The Inflammatory Potential of the Diet Is Associated with Depressive Symptoms in Different Subgroups of the General Population

Diet quality and depression risk: A systematic review and meta-analysis of prospective studies

BACKGROUND

The association between diet and the onset and treatment of depression is unclear. This study aims to estimate the evidence for the prospective association between diet quality and depression.

METHODS

Systematic searches in PubMed, Web of Science and Embase up to 2024/01/04 of propective studies on the potential relationship between diet quality and depression identified 21 randomized clinical trials (RCT) and 92 prospective cohorts (PC) (>700,000 participants), that were pooled in random-effects frequentist and Bayesian meta-analyses.

RESULTS

Treatment-RCT yielded anecdotal-to-moderately strong support for the hypothesis that dietary interventions improve depression (d = -0.80, 95 % CI = -1.46 to -0.14), though their internal validity was low. Interventional effects were observed in nonpatient samples (d = -0.17, -0.29 to -0.08). Prevention-RCT yielded strong evidence indicating no association. Data from PC showed that adherence to some dietary patterns/food groups was associated with depression, e.g., adherence to the Mediterranean-diet was associated to fewer self-reported symptoms (OR = 0.91, 95%CI = 0.88-0.96), with anecdotal-to-moderate strength of evidence but no dose-response relationship. For most dietary patterns and food-groups (e.g., fish), data supported the null-hypothesis of no effect. Effect moderation was present: associations were evident when depression was self-reported but not when diagnosed. Postpartum-depression studies yielded evidence showing dose-response associations between fish (OR = 0.84, 95%CI = 0.78-0.91) and dietary DHA/EPA/Omega3 consumption (OR = 0.84, 95%CI = 0.77-0.92) with self-reported depression-scores.

CONCLUSIONS

The strength of the current evidence on the hypothesis that dietary quality influences depression outcome is very low, due to reverse causation and low internal and construct validity. The clinical significance of fish/dietary DHA/EPA/Omega3 intake to reduce the risk of postpartum-depression should be further investigated.

The Relationship of Certain Diseases and Dietary Inflammatory Index in Older Adults: A Narrative Review

PURPOSE OF REVIEW

One of the important markers affecting aging processes is the increase in inflammatory markers. Many chronic diseases are associated with inflammation and chronic inflammation increases with aging. Inflammation can change with dietary components. Foods, compounds and nutrients that have anti-inflammatory or proinflammatory properties attract attention. According to the Dietary Inflammatory Index, positive scores are obtained if the nutrient has a proinflammatory effect on cytokines, and negative scores are obtained if it has an anti-inflammatory effect.

RECENT FINDINGS

A higher proinflammatory diet is associated with cardiometabolic diseases, neurodegenerative disease, cancers and musculoskeletal health and related mortality. In this study, its relationship with type 2 diabetes mellitus, obesity, metabolic syndrome, musculoskeletal diseases, dementia, depression and cancer, which are more common in older adults and known to be associated with inflammation, was examined. Although studies involving under 65 years old are more prevalent, research involving older adults and Dietary Inflammatory Index (DII) is more limited. It is known that chronic inflammation increases with aging. Diet is one of the factors affecting inflammation. In the light of these investigations, the topics of anti-inflammatory nutrition and DII for the treatment of inflammation-related diseases in older adults are strong and open to development topics of discussion. Despite the significant interest in the potential positive effects of anti-inflammatory nutrition on diseases, contributing to clearer evidence of its protective effects on health necessitates further randomized controlled trials, in vivo, in vitro, cell, animal, human and case-control studies for better risk assessment.

Is there a link between the inflammatory potential of a diet and mental health among patients with migraine? Findings from a cross-sectional survey

AIMS

In this study, we aimed to evaluate the relationship between the dietary inflammatory index (DII) and mental health outcomes among patients with migraine headaches.

METHODS

In this cross-sectional study, 262 subjects were included. The dietary intakes were collected using a validated 168-item semi-quantitative food frequency questionnaire. Items were scored according to their inflammatory potential, so a higher DII indicated a more pro-inflammatory diet. The association between DII and the mental health of participants was investigated using multinomial logistic regression and odds ratio (OR) with a corresponding 95% confidence interval (CI) was reported.

RESULTS

Overall, 224 women and 38 men, with a mean (standard error) DII of -2.96 (0.06), age of 36.1 (0.53) years, and BMI of 25.55 (0.21) kg/m2, comprised our study population. DII was positively associated with a higher risk of depression in patients with the highest adherence to a pro-inflammatory diet compared to those with the lowest adherence (OR = 1.76; 95%CI: 1.04, 3.00; Ptrend = 0.035). Adjustments for age, sex, marital status, smoking status, migraine headache index score, number of family members, mean arterial pressure, medication, physical activity, and BMI intensified the association in a way that the risk of depression was 2.03 times higher in patients with the highest adherence to a pro-inflammatory diet compared to those with the lowest adherence to a pro-inflammatory diet (OR = 2.03; 95%CI: 1.18, 3.49; Ptrend = 0.011).

CONCLUSION

Our findings suggest that depression was positively associated with adherence to a pro-inflammatory diet. However, no significant association was observed between anxiety and stress with DII.

Role of Branched and Aromatic Amino Acids, Diet Inflammatory Index, and Anthropometric Indices on Mental Health

Background

Mental health disorders are one of the most important and increasing health problems in the youth of today's societies. Some dietary intake and body mass status are factors that affect mental health. This study aimed to investigate the relationship between the intake of branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) and anthropometric and dietary inflammatory indices with mental health, including depression, anxiety, and stress.

Methods

In this case-control study, the data of 138 teenage girls aged 13-18 years were collected. Three-day 24-hour food recall and standard anthropometric methods were used to calculate the dietary inflammation intake score of normal and energy-adjusted diets. Mental health disorders were diagnosed by the DASS-21 questionnaire. Statistical analysis used Student's t-test, correlation, and multiple regression were used to analyze the data based on the study's statistical requirements.

Results

Based on the findings, 59 (42%) of the girls had mental disorders, and 79 (58%) were healthy. The average weight of stressed people was significantly higher than that of healthy people, and the BMI of anxious people was significantly higher than that of nonanxious people (P < 0.05). A significant positive correlation was found between stress and weight and energy intake. Additionally, there was a significant negative correlation between BCAAs and mental health. The average intake of BCAAs was significantly lower in patients (P = 0.01). The trend analysis showed significantly lower BCAA levels among the 4th quartile of mental disorders. No significant relationship was observed between DII, AAA, and anthropometric indices. After adjustment of the results, no relationship was observed between mental health and the studied factors.

Conclusions

BCAA might be related to mental health. Further studies in different age and sex groups are highly recommended.

Accelerated biological aging as potential mediator mediates the relationship between pro-inflammatory diets and the risk of depression and anxiety: A prospective analysis from the UK biobank

BACKGROUND

The relationship between inflammatory dietary patterns and the risk of depression/anxiety has not been clearly established due to differences in study populations, geographic regions, sex, and methods of calculating the inflammatory index.

METHODS

We drew upon a prospective cohort in the UK Biobank and calculated the energy-adjusted dietary inflammatory index (E-DII). The follow-up time was defined from the date of completing the last dietary survey questionnaire to the date of diagnosis of depression, anxiety, phobic anxiety, other types of anxiety, death, loss to follow-up, or the respective censoring dates for England (September 30, 2021), Scotland (July 31, 2021), and Wales (February 28, 2018). The final follow-up times end on September 30, 2021, July 31, 2021, and February 28, 2018, for England, Scotland, and Wales, respectively. During the follow-up process, if a participant develops the condition, dies, or is lost to follow-up, the follow-up is terminated. We used Cox regression to evaluate the connection between E-DII and depression/anxiety. We employed restricted cubic spline curves for nonlinear relationships. We also conducted mediation analyses to explore whether biological age mediated the relationship between E-DII and depression. Additionally, we investigated whether genetic susceptibility modified the relationship between E-DII and depression through interaction modeling.

