Examining the Role of Anxiety and Depression in Dietary Choices among College Students

Anxiety and restrained eating in everyday life: An ecological momentary assessment study

BACKGROUND

Restrained eating has been related to psychological distress like anxiety and eating disorder symptomatology, but little is known about this relationship in daily life in non-clinical populations. We aimed to understand concurrent and temporal associations between momentary anxiety and restrained eating in everyday life within and across persons in a non-clinical sample, and examined whether this association remains after controlling for eating disorder symptomatology.

METHODS

We used a 10-day ecological momentary assessment (EMA) protocol. Participants (n = 123) completed a baseline survey with demographics and eating disorder symptomatology questions, and three EMA surveys per day reporting anxiety and restrained eating intentions. We applied mixed-effects and random intercept cross-lagged models to analyze the data.

RESULTS

Momentary anxiety and restrained eating were concurrently significantly positively associated within and between persons. When participants had more anxiety than was typical for them, they were more likely to intend to restrain eating, and people with overall higher anxiety symptoms tended to report greater restrained eating over the study period. These associations remained significant after adjusting for eating disorder symptomatology. There were no significant temporal cross-lagged effects. Anxiety-restrained eating association did not spill over into the next assessment window.

LIMITATIONS

The time window between prompts may have been too long to capture potential temporal effects, and we did not examine actual behavioral food restrictions.

CONCLUSION

Daily-life anxiety may be related to concurrent restrained eating intentions, above and beyond baseline eating disorder symptomatology. Research is needed exploring daily-life anxiety as a potential intervention target to address restrained eating.

Anxiety Symptoms Influence Food Consumption Differently Depending on Nutritional Status During the COVID-19 Pandemic: A Longitudinal Study with University Students

BACKGROUND

Anxiety symptoms are factors that directly affect eating habits, but this interference can be heterogeneous depending on the nutritional status of the individuals.

OBJECTIVES

To analyze whether the presence of anxiety symptoms at the beginning of the pandemic influenced the change in food consumption according to its purpose and extent of processing during a one-year follow-up and whether this association occurs equally with excess weight and without excess weight university students.

METHODS

This longitudinal study was carried out with 583 university students from a public Higher Education Institution (HEI) in Brazil. The Generalized Estimating Equation (GEE) was used to verify whether anxiety symptoms were associated with changes in food consumption over time.

RESULTS

The results showed that previous moderate/severe anxiety symptoms were associated with an increased frequency of consumption of both fresh or minimally processed foods (β: 0.2 95%CI: 0.1; 0.7 p = 0.013) and ultra-processed foods (β: 5.6 95%CI: 1.8; 17.7 p = 0.003), but with different magnitudes. In university students who were not excess weight, previous moderate/severe anxiety symptoms were associated with a reduction in the frequency of consumption of fresh or minimally processed foods (β: -2.0 95%CI: -3.5; -0.5 p = 0.008), while in those who were excess weight, there was an increase in consumption of ultra-processed foods (β: 4.5 95%CI: 2.2; 6.8 p < 0.001).

CONCLUSION

This study confirms the influence of anxiety symptoms on food consumption according to the extent and purpose of processing. In addition, these results emphasize the role of psychological distress in the university population, and that this factor can affect excess weight and without excess weight individuals differently.

The Relationship between Lifestyle Behaviors and Mental Illness in Women in College

Women, particularly those in college, have the highest prevalence of any mental illness (MI), which negatively impacts social connection, academic performance, and health. Research into alternative treatment methods suggests that lifestyle behaviors are safer and more effective than medication at reducing MI symptoms. This study explores the relationship between lifestyle behaviors and MI in college women through an online survey. The survey included a food frequency questionnaire (Diet History Questionnaire II) and questions about lifestyle behaviors, symptoms of MI, and sociodemographic information. Diet quality was calculated using the Healthy Eating Index (HEI), and MI was assessed using the Depression, Anxiety, and Stress Scale-21. Independent sample t-tests, ANOVA, and chi-square analyses were conducted. A total of 222 women completed the survey. Overall, diet quality was poor, with a mean HEI of 62.6 ± 10.4. No significant differences or associations were found between MI groups for total HEI score, sleep, or tobacco use. However, alcohol use was significantly associated with MI (p = 0.049). Individuals with fewer concurrent unhealthy lifestyle behaviors had less severe symptoms of depression (p = 0.009) and anxiety (p < 0.001) compared to those with more unhealthy lifestyle behaviors. In this study, alcohol use was the only independent lifestyle behavior associated with symptoms of MI. We also found an association between the number of concurrent unhealthy lifestyle behaviors and depression and anxiety symptoms. Future research should explore the benefits of a healthy lifestyle on MI in a more diverse sample of women.

Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio

Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.

The relationship between health-promoting behaviors and negative emotions in college freshmen: a cross-lagged analysis

Background

The prevalence of mental health issues has been gradually increasing among college students in recent years. Improvements in mental health can be achieved through changes in daily behavior and the use of psychological counseling. This study aims to investigate the relationship between health-promoting behaviors and negative emotions among college freshmen as they enter the university. It also examines the impact of various sub-dimensions of health-promoting behaviors and other factors on the negative emotions (stress, anxiety, and depression) experienced by college freshmen.

Methods

Using the Negative Emotion and Health-Promoting Behavior scales, a 7-month longitudinal study was conducted on 4,252 college freshmen, with collection of data at two time points (T1: November 12, 2021; T2: June 17, 2022). Out of this longitudinal study, 3,632 valid samples were obtained. This research aimed to explore the association and impact between negative emotions and the level of health-promoting behaviors among college students during their time at the university.

Results

① There were significant differences in the levels of health-promoting behaviors and negative emotions over the course of 7 months (P < 0.05). Health-promoting behaviors were found to have a significant negative correlation with negative emotions (P < 0.05). ② Negative emotions at T1 significantly negatively predicted health-promoting behaviors at T2 (β = -0.11, P < 0.01), while health-promoting behaviors at T1 significantly negatively predicted negative emotions at T2 (β = -0.12, P < 0.001). ③ Stress management (β = -0.104, P < 0.05; β = -0.087, P < 0.05), self-actualization (β = -0.282, P < 0.01; β = -0.260, P < 0.05), health responsibility (β = -0.057, P < 0.05; β = -0.088, P < 0.05), and interpersonal relations (β = 0.068, P < 0.01; β = 0.138, P < 0.05) were important components in improving stress and anxiety. Self-actualization (β = -0.437, P < 0.001), exercise (β = 0.048, P < 0.001), nutrition (β = 0.044, P < 0.001), and interpersonal relations (β = 0.065, P < 0.001) were important components in improving depression. ④ Gender, place of household registration, and whether the individual is the only child were significant factors affecting negative emotions in college freshmen.

Conclusion

The level of health-promoting behaviors is an important indicator for assessing the negative emotional states of college freshmen. Enhancing health-promoting behaviors across various dimensions can help alleviate different types of negative emotions. Gender, place of household registration, and being the only child are significant factors that influence negative emotions.

Association between depression and endometriosis using data from NHANES 2005-2006

Studies on the association between depression and self-reported endometriosis are limited, and further studies are required to investigate this association. Data were collected from the National Health and Nutrition Examination Survey database (2005-2006). Based on the inclusion and exclusion criteria, 100 participants with self-reported endometriosis and 1295 participants without self-reported endometriosis were included, representing a total population of 64,989,430. Depression severity was assessed using the Patient Health Questionnaire 9 (PHQ9). A survey-weighted logistic regression analysis was performed to explore the association between depression and endometriosis. Subgroup analyses were conducted to explore heterogeneity. The prevalence of endometriosis was 7.17%. A significant positive association was found between the PHQ9 score and endometriosis. After adjusting for all covariates, the PHQ9 score positively correlated with endometriosis. Furthermore, compared with the participants without depression, those with moderate depression were more prone to have endometriosis both in unadjusted and fully adjusted model. However, the relationship between severe depression and endometriosis was not significant in all models (P > 0.05). Our findings highlight the influence of depression on the prevalence of self-reported endometriosis. Further studies are required to elucidate the causal relationship between depression and self-reported endometriosis.

A Randomized Controlled Trial of the Effects of a Web-Based Intervention on Perceived Stress and Diet Quality Among First-Year University Students

Background

e-Health interventions can potentially improve health care. My Viva Plan® (MVP) is a web-based program that focuses on mindfulness, nutrition, and physical fitness. The aim of this study was to evaluate the effects of this platform on stress indicators and diet quality among first-year university students.

