Is low folate a risk factor for depression? A meta-analysis and exploration of heterogeneity

Association of serum total folate and serum vitamin D concentrations with W-shape in depressed older adults with cognitive dysfunction: A cross-sectional observational study

BACKGROUND

Depression and cognitive dysfunction are prevalent in the elderly population and have a serious impact on patients' quality of life and social functioning. Nutritional factors play a key role in the prevention and management of these disorders, particularly folate and vitamin D. The aim of this study was to elucidate the association between serum total folate and serum vitamin D concentrations and depressive symptoms and cognitive dysfunction in older adults.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, 2042 participants aged 60 years and older were analyzed. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Animal Fluency test and the Digit Symbol Substitution Test (DSST). Associations between serum total folate and vitamin D concentrations and depression with cognitive dysfunction were analyzed using multivariate logistic regression models, incorporating stratification and sensitivity analyses.

RESULTS

For every 1 nmol/L increase in serum vitamin D concentration, there was a 1 % reduction in the risk of depression in older adults (OR = 0.99 95 % CI 0.98-0.99). Serum total folate showed a significant W-shaped association with depression with cognitive dysfunction: when serum total folate concentration was below 33.00 nmol/L, the risk of depression was reduced by 7.6 % for every 1 nmol/L increase in its concentration (OR = 0.924 95 % CI 0.89-0.959); this association was not significant when the concentration was above 33.00 nmol/L (OR = 1.006 95 % CI 0.998-1.013).

CONCLUSIONS

Adequate levels of vitamin D and folate may help prevent and manage depression and cognitive dysfunction in older adults. The W-shaped association between serum total folate and these conditions suggests that folic acid supplementation could be effective within a specific range, warranting further exploration and validation through clinical studies.

The Role of Water-Soluble Vitamins and Vitamin D in Prevention and Treatment of Depression and Seasonal Affective Disorder in Adults

Depression is a major global health concern expected to worsen by 2030. In 2019, 28 million individuals were affected by depressive disorders. Dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression. B vitamins are crucial for neurological function and mood regulation. Deficiencies in these vitamins are linked to depression. Studies on individual B vitamins show promise in improving depressive symptoms, particularly thiamin, riboflavin, niacin, and folate. Vitamin C deficiency may heighten depressive symptoms, but its exact role is not fully understood. Seasonal Affective Disorder (SAD) is associated with insufficient sunlight exposure and vitamin D deficiency. Vitamin D supplementation for SAD shows inconsistent results due to methodological variations. Further investigation is needed to understand the mechanisms of vitamins in depression treatment. Moreover, more research on SAD and light therapy's efficacy and underlying mechanisms involving photoreceptors, enzymes, and immune markers is needed. Although dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression, dietitians treating psychiatric disorders face challenges due to diverse study designs, making direct comparisons difficult. Therefore, this article reviews the current literature to assess the role of dietary and supplemental vitamins in the prevention and treatment of depression. This review found that, although evidence supports the role of B vitamins and vitamins C and D in preventing and treating depression, further research is needed to clarify their mechanisms of action and determine the most effective intervention strategies.

Folate supplementation as a beneficial add-on treatment in relieving depressive symptoms: A meta-analysis of meta-analyses

The results of meta-analyses investigating the role of folate on depression are conflicting. The aim of this umbrella meta-analysis was to obtain an overall effect and give a concise and resolving conclusion. International scientific databases including PubMed, Scopus, and Web of Science were searched up to Oct 2023. All observational and interventional meta-analyses investigating the role of folate in depression were included in the study. Random-effects model was employed to obtain pooled results. I 2 statistics and Cochrane Q test were used to assess the between-study heterogeneity. The quality of included meta-analyses was evaluated using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR2) questionnaire. Overall 11 studies were included, of which 8 studies went under quantitative evaluation. The results indicated that folate supplementation significantly relieved depression symptoms [(SMD: -0.42; 95% CI: -0.57, -0.27, p < .001; I 2 = 0.0%, p-heterogeneity = 0.554) (WMD: -3.20; 95% CI: -4.00, -2.41, p < .001, I 2 = 14.8%, p-heterogeneity = 0.318)] with low levels of heterogeneity. Also, based on observational studies, folate insufficiency significantly increased the odds ratio of depression by 35% (OR:1.35; 95% CI: 1.27, 1.42, p < .001, I 2 = 8.7%, p-heterogeneity = 0.350). The findings support the fact that folate supplementation could be suggested as an efficacious and adjuvant agent in the alleviation of depression symptoms along with routine medications.

Association between Oral Health and Depressive Symptoms in Chinese Older Adults: The Mediating Role of Dietary Diversity

Diet is a modifiable factor in healthy population aging. Additionally, oral health and diet are important factors affecting depressive symptoms. To assess the mediating role of dietary diversity (DD) in oral health and depressive symptoms in older adults, we selected 8442 participants aged ≥ 65 years from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) for a cross-sectional study. Depressive symptoms were determined based on scores on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Dietary diversity scores (DDS) were established based on the frequency of intake of food groups. Oral health was measured by denture use and toothbrushing frequency. Stepwise multiple linear regression and PROCESS macros were used for mediated effects analysis and testing. The sample had a positive detection rate of 44.1% for depressive symptoms, 40.8% for denture use, and 41.9% for once-a-day toothbrushing. Denture use (ρ = -0.077, p < 0.01) and toothbrushing frequency (ρ = -0.115, p < 0.01) were negative predictors of depressive symptoms in older adults. DD significantly mediated the association between denture use (indirect effect -0.047; 95%CI: -0.068-0.028; p < 0.001), toothbrushing frequency (indirect effect -0.041; 95%CI: -0.054-0.030; p < 0.001), and depressive symptoms. Denture use and toothbrushing frequency not only directly reduce the risk of depressive symptoms in older adults, but also indirectly affect depressive symptoms through DD.

Association between high or low-quality carbohydrate with depressive symptoms and socioeconomic-dietary factors model based on XGboost algorithm: From NHANES 2007-2018

BACKGROUND

Depressive symptoms are a serious public mental health problem, and dietary intake is often considered to be associated with depressive symptoms. However, the relationship between the quality of dietary carbohydrates and depressive symptoms remains unclear. Therefore, this study aimed to investigate the relationship between high and low-quality carbohydrates and depressive symptoms and to attempt to construct an integrated model using machine learning to predict depressive symptoms.

METHODS

A total of 4982 samples from the National Health and Nutrition Examination Survey (NHANES) were included in this study. Carbohydrate intake was assessed by a 24-h dietary review, and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ9). Variance inflation factor (VIF) and Relief-F algorithms were used for variable feature selection.

RESULTS

The results of multivariate linear regression showed a negative association between high-quality carbohydrates and depressive symptoms (β: -0.147, 95 % CI: -0.239, -0.056, p = 0.002) and a positive association between low-quality carbohydrates and depressive symptoms (β: 0.018, 95 % CI: 0.007, 0.280, p = 0.001). Subsequently, we used the XGboost model to produce a comprehensive depressive symptom evaluation model and developed a corresponding online tool (http://8.130.128.194:5000/) to evaluate depressive symptoms clinically.

LIMITATIONS

The cross-sectional study could not yield any conclusions regarding causality, and the model has not been validated with external data.

CONCLUSIONS

Carbohydrate quality is associated with depressive symptoms, and machine learning models that combine diet with socioeconomic factors can be a tool for predicting depression severity.

