Dietary patterns and depression risk: A meta-analysis

Association between dietary patterns and adult depression symptoms based on principal component analysis, reduced-rank regression and partial least-squares

BACKGROUND & AIMS

There have been inconsistent findings on the association between dietary patterns and depressive symptoms (DepS). In addition, studies have used single analysis methods to identify dietary patterns. In the current study, we aimed to determine the association between dietary patterns, derived by principal component analysis (PCA), reduced-rank regressions (RRR) and partial least-squares (PLS), and DepS among adults using a cohort study in Australia.

METHODS

We examined a total of 1743 study participants (≥24 years, 48.9% males) using cross-sectional and longitudinal data from the North West Adelaide Health Study (NWAHS). The Center for Epidemiological Studies-Depression (CES-D) scale was used to assess DepS and a score ≥16 was considered as having depression. Dietary data were collected using a food frequency questionnaire. Eicosapentaenoic acid (EPA)/Docosahexaenoic acid (DHA), folate, magnesium (Mg) and zinc (Zn) densities were chosen as the response variables for RRR and PLS analyses. Dietary patterns were identified by PCA, RRR and PLS. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated across quartiles (Q) using log-binomial logistic regression to assess the association between dietary patterns and DepS. Sensitivity analyses, including a longitudinal association between dietary patterns and DepS among 859 participants, were performed. Multiple imputation was performed to investigate the effect of missing data on the estimates.

RESULTS

In this study, 16.9% (14.2% in men and 20.8% in women) of the participants had DepS. We retained two, four and four dietary patterns captured by PCA, RRR and PLS respectively. The 'prudent' pattern determined by PCA [OR_Q4VsQ1 = 0.57; 95% CI: 0.35, 0.92] and PLS [OR_Q4VsQ1 = 0.66; 95% CI: 0.43, 1.00] together with the 'typical Australian' pattern determined by RRR [OR_Q4VsQ1 = 0.60; 95% CI: 0.40, 0.90] were inversely associated with DepS whereas the 'western' pattern derived by PCA [OR_Q4VsQ1 = 2.04; 95% CI: 1.12, 3.68] and PLS [OR_Q4VsQ1 = 1.62; 95% CI: 1.05, 2.50] was positively associated with DepS. In the longitudinal analysis, the 'prudent' pattern determined by PCA [OR_Q4VsQ1 = 0.52; 95% CI: 0.25, 1.09] tended to be inversely associated with DepS whereas 'western' patterns determined by PCA [OR_Q4VsQ1 = 3.47; 95% CI: 1.37, 8.78] and PLS [OR_Q4VsQ1 = 2.47; 95% CI: 1.24, 4.91] were positively associated with DepS. We found that a dietary pattern characterized by high intakes of fruits, vegetables, medium fat dairy, nuts, legumes, and fish was inversely associated with DepS in this population-based study. Contrary to this, a dietary pattern characterized by high intakes of processed and red meat, fast foods (snacks and takeaway foods), soft drinks, white bread and high-fat dairy products were significantly associated with DepS. Multiple imputation and sensitivity analysis identified similar patterns of association between dietary pattern and DepS.

CONCLUSIONS

The findings indicate that the 'western' pattern was consistently associated with an increased risk, and the 'prudent' pattern tended to be associated with a reduced risk of DepS. This suggests that dietary interventions may assist with the treatment of DepS. However, current evidence on the impact of diet on DepS should be supported using further longitudinal studies with extended follow up, larger sample sizes and repeated measures.

Brain 5-HT Deficiency Prevents Antidepressant-Like Effects of High-Fat-Diet and Blocks High-Fat-Diet-Induced GSK3β Phosphorylation in the Hippocampus

Obesity is associated with an increased risk of depression and anxiety disorders, but the nature of the relationship(s) between obesity and mental illness remains highly controversial. Some argue that depression and anxiety lead to increased consumption of "comfort foods," the intake of which reduces negative affect and promotes obesity. In contrast, others have theorized that negative affect results from chronic excessive consumption of highly palatable foods. The brain serotonin (5-HT) system has long been implicated in both the development and treatment of mental illness. Preclinical studies have shown that low brain 5-HT exacerbates depression- and anxiety-like behaviors induced by stress and blocks reductions in depression-like behavior induced by antidepressants, but the effects of brain 5-HT deficiency on responses to high-fat diet (HFD) have not been explored. The current work used genetically modified mice to evaluate the effects of low 5-HT on behavioral and molecular alterations induced by chronic exposure to HFD. Our results reveal that HFD decreases depression-like behavior and increases some anxiety-like behaviors in wild-type (WT) mice. However, genetic brain 5-HT deficiency blocks HFD-induced reductions in forced swim immobility and prevents HFD-induced increases in hippocampal GSK3β phosphorylation despite having no significant effects on HFD-induced changes in body weight or anxiety-like behavior. Together, our results suggest that brain 5-HT deficiency significantly impacts a subset of behavioral and molecular responses to HFD, a finding that could help explain the complex relationships between obesity and mental illness.

The relationship between dietary inflammatory index and psychosomatic complaints profiles: results from SEPAHAN cross-sectional study

Background

Although the dietary inflammatory index (DII) has been evaluated in relation to psychological disorders risk, the association between DII and psychosomatic complaints is unclear. This study aimed to determine the association between DII, as a proxy measure of the inflammatory potential of the diet, and psychosomatic complaints.

Methods

This cross-sectional study included 2818 people from the general population, aged 19 to 69 years, of Isfahan province in Iran. Dietary intake was assessed using a validated dish-based food-frequency questionnaire. Psychosomatic complaints were assessed using a self-administered validated Persian questionnaire. Twenty-seven nutrients or foods were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a higher DII score indicated a more pro-inflammatory diet. The risk of being in the top median of a psychosomatic complaints profile across the tertiles of DII was assessed using logistic regression.

Results

Four psychosomatic complaints profiles (psychological, gastrointestinal, neuro-skeletal and pharyngeal- respiratory) were identified. After controlling for potential confounders, individuals in the top tertile of DII had higher odds for experiencing high somatic complaints scores for the psychological (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.10, 1.89; P trend = 0.009), gastrointestinal (OR = 1.22, 95% CI: 0.99, 1.75; P = 0.058) or neuro-skeletal (OR = 1.56, 95% CI: 1.10, 2.22; P = 0.013) profile. The association for pharyngeal-respiratory complaints did not remain significant after adjustment for stressful life events, medical condition, and anti-psychotropic medicine use.

Conclusion

The significant positive link between DII and the various psychosomatic complaints profiles suggests that a diet with anti-inflammatory potential might be favourably related to psychosomatic complaints. Further studies, particularly clinical trials and longitudinal studies, are warranted to investigate the inflammatory potential of diet in relation to psychosomatic complaints.

Are Psychological Distress and Resilience Associated with Dietary Intake Among Australian University Students?

University students report unhealthy diets and experience poorer mental health than the general population. This study explores the association between psychological distress and resilience with dietary intake in a sample of Australian university students. Cross-sectional data from the University of Newcastle Student Healthy Lifestyle Survey 2017 were analysed. Psychological distress (Kessler Scale), resilience (Brief Resilience Scale) and fruit, vegetable, soft drink, takeaway food and breakfast intakes (short diet questions) were assessed. Socio-demographic (e.g., gender), student (e.g., undergraduate/postgraduate) and health characteristics (e.g., physical activity) were captured. Multivariate linear regression models explored associations between psychological distress and resilience with dietary intake, with adjustment for potential confounders. Analysis included 2710 students (mean age 26.9 ± 9.5 years, 30.4% male). In adjusted models, lower psychological distress was associated with higher fruit (β = -0.37, p = 0.001) and vegetable (β = -0.37, p < 0.001) serves/day, more frequent breakfast consumption (p < 0.001) and less frequent soft drink and takeaway food consumption (p < 0.001). Higher resilience was associated with higher fruit (β = 0.03, p = 0.022) and vegetable (β = 0.06, p < 0.001) serves/day, more frequent breakfast consumption (p = 0.005), and less frequent soft drink (p < 0.001) and takeaway food consumption (p = 0.001). These results highlight a potential link between psychological distress and resilience with diet, and that further research in this area is warranted.

