A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults

Mediterranean diet in the management and prevention of obesity

The current pandemic of obesity represents a major global public health problem, mainly due to its association with chronic non-communicable disabling conditions and with increased mortality. Population aging increases the chances of non-communicable chronic diseases allowing a longer exposure to risk factors for these disabling conditions. Obesity is a major risk factor contributing to pathological aging. Numerous epidemiological studies have shown that the risk of death due to cardiovascular disease and cancer increases progressively as overweight and obesity rise. Nutrition research is now focused on the effects of combinations of foods in dietary patterns instead of those of single nutrients or foods. The dietary model with the largest body of evidence of health benefit is that traditionally followed by inhabitants of some Mediterranean countries. There is evidence confirming the inverse association of adhering to Mediterranean diet with overweight and obesity. Four meta-analyses of randomized controlled trials, including up to 16 trials, have shown a greater reduction of body weight and BMI with MedDiet compared to other diets, while a meta-analysis of 7 prospective cohort studies, found a reduced risk of becoming obese and gaining weight over time associated with a higher adherence to MedDiet. This narrative review examines studies reporting inverse associations of a higher adherence to the MedDiet with overweight/obesity and with age-associated chronic diseases related to obesity.

Decreased Levels of Vitamin D in Bipolar Patients

Recently, vitamin D is considered a pleiotropic hormone, and as such, it has also become a topic of renewed interest in neuropsychiatry for its proposed role in the aetiology and pathophysiology of different psychiatric conditions, including mood disorders (MDs). This seems particularly crucial while considering the relatively high and often neglected prevalence of hypovitaminosis D in the general population and in specific groups, such as patients suffering from the most common type of MDs, which are major depression (MDD) and bipolar disorders (BDs). Therefore, in view of the controversial literature and findings on this topic and its potential therapeutic implications, the present study aimed at evaluating vitamin D levels in the plasma of a sample of inpatients fulfilling the DSM-5 criteria for mood episodes within BDs. The clinical picture was assessed by means of specific rating scales. The results showed that the vitamin D levels (mean ± SD, nM/L) of the bipolar patients of our sample were significantly lower (14.58 ± 11.27 nmol/L) than the normative values (>30 nmol/L). Eleven patients had sufficient values and only 4 had optimal, while 19 showed insufficient, 18 critical, and 17 severely critical levels. No differences emerged according to different socio-demographic or clinical features. In our opinion, the present findings strengthen previous research highlighting decreased vitamin D levels in bipolar patients and support the role of this pleiotropic hormone in BDs. Nevertheless, further studies should follow to corroborate the data of this preliminary study and to address the potential benefits of vitamin D supplementation in the treatment of MDs.

The Role of Diet as a Modulator of the Inflammatory Process in the Neurological Diseases

Neurological diseases are recognized as major causes of disability and mortality worldwide. Due to the dynamic progress of diseases such as Alzheimer’s disease (AD), Parkinson’s Disease (PD), Schizophrenia, Depression, and Multiple Sclerosis (MD), scientists are mobilized to look for new and more effective methods of interventions. A growing body of evidence suggests that inflammatory processes and an imbalance in the composition and function of the gut microbiome, which play a critical role in the pathogenesis of various neurological diseases and dietary interventions, such as the Mediterranean diet the DASH diet, or the ketogenic diet can have beneficial effects on their course. The aim of this review was to take a closer look at the role of diet and its ingredients in modulating inflammation associated with the development and/or progression of central nervous system diseases. Presented data shows that consuming a diet abundant in fruits, vegetables, nuts, herbs, spices, and legumes that are sources of anti-inflammatory elements such as omega-3 fatty acids, polyphenols, vitamins, essential minerals, and probiotics while avoiding foods that promote inflammation, create a positive brain environment and is associated with a reduced risk of neurological diseases. Personalized nutritional interventions may constitute a non-invasive and effective strategy in combating neurological disorders.

How Soon Do Depression and Anxiety Symptoms Improve after Bariatric Surgery?

Depression and anxiety are prevalent among bariatric surgery candidates, yet little is known about the course of symptoms after surgery. This study aimed to identify how soon changes in depression and anxiety occur after surgery. A retrospective review of patients treated at a university hospital was conducted. Participants attended a presurgical psychological evaluation, completed surgery, and attended follow-up visits with bariatric medical providers (2 weeks, 6 weeks, 3 months, and 6 months postoperatively). Depression and anxiety symptoms were assessed at all time points by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety. Generalized estimating equations models with repeated measures by person over time were used to examine change in depression and anxiety symptoms across time. Among 27 patients, anxiety (incident rate ratio (IRR) = 0.81, p = 0.04) and depression (IRR = 0.78, p = 0.05) significantly improved both 6 weeks and 3–6 months after bariatric surgery, after controlling for education, marital status, surgery type, age, and baseline body mass index. This is the first known study to show faster improvement in anxiety compared to depression after bariatric surgery. Understanding reductions in anxiety and depression symptoms may be important for postoperative care and timing of weight maintenance interventions.

Administration Time and Dietary Patterns Modified the Effect of Inulin on CUMS-Induced Anxiety and Depression

SCOPE

Prebiotics exert anxiolytic and antidepressant effects through the microbiota-gut-brain axis in animal models. However, the influence of prebiotic administration time and dietary pattern on stress-induced anxiety and depression is unclear. In this study, whether administration time can modify the effect of inulin on mental disorders within normal and high-fat diets are investigated.

METHODS AND RESULTS

Mice subjected to chronic unpredicted mild stress (CUMS) are administered with inulin in the morning (7:30-8:00 am) or evening (7:30-8:00 pm) for 12 weeks. Behavior, intestinal microbiome, cecal short-chain fatty acids, neuroinflammatory responses, and neurotransmitters are measured. A high-fat diet aggravated neuroinflammation and is more likely to induce anxiety and depression-like behavior (p < 0.05). Morning inulin treatment improves the exploratory behavior and sucrose preference better (p < 0.05). Both inulin treatments decrease the neuroinflammatory response (p < 0.05), with a more evident trend for the evening administration. Furthermore, morning administration tends to affect the brain-derived neurotrophic factor and neurotransmitters.

CONCLUSION

Administration time and dietary patterns seem to modify the effect of inulin on anxiety and depression. These results provide a basis for assessing the interaction of administration time and dietary patterns, providing guidance for the precise regulation of dietary prebiotics in neuropsychiatric disorders.

Association between Dairy Consumption and Psychological Symptoms: Evidence from a Cross-Sectional Study of College Students in the Yangtze River Delta Region of China

BACKGROUND

Assessing the dairy consumption and psychological symptoms of Chinese college students as a reference for the mental health of Chinese college students.

METHODS

A three-stage stratified whole-group sampling method was used to investigate dairy consumption and psychological symptoms among 5904 (2554 male students, accounting for 43.3% of the sample) college students in the Yangtze River Delta region. The mean age of the subjects was 20.13 ± 1.24 years. Psychological symptoms were surveyed using the Brief Questionnaire for the Assessment of Adolescent Mental Health. The detection rates of emotional problems, behavioral symptoms, social adaptation difficulties and psychological symptoms among college students with different dairy consumption habits were analyzed using chi-square tests. The association between dairy consumption and psychological symptoms was assessed using a logistic regression model.

RESULTS

College students from the "Yangtze River Delta" region of China participated in the study, of which 1022 (17.31%) had psychological symptoms. The proportions of participants with dairy consumption of ≤2 times/week, 3-5 times/week, and ≥6 times/week were 25.68%, 42.09%, and 32.23%, respectively. Using dairy consumption ≥6 times/week as a reference, multifactor logistic regression analysis showed that college students with dairy consumption ≤2 times/week (OR = 1.42, 95% CI: 1.18, 1.71) were at higher risk of psychological symptoms (p < 0.001).

