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Background: To address nutrition-related population mental health data gaps, we examined relationships among food insecurity, diet quality, and perceived mental health. Methods: Stratified and logistic regression analyses of respondents aged 19-70 years from the Canadian Community Health Survey, Cycle 2.2 were conducted (n = 15,546). Measures included the Household Food Security Survey Module, diet quality (i.e., comparisons to the Dietary Reference Intakes, Healthy Eating Index), perceived mental health (poor versus good), sociodemographics, and smoking. Results: In this sample, 6.9% were food insecure and 4.5% reported poor mental health. Stratified analysis of food security and mental health status by age/gender found associations for poor diet quality, protein, fat, fibre, and several micronutrients (p-values < 0.05); those who were food insecure tended to have higher suboptimal intakes (p-values < 0.05). After adjustment for covariates, associations in relation to mental health emerged for food insecurity (OR = 1.60, 95% CI 1.45-1.71), poor diet quality (1.61, 95% CI 1.34-1.81), and suboptimal intakes of folate (OR = 1.58, 95% CI 1.17-1.90) and iron (OR = 1.45, 95% CI 1.23-1.88). Conclusions: Population approaches that improve food security and intakes of high quality diets may protect people from poor mental health.
Food Insecurity, Poor Diet Quality, and Suboptimal
Intakes of Folate and Iron Are Independently
Associated with Perceived Mental Health in
Canadian Adults
Karen M. Davison 1, *, Lovedeep Gondara 2and Bonnie J. Kaplan 3
1School of Nursing, University of British Columbia andHealth Science Program, Department of Biology,
Kwantlen Polytechnic University, Surrey, BC V3W 2M8, Canada
2Department of Computer Science, University of Illinois Springfield and Department of Computer Science,
Simon Fraser University, Burnaby, BC V5A 1S6, Canada;
3Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
*Correspondence:; Tel.: +1-604-300-0331
Received: 3 January 2017; Accepted: 10 March 2017; Published: 14 March 2017
Background: To address nutrition-related population mental health data gaps, we examined
relationships among food insecurity, diet quality, and perceived mental health. Methods: Stratified
and logistic regression analyses of respondents aged 19–70 years from the Canadian Community
Health Survey, Cycle 2.2 were conducted (n= 15,546). Measures included the Household Food
Security Survey Module, diet quality (i.e., comparisons to the Dietary Reference Intakes, Healthy Eating
Index), perceived mental health (poor versus good), sociodemographics, and smoking. Results:
In this sample
, 6.9% were food insecure and 4.5% reported poor mental health. Stratified analysis
of food security and mental health status by age/gender found associations for poor diet quality,
protein, fat, fibre, and several micronutrients (p-values < 0.05); those who were food insecure tended
to have higher suboptimal intakes (p-values < 0.05). After adjustment for covariates, associations
in relation to mental health emerged for food insecurity (OR = 1.60, 95% CI 1.45–1.71), poor diet
quality (1.61, 95% CI 1.34–1.81), and suboptimal intakes of folate (OR = 1.58, 95% CI 1.17–1.90) and
iron (
OR = 1.45
, 95% CI 1.23–1.88). Conclusions: Population approaches that improve food security
and intakes of high quality diets may protect people from poor mental health.
Keywords: food insecurity; diet quality; nutrient intakes; mental health
1. Introduction
A growing body of evidence indicates relationships among food insecurity, diet quality,
and mental
health; however, their simultaneous effects are rarely studied. Food insecurity occurs
when people are physically or economically unable to consume a sufficient quantity of food or have
uncertainty in their ability to do so [
], and it has been associated with various indicators of mental
ill health such as depression, mania, disordered eating, impaired cognition, higher internalizing and
externalizing behaviours, and suicidal ideation [
]. For indicators such as depression, the links with
food insecurity and nutrition may be bidirectional [
]. Diet quality, which encompasses adequacy
or sufficiency, moderation, variety or diversity, and balance or equilibrium of nutrient and food
intakes [
], is also critical to mental health. The two concepts of food insecurity and diet quality are
interrelated: food insecurity includes the components of insufficient food quantity and quality, feelings
of deprivation, and disrupted eating [
], and so it is inversely associated with higher levels of diet
quality [9].
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The understanding about the relationship between food insecurity and diet quality with respect
to mental health is evolving. Food insecurity can contribute to over- and under-nutrition, nutrient
excesses, disproportions, and deficiencies, as well as eating disturbances [
]. Manifestations of
nutritional deficiencies include psychiatric symptoms, and single nutrients such as omega-3 fatty
acids and folate have received attention in epidemiologic and intervention studies targeting mental
health [
]. Intervention studies that have utilized multi-nutrient formulas with both minerals
and vitamins have shown an even greater benefit for mental health [
], indicating the need for all
essential nutrients for optimal mental function. Studies of adults with mood disorders, for example,
have indicated that when compared to a general population, a larger proportion had suboptimal
intakes of essential nutrients [
]. Furthermore, nutrient intakes have been found to be correlated with
psychological functioning [
], and when food insecurity was also present, nutrient intakes and mania
symptoms were worse [18]. Eating disturbances (e.g., fasting, binging), which can impact nutritional
status, are also associated with both food insecurity and mental health [
]. Compromised diet
quality caused by food insecurity may also contribute to alterations in the gut–microbiota–brain
axis [
], creating metabolic, immune, and inflammatory responses [
] that contribute to worsening
mental health. Conversely, intake of a good quality diet combined with food security can contribute
to anti-inflammatory and protective effects of various nutrients and other bioactive components that
optimize the brain’s biochemistry and support cognitive health.
While both food security and diet quality are critical to mental health, there has been limited
research examining their relationships. Specifically, there are knowledge gaps about how food
insecurity may impact nutrient intakes in the context of poor and good levels of mental health
and how these relationships may be influenced by different determinants of health such as income.
Furthermore, despite burgeoning research in this area, studies have focused on specific mental health
conditions and have narrowly defined a “good outcome” as a reduction in symptoms of mental illness
and/or improved functional ability. In recent years, however, the concept of mental health has moved
to a broader interest in individuals’ appraisals about their experiences and the meaning that they
attribute to these experiences [24], as this may impact health service use.
There has been increasing recognition that barriers to better nutrition must be understood at
the population level among groups who are most likely to have poorer-quality diets and to be at
risk for mental health conditions. Therefore, examining measures of mental health in a general
population and their potential associations with food insecurity and diet quality can provide direction
on population-level interventions and policies that foster mental health for individuals without
diagnosed mental health conditions, potentially prevent or delay the development of a mental health
condition, and optimize outcomes for those with mental health conditions that are symptomatic.
The importance
of this research is emphasized by the fact that food security status and diet quality
are modifiable. To help address these knowledge gaps, we analysed data from a large well-designed
cross-sectional study to examine: (1) differences in energy and nutrient intakes by food security and
perceived mental health status; (2) differences in adequacy of macro- and micronutrient intakes by food
security and perceived mental health status; and (3) the simultaneous effects of food insecurity, diet
quality, and suboptimal micronutrient intakes in relation to perceived mental health. We hypothesized
that: (1) diet quality is compromised by poor mental health and food insecurity; and (2) food insecurity
and diet quality are independent predictors of poor mental health.
2. Materials and Methods
2.1. Sample
The sample was derived from cycle 2.2 (Nutrition) of the Canadian Community Health Survey
(2004) conducted by Statistics Canada [
]. A complete description of the survey data is provided in
documentation from Health Canada [
]. The survey sample consisted of 35,107 respondents (0 years+)
living in private residences in Canada’s 10 provinces. Initial interviews were conducted in-person
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and collected information about the respondent’s demographics, general health, dietary intake (24-h
recall), and food security. A second 24-h recall was conducted by telephone with 10,786 respondents 3
to 10 days after the initial interview. For our analysis, we used data from adult respondents aged 19 to
70 (n= 20,498). Adults were selected, as associations between food insecurity and dietary quality is
less consistently associated with low dietary quality in children. This is believed to be due to adults
shielding children from compromised diets in the context of household food insecurity [
]. Thus, those
less than 19 years of age (n= 15,190) were excluded. In addition, adults aged 70 years+ (n= 4371) were
excluded, as there was limited data available on the second 24-h diet recalls in this age group.
