Association of Food Insecurity with Nutrient Intake and Depression among Korean and US Adults: Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys

Assessing and Monitoring Nutrition Security in the United States: A Narrative Review of Current Measures and Instruments

PURPOSE OF REVIEW

Because nutrition plays a crucial role in the development of chronic diseases, ensuring nutrition security is important for promoting population health. Nutrition security is defined as having consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Distinguished from food security, nutrition security consists of two constructs: healthy diets and nutritional status. The study aimed to identify population measures that reflect the important constructs of nutrition security (i.e., healthy diets and nutritional status) to inform U.S. nutrition security assessment and monitoring.

RECENT FINDINGS

Through a narrative review conducted across multiple databases, associations between subconstructs of healthy diets and nutritional status were identified. Of the six subconstructs that constitute healthy diets, nutrient adequacy and moderation were most often used to assess and monitor healthfulness of U.S. population diets and were associated with health outcomes. There is little evidence of an association between health outcomes and macronutrient balance or diversity in the U.S. Thirteen instruments were identified as potentially suitable for measuring at least one subconstruct of healthy diet in the population. This review highlights the importance of nutrition security in addressing population health challenges. It emphasizes the potential use of multiple instruments and measures to comprehensively monitor population nutrition security and inform intervention strategies. Identifying feasible and practical measures for assessing and monitoring nutrition security is imperative for advancing population health and mitigating the burden of chronic diseases.

Menopausal symptoms by HIV status and association with health-related quality of life among women in Zimbabwe: a cross-sectional study

BACKGROUND

The scale-up of antiretroviral therapy programmes has resulted in increased life expectancy of people with HIV in Africa. Little is known of the menopausal experiences of African women, including those living with HIV. We aimed to determine the prevalence and severity of self-reported menopause symptoms in women at different stages of menopause transition, by HIV status, and evaluate how symptoms are related to health-related quality of life (HRQoL). We further sought to understand factors associated with menopause symptoms.

METHODS

A cross-sectional study recruited women resident in Harare, Zimbabwe, sampled by age group (40-44/45-49/50-54/55-60 years) and HIV status. Women recruited from public-sector HIV clinics identified two similarly aged female friends (irrespective of HIV status) with phone access. Socio-demographic and medical details were recorded and women staged as pre-, peri- or post-menopause. The Menopausal Rating Scale II (MRS), which classified symptom severity, was compared between those with and without HIV. Linear and logistic regression determined factors associated with menopause symptoms, and associations between symptoms and HRQoL.

RESULTS

The 378 women recruited (193[51.1%] with HIV), had a mean (SD) age of 49.3 (5.7) years; 173 (45.8%), 51 (13.5%) and 154 (40.7%) were pre-, peri and post-menopausal respectively. Women with HIV reported more moderate (24.9% vs. 18.1%) and severe (9.7% vs. 2.6%) menopause symptoms than women without HIV. Peri-menopausal women with HIV reported higher MRS scores than those pre- and post-menopausal, whereas in HIV negative women menopausal stage was not associated with MRS score (interaction p-value = 0.014). With increasing severity of menopause symptoms, lower mean HRQoL scores were observed. HIV (OR 2.02[95% CI 1.28, 3.21]), mood disorders (8.80[2.77, 28.0]), ≥ 2 falls/year (4.29[1.18, 15.6]), early menarche (2.33[1.22, 4.48]), alcohol consumption (2.16[1.01, 4.62]), food insecurity (1.93[1.14, 3.26]) and unemployment (1.56[0.99, 2.46]), were all associated with moderate/severe menopause symptoms. No woman reported use of menopausal hormone therapy.

CONCLUSIONS

Menopausal symptoms are common and negatively impact HRQoL. HIV infection is associated with more severe menopause symptoms, as are several modifiable factors, including unemployment, alcohol consumption, and food insecurity. Findings highlight an unmet health need in ageing women in Zimbabwean, especially among those living with HIV.

Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018-2023)

Depression is classified as one of the most common mental disorders. Its prevalence has recently increased, becoming a growing public health threat. This review focuses on clarifying the role and importance of individual nutrients in the diet and the impact of nutrient deficiencies on the risk of depression. Deficiencies in nutrients such as protein, B vitamins, vitamin D, magnesium, zinc, selenium, iron, calcium, and omega-3 fatty acids have a significant impact on brain and nervous system function, which can affect the appearance of depressive symptoms. However, it is important to remember that diet in itself is not the only factor influencing the risk of or helping to treat depression. There are many other aspects, such as physical activity, sleep, stress management, and social support, that also play an important role in maintaining mental health. The data review observed that most of the available analyses are based on cross-sectional studies. Further studies, including prospective cohort, case-control studies, are recommended to draw more reliable conclusions.

