Food and Mood: Diet Quality is Inversely Associated with Depressive Symptoms in Female University Students

The influence of diet quality on health-related quality of life in undergraduates

Objective: Explore the relationship between fruit and vegetable (FV) intake and health-related quality of life (HRQOL) in undergraduates. Participants: Undergraduates (N = 655). Methods: Using the Centers for Disease Control's Healthy Days Core Module and National Cancer Institute's (NCI) FV screener, differences in HRQOL between students who had consumed above the sample's average FV intake and their counterparts were evaluated. Multiple regression analyses assessed behaviors that predicted HRQOL. Results: Differences existed between HRQOL of students who consumed above average FV (M = 2.2 1.3) and peers, F(9,602) = 509, p < 0.001, Wilk's Δ = 0.116, partial n2 = 0.884. Predictors explained 30.0% of the variance in days per month feeling healthy (r2 = 0.29, F(4, 549) = 58.6, p < 0.001): perceived stress (β = 0.46, p < 0.001), body mass index (BMI) (β = 0.11, p < 0.01), FV intake (β = 0.16, p < 0.001), and sleep duration (β = 0.08, p < 0.05). Conclusions: FV intake and modifiable behaviors influenced HRQOL, suggesting that multifaceted interventions could improve HRQOL in this population.

Influence of lifestyle on suboptimal health: Insights from a national cross-sectional survey in China

Background

Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China.

Methods

We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30 505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants' lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs).

Results

We included 22 897 participants (female: 13 056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day.

Conclusions

We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS.

Registration

Chinese Clinical Trial Registry (ChiCTR2200061046).

Mental Wellbeing and Health-Risk Behaviours of University Students in Brunei: A Cross-Sectional Study during COVID-19 Pandemic

Background: The coronavirus disease discovered in 2019 (COVID-19) has impacted the health behaviour of university students in a range of western nations and had a number of detrimental effects on their mental wellbeing. However, little is known about the impact on university students in Southeast Asia, particularly in Brunei. This study aims to estimate the prevalence and factors related to poor mental wellbeing and engaging in health-risk behaviors among university students in Brunei during the COVID-19 pandemic. Methods: A cross-sectional online survey of students in all public universities was conducted from March to June 2021. Warwick-Edinburgh Mental Well-being Scale, Global Physical Activity Questionnaire, and WHO STEPs questionnaires were used to measure mental wellbeing, physical activity, and health behaviors, respectively. Logistic regressions were applied. Results: A total of 1020 university students participated in this study (57% response rate). Prevalence of poor mental wellbeing and physical inactivity were 30% and 42.8%, respectively. Excessive snacking (89.7%), sugar intake (81.7%), and salt intake (53.8%) were the most prevalent health-risk behaviors. Body mass index and participating in sports activities were the most common factors related to mental wellbeing and health-risk behaviors. Conclusions: Participating in certain sports activities appears to have protective effects against study outcomes. However, a high prevalence of physical inactivity and unhealthy diet among university students is a concern, as it could be indicative of future non-communicable disease trends.

Association between diet and symptoms of anxiety and depression in college students: A systematic review

Objective: To gather research evidence on the association between diet and depression and anxiety among college students. Methods: Systematic searches were performed in CINAHL, PsycINFO, PubMed, and ScienceDirect databases to identify potentially relevant articles published between January 2000 and September 2020. Data were extracted from 21 selected studies. Results: Most of the cross-sectional studies found a positive association between diet and depression and anxiety; however, a few studies found inconsistent results. Moreover, several interventional studies demonstrated that a healthy diet (including consumption of fruit and vegetables) improved depression in the intervention group. Conclusions: The methodological limitations of cross-sectional studies to explain causality and the limited number of prospective interventional studies point to a pressing need to conduct more prospective, longitudinal, and randomized controlled trials to generalize the causal associations between diet and depression and anxiety. Further research is needed to investigate the biological mechanisms of nutrients' actions on anxiety and depression.

