Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study

Diet quality and anxiety: a critical overview with focus on the gut microbiome

Anxiety disorders disproportionally affect females and are frequently comorbid with eating disorders. With the emerging field of nutritional psychiatry, focus has been put on the impact of diet quality in anxiety pathophysiology and gut microbiome underlying mechanisms. While the relationship between diet and anxiety is bidirectional, improving dietary habits could better facilitate the actions of pharmacological and psychological therapies, or prevent their use. A better understanding of how gut bacteria mediate and moderate such relationship could further contribute to develop personalized programs and inform probiotics and prebiotics manufacturing. To date, studies that look simultaneously at diet, the gut microbiome, and anxiety are missing as only pairwise relationships among them have been investigated. Therefore, this study aims at summarizing and integrating the existing knowledge on the dietary effects on anxiety with focus on gut microbiome. Findings on the effects of diet on anxiety are critically summarized and reinterpreted in relation to findings on (i) the effects of diet on the gut microbiome composition, and (ii) the associations between the abundance of certain gut bacteria and anxiety. This novel interpretation suggests a theoretical model where the relationship between diet and anxiety is mediated and/or modulated by the gut microbiome through multiple mechanisms. In parallel, this study critically evaluates methodologies employed in the nutritional field to investigate the effects of diet on anxiety highlighting a lack of systematic operationalization and assessment strategies. Therefore, it ultimately proposes a novel evidence-based approach that can enhance studies validity, reliability, systematicity, and translation to clinical and community settings.

The association of major dietary patterns with odds and severity of anxiety disorders: a case-control study

Background: In the present study, we explored the association between major dietary patterns, odds, and severity of anxiety disorders, which has not been clarified to date.Methods: This case-control study was conducted on 85 patients who were group-matched by gender with 170 healthy subjects. Dietary intakes were evaluated applying a 147-item validated food frequency questionnaire (FFQ). Anthropometric data collection was accomplished based on precise clinical assessments. Major dietary patterns were identified using principal component analysis (PCA). Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association of the identified dietary patterns with anxiety disorders. Multiple linear regression analysis was used to evaluate the association between the GAD-7 score and major dietary pattern scores.Results: Three major dietary patterns were derived through PCA labeled as 'healthy', 'Western', and 'Mixed'. Those in the top tertile of the healthy dietary pattern were less likely to have anxiety disorders (OR =   0.26; 95%CI: 0.10, 0.66), while no significant relationship was found between Western and mixed dietary patterns and the odds of anxiety disorders. The severity of anxiety disorders, assessed by the GAD-7 score, was reduced by higher adherence to healthy dietary pattern (P = 0.003), and increased by greater adherence to mixed (P = 0.002) and Western (P = 0.001) dietary patterns.Conclusion: We provided evidence demonstrating an inverse association of healthy dietary pattern with odds, and severity of anxiety disorders. Also, higher adherence to Western and mixed dietary patterns resulted in greater GAD-7 scores.

Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls

Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.

Cross-sectional and longitudinal associations between self-esteem and BMI depends on baseline BMI category in a population-based study

BACKGROUND

Some studies have reported associations between self-esteem and weight status, but longitudinal data on adults remain scarce. The aim of this population-based study was to analyze the cross-sectional and longitudinal association between self-esteem and body mass index (BMI) and to investigate whether baseline BMI has an impact on this association.

METHODS

In 2016, 29,735 participants aged ≥ 18 years in the NutriNet-Santé cohort completed the Rosenberg Self-Esteem Scale. BMI was self-reported yearly over a 4-year period. Association between self-esteem and BMI was assessed using mixed models and logistic regressions. Analyses were stratified by BMI (categorical) at baseline and adjusted on sociodemographic and lifestyle characteristics.

RESULTS

At baseline, higher self-esteem was associated with higher BMI in normal weight individuals(p = 0.32), and with lower BMI in obese class II and III individuals (p = 0.13). In addition, higher baseline self-esteem was associated with BMI increase over time in normal weight individuals (p = 0.15). Among normal weight individuals, those with higher self-esteem were less likely to show a decrease in their BMI (p = 0.005), while no association was observed with BMI increase (p = 0.81).

DISCUSSION

Our findings suggest that the association between self-esteem and BMI depends on the initial category of BMI, with a negligible effect of self-esteem.

Dietary eating patterns, dairy consumption, and anxiety: A systematic literature review

BACKGROUND

Nutrition affects both physical and mental health but evidence is mixed regarding potential associations between anxiety and diet, particularly dairy consumption. We conducted a systematic literature review (SLR) of dairy consumption and/or various dietary patterns and risk of anxiety.

METHODS

Literature searches were conducted in PubMed and Embase. All study designs except case reports, small case series, and SLRs were considered for inclusion. Reference lists of previously published SLRs were reviewed for any relevant additional studies. Studies of populations without dairy sensitivities exploring the association between dietary patterns and/or dairy consumption and anxiety published through May 2022 were identified using predefined eligibility criteria. Study quality was determined using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

For this SLR, 132 studies were included; 80 were cross-sectional. Studies examined different dietary patterns (e.g., Mediterranean, gluten-free) and anxiety using various anxiety scales, with 19 studies specifically reporting on whole dairy consumption and anxiety. Dairy consumption was significantly associated with a lower risk of anxiety in 7 studies, while the remaining 12 studies showed no significant associations. Evidence was mixed for the association between various dietary patterns and anxiety, but more studies observed a lower risk of anxiety with greater adherence to "healthy" diets (e.g., Mediterranean, diet quality score, vegetarian/vegan) than a higher risk. Notable heterogeneity in study populations, time periods, geographical locations, dietary assessment methods, and anxiety scales was observed.

CONCLUSIONS

The results of this SLR suggest a potential link between diet including diary consumption and anxiety, but future studies, especially with longitudinal designs that measure diet and anxiety at several timepoints and comprehensively adjust for confounders, are needed to fully understand the relationship between diet and anxiety.

COVID-19 Lockdown and Changes in Dietary and Lifestyle Behaviors in a French Longitudinal Cohort

BACKGROUND

The COVID-19 pandemic has imposed local lockdowns resulting in strong disruptions in our lifestyles and dietary behaviors. This study aimed to determine how the lockdown in France affected these behaviors and weight during the lockdown and in a one month follow up period of time after the end of the lockdown.

METHODS

The study design was a longitudinal cohort, among French adults. A total of 593 participants (68.6% female), with a mean age of 42.2 years (SD = 15.2) completed a self-reported questionnaire on four occasions spaced one month apart, from the beginning of the lockdown starting 17 March 2020, until one month after its end (mid-June 2020). Clusters of participants were formed using the non-supervised k-means algorithm.

RESULTS

The mean weight gain after one month of lockdown was 0.56 kg (SD = 0.6). The cluster analysis exposed three different patterns of behavioral changes, despite no significant differences in age or BMI between clusters. These three groups have experienced different weight change dynamics over the follow-up duration. The first cluster (n = 210) reported fewer changes in sleep quality and quantity and less change in snacking frequency (p ≤ 0.001). The second cluster (n = 200) reported significantly lower levels of stress than the other clusters (p ≤ 0.001). The third cluster (n = 183) differed from the others, with a more degraded quality of sleep reported throughout the lockdown (p ≤ 0.01). However, changes in eating behaviors and body weight were not significant.

CONCLUSIONS

During the lockdown, behavioral changes occurred, both health-favorable and non-health-favorable, yet they had a minor impact on eating behaviors and reported body weight once the restrictive measures were lifted. The identification of three patterns suggests that, in such constraining situations, personalized recommendations should be provided.

Lower 24-h urinary potassium excretion is associated with higher prevalent depression and anxiety status in general population

BACKGROUND

Uncertainty remains about the association of potassium (K) intake with depression and anxiety status. We explored their relationship using 24-h urinary K, reflecting K intake, in general population.

METHODS

We collected 24-h urine and performed self-rating depression and anxiety scales (SDS, SAS) cross-sectionally in adults selected by random sampling in China. SDS and SAS standard score ≥50 defined depression and anxiety status. Participants were divided into three groups (T1, T2, and T3) by 24-h urinary K tertile. Odds ratios (OR) and 95% confidence intervals were calculated. Sensitivity analysis was performed by excluding anti-hypertensive agent takers.