Fish Oil, but Not Olive Oil, Ameliorates Depressive-Like Behavior and Gut Microbiota Dysbiosis in Rats under Chronic Mild Stress

Background: This study investigated the effects of fish oil and olive oil in improving dysbiosis and depressive-like symptoms. Methods and results: Male rats were fed normal, fish oil-rich or olive oil-rich diets for 14 weeks. Chronic mild stress (CMS) was administered from week 2. The sucrose preference test (SPT) and forced swimming test (FST) were used to determine depressive-like behavior. The SPT results revealed that the CMS, CMS with imipramine (CMS+P) treatment, and CMS with olive oil diet (CMS+O) groups exhibited significantly reduced sucrose intake from week 8, whereas the fish oil diet (CMS+F) group exhibited significantly reduced sucrose intake from week 10. The FST results showed that the immobile time of the CMS+F group was significantly less than that of the CMS-only group. Next generation sequencing (NGS) results showed CMS significantly reduced the abundance of Lactobacillus and increased that of Marvinbryantia and Ruminiclostridium_6. However, the CMS+F group showed an increase in the abundance of Eisenbergiella, Ruminococcaceae_UCG_009, and Holdemania, whereas the CMS+O group showed an increase in the abundance of Akkermansia. Conclusions: CMS stimuli altered the gut microbiome in depressed rats. Fish oil and olive oil exerted part of a prebiotic-like effect to ameliorate dysbiosis induced by CMS. However, only fish oil ameliorated depressive-like symptoms.

Stress and Western diets increase vulnerability to neuropsychiatric disorders: A common mechanism

In modern lifestyle, stress and Western diets are two major environmental risk factors involved in the etiology of neuropsychiatric disorders. Lifelong interactions between stress, Western diets, and how they can affect brain physiology, remain unknown. A possible relation between dietary long chain polyunsaturated fatty acids (PUFA), endocannabinoids, and stress is proposed. This review suggests that both Western diets and negative stress or distress increase n-6/n-3 PUFA ratio in the phospholipids of the plasma membrane in neurons, allowing an over-activation of the endocannabinoid system in the limbic areas that control emotions. As a consequence, an excitatory/inhibitory imbalance is induced, which may affect the ability to synchronize brain areas involved in the control of stress responses. These alterations increase vulnerability to neuropsychiatric disorders. Accordingly, dietary intake of n-3 PUFA would counter the effects of stress on the brain of stressed subjects. In conclusion, this article proposes that PUFA, endocannabinoids, and stress form a unique system which is self-regulated in limbic areas which in turn controls the effects of stress on the brain throughout a lifetime.

Microbiota-Gut-Brain Axis: New Therapeutic Opportunities

The traditional fields of pharmacology and toxicology are beginning to consider the substantial impact our gut microbiota has on host physiology. The microbiota-gut-brain axis is emerging as a particular area of interest and a potential new therapeutic target for effective treatment of central nervous system disorders, in addition to being a potential cause of drug side effects. Microbiota-gut-brain axis signaling can occur via several pathways, including via the immune system, recruitment of host neurochemical signaling, direct enteric nervous system routes and the vagus nerve, and the production of bacterial metabolites. Altered gut microbial profiles have been described in several psychiatric and neurological disorders. Psychobiotics, live biotherapeutics or substances whose beneficial effects on the brain are bacterially mediated, are currently being investigated as direct and/or adjunctive therapies for psychiatric and neurodevelopmental disorders and possibly for neurodegenerative disease, and they may emerge as new therapeutic options in the clinical management of brain disorders.

Microbiome and Mental Health, Specifically as It Relates to Adolescents

PURPOSE OF REVIEW

This article reviews the relationship of the microbiome, the gut-brain axis, and depression. It also will review factors which can influence this relationship, such as chronic stress, medications, and the Western diet typically consumed by adolescents.

RECENT FINDINGS

Changes in the gut microbiome increase the release of microbial lipopolysaccharides (LPS) which activate a gut inflammatory response. Gut pro-inflammatory cytokines stimulate the afferent vagal nerve which in turn impacts the hypothalamic-pituitary-adrenal (HPA) axis inducing symptoms associated with depression. Recent research suggests that gut inflammation can induce neuroinflammation which, in turn, stimulates microglia activation and the kynurenine pathway and can activate systemic inflammation-inducing depressive symptoms. Promoting a healthy diet and lifestyle changes, limiting exposure to pesticides, limiting medications that affect the microbiome and the use of such things pre/probiotics and other interventions may complement existing efforts to curb the rise in depression. Alternative and complementary therapies may serve as effective treatments in adolescents with depression.

Association of dietary patterns and degree of food processing with feelings of depression in pregnancy

Abstract Objectives: to investigate the relationship of dietary patterns and degree of food processing with feelings of depression in pregnancy. Methods: cross-sectional study conducted with 784 adult pregnant women in Ribeirão Preto, SP, between 2011 and 2012. Feelings of depression were obtained through a structured questionnaire. Two 24-hour dietary recalls were obtained (24th-39th weeks of gestation) and adjusted through the Multiple Source Method. Four dietary patterns were determined: “Brazilian traditional”,“snacks”, “coffee”, and “healthy”. Adjusted logistic regression models were used to assess the relationship ofthe tertiles of dietary patterns and energy contribution (% E) of foods according to the degree of industrial processing with feelings of depression (always/most of the time vs. sometimes/never). Results: 12% of the women reported feelings of depression during the pregnancy. Women with greater adherence to “Brazilian traditional”[OR= 0.54 (CI95%= 0.30-0.97)] and “healthy” patterns [0.53 (0.30-0.94)] and with higher % E from minimally processed foods [0.51 (0.28-0.93)] presented a lower chance of feelings of depression. A higher % E from ultra-processed foods [2.39 (1.29-4.41)] was directly associated with the outcome. No associations with the other patterns were found. Conclusions: greater adherence to the“Brazilian traditional” and “healthy” dietary patterns was inversely associated with feelings of depression during pregnancy, possibly mediated by the degree of industrial processing of the foods.

Neuroendocrine drivers of risk and resilience: The influence of metabolism & mitochondria

The manifestation of risk versus resilience has been considered from varying perspectives including genetics, epigenetics, early life experiences, and type and intensity of the challenge with which the organism is faced. Although all of these factors are central to determining risk and resilience, the current review focuses on what may be a final common pathway: metabolism. When an organism is faced with a perturbation to the environment, whether internal or external, appropriate energy allocation is essential to resolving the divergence from equilibrium. This review examines the potential role of metabolism in the manifestation of stress-induced neural compromise. In addition, this review details the current state of knowledge on neuroendocrine factors which are poised to set the tone of the metabolic response to a systemic challenge. The goal is to provide an essential framework for understanding stress in a metabolic context and appreciation for key neuroendocrine signals.