Methods

Ninety-seven university students were enrolled in a randomized, controlled clinical trial. Participants were randomized into control (n = 49) and MVP (n = 48) groups. Perceived stress was measured using the self-report Stress Indicator Questionnaire. Diet quality was assessed by the nutrient-rich foods index, and body composition was assessed by a hand-to-foot, multifrequency, bioelectrical impedance analysis.

Results

There were no differences in physical, sleep, behavioral, emotional, and personal habit indicators between groups. Diet quality and body composition were similar between groups, except among women in the MVP group with decreased body fat (-1.2 ± 2.6 kg, p < 0.05). Participant engagement was low: 50% of the MVP group did not access the platform.

Conclusions

The MVP web-based intervention was not associated with improvements in stress indicators, diet quality, and body composition, likely due to the characteristics of our cohort of healthy young individuals. Future studies should focus on enhancing motivational approaches to explore the potential of e-health interventions that improve health behavior.

Clinical Trial Registration number: NCT03579264A.

The interactive effects of psychosocial stress and diet composition on health in primates

Social disadvantage and diet composition independently impact myriad dimensions of health. They are closely entwined, as social disadvantage often yields poor diet quality, and may interact to fuel differential health outcomes. This paper reviews effects of psychosocial stress and diet composition on health in nonhuman primates and their implications for aging and human health. We examined the effects of social subordination stress and Mediterranean versus Western diet on multiple systems. We report that psychosocial stress and Western diet have independent and additive adverse effects on hypothalamic-pituitary-adrenal and autonomic nervous system reactivity to psychological stressors, brain structure, and ovarian function. Compared to the Mediterranean diet, the Western diet resulted in accelerated aging, nonalcoholic fatty liver disease, insulin resistance, gut microbial changes associated with increased disease risk, neuroinflammation, neuroanatomical perturbations, anxiety, and social isolation. This comprehensive, multisystem investigation lays the foundation for future investigations of the mechanistic underpinnings of psychosocial stress and diet effects on health, and advances the promise of the Mediterranean diet as a therapeutic intervention on psychosocial stress.

Investigation of the interaction between Genetic Risk Score (GRS) and fatty acid quality indices on mental health among overweight and obese women

BACKGROUND & AIMS

Mental disorders are associated with dietary fatty acids and genome-wide association studies have found multiple risk loci robustly related to depression, anxiety, and stress. The aim of this study is to investigate the interaction of genetic risk score (GRS) and dietary fat quality indices on mental health.

METHODS

This cross-sectional study included 279 overweight and obese women for N6/N3 ratio and 378 overweight and obese women for CSI aged 18-68 years. Using reliable and verified standard protocols, body composition, anthropometric indices, blood pressure, physical activity, and dietary fat quality were measured. Serum samples were used to determine biochemical tests. A genetic risk score (GRS) was calculated using the risk alleles of the three SNPs. A generalized linear model (GLM) was applied to assess the interactions between GRS and fat quality indices. Mental health was evaluated using Depression Anxiety Stress Scales (DASS-21).

RESULTS

The mean (± SD) age and BMI of our participants were 36.48 (8.45) and 30.73 (3.72) kg/m2 respectively. There was a marginally significant mean difference among tertiles of the CSI in terms of stress (P = 0.051), DASS-21 (P = 0.078) in the crude model. After adjusting for age, energy intake, physical activity and BMI in model 1, there was a positive interaction between GRS and T3 of N6/N3 ratio on anxiety (β = 0.91, CI = 0.08,1.75, P = 0.031), depression (β = 1.05, CI = 0.06,2.04, P = 0.037), DASS-21 (β = 2.22, CI= -0.31,4.75, P = 0.086).

CONCLUSION

Our findings indicate that higher ratio of N-6 to N-3 considering genetics were predictive of mental disorder in our population.

Food insecurity in Piura, Peru, in the context of post-earthquake and the COVID-19 pandemic

Introduction

Piura, located in a seismic zone, faces challenges related to food security. The aim of this study was to analyze aspects related to food insecurity in the region following the 6.1-magnitude earthquake that occurred in 2021, within the context of the COVID-19 pandemic.

Methods

A secondary analysis was performed in 177 people exposed to the earthquake in Piura. Food insecurity was assessed with the Household Food Insecurity Access Scale. Its association with insomnia, resilience, anxiety/depressive symptoms, and general variables were determined using generalized linear models.

