Fruit and vegetable intake in relation to depressive and anxiety symptoms among adolescents in 25 low- and middle-income countries

Association of dietary flavonoid intake with the prevalence and all-cause mortality of depressive symptoms: Findings from analysis of NHANES

BACKGROUND

This study aimed to explore the relationship between flavonoids intake and the prevalence and all-cause mortality of depressive symptoms in American adults.

METHODS

Analyzing 2007-2008, 2009-2010, and 2017-2018 NHANES data, we examined the association between dietary flavonoid and depressive symptoms, including specific subclasses assessment and mortality outcomes tracking until December 31, 2019. Our methodology included weighted multivariate logistic regression, weighted cox proportional hazards regression and restricted cubic spline (RCS) models, supported by stratified and sensitivity analyses.

RESULTS

Among the 12,340 participants in total, 1129 exhibited depressive symptoms. The multiple logistic regression analysis showed a significant reduction in total flavonoid and subclass intake in individuals with current depressive symptoms. Adjusted odds ratios (ORs) for the highest quartiles were 0.69 for anthocyanidins and 0.63 for flavones. Interaction effects emerged in non-hypertensive, higher-income, and normal-weight groups for flavones intake. The RCS model indicated an L-shaped association between depressive symptoms and total flavonoid intake, with inflection points at 346 mg/day. During a median follow-up of 119 months, 148 deaths occurred among patients with depressive symptoms. Hazard ratios (HRs) for all-cause mortality showed a significant positive correlation between total flavonoid intake and survival in model 1 (HR = 0.56), with an optimal intake range of 45.2-948.3 mg/day according to the RCS model.

LIMITATIONS

The study relied on U.S. population survey data, potentially limiting generalizability. Unmeasured confounding factors may exist, and genetic factors were not considered.

CONCLUSIONS

Adequate intake of flavonoids, especially anthocyanidins and flavones, is associated with reduced odds of depressive symptoms. Additionally, optimal intake ranges of flavonoid intake for mental health benefits were observed for all-cause mortality in population with depressive symptoms.

The relationship between dietary sugar consumption and anxiety disorders: A systematic review

High-sugar intake is a risk factor for chronic diseases such as cardiovascular disease and type 2 diabetes, but less is known about its role in anxiety disorders. This systematic review aimed to systematically synthesise and assess the existing evidence regarding the association between dietary sugars intake and anxiety disorders. Following PRISMA guidelines, a systematic search of PubMed, MEDLINE, Embase, APA PsycArticles and APA PsycINFO was conducted up to 19th August 2022. Study quality was assessed by the Newcastle-Ottawa scale (NOS) and the Cochrane risk of bias tool. Eleven studies (10 cross-sectional and 1 randomised controlled trial [RCT]) were included. Seven cross-sectional studies had very good quality or good quality, and the quality of the RCT was at low risk of bias. These studies examined sugar-sweetened beverages (n = 7), sugar-sweetened foods (n = 4) and/or added sugar (n = 5). The findings suggest a possible positive relationship of added sugar consumption with anxiety disorders, with age as a potential moderator in such association. No conclusions can be drawn on the associations between sugar-sweetened beverages, sugar-sweetened foods consumption and anxiety disorders. Due to the included studies being mostly cross-sectional, the conclusions drawn from the existing evidence should be interpreted with caution. The longitudinal design is warranted to investigate any causal relationship and the potential mechanisms underlying these heterogeneous results. The potential difference in effect at different ages observed in this review should be further examined.

The Role of Dietary Patterns and Nutritional Supplements in the Management of Mental Disorders in Children and Adolescents: An Umbrella Review of Meta-Analyses: Le rôle des habitudes alimentaires et des suppléments nutritionnels dans la prise en charge des troubles mentaux chez les enfants et les adolescents : une méta-revue de méta-analyses

OBJECTIVE

In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents.

METHODS

Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024.

RESULTS

Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 μg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory.

CONCLUSION

Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.

