Mood food: chocolate and depressive symptoms in a cross-sectional analysis

Chocolate intake and muscle pain sensation: A randomized experimental study

BACKGROUND

Chocolate, as a cocoa-derived product rich in flavanols, has been used for medical and anti-inflammatory purposes. Therefore, the aim of this study was to investigate if the ingestion of different percentages of cocoa products affects the experimentally induced pain caused by intramuscular hypertonic saline injections in the masseter muscle of healthy men and women.

METHODS

This experimental randomized, double-blind, and controlled study included 15 young, healthy, and pain-free men and 15 age-matched women and involved three visits with at least a 1-week washout. Pain was induced twice at each visit with intramuscular injections of 0.2 mL hypertonic saline (5%), before and after intake of one of the different chocolate types: white (30% cocoa content), milk (34% cocoa content), and dark (70% cocoa content). Pain duration, pain area, peak pain, and pressure pain threshold (PPT) were assessed every fifth minute after each injection, up until 30 min after the initial injection. Descriptive and inferential statistics were performed using IBM® SPSS (Version 27); significance level was set to p<0.05.

RESULTS

This study showed that intake of chocolate, no matter the type, reduced the induced pain intensity significantly more than no intake of chocolate (p<0.05, Tukey test). There were no differences between the chocolate types. Further, men showed a significantly greater pain reduction than women after intake of white chocolate (p<0.05, Tukey test). No other differences between pain characteristics or sexes were revealed.

CONCLUSION

Intake of chocolate before a painful stimulus had a pain-reducing effect no matter the cocoa concentration. The results indicate that perhaps it is not the cocoa concentration (e.g., flavanols) alone that explains the positive effect on pain, but likely a combination of preference and taste-experience. Another possible explanation could be the composition of the chocolate, i.e. the concentration of the other ingredients such as sugar, soy, and vanilla. ClinicalTrials.gov Identifier: NCT05378984.

Sucrose Preference Test as a Measure of Anhedonic Behavior in a Chronic Unpredictable Mild Stress Model of Depression: Outstanding Issues

Despite numerous studies on the neurobiology of depression, the etiological and pathophysiological mechanisms of this disorder remain poorly understood. A large number of animal models and tests to evaluate depressive-like behavior have been developed. Chronic unpredictable mild stress (CUMS) is the most common and frequently used model of depression, and the sucrose preference test (SPT) is one of the most common tests for assessing anhedonia. However, not all laboratories can reproduce the main effects of CUMS, especially when this refers to a decrease in sucrose preference. It is also unknown how the state of anhedonia, assessed by the SPT, relates to the state of anhedonia in patients with depression. We analyzed the literature available in the PubMed database using keywords relevant to the topic of this narrative review. We hypothesize that the poor reproducibility of the CUMS model may be due to differences in sucrose consumption, which may be influenced by such factors as differences in sucrose preference concentration threshold, water and food deprivation, and differences in animals’ susceptibility to stress. We also believe that comparisons between animal and human states of anhedonia should be made with caution because there are many inconsistencies between the two, including in assessment methods. We also tried to offer some recommendations that should improve the reproducibility of the CUMS model and provide a framework for future research.

Public Health Response to the SARS-CoV-2 Pandemic: Concern about Ultra-Processed Food Consumption

Introduction: There is scientific consistency in the concept of ultra-processed foods (UPFs) as a descriptor of an unhealthy diet. The most recent literature points to troubling evidence that policies adopted to address the SARS-CoV-2 pandemic may have contributed to diverting eating habits toward a poorer diet. Considering the historically unique SARS-CoV-2 pandemic lockdown scenario, and the health burden imposed by UPFs on human health, it is critical to investigate how the epidemic has influenced UPF intake directly. Reviewing the literature, we aimed to assess the changes in the consumption of UPFs during the pandemic lockdown compared to previous habits in the general population. Methods: Consulting six databases, we examined articles investigating the consumption of UPFs according to the NOVA classification both before the SARS-CoV-2 pandemic and during lockdowns. In total, 28 reports were included in the final analysis. Results: A clear trend of an increasing consumption of sweets (chocolate, candy, cookies, pastries, cakes, desserts, and confectionery, 31.75% increase vs. 21.06% decrease), packaged fatty or salty snacks (23.71% increase vs. 20.73% decrease), and baked goods (bread products, pizza, and sandwiches, 28.03% increase vs. 13.5% decrease) emerged, versus a decrease in ready-to-eat dishes (16.2% increase vs. 22.62% decrease) and ready-made meals (10.6% increase vs. 31.43% decrease), such as instant soups, canned foods, fast food, and chips, as well as sugary drinks in general (14.55% increase vs. 22.65% decrease). No trend was observed for processed meat consumption. Conclusion: The current pandemic scenario raises concerns about the increased consumption of UPFs, especially sweets, snacks, and baked goods, and points to an urgent need to implement policy strategies to manage the trade in these foods from a preventive perspective.