RESULTS

In the final analysis, we included a total of 151,295, 159,695, 165,649, and 160,097 participants for the analysis of depression, all types of anxiety, specific phobia anxiety, and other types of anxiety, respectively. For every one-unit increase in E-DII, the risk of experiencing depression and anxiety increased by 5 % and 4 %, respectively. We identified a "J"-shaped nonlinear relationship (P for nonlinear = 0.003) for both depression and anxiety. A significant association with an elevated risk of depression was observed when E-DII exceeded 0.440, and an increased risk of anxiety was noted when E-DII was more than -0.196. Mediation analysis demonstrated that PhenoAge age acceleration (AA) (For depression, proportion of mediation = 9.6 %; For anxiety, proportion of mediation = 10.1 %) and Klemera-Doubal method Biological Age (KDM AA) (For depression, proportion of mediation = 2.9 %; For anxiety, proportion of mediation = 5.1 %) acted as mediators between E-DII and the development of depression and anxiety (P < 0.05).

CONCLUSIONS

Diets with pro-inflammatory characteristics are associated with a heightened risk of depression and anxiety. Furthermore, the association of pro-inflammatory diets and depression is mediated by biological age.

An Overview of the Potential Role of Nutrition in Mental Disorders in the Light of Advances in Nutripsychiatry

PURPOSE OF REVIEW

As research on the potential impact of nutrition on mental disorders, a significant component of global disability continues to grow the concepts of "nutritional psychiatry, psycho-dietetics/nutripsychiatry" have taken their place in the literature. This review is a comprehensive examination of the literature on the the potential mechanisms between common mental disorders and nutrition and evaluates the effectiveness of dietary interventions.

RECENT FINDINGS

Inflammation, oxidative stress, intestinal microbiota, mitochondrial dysfunction, and neural plasticity are shown as potential mechanisms in the relationship between mental disorders and nutrition. As a matter of fact, neurotrophic factors, which make important contributions to repair mechanisms throughout life, and neuronal plasticity, which plays a role in mental disorders, are affected by nutritional factors. In metabolism, the antioxidant defense system works with nutritional cofactors and phytochemicals. A balanced, planned diet that provides these components is more likely to provide nutrients that increase resilience against the pathogenesis of mental disorders. Nutrition can be considered a risk factor for mental disorders. Therefore, developing public health strategies focused on improving diet may help reduce the global burden of mental disorders and other related diseases.

Factors associated with depressive symptoms among cancer patients: a nationwide cross-sectional study

OBJECTIVE

Research on factors contributing to depressive symptoms in cancer patients at a national level, encompassing a comprehensive set of variables was limited. This study aimed to address this gap by identifying the factors associated with depressive symptoms among cancer patients through a nationwide cross-sectional analysis.

METHODS

Various factors, including demographic, socioeconomic, behavioral patterns, general and self-rated health status, chronic conditions, dietary habits, and cancer-related factors, were examined. Data was from the National Health and Nutrition Examination Survey. Univariate and multivariate logistic regression analyses were performed to identify associated factors. The receiver-operating characteristic (ROC) curve was used to evaluate the performance of the logistic model.

RESULTS

The findings showed that five sociodemographic factors, two behavioral styles, self-rated health status, comorbid arthritis, two dietary factors and two cancer-related factors were strongly associated with depressive symptoms. Compared with those aged 20-39 years, cancer individuals aged 40-59 years (OR = 0.48, P < 0.05) and those 60 years or older (OR = 0.18, P < 0.05) had lower odds of depression. Positive factors included being never married (OR = 1.98, P < 0.05), widowed, divorced or separated (OR = 1.75, P < 0.05), unemployment (OR = 1.87, P < 0.05), current smoking (OR = 1.84, P < 0.05), inadequate sleep (OR = 1.96, P < 0.05), comorbid arthritis (OR = 1.79, P < 0.05), and poor self-rated health status (OR = 3.53, P < 0.05). No significant association was identified between the Healthy Eating Index 2015 and the Dietary Inflammatory Index with depression (P > 0.05). Shorter cancer diagnosis duration was associated with reduced odds of depression (P < 0.05). The logistic model had an area under the curve of 0.870 (95% CI: 0.846-0.894, P < 0.05).

CONCLUSIONS

Cancer patients should receive enhanced family and social support while cultivating a healthy lifestyle and diet. Incorporating plenty of fruits, greens, and beans is highly recommended, along with establishing a comprehensive health management framework.

Association between dietary inflammatory index and mental disorders using multilevel modeling with GLIMMIX

Introduction

The Dietary Inflammatory Index (DII) is a composite nutritional index that has gained significant attention in the past decade due to its association with physical and mental well-being. To accurately assess the precise effects of DII on health outcomes, the effects of nutrients and foods need to be adjusted. This study aimed to investigate the association between DII and mental disorders (depression, anxiety, and stress) using multilevel modeling to minimize the bias of the previous methods.

Methods

This cross-sectional analytical study was conducted using data from the initial phase of the Tehran University of Medical Sciences Employees' Cohort Study (TEC). Nutritional information was obtained through a dish-based semi-quantitative food frequency questionnaire (DFQ), while psychological data were collected using the depression, anxiety and stress scale (DASS-42). The acquired data were analyzed using multilevel modeling in three levels (foods, nutrients, and DII, respectively) through GLIMMIX in the SAS software.

Results

A total of 3,501 individuals participated in this study. The results of the multilevel model demonstrated a significant statistical association between DII and mental disorders after adjusting for baseline characteristics, nutrients and foods. For each unit increase in DII, the mean scores for stress, anxiety, and depression increased by 3.55, 4.26, and 3.02, respectively (p < 0.001).

Conclusion

Based on the multilevel model's findings, it is recommended to minimize the use of pro-inflammatory nutrients and foods to increase the mental health. Multilevel data analysis has also been recommended in nutritional studies involving nested data to obtain more accurate and plausible estimates.

Construct Validation of the Dietary Inflammatory Index (DII) among Young College-Aged Women

The Dietary Inflammatory Index (DII) is designed to assess the inflammatory potential of the diet. While previous research has utilized DII among college-aged women, no study to date has validated it in this population. We conducted a construct validation of DII among 393 healthy women aged 18-31 years against a robust panel of 14 inflammatory biomarkers, including CRP, IL-1β, IL-4, IL-6, IL-10, and TNF-α, which were used in the development of DII. Three linear regression models were constructed: (1) an age-adjusted model, (2) the most parsimonious model based on likelihood ratio tests, and (3) a fully adjusted model for age, race, body mass index, waist circumference, physical activity, smoking status, and nonsteroidal anti-inflammatory drug use. DII was derived from the Harvard food frequency questionnaire and categorized into quartiles. Consistent with our hypothesis, DII was negatively and significantly associated with back-transformed IL-10 levels, confirming that a more pro-inflammatory diet was associated with lower levels of an anti-inflammatory cytokine (Model 3: Q4 vs. Q1 β = 0.62; 95% CI: 0.42, 0.93; p-trend = 0.04). While validated in other populations, DII may not be a suitable tool for assessing the inflammatory potential of the diet among college-aged women.

Association between empirical dietary inflammatory index, odds, and severity of anxiety disorders: A case-control study

Diet may be a modifiable factor in the prevention of psychiatric disorders by modulating inflammation. In this study, we evaluated the association between empirical dietary inflammatory index (EDII) that is designed to evaluate the inflammatory potential of diets and anxiety disorders (AD) in adults. This case-control study was carried out on 85 patients who were group matched by gender with 170 healthy subjects. Data for dietary intake were assessed by using a 147-item validated food frequency questionnaire (FFQ). Anthropometric measures were collected using standard methods. EDII score was developed according to participants' dietary intakes of 28 predefined food groups. Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association of empirically derived inflammatory potential of the diet and anxiety disorder. We observed that after adjusting for confounders, individuals in the top category of EDII score were 2.09 fold more likely to have anxiety disorder compared with those in the bottom category (OR: 2.09, 95% CI: 1.01, 4.33). Also, higher EDII contributed to a higher GAD-7 score (p < .001). There was a significant positive linear association between EDII and AD (β = 3.64, p < .001). After controlling for potential confounders AD had a strong positive correlation with the EDII score (r = .61, p-value <.001). In conclusion, in this case-control study, we realized that there is a positive association between the EDII score, odds, and severity of anxiety disorder. Ultimately, the potential role necessitates clarifying this association by conducting large-population prospective cohort studies.