Effects of Mediterranean and Western dietary patterns on perceived stress and mental distress

Compared to the Western diet, the Mediterranean diet has many known benefits for both mental health and physical health; however, little is known about the effect of these dietary patterns on perceived stress and mental distress. To assess the relationship between dietary patterns, perceived stress and mental wellbeing, an anonymous online questionnaire targeting adults 18 and older was distributed via several social media platforms and email listservs. The survey included demographic questions, the Food-Mood Questionnaire, the Perceived Stress Scale and the Kessler Psychological Distress scale (K-6). A total of 1591 participants completed the survey. The data was analyzed using Principal Component Analysis and Pearson Correlation Coefficient in SPSS version 28.0. The results showed significant negative correlations between perceived stress and mental distress with several components of the Mediterranean diet, such as whole grains, seafood, fruits, vegetables, and beans. Despite being attributed to the Western diet, meat produced a negative correlation with perceived stress and mental distress. However, significant positive correlations between perceived stress and mental distress and the Western diet, such as fast food and high glycemic index food, were detected. Our findings provide evidence that dietary patterns modulate the stress response and suggest that incorporating components of the Mediterranean diet is beneficial for mental wellbeing and stress reduction.

Associations of vegetable and fruit intake, physical activity, and school bullying with depressive symptoms in secondary school students: the mediating role of internet addiction

BACKGROUND

Few studies have simultaneously focused on the associations of vegetable and fruit intake, physical activity, school bullying, and Internet addiction (IA) with depressive symptoms. This study aimed to explore the direct and indirect effects of the above factors on depressive symptoms in adolescents by constructing a structural equation model (SEM).

METHODS

This study was conducted in Qingdao from September to November 2021. A total of 6195 secondary school students aged 10-19 years were included in the analysis. Information on all variables was assessed using a self-administered questionnaire. An SEM was constructed with depressive symptoms as the endogenous latent variable, IA as the mediating variable, and vegetable and fruit intake, physical activity, and school bullying as the exogenous latent variables. The standardized path coefficients (β) were the direct effects between the latent variables, and the indirect effects were obtained by the product of direct effects between relevant latent variables.

RESULTS

The median value with the interquartile range of depressive symptom scores was 7 (3,12). Vegetable and fruit intake (β=-0.100, P<0.001) and physical activity (β=-0.140, P<0.001) were directly negatively related to depressive symptoms. While school bullying (β=0.138, P<0.001) and IA (β=0.452, P<0.001) were directly positively related to depressive symptoms. IA had the greatest impact on depressive symptoms. Vegetable and fruit intake, physical activity, and school bullying could not only directly affect depressive symptoms, but also indirectly affect depressive symptoms through the mediating effect of IA, the indirect effects and 95% confidence intervals (CIs) were -0.028 (-0.051, -0.007), -0.114 (-0.148, -0.089) and 0.095 (0.060, 0.157), respectively. The results of the multi-group analysis showed that the SEM we constructed still fit in boy and girl groups.

CONCLUSIONS

The results indicated that vegetable and fruit intake, physical activity, school bullying, and IA had a significant direct impact on depressive symptoms, among which IA had the greatest impact. In addition, both vegetable and fruit intake, school bullying, and physical activity indirectly affected depressive symptoms through the mediating effect of IA. The impact of IA on depressive symptoms should be given extra attention by schools and parents. This study provides a scientific and effective basis for the prevention and control of adolescent depressive symptoms.

Adherence to the nordic diet is associated with anxiety, stress, and depression in recovered COVID-19 patients, a case-control study

BACKGROUND

Follow-up of COVID-19 recovered patients to discover important adverse effects on other organs is required. The psychological health of COVID-19 patients may be affected after recovery.

AIM

We aimed to evaluate the association between adherence to the Nordic diet (ND) and psychological symptoms caused by COVID-19 after recovery.

METHOD

Dietary data on 246 qualified adults (123 cases and 123 controls). The dietary intake in this case-control study was calculated by a reliable and valid food frequency questionnaire (FFQ). Depression Anxiety Stress Scale (DASS), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Short-Form Health Survey (SF-36) were used to analyze participant's anxiety, stress, depression, sleep quality, insomnia, and quality of life of participants.

RESULTS

There was a significant inverse relationship between total anxiety, stress, and depression scores and the intake of whole grains (P < 0.05). Furthermore, there was a significant inverse association between depression and fruit intake (P < 0.05). A significant negative correlation was found between insomnia and sleep quality and the intake of root vegetables (P < 0.05). In the multinomial-regression model, a significant association between the Nordic diet and anxiety, stress, and depression was found only in the case group (OR = 0.719, 95% CI 0.563-0.918, p-value = 0.008; OR = 0.755, 95% CI 0.609-0.934, P-value = 0.010, and, OR = 0.759, 95% CI 0.602-0.956, P-value = 0.019 respectively).