The Association between Postpartum Practice and Chinese Postpartum Depression: Identification of a Postpartum Depression-Related Dietary Pattern

Conflicting results of Chinese traditional postpartum practices have aroused concerns over their health effects. The role of postpartum practices in postpartum depression (PPD) is still a matter of discussion, especially from a dietary practice point of view. The current study was designed to (1) explore the association between postpartum practices and PPD, (2) to identify the dietary pattern related to PPD, and (3) to identify the possible pathways among postpartum practices and PPD. This study is part of the YI Study, which was a cross-sectional study conducted in 10 cities in China. Data for 955 postpartum women were used in the current analysis. The Edinburgh Postnatal Depression Scale (EPDS-10) was used to evaluate PPD with a cutoff value of 9. Postpartum practice was based on the participants’ self-reported practices. Individual practices were recorded and categorized as dietary and non-dietary practices. The dietary pattern was identified based on the food intake frequencies of 25 food groups using the method of reduced rank regression. Structural equation modeling was used to explore the potential pathways between postpartum practices and PPD. The current study observed significant associations between postpartum practices and PPD (Adjusted OR = 1.41, 95% CI: 1.04–1.90). A similar trend was also found between dietary postpartum practices and PPD (Adjusted OR = 1.39, 95%CI: 1.03–1.88) but not for non-dietary practices and PPD (Adjusted OR = 1.26, 95%CI: 0.92–1.75). A PPD-related dietary pattern was identified with the characteristics of a high intake of meat and eggs and a lower intake of vegetables, mushrooms, and nuts. This dietary pattern was significantly associated with a higher chance of adhering to postpartum practice (Adjusted OR = 1.26, 95% CI: 1.10–1.44). Based on the pathway analysis, this study also observed the association between postpartum practices and PPD, and the association between dietary practices and PPD were both mediated by sleep quality. In conclusion, this study demonstrated that a substantial proportion of women in modern China experience traditional postpartum Chinese practices and that either overall or dietary-related postpartum practices are associated with a higher risk of PPD. The current dietary practices in postpartum rituals may play an important role in developing PPD. A culturally embedded, science-based dietary guideline is required to help women to achieve both physical and psychological health in the postpartum period.

Sensory Stimulation Via the Visual, Auditory, Olfactory and Gustatory Systems Can Modulate Mood and Depression

Depression is one of the most common mental disorders, predicted to be the leading cause of disease burden by the next decade. There is great deal of emphasis on the central origin and potential therapeutics of depression whereby the symptomatology of depression has been interpreted and treated as brain generated dysfunctions filtering down to the periphery. This top-down approach has found strong support from clinical work and basic neuroscientific research. Nevertheless, despite great advances in our knowledge of the etiology and therapeutics of depression, success in treatment is still by no means assured.. As a consequence, a wide net has been cast by both clinicians and researchers in search of more efficient therapies for mood disorders. As a complementary view, the present integrative review advocates approaching mood and depression from the opposite perspective: a bottom-up view that starts from the periphery. Specifically, evidence is provided to show that sensory stimulation via the visual, auditory, olfactory and gustatory systems can modulate depression. The review shows how -depending on several parameters- unisensory stimulation via these modalities can ameliorate or aggravate depressive symptoms. Moreover, the review emphasizes the bidirectional relationship between sensory stimulation and depression. Just as peripheral stimulation can modulate depression, depression in turn affects-and in most cases impairs-sensory reception. Furthermore, the review suggests that combined use of multisensory stimulation may have synergistic ameliorative effects on depressive symptoms over and above what has so far been documented for unisensory stimulation.

The effect of cocoa-rich products on depression, anxiety, and mood: A systematic review and meta-analysis