A systematic review of the association of diet quality with the mental health of university students: implications in health education practice

University students are at risk of experiencing mental health problems during the transition from home to university. This transition can also adversely affect their diet quality. This review aims to examine bidirectional associations from observational studies regarding the influence of diet quality on the mental health of university students, and vice versa. The databases PubMed, CINAHL, EMBASE, PsycINFO, The Cochrane Library and Web of Science were searched using relevant search terms. The searches were last updated on 15 July 2022. Majority of studies (36 out of 45) found that good diet quality of students was associated with better mental health in terms of depression, anxiety, stress and overall general mental well-being. Moreover, majority of studies (19 out of 23) found that stress and anxiety of students were associated with poorer diet quality. The effect sizes observed were generally small-moderate. Healthy diets of students have been associated with better mental health in terms of depression, anxiety, stress or other mental health issues. Stress experienced by university students has been associated with unhealthy diets. There are implications for health education research, as interventions to improve diet quality at the university level could reduce mental health issues; additionally, interventions to support students under stress may lead to healthier dietary habits when living on campuses. Randomized controlled trials and intervention studies are needed to further investigate these implications.

Diet Quality among Students Attending an Australian University is Compromised by Food Insecurity and Less Frequent Intake of Home Cooked Meals. A Cross-Sectional Survey Using the Validated Healthy Eating Index for Australian Adults (HEIFA-2013)

Poor diet quality is commonly reported in young adults. This study aimed to measure the diet quality of students attending a large Australian university (including domestic and international students), and to examine the effect of food security status and other key factors likely to impact their diet quality. Using the Automated Self-Administered 24-h recall Australian version, a cross-sectional survey collected dietary recalls from domestic and international students in one university in Sydney. Diet quality was assessed using the validated Healthy Eating Index for Australian Adults (HEIFA-2013) which gives a score out of 100. Food security status was measured by the 18-item Household Food Security Survey Module. Differences in the mean HEIFA-2013 scores by student characteristics were determined by analysis of covariance. A total of 141 students completed one dietary recall. The mean HEIFA-2013 score for students was low (mean 52.4, 95% CI 50.0–54.8). Food-insecure students had a poorer diet quality (mean 43.7, 95% CI 35.7–51.8) than their food-secure peers (mean 53.2, 95% CI 50.8–55.7, p = 0.027). The mean HEIFA-2013 score was similar in domestic (mean 52.5, 95% CI 49.9–55.2) and international students (mean 51.9, 95% CI 46.3–57.5, p = 0.845). Those reporting self-perceived excellent cooking skills and higher cooking frequency had better diet quality. Interventions to improve food and nutrition knowledge and skills and address food insecurity may help tertiary education students cook more frequently and achieve better diet quality.

The Association between Diet and Sleep Quality among Spanish University Students

While it has long been recognized that diet is a leading behavioral risk factor for human health, recent scientific findings have also suggested that diet and sleep quality may be connected. The purpose of the present study is to evaluate the association between diet and sleep quality among a group of Spanish university students. To do so, a cross-sectional study of 868 students was carried out. Sleep quality was assessed using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI), while diet was assessed using the Spanish Healthy Eating Index (SHEI). The study revealed a noteworthy rate of bad sleepers (51.6%) and students whose diet needed modifications (82.2%). Unhealthy eaters were more likely to have poor sleep quality (aOR = 4.20; CI 95%: 2.07-8.52). The unbalanced intake of vegetables (aOR = 1.63; CI 95%: 1.14-2.34), fruits (aOR = 4.08; CI 95%: 2.90-5.74), dairy products (aOR = 1.96; CI 95%: 1.41-2.72), lean meats (aOR = 1.82; CI 95%: 1.19-2.78), legumes (aOR = 1.43; CI 95%: 1.00-2.02), sweets (aOR = 1.60; CI 95%: 1.13-2.25) and sugary soft drinks (aOR = 1.46; CI 95%: 1.07-1.99) was associated with lower sleep quality.

Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study

Plant-based dietary patterns (vegan and vegetarian) are often considered 'healthy' and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18-44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p<0.001 accounting for 6% of the variation in depressive symptoms. For those without depression, higher diet quality was protective against depressive symptoms F(1, 125)=6.49, p=0.012. Conversely, for those with depression no association with diet quality was found F(1, 89)=0.01, p=0.963. These findings suggest that a high-quality plant-based diet may be protective against depressive symptoms in vegans and vegetarians. In line with emerging research between food and mental health, higher-quality dietary patterns are associated with a reduced risk of depressive symptoms. Given the rapidly increasing rate of vegan and vegetarian food products within Australia, understanding the potential mechanisms of effects through which a plant-based diet may influence depressive symptoms is required.