2.2. Measures
2.2.1. Perceived Mental Health
The variable “perceived mental health” is a general indicator of individuals who are suffering
from some form of mental disorder, mental or emotional problems, or distress, which is not necessarily
reflected in the more global measure “self-perceived health” [
], and can affect service use [
]. This
measure of overall mental health status is considered to align with the World Health Organization’s
definition of mental health where a person with or without a diagnosed mental health condition can
experience well-being in which they realize their own abilities, can cope with the normal stresses
of life, can work productively, and contribute to their community [
]. Research suggests perceived
mental health is associated with mental morbidity measures such as non-specific psychological distress,
depressive symptoms, activity limitations, and physical and emotional role functioning [
]. Strong
positive associations between all mental morbidity measures and perceived mental health have been
reported, with stronger associations between past month prevalence as compared to past 2- to 12-month
prevalence and lifetime disorder [30].
Respondents rated perceived mental health based on answers to the question: “How would
you say your mental health is? Excellent? Very good? Good? Fair? Poor?” The responses were
dichotomized as poor/fair (poor mental health) and good/very good/excellent (good mental health).
This treatment of the perceived mental health measure has been done in other studies [
], and is
an established approach to modifying self-reported health measures [33].
2.2.2. Food Security
Food security was measured using the 18-item Household Food Security Survey Module
]. Food insecurity was determined based on affirmative responses to either of the “food
sufficiency questions” which asked whether the household, in the past 12 months, sometimes did
not have enough to eat or often did not have enough to eat. Food security status was classified as:
(1) Food secure: access at all times in the previous year to enough food for an active, healthy life for
all household members; (2) Food insecure: included categories of moderate or severe food insecurity
where any household member had compromises in quality and/or quantity of food consumed which
may have disrupted eating patterns.
2.2.3. Diet Quality
There are various diet quality indicators, and it is recommended that more than one be selected
when testing associations with health outcomes [
]. For the current study, the indicators of diet
quality included measures of energy and nutrient intakes and comparisons to North American dietary
standards, as well as an index of diet quality. Nutrient intakes were compared to the Dietary Reference
Intakes (DRIs) [
] by specified age/gender categories to review patterns of nutrient inadequacies.
To assess intakes of the major nutrients, the Acceptable Macronutrient Distribution Ranges (AMDR)
were used as the reference. The AMDR is a range of intakes for a particular energy source that is
expressed as a percentage of total energy intakes, and is associated with reduced risk of chronic
disease while providing adequate intakes of essential nutrients [
]. To estimate the prevalence of
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potentially inadequate micronutrient nutrient intakes, the Estimated Average Requirement (EAR) cut
point method of the Dietary Reference Intakes was used. The EAR is a nutrient intake value that is
estimated to meet the requirements of half of the healthy individuals in a group. For nutrients with
an EAR, the percentage below the EAR reflects the prevalence of potentially inadequate intakes for a
given nutrient. For iron, “the full probability approach” [
] was used, which accounts for skewness
in the requirement distributions of this nutrient.
The Canadian Healthy Eating Index (HEI) [
] was also used as an indicator of diet quality.
includes nine scored components of the intakes of the four food groups of the Canadian Food
Guide [
], total fat (percent of energy intake), saturated fat (percent of energy intake), total cholesterol
intake, total sodium intake, and diet variety. The diet variety component is based on having at least
one serving from each food group (i.e., vegetables and fruit, grain products, meat and alternatives,
milk and alternatives). A final score of
50 indicates poor diet quality, 51 to 80 indicates a diet that
needs improvements, and 81 to 100 indicates good diet quality.
2.2.4. Covariates
The covariates sex, age (categories of 19–30, 31–50, 51–70 years), income (five categories: lowest
income, lower middle income, middle income, upper middle income, highest income), education
(secondary school graduate or less vs. education above secondary school level), relationship status
(married or common-law vs. single), and smoking status (current daily smoker vs. not a current daily
smoker) were also included, as these factors can influence dietary intakes and food security. A five-level
variable describes income adequacy according to total household income in the past 12 months and
the number of people in the household. The highest level of education obtained by the respondent was
classified as less than secondary school graduation, secondary school graduation, some postsecondary
education, and postsecondary graduation. Relationship status included the categories of married,
common-law, widowed/separated/divorced, and single/never married. A dichotomous variable
differentiated those who were and were not current daily smokers (i.e., smoking daily or occasionally
at the present time).
2.3. Analysis
The secured data was analysed in the Statistics Canada Research Data Centre at the University of
British Columbia using SAS (version 9.1, 2003, SAS Institute, Cary, NC, USA) and SIDE-IML (Software
for Intake Distribution Estimation in IML language, version 1.11, 2001, Iowa State University, Ames,
IA, USA). Survey weights are incorporated into the calculations to provide national representation [
To account for survey design effects, the bootstrap resampling technique was used [39].
To assess for quality in dietary intake reporting, energy intake (EI) was examined in relation to
estimated energy requirements (EER) [
] based on respondents’ sex, age, self-reported physical
activity level, as well as self-reported or measured height and weight to estimate requirements [
The physical activity coefficients used in the EER equation were based on three levels which account
for the frequency and duration of activity: active, moderately active, or inactive [26].
To compare differences between food security status and nutrient intakes in relation to mental
health, Mann–Whitney Utests, chi-square tests, ANOVAs, or their non-parametric equivalents
(e.g., Kruskal–Wallis tests) were used where applicable. The nutritional adequacy of intakes by age/sex
group and food security status was determined using data from the first (full sample) and second
(subsample) dietary recalls [
]. The prevalence of potentially inadequate intakes were estimated using
the EAR cut point approach for nutrients which have an EAR, accounting for age/sex categories and
increased requirements of vitamin C in current smokers [4347].
To examine relationships between the outcome variable mental health (poor vs. good) in relation
to food security, diet quality, and suboptimal intakes of micronutrient intakes as defined by EAR
cut-offs, logistic regression analysis was conducted which controlled for the covariates. Goodness-of-fit
Nutrients 2017,9, 274 5 of 12
chi-squared tests were applied to assess for model fit. The level of significance for all statistical tests
was p< 0.05.
3. Results
3.1. Sample
The sample consisted of more females (55%) than males (45%); about two-thirds (68.4%) of the
sample were less than 50 years. Almost 7% (6.9%) were food insecure, and 4.5% reported poor or
fair mental health. Within the adult sample (19 to 70 years), about 8% (7.8%) were post-secondary
graduates, 44.1% earned an income considered to be at the lower middle range or less, and 50.1% were
in a relationship.
3.2. Bivariate Analyses
The medians of EI:EER tended to be lower among those who reported food insecurity, however
no significant differences were found (Table S1). Poor quality diets as defined by the HEI were more
prevalent among those with poor mental health (33.6%) compared to those with good mental health
(26.9%; p< 0.001), and there were significant associations between food security status, diet quality,
and mental health (all p-values < 0.05). For macronutrient and fibre intakes, there were significant
associations between mental health and food insecurity for protein (grams) in males between 31 to
50 years and 51 to 70 years, carbohydrates (g) and fat (g) in females between 31 to 50 years and
51 to
70 years, and fibre (g) in males between 31 to 50 years and females
51 to
70 years (Table S1).
For micronutrients, there was a relatively consistent trend observed for intakes by gender categories
where those with good mental health and food secure status had higher intakes than those reporting
poor mental health and food insecure status (Table S2). For females between 19 to 30 years, vitamin C
intakes were significantly lower for those with poor mental health and food insecure status (p< 0.05).