CONCLUSION

During the COVID-19 pandemic, Chinese college students with lower dairy consumption exhibited higher detection rates of psychological symptoms. Dairy consumption was negatively associated with the occurrence of psychological symptoms. Our study provides a basis for mental health education and increasing knowledge about nutrition among Chinese college students.

Association between dietary patterns and depression: an umbrella review of meta-analyses of observational studies and intervention trials

CONTEXT

Depression is the most common causes of disease burden worldwide (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858).

OBJECTIVE

An umbrella review has been performed to assess the strength and validity of the available observational and trial evidence for the association between a variety of dietary patterns and depression.

DATA SOURCES

MEDLINE/PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and Cochrane Database were searched.

DATA EXTRACTION

The Joanna Briggs Institute Umbrella Review Methodology was used.

DATA ANALYSIS

The review included 19 articles, covering a relatively wide range of dietary patterns: healthy dietary patterns (n = 8), Mediterranean diet (MedDiet) (n = 6), Dietary Inflammatory Index (DII) (n = 5), Western diet (n = 4), Dietary Approaches to Stop Hypertension (DASH) (n = 2), vegetarian diets (n = 4), and other dietary interventions (n = 2). The methodological quality of the included meta-analyses was generally low or critically low. The strength of the evidence was generally weak, although convincing or suggestive evidence was found for an inverse relationship between MedDiet/DII and depression. Higher adherence to the MedDiet and lower DII score were significantly associated with lower risk of depression.

CONCLUSION

Considering the generally high heterogeneity and low quality of the available evidence, further studies adopting more coherent and uniform methodologies are needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020223376.

Association between dietary caffeine, coffee, and tea consumption and depressive symptoms in adults: A systematic review and dose-response meta-analysis of observational studies

Background

Recent studies have reported an association between dietary caffeine intake (coffee and tea) and the presence of depressive symptoms. However, the findings are not conclusive.

Purpose

This study aimed to examine the correlation between the consumption of dietary caffeine (coffee and tea) and the presence of depressive symptoms in adults.

Methods

PubMed and Scopus databases were searched until December 2021. Two investigators analyzed data from identified studies and rated the quality of the evidence using the GRADE approach. Using the random-effects models, we estimated the relative risks (RRs) and 95% confidence intervals (CIs). We also modeled the dose-response associations through a one-stage, weighted mixed-effects meta-analysis.

Results

A total of 29 eligible studies included a total of 422,586 participants. On comparing the highest with the lowest category in cohort studies, we identified an inverse association between the intake of coffee and depressive symptoms (RR: 0.89, 95%CI: 0.82-0.95; I² = 63.7%, GRADE = low). There was a 4% reduction in the risk of depression associated with an increase in coffee intake of 240 ml/day (RR: 0.96, 95%CI: 0.95, 0.98; I² = 22.7%). By comparing the highest category with the lowest category in cohort studies, we discovered that caffeine intake was inversely associated with depressive symptoms (RR: 0.86, 95%CI: 0.79, 0.93; I² = 0.0%, GRADE = moderate). Based on our data analysis, no correlation exists between tea consumption and depressive symptoms.

Conclusion

According to our findings, coffee and dietary caffeine may have a protective effect against the development of depression. However, no evidence suggesting a link between tea consumption and reduced depressive symptoms has been found. Therefore, further longitudinal studies are needed to substantiate the causal relationship between coffee, tea, and caffeine and the risk of depression.

Dietary fiber intake, depression, and anxiety: a systematic review and meta-analysis of epidemiologic studies

BACKGROUND

Findings of previous studies on relationship between dietary fiber intake and depression were inconsistent. We performed a meta-analysis on the association of dietary fiber intake with depression and anxiety in epidemiologic studies.

METHODS

We conducted a systematic search of electronic databases, up to May 2021. Data from 18 publications (12 cross-sectional, five cohort and one case-control studies) on dietary fiber consumption in relation to depression or anxiety were included. For depression, fifteen studies were conducted on adults and three others on adolescents. Anxiety was not included in the analysis, due to insufficient eligible studies.

RESULTS

Total dietary fiber intake was associated with a 10% lower odds of depression (OR = 0.90; 95% confidence interval [CI]: 0.86, 0.95) in adults and a 57% lower odds (OR = 0.43, 95% CI: 0.32, 0.59) in adolescents. Dose-response meta-analysis revealed an inverse linear association between total dietary fiber intake and odd of depression in adults; such that each 5-g increase in total dietary fiber intake was associated with a 5% reduction in risk of depression (OR = 0.95; 95% CI: 0.94, 0.97). An inverse significant association was observed between intake of fiber from vegetables (OR = 0.73; 95% CI: 0.66, 0.82) and soluble fiber (OR = 0.80, 95% CI: 0.71, 0.91) and odds of depression. However, cereal fiber, fiber from fruits and insoluble fiber were marginally associated with a reduction in having depression.

CONCLUSIONS

High intake of dietary fiber was protectively associated with depression in adults, in a dose-response fashion.

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

Water is a vital nutrient with innumerable functions for every living cell. The functions of human skin include protection against dehydration of the body. Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that presents with dry skin, erythematous and eczematous lesions, and lichenification. This paper discusses the question of whether extra water intake in children with AD affects skin hydration and the skin barrier function. Among the methods used to treat dry skin, topical leave-on products are the first-line treatment, intended to improve hydration and the skin barrier function. The effectiveness of adequate water intake as a measure to treat dry skin is still under debate. Normal skin hydration increases with dietary water intake, particularly in those with prior lower water consumption. Skin dryness in AD is instrumental to the itch and inflammation cycle, contributing to barrier impairment and aggravating disease severity and flares. Certain emollients provide significant hydration to AD skin, with relief of dryness and reduction in barrier impairment, disease severity, and flares. Further investigations are needed to evaluate the optimum water intake levels in children with AD, as important questions remain unanswered, namely, does oral hydration provide relief of skin dryness and reduce barrier impairment, disease severity, and flares; is there any additional benefit from using mineral or thermal spring water; or is there a need to specifically study the fluid/water intake in children with AD and food allergy (FA) restrictions?

Dietary Fats and Depressive Symptoms in Italian Adults

BACKGROUND

Depression represents one of the major causes of disability worldwide, with an important socioeconomic cost. Although many risk factors have been considered in its pathogenesis, nutrition seems to play a determinant role in its prevention. With regard to individual macronutrients, dietary fats and especially n-3 polyunsaturated fatty acids (n-3 PUFA) are the most studied. However, previous data about other dietary fatty acids, such as n-6 PUFA, are conflicting, and little is known about saturated fatty acids (SFA), especially when considering carbon chain length. Thus, we investigated whether single types and subtypes of dietary fats are related to depressive symptoms in Italian individuals living in the Mediterranean area.

METHODS

Dietary and socio-demographic data of 1572 individuals were analyzed. Food frequency questionnaires (FFQs) were used to determine the consumption of total dietary fat and each specific class of dietary fat, such as SFA, monounsaturated fatty acid (MUFA), and PUFA. The intake of fatty acids was also assessed according to the carbon-chain length of each single class. The Center for Epidemiologic Studies Depression Scale (CES-D) was used as a screening tool for depressive symptoms.