In the popular imaginary, cocoa-derived products, like chocolate, represent a panacea for mood and affectivity. However, whether this is a myth or a fact has yet to be clarified. A systematic review and meta-analysis were conducted according to the PRISMA guidelines to investigate the effect of cocoa-derived food on depressive and anxiety symptoms, positive and negative affect. We searched Web of Knowledge^TM and PsycINFO up to April 3, 2020. After screening 761 records, we selected nine studies. Two trials evaluated the long-term effects of cocoa consumption (>1 week), two studies the short-term effects (3 days), while five studies were conducted in acute (single administration). Random-effects meta-analyses found an overall significant effect of cocoa-rich products on depressive (Hedge's g = -0.42, 95% CI -0.67 to -0.17) and anxiety symptoms (Hedge's g = -0.49, 95% CI -0.78 to -0.19). Moreover, both positive (Hedge's g = 0.41, 95% CI 0.06 to 0.77) and negative affect (Hedge's g = -0.47, 95% CI -0.91 to -0.03) significantly improved. In all meta-analyses, the effect size was medium, while heterogeneity was low. Our findings suggest that the consumption of cocoa-rich products may improve affect and mood in the short term. However, given the short duration of trials, our results cannot be generalized to long-term intake of cocoa-derived food. Cautious interpretation is also needed due to the low number of participants and studies included in the meta-analyses.

Chocolate Consumption and Sex-Interest

Media and popular literature link chocolate and sex-interest in women, but there is little research examining their association. This cross-sectional analysis sought to address this gap by assessing the relation of chocolate-consumption frequency to self-rated interest in sex. Seven-hundred twenty-three (723) Southern California men and women, age >20, completed surveys providing chocolate-consumption frequency (Choc0, x/week) and interest in sex (rated 0-10). 

Regression (robust standard errors) examined the relationship of chocolate-consumption frequency (Choc0, x/week) to sex-interest, adjusted for potential confounders. Tests for gender and age interactions guided gender- and age-stratified analyses. The mean sex-interest was 7.0±3.0 overall; 5.7±3.1 in women and 7.4±2.8 in men. The reported chocolate frequency was 2.0±2.5x/week overall; 2.5±2.8x/week in women and 1.8±2.4x/week in men. Those who ate chocolate more frequently reported lower interest in sex. Significance was sustained with an adjustment: per-time-per-week chocolate was eaten, β=-0.11(SE=0.050), p=0.02. The gender interaction was significant (p=0.03). The gender-stratified analysis showed the effect was driven by the much stronger relation in women: full model, per time-per-week chocolate consumed, β=-0.26(SE=0.08), p=0.002. Chocolate-consumption frequency was the strongest assessed predictor of sex-interest in women. A relationship was not observed in men, though a trend was present in younger men.

Women who ate chocolate more frequently reported less interest in sex, a finding not explained by assessed potential confounders. Popular portrayals in which chocolate is represented as substituting for sex and “satisfying” the need for sex in women represent one possible explanation for these findings.

Cocoa-Rich Chocolate and Quality of Life in Postmenopausal Women: A Randomized Clinical Trial

Menopause has a negative impact on quality of life (QoL). The aim of the present study was to analyse the effect on QoL of adding 10 g per day of chocolate with a high concentration of cocoa (99%) to the habitual diet, for 6 months, in a sample of postmenopausal women. Postmenopausal women (n = 140) aged 50–64 years were randomised to either an addition of 10 g per day of cocoa-rich chocolate to their usual diet or no supplement addition. All variables were measured at baseline and after six months of intervention. QoL was evaluated using the 3-level version of EuroQol-5D (EuroQoL-5D-3L), the EuroQol Visual Analogue Scale (EQ-VAS) and the Cervantes scale. Analysis of covariance (ANCOVA) analyses adjusted for the main determinants of QoL considered in this study showed no changes in the global score of QoL evaluated with the EuroQoL-5D-3L. The intervention group showed an increase of 6.0 points (95% confidence interval (CI): 0.4, 11.7) in the EQ-VAS compared to the control group (p = 0.036). No significant changes were observed between groups in the global score of QoL nor in the dimensions and subdimensions measured with the Cervantes scale. The additional daily contribution of 10 g of cocoa-rich chocolate in postmenopausal women could have a slight impact on their perception toward their health state, although without modifying the health-related QoL or the dimensions that compose it.

Is there a relationship between chocolate consumption and symptoms of depression? A cross-sectional survey of 13,626 US adults

OBJECTIVE

To examine associations between chocolate consumption and depressive symptoms in a large, representative sample of US adults.

METHODS

The data were from 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey between 2007-08 and 2013-14. Daily chocolate consumption was derived from two 24-hr dietary recalls. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), with scores ≥10 indicating the presence of clinically relevant symptoms. We used multivariable logistic regression to test associations of chocolate consumption (no chocolate, non-dark chocolate, dark chocolate) and amount of chocolate consumption (grams/day, in quartiles) with clinically relevant depressive symptoms. Adults with diabetes were excluded and models controlled for relevant sociodemographic, lifestyle, health-related, and dietary covariates.

