Association between depression and fruit and vegetable consumption among adults in South Asia

Association between junk food consumption and mental health problems in adults: a systematic review and meta-analysis

BACKGROUND

Anxiety and depression can seriously undermine mental health and quality of life globally. The consumption of junk foods, including ultra-processed foods, fast foods, unhealthy snacks, and sugar-sweetened beverages, has been linked to mental health. The aim of this study is to use the published literature to evaluate how junk food consumption may be associated with mental health disorders in adults.

METHODS

A systematic search was conducted up to July 2023 across international databases including PubMed/Medline, ISI Web of Science, Scopus, Cochrane, Google Scholar, and EMBASE. Data extraction and quality assessment were performed by two independent reviewers. Heterogeneity across studies was assessed using the I2 statistic and chi-square-based Q-test. A random/fixed effect meta-analysis was conducted to pool odds ratios (ORs) and hazard ratios (HRs).

RESULTS

Of the 1745 retrieved articles, 17 studies with 159,885 participants were suitable for inclusion in the systematic review and meta-analysis (seven longitudinal, nine cross-sectional and one case-control studies). Quantitative synthesis based on cross-sectional studies showed that junk food consumption increases the odds of having stress and depression (OR = 1.15, 95% CI: 1.06 to 1.23). Moreover, pooling results of cohort studies showed that junk food consumption is associated with a 16% increment in the odds of developing mental health problems (OR = 1.16, 95% CI: 1.07 to 1.24).

CONCLUSION

Meta-analysis revealed that consumption of junk foods was associated with an increased hazard of developing depression. Increased consumption of junk food has heightened the odds of depression and psychological stress being experienced in adult populations.

Defining a vitamin A5/X specific deficiency - vitamin A5/X as a critical dietary factor for mental health

A healthy and balanced diet is an important factor to assure a good functioning of the central and peripheral nervous system. Retinoid X receptor (RXR)-mediated signaling was identified as an important mechanism of transmitting major diet-dependent physiological and nutritional signaling such as the control of myelination and dopamine signalling. Recently, vitamin A5/X, mainly present in vegetables as provitamin A5/X, was identified as a new concept of a vitamin which functions as the nutritional precursor for enabling RXR-mediated signaling. The active form of vitamin A5/X, 9-cis-13,14-dehydroretinoic acid (9CDHRA), induces RXR-activation, thereby acting as the central switch for enabling various heterodimer-RXR-signaling cascades involving various partner heterodimers like the fatty acid and eicosanoid receptors/peroxisome proliferator-activated receptors (PPARs), the cholesterol receptors/liver X receptors (LXRs), the vitamin D receptor (VDR), and the vitamin A(1) receptors/retinoic acid receptors (RARs). Thus, nutritional supply of vitamin A5/X might be a general nutritional-dependent switch for enabling this large cascade of hormonal signaling pathways and thus appears important to guarantee an overall organism homeostasis. RXR-mediated signaling was shown to be dependent on vitamin A5/X with direct effects for beneficial physiological and neuro-protective functions mediated systemically or directly in the brain. In summary, through control of dopamine signaling, amyloid β-clearance, neuro-protection and neuro-inflammation, the vitamin A5/X - RXR - RAR - vitamin A(1)-signaling might be "one of" or even "the" critical factor(s) necessary for good mental health, healthy brain aging, as well as for preventing drug addiction and prevention of a large array of nervous system diseases. Likewise, vitamin A5/X - RXR - non-RAR-dependent signaling relevant for myelination/re-myelination and phagocytosis/brain cleanup will contribute to such regulations too. In this review we discuss the basic scientific background, logical connections and nutritional/pharmacological expert recommendations for the nervous system especially considering the ageing brain.

The mediating effect of health behaviors on the association between job strain and mental health outcome: a national survey of police officers

Police officers often face emotionally challenging interpersonal situations and numerous studies have demonstrated that policing is a stressful occupation. A study revealed a significant positive correlation between emotional demands among police officers and emotional dissonance, as well as burnout. Health-promoting behaviors can contribute to better overall health outcomes and reduce the risk of developing health problems, but there is limited research evaluating the association of job strain and health behaviors with mental health outcomes in police officers. The objective of this study was to assess the job strain associated with mental health mediated by health behaviors in Taiwanese police officers. This was a cross-sectional quantitative study conducted in Oct 2016. A total of 41,871 police officers (response rate was 79.7%) participated questionnaire that consisted of demographic information, job characteristics, health behaviors, and mental component summary (MCS) scores of the Short-Form Health Survey. Independent t-tests and one-way analysis of variance (One-way ANOVA) were conducted to assess the differences in mean MCS scores across various demographics, health behavior, and job characteristics. Multivariate regression analyses were used to assess the relationship between job strain and health behaviors with mental health outcomes. MCS scores were associated with job characteristics and health behaviors among police officers except for gender. After adjusting for covariates, multivariate analysis indicated that police officers with high job demands and high job strain index exhibited poor MCS scores. Job strain was significantly associated with MCS mediated by health behaviors (consumption of fruits and vegetables, and physical activity) in Taiwanese police officers. Since regular physical activity and increased vegetable and fruit consumption might alleviate the effects of job strain on mental health status, it is recommended that institutional policies be established to promote health-enhancing behaviors among police officers.

Method development, validation, and risk assessment of multiple pesticide residues of fruits in China

In this study, a muti-residue analysis method of 40 pesticides in five different categories of fruits in China was developed based on ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Five hundred real samples were analyzed and assessed for the dietary exposure risk. The sample treatment method was optimized by comparing four clean-up methods. The matrix effects of different fruits were evaluated. The analytical method was validated in terms of linearity, limit of detection (LOD), limit of quantification (LOQ), accuracy, and precision. The results showed that the optimal method was the treatment by clean up with ODS (octadecylsilane) and MgSO4. The matrix effect was the strongest in orange and weakest in apple. The LOD and LOQ of pesticides were 0.04-5.9 μg kg-1 and 0.13-19.5 μg kg-1, respectively. The recoveries at three spiked levels were ranged from 71.2 to 115.2% with the RSDs from 0.1 to 19.6%. Twenty-two pesticides were detected in 500 fruit samples from the major production regions of China, with concentrations ranging from 0.1 to 1930 μg kg-1. A total of 13, 10, 9, 8, and 4 pesticides were detected in peach, orange, grape, apple, and strawberry. Both the acceptable daily intake (ADI) and acute reference dose (ARfD) for all the detected pesticides were lower than 100%, indicating that the dietary intake risks are acceptable and would not pose potential health risks.

