Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people

Development and Validation of a Scoring System (SAGA Score) to Predict Weight Loss in Community-Dwelling, Self-Supported Older Adults

This retrospective cohort study explored the prevalence of substantial weight loss (≥10% per year) in independent older individuals in order to develop and validate a scoring system for high-risk group identification and targeted intervention against malnutrition. We used insurance claims and the Kokuho Database (KDB), a nationwide repository of Japanese-specific health checkups and health assessments for the older people. The study included 12,882 community-dwelling individuals aged 75 years and older who were self-supported in their activities of daily living in Saga Prefecture, Japan. Health evaluations and questionnaires categorized weight-loss factors into organic, physiological, psychological, and non-medical domains. The resulting scoring system (SAGA score), incorporating logistic regression models, predicted ≥ 10% annual weight-loss risk. The results revealed a 1.7% rate of annual substantial weight loss, with the SAGA score effectively stratifying the participants into low-, intermediate-, and high-risk categories. The high-risk category exhibited a weight-loss rate of 17.6%, highlighting the utility of this scoring system for targeted prevention. In conclusion, the validated SAGA score is a crucial tool for identifying individuals at high risk of significant weight loss, enabling tailored interventions and social support benefiting both older individuals and their relatives.

Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population

Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.

Novel Lipids to Regulate Obesity and Brain Function: Comparing Available Evidence and Insights from QSAR In Silico Models

Lipid molecules, such as policosanol, ergosterol, sphingomyelin, omega 3 rich phosphatidylcholine, α-tocopherol, and sodium butyrate, have emerged as novel additions to the portfolio of bioactive lipids. In this state-of-the-art review, we discuss these lipids, and their activity against obesity and mental or neurological disorders, with a focus on their proposed cellular targets and the ways in which they produce their beneficial effects. Furthermore, this available information is compared with that provided by in silico Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) models in order to understand the usefulness of these tools for the discovery of new bioactive compounds. Accordingly, it was possible to highlight how these lipids interact with various cellular targets related to the molecule transportation and absorption (e.g., α-tocopherol transfer protein for α-Tocopherol, ATP-binding cassette ABC transporters or Apolipoprotein E for sphingomyelins and phospholipids) or other processes, such as the regulation of gene expression (involving Sterol Regulatory Element-Binding Proteins for ergosterol or Peroxisome Proliferator-Activated Receptors in the case of policosanol) and inflammation (the regulation of interleukins by sodium butyrate). When comparing the literature with in silico Quantitative Structure-Activity Relationship (QSAR) models, it was observed that although they are useful for selecting bioactive molecules when compared in batch, the information they provide does not coincide when assessed individually. Our review highlights the importance of considering a broad range of lipids as potential bioactives and the need for accurate prediction of ADMET parameters in the discovery of new biomolecules. The information presented here provides a useful resource for researchers interested in developing new strategies for the treatment of obesity and mental or neurological disorders.

Beneficial Effect of Increased Tryptophan Intake on Its Metabolism and Mental State of the Elderly

The elderly often suffer from sleep disorders and depression, which contribute to mood disorders. In our previous work, we showed that elderly individuals with mood disorders had a lower intake of TRP and recommended a TRP-based dietary intervention to improve the mental state of such individuals. In this work, we assessed the impact of a TRP-rich diet on the mental state of, and TRP metabolism in, elderly individuals with mood disorders. Forty elderly individuals with depression and sleep disorders and an equal number of elderly subjects without mood disorders were enrolled in this study. TRP intake was evaluated with the nutrition calculator. Patients with mood disorders had a lower TRP intake than their normal counterparts and received a TRP-rich diet with TRP content of 25 mg per kilogram of the body per day for 12 weeks. The mental state was assessed before and after this dietary intervention with the Hamilton Depression Rating Scale (HAM-D) and the Insomnia Severity Index (ISI). At those times, urinary levels of TRP and its metabolites 5-hydroxyindoleacetic acid (5-HIAA), L-kynurenine (KYN), kynurenic acid (KYNA), and quinolinic acid (QA) were determined by liquid chromatography with tandem mass spectrometry and related to creatinine level. After TRP-based dietary intervention, the score of ISI and HAM-D decreased by more than half. A correlation analysis reveals that TRP, 5-HIAA, and KYNA might have anti-depressive action, while KYN and QA-pro-depressive. The levels of TRP, 5-HIAA, and KYNA in urine of mood disorder patients increased, while the levels of KYN and QA decreased. In conclusion, dietary consumption of adequate amount of tryptophan has a beneficial effect on mental health of the elderly with mood disorders and improves metabolism of this amino acid. Therefore, a TRP-enriched diet may be considered as a component of the treatment of elderly individuals with mood disorders.

SNAP work requirements increase mental health care use

OBJECTIVE

We measured the impact of Supplemental Nutrition Assistance Program (SNAP) work requirements on mental health care use.

DATA SOURCES AND STUDY SETTING

We used 2015-2018 West Virginia Medicaid and SNAP data.

STUDY DESIGN

Nine counties were exposed to SNAP work requirements. Using an event study framework, we assessed how this changed the probability and number of visits for depression and anxiety in the treatment versus the control group.

DATA COLLECTION/EXTRACTION METHODS

The sample included individuals aged 18-49, enrolled in both SNAP and Medicaid at the start of the study. Dually eligible individuals were excluded.

PRINCIPAL FINDINGS

At baseline, the probability of having a mood disorder visit was 6.1% among women and 5.3% among men, rising by 0.9 percentage points (SE 0.4, relative change +14.1%) among women and 0.7 percentage points (SE 0.3, relative change +13.0%) among men after exposure to work requirements. The probability of having an anxiety visit rose by 1.0 (SE 0.4) percentage points among women, a 17.8% relative increase over the baseline of 5.8%. Among men, the likelihood of having an anxiety visit increased by 1.0 percentage points (SE 0.5), a relative change of 24.3% over a baseline probability of 5.0%, though this effect occurred much more gradually compared to women.

