Peru, 875 adults (30), behavioral change around food was observed. Participants showed increased interest in eating healthy foods, and improved food preparation, both behavioral changes were encouraged by two important factors; the first was the belief that prevention of infection by COVID-19, and the second was associated with post-infection by COVID-19. It was believed that they would have a quick recovery and less symptomatology than people who did not follow healthy eating patterns. In addition, within the study was observed the consumption of food supplements, vitamins, and minerals that could help prevent infection or restore health, an attitude that was not noticed in previous studies. The consumption of supplements has not been of attention in Latin American countries.

In conclusion, it is possible to notice an increasing modification in HLHs, both positive and negative. Regarding those that do not seek to preserve health and avoid the development of ETCAN of the individual, they suggest as an indicator the necessary and immediate adequacy/instauration of programs that reinforce HLHs in university students, being the "terminal" education. It is necessary to reinforce the promotion of health for prevention and preservation of the quality of life (10).

Learning, school performance, and nutrition

University students perceive as a cofactor (31,32) the difficulties that have been found in the virtual educational environments, caused by the confinement derived from the COVID-19 through it. An education not centered on the student can be perceived, having repercussions on their learning and, therefore, on their school performance and, not less important, the acquisition of significant knowledge for life, and their next professional practice.

Villa et al. (2020), when conducting a cross-sectional study in 1612 university students at the beginning of the course and, consequently, an application in exam period to 872 university students. They observed that institutional communication was difficult; they did not feel comfortable in distance education, preferring face-to-face classes, and they also noted that there were unequal gaps with respect to access to virtual education (33).

Other studies, Muñoz, Lluch, (2020), and J. Clemente (2021) consider that educational inequalities in the new normality are multifactorial, affecting the acquisition and development of new learning (34). Maslow states that if the human being does not have basic aspects covered, it is difficult for him to advance to the next step that grants him self-realization. If food needs are not covered because they also depend on the economy, geographic location, etc., and are unfavorable, then academic performance can be negatively impacted (27, 31, 35).

However, Cotoonieto-Martínez, E. et al (2021); (36), invite us to reflect on the areas of opportunity, teacher training and openness to learning and the use of new technologies, oriented to the development of new skills for university students in the new normality. There are many external factors that must be considered in order to understand how students can develop learning and have optimal academic performance in the new normal.

In conclusion, research oriented to know school performance and eating habits, as well as HLHs, consider that low school performance is associated with various unhealthy eating practices: consumption of junk food, alcohol, tobacco, and drug use. In addition, university students who are overweight or obese tend to have lower academic performance. This should be a central axis in considering that nutrition has an impact on university students during the new normality caused by the pandemic and confinement derived from COVID-19 (36).

Conclusions

Considering the above data, it can be concluded that:

Eating patterns are influenced by several factors, in addition, these have an impact on unhealthy eating behaviors, and these are adopted from within the family and the lack of education and guidance in relevant food at different stages of life.

Food in Mexicans has been viewed with disinterest by the regulatory bodies of public health policies, so that inequality and inequity have generated a country that presents food insecurity, in the same sense. It is difficult for Mexicans to develop HLHs from early stages.

Programs that can be tailored to meet needs in the redirection of HLHs in college students, with the intention of helping them become adults less likely to develop ETCAN, are identified as a need.

Strategies to implement physical activity in the educational programs of university education in Mexico should emphasize the importance of the adoption of physical activity within the HLHs pantry.

The population should be informed about the proper use of dietary supplements. These recommendations should be based on scientific evidence to safeguard the safety and health of people.

The new normality forces to rethink how to develop relevant HLHs. The development of them will have an impact on the academic achievement of university students. In addition, it will decrease the repercussions that may exist at the mental level at different educational levels derived from stress; nutrition should be seen as the basis for the maintenance and prevention of these episodes. Due to the fact that mental health in university students is considered relevant, in addition, university students are considered a vulnerable group and of special attention (37). It has been observed in systematic review studies how university students perceive a decrease in their mental health caused by multiple factors. An inadequate attention to mental health could be associated to the teaching-learning processes besides affecting their academic performance and, in the same sense, their scholastic achievement. In another sense, eating behavior, as has been observed, sometimes depends on feelings and emotions, such as, worry; adding motives to the experience of emotional instability in university students.

Researchers in human nutrition are invited to generate new strategies that can relate to education and the development of adequate, realistic, and applicable HLHs in the Mexican population.

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