RESULTS

546 participants comprised current analytical sample. First, T1 and T2 groups showed higher SDS scores (40.0 vs 40.0 vs 36.0, p = .001), prevalence (19.8 vs 15.9 vs 7.1%, p = .002), whereas increased adjusted odds for depression status only in T1 group (OR = 2.71, p = .017), compared with T3 group. Second, T1 and T2 groups showed higher SAS scores (38.0 vs 40 vs 35.0, p < .001) and prevalence (14.8 vs 21.4 vs 8.8%, p = .003), whereas increased adjusted odds for anxiety status only in T2 group (OR = 2.07, p = .042), compared with T3 groups. Third, T1 and T2 groups showed higher prevalence (10.4% vs 11.5% vs 2.7%, p = .004) and adjusted odds (OR = 3.71, p = .013; OR = 3.66, p = .014) for co-existent anxiety and depression status, compared with T3 group. Most results remained consistent in sensitivity analysis.

CONCLUSIONS

Lower K intake is implicated in presence of anxiety and depression status in general population; this may provide basis for programs to increase K intake and prevent disease.

The Use of Dietary Supplements and Their Association with COVID-19-Related Anxiety among Non-Institutionalized Elderly in Northern Greece

The elderly constitute a vulnerable group for increased anxiety and poor diet during the COVID-19 pandemic. There is limited research on the levels of COVID-19-related anxiety and dietary habits including dietary supplementation practices among the elderly and very elderly in Greece. A cross-sectional survey was conducted in 364 non-institutionalized elderly (65-74 y) and very elderly (≥75 y) living in northern Greece, with the aim to investigate the use of dietary supplements and their association with other factors, particularly the COVID-19-related anxiety. Levels of anxiety were assessed with the use of the Coronavirus Anxiety Scale (CAS-5). The percentage of dietary supplement users was 62.6%. The most popular dietary supplements used were vitamin D followed by vitamin C and multivitamin and mineral supplements. Multivariate analysis showed that the very elderly and overweight individuals were less likely to consume vitamin D supplements. Approximately a third of the participants (33.8%) exhibited signs of COVID-19-related anxiety but only 8% showed dysfunctional levels of anxiety. Regression analysis indicated that women, former smokers, and people exhibiting any sign of COVID-19 anxiety were approximately two times more likely to consume dietary supplements of any kind (Gender: OR 2.34, 95% CI 1.30-4.19; Smoking: OR 2.15, 95% CI: 1.08-4.26; COVID-19 anxiety: OR 2.16, 95 % CI: 1.20-3.91). Our results provide useful insights into the current practices of dietary supplement use in this population group and could be used by dietetic and medical associations as well as public authorities in the formulation of targeted, safe, and effective interventions for the protection of public health.

Impact of the first COVID-19 lockdown on body weight: A combined systematic review and a meta-analysis

The coronavirus disease 2019 (COVID-19) and the imposed lockdowns in order to control the pandemic, had undoubtedly influenced the lifestyle of millions of people worldwide. The period of confinement, which was characterized by seizing most business activities and allowing only for e-classes at schools and universities, leading also to a lower physical activity, could have affected eating behaviors of people of all ages. In this study we aimed to investigate the impact of the first lockdown period (March-May 2020) on body weight (BW) and on body mass index (BMI) in both adults and adolescents (>16 years old). A systematic literature search was conducted in PubMed®, Scopus®, Web of Science® and EMBASE® databases and 36 observational (35 cross-sectional and one cohort) studies were included. BW and BMI changes after/during the lockdown period were examined. BW was stated as increased in a significant part of the individuals (11.1-72.4%), although a range of 7.2-51.4% of individuals reported weight loss. A significant higher BW was observed with a weighted mean between-group difference (WMD) 1.57 (95% CI 1.01 to 2.14) in the post-lockdown period compared to the before lockdown time and higher BMI, 0.31 WMD (95% CI, 0.17 to 0.45) was identified before the lockdown period. At variance with general trends, one study in older adults (>60 years old) notably reported a significant BW loss, suggesting a higher risk for lockdown-induced weight loss and potentially malnutrition in the elderly population. Overall increments in BW are an alarming effect of lockdown during the COVID-19 pandemic, leading to potential higher incidence of overweight, obesity and related health-risks as well as other noncommunicable diseases. Further studies are needed to assess potential group-specific impacts, with particular regard to weight gain in younger people and risk of weight loss, malnutrition and sarcopenia in older adults.

Association between anxiety and eating behaviors in patients with obesity

Background

Given the link between eating behavior and obesity, it is critical to identify individuals who have eating behaviors which contribute to obesity etiology. This study aimed to investigate the potential relationship between symptoms of anxiety and eating behaviors in patients with obesity.

Methods

This was a cross-sectional study analyzing baseline characteristics of 438 patients with obesity (BMI>30). Patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Three-Factor Eating Questionnaire R21 (TFEQ-R21), and the Weight Efficacy Lifestyle Questionnaire (WEL). Pearson correlation coefficients were used to evaluate the association between questionnaires. Two-sample independent t-test were conducted to examine differences in the TFEQ-R21 and WEL between low and moderate to severe levels of symptoms of anxiety.

Results

Anxiety scores (HADS-A) positively correlated with two factors of the TFEQ, emotional eating (r = 0.36) and uncontrolled eating (r = 0.27). The HADS-A score was negatively correlated with self-efficacy to resist eating in all five situational factors on the WEL (p < 0.01). Patients with symptoms of anxiety additionally showed higher mean scores for emotional eating and uncontrolled eating (p < 0.001, respectively),and lower levels of cognitive restraint (p = 0.04)) on the TFEQ-R21.

Conclusion

Patients with obesity who reported having anxiety symptoms had lower self-confidence to manage their eating and more emotional eating than patients with low anxiety symptoms. Clearly more needs to be learned about symtoms of anxiety and eating behaviors.

Associations between Resilience and Food Intake Are Mediated by Emotional Eating in the NutriNet-Santé Study

BACKGROUND

Resilience, the ability to bounce back or recover from stress, has been associated with several health-related behaviors. However, data on food intake and emotional eating are lacking.

OBJECTIVES

The objective of this cross-sectional study was to analyze the associations between resilience and diet quality and ultraprocessed food (UPF) and food group consumption, and to assess whether emotional eating was a mediator of these associations.

METHODS

In 2017, 17,840 participants (73.5% female, mean age = 55.4 ± 14.0 y) of the NutriNet-Santé study completed the Brief Resilience Scale, the revised 21-item Three-Factor Eating Questionnaire, and ≥3 self-administered 24-h dietary records. Diet quality was assessed with the modified French National Nutrition and Health Program Guideline Score. Foods and beverages consumed were categorized according to their degree of processing by the NOVA classification. We assessed the association between resilience and emotional eating using linear regression models. We also assessed the mediating role of emotional eating in the associations between resilience and diet quality, energy intake, and UPF and food group consumption, controlling for sociodemographic characteristics.

RESULTS

In our study, resilience was negatively associated with emotional eating (P < 0.0001). More resilient participants had greater overall diet quality, greater intakes of seafood, whole-grain foods, fats, unsalted oleaginous fruits, and alcoholic beverages, and lower intakes of UPFs, starchy foods, dairy desserts, sugary fatty products, and sugar and confectionery (all P < 0.05). Emotional eating was a mediator of the inverse associations between resilience and intake of energy, UPFs, dairy desserts, sugary fatty products, and of the positive associations between resilience and alcoholic beverages (all P < 0.05), with a 20-70% mediation.

CONCLUSIONS

Our findings showed that resilience was associated with an overall better diet quality in the NutriNet-Santé population-based study. These associations were partially explained by emotional eating. These findings suggest that resilience should be considered in the promotion of healthy dietary habits.The study is registered at clinicaltrials.gov as #NCT03335644.