The Inflammatory Potential of the Diet is Directly Associated with Incident Depressive Symptoms Among French Adults

BACKGROUND

Low-grade chronic inflammation has been suggested to play a substantial role in the etiology of depression; however, studies on the prospective association between the inflammatory potential of the diet and depression are limited.

OBJECTIVE

The aim of this study was to investigate the association between the inflammatory potential of the diet (measured using the Alternate Dietary Inflammatory Index, ADII) and incident depressive symptoms. We also tested the potential modulating effect of sex, age, BMI, and lifestyle indicators.

METHODS

The study sample consisted of 26,730 participants (aged 18-86 y) from the NutriNet-Santé study. Baseline ADII was computed using repeated 24-h dietary records collected during the first 2 y of the follow-up. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression scale ≥17 for men and ≥23 for women at least once during follow-up. HR and 95% CI were estimated using multivariable Cox proportional hazards models.

RESULTS

A total of 2221 incident cases of depressive symptoms were identified over a mean follow-up of 5.4 y. After accounting for a wide range of potential confounders, the highest quartile of the ADII was associated with a 15% (95% CI: 2, 31) increase in the risk of depressive symptoms compared with the lowest quartile. In the stratified analyses, associations were statistically significant only among women (HRquartile4 vs. quartile1: 1.19; 95% CI: 1.02, 1.37), middle-age adults (HRquartile4 vs. quartile1: 1.16; 95% CI: 1.00, 1.35), and participants with a BMI ≥25 (HRquartile4 vs. quartile1: 1.29; 95% CI: 1.04, 1.60).

CONCLUSIONS

Overall, a proinflammatory diet was associated with a higher risk of depressive symptoms, especially among women, middle-age adults, and participants with overweight or obesity. These findings contribute to the increasing scientific evidence showing a detrimental role of the proinflammatory diet. The NutriNet-Santé study is registered at clinicaltrials.gov as NCT03335644.

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews under the number CRD42017080579.

Systematic review of the association between dietary patterns and perinatal anxiety and depression

Background

Specific dietary factors contribute to greater risks of prenatal and postpartum anxiety and depression. This study aimed to systematically review and assess the evidence regarding the association between dietary patterns and perinatal anxiety and depression (PAAD).

Methods

A systematic search of the Latin American & Caribbean Health Sciences Literature (LILACS), PubMed, and Scopus databases for cross-sectional and cohort studies through April 2019 was conducted. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence.

Results

Ten studies (six cohort and four cross-sectional) were included. All studies had good methodological quality. In these studies, the Western (n = 10), healthy (n = 9), and traditional (n = 7) dietary patterns were examined. The healthy pattern was inversely associated with prenatal and postpartum anxiety and prenatal depression. The traditional Japanese dietary pattern, the traditional Indian-confinement dietary pattern, the United Kingdom traditional dietary and the traditional Brazilian dietary pattern were associated with a lower risk of prenatal depression, postpartum depression, prenatal anxiety and postpartum anxiety, respectively. There was no significant association between a Western dietary pattern and PAAD. The GRADE assessment suggested that the quality of the evidence was very low to low across all outcomes owing to the design, risk of bias, and small sample size.

Conclusions

There is no definitive evidence about the relationship between Western dietary patterns and perinatal anxiety and depression. However, it found an inverse association among the healthy dietary pattern and PAAD. Future studies will be required to better evaluate associations between meal patterns and PAAD. Such studies may provide new insights and assist in the development of new prevention and treatment strategies.

Dietary Inflammatory Index and Sleep Quality in Southern Italian Adults

BACKGROUND

Current evidence supports the central role of a subclinical, low-grade inflammation in a number of chronic illnesses and mental disorders; however, studies on sleep quality are scarce. The aim of this study was to test the association between the inflammatory potential of the diet and sleep quality in a cohort of Italian adults.

METHODS

A cross-sectional analysis of baseline data of the Mediterranean healthy Eating, Aging, and Lifestyle (MEAL) study was conducted on 1936 individuals recruited in the urban area of Catania during 2014-2015 through random sampling. A food frequency questionnaire and other validated instruments were used to calculate the dietary inflammatory index (DII®) and assess sleep quality (Pittsburg sleep quality index). Multivariable logistic regression analyses were performed to determine the association between exposure and outcome.

RESULTS

Individuals in the highest quartile of the DII were less likely to have adequate sleep quality (odds ratio (OR) = 0.49, 95% CI: 0.31, 0.78). Among individual domains of sleep quality, an association with the highest exposure category was found only for sleep latency (OR = 0.60, 95% CI: 0.39, 0.93).

CONCLUSIONS

The inflammatory potential of the diet appears to be associated with sleep quality in adults. Interventions to improve diet quality might consider including a dietary component that aims to lower chronic systemic inflammation to prevent cognitive decline and improve sleep quality.

Changes in Anxiety and Depression Traits Induced by Energy Restriction: Predictive Value of the Baseline Status

Current evidence proposes diet quality as a modifiable risk factor for mental or emotional impairments. However, additional studies are required to investigate the effect of dietary patterns and weight loss on improving psychological symptoms. The aim of this investigation was to evaluate the effect of energy-restriction, prescribed to overweight and obese participants, on anxiety and depression symptoms, as well as the potential predictive value of some baseline psychological features on weight loss. Overweight and obese participants (n = 305) were randomly assigned for 16 weeks to two hypocaloric diets with different macronutrient distribution: a moderately high-protein (MHP) diet and a low-fat (LF) diet. Anthropometrical, clinical, psychological, and lifestyle characteristics were assessed at baseline and at the end of the intervention. The nutritional intervention evidenced that weight loss has a beneficial effect on trait anxiety score in women (β = 0.24, p = 0.03), depression score in all population (β = 0.15, p = 0.02), particularly in women (β = 0.22, p = 0.03) and in subjects who followed the LF diet (β = 0.22, p = 0.04). Moreover, weight loss could be predicted by anxiety status at baseline, mainly in women and in those who were prescribed a LF diet. This trial suggests that weight loss triggers an improvement in psychological traits, and that anxiety symptoms could predict those volunteers that benefit most from a balanced calorie-restricted intervention, which will contribute to individualized precision nutrition.

Variation in the prevalence of depression and patterns of association, sociodemographic and lifestyle factors in community-dwelling older adults in six low- and middle-income countries

BACKGROUND

Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression.

METHOD

A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression.

RESULTS

The crude population prevalence of depression was 7.4% [95%CI: 6.5%-8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%-9.6%] compared to males 6.1% [5.0%-7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%-9.6%] in pooled data, 8.9% [6.9%-11.1%] in females and 6.6% [4.6%-9.0%] in males. Greater fruit (0.89[0.84-0.93]) and vegetable intake (0.94 [0.89-1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression.

LIMITATIONS

The cross-sectional design of this study precluded conclusions on causality.

CONCLUSION

In nationally-representative samples of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.

An apple a day: Protective associations between nutrition and the mental health of immigrants in Canada

PURPOSE

Mental illness represents a major public health burden among Canada's large immigrant population. A burgeoning cross-sectional, longitudinal, and experimental evidence base implicates nutrition in mental health. Healthier diets (e.g., those rich in certain micro-nutrients) may benefit cognitive, social, and emotional functioning through attenuated inflammation and other bio-psychological pathways. The present study examined associations between nutrition and three markers of mental health among immigrants to Canada.

METHODS

Employing cross-sectional data from immigrant respondents (n = 37,071) to a nationally representative population-based survey (the Canadian Community Health Survey: CCHS 2011-2014), we modelled associations of daily fruit and vegetable consumption with three mental health outcomes: anxiety and/or mood disorder diagnosis, being distressed (assessed via the 6-item Kessler Psychological Distress Scale), and having good self-rated overall mental health. Multivariable logistic regression analyses were employed, adjusting for various socio-demographic and lifestyle-related variables.