RESULTS

Overall, 11.1% of the population reported any chocolate consumption, with 1.4% reporting dark chocolate consumption. Although non-dark chocolate consumption was not significantly associated with clinically relevant depressive symptoms, significantly lower odds of clinically relevant depressive symptoms (OR = 0.30, 95%CI 0.21-0.72) were observed among those who reported consuming dark chocolate. Analyses stratified by the amount of chocolate consumption showed participants reporting chocolate consumption in the highest quartile (104-454 g/day) had 57% lower odds of depressive symptoms than those who reported no chocolate consumption (OR = 0.43, 95%CI 0.19-0.96) after adjusting for dark chocolate consumption.

CONCLUSIONS

These results provide some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms. Further research capturing long-term chocolate consumption and using a longitudinal design are required to confirm these findings and clarify the direction of causation.

Is comfort food actually comforting for emotional eaters? A (moderated) mediation analysis

An important but unreplicated earlier finding on comfort eating was that the association between food intake and immediate mood improvement appeared to be mediated by the palatability of the food, and that this effect was more pronounced for high than for low emotional eaters [26]. This has not yet been formally tested using mediation and moderated mediation analysis. We conducted these analyses using data from two experiments on non-obese female students (n = 29 and n = 74). Mood and eating satisfaction in Study 1, and mood, tastiness and emotional eating in Study 2 were all self-reported. In Study 1, using a sad mood induction procedure, emotional eaters ate more food, and when mood was assessed immediately after food intake, 'eating satisfaction' acted as mediator between food intake and mood improvement (decrease in sadness or increase in happiness). In Study 2, where we measured the difference in actual food intake after a control or a stress task (modified Trier Social Stress Test), and assessed mood during the food intake after stress, we found significant moderated mediation. As expected, there was a significant positive mediation effect of tastiness between food intake and mood improvement in the high emotional eaters, but also a significant negative mediation effect of tastiness between food intake and mood improvement in the low emotional eaters. This suggests that tastiness promotes 'comfort' from food in female emotional eaters, but conflicts in non-emotional eaters with a tendency to eat less when stressed. In conclusion, palatable food may indeed provide comfort specifically for high emotional eaters during eating.

Compulsive eating behaviors in Parkinson's disease

PURPOSE

Eating disorders are common in Parkinson's disease (PD) patients and often class in Impulse control disorders, however, little is known about their phenomenology. Specific symptoms and comorbidities were described in a group of PD patients in this preliminary study.

METHODS

Over a period of 6 months, 51 PD patients who experienced significant changes in eating habits following diagnosis of PD and were interviewed during regularly scheduled follow-up visits. We assessed each patient's height and weight, impulsivity, psychological distress, current eating disorder symptoms, food addiction, food habits and craving.

RESULTS

Among the PD patients who experienced modified dietary habits following diagnosis, few exhibited binge eating disorders (BED) full criteria (3.9%). However, 21.6% of patients experienced episodes of out-of-control eating with a large quantity of food in short time and 39.2% satisfied food addiction (FA) criteria without binge eating disorder. Food cravings more than once a week were experienced in approximately half of the population including all FA patients. Regarding comorbidities, FA PD patients present impulsive features and anxiety.

CONCLUSIONS

This study confirms the existence of FA profile in PD patients. Eating disorders even in PD are complex and have a cross-cutting criteria related to out-of-control eating, FA, and BED. The association of anxiety with PD-related food addiction, contrary to L-dopa equivalent daily dose mean score or the presence of dopamine agonists, underline the complex sustainability of the dopaminergic brainstem support. A study on their detailed prevalence in this population could be helpful to better understand unspecified feeding or eating disorder.

CLINICAL TRIAL NUMBER

DR-2012-007.

NAME OF THE REGISTRY

French Committee for the Protection of Persons (CPP) & French National Commission on Computing and Liberty (CNIL).

LEVEL OF EVIDENCE

Level V, descriptive study.

A comparative study of dietary habits and nutritional intakes among Korean adults according to current depression status

INTRODUCTION

Data regarding the association between depression and dietary factors in Korean adults are limited. We hypothesized that Korean men and women with depression would have poorer nutritional intakes and different dietary habits than those without depression.

METHODS

This study was based on data from the Korea National Health and Nutrition Examination Survey conducted during 2012 to 2014. Overall, 10 591 subjects (4308 men, 6529 women) aged 19 to 64 years were selected and categorized according to current depression status. Food and nutrient intakes were estimated using semi-quantitative food frequency questionnaires.