CONCLUSIONS

Exposure to SNAP work requirements was associated with increases in health care use for mood disorders and anxiety among enrollees. The policy's effect differed between men and women.

Long-term trends in the incidence of depressive disorders in China, the United States, India and globally: A comparative study from 1990 to 2019

Background

Depressive disorders have become an increasingly significant public health issue. This study is intended to show the trend of the incidence of depressive disorders in China, the United States, India and the world from 1990 to 2019, as well as the impact of age, period and cohort on it.

Methods

Extracting incidence data from the Global Burden of Disease Study 2019, we determined trends in the age-standardized incidence rate (ASIR) using Joinpoint regression. An age-period-cohort analysis was implemented to describe the effects of age, period, and cohort, as well as the long-term tendencies.

Results

From 1990 to 2019, the ASIR of depressive disorders in China was lower than that in the United States; India is lower than the United States in the first 5 years, showing a downward trend. The incidence in India and the United States is higher than the global average. The ASIR of women in the three countries is higher than that of men. In China, the elderly, early period and people born around 1954 have a higher risk of depressive disorders. In the United States, young people born around 1999 have a higher risk of depressive disorders. India is similar to China.

Conclusion

From 1990 to 2019, the age effect of China as a whole increased, and the period became stable, and the cohort effect declined. The overall age and period effects of the United States reduced, while the cohort effect increased. The age effect in India increased, while the period and cohort effects decreased. Depressive disorders are becoming ever more serious worldwide, and we'd better take measures to reduce its incidence according to the cohort effect of each age group.

Association between food insecurity and perceived stress among older adults (50+) in six low- and middle-income countries

OBJECTIVES

In this study, we assess the relationship between food insecurity andperceived stress among older adults (50+) in six low- and middle-income countries of China, Ghana, India, Mexico, Russia and, South Africa.

METHODS

Cross-sectional comparative analysis was conducted using nationally representative data from the WHO's Study on global AGEing and adult health survey. Bivariate and multivariate regression analyses examine if food insecurity was associated with perceived stress. We also examined the mediating role of health conditions on the association between food insecurity and perceived stress.

RESULTS

Across countries, the mean perceived stress score was higher among the older population with food insecurity. Regression analysis showed significant and positive association between food insecurity and perceived stress. Findings from the pooled data of six countries showed, older adults who experienced severe food insecurity (β = 4.05, p < .001) had higher perceived stress scores. The association was statistically significant in India, Russia, South Africa, and Ghana.

CONCLUSION

Food insecurity showed significant adverse impact on perceived stress among the older population in low- and middle-income countries. Policy measures to reduce household food insecurity are important for improving both mental and physical health conditions of the growing older population in low- and middle-income countries.

Food insecurity is associated with the sleep quality and quantity in adults: a systematic review and meta-analysis

OBJECTIVE

We evaluated associations between food insecurity (FI) and the quality and quantity of sleep in adults (≥18 years).

DESIGN

The current study represented a systematic review and meta-analysis of observational studies.

SETTING

Databases of PubMed, Scopus, Embase and Web of Science were searched from inception until 6 June 2022. Meta-analyses were conducted using random-effects models, and effect sizes were reported as OR and 95 % CI.

PARTICIPANTS

Data from ten eligible observational studies, including 83 764 participants, were included.

RESULTS

FI was associated with an increased risk of poor sleep quality (OR = 1·45; 95 % CI (1·24, 1·70), I2 = 95, P < 0·001, n 7). Besides, subgroup analysis showed increased risk of poor sleep quality corresponding to the severity of FI across mild (OR = 1·31; 95 % CI (1·16, 1·48), I2 = 0 %, P < 0·001, n 5), moderate (OR = 1·49; 95 % CI (1·32, 1·68), I2 = 0 %, P < 0·001, n 5) and severe (OR = 1·89; 95 % CI (1·63, 2·20), I2 = 0 %, P < 0·001, n 5) levels. Similarly, subgroup analysis by sleep problems showed that FI was associated with an increased the risk of trouble falling asleep (OR = 1·39; 95 % CI (1·05, 1·83), I2 = 91 %, P = 0·002, n 3) and trouble staying asleep (OR = 1·91; 95 % CI (1·37, 2·67), I2 = 89 %, P < 0·001, n 3). Moreover, FI was associated with the odds of shorter (OR = 1·14; 95 % CI (1·07, 1·21), I2 = 0 %, P < 0·001, n 4) and longer sleep duration (OR = 1·14; 95 % CI (1·03, 1·26), I2 = 0 %, P = 0·010, n 4).

CONCLUSIONS

Collective evidence supports that FI is associated with poor sleep quality and quantity in adults. Preventative and management strategies that address FI may provide health benefits beyond improving nutritional status per se.

Food insecurity and associated depression among older adults in India: evidence from a population-based study

OBJECTIVE

The present study aimed to examine the associations of several indicators of food insecurity with depression among older adults in India.

DESIGN

A cross-sectional study was conducted using country-representative survey data.

SETTING AND PARTICIPANTS

The present study uses data of the Longitudinal Aging Study in India conducted during 2017-2018. The effective sample size for the present study was 31 464 older adults aged 60 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was major depression among older adults. Descriptive statistics along with bivariate analysis was presented. Additionally, binary logistic regression analysis was used to establish the association between the depression and food security factors along with other covariates.

