Dear Dr. Verly-Miguel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 26 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Bruno Luciano Carneiro Alves de Oliveira

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

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2. Thank you for stating the following financial disclosure: 

"Funding received according to the grant n° 255937: Emergencial Action COVID-19 - Call C - Support for Research Network Projects on SARS-CoV-2/COVID-19. Funding provided by Carlos Chagas Filho Foundation (FAPERJ)."

Please state what role the funders took in the study.  If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" 

If this statement is not correct you must amend it as needed. 

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

4. Please upload a copy of Figure 4, to which you refer in your text on page 16. If the figure is no longer to be included as part of the submission please remove all reference to it within the text.

Additional Editor Comments:

Introduction

As the results are presented by gender, I suggest considering this difference in the introduction.

Methods

In what period, month, year and wave of COVID-19? Was this research done? Did we already have a vaccine? If so, may or may not this have affected the perception of the pandemic and thus anxiety and depression or eating habits?

No sample calculation was carried out?

What is the sampling power to capture differences in relation to population size?

The authors must consider that they are two instruments for the epidemiological screening of anxiety and depression and not for the clinical diagnosis of these conditions.

The sociodemographic variables that make up the article, especially in table 1, were not described in the methods section. For example, area of study and what corresponds.

Was the research approved by a research ethics committee in Brazil? What number indicates this approval?

Discussion

Can it be said that mental health problems were identified with the questionnaires administered? Or would it be better to talk about the symptoms of the conditions being researched?

There are other limitations that the authors did not mention: Information, memory, confirmation bias. This is tracking data. Sample size. University students from a single state in Brazil, with a financial standard that may define a dietary pattern that may be different from the general and non-university adult population.

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Dear Dr. Verly-Miguel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Comments follow at the end of the email.

==============================

Please submit your revised manuscript by May 04 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Sandro Vieira Soares, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Based on the reviewers' reports, I have carefully evaluated the manuscript and would like to recommend a minor revision. While the manuscript is of high quality and contributes significantly to the field, there are a few points raised by the reviewers that require clarification or adjustment before proceeding with publication.

Reviewer 2:

The conclusion of the article is concise but does not sufficiently address the main findings and implications of the study. For a manuscript submitted to a high-impact journal like PLOS ONE, it is recommended that the Conclusion section be more comprehensive, reflecting the following points:

Summary of key findings: The conclusion should synthesize the main findings discussed in the paper, particularly the significant relationship between symptoms of anxiety and depression and the increased consumption of hyperpalatable foods, mediated by meal substitution with snacks. This is crucial to reinforce the importance of the discoveries.

Practical and scientific implications: The impact of the results on the mental and behavioral health of university students should be emphasized more strongly. For example, the conclusion could discuss the potential long-term implications of these eating habits for both the mental and physical health of the university population.

Study limitations: While the limitations have been addressed in the discussion, it would be important to briefly mention them in the conclusion, particularly the high non-response rate and the online data collection method, which may affect the generalizability of the results.

Suggestions for future research: Including a brief mention of future research directions could enhance the conclusion. For instance, suggesting longitudinal studies to investigate the continuity of these eating behaviors post-pandemic or applying the study to other university populations from different geographical and socioeconomic contexts.

A more robust conclusion would help better contextualize the results and provide a clearer understanding of the study’s relevance to the field of public health and eating psychology. Additionally, it could strengthen the paper’s impact on its readership.

Reviewer 3:

In the process of composing and describing variables, the authors treat the self-reported manifestations of anxiety and depression symptoms as mental disorders. The reviewer considers that this expression can lead to confusion to the less experienced reader on the subject, since it would characterize the possibility of considering the presence of mental disorders by the set of answers to the questionnaires. Although it is known by the authors that this is not the main objective of their work, the reviewer is careful to characterize the possible confusion on the part of the reader. It is therefore suggested that the authors may replace the expression mental disorders with self-reported symptoms of anxiety and/or depression, or even with responses of self-reported symptoms of anxiety and/or depression.

