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A combined high-sugar and high-saturated-fat dietary pattern is associated with more depressive symptoms in a multi-ethnic population: the HELIUS (Healthy Life in an Urban Setting) study

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Abstract

Objective To identify a high-sugar (HS) dietary pattern, a high-saturated-fat (HF) dietary pattern and a combined high-sugar and high-saturated-fat (HSHF) dietary pattern and to explore if these dietary patterns are associated with depressive symptoms. Design We used data from the HELIUS (Healthy Life in an Urban Setting) study and included 4969 individuals aged 18–70 years. Diet was assessed using four ethnic-specific FFQ. Dietary patterns were derived using reduced rank regression with mono- and disaccharides, saturated fat and total fat as response variables. The nine-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms by using continuous scores and depressed mood (identified using the cut-off point: PHQ-9 sum score ≥10). Setting The Netherlands. Results Three dietary patterns were identified; an HSHF dietary pattern (including chocolates, red meat, added sugars, high-fat dairy products, fried foods, creamy sauces), an HS dietary pattern (including sugar-sweetened beverages, added sugars, fruit (juices)) and an HF dietary pattern (including high-fat dairy products, butter). When comparing extreme quartiles, consumption of an HSHF dietary pattern was associated with more depressive symptoms (Q1 v . Q4: β =0·18, 95 % CI 0·07, 0·30, P =0·001) and with higher odds of depressed mood (Q1 v . Q4: OR=2·36, 95 % CI 1·19, 4·66, P =0·014). No associations were found between consumption of the remaining dietary patterns and depressive symptoms. Conclusions Higher consumption of an HSHF dietary pattern is associated with more depressive symptoms and with depressed mood. Our findings reinforce the idea that the focus should be on dietary patterns that are high in both sugar and saturated fat.

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... We defined an HSHF dietary pattern, based on baseline dietary intake. A previous study showed that such an HSHF dietary pattern was associated with more depressive symptoms in this multi-ethnic population [22]. Due to the high co-morbidity between depression and T2D [23], we expected that this pattern might also contribute to ethnic differences in the burden of T2D. ...
... The HSHF dietary pattern was derived using Reduced Rank Regression (RRR; [22]). RRR is a statistical method that derives latent variables (dietary patterns) from a set of predictor variables (food groups) that explain the maximum variation in another set of variables known as response variables (nutrients). ...
... RRR is an established method to derive dietary patterns and has been increasingly used in nutritional epidemiology [26]. Specifically, the HSHF dietary pattern used in this paper was originally derived in this population by Vermeulen et al. in a study of diet and depression [22]. RRR has some similarities with Principal Component Analysis (PCA) in that it is a reduction method that derives a latent variable. ...
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The risk for type 2 diabetes (T2D) in ethnic minorities in Europe is higher in comparison with their European host populations. The western dietary pattern, characterized by high amounts of sugar and saturated fat (HSHF dietary pattern), has been associated with a higher risk for T2D. Information on this association in minority populations is scarce. Therefore, we aimed to investigate the HSHF dietary pattern and its role in the unequal burden of T2D prevalence in a multi-ethnic population in The Netherlands. We included 4694 participants aged 18–70 years of Dutch, South-Asian Surinamese, African Surinamese, Turkish, and Moroccan origin from the HELIUS study. Dutch participants scored the highest on the HSHF dietary pattern, followed by the Turkish, Moroccan, African Surinamese, and South-Asian Surinamese participants. Prevalence ratios (PR) for T2D were then calculated using multivariate cox regression analyses, adjusted for sociodemographic, anthropometric, and lifestyle factors. Higher adherence to an HSHF diet was not significantly related to T2D prevalence in the total study sample (PR 1.04 high versus low adherence, 95% CI: 0.80–1.35). In line, adjustment for HSHF diet score did not explain the ethnic differences in T2D. For instance, the PR of the South-Asian Surinamese vs. Dutch changed from 2.76 (95% CI: 2.05–3.72) to 2.90 (95% CI: 2.11–3.98) after adjustment for HSHF. To conclude, a western dietary pattern high in sugar and saturated fat was not associated with T2D, and did not explain the unequal burden in prevalence of T2D across the ethnic groups.