RESULTS

The overall prevalence of major depression was 8.4% among older adults in India. A proportion of 6.3% of the older adults reduced the size of meals, 40% reported that they did not eat enough food of their choice, 5.6% mentioned that they were hungry but did not eat, 4.2% reported that they did not eat for a whole day and 5.6% think that they have lost weight due to lack of enough food in the household. Older adults who reported to have reduced the size of meals due to lack of enough food (adjusted OR (AOR): 1.76, CI 1.44 to 2.15) were hungry but did not eat (AOR: 1.35, CI 1.06 to 1.72) did not eat food for a whole day (AOR: 1.33; CI 1.03 to 1.71), lost weight due to lack of food (AOR: 1.57; CI 1.30 to1.89) had higher odds of being depressed in reference to their respective counterparts.

CONCLUSION

The findings suggest that self-reported food insecurity indicators were strongly associated with major depression among older Indian adults. The national food security programmes should be enhanced as an effort to improve mental health status and quality of life among older population.

Nutritional therapy can reduce the burden of depression management in low income countries: A review

Depression is a serious mental and mood disorder with global health and economic burden. This burden may be overwhelming in low income countries, although there are insufficient data. Most antidepressant formulations are predicated on the monoamine, neuroendocrine and neuro-inflammation hypotheses, with little or no cognizance to other neurochemicals altered in depression. A nutritional strategy with or without conventional antidepressants is recommended, as nutrition plays vital roles in the onset, severity and duration of depression, with poor nutrition contributing to its pathogenesis. This review discusses nutritional potentials of utilizing omega-3 fatty acids, proteins, vitamins, minerals and herbs or their phytochemicals in the management of depression with the aim of reducing depression burden. Literature search of empirical data in books and journals in data bases including but not limited to PubMed, Scopus, Science Direct, Web of Science and Google Scholar that might contain discussions of sampling were sought, their full text obtained, and searched for relevant content to determine eligibility. Omega-3 fatty and amino acids had significant positive anti-depression outcomes, while vitamins and minerals although essential, enhanced omega-3 fatty and amino acids activities. Some herbs either as whole extracts or their phytochemicals/metabolites had significant positive anti-depression efficacy. Nutrition through the application of necessary food classes or herbs as well as their phytochemicals, may go a long way to effectively manage depression. This therefore will provide inexpensive, natural, and non-invasive therapeutic means with reduced adverse effects that can also be applied alongside clinical management. This nutritional strategy should be given more attention in research, assessment and treatment for those with depression and other mental illness in low income countries, especially in Africa.

Nutritional status and body composition in cognitively impaired older persons living alone: The Takashimadaira study

OBJECTIVES

To investigate nutritional status and body composition in cognitively impaired older persons living alone.

METHODS

This cross-sectional study included 1051 older adults (633 women and 418 men, mean age: 77.1 years) from the Takashimadaira study. The study participants were categorized according to whether they lived alone, which was confirmed via questionnaire, and had cognitive impairment, which was defined as having a Mini Mental State Examination-Japanese score ≤23. Nutritional status was evaluated using the serum albumin level. The fat-free mass index (FFMI) was calculated based on anthropometric and body composition measurements. A logistic regression model with the outcome of a low serum albumin level (serum albumin <4 g/dL) and low FFMI (<16 kg/m2 in men and <14 kg/m2 in women) were used to analyze the data.

RESULTS

The percentages of participants in the living alone (-)/cognitive impairment (-) group, the living alone (+)/cognitive impairment (-) group, the living alone (-)/cognitive impairment (+) group, and the living alone (+)/cognitive impairment (+) group were 54.8%, 37.3%, 5.6%, and 2.3%, respectively. Compared to the living alone (-)/cognitive impairment (-) group, the living alone (+)/cognitive impairment (+) group was more likely to have a low serum albumin level (adjusted odds ratio = 3.10, 95% confidence interval = 1.31 to 7.33) and low FFMI (adjusted odds ratio = 2.79, 95% confidence interval = 1.10 to 7.06) after adjusting for potential confounders.

CONCLUSION

Cognitively impaired older adults living alone had poorer nutrition than cognitively normal and cohabitating persons in this study. Our results highlight the importance of paying extra attention to nutritional status for this group of community-dwelling older adults.

Living and eating alone on depressive symptoms by physical frailty status: A cross-sectional study based on the Korean Frailty and Aging Cohort Study

BACKGROUND

General health conditions in older adults, including their mental health, differ greatly based on their physical health conditions rather than age. Thus, we evaluated how lifestyle factors, which included eating and living, affected depressive symptoms in older adults based on their physical frailty status.

METHODS

We included older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS). Based on their eating and living patterns, we classified them into four groups: "lived and ate with others," "lived alone yet ate with others," "lived with others yet ate alone," and "lived and ate alone." Depressive symptoms and physical frailty were measured using the Korean version of the Geriatric Depression Scale and modified version of the Cardiovascular Health Study (CHS) Frailty Index, respectively.

RESULTS

A total of 2,702 participants, 11.4% lived with others yet ate alone, and 19.7% lived and ate alone. For robust older adults, after adjusting for variables, the "ate alone" group was significantly related with depressive symptoms, and the "lived and ate alone" group showed a higher risk of depressive symptoms. In the prefrail to frail participants, the "lived and ate alone" group was at a higher risk of depressive symptoms.

CONCLUSION

Eating and living alone are key risk factors for depressive symptoms in community-dwelling older adults regardless of their physical frailty status. Therefore, social interventions are needed for both physically frail and healthy older adults to support their eating patterns and increase opportunities for social interaction.

Food insecurity is associated with serious psychological distress among low-income California adults

This study examined differences in the associations between food insecurity and serious psychological distress (SPD) by key sociodemographic factors in a population-based sample of low-income adults from the 2017 California Health Interview Survey (n = 6266). After adjusting for sociodemographic characteristics, low food security, and very low food security were both positively associated with SPD among all low-income adults. Upon stratification, these associations were most pronounced among adults under age 50, males, and in adults with children. Understanding disparities in the associations between food insecurity and psychological distress is critical in developing effective programs or policies to target the most vulnerable sub-groups.

Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis

OBJECTIVES

This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone.

METHODS

Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses.