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Prevalence of mental disorders in South Asia: A systematic review of reviews

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Suboptimal dietary quality is associated with mental symptoms among adults aged 40 years and over in China: A population-based cross-sectional study

BACKGROUND

The previous studies an association between dietary patterns and psychiatric symptoms. However, few studies have examined the association of quality of dietary patterns and anxiety, depressive symptoms in the Chinese population.

METHODS

Between 2017 and 2019, a population-based, cross-sectional survey was carried out in China. Uniformed questionnaires collected the demographic characteristics and food data. The dietary quality of the adults was evaluated using the revised Diet Balance Index 2016 (DBI-16). We measured anxiety and depression symptoms using the the Generalized Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9.

RESULTS

A total of 73,737 participants were recruited during the survey period. 17.6 % and 13.7 % of residents suffer from anxiety and depression symptoms, respectively. The DBI-16 indicates that participants with anxiety or depression symptoms had higher scores of low bound score (LBS, refers to inadequate food intake) and dietary quality distance (DQD, refers to unbalanced food intake) than those without anxiety or depression. The logistic regression models showed that high levels of LBS and DQD problems were more strongly associated with anxiety (LBS:OR = 1.20, DQD:OR = 1.30) and depressive symptoms (LBS:OR = 1.21, DQD:OR = 1.44). On the contrary, higher bound score (HBS, refers to excessive food intake) was significantly negatively correlated with symptoms of anxiety and depression. Moreover, each increase in the food group was associated with 4 % lower odds of anxiety and 6 % lower odds of depression symptoms.

LIMITATIONS

Cross-sectional design and self-reporting of psychological symptoms and dietary information limit the generalizability of the results.

CONCLUSION

The dietary quality of adults aged 40 years and over in China is suboptimal, with excessive and inadequate food intake simultaneously. Dietary imbalance, and low dietary diversity may be related to anxiety and depressive symptoms.

Antidepressant-like Effects of Representative Types of Food and Their Possible Mechanisms

Depression is a mental disorder characterized by low mood, lack of motivation, negative cognitive outlook, and sleep problems. Suicide may occur in severe cases, although suicidal thoughts are not seen in all cases. Globally, an estimated 350 million individuals grapple with depression, as reported by the World Health Organization. At present, drug and psychological treatments are the main treatments, but they produce insufficient responses in many patients and fail to work at all in many others. Consequently, treating depression has long been an important topic in society. Given the escalating prevalence of depression, a comprehensive strategy for managing its symptoms and impacts has garnered significant attention. In this context, nutritional psychiatry emerges as a promising avenue. Extensive research has underscored the potential benefits of a well-rounded diet rich in fruits, vegetables, fish, and meat in alleviating depressive symptoms. However, the intricate mechanisms linking dietary interventions to brain function alterations remain largely unexplored. This review delves into the intricate relationship between dietary patterns and depression, while exploring the plausible mechanisms underlying the impact of dietary interventions on depression management. As we endeavor to unveil the pathways through which nutrition influences mental well-being, a holistic perspective that encompasses multidisciplinary strategies gains prominence, potentially reshaping how we approach and address depression.

Human nutritional relevance and suggested nutritional guidelines for vitamin A5/X and provitamin A5/X

In the last century, vitamin A was identified that included the nutritional relevant vitamin A1 / provitamin A1, as well as the vitamin A2 pathway concept. Globally, nutritional guidelines have focused on vitamin A1 with simplified recommendations and calculations based solely on vitamin A. The vitamin A / provitamin A terminology described vitamin A with respect to acting as a precursor of 11-cis-retinal, the chromophore of the visual pigment, as well as retinoic acid(s), being ligand(s) of the nuclear hormone receptors retinoic acid receptors (RARs) α, β and γ. All-trans-retinoic acid was conclusively shown to be the endogenous RAR ligand, while the concept of its isomer 9-cis-retinoic acid, being "the" endogenous ligand of the retinoid-X receptors (RXRs), remained inconclusive. Recently, 9-cis-13,14-dihydroretinoic acid was conclusively reported as an endogenous RXR ligand, and a direct nutritional precursor was postulated in 2018 and further confirmed by Rühl, Krezel and de Lera in 2021. This was further termed vitamin A5/X / provitamin A5/X. In this review, a new vitamin A5/X / provitamin A5/X concept is conceptualized in parallel to the vitamin A(1) / provitamin A(1) concept for daily dietary intake and towards dietary guidelines, with a focus on the existing national and international regulations for the physiological and nutritional relevance of vitamin A5/X. The aim of this review is to summarize available evidence and to emphasize gaps of knowledge regarding vitamin A5/X, based on new and older studies and proposed future directions as well as to stimulate and propose adapted nutritional regulations.

Anti-Inflammatory, Antioxidant, and Neuroprotective Effects of Polyphenols-Polyphenols as an Element of Diet Therapy in Depressive Disorders

Depressive disorders can affect up to 350 million people worldwide, and in developed countries, the percentage of patients with depressive disorders may be as high as 10%. During depression, activation of pro-inflammatory pathways, mitochondrial dysfunction, increased markers of oxidative stress, and a reduction in the antioxidant effectiveness of the body are observed. It is estimated that approximately 30% of depressed patients do not respond to traditional pharmacological treatments. However, more and more attention is being paid to the influence of active ingredients in food on the course and risk of neurological disorders, including depression. The possibility of using foods containing polyphenols as an element of diet therapy in depression was analyzed in the review. The possibility of whether the consumption of products such as polyphenols could alleviate the course of depression or prevent the progression of it was also considered. Results from preclinical studies demonstrate the potential of phenolic compounds have the potential to reduce depressive behaviors by regulating factors related to oxidative stress, neuroinflammation, and modulation of the intestinal microbiota.

Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases

BACKGROUND

An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases.

OBJECTIVE

The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases.

METHODS

A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging.

RESULTS

Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition.

CONCLUSIONS

Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Role of Banana (Musa balbisiana Colla) Peel Floss as Functional Food Matrix to Alleviate Chronic Stress

BACKGROUND: Banana peel (Musa balbisiana Colla) already has a diverse variety of nutritional benefits, but its perishable nature necessitates additional food processing, one of which is banana peel floss. AIM: The objective of this study was to examine the antidepressant effects of banana peel floss in experimental animals subjected to chronic mild stress (CMS) for 6 weeks. METHODS: Animals were randomly assigned into five groups. The first group was fed a control diet without CMS as a negative control. The other four groups were exposed to CMS and fed a control diet as a positive control, with three of the five groups fed a control diet supplemented with 15%, 30%, and 60% banana peel floss. The tail suspension test (TST) and the Morris water maze were used as behavioral parameters in this study (MWM). Cortisol and serotonin levels were measured in two stages: after CMS exposure or before banana peel floss intervention, and after 4 weeks of banana peel floss intervention. RESULTS: The results showed that the immobility time in TST and escape latency in the MWM test were significantly reduced in the groups supplemented with 15% and 30% banana peel floss, respectively. Furthermore, we observed a significant association between serotonin and cortisol levels and also between the duration of immobility time in TST and serotonin levels. CONCLUSIONS: The administration of banana peel floss caused significant changes in plasma serotonin concentrations, implying that the presence of dietary fiber, tryptophan, and bioactive components in banana peel floss can reduce stress-induced depression by regulating cortisol levels and increasing serotonin levels.