RESULTS

Higher consumption of fruit and vegetables demonstrated significant, protective associations with odds of having a mood and/or anxiety disorder, being distressed, and self-rated good mental health. Such patterns of association were similar regardless of ethno-cultural minority status and recency of immigration. Moreover, the protective associations of nutrition and mental health were independent of socio-demographic, health, and lifestyle factors.

CONCLUSIONS

Results suggested evidence of protective associations between healthy nutritional intake and mental illness among a large-scale sample of immigrants in Canada. Importantly, the protective associations of healthier diets with immigrants' mental health were independent of various markers of healthy lifestyles (e.g., general health status, physical activity, alcohol use). Healthy dietary intake may, therefore, be worth consideration in efforts to prevent mental illness among immigrants.

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students

PURPOSE

Examining the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students.

METHODS

This cross-sectional study was conducted among 240 university students (mean age 21.5 years; 86.7% female). Mental health was evaluated using validated Persian versions of the 12-item general health questionnaire (GHQ-12) and the 21-item depression, anxiety, and stress scale (DASS-21). The lower the subjects' scores on these questionnaires, the better their mental health. Usual past-year dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. The DASH score was computed based on energy-adjusted intakes of eight major dietary components emphasized or minimized in the DASH pattern. The higher the DASH score of a subject, the greater his/her adherence to the DASH pattern.

RESULTS

The Pearson's correlation coefficients of DASH score with GHQ-12 total score, DASS-21 total score, and DASS-21 depression, anxiety, and stress subscale scores were - 0.431, - 0.441, - 0.434, - 0.325, and - 0.408, respectively (all P < 0.001). Compared to those in the lowest tertile, subjects in the highest tertile of DASH score had lower means of GHQ-12 total score (mean difference - 4.6; P < 0.001), DASS-21 total score (mean difference - 9.1; P < 0.001), and DASS-21 depression, anxiety, and stress subscale scores (mean differences for depression, anxiety, and stress - 3.6, - 2.4, and - 3.2, respectively; all P < 0.001).

CONCLUSIONS

The findings indicate that greater adherence to the DASH dietary pattern is associated with better mental health in Iranian university students. However, prospective studies of sufficient methodological quality are needed to confirm these findings.

Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort

BACKGROUND

Ultra-processed food (UPF) consumption has increased over the last decades in Westernized countries. Our objective was to investigate for the first time the association between the proportion of UPF (%UPF) in the diet and incident depressive symptoms in the NutriNet-Santé cohort.

METHODS

The sample included 20,380 women and 6350 men (aged 18-86 years) without depressive symptoms at the first Center for Epidemiologic Studies Depression Scale (CES-D) measurement, using validated cut-offs (CES-D score ≥ 17 for men and ≥ 23 for women). The proportion of UPF in the diet was computed for each subject using the NOVA classification applied to dietary intakes collected by repeated 24-h records (mean = 8; SD = 2.3). The association between UPF and depressive symptoms was evaluated using multivariable Cox proportional hazards models.

RESULTS

Over a mean follow-up of 5.4 years, 2221 incident cases of depressive symptoms were identified. After accounting for a wide range of potential confounders, an increased risk of depressive symptoms was observed with an increased %UPF in the diet. In the main model adjusted for sociodemographic characteristics, body mass index, and lifestyle factors, the estimated hazard ratio for a 10% increase in UPF was 1.21 (95% confidence interval = 1.15-1.27). Considering %UPF in food groups, the association was significant only for beverages and sauces or added fats.

CONCLUSION

Overall, UPF consumption was positively associated with the risk of incident depressive symptoms, suggesting that accounting for this non-nutritional aspect of the diet could be important for mental health promotion.

Association of food groups with depression and anxiety disorders

PURPOSE

Adherence to the Mediterranean diet has been associated with fewer depressive symptoms, however, it is unknown whether this is attributed to some or to all components. We examined the association between the individual food groups of the Mediterranean Diet Score (MDS), in isolation and in combination, with depression and anxiety (symptom severity and diagnosis).

METHODS

Data from 1634 adults were available from the Netherlands Study of Depression and Anxiety. Eleven energy-adjusted food groups were created from a 238-item food frequency questionnaire. In regression analysis, these were associated in isolation and combination with (1) depressive and anxiety disorders (established with the Composite International Diagnostic Interview) (current disorder n = 414), and (2) depression and anxiety severity [measured with the Inventory of Depressive Symptomatology (IDS), the Beck Anxiety Inventory (BAI) and the Fear Questionnaire (FEAR)].

RESULTS

Overall, the MDS score shows the strongest relationships with depression/anxiety [Diagnosis: odds ratio (OR) 0.77 per SD, 95% confidence interval (95% CI) 0.66-0.90, IDS: standardised betas (β) - 0.13, 95% CI - 0.18, - 0.08] and anxiety (BAI: β - 0.11, 95% CI - 0.16, - 0.06, FEAR: β - 0.08, 95% CI - 0.13, - 0.03). Greater consumption of non-refined grains and vegetables was associated with lower depression and anxiety severity, whilst being a non-drinker was associated with higher symptom severity. Higher fruit and vegetable intake was associated with lower fear severity. Non-refined grain consumption was associated with lower odds and being a non-drinker with greater odds of current depression/anxiety disorders compared to healthy controls, these associations persisted after adjustment for other food groups (OR 0.82 per SD, 95% CI 0.71-0.96, OR 1.26 per SD 95% CI 1.08-1.46).

CONCLUSION

We can conclude that non-refined grains, vegetables and alcohol intake appeared to be the driving variables for the associated the total MDS score and depression/anxiety. However, the combined effect of the whole diet remains important for mental health. It should be explored whether an increase consumption of non-refined grains and vegetables may help to prevent or reduce depression and anxiety.

The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Poor diet can be detrimental to mental health. However, the overall evidence for the effects of dietary interventions on mood and mental well-being has yet to be assessed. We conducted a systematic review and meta-analysis examining effects of dietary interventions on symptoms of depression and anxiety.

METHODS

Major electronic databases were searched through March 2018 for all randomized controlled trials of dietary interventions reporting changes in symptoms of depression and/or anxiety in clinical and nonclinical populations. Random-effects meta-analyses were conducted to determine effect sizes (Hedges' g with 95% confidence intervals [CI]) for dietary interventions compared with control conditions. Potential sources of heterogeneity were explored using subgroups and meta-regression analyses.

RESULTS

Results: Sixteen eligible randomized controlled trials (published in English) with outcome data for 45,826 participants were included; the majority of which examined samples with nonclinical depression (n = 15 studies). Nonetheless, dietary interventions significantly reduced depressive symptoms (g = 0.162, 95% CI = 0.055 to 0.269, p = 0.003). Similar effects were observed among high-quality trials (g = 0.171, 95% C.I.=0.057 to 0.286, p=0.003) and when compared with both inactive (g = 0.114, 95% C.I.=0.008 to 0.219, p=0.035) and active controls (g = 0.224, 95% C.I.= 0.052 to 0.397, p = 0.011). No effect of dietary interventions was observed for anxiety (k = 11, n = 2270, g = 0.085, 95% C.I. = -0.031 to 0.202, p=0.151). Studies with female samples observed significantly greater benefits from dietary interventions, for symptoms of both depression and anxiety.

CONCLUSIONS

Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population. Future research is required to determine the specific components of dietary interventions that improve mental health, explore underlying mechanisms, and establish effective schemes for delivering these interventions in clinical and public health settings.

