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International Society for Nutritional Psychiatry Research consensus position statement: Nutritional medicine in modern psychiatry

International Society for Nutritional Psychiatry
Research consensus position statement: nutritional
medicine in modern psychiatry
In recent years, there has been an unprecedented growth
in both the quantity and methodological quality of research
directed at exploring the relationship between nutrition and
mental health. Indeed, the strength of data has now afforded
nutritional medicine a place in the mainstream psychiatric
discourse (1).
Robust associations have been established between nutri-
tional quality and mental health, with the bulk of this evi-
dence indicating a protective effect of healthy diets on
depressed mood (2), and the newest research supporting a
detrimental impact of unhealthy diets on the mental health
of young people (3,4) and adults (5,7).
There are also convincing data supporting the applica-
tion of certain nutrient-based supplements (nutraceuti-
cals) as monotherapy or combined therapy (8), or as aug-
mentation therapy (9).
Although the growth in scientific research related to nutri-
tion in psychiatry may be recent, it is now at a stage where it
can no longer be ignored. In light of this, we aim to provide a
platform to move towards a new integrated paradigm in psy-
chiatry whereby nutritional considerations (both education-
al and prescriptive) can be considered “mainstream” (1). To
this end, we present a consensus position statement from the
International Society for Nutritional Psychiatry Research
In brief, the ISNPR was formed in 2013 with the aim to
advance research and communication on nutritional med-
icine in the field of psychiatry. One of its first goals was to
formulate a position statement that embodied the princi-
ples of the organization, allowing for codification of the
society’s underpinning tenets.
In order to develop this, we employed a Delphi-based
model by which ISNPR researcher and clinician members
could vote on a select list of 110 statements created by an
expert steering committee.
The committee provided a list of sub-statements con-
cerning three main topics/areas: the current general needs
and challenges in psychiatry; key elements of diet and
nutraceutical evidence related to mental health/psychia-
try; potential public health and clinical applications. These
were transcribed and tabulated in Survey Monkey for online
voting by the wider ISNPR membership.
A Likert scale (0–10) was used for each statement
(05don’t include, 55don’t know/depends, 105definitely
include), and statements that received a mean score of
>6.5/10 by ISNPR members were reviewed by the steer-
ing committee for inclusion in the position statement,
which is presented below.
Present treatment of mental disorders is achiev-
ing sub-optimal outcomes; in addition little atten-
tion is given to preventative efforts. Due to the
immense burden of mental disorders, there is now
an urgent need to identify modifiable targets to
reduce the incidence of these disorders. Diet and
nutrition offer key modifiable targets for the preven-
tion of mental disorders and have a fundamental
role in the promotion of mental health.
Epidemiological data, basic science, and clinical
evidence suggest that diet influences both the risk
for and outcomes of mental disorders. As such, we
advocate that evidence-based nutritional change
should be regarded as an efficacious and cost-
effective means to improve mental health.
In addition to dietary modification, we recognize
that nutrient-based (nutraceutical) prescription has
the potential to assist in the management of mental
disorders at the individual and population level.
Many of these nutrients have a clear link to brain
health, including: omega-3s, B vitamins (particu-
larly folate and B12), choline, iron, zinc, magne-
sium, S-adenosyl methionine (SAMe), vitamin D,
and amino acids. While we advocate for these to
be consumed in the diet where possible, additional
select prescription of these as nutraceuticals may
also be justified.
Ongoing research (including randomized con-
trolled trials) in the area is recognized as critical,
using methodologically rigorous designs. Further
explication of the biological pathways affected by
nutritional modification is also required. Clinical
trials of nutraceuticals should include assessment
of biomarkers in tandem with clinical outcomes.
Global research and health promotion activities
focused on improving population health should
also include mental health parameters as priority
targets and measured outcomes.
Importantly, the activities of the food industry need
to be examined at a governmental level and relevant
policies designed to reduce the global burden of physi-
cal and mental ill-health attributable to poor diet.
Such policies are advised to stimulate significant pub-
lic change in dietary habits back towards a traditional
wholefood diet (dependent on the culture). Further,
there is now a vital need for better public and clinician
education to communicate current research findings
from the field.
In summary, nutrition and nutraceuticals should
now be considered as mainstream elements of psychi-
atric practice, with research, education, policy, and
health promotion reflecting this new paradigm.