RESULTS

The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p < .05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p < .05).

CONCLUSIONS

Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

Vitamin E for the management of major depressive disorder: possible role of the anti-inflammatory and antioxidant systems

OBJECTIVES

Vitamin E has various functions in humans, including antioxidant, anti-inflammatory, anti-cancer, and anti-atherogenic actions, as well as direct effects on enzymatic activities and modulation of gene transcription. In addition to these functions, vitamin E is also important for the central nervous system, and its role in the prevention and/or treatment of some neurological diseases has been suggested. In particular, the role of vitamin E in the modulation of major depressive disorder (MDD) is an issue that has emerged in recent studies. Many factors have been implicated in the pathophysiology of this disorder, including inflammation, oxidative, and nitrosative stress.

METHODS

This narrative review discusses the involvement of inflammation, oxidative, and nitrosative stress in the pathophysiology of MDD and presents clinical and preclinical studies that correlate vitamin E with this psychiatric disorder.

RESULTS

We gathered evidence from clinical studies that demonstrated the relationship between low vitamin E status and MDD symptoms. Vitamin E has been reported to exert a beneficial influence on the oxidative and inflammatory status of individuals, factors that may account for the attenuation of depressive symptoms. Preclinical studies have reinforced the antidepressant-like response of vitamin E, and the mechanisms underlying its effect seem to be related to the modulation of oxidative stress and neuroinflammation.

CONCLUSION

We suggest that vitamin E has potential to be used as an adjuvant for the management of MDD, but more studies are clearly needed to ascertain the efficacy of vitamin E for alleviating depressive symptoms.

Association Between Macronutrients Intake and Depression in the United States and South Korea

Although the risk for depression appears to be related to daily dietary habits, how the proportion of major macronutrients affects the occurrence of depression remains largely unknown. This study aims to estimate the association between macronutrients (i.e., carbohydrate, protein, fat) and depression through national survey datasets from the United States and South Korea. Association between the prevalence of depression and each macronutrient was measured from 60,935 participants from the National Health and Nutrition Examination Survey (NHANES) and 15,700 participants from the South Korea NHANES (K-NHANES) databases. When the proportion of calories intake by protein increased by 10%, the prevalence of depression was significantly reduced both in the United States [Odds Ratio, OR (95% CI), 0.621 (0.530-0.728)] and South Korea [0.703 (0.397-0.994)]. An association between carbohydrate intake and the prevalence of depression was seen in the United States [1.194 (1.116-1.277)], but not in South Korea. Fat intake was not significantly associated with depression in either country. Subsequent analysis showed that the low protein intake groups had significantly higher risk for depression than the normal protein intake groups in both the United States [1.648 (1.179-2.304)] and South Korea [3.169 (1.598-6.286)]. In the daily diet of macronutrients, the proportion of protein intake is significantly associated with the prevalence of depression. These associations were more prominent in adults with insufficient protein intake, and the pattern of association between macronutrients and depression in Asian American and South Korean populations were similar. Our findings suggest that the proportion of macronutrients intake in everyday life may be related to the occurrence of depression.

Association between dietary protein intake and the risk of depressive symptoms in adults

Depression is an important public health problem. The aim of the study is to explore the associations of total protein intake and protein sources with the risk of depressive symptoms. This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2007–2014. Dietary protein intake was obtained from two 24-h dietary recall interviews. Depressive symptoms were assessed by a nine-item Patient Health Questionnaire. Logistic regression models and restricted cubic spline models were used to estimate the associations of total protein intake (g/kg per d) and protein sources with the risk of depressive symptoms. A total of 17 845 individuals aged 18 years and older were included in this study. Total protein intake was inversely associated with the risk of depressive symptoms. The full-adjusted OR of depressive symptoms was 0·34 (95 % CI 0·17, 0·68) for quartile (Q) 4 v. Q1 of total protein intake. For protein intake from milk and milk products, the association with depressive symptoms was significant both for Q2 v. Q1 (OR 0·61; 95 % CI 0·41, 0·93) and Q3 v. Q1 (OR 0·37; 95 % CI 0·24, 0·59) in the full-adjusted model. In the dose–response analysis, the shape of the associations of total protein intake and protein intake from milk and milk products with the risk of depressive symptoms was approximately L-shaped and U-shaped, respectively. The present study demonstrated that total protein intake and protein intake from milk and milk products might reduce the risk of depressive symptoms in US adults.

A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial

BACKGROUND

Given that current unimodal strategies for treating late-life depression are insufficient, the awareness of the necessity and importance of multidomain intervention has increased. We assessed the efficacy of multidomain intervention in reducing symptoms of late-life depression.

METHODS

This was a 12-week community-based randomized controlled trial in 78 older adults diagnosed with major depressive disorder. Participants were randomly assigned to the multidomain intervention or supportive therapy group. We provided four home visits and 12 telephone calls over 12 weeks. Four therapeutic approaches (physical activity, healthy diet, social activity, and brief cognitive restructuring) were incorporated into the multidomain intervention. The primary outcome was the change in depressive symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Secondarily, we investigated changes in resting-state functional connectivity.

RESULTS

The MADRS total score was reduced more in the multidomain intervention group than in the supportive therapy group during the 12 weeks (intervention × time interaction, P = =0.007). After correction for multiple comparisons, the multidomain intervention group exhibited a lower MADRS total score at week 12 (score difference 5.117; P = =0.029). At follow-up, the multidomain intervention group also exhibited less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network (FDR < 0.1).

LIMITATIONS

Caution is needed in the interpretation of the results, considering the small sample size and high percentage of female participants.

CONCLUSIONS

A 12-week multidomain intervention resulted in a greater reduction of depressive symptoms among the elderly with major depressive disorder than their counterparts who received supportive therapy.