REGISTRATION

PROSPERO Online Protocol: CRD42018091256.

Adherence to the Mediterranean diet and risk of depression: a systematic review and updated meta-analysis of observational studies

CONTEXT

More than 300 million people worldwide have been diagnosed with depression, which is a leading cause of disability and disease burden. Elucidating dietary patterns that may reduce the risk of depression could help reduce the incidence of other diseases.

DATA SOURCES

PubMed/MEDLINE, ISI Web of Science, Scopus, Embase, and Google Scholar databases were searched to identify relevant publications up to May 2018.

STUDY SELECTION

All observational studies that considered the Mediterranean diet as the exposure variable and depression as the main outcome or as one of the outcome variables were included in this systematic review and meta-analysis. Two authors independently screened 3229 publications. A total of 14 observational studies were included in the meta-analysis.

DATA EXTRACTION

Two authors independently extracted the data and assessed the risk of bias.

RESULTS

The studies in the meta-analysis included a total of 56 043 participants. When 5 effect sizes from 4 cohort studies were combined, no significant association was observed between adherence to the Mediterranean diet and risk of depression (overall hazard ratio = 0.95; 95%CI, 0.79-1.16). When 3 effect sizes from 3 cohort studies that reported β coefficients were combined, again no significant association was found (β = -0.00; 95%CI, -0.12, 0.12). However, when 9 effect sizes from 9 cross-sectional studies were combined, an inverse significant association was found between adherence to the Mediterranean diet and risk of depression (overall odds ratio = 0.72; 95%CI, 0.60-0.87).

CONCLUSIONS

The analysis of cohort studies revealed no significant association was found between adherence to the Mediterranean diet and risk of depression. However, an inverse significant association between adherence to the Mediterranean diet and odds of depression in cross-sectional studies.

Higher Adherence to the Mediterranean Diet is Related to More Subjective Happiness in Adolescents: The Role of Health-Related Quality of Life

Adherence to the Mediterranean diet (MD) has previously been related to better quality of life in the general population. Further, children and adolescents have obtained better health outcomes when they have shown high adherence to the MD in recent studies. Nevertheless, the association between the adherence to this type of diet and subjective happiness have not been previously analysed in this population. The main aim of the present study was to evaluate the relationship between MD adherence, health-related quality of life (HRQOL) and subjective happiness in a sample of 527 Spanish adolescents. Results obtained show positive associations of MD adherence with higher levels of subjective happiness and better HRQOL. Moreover, mediation analyses showed a full mediation effect of some components of HRQOL, namely, emotional well-being, mood and emotions, financial resources and social acceptance, in the association between MD adherence and subjective happiness. This study advances our understanding of the association of MD and levels of happiness in the general population, specifically in adolescents, through the positive effects of specific components of HRQOL. Future studies should evaluate other variables that could influence or also mediate this relationship, evaluating specific groups of adolescents, such as clinical samples.

Diet quality and mental health problems in late childhood

Objectives: There is evidence that diet quality is associated with mental health problems in adults and adolescents. Yet the extent to which overall diet quality (not individual nutrients or dietary patterns) may be associated with mental health problems in pre-adolescent children, a common time for first onset of symptoms, remains unclear. This study examined associations between overall diet quality, using a brief measure, and mental health problems during late childhood, in a large community sample. Methods: Participants were 787 eight and nine-year-old children taking part in the Childhood to Adolescence Transition Study. Parents reported on their child's mental health problems using the Strengths and Difficulties Questionnaire and on their child's diet quality, using a six-item screening tool. Results: Regression analyses were conducted, adjusting for child age, sex, body mass index, and family socioeconomic status. Overall diet quality was significantly associated with children's mental health before (beta = -0.11, 95% CI -0.18 to -0.04, p = 0.004) and after adjustments for age, sex, body mass index and family socioeconomic status (beta = -0.10, 95% CI -0.18 to -0.03, p = 0.007). Conclusion: Concordant with previous literature, results indicate that better overall diet quality is related to more positive mental health in pre-adolescent children. Additionally, these results support the utility and efficacy of a brief (six-item) parent-report questionnaire as an indicator of overall diet quality.

Fruit and vegetable consumption and mental health across adolescence: evidence from a diverse urban British cohort study

BACKGROUND

Evidence on the relationship between fruit and vegetable consumption (FV) and mental health in adolescence is sparse and inconsistent. Social determinants of FV include ethnicity, family environments and economic disadvantage. We investigated the relationship between FV and mental health in the British multi-ethnic Determinants of Adolescents (now young Adult) Social well-being and Health (DASH) longitudinal study.

METHODS

A longitudinal study of 4683 adolescents living in London at age 11-13 years and followed up at 14-16 years. FV was measured using validated questions on the number of portions consumed daily. Mental health was measured by the Strengths and Difficulties Questionnaire as mean Total Difficulties Score (TDS) and by classification as a 'probable clinical case' (TDS > 17). Social measures included ethnicity, parenting and socioeconomic circumstances. Multilevel modelling was used to investigate the association between FV and mental health throughout adolescence.

RESULTS

Low FV was common among adolescents, with approximately 60-70% of adolescents reporting < 5 portions/day and 20-30% reporting < 1 portion/day. In late adolescence, most ethnic minority groups reported lower FV than their White peers. In fully adjusted models, < 1 portion/day remained a significant correlate with mean TDS (Coef: 0.55, 0.29-0.81, P < 0.001) and TDS > 17 (Odds Ratio: 1.43, 1.11-1.85, P = 0.007). Gender- or ethnic-specific effects were not observed. Low parental care partly attenuated the association between FV and mental health.

CONCLUSIONS

Low FV is a longitudinal correlate of poor mental health across adolescence. A focus on FV in parenting interventions could yield interrelated benefits across developmental outcomes given its importance to both physical and socioemotional health.

Impact of consuming green and yellow vegetables on the depressive symptoms of junior and senior high school students in Japan

Adolescent depression is a significant public health concern. Although skipping breakfast is associated with depressive symptoms in adolescents, the effects of dietary patterns on their depressive symptoms remain unknown. Therefore, this study aims to determine whether dietary patterns are associated with depressive symptoms among junior and senior high school students in Japan. A total of 441 junior high school students and 417 senior high school students participated in this study. The Center for Epidemiologic Studies Depression scale (CES-D) was used to measure the participants' depressive symptoms. We surveyed the participants' breakfast consumption pattern, as well as their general dietary patterns (meat, fish, green and yellow vegetables, milk and dairy products, and fruits), using a self-report questionnaire. The results indicated that the senior high school students had a significantly higher CES-D score than the junior high school students. We found negative and significant partial correlations between regular consumption of breakfast and depressive symptoms, and between regular consumption of green and yellow vegetables and depressive symptoms in both junior and senior high school students, after controlling for age, sex, and sleep duration. Furthermore, a one-way analysis of covariance (ANCOVA) revealed that adolescents who consumed green and yellow vegetables every day (one or more times per day) had significantly lower depressive symptoms than those from the "Never/1-2 times a week" group. The findings of this study reveal that the regular consumption of green and yellow vegetables is associated with lower depressive symptoms in adolescents, that is, the consumption of green and yellow vegetables may be vital in the context of adolescents' mental health.