Thiamin and folate intakes among males and females 31 to 50 years were also significantly lower for
those with poor mental health and food insecure status. For males in the same age group, significantly
lower intakes of vitamins B
, B
, and B
, as well as the minerals phosphorus, potassium, and zinc in
those with poor mental health and food insecure status. For males and females 51 to 70 years, there was
significant association for vitamin C when stratified by mental health and food security. For females
in this age range, many significant associations were also found that included vitamins A, B
, B
, B
, B
, B
, and D, as well as the minerals magnesium, phosphorus, and potassium. Interestingly, for
many of the B vitamins, intakes were slightly higher among females with food insecure status who
reported poor mental health.
When compared to the DRIs, a significantly higher proportion of respondents that were
food insecure had protein intakes below the AMDRs, regardless of mental health status (Table 1).
A significantly higher proportion of the sample with food insecure and poor mental health status had
micronutrient intakes below the EARs for all vitamins and minerals analysed (exception: vitamin B
3.3. Multivariate Analyses
After adjusting for the covariates, those with poor mental health status had an increased odds
of being food insecure (OR = 1.60, 95% CI 1.45 to 1.71), having poor diet quality as measured by the
HEI (1.61, 95% CI 1.34 to 1.81), protein intakes below the AMDR (OR = 1.01, 95% CI 1.00 to 1.02),
and potentially
inadequate intakes of folate (OR = 1.58, 95% CI 1.17 to 1.90) and iron (OR = 1.45, 95%
CI 1.23 to 1.88) (Table 2).
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Table 1.
Prevalence estimates for categories of the acceptable macronutrient distribution ranges
(AMDRs) and estimated average requirements (EARs) by mental health and food security a.
Variable Good Mental Health Poor Mental Health
Food Secure Food Insecure Food Secure Food Insecure
<20% 9.9 15.4 ** 10.6 18.6 **
20% to 35% 52.7 51.7 55.4 53.1
>35% 37.4 32.9 ** 34.0 28.3 **
<45% 20.3 16.3 ** 19.0 21.3
45% to 65% 52.8 58.4 ** 56.9 64.5 **
>65% 26.4 25.2 24.1 14.2 **
Vitamin A 52.3 62.8 ** 54.4 67.0 **
Vitamin B1(Thiamin) 18.1 21.7 ** 24.4 39.2 **
Vitamin B2(Riboflavin) 15.8 21.2 ** 19.7 37.7 **
Vitamin B3(Niacin) 2.5 4.3 ** 6.4 8.7 **
Vitamin B6(Pyridoxine) 26.7 33.0 ** 39.6 42.5 **
Vitamin B9(Folate) 79.4 82.7 ** 87.1 87.2
Vitamin C 35.9 46.0 ** 43.2 55.7 **
Iron 7.3 11.3 ** 12.5 18.9 **
Magnesium 49.8 59.5 ** 58.5 61.2 **
Phosphorus 10.4 17.1 ** 16.7 23.7 **
Zinc 33.5 43.9 ** 37.9 45.6 **
Carbohydrates and some micronutrients with EARs are not reported because stratified analysis created cell sizes
<5; ** p< 0.001; test-statistics (z-statistic) range from 2.56 to 75.75; p-values 0.011 to <0.0001.
Table 2.
Logistic regression estimates of food insecurity, healthy eating index (HEI), acceptable
macronutrient distribution ranges (AMDRs), and estimated average requirements (EARs) in relation to
poor mental health.
Variable Odds Ratio (95% CI) p-Value
Food insecurity 1.60 (1.45–1.71) 0.0048
Poor vs. good 1.61 (1.34–1.81) 0.0296
Needs improvement vs. good 1.06 (1.00–1.11) 0.2298
Fat 1.00 (0.97–1.03) 0.8252
Protein 1.01 (1.00–1.02) 0.0312
Vitamin A 0.88 (0.59–1.31) 0.5253
Vitamin B1(Thiamin) 1.45 (0.98–1.13) 0.0604
Vitamin B2(Riboflavin) 1.35 (0.66–2.76) 0.4056
Vitamin B3(Niacin) 0.53 (0.21–1.32) 0.1727
Vitamin B6(Pyridoxine) 0.79 (0.46–1.38) 0.4133
Vitamin B9(Folate) 1.58 (1.17–1.90) 0.0148
Vitamin C 1.37 (0.90–2.08) 0.1376
Iron 1.45 (1.23–1.88) 0.0192
Zinc 1.35 (0.90–2.01) 0.1479
Significant associations were also indicated for income, smoking status, and marital status (p< 0.05).
4. Discussion
This study provided evidence that dietary quality was lower for those who were food insecure
and had poor mental health. Based on stratified analysis by age and gender, significant associations
were found between mental health and food insecurity for protein, fat, carbohydrates, fibre, vitamins
Nutrients 2017,9, 274 7 of 12
A, B
, B
, B
, B
, B
, B
, C, and D, as well as the minerals magnesium, phosphorus, potassium,
and zinc
—particularly for older females. Furthermore, for those who were food insecure and had poor
mental health, there was a higher prevalence of potentially inadequate intakes of most vitamins and
minerals. When food insecurity, diet quality, and potentially inadequate intakes were simultaneously
analysed with adjustment for covariates, food insecurity, poor diet quality, and suboptimal intakes of
protein (marginal significance), folate, and iron all independently predicted poor mental health. Food
insecurity and poor diet quality appeared to be the most significant predictors of poor mental health.
This study is the first to concurrently analyse food insecurity, diet quality, suboptimal nutrient
intakes, and perceived mental health, and found results that are consistent with previous investigations
that individually showed lower nutrient intakes, poor diet quality, and food insecurity are associated
with poor perceived mental health [
]. In addition, our findings indicated that food insecurity
is associated with dietary compromises that are of sufficient magnitude to impact nutritional
and mental health, regardless of whether respondents did or did not have a diagnosed mental
health condition.
Food insecurity tended to systematically drive increases in the proportion of individuals
consuming a poor-quality diet and low intake levels of essential nutrients. Vitamins and minerals have
important roles in various brain physiological processes, and have been linked with mental health [
Insufficient micronutrient levels can have harmful effects on the brain by reducing proteins such
as brain-derived neurotropic factor (BDNF) and by up-regulating the stress response, immune, and
oxidative systems [
]. Iron is involved in myelin production [
] and is a cofactor for neurotransmitter
synthesis [
]. Zinc is involved in neuron migration, synaptogenesis, and neurogenesis [
]. Vitamins
, B
, and B
affect methylation in the central nervous system [
], and maintain the integrity
of the myelin sheath [
]. Indeed, all dietary vitamins and minerals have critical roles in brain
metabolism [15].
Multiple integrated mechanisms could explain the various findings reported here. For example,
diet quality may represent the concerted action of various compounds within foods working
synergistically [
] that support mental health. Individually, inadequate intakes of nutrients such as
folate and iron independently predicted mental health, suggesting that there is a heightened need for
some specific nutrients in relation to mental well-being. The results are particularly surprising for folate
intakes, given that in 1998 the Government of Canada instituted mandatory folic acid fortification
for all white flour and enriched pasta and cornmeal products [
], and the proportion of respondents
with poor mental health consuming levels below the EAR did not differ significantly by food security
status. While food insecurity encompasses components of dietary quality, many individual (
e.g., stress
and anxiety associated with attempts to access food), household (e.g., deprivation, parent’s placement
of a child’s nutrition needs above theirs), and structural (e.g., poverty, stigma) drivers also explain
independent links between food insecurity and mental health [
]. Clearly, future research is needed
to help disentangle the complex relationships between nutritional and population mental health, which
can then better direct food and health policies.
