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Background: Restrictions related to the COVID-19 pandemic affected many health behaviours, including diet. We aimed to examine changes in food and drink purchasing during the first 3 months of the COVID-19 pandemic in England., Methods: In this interrupted time-series analysis, we used transaction-level purchasing data for food and drink items bought for at-home (n=1245 households) and out-of-home consumption (n=226 individuals) for London and the North of England (Kantar GB). Outcomes included household-level weekly purchased total energy, energy from specific products, alcohol volume, and frequency of out-of-home purchasing occasions. We compared purchases between March 16 and June 11, 2020 (pandemic restrictions, the intervention) and Jan 1, 2019, to March 15, 2020 (counterfactual). The effect of the intervention was modelled using 2-part negative binomial regression models adjusted for time, season, festivals, region, and sociodemographic characteristics. Subgroup analyses explored interactions between the intervention and sociodemographic characteristics and usual purchasing levels., Findings: The marginal mean estimate of total take-home energy purchased was 17·4% (95% CI 14·9-19·9; 6130 kcal) higher during the intervention period than during the counterfactual period. Increases of 35·2% (23·4-47·0; 505 mL) in take-home volume of alcoholic beverages and 1·2% (0·1-2·4; 165 kcal) in foods and drinks high in fat, salt, and sugar were observed. Reductions in purchased energy from ultraprocessed foods (-4·0%, -5·2 to -2·8; -541 kcal), and out-of-home purchasing frequency (-44·0%, -58·3 to -29·6; -0·6 days) were observed. Highest socioeconomic status was associated with largest increases in total purchased energy (increase of 7217 kcal, 95% CI 5450-8985, vs 2479 kcal, 935-4023, among low socioeconomic status), while older age groups reported fewer changes in purchasing. Higher usual purchasing levels were associated with greater reductions during pandemic restrictions and vice versa, except for the absolute difference in alcohol purchasing, which increased the most for those with higher pre-pandemic purchasing (lowest 123·2 mL, 95% CI 71·3-175·0; highest 708·3 mL, 381·3-1035·3)., Interpretation: Pandemic restrictions were associated with marked changes in purchasing, notably increases in energy and alcohol and decreases in ultra-processed-food and out-of-home purchasing, which differed by individual characteristics. Future research should ascertain if changes persisted, if these changes translate into changes in health, and whether other regions experienced similar effects., Funding: National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR)., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Online food delivery services facilitate access to unhealthy foods and have proliferated during the COVID-19 pandemic. This study explores associations between neighbourhood deprivation and exposure to online food delivery services and changes in exposure by deprivation during the first year of the pandemic. Data on food outlets delivering to 661 postcode districts in London and the North of England in 2020 and 2021 were collected from three online delivery platforms. The association between area deprivation and overall exposure to online food delivery services was moderated by region, with evidence of a positive relationship between count of outlets and deprivation in the North of England, and a negative relationship in London. There was no association between area deprivation and growth of online food delivery services. Associations between neighbourhood deprivation and exposure to the digital food environment vary geographically. Consequently, policies aimed at the digital food environment need to be tailored to the local context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)