Association of dietary phytochemical index and mental health in women: a cross-sectional study

Previous studies have shown that unhealthy dietary patterns are among the most important modifiable risk factors in the development of mental health disorders. We examined the association of dietary phytochemical index (DPI) with symptoms of depression, anxiety and psychological distress in Iranian women. In this cross-sectional study, a total of 488 women aged 20–50 years old attending health centres in the south of Tehran in 2018 were included. A validated and reliable FFQ was used for dietary assessment. Symptoms of depression, anxiety and psychological distress were assessed using a validated depression, anxiety, stress scales questionnaires with twenty-one-items. DPI was estimated using the following formula: (daily energy derived from phytochemical-rich foods (kJ)/total daily energy intake (kJ))×100. The mean age of the study participants was 31·9 (sd7·7) years. The prevalence of depressive symptoms, anxiety and psychological distress among study participants was 34·6, 40·6 and 42·4 %, respectively. After controlling for potential confounders, women in the highest tertile of DPI had a lower prevalence of depressive symptoms (OR 0·22; 95 % CI 0·12, 0·38) and anxiety (OR 0·33; 95 % CI 0·20, 0·55), as well as psychological distress (OR 0·30; 95 % CI 0·18, 0·49) compared with those in the lowest tertile. In conclusion, we found a significant association between DPI and mental health in women. Prospective studies are needed to confirm these findings.

Associations Between Unhealthy Weight-Loss Strategies and Depressive Symptoms

INTRODUCTION

There appears to be a link between weight loss and improved mental health, but less is known about how using unhealthy weight-loss strategies impacts the odds of reporting depression.

METHODS

This study includes respondents from the National Health and Nutrition Examination Survey from 2005 to 2014 who attempted to lose weight over the past year. Analysis occurred in 2017. Multivariable logistic regression was used to describe associations between all weight-loss strategies, including those grouped as unhealthy (smoking, vomiting, laxatives, skipping meals, and using diet pills), and the adjusted odds of depression (Patient Health Questionnaire-9 score ≥10). The model was then stratified by BMI, sex, race, and antidepressant use to compare the effect of using at least one unhealthy weight-loss strategy and depression within certain populations.

RESULTS

The sample included 6,765 respondents (weighted n=59.2 million, 95% CI=55.5, 62.9 million). Of these respondents, 18.0% (n=1,270) reported using at least one unhealthy weight-loss strategy. In unadjusted analysis, unhealthy weight-loss strategies were generally associated with higher incidence and odds of reporting depression. In multivariable analysis, using at least one unhealthy weight-loss strategy was significantly associated with odds of reporting depression (AOR=1.47, 95% CI=1.14, 1.91, p<0.01). When the model was stratified, this effect was statistically significant among respondents with class I or II obsesity (AOR=2.20, 95% CI=1.56, 3.10, p<0.01); female respondents (AOR=1.46, 95% CI=1.06, 2.00, p=0.02); and respondents who did not use an antidepressant (AOR=1.57, 95% CI=1.14, 2.15, p=0.01).

CONCLUSIONS

Unhealthy weight-loss strategies are associated with increased odds of depression. This may inform screening practices and public health messaging.

Adherence to a healthy dietary pattern is associated with less severe depressive symptoms among adolescent girls

There is growing interest on the impact of diet on depressive disorders. However, there are limited data on the association between dietary patterns and depression symptoms among Iranian adolescents. The aim of this study was to evaluate the association between dietary patterns and depression score among Iranian adolescent girls. Data were obtained from 750 adolescent girls, who were recruited from several schools using a random cluster sampling. Dietary data were collected using a valid and reliable food frequency questionnaire (FFQ). Beck's depression inventory (BDI-II) was used to assess depression severity score. The prevalence of girls diagnosed with depression was 29.1%. Three major dietary patterns were identified in the study based on factor analysis: "Healthy", "Traditional" and "Western". The multivariate-adjusted odds ratio of having depressive symptoms was 0.55 (95% confidence intervals, 0.34-0.89) for the highest versus lowest quartile of the healthy dietary pattern score. However, there were no significant associations between the Traditional and Western dietary patterns and depression symptoms. Our results indicate that adherence to a Healthy dietary pattern characterized by high intakes of fruits, vegetables, fish and dairy products is associated with a lower probability of having depressive symptoms among Iranian adolescent girls.

Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study

INTRODUCTION

Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight/obesity, and associated obesogenic risk behaviours with health related quality of life and physical, social, emotional and school sub-domains, among a large cohort of Australian primary school children.

METHODS

The data were derived from the Goulburn Valley Health Behaviours Monitoring study whereby a census-styled school recruitment process and high participatory opt-out (passive) procedure was employed. All primary schools in three Local Government Areas were invited to participate between July-September 2016 with 39/62 (62%) of schools participating and 1606/2034 (79%) students in Grade 2 (aged approx. 7-8 years), Grade 4 (aged approx. 9-10 years) and Grade 6 (aged approx. 11-12 years) participating. Measured height and weight were collected among participating students and older children (Grade 4 and 6) who also completed a self-report behavioural questionnaire, including the paediatric quality of life inventory.

RESULTS

Among 809 children aged 9 to 12 years, there were 219 (27.1%) classified as overweight/obese. Male children classified as overweight/obese reported significantly lower health related quality of life in the physical functioning and global functioning scores, compared to normal weight males. Significantly higher quality of life scores were observed among all children who met the physical activity recommendations on five out of the seven previous days. Significantly higher scores were observed among males adhering to the daily screen time recommendations, and among those meeting daily recommendations for fruit consumption. Among male school children, soft drink consumption was associated to lower health related quality of life.

CONCLUSION

Although cross-sectional, these findings highlight children with overweight/obesity and some underlying lifestyle behavioural risk factors, had significantly lower healthy-related quality of life, although this was observed most consistently among male school children. These findings have not previously been identified in young children and highlights the need to consider mental and emotional health in public health efforts to prevent obesity.

TRIAL REGISTRATION

ANZCTR Trial Registry: ACTRN12616000980437 retrospectively registered 26 July 2016.

Dietary Inflammatory Potential and the Risk of Incident Depression in Adults: A Systematic Review

Diet is proposed to have a stimulatory or preventative influence on mental health and the risk of depressive symptoms, given that the diet can have either a pro- or an anti-inflammatory effect. This study aimed to collate the relation between dietary inflammatory potential and the risk of depression. PubMed, Google Scholar, ScienceDirect, and Scopus databases, as well as Google were searched for articles published at any date until May 2018. Original English-language articles involving human participants and studies that investigated the association between dietary inflammatory potential and the risk of developing depression were included. Duplicated and irrelevant reports were screened out and data were extracted during critical analysis. Our search method initially identified 173 articles, of which 48 remained after duplicates had been removed. Thirteen articles were screened and identified as being relevant to the study topic. After critical analysis, 12 articles were included in the final analysis. All of the articles but 1 reported that higher dietary inflammatory index (DII) is associated with a higher risk of developing depression. Three studies indicated that DII was positively correlated with circulating inflammatory markers; however, in these studies increased concentrations of circulating inflammatory markers did not predict the diet-depression relation. Low literacy, unhealthy lifestyle, nutritional status, marital status, and age were potent contributory factors to whether or not a diet with inflammatory potential was consumed. These findings support the hypothesis that the DII is an appropriate tool for measuring dietary inflammatory potential, and reinforce the role of diets with inflammatory potential in the pathophysiology of depression.

Adopting a Mediterranean-Style Eating Pattern with Different Amounts of Lean Unprocessed Red Meat Does Not Influence Short-Term Subjective Personal Well-Being in Adults with Overweight or Obesity

Background

Reducing red meat intake is commonly recommended. Limited observational studies suggest that healthy eating patterns with red meat are associated with improved quality of life.

