The relation between low carbohydrate diet score and psychological disorders among Iranian adults

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.

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

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

Low-carbohydrate-diet score, dietary macronutrient intake, and depression among adults in the United States

BACKGROUND

The aim was to ascertain whether low-carbohydrate-diet (LCD) score and dietary macronutrient intake are associated with depression.

METHODS

This cross-sectional study included 23,204 United States adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary macronutrient intake was evaluated by the average of two 24-h dietary recall interviews. LCD score was calculated by summing the 11 quantiles values of the percentages of energy derived from carbohydrate, protein, and fat. Major depression was defined as a nine-item Patient Health Questionnaire score of 10 or more. Logistic regression and restricted cubic spline models were used to explore the relationship between LCD score, dietary macronutrient intake, and depression.

RESULTS

LCD score was significantly associated with the risk of depression after adjustment for covariates (odds ratio, 0.98; 95 % confidence interval, 0.97-0.99; p < 0.001). Restricted cubic splines showed that the pattern of this inverse association was nonlinear. Among macronutrients, carbohydrate and protein intake was nonlinearly associated with the risk of depression, whereas fat intake was not related to the risk of depression. A decreased risk of depression was observed when the carbohydrate intake was moderate (45.3 %-59.1 %). The pattern of the association between protein intake and the risk of depression was L-shaped.

CONCLUSIONS

LCD score was inversely associated with the risk of depression in a nonlinear manner in a nationally representative sample of adults from the United States. Furthermore, moderate carbohydrate intake and high protein intake were correlated with a lower risk of depression.

Low-carbohydrate diet as a nutritional intervention in a major depression disorder: focus on relapse prevention

Objectives: Mood disorders are trending to be among the leading causes of years lived with disability. Despite multiple treatment options, around 30% patients with major depressive disorder (MDD) develop treatment resistant depression (TRD) and fail to respond to current pharmacological therapies. This study aimed to explore the potential benefits of nutritional treatment strategies, along with their molecular mechanisms of action, focusing especially on low-carbohydrate diet (LCHD), ketogenic diet (KD) and other strategies based on carbohydrates intake reduction.Methods: A comprehensive literature review was conducted to determine the impact of LCHD on alleviating depressive symptoms in patients with MDD, along with an explanation of its mode of action.Results: The study revealed significant impact of nutritional interventions based on restriction in carbohydrate intake such as LCHD, KD or sugar-sweetened beverages (SSB) exclusion on anxiety or depression symptoms reduction, mood improvement and lower risk of cognitive impairment or depression. The efficacy of these approaches is further substantiated by their underlying molecular mechanisms, mainly brain-derived neurotrophic factor (BDNF) which is a potential key target of sugar restriction diets in terms of neuroplasticity.Discussion: Healthcare professionals may consider implementing LCHD strategies for MDD and TRD patients to modify the disease process, maintain euthymia, and prevent depressive episode relapses. Ranging from the exclusion of SSB to the adherence to rigorous LCHD regimens, these nutritional approaches are safe, straightforward to implement, and may confer benefits for well-being and relapse prevention in this specific patient population.

The association between dietary anti-oxidant quality score and psychological disorders among Iranian adults: a population-based study

OBJECTIVE

Evidence linking relation between dietary antioxidant quality score (DAQS) and psychological disorders is limited. Therefore, this study aimed to assess relationship between DAQSs and psychological disorders including depression, anxiety and stress among Iranian adults.

METHODS

This cross-sectional study used data on 7165 participants of the recruitment phase of Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd Study (TAMYZ). Dietary intakes and psychological problems were evaluated using a validated semi-quantitative food frequency questionnaire and the validated Iranian version of depression, anxiety and stress scale questionnaire. DAQS was calculated for each person by summing up the assigned scores to a ratio between daily consuming each of the nutrients including vitamin A, C, E, selenium, manganese, zinc and their daily recommended intake (Score of 0 for a ratio of <2/3 and 1 for a ratio of >2/3). Eventually, association between DAQS and psychological disorders was assessed via logistic regression analysis.

RESULTS

Although no significant relationship was observed between DAQS and psychological disorders in general population, a protective role was found for DAQS against anxiety only in women after adjusting history of chronic disease; age; marital status; education level; smoking status; total energy intake and physical activity level (second tertile versus first tertile: OR: 0.63, 95% CI: 0.40-0.99). However, this finding was nonsignificant after further adjustment for body mass index.

CONCLUSION

Average levels of DAQS might be related to psychological distress especially among women. However, more studies are recommended to valid the findings.

Association between dietary anthocyanidins intake and depression among US adults: a cross-sectional study (NHANES, 2007-2010 and 2017-2018)

BACKGROUND

Anthocyanidins encompass a diverse array of compounds that possess notable anti-inflammatory and antioxidant properties with pharmacological activity. However, the correlation between the consumption of anthocyanidins through diet and its impact on depression has yet to be investigated.