Non-attitudinal and non-knowledge based factors constrain households from translating good nutritional knowledge and attitude to achieve the WHO recommended minimum intake level for fruits and vegetables in a developing country setting: evidence from Gulu district, Uganda

BACKGROUND

The high level of incidence of mortality attributed to non-communicable diseases such as cancer, diabetes and hypertension being experienced in developing countries requires concerted effort on investment in strategies that can reduce the risks of development of such diseases. Fruits and vegetables (FV) contain natural bioactive compounds, and if consumed at or above 400 g per day (RDMIL) as recommended by World Health Organization (WHO) is believed to contribute to reduced risk of development of such diseases. The objective of this study was to determine in a developing country set-up, the extent to which rural and urban households conform to RDMIL, the status of nutritional attitude (NA) and knowledge (NK) associated with consumption of FV, and to delineate non-attitudinal and non-knowledge-based factors (NANK) that hinder achievement of RDMIL.

METHOD

A cross-sectional survey of 400 randomly selected households and 16 focus group discussions (FGD) were conducted using Gulu district of Uganda as a microcosm for a developing country setting. Level of consumption of FV was assessed using 24-h dietary recall and compared to RDMIL as a fraction (%). The status of NK and NA were determined using sets of closed-ended questions anchored on a three-point Likert scale. Further quantitative statistical analyses were conducted using t-test, chi-square, Pearson's correlation and multiple linear regression. FGD provided data on NANK factors and were analysed using qualitative content analysis procedure.

RESULTS

Urban and rural inhabitants met up to 72.0 and 62.4% of the RMDIL, respectively, with absolute intake being higher among urban than rural households by 37.54 g. NK and NA were good but the intensity of NK was higher among urban respondents by 11%. RDMIL was positively correlated with NA while socio-demographic predictors of RDMIL varied with household location. FGD revealed that primary agricultural production constraints, market limitations, postharvest management limitations, health concerns, social discomfort and environmental policy restrictions were the major NANK factors that hindered achievement of the RDMIL.

CONCLUSIONS

These results indicate that NANK factors constrain households from translating good NA and NK to achieve the RMDIL.

Vitamin A5/X controls stress-adaptation and prevents depressive-like behaviors in a mouse model of chronic stress

9-cis-13,14-dihydroretinoic acid (9CDHRA), acts as an endogenous ligand of the retinoid X receptors (RXRs), and is an active form of a suggested new vitamin, vitamin A5/X. Nutritional-relevance of this pathway as well as its detailed role in vertebrate physiology, remain largely unknown. Since recent GWAS data and experimental studies associated RXR-mediated signaling with depression, we explored here the relevance of RXR and vitamin A5/X-mediated signaling in the control of stress adaptation and depressive-like behaviors in mice. We found that compromised availability of 9CDHRA in Rbp1−/− mice was associated with increased despair in the forced swim and anhedonia in the sucrose preference test. 9CDHRA similarly to synthetic RXR agonist, BMS649, normalized despair behaviors in Rbp1−/− but not Rxrγ−/− mice, supporting involvement of RXR signaling in anti-despair activity of these ligands. Importantly, similarly to BMS649, the 9CDHRA and its nutritional-precursor, 9-cis-13,14-dihydroretinol (vitamin A5/X alcohol), prevented development of depressive-like behaviors in mice exposed to chronic social defeat stress, revealing the beneficial role of RXRs and its endogenous ligand in stress adaptation process. These data point to the need for relevant nutritional, biochemical and pharmacological studies of this signaling pathway in human, both in physiological conditions and in pathologies of stress-related disorders.

Gender Differences in Healthy and Unhealthy Food Consumption and Its Relationship with Depression in Young Adulthood

This study explores the relationship between the consumption of healthy and unhealthy foods and depression among young adults and the moderating effect of gender on these relationships. The National Longitudinal Survey of Youth 1979 for Children and Young Adults (NLSY79 CY) was used. A total of 2983 young adults were selected for the final sample. Logistic Regression Analysis and Ordinary Linear Regression were conducted to examine the research questions. Young men were overall more likely than young women to engage in negative eating habits. The consumption of healthy foods, which included fruits and vegetables, had a significant inverse relationship with depression. An interaction effect was found, indicating that gender moderated the relationship between fruit consumption and depression among young adults. Young males need to be taught more about the importance of good eating habits. Eating more fruits and vegetables (healthy foods) is more important than avoiding fast food or soft drinks (unhealthy foods) for young adults' mental health. The gender differences in the effect of fruit consumption implies that increased fruit consumption may be critical to reduce young females' depression.

Association between weekly fruit and vegetable consumption and depressive symptoms: results from the Korean Elderly Environmental Panel study

OBJECTIVES

Although previous studies have investigated the correlation between fruit and vegetable consumption and depression, the results remain inconclusive. The present study aimed to investigate the association between weekly fruit and vegetable consumption and depressive symptoms in elderly Koreans.

METHODS

A multiple covariate linear regression analysis was performed using the data of 1,226 elderly individuals ≥ 60 years of age who participated in the Korean Elderly Environmental Panel II study from 2012 to 2014. Depressive symptoms were evaluated using the Korean version of the Short form Geriatric Depression Scale (SGDS-K). Generalized linear mixed-effects models were constructed to analyze the repeated measurements of 305 people who participated in the survey every year.

RESULTS

After adjusting for confounders, SGDS-K scores were negatively associated with the frequency of weekly fruit consumption as follows (β [95% confidence interval; CI]: -0.17 [-0.28 to -0.05], -0.17 [-0.27 to -0.07], -0.42 [-0.54 to 0.29], and -0.33 [-0.44 to -0.21]) for less than 1 time/wk, 1-3 times/wk, 4-6 times/wk, and daily, respectively, compared to no consumption. The SGDS-K scores were also negatively associated with the frequency of vegetable consumption (β [95% CI]: -0.86 [-1.18 to -0.55], -0.18 [-0.35 to -0.01], -0.36 [-0.53 to -0.18], and -0.15 [-0.29 to 0.00]) in the above order, respectively.

CONCLUSIONS

Fruit consumption was inversely associated with depression levels in a dose-dependent manner. Although there was no dose-response relationship between vegetable consumption and the level of depression, it was negatively associated with SGDS-K scores.

Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey

OBJECTIVE

To assess the prevalence of and factors associated with depression among adolescent boys and girls.

DESIGN

We conducted a nationwide cross-sectional study.

SETTING

This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh.

PARTICIPANTS

We interviewed 4907 adolescent boys and 4949 adolescent girls.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was 'any depression' and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe.

RESULTS

The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6-9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121 minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression.

CONCLUSION

The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.

Prevalence and Associated Factors of Suicidal Behavior Among Patients and Residents in Northwest Ethiopia

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p-value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5-6%). It was found to be 4.4% with 95% CI range 4-5% in residents and 7.9% with 95% CI range 6-9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries.

Association of Mediterranean Diet Adherence, Functional Food Consumption and Anthropometric Characteristics with Anxiety and Depression Indexes in a Sample of Healthy Greek Adults: A Cross-Sectional Study

The purpose of this randomized, retrospective study was to investigate the possible association among levels of anxiety and depression and functional food consumption frequency, Mediterranean diet adoption and anthropometric indices in a sample of Greek, mainly young, adults. One hundred twenty healthy adults, 80% of whom were 18–35 years old, were randomly recruited from the North Aegean Islands, mainly from the Aegean University campus. The degree of anxiety was evaluated using the State-Trait Anxiety Inventory (STAI-X-1,2) whereas the degree of depression was assessed using the Beck Depression Inventory (BDI). Mediterranean diet adherence was evaluated using the Med Diet Score and functional foods consumption frequency by a validated food frequency questionnaire (FFQ). According to our results, the study did not show a statistically significant association between Mediterranean diet adherence and anxiety or depression levels (p > 0.05), and a trend association was observed only for the depression grouped score. In parallel, increased depression level was significantly correlated with an increased body mass index (BMI) (p = 0.019). In addition, the consumption of specific functional foods, such as beans, nuts, pomegranate, spinach and foods enriched with β-glucans, correlated with state-trait anxiety or depression levels, as well as with anthropometric indices (p < 0.05). The results of the study may contribute to the elucidation of the possible role of the Mediterranean diet and functional food consumption on self-esteem, anxiety and depression.

Fruit and vegetable consumption among South Asians: A systematic review and meta-analysis

BACKGROUND AND AIMS

Low consumption of fruit and vegetables is associated with high prevalence of non-communicable diseases, especially among South Asians. The aim of our study was to systematically review data published on fruit and vegetable intake among South Asian countries.

METHODS

This review included 43 studies conducted from December 1999 to 2019 among South Asians. Literature searching was undertaken in PubMed® database and World Health Organization website. The main outcomes were pooled using random effect meta-analysis.

RESULTS

The highest fruit consumption by both men and women (2.4 servings/day) was found in Bhutan (2004) while the lowest reports (0.43 servings/day) were from Sri Lanka (2011) and Bangladesh (2002). With regard to vegetable consumption, Indians (2007) had the lowest reported intake (0.9 servings/day), while the highest value, 3.8 servings/day, was reported in Bhutanese adults (2014). When both intakes were considered, the highest (4.28; 95% CI, 4.02 to 4.55; p=0.15; I²=51%, p<0.001) and the lowest (1.83; 95% CI, 1.41 to 2.25; p<0.001; I²=100%, p<0.001) pooled mean values, were attained for Bhutan and Bangladesh, respectively. The highest percentage of respondents (86.2%) achieved the World Health Organization recommendation of five fruit and vegetables (400 g) per day in Afghanistan (2013) whereas the lowest (0%) reported in Bangladesh (2005).

CONCLUSIONS

Residents of almost all South Asian countries appear to consume extremely low quantities of fruit and vegetables, lower than the World Health Organization recommendation. Hence, immediate initiatives should be implemented to enhance the intake of fruit and vegetables across the region.

Effect of financial stress on self-rereported health and quality of life among older adults in five developing countries: a cross sectional analysis of WHO-SAGE survey

In developing countries, older adults (65 years of age and above) share an increased vulnerability to catastrophic health expenditures and financial stress which can have significant bearing on their health and well-being. Currently, research evidence on how financial stress correlates with health and well-being among older adults in the developing countries is limited. Therefore, in this study, we aimed to assess the relationship between financial stress and subjective 1) health, 2) depression, 3) quality of life, and 4) life satisfaction among older adults in five developing countries.

METHODS

Data used in this study were cross-sectional which were collected from the first wave of Study on Global AGEing and Health (SAGE) survey of World Health Organization. Sample population were 12,299 community dwelling men and women in China (n = 4548), Ghana (n = 1968), India (n = 2441), South Africa (n = 1924), and Russia (n = 1418). Using generalized linear models with logit links, we assessed the correlation between self-reported financial stress and income inequality with the four outcome measures by adjusting for various sociodemographic factors.

RESULTS

Overall, the prevalence of good self-reported health, quality of life and positive life-satisfaction was 47.11, 79.25 and 44.40% respectively, while 20.13% of the participants reported having depression during past 12 months. Only about a fifth (18.67%) of the participants reported having enough money to meet daily their necessities completely, while more than quarter (28.45%) were in the lowest income quintile. With a few exceptions, the odds of reporting good self-reported health, quality of life, and life satisfaction were generally lower among those with varying degrees of financial stress, and larger among those in the higher income quintiles. Conversely, the likelihood of self-reported depression was significantly higher among those with any level of financial stress, and lower among those in the higher income quintiles.

CONCLUSION

This study concludes that both subjectively and objectively measured financial stress are inversely associated with good self-reported health, quality of life, life satisfaction, and positively associated with self-reported depression among older adults.

Community Supported Agriculture as a Driver of Food-Related Well-Being

Background: There is a growing amount of research interest to understand the role of food in well-being. The demand for community supported agriculture (CSA), bringing people spatially, economically, and socially closer to food, is continuously expanding. CSAs play an important role in both sustainable agriculture practices and influencing consumers’ food-related practices, but yet have received little attention in well-being research. Methods: This study explores food-related well-being among CSA members by using an exploratory, qualitative research design and a thematic analysis of semi-structured interviews. Results: The findings stress the relevance of psychological, social, and spiritual aspects of food-related well-being beyond the nutritional characteristics of food in CSA. Conclusion: The role of sustainable agriculture in contributing to food-related well-being becomes particularly evident based on consumers’ experiences. These results are important in convincing people that their food-related experiences belong to their perceived well-being as well as stimulating people to elevate their multidimensional expectations in relation to food.

The relation between dietary intakes and psychological disorders in Iranian adults: a population-based study

BACKGROUND

Previous studies showed an association between dietary intakes and psychological disorders. This study aimed to assess the association between dietary intakes and psychiatric disorders in Iran.

