Diet Quality and Mental Health Status among Division 1 Female Collegiate Athletes during the COVID-19 Pandemic

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.

Depression, anxiety and stress among female student-athletes: a systematic review and meta-analysis

OBJECTIVE

To identify, quantify and analyse determinants of depression, anxiety and stress symptoms among female student-athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Five online databases (PubMed, CINAHL, PsychInfo, SportDiscus and Web of Science) searched from inception through 14 September 2023. Hand-searches and contacting authors for eligible studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles were included if they were published in English, included female student-athletes competing at National Collegiate Athletic Association institutions, and measured symptom-level depression, anxiety and/or stress.

RESULTS AND SUMMARY

We screened 2415 articles; 52 studies (N=13 849) were included in the systematic review with 13 studies qualifying for meta-analysis. Seventeen determinants were identified including injury (eg, concussions), health (eg, sleep hygiene) and social factors (eg, social support). As data specific to female student-athletes was delineated from studies that included other populations, we observed 16 studies (30.7%) reported that identifying as female was a meaningful determinant of depression, anxiety and stress in athletes. Results of the meta-analysis (k=13, N=5004) suggested a small but significant association (r=0.15, 95% CI 0.05 to 0.24, p=0.004) between other determinants and depression, anxiety, and stress among female student-athletes.

CONCLUSION

Coaches, trainers and clinicians are key contributors in supporting female student-athlete mental health, with responsibilities for integrating mental skill training, sleep hygiene education and regular assessments. Comprehensive mental health and tailored education programmes considering determinants such as injury, health and social factors specific to female student-athletes are needed to enhance mental health equity in sport.

PROSPERO REGISTRATION NUMBER

CRD42022362163.

Dietary eating patterns, dairy consumption, and anxiety: A systematic literature review

BACKGROUND

Nutrition affects both physical and mental health but evidence is mixed regarding potential associations between anxiety and diet, particularly dairy consumption. We conducted a systematic literature review (SLR) of dairy consumption and/or various dietary patterns and risk of anxiety.

METHODS

Literature searches were conducted in PubMed and Embase. All study designs except case reports, small case series, and SLRs were considered for inclusion. Reference lists of previously published SLRs were reviewed for any relevant additional studies. Studies of populations without dairy sensitivities exploring the association between dietary patterns and/or dairy consumption and anxiety published through May 2022 were identified using predefined eligibility criteria. Study quality was determined using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

For this SLR, 132 studies were included; 80 were cross-sectional. Studies examined different dietary patterns (e.g., Mediterranean, gluten-free) and anxiety using various anxiety scales, with 19 studies specifically reporting on whole dairy consumption and anxiety. Dairy consumption was significantly associated with a lower risk of anxiety in 7 studies, while the remaining 12 studies showed no significant associations. Evidence was mixed for the association between various dietary patterns and anxiety, but more studies observed a lower risk of anxiety with greater adherence to "healthy" diets (e.g., Mediterranean, diet quality score, vegetarian/vegan) than a higher risk. Notable heterogeneity in study populations, time periods, geographical locations, dietary assessment methods, and anxiety scales was observed.

CONCLUSIONS

The results of this SLR suggest a potential link between diet including diary consumption and anxiety, but future studies, especially with longitudinal designs that measure diet and anxiety at several timepoints and comprehensively adjust for confounders, are needed to fully understand the relationship between diet and anxiety.

Dietary Intake and Supplement Use in Competitive Women Bodybuilders

(1) Background: Women bodybuilders use extreme diets, dietary supplementation, and training regimes to sculpt their physiques. Women's participation in bodybuilding competitions has increased since the 1980s. Currently, studies on their dietary intake and supplement use are limited. Their dietary intake may be of poor quality and low in several micronutrients, while supplement use appears to be omnipresent. Thus, the aim of this study was to examine and compare the dietary intake, supplement use, and diet quality of in-season and off-season women bodybuilders. (2) Methods: In a cross-sectional design, we compared dietary intake, supplement use, and diet quality between seasons in women bodybuilders (n = 227). An online questionnaire was developed, validated, and administered to assess all non-dietary and supplement variables. The Automated Self-Administered 24 h Dietary Assessment Tool was used to collect four 24 h dietary recalls. The Healthy Eating Index-2015 (HEI-2015) was used to calculate diet quality. The analysis of covariance and Welch's t-tests were used to assess the differences between in-season and off-season women bodybuilders' dietary intake, supplement, and HEI-2015 variables. (3) Results: In-season competitors reported consuming significantly less energy, carbohydrates, and fat but more protein than off-season competitors. All competitors consumed excess protein, while in-season competitors consumed excess fat and off-season competitors consumed less energy than the physique athlete nutrition recommendations. All competitors' micronutrient intakes were above the Dietary Reference Intakes. Supplements were used by all competitors, and the mean number used was similar between seasons. The HEI-2015 scores were not significantly different between seasons yet were below the US Dietary Guidelines for Americans. (4) Conclusion: Women bodybuilders would benefit from health education to achieve physique athlete nutrition recommendations, improve diet quality, and safe/efficacious supplement use to reach physique goals and improve overall health.