The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity-Interdependent Mechanisms/Co-Occurrence

Obesity and depression are interdependent pathological disorders with strong inflammatory effects commonly found worldwide. They determine the health status of the population and cause key problems in terms of morbidity and mortality. The role of gut microbiota and its composition in the treatment of obesity and psychological factors is increasingly emphasized. Published research suggests that prebiotic, probiotic, or symbiotic preparations can effectively intervene in obesity treatment and mood-dysregulation alleviation. Thus, this literature review aims to highlight the role of intestinal microbiota in treating depression and obesity. An additional purpose is to indicate probiotics, including psychobiotics and prebiotics, potentially beneficial in supporting the treatment of these two diseases.

Serum levels of folate, vitamin B6, and vitamin B12 are associated with cognitive impairments in depression patients

INTRODUCTION

Depression is a common mental disorder that endangers physical and mental health. In our study, we aimed to explore whether B vitamins are associated with depression and cognitive dysfunction.

METHODS

We enrolled a total of 220 patients with depression and selected 100 controls at the same time. We determined depression and cognitive impairment by assessments. We recorded the basic parameters of the participants and collected blood samples. In addition, we measured serum levels of B vitamins and brain-derived neurotrophic factor (BDNF).

RESULTS

We found significant differences in the duration of depression, education, and Hamilton Depression Rating Scale scores between the D-NCI and D-CI groups. We also identified the independent risk factors for patients with depression and cognitive dysfunction. Compared with the healthy controls, serum folate, vitamin B6, and vitamin B12 positively correlated with cognitive dysfunction. The patients with depression and cognitive dysfunction had the lowest levels of B vitamins compared with the other two groups. Our results also showed that the levels of serum folate, vitamin B6, and vitamin B12 in the patients with depression had a positive correlation with each other.

CONCLUSION

Our results indicate that vitamin B is associated with depression and cognitive dysfunction and is positively associated with cognitive dysfunction.

Folic acid supplementation during pregnancy and postpartum depressive symptoms

OBJECTIVE

To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort.

METHODS

This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity).

RESULTS

The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum.

CONCLUSION

There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

Folate and Its Significance in Depressive Disorders and Suicidality: A Comprehensive Narrative Review

Depressive disorders pose significant challenges to global public health, necessitating effective prevention and management strategies. Notably, the occurrence of suicide frequently coincides with depressive episodes. Suicide is as a paramount global health concern that demands efficacious preventive strategies. Current psychiatric approaches heavily rely on pharmacological interventions but have had limited success in addressing the global burden of mental health issues. Suboptimal nutrition, with its impact on the neuroendocrine system, has been implicated in the underlying pathology of depressive disorders. Folate, a group of water-soluble compounds, plays a crucial role in various central nervous system functions. Depressed individuals often exhibit low levels of serum and red blood cell folate. Multiple studies and systematic reviews have investigated the efficacy of folic acid and its derivative, L-methylfolate, which can cross the blood-brain barrier, as stand-alone or adjunct therapies for depression. Although findings have been mixed, the available evidence generally supports the use of these compounds in depressed individuals. Recent studies have established links between the one-carbon cycle, folate-homocysteine balance, immune system function, glutamate excitation via NMDA (N-methyl-D-aspartate) receptors, and gut microbiome eubiosis in mood regulation. These findings provide insights into the complex neurobiological mechanisms underlying the effects of folate and related compounds in depression. Through a comprehensive review of the existing literature, this study aims to advance our understanding of the therapeutic potential of folic acid and related compounds in depression treatment. It also seeks to explore their role in addressing suicidal tendencies and shed light on the neurobiological mechanisms involved, leveraging the latest discoveries in depression research.

Irritable bowel syndrome and mental health comorbidity - approach to multidisciplinary management

Irritable bowel syndrome (IBS) affects 5-10% of the global population. Up to one-third of people with IBS also experience anxiety or depression. Gastrointestinal and psychological symptoms both drive health-care use in people with IBS, but psychological comorbidity seems to be more important for long-term quality of life. An integrated care approach that addresses gastrointestinal symptoms with nutrition and brain-gut behaviour therapies is considered the gold standard. However, best practice for the treatment of individuals with IBS who have a comorbid psychological condition is unclear. Given the rising prevalence of mental health disorders, discussion of the challenges of implementing therapy for people with IBS and anxiety and depression is critical. In this Review, we draw upon our expertise in gastroenterology, nutrition science and psychology to highlight common challenges that arise when managing patients with IBS and co-occurring anxiety and depression, and provide recommendations for tailoring clinical assessment and treatment. We provide best practice recommendations, including dietary and behavioural interventions that could be applied by non-specialists and clinicians working outside an integrated care model.

Folate Deficiency Increased Microglial Amyloid-β Phagocytosis via the RAGE Receptor in Chronic Unpredictable Mild-Stress Rat and BV2 Cells

Depression is often considered one of the prevalent neuropsychiatric symptoms of Alzheimer's disease (AD). β-amyloid (Aβ) metabolism disorders and impaired microglia phagocytosis are potential pathological mechanisms between depression and AD. Folate deficiency (FD) is a risk factor for depression and AD. In this study, we used a chronic unpredictable mild stress (CUMS) rat model and a model of Aβ phagocytosis by BV2 cells to explore the potential mechanisms by which FD affects depression and AD. The results revealed that FD exacerbated depressive behavior and activated microglia in CUMS rats, leading to an increase in intracellular Aβ and phagocytosis-related receptors for advanced glycation end products (RAGE). Then, in vitro results showed that the expression of the RAGE receptor and M2 phenotype marker (CD206) were upregulated by FD treatment in BV2 cells, leading to an increase in Aβ phagocytosis. However, there was no significant difference in the expression of toll-like receptor 4 (TLR4) and clathrin heavy chain (CHC). Furthermore, when using the RAGE-specific inhibitor FPS-ZM1, there was no significant difference in Aβ uptake between folate-normal (FN) and FD BV2 cell groups. In conclusion, these findings suggest FD may promote microglia phagocytosis Aβ via regulating the expression of RAGE or microglia phenotype under Aβ treatment.

Empirically derived dietary patterns and postpartum depression symptoms in a large sample of Iranian women

BACKGROUND

Postpartum Depression (PPD) is a major depressive disorder that mainly begins within one month after delivery. The present study aimed to determine the relationship between dietary patterns and the occurrence of high PPD symptoms in women participating in the initial phase of the Maternal and Child Health cohort study, Yazd, Iran.

METHODS

This cross-sectional study was carried out in the years 2017-2019 included 1028 women after childbirth The Food Frequency Questionnaire (FFQ) and the Edinburgh Postnatal Depression Scale (EPDS) were study tools. The EPDS questionnaire was used to measure postpartum depression symptoms and a cut-off score of 13 was considered to indicate high PPD symptoms. The baseline data related to dietary intake was collected at the beginning of the study at the first visit after pregnancy diagnosis and the data related to depression, were collected in the second month after delivery. Dietary patterns were extracted by exploratory factor analysis (EFA). Frequency (percentage) and mean (SD) were used for description. Chi-square test, Fisher's exact test, independent sample t-test, and multiple logistic regression (MLR) were used for data analysis.

RESULTS

The incidence of high PPD symptoms was 24%. Four posterior patterns were extracted including prudent pattern, sweet and dessert pattern, junk food pattern and western pattern. A high adherence to the western pattern was associated with a higher risk of high PPD symptoms than a low adherence (OR_T3/T1: 2.67; p < 0.001). A high adherence to the Prudent pattern was associated with a lower risk of high PPD symptoms than a low adherence (OR_T3/T1: 0.55; p = 0.001). There are not any significant association between sweet and dessert and junk food patterns and high PPD symptoms risk (p > 0.05).