370 World Psychiatry 14:3 - October 2015
As detailed in our consensus statement, we advocate for
the pursuit of an integrative psychiatric model, with diet as a
key element. Further, the select use of evidence-based nutra-
ceuticals should be a mainstay of treatment as either stand-
alone therapies (mainly in cases of less severe mental disor-
ders, non-tolerance to medication, nutrient deficiencies, or
patient choice), or as adjunctive interventions with psycho-
tropic medications to augment treatment efficacy. We recog-
nize the importance of clinician and public education regard-
ing evidence-based nutrition and nutraceuticals to drive
mainstream acknowledgement of their impact on mental
It is the intention that this position statement and the
ongoing work of ISNPR will assist in facilitating a trans-
formation in psychiatry to better address the substantial
global burden of mental illness, recognizing and embrac-
ing diet and nutrition as central determinants of both
physical and mental health.
Jerome Sarris
, Alan C. Logan
, Tasnime N.
, G. Paul Amminger
, Vicent Balanz
, Marlene P. Freeman
, Joseph Hibbeln
Yutaka Matsuoka
, David Mischoulon
, Tetsuya
, Akiko Nanri
, Daisuke Nishi
, Natalie
, Drew Ramsey
, Julia J. Rucklidge
Almudena Sanchez-Villegas
, Andrew Scholey
Kuan-Pin Su
, Felice N. Jacka
Department of Psychiatry, University of Melbourne,
Melbourne Clinic, Melbourne, Australia;
Centre for
Human Psychopharmacology, Swinburne University of
Technology, Hawthorn, Australia;
CAMNR, Calabasas,
Inserm U1198, Montpellier, France; EPHE,
Paris, France; University Montpellier 2, Montpellier,
Department of Epidemiology and Public
Health, University College London, London, UK;
gen, The National Centre of Excellence in Youth Men-
tal Health, Australia;
Teaching Unit of Psychiatry and
Psychological Medicine, La Fe University and Polytech-
nic Hospital, University of Valencia Medical School,
CIBERSAM, Valencia, Spain;
Perinatal and Reproduc-
tive Psychiatry, Massachusetts General Hospital, Bos-
ton, MA, USA;
National Institute on Alcohol Abuse
and Alcoholism, NIH, Bethesda, MD, USA;
ment of Clinical Epidemiology, Translational Medical
Center, National Center of Neurology and Psychiatry,
Tokyo, Japan;
Depression Clinical and Research Pro-
gram, Massachusetts General Hospital, Boston, MA,
Department of Epidemiology and Prevention,
National Center for Global Health and Medicine,
Tokyo, Japan;
Department of Mental Health Policy
and Evaluation, National Institute of Mental Health,
School of Population Health, University of
South Australia, Adelaide, Australia;
Columbia Uni-
versity College of Physicians and Surgeons, New York,
Department of Psychology, University of
Canterbury, Christchurch, New Zealand;
Institute of Biomedical and Health Sciences, University
of Las Palmas de Gran Canaria, Las Palmas de Gran
Canaria, Spain;
CIBEROBN, Instituto de Salud Car-
los III, Madrid, Spain;
Department of Psychiatry and
Mind-Body Interface Laboratory, China Medical Uni-
versity Hospital, Taichung, Taiwan;
Graduate Insti-
tute of Neural and Cognitive Sciences, China Medical
University, Taichung, Taiwan;
of Medicine, Deakin University, Geelong, 3220, Austra-
Murdoch Children’s Research Centre, Parkville,
Department of Psychiatry, University of
Melbourne, Royal Melbourne Hospital, Melbourne,
Black Dog Institute, Road Prince of Wales
Hospital, Randwick, Australia
1. Sarris J, Logan A, Akbaraly T et al. Nutritional medicine as main-
stream in psychiatry. Lancet Psychiatry 2015;2:271-4.
2. Lai JS, Hiles S, Bisquera A et al. A systematic review and meta-
analysis of dietary pattern and depression in community-dwelling
adults. Am J Clin Nutr 2013;99:181-97.
3. O’Neil A, Quirk SE, Housden S et al. Relationship between diet
and mental health in children and adolescents: a systematic
review. Am J Public Health 2014;104:e31-42.
