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Background Since early 2020, the Covid-19 pandemic has engulfed the world. Amidst the growing number of infections and deaths, there has been an emphasis of patients with non-communicable diseases as they are particularly susceptible to the virus. The objective of this literature review is to systematize the available evidence on the link between non-communicable diseases and Covid-19. Methods We have conducted a systematic review of the literature on Covid-19 and non-communicable diseases from December, 2019 until 15th of November, 2020. The search was done in PubMed and in doing so we used a variety of searching terms in order to isolate the final set of papers. At the end of the selection process, 45 papers were selected for inclusion in the literature review. Results The results from the review indicate that patients with certain chronic illnesses such as diabetes, hypertension (and other cardiovascular diseases), chronic respiratory illnesses, chronic kidney and liver conditions are more likely to be affected by Covid-19. More importantly, once they do get infected by the virus, patients with chronic illnesses have a much higher likelihood of having worse clinical outcomes (developing a more severe form of the disease or dying) than an average patient. There are two hypothesized channels that explain this strong link between the chronic illnesses enumerated above and Covid 19: (i) increased ACE2 (angiotensin-converting enzyme 2) receptor expressions, which facilitates the entry of the virus into the host body; and (ii) hyperinflammatory response, referred to as “cytokine storm”. Finally, the literature review does not find any evidence that diabetes or hypertension related medications exacerbate the overall Covid-19 condition in chronic illness patients. Conclusions Thus, the evidence points out to ‘business as usual’ disease management model, although with greater supervision. However, given the ongoing Covid-19 vulnerabilities among people with NCDs, prioritizing them for the vaccination process should also figure high on the agenda on health authorities.

One common strategy for governments to tackle the non-communicable disease (NCD) epidemic is front-of-package (FOP) nutrition labeling. The Kingdom of Saudi Arabia (KSA) is considering implementing a new FOP label that is based on either France’s Nutri-Score (NS), which labels all foods (A = healthiest to E = least healthy) based on overall nutritional quality, or the Chilean warning label (WL) approach, which identifies foods to avoid based on select nutritional characteristics. Using a fully functional online grocery store, this study aimed to test these two promising FOP strategies by randomizing 656 KSA adults into one of the three versions of the store to complete a hypothetical grocery shop: no-label (control), NS, and WL. The NS was modified with a sugar percentage tag given that reducing sugar consumption is one of KSA’s public health goals. We found that both modified NS labels and Chilean warning labels positively influenced food and beverage choices among KSA participants, but there were differential effects across the two labels. Relative to the control, NS improved the overall diet quality of the shopping baskets, measured by the weighted (by the number of servings) average NS point (ranging from 0, least healthy, to 55, healthiest), by 2.5 points [95% CI: 1.7, 3.4; p < 0.001], whereas results for WL were not statistically significant (0.6 points [95% CI: −0.2,1.5]). With respect to each nutritional attribute, we found that NS reduced sugar intake per serving, whereas WL was effective at decreasing energy and saturated fat intake per serving from food and beverages purchased. Our results suggest that the NS approach that identifies the healthiness of all foods using a holistic approach appears preferable if the purpose of the label is to improve overall diet quality as opposed to addressing select nutrients to avoid.

The metabolic syndrome (MetS) is routinely operationalised as a cluster of adverse risk factors for both cardiovascular heart disease and type 2 diabetes. Amongst the risk factors which may contribute to the development (and consequences) of MetS is sleep. The overarching aim of the present thesis is to generate an improved understanding of the available evidence regarding the speculative relationship between sleep and MetS. After a systematic review and meta-analysis of previous empirical studies exploring the relationship between MetS and sleep, the present study draws on a large-scale, nationally representative survey of UK adults in which directly measured and self-reported MetS symptoms/components and self-reported sleep characteristics have been recorded; and assesses the reliability of self-reported indicators of MetS before re-evaluating the association between MetS and sleep. The systematic review suggested that, while there is some evidence of an association between MetS and sleep across a range of sleep-related characteristics, this evidence draws on a small number of non-UK cross-sectional studies, some of which involved methods that are prone to error and bias. On the other hand, the self-reported MetS components identified in the UKHLS questionnaires provided substantial agreement with direct measures thereof. The subsequent associations observed between three key components of MetS (elevated waist circumference; high blood pressure; and diabetes – and different combinations thereof) and seven self-reported sleep characteristics were dependent upon: the specific sleep characteristic examined; the choice of referent group used; adjustment for sociodemographic and/or lifestyle covariates; and the use of self-reported or directly measured MetS components. Key differences between these findings and those of previous studies suggest these associations remain speculative and subject to methodological and contextual variation between studies.