CONCLUSION

High adherence to prudent patterns was characterized by high intake of vegetables, fruit and juice, nuts and beans, low-fat dairy products, liquid oil, olive, eggs, fish, whole grains had a protective effect against high PPD symptoms, but the effect of western pattern was characterized by high intake of red and processed meats and organs was reverse. Therefore, it is suggested that health care providers have a particular emphasis on the healthy food patterns such as the prudent pattern.

Intended and Unintended Benefits of Folic Acid Fortification-A Narrative Review

Inadequate folate intake during pregnancy is the leading cause of the development of neural tube defects (NTDs) in newborns. For this reason, mandatory fortification of folic acid, a synthetic, easily bioavailable form, in processed cereals and cereal products has been implemented in the US since 1 January 1998 to reduce the risk of NTD in newborn children. This report aimed to review the literature related to the impact of mandated folic acid fortification on the intended and unintended benefits to health. Potential adverse effects were also discussed. We searched Pubmed, Google Scholar, Embase, SCOPUS, and Cochrane databases for reports. About 60 reports published between January 1998 and December 2022 were reviewed, summarized, and served as background for this review. The intended benefit was decreased prevalence of NTDs, while unintended benefits were reduction in anemia, blood serum homocysteine, and the risk of developing cardiovascular diseases. Potential issues with folic acid fortification are the presence of unmetabolized folic acid in circulation, increased risk of cancer, and the masking of vitamin B-12 deficiency. From a health perspective, it is important to monitor the impact of folic acid fortification periodically.

Mood Disorders in Youth: Complementary and Integrative Medicine

Omega-3 polyunsaturated fatty acids, probiotics, vitamin C, vitamin D, folic acid and L-methyl folate, broad-spectrum micronutrients, N-acetylcysteine, physical activity, herbs, bright light therapy, melatonin, saffron, meditation, school-based interventions, and transcranial photobiomodulation are reviewed, with a focus on their use for treating mood disorders in children and adolescents. For each treatment, all published randomized controlled trials are summarized.

Water-soluble vitamin insufficiency, deficiency and supplementation in children and adolescents with a psychiatric disorder: a systematic review and meta-analysis

Nutrition is fundamental for brain development, but relatively little is known about water-soluble vitamin (WSV) levels and the effect of supplementation on psychiatry symptoms in children and adolescents (CAD) with psychiatric disorders. Our team systematically reviewed all studies concerning WSV abnormalities or supplementation in CAD with any psychiatric disorder. We searched for original studies published between 1990 and 15/05/2020 which were not based on retrospective chart review and which included WSV blood level measurements or investigated the effect of WSV supplementation on psychiatric symptoms in psychiatric patients aged 18 or under. Forty-two articles were included, 69% of which (N = 29) examined Autism Spectrum Disorders (ASD), with most of these assessing folate or vitamin B₁₂ supplementation (N = 22, 75.9% of ASD studies). Meta-analyses showed significantly lower vitamin B₁₂ levels in ASD and ADHD patients vs. healthy controls (HC), while folate levels were higher in ADHD patients vs. HC. Most of the studies (9/10, 90%) showed a decrease in symptoms as measured by clinical scales after supplementation. There was significant heterogeneity between the studies, however many found different types of vitamin abnormalities in CAD with psychiatric disorders.

Vitamin B12, homocysteine, and folic acid in patients suffering from bipolar disorders: Relationship with suicide

OBJECTIVES

Vitamin B12, folic acid, and homocysteine play a key role in 'one-carbon metabolism', involved in different brain processes. Altered levels have been reported in mood disorders (MDs), particularly in major depression (MDD), while the information in bipolar disorders (BDs) is limited. The present study aimed at assessing vitamin B12, homocysteine, and folic acid in 69 bipolar inpatients.

METHODS

Twenty-seven patients were diagnosed with BDI, 15 BDII, 16 schizoaffective disorders, and 11 MDD, according to DSM-5 criteria. The clinical picture was assessed by the MINI, HRSD, YMRS, and CGI. The blood parameters were measured according to common clinical-chemical methods.

RESULTS

Thirty-four patients had significantly lower vitamin B12, and 14 higher homocysteine levels than normative values. Folic acid levels were normal in the majority of the sample. Patients with a family history of suicide showed significantly lower levels of vitamin B12.

CONCLUSIONS

Our results underline the utility of assessing vitamin B12, homocysteine, and folic acid in patients with BD. Although other studies are necessary, the present findings that lower levels of vitamin B12 seem typical of patients with a family history of suicide independently from the phase of illness suggest that they might constitute a possible predictor of suicide.

The association between major dietary patterns and severe mental disorders symptoms among a large sample of adults living in central Iran: Baseline data of YaHS-TAMYZ cohort study

Background

The diet’s role in developing psychological disorders has been considered by researchers in recent years.

Objective

To examine the association between major dietary patterns and severe mental disorders symptoms in a large sample of adults living in Yazd city, central Iran.

Methods

This cross-sectional study used the baseline data of a population-based cohort study (Yazd Health study: YaHS). Dietary intakes were assessed by a multiple-choice semi-quantitative food frequency questionnaire (FFQ, Yazd nutrition survey called TAMYZ). Psychological assessments were also done by using the depression, anxiety, and stress scale-21 (DASS-21) questionnaire. Major dietary patterns were identified using principal component analysis (PCA). Analysis of covariance (ANCOVA) and logistic regression analyses were used to evaluate the relationship between dietary patterns and mental disorders symptoms.

Results

A total of 7574 adults were included in the current analysis. Four major dietary patterns were identified: "Sugar and Fats”, “Processed Meats and Fish”, "Fruits" and “Vegetables and Red Meat”. After adjustment for all confounding variables, participants in the fifth quintile of “Fruits” dietary pattern which was highly correlated with dried fruits, canned fruits, fruit juice, olive, hydrogenated fats and fruits intake, had a lower odds of severe depression (OR=0.61, 95% CI: 0.45–0.81, p for trend=0.057), anxiety (OR=0.64, 95% CI: 0.50–0.80, p for trend=0.007), and stress, (OR=0.45, 95% CI: 0.30–0.68, p for trend=0.081).

Conclusions

The intake of a dietary pattern high in dried fruits, canned fruits, fruit juice, olive, hydrogenated fats, and fruits might be inversely associated with depression, anxiety, and stress symptoms. Future prospective studies are needed to warrant this finding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13518-w.

Continuous supplementation of folic acid in pregnancy and the risk of perinatal depression-A meta-analysis

BACKGROUND

The blood folic acid¹(FA) level of depressed patients seems to be lower than that of normal, and pregnant women are at greater risk of FA deficiency. The relationship between FA and perinatal depression has not been well described.

METHODS

We conducted a meta-analysis of the evidence for the association between the two, using current FA supplementation behavior during pregnancy and blood FA levels as exposures, and the incidence of perinatal depressive symptoms and mean Edinburgh Postnatal Depression Scale² (EPDS) scores as outcomes. The present study was recorded in PROSPERO (2019 CRD: 42,020,211,509).

RESULTS

Fifteen studies were identified, covering a total of 26,275 women from eleven observational studies and four randomized controlled trials. For the primary outcome of folic acid supplementation behavior and risk of perinatal depression, the overall odds ratio was 0.742 (95% CI: (0.647-0.852)), with a combined effect value of 0.84 (95% CI: (0.76, 0.93)) for studies in which an OR could be extracted. A negative association was observed between blood folate levels and depressive symptoms (Standardized mean difference (SMD) =-0.127, 95% CI:(-0.183,-0.071)). No association was observed between folic acid intervention and EPDS score. Continuous supplementation of folic acid during pregnancy may reduce the incidence of perinatal depressive symptoms (R = 0.017, (95 CI%:(0.014, 0.021)).