RESULTS

Compared with non-depression, depression was associated with a higher body mass index and likelihood of a separated/divorced/widowed status, in addition to lower physical activity and employment rates. After adjusting for multiple variables, men with depression had lower intakes of rice cakes (P = 0.017) and eggs (P = 0.039) and a higher intake of chocolate (P = 0.040) than their non-depressed counterparts. Women with depression had a higher intake of carbonated drinks than those without depression (P = 0.015). However, the groups did not differ significantly in terms of nutrient intakes. A multivariable logistic regression analysis of dietary habits showed that depression correlated inversely with eating out (≥1 time/day vs <1 time/month) among men [odds ratio (OR) = 0.23, 95% confidence interval (CI): 0.10-0.55] and women (OR = 0.14, 95% CI: 0.05-0.35) and positively with a lower number of daily meals (<3 vs ≥3) among women (OR = 1.45, 95% CI: 1.01-2.11).

DISCUSSION

Current depression status was associated with differences in some specific dietary intakes and habits in a sample of Korean adults.

Tea, cocoa, coffee, and affective disorders: vicious or virtuous cycle?

BACKGROUND

The prevalence of psychiatric disorders is increasing worldwide, which underscores the importance of increasing research in this field, in terms of better detection, prevention based on improvement of lifestyle and diet, and effectiveness of treatment. Increasing evidence suggest that diet and exercise can affect proper neuronal development and physiology and protect the brain from neurological illnesses or injuries. Of note, cocoa, tea, and coffee are being actively investigated because they are rich in (poly)phenolic compounds that can modulate mental health, namely brain plasticity, behavior, mood, depression, and cognition.

METHODS

We here systematically review human studies conducted on tea, cocoa, and coffee as related to affective disorders such as depression and anxiety. We carried out a systematic literature search in April 2016, using MEDLINE, on data from the last 10 years. After screening 955 articles, we selected 17 articles that met the criteria of being human studies and that used whole foods or their components.

RESULTS

The results of our systematic review indicate that consumption of tea, cocoa, or coffee might have protective effects against depression.

CONCLUSIONS

Even though this is encouraging, it should be underscored that the near totality of the current evidence comes from observational studies. Ad-hoc human trials and mechanistic, basic science studies are needed before we can provide sound advice to the public.

Sugar addiction: is it real? A narrative review

In animal studies, sugar has been found to produce more symptoms than is required to be considered an addictive substance. Animal data has shown significant overlap between the consumption of added sugars and drug-like effects, including bingeing, craving, tolerance, withdrawal, cross-sensitisation, cross-tolerance, cross-dependence, reward and opioid effects. Sugar addiction seems to be dependence to the natural endogenous opioids that get released upon sugar intake. In both animals and humans, the evidence in the literature shows substantial parallels and overlap between drugs of abuse and sugar, from the standpoint of brain neurochemistry as well as behaviour.

Dietary flavonoid intake and risk of incident depression in midlife and older women

BACKGROUND

The impact of dietary flavonoid intakes on risk of depression is unclear.

OBJECTIVE

We prospectively examined associations between estimated habitual intakes of dietary flavonoids and depression risk.

DESIGN

We followed 82,643 women without a previous history of depression at baseline from the Nurses' Health Study [(NHS) aged 53-80 y] and the Nurses' Health Study II [(NHSII) aged 36-55 y]. Intakes of total flavonoids and subclasses (flavonols, flavones, flavanones, anthocyanins, flavan-3-ols, polymeric flavonoids, and proanthocyanidins) were calculated from validated food-frequency questionnaires collected every 2-4 y. Depression was defined as physician- or clinician-diagnosed depression or antidepressant use and was self-reported in response to periodic questionnaires. Cox proportional hazards models were performed to examine associations.

RESULTS

A total of 10,752 incident depression cases occurred during a 10-y follow-up. Inverse associations between flavonol, flavone, and flavanone intakes and depression risk were observed. Pooled multivariable-adjusted HRs (95% CIs) were 0.93 (0.88, 0.99), 0.92 (0.86, 0.98), and 0.90 (0.85, 0.96) when comparing the highest (quintile 5) with the lowest (quintile 1) quintiles, respectively, with evidence of linear trends across quintiles (P-trend = 0.0004-0.08). In flavonoid-rich food-based analyses, the HR was 0.82 (95% CI: 0.74, 0.91) among participants who consumed ≥2 servings citrus fruit or juices/d compared with <1 serving/wk. In the NHS only, total flavonoids, polymers, and proanthocyanidin intakes showed significantly (9-12%) lower depression risks. In analyses among late-life NHS participants (aged ≥65 y at baseline or during follow-up), for whom we were able to incorporate depressive symptoms into the outcome definition, higher intakes of all flavonoid subclasses except for flavan-3-ols were associated with significantly lower depression risk; flavones and proanthocyanidins showed the strongest associations (HR for both: 0.83; 95% CI: 0.77, 0.90).