RESULTS

After adjustment for potential confounding factors, a significant inverse association between low/moderate levels of PUFA intake and depressive symptoms (Q2 vs. Q1, odds ratio (OR) = 0.60, 95% CI: 0.44, 0.84) was found. On the other hand, moderate saturated fat consumption was associated with depressive symptoms (Q3 vs. Q1, OR = 1.44, 95% CI: 1.02, 2.04). However, when considering carbon chain length, individuals with a lower to moderate intake of short-chain saturated fatty acids (SCSFA) and medium-chain saturated fatty acids (MCSFA) were less likely to have depressive symptoms (Q3 vs. Q1, OR = 0.48, 95% CI: 0.31, 0.75), while moderate intake of arachidic acid (C20:0) was directly associated with depressive symptoms (Q3 vs. Q1, OR = 1.87, 95% CI: 1.26, 2.77). Among single MUFAs, higher myristoleic acid (C14:1) intake was directly associated with depressive symptoms (Q4 vs. Q1, OR = 1.71, 95% CI: 1.12, 2.61), while moderate intake of erucic acid (C22:1) was associated with lower odds of having depressive symptoms (Q3 vs. Q1, OR = 0.54, 95% CI: 0.33, 0.86). When considering individual PUFAs, individuals with moderate and higher intakes of arachidonic acid (C20:4) were less likely to have depressive symptoms (OR = 0.64, 95% CI: 0.45, 0.91; OR = 0.59, 95% CI: 0.38, 0.91, respectively). Similarly, higher eicosapentaenoic acid (C20:5) intake was inversely associated with depressive symptoms (Q4 vs. Q1, OR = 0.35, 95% CI: 0.12, 0.98), while a significant association for docosahexaenoic acid (C22:6) was retrieved only for low intakes (Q2 vs. Q1, OR = 0.33, 95% CI: 0.12, 0.88).

CONCLUSIONS

Dietary fat intake may be associated with depressive symptoms, underlying the importance of distinguishing between different fat types. This study confirms the pivotal role of PUFAs and reopens the debate on the role of saturated fatty acids, suggesting plausible effects of moderate intakes of short-chain fatty acids.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

Environmental Factors in the Etiology of Mental Disorders in the Czech Republic

BACKGROUND

Both genetic and environmental factors are important in etiology of mental disorders. Calculating polyenviromic risk/protective scores provides an updated perspective in research on the environmental causes of psychiatric disorders. We aimed to compare environmental risk and protective factors in patients with psychosis or a mood disorder (PSYCH+MOOD) and those with an anxiety disorder (ANX).

METHODS

We administered the internationally accepted questionnaire from the EUropean Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study, enriched with mood and anxiety disorder-relevant measures, to patients at two large university hospitals in the Czech Republic.

RESULTS

Ninety-four PSYCH+MOOD patients (average age 42.5 years; 46 males) and 52 ANX patients (average age 47.2 years; 17 males) participated. Neither polyenviromic risk score nor polyenviromic protective score differed significantly between PSYCH+MOOD and ANX groups (p = 0.149; p = 0.466, respectively).

CONCLUSION

Scientific validity of the polyenviromic risk/protective score construct must still be demonstrated in large psychiatric samples, ideally in prospective studies. Nevertheless, researchers have already started to investigate environmental factors in the etiology of mental disorders in their complexity, similarly to polygenic risk scores.

Plant-Based Diet and Risk of Frailty in Older Chinese Adults

OBJECTIVES

This study examined the relationship between the consumption of plant-based diet and frailty in older Chinese adults.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

The final sample included data from 3990 older adults from 2011-2014 from the Chinese Longitudinal Healthy Longevity Survey.

MEASUREMENTS

A plant-based diet index (PDI) was calculated based on a qualitative food frequency questionnaire. Frailty was defined using modified Fried criteria. A Generalized Estimating Equation was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for frailty. We further performed subgroup analyses stratified by sex and lifestyle factors.

RESULTS

557 cases of frailty were observed. After adjustment for covariates, the RR for frailty of a high PDI was 0.792 (95% CI: 0.644-0.973), relative to a low PDI. During follow-up, compared with respondents with a continually low PDI, the respondents with a continually high PDI had a significantly reduced risk of frailty (RR = 0.683, 95% CI: 0.514-0.908). In further subgroup analysis, a consistently high PDI over time resulted in a significantly reduced risk of frailty for male (RR = 0.591, 95% CI: 0.391-0.893); for never smokers (RR = 0.670, 95% CI: 0.458-0.979); for people who did never consume alcohol (RR = 0.654, 95% CI: 0.454-0.941); and for people with current or former exercise habits (RR = 0.488, 95% CI: 0.313-0.762).

CONCLUSION

Plant-based diet was associated with low risk of frailty in men and in older adults with healthy lifestyle. These findings stress that plant-based diet should be recommended as a dietary strategy to prevent and reduce frailty in older adults; in addition, more dietary interventions along with lifestyle modification should be adopted to promote successful ageing, especially for women.

Post-Disaster Mental Health and Dietary Patterns among Older Survivors of an Earthquake and Tsunami

OBJECTIVES

Research suggests that cardiometabolic disease risks are elevated among survivors of natural disasters, possibly mediated by changes in diet. Using the Brief Dietary History Questionnaire, we examined (1) dietary patterns among older survivors of the 2011 Great East Japan Earthquake and Tsunami, and (2) the contribution of posttraumatic stress symptoms (PTSS)/depressive symptoms, as well as relocation to temporary housing on dietary patterns and (3) gender differences in the associations.

DESIGN, SETTING AND PARTICIPANTS

Data came from a prospective cohort study of 1,375 survivors aged 65-89 years (44.6% male).

MEASUREMENTS

PTSS/depression onset was evaluated in 2013, 2.5 years after the disaster. Dietary data was collected with a self-administered brief-type diet history questionnaire in 2020. A principal component analysis identified three posterior dietary patterns.

RESULTS

Diet 1 consisted of high intake of vegetables, soy products, and fruits; Diet 2 consisted of carbohydrate-rich foods and snacks/sweets; Diet 3 consisted of high intake of alcoholic beverages, meat, and seafood. Least-squares linear regression revealed that individuals with PTSS/depression were less likely to exhibit Diet 1, while individuals with PTSS were more likely to exhibit Diet 2 and 3. Especially, males who had depression showed an unhealthy dietary pattern. Those who have lived in a trailer-style temporary housing reported less consumption of Diet 3.

CONCLUSION

Survivors of disaster with symptoms of mental illness tended to exhibit less healthy dietary patterns after 9 years. Diet varied by type of post-disaster mental illness, gender, and current social circumstances. We lacked pre-disaster BDHQ data, which is a limitation.

Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases

BACKGROUND

An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases.

OBJECTIVE

The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases.

METHODS

A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging.

RESULTS

Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition.

CONCLUSIONS

Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.

Causal influence of dietary habits on the risk of major depressive disorder: A diet-wide Mendelian randomization analysis

BACKGROUND

Extensive observational evidence links diet quality to the risk for major depressive disorder (MDD), while clinical trials show that dietary improvement can improve depressive symptoms. However, due to issues with blinding dietary trials, confirming a causal relationship for diet's influence on MDD requires further research. Thus, we systemically investigated the bi-directional causal relationships between dietary habits and MDD by using two-sample Mendelian randomization (MR).

METHODS

We collected publicly available genome-wide association studies' summary statistics for dietary habits from UK Biobank (n = 449,210) and MDD from the Psychiatric Genomics Consortium (n = 142,646). We used a weighted median approach to synthesize MR estimates across genetic instruments. For the robustness of our results, we compared weighted median results with results from the inverse-variance weighted, the weighted mode, and MR-PRESSO.

RESULTS

There was moderate evidence that beef intake has a protective effect on MDD. There was weak but detectable evidence that cereal intake has a protective effect on MDD, while non-oily fish intake might increase the risk of MDD. We did not observe any causal effect of MDD on dietary habits.

LIMITATIONS

Our study may suffer from the violation of assumptions of MR due to horizontal pleiotropy; therefore, we did several sensitivity analyses to detect and minimize the bias.

CONCLUSIONS

In this two-sample MR analysis, we observed that higher beef intake may be protective against MDD. However, MDD did not appear to affect dietary habits. Potential mechanisms need to be further investigated to support our novel findings.

Childhood stress and midlife depression in women: the influence of diet quality

OBJECTIVE

How does diet quality (DQ) moderate associations between serious childhood stress exposures and adult depression?