4. Jacka FN, Ystrom E, Brantsaeter AL et al. Maternal and early
postnatal nutrition and mental health of offspring by age 5 years:
a prospective cohort study. J Am Acad Child Adolesc Psychiatry
5. Akbaraly TN, Brunner EJ, Ferrie JE et al. Dietary pattern and
depressive symptoms in middle age. Br J Psychiatry 2009;195:
6. Sanchez-Villegas A, Delgado-Rodr
ıguez M, Alonso A et al. Asso-
ciation of the Mediterranean dietary pattern with the incidence of
depression: the Seguimiento Universidad de Navarra/University
of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 2009;
7. Jacka FN, Pasco JA, Mykletun A et al. Association of Western and
traditional diets with depression and anxiety in women. Am J Psy-
chiatry 2010;167:305-11.
8. Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas
for the treatment of psychiatric symptoms: a systematic review.
Expert Rev Neurother 2013;13:49-73.
9. Sarris J, Kavanagh D, Byrne G. Adjuvant use of nutritional and
herbal medicines with antidepressants, mood stabilizers and ben-
zodiazepines. J Psychiatr Res 2010;44:32-41.
DOI 10.1002/wps.20223
... Various nutrients, such as tryptophan, vitamin B6, vitamin B12, folic acid (folate), phenylalanine, tyrosine, histidine, choline, and glutamic acid, are essential for the synthesis of neurotransmitters like serotonin, dopamine, and norepinephrine [37]. These neurotransmitters are involved in regulating mood, appetite, and cognition, thus highlighting the importance of adequate nutrient intake for optimal mental health [38][39][40]. The International Society for Nutritional Psychiatry Research has advocated for the integration of nutritional medicine into mainstream psychiatric practice, emphasizing the need for research, education, policy, and health promotion to support this innovative approach [38]. ...
... These neurotransmitters are involved in regulating mood, appetite, and cognition, thus highlighting the importance of adequate nutrient intake for optimal mental health [38][39][40]. The International Society for Nutritional Psychiatry Research has advocated for the integration of nutritional medicine into mainstream psychiatric practice, emphasizing the need for research, education, policy, and health promotion to support this innovative approach [38]. However, the implementation of this framework faces challenges due to the complexity and multidimensional nature of both mental health and nutrition [41]. ...
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Depressive disorders pose significant challenges to global public health, necessitating effective prevention and management strategies. Notably, the occurrence of suicide frequently coincides with depressive episodes. Suicide is as a paramount global health concern that demands efficacious preventive strategies. Current psychiatric approaches heavily rely on pharmacological interventions but have had limited success in addressing the global burden of mental health issues. Suboptimal nutrition, with its impact on the neuroendocrine system, has been implicated in the underlying pathology of depressive disorders. Folate, a group of water-soluble compounds, plays a crucial role in various central nervous system functions. Depressed individuals often exhibit low levels of serum and red blood cell folate. Multiple studies and systematic reviews have investigated the efficacy of folic acid and its derivative, L-methylfolate, which can cross the blood–brain barrier, as stand-alone or adjunct therapies for depression. Although findings have been mixed, the available evidence generally supports the use of these compounds in depressed individuals. Recent studies have established links between the one-carbon cycle, folate–homocysteine balance, immune system function, glutamate excitation via NMDA (N-methyl-D-aspartate) receptors, and gut microbiome eubiosis in mood regulation. These findings provide insights into the complex neurobiological mechanisms underlying the effects of folate and related compounds in depression. Through a comprehensive review of the existing literature, this study aims to advance our understanding of the therapeutic potential of folic acid and related compounds in depression treatment. It also seeks to explore their role in addressing suicidal tendencies and shed light on the neurobiological mechanisms involved, leveraging the latest discoveries in depression research.
... Among lifestyle behaviors, nutrition has gained attention in the last decade as a modifiable factor potentially relevant to prevent and manage mental disorders (7). In addition to the benefits of healthy dietary patterns (i.e., Mediterranean diet, Dietary Approaches to Stop Hypertension [DASH] diet, MedDiet-DASH Intervention for Neurodegenerative Delay [MIND], etc.) in cardiovascular health (8), some authors have suggested that these diets are associated with lower cognitive decline (9, 10) and depression risk (11). ...
... Moreover, fiber and nutrients from nuts could optimize the gut microbiota, which may lead to lower depressive symptoms and a better mood state through the microbiome-gut-brain axis (36,37). Additionally, increased production of essential neurotransmitters (gamma-aminobutyric acid and serotonin) could contribute to fewer depressive symptoms attributed to nut consumption (7,38). ...