There are several limitations of this study. With the cross-sectional design, causality cannot
be inferred. However, results from longitudinal studies suggest that bidirectional relationships
occur between poor mental health (defined as depression), food insecurity, and diet quality [
focuses on income and does not consider factors such as diet self-efficacy (i.e., the belief
in one’s ability to manage diet even in the face of obstacles such as stress) and other important
psychosocial variables that relate to dietary behaviours [
]. The HFSSM also does not account for
intra-household variations [
], and the measures of food insecurity (previous year) and diet quality
(previous 24 h) reflected incongruent time frames. The reporting of suboptimal macronutrient, vitamin,
and mineral nutrient intakes were confined to those where reference levels (e.g., EARs) exist and
sufficient data was available to analyse. As is common with dietary surveys, underreporting did occur
and may have overestimated prevalences of suboptimal intakes. However, no significant differences
were observed in EI:EER and food security status among the age/gender categories. It is difficult to
Nutrients 2017,9, 274 8 of 12
determine how these results may translate to other countries, as food insecurity and mental health
measures vary. In national surveys, the US and Canada use versions of the HFSSM, and estimates of
food insecurity in the US appear to be double that observed in Canada [
]. However, in Canada,
food insecurity appears to have more of an impact on nutritional inadequacy [
]. None of the other
industrialized countries use the same self-report mental health measure as the CCHS. The monitoring
of self-reported mental health has only emerged in recent years, and this measure is increasingly
recognized to be relevant as poor mental health has been associated with physical health, health service
utilization, and psychiatric morbidities [67].
The results of this study suggest that alternatives for food and social policy need to be explored.
In the Canadian context, there are limited publicly funded food programs that provide assistance to
vulnerable households. In the US, for example, food subsidy programs such as the US Department of
Agriculture’s Supplemental Nutrition Assistance Program (SNAP) for Women, Infants, and Children
(WIC) exist to improve food security for low-income individuals and households. Evidence suggests
that participation in these programs contributes to small increases in the intake of targeted nutrients
and foods, and that the nutrition education component of the programs (SNAP-Ed) improves skills
in food resource management [
]. Thus, contextual factors such as food and nutrition assistance
programs, food supply, food pricing, and other policies and programs need to be explored as means to
ameliorate food insecurity, improve diet quality, and foster mental health within populations.
5. Conclusions
Overall, the results suggested that food insecurity, poor diet quality, and inadequate intakes of
selected micronutrients were independently associated with poor mental health in a general national
sample. These findings suggest that public policies that support both food security and high quality
dietary intakes could promote mental health and well-being. Population-based interventions that have
the potential to improve diet quality and food security—such as the July 2016 Canadian Universal
Child Care Benefit for families below specified income levels—should be evaluated in relation to
mental health.
Supplementary Materials:
The following are available online at 6643/9/3/274/s1,
Table S1: Intakes of energy and macronutrients from first 24-h dietary recall according to mental health and food
security status; Table S2: Intakes of vitamins and minerals from first 24-h dietary recall according to mental health
and food security status.
Gratitude is extended to Didier Garriguet of Statistics Canada who provided tools that helped
with the use of SIDE-IML and the Canadian Healthy Eating Index. This project was part of Karen Davison’s
post-doctoral work at the University of British Columbia in the School of Nursing. Her fellowship was funded by
the Canadian Institutes of Health Research Intersections of Mental Health Perspectives in Addictions Research
Training (IMPART) program.
Author Contributions:
K.M.D. and B.J.K. submitted the project proposal, including research plan, to Statistics
Canada for approval to access the secure data. K.M.D. and L.G. analysed the data. K.M.D. drafted the manuscript.
All authors read and provided edits on manuscript drafts. All authors approved the final manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
1. Davis, B.; Tarasuk, V. Hunger in Canada. Agric. Hum. Values 1994,11, 50–57. [CrossRef]
Weaver, L.J.; Hadley, C. Moving beyond hunger and nutrition: A systematic review of the evidence linking
food insecurity and mental health in developing countries. Ecol. Food Nutr.
,48, 263–284. [CrossRef]
Davison, K.M.; Marshall-Fabien, G.L.; Tecson, A. Association of moderate and severe food insecurity
with suicidal ideation in adults: National survey data from three Canadian provinces. Soc. Psychiatry
Psychiatr. Epidemiol. 2015,50, 963–972. [CrossRef] [PubMed]
Nutrients 2017,9, 274 9 of 12
McIntyre, L.; Williams, J.V.A.; Lavorato, D.H.; Patten, S. Depression and suicide ideation in late adolescence
and early adulthood are an outcome of child hunger. J. Affect. Disord.
,150, 123–129. [CrossRef]
Slopen, N.; Fitzmaurice, G.; Williams, D.R.; Gilman, S.E. Poverty, food insecurity, and the behavior for
childhood internalizing and externalizing disorders. J. Am. Acad. Child. Adolesc. Psychiatry
,49, 444–452.
Huddleston-Casas, C.; Charigo, R.; Simmons, L.A. Food insecurity and maternal depression in rural,
low-income families: A longitudinal investigation. Public Health Nutr.
,12, 1133–1140. [CrossRef]
7. Garriguet, D. Diet quality in Canada. Health Rep. 2009,20, 41–52. [PubMed]
Radimer, K.L.; Olson, C.M.; Greene, J.C.; Campbell, C.C.; Habicht, J.P. Understanding hunger and developing
indicators to assess it in women and children. J. Nutr. Educ. 1992,24, 36s–44s. [CrossRef]
Hanson, K.L.; Connor, L.M. Food insecurity and dietary quality in US adults and children: A systematic
review. Am. J. Clin. Nutr. 2014,100, 684–692. [CrossRef] [PubMed]
Drewnowski, A.; Specter, S.E. Poverty and obesity: The role of energy density and energy costs. Am. J.
Clin. Nutr. 2004,79, 6–16. [PubMed]
Dixon, L.B.; Winkleby, M.A.; Radimer, K.L. Dietary intake and serum nutrients differ between adults from
food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey,
1988–1994. J. Nutr. 2001,131, 1232–1246. [PubMed]
Laraia, B.; Vinikoor-Imler, L.C.; Siega-Riz, A.M. Food insecurity during pregnancy leads to stress, disordered
eating, and greater postpartum weight among overweight women. Obesity (Silver Spring)
,23, 1303–1311.
[CrossRef] [PubMed]
Bodnar, L.M.; Wisner, K.L. Nutrition and depression: Implications for improving mental health among
child-bearing-aged women. Biol. Psychiatry 2005,58, 679–685. [CrossRef] [PubMed]
Mischoulon, D.; Fava, M. Are nutritional supplements ready for prime time? J. Clin. Psychiatry
1497–1498. [CrossRef] [PubMed]
Popper, C.W. Single-micronutrient and broad-spectrum micronutrient approaches for treating mood
disorders in youth and adults. Child Adolesc. Psychiatr. Clin. N. Am.
,23, 591–672. [CrossRef]
Davison, K.M.; Kaplan, B.J. Vitamin and mineral intakes in adults with mood disorders: Comparisons to
nutrition standards and associations with sociodemographic and clinical variables. J. Am. Coll. Nutr.
30, 547–558. [CrossRef] [PubMed]
Davison, K.M.; Kaplan, B.J. Nutrient intakes are correlated with overall psychiatric functioning in adults
with mood disorders. Can. J. Psychiatry 2012,57, 85–92. [CrossRef] [PubMed]
Davison, K.M.; Kaplan, B.J. Food insecurity in adults with mood disorders: Prevalence estimates and
associations with nutritional and psychological health. Ann. Gen. Psychiatry
,14. [CrossRef] [PubMed]
Davison, K.M.; Marshall-Fabien, G.L.; Gondara, L. Sex differences and eating disorder risk among
psychiatric conditions, compulsive behaviors and substance use in a screened Canadian national sample.
Gen. Hosp. Psychiatry 2014,36, 411–414. [CrossRef] [PubMed]
Davison, K.M. The relationships among psychiatric medications, eating behaviors, and weight. Eat. Behav.
2013,14, 187–191. [CrossRef] [PubMed]
Romero-Dazaa, N.; Himmelgreen, D.A.; Pérez-Escamillac, R.; Segura-Millánd, S.; Merrill, S. Food habits of
drug-using Puerto Rican women in inner-city Hartford. Am. J. Phys. Anthropol.
,18, 281–298. [CrossRef]
Petra, A.I.; Panagiotidou, S.; Hatziagelaki, E.; Stewart, J.M.; Conti, P.; Theoharides, T.C. Gut-microbiota-brain
axis and its effect on neuropsychiatric disorders with suspected immune dysregulation. Clin. Ther.