METHODS

We analyzed a cohort of Californian women at midlife (N=382; age 36-42). Serious childhood stress was defined as high perceived stress during childhood or adverse childhood experiences (ACEs) of physical abuse, sexual abuse, and/or household substance abuse. Women were dichotomized by current depression risk (high/low). The Healthy Eating Index (HEI)-2015 and Alternate Healthy Eating Index (AHEI)-2010 measured current DQ from 3-day food records. Interactions between childhood stress exposures and DQ indices were tested one-by-one in multivariable Poisson regression models.

RESULTS

Depression risks associated with endorsing all 3 ACEs differed by HEI and AHEI scores, as did risks associated with endorsing high perceived stress, physical abuse, and sexual abuse by AHEI. Where DQ moderated stress-depression associations, predicted prevalences of high depression risk did not vary with DQ among women endorsing the particular childhood stressors. However, among non-endorsing women, predicted high depression risk prevalences were significantly lower with higher DQ compared to in their stress-exposed counterparts - e.g. at the 90th AHEI percentile, depression prevalences were ∼20% among 'non-childhood-stressed' women versus 48.8% (high perceived stress, sexual abuse), 52.0% (physical abuse), and 73.0% (3 ACEs) in 'childhood-stressed' women.

CONCLUSIONS

Higher current DQ, particularly as aligned with chronic disease prevention guidelines, predicts lower depression risk in women with low childhood adversity. DQ did not buffer depression risk in women with high childhood stress. Further research is warranted to examine persistent pathways of depression risk and diet's role within.

Anti-Inflammatory Dietary Diversity and Depressive Symptoms among Older Adults: A Nationwide Cross-Sectional Analysis

The purpose of this study was to associate the anti-inflammatory dietary diversity and depressive symptoms among a nationwide sample of Chinese older adults. We used data from the 2018 wave of Chinese longitudinal healthy longevity survey (CLHLS). We assessed depressive symptoms using the 10 items of the center for epidemiologic studies depression scale (CES-D-10). Based on the dietary diversity index (DDI) generated by previous studies, we construct two novel indicators: the protein-enriched dietary diversity index diet (PEDDI) and the anti-inflammatory dietary diversity index diet (AIDDI). We used multivariate logistic models to evaluate the associations of DDI, PEDDI, and AIDDI with depressive symptoms, statistically adjusted for a range of potential confounders. A total of 12,192 participants (mean age 83.6 years) were included in the analysis. We found that participants with a higher score of DDI (OR = 0.91, 95% CI: 0.89-0.92) and PEDDI (OR = 0.91, 95% CI: 0.88-0.93) showed lower odds of having depressive symptoms, while the association between AIDDI and depressive symptoms was more marked (OR = 0.80, 95% CI: 0.78-0.83). The associations remained in subgroup analyses and sensitivity analyses. The results indicate that intaking diversified diet, particularly anti-inflammatory foods, may be associated with a lower risk of depressive symptoms. The findings of this study, if confirmed as causal, provide evidence that an intervention of adopting an anti-inflammatory diversified diet may reduce the burden of depression among older adults.

Relationship between Dietary Inflammatory Index and Postpartum Depression in Exclusively Breastfeeding Women

(1) Background: Research has shown that chronic inflammation can increase the risk of depression. The dietary inflammatory index (DII) is a novel measure of dietary inflammation, which has been used to investigate the relationship between diet and mental disorders in adults. However, little research has been conducted to establish an association between dietary inflammation (as measured by DII) and postpartum depression (PPD) in exclusively breastfeeding women. (2) Methods: In this cross-sectional study, 293 women who were exclusively breastfeeding for 6 months or less were enrolled. The DII scores were evaluated using semi-quantitative Food Frequency Questionnaires (FFQ), and the Edinburgh Postpartum Depression Scale (EPDS) was used to measure depression levels of breastfeeding mothers during the six months following delivery. The participants were classified by tertiles, and the possibility of DII being associated with PPD was assessed by binary regression analysis. (3) Results: The average DII score was 2.32 ± 1.08, which ranged from -1.66 to 4.19. The rate of depression was 60.1%. Adjusted for potential risk factors such as age, educational level, occupational level, number of babies, number of caregivers, social support level, and sleep quality, the results showed that the lowest DII score was associated with a lower risk of PPD than the highest score (OR tertile Q₁ vs. 3 = 0.47, 95% CI: 0.24, 0.93, p = 0.030). (4) Conclusions: In exclusive breastfeeding women, the inflammatory potential of dietary intake seems to be related to depression. Interventions to improve diet quality might consider including a dietary component that aims to lower chronic systemic inflammation to prevent PPD. However, the relationship between DII and PPD among Chinese women remains to be demonstrated in a larger population.

Cross-sectional examination of ultra-processed food consumption and adverse mental health symptoms

OBJECTIVE

To explore whether individuals who consume higher amounts of ultra-processed food (UPF) have more adverse mental health symptoms.

DESIGN

Using a cross-sectional design, we measured the consumption of UPF as a percentage of total energy intake in kilo-calories using the NOVA food classification system. We explored whether individuals who consume higher amounts of UPF were more likely to report mild depression, more mentally unhealthy days and more anxious days per month using multivariable analyses adjusting for potential confounding variables.

SETTING

Representative sample from the United States National Health and Nutrition Examination Survey between 2007 and 2012.

PARTICIPANTS

10 359 adults aged 18+ without a history of cocaine, methamphetamine or heroin use.

RESULTS

After adjusting for covariates, individuals with the highest level of UPF consumption were significantly more likely to report at least mild depression (OR: 1·81; 95 % CI1·09, 3·02), more mentally unhealthy (risk ratio (RR): 1·22; 95 % CI 1·18, 1·25) and more anxious days per month (RR: 1·19; 95 % CI 1·16, 1·23). They were also significantly less likely to report zero mentally unhealthy (OR: 0·60; 95 % CI 0·41, 0·88) or anxious days (OR: 0·65; 95 % CI 0·47, 0·90).

CONCLUSIONS

Individuals reporting higher intakes of UPF were significantly more likely to report mild depression, more mentally unhealthy and more anxious days and less likely to report zero mentally unhealthy or anxious days. These data add important information to a growing body of evidence concerning the potential adverse effects of UPF consumption on mental health.

The association between dietary inflammatory index and psychological profile among men with spinal cord injury

OBJECTIVE

The present study was designed to examine the relationship between the dietary inflammatory index (DII) and depression, anxiety and stress in Iranian men with spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Mottahary SCI clinic, Isfahan, Iran.

PARTICIPANTS

The current study was conducted on 150 men with SCI aged 40-65 years.

OUTCOME MEASURES

Dietary data were collected using a semi-quantitative 148 item food frequency questionnaire (FFQ). The Depression, Anxiety, Stress Scale-21 (DASS-21) was used to assess the psychological profile of the participants.

RESULTS

The DII score ranged from -3.62 to 4.02. Overall, 34% of study participants had at least mild levels of depression and anxiety symptoms and 25% had at least mild levels of stress symptoms. A one-unit increase in the DII was significantly associated with higher scores of depressive symptoms (β = 1.31, 95% CI 0.44-2.18; P = 0.003). Also, a one-unit increase in the DII was associated with higher odds of having at least mild depressive symptoms (OR = 1.77, 95% CI 1.17, 2.67; P = 0.007). No significant association was found between the DII and anxiety and stress.

CONCLUSION

The present study indicated that a higher DII score is associated with higher odds of depressive symptoms in men with SCI. These initial findings highlight the crucial role of the inflammatory potential of diet in the mental health of subjects with SCI. Future prospective studies are warranted to confirm these findings.