METHODS

This study utilized the Food and Nutrient Database for Dietary Studies (FNDDS) expanded flavonoid intake database, as well as data from the National Health and Nutrition Examination Survey (NHANES) from the years 2007 to 2010 and 2017 to 2018. The analysis of the collected data was conducted in R, following the guidelines outlined in the official NHANES user guide "Stratified Multi-stage Probability Sampling". Three different models were developed using logistic regression to assess the protective effects of T3 (representing the highest intake of anthocyanidins) against depression. Additionally, the study aimed to investigate whether there existed a non-linear relationship between the dietary intake of anthocyanidins and the prevalence of depression by employing restricted cubic spline (RCS) analysis.

RESULTS

A total of 6,845 eligible participants were included in this cross-sectional study, with their data appropriately weighted to represent a population of 89.8 million people in the United States of America. The results demonstrated that individuals diagnosed with depression had a significantly lower dietary intake of anthocyanidins compared to those without depression (P < 0.0001). Moreover, significant differences were observed among different participant groups regarding socioeconomic status and the presence of chronic physical illnesses (such as hypertension, glucose status, and chronic kidney disease risk, etc.) (P < 0.05). After adjustment for covariates, participants with the highest intake of anthocyanins (T3) demonstrated a significantly reduced risk of depression [OR_T3 = 0.67, 95%CI: (0.48-0.95), (P_trend= 0.02]. Furthermore, the RCS analysis revealed a significant linear relationship between dietary anthocyanidin intake and depression (P for non-linear = 0.5876).

CONCLUSION

Our findings reveal a negative association between dietary anthocyanidin intake and depression.

Dietary choline and betaine intake, cardio-metabolic risk factors and prevalence of metabolic syndrome among overweight and obese adults

BACKGROUND

Choline is an important metabolite involved in phospholipids synthesis, including serum lipids, and is the immediate precursor of betaine. There are numerous studies with inconsistent results that evaluated the association between dietary choline intakes with cardiovascular risk factors. In addition, the association between dietary betaine and choline intakes with cardio-metabolic risk factors is not well studied. In the current study, our aim was to evaluate dietary choline and betaine intakes in the usual diet of obese individuals and to assess its association with serum lipids, blood pressure and glycemic markers among obese individuals.

METHODS

We recruited a total number of 359 obese people aged between 20 and 50 years in the present study. A semi-quantitative food frequency questionnaire (FFQ) was used for dietary assessment; dietary choline and betaine intakes were calculated using the United States Department of Agriculture (USDA) database. National cholesterol education program adult treatment panel (NCEP-ATP)-III criteria was used metabolic syndrome (MetS) definition. Enzymatic methods were used to assess biochemical variables. Body composition was measured with the bioelectrical impedance analysis (BIA) method.

RESULTS

Higher body mass index (BMI), waist to hip ratio (WHR), fat-free mass (FFM) and basal metabolic rate (BMR) were observed in higher tertiles of dietary choline intake (P < 0.01). There was no significant difference in terms of biochemical parameters among different tertiles of dietary choline intake, while systolic blood pressure (SBP) and diastolic blood pressure (DBP) were reduced in higher betaine tertiles (P < 0.05). For total dietary choline and betaine intakes, there was a reduction in DBP and low density lipoprotein (LDL) concentrations (P < 0.05). Also, a non-significant reduction in serum total cholesterol (TC), triglyceride (TG) and MetS prevalence was observed in higher tertiles of dietary choline and betaine intakes. After classification of the study population according to MetS status, there was no significant difference in biochemical variables in subjects with MetS (P > 0.05), while in the non-MetS group, SBP, DBP, TG and insulin levels reduced in higher tertiles of dietary betaine and choline (P > 0.05).

CONCLUSION

According to our findings, higher dietary intakes of choline and betaine were associated with lower levels of blood pressure and LDL concentrations among obese individuals. Further studies are warranted to confirm the results of the current study.

Association of low-carbohydrate-diet score and cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

To investigate the association between low-carbohydrate-diet (LCD) score and cognitive performance based on a nationally representative sample aged ≥ 60 years from National Health and Nutrition Examination Survey (NHANES) database.

METHODS

This cross-sectional study included 2,537 eligible older adults from the NHANES database 2011-2014. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning subtest, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST) were used to assess the cognitive performance. All participants were categorized into the low and normal cognitive performance groups. The univariate and multivariate logistic regression analyses were utilized to evaluate the association of LCD score with cognitive performance. Stratified analyses based on age, body mass index (BMI), gender, marital status, education level was conducted.