An fMRI study of cognitive regulation of reward processing in generalized anxiety disorder (GAD)

BACKGROUND

Cognitive regulation can affect the process of decision making. Generalized anxiety disorder (GAD) patients seem to have an impairment in cognitive regulation of reward processing concerning food stimuli. This study aims to explore the impact of GAD in cognitive regulation of food-related rewards.

METHODS

GAD patients (n=11) and healthy controls (n=15) performed a cognitive regulation craving task with food images while undergoing a functional magnetic resonance imaging (fMRI) acquisition. Between-group differences in functional connectivity were measured using dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) seeds during cognitive regulation.

RESULTS

During cognitive regulation, there was a significant interaction for functional connectivity between the right dlPFC and bilateral vmPFC with the thalamus. GAD patients had lower functional connectivity for cognitive regulation conditions (distance and indulge) than for the non-regulated condition in these clusters, while control participants presented the opposite pattern. GAD group presented fixed food valuation scores after cognitive regulation.

CONCLUSIONS

GAD participants showed inflexibility while valuating food images, that could be produced by cognitive regulation deficits underpinned by functional connectivity alterations between prefrontal regions and the thalamus. These results show cognitive inflexibility and difficulty in the modulation of cognitive responses during decision making in GAD patients.

Modifiable Host Factors for the Prevention and Treatment of COVID-19: Diet and Lifestyle/Diet and Lifestyle Factors in the Prevention of COVID-19

Many studies have shown that the immune system requires adequate nutrition to work at an optimal level. Not only do optimized nutritional strategies support the immune system, but they also reduce chronic inflammation. Nutritional supplements that are recommended for patients with critical illnesses are thought to also be effective for the coronavirus disease 2019 (COVID-19) patients in the intensive care unit. Some studies have recommended fresh fruits and vegetables, soy, nuts, and antioxidants, such as omega-3 fatty acids, to improve immune system activity. Although nutritional status is considered to be an important prognostic factor for patients with COVID-19, there is to date no sufficient evidence that optimal nutritional therapies can be beneficial for these patients. Some have argued that the COVID-19 pandemic is a good opportunity to test the effectiveness of nutritional intervention for infectious diseases. Many researchers have suggested that testing the proposed nutritional approaches for infectious diseases in the context of a pandemic would be highly informative. The authors of other review papers concluded that it is important to have a diet based on fresh foods, such as fruits, vegetables, whole grains, low-fat dairy products, and healthy fats (i.e., olive oil and fish oil), and to limit the intake of sugary drinks as well as high-calorie and high-salt foods. In this review, we discuss the clinical significance of functional food ingredients as complementary therapies potentially beneficial for the prevention or treatment of COVID-19. We believe that our review will be helpful to plan and deploy future studies to conclude these potentials against COVID-19, but also to new infectious diseases that may arise in the future.

The association of plant-based dietary patterns and psychological disorders among Iranian adults

BACKGROUND

Plant-based dietary pattern, a new scoring system, has had a favorable relationship with the risk of chronic diseases, however, the associations with mental health are long disputed. Thus, we examined the association between an overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and psychological disorders in adult Iranian patients.

METHODS

In this large cross-sectional study, 3,362 Iranian men and women were recruited. Dietary data were gathered using a validated and reliable Willett format food frequency questionnaire (FFQ). Plant-based dietary pattern scores were calculated based on the method of Satija et al. Psychological profile assessment was done using the validated hospital anxiety and depression scale (HADS) and the general health questionnaire (GHQ).

RESULTS

A total number of 943, 448, and 760 participants who suffered from depression, anxiety, and psychological distress, respectively, were identified. In the multivariable-adjusted analysis, participants in the highest category of PDI and hPDI scores had lower odds of having depression and anxiety than those in the lowest category. This association was also found between hPDI and psychological distress (OR: 0.51, 95% CI: 0.38-0.68). In contrast, higher scores of uPDI was associated with increased odds of anxiety (OR: 1.60, 95% CI: 1.06-2.42) and psychological distress (OR: 1.38, 95% CI: 1.01-1.90).

LIMITATION

The cross-sectional study design.

CONCLUSION

Our results indicated that greater adherence to the overall plant-based diet and healthy plant-based diet was inversely associated with psychological disorders, while following unhealthy plant-based diet increased the risk of anxiety and psychological distress.

Changes in the Lifestyle of the Spanish University Population during Confinement for COVID-19

The aim of this study was to evaluate the influence of the lockdown due to the COVID-19 pandemic, on eating and physical activity behavior, in a university population. A healthy diet such as the Mediterranean Diet (MD) pattern, rich in fruit and vegetables, can prevent degenerative diseases such as obesity, diabetes, cardiovascular diseases, etc. We conducted a cross-sectional study and data were collected by an anonymous online questionnaire. Participants completed a survey consisting of 3 sections: sociodemographic data; dietary behavior and physical activity; the Mediterranean Diet questionnaire (MEDAS-14) and the Emotional Eater Questionnaire (EEQ). A total of 168 participants completed the questionnaire: 66.7% were women, 79.2% were from Spain, 76.8% were students, 76.2% lived in their family home and 66.1% were of normal weight. During lockdown our population shopped for groceries 1 time or less per week (76.8%); maintained the same consumption of fruits (45.2%), vegetables (50.6%), dairy products (61.9%), pulses (64.9%), fish/seafood (57.7%), white meat (77.4%), red and processed meat (71.4%), pastries and snacks (48.2%), rice/pasta/potatoes (70.2%) and nuts (62.5%), spirits (98.8%) and sugary drinks (91.7%). Cooking time increased (73.2%) and the consumption decreased of low alcohol drinks (60.1%), spirits (75%) and sugary drinks (57.1%), and physical activity also diminished (49.4%). University Employees (UE) gained more weight (1.01 ± 0.02) than students (0.99 ± 0.03) (p < 0.05) during the confinement period. A total of 79.8% of the participants obtained a Medium/High Adherence to the MD during lockdown. Emotional and very emotional eaters were higher in the female group (p < 0.01). In the event of further confinement, strategies should be implemented to promote a balanced and healthy diet together with the practice of physical activity, taking special care of the female and UE groups.

The impact of COVID-19 lockdown on disordered eating behaviors: the mediation role of psychological distress

PURPOSE

This study aimed to explore the early associations between the experienced psychosocial impact of the COVID-19 pandemic crisis during lockdown, depressive symptomatology, anxiety/stress levels, and disordered eating behaviors in adults during a first COVID-19 lockdown period.

METHODS

This was a community-based cross-sectional study assessing 254 Portuguese adults (82.7% women; 35.82 ± 11.82 years) 1 week after the end of the first mandatory COVID-19 lockdown in Portugal. An online survey was conducted to evaluate psychological distress, disordered eating, and psychosocial impact of the COVID-19 pandemic. Pearson correlations and Structural Equation Modeling were performed.

RESULTS

Participants reported the presence of meal skipping (52.8%), grazing eating behavior (80.9%), overeating (81.0%), loss of control over eating (47.2%), and binge eating episodes (39.2%) during lockdown. Structural equation modeling analyses, controlling for age and sex, indicated that there was a significant indirect effect of the experienced psychosocial impact of COVID-19 pandemic on disordered eating behaviors mediated through psychological distress.

CONCLUSION

The psychosocial impact of the COVID-19 pandemic crisis may lead to disordered eating, and this relation may occur through the elevation of psychological distress. These findings can be used to inform interventions, to enhance mental health and manage disordered eating during similar future situations. Level of evidence V: cross-sectional descriptive study.