Shared biological mechanisms of depression and obesity: focus on adipokines and lipokines

Depression and obesity are both common disorders currently affecting public health, frequently occurring simultaneously within individuals, and the relationship between these disorders is bidirectional. The association between obesity and depression is highly co-morbid and tends to significantly exacerbate metabolic and related depressive symptoms. However, the neural mechanism under the mutual control of obesity and depression is largely inscrutable. This review focuses particularly on alterations in systems that may mechanistically explain the in vivo homeostatic regulation of the obesity and depression link, such as immune-inflammatory activation, gut microbiota, neuroplasticity, HPA axis dysregulation as well as neuroendocrine regulators of energy metabolism including adipocytokines and lipokines. In addition, the review summarizes potential and future treatments for obesity and depression and raises several questions that need to be answered in future research. This review will provide a comprehensive description and localization of the biological connection between obesity and depression to better understand the co-morbidity of obesity and depression.

Effect of the dietary inflammatory potential on the trajectory of body adiposity in a Brazilian cohort of university students

OBJECTIVES

University students are vulnerable to unhealthy eating habits that characterize a proinflammatory diet. This study aimed to estimate the dietary inflammatory index (DII) and its association with the trajectory of body adiposity markers in university students.

METHODS

The study analyzed data from 685 students entering a Brazilian public university in 2016 and 2017 and followed until 2018. DII was estimated from 39 dietary parameters obtained by 24-h dietary recall. Body adiposity was assessed by anthropometric markers and the percentage of body fat. Linear mixed-effects models were used to estimate the trajectory of adiposity markers according to DII tertiles.

RESULTS

After adjustment for confounding variables, at baseline, DII showed a positive association with increased percentage of body fat among men (β = 0.52; 95% CI: 0.01; 1.03) and waist-to-height ratio (WHtR; β = 0.15; 95% CI: 0.12; 0.18) and among women with all body adiposity markers: BMI (β = 0.68; 95% CI: 0.30; 1.05), percentage of body fat (β = 1.43; 95% CI: 0.74; 2.11), WC (β = 1.15; 95% CI: 0.41; 1.89) and WHtR (β = 0.13; 95% CI:0,10; 0.16). The rate of change of the outcome variables over time was not associated with DII at baseline.

CONCLUSIONS

The diet of university students in this Brazilian cohort study was characterized as proinflammatory and it was associated with body adiposity markers.

The role of dietary inflammatory index and physical activity in depressive symptoms: Results from NHANES 2007-2016

BACKGROUND

Depression is a major public health problem. This study was aimed to analyze the relationship between dietary inflammation index (DII), physical activity, and depressive symptoms, and to explore the effect of different lifestyles on depressive symptoms by combining DII and physical activity to form four lifestyle groups.

METHODS

This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. A total of 21,785 subjects were involved. Depressive symptoms and dietary inflammation were measured by the Patient Health Questionnaire (PHQ-9) and Energy-adjusted Dietary Inflammatory Index, respectively. The participants were divided subgroups by different physical activity combined pro-inflammatory or anti-inflammatory diet groups.

RESULTS

Both pro-inflammatory diet and inactivity were positively associated with depressive symptoms. Compared with the anti-inflammatory diet & active group, the risk of depressive symptoms was 2.061 times higher in the pro-inflammatory diet & inactive group, 1.351 times higher in the pro-inflammatory diet & active group, and 1.603 times higher in the anti-inflammatory diet & inactive group. Physical inactivity was associated with a higher risk of depressive symptoms than a pro-inflammatory diet. Females and the 20-39 age group showed a strong association between lifestyles and depressive symptoms.

LIMITATIONS

Because of the cross-sectional study, no causal conclusions could be drawn. Moreover, PHQ-9 is a relatively basic method of identifying depressive symptoms, more and further research is needed.

CONCLUSIONS

Both a pro-inflammatory diet and physical inactivity were associated with higher risk of depressive symptoms, especially for young and female population.

Plant and animal protein intake and its association with depression, anxiety, and stress among Iranian women

BACKGROUND

Mental disorders are conditions that affect the usual function of the brain, causing a huge burden on societies. The causes are often unclear, but previous research has pointed out, as is the case with many other diseases, that nutrition could have a major role in it. Amino acids, the building blocks of proteins, are the main precursor of neurotransmitters (the chemical messengers in the brain) malfunction of which is heavily associated with a wide range of brain disorders.

METHODS

We assumed different sources of dietary protein could have different impacts on mental well-being. Hence, we decided to collect the nutritional data (with a validated and reliable semi-quantitative food-frequency questionnaire) from a sample of 489 Iranian women and investigate the association between animal and plant protein sources and the risk of depression, anxiety, and stress. Symptoms of these mental disorders were assessed using a validated Depression, Anxiety, and Stress Scales (DASS) questionnaire with 21 items.

RESULTS

After multivariable adjustment, it was shown that women in the highest tertile of animal protein intake were more likely to show symptoms of depression (OR: 2.63; 95% CI: 1.45, 4.71; P = 0.001), anxiety (OR: 1.83; 95% CI: 1.04, 3.22; P = 0.03), and stress (OR: 3.66; 95% CI: 2.06, 6.50; p < 0.001). While no significant association was seen between plant protein and any of the studied mental disorders.

CONCLUSION

Overall, our findings suggest that a diet high in animal protein could predispose individuals to mental illnesses.

The association between dietary inflammation index and depression

Objective

We aimed to evaluate whether depression is associated with increased risk of dietary inflammatory index (DII) or energy-adjusted DII (E-DII) and whether the association is partly explained by insulin resistance (IR).

Methods

Base on the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Univariate analyses of continuous and categorical variables were performed using t-test, ANOVA, and χ ² test, respectively. Logistic regression was used to analyze the relationship between DII or E-DII and depression in three different models. Mediation analysis was used to assess the potential mediation effects of homeostatic model assessment-IR (HOMA-IR).

Results

A total of 70,190 participants were included, and the DII score was higher in the depressed group. DII score was related to all participant characteristics except age (p < 0.05). After being included in covariates (Model 3), participants in the highest quartile of DII score have increased odds of depression (OR: 1.82, 95% CI: 1.28-2.58) compared with those in the first quartile of DII score. And, a significant dose-response relationship was found (p-trend <0.05). No interaction between DII and HOMA-IR was observed in terms of the risk of depression, and HOMA-IR did not find to play a mediating role in the association between DII and depression. Similar results were obtained for the association between E-DII and depression.

Conclusion

Our results suggest that a higher pro-inflammatory diet increases the risk of depression in U.S. adults, while there was no evidence of a multiplicative effect of DII or E-DII and HOMA-IR on disease risk, nor of a mediating effect of HOMA-IR.

Dietary inflammatory potential and the incidence of depression and anxiety: a meta-analysis

The potential modifiable role of diet in common psychological disorders, including depression and anxiety, has attracted growing interest. Diet may influence the occurrence of mental disorders through its inflammatory characteristics. The purpose of this meta-analysis was to explore whether dietary inflammatory potential is associated with the risk of depression and anxiety. A systematic literature search was conducted in PubMed, Web of Science, and Embase databases up to February 2021. Articles related to dietary inflammatory potential and risk of depression or anxiety were included. After the elimination of repetitive and irrelevant literature, we conducted quality assessment, publication bias, and sensitivity analysis. In total, 17 studies with a total of 157,409 participants were included in the final analysis. Compared with the lowest inflammatory diet group, the highest group was significantly associated with the incidence of depression and anxiety, with the following pooled odds ratios (ORs) and 95% confidence intervals (95% CIs): 1.45 (1.30 ~ 1.62) for depression and 1.66 (1.41 ~ 1.96) for anxiety. A subgroup analysis by gender showed that this association was more prominent in women. For depression, the increased risk was 49% in women (OR 1.49, 95% CI 1.28 ~ 1.74) and 27% in men (OR 1.27, 95% CI 1.06 ~ 1.52). As for anxiety, the increased risk was 80% in women (OR 1.80, 95% CI 1.30 ~ 2.49) and 47% in men (OR 1.53, 95% CI 0.81 ~ 2.89). As a result, long-term anti-inflammatory eating patterns may prevent depression and anxiety, whereas pro-inflammatory eating patterns may promote these conditions. People should add more fish, fish oil, fresh fruit, walnuts, and brown rice to their diet.