Results

Food insecurity was observed in 31.1% (95% CI: 24.3-38.4) of participants. This prevalence was higher in people with mild (PR: 1.73, 95% CI: 1.12-2.70) and moderate (PR: 1.55, 95% CI: 1.09-2.22) anxiety symptoms, severe depressive symptoms (PR: 2.74, 95% CI: 1.24-6.03), and previous exposure to the El Niño Phenomenon (PR: 1.72; 95% CI: 1.06-2.81). An income higher than 5000 Peruvian soles (approximately 1300 US dollars) was associated with a lower prevalence of food insecurity (PR: 0.22, 95% CI: 0.13-0.40).

Conclusions

Overall, three out of 10 individuals experienced food insecurity after the 2021 earthquake in Piura. Food insecurity may be aggravated by mental disorders, previous exposure to the El Niño phenomenon, and the COVID-19 pandemic. Our study contributes to the field by exploring a range of variables related to food insecurity in a unique context: post-earthquake and during the COVID-19 health emergency in Peru. These findings enhance our understanding of food insecurity at the regional level and highlight the need for preventive food security programs in seismic events.

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.

Relationship between nutritional status and anxiety and depression in hospitalized diabetic patients in Turkey

BACKGROUND

Anxiety and depression often coexist in patients with chronic diseases. We evaluated the nutritional status of diabetic patients and its relationship with anxiety and depression.

METHODS

Demographic, diabetic information (disease duration, treatment, hospitalization) information and anthropometric measurements (weight, height, waist, and hip circumference) were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. 24-h food records were obtained to determine daily energy and nutrient intake.

RESULTS

In this study of 222 patients, the rates of anxiety, depression and anxious depression were 23.8%, 21.6%, 12.2%, respectively. Those who skipped medication/insulin doses and did not exercise regularly had significantly higher anxiety and depression scores. Anxiety and depression scores were positively correlated with disease duration, waist circumference, waist/hip, and waist/height. Being married, engaging in regular exercise, and increased vitamin B₆ consumption were inversely related to anxiety and depression. According to food records, patients with anxiety and depression have a higher proportion of energy from dietary carbohydrates. Anxiety and depression scores were negatively related to dietary energy, protein, fat, some vitamin (retinol, group B, C, and D), and mineral (K, Mg, P, Fe, Zn, Cu) intake.

CONCLUSIONS

Maintaining healthy body weight, compliance with medication/insulin treatment, and regular exercise may help in the prevention of anxiety and depression in hospitalized diabetic patients. Alternatively, anxiety and depression may adversely affect body weight, compliance with treatment, and engaging in regular exercise. Prospective studies are needed to determine the direction of causality.

Association between university student junk food consumption and mental health

Background: On a global scale, the mental health consequences of eating habits among the general population are becoming a concern. Particular attention should be directed to the youthful population. Aims: Determine the relationship between university students' consumption of junk food and their levels of stress, anxiety, and depression. Method: University students were asked to complete: a demographic questionnaire, questions on junk food consumption, and depression anxiety stress scores (DASS-21). Body mass index measurements were taken. Logistic regressions were utilized to construct odds ratios (ORs) with 95% confidence intervals to identify the association between university students' consumption of junk food and their levels of stress, anxiety, and depression. Results: There were (N = 509), 66% females and 34% males, mean age was (M = 18.1 ± .5) years participated in this study. Daily consumption of junk food was significantly linked to stress (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.5-8.3), anxiety (OR, 11.1; 95% CI, 6.2-20.1), and depression (OR, 7.9; 95% CI, 4.5-13.9). Conclusions: This is the first thorough study conducted in Egypt to examine the relationship between stress, anxiety, and depression, and junk food consumption among undergraduates at a private Egyptian university. Many college students struggle emotionally, and those who are emotionally troubled are more likely to participate in eating unhealthy food. Our research will be used to inform regional policies on adolescent nutrition and to create preventative strategies.

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.

Dietary patterns, nutritional status, and mortality risks among the elderly

Introduction

While most epidemiological studies have focused on the effects of individual dietary patterns and nutritional status on health, the relationships between the combinations of these factors and patient prognosis requires further investigation.

Objective

This study explored mortality risk in individuals with different combinations of dietary patterns or nutritional status.

Methods

Unsupervised K-means clustering was used to classify populations. The analyses included Cox proportional risk and competing risk models.