984–995. [CrossRef] [PubMed]
Maes, M.; Kubera, M.; Leunis, J.C.; Berk, M.; Geffard, M.; Bosmans, E. In depression, bacterial translocation
may drive inflammatory responses, oxidative and nitrosative stress (O&NS), and autoimmune responses
directed against O&NS-damaged neoepitopes. Acta Psychiatr. Scand. 2013,127, 344–354. [PubMed]
White, R.G.; Imperiale, M.G.; Perera, E. The Capabilities Approach: Fostering contexts for enhancing mental
health and wellbeing across the globe. Glob. Health 2016,12, 16. [CrossRef] [PubMed]
Statistics Canada. Canadian Community Health Survey (CCHS) Cycle 2.2 (2004) Nutrition: General Health and
24-h Dietary Recall Components User Guide; Statistics Canada: Ottawa, ON, Canada, 2006.
Nutrients 2017,9, 274 10 of 12
Health Canada. Canadian Community Health Survey Cycle 2.2 Nutrition (2004)—A Guide to Accessing and
Interpreting the Data. Available online:
guide_escc-eng.php2006 (accessed on 14 July 2016).
Statistics Canada. Perceived Mental Health. Available online:
2009001/status/pmh-eng.htm (accessed on 14 July 2016).
Fleishman, J.A.; Zuvekas, S.H. Global self-rated mental health: Associations with other mental health
measures and with role functioning. Med. Care 2007,45, 602–609. [CrossRef] [PubMed]
World Health Organization. Mental Health: Strengthening Mental Health Promotion (Fact sheet No. 220).
Available online: (accessed on 14 July 2016).
30. Mawani, F.N.; Gilmour, H. Validation of self-rated mental health. Health Rep. 2010,21, 61–75. [PubMed]
Puyat, J.H. Is the influence of social support on mental health the same for immigrants and non-immigrants?
J. Immigr. Minor. Health 2013,15, 598–605. [CrossRef] [PubMed]
Chadwick, K.A.; Collins, P.A. Examining the relationship between social support availability, urban
center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis.
Soc. Sci. Med. 2015,128, 220–230. [CrossRef] [PubMed]
Manor, O.; Matthews, S.; Power, C. Dichotomous or categorical response? Analysing self-rated health and
lifetime social class. Int. J. Epidemiol. 2000,29, 149–157. [CrossRef] [PubMed]
Bickel, G.; Nord, M.; Price, C.; Hamilton, W.; Cook, J. Measuring Food Security in the United States: Guide
to Measuring Household Food Insecurity; Office of Analysis, Nutrition, and Evaluation, Food and Nutrition
Service, US Department of Agriculture: Alexandria, VA, USA, 2010.
Wirt, A.; Collins, C.E. Diet quality—What is it and does it matter? Public Health Nutr.
,12, 2473–2492.
[CrossRef] [PubMed]
Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements; The National
Academies Press: Washington, DC, USA, 2006.
Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Assessment; The National Academies
Press: Washington, DC, USA, 2000.
38. Health Canada. Eating Well With Canada's Food Guide; Health Canada: Ottawa, ON, Canada, 2007.
Rust, K.F.; Rao, J.N. Variance estimation for complex surveys using replication techniques. Stat. Methods
Med. Res. 1996,5, 283–310. [CrossRef] [PubMed]
Devaney, B.; Kim, M.; Carriquiry, A.; Camano-Garcia, G. Assessing the Nutrient Intakes of Vulnerable Subgroups.
Report No.: CCR11; US Department of Agriculture, Economic Research Service: Washington, DC, USA, 2005.
Rennie, K.; Coward, A.; Jebb, S. Estimating under-reporting of energy intake in dietary surveys using an
individualised method. Br. J. Nutr. 2007,97, 1169–1176. [CrossRef] [PubMed]
Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids; The National Academies Press: Washington, DC, USA, 2005.
Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride and Sulfate; The National
Academies Press: Washington, DC, USA, 2003.
Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12,
Pantothenic Acid, Biotin and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary
Reference Intakes and the Panel on Folate, Other B Vitamins and Choline and Subcommittee on Upper Reference Levels
of Nutrients; The National Academies Press: Washington, DC, USA, 1998.
Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride.
A Report
of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and the Panel on Calcium
and Related Nutrients; The National Academies Press: Washington, DC, USA, 1997.
Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper,
Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. A Report of the Panel on Antioxidants
and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of
Dietary Reference Intakes and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes;
The National Academies Press: Washington, DC, USA, 2001.
Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids; The National
Academies Press: Washington, DC, USA, 2000.
Nutrients 2017,9, 274 11 of 12
Jacka, F.N.; Mykletun, A.; Berk, M.; Bjelland, I.; Tell, G.S. The association between habitual diet quality and
the common mental disorders in community-dwelling adults: The Hordaland Health study. Psychosom. Med.
2011,73, 483–490. [CrossRef] [PubMed]
Opie, R.S.; O’Neil, A.; Itsiopoulos, C.; Jacka, F.N. The impact of whole-of-diet interventions on depression
and anxiety: A systematic review of randomised controlled trials. Public Health Nutr.
,18, 2074–2093.
[CrossRef] [PubMed]
Numakawa, T.; Richards, M.; Nakajima, S.; Adachi, N.; Furuta, M.; Odaka, H.; Kunugi, H. The role
of brain-derived neurotrophic factor in comorbid depression: Possible linkage with steroid hormones,
cytokines, and nutrition. Front. Psychiatry 2014,5, 136. [CrossRef] [PubMed]
Todorich, B.; Pasquini, J.M.; Garcia, C.I.; Paez, P.M.; Connor, J.R. Oligodendrocytes and myelination:
The role
of iron. Glia 2016,57, 467–478. [CrossRef] [PubMed]
Youdim, M.; Yehuda, S. The neurochemical basis of cognitive deficits induced by brain iron deficiency:
Involvement of dopamine-opiate system. Cell. Mol. Biol. 2000,46, 491–500. [PubMed]
Bhatnagar, S.; Taneja, S. Zinc and cognitive development. Br. J. Nutr.
,85, S139–S145. [CrossRef]
Alpert, J.E.; Fava, M. Nutrition and depression: The role of folate. Nutr. Rev.
,55, 145–149. [CrossRef]
55. Hankey, G.J.; Eikelboom, J.W. Homocysteine and vascular disease. Lancet 1999,354, 407–413. [CrossRef]
Jacobs, D.R., Jr.; Gross, M.D.; Tapsell, L.C. Food synergy: An operational concept for understanding nutrition.
Am. J. Clin. Nutr. 2009,89, 1543S–1548S. [CrossRef] [PubMed]
Public Health Agency of Canada. Folic Acid and Prevention of Neural Tube Defects. Available online: (accessed on 14 July 2016).
Weiser, S.D.; Young, S.L.; Cohen, C.R.; Kushel, M.B.; Tsai, A.C.; Tien, P.C.; Hatcher, A.M.; Frongillo, E.A.;
Bangsberg, D.R. Conceptual framework for understanding the bidirectional links between food insecurity
and HIV/AIDS. Am. J. Clin. Nutr. 2011,94, 1729S–1739S. [CrossRef] [PubMed]
Hadley, C.; Crooks, D.L. Coping and the biosocial consequences of food insecurity in the 21st century. Am. J.
Phys. Anthropol. 2012,149, 72–94. [CrossRef] [PubMed]
Beydoun, M.A.; Fanelli-Kuczmarski, M.T.; Shaked, D.; Dore, G.A.; Beydoun, H.A.; Rostant, O.S.; Evans, M.K.;
Zonderman, A.B. Alternative Pathway Analyses Indicate Bidirectional Relations between Depressive
Symptoms, Diet Quality, and Central Adiposity in a Sample of Urban US Adults. J. Nutr.