Kynurenic acid as a biochemical factor underlying the association between Western-style diet and depression: A cross-sectional study

Consumption of a Western-style diet (WS-diet), high in saturated fat and added sugar, is associated with increased depression risk. However, the physiological mechanisms underlying the relationship requires elucidation. Diet can alter tryptophan metabolism along the kynurenine pathway (KP), potentially linking inflammation and depression. This study aimed to examine whether urinary inflammatory markers and KP metabolites differed according to WS-diet consumption and depression severity. Depression symptoms and habitual WS-diet consumption were assessed in 169 healthy adults aged 17–35 recruited from two experimental studies. Targeted metabolomics profiling of seven KP metabolites, ELISA-based assays of interleukin-6 (IL-6) and C-reactive protein (CRP) were performed using urine samples collected from the participants. Parametric tests were performed for group comparison and associations analysis. Multilevel mixed-effect modelling was applied to control for biases. Higher intake of WS-diet was associated with lower levels of neuroprotective kynurenic acid (KA; R = −0.17, p = 0.0236). There were no differences in IL-6 or CRP across diet groups (p > 0.05). Physical activity had negative associations with most KP metabolites. Mixed-effects regression analysis showed the glutamatergic inhibitor, KA, was the only biomarker to have a significant association with depression symptoms in a model adjusted for demographic and lifestyle variables: a unit increase in KA was associated with 0.21 unit decrease in Depression Anxiety and Stress Scale-21 depression score (p = 0.009). These findings suggest that urinary KA is associated with both habitual WS-diet intake, and levels of depression symptoms, independent of inflammation. Findings support the role of neuroprotection and glutamatergic modulation in depression. We propose that KA may act as endogenous glutamatergic inhibition in regulating depression severity in the absence of inflammation. Further comparison with blood-based markers will assist in validating the utility of non-invasive urine samples for measuring KP metabolites.

The impact of diet and lifestyle on wellbeing in adults during COVID-19 lockdown

A healthy diet and lifestyle may protect against adverse mental health outcomes, which is especially crucial during stressful times, such as the COVID-19 pandemic. This preregistered longitudinal online study explored whether diet and lifestyle (physical activity, sleep, and social interactions) were associated with wellbeing and mood during a light lockdown in Germany. Participants (N = 117, 72 males; 28 ± 9 years old) answered mental health and lifestyle questionnaires (social connections, sleep, activity) followed by submitting 1 week of food and mood-lifestyle diary (food intake, positive and negative mood, mental wellbeing, sleep quality, physical activity level, quantity and quality of social interactions) via a smartphone app. We used multivariate linear and mixed-effects models to associate mood and wellbeing with dietary components and lifestyle factors. Interindividual analyses revealed that sleep and social interaction significantly impacted mood and wellbeing. Interestingly, fruit and vegetable intake correlated with wellbeing, even when controlling for all lifestyle factors. Fruit and vegetable intake also significantly correlated with daily fluctuations in wellbeing within individuals next to sleep, physical activity, and social interactions. We observed gender differences in fruit and vegetable intake and anxiety levels. Our results emphasize the importance of diet contributing to individual wellbeing, even in the challenging times of a pandemic. Future research is necessary to test if our findings could extend to other populations.

Association between the Prime Diet Quality Score and depressive symptoms in a Mediterranean population with metabolic syndrome. Cross-sectional and 2-year follow-up assessment from PREDIMED-PLUS study

The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (P_{for trend} = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = -0·67 z-score (-1·17, -0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.

Early-life stress and dietary fatty acids impact the brain lipid/oxylipin profile into adulthood, basally and in response to LPS

Brain lipid dysregulation is a hallmark of depression and Alzheimer's disease, also marked by chronic inflammation. Early-life stress (ELS) and dietary intake of polyunsaturated fatty acids (PUFAs) are risk factors for these pathologies and are known to impact inflammatory processes. However, if these early-life factors alter brain lipid homeostasis on the long-term and thereby contribute to this risk remains to be elucidated. We have recently shown that an early diet enriched in omega(ω)-3 PUFAs protected against the long-term negative effects of ELS on cognition and neuroinflammation. Here, we aim to understand if modulation of brain lipid and oxylipin profiles contributes to the detrimental effects of ELS and the protective ones of the diet. We therefore studied if and how ELS and early dietary PUFAs modulate the brain lipid and oxylipin profile, basally as well as in response to an inflammatory challenge, to unmask possible latent effects. Male mice were exposed to ELS via the limited bedding and nesting paradigm, received an early diet with high or low ω6/ω3 ratio (HRD and LRD) and were injected with saline or lipopolysaccharide (LPS) in adulthood. Twenty-four hours later plasma cytokines (Multiplex) and hypothalamic lipids and oxylipins (liquid chromatography tandem mass spectrometry) were measured. ELS exacerbated the LPS-induced increase in IL-6, CXCL1 and CCL2. Both ELS and diet affected the lipid/oxylipin profile long-term. For example, ELS increased diacylglycerol and LRD reduced triacylglycerol, free fatty acids and ceramides. Importantly, the ELS-induced alterations were strongly influenced by the early diet. For example, the ELS-induced decrease in eicosapentaenoic acid was reversed when fed LRD. Similarly, the majority of the LPS-induced alterations were distinct for control and ELS exposed mice and unique for mice fed with LRD or HRD. LPS decreased ceramides and lysophosphotidylcholine, increased hexosylceramides and prostaglandin E₂, reduced triacylglycerol species and ω6-derived oxylipins only in mice fed LRD and ELS reduced the LPS-induced increase in phosphatidylcholine. These data give further insights into the alterations in brain lipids and oxylipins that might contribute to the detrimental effects of ELS, to the protective ones of LRD and the possible early-origin of brain lipid dyshomeostasis characterizing ELS-related psychopathologies.

Nutrition and mental health: A review of current knowledge about the impact of diet on mental health

Applied psychopharmacotherapy and psychotherapy do not always bring the expected results in the treatment of mental disorders. As a result, other interventions are receiving increasing attention. In recent years, there has been a surge in research on the effects of nutrition on mental status, which may be an important aspect of the prevention of many mental disorders and, at the same time, may lead to a reduction in the proportion of people with mental disorders. This review aims to answer whether and to what extent lifestyle and related nutrition affect mental health and whether there is scientific evidence supporting a link between diet and mental health. A review of the scientific evidence was conducted based on the available literature by typing in phrases related to nutrition and mental health using the methodological tool of the PubMed database. The literature search yielded 3,473 records, from which 356 sources directly related to the topic of the study were selected, and then those with the highest scientific value were selected according to bibliometric impact factors. In the context of current changes, urbanization, globalization, including the food industry, and changes in people’s lifestyles and eating habits, the correlations between these phenomena and their impact on mental state become important. Knowledge of these correlations creates potential opportunities to implement new effective dietary, pharmacological, therapeutic, and above all preventive interventions. The highest therapeutic potential is seen in the rational diet, physical activity, use of psychobiotics, and consumption of antioxidants. Research also shows that there are nutritional interventions that have psychoprotective potential.

The association between dietary inflammatory index, dietary antioxidant index, and mental health in adolescent girls: an analytical study

BACKGROUND

Diet is considered as one of the modifiable factors that appears to exert a vital role in psychological status. In this way, we designed this study to examine the association between dietary inflammatory index (DII), dietary antioxidant index (DAI), and mental health in female adolescents.

METHODS

This cross-sectional study included 364 female adolescents selected from high schools in the five regions of Tabriz, Iran. A 3-day food record was used to extract the dietary data and calculate DII/DAI scores. DII and DAI were estimated to assess the odds of depression, anxiety, and stress based on the Depression Anxiety Stress Scales-21. Adjusted relationships of the DII and DAI with depression, anxiety, and stress were determined using multiple regression after adjusting for age, energy intake, BMI, family income and mother and father education. Overweight was defined as body mass index (BMI)-for-age >  + 1 z-score relative to world health organization standards.

RESULTS

Depression, anxiety, and stress were observed in 21.4%, 26.6%, and 25.7% of subjects, respectively. The percentage of overweight among adolescents was 19.4%. The association between DII and score of mental health profile was positive among subjects in the third tertile of DII compared to subjects in the first tertile. However, this association was not statistically significant after adjusting for confounding variables. Moreover, there was a significant inverse association between DAI and depression and anxiety; and a statistically insignificant association between DAI and stress after adjusting for confounders.