CONCLUSION

Adherence to the Nordic diet might reduce anxiety, stress, and depression in recovered COVID-19 patients.

Relationship between fruit and vegetable consumption and internet addiction with insomnia and depression as multiple mediators during the COVID-19 pandemic: a three-wave longitudinal study in Chinese college students

BACKGROUND

The relationships between fruit and vegetable consumption (FV) and Internet addiction (IA) in college students still remained unknown together with the internal mechanisms. Given the limitations of previous cross-sectional design, longitudinal research was necessary to be conducted to explore more precise correlations. Using the three-wave data in a longitudinal design, this study aimed to explore the association between FV and IA among Chinese college students and potential multiple mediators of insomnia and depression during the COVID-19 pandemic.

METHODS

A total of 579 college students were recruited during three waves (T1: August 2020; T2: November 2020; T3: February 2021). FV (T1), insomnia (T2), depression (T2) and IA (T3) symptoms were reported. The descriptive statistics of the sociodemographic characteristics and correlation analyses of the study variables were calculated. The significance of the mediation effects was measured conducting a bootstrap method with SPSS PROCESS macro.

RESULTS

FV was negatively correlated with IA, and lower FV predicted higher risk of IA. Depression mediated the association between FV and subsequent IA. Insomnia and depression were multiple mediators, which in turn mediated the links between FV and subsequent IA.

CONCLUSIONS

The three-wave longitudinal study has revealed that FV had indirect effects on IA through individual mediating factor of depression and multiple mediating roles of insomnia and depression sequentially. The policy makers, educators and researchers should pay attention to the impact of the interventions from healthy diet, in order to optimize the coping strategies for preventing college students from IA.

A pooled analysis of temporal trends in the prevalence of anxiety-induced sleep loss among adolescents aged 12-15 years across 29 countries

Background

Previous studies examining trends in sleep loss among adolescents have mainly focused on single countriy and region. This study aims to analyze temporal trends in the prevalence of anxiety-induced sleep loss among adolescents from 29 countries in five regions.

Methods

This study used data from the Global School-based Student Health Survey 2003-2018, which surveyed 215,380 adolescents from 29 countries with at least two cross-sectional surveys per country. The weighted country-specific prevalence of anxiety-induced sleep loss and trends across the survey years were evaluated. Random- or fixed-effects meta-analyses were used to calculate pooled prevalence and temporal trends across 29 countries.

Results

Temporal variations in anxiety-induced sleep loss across countries were identified. Increasing (Suriname, Vanuatu, and Myanmar), decreasing (Namibia, Jamaica, the Philippines, Samoa, and Indonesia), and stable (all other countries) trends in anxiety-induced sleep loss were noted. The pooled weighted prevalence of anxiety-induced sleep loss was 11.35 and 10.67% in the first and last surveys, respectively. There was no meaningful change in the propensity to have anxiety-related sleep disorders over time, with the reduction and OR of these two surveys being 0.54 (-0.53-1.61) and 0.98 (0.88-1.10). For subgroup analyses, no significant differences in pooled anxiety-induced sleep loss trends were seen between the two surveys for different sexes, regions, incomes, survey years in the first wave, survey periods, or number of surveys.

Conclusion

Trends in the prevalence of anxiety-induced sleep loss in adolescents varied significantly across different countries. Generally, a stable trend was observed in 21 of the 29 countries surveyed. Our study provides data that can aid policymakers in establishing country-specific strategies for reducing anxiety-induced sleep loss in adolescents.

Overview of Food Preservation and Traceability Technology in the Smart Cold Chain System

According to estimates by the Food and Agriculture Organization of the United Nations (FAO), about a third of all food produced for human consumption in the world is lost or wasted-approximately 1.3 billion tons. Among this, the amount lost during the storage stage is about 15-20% for vegetables and 10-15% for fruits. It is 5-10% for vegetables and fruits during the distribution stage, resulting in a large amount of resource waste and economic losses. At the same time, the global population affected by hunger has reached 828 million, exceeding one-tenth of the total global population. The improvement of the cold chain system will effectively reduce the amount of waste and loss of food during the storage and transportation stages. Firstly, this paper summarizes the concept and development status of traditional preservation technology; environmental parameter sensor components related to fruit and vegetable spoilage in the intelligent cold chain system; the data transmission and processing technology of the intelligent cold chain system, including wireless network communication technology (WI-FI) and cellular mobile communication; short-range communication technology, and the low-power, wide-area network (LPWAN). The smart cold chain system is regulated and optimized through the Internet of Things, blockchain, and digital twin technology to achieve the sustainable development of smart agriculture. The deep integration of artificial intelligence and traditional preservation technology provides new ideas and solutions for the problem of food waste in the world. However, the lack of general standards and the high cost of the intelligent cold chain system are obstacles to the development of the intelligent cold chain system. Governments and researchers at all levels should strive to highly integrate cold chain systems with artificial intelligence technology, establish relevant regulations and standards for cold chain technology, and actively promote development toward intelligence, standardization, and technology.