Objectives To assess the cross-sectional and longitudinal associations between nut consumption and depression in two cohorts of older adults.Design, Setting, Participants and MeasurementsThe first cohort (Seniors-ENRICA-I or SE-I) included a representative sample of Spanish noninstitutionalized adults aged ≥65 years interviewed in 2010 and 2013. The second cohort (SE-II) included individuals from the Madrid region, Spain, aged ≥65 years interviewed in 2017 and in 2019. Nut consumption was estimated with a validated computer-based diet history. Depression was defined as self-reported physician-diagnosed depression or the use of antidepressants. Logistic regression models were adjusted for the main confounders. The DerSimonian and Laird random-effect method was used to meta-analyze the results from both studies. A participant-level pooled analysis was conducted to examine the robustness of our analyses.ResultsThe SE-I included 2278 individuals (233 prevalent cases) in the cross-sectional analysis and 1534 (108 incident cases) in the longitudinal analysis; the corresponding figures for SE-II were 2726 (407 prevalent cases) and 1566 (74 incident cases). In the meta-analysis of cross-sectional results from the two studies, compared to consuming <1 serving (30 g) of nuts/week, the odds ratio (95% confidence interval) for depression was 0.90 (0.64, 1.16) for consuming 1 to <3 servings/week and 0.92 (0.70, 1.13) for consuming ≥3 servings/week; the corresponding figures for the longitudinal results were 0.90 (0.41, 1.38) and 0.66 (0.35, 0.97).Conclusion Nut consumption was associated with a lower risk of depression in a pooled longitudinal analysis using data from two cohorts of older adults. Nuts should be recommended as part of a healthy diet in older adults.
... Moreover, a previous observational study found that unhealthy diet is associated with a higher likelihood of mental health problems in the adult population [32]. Reduced consumption of well-balanced nutrient-rich foods (e.g. a lack of fruits and vegetables) and/or higher consumption of energy-dense foods was shown to be independently associated with increased levels of stress and depression [32][33][34][35][36][37]. These mental health factors are key determinants of SHS. ...
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Background Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China. Methods We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30 505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants’ lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs). Results We included 22 897 participants (female: 13 056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day. Conclusions We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS. Registration Chinese Clinical Trial Registry (ChiCTR2200061046).
... Background Diet is receiving more attention as a major proponent of modifiable risk factors [1]. Nutritional psychiatry is a relatively young field of study that looks at the impact of dietary patterns, quality, and composition on mood disorders (including anxiety and depression) and other neuropsychiatric illnesses [2][3][4]. Studies show that a large percentage of young people have eating habits that are not consistent with a healthy diet (low intake of fruit and vegetables, frequent consumption of snacks, sweets and soft drinks, etc.) [5]. Self-report tools are simpler to use and enable coverage of a broader population at low cost, making individual self-report one of the most effective evaluation methods for examining people's mental health [6]. ...
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The emerging field of nutritional psychiatry offers proof that diet quality can be changed to reduce one’s risk of developing mental illness. What you eat has a big impact on teenage mental health, and the quality and frequency of breakfast, as well as the different food groups, can affect adolescent mental health. In this study, regression models were employed to analyze four indicators (self-rated health, body satisfaction, life satisfaction, and eight symptoms) of mental health problems as well as demographic factors (gender, age, body mass index, affluence class, physical activity), with forest plots displaying the regression connections. This study, a descriptive cross-sectional survey of 3480 adolescents aged 11 to 15 years, chosen data from the 2018 Greek Health Behaviour in School-aged Children (HBSC) International Study for secondary analysis. The data revealed that high levels of four indicators of mental health (self-rated health, body satisfaction, life satisfaction, and eight symptoms) were significantly related to breakfast quality, total dietary patterns. Students reporting poor total food quality, for example, were more predictive of self-assessment when unhealthy (2.286 95% CI 1.851–2.824), and the largest connections with eating a “bad” breakfast were discovered when the eight symptoms of mental status were the worst (− 0.869 95% CI: − 1.300, − 0.439); physical activity may enhance the positive relationship of diet quality on mental health, while obesity weakens this positive relationship; and age patterns varied by gender, with girls and older individuals showing a higher risk of diet quality and mental health. Conclusions: The findings revealed that each of the four indices of general mental health was correlated with teenage breakfast and overall diet quality. Physical activity and weight were shown to be moderating factors, and obesity had the biggest impact on psychological risk. Gender, age, and family economic inequality were potential explanations for the rise in psychological symptoms. Researchers are urged to focus more on nutritional psychiatry research and look into psychological perception disparities in the future. What is Known: • There is a potential correlation between adolescent dietary patterns or quality and mental health. • Factors such as age, gender, socio-economic status, body weight and physical activity all have an impact on diet and mental health outcomes. What is New: • There have been no studies of the ability to simultaneously predict breakfast quality and overall diet quality for broadly defined mental health complaints [positive (life satisfaction), neutral (body satisfaction, self-rated health) and negative (eight symptoms: depressed mood, irritability, nervousness, difficulty sleeping, dizziness, headache, stomachache and backache)]. • Differences in overall diet quality trends between demographic subgroups remain unclear.