Evaluation of the relationship between anxiety and nutritional habits in Turkish patients with multiple sclerosis during the Covid-19 outbreak

ABSTRACT Objective The Coronavirus disease 2019 is a global public health problem that has led to psychological disorders (depression, anxiety, etc.), especially in fragile individuals such as those affected by multiple sclerosis. This study investigated the relationship between anxiety and nutritional habits during the Coronavirus disease 2019 outbreak in multiple sclerosis patients. Methods This cross-sectional study was an online survey of multiple sclerosis patients living in Turkey. The total sample consisted of 294 multiple sclerosis patients. A questionnaire containing general demographic data, the Beck Anxiety Inventory, and nutritional attitudes and habits was applied to multiple sclerosis patients. Results Moderate or severe anxiety scores were found in 42.2% of multiple sclerosis patients. Weight gain was reported in 40.5% of them during the outbreak. A statistically significant difference was found in the distribution of individuals’ Beck Anxiety Inventory scores for consumption of nuts/seeds, rice/pasta, cake/cookies, and water. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.04 times increased consumption of bread and rice/pasta and a 1.05 times increased consumption of cake/cookies either before or after controlling for potential confounders. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.06 times decreased consumption of water and a 1.04 times decreased consumption of meat and poultry, fruit (fresh), and rice/pasta, either before or after controlling for potential confounders. Conclusion During the Coronavirus disease 2019 outbreak, anxiety led to changes in multiple sclerosis patients’ nutritional habits and food preferences. The continuous surveillance of psychological consequences and nutritional counseling during outbreaks should become routine as part of preparedness efforts worldwide.

Changes in home cooking and culinary practices among the French population during the COVID-19 lockdown

In March 2020, the COVID-19 pandemic led to a strict lockdown in France for 2 months, drastically changing the daily life of the population. We investigated changes in perceived diet quality and cooking practices during the lockdown in comparison with the preceding period. Between June 9 and 30, 2020, 2422 participants were recruited and completed a questionnaire regarding the evolution of their overall diet and cooking habits during the lockdown. Descriptive analyses showed that 41.5% of participants described dietary changes with a similar proportion reporting positive or negative changes (22.0% and 19.5%, respectively). The exceptional circumstances of the lockdown provided a positive opportunity for some people to improve their diet quality by spending more time cooking (54.8% of those reporting a positive change) or eating more fresh products, including fruits and vegetables (47.4%). By contrast, other participants reported a decline in their diet quality, mainly caused by poorer dietary choices due to the consumption of comfort food (50.3% of those reporting a negative change), snacking (40.1%), or food supply issues (35.9%). The lockdown led to a massive rise in home cooking with 42.0% of all participants cooking more frequently (vs 7.0% cooking less), as barriers such as time constraints were reduced. Using multivariate analyses, we found that this change in cooking frequency varied among population subgroups, especially in regard to financial situation, as individuals in financial difficulty tended to cook less. As home cooking has already been linked to better diet quality and thus health status, our results suggest that the lockdown increased social health inequalities. An adequate public health response is therefore needed to support nutritionally vulnerable populations.

Association between positive psychological traits and changes in dietary behaviour related to first COVID-19 lockdown: A general population-based study

Background

The spread of the coronavirus disease (COVID-19) led many countries to implement lockdown measures, which resulted in changes in dietary behaviours that could persist over the long term and have associated health consequences. Psychological traits may impact these changes given their known association with dietary behaviours. We aimed to investigate in a population-based study, whether positive psychological traits were associated with changes of snacking behaviour and food consumption observed during the first COVID-19 lockdown period.

Design

In 2016, levels of optimism, resilience, self-esteem, satisfaction with life, mindfulness and mastery were assessed in 33,766 adults of the French NutriNet-Santé cohort. Snacking and food group consumption were assessed in April–May 2020. Association between psychological traits and changes (no change, increase, decrease) in snacking and food group consumption were assessed using logistic regressions. Multiple correspondence analysis followed by ascending hierarchical classification were used to derive clusters of dietary behaviours. Covariance analyses were used to compare mean scores of psychological traits between clusters. Analyses were adjusted for sociodemographic and lifestyle characteristics, anxiety and depressive symptomatology.

Results

Participants with higher levels of optimism, resilience, self-esteem, satisfaction with life, mindfulness or mastery were less likely to change their snacking behaviour and food group consumption of various food groups. Individuals with lower levels were more likely to make changes, with either unhealthy (e.g., less fruits and vegetables, more processed meat) or healthy (e.g., more pasta/rice (whole-grain)) changes. Overall, individuals showed higher levels of positive psychological traits in the “no change” cluster, followed by the “healthy” and the “unhealthy” cluster (all P < 0.05).

Conclusions

Individuals with higher levels of optimism, resilience, self-esteem, satisfaction with life, mindfulness or mastery were less impacted by the lockdown in terms of dietary behaviours.

Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury

OBJECTIVE

To compare the prevalence of anxiety/depression and overweight/obesity (Aim 1) and the multimorbidity of these conditions (Aim 2) in a sample of adults with and without spinal cord injury (SCI). Aim 3 was to examine whether overweight/obese individuals with SCI differ on the prevalence of anxiety/depressive disorders compared to non-overweight/obese individuals with SCI.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Individuals ≥16 years old who had patient encounters between January 1, 2011, and February 28, 2018. In total, 761 598 individuals were included, of which 3136 had SCI.

MAIN OUTCOME MEASURES

Individuals were identified as diagnosed with SCI, anxiety and/or depressive disorders, and overweight/obesity using the International Classification of Diseases.

RESULTS

Age-adjusted odds ratios (ORs) were calculated using logistic regression. In contrast to non-SCI individuals, those with SCI had increased odds of anxiety disorders (OR: 3.58, 95% CI [3.29-3.90]), depressive disorders (OR: 4.33, 95% CI [3.95-4.74]), and overweight/obesity (OR: 3.08, 95% CI [2.80-3.38]). Pertaining to multimorbidity, individuals with SCI had increased odds of having overweight/obesity alongside anxiety disorders (OR: 4.30, 95% CI [3.71-4.98]) and overweight/obesity alongside depressive disorders (OR: 4.69, 95% CI [4.01-5.47]) compared to those without SCI. Individuals with SCI who were diagnosed as overweight/obese had increased odds of having anxiety disorders (OR: 2.54, 95% CI [2.06-3.13]), and depressive disorders (OR: 2.70, 95% CI [2.18-3.36]), relative to non-overweight/obese individuals with SCI.

CONCLUSIONS

This work is among the first to find evidence that individuals with SCI are at heightened odds of overweight/obesity alongside anxiety and/or depressive disorders. This early work holds clinical implications for treating these interrelated comorbidities in SCI.

COVID-19 Self-quarantine and Weight Gain Risk Factors in Adults

PURPOSE OF REVIEW

The COVID-19 pandemic is associated with weight gain in certain individuals. This review highlights the risk factors for weight gain during COVID-19 self-quarantine in adults.

RECENT FINDINGS

Among those who have gained weight during COVID-19 self-quarantine, self-reported body weight has increased between .5 and 1.8 kg (± 2.8 kg) after just 2 months of quarantine. Identified risk factors for weight gain during COVID-19 self-quarantine are the following: increased sedentary behaviors, decreased physical activity, increased snacking frequency (particularly after dinner), increased alcohol intake, decreased water intake, emotional eating, decreased sleep quality, and being overweight/obese. Having identified risk factors for weight gain during the COVID-19 pandemic, practitioners and researchers should devise plans to assist those who have gained weight to re-learn weight management/weight loss strategies.

Changes in Lifestyle and Dietary Habits during COVID-19 Lockdown in Italy: Results of an Online Survey

COVID-19 is an unprecedented global pandemic. On 12 March 2020, a lockdown order was issued in Italy in attempt to contain the health crisis. The study aimed to assess the impact of the COVID-19 lockdown on diet, physical activity, sleep quality, and distress in an Italian cohort. An online anonymous interview, which included validated questionnaires was created to compare lifestyle habits pre- and during the lockdown. Data analysis from 604 subjects with a mean age of 29.8 years was carried out using multivariate analysis. Compared to pre-COVID-19 times, 67% of people changed their eating habits and increased consumption of foods containing added sugars. Women and men with low adherence to the Mediterranean Diet (MedDiet) were more likely to be physically inactive (p < 0.0001 and p < 0.01, respectively). Results from logistic regression showed a three times higher risk of being inactive if adherence to the MedDiet was low (p < 0.0001), especially in men between 26 and 35 years. Lower levels of distress were reported in males who were physically active (89%) (p < 0.001). Our findings may help to identify effective lifestyle interventions during restrictive conditions.