The association between dietary inflammatory index and psychological profile among men with spinal cord injury

OBJECTIVE

The present study was designed to examine the relationship between the dietary inflammatory index (DII) and depression, anxiety and stress in Iranian men with spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Mottahary SCI clinic, Isfahan, Iran.

PARTICIPANTS

The current study was conducted on 150 men with SCI aged 40-65 years.

OUTCOME MEASURES

Dietary data were collected using a semi-quantitative 148 item food frequency questionnaire (FFQ). The Depression, Anxiety, Stress Scale-21 (DASS-21) was used to assess the psychological profile of the participants.

RESULTS

The DII score ranged from -3.62 to 4.02. Overall, 34% of study participants had at least mild levels of depression and anxiety symptoms and 25% had at least mild levels of stress symptoms. A one-unit increase in the DII was significantly associated with higher scores of depressive symptoms (β = 1.31, 95% CI 0.44-2.18; P = 0.003). Also, a one-unit increase in the DII was associated with higher odds of having at least mild depressive symptoms (OR = 1.77, 95% CI 1.17, 2.67; P = 0.007). No significant association was found between the DII and anxiety and stress.

CONCLUSION

The present study indicated that a higher DII score is associated with higher odds of depressive symptoms in men with SCI. These initial findings highlight the crucial role of the inflammatory potential of diet in the mental health of subjects with SCI. Future prospective studies are warranted to confirm these findings.

The relationship between ultra-processed food consumption and internalising symptoms among adolescents from São Paulo city, Southeast Brazil

OBJECTIVE

To investigate the association between ultra-processed food (UPF) consumption and internalising symptoms (IS) among adolescents.

DESIGN

It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (IS-SBQ). UPF was evaluated with a FFQ extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with structural equation models.

SETTING

São Paulo, SP, Brazil.

PARTICIPANTS

A total of 2680 students, M_age = 14·85; (95 % CI 14·81, 14·88).

RESULTS

UPF consumption was associated with higher scores in IS in the crude (β = 0·14; P < 0·001) and adjusted (β = 0·12; P < 0·001) models. The higher the consumption of UPF, the higher is the IS score. The following variables were associated with a lower risk of UPF consumption: male sex, public school and having more meals with parents. The change in the magnitude of the standardised score was almost negligible, but the model was significantly improved with the inclusion of covariates.

CONCLUSIONS

Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasises the importance of a healthy diet with a reduction in UPF consumption among adolescents.

The association between dietary inflammatory index, dietary antioxidant index, and mental health in adolescent girls: an analytical study

BACKGROUND

Diet is considered as one of the modifiable factors that appears to exert a vital role in psychological status. In this way, we designed this study to examine the association between dietary inflammatory index (DII), dietary antioxidant index (DAI), and mental health in female adolescents.

METHODS

This cross-sectional study included 364 female adolescents selected from high schools in the five regions of Tabriz, Iran. A 3-day food record was used to extract the dietary data and calculate DII/DAI scores. DII and DAI were estimated to assess the odds of depression, anxiety, and stress based on the Depression Anxiety Stress Scales-21. Adjusted relationships of the DII and DAI with depression, anxiety, and stress were determined using multiple regression after adjusting for age, energy intake, BMI, family income and mother and father education. Overweight was defined as body mass index (BMI)-for-age >  + 1 z-score relative to world health organization standards.

RESULTS

Depression, anxiety, and stress were observed in 21.4%, 26.6%, and 25.7% of subjects, respectively. The percentage of overweight among adolescents was 19.4%. The association between DII and score of mental health profile was positive among subjects in the third tertile of DII compared to subjects in the first tertile. However, this association was not statistically significant after adjusting for confounding variables. Moreover, there was a significant inverse association between DAI and depression and anxiety; and a statistically insignificant association between DAI and stress after adjusting for confounders.

CONCLUSIONS

Our results highlighted the importance of a healthy and anti-inflammatory diet on mental health in female adolescents. Therefore, modifying unhealthy dietary habits are likely to be effective in the management of psychosocial disorders.

Dietary Inflammatory Index (DII) is Associated with Movement-Evoked Pain Severity in Adults with Chronic Low Back Pain: Sociodemographic Differences

Chronic low back pain (CLBP) is one of the leading causes of pain and disability in adults in the United States and disproportionately burdens non-Hispanic Black (NHB) individuals and females. Approximately 90% of CLBP cases are of unknown cause, and it is imperative that potential causes be explored. It has been reported that diet quality can influence pain state via diet-induced inflammation. The present study assessed the relationship between Dietary Inflammatory Index (DII) and movement evoked-pain severity in people with CLBP and investigated whether race/sex moderated the relationship between DII and movement-evoked pain. Results revealed no significant differences in DII scores between males and females, or between NHB and non-Hispanic White (NHW) participants. Participant sex significantly modified the relationship between DII and movement-evoked pain severity (P = .0155), such that movement-evoked pain severity was significantly impacted by DII scores in females, but not males. Participant race did not significantly moderate the DII - movement-evoked pain severity relationship. These results suggest that diet-induced inflammation may impact the CLBP experiences of females to a greater degree than males. Further research is needed to determine whether dietary interventions that reduce inflammation improve CLBP outcomes and whether these interventions may be differentially-beneficial based on sex. PERSPECTIVE: This article highlights the impact of diet-induced inflammation in a community-based sample as a whole, as well as stratified in various sociodemographic groups. This work expands our understanding of the influence of diet on pain experience and suggests that modifications to diet may be efficacious treatments for reducing chronic pain.

Inflammatory Cytokines, but Not Dietary Patterns, Are Related to Somatic Symptoms of Depression in a Sample of Women

Background

Depression is a heterogenous disorder with both cognitive and somatic symptom dimensions that may differentially relate to systemic inflammation. Diet, which has the potential to modulate both inflammation levels and mood, is yet to be studied within the context of individual depression dimensions. This study examined the associations between inflammatory cytokines and dietary patterns with depressive symptom dimension profiles among a sample of women recruited in a non-clinical setting.

Methods

Inflammatory cytokines (IL-6 and TNF-α), inflammatory diet (Diet Inflammatory Index; DII), and depressive symptoms (Beck Depression Inventory-II; BDI-II) were measured in 136 females (M age = 22.01 ± 4.02, range 18-59 years). Multiple linear regressions were used to investigate the relationships between inflammatory cytokines and diet with self-reported cognitive, somatic, and total depressive symptoms, adjusting for demographic factors.

Results

Findings showed that increased somatic dimension scores were positively associated with IL-6 (ß = 0.273, p = 0.002) and TNF-α (ß = 0.215, p = 0.017), but not inflammatory diet (p = 0.300). Total BDI-II scores were only positively associated with IL-6 (ß = 0.221, p = 0.012), and cognitive dimension scores were not associated with any inflammation measures.

Conclusions

These findings contribute to existing evidence that inflammatory cytokines are associated with the somatic symptoms of depression. Inflammatory diet index was not associated with depression measures.

Association of the Dietary Inflammatory Index with Depressive Symptoms among Pre- and Post-Menopausal Women: Findings from the National Health and Nutrition Examination Survey (NHANES) 2005-2010

During their lifetime, 20% of US women experience depression. Studies have indicated that a high Dietary Inflammatory Index (DII) score is associated with high C-reactive protein (CRP) levels and depression. No previous study has compared the association of the DII with different measures of depression (e.g., somatic, cognitive) among pre- and post-menopausal women. We used data from 2512 pre-menopausal and 2392 post-menopausal women from the National Health and Nutrition Examination Survey (NHANES) 2005−2010 database. We ran linear and logistic regression models to compare the association of the DII with survey-measured depression among pre- and post-menopausal women. We further assessed the mediation effect of CRP on the association of the DII and depression, using structural equation modeling. The odds of experiencing depression among pre-menopausal women was higher for all DII quartiles compared to the reference group (i.e., DII Q1), with an odds ratio (OR) of 3.2, 5.0, and 6.3 for Q2, Q3, and Q4, respectively (p < 0.05). Among post-menopausal women, only Q4 had 110% higher odds of experiencing depression compared to Q1 (p = 0.027). No mediation effect of CRP was found between DII and any of our depression outcome measures. Our findings suggest that lifestyle habits, such as diet, may have a stronger influence on mental health among pre-menopausal women than post-menopausal women.