Microwave-assisted enzymatic extraction brings a notably high yield of polysaccharides from mountain Zizania latifolia

Mountain Zizania latifolia is produced at scale in China, and the edible swollen culm is exported to many countries, but little attention has been paid to its functional components. In this work, microwave-assisted enzymatic extraction (MAEE) is used for the first time to extract polysaccharides from mountain Z. latifolia swollen culm (PMZL). MAEE conditions optimized by Box-Behnken design-response surface methodology were as follows: 2.4% cellulase, microwaving for 6.0 min at 607 W, with a liquid-to-solid ratio of 63:1 ml g^-1 . Under these conditions, a notably high yield of 60.43% ± 1.12% for PMZL was achieved, which was significantly higher (p < 0.01) than from plain-grown varieties. PMZL are naturally occurring sulfated polysaccharide-protein complexes containing 8.46% ± 0.18% proteins and 7.86% ± 0.73% sulfates. PMZL comprises mannose, glucosamine, rhamnose, glucose, galactose, and arabinose at molar ratios of 3.80:2.68:1.00:17.41:5.12:2.91, with a weight-average molecular weight of 1569,219 Da and a number-average molecular weight of 364,088 Da. The surface morphology of PMZL is composed of tightly packed oval particles, and this kind of promising polysaccharides preferentially scavenges reactive nitrogen species. PRACTICAL APPLICATION: Due to global warming, the land available for planting vegetables is likely to expand to higher areas, so greater attention should now be paid to mountain-grown vegetables. This study provides an efficient way to obtain novel polysaccharides from mountain Zizania latifolia using microwave-assisted enzymatic extraction with a remarkably high yield of 60.4%. This promising source of natural carbohydrates has potential uses in pharmaceutical, nutraceutical, functional foods, cosmetics, and functional materials industries.

Associations between dietary intake, diet quality and depressive symptoms in youth: A systematic review of observational studies

Background: Depression is the third leading cause of worldwide disease burden among youth, and nutrition- and diet-related behaviors have been considered as an effective strategy for reducing the risk of depressive symptoms. This systematic review aims to examine associations between dietary intake and diet quality with depressive symptoms among youth. Methods: In this systematic review, a search of scientific articles published between 2000 and 2021 was performed in four databases (CINAHL, Embase, PsycInfo, and PubMed) according to the PRISMA checklist. After applying inclusion and exclusion criteria, observational studies that focused on associations between micronutrient, macronutrient, food group intake, and diet quality and depressive symptoms among youth, ages 3 to 18, were selected for review. Results: Thirty-two articles met the review criteria. Dietary intake of magnesium, vitamin B12, fiber, fruits, vegetables, and fish were consistently inversely related to depressive symptoms. However, the evidence of associations between intake of vitamins B6, C, D, and E, iron, copper, zinc, omega-3 fatty acids, carbohydrate, and dietary fat and depressive symptoms was mixed. Dietary effects on decreased depressive symptoms were more pronounced in children than adolescents. Additionally, most studies failed to adjust for potential confounding variables. Conclusion: This review provides preliminary and comprehensive evidence for a relationship between dietary intake, diet quality, and depressive symptoms in youth. Although the results are heterogeneous and more research is needed, our findings indicate the importance of nutrition interventions for youth for decreasing depressive symptoms or for preventing further symptom exacerbation.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Relationship Between Fruit and Vegetables Intake and Common Mental Disorders in Youth: A Systematic Review