Prospective study on the association between dietary non-enzymatic antioxidant capacity and depressive symptoms

BACKGROUND & AIMS

Oxidative stress has been suggested to play an important role in the pathophysiology of depression, and a diet high in antioxidants may improve mood. However, studies addressing this issue are scarce. The aim of this cohort study was to investigate the prospective association between dietary non-enzymatic antioxidant capacity (NEAC) in overall diet and depressive symptoms in Japanese employees. Additionally, we examined the association separated by dietary NEAC sources.

METHOD

Participants were 911 workers without depressive symptoms at baseline and participated in 3-y follow-up survey. Dietary NEAC was determined from a database of NEAC measurements obtained by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC). Dietary NEAC was calculated by multiplying the estimated NEAC values with the consumed amount and summing up those values. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate odds ratios of depressive symptoms according to overall NEAC and separately from foods and beverages.

RESULTS

At 3-y follow-up, 153 (16.8%) workers were newly identified as having depressive symptom. No significant associations were found between higher level of overall dietary NEAC and decreased risk of depressive symptoms after adjustment for potential confounders (overall: FRAP, P for trend = 0.19 and ORAC, P for trend = 0.20). Likewise, neither higher dietary NEAC from foods nor beverages were related with lower depressive symptoms.

CONCLUSION

Our findings did not support an inverse association between dietary NEAC and the risk of depressive symptoms in Japanese workers.

Prevalence and risk factors associated with non-traffic related injury in the older population in Ghana: Wave 2 of the WHO Study on Global AGEing and adult health (SAGE)

Injuries are a significant cause of hospitalization in the older population, leading to a decline in physical activity and greater dependence on others. Compared to traffic related injury, relatively fewer studies have been conducted on non-traffic related injury in the older population in Ghana. This analysis provides a nationwide baseline prevalence and associated factors of non-traffic related injuries among older adults in Ghana. Data from the 2014-2015 nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 was used. A final sample of 3461 older adults living in 2827 households was used in the statistical modelling. Predictors of injury were examined using both single-level and multilevel binary logistic regression models. The prevalence of non-traffic related injury found in this study was 3.74%. The odds of being injured decreased among females (OR = 0.66, 95% CI: 0.46, 0.95) compared to their male counterparts and those who rated their heath state as moderate (OR = 0.59, 95% CI: 0.38, 0.94). Depression was the only risk factor identified in the multivariable model (OR = 2.55, 95%CI: 1.38, 4.71). The study did not observe significant residual household-level variation in injury status. The role of depression as a risk factor suggests that interventions that aim to reduce non-traffic related injury in older adults should consider improving mental health.

Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa

PURPOSE

Household food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidemic, and having the largest share of poverty in South Africa, this relationship remains unexamined. This study investigated the association between major depressive episode (MDE) and household food insecurity among individuals with MDR-TB.

METHODS

We enrolled and interviewed 141 newly admitted microbiologically confirmed MDR-TB inpatients at a specialized TB hospital in KwaZulu-Natal Province, South Africa. Logistic regression models were fitted to assess the relationship between MDE and household food insecurity, while accounting for socio-demographic status (e.g., age, gender, education, marital status, social grant status, income, and preference for living in one's community).

RESULTS

The prevalence of MDE and household food insecurity was 11.35% and 21.01%, respectively. MDE was significantly associated with household food insecurity (aOR 4.63, 95% CI 1.17-18.38). Individuals who are female (aOR 6.29, 95% CI 1.13-35.03), young (aOR 8.86, 95% CI 1.69-46.34), have low educational attainment (aOR 6.19, 95% CI 1.70-22.59) and receive social grants (aOR 7.60, 95% CI 2.36-24.48) were most at risk of household food insecurity.

CONCLUSIONS

MDE in individuals with MDR-TB was significantly associated with household food insecurity, independent of socio-economic status. Although MDR-TB is not exclusively a disease of the poor, individuals from socio-economically disadvantaged backgrounds (e.g., female, young adults, low education, and social grant recipients) were more likely to experience household food insecurity. Our study underscores the need to address the co-occurring cycles of food insecurity and untreated MDE in South Africa.

Social Assistance Payments and Food Insecurity inAustralia: Evidence from the HouseholdExpenditure Survey

It is widely understood that households with low economic resources and poor labour market attachment are at considerable risk of food insecurity in Australia. However, little is known about variations in food insecurity by receipt of specific classes of social assistance payments that are made through the social security system. Using newly released data from the 2016 Household Expenditure Survey, this paper reports on variations in food insecurity prevalence across a range of payment types. We further investigated measures of financial wellbeing reported by food-insecure households in receipt of social assistance payments. Results showed that individuals in receipt of Newstart allowance (11%), Austudy/Abstudy (14%), the Disability Support Pension (12%), the Carer Payment (11%) and the Parenting Payment (9%) were at significantly higher risk of food insecurity compared to those in receipt of the Age Pension (<1%) or no payment at all (1.3%). Results further indicated that food-insecure households in receipt of social assistance payments endured significant financial stress, with a large proportion co-currently experiencing “fuel” or “energy” poverty. Our results support calls by a range of Australian non-government organisations, politicians, and academics for a comprehensive review of the Australian social security system.

Household food insecurity and breakfast skipping: Their association with depressive symptoms

Household food insecurity limits families' access to sufficient and varied safe foods, which may result in problems such as insufficient food intake and nutritional imbalance. This may lead to health issues such as obesity, chronic illness, mental health problems, and even poor quality of life. Breakfast skipping is a risk factor for eating disorders which is related to diseases such as metabolic disorder and depressive symptoms. This study examined household food insecurity and breakfast skipping and their association with depressive symptoms. In this study, we used data from the 2015 Korean Community Health Survey. Study participants were a total of 225,965 people aged 18 years or older who answered questions related to eating habits. Multiple logistic regression analyses were used to identify factors associated with depressive symptoms. Those in households with low food security and very low food security were more likely to experience depressive symptoms. Individuals that skip breakfast 2 days or more per week were more likely to experience depressive symptoms. Our study suggests that those living in households with lower food security and who skip breakfast often should pay more attention to their mental health.