1241–1249. [CrossRef] [PubMed]
Bandura, A. Personal and collective efficacy in human adaptation and change. In Advances in Psychological
Science: Personal, Social and Cultural Aspects; Adair, J.G., Belanger, D., Dion, K.L., Eds.; Psychology Press:
Hove, UK, 1998; Volume 1, pp. 51–71.
Adriaanse, M.A.; Vinkers, C.D.; De Ridder, D.T.; Hox, J.J.; De Wit, J.B. Do implementation intentions help
to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence. Appetite
183–193. [CrossRef] [PubMed]
Stuff, J.E.; Casey, P.H.; Szeto, K.L.; Gossett, J.M.; Robbins, J.M.; Simpson, P.M.; Connell, C.; Bogle, M.L.
Household food insecurity is associated with adult health status. J. Nutr. 2004,134, 2330–2335. [PubMed]
Tarasuk, V.; Mitchell, A.; Dachner, N. Household Food Insecurity in Canada, 2012. Research to Identify Policy
Options to Reduce Food Insecurity (PROOF); University of Toronto: Toronto, ON, Canada, 2014.
Nord, M.; Hooper, M.D.; Hopwood, H. Household-level income-related food insecurity is less prevalent in
Canada than in the United States. J. Hunger Environ. Nutr. 2008,3, 17–35. [CrossRef]
Kirkpatrick, S.I.; Dodd, K.W.; Parsons, R.; Ng, C.; Garriguet, D.; Tarasuk, V. Household Food Insecurity Is
a Stronger Marker of Adequacy of Nutrient Intakes among Canadian Compared to American Youth and
Adults. J. Nutr. 2015,145, 1596–1603. [CrossRef] [PubMed]
World Health Organization (WHO). The World Health Report 2001—Mental Health: New Understanding;
World Health Organization (WHO): New Hope, Switzerland, 2001.
Black, A.P.; Brimblecombe, J.; Eyles, H.; Morris, P.; Vally, H.; O’Dea, K. Food subsidy programs and the
health and nutritional status of disadvantaged families in high income countries: A systematic review.
BMC Public Health 2012,12, 1099. [CrossRef] [PubMed]
Nutrients 2017,9, 274 12 of 12
69. Kaiser, L.; Chaidez, V.; Algert, S.; Horowitz, M.; Martin, A.; Mendoza, C.; Neelon, M.; Ginsburg, D.C. Food
Resource Management Education With SNAP Participation Improves Food Security. J. Nutr. Educ. Behav.
2015,47, 374–378. [CrossRef] [PubMed]
Institute of Medicine. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit
Adequacy; National Academies Press: Washington, DC, USA, 2013.
2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
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Supplementary resource (1)

... poor?". The variable was dichotomized as poor mental health (poor/fair responses) and good mental health (good/very good/excellent responses) as has been commonly done in various studies (19)(20)(21). Perceived mental health is an indicator for some forms of mental disorder, mental or emotional problems, or distress (22,23). It has been associated with mental morbidity measures, such as nonspecific psychological distress, depressive symptoms, activity limitations, and physical and emotional role functioning (24)(25)(26)(27). ...
... Although it appears that mental health state significantly impacts the report of energy-adjusted nutrient intakes, it is unclear whether those reporting poor mental health state are more prone to under-report food intakes due to reasons such as impairments in recall of food intake (30) or that they are simply consuming less food. In a study, which explored perceived mental health and dietary intakes in the same dataset analyzed for this study, it was reported that those reporting poorer mental health consumed diets of lower quality based on the Canadian Healthy Eating Index (20). In another study, it was indicated that intakes of vitamins B 1 , B 2 , B 6 , B 9 , B 12 , phosphorus, and zinc were significantly lower among individuals with verified mood disorders when compared to a healthy population sample (31). ...
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Background Food energy under-reporting is differentially distributed among populations. Currently, little is known about how mental health state may affect energy-adjusted nutrient intakes among food energy under-reporters. Methods Stratified analysis of energy-adjusted nutrient intake by mental health (poor vs. good) and age/sex was conducted using data from Canadian Community Health Survey (CCHS) respondents (14–70 years; n = 8,233) who were deemed as under-reporters based on Goldberg's cutoffs. Results Most were experiencing good mental health (95.2%). Among those reporting poor mental health, significantly lower energy-adjusted nutrient intakes tended to be found for fiber, protein, vitamins A, B 2 , B 3 , B 6 , B 9 , B 12 , C, and D, and calcium, potassium, and zinc (probability measures ( p ) < 0.05). For women (51–70 years), all micronutrient intakes, except iron, were significantly lower among those reporting poor mental health ( p < 0.05). For men (31–50 years), B vitamin and most mineral intakes, except sodium, were significantly lower among those reporting poor mental health ( p < 0.05). Among women (31–50 years) who reported poor mental health, higher energy-adjusted intakes were reported for vitamin B 9 and phosphorus ( p < 0.05). Conclusions Among food energy under-reporters, poor mental health tends to lower the report of specific energy-adjusted nutrient intakes that include ones critical for mental health. Future research is needed to discern if these differences may be attributed to deviations in the accurate reports of food intakes, measurement errors, or mental health states.
... Food insecurity has negative impacts on health 15 , including the function of the immune system 16,17 . The consumption of a healthy and nutritious diet, which is essential for better immune function 18 , is less common in food-insecure households 19 . In a study conducted by Larson among adults in Minnesota, reduced food security was associated with lower consumption of healthy foods, such as fruit and vegetables, and higher consumption of calorie-rich fast foods and snacks 20 . ...
... The food quality and dietary diversity of foodinsecure households are lower than food-secure ones 19,34 . A healthy diet that provides the micronutrients needed by the body contributes to the better functioning of the immune system 35 . ...
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Introduction: Food insecurity has negative impacts on health, including the function of the immune system. The association between food insecurity and COVID-19 infection rates has not been fully understood. This study aimed to examine whether food-insecure households are more vulnerable to COVID-19 infection. Materials and Methods: This online cross-sectional study was conducted on 2,871 Iranian adults (31 provinces), from August to September 2020. Demographic and socio-economic information was collected using a questionnaire. The Household Food Insecurity Access Scale (HFIAS) was used for assessing household food insecurity. The data analysis was performed by SPSS.22, using Chi-square test, ANOVA test, and Multinomial Logistic Regression Model. Results: The findings indicated that healthcare personnel were at higher risk of COVID-19 (CI = 1.90, 7.05; OR = 3.66; P < 0.001). It was also shown that HFIAS scores were significantly higher among infected people compared to non-infected (CI = 1.00, 1.05; OR = 1.03; P < 0.05). Women were at lower risk of infection compared to men (CI = 0.41, 0.87; OR = 0.60; P < 0.05). Conclusions: Based on the results, in addition to long-term policies to improve food security, policymakers are recommended to implement short-term policies to reduce the vulnerability of the community to COVID-19 virus.
... A number of studies have attempted to assess the impact of SDH components on mental health outcomes. First, there has been ample evidence about the link between food insecurity and poor mental health (Leung et al., 2015;Davison et al., 2017;Pourmotabbed et al., 2020). In a recent systematic review and meta-analysis, for example, Pourmotabbed et al. (2020) concluded that food insecurity was significantly associated with the likelihood of being stressed or depressed. ...
... Our second major finding is the impact of food insecurity on mental health. Consistent with previous studies (Leung et al., 2015;Davison et al., 2017;Pourmotabbed et al., 2020), we find those who had higher food insecurity scores showed worse mental health outcomes. Food insecurity is a consequence of limited resources and affects many households in rural areas causing malnutrition (Blue Bird Jernigan et al., 2017) and has been suggested to be a risk factor for depression (Pourmotabbed et al., 2020). ...