Objective: Recent evidence suggests that adequate fruit and vegetables intake (FVI) might be associated with lower risk of common mental disorders (CMDs) in adults, but studies in youth are also beginning to emerge and are synthesized in this systematic review. Methods: Online databases were searched from inception to 30 October 2020 to locate cross-sectional, cohort, and case-control studies focusing on the FVI and CMDs in youth (i.e., 10-18 years old). The risk of bias of studies was assessed using Joanna Briggs Institute Critical Appraisal Tool and the Newcastle-Ottawa quality assessment scale. Results: Among 3,944 records identified, 12 studies (8 cross-sectional, 1 case-control, and 3 prospective cohort studies) were included in the final synthesis. None of the prospective cohort studies identified a statistically significant association between FVI and CMDs in youth, although inconsistent associations were reported in cross-sectional and case-control studies. Conclusion: The lack of associations between FVI and CMDs in youth, along with consistent associations in adults, might be explained by the accumulation of risk theoretical model and methodological challenges.

The relation between MIND diet with psychological disorders and psychological stress among Iranian adults

BACKGROUND

Given the role of dietary antioxidants in relieving depression, anxiety, and stress, as well as studies on the beneficial effects of the Mediterranean and Dash diets separately on these problems, in this study, we examine the relationship between the MIND index (Mediterranean- DASH diet Intervention for Neurodegenerative Delay) as a combined indicator of the Mediterranean and DASH diet with psychological disorders such as depression, anxiety, and psychological stress among a large sample of the Iranian adult population.

METHODS

This cross-sectional study was performed on 7165 participants of the enrollment phase of Yazd Health Study (YaHS) and Yazd Nutrition Study (TAMYZ) a valid 178-item semi-quantitative food frequency questionnaire (FFQ) was used to assess participants' food intake. The MIND diet score was calculated based on participants' dietary intakes obtained from FFQ. Also, the valid Iranian version of the Depression, Anxiety, and Stress Scale (DASS 21) was used to assess psychological disorders and stress. In addition, the association between the MIND diet and psychological disorders and stress was assessed through logistic regression.

RESULTS

The mean ± SD score was 3.33 ± 3.79 for depression, 2.99 ± 3.65 for anxiety, and 5.93 ± 4.70 for psychological stress. The mean score of MIND in this study was 7.56. After adjustment for after adjusting for age, gender, intake of energy, BMI, history of chronic disease, marital status, education level, smoking history, physical activity level, pregnancy or lactation, intakes of dietary EPA, DHA, and fiber, individuals in highest compared to the lowest quartile of MIND diet score had significantly lower odds of depression (OR = 0.62, 95% CI 0.40 - 0.96; P-trend = 0.02) and anxiety (OR = 0.61, 95% CI 0.41 - 0.91; P-trend = 0.01). However, no significant association was observed for psychological stress (OR = 0.57, 95% CI 0.28 - 1.14; P-trend = 0.83).

CONCLUSION

Therefore, it seems that following the MIND diet can prevent the possibility of these psychological problems. However, there is a need to design studies with more robust methodologies such as clinical trial studies.

The Serial Mediation of the Association between Breakfast Skipping and Suicidality by Weight Status and Depressive Symptoms: Findings from the National Youth Risk Behavior Surveys of the United States

Background: The evidence is limited for the dose–response association between breakfast skipping and suicidality. The underlying pathway from breakfast skipping to suicidality has also rarely been explored in previous studies. Methods: The data of Youth Risk Behavior Surveys (YRBSs) of the United States from 2011 to 2019 were used with a sample size of 74,074. The male: female ratio was nearly 1:1. Binary logistic regression models with complex sampling design were adopted to show the effect of breakfast skipping on weight status, depressive symptoms, and suicidality. Serial mediation was used to explore the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms. Findings: The weighted prevalence rates (95% confidence interval) of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt for skipping breakfast totally (0 times/week) were 25.6% (24.4–26.8%), 21.7% (20.5–22.9%), 14.2% (13.0–15.3%), and 5.3% (4.6–5.9%). Breakfast skipping was significantly associated with increased risk of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt. There was statistical significance for the linear dose–response association between breakfast skipping and overweight/obesity, depressive symptoms, and suicidality regardless of sex and age. A serial mediation with effect sizes between 39.68% and 51.30% for the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms was found in this study. Conclusions: This study emphasizes the hazards of breakfast skipping, which could increase the risk of suicidality among adolescents. Overweight/obesity and depressive symptoms as the mediating factors for the association between breakfast skipping and suicidality should also be with more attention.