... Previous prospective studies of the relation between the independent contribution of sugar and saturated fat to depression found that sugar intake [by studying sweet foods and beverages (8) and the glycemic index (9)] and saturated fat intake (10) were associated with higher depressive symptoms. However, it is difficult to determine the effect of single nutrients in examining diet-disease relations (11) because people consume dietary patterns that consist of complex combinations of nutrients that are highly correlated and interact with each other (12). Moreover, it is difficult to distinguish between a sugar and a saturated fat dietary pattern because many foods contain both macronutrients and the restriction of 1 macronutrient implies the increase of another macronutrient to maintain energy balance (13). ...
... A previous study showed that a "combined high-sugar and saturated-fat" dietary pattern was associated with higher depressive symptoms and depressed mood in a multiethnic population by using reduced rank regression (RRR) (11). However, due to the cross-sectional nature of this study, reverse causation may have been present. ...
... All response variables were logtransformed because they were not normally distributed. In total, 34 food groups were created on the basis of nutrient profile and previous studies on dietary patterns and depression (Supplemental Table 1) (3,11). All 34 food groups received a factor loading, but for simplicity, we reported only the food groups that loaded highly (≥0.20) and which we considered as being characteristic of the respective dietary pattern. ...
Article
Background: The consumption of unhealthy "Western" dietary patterns has been previously associated with depressive symptoms in different populations. Objective: We examined whether high-sugar and high-saturated-fat dietary patterns are associated with depressive symptoms over 5 y in a British cohort of men and women. Methods: We used data from the Whitehall II study in 5044 individuals (aged 35-55 y). Diet was assessed at phase 7 (2003-2004) using a validated food-frequency questionnaire. Dietary patterns were derived by using reduced rank regression with sugar, saturated fat, and total fat as response variables. The Center for Epidemiological Studies-Depression (CES-D) scale was used to assess depressive symptoms (CES-D sum score ≥16 and/or use of antidepressant medication) at phase 7 and at phase 9 (2008-2009). We applied logistic regression analyses to test the association between dietary patterns and depressive symptoms. All analyses were stratified by sex. Results: In total, 398 cases of recurrent and 295 cases of incident depressive symptoms were observed. We identified 2 dietary patterns: a combined high-sugar and high-saturated-fat (HSHF) and a high-sugar dietary pattern. No association was observed between the dietary patterns and either incidence of or recurrent depressive symptoms in men or women. For example, higher consumption of the HSHF dietary pattern was not associated with recurrent depressive symptoms in men (model 3, quartile 4: OR: 0.67; 95% CI: 0.36, 1.23; P-trend = 0.13) or in women (model 3, quartile 4: OR: 1.26; 95% CI: 0.58, 2.77; P-trend = 0.97). Conclusion: Among middle-aged men and women living in the United Kingdom, dietary patterns containing high amounts of sugar and saturated fat are not associated with new onset or recurrence of depressive symptoms.
... Previous studies have suggested that unhealthy dietary choice could affect one's biology, leading to the development of depression. The western and high fat and high sugar dietary patterns have been found to be associated with a higher risk of depression [40][41][42][43][44]; however, some reports did not find this association [45]. The 'comfort food hypothesis' suggests that chronic stress can promote a coping strategy leading to higher macronutrient intake and preference towards food containing more carbohydrates and saturated fats. ...
... To avoid recall bias and add objective measures to the results, this measure should be complemented by peripheral blood assays to obtain precision with respect to the biological availability of nutrients. Our findings on the associations between psychosocial factors and micronutrients intakes are supported by previous studies in other populations [40][41][42][43][44][54][55][56][57][58][59]64,65]. However, given the number of comparisons made, they should be considered as preliminary and in need of confirmation by future studies. ...