Association of Nutritional Status with Depression and Cognitive Function of Older Women Residing in Old-age Homes of Kolkata, India

Introduction:

Depression and cognitive function are said to be the foes of the nutritional status of the older adults. Depression is the most common psychological problem in old age, while deterioration of cognitive function is also observed in this age group.

Objectives:

The main objective of the study is to find out the association of nutritional status with depression and cognitive function of older women.

Materials and Methods:

A cross-sectional study was done among 196 older women, residing in old-age homes of Kolkata. Nutritional status of the participants was assessed by the long version of Mini Nutritional Assessment tool (MNA^®). Level of depression was assessed by Geriatric Depression Scale (GDS 30). Cognitive function was checked by using the Folstein Mini-Mental State Examination (MMSE). Chi-square, Kruskal–Wallis test, and Spearman's rho correlation coefficient was calculated using SPSS software.

Results:

About 38.3% and 14.8% participants were suffering from mild and severe depression. 13.2% and 9.2% older women were found with borderline impairment and impairment in cognitive function, respectively. Significant correlation of nutritional status was found with both depression and cognitive function (P < 0.05), and this was supported by multinominal logistic regression model.

Conclusions:

Both depression and impairment in cognitive function can cause malnutrition or vice versa among older women.

Food Insecurity among Older Aboriginal and Torres Strait Islanders

It is well established that Indigenous populations are at a heightened risk of food insecurity. Yet, although populations (both Indigenous and non-Indigenous) are ageing, little is understood about the levels of food insecurity experienced by older Indigenous peoples. Using Australian data, this study examined the prevalence and correlates of food insecurity among older Aboriginal and Torres Strait Islanders. Using nationally representative data, we employed ordinal logistic regression models to investigate the association between socio-demographic characteristics and food insecurity. We found that 21% of the older Aboriginal and Torres Strait Islander population were food insecure, with 40% of this group exposed to food insecurity with food depletion and inadequate intake. This places this population at a 5 to 7-fold risk of experiencing food insecurity relative to their older non-Indigenous peers. Measures of geography, language and low socio-economic status were highly associated with exposure to food insecurity. Addressing food insecurity offers one pathway to reduce the disparity in health outcomes between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Policies that consider both remote and non-remote Australia, as well as those that involve Aboriginal people in their design and implementation are needed to reduce food insecurity.

Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression

BACKGROUND

Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.

OBJECTIVE

To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.

DESIGN

The cross-sectional study was conducted from February 2017 to May 2017.

PARTICIPANTS/SETTING

A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.

MAIN OUTCOME MEASURES

Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).

STATISTICAL ANALYSES PERFORMED

Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.

RESULTS

Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).

CONCLUSIONS

Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

Food insecurity and depressive symptoms of older adults living alone in South Korea

In South Korea, the number of older adults living alone is rapidly increasing with the growth of the ageing population. Although there is some evidence of a link between financial strain and depression in this population, there is limited empirical evidence on the relationship between food insecurity and depression in older adults living alone despite the fact that they have a high prevalence of food insecurity and tend to seek food assistance. This study aims to investigate whether food insecurity explains depressive symptoms in Korean older adults living alone. We employed data from the Korea Welfare Panel Study collected from a large-scale national sample in South Korea. Our sample consisted of 815 older adults aged 65 or older who lived alone. Conducting ordinary least square regression analyses, we tested the main effect of food insecurity on depression and the interaction effect of food insecurity and low income. We found that the relationship between food insecurity and depressive symptoms differed by low-income status (b = 6.27, p = 0.047). The association was significant only in the low-income group (b = 1.37, p = 0.04). These findings suggest that protecting access to food may be a promising strategy to lessen depressive symptoms associated with financial strain among older adults living alone.

Prevalence of Depression and Associated Factors in Non-institutionalized Older Adults With a Previous History of Falling

The purpose of this paper was to estimate the prevalence of depression and associated factors in people aged 65 or older with a history of falling in the last 12months. A cross-sectional descriptive study was performed involving a random sample of 213 participants from two social centers for older adults in the city of Zaragoza (Spain). The mean age of the participants was 77.3years (SD±7.0). Our findings reveal a prevalence of depression of 28.2% in the study sample, with older adults who were at a high risk of falling being more susceptible to developing depression. In conclusion, one in three elderly people who were at risk of suffering a fall in the 12months prior to data collection had symptoms of depression. This is in agreement with the results from previous studies, which confirm that there is a high prevalence of depression in elderly patients with a previous history of falls.

Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study

This study examines the prevalence of depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong. Recent epidemiological data suggest that the prevalence of mild to severe depression, anxiety and stress among qualified nurses in Hong Kong stands at 35.8%, 37.3% and 41.1%, respectively. A total of 661 nursing students were recruited to participate in our cross-sectional mental health survey using the Depression, Anxiety and Stress Scale 21. Multiple logistic regression was used to determine significant relationships between variables. Working in general medicine, being in financial difficulty, having sleep problems, not having leisure activity and perceiving oneself in poor mental health were significant correlates of past-week depression, anxiety and stress. Year of study, physical inactivity and family crisis in the past year correlated significantly with depression. Imbalanced diets significantly correlated with anxiety. Stress was significantly associated with a lack of alone time. This is the first study to confirm empirically that clinical specialty, financial difficulties and lifestyle factors can increase nursing students’ levels of depression and anxiety and symptoms of stress. Prevention, including the early detection and treatment of mental disorder, promises to reduce the prevalence of these indicators among this group.