The discussion item presents a close relationship between the objectives of the investigation and the findings in the international and national literature regarding the possibility of explaining the characteristics of food choice and manifestations, whether demographic, school, gender, or even from the interference of symptomatic manifestations of anxiety and depression. The conclusion can be briefly expanded to account for the main aspects, including limitations, of the study, even if they are presented in the previous topic.

The study deals with a sensitive, important, current and relevant theme in the context of human development, collective health, nutritional health as well as social processes related to the university environment, in a specific period that was the COVID-19 pandemic. For these reasons, the reviewer reinforces the need for and importance of the manuscript being clear and not generating doubts, while encouraging authors to rectify it.

Reviewer 4:

Title – I suggest including a mention of covid-19.

Abstract – The sentence about the analysis method is after the results. I suggest inverting it.

Introduction – I suggest inserting the percentage value next to the numbers 3.973 and 771 (line 72)

Methods

• Sample weighting – There is no need to repeat the values 5.9 and 18.7 (lines 83 and 84)

• Questionnaire: If possible, insert a bibliographic reference in line 88, when it is mentioned that 29 food-items frequently cited in dietary surveys in Brazil were included or inform the types of foods included.

• Study variables – check if the translation of the meaning of the acronym BMI (weight status?) is correct

• Data Analysis – Press enter in the sentence that begins with ‘To assess the goodness...’ (line 145)

Results

� Standardize table formatting (see detailed item below).

� Complete the value after the decimal point in the text. It was not presented in line 182 (46%)

� There are sentences that are in this section, but that should be taken to the methods section. Lines: 204 to 210 ‘Modification indexes were used... with cakes consumption’. Or for the Discussion section – lines 196 to 201

Discussion

� There is no need to repeat the results presented previously. If they are maintained, leave only one space after the comma. Example: lines 286 – (65.24%), 287, 291, 292, 310

Conclusion – Insert recommendations for health strategies or policies that can change this reality.

References – Check if the way of presenting the references is in accordance with the journal’s instructions. There are some that contain ellipses in the presentation of the authors/co-authors. Examples: 15, 18, 20, 33 and 35.

Tables

� The titles of all tables should be complemented with the location and year.

� (,) and (.) are being used to present the percentage values. Correcting

� There are percentage values where a decimal point was not added (example Married – table 1)

� The tables need to be reformatted as tables. There are several corrections to be made. Example: dividing lines should not be used below the variables that correspond to the columns.

� It is not necessary to repeat (p=) in all the values that appear in the p-value column

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

Reviewer #2: (No Response)

Reviewer #3: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: (No Response)

Reviewer #3: Yes

Reviewer #4: Yes

**********

Reviewer #1: I would like to commend the authors for the excellent work presented. The study is well-executed, relevant, and addresses a timely and significant issue in the context of mental health and eating habits during the COVID-19 pandemic. The methodology employed was appropriate and robust, and the data analysis, particularly the use of structural equation modeling, effectively explored the interrelationships between symptoms of anxiety and depression and the consumption of hyperpalatable foods. The results are relevant and make a valuable contribution to understanding the impact of the pandemic on the eating behaviors of Brazilian university students, providing important insights both for academia and public health policies.

The conclusion of the article is concise but does not sufficiently address the main findings and implications of the study. For a manuscript submitted to a high-impact journal like PLOS ONE, it is recommended that the Conclusion section be more comprehensive, reflecting the following points:

Summary of key findings: The conclusion should synthesize the main findings discussed in the paper, particularly the significant relationship between symptoms of anxiety and depression and the increased consumption of hyperpalatable foods, mediated by meal substitution with snacks. This is crucial to reinforce the importance of the discoveries.

Practical and scientific implications: The impact of the results on the mental and behavioral health of university students should be emphasized more strongly. For example, the conclusion could discuss the potential long-term implications of these eating habits for both the mental and physical health of the university population.