METHODS

In this cross sectional research, the data on 9965 adults were extracted from enrollment phase of Yazd Health Study (YaHS); a population-based cohort study on Iranian adults which was conducted during 2014 to 2016. Data on socio-demographic characteristics, tobacco use, history of chronic disease, and dietary assessment were collected using a validated researcher-made questionnaire. Moreover, anthropometric measurement was conducted. Psychological and physical activity assessments were also performed by depression, anxiety and stress scale questionnaire (DASS 21 items) and the short form of the International Physical Activity Questionnaire (IPAQ) respectively. Finally, multiple logistic regression analysis was used to evaluate relation between dietary intakes and psychological disorders.

RESULTS

After adjusting for the confounders, egg (depression: OR = 0.72, 95% CI: 0.52-0.98; anxiety: OR = 0.72, CI: 0.55-0.94), fruits (depression: OR = 0.60, 95% CI: 0.43-0.82; anxiety: OR = 0.70, 95% CI: 0.53-0.91), milk (depression: OR = 0.72, CI: 0.58-0.89; anxiety: OR = 0.73, CI: 0.61-0.87), and yogurt (depression: OR = 0.67, CI: 0.47-0.97; anxiety: OR = 0.54, CI: 0.4-0.73) were found to have protective effects on depression and anxiety. Higher fish consumption was associated with greater depression odds (OR = 1.54, CI: 1.18-2.04). Vegetables' intake had an inverse relationship with anxiety (OR = 0.74, CI = 0.58-0.93) and stress (OR = 0.59, CI: 0.42-0.82). Fruits (OR = 0.6, CI: 0.43-0.85) and milk consumption (OR: 0.61, CI: 0.47-0.77) were found to have protective effects on stress.

CONCLUSIONS

Egg, fruits, milk, yogurt, and vegetables' consumption had an inverse relationship with psychiatric disorders; whereas, higher fish intake was associated with higher depression chance. Further prospective studies are needed to confirm these findings.

Relationships between depression and food intake in climacteric women

Objective: This study evaluated the associations between food intake - especially omega-3 (n-3) - and depressive symptoms in climacteric women.Methods: Four hundred climacteric women were included in this research. The Kupperman Index, the Center for Epidemiologic Studies Depression Scale, and a 3-day food diary were used to investigate climacteric symptoms, depressive symptoms, and food intake, respectively. Sociodemographic, clinical, and anthropometric variables were also explored.Results: Statistically significant associations were observed between depression and climacteric symptoms, climacteric phase, previous history of depression, antidepressant drug use, family income, sleep pattern, and consumption of carbohydrates, fiber, polyunsaturated fatty acids, magnesium, zinc, and vitamins C, D, and B12. No association was observed between n-3 consumption and depression.Conclusion: Climacteric symptoms and food intake are important factors linked to depression during the climacteric period. Further studies are needed to clarify the changes in this phase of women's lives, as well as to investigate the role of the diet in the depression treatment or prevention.

Food consumption and depression among Brazilian adults: results from the Brazilian National Health Survey, 2013

Abstract: Our study aimed to evaluate the association between food consumption and depression. We used data from the Brazilian National Health Survey; a cross-sectional study carried out in 2013 among 46,785 Brazilian adults. The exposures were regular consumption (≥ 5 times/week) of the markers of healthy (beans, vegetables, fruits, and natural fruit juices) and unhealthy food (sugar sweetened beverages; sweets and the substitution of lunch or dinner for snacks); and a nutritional score elaborated by combining the frequency of consumption of markers of healthy and unhealthy food, the higher the value, the better the diet. The outcome was depression, assessed through the PHQ-9 questionnaire answered by the participants. Those with PHQ-9 scores greater than or equal to 10 were classified as presenting depression. We performed logistic regression models adjusted for potential confounders. Regular consumption of sweets (OR = 1.53; 95%CI: 1.33-1.76) and regular replacement of meals for snacks (OR = 1.52; 95%CI: 1.21-1.90) were positively associated with depression. Regular consumption of sugar sweetened beverages was positively associated with depression among women (OR = 1.27; 95%CI: 1.10-1.48). Regular consumption of beans was negatively associated with depression (OR = 0.74; 95%CI: 0.65-0.84), consistent for both sexes. Comparing the top quintile of the nutritional score (healthier diet) to the bottom quintile (less healthy) we found a negative association with depression (OR = 0.63; 95%CI: 0.52-0.75). Our results add evidence on a possible role of food consumption in depression; future longitudinal studies should explore the mechanisms of these associations.

Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review

The role of a properly balanced diet in the prevention and treatment of mental disorders has been suggested, while vegetables and fruits have a high content of nutrients that may be of importance in the case of depressive disorders. The aim of the study was to conduct a systematic review of the observational studies analyzing association between fruit and vegetable intake and mental health in adults. The search adhered to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42019138148). A search for peer-reviewed observational studies published until June 2019 was performed in PubMed and Web of Science databases, followed by an additional manual search for publications conducted via analyzing the references of the found studies. With respect to the intake of fruit and/or vegetable, studies that assessed the intake of fruits and/or vegetables, or their processed products (e.g., juices), as a measure expressed in grams or as the number of portions were included. Those studies that assessed the general dietary patterns were not included in the present analysis. With respect to mental health, studies that assessed all the aspects of mental health in both healthy participants and subjects with physical health problems were included, but those conducted in groups of patients with intellectual disabilities, dementia, and eating disorders were excluded. To assess bias, the Newcastle-Ottawa Scale (NOS) was applied. A total of 5911 studies were independently extracted by 2 researchers and verified if they met the inclusion criteria using a 2-stage procedure (based on the title, based on the abstract). After reviewing the full text, a total of 61 studies were selected. A narrative synthesis of the findings from the included studies was performed, which was structured around the type of outcome. The studies included mainly focused on depression and depressive symptoms, but also other characteristics ranging from general and mental well-being, quality of life, sleep quality, life satisfaction, flourishing, mood, self-efficacy, curiosity, creativity, optimism, self-esteem, stress, nervousness, or happiness, to anxiety, minor psychiatric disorders, distress, or attempted suicide, were analyzed. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. However, it must be indicated that the studies included were conducted using various methodologies and in different populations, so their results were not always sufficiently comparable, which is a limitation. Taken together, it can be concluded that fruits and/or vegetables, and some of their specific subgroups, as well as processed fruits and vegetables, seems to have a positive influence on mental health, as stated in the vast majority of the included studies. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health.