... Over the past 15 years, in an effort to improve prevention strategies and to complement currently available treatments, there has been a growing scientific interest in studying the relationships between diet and depression [23][24][25]. In addition to genetics, which accounts for 30-40% of the risk of developing depression [26,27], environmental factors such as a history of childhood abuse or neglect [28,29], adverse life events [30,31], social isolation [32,33], socioeconomic status [34,35], and lifestyle [36,37], play a crucial role. ...
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Our objectives are to perform (1) an umbrella review on diet and depression, (2) a systematic review update on dietary patterns and depression, and (3) updated meta-analyses using studies from the previous two objectives. Systematic reviews examining the relationships between diet and depression and primary studies on the relationship between dietary patterns and depression will be systematically retrieved via several databases. All articles identified through the database searches will be imported into Covidence. Following duplicates removal, two authors will independently perform title and abstract screening and full-text assessment against eligibility criteria. Data will be extracted using tables developed for both systematic reviews and primary studies. The methodological quality of systematic reviews will be assessed using the AMSTAR-2 tool. The risk of bias in randomized trials, cohort and cross-sectional studies, as well as case-control studies, will be assessed with the Cochrane risk-of-bias (RoB-2) tool, the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the NHLBI Quality Assessment Tool for Case-Control studies, respectively. For each dietary variable, data extracted will be used to produce: (1) a summary of systematic reviews' characteristics and results table, (2) a summary of the primary studies characteristics table, (3) a qualitative summary of results from the primary studies table, and (4) a quantitative summary of results in the form of forest plots. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Upon completion, this systematic review will be the most comprehensive and up-to-date synthesis of currently available evidence on the relationships between diet and depression. It will serve as a key reference to guide future research and as a resource for health professionals in the fields of nutrition and psychiatry. PROSPERO CRD42022343253.
... Although primary prevention of severe mental illness is considered utopian, targeting potential prenatal causal factors may improve the mental health of offspring. Since fetal brain development is influenced by maternal nutrients, optimizing maternal prenatal micronutrition may be a possible target for primary prevention of mental health problems (Fusar-Poli et al., 2021;Sarris et al., 2015). ...
Aim: There is increasing interest in the role of choline in brain development, including its possible role in promoting mental health and preventing mental illness. Choline is an essential micronutrient in fetal brain maturation. In more than 90% of pregnant women, choline intake has been found to be lower than the daily-recommended dose. The aim of this article is to review what is known about the effects of maternal choline supplementation on fetal brain development, early child development and mental health. Methods: A narrative review of the literature. Results: A limited number of studies suggest that maternal choline supplementation during pregnancy may enhance fetal brain development and improve early signs and symptoms that may predispose to mental illness. Conclusion: The general low maternal choline intake during pregnancy, expected health benefits and low risks, make a plea for maternal choline supplementation to promote mental health. Choline supplementation may be especially important for pregnant women with a (family) history of severe mental illness and/or alcohol dependence.
... An interaction between air pollution and plant-based dietary patterns on cognitive function among older adults was also found [13]. Regarding depression, the founding of the International Society for Nutritional Psychiatry Research provides a promising focal point [14]. Recently, the Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet has received considerable attention from the field of psychiatry due to its emphasis on unprocessed foods that are rich in antioxidant nutrients that reduce oxidative stress and inflammation and its ease of adherence [15]. ...
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This study aims to explore the interaction between a Chinese version of the Mediterranean–DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011–2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean–DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.