Study limitations: While the limitations have been addressed in the discussion, it would be important to briefly mention them in the conclusion, particularly the high non-response rate and the online data collection method, which may affect the generalizability of the results.

Suggestions for future research: Including a brief mention of future research directions could enhance the conclusion. For instance, suggesting longitudinal studies to investigate the continuity of these eating behaviors post-pandemic or applying the study to other university populations from different geographical and socioeconomic contexts.

A more robust conclusion would help better contextualize the results and provide a clearer understanding of the study’s relevance to the field of public health and eating psychology. Additionally, it could strengthen the paper’s impact on its readership.

Reviewer #2: PONE-D-24-00167_R1 – Review - Anxiety and depression negatively affected the eating habits of university students in Brazil

In this review, I was only responsible for assessing whether the authors had responded to the suggestions for changes made by previous reviewers.

I found that all suggestions were accepted and questions answered. I therefore consider the manuscript accepted for publication.

I would like to take this opportunity to also make some suggestions, only for some additional improvements. There is no need to return it to me.

Title – I suggest including a mention of covid-19.

Abstract – The sentence about the analysis method is after the results. I suggest inverting it.

Introduction – I suggest inserting the percentage value next to the numbers 3.973 and 771 (line 72)

Methods

• Sample weighting – There is no need to repeat the values 5.9 and 18.7 (lines 83 and 84)

• Questionnaire: If possible, insert a bibliographic reference in line 88, when it is mentioned that 29 food-items frequently cited in dietary surveys in Brazil were included or inform the types of foods included.

• Study variables – check if the translation of the meaning of the acronym BMI (weight status?) is correct

• Data Analysis – Press enter in the sentence that begins with ‘To assess the goodness...’ (line 145)

Results

� Standardize table formatting (see detailed item below).

� Complete the value after the decimal point in the text. It was not presented in line 182 (46%)

� There are sentences that are in this section, but that should be taken to the methods section. Lines: 204 to 210 ‘Modification indexes were used... with cakes consumption’. Or for the Discussion section – lines 196 to 201

Discussion

� There is no need to repeat the results presented previously. If they are maintained, leave only one space after the comma. Example: lines 286 – (65.24%), 287, 291, 292, 310

Conclusion – Insert recommendations for health strategies or policies that can change this reality.

References – Check if the way of presenting the references is in accordance with the journal’s instructions. There are some that contain ellipses in the presentation of the authors/co-authors. Examples: 15, 18, 20, 33 and 35.

Tables

� The titles of all tables should be complemented with the location and year.

� (,) and (.) are being used to present the percentage values. Correcting

� There are percentage values where a decimal point was not added (example Married – table 1)

� The tables need to be reformatted as tables. There are several corrections to be made. Example: dividing lines should not be used below the variables that correspond to the columns.

� It is not necessary to repeat (p=) in all the values that appear in the p-value column

�

Reviewer #3: The manuscript presented refers to a study to monitor eating habits in a sample of university students from a state in the southeastern region of Brazil, during the COVID-19 pandemic period. The authors use a set of varied, pertinent and compatible references to the theme and current events. The manuscript, written in a clear and objective way, seeks to establish possible associations between the process of food choice and symptomatic manifestations of anxiety and depression. The authors present a methodological set capable of meeting this objective, detailing the aspects of sampling, instrumental, statistical analysis and procedures, thus characterizing the possibility of reproduction of the present study. The statistical processes described are compatible with those recommended by international literature and meet the objective and characteristics of the defined variables. The use of tables and charts is pertinent and compatible with the need of illustrating the information to the reader of the findings.