LIMITATIONS

Lack of rigorous randomized controlled trials due to ethical issues, and the research is heterogeneous and does not consider the influence of genetic factors.

CONCLUSIONS

Continuous use of FA during pregnancy may reduce the incidence of perinatal depressive symptoms.

Inflammation mediated the effect of dietary fiber on depressive symptoms

BACKGROUND AND AIMS

Previous studies showed that inflammation affects depressive symptoms. Dietary fiber may be associated with inflammation and depressive symptoms. We aimed to investigate the relationship between inflammation and depressive symptoms at different levels of dietary fiber intake and to explore whether dietary fiber affects depression through inflammation.

METHODS

A total of 8,430 National Health and Nutrition Examination Survey (NHANES) samples were collected between 2015 and 2018. Factor analysis was used to determine dietary patterns. Linear regression and logistic regression analysis were used to explore the relationship between nutrients, inflammation, and depressive symptoms, and the mediation analysis was conducted using the bootstrap method.

RESULTS

Factor 3 (dietary fiber and vitamins) was inversely associated with depressive symptoms and inflammation. The upper quartile scores of the dietary inflammatory index (DII) and C-reactive protein (CRP) were associated with depressive symptoms compared with controls (DII: OR = 1.851, 95% CI: 1.267-2.705; CRP: OR = 1.737, 95% CI: 1.136-2.656). The DII score and CRP were associated with depressive symptoms in the group with low dietary fiber intake (DII: OR = 2.736, 95% CI: 1.628-4.598; CRP: OR = 2.092, 95% CI: 1.196-3.658) but not in the high dietary fiber intake group. Mediating analysis showed that CRP partially mediated the effect of dietary fiber intake on depressive symptoms (β_indirect = -0.0025, 95% CI: -0.0038 to -0.0013), and the mediated proportion was 10.5%.

CONCLUSION

In this study, we found that DII scores and CRP were not associated with depressive symptoms in participants with high dietary fiber intake, and inflammation partially mediates the effect of dietary fiber on depressive symptoms.

The association between dietary patterns and depression in adolescents: A cross-sectional study

INTRODUCTION AND PURPOSE

So far, few studies have examined the relationship between dietary patterns and depression in adolescents. The aim of the present study was to determine this relationship in a sample of adolescent Iranian girls.

MATERIALS AND METHODS

347 female high school students aged 14-17 years living in Shiraz, Iran participated in this cross-sectional study. General and physical activity questionnaires, 3-d dietary recalls, and Beck Depression Inventory-Second Edition (BDI-II) were completed for all individuals and their anthropometric characteristics were measured. The major dietary patterns were then identified using principal component factor analysis.

FINDINGS

In total, 2 major dietary patterns were identified. After adjusting for potential confounders in multivariate linear regression analysis, the Western pattern (characterized by high consumption of French fries, hydrogenated fats, mayonnaise, sweets and desserts, high-fat dairy, refined grains, red or processed meats, pickles, organ meats and soft drinks and low consumption of low-fat dairy) was positively (standardized β coefficient: 0.510, P < 0.001) and the healthy pattern (characterized by high intake of vegetables, legumes, boiled potatoes, poultry, fish, vegetable oils, olives, fruits and fruit juices and low-fat dairy and low intake of refined grains) was inversely associated (standardized β coefficient: -0.508, P < 0.001) with BDI-II score.

CONCLUSION

Overall, findings of this study indicate that certain dietary patterns are associated with depression in adolescent Iranian girls. However, more studies are needed to further confirm these findings.

Fruit and vegetable intake and mental health among family caregivers of people with dementia in Uganda

Consumption of fruits and vegetables is correlated with improved mental wellbeing. Although this growing body of research has been recognized by researchers and clinicians in high-income countries, fewer studies examining this relationship have been conducted in low- and middle-income settings. In this study, we sought to estimate the association between fruit and vegetable intake and symptoms of depression and anxiety. We conducted a cross-sectional study among 242 family caregivers of people with dementia in southwestern Uganda. Fruit and vegetable intake in the past week was measured with a food frequency questionnaire. Depression and anxiety were assessed using the depression and anxiety subscales of the 42-item Depression, Anxiety and Stress Scales. Multivariable regression models were used to estimate the associations between fruits and vegetable consumption and depression and anxiety, adjusting for caregiving burden and other potential confounders. Depression symptom severity was negatively associated with consumption of jackfruits (b =-4.68; 95% confidence interval [CI], -8.96 to -0.39), green leafy vegetables (b =-14.1; 95% CI, -18.0 to -10.1), root vegetables (b =-14.0; 95% CI, -19.5 to -8.63), and other vegetables (b =-14.8; 95% CI, -19.3 to -10.3), and frequent consumption of vegetables (b =-1.91; 95% CI, -3.77 to -0.04). Anxiety symptom severity was negatively associated with consumption of green leafy vegetables (b =-12.2; 95% CI, -16.0 to -8.46), root vegetables (b=-12.6; 95% CI, -17.5 to -7.58), and other vegetables (b =-12.7; 95% CI, -17.0 to -8.40), and frequent consumption of vegetables (b =-2.07; 95% CI, -3.84 to -0.29). Our results suggest that fruit and vegetable consumption is associated with reduced depression and anxiety symptoms.

Association between consumption of fruits and vegetables with suicidal ideation

OBJECTIVE

To investigate the association between fruit and vegetable (F&V) intake with suicidal ideation.

DESIGN

Cross-sectional study using a Korean Community Health Survey.

SETTING

F&V consumers were defined as individuals who had consumed fruits or vegetables more than once per day. Multivariable logistic regression models were used to identify factors associated with suicidal ideation including F&V consumption and to estimate the prevalence of having suicidal ideation after consideration of potential confounders.

PARTICIPANTS

221 081 Korea adults (nationally representative).

RESULTS

Approximately 55 % of participants were F&V consumers. They were more likely to be young, be women, attain high educational levels, be married and be healthier physically and psychologically than the F&V non-consumers. Non-consumers had an increased risk for suicidal ideation than consumers even when potential confounders were considered, and this trend was more remarkable with vegetable intake.

CONCLUSION

F&V intake is associated with low risk for suicidal ideation.

Eating alone and depressive symptoms among the Japanese working population: The Furukawa nutrition and health study

The aim of this study was to determine the cross-sectional associations between frequency of eating with others and depressive symptoms in Japanese employees while accounting for lifestyle and dietary factors. We also examined the relationship with stratification by living arrangement. Participants were 1876 workers aged 18-74 years who participated in a health survey at a periodic checkup. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Frequency of eating with others was categorized into ranges between daily and <1 day/week. Associations between frequency of eating with others and depressive symptoms were assessed using logistic regression analysis, with adjustment for lifestyle and dietary factors. The prevalence of depressive symptoms was 32.9%. The prevalence of depressive symptoms tended to increase with decreasing frequency of eating with others, with multivariate-adjusted odds ratios (95% confidence intervals) for the highest through lowest frequency groups of eating meals with others being 1.00 (reference), 1.27 (0.92-1.74), 1.56 (1.11-2.21), 1.86 (1.29-2.67), and 2.22 (1.53-3.22), respectively (P for trend<0.001). In analysis stratified by living arrangement, a significant association was found with those living with others but not those living alone (P for interaction <0.001). Lower frequency of eating with others may be associated with higher odds of depressive symptoms among Japanese workers living with others, even after controlling for lifestyle and dietary factors.