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Introdução: Funcionamento e composição do sistema nervoso central são dependentes da presença de macro e micronutrientes. Nesse sentindo, estudos demonstram que intervenções dietéticas apresentam resultados positivos em sintomas psiquiátricos. Tal fato, está relacionado à influência dos nutrientes nas funções cognitivas e no funcionamento cerebral. Objetivo: Descrever o impacto de intervenções dietéticas nos transtornos psiquiátricos. Métodos: revisão de literatura foi realizada com as palavras chaves “Macronutrients”, “Micronutrients”, “Mental health” e “Psychiatric Disorders” na base dados Pubmed e Science Direct. Foram utilizados artigos dos últimos 10 anos, nos idiomas inglês e português. Resultados: Na análise evidencia-se diversos mecanismos fisiopatológicos que sofrem influência de vitaminas e minerais no que tange o campo da saúde mental, como vitaminas do complexo B, vitamina D, ácidos graxos, zinco, magnésio, selênio e cálcio. Diversos estudos apresentam resultados positivos em indivíduos com sintomas de transtornos psicológicos, como depressão, TDAH e esquizofrenia, que realizaram a suplementação desses nutrientes, sendo que a suplementação em adultos saudáveis também apresenta benefícios sutis para sintomas de humor e ansiedade. Além disso, foram observados benefícios adicionais quanto ao uso de doses mais altas, acima da Ingestão Dietética Recomendada (Recommended Dietary Allowance - RDA). Conclusão: Os resultados demonstram que a prescrição baseada em nutrientes tem potencial auxiliador no manejo de transtornos psiquiátricos em nível individual e populacional, inclusive através de suplementações com dosagens acima da Ingestão Dietética Recomendada (RDA).
This scoping review aims to evaluate the impact of nutrition counseling on mental health and wellbeing among people affected by obesity. Depression and obesity are major sources of morbidity and mortality worldwide. The prevalence of obesity is higher in patients with severe or suboptimally managed depression. Change in dietary quality prompted by nutrition counseling may pose a unique opportunity for intervention. Of the 1745 studies identified, 26 studies (total n = 6727) met inclusion criteria. Due to the heterogeneity of methods and outcome reporting, it was not possible to perform meta-analysis. Across all included studies, 34 different scales were used to quantify mental health/wellbeing. Eleven studies (42.3%) reported statistically significant findings between intervention and control groups. Only two of these studies assessed nutrition counseling independently rather than as part of a multidisciplinary intervention. Overall, many studies have examined the role of nutrition counseling on mental health/wellbeing in individuals affected by obesity. However, due to inconsistency in study methodologies and outcome measurement tools, it is challenging to draw robust or clinically meaningful conclusions about the effects of nutrition counseling on mental health in this population.
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Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefi ts in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional defi ciencies) and mental health, and for the select use of nutrient-based supplements to address defi ciencies, or as monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics (members of the International Society for Nutritional Psychiatry Research), in which we provide a context and overview of the current evidence in this emerging fi eld of research, and discuss the future direction. We advocate recognition of diet and nutrition as central determinants of both physical and mental health.
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We systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure. We found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse. When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained. Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span.
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Ingesting minerals and vitamins in combination makes physiological sense, and research on the use of broad-spectrum formulations for psychiatric symptoms is increasing rapidly. This review covers formulas consisting of at least four vitamins and/or minerals and includes four experimental designs: randomized controlled trials, open-label trials, case-control studies and case studies with within-subject crossovers. Nevertheless, there is evidence for the efficacy of micronutrients in the treatment of stress and antisocial behaviors as well as depressed mood in nonclinical and elderly populations. Many reports studied mood changes in healthy populations, making it difficult to generalize to clinical samples. There is also preliminary support for the treatment of autism with micronutrients. However, despite positive preliminary findings, there are less data available to support efficacy of micronutrient formulas in treating bipolar disorder, attention deficit-hyperactivity disorder and substance abuse/dependence and no clinical trials have been done with clinically depressed or anxious patient samples, psychosis or eating disorders.
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Studies of diet and depression have focused primarily on individual nutrients. To examine the association between dietary patterns and depression using an overall diet approach. Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: 'whole food' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies - Depression (CES-D) scale. After adjusting for potential confounders, participants in the highest tertile of the whole food pattern had lower odds of CES-D depression (OR = 0.74, 95% CI 0.56-0.99) than those in the lowest tertile. In contrast, high consumption of processed food was associated with an increased odds of CES-D depression (OR = 1.58, 95% CI 1.11-2.23). In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective.