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Adolescent pregnant women are at greater risk for nutritional deficits, stress, and depression than their adult counterparts, and these risk factors for adverse pregnancy outcomes are likely interrelated. This study evaluated the prevalence of nutritional deficits in pregnant teenagers and assessed the associations among micronutrient dietary intake, stress, and depression. One hundred and eight pregnant Latina adolescents completed an Automated Self-Administered 24-hour dietary recall (ASA24) in the 2nd trimester. Stress was measured using the Perceived Stress Scale and the Prenatal Distress Questionnaire. Depressive symptoms were evaluated with the Reynolds Adolescent Depression Scale. Social support satisfaction was measured using the Social Support Questionnaire. More than 50% of pregnant teenagers had an inadequate intake (excluding dietary supplement) of folate, vitamin A, vitamin E, iron, zinc, calcium, magnesium, and phosphorous. Additionally, >20% of participants had an inadequate intake of thiamin, riboflavin, niacin, vitamin B6, vitamin B12, vitamin C, copper, and selenium. Prenatal supplement inclusion improved dietary intake for most micronutrients except for calcium, magnesium, and phosphorous, (>50% below the Estimated Average Requirement (EAR)) and for copper and selenium (>20% below the EAR). Higher depressive symptoms were associated with higher energy, carbohydrates, and fats, and lower magnesium intake. Higher social support satisfaction was positively associated with dietary intake of thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, vitamin C, vitamin E, iron, and zinc. The findings suggest that mood and dietary factors are associated and should be considered together for health interventions during adolescent pregnancy for the young woman and her future child.
... A subsequent study of 15,546 Spanish university graduates likewise observed a heightened risk of depression among the heaviest consumers of sugar over a 10-year follow-up [20], and another recent cohort study also reported a positive association between sugar intake and the onset of future depressive symptoms [21]. Conversely, two recent cohort studies failed to find the hypothesized association [22,23]: Gopinath et al. [22] did not find a statistically significant association between total sugar intake and depressive symptoms, while Vermeulen et al. [23] similarly found no relationship between symptoms and a high-sugar dietary pattern. It should be noted, however, that unlike the aforementioned supporting studies [18,19,20], the two contrary studies [22,24] did not specifically examine the impact of added sugars, per se. ...
... A subsequent study of 15,546 Spanish university graduates likewise observed a heightened risk of depression among the heaviest consumers of sugar over a 10-year follow-up [20], and another recent cohort study also reported a positive association between sugar intake and the onset of future depressive symptoms [21]. Conversely, two recent cohort studies failed to find the hypothesized association [22,23]: Gopinath et al. [22] did not find a statistically significant association between total sugar intake and depressive symptoms, while Vermeulen et al. [23] similarly found no relationship between symptoms and a high-sugar dietary pattern. It should be noted, however, that unlike the aforementioned supporting studies [18,19,20], the two contrary studies [22,24] did not specifically examine the impact of added sugars, per se. ...
Article
Added sugars are ubiquitous in contemporary Western diets. Although excessive sugar consumption is now robustly associated with an array of adverse health consequences, comparatively little research has thus far addressed its impact on the risk of mental illness. But ample evidence suggests that high-dose sugar intake can perturb numerous metabolic, inflammatory, and neurobiological processes. Many such effects are of particular relevance to the onset and maintenance of depressive illness, among them: systemic inflammation, gut microbiota disruption, perturbed dopaminergic reward signaling, insulin resistance, oxidative stress, and the generation of toxic advanced glycation end-products (AGEs). Accordingly, we hypothesize that added dietary sugars carry the potential to increase vulnerability to major depressive disorder, particularly at high levels of consumption. The present paper: (a) summarizes the existing experimental and epidemiological research regarding sugar consumption and depression vulnerability; (b) examines the impact of sugar ingestion on known depressogenic physiological processes; and (c) outlines the clinical and theoretical implications of the apparent sugar-depression link. We conclude that the extant literature supports the hypothesized depressogenic impact of added dietary sugars, and propose that an improved understanding of the effects of sugar on body and mind may aid in the development of novel therapeutic and preventative measures for depression.
... This suggests a potential mechanism whereby LHb activity is entrained by diet, with post-feeding surges in insulin causing increased IRS-1 signalling and thus changes in Kir4.1 expression (Crosby et al., 2019). Such a process could also explain how high-sugar diets may exacerbate depression (Vermeulen et al., 2017). ...