CONCLUSIONS

Our results highlighted the importance of a healthy and anti-inflammatory diet on mental health in female adolescents. Therefore, modifying unhealthy dietary habits are likely to be effective in the management of psychosocial disorders.

Systematic evidence and gap map of research linking food security and nutrition to mental health

Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research.

There is a broad range of research available on the relationship between food security and mental health. Here the authors carry out a systematic mapping of evidence on food security and nutrition related to mental health and identifies trends in themes, setting, and study design over the 20 year period studied.

Eating Habits in Patients with Familial Hypercholesterolemia from North-Eastern Romania

(1) Background: Familial hypercholesterolemia (FH) is a genetic autosomal dominant disorder characterized by elevated levels of low-density lipoprotein cholesterol (LDL) that develops deposits of lipids in the arterial wall. Since it is underdiagnosed and undertreated, the disease has a high risk of premature cardiovascular disease and death. Patients are not always aware of the changes they should make in their diet. Thus, our study aimed to evaluate through a food frequency questionnaire their eating habits. (2) Methods: We included 70 patients with FH and 20 subjects in a control group that were evaluated through a physical examination and blood tests. They also completed a food frequency questionnaire. (3) Results: Throughout our study, we observed several aspects: regardless of age, patients with FH had higher carbohydrate intakes compared to the control group; from the same group, a positive correlation was observed between salami intake and the levels of glucose and glycated hemoglobin. Moreover, the sour cream preference was associated with higher liver function tests. In the control group, we observed a higher intake of pasta and fast food and fewer fruit portions. (4) Conclusions: As far as we know, this is the first study from Romania that evaluated the eating habits of patients diagnosed with FH. Our study reveals that, although patients with FH avoid junk food, they still have a high intake of carbohydrates when compared to the control group. Further research is needed in order to get a comprehensive nutritional evaluation of these patients.

Is dietary quality associated with depression? An analysis of the Australian longitudinal study of women's health data

Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over 6 years at two time points, 2003 (n 9081, Mean age = 27·6) and 2009 (n 8199, Mean age = 33·7) using secondary data from the Australian Longitudinal Study on Women's Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms (β = -0·03, 95 % CI (-0·04, -0·02)) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression.

Fruit and vegetable consumption and depression symptoms in young women: results from 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health

PURPOSE

Growing evidence suggests that specific food groups may play an important role in improving mental health. However, very few studies explored the association between individual dietary factors and depression symptoms by following a large cohort of individuals over a long period. We examined the differential effects of fruit and vegetables in relation to depression symptoms over a 15-year follow-up period in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health.

METHODS

Fruit and vegetable consumption was assessed using short questions. The Center for Epidemiologic Studies Depression-10 scale with a cut off ≥ 10 indicated depressive symptoms. Multiple imputations with generalised estimating equations models were performed to estimate odds ratio of depression symptoms according to fruit and vegetable consumption.

RESULTS

A total of 4241 participants with a mean age of 27.6 (SD 1.45) years at baseline were followed up at five surveys (2003-2018). Fruit and vegetable intake (≥ 2 servings) was cross-sectionally associated with lower odds of depressive symptoms. In longitudinal analysis, a higher intake of fruit (≥ 4 servings) and vegetable (≥ 5 servings) was consistently associated with lower odds of depressive symptoms, with a 25% lower odds (OR 0.75; 95% CI 0.57, 0.97; p = 0.031) and a 19% lower odds (OR 0.81; 95% CI 0.70, 0.94; p = 0.007) than consuming one serve or less fruit and vegetable, respectively.

CONCLUSION

These results suggest that a higher intake of fruit and vegetables was associated with a lower risk of depression symptoms over 15 years from a population-based prospective study of Australian women.

Dietary diversity and depression: cross-sectional and longitudinal analyses in Spanish adult population with metabolic syndrome. Findings from PREDIMED-Plus trial

OBJECTIVE

To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.

DESIGN

An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.

SETTING

Spanish older adults with metabolic syndrome (MetS).

PARTICIPANTS

A total of 6625 adults aged 55-75 years from the PREDIMED-Plus study with overweight or obesity and MetS.

RESULTS

Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).

CONCLUSIONS

According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.

Western diet associated with increased post-stroke depressive symptoms

The present study examines the association of diet with depressive symptoms among stroke survivors from a community cohort of older adults. Depression is common after stroke. A healthy diet has previously been associated with fewer depressive symptoms in older individuals, but it is unknown if this effect is also seen in stroke survivors. Eighty-six participants from the Memory and Aging Project with a history of stroke at their study baseline enrolment, complete dietary data and two or more assessments for depression were included in this observational prospective cohort analysis. Depressive symptoms were assessed annually with a 10-item version of the Center for Epidemiologic Studies Depression scale. Diet was assessed using a validated food-frequency questionnaire administered at baseline. Diet scores were based on analysis of participants' reported intakes of 144 food items. A generalised estimating equation (GEE) model was applied to examine the association of diet score with depressive symptoms. The study participants had a mean age of 82 ± 7⋅17 years and 14⋅42 ± 2⋅61 years of education, and 82⋅56 % were female. Western diet score was positively associated with depressive symptoms over time (diet score tertile 3 v. tertile 1: β = 0⋅22, se = 0⋅09, P = 0⋅02; P for trend = 0⋅022). Interaction with sex suggested a stronger effect in females. A Western diet was associated with more post-stroke depressive symptoms, suggesting nutrition is important not only for reducing cerebrovascular risk, but for protecting post-stoke mental health as well.

Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews

BACKGROUND

Depression has been identified as one of the leading causes of the disease burden worldwide. Identification of the potential factors that increased or decreased the risk of depression could be important to provide prevention strategies. We aimed to conduct an umbrella review of risk factors for depression in the elderly and assessed the credibility of evidence of the association between each factor and depression.

METHODS

We searched PubMed and Web of Science from 1990 to April 11, 2021 for articles investigating associations between potential factors and depression. For each association, we recalculated the summary effect size and 95% confidence intervals using random effects models. The 95% prediction interval and between-heterogeneity were also reported. For publication bias, small-study effect and excess of significance bias were assessed.

RESULTS

Twenty-five publications met the inclusion criteria, including twenty-two meta-analyses and three qualitative systematic reviews. Approximately 1,199,927 participants and 82 unique factors were reported. Two factors were rated as convincing evidence and four factors showed highly suggestive evidence. These risk factors were aspirin use, individuals aged 80 years and above, sleep disturbances and persistent sleep disturbances, hearing problem, poor vision, and cardiac disease.

LIMITATIONS

Most studies that we included were of low quality.

CONCLUSIONS

We found several risk factors for depression with different levels of evidence, in which aspirin use and individuals aged 80 years and above presented the strongest evidence. Further research is warranted to support other findings from this umbrella review using a large, well-designed cohort study.

The association between major dietary patterns and severe mental disorders symptoms among a large sample of adults living in central Iran: Baseline data of YaHS-TAMYZ cohort study

Background

The diet’s role in developing psychological disorders has been considered by researchers in recent years.

Objective

To examine the association between major dietary patterns and severe mental disorders symptoms in a large sample of adults living in Yazd city, central Iran.

Methods

This cross-sectional study used the baseline data of a population-based cohort study (Yazd Health study: YaHS). Dietary intakes were assessed by a multiple-choice semi-quantitative food frequency questionnaire (FFQ, Yazd nutrition survey called TAMYZ). Psychological assessments were also done by using the depression, anxiety, and stress scale-21 (DASS-21) questionnaire. Major dietary patterns were identified using principal component analysis (PCA). Analysis of covariance (ANCOVA) and logistic regression analyses were used to evaluate the relationship between dietary patterns and mental disorders symptoms.