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Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression. To assess the association between adherence to the MDP and the incidence of clinical depression. Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted. A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project). A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing. Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up. After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes. Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.
Studies of single nutrients on depression have produced inconsistent results, and they have failed to consider the complex interactions between nutrients. An increasing number of studies in recent years are investigating the association of overall dietary patterns and depression. This study aimed to systematically review current literature and conduct meta-analyses of studies addressing the association between dietary patterns and depression. Six electronic databases were searched for articles published up to August 2013 that examined the association of total diet and depression among adults. Only studies considered methodologically rigorous were included. Two independent reviewers completed study selection, quality rating, and data extraction. Effect sizes of eligible studies were pooled by using random-effects models. A summary of the findings was presented for studies that could not be meta-analyzed. A total of 21 studies were identified. Results from 13 observational studies were pooled. Two dietary patterns were identified. The healthy diet pattern was significantly associated with a reduced odds of depression (OR: 0.84; 95% CI: 0.76, 0.92; P < 0.001). No statistically significant association was observed between the Western diet and depression (OR: 1.17; 95% CI: 0.97, 1.68; P = 0.094); however, the studies were too few for a precise estimate of this effect. The results suggest that high intakes of fruit, vegetables, fish, and whole grains may be associated with a reduced depression risk. However, more high-quality randomized controlled trials and cohort studies are needed to confirm this finding, specifically the temporal sequence of this association.
Diet quality is related to the risk for depression and anxiety in adults and adolescents; however, the possible impact of maternal and early postnatal nutritional exposures on children's subsequent mental health is unexplored. The large prospective Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and 2008. Data were collected from mothers during pregnancy and when children were 6 months and 1.5, 3, and 5 years of age. Latent growth curve models were used to model linear development in children's internalizing and externalizing problems from 1.5 to 5 years of age as a function of diet quality during pregnancy and at 1.5 and 3 years. Diet quality was evaluated by dietary pattern extraction and characterized as "healthy" or "unhealthy." The sample comprised 23,020 eligible women and their children. Adjustments were made for variables including sex of the child, maternal depression, maternal and paternal age, maternal educational attainment, household income, maternal smoking before and during pregnancy, mothers' parental locus of control, and marital status. Higher intakes of unhealthy foods during pregnancy predicted externalizing problems among children, independently of other potential confounding factors and childhood diet. Children with a high level of unhealthy diet postnatally had higher levels of both internalizing and externalizing problems. Moreover, children with a low level of postnatal healthy diet also had higher levels of both internalizing and externalizing problems. Among this large cohort of mothers and children, early nutritional exposures were independently related to the risk for behavioral and emotional problems in children.
Key biological factors that influence the development of depression are modified by diet. This study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women ages 20-93 years randomly selected from the population. A diet quality score was derived from answers to a food frequency questionnaire, and a factor analysis identified habitual dietary patterns. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological symptoms, and a structured clinical interview was used to assess current depressive and anxiety disorders. After adjustments for age, socioeconomic status, education, and health behaviors, a "traditional" dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 score. There was also an inverse association between diet quality score and GHQ-12 score that was not confounded by age, socioeconomic status, education, or other health behaviors. These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders, although reverse causality and confounding cannot be ruled out as explanations. Further prospective studies are warranted.
Adjuvant use of nutritional and herbal medicines has potential to increase the efficacy of synthetic pharmaceuticals, and perhaps also decrease their side-effects by allowing lower doses to be prescribed. We evaluated current evidence for adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines; and explored novel future areas of research. The paper also critiques current evidence for co-administration of St. John's wort with synthetic antidepressants. We performed a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane database, China National Knowledge Infrastructure and the Chinese Science Citation Database. Search results were supplemented by a review of reference lists and a forward search using the Web of Science. Where possible we calculated effect sizes. Encouraging evidence exists for the use of omega-3 fatty acids, SAMe, folic acid and l-tryptophan adjuvantly with antidepressants to enhance response and improve efficacy. Various nutrients also have emerging evidence as effective adjuncts with antipsychotics and mood stabilizers. While some evidence supports nutritional adjuvancy with various psychopharmacotherapies, adjuvant use of herbal therapies has not been sufficiently studied to warrant standard clinical application. This remains a promising area of research via robust, safety-conscious studies.