Low folate induces abnormal neuronal maturation and DNA hypomethylation of neuronal differentiation-related genes in cultured mouse neural stem and progenitor cells

Folate deficiency in a fetus is well known to cause neurodevelopment defects and development disorders. A low level of folate is also thought to be a risk for depression in adults. We have previously shown that post-weaning low folate induces neuronal immaturity in the dentate gyrus in mice, which suggests that low folate causes neuropsychological disorders via inhibition of neuronal maturation. In this study, we examined the effects of low folate on expression and epigenetic modification of genes involved in neuronal differentiation and maturation in primary mouse neural stem/progenitor cells (NSPCs) in vitro. An increase in Nestin (NSPC marker)-positive cells was observed in cells differentiated in a low folate medium for 3 days. An increase in βIII-tubulin (Tuj1: immature neuron marker)-positive cells and a decrease in microtubule-associated protein 2 (MAP2: mature neuron marker)-positive cells were observed in cells differentiated in a low folate medium for 7 days. In these cells, mRNA levels for genes involved in neuronal differentiation and maturation were altered. Hypomethylation of DNA, but not of histone proteins, was also observed at some promoters of these neuronal genes. The level of S-adenosylmethionine (SAM), a methyl donor, was decreased in these cells. The abnormalities in neural maturation and changes in gene expression in culture under low folate conditions were partially normalized by addition of SAM (5 μM). Based on these results, decreased SAM may induce DNA hypomethylation at genes involved in neuronal differentiation and maturation under low folate conditions, and this hypomethylation may be associated with low folate-induced neuronal immaturity.

Immunostimulant and Antidepressant Effect of Natural Compounds in the Management of Covid-19 Symptoms

In recent years, the use of natural compounds as adjuvant treatments and alternatives to traditional pharmacological therapies has become increasingly popular. These compounds have a wide range of biological effects, such as: antioxidant, anti-aging, hypocholesterolizing, hypoglycemic, antitumoral, antidepressant, anxiolytic activity, etc. Almost all of these compounds are easily available and are contained in different foods. At the end of 2019 the Coronavirus SARS-CoV-2 appeared in China and quickly spread throughout the world, causing a pandemic. The most common symptoms of this infection are dry cough, fever, dyspnea, and in severe cases bilateral interstitial pneumonia, with consequences that can lead to death. The nations, in trying to prevent the spread of infection, have imposed social distancing and lockdown measures on their citizens. This had a strong psychological-social impact, leading to phobic, anxious and depressive states. Pharmacological therapy could be accompanied by treatment with several natural compounds, such as vitamins, baicalein, zinc and essential oils. These compounds possess marked immunostimulant activity, strengthening the immune response and mitigating interactions between the virus and the host cell. They also have an antidepressant effect, acting on certain neurotransmitters.

Prospective study on the association between serum amino acid profiles and depressive symptoms among the Japanese working population

Objective

Accumulating evidence suggests that amino acids, particularly tryptophan and glutamate, play an important role in the pathology of depression, but prospective epidemiologic data on this issue is scarce. We examined the association between circulating amino acids and the risk of depressive symptoms in a Japanese working population.

Methods

Participants were 841 workers who were free from depressive symptoms and provided blood at baseline and completed 3-yr follow-up survey. 30 varieties of amino acid concentrations in serum were measured using liquid chromatography/mass spectrometry. Depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to calculate the odds ratios of depressive symptoms according to serum amino acids with adjustment for lifestyle factors.

Results

A total of 151 (18.0%) workers were newly identified as having depressive symptoms at the follow-up. Baseline tryptophan and glutamate concentrations in serum were not appreciably associated with the risk of depressive symptoms. Risk of depressive symptoms tended to increase with increasing arginine concentrations; the multivariable-adjusted odds ratio for the highest versus lowest tertile of serum arginine was 1.65 (95% confidence interval: 0.96–2.83; P for trend = 0.07). No clear association was found for other amino acids.

Conclusions

Results of the present study do not support a significant role of circulating amino acids in the development of depressive symptoms among Japanese.

Malnutrition is associated with depression in Japanese older adults requiring long-term care or support

[Purpose] To characterize depression related to nutritional status in older adults requiring long-term care. [Participants and Methods] One hundred and six individuals (66 males and 40 females) over the age of 65 who required support level 1/2 or care level 1 and were receiving day care through the long-term care insurance (LTCI) system, were enrolled. The survey items included basic attributes, comorbidities, previous medical history, requiring support/care under Japan’s LTCI system, the Mini Nutritional Assessment–Short Form, the Geriatric Depression Scale 15 (GDS-15), and body mass index (BMI). The factors associated with malnutrition/risk of malnutrition were evaluated. In addition, the relationship between nutritional status and the GDS-15 items was evaluated. [Results] Depression, LTCI, BMI, and gender were identified as related factors for malnutrition/risk of malnutrition. Compared with the favorable nutritional status group, the malnutrition/risk of malnutrition group reported GDS-15 items such as “Dropped activities and interests”, “Feel that life is empty”, “In good spirits most of the time (reversed)”, “Afraid of something bad”, “Prefer to stay at home”, and “Feel full of energy (reversed)”. [Conclusion] The results show certain parameters characteristic of depression in Japanese older adults with malnutrition requiring long-term care/support. These data will help guide future research and interventions.

The Management of Prodromal Symptoms of Bipolar Disorder: Available Options and Future Perspectives

The onset of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder could be considered as an important alarm bell for the development of the disease and should be carefully detected. The management of prodromes in bipolar high-risk patients appears to be an important means of prevention; nevertheless, at the moment, there aren’t clear and widely shared treatment indications. The aim of this review is to summarize the available treatment options (pharmacological, psychosocial and nutraceutical) for the management of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder.

Impact of Supplementation and Nutritional Interventions on Pathogenic Processes of Mood Disorders: A Review of the Evidence

This narrative review was conducted using searches of the PubMed/Medline and Google Scholar databases from inception to November 2019. Clinical trials and relevant articles were identified by cross-referencing major depressive disorder (and/or variants) with the following terms: folate, homocysteine, S-adenosylmethionine (SAMe), L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, L-tryptophan, zinc, magnesium, vitamin D, omega-3 fatty acids, coenzyme Q10, and inositol. Manual reviews of references were also performed using article reference lists. Abnormal levels of folate, homocysteine, and SAMe have been shown to be associated with a higher risk of depression. Numerous studies have demonstrated antidepressant activity with L-methylfolate and SAMe supplementation in individuals with depression. Additionally, the amino acids L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, and L-tryptophan have been implicated in the development of depression and shown to exert antidepressant effects. Other agents with evidence for improving depressive symptoms include zinc, magnesium, omega-3 fatty acids, and coenzyme Q10. Potential biases and differences in study designs within and amongst the studies and reviews selected may confound results. Augmentation of antidepressant medications with various supplements targeting nutritional and physiological factors can potentiate antidepressant effects. Medical foods, particularly L-methylfolate, and other supplements may play a role in managing depression in patients with inadequate response to antidepressant therapies.

Evaluation of the Behavioural, Antioxidative and Histomorphological Effects of Folic Acid-supplemented Diet in Dexamethasone-induced Depression in Mice

BACKGROUND

The effect of folic acid in mitigating depression has remained pivotal in research.

OBJECTIVE

To determine the effects of folate supplementation on neurobehaviour oxidative stress and cerebral cortex histomorphology in the dexamethasone mouse model of depression.