Objective

The secondary objectives of this randomized crossover controlled-feeding trial were to assess the effects of following a Mediterranean-style eating pattern (Med-Pattern) with different amounts of red meat on indexes of personal well-being (i.e., perceived quality of life, mood, and sleep) in overweight or obese adults. We hypothesized that following a Med-Pattern would improve these outcomes, independent of red meat intake amount.

Methods

Forty-one participants [aged 46 ± 2 y; body mass index (kg/m2): 30.5 ± 0.6; n = 28 women, n = 13 men) were provided Med-Pattern foods for two 5-wk periods separated by 4 wk of self-selected eating. The Med-Red Pattern contained ∼500 g/wk (typical US intake), and the Med-Control Pattern contained ∼200 g/wk (commonly recommended intake in heart-healthy eating patterns) of lean, unprocessed beef or pork compensated with mainly poultry and dairy. Baseline and postintervention outcomes measured were perceived quality of life via the MOS 36-Item Short-Form Health Survey, version 2 (SF-36v2), daily mood states via the Profile of Mood States (POMS), sleep perceptions via the Pittsburgh Sleep Quality Index, and sleep patterns via actigraphy. Data were analyzed via a doubly repeated-measures ANOVA adjusted for age, sex, and body mass at each time point.

Results

Following a Med-Pattern did not change domains of physical health, mental health, total mood disturbances, sleep perceptions, and sleep patterns but improved subdomains of physical health role limitations (SF-36v2: 93.6-96.7%; P = 0.038), vitality (SF-36v2: 57.9-63.0%; P = 0.020), and fatigue (POMS: 2.9-2.5 arbitrary units; P = 0.039). There were no differences between the Med-Red and Med-Control Patterns (time × pattern, P-interaction > 0.05).

Conclusion

Following a Med-Pattern, independent of lean, unprocessed red meat intake, may not be an effective short-term strategy to meaningfully improve indexes of personal well-being in adults who are overweight or obese. This trial was registered at clinicaltrials.gov as NCT02573129.

Longitudinal Association between n-3 Long-Chain Polyunsaturated Fatty Acid Intake and Depressive Symptoms: A Population-Based Cohort Study in Japan

It remains unclear whether n-3 long-chain polyunsaturated fatty acids (LCPUFA) have a preventive effect on depression in the general population. This study investigated the longitudinal association between n-3 LCPUFA intake and depressive symptoms in community-dwelling Japanese participants. The participants were aged 40–79 years at baseline in the cohort study, wherein examinations, including the assessment of depressive symptoms and nutritional status, were biennially conducted from 1997 to 2012. The subjects (n = 2335) who had a Center for Epidemiologic Studies Depression Scale (CES-D) score < 16 at the first examination and who participated in the follow-up study at least once were included in the analysis. The follow-up end point was the first onset (CES-D ≥ 16) or the last examination participation. Hazard ratios (95% CIs) for CES-D ≥ 16 were estimated using the adjusted Cox proportional hazards model. Overall, 22.1% participants showed depressive symptoms during follow-up (average; 8.1 years). Compared with the lowest tertile, the highest HR for EPA was 0.74 (0.60–0.93), and highest and middle HRs for DHA were 0.79 (0.63–0.98) and 0.80 (0.65–0.99) (P for trend = 0.009 and 0.032), respectively. Among populations with high fish consumption, higher n-3 LCPUFA intake may be associated with a low risk of depressive symptoms.

Dietary inflammatory index and depression: a meta-analysis

OBJECTIVE

The purpose of the present meta-analysis was to evaluate the association between the inflammatory potential of diet, determined by the dietary inflammatory index (DII®) score, and depression.

DESIGN

Systematic review and meta-analysis.

SETTING

A comprehensive literature search was conducted in PubMed, Web of Science and EMBASE databases up to August 2018. All observational studies that examined the association of the DII score with depression/depressive symptoms were included.

SUBJECTS

Four prospective cohorts and two cross-sectional studies enrolling a total of 49 584 subjects.

RESULTS

Overall, individuals in the highest DII v. the lowest DII category had a 23 % higher risk of depression (risk ratio (RR)=1·23; 95 % CI 1·12, 1·35). When stratified by study design, the pooled RR was 1·25 (95 % CI 1·12, 1·40) for the prospective cohort studies and 1·16 (95 % CI 0·96, 1·41) for the cross-sectional studies. Gender-specific analysis showed that this association was observed in women (RR=1·25; 95 % CI 1·09, 1·42) but was not statistically significant in men (RR=1·15; 95 % CI 0·83, 1·59).

CONCLUSIONS

The meta-analysis suggests that pro-inflammatory diet estimated by a higher DII score is independently associated with an increased risk of depression, particularly in women. However, more well-designed studies are needed to evaluate whether an anti-inflammatory diet can reduce the risk of depression.

Prospective association between combined healthy lifestyles and risk of depressive symptoms in the French NutriNet-Santé cohort

BACKGROUND

Several modifiable lifestyle indicators, including diet, smoking, alcohol consumption, weight and physical activity have been associated with depression; however, their combined effect has been less studied. The aim of this study was to calculate a Healthy Lifestyle Index (HLI) composed of the 5 above-mentioned indicators and investigate its association with incident depressive symptoms.

METHODS

The study sample consisted of 25,837 participants from the NutriNet-Santé study, initially free of depressive symptoms. The HLI was computed by assigning 1 point to each lifestyle indicator namely healthy diet, healthy weight, moderate or high physical activity, never smoking and low alcohol consumption. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Hazard Ratios were estimated using Cox proportional hazards models and population attributable risks (PAR) were calculated.

RESULTS

A total of 2112 incident cases of depressive symptoms were identified over a mean follow-up of 5 years. After accounting for a wide range of potential confounders, a 1-point increase in the HLI was associated with a 10% (95% CI 6%; 13%) reduction in the risk of depressive symptoms. The estimated PAR representing the proportion of cases that are attributable to non-adherence to specific healthy lifestyle indicators were 8% for healthy diet, 5% for healthy weight, 5% for non-smoking and 14% for the non-adherence to a combination of healthy diet, healthy weight and non-smoking.

LIMITATIONS

Some unmeasured factors related to both depression and lifestyle indicators, such as family history of depressive disorder, stressful life events, and sleep disorders might have led to potential residual confounding.

CONCLUSIONS

Modifying unhealthy lifestyles, especially diet, weight and smoking, is a potential target of major interest in the prevention of depressive symptoms in adults.

Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes

OBJECTIVE

To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes.

DESIGN

Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as 'healthy' or 'unhealthy' using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson's correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes.

SETTING

Rural AI reservations and AN villages.

SUBJECTS

AI/AN (n 2484) with type 2 diabetes.

RESULTS

Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β=0·078, P=0·0007; males: β=0·139, P<0·0001).

CONCLUSIONS

Health professionals working with AI/AN diagnosed with type 2 diabetes should offer food choice strategies during difficult times and recognize that males may be more likely than females to select unhealthy foods when distressed.

Association between the dietary inflammatory index and common mental health disorders profile scores

BACKGROUND & AIMS

The association between diet and mental health disorders might be mediated by inflammatory properties of the diet. We evaluated the association between the dietary inflammatory index (DII) and the risk of a worsened mental health disorders profile.

METHODS

A total of 3363 Iranian adults were included in this cross-sectional study. A mental health disorders profile score was calculated using regression analysis, within the framework of factor analysis, based on anxiety, depression and psychological distress, with a higher scores indicating greater severity of mental problems. Dietary intakes were assessed using a validated dish-based food frequency questionnaire (DFQ). Twenty-seven macro- and micro-nutrients, onions, tea and caffeine were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a greater DII indicated a more pro-inflammatory diet. The odds of being in the highest tertile of mental health disorders profile across the tertiles of DII was assessed using multinomial logistic regression.