Dietary inflammatory index and depression risk in patients with chronic diseases and comorbidity

BACKGROUND

The coexistence of depression and chronic diseases can lead to greater disability and increased mortality. The objective of this study was to examine the association between Dietary Inflammatory Index (DII) and depression in patients with chronic diseases and comorbidity.

METHODS

Multivariable logistic regression analysis was used to investigate the relationship between DII and depression. Dose response relationship was analyzed using a generalized additive model with the smoothing plot.

RESULTS

A total of 7870 chronic diseases patients were enrolled. In multivariate model, the highest quintile of DII was associated with increased risk of depression in patients with diabetes (OR:1.73, 95CI%: 1.17, 2.57), hypertension (OR:1.93, 95CI%: 1.47, 2.52), coronary heart disease (OR:2.65, 95CI%: 1.18, 5.94). The dose response relationship curve suggested the DII tended to be linearly associated with depression in patients with chronic diseases and comorbidity, and the ORs for risk of depression increased with the increase of DII. Furthermore, in patients had at least one chronic comorbidity, the subgroup analysis results showed that those who age<60 years or male participants had higher risk of depression, with ORs (95% CIs) of 2.60 (1.81, 3.74) and 2.51 (1.65, 3.81), respectively.

CONCLUSION

The current study demonstrates that a higher DII is associated with an increased risk of depression in participants with chronic diseases and comorbidity, especially among those less than 60 years and men. Considering diet as a modifiable factor, limiting pro-inflammatory diet or encouraging anti-inflammatory diet may be an effective way to prevent depression and reduce depressive symptoms.

Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

The dietary inflammatory index is inversely associated with depression, which is minimally mediated by C-reactive protein

Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However, no study to date has looked at the potential mediating effect of inflammation on the association of DII and depression. We hypothesized that the association of DII and depression would be both statistically and clinically mediated substantially by inflammation. We assessed these associations using the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. Our analysis included 10,022 participants aged 20 years and older. Inflammation was assessed with C-reactive protein (CRP) levels. Diet was measured using two 24 hour dietary recalls. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9), which has a score range of 0 to 27, with the higher score showing more severe depressive symptoms. Comparing the highest to lowest DII quartiles, the mean score difference for depression was 0.47 units (95% CI 0.24-0.70, P-trend <.001) in the multivariable adjusted model. In the sex-stratified models, the results remained significant only among females, with the mean score difference of 0.72 (95% CI 0.34-1.10, P-trend <.001). CRP mediated 3.6% of the association between DII and depression in the total population in the fully adjusted model, which was statistically significant (P-trend <.001) but not clinically significant. No mediation association was found in the sex-stratified models. Further studies are needed to assess the associations with various inflammatory biomarkers in larger and more diverse populations.

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.

The Association between Dietary Habits, Substance Use, and Mental Distress among Adults in Southern Norway: A Cross-Sectional Study among 28,047 Adults from the General Population

The aim of the present study was to examine associations between dietary habits, substance use, and mental distress among adults. This cross-sectional study was conducted in 2019 using an online questionnaire and included 28,047 adults (≥18 years) from Southern Norway. Multivariable logistic regression models stratified by gender were used to examine the associations between different lifestyle behaviors and mental distress. The results showed increased odds of mental distress among males and females with low consumption of vegetables (OR:1.26; 95% CI:1.08–1.47 and 1.14; 1.02–1.28) and fish (1.28; 1.12–1.46 and 1.36; 1.22–1.52), and among females, but not males, with high consumption of sugar-sweetened beverages (1.25; 1.06–1.48) compared to those with a healthier consumption of these foods and beverages. The results also showed increased odds of mental distress among male and female smokers (1.38; 1.19–1.60 and 1.44; 1.26–1.64), and among females, but not males, reporting current use of smokeless tobacco (1.20; 1.03–1.40), compared to male and female non-smokers and female non-users of smokeless tobacco. Overall, unhealthy dietary habits, smoking and the use of smokeless tobacco was associated with increased odds of mental distress, but the relationship varied according to gender. Future studies are needed to confirm any possible causal relationships.

Association between Dietary Inflammatory Index with Bioelectrical Impedance Parameters and Characteristics Health in Overweight/Obese Women: A Cross-Sectional Study

Background:

Diet quality has been suggested as an important factor in disorders such as obesity and mental health as it controls inflammatory biomarkers. This study aimed to investigate the association between dietary inflammatory index (DII) with bioelectrical impedance parameters and characteristics of health in overweight\obese women.

Methods:

In this cross-sectional study, we calculated DII for 301 participants from their food frequency questionnaire (FFQ). Body composition was assessed through a multifrequency bioelectrical impedance analyzer (BIA). Depression, anxiety and stress scale-21 (DASS-21) was used to assess the level of characteristics of health.

Results:

The mean percentage ± SD of fat-free mass (FFM) and fat mass (FM) was 46.81 ± 5.65 and 34.05 ± 8.69, respectively. In this study, 49% (95% CI: 40.8–57.2) of participants had positive DII. Linear regression analysis revealed that FFM (P = 0.004) and total body water (TBW) (P = 0.004) were significantly associated with DII.

Conclusions:

A significant relationship was found between DII with FFM and TBW in overweight\obese women, supporting the hypothesis that an anti-inflammatory diet is associated with elevated FFM and TBW.

Familial adenomatous polyposis and changes in the gut microbiota: New insights into colorectal cancer carcinogenesis

Patients with familial adenomatous polyposis (FAP), an autosomal dominant hereditary colorectal cancer syndrome, have a lifetime risk of developing cancer of nearly 100%. Recent studies have pointed out that the gut microbiota could play a crucial role in the development of colorectal adenomas and the consequent progression to colorectal cancer. Some gut bacteria, such as Fusobacterium nucleatum, Escherichia coli, Clostridium difficile, Peptostreptococcus, and enterotoxigenic Bacteroides fragilis, could be implicated in colorectal carcinogenesis through different mechanisms, including the maintenance of a chronic inflammatory state, production of bioactive tumorigenic metabolites, and DNA damage. Studies using the adenomatous polyposis coliMin/+ mouse model, which resembles FAP in most respects, have shown that specific changes in the intestinal microbial community could influence a multistep progression, the intestinal "adenoma-carcinoma sequence", which involves mucosal barrier injury, low-grade inflammation, activation of the Wnt pathway. Therefore, modulation of gut microbiota might represent a novel therapeutic target for patients with FAP. Administration of probiotics, prebiotics, antibiotics, and nonsteroidal anti-inflammatory drugs could potentially prevent the progression of the adenoma-carcinoma sequence in FAP. The aim of this review was to summarize the best available knowledge on the role of gut microbiota in colorectal carcinogenesis in patients with FAP.

Diet Quality According to Mental Status and Associated Factors during Adulthood in Spain

Common mental disorders (CMD) are characterized by non-psychotic depressive symptoms, anxiety and somatic complaints, which affect the performance of daily activities. This study aimed to analyze prevalence of diet quality among adults with and without CMD from 2006 to 2017, to study the frequency of food consumption and diet quality according to mental status and age, and to determine which sociodemographic, lifestyle and health-related factors are associated with poor/moderate diet quality, according to mental status. A nationwide cross-sectional study was performed in adults with (n = 12,545) and without CMD (n = 48,079). The data were obtained from three Spanish National Health Surveys (2006, 2011/2012 and 2017). Two logistic regression analyses were used to identify factors associated with diet quality in people with and without CMD. Among those with CMD, the probability of having poor/moderate diet quality was significantly lower for overweight or obese people and those who took part in leisure-time physical activity. Among those without CMD, university graduates were less likely to have a poor/moderate diet quality. Good diet quality was observed more in older adults (≥65 years old) than in emerging (18–24 years old) or young adults (25–44 years old), regardless of mental status.

Association Between Dietary Inflammatory Index and Mental Health: A Systematic Review and Dose-Response Meta-Analysis

Objective: We aimed to systematically evaluate the association between Dietary Inflammatory Index (DII) and mental health.