Diet and Lifestyle Changes During the COVID-19 Pandemic in Ibero-American Countries: Argentina, Brazil, Mexico, Peru, and Spain

This study aimed to evaluate changes in dietary and lifestyle habits during the period of confinement due to the first wave of the COVID-19 pandemic in Ibero-American countries. A cross-sectional investigation was conducted with 6,325 participants of both genders (68% women), over 18 years of age and from five countries: Brazil (N = 2,171), Argentina (N = 1,111), Peru (N = 1,174), Mexico (N = 686), and Spain (N = 1,183). Data were collected during the year 2020, between April 01 and June 30 in Spain and between July 13 and September 26, in the other countries studied using a self-administered online survey designed for the assessment of sociodemographic, employment, physical activity, health status, and dietary habits changes. Most participants (61.6%), mainly those from Spain, remained constant, without improving or worsening their pattern of food consumption. Among those who changed, a pattern of better eating choices prevailed (22.7%) in comparison with those who changed toward less healthy choices (15.7%). Argentina and Brazil showed the highest proportion of changes toward a healthier pattern of food consumption. Peruvians and Mexicans were less likely to make healthy changes in food consumption (OR: 0.51; 95% CI: 0.4-0.6 and OR: 0.69; 95% CI: 0.4-0.8, respectively), when compared to Argentinians. Most respondents did not change their pattern of meal consumption, but those who did reduced their consumption of main meals and increased intake of small meals and snacks. Although most participants affirmed to be doing physical activity at home, about one-half reported perception of weight gain. Individuals with alterations in sleep pattern (either by increasing or decreasing sleep time) were more likely to change their diets to a healthier pattern. In contrast, individuals with confirmed diagnosis of COVID-19 and those who reported feeling anxious were more likely to perform changes to a less healthy eating pattern (OR: 1.72; 95% CI: 1.2-2.3 and OR: 1.21; 95% CI: 1.1-1.4, respectively). In conclusion, although most participants remained constant in their eating habits, lifestyle changes and anxiety feelings were reported. Among those who changed patterns of food consumption, healthier choices prevailed, with differences between countries. However, there were alterations in the distribution of meals, with higher consumption of snacks and small meals. These results can be used to guide policies to prevent deleterious consequences that may affect the incidence of chronic diseases.

Fruit and Vegetable Dietary Patterns and Mental Health in Women: A Systematic Review

CONTEXT

Mental health may be influenced by some dietary patterns. Among common elements of beneficial patterns is high fruit and vegetable intake. However, no systematic review has been conducted to date, to our knowledge, that has assessed the influence of fruit and vegetable dietary patterns on a broad spectrum of mental health.

OBJECTIVE

We conducted a systematic review, using the PRISMA guidelines, of the observational studies analyzing the association between the dietary pattern of fruit and vegetables and the broad aspects of mental health in adult women.

DATA SOURCES

The databases PubMed and Web of Science were searched, and additional manual search for observational peer-reviewed studies was conducted for studies published until June 2019.

DATA EXTRACTION

A total of 5911 studies were extracted and verified based on title and abstract for the inclusion criteria. All procedures were conducted independently by 2 researchers. The final number of included studies was 30. The review was structured around the type of observed outcome.

DATA ANALYSIS

The included studies had defined habitual intake associated with dietary patterns with the intake of specific fruit and/or vegetables, and/or fruit or vegetable products (eg, juices), as well as any aspect of the broad spectrum of general mental health. The Newcastle-Ottawa Scale was used to assess bias. The observed association was not stated in all the included studies; some of them revealed a reverse relationship, but only for the vegetarian/vegan diet. A vegetarian diet may be characterized by high consumption of fruits and vegetables, but it sometimes may not be properly balanced, due to excluded products. This may be the reason of observed situation.

CONCLUSIONS

A general positive influence was observed for the dietary patterns characterized by high consumption of fruit and vegetables and of fruit or vegetable products by women.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42019138148.

Plant-based dietary indices and stress in female college students: a cross-sectional study

Only a few studies have investigated the association between psychological stress and the healthfulness of plant-based diets while accounting for variances in age groups and regions. In light of this, this study aimed to identify the food groups that contribute the most to the relationship between the healthfulness of plant-based diets and psychological stress in female students in Saudi Arabia. This cross-sectional study, which included 401 female college students aged 19-35 years, collected data on blood, anthropometric indices, the perceived stress scale-10 (PSS-10) and diet using the Saudi food frequency questionnaire. An overall plant-based diet index (PDI), healthy PDI, and an unhealthy PDI (uPDI) were defined. Multiple linear regression analyses were applied to examine the associations between PSS-10 and PDI and hPDI and uPDI. No associations between the PSS-10 score and the overall PDI or uPDI scores were found; however, a six-point higher hPDI score was associated with a 0·16-point lower PSS-10 score (95 % CI, -0·24, -0·08) after controlling for lifestyle factors. Moreover, adjustments for healthy food groups, including vegetables and fruits, attenuated the association between the hPDI and PSS-10. In conclusion, healthy plant-based diets are associated with lower psychological stress in young Saudi women. This finding highlights the importance, especially for female students, of following diets that are not only plant-based but are also healthy and rich in fruits and vegetables.

Eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented public health crisis. In Peru, although the quarantine is no longer mandatory, it was during the first months of 2020. To date, no studies have assessed the impact of the COVID-19 on the eating patterns and lifestyle context in the country. We aimed to describe the eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults.

METHODS

We conducted a cross-sectional study. We used an online survey to collect information regarding eating habits, self-perceived stress and sedentary lifestyle among adults over 18 years of age residing in Lima-Peru and who complied with strict home quarantine. We presented our data according to the weight variation of the participants.

RESULTS

A total of 686 were finally included in the study. The 82.9% were female, the median BMI was 25.97 kg/m2 (IQR: 23.37-29.41) and 68.2% reported a significant variation in their weight (38.9% increased and 29.3% lost weight). All bad habits were significantly associated with weight gain, except for prolonged fasting. Additionally, a sitting time longer than usual (p = 0.001), being in front of a screen for more than five hours in the last week (p = 0.002), and most of the stressful scenarios were significantly associated with weight gain.

CONCLUSION

Almost four out of ten participants gained weight during the quarantine. This was associated with unhealthy eating habits, physical inactivity, and stressful scenarios.

Quarantine during COVID-19 outbreak: Adherence to the Mediterranean diet among the Cypriot population

OBJECTIVE

The aim of this study was to analyze adherence to the Mediterranean diet among the adult general population of Cyprus during the COVID-19 confinement.

METHODS

This was an Internet-based, cross-sectional study that collected information about socioeconomic and demographic characteristics, adherence to the Mediterranean diet and other dietary details, physical activity levels, and smoking habits using a self-administered questionnaire. The survey was conducted between April 6 and June 20, 2020, 1 to 2.5 mo after the initiation of the social confinement measures.

RESULTS

There were 1485 Cypriot adults who participated in the study. The median Mediterranean diet score was 21 (q1 = 19, q3 = 24) with men, married individuals, residents of rural regions, and physically active participants being more adherent to the Mediterranean diet compared with women; unmarried, divorced, or widowed; residents of urban regions; and physically inactive participants, respectively (P < 0.05). Multinomial logistic regression showed that being ≥45 y of age and physically active was positively associated with the Mediterranean diet score, whereas being unmarried, divorced, or widowed and a current smoker was negatively associated with the Mediterranean diet score (P < 0.05).

CONCLUSIONS

Adherence to the Mediterranean diet during the confinement imposed due to the COVID-19 pandemic among the Cypriot adult population was associated with male sex, age >45 y, being married, being physically active, and being resident of rural regions. The importance of better understanding of nutritional behavior during COVID-19 lockdowns is emphasized so public health authorities can plan future lockdown policies on nutritional recommendations, should a new pandemic occur.