METHODS

Male mice were assigned to six groups (A-F) of 10 mice each. Animals in groups A and D were fed a standard diet, while those in B and E were fed folic acid supplemented diet (25 mg/kg of feed), while C and F were fed folate supplemented diet at 50 mg/kg of feed for 8 weeks. At the beginning of the sixth 6th week, mice in groups A-C were administered distilled water, while animals in groups D-F were administered dexamethasone (DEX) at 4 mg/kg body weight by gavage. Open-field, forced swim, and tail-suspension tests were conducted at the end of the experimental period, following which animals were euthanised and blood was taken for the estimation of Malondialdehyde (MDA), reduced Glutathione, Glutathione Peroxidase, Catalase activity, and Superoxide Dismutase. Sections of the cerebral cortex were prepared for histological examination.

RESULTS

Folic acid supplementation increased body weight, locomotor, rearing and self-grooming behaviours, and decreased immobility time in the tail suspension and forced swim tests. There was also a reduction of lipid peroxidation and an increase in the antioxidant status. Folic acid supplementation was also found to be protective against the development of dexamethasone-induced changes in body weight, open-field behaviours, behavioural despair, oxidative stress and cerebrocortical morphology.

CONCLUSION

Folic-acid supplementation improves the behavioral, some antioxidant, and cerebral morphological parameters.

Association Between Folate and Health Outcomes: An Umbrella Review of Meta-Analyses

Background: There is no study that has systematically investigated the breadth and validity of the associations of folate and multiple health outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding associations between folate and multiple health outcomes by using umbrella review of meta-analysis. Methods: We searched the MEDLINE, EMBASE, and Cochrane Library databases from inception to May 20, 2018, to identify potential meta-analyses that examined the association of folate with any health outcome. For each included meta-analysis, we estimated the summary effect size and their 95% confidence interval using the DerSimonian and Laird random-effects model. We used the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) to assess methodological quality and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation working group classification) to assess the quality of evidence for each outcome included in the umbrella review. Results: Overall, 108 articles reporting 133 meta-analyses of observational studies and 154 meta-analyses of randomized controlled trials (RCTs) were included in the study. Among them, 108 unique exposure-outcome-population triplets (referred to as unique meta-analyses hereafter) of RCTs and 87 unique meta-analyses of observational studies were reanalyzed. Beneficial effects of folate were observed in the all-cause mortality rate and in a number of chronic diseases, including several birth/pregnancy outcomes, several cancers, cardiovascular disease and metabolic-related outcomes, neurological conditions, and several other diseases. However, adverse effects of folate were observed for prostate cancer, colorectal adenomatous lesions, asthma or wheezing, and wheezing as an isolated symptom and depression. Conclusions: Current evidence allows for the conclusion that folate is associated with decreased risk of all-cause mortality and a wide range of chronic diseases. However, folate may be associated with an increased risk of prostate cancer. Further research is warranted to improve the certainty of the estimates.

The Way to a Human's Brain Goes Through Their Stomach: Dietary Factors in Major Depressive Disorder

Globally, more than 250 million people are affected by depression (major depressive disorder; MDD), a serious and debilitating mental disorder. Currently available treatment options can have substantial side effects and take weeks to be fully effective. Therefore, it is important to find safe alternatives, which act more rapidly and in a larger number of patients. While much research on MDD focuses on chronic stress as a main risk factor, we here make a point of exploring dietary factors as a somewhat overlooked, yet highly promising approach towards novel antidepressant pathways. Deficiencies in various groups of nutrients often occur in patients with mental disorders. These include vitamins, especially members of the B-complex (B6, B9, B12). Moreover, an imbalance of fatty acids, such as omega-3 and omega-6, or an insufficient supply with minerals, including magnesium and zinc, are related to MDD. While some of them are relevant for the synthesis of monoamines, others play a crucial role in inflammation, neuroprotection and the synthesis of growth factors. Evidence suggests that when deficiencies return to normal, changes in mood and behavior can be, at least in some cases, achieved. Furthermore, supplementation with dietary factors (so called "nutraceuticals") may improve MDD symptoms even in the absence of a deficiency. Non-vital dietary factors may affect MDD symptoms as well. For instance, the most commonly consumed psychostimulant caffeine may improve behavioral and molecular markers of MDD. The molecular structure of most dietary factors is well known. Hence, dietary factors may provide important molecular tools to study and potentially help treat MDD symptoms. Within this review, we will discuss the role of dietary factors in MDD risk and symptomology, and critically discuss how they might serve as auxiliary treatments or preventative options for MDD.

Good, better, best: clinical scenarios for the use of L-methylfolate in patients with MDD

Depression is among the most prevalent mental disorders worldwide, and a substantial proportion of patients do not respond adequately to standard antidepressants. Our understanding of the pathophysiology of depression is no longer limited to the chemical imbalance of neurotransmitters, but also involves the interplay of proinflammatory modulators in the central nervous system, as well as folate metabolism. Additional factors such as stress and metabolic disorders also may contribute. Multiple inflammatory, metabolic, and genetic markers have been identified and may provide critical information to help clinicians individualize treatments for patients to achieve optimal outcomes. Recent advancements in research have clarified underlying causes of depression and have led to possible new avenues for adjunctive treatment. Among these is L-methylfolate, a medical food that is thought to enhance synthesis of monoamines (serotonin, norepinephrine, and dopamine), suppress inflammation, and promote neural health. Clinical studies that assessed supplemental use of L-methylfolate in patients with usual care-resistant depression found that it resulted in improved outcomes. Patients with selective serotonin reuptake inhibitor-resistant depression, and particularly subgroups with biomarkers of inflammation or metabolic disorders or folate metabolism-related genetic polymorphisms (or ≥2 of these factors), had the best responses. Considering this, the goals of this review are to 1) highlight recent advances in the pathophysiology of major depressive disorder as it pertains to folate and associated biomarkers and 2) establish the profiles of patients with depression who could benefit most from supplemental use of L-methylfolate.

The Association between Dietary Patterns and Depressive Symptoms in Chinese Adults

Background

Previous studies of the relationship between diet and depression have focused on single nutrients or food. Recent research suggested that dietary patterns may offer more information than an individual nutrient in assessing disease risk. We designed this study to assess the association between dietary patterns and depressive symptoms in the adult population of China.

Methods

We identified 372 Chinese residents for this research. Factor analysis was used to extract dietary patterns from 30 predefined food groups. Dietary intake was assessed using an effective self-administered food frequency questionnaire, and depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) score. Subjects were considered to have depressive symptoms when they had a PHQ-9 score of >4.

Results

We identified four eating patterns: “vegetables-fruits,” “traditional Chinese,” “pastry-fruits,” and “animal food” dietary patterns. After adjusting for potential confounders, participants in the highest tertile animal food pattern (considered to be an unhealthy pattern) were more prone to depressive symptoms compared with participants in the lowest tertile (OR = 2.08, 95% CI: 1.02-4.24).

Conclusions

The animal food pattern was associated with an increased risk of depressive symptoms.

Diet quality and depressive symptoms. Assessing the direction of the association in a population-based cohort study

BACKGROUND

Emerging evidence links a poor diet with mental ill-health although the direction of this association is unclear. The aim was to examine the bidirectional prospective relationships between core (and non-core food consumption, and symptoms of depression.

METHODS

Depressive symptoms (Mental Health Index-5, MHI-5), current/prior depression and consumption of core (recommended food groups) and non-core (discretionary) foods were assessed in the population-based 2013 and 2017 Household Income and Labour Dynamics in Australia cohort study. Three cross-lagged linear models assessed associations between all three baseline variables in 2013, alternating 2017 variables as outcomes.