Results

A total of 7574 adults were included in the current analysis. Four major dietary patterns were identified: "Sugar and Fats”, “Processed Meats and Fish”, "Fruits" and “Vegetables and Red Meat”. After adjustment for all confounding variables, participants in the fifth quintile of “Fruits” dietary pattern which was highly correlated with dried fruits, canned fruits, fruit juice, olive, hydrogenated fats and fruits intake, had a lower odds of severe depression (OR=0.61, 95% CI: 0.45–0.81, p for trend=0.057), anxiety (OR=0.64, 95% CI: 0.50–0.80, p for trend=0.007), and stress, (OR=0.45, 95% CI: 0.30–0.68, p for trend=0.081).

Conclusions

The intake of a dietary pattern high in dried fruits, canned fruits, fruit juice, olive, hydrogenated fats, and fruits might be inversely associated with depression, anxiety, and stress symptoms. Future prospective studies are needed to warrant this finding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13518-w.

Frequency of fruit consumption and savoury snacking predict psychological health; selective mediation via cognitive failures

While there is growing interest in the link between diet and psychological health, there is a surprising lack of studies investigating the precise associations between nutrient-rich foods (such as fruit and vegetables) versus nutrient-poor foods (such as energy-dense savoury and sweet snacks), and psychological health. Similarly, the psychological processes underpinning the relationship between dietary intake and psychological health remain unclear. Hence, the present study aimed to explore the relationship between dietary consumption and psychological health, with cognitive processes as a theoretical mediator. This cross-sectional online study included 428 healthy adults (53% female; mean age= 39.7, SD= 13.0), with participants completing a range of validated questionnaires measuring dietary habits and psychological health. Stepwise multiple regression revealed that more frequent consumption of fruit was associated with reduced symptoms of depression (β = -.109, p = 0.025) and greater positive psychological wellbeing (β = .187, p < 0.001). Conversely, more frequent savoury snacking was associated with increased anxiety (β = .127, p = 0.005). Further, mediation analyses revealed that more frequent consumption of savoury snacks was associated with increased symptoms of depression, stress, anxiety, and reduced psychological wellbeing, via an increase in cognitive failures (ps < 0.001). These results provide new insights on the independent associations between certain types of food and psychological health, and the psychological mechanisms that may mediate these. Further work is now required to establish causality and determine whether these may represent modifiable dietary targets that can directly (and indirectly) influence our psychological health.

Edible Mushrooms as a Potential Component of Dietary Interventions for Major Depressive Disorder

Dietary interventions for people suffering from major depressive disorder (MDD) are an ongoing field of research. In this article, we present a comprehensive background for understanding the possibility of using edible medicinal mushrooms as an adjunctive treatment for MDD. We start with a brief history of MDD, its diagnosis, epidemiology and treatment, and the effects of diet on depression symptoms, followed by a review of neurobiological, behavioral, and clinical studies of medicinal mushrooms. We specifically highlight the results of preclinical and clinical studies on dietary supplementation with three selected mushroom species: Lion’s mane (Hericium erinaceus), Caterpillar mushroom (Cordyceps militaris), and Lingzhi/Reishi (Ganoderma lucidum). Preliminary small-sample clinical studies suggest that Lion’s mane can influence well-being of humans. In the case of Reishi, the results of clinical studies are equivocal, while in the case of Caterpillar Mushroom, such studies are underway. Edible mushrooms contain 5-hydroxy-L-tryptophan (5-HTP), which is a direct precursor of serotonin—a neurotransmitter targeted in pharmacotherapy of MDD. Therefore, in light of the well-recognized role of stress as a pathogenic factor of MDD, we also describe the neurobiological mechanisms of the interaction between stress and serotonergic neurotransmission; and summarize the current state of knowledge on dietary supplementation with 5-HTP in MDD.

Dietary patterns, breakfast consumption, meals with family and associations with common mental disorders in adolescents: a school-based cross-sectional study

Background

Adolescence is a period of transition and vulnerabilities, in which mental illnesses can develop more easily. The objective of this work is to analyze the association of dietary patterns, breakfast consumption, and the practice of having meals accompanied by the family with the presence of Common Mental Disorders in Brazilian adolescents.

Methods

This is a cross-sectional study which analyzed data from 71,553 Brazilian adolescents aged 12–17 years, from the Study of Cardiovascular Risk in Adolescents (Portuguese acronym, “ERICA”). Principal Component Analysis was performed to identify dietary patterns, and Logistic Regression Models were performed to identify the associations between Common Mental Disorders, dietary patterns, and eating practices that are breakfast consumption and practice of having meals accompanied by family.

Results

Two patterns were found, a Healthy Dietary Pattern and an Unhealthy Dietary Pattern. Adolescents classified in the second (OR: 0.79; 95% CI 0.70—0.89) or third (OR: 0.86; 95% CI 0.77—0.96) tercile of the Healthy Dietary Pattern had a lower chance of having Common Mental Disorders. Eating breakfast sometimes (OR: 0.71; 95% CI 0.61—0.83) or almost every day/every day (OR: 0.54; 95% CI 0.47—0.62), and the practice of having the main meals with the family sometimes (OR: 0.69; 95% CI 0.57—0.84) or almost every day/every day (OR: 0.50; 95% CI 0.44–0.58), decreased the chance for Common Mental Disorders.

Conclusion

This study observed that healthy dietary patterns are associated with better mental health in adolescents, thus should be encouraged and promoted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13367-7.

Inflammatory Cytokines, but Not Dietary Patterns, Are Related to Somatic Symptoms of Depression in a Sample of Women

Background

Depression is a heterogenous disorder with both cognitive and somatic symptom dimensions that may differentially relate to systemic inflammation. Diet, which has the potential to modulate both inflammation levels and mood, is yet to be studied within the context of individual depression dimensions. This study examined the associations between inflammatory cytokines and dietary patterns with depressive symptom dimension profiles among a sample of women recruited in a non-clinical setting.

Methods

Inflammatory cytokines (IL-6 and TNF-α), inflammatory diet (Diet Inflammatory Index; DII), and depressive symptoms (Beck Depression Inventory-II; BDI-II) were measured in 136 females (M age = 22.01 ± 4.02, range 18-59 years). Multiple linear regressions were used to investigate the relationships between inflammatory cytokines and diet with self-reported cognitive, somatic, and total depressive symptoms, adjusting for demographic factors.

Results

Findings showed that increased somatic dimension scores were positively associated with IL-6 (ß = 0.273, p = 0.002) and TNF-α (ß = 0.215, p = 0.017), but not inflammatory diet (p = 0.300). Total BDI-II scores were only positively associated with IL-6 (ß = 0.221, p = 0.012), and cognitive dimension scores were not associated with any inflammation measures.

Conclusions

These findings contribute to existing evidence that inflammatory cytokines are associated with the somatic symptoms of depression. Inflammatory diet index was not associated with depression measures.

Associations of Dietary Vitamin A and Beta-Carotene Intake With Depression. A Meta-Analysis of Observational Studies

Objective

To clarify the associations of dietary vitamin A and beta-carotene intake with depression based on a meta-analysis of observational studies.

Methods

An extensive literature search on February 2022 (PubMed, Web of Science and Embase) was employed to identify observational studies on the associations of dietary vitamin A and beta-carotene intake with depression. The pooled relative risk (RR) of depression for the highest vs. lowest dietary vitamin A and beta-carotene intake category, and the standard mean difference (SMD) of dietary vitamin A and beta-carotene intake for depression vs. control subjects, were calculated.