In the process of composing and describing variables, the authors treat the self-reported manifestations of anxiety and depression symptoms as mental disorders. The reviewer considers that this expression can lead to confusion to the less experienced reader on the subject, since it would characterize the possibility of considering the presence of mental disorders by the set of answers to the questionnaires. Although it is known by the authors that this is not the main objective of their work, the reviewer is careful to characterize the possible confusion on the part of the reader. It is therefore suggested that the authors may replace the expression mental disorders with self-reported symptoms of anxiety and/or depression, or even with responses of self-reported symptoms of anxiety and/or depression.

The discussion item presents a close relationship between the objectives of the investigation and the findings in the international and national literature regarding the possibility of explaining the characteristics of food choice and manifestations, whether demographic, school, gender, or even from the interference of symptomatic manifestations of anxiety and depression. The conclusion can be briefly expanded to account for the main aspects, including limitations, of the study, even if they are presented in the previous topic.

The study deals with a sensitive, important, current and relevant theme in the context of human development, collective health, nutritional health as well as social processes related to the university environment, in a specific period that was the COVID-19 pandemic. For these reasons, the reviewer reinforces the need for and importance of the manuscript being clear and not generating doubts, while encouraging authors to rectify it.

Reviewer #4: Manuscript Review Report – PLOS ONE

Dear Editors,

After a detailed analysis of the submitted manuscript, I highlight the following observations regarding adherence to PLOS ONE's criteria and the corrections made by the authors:

1. Manuscript Style:

It was requested that the manuscript comply with PLOS ONE's style requirements. The authors reported that they revised the text according to the required guidelines, ensuring greater clarity and standardization.

2. Funding Statement:

The journal requested that the authors specify the role of funders in the study. The following statement was included: "The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript." This information is now clear and in accordance with the guidelines.

3. Ethics Statement:

The authors were asked to include the complete ethics statement in the Methods section, specifying the responsible committee and participant consent. They confirmed that the study was approved by the Research Ethics Committee of the Institute of Social Medicine at the State University of Rio de Janeiro, under opinion number 4.189.209.

4. Figures and Tables Correction:

An error was identified in the mention of a nonexistent figure. The authors clarified that the reference to “Figure 4” was incorrect and that it actually referred to “Table 4.” The manuscript was appropriately corrected.

5. Methodological Adjustments:

Reviewers requested more details about the data collection period and the vaccination situation in Brazil during the study. The authors clarified that the data were collected between August 6, 2020, and March 13, 2021, during the second wave of COVID-19, when vaccines were not yet available in the country.

6. Sample Size Calculation:

It was questioned whether the sample size calculation was performed and what the statistical power was to detect significant differences. The authors explained that the statistical power was 0.8, considering a minimum sample of 384 participants, with a 50% proportion and a 0.05 error.

7. Distinction Between Screening and Diagnosis:

Reviewers emphasized that the instruments used were intended for epidemiological screening, not clinical diagnosis. The authors adjusted the text to clarify that the approach was based on the identification of self-reported symptoms.

8. Sociodemographic Variables:

Reviewers noted that some variables, such as the area of study, were not described in the Methods section. In response, the authors removed this variable from Table 1, as it was not used in subsequent analyses.

9. Study Limitations:

Limitations were pointed out, such as recall bias, confirmation bias, and the representativeness of the sample, composed of university students from a single Brazilian state. The authors acknowledged these limitations and included the observations in the appropriate section of the manuscript.

Conclusion:

The authors addressed the reviewers' requests, making the necessary corrections regarding technical, methodological, and ethical aspects. Given the changes made and the clarity of the justifications provided, I consider the manuscript suitable for publication, provided that the editors are satisfied with the revisions made.

Sincerely,

Andréa Cristina Alves

PLOS ONE Reviewer

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  JOAO CARLOS ALCHIERI

Reviewer #4: No

**********

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org

Depression, anxiety and change in eating habits during the COVID-19 pandemic in Brazilian university students

PONE-D-24-00167R2

Dear Dr. Verly-Miguel,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sandro Vieira Soares, Ph.D.

Academic Editor

PLOS ONE