RESULTS

In the population (n = 10,003; 48.3% women; 48.5[15.7] years), core food score in 2013 was associated with MHI-5 (β:0.102, 95%CI: 0.010,0.193) in 2017, while the non-core food score was not (β:-0.030, 95%CI:-0.099,0.160). Depressive symptom score in 2013 was not associated with either food score in 2017. Current/prior diagnosis of depression in 2013 was associated with core (β:-0.198, 95%CI:-0.329,-0.067) but not non-core (β:-0.036, 95%CI: -0.151,0.080) food score in 2017.

LIMITATIONS

Results may not be generalizable to the whole population due to some selection bias, self-report depression diagnosis may have led to misclassification of previous mental illness, and core and non-core food scores are not validated measures of diet quality.

CONCLUSIONS

There is a prospective association between core food consumption and depressive symptoms. This association is of small magnitude and we cannot discount insufficient core food consumption reflecting an effect of prior mental illness. Our results suggest that, for depression, public health focus should be on improving core food intake.

Amino acid metabolism, lipid metabolism, and oxidative stress are associated with post-stroke depression: a metabonomics study

Background

Post-stroke depression (PSD) is a mood disorder characterized by depression and anhedonia caused by stroke. Metabolomics identified metabolites associated with PSD, but previous studies are based on gas chromatography (GC)/mass spectrometry (MS). This study aimed to perform a liquid chromatography (LC)-MS-based metabolomics study of the plasma metabolite profiles between patients with PSD and controls.

Methods

This was a prospective study of patients with stroke enrolled between July and December 2017 at the Second Affiliated Hospital of Nanchang University. Patients were grouped as Hamilton Depression Rating Scale > 7 (PSD) or < 7 (controls). Metabonomics profiling of plasma sampled was conducted by LC-MS. By combining multivariable and univariable statistical analyses, significant differential metabolites between the two groups were screened. The threshold for significant differences was VIP ≥1 and P < 0.05. Log₂FC is the logarithm of the mean ratio between the two groups.

Results

There were no significant difference with respect to age, NIHSS score, and MMSE between the two groups (all P > 0.05). There were six differential metabolites between the PSD and stroke groups, of which three metabolites were increased and three were decreased. Compared with the control group, p-chlorophenylalanine (Log₂FC = 1.37, P = 0.03), phenylacetyl glutamine (Log₂FC = 0.21, P = 0.048), and DHA (Log₂FC = 0.77, P = 0.01) levels were higher in the PSD group, while betaine (trimethylglycine) (Log₂FC = − 0.79, P = 0.04), palmitic acid (Log₂FC = − 0.51, P = 0.001), and MHPG-SO₄ (Log₂FC = − 2.37, P = 0.045) were decreased.

Conclusion

Plasma metabolomics showed that amino acid metabolism (phenylacetyl glutamine, p-chlorophenylalanine, trimethylglycine), lipid metabolism (DHA, palmitic acid, trimethylglycine), and oxidative stress (DHA, palmitic acid, trimethylglycine) were associated with PSD. These results could help to reveal the pathophysiological mechanism of PSD and eventually identify treatment targets.

Associations between long-term adherence to healthy diet and recurrent depressive symptoms in Whitehall II Study

PURPOSE

We examined whether long-term adherence to three diet quality scores-the Alternative Healthy Eating Index-2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH) and  transformed-Mediterranean Diet Score (tMDS), Alternative Healthy Eating Index-2010 (AHEI-2010) and Dietary Approach to Stop Hypertension (DASH) is associated with the risk of recurrent depressive symptoms.

METHODS

Analyses were conducted on a sample of 4949 men and women from the Whitehall II study. Diet scores were calculated using data collected from food frequency questionnaires repeated over 11 years of exposure (1991/1993-2002/2004). Recurrence of depressive symptoms was defined when participants reported at least two episodes of depressive symptoms (assessed by Center for Epidemiologic Studies Depression Scale and use of antidepressants) over the four phases of follow-up (2002/04-2015/16).

RESULTS

After adjustment for potential cofounders, higher scores on AHEI-2010, DASH and tMDS at the end of the exposure period were associated with lower risk of recurrent depressive symptoms over the 13-year follow-up. Repeat measures of dietary history showed that participants who maintained a high AHEI-2010 score over the 11-year exposure period had a 19% (OR 0.81, 95% CI 0.65-1.00) lower odds of recurrent depressive symptoms compared to those who maintained a low AHEI score. Participants whose AHEI-2010 score decreased over time had a 1.34-fold increased odds (95% CI 1.02-1.75) of developing recurrent depressive symptoms compared to those maintaining a high AHEI-2010. No robust associations were observed for long-term tMDS and DASH.

CONCLUSION

Our findings suggest that long-term adherence to healthy diet defined by Alternative Healthy Eating Index-2010 confers protection against recurrent depressive symptoms.

Dietary patterns and depressive symptoms among Iranian women

We aimed to investigate the association between dietary patterns and depressive symptoms among 217 Iranian women aged 20-45 years. In this study, dietary intake was assessed using a valid and reliable semi-quantitative food frequency questionnaire. A principal component analysis was applied to detect the major dietary patterns. The Beck Depression Inventory was used to assess the depressive symptoms. Two major dietary patterns were identified: the "semi-Mediterranean" dietary pattern and the "western" dietary pattern. Participants with the "western" dietary pattern had a higher rate of depressive symptoms (p < 0.05). However, the "semi-Mediterranean" dietary pattern had no significant association with the depressive symptoms.

Post-weaning folate deficiency induces a depression-like state via neuronal immaturity of the dentate gyrus in mice

Folate deficiency has been suggested as a risk factor for depression in preclinical and clinical studies. Several hypotheses of mechanisms underlying folate deficiency-induced depressive symptoms have been proposed, but the detailed mechanisms are still unclear. In this study, we assessed whether post-weaning folate deficiency affect neurological and psychological function. The low folate diet-fed mice showed depression-like behavior in the forced swim test. In contrast, spontaneous locomotor activity, social behavior, coordinated motor skills, anxiety-like behavior and spatial memory did not differ between control and low folate diet-fed mice. In the dentate gyrus (DG) of the hippocampus, decreased number of newborn mature neurons and increased number of immature neurons were observed in low folate diet-fed mice. Staining with Golgi-Cox method revealed that dendritic complexity, spine density and the number of mature spines of neurons were markedly reduced in the DG of low folate diet-fed mice. Stress response of neurons indicated as c-Fos expression was also reduced in the DG of low folate diet-fed mice. These results suggest that reduction in the degree of maturation of newborn hippocampal neurons underlies folate deficiency-induced depressive symptoms.

Association between Breakfast Consumption and Depressive Symptoms among Chinese College Students: A Cross-Sectional and Prospective Cohort Study

Skipping breakfast has been suggested to increase the risk of depressive symptoms, but there is no information regarding young adults. We aimed to investigate the relationship between the frequency of breakfast consumption and the risk of depressive symptoms among Chinese college students. We investigated a cross-sectional (n = 1060) and one-year prospective (n = 757) relationship between the frequency of breakfast consumption and the risk of depressive symptoms. The frequency of breakfast consumption was categorized into “≤1 time/week”, “2–5 times/week”, or “≥6 times/week”. Depressive symptoms were assessed using the 20-item Zung self-rating depression scale (SDS) with an SDS score of ≥50 to indicate moderate to severe depressive symptoms. In the cross-sectional analysis, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of depressive symptoms related with the breakfast consumption categories were 1.00 (reference) for ≥6 times/week, 1.761 (95% CI: 1.131, 2.742) for 2–5 times/week, and 3.780 (95% CI: 1.719, 8.311) for ≤1 time/week (p for trend: <0.001) after adjusting for these potential confounders. Similarly, in the one-year prospective analysis, we found that 10.2% of participants was classified as having moderate to severe depressive symptoms. Multivariate logistic regressions analysis revealed a significant negative relationship between the frequency of breakfast consumption and the risk of depressive symptoms. The ORs (95% CI) for depressive symptoms with decreasing breakfast consumption frequency were 1.00 (reference) for ≥6 times/week, 2.045 (1.198, 3.491) for 2–5 times/week, and 2.722 (0.941, 7.872) for ≤1 time/week (p for trend: 0.005). This one-year prospective cohort study showed that skipping breakfast is related to increased risk of depressive symptoms among Chinese college students. Future research using interventional or experimental studies is required to explore the causal relationship between the effects of breakfast consumption and depressive symptoms.