CONCLUSIONS

Higher flavonoid intakes may be associated with lower depression risk, particularly among older women. Further studies are needed to confirm these associations.

Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate

BACKGROUND

Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking.

OBJECTIVES

To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients.

METHODS

One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4).

RESULTS

Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets.

CONCLUSIONS/IMPORTANCE

In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.

A Fat to Forget: Trans Fat Consumption and Memory

Purpose

We sought to assess the relation of dietary trans fatty acid (dTFA) consumption to word-memory.

Methods

We analyzed cross-sectional data from the 1999-2005 UCSD Statin Study. Participants were 1018 adult men and non-procreative women age ≥20 without diagnosed diabetes, CVD, or extreme LDL-cholesterol. Primary analyses focused on men, as only men (N = 694) were effectively represented in younger adult ages. “Recurrent words” assessed word memory. dTFA (grams/day) estimates were calculated from the Fred Hutchinson Food Frequency Questionnaire. Regression, stratified at age 45, assessed the relation between memory and dTFA in various adjustment models. Major findings were replicated in the full sample (including women). Potential mediators were examined.

Results

An age-by-dTFA interaction was significant. dTFA adversely predicted memory in younger adults (only), robust to adjustment model. Each gram/day dTFA was associated with an estimated 0.76 fewer words recalled (full model) (SE = 0.27, 95%CI = 0.22,1.3, P = 0.006). Adjustment for systolic blood pressure, waist circumference and BMI (but not lipid or glycemic variables) attenuated the relationship, consistent with mediation by factors involving, relating to, or concurrently influencing, these factors.

Conclusion

Greater dTFA was significantly associated with worse word recall in younger adults. Prooxidant and energetic detriments of dTFA and triangulation with other evidence offer prospects for causality.

Chocolate and health-related quality of life: a prospective study

Background

Chocolate consumption has been associated with a short-term reduction in blood pressure and cholesterol, and improvement of insulin sensitivity; however, participants could not be aware of presenting hypertension or hypercholesterolemia. Moreover, the effect of chocolate on mental health is uncertain. This study assessed the association of regular chocolate consumption with the physical (PCS) and mental (MCS) components of health-related quality of life (HRQL).

Materials and methods

We analyzed data from a cohort of 4599 individuals recruited in 2008–2010 and followed-up once prospectively to January 2013 (follow-up mean: 3.5 years). Regular chocolate consumption was assessed at baseline with a validated diet history. HRQL was assessed with the SF-12 v.2 at baseline and at follow-up. Analyses were performed with linear regression and adjusted for the main confounders, including HRQL at baseline.

Results

At baseline, 72% of the study participants did not consume chocolate, 11% consumed ≤10 g/day and 17% >10 g/day. Chocolate consumption at baseline did not show an association with PCS and MCS of the SF-12 measured three years later. Compared to those who did not consume chocolate, the PCS scores were similar in those who consumed ≤10g/day (beta: -0.07; 95% confidence interval (95% CI): -0.94 to 0.80) and in those who consumed >10g/day (beta: 0.02; 95% CI:-0.71 to 0.75); corresponding figures for the MCS were 0.29; 95% CI: -0.67 to 1.26, and -0.57; 95%CI: -1.37 to 0.23. Similar results were found for sex, regardless of obesity, hypertension, hypercholesterolemia, diabetes or depression.

Conclusions

No evidence was found of an association between chocolate intake and the physical or mental components of HRQL.

Difference in diet between a general population national representative sample and individuals with alcohol use disorders, but not individuals with depressive or anxiety disorders

BACKGROUND

Mental disorders influence diet and food consumption, but there is a lack of consistent findings.

AIMS

To investigate food consumption, nutrient intakes and serum metabolic biomarkers in depressive, anxiety and alcohol use disorders in comparison with the remaining from a population-based nationwide sample.

METHODS

The study was based on the Health 2000 Survey data of which 5504 subjects aged 30 and over (3009 women and 2495 men) were used for the analysis. Depressive disorder, anxiety disorders and alcohol use disorders were diagnosed using the Composite International Diagnostic Interview (M-CIDI). The consumption of food and beverage items, and nutrient intakes were measured with a validated food frequency questionnaire, and the concentrations of biomarkers were determined in blood samples.

RESULTS

Overall, no similar differences with both genders were found in the intakes of energy, dietary fibre or macronutrients or in biomarkers in depressive or anxiety disorders. Women suffering from depressed disorder consumed more soft drinks (P = 0.034) and women suffering from anxiety disorders consumed more oils (P = 0.001), polyunsaturated fatty acids (P = 0.001) and less potatoes (P = 0.002) than the remaining participants. Men suffering from depressive disorder consumed less sweets and chocolate (P = 0.001) and men with anxiety disorder consumed more tea (P = 0.033) compared with the remaining participants. In alcohol use disorders, the intake of carbohydrate was lower in both genders (P = 0.001 for women, P = 0.001 for men).