The present study utilised the social determinants of health (SDH) framework to see whether indicators of the framework have an impact on anxiety and depression of people living in rural Black Belt communities in Alabama. Data from a convenient sample of 159 African-Americans aged 18 or older were from two sites in rural Alabama. The levels of anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ9). Multiple linear regression model was used to examine the association between SDH and anxiety and depression level of participants. The mean PHQ9 score of participants was 5.57 out of twenty-seven. Four SDH were significantly related to PHQ9 levels amongst participants: participants with higher food insecurity scores, higher transportation needs and higher threats to interpersonal safety tended to have higher scores in PHQ9. Moreover, health literacy levels were negatively associated with PHQ9 scores amongst participants. Our study highlights understanding SDH specifically for residents in rural communities that are socially and culturally isolated is important for developing preventive approaches that enhance access to mental health treatments. A comprehensive public health policy that incorporates our study findings is needed for the rural areas of the USA.
... Food insecurity is associated with lower academic performance among community college and university students [4][5][6]. Food insecurity is associated with poor nutrition [7,8] and consumption of less fruits and vegetables [8][9][10][11]. Healthier diets, especially ones that emphasize fruits and vegetables, have been associated with academic achievement among school-aged children [12,13]. ...
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Despite community college students experiencing food insecurity there has been a dearth of research conducted on the feasibility of providing a program designed to increase access to fruits and vegetables among community colleges. This study used a mixed methods sequential explanatory design to examine the feasibility of delivering an on-campus food distribution program (FDP) to community college students and to examine the association between FDP and food insecurity and dietary intake. The study also explored the student’s experiences related to barriers and facilitators of program utilization. In phase one, the FDP occurred for eight months and students could attend twice per month, receiving up to 60 pounds of food per visit. Online questionnaires were used to collect students’ food security and dietary intake. Among the 1000 students offered the FDP, 495 students enrolled, with 329 students (66.5%) attending ≥1. Average attendance = 3.27 (SD = 3.08) [Range = 1–16] distributions. The FDP did not reduce food insecurity nor improve dietary intake. In phase two, a subsample of students (n = 36) discussed their FDP experiences through focus groups revealing three barriers limiting program utilization: program design and organization, personal schedule and transportation, and program abuse by other attendees. Facilitators to greater program utilization included: the type of food distributed and welcoming environment, along with allowing another designated individual to collect food. To maximize program use, it is suggested that reported barriers be addressed, which might positively influence food insecurity and dietary intake.
... Indeed, the present study confirms findings of prior research, wherein it was suggested that household food insecurity is a marker of nutritional vulnerability which increases the susceptibility to nutrient inadequacies [14,36,37]. A previous study in Canada has shown compromised nutrient intake among food insecure households who are struggling with food sources [38]. In relation to the food group groups consumed, the reduced nutrient intakes on total protein, iron, and B vitamins may be ascribed to the lower consumption of meat, poultry, and milk products among food insecure households since these are major food sources for the nutrients aforementioned. ...
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Food insecurity is often deeply rooted in poverty. Hence, accessibility and the quality of foods consumed may affect the dietary pattern. The study aims to assess the relationship between food insecurity and dietary consumption. This investigation analyzed the data from the 2015 Updating of Nutritional Nutrition Survey. The Household Food Insecurity Access Scale (HFIAS) was used to determine household food security status and the prevalence of food insecurity. Food weighing, food inventory, and food recall were the methods used to collect food consumption data of sampled households. The study revealed poor nutrient quality and a greater likelihood of inadequacy of nutrients among moderate and severe food insecure households. Mild, moderate, and severe levels of food insecurity were found to affect 12%, 32%, and 22% of the population, respectively. The test showed that both moderate and severe food insecure families have significantly lower mean consumption of meat, milk, and fats and oils in contrast to food secure households. In comparison with food secure households, moderate and severe food insecure households consume higher amounts of cereals and cereal products, rice, and vegetables. Moderate and severe food insecure households have higher consumption of total carbohydrates but have significantly lower average intake of vitamin A, riboflavin, niacin, and total fat related to food stable households. Moreover, the results of the multiple logistic regression revealed that food insecure households have a higher likelihood to be deficient in energy, protein, calcium, vitamin A, thiamin, riboflavin, niacin, and vitamin C intakes, but except for iron (p value <0.05). Indeed, household food insecurity was associated with the higher consumption of calorie-dense food among Filipino households. This explains a lower nutrient quality and a higher likelihood of inadequacy of nutrients among moderate and severe food insecure households.
... While the exploration of this disparity was beyond the scope of the article, it would have been useful to have this reality be made more prominent and included in the title. Food insecurity is a major determinant of diet quality (as seen in the article results) and is also associated with both mental and physical ill health and a reduced ability to manage disease (26)(27)(28) . As Canada grapples with its colonialist past's impact on health (9,29) and Indigenous people are forced to deal with historic traumas recently evidenced by the gruesome discoveries of unmarked children's burial sites close to some of the infamous residential schools (30) , the Indigenous population continues to also pay the price of continuing discrimination with suboptimal health, social, and economic outcomes (31) . ...
This overview focuses on food security issues for older adults in selected countries where sufficient evidence-based data were available and on food insecurity and the homeless in the United Kingdom, Canada, and the United States. Specific requirements for older adults were taken from the scientific literature for countries categorized as developed, developing, or in transition. The introduction was structured for scope, food access, cause and effect of food insecurity, sociodemography, dietary intervention and health, satellite technology production and consumption, traditional plants and diets, and near-horizon advances for the 21st century. The unit level was the individual, male and female, household/family, community or tribe, and ethic group. Barriers to food access included low income and lack of transportation to urban retail outlets. Traditional edible wild plant diets were identified as food supplements. Relevant outcomes included incidences of cardiovascular disease, mental health, the obesity paradox, frailty, and HIV/AIDS. Appropriate national and state advisory schemes were identified in some examples, and outcomes were documented. Design methodologies using information technology were developed in relation to spatial modeling of urban retail outlets, telemedicine, agriculture, and weather forecasting.
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Objective This study investigated if the coronavirus disease (COVID-19) pandemic influenced college student food insecurity and factors that might contribute to a student becoming newly food insecure. Design A convenience sample was assessed using a cross-sectional survey. Setting Online. Participants College students (n = 2,018) enrolled at a land-grant institution in Appalachia. Main Outcome Measure(s) Food insecurity was assessed using the Hunger Vital Sign with reference before COVID-19 and since COVID-19. Demographic and pandemic-specific questions and their associations with food insecurity status were assessed. Analysis Students were categorized as food secure (food secure before and since COVID-19 or food insecure in the year before COVID-19 but not food insecure since COVID-19), consistently food insecure (food insecure before and since COVID-19), and newly food insecure (food secure before but food insecure since COVID-19). Multivariate logistic regression was used to investigate the relationship between new food insecurity and contributing factors. Results Of respondents, 68.4% were food secure, 16.5% were consistently food insecure, and 15.1% were newly food insecure. Loss of employment, increased grocery expenditure, anxiety, and a perceived threat posed by COVID-19 were significant indicators of students being newly food insecure. Conclusions and Implications More students were facing food insecurity as a result of the COVID-19 pandemic. Continued advocacy for sustainable solutions to college food insecurity is needed.
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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.
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Food insecurity is interrelated with low food supply consumption which has the high disposition to poor diet quality. However, less study has been done in assessing the relationship between food insecurity and diet quality of children in Malaysia. Therefore, this study objectives are to determine the food insecurity level and diet quality of children from B40 families in Kedah. This cross-sectional study was carried out among 106 children aged 7 – 12 years old from one selected district in Pendang, Kedah. Radimer/Cornell Hunger was used to determine food insecurity level of the children, while diet quality of the children was assessed by applying modified Healthy Eating Index (HEI) 2005. Based on the result, 43.4% of the household were categorized as food secure while 56.6% were food insecure. Those food insecure were classified into three levels and the study found that 61.0% were household food insecure, 28.0% were individual food insecure and 11.0% of the household were child hungry. About 28.3% of them had poor diet quality, 69.8% of them had diet that needs improvements and only 1.9% of them had good diet quality. However, there was no significant relationship found between food insecurity and diet quality of these children (p = 0.436). This is somehow indicated that food insecurity does not reflect the diet quality of children from the B40 families in this study.