Results

After considering a complex sampling design, the results showed that among 12,724 participants aged >60 years, 6.99% died from cancer and 10.47% from cardiovascular and cerebrovascular disease (CCVD). After correcting for participant baseline information and chronic conditions, the geriatric nutritional risk index and healthy eating index (HEI) were negatively associated with the risk of all-cause and cause-specific mortality. The opposite was true for the dietary inflammatory index (DII). After sorting the population three clusters based on study scores showed higher risks of all-cause mortality and cancer-related death in Cluster 2 and 3.

Discussion

These results suggest that different nutritional status and dietary patterns are associated with the risk of all-cause mortality and death from cancer and CCVD in people aged >60 years in the United States. Dietary patterns with high HEI and low DII were beneficial to health, whereas nutritional status needs to be maintained at a level that is not too low.

Athlete students lead a healthier life than their non-athlete peers: A cross-sectional study of health behaviors, depression, and perceived health status among university students

Some studies show that athlete students are more likely to engage in health-risk behaviors with negative health consequences, while others suggest that they lead a healthier life than their non-athlete peers. Given these inconsistent results, this study aims to compare health behaviors, depression, and perceived health status between athlete and non-athlete students, and explore the associations between health behaviors and health outcomes. An online questionnaire survey including Heath Habits Scale for five health-risk behaviors and five health-promoting behaviors, Patient Health Questionnaire-9 (PHQ-9), and 5-point scale for perceived health status was conducted in Beijing Sports University in March 2021. Data from 372 athlete students and 252 non-athlete students aging from 18 to 22 were included in this study. Chi-squared tests and t-tests were used to determine differences between athlete and non-athlete samples, and logistic regression analyses were conducted to examine the associations of health behaviors with depression and perceived health status. The significance level was p &lt; 0.05. The results show that compared with non-athlete students, athlete students perform better in health habits (10.01 vs. 8.27), report lower proportion of depression (44.6% vs. 54.4%) and higher proportion of good health (77.2% vs. 55.6%). Health behaviors, such as getting adequate sleeping, participating in vigorous physical activity, overeating, and smoking, were significantly associated with health outcomes of athlete students. The findings may contribute to the better understanding of health behaviors in athlete students and warrant continued attention on mental health and health habits in this population.

Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review

The rising prevalence of depression among Type 2 Diabetes Mellitus (T2DM) patients has triggered an alarming situation, and further actions need to be taken by health care professionals and policymakers to curb the issue. There is a lack of evidence review in terms of the biopsychosocial and nutritional factors that are related to depression among T2DM. Hence, this review aimed to identify available evidence on the biopsychosocial and nutritional factors associated with depression among T2DM patients based on the existing literature. Articles were systematically searched from four databases, namely PubMed, Scopus, Web of Science, and EBSCOHost. The approach for the identification of the final articles followed PRISMA guidelines. The selected full-text articles were published between 2017 and 2021 in the English language, and included studies focused on depression among T2DM patients. Using AXIS tools, the eligible articles were evaluated to assess the quality of studies. A total of 19 studies were included in the review, and information related to research questions and associated factors was extracted. Biological, psychological, social, and nutritional factors were shown to be linked with depression among T2DM patients. Future studies need to considered using the biopsychosocial model and incorporating nutritional factors to manage the issues of depression among T2DM patients.

Relationships Between Depressive Symptoms, Dietary Inflammatory Potential, and Sarcopenia: Mediation Analyses

Background

Sarcopenia is a major public health problem. Depressive symptoms and dietary inflammatory potential play important roles in the development of sarcopenia. We aimed to disentangle the relationships between depressive symptoms, dietary inflammatory potential, and sarcopenia.

Methods

A total of 6,082 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Sarcopenia was defined according to the Foundation for the National Institutes for Health (FNIH) criteria. The Depressive symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Dietary Inflammatory Index (DII) was calculated based on 24-h dietary recall interview. Two sets of mediation models were constructed separately.

Results

Depressive symptoms and DII were associated with sarcopenia, with odds ratios [ORs] (95% CIs) 2.54 (1.27, 5.13) and 1.17 (1.00, 1.37), respectively. DII score mediated the association of depressive symptoms with low muscle mass, explaining a total of 10.53% of the association (indirect effect = 0.004). Depressive symptoms had a significant mediating effects on the association between DII with low muscle mass, explaining a total of 12.50% of the association (indirect effect = 0.001).