Identifying the Group Vulnerable to Unmet Medical Needs Due to Food Security: According to Children in the Household

OBJECTIVE

Adults may experience unmet medical needs for various reasons. The purpose of this study was to examine the effect of food security on unmet medical needs according to the presence of children in the household of adults, as well as to identify the medically vulnerable group considering individual and household characteristics.

METHODS

This study was conducted using data from the National Health and Nutrition Examination Survey for 2013-2015 and 2019-2020. The subjects of the study were 23,069 adults 19 years of age or older, and were divided into two groups according to whether or not children were included in the household. In order to observe the association between food security and unmet medical needs, multiple logistic regression analysis was performed. In addition, a subgroup analysis was performed in consideration of individual and household characteristics.

RESULTS

When food security was unstable for households with children, or without children, there was a high correlation with unmet medical needs. Considering individual and household characteristics, in groups with lower age and household income level, or higher number of members in household and subjective health status, food security was strongly correlated with unmet medical needs in households with children. Contrarily, households without children showed a high correlation in the opposite characteristics of households with children, excluding household income level.

CONCLUSION

Food security was highly correlation with unmet medical needs regardless of whether or not children were included in the household. However, according to the individual and household characteristics of households with and without children, the relationship between food security and unmet medical needs was found to be different. Therefore, it is necessary to prepare a health policy that can increase access to medical services in consideration of food security and individual and household characteristics depending on whether or not children are included in the household.

Correlation between dietary score and depression in cancer patients: Data from the 2005–2018 National Health and Nutrition Examination Surveys

Aim

To investigate the correlation between dietary score and depression in patients with cancer.

Methods

In this cross-sectional study, data were collected from the National Health and Nutrition Examination Survey (NHANES) 2005–2018, a cross-sectional and nationally representative database, to compare 322 patients with depression to 2,868 with no depression. Mediterranean (MEDS) diet, Dietary Approaches to Stop Hypertension (DASH) diet, and the Healthy Eating Index 2015 (HEI-2015) score were calculated. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Weighted logistic regression models were used to explore the relationship between dietary scores and depression in patients with cancer. Subgroup analysis was performed by sleep disorders, sex, cancer type, number of tumors, and pain relief prescription treatment.

Results

The final study sample included 3,190 adults, with 56.94% of them being women, representing 2,177 (86.51%) non-Hispanic white adults. After multivariable adjustment, the MEDS score was correlated with a reduced risk of depression in patients with cancer [odds ratio (OR): 0.90, 95% confidence interval (CI): 0.82–0.97, p = 0.010]. Moreover, the MEDS score was correlated with depression in cancer patients with sleep disorders (OR: 0.84, 95% CI: 0.76–0.93, p = 0.001), in female patients with cancer (OR: 0.83, 95% CI: 0.74–0.92, p < 0.001), particularly in female cancer reproductive system patients (OR: 0.69, 95% CI: 0.57–0.82, p < 0.001). MEDS score also showed a decreased risk of depression in patients with 1 cancer (OR: 0.90, 95% CI: 0.82–0.98, p = 0.019). MEDS score (OR: 0.86, 95% CI: 0.86–0.98, p = 0.024) and DASH (OR: 0.91, 95% CI: 0.84–0.98, p = 0.015) score were related to a decreased risk of depression in patients with cancer using pain relief prescription.

Conclusion

Good diet quality is significantly correlated with decreased risk of depression in patients with cancer. Aligning with the Dietary Guidelines, such as the MEDS diet, may be beneficial to the reduced risk of depression in patients with cancer.

Significant Nutritional Gaps in Tibetan Adults Living in Agricultural Counties Along Yarlung Zangbo River

Background

Dietary intake and nutritional assessing data from a representative sample of adult population living in an agricultural zone on Tibet Plateau are still lacking nowadays. This study aimed to assess the daily dietary intakes and respective food sources in 552 local residents (≥ 18 years old, 277 men and 275 women) living in 14 agricultural counties along the Yarlung Zangbo River on Tibet Plateau.

Methods

Food consumption data were collected using a validated cultural-specific food frequency questionnaire that contained all local Tibetan foods and analyzed with three fixed factors: gender, age, and region. Nutrient intakes were calculated using Chinese food composition tables. Nutritional gaps and the percentages of participants who had inadequate and excessive nutrient intakes were calculated by estimated average requirement (EAR) cut-point methods.