CONCLUSIONS

A difference in the usual diet exists between individuals with alcohol use disorders and the remaining participants on a population level. No consistent difference in both genders between those with depressive or anxiety disorders and the remaining was found.

Mechanisms of body weight fluctuations in Parkinson's disease

Typical body weight changes are known to occur in Parkinson’s disease (PD). Weight loss has been reported in early stages as well as in advanced disease and malnutrition may worsen the clinical state of the patient. On the other hand, an increasing number of patients show weight gain under dopamine replacement therapy or after surgery. These weight changes are multifactorial and involve changes in energy expenditure, perturbation of homeostatic control, and eating behavior modulated by dopaminergic treatment. Comprehension of the different mechanisms contributing to body weight is a prerequisite for the management of body weight and nutritional state of an individual PD patient. This review summarizes the present knowledge and highlights the necessity of evaluation of body weight and related factors, as eating behavior, energy intake, and expenditure in PD.

Sugar addiction: pushing the drug-sugar analogy to the limit

PURPOSE OF REVIEW

To review research that tests the validity of the analogy between addictive drugs, like cocaine, and hyperpalatable foods, notably those high in added sugar (i.e., sucrose).

RECENT FINDINGS

Available evidence in humans shows that sugar and sweetness can induce reward and craving that are comparable in magnitude to those induced by addictive drugs. Although this evidence is limited by the inherent difficulty of comparing different types of rewards and psychological experiences in humans, it is nevertheless supported by recent experimental research on sugar and sweet reward in laboratory rats. Overall, this research has revealed that sugar and sweet reward can not only substitute to addictive drugs, like cocaine, but can even be more rewarding and attractive. At the neurobiological level, the neural substrates of sugar and sweet reward appear to be more robust than those of cocaine (i.e., more resistant to functional failures), possibly reflecting past selective evolutionary pressures for seeking and taking foods high in sugar and calories.

SUMMARY

The biological robustness in the neural substrates of sugar and sweet reward may be sufficient to explain why many people can have difficultly to control the consumption of foods high in sugar when continuously exposed to them.

Many apples a day keep the blues away--daily experiences of negative and positive affect and food consumption in young adults

OBJECTIVES

Prior research has focused on the association between negative affect and eating behaviour, often utilizing laboratory or cross-sectional study designs. These studies have inherent limitations, and the association between positive affect and eating behaviour remains relatively unexplored. Therefore, the objective of this study was to investigate the bidirectional relationships between daily negative and positive affective experiences and food consumption in a naturalistic setting among healthy young adults.

DESIGN

Daily diary study across 21 days (microlongitudinal, correlational design).

METHODS

A total of 281 young adults with a mean age of 19.9 (± 1.2) years completed an Internet-based daily diary for 21 consecutive days. Each day they reported their negative and positive affect, and their consumption of five specific foods. Hierarchical linear modelling was used to test same-day associations between daily affect and food consumption, and next-day (lagged) associations to determine directionality. Moderating effects of BMI and gender were also examined in exploratory analyses.

RESULTS

Analyses of same-day within-person associations revealed that on days when young adults experienced greater positive affect, they reported eating more servings of fruit (p = .002) and vegetables (p < .001). Results of lagged analysis showed that fruits and vegetables predicted improvements in positive affect the next day, suggesting that healthy foods were driving affective experiences and not vice versa. Meaningful changes in positive affect were observed with the daily consumption of approximately 7-8 servings of fruit or vegetables.

CONCLUSIONS

Eating fruit and vegetables may promote emotional well-being among healthy young adults.

Recruiting a special sample with sparse resources: lessons from a study of Gulf War veterans

BACKGROUND

Recruitment is the most common failure point for clinical studies, with recruitment failure adversely affecting science, dollar costs, human capital, and the ethical risk-benefit trade-off to study participants. Added problems attend recruitment of special and/or challenging candidate populations, particularly in settings of sparse recruitment resources. Obstacles to study recruitment and participation of ill Gulf War veterans (GWVs) include health barriers, work and family obligations, mistrust of the medical/scientific community, and challenges to identifying/reaching potential participants.

PURPOSE

We sought to identify and implement a minimal-cost multipronged recruitment approach for a small single-site (<50 participants) study of a special group, ill GWVs, with approaches substantially applicable to other recruitment settings and larger multisite studies.