Conclusions

Our findings suggested that both depressive symptoms and dietary inflammatory potential had direct effects, and indirect effects on low muscle mass, handgrip strength, muscle mass, through each other. It provides important insights into integrated nutritional and psychological intervention strategies in preventing sarcopenia.

A population-based study of macronutrient intake according to mental health status with a focus on pure and comorbid anxiety and eating disorders

PURPOSE

Eating disorders (ED) and anxiety impact food choices. In addition, comorbid anxiety seems to increase ED symptoms and severity. However, the association between such comorbidity and dietary intake is unknown. This population-based, cross-sectional study aimed to assess macronutrient intake according to mental health status (i.e., no disorder, pure and comorbid anxiety and ED).

METHODS

The study included N = 24,771 participants (74% female, mean age = 53.2 ± 13.7 years) in the NutriNet-Santé cohort, who completed once the trait subscale of the State-Trait Anxiety Inventory (STAI-T; high anxiety: ≥ 40 points) between 2013 and 2016 and the SCOFF questionnaire screening for ED in 2014. The Expali algorithm was applied to categorize ED (no ED; restrictive: RS; bulimic: BL; hyperphagic: HP; other ED). Participants were divided into ten groups by crossing their anxiety status (two groups: low or high) and their ED status (five groups). Macronutrient intakes were evaluated from ≥ 3 24-h dietary records. Analyses of covariance (ANCOVA) and Dunnett-Hsu tests (reference = no disorder) were performed.

RESULTS

Significant differences in macronutrient intake were seen between the pure and comorbid forms, especially for RS and HP. Compared to the "no disorder" group, a significantly higher percentage of energy from carbohydrates, higher intakes of total carbohydrates, simple sugars, and plant-based protein, lower intakes of total fat, saturated and monounsaturated fatty acids, and cholesterol were observed in the comorbid anxiety + RS group, but not in the pure RS group. In contrast, significantly lower intakes of added sugar and plant-based protein, and a higher intake of cholesterol were observed in the pure HP group, but not in the comorbid anxiety + HP group. For BL and other ED, similar results were observed between the pure and comorbid forms.

CONCLUSION

This large epidemiological study provided some support for differences in macronutrient intake between individuals with pure or comorbid anxiety and ED. Differences in intake were largely dependent on ED type. Future prospective studies and studies using clinically defined anxiety and ED are needed to elucidate causality as well as potential effect modification of the observed associations.

Food approach and avoidance appetitive traits in university students: A latent profile analysis

Eating behaviors are influenced by many factors including appetitive traits. Few studies have utilized latent profile analysis (LPA) to examine food approach and food avoidance appetitive traits. This study utilized LPA to define cluster profile groups based on appetitive traits in undergraduate and graduate/professional students at a large University in the southwest United States. Students completed a cross-sectional online survey in fall 2020 assessing demographic information, appetitive traits via the Adult Eating Behavior Questionnaire (AEBQ), and anxiety via the Generalized Anxiety Disorder Scale (GAD-7; higher scores indicate more severe anxiety symptoms). Appetitive traits were combined into eight scales (four food approach and four food avoidance traits). Latent profile analyses were conducted to identify homogenous subgroups of participants based on AEBQ scale scores. The final sample included 1243 students (mean age = 26.5 years, 73% female, 59% White, 57% undergraduates). LPA revealed four cluster profile groups: Cluster 1 (moderate eaters: lower than mean scores for food approach and avoidance traits), Cluster 2 (food seekers and avoiders: higher than mean scores for food approach and avoidance traits), Cluster 3 (food seekers: higher than mean scores for food approach traits), and Cluster 4 (food avoiders: higher than mean scores for food avoidance traits). Distribution of age, gender, race/ethnicity, and student status differed significantly between clusters. GAD-7 score was highest in Cluster 2 (food seekers and avoiders) and lowest in Cluster 1 (moderate eaters). Among the four LPA-defined cluster profile groups, students who endorsed both food approach and avoidance traits reported more severe anxiety symptoms compared to moderate eaters, food seekers, and food avoiders. It is useful to consider clusters of appetitive traits instead of individual appetitive traits when examining associations with physical and mental health.

Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic

Background

COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic.

Methods

Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender.

Results

Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18–20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen’s d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food.

Conclusions

Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00701-9.