Results

A total of 25 observational studies (100,955 participants), which included 24 cross-sectional/case-control and 1 prospective cohort study, were included in this study. The overall multi-variable adjusted RR demonstrated that dietary vitamin A intake was inversely associated with depression (RR = 0.83, 95%CI: 0.70–1.00; P = 0.05). In addition, the combined SMD showed that the dietary vitamin A intake in depression was also lower than that in control subjects (SMD = −0.13, 95%CI: −0.18 to −0.07; P < 0.001). On the other hand, the overall multi-variable adjusted RR indicated that dietary beta-carotene intake was negatively associated with depression (RR = 0.63, 95%CI: 0.55–0.72; P < 0.001). The combined SMD showed that the dietary beta-carotene intake in depression was also lower than that in control subjects (SMD = −0.34, 95%CI: −0.48 to −0.20; P < 0.001).

Conclusion

Our results suggest that both dietary vitamin A and beta-carotene intake is inversely associated with depression. However, due to the limited evidence, further prospective cohort studies are still needed.

Short-Chain Fatty Acids Ameliorate Depressive-Like Behaviors of High Fructose-Fed Mice by Rescuing Hippocampal Neurogenesis Decline and Blood–Brain Barrier Damage

Excessive fructose intake is associated with the increased risk of mental illness, such as depression, but the underlying mechanisms are poorly understood. Our previous study found that high fructose diet (FruD)-fed mice exhibited neuroinflammation, hippocampal neurogenesis decline and blood–brain barrier (BBB) damage, accompanied by the reduction of gut microbiome-derived short-chain fatty acids (SCFAs). Here, we found that chronic stress aggravated these pathological changes and promoted the development of depressive-like behaviors in FruD mice. In detail, the decreased number of newborn neurons, mature neurons and neural stem cells (NSCs) in the hippocampus of FruD mice was worsened by chronic stress. Furthermore, chronic stress exacerbated the damage of BBB integrity with the decreased expression of zonula occludens-1 (ZO-1), claudin-5 and occludin in brain vasculature, overactivated microglia and increased neuroinflammation in FruD mice. These results suggest that high fructose intake combined with chronic stress leads to cumulative negative effects that promote the development of depressive-like behaviors in mice. Of note, SCFAs could rescue hippocampal neurogenesis decline, improve BBB damage and suppress microglia activation and neuroinflammation, thereby ameliorate depressive-like behaviors of FruD mice exposed to chronic stress. These results could be used to develop dietary interventions to prevent depression.

A Possible Antidepressive Effect of Dietary Interventions: Emergent Findings and Research Challenges

Purpose

Despite recent advancements in the treatment of depression, the prevalence of affected individuals continues to grow. The development of new strategies has been required and emerging evidence has linked a possible antidepressant effect with dietary interventions. In this review, we discuss recent findings about the possible antidepressant effect of dietary interventions with an emphasis on the results of randomized controlled trials.

Recent findings

A high consumption of refined sugars and saturated fat and a low dietary content of fruits and vegetables has been associated with the development of depression. There is evidence supporting a small to moderate beneficial effect of a Mediterranean-type diet in depression. In addition, new dietary protocols are being studied for their use as possible interventions, such as the ketogenic diet, Nordic diet, and plant-based diet.

Summary

Lifestyle interventions surrounding diet and nutrition are a relatively affordable way to enhance response to treatment and to be employed as an adjunct in mental health care. Most studies, however, are limited by the difficulty in controlling for the placebo effect. Mediterranean-style diets seem to be the most promising as an adjunctive treatment for mood disorders. Larger randomized controlled trials that could assess predictors of response to dietary interventions are needed to establish a clear positive effect of diet and guide clinical care and nutritional recommendations concerning mental health care.

Role of diet and its effects on the gut microbiome in the pathophysiology of mental disorders

There is emerging evidence that diet has a major modulatory influence on brain-gut-microbiome (BGM) interactions with important implications for brain health, and for several brain disorders. The BGM system is made up of neuroendocrine, neural, and immune communication channels which establish a network of bidirectional interactions between the brain, the gut and its microbiome. Diet not only plays a crucial role in shaping the gut microbiome, but it can modulate structure and function of the brain through these communication channels. In this review, we summarize the evidence available from preclinical and clinical studies on the influence of dietary habits and interventions on a selected group of psychiatric and neurologic disorders including depression, cognitive decline, Parkinson's disease, autism spectrum disorder and epilepsy. We will particularly address the role of diet-induced microbiome changes which have been implicated in these effects, and some of which are shared between different brain disorders. While the majority of these findings have been demonstrated in preclinical and in cross-sectional, epidemiological studies, to date there is insufficient evidence from mechanistic human studies to make conclusions about causality between a specific diet and microbially mediated brain function. Many of the dietary benefits on microbiome and brain health have been attributed to anti-inflammatory effects mediated by the microbial metabolites of dietary fiber and polyphenols. The new attention given to dietary factors in brain disorders has the potential to improve treatment outcomes with currently available pharmacological and non-pharmacological therapies.

Associations of Dietary Vitamin C and E Intake With Depression. A Meta-Analysis of Observational Studies

Objective

The associations of dietary vitamin C and E intake with depression remains conflicting. This meta-analysis of observational study was therefore employed to clarify the issue further.

Methods

An extensive literature review (PubMed, Web of Science and Embase) was performed in January 2022 to identify the observational studies on the associations of dietary vitamin C and E intake with depression. The pooled relative risk (RR) of depression for the highest versus lowest dietary vitamin C and E intake category, and the weighted mean difference (WMD) of dietary vitamin C and E intake for depression versus control subjects, were calculated.

Results

A total of 25 observational studies (91966 participants) were included in this meta-analysis. The overall multi-variable adjusted RR demonstrated that dietary vitamin C intake was inversely associated with depression (RR = 0.72, 95% CI: 0.57 to 0.91; P = 0.005). In addition, the combined WMD showed that the dietary vitamin C intake in depression was lower than that in control subjects (WMD = −11.58, 95% CI: −14.88 to −8.29; P < 0.001). Similarly, the overall multi-variable adjusted RR demonstrated that dietary vitamin E intake was negatively associated with depression (RR = 0.84, 95% CI: 0.72 to 0.98; P = 0.02). Moreover, the combined WMD showed that the dietary vitamin E intake in depression was also lower than that in control subjects (WMD = −0.71, 95% CI: −1.07 to −0.34; P < 0.001).

Conclusion

The results of this meta-analysis suggest that both dietary vitamin C and E intake is inversely associated with depression. However, due to the limited evidence, more well-designed prospective cohort studies are still needed.

The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice

Physical therapists have unique education in the comprehensive biopsychosocial assessment and treatment of chronic pain and its mechanisms. Recently, physical therapists have raised awareness regarding the impact of nutrition on promoting health and managing noncommunicable diseases. Robust evidence supports the implementation of nutrition in physical therapist education and practice. Of particular interest for the physical therapist are investigations that use dietary interventions for the treatment of chronic pain. Yet physical therapists have received little guidance regarding their role in nutrition care for pain management and may pass on opportunities to counsel their patients on the connection between nutrition and pain. Therefore, a clinical paradigm shift and unified voice within the profession is called on to encourage physical therapists to develop tailored multimodal lifestyle interventions that include nutrition care for the management of chronic pain. This Perspective describes evidence supporting the implementation of nutrition care in physical therapist practice, supports the role of nutritional pain management for physical therapists, and encourages the use of nutrition care for primary, secondary, tertiary, prevention, health promotion, and wellness related to chronic pain. To achieve these aims, this Perspective offers suggestions for how physical therapists can (1) enhance clinical decision making; (2) expand professional, jurisdictional, and personal scope of practice; (3) evolve entry-level education; and (4) stimulate new investigations in nutrition care and pain science research. In doing so, physical therapists can assert their role throughout the pain management continuum, champion innovative research initiatives, and enhance public health by reducing the impact of chronic pain.

IMPACT

The nutrition care process for pain management is defined as the basic duty to provide adequate and appropriate nutrition education and counseling to people living with pain. Including the nutrition care process as part of a multimodal approach to pain management provides an opportunity for physical therapists to assert their role throughout the pain management continuum. This includes championing innovative research initiatives and enhancing public health by reducing the impact of chronic pain for over 50 million Americans.