RESULTS

After adjusting age, education level, marital status, household income, history of diabetes, history of hypertension, history of congestive heart failure, history of coronary heart disease, history of heart disease, history of stroke, magnesium and the using of psychotropic medication, LCD score was correlated with the CERAD word learning subtest. The associations between LCD score and AFT, DSST were not statistically significant. Moreover, LCD score was also related to cognitive performance among individuals who were aged < 65 years or BMI 25-30 kg/m² or was married/separated, or had an education level of high school or above.

CONCLUSION

The adherences to LCD might be associated with the risk of cognitive performance among older adults. Further large-scale cohort studies are needed to test the causal relationship of LCD and cognitive performance.

Adherence to low carbohydrate diets and non-alcoholic fatty liver disease: a case control study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is defined as the excessive accumulation of fat in the liver cells of people who do not drink alcohol. The aim of study is investigated the association between low carbohydrate diets (LCDs) and NAFLD.

METHODS

This age and gender-matched case-control study was conducted on 120 patients newly diagnosed with NAFLD and 120 adults without NAFLD. Diagnosis of NAFLD based on laboratory tests and abdominal ultrasound. Low carbohydrate diets score calculated on the percentage of energy as carbohydrate, fat, and protein. Participants in the highest rank intake of fat and protein and lowest intake of carbohydrate received 10 points. Multivariable logistic odds ratio was used for examine the relation between LCDs and NAFLD.

RESULTS

This study showed subjects in the highest tertile of LCD has more intake of zinc and vitamin B12 compare to lowest. Also, intake of protein (p = 0.02) carbohydrate (p < 0.02) and cholesterol (p = 0.02) were significantly higher in patient with NAFLD compare to control subjects. There was no significant association between LCD and risk of NAFLD (OR: 1.36; 95% CI: 0.97-1.92; P-trend = 0.13) in crude and adjusted (OR: 1.31; 95% CI: 0.84-2.04; P-trend = 0.23) model.

CONCLUSION

However, we showed that intake of protein, carbohydrate and cholesterol are higher in NAFLD, but our results of study showed that LCDs with higher proportion intakes of protein and fat was not associated with NAFLD. Further prospective studies are required for confirm these associations.

The association of dietary macronutrient quality indices with depression and anxiety symptoms and quality of life in Iranian adults: The LipoKAP study

BACKGROUND

Macronutrients' quality may impact differently on mental health and quality of life (QOL). This study aimed to investigate the potential relationship between the carbohydrate quality index (CQI), fat quality index (FQI), protein quality index (PQI), the affective mental symptoms and QOL among Iranian adults.

METHODS

The LipoKAP is a cross-sectional study, conducted with 2456 adults in Iran. A validated food frequency questionnaire was used to evaluate usual dietary intakes. A validated Iranian version of the Hospital Anxiety and Depression Scale was used to assess the severity of anxiety and depression. QOL was assessed by EQ-5D.

RESULT

In the fully adjusted model, participants in the highest tertile of CQI had lower QOL than those in the lowest tertile (OR = 1.35; 95 % CI: 1.06, 1.73). Individuals in the top tertile of FQI (OR = 0.71; 95 % CI: 0.55, 0.91) and PQI (OR = 0.78; 95 % CI: 0.60; 1.01) were less likely to report lower QOL than those in the bottom tertile. An inverse association was found between PQI and depressive symptoms (OR = 0.72, 95 % CI: 0.55, 0.95), but not for CQI and FQI.

LIMITATIONS

The cross-sectional design of the study and the use of a memory-based dietary tool may limit the generalizability of our findings.

CONCLUSION

Higher PQI was associated with lower risk of depressive symptoms and having a low-quality life. Although CQI and FQI were not related to depressive and anxiety symptoms, higher values of FQI were associated with better QOL, while CQI showed an inverse association.

Low-carbohydrate diet score is associated with improved blood pressure and cardio-metabolic risk factors among obese adults

Obesity is associated with numerous co-morbidities and diet, is one of the modifiable risk factors for prevention against these obesity-related metabolic disorders. In the current study, we aimed to evaluate the association between adherence to low carbohydrate diet (LCD) score and serum lipids, glycemic markers, blood pressure, and anthropometric parameters among obese individuals. The current cross-sectional study is a combination of two projects with total participants of 359 obese individuals (body mass index [BMI] ≥ 30 kg/m2 ) aged 20-50 years were included. Dietary intake was assessed by a validated semi-quantitative food frequency questionnaire (FFQ) of 132 food items. Low carbohydrate diet score was estimated by deciles of dietary intakes. Metabolic syndrome (MetS) was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Enzymatic methods were used to assess serum lipids, glucose, and insulin concentrations. Blood pressure was measured by sphygmomanometer and body composition with bioelectrical impedance analysis (BIA). Higher adherence to LCD score was associated with significantly lower DBP and triglyceride (TG) concentrations and increased high density lipoprotein (HDL)-C levels after adjustment for the confounders (p < 0.05). A non-significant reduction in systolic blood pressure (SBP) and total cholesterol (TC) values were also observed. Also, high adherence to LCD score was associated with reduced prevalence of metabolic syndrome (p < 0.05). Higher BMI, fat mass, and lower fat-free mass were also accompanied with higher adherence to LCD score. According to our study, low carbohydrate diet score was associated with more favorable cardio-metabolic risk factors independent of some confounders like age, BMI, sex, and physical activity level. Further studies in different communities will help for generalization of our findings.