Nutrient Intake and Depression Symptoms in Spanish Children: The ANIVA Study

The aim of this study was to examine the relationship between nutritional intake and depressive symptoms in Valencian schoolchildren. The ANIVA (Antropometria y Nutricion Infantil de Valencia) study is a descriptive cross-sectional study. During academic year 2013–2014, 710 schoolchildren aged 6–9 years were selected from eleven primary schools in Valencia (Spain). Children’s dietary intake was measured on three-day food records, completed by parents/guardians; children completed the 20-item Center for Epidemiologic Studies Depression Scale for Children (CES-DC) Questionnaire to measure depressive symptoms. Weight, height, and body mass index (BMI), and z-scores were evaluated in all subjects. Nutrient adequacy was assessed using Spanish dietary recommended intakes (DRIs); 20.70% of the sample presented depressive symptoms. We identified a positive association between children with depressive symptoms and non-depressive symptoms for thiamin, vitamin K, and bromine (p < 0.05), and a negative association for protein, carbohydrates, pantothenic acid, biotin, vitamin B₁₂ and E, zinc, manganese, cobalt, and aluminum (p < 0.05). Statistically significant differences were found between both groups according to the DRIs for intakes of total energy (p = 0.026), fiber (p < 0.001), vitamin C (p < 0.001), vitamin E (p = 0.004), magnesium (p = 0.018), and iron (p = 0.013). Our results demonstrated that carbohydrates were the most closely associated factor with depressive symptoms, and highlight the potential significant public health implications of inadequate nutritional intake on schoolchildren’s mental health.

Evaluation of Nutritional Status of Patients with Depression

Aims and Objectives. Our goal was to determine nutritional status, body composition, and biochemical parameters of patients diagnosed with depression based on DSM-IV-TR criteria. Methods. A total of 59 individuals, aged 18–60 years admitted to Mental Health Centre of Kayseri Education and Research Hospital, were included in the study. The participants were randomly assigned to two groups; depression group (n = 29) and control group (n = 30). Anthropometric measurements, some biochemical parameters, demographic data, and 24-hour dietary recall were evaluated. Results. 65.5% of depression and 60.0% of control group were female. Intake of vitamins A, thiamine, riboflavin, B6, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and fibre (p < 0.05) were lower in depression group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio (p < 0.05) were significantly higher in depression group. Fasting blood glucose levels, serum vitamins B12, and folic acid (p < 0.05) in depression group were lower than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion. Some vitamin B consumption and serum vitamin B12 and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future research exploring nutritional status of individuals with depression is warranted.

Mechanisms of the anorexia of aging-a review

Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.

Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers

Background

Although dietary quality in middle-age and the prime age of a person’s work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately.

Methods

In 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator.

Results

In the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women.

Conclusion

This study suggests that it is necessary to support the improvement of dietary quality in middle age by considering the characteristics of sex and age group and also by providing supportive environment to enhance emotional well-being based on equivalent income, cooperating different field professionals to provide such as employment or community support program.

Association of participation in the supplemental nutrition assistance program and psychological distress

OBJECTIVES

We assessed whether households' participation in the Supplemental Nutrition Assistance Program (SNAP) was associated with improvements in well-being, as indicated by lower rates of psychological distress.

METHODS

We used longitudinal data for 3146 households in 30 states, collected between October 2011 and September 2012 for the SNAP Food Security survey, the largest longitudinal national survey of SNAP participants to date. Analyses compared households within days of program entry to the same households approximately 6 months later. We measured psychological distress in the past 30 days on a 6-item Kessler screening scale and used multivariable regression to estimate associations between SNAP participation and psychological distress.

RESULTS

A smaller percentage of household heads exhibited psychological distress after 6 months of participation in SNAP than at baseline (15.3% vs 23.2%; difference = -7.9%). In adjusted models, SNAP participation was associated with a decrease in psychological distress (adjusted relative risk = 0.72; 95% confidence interval = 0.66, 0.78).

CONCLUSIONS

Continuing support for federal nutrition programs, such as SNAP, may reduce the public health burden of mental illness, thus improving well-being among vulnerable populations.

Food insufficiency, housing and health-related quality of life: results from the Positive Spaces, Healthy Places study

Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = -2.1, CI = -3.9,-0.3); (ES = -3.5, CI = -6.1,-1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.

Food insecurity is associated with poor sleep outcomes among US adults

BACKGROUND

Although food insecure (FI) adults are at risk of chronic conditions, little research attention is given to their health behaviors, such as sleep.

OBJECTIVE

We examined the associations between adult food security status and sleep duration, sleep latency, and sleep complaints reported to a health care professional.

METHODS

Our population-based sample included 5637 men and 5264 women (≥22 y) who participated in the NHANES 2005-2010. Food security status was assessed with USDA's 10-item adult Food Security Survey Module. Self-reported information about sleep duration, sleep latency, and sleep complaints to a health care professional were used as sleep outcomes. Multiple linear, stratified by sex, and logistic regression models were used to estimate the association between food security status and the 3 sleep outcomes.

RESULTS

Very low food secure (FS) women reported significantly shorter sleep duration than fully FS women (difference: -30 ± 5.2 min; P < 0.01); however, no relation to sleep duration was observed among men. Among men, participants who were marginally FS (4 ± 1.1 min), low FS (4 ± 1.7 min), and very low FS (5 ± 1.8 min) reported significantly longer sleep latency than fully FS men (P < 0.05), but no association with sleep latency was observed among women. The divergent patterns in sleep duration and latency were likely because of our reference groups reporting undesirable sleep outcomes; fully FS men reported inadequate sleep and fully FS women reported long sleep latency. Among both men and women, marginally FS (OR: 1.64; 95% CI: 1.24, 2.16), low FS (OR: 1.63; 95% CI: 1.16, 2.30), and very low FS (OR: 1.99; 95% CI: 1.36, 2.92) participants were more likely to report sleep complaints than their fully FS counterparts (P < 0.05).

CONCLUSIONS

Poor sleep quantity and quality may predispose FI adults to adverse health outcomes.