Foods, Nutrients and Dietary Patterns in Relation to Irrational Beliefs and Related Psychological Disorders: The ATTICA Epidemiological Study

We explored the differences in dietary habits and dietary patterns between individuals characterized by irrational beliefs with no or low anxiety and depressive symptoms and individuals characterized by irrational beliefs with high anxiety and depressive symptomatology. Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of cardiovascular disease (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent mental health assessment through the irrational beliefs inventory (IBI), the Zung self-rating depression scale (ZDRS) and the state–trait anxiety inventory (STAI). Demographic characteristics, a thorough medical history, dietary behaviour and other lifestyle behaviours were also evaluated and analysed using factor analysis. Five main factors related to dietary patterns were extracted for the high-IBI/low-STAI group of participants (explaining the 63% of the total variation in consumption), whereas four factors were extracted for the high-IBI/high-STAI participants, the high-IBI/low-ZDRS participants and the high-IBI/high-ZDRS participants, explaining 53%, 54% and 54% of the total variation, respectively. A Western-type dietary pattern was the most dominant factor for individuals reporting irrational beliefs and anxiety or depressive symptomatology. The high refined carbohydrates and fats dietary pattern was the most dominant factor for individuals with irrational beliefs but without psychopathology. Linear regression analysis showed that irrational beliefs, in combination with anxiety or depression, age, sex and BMI, were important predictors of adherence to the Mediterranean diet. Dietary habits interact with irrational beliefs and, in association with the consequent psychological disorders, are associated with overall diet, and presumably may affect the health status of individuals.

Consequences of the COVID-19 Syndemic for Nutritional Health: A Systematic Review

Confinement at home, quarantine, and social distancing are some measures adopted worldwide to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), which has been generating an important alteration in the routines and qualities of life of people. The impact on health is still being evaluated, and consequences in the nutritional field are not entirely clear. The study objective was to evaluate the current evidence about the impact that preventive measures of physical contact restriction causes in healthy nutrition. A systematic review was carried out according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" PRISMA Group and Cochrane method for rapid systematic reviews. Searching was performed in six electronic databases and evaluated articles published between 2010 and 2020, including among their participants adult subjects who had been exposed to the preventive measures of physical contact restriction. Seven studies met the selection criteria and reported an overall increase in food consumption, weight, Body Mass Index (BMI), and a change in eating style. Findings suggest that healthy nutrition is affected by preventive measures to restrict physical contact as a result of the COVID-19 syndemic.

Nutrition and behavioral health disorders: depression and anxiety

Suboptimal nutrition has been implicated in the underlying pathology of behavioral health disorders and may impede treatment and recovery. Thus, optimizing nutritional status should be a treatment for these disorders and is likely important for prevention. The purpose of this narrative review is to describe the global burden and features of depression and anxiety, and summarize recent evidence regarding the role of diet and nutrition in the prevention and management of depression and anxiety. Current evidence suggests that healthy eating patterns that meet food-based dietary recommendations and nutrient requirements may assist in the prevention and treatment of depression and anxiety. Randomized controlled trials are needed to better understand how diet and nutrition-related biological mechanisms affect behavioral health disorders, to assist with the development of effective evidence-based nutrition interventions, to reduce the impact of these disorders, and promote well-being for affected individuals.

Consumption of Dietary Fiber in Relation to Psychological Disorders in Adults

Background: Previous observational studies suggested a relationship between dietary fiber consumption and mental health, but the findings were conflicting. We evaluated the link between dietary fiber intake and prevalence of depression, anxiety, and psychological distress among a large population of Iranian adults. Methods: A cross-sectional study among 3,362 Iranian adults working in 50 health centers was done. Data of dietary intakes were collected through a validated semiquantitative dish-based 106-item food frequency questionnaire (FFQ). Anxiety, depression, and psychological distress were defined based on the Iranian validated version of Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ). Results: After adjustment for potential confounders, participants in the top quartile of total dietary fiber intake had a 33% and 29% lower risk of anxiety and high psychological distress [odds ratio (OR): 0.67; 95% CI: 0.48, 0.95 and OR: 0.71; 95% CI: 0.53, 0.94, respectively] compared to the bottom quartile of intake. The highest total dietary fiber intake was also inversely related to a lower risk of depression in women (OR: 0.63; 95% CI: 0.45, 0.88) but not in men. Among overweight or obese participants, higher intake of dietary fiber was related to a decreased risk of high psychological distress (OR: 0.52; 95% CI: 0.34, 0.79). A high level of dietary fiber intake was related to a lower risk of anxiety in normal-weight individuals (OR: 0.50; 95% CI: 0.31, 0.80). Conclusion: Significant inverse associations between total dietary fiber intake with anxiety and high psychological distress were found in Iranian adults. More consumption of dietary fiber was also related to reduced odds of depression in women. More investigations with prospective nature are needed to affirm these findings.

Reported Changes in Dietary Habits During the COVID-19 Lockdown in the Danish Population: The Danish COVIDiet Study

This paper focuses on the effect of the COVID-19 lockdown on the dietary habits of adult Danes. Two aspects were specifically considered: 1) reported changes in intake of specific food categories and 2) effect on healthy eating, operationalized as adherence to the Mediterranean diet (MEDAS score). Respondents (N = 2,462) completed a 44-items self-administered online survey designed for the assessment of their socio-demographic characteristics, general food habits, and consumption frequency of selected foods (mainly related to the MedDiet) during the lockdown. The data indicated that the lockdown has affected dietary habits of adult Danes to a relatively limited degree. The most important findings were that a substantial proportion of respondents (≥28%) reported eating more, snacking more, exercising less, and gaining weight during the lockdown. Results could be linked to the amount of time spent at home (e.g., a higher cooking frequency) a higher degree of emotional eating during the lockdown (e.g., a higher consumption of pastries and alcohol). Women were generally affected to a higher degree than men. Additionally, dietary changes during the lockdown to a certain degree reflected pre-existing (un)healthy eating habits, as positive health outcomes were observed in respondents with a high MEDAS score and negative outcomes (e.g., weight gain and higher intakes of pastries and carbonated beverages) were associated with respondents with a low MEDAS score. These changes, if sustained long-term, are potentially concerning from a public health perspective, especially given that more than half of the respondents were characterized by a low adherence to the MedDiet.

Psychiatric morbidities of female obesity before and after dieting: an Egyptian sample

Background

The rate of occurrence of psychiatric morbidities like anxiety, depression, perceived stress, and the overall quality of life are very high among female patients with obesity; therefore, our study investigates such variables before and after weight loss in female patients on diet restriction; this can help obesity-multidisciplinary teams target these psychiatric correlates to reach a more satisfactory outcome.

Results

Anxiety, depression, and perceived stress scores decreased significantly in parallel to the weight loss reported (p < 0.0001). Except for social functioning, all other domains of quality of life improved significantly after weight loss. Those with higher education level showed significantly lower stress, anxiety, and depression scores before weight loss compared to married and highly educated ones respectively. After weight loss, highly educated participants showed lower perceived stress and depression scores than those with middle education.

Conclusions

Anxiety, depression, and perceived stress factors are significantly decreased after weight reduction with an improved quality of life as well compared to their scores prior.