Methods: We searched PubMed, Embase, and Web of Science from their inception to December 31, 2020. Categorical meta-analysis and dose–response meta-analysis were performed to evaluate the association between DII and mental health.

Results: A total of 16 studies were included in this meta-analysis. Compared with the lowest DII category, the highest category was significantly associated with a variety of mental health outcomes, with the following pooled odds ratios (ORs) and 95% confidence intervals (95% CIs): 1.28 (1.17–1.39) for symptoms of depression, 1.27 (1.08–1.49) for symptoms of anxiety, 1.85 (1.43–2.40) for distress, and 4.27 (1.27–14.35) for schizophrenia. Furthermore, there was a linear dose–response relationship between DII and symptoms of depression in that a 1-unit increment in DII was associated with an increased risk of 6% for symptoms of depression (OR: 1.06, 95% CI: 1.03–1.19).

Conclusion: The present study indicates that more pro-inflammatory diet, as estimated by the higher DII score, is associated with symptoms of mental disorder. It may be of clinical and public health significance regarding the development of novel nutritional psychiatry approaches to promote good mental health.

Breakfast skipping alone and in interaction with inflammatory based quality of diet increases the risk of higher scores of psychological problems profile in a large sample of Iranian adults

The authors investigate the association of breakfast skipping and its interaction with a dietary inflammatory index (DII) with the severity of psychological disorders. A total of 2876 Iranian general adults were enrolled in this cross-sectional study. Psychological problems profile score was calculated using the regression method in the framework of factor analysis based on depression, anxiety and psychological distress. The higher scores indicate more severity of mental problem. The frequency of breakfast eating in a week was assessed. Dietary intakes were assessed using a food-frequency questionnaire and twenty-seven items were included in the calculation of DII. In the crude model, individuals who ate breakfast seldom had the highest odds for having worse psychological problems profile (OR 3⋅59; 95 % CI 2⋅52, 5⋅11). Adjustment for various confounders did not change the associations (OR 3⋅35; 95 % CI 2⋅11, 5⋅32). In the adjusted multinomial logistic regression model, participants with high DII (>median) who skipped breakfast had highest risk of being in the higher tertiles of psychological problems profile compared with those who had low DII (<median) and ate breakfast (OR 6⋅67; 95 % CI 3⋅45, 12⋅90). Similar results were observed in women and men regarding the impact of breakfast skipping alone and interaction with DII on scores of psychological problems profile. Breakfast skipping is associated with higher risk of psychological problems. Similar findings were obtained in the stratified analysis by sex. Our findings confirmed that the DII and breakfast skipping are associated with mental health, interactionally. Further longitudinal studies are needed to confirm the true link between breakfast skipping and psychological problems.

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

Association between the Inflammatory Potential of Diet and Stress among Female College Students

A pro-inflammatory diet may have an adverse influence on stress and inflammatory biomarker levels among college students. The dietary inflammatory index (DII®) is a tool used to assess the inflammatory potential of a diet. However, evidence for the association between DII and stress is limited. We examined the association between energy-adjusted DII (E-DIITM), high sensitivity-C-reactive protein [hs-CRP], and stress among female college students. This cross-sectional study included 401 randomly selected female students, aged 19-35 years. Data collection included blood, anthropometric measurements, a healthy-history questionnaire, the perceived stress scale (PSS-10), the Saudi food frequency questionnaire (FFQ), and E-DII. Multiple linear regression analyses were used to examine the association between FFQ-derived E-DII score, hs-CRP, and PSS. A higher E-DII score per 1SD (1.8) was associated with a 2.4-times higher PSS score (95% CI: 1.8, 3.1). Higher hs-CRP per 1SD (3.3 mg/L) was associated with a 0.9 (95% CI: 0.7-1.1) times higher PSS score, independent of lifestyle and dietary factors. Our findings indicate that pro-inflammatory diets were highly prevalent among Saudi college students and were associated with higher stress levels. Consideration of the role of stress and focusing on anti-inflammatory foods may be key for healthier dietary habits.

Absence of association between inflammatory dietary pattern and low trauma fractures: Results of the French cohort NutriNet-Santé

INTRODUCTION

The aim of our study was to assess the association between the Alternate Dietary Inflammatory Index (ADII) and the risk of fracture in a French cohort of women and men older than 50 years.

METHODS

A total of 15,096 participants were included from the French NutriNet-Santé cohort. The ADII score was calculated at inclusion. Incident low trauma fractures were retrospectively self-reported by participants on a specific additional questionnaire. Multivariate hazard ratio obtained from Cox proportional hazard regression models were used to characterize an association between ADII (in quartiles) and incident low trauma fractures.

RESULTS

In all, 12,046 participants (7607 (63.2%) women and 4439 (36.8%) men) were included in our study. For fractures, 806 (10.6%) and 191 (4.3%) low trauma fractures were recorded respectively in women and in men. Mean ADII was -1.23 (±3.13) for women and -0.87 (±3.64) for men. No association was detected between the ADII score and the risk of vertebral fracture (P=0.21), major osteoporotic fracture (P=0.93) and any low trauma fracture (P=0.72) in women nor in men (P=0.06 for major fracture and P=0.10 for low trauma fracture) after adjustment for sociodemographic, lifestyle variables and for bone treatments.

CONCLUSION

This study in postmenopausal women and men older than 50 years from the general population did not show any association between inflammatory dietary pattern measured using the ADII and the risk of incident low trauma fracture.

Food additives: distribution and co-occurrence in 126,000 food products of the French market

Background. More than 330 food additives (e.g. artificial sweeteners, emulsifiers, dyes) are authorized in Europe, with a great variability of use across food products. Objective. The objective of this study was to investigate the distribution and co-occurrence of food additives in a large-scale database of foods and beverages available on the French market. Design. The open access crowdsourced Open Food Facts database (https://world.openfoodfacts.org/) was used to retrieve the composition of food and beverage products commonly marketed on the French market (n = 126,556), based on the ingredients list. Clustering of food additive variables was used in order to determine groups of additives frequently co-occurring in food products. The clusters were confirmed by network analysis, using the eLasso method. Results. Fifty-three-point eight percent of food products contained at least 1 food additive and 11.3% at least 5. Food categories most likely to contain food additives (in more than 85% of food items) were artificially sweetened beverages, ice creams, industrial sandwiches, biscuits and cakes. The most frequently used food additives were citric acid, lecithins and modified starches (>10,000 products each). Some food additives with suspected health effects also pertained to the top 50: sodium nitrite, potassium nitrate, carrageenan, monosodium glutamate, sulfite ammonia caramel, acesulfame K, sucralose, (di/tri/poly) phosphates, mono- and diglycerides of fatty acids, potassium sorbate, cochineal, potassium metabisulphite, sodium alginate, and bixin (>800 food products each). We identified 6 clusters of food additives frequently co-occurring in food products. Conclusions. Food additives are widespread in industrial French products and some clusters of additives frequently co-occurring in food products were identified. These results pave the way to future etiological studies merging composition data to food consumption data to investigate their association with chronic disease risk, in particular potential ‘cocktail effects’.

Evidence of the Importance of Dietary Habits Regarding Depressive Symptoms and Depression

BACKGROUND

Mental illness is one of the fastest rising threats to public health, of which depression and anxiety disorders are increasing the most. Research shows that diet is associated with depressive symptoms or depression (depression).

AIM

This study aimed to investigate the diets impact on depression, by reviewing the scientific evidence for prevention and treatment interventions.

METHOD

A systematic review was conducted, and narrative synthesis analysis was performed.

RESULT

Twenty scientific articles were included in this review. The result showed that high adherence to dietary recommendations; avoiding processed foods; intake of anti-inflammatory diet; magnesium and folic acid; various fatty acids; and fish consumption had a depression. Public health professionals that work to support and motivate healthy eating habits may help prevent and treat depression based on the evidence presented in the results of this study. Further research is needed to strengthen a causal relationship and define evidence-based strategies to implement in prevention and treatment by public healthcare.

The relationship between inflammatory dietary pattern in childhood and depression in early adulthood

BACKGROUND

Inflammation may be a hidden process in the relationship between dietary intake and depression, but no study has evaluated the role of diet and inflammation jointly in explaining depression risk in early life. The current study aims to investigate the relationship between inflammatory dietary pattern (IDP) in childhood and depression in early adulthood.