Care Their Diet and Mind: Association between Eating Habits and Mental Health in Chinese Left-behind Children

Studies have shown that the prevalence of mental health problems is high among left-behind children (LBC). Modifiable eating habits may play an important role in promoting mental health among these adolescents. This study aimed to investigate the situation of dietary habits and their association with mental health problems in a sample of Chinese LBC. We conducted this cross-sectional study in an economically disadvantaged area of China in May 2020. Information on socio-demographic factors, eating habits (the frequency of eating carbohydrates, fruits, vegetables, protein, and breakfast), and mental health problems (insomnia, depression, and anxiety) were collected among local adolescents. Among 8939 adolescents were recruited, a total of 3314 LBC (1455 males and 1859 females, aged 12–17 years) were identified and included in the current study. Associations between dietary habits and mental health were analyzed by generalized linear models. Results indicated that the dietary pattern was unhealthy among LBC and even worse in females. Compared to routinely eating breakfast and fruits, lower frequencies of eating breakfast and fruits were identified as two significant factors with higher risks of mental health problems. Moreover, the association was more pronounced in females. Therefore, improving diet quality, particularly the frequency of eating breakfast and fruit intake may be an effective approach in the mental health promotion for LBC, especially for females.

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity

Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19.

METHOD

Cross-sectional study (N = 1,794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety.

RESULTS

The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms.

CONCLUSIONS

These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents' mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise.

A novel, complex systems approach to modelling risk of psychological distress in young adolescents

Adolescence is a period of significant anatomical and functional brain changes, and complex interactions occur between mental health risk factors. The Longitudinal Adolescent Brain Study commenced in 2018, to monitor environmental and psychosocial factors influencing mental health in 500 adolescents, for 5 years. Participants are recruited at age 12 from the community in Australia's Sunshine Coast region. In this baseline, cross-sectional study of N = 64 participants, we draw on the network perspective, conceptualising mental disorders as causal systems of interacting entities, to propose a Bayesian network (BN) model of lifestyle and psychosocial variables influencing chances of individuals being psychologically well or experiencing psychological distress. Sensitivity analysis of network priors revealed that psychological distress (Kessler-10) was most affected by eating behaviour. Unhealthy eating increased the chance of moderate psychological distress by 600%. Low social connectedness increased the chance of severe psychological disorder by 200%. Certainty for psychological wellness required 33% decrease in unhealthy eating behaviours, 11% decrease in low social connectedness, and 9% reduction in less physical activity. BN can augment clinician judgement in mental disorders as probabilistic decision support systems. The full potential of BN methodology in a complex systems approach to psychopathology has yet to be realised.

Adherence to the vegetarian diet may increase the risk of depression: a systematic review and meta-analysis of observational studies

CONTEXT

Several epidemiological studies have investigated the association between a vegetarian diet and risk of depression, but because of inconsistency between studies, the exact association remains unclear.

OBJECTIVE

In this systematic review and meta-analysis, the relationship between vegetarian diets and risk of depression in observational studies was evaluated.

DATA SOURCES

The Medline, Embase, Scopus, ISI Web of Science, and Cochrane Library databases were searched from inception through September 1, 2020.

STUDY SELECTION

Observational studies were included that examined mean levels of depression and risk for depression in vegetarians compared with nonvegetarians.

DATA EXTRACTION

Pooled effect sizes were estimated using the random-effects model and were reported as standardized mean differences or odds ratios (ORs) with their corresponding 95%CIs. Heterogeneity was tested using the I2 statistic.

RESULTS

Combining 9 effect sizes in this meta-analysis illustrated that adherence to a vegetarian diet was associated with a 53% greater risk of depression compared with that of omnivores (95%CI, 1.14-2.07; I2 = 69.1%). Subgroup analysis of depression risk suggested that results depended on the type of vegetarian diet and country where the study was conducted. For studies that assessed a semivegetarian diet (OR, 1.86; 95%CI, 1.42-2.44; I2 = 35.7%) and those conducted in Europe and the United States (OR, 1.45; 95%CI, 1.06-1.98; I2 = 73.2%), there was a positive association between a vegetarian diet and depression, but in lacto-ovo vegetarians and Asian countries, a null association was found. Comparing mean depression scores showed no evidence of difference between vegetarians and nonvegetarians (n = 16; standardized mean difference, 0.10; 95%CI, -0.01 to 0.21; I2 = 79.1%).