Association of dietary acid-base load and psychological disorders among Iranian women: A cross-sectional study

Metabolic acidosis, which can be affected by dietary acid-base load, seems to be associated with psychological disorders through different pathways. Given limited evidence on dietary acid-base load, we aimed to examine the association of dietary acid-base load with psychological disorders in Iranian women. This cross-sectional study was performed on 447 female subjects (20-50 years old). Dietary intake was assessed using a valid food frequency questionnaire for Iran. Dietary acid-base load was calculated through different indices including potential renal acid load (PRAL), net endogenous acid production (NEAP), and dietary acid load (DAL). To assess psychological disorders, an Iranian validated version of depression, anxiety, and stress scale (DASS-21) was used. The mean value of PRAL, NEAP, and DAL were -8.87mEq/da, 37.94mEq/day, and 30.77mEq/day, respectively. Considering a wide range of confounding variables, compared with the first tertile, a significant positive association was observed between dietary acid-base load and depression (OR_PRAL: 3.63; 95 %CI:1.97, 6.71; P_trend = 0.0001) (OR_NEAP:3.42; 95 %CI: 1.87, 6.23; P_trend = 0.0001) (OR_DAL: 3.02; 95 %CI: 1.64, 5.58; P_trend = 0.0001). Women in the high dietary acid-base load category had higher anxiety (OR_PRAL: 3.31; 95 %CI: 1.81, 6.06; P_trend = 0.0001) (OR_NEAP:3.47; 95 %CI: 1.90, 6.33; P_trend = 0.0001) (OR_DAL: 3.25; 95 %CI: 1.76, 5.98; P_trend = 0.0001). Moreover, there was a strong positive relationship between dietary acid-base load and psychologicaldistress (OR_PRAL: 3.79; 95 %CI: 2.09, 6.90; P_trend = 0.0001) (OR_NEAP: 3.67; 95 %CI: 2.04, 6.58; P_trend = 0.0001) (OR_DAL: 3.00; 95 %CI: 1.66, 5.43; P_trend = 0.0001). Women with higher dietary acid-base load score had greater odds for depression, anxiety, and psychological distress compared to lower ones.

The association of red meat consumption and mental health in women: A cross-sectional study

OBJECTIVES

Previous studies have shown that red meat consumption has beneficial effects on health. The purpose of this study was to determine the relationship between red meat consumption and depression, anxiety and psychological distress in Tehrani women.

METHODS

In this cross-sectional study, 482 women aged 20-50 years old referred to the health centers of Tehran University of Medical Sciences in 2018 were selected by multistage cluster sampling. The usual dietary intake was evaluated using a semi-quantitative food frequency questionnaire containing 168 items that its validity and reliability were approved previously. The red meat category was defined as the sum of red meats (beef, lamb), and organ meats (beef liver, kidney, and heart, ruminant meat). Psychological disorders were assessed using a validated Depression, Anxiety, Stress Scales (DASS) questionnaires with 21-items. In the logistic regression analysis, the results were adjusted to the confounding factors.

RESULTS

The mean age of the study participants was 31.87 ± 7.6 years. The prevalence of depressive symptoms, anxiety and psychological distress among participants was 34%, 40% and 42%, respectively. After controlling for potential confounders, women in the highest quartile of red meat had a highest prevalence of depressive symptoms (OR: 2.51; 95% CI: 1.32-4.76; p = 0.002), anxiety (OR: 1.82; 95% CI: 1.00-3.29; p = 0.034) and stress (OR: 3.47; 95% CI: 1.88-6.42; p < 0.001) compared with those in the lowest quartile.

CONCLUSIONS

We found a significant association between red meat intake and mental health in women. Prospective studies are needed to confirm these findings.

Evaluation of the effects of fear and anxiety on nutrition during the COVID-19 pandemic in Turkey

Objective:

The aim of this study was to evaluate effects of fear and anxiety on nutrition during the COVID-19 pandemic.

Design:

Participants were recruited by an online survey in this cross-sectional study. The questionnaire included general demographic characteristics, level of fear and anxiety, and nutritional habits. The Fear of COVID-19 Scale (FCV-19S) and Generalized Anxiety Disorder-7 test (GAD-7) were used to determine fear and anxiety.

Setting:

Turkey.

Participants:

A total sample consisted of 1012 adults.

Results:

In pandemic, fear and anxiety caused individuals to skip breakfast and snacks less, but more at lunch. A positive significant correlation was observed between the increased consumption of yoghurt, cheese and water and FCV-19S scores. There was a positive significant correlation between cheese, legume, nuts-seeds, cake-cookies, dessert and tea consumption and GAD-7 scores. A 1-unit increase in FCV-19S scores affected 1·04 times of increased consumption of yoghurt, kefir, cheese, nuts-seeds, fruit (dry) and rice-pasta. A 1-unit increase in GAD-7 scores affected 1·03 times of increased consumption of egg and fruit (fresh); 1·04 times of increased consumption of cheese and other vegetables; 1·05 times of increased consumption of milk, meat, poultry, fish, legume, nuts-seeds, fruit (dry), cake-cookies and tea; 1·07 times of increased consumption of rice-pasta and coffee and 1·08 times of increased consumption of bread and dessert.

Conclusions:

In pandemic, anxiety and fear led to changes in individuals’ nutritional habits and food preferences. Continuous surveillance of psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. In addition, the effects of these psychological problems on nutrition should be evaluated.

Psychosocial Functioning, BMI, and Nutritional Behaviors in Women at Cardiovascular Risk

Psychosocial factors such as depression, anxiety, and stress are associated with increased cardiovascular risk. Health behaviors may play a role in this relationship, as individuals experiencing elevated levels of anxiety, stress, and/or depression may be less likely to engage in risk-reducing behaviors such as diet and exercise. Some evidence suggests that this relationship is particularly relevant for women. This study explored the relationship between levels of anxiety, depression, stress, and specific nutritional behaviors in a sample of 187 women at cardiovascular risk. BMI was explored as a possible moderator of these relationships. Higher levels of depression in patients with high BMI was associated with increased fruit consumption, whereas this was not seen in highly depressed patients with normal BMI. The reverse pattern was seen for consumption of sweet drinks. Anxiety was found to have a complex relationship with consumption of sweetened drinks and white bread, with higher consumption at moderately elevated levels of anxiety and reduced consumption at the highest levels. Possible interpretations of these findings, as well as their implications for lifestyle interventions with this population are discussed. These findings suggest a number of questions for further research.

Examining the Role of Anxiety and Depression in Dietary Choices among College Students

This study examines the role of anxiety and depression symptoms in predicting dietary choices in emerging adults while accounting for sex differences in these relationships. Participants were 225 English speaking undergraduates enrolled in a university in southeastern United States. Participants were recruited through an online research recruitment application utilized by the university. Participants volunteered for a two-phased anonymous survey monitoring the effects of eating habits and gastrointestinal health in young adults. As part of this effort, participants completed self-reporting measures related to anxiety and depression, as well as an automated, self-administered 24-h diet recall. Multigroup path analysis was used to test primary hypotheses. Overall, a decrease in total caloric intake and an increase in sugar consumption were found as self-reported symptoms of anxiety and depression increased. In addition, there were sex differences in the relationship between depression and food choices. Men consumed more saturated fat as well as less fruits and vegetables as self-reported symptoms of depression increased. Results suggest symptoms of depression are a greater risk factor for poor nutrition in male college students than females. The findings provide another justification to screen for psychological distress in student health services given the implications on behavioral lifestyle and health.

Mediterranean Diet and the Emotional Well-Being of Students of the Campus of Melilla (University of Granada)

A certain link exists between the consumption of particular groups of food and well-being. In this study, we analyzed in depth the relationship between strict adherence to the Mediterranean diet (MD) and emotional well-being through a descriptive, exploratory, transversal, and correlational study of students from the Campus of Melilla, University of Granada, Spain. The sample consisted of 272 individuals. Adherence to the MD was measured with the PREvención con DIetaMEDiterránea (PREDIMED) questionnaire, emotional well-being (both positive and negative affection) with the Spanish version of the Positive and Negative Affect Schedule (PANAS), the state of perceived health with the Short Form-36 (SF36), and the degree of physical activity using the International Physical Activity Questionnaire Short Form (IPAQ-SF). A strict adherence to the MD was found to be significantly related to positive emotional state (β = 0.018, p = 0.009). The perceived state of health (β = 0.192, p < 0.001), mental role (β = 0.346, p < 0.001), and physical activity (β = 0.155, p = 0.007) were found to be predictive factors of a positive emotional state. Conversely, the relationship between the adherence to the MD and a negative emotional state was not significant. Various components of the MD were found to be independently connected to well-being. The results suggest that adopting a nutritional pattern such as the MD is linked to an improvement in emotional well-being.

Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study

The aim of this study was to evaluate whether dietary behaviours of the Spanish adult population were changed during the COVID-19 outbreak confinement. For that purpose, an online questionnaire, based on 44 items including socio-demographic data, Mediterranean diet (MedDiet) Adherence Screener (MEDAS) as a reference of a healthy diet, processed foods intake, changes in their usual food choices and weight gain was distributed using social media and snowball sampling. A total of 7514 participants (37% aged below 35 years, 70.6% female, 77.9% university-level education or higher) from all the Spanish territory completed the questionnaire. Results outlined healthier dietary behaviours during the confinement when compared to previous habits. Overall, the MEDAS score (ranging from 0 to 14, whereby higher a scoring reflects greater adherence to the MedDiet) increased significantly from 6.53 ± 2 to 7.34 ± 1.93 during the confinement. Multivariate logistic regression models, adjusted for age, gender, region and other variables, showed a statistically significant higher likelihood of changing the adherence to the MedDiet (towards an increase in adherence) in those persons who decreased the intake of fried foods, snacks, fast foods, red meat, pastries or sweet beverages, but increased MedDiet-related foods such as olive oil, vegetables, fruits or legumes during the confinement. COVID-19 confinement in Spain has led to the adoption of healthier dietary habits/behaviours in the studied population, as reflected by a higher adherence to the MedDiet. This improvement, if sustained in the long-term, could have a positive impact on the prevention of chronic diseases and COVID-19-related complications.

Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review

Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA)

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (<3/day; aORs = 1.24–1.26), and pastry consumption (>1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Dietary habits and psychological disorders in a large sample of Iranian adults: a population-based study

BACKGROUND

Since an association has been found between diet and psychological problems, this study aimed to evaluate the relationship between dietary habits and psychological problems among Iranian adults.

METHODS

Data on dietary habits and psychological problems among 9965 adults were provided from the recruitment phase of Yazd Health Study, a population-based cohort research on Iranian adults. The association between dietary habits and psychological problems was assessed by multiple logistic regression analysis.

RESULTS

After the adjustment for confounders, fast food and fried food consumptions were associated with increased depressive [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.18-2.20] and stress symptoms (OR = 2.47, 95% CI 1.46-4.18), respectively. Eating breakfast had a protective role on stress features (OR = 0.60, 95% CI 0.39-0.92), while snack intake was related to higher odds of depressive (OR = 1.36, 95% CI 1.01-1.84), anxiety (OR = 1.99, 95% CI 1.55-2.56) and stress symptoms (OR = 1.73, 95% CI 1.23-2.54). There was also an inverse association between sweetened drink consumption and depressive (OR = 0.76, 95% CI 0.59-0.96), anxiety (OR = 0.76, 95% CI 0.62-0.93), and stress features (OR = 0.73, 95% CI 0.55-0.97; OR = 0.63, 95% CI 0.48-0.82).

CONCLUSIONS

Even though an inverse relationship was found between sweetened drinks intake and psychological problems, snack consumption was associated with higher chances of them. Eating breakfast had a protective effect on stress symptoms, while fast food and fried food intakes were related to increased depressive and stress features chances, respectively.

Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study

By 2050, the global population aged 60 years and over is expected to reach nearly 2.1 billion and affective disorders might be also expected to increase. Although nutrition has been related with affective disorders, there is a lack of studies assessing the relation between dietary habits and anxiety among European and Mediterranean older populations. In the present study, we aimed to evaluate the association between dietary habits, energy intake, and anxiety symptoms using data from 1128 Greek older adults (>50 years) without pre-existing cardiovascular disease (CVD) or any other chronic disease who participated in the ATTICA study. Various socio demographic lifestyle, bio-clinical (e.g., blood pressure), and psychological (e.g., depression) characteristics were used, and dietary habits as well as energy intake were calculated using standard procedures. Older people with anxiety were more likely to be sedentary, to be smokers, and to show symptoms of depression. The saturated fat and added sugars (SFAS) dietary pattern was associated with higher anxiety levels (non-standardized b (95% CI): 5.82 (0.03 to 11.61)). No association between energy intake tertiles and anxiety levels pictured in the later regression model. Moreover, female gender, family status, and depression were positively related to anxiety. Therefore, promoting healthy dietary habits could reduce anxiety symptoms of the older adults.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies

Findings from observational studies investigating the association between fruit and vegetable consumption and risk of depression were inconsistent. We conducted a systematic review and meta-analysis to summarise available data on the association between fruit and vegetable intake and depression. A systematic literature search of relevant reports published in Medline/PubMed, ISI (Web of Science), SCOPUS and Google Scholar until Oct 2017 was conducted. Data from 27 publications (sixteen cross-sectional, nine cohort and two case-control studies) on fruit, vegetables and/or total fruit and vegetable consumption in relation to depression were included in the systematic review. A total of eighteen studies that reported relative risks (RR), hazard ratios or OR for the relationship were included in the meta-analysis. The pooled RR for depression in the highest v. the lowest category of fruit intake was 0·83 (95 % CI 0·71, 0·98) in cohort studies and 0·76 (95 % CI 0·63, 0·92) in cross-sectional studies. Consumption of vegetables was also associated with a 14 % lower risk of depression (overall RR=0·86; 95 % CI 0·75, 0·98) in cohort studies and a 25 % lower risk of depression (overall RR=0·75; 95 % CI 0·62, 0·91) in cross-sectional studies. Moreover, an inverse significant association was observed between intake of total fruit and vegetables and risk of depression (overall RR=0·80; 95 % CI 0·65, 0·98) in cross-sectional studies. In a non-linear dose-response association, we failed to find any significant association between fruit or vegetable intake and risk of depression (fruit (cross-sectional studies): P non-linearty=0·12; vegetables (cross-sectional studies): P non-linearty<0·001; (cohort studies) P non-linearty=0·97). Meta-regression of included observational studies revealed an inverse linear association between fruit or vegetable intake and risk of depression, such that every 100-g increased intake of fruit was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·99). With regard to vegetable consumption, every 100-g increase in intake was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·98) and 5 % reduced odds in cross-sectional studies (RR=0·95; 95 % CI 0·91, 0·98). This meta-analysis of observational studies provides further evidence that fruit and vegetable intake was protectively associated with depression. This finding supports the current recommendation of increasing fruit and vegetable intake to improve mental health.

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

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

Making Sense of … the Microbiome in Psychiatry

Microorganisms can be found almost anywhere, including in and on the human body. The collection of microorganisms associated with a certain location is called a microbiota, with its collective genetic material referred to as the microbiome. The largest population of microorganisms on the human body resides in the gastrointestinal tract; thus, it is not surprising that the most investigated human microbiome is the human gut microbiome. On average, the gut hosts microbes from more than 60 genera and contains more cells than the human body. The human gut microbiome has been shown to influence many aspects of host health, including more recently the brain.Several modes of interaction between the gut and the brain have been discovered, including via the synthesis of metabolites and neurotransmitters, activation of the vagus nerve, and activation of the immune system. A growing body of work is implicating the microbiome in a variety of psychological processes and neuropsychiatric disorders. These include mood and anxiety disorders, neurodevelopmental disorders such as autism spectrum disorder and schizophrenia, and even neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. Moreover, it is probable that most psychotropic medications have an impact on the microbiome.Here, an overview will be provided for the bidirectional role of the microbiome in brain health, age-associated cognitive decline, and neurological and psychiatric disorders. Furthermore, a primer on the common microbiological and bioinformatics techniques used to interrogate the microbiome will be provided. This review is meant to equip the reader with a primer to this exciting research area that is permeating all areas of biological psychiatry research.

Looking beyond the mirror: Psychological distress; disordered eating, weight and shape concerns; and maladaptive eating habits in lawyers and law students

Research indicates that, in comparison to professionals and University students in other disciplines, lawyers and law students may be at greater risk of experiencing high levels of psychological distress. There is also a large body of literature supporting an association between stress, anxiety and depression and unhealthy eating. This article reports on the results of a study of Australian legal professionals and law students that evidence a positive association between psychological distress; disordered eating, weight and shape concerns; and maladaptive eating habits in lawyers and law students. Additionally, this study confirms a positive link between frequency of exercise and subjective physical well-being, that in turn is associated with enhanced emotional well-being. Based on the results of this study, we suggest simple yet effective strategies law firms and law schools might adopt to support the mental health of their staff and students.