METHODS

This study used data prospectively collected over 10 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n ​= ​6939) free from depression at baseline (age 8.5 years). An IDP score was empirically derived via reduced rank regression and stepwise linear regression based on dietary intake data from the food frequency questionnaire at 8.5 years and levels of inflammatory biomarkers, C-reactive protein and interleukin-6, at 9.5 years. At age 18 years, depression cases were identified via the International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis and the Clinical Interview Schedule-Revised (CIS-R) depression score. Logistic regression models were constructed to examine the relationship between the IDP score and risk of depression adjusted for potential confounders. Analyses stratified by weight status were also conducted. Multiple imputations were utilized to minimize bias due to loss-to-follow-up.

RESULTS

Participants in the highest tertile of IDP score had 1.34 times odds to develop depression compared to those in the lowest tertile (95% CI, 1.08-1.66; P-trend<0.01), after dietary misreporting status and energy intake were adjusted. After all covariates were adjusted, the relationship between IDP tertiles and depression was attenuated (highest tertile vs. lowest tertile: OR ​= ​1.21; 95% CI, 0.96-1.51); in addition, the relationship was marginally significant among participants who were not overweight or obese (p ​< ​0.10) but not significant among participants who were overweight or obese.

CONCLUSIONS

Higher IDP in childhood seems to be associated with higher depression risk in early adulthood. The study provides preliminary evidence that chronic inflammation may underlie the relationship between diet and depression even for children, especially those who are not overweight or obese.

The relationship between dietary inflammatory index and psychosomatic complaints profiles: results from SEPAHAN cross-sectional study

Background

Although the dietary inflammatory index (DII) has been evaluated in relation to psychological disorders risk, the association between DII and psychosomatic complaints is unclear. This study aimed to determine the association between DII, as a proxy measure of the inflammatory potential of the diet, and psychosomatic complaints.

Methods

This cross-sectional study included 2818 people from the general population, aged 19 to 69 years, of Isfahan province in Iran. Dietary intake was assessed using a validated dish-based food-frequency questionnaire. Psychosomatic complaints were assessed using a self-administered validated Persian questionnaire. Twenty-seven nutrients or foods were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a higher DII score indicated a more pro-inflammatory diet. The risk of being in the top median of a psychosomatic complaints profile across the tertiles of DII was assessed using logistic regression.

Results

Four psychosomatic complaints profiles (psychological, gastrointestinal, neuro-skeletal and pharyngeal- respiratory) were identified. After controlling for potential confounders, individuals in the top tertile of DII had higher odds for experiencing high somatic complaints scores for the psychological (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.10, 1.89; P trend = 0.009), gastrointestinal (OR = 1.22, 95% CI: 0.99, 1.75; P = 0.058) or neuro-skeletal (OR = 1.56, 95% CI: 1.10, 2.22; P = 0.013) profile. The association for pharyngeal-respiratory complaints did not remain significant after adjustment for stressful life events, medical condition, and anti-psychotropic medicine use.

Conclusion

The significant positive link between DII and the various psychosomatic complaints profiles suggests that a diet with anti-inflammatory potential might be favourably related to psychosomatic complaints. Further studies, particularly clinical trials and longitudinal studies, are warranted to investigate the inflammatory potential of diet in relation to psychosomatic complaints.

Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review

There are over 1,000,000 publications on diet and health and over 480,000 references on inflammation in the National Library of Medicine database. In addition, there have now been over 30,000 peer-reviewed articles published on the relationship between diet, inflammation, and health outcomes. Based on this voluminous literature, it is now recognized that low-grade, chronic systemic inflammation is associated with most non-communicable diseases (NCDs), including diabetes, obesity, cardiovascular disease, cancers, respiratory and musculoskeletal disorders, as well as impaired neurodevelopment and adverse mental health outcomes. Dietary components modulate inflammatory status. In recent years, the Dietary Inflammatory Index (DII®), a literature-derived dietary index, was developed to characterize the inflammatory potential of habitual diet. Subsequently, a large and rapidly growing body of research investigating associations between dietary inflammatory potential, determined by the DII, and risk of a wide range of NCDs has emerged. In this narrative review, we examine the current state of the science regarding relationships between the DII and cancer, cardiometabolic, respiratory and musculoskeletal diseases, neurodevelopment, and adverse mental health outcomes. We synthesize the findings from recent studies, discuss potential underlying mechanisms, and look to the future regarding novel applications of the adult and children's DII (C-DII) scores and new avenues of investigation in this field of nutritional research.

Increased Dietary Inflammatory Index Is Associated with Schizophrenia: Results of a Case-Control Study from Bahrain

BACKGROUND

Several studies have indicated that chronic low-grade inflammation is associated with the development of schizophrenia. Given the role of diet in modulating inflammatory markers, excessive caloric intake and increased consumption of pro-inflammatory components such as calorie-dense, nutrient-sparse foods may contribute toward increased rates of schizophrenia. This study aimed to examine the association between dietary inflammation, as measured by the dietary inflammatory index (DII^®), and schizophrenia.

METHODS

A total of 120 cases attending the out-patient department in the Psychiatric Hospital/Bahrain were recruited, along with 120 healthy controls matched on age and sex. The energy-adjusted DII (E-DII) was computed based on dietary intake assessed using a comprehensive food frequency questionnaire (FFQ). Logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusting for potential confounders including age, sex, body mass index, education, employment, diabetes, hypertension, and cardiovascular disease with E-DII expressed both as a continuous variable and categorized as quartiles.

RESULTS

The mean E-DII score for the entire sample was 1.79 ± 1.52, indicating a generally pro-inflammatory diet. The cases with schizophrenia appeared to have a higher E-DII score compared to controls: 1.99 ± 1.39 vs. 1.60 ± 1.38, respectively (p = 0.009). For every one unit increase in the E-DII score, the odds of having schizophrenia increased by 62% (OR 1.62; 95% CI 1.17-2.26). Similarly, increased risk was observed when the E-DII was used as quartiles, with participants in most pro-inflammatory quartile 4 being nearly 6 times more likely to be schizophrenic than participants in the most anti-inflammatory group quartile 1 (OR 5.96; 1.74-20.38; p-trend = 0.01).

CONCLUSIONS

The data suggest that a pro-inflammatory diet, as indicated by increasing E-DII score, is associated with schizophrenia. This is the first study to examine the association between the DII and schizophrenia in a Middle Eastern population. Although these results are consistent with findings from research conducted in depression, additional studies are required before generalizing the findings to other populations.

Empirically derived food-based dietary inflammatory index is associated with increased risk of psychological disorders in women

Purpose/introduction: There is no study on the association of empirically derived food-based dietary inflammatory index (FDII) and risk of psychological disorders. We investigated the association between FDII and odds of psychological disorders in Iranian adults.Methods and materials: In this cross-sectional study, data on dietary intakes of 3363 Iranian adult participants were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. FDII score was constructed based on participants' dietary intakes of 28 pre-defined food groups. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ) was used to assess psychological disorders. Depression, anxiety and psychological distress were defined based on standard criteria.Results: After controlling for potential confounders, participants in the top quintile of FDII score had a greater odds of depression (OR: 1.49; 95% CI: 1.08-2.06), anxiety (OR: 1.92; 95% CI: 1.24-2.96), and psychological distress (OR: 1.55; 95% CI: 1.10-2.19) compared with those in the bottom quintile. When we did the analyses stratified by gender, we found a significant positive association between FDII score and depression (OR: 1.57; 95% CI: 1.04-2.35), anxiety (OR: 1.99; 95% CI: 1.19-3.34), and psychological distress (OR: 1.68; 95% CI: 1.10-2.56) among women comparing the highest and the lowest quintiles. We found no significant association between FDII score and psychological disorders in men.Conclusion: We found that greater FDII score was positively associated with psychological disorders. In the gender-stratified analysis, this was seen in women but not in men.

The Inflammatory Potential of the Diet is Directly Associated with Incident Depressive Symptoms Among French Adults

BACKGROUND

Low-grade chronic inflammation has been suggested to play a substantial role in the etiology of depression; however, studies on the prospective association between the inflammatory potential of the diet and depression are limited.