Low fruit and vegetable intake is associated with depression among Korean adults in data from the 2014 Korea National Health and Nutrition Examination Survey

BACKGROUND

Depression is a major mental disorder worldwide. The prevalence of depression among Korean adults was estimated to be 5.6% in 2006 and 6.7% in 2011, and that increased to 10.3% in 2013. Using national data, the present study investigated the association between vegetable and fruit intake and the prevalence of depression among Korean adults.

METHODS

This analysis used data from 4349 subjects aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES, 2014). Depression was assessed using the self-reported Patient Health Questionnaire (PHQ)-9. Food and nutrient intake was assessed using the 24-h recall method. Individual food intake was categorized into 18 food groups. The statistical analyses in this study were performed by adopting stratification, clustering, and sample weight variables using SPSS Ver. 23.0. Cronbach's α was used to determine the internal consistency of the PHQ-9 items. Logistic regression analysis was used to estimate the odds ratios of depression adjusted for several confounders.

RESULTS

The depression rate of all subjects was between 8.7 and 4.7% and decreased as vegetable and fruit intake increased. With regard to sex, the depression rate decreased from 6.4 to 2.5% in males and from 11.4 to 6.6% in females as vegetable and fruit intake increased. Thus, the results of this study reveal an inverse association between vegetable and fruit intake and depression. The odds ratios show that vegetable and fruit intake was inversely associated with depression with no adjustment. When the data were adjusted for age, energy intake, obesity, smoking, drinking, stress, eating-out frequency, breakfast, and food security, subjects exhibited significantly lower rates of depression with higher vegetable and fruit intakes.

CONCLUSIONS

This is the first study to investigate the association between vegetable and fruit consumption and depression in a Korean population. Additional epidemiological studies are needed to find the underlying reasons for that association.

Dietary Diversity and Child Development in the Far West of Nepal: A Cohort Study

Poverty adversely affects child development through multiple pathways in low- and middle-income countries. Relationships between diet and child development are poorly understood. In this study, we aimed to explore these associations in a longitudinal cohort of 305 children in rural Nepal (baseline mean age 14 months), evaluating dietary diversity and the consumption of specific food groups at three timepoints over 1.5 years. Child development was assessed using the Ages and Stages questionnaire-version 3 (ASQ-3). Associations between the number of days that children consumed minimum dietary diversity (MDD) (≥4/8 items) and specific food groups over time (range 0–3) and total and subscale ASQ scores at age 23–38 months were estimated using multiple linear and logistic regression, dichotomizing scores at the lowest quartile. After adjusting for confounders, each additional day of consuming MDD was associated with a 35% reduction in the odds of low total ASQ score [OR 0.65, 95% CI (0.46, 0.92)]. The consumption of animal source foods [OR 0.64, (0.46, 0.89)], and vegetables/fruits [OR 0.60, (0.41, 0.90), but not processed foods [OR 0.99, (0.62, 1.59)] was associated with lower odds of low total development. Vegetables, fruits and animal source foods may be important for child development in this setting.

Exploring Singapore's consumption of local fish, vegetables and fruits, meat and problematic alcohol use as risk factors of depression and subsyndromal depression in older adults

Background

Depression is a chronic mental disorder that severely impacts the older adult population globally. Nutritional psychiatry is an approach that has gained traction over the years. Exploring locally relevant consumption of common types of fish, vegetables and fruits (V&F), meat and problematic alcohol use (PAU) as risk factors associated with depression and subsyndromal depression (SSD) could reveal modifiable factors that could be targeted in the local older adult population in Singapore.

Methods

Data collected from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional population-based epidemiological study of Singapore’s older adult population was analysed for the purposes of this study. Two thousand five hundred sixty-five participants were recruited and comprised of Singapore citizens and permanent residents aged ≥60 years. Data on fish, meat, and V&F consumption were collected using the sociodemographic and risk factor questionnaire. The CAGE (Cut, Annoyed, Guilt, and Eye-opener) questionnaire was used to determine PAU. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) was used to obtain participants’ diagnosis of depression or SSD. A multinomial logistic regression was used to explore the relationship between depression and dietary factors.

Results

Consumption of V&F in the last 3 days was less likely to be associated with depression and SSD. Frequent consumption of specific species of fish was associated with depression and SSD. PAU and the frequent consumption of Himantura gerrardi (stingray) were more likely to be associated with SSD. Finally, meat consumption was more likely to be associated with depression and SSD.

Conclusions

The preliminary findings of the study support a need for healthy eating for the older adult population in Singapore. Further directions include a more thorough health and nutrition survey to capture accurate diets among the older adults in Singapore.

Dietary Patterns: A New Therapeutic Approach for Depression?

Introduction:

The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact.

Method:

A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included.

Results:

We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results.

Discussion:

he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms.

Conclusion:

More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

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

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

Possible relation between consumption of different food groups and depression

BACKGROUND

Diverse studies have investigated the relationship between diet and depression. In fact some cross-sectional studies suggested that a healthy diet reduced the risk for depression. The main objective of this study was to assess the relationship of consumption of different food groups with depression. The food groups were selected based on their content of substances that were precursors to neurotransmitters (tryptophan or inositol) or their effect on oxidative stress.

METHODS

This observational retrospective study compared the diets of individuals who were with depressive symptoms (Beck Depression Inventory Questionnaire [BDI] ≥ 10; 53 women, 23 men, age 38+/- 11) and with no depressive levels (BDI < 10; 33 women, 23 men, age 41+/- 13). Dietary data were collected from a questionnaire that asked about consumption of legumes, nuts, whole-grain foods, fruits and vegetables, chocolate, and sweet foods and refined sugars.

RESULTS

Depressed individuals consumed significantly lower amounts of legumes, fruits, and vegetables, but higher amounts of sweets and refined sugars (p < 0.05 for all comparisons). After statistical adjustment for age and sex, the consumption of no legumes (adjusted odds ratio [aOR] = 2.60, 95% confidence interval [CI] = 1.19-5.67), low consumption of fruits and vegetables (aOR = 2.69, 95% CI = 1.18-6.13), and high consumption of sweet foods and refined sugars (aOR = 1.91, 95% CI = 1.23-2.99) were significantly associated with depression. The two groups had no significant differences in the consumption of chocolate.

DISCUSSION

The results indicate significant relationships of the consumption of certain foods with depression, although the study design precludes any conclusions regarding causality. Further studies are necessary to determine the causal relationships of the consumption of specific foods with depression, and of depression with the consumption of specific foods.

CONCLUSION

In spite of the limitations, we find that individuals without depression consumed more legumes, fruits, and vegetables, but fewer sweets and pastries than those with depression.