The association between low-carbohydrate diet score and sleep duration among Iranian adults

Sleep disorders are linked to obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The evidence suggests that dietary carbohydrate content may be related to sleep duration. We designed a study to investigate the association between a low-carbohydrate diet (LCD) with long sleep duration (> 8 h) and short sleep duration (< 5 h). This cross-sectional analysis was conducted on data obtained from the recruitment phase of Yazd Health Study (YaHS) and the Taghzieh Mardom-e-YaZd (TAMYZ). The dietary intake was assessed using a validated food frequency questionnaire. The LCD score was calculated for each subject based on summing up assigned scores to deciles of percentages of energy from macronutrients. Sleep duration was assessed using a nocturnal sleep questionnaire. The association between LCD and sleep duration was evaluated using logistic regressions in crude and adjusted models. A total of 5929 subjects were entered into the analysis. Most of the participants were aged 20-29 years (24.8%), male (52.2%) and never smokers (87.7%). After adjusting for level of physical activity, age, sex, total energy, smoking status and body mass index in model III, a significant direct association was observed between LCD score with long sleep duration (OR 1.15; 95% CI1-1.32, P = 0.049) and short sleep duration (OR 1.29; 95% CI 1.02-1.62, P = 0.028). Higher LCD score is associated with higher chance of long sleep duration and short sleep duration. Regarding the nature of our study, cohort and clinical trial studies in future are required to reach a causal association and a definitive conclusion.

The association between low-carbohydrate diet score and metabolic syndrome among Iranian adults

OBJECTIVE

Assessing the relationship between low-carbohydrate diet (LCD) score and metabolic syndrome (Mets) in Iranian adults.

DESIGN

Cross-sectional study.

SETTING

Yazd Health Study and Taghzieh Mardom-e-Yazd study.

PARTICIPANTS

Data of 2074 participants were used. Dietary intakes were assessed by a validated semi-quantitative FFQ. LCD score was calculated for each person by summing up the assigned scores to deciles of energy percentages from macronutrients. Mets was evaluated using National Cholesterol Education Program Adult Treatment Panel III. Eventually, association between LCD score and Mets was examined using logistic regression.

RESULTS

Total Mets prevalence was approximately 40·5 %. After adjustment for confounders, subjects in the higher quartile of LCD score had a significant lower chance of Mets than lower quartile among all participants (Q4 v. Q1: OR: 0·68, 95 % CI (0·50, 0·92)) and separately in men (Q4 v. Q1: OR: 0·54, 95 % CI (0·34, 0·86)) and women (Q2 v. Q1: OR: 0·53, 95 % CI (0·34, 0·82)). Furthermore, more LCD adherence in men reduced abdominal obesity by 47 % (Q3 v. Q1: OR: 0·53, 95 % CI (0·28, 0·99)). A significant inverse relation was also observed between low HDL cholesterol and LCD score in all participants (Q4 versus Q1 OR: 0·74, 95% CI: 0·56-0·99) and separately in men (Q4 versus Q1 OR: 0·63, 95% CI: 0·40-0·98).

CONCLUSIONS

More adherence to LCD might be related to lower chance of Mets and some of its components such as low HDL-cholesterol and abdominal obesity specially in men. Further studies are required to confirm the findings.

Dietary Diversity and Healthy Aging: A Prospective Study

Population aging is a global phenomenon. The present study determined the effects of dietary diversity score (DDS) and food consumption on healthy aging. A subset of the data of the China Health and Nutrition Survey was utilized in this study. DDSs were calculated using the dietary data collected in the years 2009 and 2011. A healthy aging score (HAS) was calculated by summing the standardized scores on physical functional limitation, comorbidity, cognitive function, and psychological stress based on the data collected in the year 2015, with a lower HAS indicating a healthier aging process. Life quality was self-reported in the year 2015. This study found that DDS was inversely associated with HAS (T3 vs. T1: β −0.16, 95%CI −0.20 to −0.11, p-trend <0.001). The consumption of meat and poultry, aquatic products, and fruits was inversely associated with HAS, and participants in the highest tertile of staple foods consumption had a higher HAS than those in the lowest tertile. HAS was inversely associated with good self-reported life quality and positively associated with bad life quality. In conclusion, food consumption may influence the aging process, and adherence to a diverse diet is associated with a healthier aging process in elderly people.