METHODS

Categories of recruitment approach included directed as well as general media, collaborations with support groups/interest groups, local free advertising resources (Craigslist and Backpage), physician outreach, Internet-based approaches, and referrals from study participants and screenees. We describe the subcategories and yield of each approach within each approach.

RESULTS

Each approach contributed candidates to the final recruitment tally, with the largest fractional contribution by directed media (52%). Among the remainder, no other individual approach was clearly dominant (largest contribution: 13%).

LIMITATIONS

Special population subsamples present special challenges; all approaches cited may not be useful in all settings and subpopulations.

CONCLUSIONS

A multipronged suite of minimal-cost approaches led to successful recruitment to target for this single-site clinical trial for a special population with significant recruitment challenges. It additionally yielded a nation-wide corpus of several hundred individuals interested in participation in future studies of GWVs. While certain approaches produced disproportionate yield, it was not possible to predict these a priori. We suggest that this model, which incorporates a suite of approaches, and delineates backup approaches in the event of recruitment shortfall, may provide a template applicable to recruitment of other special samples in settings of limited resources and also is germane to cost-effective recruitment in studies more generally.

Depression and dietary intake in a cohort of HIV-positive clients in Sydney

This cross-sectional study aimed to compare dietary intake in people living with HIV (PLHIV) experiencing symptoms of depression with those not reporting depression. The Centre for Epidemiologic Studies Depression Scale (CES-D10) was used to classify the risk of depression. Dietary nutrient intake was determined using the diet history and food frequency questionnaire. Depressed ( n = 21) compared with non-depressed ( n = 37) subjects had significantly lower mean intake of fibre (16.1 versus 25.4 g/day), vitamin A (801.5 versus 1524.8 mg/day), magnesium (299.8 versus 380.0 mg/day) and folate (264.8 versus 402.9 μg/day). The proportion of subjects achieving the recommended intake of these nutrients, with the exception of folate was also found to be lower in the depressed group compared with non-depressed group. The study found that depressive symptomatology in PLHIV was associated with poorer dietary nutrient intake. A multidisciplinary model of care that includes a nutrition assessment is recommended for the management of PLHIV with depression to reduce the risk of associated nutritional problems.

Cocoa and chocolate in human health and disease

Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks.

Are "social drugs" (tobacco, coffee and chocolate) related to the bipolar spectrum?

BACKGROUND

Across all ages and cultures, mankind has always used substances in order to induce pleasurable sensations or desirable psychophysical states. These substances, notably caffeine, tobacco, alcohol and chocolate, can be labeled 'social drugs'.

METHODS

We analyzed the social drug habits of 562 patients suffering from mood disorders, according to DSM-IV-R criteria (major depressive episode, recurrent depression, bipolar type I and II disorders and depression not otherwise specified). The sample was also divided into bipolar and non-bipolar according to Hypomania Check-list 32 (HCL-32), which proposes a broader concept of hypomania and soft bipolarity, comprising the spectrum of bipolar disorders proper, along with other, "softer" expressions of bipolarity intermediate between bipolar disorder and normality.

RESULTS

Using HCL-32 criteria, but DSM-IV-R criteria, a link was confirmed between bipolar spectrum and substance use including social drugs such as tobacco and coffee.

LIMITATION

Observational correlational study.

CONCLUSION

This study is in support of earlier theoretical formulations within the framework of the Pisa-San Diego collaboration.

Dopamine polymorphisms and depressive symptoms predict foods intake. Results from a nationally representative sample

Depression and variation in dopamine related genes have both independently been associated with food consumption. Depressive symptoms could synergistically interact with genetic variation to influence food intake. We examined the interaction between high depressive symptoms and functional polymorphisms of dopamine transporter (SLC6A3), monoamine oxidase A (MAOA), dopamine receptor D2 (DRD2) and dopamine receptor D4 (DRD4) on intake of high-calorie sweet, high-calorie non-sweet, and low-calorie foods in the National Longitudinal Study of Adolescent Health (Add Health). Multivariate linear regression analyses were used to examine main effects of gene and depression symptoms and their interaction (genotype-by-high depression symptoms) on food categories. Applying a false discovery rate criterion for multiple comparisons indicated a statistically significant interaction for females with high depressive symptoms and the SLC6A3 gene, such that those with the SLC6A3 10/10 allele reported greater intake of high-calorie sweet foods than their counterparts high in depressive symptoms with the SLC6A3 any 9 allele (LS mean 10/10 allele=2.5, SE=.13; LS mean any 9 allele=1.8, SE=.13, p<.05). These findings highlight that the relationship between depression and food intake may vary as a function of genetic polymorphism. Further research is needed to confirm these findings.