CONCLUSION

Vegetarian diet significantly increased depression risk; however, the findings were not robust, and more studies are required to investigate the vegetarian diet and depression association.

Relationship between sedentary behaviour and anxiety symptoms among youth in 24 low- and middle-income countries

Background

Anxiety is burdensome and common in youth. Sedentary behaviour has been identified as potentially modifiable dangerous factors for many diseases. Nevertheless, little is known about the relationship between sedentary behaviour and the risk of anxiety symptoms in youth. Therefore, we aimed to examine the association among youth in 24 low- and middle-income countries (LMICs).

Methods

Data from the Global School-based Student Health Survey (GSHS) were analyzed in 59587 youth aged 12–15 years. Most of the country-wide data were nationally representative. Anxiety symptoms were self-reported. Multivariable logistic regression and meta-analyses of country-wise estimates were conducted.

Results

The prevalence of anxiety symptoms was 10.3%. Countrywide meta-analysis demonstrated that sedentary behaviour of >2 h/day (vs.≤2 h/day) was associated with an increased risk of anxiety symptoms (OR = 1.22; 95% CI = 1.10–1.37).

Conclusions

This study provides multi-national evidence of the dangerous effect of sedentary behaviour against anxiety symptoms among youth in LMICs. Decreasing the level of sedentary behaviour during adolescence could be an important target for reducing the prevalence of anxiety.

Prevalence and Associated Factors of Loneliness Among National Samples of In-School Adolescents in Four Caribbean Countries

BACKGROUND

The goal of the study was to estimate the prevalence and correlates of loneliness among adolescent school children in four Caribbean countries.

METHODS

Nationally representative cross-sectional data were analysed from 9,143 adolescents (15 years=median age) that took part in the "2016 Dominican Republic, 2016 Suriname, 2017 Jamaica and 2017 Trinidad and Tobago "Global School-Based Student Health Survey (GSHS)."

RESULTS

The prevalence of loneliness was 15.3% in four Caribbean countries, ranging from 12.1% in Dominican Republic to 18.6% in Jamaica. In adjusted logistic regression analysis, female sex, having no close friends, older age, anxiety induced sleep disturbance, frequent bullying victimization (≥3 days/month), having been physically attacked, parental emotional neglect, having sustained multiple serious injuries (past year) and not eating fruit and vegetables were associated with loneliness. In addition, in sex stratified adjusted logistic regression analysis, among boys, daily exposure to passive smoking, and being from Suriname, and among girls, frequent experience of hunger, low peer support, trouble from drinking alcohol and high leisure-time sedentary behaviour (≥8 hrs/day) were associated with loneliness. Moreover, in addition to above results, in unadjusted analysis, involvement in physical fight, parents never check on homework, parental disrespect of privacy, frequent school truancy (≥3 days/month), current tobacco use, having no physical education and drinking frequently soft drinks (≥3/day) were associated with loneliness.

CONCLUSION

Almost one in six students reported loneliness and several associated factors were identified which can aid intervention strategies.

Clustering of Poor Dietary Habits among Adolescents Aged 12 to 15 Years in 52 Low-Income and Middle-Income Countries

Very few studies have reported the co-occurrence of poor dietary habits. We thus aimed to estimate the co-occurrence of poor dietary habits in adolescents in low-income and middle-income countries (LMICs). Data were obtained from the Global School-Based Student Health Surveys (GSHS) from 2009 to 2017. The suboptimal dietary factors included fast food consumption, carbonated soft drink consumption, and low fruit and vegetable intake, which were assessed with a questionnaire survey. We calculated the corresponding country-specific prevalence with the number of suboptimal dietary factors. We also calculated pooled estimates across countries using a meta-analysis with random-effects. Our study included 145,021 adolescents between 12 and 15 years of age from 52 LMICs. The prevalence of fast food consumption, carbonated soft drink consumption, and low fruit and vegetable intake ranged from 20.9% in Pakistan to 80.0% in Thailand, from 22.4% in Kiribati to 79.3% in Suriname, and from 45.9% in Vanuatu to 90.7% in Nepal, respectively. The prevalence of exposure to two or three suboptimal dietary factors varied greatly across countries, ranging from 31.8% in Pakistan to 53.8% in Nepal and from 8.6% in Vietnam to 36.4% in Suriname, respectively. The pooled prevalence of exposure to two or three suboptimal dietary factors was 41.8% and 20.0%, respectively. Our findings indicate that poor dietary habits are frequent and tend to co-occur in adolescents in LMICs. Country-specific policies and programs are needed to address these conditions.