Factors Related to Diet Quality: A Cross-Sectional Study of 1055 University Students

Given that there is only a limited body of evidence available concerning the dietary habits of Spanish university students, the present study assesses the quality of this group's diet, their adherence to the National Food-Based Dietary Guidelines, and the predictive factors of their diet quality. To do so, a cross-sectional study was performed on a sample of 1055 students. The quality of the participants' diets was then analysed by using the Spanish Healthy Eating Index, and then their level of compliance was assessed in light of the dietary recommendations put forth by the Spanish Society for Community Nutrition. According to these standards, only 17.4% of the participants had a healthy diet. The level of compliance with the recommendations was poor, highlighting especially the low levels of "fruit" and "vegetables" that they consumed as well as high levels of "cold meats and cuts" and "sweets". The factors that predicted a worse diet are being male, living alone, low levels of physical activity, smoking, high alcohol intake, leading a sedentary lifestyle, psychological distress, and insomnia (p < 0.005). Furthermore, participants with low or high body weights showed signs of a higher quality diet (p < 0.001). The present findings suggest that a significant proportion of university students ought to change their dietary habits; these also attest to the importance of developing strategies that are directly targeted at university students in order to promote a healthy diet.

Relationship between psychological distress and the adherence to the Korean healthy eating index (KHEI): the Korea National Health and Nutrition Examination Survey (KNHANES) 2013 and 2015

BACKGROUND/OBJECTIVES

This study examined the association of depressive symptoms, stress perception, and suicidal ideation with overall dietary quality using the newly developed Korean healthy eating index (KHEI).

SUBJECTS/METHODS

This study included 9,607 adults (3,939 men and 5,668 women, ≥ 19 years) who participated in the 6th Korea National Health and Nutrition Examination Survey 2013 and 2015. The KHEI scores were calculated using the food frequency questionnaire data. Survey logistic regression analyses were performed to analyze the association between psychiatric distress and dietary quality.

RESULTS

The percentage of subjects with experience of depressive mood, higher stress perception, and suicidal ideation was 8.2%, 25.0%, and 3.7% in men and 15.4%, 27.3%, and 6.0% in women, respectively. The mean KHEI score was 61.5 ± 0.29 in men and 64.8 ± 0.24 in women (P < 0.001). The present study found a difference in the adherence to specific dietary components of the KHEI between sexes. Men experiencing depressive symptoms were less likely to eat meat, fish, eggs, and beans, while depressed women showed lower vegetable intake. Both men and women with suicidal ideation showed a lower intake of vegetables. The men with stress had a lower breakfast eating score than those without stress (7.21 vs. 6.77, P = 0.016). The multivariate-adjusted odds ratios for depressive symptoms, stress perception, and the suicidal idea in women with the highest quartile of KHEI scores compared to the lowest quartile was 0.69 (95% confidence interval, 0.51-0.92), 0.73 (0.58-0.82), and 0.52 (0.33-0.82), respectively and significant dose-response associations were observed (P for trends < 0.05 for all). On the other hand, these associations were not observed in men after adjusting for the confounding variables (P for trends > 0.05 for all).

CONCLUSIONS

Poor adherence to dietary recommendations is associated with psychological distress, especially in women.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on university students' dietary intake, physical activity, and sedentary behaviour

University students are a vulnerable group for poor dietary intake, insufficient physical activity and sedentary behaviour. The purpose of this study was to examine the impact of coronavirus disease (COVID-19) on university students' dietary intake, physical activity, and sedentary behaviour. Participants were students (n = 125) from the Universities of Saskatchewan and Regina. An online questionnaire was administered retrospectively (for prepandemic) and prospectively (during the pandemic) to examine students' dietary intake, physical activity, and sedentary behaviour. Overall, nutrient and caloric intakes were significantly reduced (p < 0.05) during the pandemic, and alcohol intake increased (p = 0.03). Before the pandemic, 16% and 54% of the participants were meeting the Canadian 24-Hour Movement Guidelines for Adults (18-64 years) of 150 min of moderate-vigorous physical activity and 8 h or less of sedentary activity, respectively. Only 10% met the guidelines for physical activity while 30% met the guidelines for sedentary behaviour during the pandemic. The minutes per week spent engaging in moderate to vigorous physical activity during the pandemic decreased by approximately 20% (p < 0.001). The hours spent in sedentary activities increased by 3 h per day (p < 0.001). Our findings confirm that during the pandemic, students' inadequate dietary intake, high alcohol consumption, low physical activity, and high sedentary behaviour were significantly compounded. Novelty: During COVID-19, the nutrient and caloric intakes of university students decreased, and alcohol intake increased significantly. University students' physical activity levels decreased, and sedentary activity increased significantly during COVID-19. During COVID-19 students did not engage in sufficient physical activity to offset the increased sedentary behaviour.