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Concerted efforts have been made in recent years to achieve equity and equality in mental health for all people across the globe. This has led to the emergence of Global Mental Health as an area of study and practice. The momentum that this has created has contributed to the development, implementation and evaluation of services for priority mental disorders in many low- and middle-income countries. This paper discusses two related issues that may be serving to limit the success of mental health initiatives across the globe, and proposes potential solutions to these issues. First, there has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted. The second limitation relates to the lack of an overarching theoretical framework guiding efforts to reduce inequalities and inequities in mental health across the globe. This paper discusses the potential impact that the Capabilities Approach (CA) could have for addressing both of these issues. As a framework for human development, the CA places emphasis on promoting wellbeing through enabling people to realise their capabilities and engage in behaviours that they subjectively value. The utilization of the CA to guide the development and implementation of mental health interventions can help Global Mental Health initiatives to identify sources of social inequality and structural violence that may impede freedom and individuals’ opportunities to realise their capabilities.
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Background: Temporality between socioeconomic status (SES), depressive symptoms (DS), dietary quality (DQ), and central adiposity (CA) is underexplored. Objectives: Alternative pathways linking SES to DQ, DS, and CA were tested and models compared, stratified by race and sex. Methods: With the use of data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (baseline age: 30-64 y; 2 visits; mean follow-up: 4.9 y), 12 structural equation models (SM) were conducted and compared. Time-dependent factors included the Center for Epidemiologic Studies-Depression [CES-D total score, baseline or visit 1 (v1), follow-up or visit 2 (v2), mean across visits (m), and annual rate of change (Δ)], 2010 Healthy Eating Index (HEI) (same notation), and central adiposity principal components' analysis score of waist circumference and trunk fat (kg) (Adipcent) (same notation). Sample sizes were white women (WW, n = 236), white men (WM, n = 159), African American women (AAW, n = 395), and African American men (AAM, n = 274), and a multigroup analysis within the SM framework was also conducted. Results: In the best-fitting model, overall, ∼31% of the total effect of SES→Adipcent(v2) (α ± SE: -0.10 ± 0.03, P < 0.05) was mediated through a combination of CES-D(v1) and ΔHEI. Two dominant pathways contributed to the indirect effect: SES→(-)CES-D(v1)→(+)Adipcent(v2) (-0.015) and SES→(+) ΔHEI→(-)Adipcent(v2) (-0.017), with a total indirect effect of -0.031 (P < 0.05). In a second best-fitting model, SES independently predicted Adipcent(v1, -0.069), ΔHEI(+0.037) and CES-D(v2, -2.70) (P < 0.05), with Adipcent(v1) marginally predicting ΔHEI(-0.014) and CES-D(v2, +0.67) (P < 0.10). These findings were indicative of DS's and CA's marginally significant bidirectional association (P < 0.10). Although best-fit-selected models were consistent across race × sex categories, path coefficients differed significantly between groups. Specifically, SES→Adipcent[v1(+0.11), v2(+0.14)] was positive among AAM (P < 0.05), and the overall positive association of Adipcent(v1)→CES-D(v2) was specific to AAW (+0.97, P < 0.10). Conclusions: Despite consistent model fit, pathways linking SES to DQ, DS, and CA differed markedly among the race × sex groups. Our findings can inform the potential effectiveness of various mental health and dietary interventions.
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Because little is known about food insecurity in people with mental health conditions, we investigated relationships among food insecurity, nutrient intakes, and psychological functioning in adults with mood disorders. Data from a study of adults randomly selected from the membership list of the Mood Disorder Association of British Columbia (n = 97), Canada, were analyzed. Food insecurity status was based on validated screening questions asking if in the past 12 months did the participant, due to a lack of money, worry about or not have enough food to eat. Nutrient intakes were derived from 3-day food records and compared to the Dietary Reference Intakes (DRIs). Psychological functioning measures included Global Assessment of Functioning, Hamilton Depression scale, and Young Mania Rating Scale. Using binomial tests of two proportions, Mann-Whitney U tests, and Poisson regression we examined: (1) food insecurity prevalence between the study respondents and a general population sample from the British Columbia Nutrition Survey (BCNS; n = 1,823); (2) differences in nutrient intakes based on food insecurity status; and (3) associations of food insecurity and psychological functioning using bivariate and Poisson regression statistics. In comparison to the general population (BCNS), food insecurity was significantly more prevalent in the adults with mood disorders (7.3% in BCNS vs 36.1%; p < 0.001). Respondents who were food-insecure had lower median intakes of carbohydrates and vitamin C (p < 0.05). In addition, a higher proportion of those reporting food insecurity had protein, folate, and zinc intakes below the DRI benchmark of potential inadequacy (p < 0.05). There was significant association between food insecurity and mania symptoms (adjusted prevalence ratio = 2.37, 95% CI 1.49-3.75, p < 0.05). Food insecurity is associated with both nutritional and psychological health in adults with mood disorders. Investigation of interventions aimed at food security and income can help establish its role in enhancing mental health.
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Gut microbiota regulate intestinal function and health. However, mounting evidence indicates that they can also influence the immune and nervous systems and vice versa. This article reviews the bidirectional relationship between the gut microbiota and the brain, termed the microbiota-gut-brain (MGB) axis, and discusses how it contributes to the pathogenesis of certain disorders that may involve brain inflammation. Articles were identified with a search of Medline (starting in 1980) by using the key words anxiety, attention-deficit hypersensitivity disorder (ADHD), autism, cytokines, depression, gut, hypothalamic-pituitary-adrenal (HPA) axis, inflammation, immune system, microbiota, nervous system, neurologic, neurotransmitters, neuroimmune conditions, psychiatric, and stress. Various afferent or efferent pathways are involved in the MGB axis. Antibiotics, environmental and infectious agents, intestinal neurotransmitters/neuromodulators, sensory vagal fibers, cytokines, and essential metabolites all convey information to the central nervous system about the intestinal state. Conversely, the hypothalamic-pituitary-adrenal axis, the central nervous system regulatory areas of satiety, and neuropeptides released from sensory nerve fibers affect the gut microbiota composition directly or through nutrient availability. Such interactions seem to influence the pathogenesis of a number of disorders in which inflammation is implicated, such as mood disorder, autism-spectrum disorders, attention-deficit hypersensitivity disorder, multiple sclerosis, and obesity. Recognition of the relationship between the MGB axis and the neuroimmune systems provides a novel approach for better understanding and management of these disorders. Appropriate preventive measures early in life or corrective measures such as use of psychobiotics, fecal microbiota transplantation, and flavonoids are discussed. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
Responding to the expansion of scientific knowledge about the roles of nutrients in human health, the Institute of Medicine has developed a new approach to establish Recommended Dietary Allowances (RDAs) and other nutrient reference values. The new title for these values Dietary Reference Intakes (DRIs), is the inclusive name being given to this new approach. These are quantitative estimates of nutrient intakes applicable to healthy individuals in the United States and Canada. This new book is part of a series of books presenting dietary reference values for the intakes of nutrients. It establishes recommendations for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. This book presents new approaches and findings which include the following: The establishment of Estimated Energy Requirements at four levels of energy expenditure Recommendations for levels of physical activity to decrease risk of chronic disease The establishment of RDAs for dietary carbohydrate and protein The development of the definitions of Dietary Fiber, Functional Fiber, and Total Fiber The establishment of Adequate Intakes (AI) for Total Fiber The establishment of AIs for linolenic and a-linolenic acids Acceptable Macronutrient Distribution Ranges as a percent of energy intake for fat, carbohydrate, linolenic and a-linolenic acids, and protein Research recommendations for information needed to advance understanding of macronutrient requirements and the adverse effects associated with intake of higher amounts Also detailed are recommendations for both physical activity and energy expenditure to maintain health and decrease the risk of disease. © 2002/2005 by the National Academy of Sciences. All rights reserved.
For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families. In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA's Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task. © 2013 by the National Academy of Sciences. All rights reserved.
Purpose: Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates. Methods: We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder. Results: There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06-1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42-2.23) food insecurity. Conclusions: The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.