Microporous modified atmosphere packaging to extend shelf life of fresh foods: A review

In recent years, microporous modified atmosphere packaging has been widely concerned because of its adjustable air permeability and low processing cost. With the development and increasing demand of fresh food industry, the limited permeability of film in modified atmosphere packaging can't meet the fresh-keeping requirements of fresh foods, especially vegetables and fruits. Microporous film can flexibly adjust the gas permeability according to the physiological metabolic characteristics of fresh foods, which has gradually become a fresh-keeping technology in the domain of vegetables and fruits. This paper reviewed the research progress of microporous modified atmosphere packaging and its extension on shelf life of fresh foods. The latest applied researches were described in a comprehensive manner, particularly fruits and vegetables. Besides, this article also covered theoretical support and analysis, including the perforation mode, air permeability mechanism and mathematical model of microporous film, the characteristics of fresh foods, pore parameters and traits of film materials. This paper payed attention to the application of environmentally friendly degradable film materials (biological film materials, nano materials) in fruits and vegetables preservation. Research has shown that the degradable material can enlarge the fresh-keeping effect of microporous modified atmosphere packaging, which is worthy of further research and development. Finally, the development trends and directions in the future were discussed.

Serious physical injury and depressive symptoms among adolescents aged 12-15 years from 21 low- and middle-income countries

BACKGROUND

Little is known about the relationship between physical injury and depression in youths from low- and middle-income countries (LMICs). Therefore, the aim of this study was to analyze the association between serious physical injury and depressive symptoms among adolescents in 21 LMICs.

METHODS

Data from the Global School-based Student Health Survey (2003-2008) were analyzed. Serious physical injury and depressive symptoms in the past 12 months were assessed with self-report measures. The association between serious physical injury and depressive symptoms was examined using multivariable logistic regression analysis and meta-analysis.

RESULTS

The final sample consisted of 44,333 adolescents aged 12-15 years. After adjustment for sex, age, food insecurity, alcohol consumption, and country, an increasing number of serious physical injuries in the past 12 months was associated with increments in the odds for depressive symptoms in a dose-dependent fashion. Those who had ≥6 serious injuries (vs. no injuries) were 2.79 (95%CI=2.23-3.48) times more likely to have depressive symptoms. The pooled odds ratio (OR) (95%CI) for the association between at least one serious physical injury and depressive symptoms obtained by meta-analysis based on country-wise estimates was 1.83 (1.67-2.01) with a moderate level of between-country heterogeneity (I²=56.0%).

LIMITATIONS

This was a cross-sectional study and causality of the association cannot be deduced.

CONCLUSIONS

Serious physical injury may be a risk factor for depressive symptoms among adolescents in LMICs. Efforts to prevent physical injury and the provision of adequate health care for those who are injured may improve mental wellbeing among adolescents in this setting.

Mild to Severe Depressive Symptoms in Elderly Stroke Survivors and Its Associated Factors: Evidence From a Cross-Sectional Study in Zhejiang Province, China

Objective: The objective of the study is to explore the prevalence of mild to severe depressive symptoms in elderly stroke survivors and its associated factors. Methods: We did data analyses of 335 elders with stroke history. Data were collected in a survey conducted between 2014 and 2015, among permanent residents aged 60 and older in Zhejiang Province, China. Prevalence of mild to severe depressive symptoms among stroke survivors were calculated, and univariate analyses and multilevel logistic regression were used to explore its associated factors. Results: Prevalence of mild to severe depressive symptoms was 22.09% (95% CI: 17.65-26.53%) in elders with stroke history, more than twice compared to their counterparts not suffering stroke (9.77%, P < 0.001). In multilevel logistic regression, we found that elderly stroke survivors who were illiterate (OR = 2.33, p = 0.008), or had limitation in activities of daily living (OR = 3.04, p = 0.001) were more likely to be present with mild to severe depressive symptoms, respectively, while those with more fresh vegetable consumption were at lower odds (OR = 0.82, p = 0.047). Conclusions: Prevalence of mild to severe depressive symptoms was high in elderly stroke survivors. Targeted screening might be needed for those being illiterate, disabled in activities of daily living, and having little consumption of fresh vegetable. The association between fresh vegetable consumption and depressive symptom in stroke patients calls for further research.