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The neural circadian system consists of the master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN) communicating time of day cues to the rest of the body including other brain areas that also rhythmically express circadian clock genes. Over the past 16 years, evidence has emerged to indicate that the habenula of the epithalamus is a candidate extra-SCN circadian oscillator. When isolated from the SCN, the habenula sustains rhythms in clock gene expression and neuronal activity, with the lateral habenula expressing more robust rhythms than the adjacent medial habenula. The lateral habenula is responsive to putative SCN output factors as well as light information conveyed to the perihabenula area. Neuronal activity in the lateral habenula is altered in depression and intriguingly disruptions in circadian rhythms can elevate risk of developing mental health disorders including depression. In this review, we will principally focus on how circadian and light signals affect the lateral habenula and evaluate the possibility that alteration in these influences contribute to mental health disorders.
... Systematic reviews and meta-analysis of longitudinal studies indicate that obesity increases the risk for onset of depression by 55% and depression increases the risk for obesity onset by 58% . Although not all results are consistent, epidemiological data also suggest that a higher quality diet lowers the risk of onset of depressive symptoms (Molendijk et al., 2018) while consumption of high-sugar and high-saturated-fat diets is associated with greater depressive symptoms and depressed mood (Vermeulen et al., 2017). A couple of intervention studies also show that improvements in dietary quality (Mediterraneanstyle diet) led to improvements in depressive symptoms in adults (Opie et al., 2017;Parletta et al., 2017), further supporting the role of diet in depression. ...
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Obesity continues to be one of the major public health problems due to its high prevalence and co-morbidities. Common co-morbidities not only include cardiometabolic disorders but also mood and cognitive disorders. Obese subjects often show deficits in memory, learning and executive functions compared to normal weight subjects. Epidemiological studies also indicate that obesity is associated with a higher risk of developing depression and anxiety, and vice versa. These associations between pathologies that presumably have different etiologies suggest shared pathological mechanisms. Gut microbiota is a mediating factor between the environmental pressures (e.g., diet, lifestyle) and host physiology, and its alteration could partly explain the cross-link between those pathologies. Westernized dietary patterns are known to be a major cause of the obesity epidemic, which also promotes a dysbiotic drift in the gut microbiota; this, in turn, seems to contribute to obesity-related complications. Experimental studies in animal models and, to a lesser extent, in humans suggest that the obesity-associated microbiota may contribute to the endocrine, neurochemical and inflammatory alterations underlying obesity and its comorbidities. These include dysregulation of the HPA-axis with overproduction of glucocorticoids, alterations in levels of neuroactive metabolites (e.g., neurotransmitters, short-chain fatty acids) and activation of a pro-inflammatory milieu that can cause neuro-inflammation. This review updates current knowledge about the role and mode of action of the gut microbiota in the cross-link between energy metabolism, mood and cognitive function.
... For generations, unhealthy dietary patterns and a sedentary lifestyle have become major contributors to the increased prevalence of non-communicable diseases (NCDs), particularly of obesity and other cardiometabolic disorders [2,3]. Emerging evidence suggests that dietary habits, high-sugar and saturated-fat, also contribute to anxiety and mood disorders, which show bidirectional associations with obesity [4]. Diet is, on the other hand, one of the key environmental factors shaping the flexible fraction of our gut microbiota and its functions [5]. ...
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The gut microbiota coexists in partnership with the human host through adaptations to environmental and physiological changes that help maintain dynamic homeostatic healthy states. Break-down of this delicate balance under sustained exposure to stressors (e.g. unhealthy diets) can, however, contribute to the onset of disease. Diet is a key modifiable environmental factor that modulates the gut microbiota and its metabolic capacities that, in turn, could impact human physiology. On this basis, the diet and the gut microbiota could act as synergistic forces that provide resilience against disease or that speed the progress from health to disease states. Associations between unhealthy dietary patterns, non-communicable diseases and intestinal dysbiosis can be explained by this hypothesis. Translational studies showing that dietary-induced alterations in microbial communities recapitulate some of the pathological features of the original host further support this notion. In this introductory paper by the European project MyNewGut, we briefly summarize the investigations conducted to better understand the role of dietary patterns and food components in metabolic and mental health and the specificities of the microbiome-mediating mechanisms. We also discuss how advances in the understanding of the microbiome's role in dietary health effects can help to provide acceptable scientific grounds on which to base dietary advice for promoting healthy living.