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

BACKGROUND & AIMS

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

METHOD

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

RESULTS

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

CONCLUSION

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

Folic acid ameliorates depression-like behaviour in a rat model of chronic unpredictable mild stress

Background

Depression is characterized by significant and low mood. Classical antidepressants are still not adequate in treating depression because of undesirable side effects. Folic acid, a member of the vitamin B complex, in considered to be strongly associated with the function and development of the central nervous system. Thus, in this study, we established a model of depression through chronic unpredictable mild stress (CUMS) in rats and assessed the antidepressant effects and mechanisms of folic acid.

Methods

Sprague–Dawley rats were randomly divided into four groups: control, chronic unpredictable mild stress (CUMS), CUMS treated with folic acid, and CUMS treated with citalopram. Rats were assessed in terms of weight change, open-field test and sucrose preference. Homocysteine, monoamine neurotransmitters, interleukin-6, brain-derived neurotrophic factor (BDNF), β-endorphin levels in the serum and brains of rats were analysed.

Results

Folic acid exhibited antidepressant-like effects in open-field and sucrose preference tests. Folic acid treatment effectively increased the levels of monoamine neurotransmitters, BDNF and β-endorphin, interleukin-6 and homocysteine levels were also significantly suppressed by folic acid administration.

Conclusions

These findings serve as preclinical evidence that folic acid plays an antidepressant-like role in several pathways involving monoamine neurotransmitters. Thus, folic acid may be used as a potential antidepressant.

RETRACTED: The protective role of microRNA-133b in restricting hippocampal neurons apoptosis and inflammatory injury in rats with depression by suppressing CTGF

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. Concern was raised about the integrity of the images in Figures 5, 6A and 8A, which appear to contain suspected duplications, as detailed here: https://pubpeer.com/publications/773D824533241B2186D16AA3FFCB3F and here: https://docs.google.com/spreadsheets/d/1r0MyIYpagBc58BRF9c3luWNlCX8VUvUuPyYYXzxWvgY/edit#gid=262337249. Additional suspected image duplications were detected within Figure 7A. Our analysis suggested these image anomalies represent either direct duplications of the entire image, or contain several repeated features between or within an image. The journal requested the corresponding author comment on these concerns and provide the raw data. The authors did not respond to this request and therefore the Editor-in-Chief decided to retract the article.

Dietary Patterns and Depression: First Results in a Cross-Sectional Study from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background: Relations between diet and mental health continue to be a subject for controversy and an increasing numbers of studies. Recent literature is represented by papers that examine overall diet by way of dietary patterns and its association with depression, replacing previous studies about nutrients. The aim of this cross-sectional study is to evaluate the relation between dietary patterns and depressive episode in the baseline (2008–2010) population of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We analyzed 14,798 participants of ELSA-Brasil. Methods: We constructed dietary patterns based on the Food Frequency Questionnaire using multiple correspondence and cluster analysis; to evaluate depressive episodes, we used the Clinical Interview Schedule-Revised (CIS-R). As an independent variable, we used the patterns: Traditional, Low-Sugar/Low-Fat, Fruit-Vegetables, and Bakery Products. We used multiple logistic regression models to evaluate relations between the dietary patterns and depressive episodes. Results: The Traditional pattern showed the highest percentages of consumption. After adjusting, the Bakery Products (OR = 1.33; 95%CI 1.05–1.70) was associated positively and significantly with depressive episodes only for women. Conclusions: International studies corroborated this finding, suggesting that the Bakery Products pattern could be a marker of a specific population group in which depressive episodes are frequent.

Serum folate levels in bipolar disorder: a systematic review and meta-analysis

BACKGROUND

Bipolar disorder (BD) is a major psychiatric illness, however its physiopathology is unclear. The role of folate in the physiopathology of BD is controversial. We conducted this systematic review and meta-analysis to investigate the effect of folate in BD patients.

METHODS

We performed a thorough literature study of the PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov databases until December 21st, 2018. Random effects meta-analysis was conducted.

RESULTS

Six articles involving 481 patients with BD and 760 controls were included. The meta-analysis results suggested that serum folate levels in the patients with BD were significantly lower than those in the controls (Hedges' g = - 0.211, 95% confidence interval = - 0.391 to - 0.031, p = 0.021).

CONCLUSION

The current meta-analysis show it might be association between lower serum folate levels and patient with BD. However, we could not distinguish the potentially confounding effects of mood states on the folate levels. Further prospective studies including subjects with different mood states and possible physiopathology are warranted to investigate the association between folate deficiency and the etiology of BD.

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials

The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from "nutrient supplements", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.

Linking What We Eat to Our Mood: A Review of Diet, Dietary Antioxidants, and Depression

Studies have shown that diet and nutrition play significant roles in the prevention of depression and its clinical treatment. The present review aims to provide a clear understanding of the associations between diet patterns, specific foods, nutrients such as antioxidants, and depression. As a result, balanced dietary patterns such as the Mediterranean diet and certain foods such as fish, fresh vegetables, and fruits have been associated with a lower risk of depression or depressive symptoms, while high-fat Western diets and sugar-sweetened beverages have been associated with higher risk of depression or depressive symptoms. Dietary antioxidants such as green tea polyphenols or isoflavonoid intake have been negatively associated with depression or depressive symptoms. It is concluded that diet patterns, specific foods, and antioxidants play important roles in the prevention and clinical treatment of depression.

Is Depression Related to Low Folate Levels in People with Epilepsy? An Observational Study and Meta-analysis

Background:

Both depression and low serum levels of folate are common in people with epilepsy (PWE), the latter especially in patients on hepatic enzyme-inducing antiepileptic drugs (AEDs). We did a cross-sectional study and a meta-analysis to assess if lower folate levels have any relation with depression in PWE.

Materials and Methods:

Two hundred and one PWE were recruited and assessed for depression using the Inventory of Depressive Symptomatology-Self-Rated (IDS-SR) and Inventory of Depressive Symptomatology-Clinician Rated; serum folate levels were measured in them at the same time. Literature search was carried out and studies with data on depression as well as folate levels in PWE were included. Statistical analysis to determine frequency of depression, low folate levels, and relation between them among our cases and the pooled data from the included studies was done.

Results:

Depression was observed in 65.68% and low serum folate (<4 ng/ml) in 48.75% of PWE (over 80% on older AEDs); there was no statistically significant correlation between them. However, on analyzing the pooled data of six studies including the present, the Fisher's z-transformed correlation coefficient was −0.1690 (95% confidence interval [−0.3175, −0.0124], P = 0.0464).

Conclusions:

Depression and low folate levels are common in PWE. Low folate levels have a mild but significant negative correlation with depression in this population, and folate supplementation would be advisable for those on the older AEDs.