RESULTS

Either in the crude or fully-adjusted multinomial logistic regression models, participants in the lowest tertile of DII had a lower risk for being in the top tertile of mental health disorders profile (adjusted model: OR: 0.45; 95% CI: 0.33, 0.60; P trend<0.001). In a stratified analysis by sex, similar findings were observed in both genders, although there was only a trend for the associations to be significant in men (men: OR: 0.53; 95% CI: 0.31, 0.90; P trend = 0.070; women: OR: 0.40; 95% CI: 0.27, 0.58; P trend<0.0001).

CONCLUSIONS

Our findings suggest a direct association between the pro-inflammatory properties of the diet and an increased risk of higher mental health disorders profile scores. Prospective dietary intervention studies and observational prospective cohorts are required to confirm these findings.

A review of dietary and microbial connections to depression, anxiety, and stress

Objective: Pre-clinical evidence suggests that the gastrointestinal microbiota contributes to mood and behavior disorders. Among humans, diet quality and patterns, which also impact the gastrointestinal microbiota, have been linked to depression, anxiety, and stress. This review summarizes findings from clinical studies using dietary intervention to improve depression, anxiety, or stress and the role the gastrointestinal microbiota may have in these disorders.Methods: A literature search was conducted using the keywords microbiome, microbiota, depression, anxiety, stress, diet, dietary pattern, diet quality, fiber, prebiotics, probiotics, and mood.Results: Mood was improved by enhancing diet quality. Fructooligosaccharide and galactooligosaccharide improved anxiety and depression in participants consuming ≥ 5 g/day. Additionally, bifidobacteria were enriched in subjects consuming ≥ 5 g/day. Probiotic consumption improved psychological or biological measures of depression, anxiety, or stress in individuals predisposed to a mood disorder. Probiotics suppressed biological markers of stress in healthy individuals in a strain-dependent manner.Discussion: High-quality diets, prebiotics, and probiotics may beneficially affect mood. Habitual diets rich in dietary fiber and omega-3-polyunsaturated fatty acids may be linked to reduced risk of developing symptoms of depression, anxiety, and stress; however, additional studies are necessary. Certain probiotics may enhance mood, but their influence on the gastrointestinal microbiota requires further investigation.

Egg consumption and prevalence of psychological disorders in adults

PURPOSE

No previous study has examined the associations between egg consumption and prevalence of psychological disorders. The present study was conducted to determine the association between egg consumption and depression in a large sample of Iranian adults.

METHODS

This cross-sectional study was conducted on 3172 adults in Isfahan, Iran. Egg consumption was assessed by using a validated, self-administered, dish-based, semi-quantitative food frequency questionnaire. The Iranian validated version of Hospital Anxiety and Depression Scale was used to screen for anxiety and depression. The Iranian validated version of General Health Questionnaire with 12 items was used to assess psychological distress. Depression, anxiety and psychological distress were defined according to standard criteria.

RESULTS

The mean age of the study participants was 36.5 ± 7.9 years. Depression, anxiety and psychological distress were prevalent among 28.4, 13.6 and 23% of the study subjects, respectively. After controlling for potential confounders, no significant association was observed between egg intake and depression (OR for comparing extreme quartiles: 1.08; 95% CIs 0.80-1.45) and anxiety (OR 0.79; 95% CIs 0.54-1.16), as well as psychological distress (OR 1.03; 95% CIs 0.76-1.41) in the whole population. In men, significant positive associations were observed between egg intake and depression before controlling for BMI (OR 1.68; 95% CIs 1.01-2.80); however, the associations became non-significant after taking BMI into account (OR 1.62; 95% CIs 0.96-2.72).

CONCLUSIONS

We found no significant association between egg intake and psychological disorders. Further studies, in particular of prospective design, are warranted.

Prospective association between adherence to dietary recommendations and incident depressive symptoms in the French NutriNet-Santé cohort

A posteriorihealthier dietary patterns and several nutrients have been associated with lower risks of depression in various studies; however, evidence is lacking with regard to the prospective association between adherence to nutritional recommendations (food-based and nutrient-based recommendations) and incident depression or depressive symptoms. In this study, we investigate such associations in the NutriNet Santé cohort. The study sample included 26 225 participants (aged 18–86 years) who were initially free of depressive symptoms. Adherence to nutritional recommendations was measured by four scores namely modified French Programme National Nutrition Santé-Guideline Score (mPNNS-GS), Alternative Healthy Eating Index-2010 (AHEI-2010), Probability of Adequate Nutrient Intake Dietary Score (PANDiet) and Diet Quality Index-International (DQI-I), using non-consecutive dietary record data during the first 2 years of follow-up (mean number of recording days=8,sd2). Depressive symptoms were defined by a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥17 for men and ≥23 for women. We used Cox proportional hazards models to estimate hazard ratios and 95 % CI, modelling the dietary scores as standardised continuous variables and as tertiles. Over a mean follow-up of 6 years, we identified 2166 incident cases of depressive symptoms. All dietary scores with the exception of the AHEI-2010 were significantly inversely associated with incident depressive symptoms. In the fully adjusted model, an increase of 1sdin the mPNNS-GS, PANDiet and DQI-I was, respectively, associated with an 8 % (95 % CI 4, 13), 5 % (95 % CI 1, 9) and 9 % (95 % CI 5, 13) reduction in the risk of depressive symptoms. Overall, these findings suggest that diet in accordance with national or international guidelines could have beneficial effects with regard to mental health.

Dietary Polyphenol Intake and Depression: Results from the Mediterranean Healthy Eating, Lifestyle and Aging (MEAL) Study

Background: The epidemiological evidence for a relation between dietary polyphenol intake and depression is limited. Therefore, the aim of this study was to assess the association between habitual dietary intake of total polyphenols, their classes, subclasses and individual compounds and depressive symptoms among the participants of the Mediterranean healthy Eating, Lifestyle and Aging (MEAL) study. Methods: Demographic and dietary characteristics of 1572 adults living in southern Italy were analyzed. Food frequency questionnaires and Phenol-Explorer were used to calculate habitual dietary intakes of polyphenols. The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used as screening tool for depressive symptoms. Multivariate logistic regression analyses were used to test associations and were expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: A total of 509 individuals reported having depressive symptoms. Based on multivariate logistic regression analyses, total polyphenol intake was not associated with depressive symptoms. After adjustment for potential confounding factors, dietary intake of phenolic acid (OR = 0.64, 95% CI: 0.44, 0.93), flavanones (OR = 0.54, 95% CI: 0.32, 0.91), and anthocyanins (OR = 0.61, 95% CI: 0.42, 0.89) showed significant inverse association with depressive symptoms, when comparing the highest with the lowest quartile. Moreover, flavanones and anthocyanins, were associated with depressive symptoms in a dose-response manner. Among individual compounds, inverse association was observed for quercetin (OR = 0.53, 95% CI: 0.32, 0.86) and naringenin (OR = 0.51, 95% CI: 0.30, 0.85), for the highest versus lowest quartile of intake. When taking into consideration the major sources of the polyphenols, only citrus fruits and wine consumption was inversely associated with depressive symptoms (Q4 vs. Q1: OR= 0.51, 95% CI: 0.35, 0.75; Q4 vs. Q1: OR = 0.53, 95% CI: 0.38, 0.74, respectively). Conclusions: Higher dietary intake of flavonoid may be inversely associated with depressive symptoms. Further studies are needed to definitively confirm these observed associations.