... Stress and depressive symptoms have been shown to alter eating patterns, resulting in increased selection of less-nutritious food, particularly food high in fat and sugar, and processed foods, and decreased selection of fruits and vegetables (reviewed in Baskin et al. 2015). Previous studies have suggested that a diet high in fats and sugar could affect one's biology, leading to the development of depression (Sánchez-Villegas et al. 2011Vermeulen et al. 2017). ...
Article
The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress—defined broadly to include perceived stress, life events, depression, and anxiety—on fetal and infant brain–behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth. Expected final online publication date for the Annual Review of Clinical Psychology Volume 15 is May 7, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... High BMI indexes correlate with chronic diseases such as hypertension, dyslipidemia, type 2 diabetes, cardiovascular diseases, and metabolic syndrome, as well as development of some type of cancers [16]. Emerging evidence suggests that dietary habits, high-sugar and saturated fat, also contribute to anxiety and mood disorders, which show bi-directional associations with obesity [17,18]. ...
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Obesity is a global pandemic complex to treat due to its multifactorial pathogenesis—an unhealthy lifestyle, neuronal and hormonal mechanisms, and genetic and epigenetic factors are involved. Scientific evidence supports the idea that obesity and metabolic consequences are strongly related to changes in both the function and composition of gut microbiota, which exert an essential role in modulating energy metabolism. Modifications of gut microbiota composition have been associated with variations in body weight and body mass index. Lifestyle modifications remain as primary therapy for obesity and related metabolic disorders. New therapeutic strategies to treat/prevent obesity have been proposed, based on pre- and/or probiotic modulation of gut microbiota to mimic that found in healthy non-obese subjects. Based on human and animal studies, this review aimed to discuss mechanisms through which gut microbiota could act as a key modifier of obesity and related metabolic complications. Evidence from animal studies and human clinical trials suggesting potential beneficial effects of prebiotic and various probiotic strains on those physical, biochemical, and metabolic parameters related to obesity is presented. As a conclusion, a deeper knowledge about pre-/probiotic mechanisms of action, in combination with adequately powered, randomized controlled follow-up studies, will facilitate the clinical application and development of personalized healthcare strategies.
... Other evidence for associations of meat consumption with depression comes from studies investigating Western dietary pattern as a whole [41], rather than its single components (i.e., high intake of red and processed meat, refined grains, sweets and high fat dairy products). Our finding of a lack of association with high fat dairy products and red/processed meat suggests that perhaps the other elements of the Western diet, namely high sugar and fat consumption, drive the association between a Western dietary pattern and depressive symptom, which has been confirmed by other studies [42,43]. ...
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Purpose Adherence to the Mediterranean diet has been associated with fewer depressive symptoms, however, it is unknown whether this is attributed to some or to all components. We examined the association between the individual food groups of the Mediterranean Diet Score (MDS), in isolation and in combination, with depression and anxiety (symptom severity and diagnosis). Methods Data from 1634 adults were available from the Netherlands Study of Depression and Anxiety. Eleven energy-adjusted food groups were created from a 238-item food frequency questionnaire. In regression analysis, these were associated in isolation and combination with (1) depressive and anxiety disorders (established with the Composite International Diagnostic Interview) (current disorder n = 414), and (2) depression and anxiety severity [measured with the Inventory of Depressive Symptomatology (IDS), the Beck Anxiety Inventory (BAI) and the Fear Questionnaire (FEAR)]. Results Overall, the MDS score shows the strongest relationships with depression/anxiety [Diagnosis: odds ratio (OR) 0.77 per SD, 95% confidence interval (95% CI) 0.66–0.90, IDS: standardised betas (β) − 0.13, 95% CI − 0.18, − 0.08] and anxiety (BAI: β − 0.11, 95% CI − 0.16, − 0.06, FEAR: β − 0.08, 95% CI − 0.13, − 0.03). Greater consumption of non-refined grains and vegetables was associated with lower depression and anxiety severity, whilst being a non-drinker was associated with higher symptom severity. Higher fruit and vegetable intake was associated with lower fear severity. Non-refined grain consumption was associated with lower odds and being a non-drinker with greater odds of current depression/anxiety disorders compared to healthy controls, these associations persisted after adjustment for other food groups (OR 0.82 per SD, 95% CI 0.71–0.96, OR 1.26 per SD 95% CI 1.08–1.46). Conclusion We can conclude that non-refined grains, vegetables and alcohol intake appeared to be the driving variables for the associated the total MDS score and depression/anxiety. However, the combined effect of the whole diet remains important for mental health. It should be explored whether an increase consumption of non-refined grains and vegetables may help to prevent or reduce depression and anxiety.