OBJECTIVE

The aim of this study was to investigate the association between the inflammatory potential of the diet (measured using the Alternate Dietary Inflammatory Index, ADII) and incident depressive symptoms. We also tested the potential modulating effect of sex, age, BMI, and lifestyle indicators.

METHODS

The study sample consisted of 26,730 participants (aged 18-86 y) from the NutriNet-Santé study. Baseline ADII was computed using repeated 24-h dietary records collected during the first 2 y of the follow-up. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression scale ≥17 for men and ≥23 for women at least once during follow-up. HR and 95% CI were estimated using multivariable Cox proportional hazards models.

RESULTS

A total of 2221 incident cases of depressive symptoms were identified over a mean follow-up of 5.4 y. After accounting for a wide range of potential confounders, the highest quartile of the ADII was associated with a 15% (95% CI: 2, 31) increase in the risk of depressive symptoms compared with the lowest quartile. In the stratified analyses, associations were statistically significant only among women (HRquartile4 vs. quartile1: 1.19; 95% CI: 1.02, 1.37), middle-age adults (HRquartile4 vs. quartile1: 1.16; 95% CI: 1.00, 1.35), and participants with a BMI ≥25 (HRquartile4 vs. quartile1: 1.29; 95% CI: 1.04, 1.60).

CONCLUSIONS

Overall, a proinflammatory diet was associated with a higher risk of depressive symptoms, especially among women, middle-age adults, and participants with overweight or obesity. These findings contribute to the increasing scientific evidence showing a detrimental role of the proinflammatory diet. The NutriNet-Santé study is registered at clinicaltrials.gov as NCT03335644.

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.

The dietary inflammatory index is associated with gastrointestinal infection symptoms in the national health and nutrition examination survey

Inflammation influences many aspects of health including gastrointestinal illnesses. Associations between the Dietary Inflammatory Index (DII®) and gastrointestinal symptoms were examined using cross-sectional data from the National Health and Nutrition Examination Survey (years 2005-2014, n = 25,553). Outcomes included self-reported presence of mucus or liquid in bowel leakage and stomach illness in the past month, diarrhoea in the past year and number of weekly bowel movements. Energy-adjusted DII (E-DII) scores were estimated from one 24-h dietary recall. Analyses included survey design-appropriate logistic and linear regression. Compared to E-DII quartile 1 (anti-inflammatory), E-DII quartile 4 (pro-inflammatory) had elevated odds of mucus in leakage: 71% (95% confidence interval [95%CI] = 1.01-1.20); liquid in leakage: 74% (95%CI = 1.30-2.33); stomach illness: 43% (95%CI = 1.18-1.72); and diarrhoea: 65% (95%CI = 1.21-2.26). Those with more anti-inflammatory diets had more bowel movements. Future questions should address whether anti-inflammatory diets provide protective effects against gastrointestinal infections and if these relationships are modified by other health behaviours.

What Is the Role of Dietary Inflammation in Severe Mental Illness? A Review of Observational and Experimental Findings

Severe mental illnesses (SMI), including major depressive disorder, bipolar disorder, and schizophrenia, are associated with increased inflammation. Given diet's role in modulating inflammatory processes, excessive calorie-dense, nutrient-deficient processed food intake may contribute toward the heightened inflammation observed in SMI. This review assesses the evidence from observational and experimental studies to investigate how diet may affect physical and mental health outcomes in SMI through inflammation-related pathways. Cross-sectional studies indicate that individuals with SMI, particularly schizophrenia, consume more pro-inflammatory foods and fewer anti-inflammatory nutrients than the general population. Cohort studies indicate that high levels of dietary inflammation are associated with increased risk of developing depression, but there is currently a lack of evidence for schizophrenia or bipolar disorder. Randomized controlled trials show that dietary interventions improve symptoms of depression, but none have tested the extent to which these benefits are due to changes in inflammation. This review summarizes evidence on dietary inflammation in SMI, explores the directionality of these links, and discusses the potential use of targeted nutritional interventions for improving psychological well-being and physical health outcomes in SMI. Establishing the extent to which diet explains elevated levels of inflammatory markers observed in SMI is a priority for future research.

Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions

The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.

Dietary inflammatory index and depression: a meta-analysis

OBJECTIVE

The purpose of the present meta-analysis was to evaluate the association between the inflammatory potential of diet, determined by the dietary inflammatory index (DII®) score, and depression.

DESIGN

Systematic review and meta-analysis.

SETTING

A comprehensive literature search was conducted in PubMed, Web of Science and EMBASE databases up to August 2018. All observational studies that examined the association of the DII score with depression/depressive symptoms were included.

SUBJECTS

Four prospective cohorts and two cross-sectional studies enrolling a total of 49 584 subjects.

RESULTS

Overall, individuals in the highest DII v. the lowest DII category had a 23 % higher risk of depression (risk ratio (RR)=1·23; 95 % CI 1·12, 1·35). When stratified by study design, the pooled RR was 1·25 (95 % CI 1·12, 1·40) for the prospective cohort studies and 1·16 (95 % CI 0·96, 1·41) for the cross-sectional studies. Gender-specific analysis showed that this association was observed in women (RR=1·25; 95 % CI 1·09, 1·42) but was not statistically significant in men (RR=1·15; 95 % CI 0·83, 1·59).

CONCLUSIONS

The meta-analysis suggests that pro-inflammatory diet estimated by a higher DII score is independently associated with an increased risk of depression, particularly in women. However, more well-designed studies are needed to evaluate whether an anti-inflammatory diet can reduce the risk of depression.

Diet and physical activity in the association between depression and metabolic syndrome: Constances study

BACKGROUND

The association between depression and the metabolic syndrome remains poorly understood. Diet and physical activity may partly explain this association.

METHODS

Baseline data on 64,861 subjects from the French population-based Constances cohort was analyzed. Depressive symptoms were determined with the Center of Epidemiologic Studies Depression (CES-D) scale. A CES-D score ≥ 19 combined with self-reported limitations related to depressive symptoms was used to define depression. The metabolic syndrome was defined according to the International Diabetes Federation criteria. Dietary patterns were determined with a food frequency questionnaire and a principal component analysis. Physical activity was measured with 3 questions resulting in a composite 6-point scale. Associations between depression and the metabolic syndrome were estimated through logistic regression and path analysis.

RESULTS

The odds-ratios (95% confidence interval) for the association between depression and the metabolic syndrome, adjusting for age, sex, education and income, was 1.75 (1.57-1.96). The path analysis showed that 23% of this association was explained by diet and physical activity, 67% being attributed to physical activity.

LIMITATIONS

The cross-sectional nature of the analyses warrants the results to be confirmed by longitudinal analyses.

CONCLUSION

Diet and physical activity might partially explain the association between depressive symptoms and metabolic syndrome but other factors (e.g. inflammatory factors) are involved.

Dietary Inflammatory Potential and the Risk of Incident Depression in Adults: A Systematic Review

Diet is proposed to have a stimulatory or preventative influence on mental health and the risk of depressive symptoms, given that the diet can have either a pro- or an anti-inflammatory effect. This study aimed to collate the relation between dietary inflammatory potential and the risk of depression. PubMed, Google Scholar, ScienceDirect, and Scopus databases, as well as Google were searched for articles published at any date until May 2018. Original English-language articles involving human participants and studies that investigated the association between dietary inflammatory potential and the risk of developing depression were included. Duplicated and irrelevant reports were screened out and data were extracted during critical analysis. Our search method initially identified 173 articles, of which 48 remained after duplicates had been removed. Thirteen articles were screened and identified as being relevant to the study topic. After critical analysis, 12 articles were included in the final analysis. All of the articles but 1 reported that higher dietary inflammatory index (DII) is associated with a higher risk of developing depression. Three studies indicated that DII was positively correlated with circulating inflammatory markers; however, in these studies increased concentrations of circulating inflammatory markers did not predict the diet-depression relation. Low literacy, unhealthy lifestyle, nutritional status, marital status, and age were potent contributory factors to whether or not a diet with inflammatory potential was consumed. These findings support the hypothesis that the DII is an appropriate tool for measuring dietary inflammatory potential, and reinforce the role of diets with inflammatory potential in the pathophysiology of depression.