[Eating behavior and relationships with stress, anxiety, depression and insomnia in university students.]

Introduction

Introduction: there is growing evidence linking food consumption with psychological health of adult people. This association has not been well explored among university students. Objectives: the aims of this study were to analyze the diet quality in a university population, and to assess its association with prevalence of anxiety, stress, depression, and insomnia. Methods: cross-sectional study of a sample of 1055 university students. Three validated questionnaires were used: the Healthy Eating Index (HEI), the Depression Anxiety Stress Scales (DASS 21), and the Insomnia Severity Index. Results: The average HEI score was 68,57±12,17. Prevalence of unhealthy eating was 82,3%, higher in women (84,8% vs. 76,4%). Unhealthy eating was significantly associated with prevalence of anxiety, depression, and stress. Excessive intake of sweets and low of dairy products were associated with higher prevalence of psychological and sleep disturbances. Conclusions: unhealthy eating patterns are common in university population and are related to anxiety, stress, and depression. Educational interventions to reduce unhealthy food consumption in university students can also result in psychological health improvements and/or vice versa.

Are Psychological Distress and Resilience Associated with Dietary Intake Among Australian University Students?

University students report unhealthy diets and experience poorer mental health than the general population. This study explores the association between psychological distress and resilience with dietary intake in a sample of Australian university students. Cross-sectional data from the University of Newcastle Student Healthy Lifestyle Survey 2017 were analysed. Psychological distress (Kessler Scale), resilience (Brief Resilience Scale) and fruit, vegetable, soft drink, takeaway food and breakfast intakes (short diet questions) were assessed. Socio-demographic (e.g., gender), student (e.g., undergraduate/postgraduate) and health characteristics (e.g., physical activity) were captured. Multivariate linear regression models explored associations between psychological distress and resilience with dietary intake, with adjustment for potential confounders. Analysis included 2710 students (mean age 26.9 ± 9.5 years, 30.4% male). In adjusted models, lower psychological distress was associated with higher fruit (β = -0.37, p = 0.001) and vegetable (β = -0.37, p < 0.001) serves/day, more frequent breakfast consumption (p < 0.001) and less frequent soft drink and takeaway food consumption (p < 0.001). Higher resilience was associated with higher fruit (β = 0.03, p = 0.022) and vegetable (β = 0.06, p < 0.001) serves/day, more frequent breakfast consumption (p = 0.005), and less frequent soft drink (p < 0.001) and takeaway food consumption (p = 0.001). These results highlight a potential link between psychological distress and resilience with diet, and that further research in this area is warranted.

A prospective analysis of dietary fiber intake and mental health quality of life in the Iowa Women's Health Study

OBJECTIVE

Recent studies have reported associations between dietary intake and mental health. Dietary fiber is one nutrient that may modulate mental health, specifically depression risk, through the gut microbiome. We prospectively examined the association between dietary fiber intake and mental health-related quality of life (QOL) scores, a proxy for depressive symptoms, in a cohort of 14,129 post-menopausal women in the Iowa Women's Health Study.

METHODS

Dietary intake was assessed at baseline [1986] using a 127-item food frequency questionnaire. Mental health-related QOL scores were assessed at the follow-up questionnaire [2004] using the Mental Health (MH) component and Mental Health Composite (MCS) scales derived from the SF-36 Health Survey. The association between dietary fiber intake and mean QOL scores was examined using linear regression, with adjustment for age, alcohol intake, energy intake, waist-to-hip ratio, physical activity, smoking status, and education.

RESULTS

The median dietary fiber intake was 19.0 g/day, ranging from 1.1 to 89.4 g/day. Multivariable-adjusted mean MH scores were higher among those with higher fiber intake (P _{for trend} = 0.02). For MCS score, the association with fiber intake observed in a model adjusted for age and energy intake became insignificant after multivariable adjustment.

CONCLUSIONS

Our study is one of the first prospective analyses of the association between higher dietary fiber intake and increased MH QOL scores later in life. Given a plausible biological mechanism underlying the association between fiber intake and mental health, additional studies are warranted.

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews under the number CRD42017080579.