Results

Compared with the dietary reference intakes, 68.4% of nutrient intakes were inadequate. Fiber, Ca, I, Zn, Se, and vitamin (Va, Vc, and folic acid) intakes appeared to be particularly deficient. The dietary energy intake was 7838.8 ± 537.1 KJ/d, with 78 and 84% of EAR values for men and women, respectively. The dietary intakes of most nutrients were below the estimated energy requirement/EAR or adequate intake values, while more than 70% of the participants had excessive intake of carbohydrate, especially the elderly (aged ≥ 51 years). The nutritional gap of Cu was more than 300%. Almost 100% of the participants was vulnerable to fiber, Se, and Va shortfalls due to the deficiency in sole food sources. The top five food sources of Se intake were highland barley (34.2%), meat (13%), rice (12.4%), eggs (12.2%), and cultural-specific beverages (7.8%). Eggs (42.1%), tubers (62.2%), vegetables (66.4%), and highland barley (49.7%) were the first contributors of Va, Ve, Vc, and folic acid, respectively.

Conclusion

The dietary intake of a large sample of Tibetan adult population living in agricultural counties of Tibetan Autonomous Region is alarmingly insufficient. Gender inequality is common, and regional difference is widespread due to rapid urbanization. Young Tibetan adults aged 18–30 years are particularly vulnerable to micronutrient shortfalls and currently facing the risk of nutrition-insecurity-related dietary inadequacy. The respondents who belong to the elderly category (≥51 years of age) are facing the risk of “double burden of malnutrition” characterized by the coexistence of undernutrition, including micronutrient deficiencies and overweight or obesity.

The Relationship of Lifestyle Risk Factors and Depression in Korean Adults: A Moderating Effect of Overall Nutritional Adequacy

Background: Little is known regarding the role of nutrition in determining the associations between lifestyle risk factors and depression. Objectives: This study examined whether or not nutritional adequacy modulates the relationship between depression and lifestyle risk factors in Korean adults aged 18-65 years (n = 7446). Methods: Data were obtained from the 2016 and 2018 Korea National Health and Examination Survey. Depression, smoking, at-risk alcohol consumption, physical inactivity, sleep deprivation, and mean adequacy ratio (MAR) were assessed. Results: Individuals with two (OR = 1.960, p < 0.001), three (OR = 4.237, p < 0.001), or four (OR = 5.312, p < 0.001) risk factors had a significantly higher risk of depression compared to individuals with one or zero risk factor. In contrast, individuals with moderate MAR (OR = 0.607, p < 0.001) and high (OR = 0.698, p < 0.001) MAR had a lower depression risk compared to individuals with low MAR. Moderation analysis showed a moderating effect of MAR (coefficient = −0.220, p = 0.007) on the relationship between risk factors and depression. Conclusions: The current findings suggest that overall nutritional adequacy plays a modulating role in determining the relationship between depression and lifestyle risk factors in Korean adults.

Food insecurity and brain health in adults: A systematic review

Food insecurity has been associated with adverse effects on physical health and well-being in both high and low-income countries, but effects on brain health are not clear. The purpose of this systematic review was to determine the relationship between food insecurity and important brain health outcomes in adults including depression, stroke, cognitive impairment and dementia. Electronic databases were searched to find studies which investigated relations between food insecurity and predefined brain health outcomes. Thirty studies met the inclusion criteria for review of which 23 were conducted in high income countries and seven in low- or middle-income countries. Most studies (n = 24) were cross-sectional, five were prospective and 1 was a case-control design. Seven studies reporting outcomes relating to cognitive performance and 24 relating to depression. No studies investigated relations between food insecurity and stroke or dementia. There was substantial heterogeneity in the populations studied as well as measures of food insecurity and outcomes which made comparisons between studies difficult. Overall, the findings highlighted that individuals who were food insecure had increased likelihood of depressive symptoms and poorer global cognition than those who were food secure. It is possible that social support and food aid programmes attenuate the effects of food insecurity on depressive symptoms. Future research is needed to determine whether interventions to alleviate food insecurity can benefit brain health in vulnerable populations.

Analysis of the Effects of Nutrient Intake and Dietary Habits on Depression in Korean Adults

While several studies have explored nutrient intake and dietary habits associated with depression, few studies have reflected recent trends and demographic factors. Therefore, we examined how nutrient intake and eating habits are associated with depression, according to gender and age. We performed simple and multiple regressions using nationally representative samples of 10,106 subjects from the Korea National Health and Nutrition Examination Survey. The results indicated that cholesterol, dietary fiber, sodium, frequency of breakfast, lunch, dinner, and eating out were significantly associated with depression (p-value < 0.05). Moreover, depression was associated with nutrient intake and dietary habits by gender and age group: sugar, breakfast, lunch, and eating out frequency in the young women’s group; sodium and lunch frequency among middle-age men; dietary fibers, breakfast, and eating out frequency among middle-age women; energy, moisture, carbohydrate, lunch, and dinner frequency in late middle-age men; breakfast and lunch frequency among late middle-age women; vitamin A, carotene, lunch, and eating out frequency among older age men; and fat, saturated fatty acids, omega-3 fatty acid, omega-6 fatty acid, and eating out frequency among the older age women’s group (p-value < 0.05). This study can be used to establish dietary strategies for depression prevention, considering gender and age.