Macronutrient intake and depressive symptoms among Japanese male workers: the Furukawa Nutrition and Health Study

This study was aimed to examine the cross-sectional association of protein, carbohydrate, and fat intake with depressive symptoms among 1794 Japanese male workers aged 18-69 years who participated in a health survey. Dietary intake was assessed with a validated self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Odds ratio of depressive symptoms (CES-D scale of ≥16) was estimated by using multiple logistic regression with adjustment for covariates including folate, vitamin B6, vitamin B12, polyunsaturated fatty acid, magnesium, and iron intake. Multivariable-adjusted odds ratio of depressive symptoms for the highest quartile of protein intake was 26%, albeit not statistically significant, lower compared with the lowest. The inverse association was more evident when a cutoff value of CES-D score ≥19 was used. The multivariable-adjusted odds ratios (95% confidence intervals) for the highest through lowest quartile of protein intake were 1.00 (reference), 0.69 (0.47-1.01), 0.69 (0.44-1.09), and 0.58 (0.31-1.06) (P for trend=0.096). Neither carbohydrate nor fat intake was associated with depressive symptoms. Our findings suggest that low protein intake may be associated with higher prevalence of depressive symptoms in Japanese male workers.

Platelet hyperactivity, neurobehavioral symptoms and depression among Indian women chronically exposed to low level of arsenic

The prevalence of neurobehavioral symptoms (NBS) and depression has been investigated in premenopausal rural women of West Bengal, India enrolled from arsenic (As) endemic (groundwater As 11-50 μg/L; n = 342) and control areas (As level ≤ 10 μg/L; n = 312). The subjective symptoms questionnaire and Beck's 21-point depression inventory-II were used for the detection of NBS and depression, respectively. Platelet P-selectin expression was measured by flow cytometry, plasma neurotransmitter activity with high performance liquid chromatography and groundwater As level by atomic absorption spectroscopy. The As level in groundwater was 2.72 ± 1.18 μg/L in control and 28.3 ± 13.51 μg/L in endemic areas (p < 0.0001). Women residing in endemic areas demonstrated a higher prevalence of depressive symptoms (39.8 vs. 19.9%, p < 0.001) and anxiety (43.3 vs. 18.0% in control, p < 0.001), fatigue (68.4 vs. 23.4%, p < 0.0001), reduced sense of taste (15.8 vs. 4.5%, p<0.0001) and smell (14.9 vs. 5.8%, p < 0.001); burning sensation (36.8 vs. 5.4%, p < 0.0001) and tingling or numbness in the extremities (25.1 vs. 5.1%, p < 0.0001); and transient loss of memory (69.9 vs. 28.2%, p < 0.001). As-exposed women had 1.6-times more plasma epinephrine and norepinephrine (p < 0.05), 1.8-times higher level plasma serotonin with 28.9% lower intraplatelet serotonin (p < 0.05 for both), but their plasma dopamine level was not significantly different (p>0.05) from that of controls. Moreover, women from endemic areas had 2.3-times more P-selectin-expressing platelets in their circulation (p < 0.001). After controlling the potential confounders, chronic low level As (11-50 μg/L) exposure showed a positive association with the prevalence of neurobehavioral symptoms and depression among Indian women in their child-bearing age.

Food and mental health: relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom

AIMS

The current study assessed, by university and sex, the association between nutritional behaviour (twelve independent variables), and stress and depressive symptoms (dependent variables) in a sample from three UK countries.

METHODS

A cross-sectional survey was undertaken among undergraduates enrolled across seven universities in England, Wales and Northern Ireland (N = 3,706). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale and modified Beck Depression Inventory. Sex and university comparisons were undertaken. Univariable and multivariable regression analyses were computed for each of the two outcomes--perceived stress and depressive symptoms.

RESULTS

The frequencies of consuming of the various food groups differed by university and sex, as did depressive symptoms and perceived stress. Multivariable regression analyses indicated that consuming 'unhealthy' foods (e.g. sweets, cookies, snacks, fast food) was significantly positively associated with perceived stress (females only) and depressive symptoms (both males and females). Conversely, consuming 'healthy' foods (e.g. fresh fruits, salads, cooked vegetables) was significantly negatively associated with perceived stress and depressive symptoms scores for both sexes. There was significant negative association between consuming fish/sea food and depressive symptoms among males only. For males and for females, consuming lemonade/soft drinks, meat/sausage products, dairy/dairy products, and cereal/cereal products were not associated with either perceived stress or depressive symptoms.

CONCLUSIONS

The associations between consuming 'unhealthy' foods and higher depressive symptoms and perceived stress among male and female students as well as the associations between consuming 'healthy' foods and lower depressive symptoms and perceived stress among male and female students in three UK countries suggest that interventions to reduce depressive symptoms and stress among students could also result in the consumption of healthier foods and/or vice versa.

Mediterranean diet interventions to prevent cognitive decline--opportunities and challenges

Cognitive decline has a profound impact on the health and quality of life of older people and their caregivers. Exploring mechanisms to delay cognitive decline has become an urgent economic priority, given the projected changes in population demographics. Systematic reviews and meta-analyses of observational studies suggest that adherence to a Mediterranean Diet (MD) is associated with reduced cognitive decline, but such an observation needs to be tested in randomised controlled trials. Intervention evidence is currently limited, and future studies need to be adequately powered, with careful attention given to choice of participants, outcomes being assessed, study duration and strategies to achieve compliance. Alongside these studies, consideration has to be given to how best promote and encourage dietary change in older people in general, and particularly in those experiencing the early stages of cognitive decline, as there may be specific factors that need to be considered when designing lifestyle behaviour change interventions in this group.

Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis

BACKGROUND

The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet.

METHODS

This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥11).

RESULTS

Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS≥11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety.

CONCLUSIONS

The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression.