Fish and fat intake and prevalence of depressive symptoms during pregnancy in Japan: baseline data from the Kyushu Okinawa Maternal and Child Health Study

Maternal fat intake in pregnancy and risk of depressive symptoms in Japanese adolescents: the Kyushu Okinawa Maternal and Child Health Study

The current prebirth cohort study investigated the association between maternal intake of specific types of fatty acids during pregnancy and adolescent depressive symptoms based on the Center for Epidemiologic Studies Depression Scale. Subjects were 873 mother-child pairs. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. The risk of depressive symptoms was 23.3% among the 873 adolescents at 13 years of age. Higher maternal saturated fatty acid intake during pregnancy was independently associated with a reduced risk of depressive symptoms in adolescents. Maternal intake of total fat, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol during pregnancy was not significantly related to depressive symptoms in adolescents. Higher maternal intake of saturated fatty acids during pregnancy may be inversely associated with adolescent depressive symptoms.

Dietary Intake of Nutrients Involved in Serotonin and Melatonin Synthesis and Prenatal Maternal Sleep Quality and Affective Symptoms

Poor sleep quality and psychological distress in pregnancy are important health concerns. Serotonin and melatonin levels may underlie variation in these adverse outcomes. In this study, we examined dietary nutrients involved in serotonin and melatonin synthesis in relation to maternal sleep quality and affective symptoms during pregnancy. Pregnant women at no greater than normal medical risk at enrollment completed 24-hour dietary recalls in mid-late pregnancy. Usual intakes of vitamin B6, vitamin D, eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), and tryptophan were estimated from dietary intake of foods and supplements using the National Cancer Institute (NCI) method. Sleep quality, depression, and anxiety were measured using validated questionnaires. Associations between nutrient intakes, sleep quality, and affective symptoms were estimated using generalized estimating equation models adjusting for potential confounding factors. In minimally adjusted models, EPA + DHA and tryptophan intakes were associated with a lower score indicating better sleep quality (b: -1.07, 95% CI: -2.09, -0.05) and (b: -12.40, 95% CI: -24.60, -0.21), respectively. EPA + DHA and tryptophan intakes were also associated with a lower odds of shorter sleep duration and sleep disturbances. In addition, tryptophan was associated with a lower odds of higher sleep latency. However, associations were attenuated and nonsignificant after adjustment for demographic and lifestyle factors. In conclusion, intakes of EPA + DHA and tryptophan were associated with improved sleep quality, but these associations were confounded by maternal demographic and lifestyle characteristics. This study highlights the need to consider dietary intake and pregnancy health in the context of demographic characteristics and lifestyle behaviors.

Association of Pregnant Women's Perinatal Depression with Sociodemographic, Anthropometric and Lifestyle Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study

Background: In recent decades, the incidence of depression has gradually increased in the general population globally. Depression is also common during gestation and could result in detrimental gestational complications for both the mother and the fetus. The survey presented aimed to evaluate whether pregnant women's perinatal depression could be associated with socio-demographic, anthropometry and lifestyle factors, and perinatal and postnatal outcomes. Methods: This is a cross-sectional survey conducted on 5314 pregnant women. Socio-demographic and lifestyle factors were recorded by relevant questionnaires via face-to-face interviews. Anthropometric parameters were measured by qualified personnel. Perinatal depressive symptomatology status was evaluated by Beck's Depression Inventory (BDI-II) questionnaire. Results: Depressive symptoms throughout gestation were found in 35.1% of the enrolled women. Perinatal depression was significantly associated with lower educational and economic level, pre-pregnancy regular smoking and reduced levels of Mediterranean diet adherence levels, a higher prevalence of gestational diabetes and preterm birth, as well as a higher incidence of delivering by caesarean section and abnormal childbirth weight. Perinatal depression was also significantly associated with a higher prevalence of maternal postpartum depression and lower prevalence of exclusive breastfeeding practices, as well as with a higher incidence of childhood asthma. Conclusions: Pregnant women's perinatal depression appears to be associated with various socio-demographic, anthropometry, and lifestyle characteristics and with a higher frequency of several adverse pregnancy complications. The present findings emphasize the importance of pregnant women's perinatal mental health, highlighting the need to develop and apply public strategies and policies for psychological counseling and support of future mothers to minimize probable risk factors that may trigger perinatal depression. Novel well-organized, follow-up surveys of enhanced validity are highly recommended to establish more definitive conclusions.

Nut consumption during pregnancy is associated with decreased risk of peer problems in 5-year-old Japanese children

OBJECTIVES

Nuts are nutrient-dense foods rich in unsaturated fatty acids, protein, dietary fiber, vitamins, and minerals. The present prebirth cohort study examined the association between maternal nut intake during pregnancy and the risk of childhood behavioral problems in 5-year-old Japanese children.

METHODS

Study subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent-reported version of the Strengths and Difficulties Questionnaire. Adjustments were made for a priori-selected nondietary confounders and potentially related dietary factors.

RESULTS

Compared with mothers who had not eaten nuts during pregnancy, mothers who had eaten nuts had a significantly reduced risk of peer problems in children; the adjusted odds ratio was 0.64 (95% confidence interval: 0.42-0.97). There were no measurable associations between maternal consumption of nuts during pregnancy and the risk of childhood emotional problems, conduct problems, hyperactivity problems, and low prosocial behavior.

CONCLUSIONS

Maternal consumption of nuts during pregnancy may be associated with a decreased risk of peer problems in 5-year-old children.

Association between Western Dietary Patterns, Typical Food Groups, and Behavioral Health Disorders: An Updated Systematic Review and Meta-Analysis of Observational Studies

Western dietary patterns (WDP) and typical food groups may play a major role in the risk of behavioral health disorders. Nevertheless, the relationships between WDP, common food categories, and mental health disorders lack consistency and remain incompletely understood in relation to potential mechanisms. Therefore, the objective of the present study was conducted to synthesize available evidence linking WDP and typical food groups to these outcomes. Web of Science, PubMed, EMBASE, and MEDLINE were searched up to August 2023. Random effect meta-analyses were performed to obtain pooled odds ratio and the relative risk for the prevalence of outcomes and the incidence of outcomes, respectively. A total of 54 articles were included. WDP was associated with increased risk of both depression (1.19; 95% CI: 1.06-1.32) and depressive symptoms (1.20; 95% CI: 1.08-1.34). Except for high-fat dairy products, food groups are associated with an increased risk of anxiety, depression, and depressive symptoms. This review presents evidence to further understand the relationship between WDP, typical food groups, and the incidence of behavioral health disorders, and more randomized controlled trials and cohort studies are urgently required to confirm these findings and elucidate potential mechanisms.

Association between dietary intake and symptoms of depression and anxiety in pregnant women: Evidence from a community-based observational study

Dietary intake is considered as a crucial factor affecting mental health symptoms, particularly depression and anxiety symptoms, especially in the case of pregnant women. This study explored the role of dietary intake in depression and anxiety symptoms of pregnant women and provided evidence for primary care interventions. We enrolled 806 pregnant women in their third trimester from 14 communities in Hengyang City, Hunan Province, China, from July 2019 to September 2019. The Chinese version of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder questionnaire-7 (GAD-7) were used to assess depression and anxiety symptoms. Dietary intake, demographic characteristics, BMI, and pregnancy characteristics were collected using a self-designed, structural questionnaire. A covariate-adjusted logistic regression was conducted to examine the relationship between mental health symptoms and dietary intake. The prevalence of anxiety and depression symptoms in our population were 7.7% (95% CI: 5.9%-9.5%) and 9.2% (95% CI: 7.2%-11.2%), respectively. Women consuming eggs and egg products once a week (OR: 3.688, 95% CI: 1.476-9.215) were more likely to have depression symptom than consumed eggs and egg products once or more per day. Consuming green leafy vegetable <2-3 times per month had a significantly greater risk for depression symptoms than consuming the same once or more per day (OR: 3.450, 95% CI: 1.145-10.393). Women who consumed eggs and egg products 2-3 times a week had an increased likelihood of experiencing anxiety symptoms (OR: 2.253, 95% CI: 1.049-4.837). Anxiety symptoms in women consuming green leafy vegetables <2-3 times per month probably increased by 3.988 times (95% CI: 1.327-11.985) compared with women consuming the same once or more per day. Consuming salted and smoked food <2-3 times per month was protective against anxiety symptoms (OR: 0.181, 95% CI: 0.040-0.828) than consuming the same every day. Implementing interventions to promote healthy dietary among pregnant women is crucial due to its association with mental health. However, future researches are warranted to confirm the reliability and causal association obtained in this study.

Pre- and postnatal maternal hair dye use and risk of wheeze and asthma in 5-year-old Japanese children: the Kyushu Okinawa Maternal and Child Health Study

The present study investigated the association between pre- and postnatal maternal hair dye use and the risk of wheeze and asthma in Japanese children aged 5 years. Study participants were 1199 mother-child pairs. Information on the variables under study was obtained using repeated questionnaires completed by parents. Prenatal maternal hair dye use was associated with an increased risk of current wheeze and ever doctor-diagnosed asthma; the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) were 1.44 (1.02-2.02) and 1.51 (1.00-2.25), respectively. Postnatal maternal hair dye use was related to the risk of doctor-diagnosed asthma; the adjusted OR (95% CI) was 1.58 (1.03-2.40). Children who were exposed to maternal hair dye use both prenatally and postnatally had an increased risk of childhood current wheeze and ever doctor-diagnosed asthma; the adjusted ORs (95% CIs) were 1.59 (1.03-2.42) and 1.76 (1.06-2.88), respectively. Our findings suggest that perinatal maternal hair dye use is associated with the risk of wheeze and asthma in children.

Effects of Varied Omega-3 Fatty Acid Supplementation on Postpartum Mental Health and the Association between Prenatal Erythrocyte Omega-3 Fatty Acid Levels and Postpartum Mental Health

We investigated the postpartum mental health of women who had consumed perilla oil or fish oil containing various omega-3 fatty acids for 12 weeks starting in mid-pregnancy. The association between fatty acids in maternal erythrocytes and mental health risk factors was also examined. Healthy Japanese primiparas in mid-pregnancy (gestational weeks 18-25) were randomly divided into two groups and consumed approximately 2.0 g/day of omega-3 fatty acids in either perilla oil (the ALA dose was 2.4 g/day) or fish oil (the EPA + DHA dose was 1.7 g/day) for 12 weeks. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS) as the primary measure and the Mother-to-Infant Bonding Scale (MIBS) as the secondary measure. Data from an observational study were used as a historical control. Maternal blood, cord blood, and colostrum samples were collected for fatty acid composition analysis. In addition, completers of the observational studies were enrolled in a case-control study, wherein logistic regression analysis was performed to examine the association between maternal fatty acids and EPDS score. The proportion of participants with a high EPDS score (≥9) was significantly lower in the perilla oil group (12.0%, p = 0.044) but not in the fish oil group (22.3%, p = 0.882) compared with the historical control (21.6%), while the proportions between the former groups also tended to be lower (p = 0.059). No marked effect of omega-3 fatty acid intake was observed from the MIBS results. In the case-control study of the historical control, high levels of α-linolenic acid in maternal erythrocytes were associated with an EPDS score of <9 (odds ratio of 0.23, 95% confidence interval: 0.06, 0.84, p = 0.018 for trend). The results of this study suggest that consumption of α-linolenic acid during pregnancy may stabilize postpartum mental health.

Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence

Postpartum depression, with a prevalence ranging between 14% and 25% worldwide, has been considered an urgent health concern that negatively affects both mothers' and their infants' health. Postpartum depression may negatively affect maternal sociodemographic and anthropometric parameters and lifestyle factors. Nutrition has recently been identified as a crucial factor for the management and co-treatment of postpartum depression. This survey aims to determine the possible association of postpartum depression with mothers' socio-demographic and anthropometric characteristics, perinatal outcomes, breastfeeding practices, and Mediterranean diet (MD) adherence.

METHODS

This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data.

RESULTS

Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors.

CONCLUSIONS

This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.

What Is the Evidence for Dietary-Induced DHA Deficiency in Human Brains?

Docosahexaenoic acid (DHA) is a major constituent of neural and visual membranes and is required for optimal neural and visual function. DHA is derived from food or by endogenous synthesis from α-linolenic acid (ALA), an essential fatty acid. Low blood levels of DHA in some westernised populations have led to speculations that child development disorders and various neurological conditions are associated with sub-optimal neural DHA levels, a proposition which has been supported by the supplement industry. This review searched for evidence of deficiency of DHA in human populations, based on elevated levels of the biochemical marker of n-3 deficiency, docosapentaenoic acid (22:5n-6). Three scenarios/situations were identified for the insufficient supply of DHA, namely in the brain of new-born infants fed with high-linoleic acid (LA), low-ALA formulas, in cord blood of women at birth who were vegetarians and in the milk of women from North Sudan. Twenty post-mortem brain studies from the developed world from adults with various neurological disorders revealed no evidence of raised levels of 22:5n-6, even in the samples with reduced DHA levels compared with control subjects. Human populations most likely at risk of n-3 deficiency are new-born and weanling infants, children and adolescents in areas of dryland agriculture, in famines, or are refugees, however, these populations have rarely been studied. This is an important topic for future research.

Maternal Consumption of Dairy Products during Pregnancy Is Associated with Decreased Risk of Emotional Problems in 5-Year-Olds: The Kyushu Okinawa Maternal and Child Health Study

Milk is a good source of fats, minerals, and vitamins. The present prebirth cohort study examined the association between maternal dairy product intake during pregnancy and the risk of childhood behavioral problems in 5-year-old Japanese children. Study subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent-reported version of the Strengths and Difficulties Questionnaire. Adjustments were made for a priori selected non-dietary confounders and potentially related dietary factors. A significant inverse exposure-response association was observed between maternal total dairy intake during pregnancy and the risk of childhood emotional problems (adjusted odds ratio [OR] between extreme quartiles, 0.62; 95% confidence interval [CI]: 0.36-1.03, p for trend, 0.04). The greater maternal consumption of cow's milk, but not yogurt or cheese, during pregnancy was independently related to a reduced risk of emotional problems in children (adjusted OR between extreme quartiles, 0.41; 95% CI: 0.23-0.70, p for trend, 0.003). Higher maternal consumption levels of total dairy products, especially cow's milk, during pregnancy may be associated with a decreased risk of emotional problems in 5-year-old children.

Tryptophan intake is related to a lower prevalence of depressive symptoms during pregnancy in Japan: baseline data from the Kyushu Okinawa Maternal and Child Health Study

OBJECTIVE

Tryptophan is an essential amino acid wholly derived from diet. While the majority of tryptophan is degraded through the kynurenine pathway into neuroactive metabolites like quinolinic acid and kynurenic acid, a small proportion of ingested tryptophan is metabolized into the neurotransmitter serotonin. The current cross-sectional study in Japan examined the association between tryptophan intake and depressive symptoms during pregnancy.

METHODS

Study subjects were 1744 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined as a score ≥ 16 on the Center for Epidemiologic Studies Depression Scale. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure at home and at work, employment, household income, education, body mass index, and intake of saturated fatty acids, eicosapentaenoic acid plus docosahexaenoic acid, calcium, vitamin D, and isoflavones.

RESULTS

The prevalence of depressive symptoms during pregnancy was 19.2%. After adjustment for confounding factors, higher tryptophan intake was independently inversely associated with the prevalence of depressive symptoms during pregnancy: the adjusted prevalence ratios (95% confidence intervals) for depressive symptoms during pregnancy in the first, second, third, and fourth quartiles of tryptophan intake were 1 (reference), 0.99 (0.76-1.28), 0.94 (0.71-1.25), and 0.64 (0.44-0.93), respectively (p for trend = 0.04).

CONCLUSIONS

Higher estimated tryptophan intake was cross-sectionally independently associated with a lower prevalence of depressive symptoms during pregnancy in Japanese women.

Perinatal maternal depressive symptoms and risk of behavioral problems at five years

BACKGROUND

Evidence on the association between perinatal maternal depression and children's behavioral development is limited. We investigated the association between maternal depressive symptoms during pregnancy and postpartum and the risk of childhood behavioral problems using data from a birth cohort study.

METHODS

Study subjects were 1199 mother-child pairs. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale during pregnancy and the Edinburgh Postnatal Depression Scale at 4 months postpartum. Children's behavioral development at 5 years of age was assessed with the Strengths and Difficulties Questionnaire.

RESULTS

Compared with children whose mothers did not experience depressive symptoms during pregnancy, those whose mothers did experience depressive symptoms during pregnancy had increased risk of emotional symptoms, conduct problems, hyperactivity, peer problems, and low prosocial behavior. Maternal depressive symptoms at around 4 months postpartum were associated with increased risk of childhood emotional problems. Compared with children whose mothers did not experience depressive symptoms during the perinatal period, those whose mothers did experience depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

CONCLUSIONS

Our findings suggest that perinatal maternal depression is associated with behavioral problems in children.

IMPACT

Several epidemiological studies in Western countries have examined the association between perinatal maternal depression and children's behavioral development, yet the results are conflicting and inconclusive. There is limited evidence on this topic in Asia. In our study using data from a prospective pregnancy birth cohort, maternal depressive symptoms around 4 months postpartum were associated with an increased risk of emotional symptoms in children aged 5 years. Children whose mothers had exhibited depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

The Longevity Improvement & Fair Evidence (LIFE) Study: Overview of the Study Design and Baseline Participant Profile

BACKGROUND

The Longevity Improvement & Fair Evidence (LIFE) Study, which was launched in 2019, is a multi-region community-based database project that aims to generate evidence toward extending healthy life expectancy and reducing health disparities in Japan. Herein, we describe the LIFE Study's design and baseline participant profile.

METHODS

Municipalities participating in the LIFE Study provide data from government-administered health insurance enrollees and public assistance recipients. These participants cover all disease types and age groups. Centered on healthcare claims data, the project also collects long-term care claims data, health checkup data, vaccination records, residence-related information, and income-related information. The different data types are converted into a common data model containing five modules (health care, long-term care, health checkup, socioeconomic status, and health services). We calculated the descriptive statistics of participants at baseline in 2018.

RESULTS

The LIFE Study currently stores data from 1,420,437 residents of 18 municipalities. The health care module contains 1,280,756 participants (mean age: 65.2 years), the long-term care module contains 189,069 participants (mean age: 84.3 years), and the health checkup module contains 274,375 participants (mean age: 69.0 years). Although coverage and follow-up rates were lower among younger persons, the health care module includes 74,151 children (0-19 years), 273,157 working-age adults (20-59 years), and 933,448 older persons (≥60 years).

CONCLUSION

The LIFE Study provides data from over 1 million participants and can facilitate a wide variety of life-course research and cohort studies. This project is expected to be a useful platform for generating real-world evidence from Japan.

Relationship between the combination of polyunsaturated fatty acids intake and psychological distress during pregnancy: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

No studies have examined the association of the combination of n-3 polyunsaturated fatty acids (PUFAs) and n-6 PUFAs intake with psychological distress during pregnancy. To examine these associations, we divided Japanese pregnant women into 25 groups based on combining quintiles of n-3 PUFAs intake and quintiles of n-6 PUFAs intake. We conducted multivariable logistic regression analyses to assess the risk of psychological distress during pregnancy (Kessler Psychological Distress Scale ≥ 5 or 13). Compared to the third quintile of both n-3 PUFAs and n-6 PUFAs intake, the groups with unbalanced intake, high intake of both, and low intake of both were associated with a higher risk of both Kessler Psychological Distress Scale ≥ 5 and 13 in early and mid-pregnancy. Further research is needed to identify the precise combination of n-3 PUFAs and n-6 PUFAs intake associated with the lowest psychological distress during pregnancy.

Maternal Nutritional Status and Development of Atopic Dermatitis in Their Offspring

Atopic dermatitis (AD) is the leading chronic skin inflammatory disease and the initial manifestation of atopic march. Available evidence supports the notion that primary prevention early in life leads to a decreased incidence of AD, thus possibly decreasing the subsequent occurrence of atopic march. Nutritional status is essential to a proper functioning immune system and is valued for its important role in AD. Essential nutrients, which include carbohydrates, proteins, lipids, vitamins, and minerals, are transferred from the mother to the fetus through the placenta during gestation. Various nutrients, such as polyunsaturated fatty acids (PUFAs) and vitamin D, were studied in relation to maternal status and offspring allergy. However, no strong evidence indicates that a single nutrient or food in mothers' diet significantly affects the risk of childhood AD. In the light of current evidence, mothers should not either increase nor avoid consuming these nutrients to prevent or ameliorate allergic diseases in their offspring. Each essential nutrient has an important role in fetal development, and current government recommendations suggest specific intake amounts for pregnant women. This review discusses evidence on how various nutrients, including lipids (monounsaturated fatty acids, PUFAs, saturated fatty acids, and short-chain fatty acids), carbohydrates (oligosaccharides and polysaccharides), proteins, vitamins (A, B, C, D, and E), and trace minerals (magnesium, iron, zinc, copper, selenium, and strontium) in maternal status are associated with the development of AD and their possible mechanisms.

Red and White Meat Intake in Relation to Mental Disorders in Iranian Adults

Background: The association between meat consumption and mental disorders is less investigated in Iranian population. We examined the association between meat consumption and prevalence of symptoms of depression, anxiety, and psychological distress in Iranian adults. Methods: This cross-sectional study included 3,362 participants aged 18-55 years old. A dish-based 106-item semiquantitative food frequency questionnaire (FFQ) was used to assess usual dietary intake of study population. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), all validated in Iranian population, were applied to collect data on symptoms of anxiety, depression, and psychological distress, respectively. Results: The prevalence of symptoms of depression, anxiety, and psychological distress in the study population was 28.6, 13.6, and 22.6%, respectively. After considering potential confounders, individuals in the top quartile of red meat intake had 43% increased risk of depression symptoms [odds ratio (OR) = 1.43; 95% CI: 1.09-1.89] compared to those in the first quartile. No significant relation was observed between red meat intake and anxiety or psychological distress symptoms. White meat consumption was not associated with mental disorders. Stratified analysis by sex showed that male participants in the highest quartile of red meat intake had 92% greater risk of depression symptoms (95% CI: 1.17-3.15) than those individuals in the lowest category. Red and white meat intake was not associated with mental disorders in women. In overweight or obese individuals, despite lack of any association between red meat intake and mental disorders, high intake of white meat was associated with a lower odds of psychological distress symptoms (OR = 0.64; 95% CI: 0.42-0.99) and a lower risk of depression symptoms (OR = 0.68; 95% CI: 0.45-1.00). In normal-weight participants, those in the highest quartile of red meat intake had greater odds for depression symptoms than those in the lowest quartile (OR = 1.66; 95% CI: 1.14-2.42). Conclusions: We found that red meat consumption was associated with increased risk of depression symptoms, especially in men, and normal-weight participants. In overweight or obese participants, white meat intake was inversely associated with psychological distress symptoms.

Associations of maternal stress and/or depressive symptoms with diet quality during pregnancy: a narrative review

BACKGROUND

Pregnancy can be a stressful time for many women; however, it is unclear if higher stress and depressive symptoms are associated with poorer diet quality during pregnancy.

OBJECTIVE

The aims for this narrative review were to (1) synthesize findings of original, peer-reviewed studies that examined associations of stress and/or depressive symptoms with diet quality during pregnancy; (2) review the measurement tools used to assess stress, depressive symptoms, and diet quality; (3) identify current gaps in the extant literature; and (4) offer recommendations for future research.

METHODS

A search strategy was used to identify peer-reviewed manuscripts published between January 1997 and October 2018, using the following databases: PubMed, CINAHL Complete, PsycINFO, Academic Search Complete, and Psychology & Behavioral Sciences Collection. The search was updated December 2019. Two reviewers independently assessed title, abstract, and full-text of the studies that met the inclusion criteria. Data were extracted and a quality assessment was conducted.

RESULTS

Twenty-seven observational studies were identified in this review (21 cross-sectional and 6 longitudinal). In 22 studies, higher stress and/or depressive symptoms were associated with poorer diet quality or unhealthy dietary patterns; 5 studies found no association. Findings are mixed and inconclusive regarding the relationship among stress, depressive symptoms, and food groups related to diet quality and frequency of fast-food consumption.

CONCLUSIONS

The current data suggest stress and depressive symptoms may be a barrier to proper diet quality during pregnancy; however, variability in the assessment tools, timing of assessments, and use of covariates likely contribute to the inconsistency in study findings. Gaps in the literature include limited use of longitudinal study designs, limited use of comprehensive diet-quality indices, underrepresentation of minority women, and lack of multilevel theoretical frameworks. Studies should address these factors to better assess associations of stress and/or depressive symptoms with diet quality during pregnancy.

Maternal metal intake during pregnancy and childhood behavioral problems in Japan: the Kyushu Okinawa Maternal and Child Health Study

OBJECTIVES

Lower maternal metal intake during pregnancy might affect childhood development. The current prebirth cohort study investigated the relationship between maternal intake of zinc, magnesium, iron, copper, and manganese during pregnancy and behavioral problems in Japanese children aged five years.

METHODS

Subjects were 1199 mother-child pairs. Dietary intake during the preceding month was assessed using a diet history questionnaire. Emotional, conduct, hyperactivity, and peer problems and low prosocial behavior were assessed using the Strengths and Difficulties Questionnaire. Maternal age, gestation at baseline, region of residence, number of children, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, smoking in the household during the first year of life, and some dietary confounders that were associated with outcomes under study in this population were adjusted for.

RESULTS

Compared with maternal magnesium intake during pregnancy in the first quartile, magnesium intake in the second, third, and fourth quartiles was independently inversely related to childhood hyperactivity problems, but not to emotional, conduct, or peer problems or low prosocial behavior: the adjusted odds ratio between extreme quartiles was 0.48 (95% confidence interval: 0.23-0.99, P for trend = 0.04). No evident associations were observed between maternal intake of zinc, iron, copper, or manganese during pregnancy and childhood emotional, conduct, hyperactivity, or peer problems or low prosocial behavior.

CONCLUSIONS

The present study suggests that higher maternal magnesium intake during pregnancy is inversely associated with hyperactivity problems in Japanese children.

Cesarean section is associated with increased risk of postpartum depressive symptoms in Japan: the Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

The association between cesarean section and the risk of postpartum depressive symptoms remains controversial. The present prebirth cohort study examined this issue in Japan.

METHODS

Study subjects were 1310 women. Information under study was obtained using a self-administered questionnaire. Postpartum depressive symptoms were defined as a total Edinburgh Postnatal Depression Scale score of nine or higher between three and four months postpartum. Multivariate logistic regression analysis was used to adjust for age, body mass index, gestational weeks at baseline, gestational weeks at delivery, number of children at baseline, previous miscarriage or stillbirth, previous abortion, history of depression, family history of depression, region of residence, employment status, educational level, household income, family structure, breastfeeding status, smoking during pregnancy, infant's birthweight, and infant's sex.

RESULTS

Postpartum depressive symptoms were identified in 8.2%. After adjustment for the confounding factors, compared with vaginal delivery, cesarean section was independently associated with an increased risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 1.95 (95% confidence interval [CI]: 1.16-3.23). This positive association was more apparent among those who had no other children at baseline than among those who already had one or more children: the adjusted ORs were 2.94 (95% CI: 1.35-6.26) and 1.45 (95% CI: 0.68-2.92), respectively; however, this interaction was not significant.

LIMITATIONS

Information on whether each cesarean section was emergency or elective and other obstetric complications was not available.

CONCLUSIONS

Cesarean section may be associated with an increased risk of postpartum depressive symptoms, especially among women without children at baseline.

Changes in Dietary Intake in Pregnant Women from Periconception to Pregnancy in the Japan Environment and Children's Study: A Nationwide Japanese Birth Cohort Study

BACKGROUND

Nutritional requirements increase during pregnancy. However, relatively few studies have examined longitudinal changes in dietary intake from periconception to pregnancy. Here, we investigated changes in the intake of food and nutrients, and compliance with dietary reference intakes (DRIs) in pregnant women.

METHODS

The Japan Environment and Children's Study, a nationwide multicenter prospective cohort study, included 30,373 pregnant women who answered a validated food frequency questionnaire repeatedly to assess changes in dietary intake in periconception and pregnancy. Energy-adjusted intakes of food groups and nutrients were described using the density method. The percentage of women not meeting DRIs was calculated.

RESULTS

Of all foods groups examined, intake of food significantly increased from periconception to pregnancy for dairy products (mean difference 23.5 g/1000 kcal, 95% confidence interval [CI] 22.0-25.0 g/1000 kcal), confectionaries (2.0 g/1000 kcal, 1.8-2.2 g/1000 kcal), and soft drinks (1.3 g/1000 kcal, 0.3-2.3 g/1000 kcal). Of all nutrients examined, intake was significantly increased for calcium (mean difference 27 mg/1000 kcal, 95% CI 25-29 mg/1000 kcal), vitamin A (15 μgRE/1000 kcal, 13-18 g/1000 kcal), and saturated fat (0.4% energy, 0.4-0.4% energy). The percentage of women not meeting DRIs increased for vitamin B group, vitamin C, saturated fat and salt.

CONCLUSION

We found that energy-adjusted intakes of calcium, vitamin A, and saturated fat increased from periconception to pregnancy, while intake of other nutrients did not increase. The percentage of women not meeting DRIs increased for water-soluble vitamins, saturated fat, and salt.

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.

Intake of fish and long-chain n-3 polyunsaturated fatty acids and risk of diseases in a Japanese population: a narrative review

Since the 1970s, the potential benefit of fish intake in terms of noncommunicable diseases has been one of the most important themes in disease prevention. Epidemiological studies have revealed the extent to which fish consumption affects the incidence of and mortality from diseases. Meta-analyses summarized the effect of fish and long-chain n-3 polyunsaturated fatty acid intake on noncommunicable diseases, especially cardiovascular diseases in Western countries. However, few reviews have spotlighted the effect of fish intake in East-Asian countries that have high population levels of fish intake such as Japan. We narratively reviewed the epidemiological studies concerned with the associations of fish and long-chain n-3 polyunsaturated fatty acid intake with risk of noncommunicable diseases, mainly of cardiovascular disease, among Japanese, whose fish intake has been twice or more than that of most Westerners. Overall, fish or long-chain n-3 polyunsaturated fatty acid intake may be beneficial for prevention of noncommunicable diseases, especially coronary heart disease and heart failure in Japanese as well as in Westerners. However, the beneficial effects of their intakes seemed to be nonlinear and varied according to disease severity and culture. Studies on other noncommunicable disease were also narratively reviewed.

BAIAP2 rs8079781, postnatal smoking exposure, and emotional problems in Japanese children aged 5 years: the Kyushu Okinawa Maternal and Child Health Study

BAIAP2 might be implicated in neurodevelopmental and psychiatric conditions via abnormal development of human cerebral asymmetry. The present prebirth cohort study examined the relationship between BAIAP2 single nucleotide polymorphism (SNP) rs8079781 and the risk of behavioral problems in Japanese children aged 5 years. Subjects were 1175 mother-child pairs. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Compared with the CC genotype of SNP rs8079781, at least one T allele was significantly inversely related to childhood emotional problems: the adjusted OR was 0.68 (95% CI 0.46-0.998, P = 0.049). Nevertheless, this significant inverse association disappeared after adjustment for multiple comparisons (adjusted P = 0.245). No associations were observed between SNP rs8079781 and childhood conduct problems, hyperactivity problems, peer problems, or low prosocial behavior. An independent positive relationship was observed between smoking in the household during the first year of life and emotional problems in children with the CC genotype, but not in those with at least one T allele (P for interaction = 0.04). This study is the first to show that at least one T allele of SNP rs8079781 was independently associated with a reduced risk of emotional problems in children aged 5 years, but this inverse association fell below significance after adjustment for multiple comparisons. The influence of smoking in the household during the first year of life might rely on rs8079781.

A Pilot Study of the Relationship between Diet and Mental Health in Community Dwelling Japanese Women

Background and Objectives: Diet is closely linked to mental health. The aim of this study was to explore the link between diet and mental health in community dwelling Japanese women. Materials and Methods: A total of 89 community dwelling Japanese women, aged 66.8 ± 7.6 years, were enrolled in this cross-sectional study. Diet surveys were evaluated using the brief-type self-administered diet history questionnaire (BDHQ) and mental health was evaluated using the general health questionnaire-12 (GHQ) and clinical parameters. Results: The mean energy intake was 1806 ± 570 kcal and the GHQ score was 1.0 ± 1.4. Among nutrients, the n-6/n-3 fatty acid ratio was significantly correlated with the GHQ score (r = 0.269, p = 0.011), and some micronutrients and vitamins were weakly or negatively correlated with the GHQ score. Among the food groups, fish and shellfish were negatively correlated with the GHQ scores. Multiple regression analysis demonstrated that the n-6/n-3 fatty acid ratio was the determinant factor for the GHQ score, even after adjusting for confounding factors. Conclusions: These results suggest that a proper diet to reduce the n-6/n-3 fatty acid ratio may improve mental health in community dwelling Japanese women.

Association of recommended food score with depression, anxiety, and quality of life in Korean adults: the 2014-2015 National Fitness Award Project

BACKGROUND

A healthy diet is a key determinant of an individual's health status and is closely related to mental health and quality of life (QoL); however, the exact nature of the relationship is unknown. This study hypothesized that a higher diet quality score is associated with a lower observance of symptoms of depression and anxiety and a higher QoL.

METHODS

This study evaluated 1,295 adults (521 men; 774 women) aged 19-64 years, who participated in the 2014-2015 National Fitness Award Project. Diet quality was measured by the recommended food score (RFS), and mental health and QoL were assessed by the beck depression inventory (BDI), beck anxiety inventory (BAI), and the World Health Organization QoL-Brief (WHOQoL-BREF).

RESULTS

After adjusting for covariates, the individuals with depression had a significantly lower RFS value compared to those without depression, and the group with a QoL score above the median had a higher RFS value than the group with a QoL score below the median. These trends occurred in both men and women. Subjects in the highest tertile of RFS showed a lower odds of depression (OR = 0.51, 95% CI = 0.32-0.81, p-trend = 0.0043) and a QoL score below the median (OR = 0.40, 95% CI = 0.30-0.54, p-trend < 0.0001) compared with those in the lowest tertile. The RFS was not associated with anxiety.

CONCLUSIONS

Our data suggest that higher diet quality may be associated with lower depressive symptoms and a better QoL in Korean adults.

Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation

BACKGROUND

Women are vulnerable to depression during their childbearing years, and giving birth to a child precipitates postpartum depression (PPD) in some women. This review focuses on comparing the effectiveness of omega-3 polyunsaturated fatty acid supplementation on depression during pregnancy or PPD after childbirth.

METHODS

MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials etc. through July 2017 were searched. Studies of dietary intake and plasma and/or milk levels of omega-3 fatty acids and trials of benefits and effects of omega-3 fatty acids supplements on pregnant or postpartum women with depression were specifically selected.

RESULTS

Omega-3 fatty acid deficiency, due to inadequate intake, fast depletion during pregnancy and lactation, is one of the risk factors of PPD. Associations between neuroinflammation (elevated pro-inflammatory cytokines) and aberrant neurotransmission (low serotonergic transmission activity) and risk of PPD have also been reported by numerous studies. Supplementation with eicosapentaenoic acid (EPA)-rich oil can effectively reduce depression during pregnancy and PPD after childbirth. Long term treatment with docosahexaenoic acid (DHA)-rich oil can be effective in reducing the risk of PPD in healthy women, but not in lactating women. Supplementation of DHA-rich oil to women begun at pregnancy and continued after childbirth exerts no beneficial effect on depression.

CONCLUSIONS

Dietary supplementation with omega-3 fatty acids rich in EPA during pregnancy or postpartum reduces some symptoms associated with depression. DHA supplementation to healthy pregnant women can also reduce the risk of PPD.

The IL18 Promoter Polymorphism, rs1946518, Is Associated with the Risk of Periodontitis in Japanese Women: The Kyushu Okinawa Maternal and Child Health Study

Interleukin-18 (IL-18) is a proinflammatory cytokine that plays an important role in periodontitis and its polymorphisms might modulate the individual susceptibility to periodontitis. Only a limited number of studies on the association between IL18 single-nucleotide polymorphisms (SNPs) and the risk of periodontitis have been realized, however. The aim of this case-control study among young post-partum Japanese women (18 to 45 years) was to determine the impact of SNPs, rs1946518 (-607 C/A) and rs187238 (-137G/C), on periodontitis. The two SNPs may be located within a transcription factor-binding element, thereby influencing transcription from the IL18 promoter. Subjects were 131 cases who had at least one tooth with a probing pocket depth of ≥ 4.0 mm and 1,017 periodontally healthy controls. Probing pocket depth measurements were performed between 1 and 12 months post-partum. In this population, the A allele of rs1946518 and the C allele of rs187238 are more common. After adjustment for age, education, smoking, and use of an interdental brush, compared with subjects with the AA or AC genotype of SNP rs1946518, those with the CC genotype had a significantly reduced risk of periodontitis (adjusted odds ratio = 0.54, 95% confidence interval = 0.29-0.97). No significant association was observed between rs187238 and the risk of periodontitis. Our study did not reveal any evidence of interaction between the IL18 polymorphisms and smoking. Our findings indicate that the IL18 promoter SNP, rs1946518, is a potential risk factor of periodontitis among young Japanese women.

Dietary intake of fish and n-3 polyunsaturated fatty acids and risks of perinatal depression: The Japan Environment and Children's Study (JECS)

The results of several epidemiological studies and clinical trials investigating the effects of n-3 polyunsaturated fatty acids (PUFAs) on antenatal and postnatal depression remain controversial. We investigated the possible association of dietary intake of fish and n-3 PUFAs with the risks of maternal and paternal psychological distress during pregnancy and of maternal postpartum depression in Japan. From a dataset comprising 104,102 maternal registrations and 52,426 paternal registrations in The Japan Environment and Children's Study, this study analyzed complete data on questionnaires for 75,139, 79,346, and 77,661 women during early pregnancy, mid-late pregnancy, and after pregnancy, respectively, and for 41,506 male partners. Multivariable logistic regression showed reduced risk of psychological distress in the second and third quintiles for fish intake in early pregnancy and in the second to fifth quintile in mid-late pregnancy. No reductions were observed for n-3 PUFA intake in early pregnancy but in the second to fourth quintile in mid-late pregnancy. For postpartum depression, reductions were observed in the second to fourth quintile for fish intake but only in the first quintile for n-3 PUFA intake. As for paternal psychological distress, only the fourth quintile for fish intake showed a significant reduced risk but none were shown for n-3 PUFA intake. In conclusion, fish intake was associated with some reduced risk of psychological distress during pregnancy, even for male partners. The associations were weaker for n-3 PUFA intake than for fish intake.

Dietary patterns and depressive symptoms during pregnancy in Japan: Baseline data from the Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

Only one Brazilian study has examined the association between dietary patterns and depressive symptoms during pregnancy. The current cross-sectional study examined this issue in Japan.

METHODS

Study subjects were 1744 pregnant women. Between April 2007 and March 2008, information under study was obtained. Dietary patterns were derived from a factor analysis of 33 predefined food groups based on a self-administered diet history questionnaire. Depressive symptoms were defined as a Center for Epidemiological Studies Depression Scale score ≥ 16. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure, employment, household income, education, and body mass index.

RESULTS

Three dietary patterns were identified: 'healthy', characterized by high intake of green and yellow vegetables, other vegetables, mushrooms, pulses, seaweed, potatoes, fish, sea products, miso soup, sugar, and shellfish; 'Japanese', characterized by high intake of rice and miso soup; and 'Western', characterized by high intake of beef and pork, processed meat, vegetable oil, chicken, eggs, shellfish, and salt-containing seasonings. The healthy and Japanese patterns were independently inversely associated with depressive symptoms during pregnancy: the adjusted prevalence ratios (95% confidence intervals, P for trend) between extreme quartiles were 0.56 (0.43-0.73, < 0.0001) and 0.72 (0.55-0.94, 0.008), respectively. No association was observed between the Western pattern and depressive symptoms during pregnancy.

LIMITATIONS

Information was obtained between the 5th and 39th week of pregnancy.

CONCLUSIONS

The healthy and Japanese dietary patterns may be inversely associated with depressive symptoms during pregnancy.

Is meat consumption associated with depression? A meta-analysis of observational studies

BACKGROUND

A number of epidemiological studies have examined the effect of meat consumption on depression. However, no conclusion has been reached. The aim of this study was to examine the relationship between meat consumption and depression.

METHODS

The electronic databases of PUBMED and EMBASE were searched up to March 2017, for observational studies that examined the relationship between meat consumption and depression. The pooled odds ratio (OR) for the prevalence of depression and the relative risk (RR) for the incidence of depression, as well as their corresponding 95% confidence interval (CI), were calculated respectively (the highest versus the lowest category of meat consumption).

RESULTS

A total of eight observational studies (three cross-sectional, three cohort and two case-control studies) were included in this meta-analysis. Specifically, six studies were related to the prevalence of depression, and the overall multi-variable adjusted OR suggested no significant association between meat consumption and the prevalence of depression (OR = 0.89, 95% CI: 0.65 to 1.22; P = 0.469). In contrast, for the three studies related to the incidence of depression, the overall multi-variable adjusted RR evidenced an association between meat consumption and a moderately higher incidence of depression (RR = 1.13, 95% CI: 1.03 to 1.24; P = 0.013).

CONCLUSIONS

Meat consumption may be associated with a moderately higher risk of depression. However, it still warrants further studies to confirm such findings due to the limited number of prospective studies.

Dietary fish, n-3 polyunsaturated fatty acid consumption, and depression risk in Japan: a population-based prospective cohort study

Systematic review of observational studies has revealed that fish consumption and levels of n-3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid are associated with a reduced risk of depression. A reverse J-shaped effect of n-3 PUFAs was suggested. However, there is limited evidence from populations with high fish consumption and no studies have used a standard psychiatrist-based diagnosis of major depressive disorder (MDD). Therefore, this population-based, prospective study investigated the association of dietary fish, n-3 PUFA, and n-6 PUFA consumption with risk of psychiatrist-diagnosed MDD in Japan. A total of 12 219 subjects were enrolled from the Saku area in 1990. Of these, we extracted 1181 participants aged 63-82 years who completed food frequency questionnaires in both 1995 and 2000 and also underwent a mental health examination in 2014-2015. Odds ratios (ORs) and 95% confidence intervals (CIs) for MDD according to fish intake and PUFA quartiles were calculated. Current MDD was diagnosed in 95 patients. We found a reduced risk of MDD in the third quartile for fish intake (111.1 g per day, OR=0.44, 95% CI=0.23-0.84), second quartile for EPA (307.7 mg per day, OR=0.54, 95% CI=0.30-0.99) and third quartile for docosapentaenoic acid (DPA) (123.1 mg per day, OR=0.42, 95% CI=0.22-0.85). ORs adjusted for cancer, stroke, myocardial infarction and diabetes remained significant for fish and DPA intake. Our results suggest that moderate fish intake could be recommended for the prevention of MDD in aged Japanese individuals.

Food-based diet quality score in relation to depressive symptoms in young and middle-aged Japanese women

Only a few studies have focused on the association between overall diet, rather than intakes of individual nutrients or foods, and depressive symptoms in Japanese. This cross-sectional study examined associations between a diet quality score and depressive symptoms in 3963 young (age 18 years) and 3833 middle-aged (mean age 47·9 (sd 4·2) years) Japanese women. Dietary information was collected using a diet history questionnaire. A previously developed diet quality score was computed mainly based on the Japanese Food Guide Spinning Top. The prevalence of depressive symptoms was 22·0 % for young women and 16·8 % for middle-aged women, assessed as a Center for Epidemiologic Studies Depression (CES-D) score ≥23 and ≥19, respectively. As expected, the diet quality score was associated positively with intakes of ‘grain dishes’, ‘vegetable dishes’, ‘fish and meat dishes’, ‘milk’ and ‘fruits’ and inversely with intakes of energy from ‘snacks, confection and beverages’ and Na from seasonings. After adjustment for potential confounders, OR for depressive symptoms in the highest v. lowest quintiles of the diet quality score was 0·65 (95 % CI 0·50, 0·84) in young women (Pfor trend=0·0005). In middle-aged women, the corresponding value was 0·59 (95 % CI 0·45, 0·78) (Pfor trend<0·0001). Analyses where the diet quality and CES-D scores were treated as continuous variables also showed inverse associations. In conclusion, this cross-sectional study showed that a higher diet quality score was associated with a lower prevalence of depressive symptoms in young and middle-aged Japanese women. Prospective studies are needed to confirm a public health relevance of this finding.

Manganese intake is inversely associated with depressive symptoms during pregnancy in Japan: Baseline data from the Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

One epidemiological study in Canada has addressed the association between zinc intake and depressive symptoms during pregnancy while another epidemiological study in Korea has examined the association between iron intake and depressive symptoms during pregnancy. The present cross-sectional study in Japan examined the association between intake of zinc, magnesium, iron, copper, and manganese and depressive symptoms during pregnancy.

METHODS

Study subjects were 1745 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined as a score ≥16 on the Center for Epidemiologic Studies Depression Scale. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure at home and at work, employment, household income, education, body mass index, and intake of saturated fatty acids, eicosapentaenoic acid plus docosahexaenoic acid, calcium, vitamin D, and isoflavones.

RESULTS

In crude analysis, significant inverse associations were observed between intake levels of zinc, magnesium, iron, copper, and manganese and the prevalence of depressive symptoms during pregnancy. After adjustment for confounding factors, only manganese intake was independently inversely associated with depressive symptoms during pregnancy: the adjusted prevalence ratio between extreme quartiles was 0.74 (95% confidence interval:0.56-0.97, P for trend=0.046).

LIMITATIONS

Information was obtained between the 5th and 39th week of pregnancy.

CONCLUSIONS

The current cross-sectional study of Japanese women demonstrated higher manganese intake to be independently associated with a lower prevalence of depressive symptoms during pregnancy.

The role of diet and nutritional supplementation in perinatal depression: a systematic review

This article presents a systematic literature review on whether dietary intake influences the risk for perinatal depression, i.e. depression during pregnancy or post-partum. Such a link has been hypothesized given that certain nutrients are important in the neurotransmission system and pregnancy depletes essential nutrients. PubMed, EMBASE and CINAHL databases were searched for relevant articles until 30 May 2015. We included peer-reviewed studies of any design that evaluated whether perinatal depression is related to dietary intake, which was defined as adherence to certain diets, food-derived intake of essential nutrients or supplements. We identified 4808 studies, of which 35 fulfilled inclusion criteria: six randomized controlled trials, 12 cohort, one case-control and 16 cross-sectional studies, representing 88 051 distinct subjects. Studies were grouped into four main categories based on the analysis of dietary intake: adherence to dietary patterns (nine studies); full panel of essential nutrients (six studies); specific nutrients (including B vitamins, Vitamin D, calcium and zinc; eight studies); and intake of fish or polyunsaturated fatty acids (PUFAs; 12 studies). While 13 studies, including three PUFA supplementation trials, found no evidence of an association, 22 studies showed protective effects from healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium. Given the methodological limitations of existing studies and inconsistencies in findings across studies, the evidence on whether nutritional factors influence the risk of perinatal depression is still inconclusive. Further longitudinal studies are needed, with robust and consistent measurement of dietary intake and depressive symptoms, ideally starting before pregnancy.

Dietary n-3 Polyunsaturated Fatty Acids in Late Pregnancy and Postpartum Depressive Symptom among Japanese Women

BACKGROUND

The use of n-3 polyunsaturated fatty acids (n-3PUFA) in preventive or therapeutic modalities for postpartum depression, especially long-chain types such as eicosapentaenoic acid (EPA) and a docosahexaenoic acid (DHA), is of considerable interest. High n-3PUFA consumption has been reported among pregnant Japanese women. Therefore, analysis of this group could provide important insights into the relationship between postpartum depression and dietary n-3PUFA consumption. To further examine the relationship between the risk of postpartum depression and n-3PUFA consumption, we conducted a prospective hospital-based birth cohort study in Japan.

DESIGN AND METHODS

Our prospective birth cohort study was performed at the National Center for Child Health and Development (NCCHD) in suburban Tokyo, Japan. Dietary n-3PUFA intake during late pregnancy was assessed by a semi-quantitative food questionnaire and participants were categorized by quintile distributions of n-3PUFA intake. A Japanese translation of the Edinburgh Postnatal Depression Scale was used to screen women for postpartum depression at 1 month after delivery (967 women) and at 6 months after delivery (710 women). We performed logistic regression analysis to examine the relationship between the risk of postpartum depression and n-3PUFA consumption after adjusting for confounding factors.

RESULTS

Significant associations between EPA, DHA, and n-3PUFA intakes in late pregnancy and postpartum depression at both 1 and 6 months after delivery were not observed.

CONCLUSION

This prospective study indicated that EPA, DHA, and n-3PUFA intake during late pregnancy was not associated with the risk of postpartum depression.

Perinatal smoking exposure and behavioral problems in Japanese children aged 5 years: The Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

Epidemiological evidence regarding the relationship between maternal secondhand smoke (SHS) exposure during pregnancy and postnatal SHS exposure and childhood behavioral problems is scarce.

OBJECTIVE

The present prebirth cohort study investigated the association between perinatal smoking exposure and behavioral problems in Japanese children aged 5 years.

METHODS

Subjects were 1200 mother-child pairs. Data on variables under study were obtained using parent questionnaires. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Strengths and Difficulties Questionnaire. Adjustment was made for maternal age, gestation at baseline, region of residence at baseline, number of children at baseline, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, child's birth weight, child's sex, and breastfeeding duration.

RESULTS

Maternal smoking during pregnancy was independently associated with increased risk of conduct problems and hyperactivity problems (adjusted odds ratios: ORs [95% confidence intervals: CIs]=1.93 [1.15-3.17] and 1.89 [1.03-3.33], respectively). Maternal SHS exposure at work during pregnancy was independently positively related to conduct problems and hyperactivity problems (adjusted ORs [95% CI]=1.54 [1.01-2.31] and 1.69 [1.04-2.67], respectively). Smoking by any household member, and especially by the child's father, during the first year of life was independently associated with an increased risk of emotional problems (adjusted ORs [95% CI]=1.55 [1.06-2.26] and 1.63 [1.11-2.40], respectively).

CONCLUSIONS

Maternal smoking and maternal SHS exposure at work during pregnancy may increase the risk of conduct problems and hyperactivity problems. Smoking by any household member, and especially by the child's father, may increase the risk of emotional problems.

Association of serum n-3 polyunsaturated fatty acids with psychological distress in the second and third trimesters of pregnancy: Adjunct Study of Japan Environment and Children's Study

The results of several epidemiological studies and clinical trials investigating the effects of n-3 polyunsaturated fatty acids (PUFAs) on antenatal and postnatal depression remain controversial. In a previous case-control study of early pregnancy in Japan, we found an inverse association between eicosapentaenoic acid and risk of psychological distress after adjusting for possible confounders. Here, in a 1:2 matched case-control study, we further investigated the possible relationship between serum n-3 PUFAs and risk of psychological distress in the second and third trimesters of pregnancy. The psychological distress group (n=71) consisted of subjects with a score of ≥13 on the Kessler Psychological Distress Scale. The control group (n=142) was matched for age, educational level, and family income. Fatty acid composition of total lipid was determined from serum samples by gas chromatography. Associations between fatty acid levels and incidence of psychological distress were evaluated by logistic regression. Sixty-six percent of blood samples were collected in the second trimester and the remainder in the third. There were no significant differences in any of the n-3 PUFAs between the two groups. After adjustment for possible confounders, none of the n-3 PUFAs showed an association with risk of psychological distress. Peripheral n-3 PUFA levels might not influence the risk of psychological distress in later pregnancy. Further research is warranted to clarify this finding.

Soy isoflavone intake and prevalence of depressive symptoms during pregnancy in Japan: baseline data from the Kyushu Okinawa Maternal and Child Health Study

OBJECTIVE

Several observational studies and trials examined the relationship between isoflavones or soybeans and depressive symptoms among peri- and postmenopausal women. We cross-sectionally evaluated the associations between intake of soy products and isoflavones and depressive symptoms during pregnancy in Japan.

METHODS

Study subjects were 1745 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale.

RESULTS

Higher intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones was independently related to a lower prevalence of depressive symptoms during pregnancy: The adjusted prevalence ratios (95 % confidence intervals, P for trend) between extreme quartiles were 0.63 (0.47-0.85, 0.002), 0.72 (0.54-0.96, 0.007), 0.74 (0.56-0.98, 0.04), 0.57 (0.42-0.76, <0.0001), 0.73 (0.55-0.98, 0.03), 0.65 (0.49-0.87, 0.003), and 0.63 (0.46-0.86, 0.002), respectively. A significant positive exposure-response relationship was found between miso intake and depressive symptoms during pregnancy. No material relationship was observed between soymilk intake and depressive symptoms during pregnancy.

CONCLUSIONS

Our study is the first to show independent inverse relationships between intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones and depressive symptoms during pregnancy.

Milk intake during pregnancy is inversely associated with the risk of postpartum depressive symptoms in Japan: the Kyushu Okinawa Maternal and Child Health Study

Only one epidemiologic study has investigated the association between dairy product intake during pregnancy and postpartum depressive symptoms. Epidemiologic evidence on the relationships between calcium and vitamin D intake during pregnancy and postpartum depressive symptoms is also lacking. The present prospective study examined these issues in Japan. Study subjects were 1319 women. During pregnancy, dietary intake during the preceding month was assessed using a self-administered diet history questionnaire in the baseline survey. Postpartum depressive symptoms were defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 9 or higher between 3 and 4 months postpartum. Adjustment was made for age, gestation at baseline, region of residence, number of children, family structure, history of depression, family history of depression, job type, education, body mass index, having smoked during pregnancy, cesarean delivery, baby's sex, baby's birth weight, and total energy intake. After adjustment for the confounding factors, compared with milk intake in the lowest quartile, intake levels in the second and fourth quartiles were independently associated with a reduced risk of postpartum depressive symptoms, although the inverse exposure-response relationship was not significant: the adjusted odds ratio between extreme quartiles was 0.51 (95% confidence interval, 0.28-0.93; P for trend = .12). No material relationships were observed between intake of total dairy products, yogurt, cheese, calcium, or vitamin D and the risk of postpartum depressive symptoms. The present prospective cohort study in Japan suggests that higher milk intake during pregnancy is associated with a reduced risk of postpartum depressive symptoms.

Serum n-3 polyunsaturated fatty acids and psychological distress in early pregnancy: Adjunct Study of Japan Environment and Children's Study

N-3 polyunsaturated fatty acids (PUFAs), especially long-chain types such as docosahexaenoic acid, are important nutrients in pregnancy, but the relationship between n-3 PUFA levels and perinatal and postnatal depression remains controversial. This study examined the possible relationship between serum n-3 PUFA levels and psychological distress among expectant mothers in early pregnancy. Data and specimen samples were obtained in a birth cohort study started at Toyama Regional Center in July 2012 as an adjunct study of the Japan Environment and Children's Study. Blood samples were collected at 9-14 weeks' gestation (75% of samples) or after 15 weeks (25%). Subjects with a Kessler Psychological Distress Scale score (K6) ⩾ 9 were assigned to the psychological distress group (n=283). The control group (n=283) was matched for age, educational level and family income. Fatty acid composition was determined from serum samples by gas chromatography. Associations between fatty acid levels and incident psychological distress were evaluated by logistic regression. After adjusting for possible confounders, eicosapentaenoic acid showed an inverse association with risk of psychological distress, with an odds ratio of 0.47 (95% confidence interval: 0.30, 0.73) for the highest tertile. This inverse association remained even after applying a higher cutoff score (K6 ⩾ 13) indicating severe psychological distress (74 pairs). We believe this is the first study to reveal the associations between serum n-3 PUFAs and risk of psychological distress in early pregnancy. Further research is required to verify the causality of these associations.