Fruit and vegetable consumption among adults in Namibia: analysis of a nationally representative population

Background: Prevalence of F&V consumption in Namibia is not known. In this study we aimed to address this gap by using nationally representative data with the objectives of measuring the prevalence of adequate F&V consumption among adult men and women and their socio demographic determinants. Methods: This study is based on data from Namibia Demographic and Health Survey (NDHS2013). Sample population were 14 185 men and women aged between 15 and 49 years.Amount of fruit and vegetable consumption was measured by self-reported frequencies and was defined as adequate (at least 5 servings/day) according to World Health Organization (WHO)guidelines. Results: Overall, only 4.3% (3.8-4.9%) of the men and women reported consuming at least 5 servings of F&V a day, with the percentage being slightly higher among women (4.8%,95% CI=3.7-6.2) compared with men (4.2%, 95% CI=3.6-4.8). In the multivariable analysis,education level and household wealth status appeared to be the only factors associated with adequate F&V intake. Men and women who had primary level education had higher odds of eating at least 5 servings of F&V a day compared with those who had no education. Regarding wealth status, men and women from non-poor households had respectively 2.13 times(OR=2.13, 95% CI=1.01-4.48) and 2.2 times (OR=2.19, 95% CI=1.56-3.38) higher odds of eating at least 5 servings of F&V a day. Conclusion: Only a small proportion of the men and women consumed adequate amount of F&V on daily basis. Having primary level education and non-poor household wealth status were positively associated with adequate amount of F&V intake.

High Vitamin C Status Is Associated with Elevated Mood in Male Tertiary Students

Micronutrient status is thought to impact on psychological mood due to the role of nutrients in brain structure and function. The aim of the current study was to investigate the association of vitamin C status with mood state in a sample of male tertiary students. We measured fasting plasma vitamin C levels as an indicator of vitamin C status, and subjective mood was determined using the Profile of Mood States (POMS) questionnaire. One hundred and thirty-nine male students aged 18 to 35 years were recruited from local tertiary institutes in Christchurch, New Zealand. The average plasma vitamin C concentration was 58.2 ± 18.6 (SD) µmol/L and the average total mood disturbance score was 25.5 ± 26.6 (possible score −32 to 200 measuring low to high mood disturbance, respectively). Plasma vitamin C concentration was inversely correlated with total mood disturbance as assessed by POMS (r = −0.181, p < 0.05). Examination of the individual POMS subscales also showed inverse associations of vitamin C status with depression, confusion, and anger. These findings suggest that high vitamin C status may be associated with improved overall mood in young adult males.

Intake of Raw Fruits and Vegetables Is Associated With Better Mental Health Than Intake of Processed Fruits and Vegetables

Background: Higher intakes of fruits and vegetables, rich in micronutrients, have been associated with better mental health. However, cooking or processing may reduce the availability of these important micronutrients. This study investigated the differential associations between intake of raw fruits and vegetables, compared to processed (cooked or canned) fruits and vegetables, and mental health in young adults.

Methods: In a cross-sectional survey design, 422 young adults ages 18–25 (66.1% female) living in New Zealand and the United States completed an online survey that assessed typical consumption of raw vs. cooked/canned/processed fruits and vegetables, negative and positive mental health (depressive symptoms, anxiety, negative mood, positive mood, life satisfaction, and flourishing), and covariates (including socio-economic status, body mass index, sleep, physical activity, smoking, and alcohol use).

Results: Controlling for covariates, raw fruit and vegetable intake (FVI) predicted reduced depressive symptoms and higher positive mood, life satisfaction, and flourishing; processed FVI only predicted higher positive mood. The top 10 raw foods related to better mental health were carrots, bananas, apples, dark leafy greens like spinach, grapefruit, lettuce, citrus fruits, fresh berries, cucumber, and kiwifruit.

Conclusions: Raw FVI, but not processed FVI, significantly predicted higher mental health outcomes when controlling for the covariates. Applications include recommending the consumption of raw fruits and vegetables to maximize mental health benefits.

Satisfaction about Patient-centeredness and Healthcare System among Patients with Chronic Multimorbidity

The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh, India and China, and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system. Cross-sectional data on 18 696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization (WHO). Outcome variables were subjective rating of (1) healthcare system's ability to involve patients in decision-making, and (2) satisfaction with the way healthcare system runs in the country. Self-reported chronic conditions were used to measure the prevalence of multimorbidity. Out of 9 chronic conditions, back pain, arthritis, and chronic cough appeared to be the most prevalent ones among majority of the participants. About one-third of the participants in China (30.7%) and two-thirds in Bangladesh (66.1%) and India (66.6%) reported having at least one chronic illness. Prevalence of multimorbidity was highest in India (34.3%) followed by Bangladesh (28.8%) and China (14.3%). In Bangladesh, India and China, respectively 70.5%, 41.7%, 61.3% women and 54.5%, 42.8% and 58.8 % men expressed dissatisfaction regarding the way healthcare system runs in their country. In Bangladesh and India, men who were living with multimorbidity were more likely to rate the patient-centeredness as "bad" than those who had no disease illness. This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India. Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.

Physical activity correlates among people with psychosis: Data from 47 low- and middle-income countries

BACKGROUND

People with schizophrenia engage in low levels of physical activity (PA). However, few large-scale studies have investigated the factors that may influence PA participation in individuals with psychosis and data from low- and middle-income countries (LMICs) is especially scarce. Thus, we investigated PA correlates in a large sample of people with a psychosis diagnosis across 47 LMICs.

METHODS

Cross-sectional data from the World Health Survey, restricting to those with a self-reported lifetime diagnosis of schizophrenia/psychotic disorder, was analyzed. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomized into those that do and do not (low PA) meet the minimum recommended PA weekly targets (≥150min). A range of socio-demographic, health behavior, and mental and physical health variables were examined using random effects logistic regression.

RESULTS

Overall 2407 people (mean 42.0years, 41.5% males) with schizophrenia/psychosis were included. The prevalence of low PA was 39.2% (95%CI=37.0%-41.2%). Male sex (odds ratio (OR)=1.33), increasing age, unemployment (vs. employed OR=2.50), urban setting (vs. rural OR=1.75), inadequate fruit consumption (vs. adequate fruit intake OR=3.03), depression (OR=1.33), sleep/energy disturbance, and mobility limitations were significantly associated with low PA. Marital status, education, wealth, smoking, vegetable and alcohol consumption, anxiety, cognition, pain, and chronic medical conditions were not significant correlates.

CONCLUSION

PA is influenced by a range of factors among people with psychosis. These correlates should be considered in interventions aiming to facilitate PA in psychotic individuals living in LMICs.

Fruits and vegetables intake and its subgroups are related to depression: a cross-sectional study from a developing country

BACKGROUND

The association of fruits and vegetables (FV) specific subgroups consumption and depression has not been investigated in healthy adult populations. Therefore, the aim of our study was to determine the relationship between intake of FV as well as their subgroups and depression.

METHODS

This cross-sectional study was conducted on 400 women attending healthcare centers. The scores of depression, anxiety, and stress were measured using the 21-item depression, anxiety and stress scales questionnaire. The participants' anthropometric and physical activity data were collected and the 147-item semi-quantitative FFQ was used for estimating the FV intake.

RESULTS

After adjustment for confounding variables, the participants in the lower quartiles of total FV, total vegetables, total fruits, citrus, other fruits and green leafy vegetables intake were more likely to experience depression compared to those in the higher quartiles (p trend < 0.03).

CONCLUSION

Our findings suggest that higher intake of total FV and some of its specific subgroups might be associated with depression.

Physical activity correlates in people with anxiety: Data from 46 low- and middle-income countries

OBJECTIVE

There is a lack of nationally-representative data on the correlates of physical activity (PA) among people with anxiety symptoms. Thus, we investigated PA correlates among community-dwelling adults with anxiety symptoms in 46 low- and middle-income countries (LMICs) using predominantly nationally-representative data.

METHOD

Cross-sectional data from the World Health Survey were analysed. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomised into those that do (≥150min moderate-vigorous PA) and do not (<150min) meet recommended PA weekly targets. Multivariable logistic regression was used to assess the correlates.

RESULTS

The analysis included 24,850 people with anxiety symptoms (43.3±16.6years; 39.7% males). The prevalence of low PA was 33.1% (95%CI=31.6%-34.6%). Older age [e.g., OR=4.57 for age≥65 vs. 18-24years], not married/cohabiting (vs. married/cohabiting OR=1.36), being in the richest quintile (vs. poorest OR=1.41), unemployed (vs. employed OR=2.18), inadequate vegetable consumption (vs. adequate OR=1.66), and poor sleep/energy, worse cognition, pain/discomfort and mobility difficulties were all significant correlates of low PA.

CONCLUSIONS

PA is associated with a range of factors among people with anxiety symptoms. Future interventions might target the identified correlates in order to facilitate people with anxiety to be more physically active.

Physical activity correlates among 24,230 people with depression across 46 low- and middle-income countries

BACKGROUND

There is a paucity of nationally representative data available on the correlates of physical activity (PA) among people with depression, especially in low- and middle-income countries (LMICs). Thus, we investigated PA correlates among community-dwelling adults with depression in this setting.

METHODS

World Health Survey data included 24,230 adults (43.1 ± 16.1 years; 36.1% male) with ICD-10 diagnoses of depression including brief depressive episode and subsyndromal depression aged ≥ 18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire. Participants were dichotomised into low and moderate-to-high physically active groups. Associations between PA and a range of sociodemographic, health behaviour and mental and physical health variables were examined using multivariable logistic regressions.

RESULTS

34.8% of participants with depression were physically inactive. In the multivariate analyses, inactivity was associated with male sex, older age, not being married/cohabiting, high socio-economic status, unemployment, living in an urban setting, less vegetable consumption, and poor sleep/ low energy. In addition, mobility difficulties and some somatic co-morbidity were associated with not complying with the 150min per week moderate-to-vigorous PA recommendations.

CONCLUSIONS

The current data provide guidance for future population level interventions across LMICs to help people with depression engage in regular PA.

Memory and Learning Complaints in Relation to Depression among Elderly People with Multimorbidity

Although current models of care are generally well-suited to providing treatment for individual medical conditions, the emergence of multimorbidity is becoming a serious concern for practitioners and policy researchers, particularly in developing countries. The challenges of tackling multimorbidity are further compounded when the multimorbidity co-occurs with psychiatric conditions such as cognitive and depressive disorders. Understanding the relationships between multimorbidity and psychiatric illnesses is therefore of considerable clinical importance. In the present study, we cross-sectionally examined whether multimorbidity has an association with perceived cognition-including memory, learning complaints, and depression-among elderly population in South Africa. Study subjects were 422 men and women aged 50 years and older. The prevalence of arthritis, asthma, cancer, diabetes, heart disease, chronic lung disease, hypertension, and stroke was respectively 31.5, 7.3, 1.7, 10.2, 1.2, 1.7, 52.1, and 31.5%, and that of multimorbidity was 30.8%. In the multivariate analysis, women with multimorbidity were 4.33 times (OR = 4.33, 95%CI = 2.96⁻14.633) more likely to report memory complaints. The odds of diagnosed depression were 1.4 times (OR = 1.4, 95%CI = 1.045⁻5.676), and the odds of self-reported depression were 1.7 times (OR = 1.7, 95%CI = 1.41⁻2.192) higher among women who had multimorbidity compared with those who had no morbid conditions. However, the association was not significant among men. Overall, the findings suggest that the occurrence of multimorbidity warrants special attention, especially regarding its compounding effects on psychological health. The findings need to be replicated through longitudinal studies that consider a broader range of chronic conditions.

Participation in physical activity and back pain among an elderly population in South Asia

Introduction

Globally, chronic back pain is one of the most commonly encountered medical conditions among an elderly population with significant bearings on health, functional mobility and general well-being.

Objective

To estimate the burden of chronic back pain and its association with physical activity (PA) among population aged 50 years and above in Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Methods

Cross-sectional data on 8502 men and women aged 50 years and above were collected from the World Health Survey (2002). Three forms of PA were considered – vigorous physical activity (VPA), moderate physical activity (MPA) and walking. Odds ratios (ORs) of the association between self-reported back pain and VPA, MPA and walking were calculated by using generalized estimating equations.

Results

The prevalence of back pain was, respectively, 64.8%, 19.8%, 69.5%, 40.6% and 36.2% in Bangladesh, India, Nepal, Pakistan and Sri Lanka. No significant association between back pain and VPA was observed among men in any of the countries. In India, Pakistan and Sri Lanka, the odds of suffering from back pain were, respectively, 29%, 2.5 times and 59% higher among women who almost never took MPA. In India, taking MPA for few days a week and almost never was associated with, respectively, 38% (OR=1.38; 95% confidence interval [CI]=1.017–1.876) and 56% (OR=1.564; 95% CI=1.003–2.438) higher odds of reporting back pain. Walking almost never was also associated with, respectively, 83% (OR=1.829; 95% CI=1.14–2.934) and 2.9 times (OR=2.854; 95% CI=1.419–5.738) higher odds of reporting back pain among men in Nepal and Pakistan, respectively.

Conclusion

Though the relationship was not consistent across sex and countries, results indicate that inadequate or nonparticipation can substantially increase the likelihood of suffering from back pain among an elderly population in this region. Further research is needed to better understand this relationship and the potential of exercised-based strategies to prevent and treat back pain among elderly persons.