... The western, high fat-high sugar, and sweet dietary patterns have been reported to be related to higher odds for depression (34)(35)(36)(37); though, some studies did not reveal such a relationship (38). In the study by Grossniklaus et al. (39), increased depressive symptoms, independently predicted increased food and beverage energy density, and explained variance above that explained by male gender, younger age, and reporting adequate caloric intake. ...
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Objectives: Mental health, sleep quality and dietary intake are interlinked. Impairment of mental health and low sleep quality may contribute to obesity through the consumption of diets high in energy density. Nevertheless, it is not clear whether dietary energy density (DED) influences mental health. This study aimed to examine the association of DED with mental health indices, including depression, anxiety, stress, and sleep quality in overweight/obese women. Results: After adjustment for age, BMI, and physical activity, subjects in the highest quartile of DED had higher systolic and diastolic blood pressure, but lower serum triglyceride, than those in the lowest quartile (p <0.05). DED was significantly associated with increased odds of stress in the crude (OR =2.15, 95%CI: 1.01-4.56, p= 0.04) and adjusted model for age, BMI, and physical activity (OR = 2.56, 95%CI: 1.13-5.79, p=0.02). No significant relationship was observed between DED and depression, anxiety and sleep quality.
... The western, high fat-high sugar and sweet dietary patterns have been reported to be related to higher odds for depression (38)(39)(40)(41); though, some studies did not reveal such a relationship (42). ...
Preprint
Full-text available
Objectives : Mental health, sleep quality and dietary intake are interlinked. Impairment of mental health and low sleep quality may contribute to obesity through the consumption of diets high in energy density. Nevertheless, it is not clear whether dietary energy density (DED) influences mental health. This study aimed to examine the association of DED with mental health indices, including depression, anxiety, stress, and sleep quality in overweight/obese women. Results: After adjustment for age, BMI, and physical activity, subjects in the highest quartile of DED had higher systolic and diastolic blood pressure, but lower serum triglyceride, than those in the lowest quartile (p <0.05). DED was significantly associated with increased odds of stress in the crude (OR =2.15, 95%CI: 1.01-4.56, p= 0.04) and adjusted model for age, BMI, and physical activity (OR = 2.56, 95%CI: 1.13-5.79, p=0.02). No significant relationship was observed between DED and depression, anxiety and sleep quality.
... The western, high fat-high sugar and sweet dietary patterns have been reported to be related to higher odds for depression [38][39][40][41]; though, some studies did not reveal such a relationship [42]. ...
Preprint
Full-text available
Objectives : Mental health, sleep quality and dietary intake are interlinked. Impairment of mental health and low sleep quality may contribute to obesity through the consumption of diets high in energy density. Nevertheless, it is not clear whether dietary energy density (DED) influences mental health. This study aimed to examine the association of DED with mental health indices, including depression, anxiety, stress, and sleep quality in overweight/obese women. Results: After adjustment for age, BMI, and physical activity, subjects in the highest quartile of DED had higher systolic and diastolic blood pressure, but lower serum triglyceride, than those in the lowest quartile (p <0.05). DED was significantly associated with increased odds of stress in the crude (OR =2.15, 95%CI: 1.01-4.56, p= 0.04) and adjusted model for age, BMI, and physical activity (OR = 2.56, 95%CI: 1.13-5.79, p=0.02). No significant relationship was observed between DED and depression, anxiety and sleep quality.
... The western, high fat-high sugar and sweet dietary patterns have been reported to be related to higher odds for depression [38][39][40][41]; though, some studies did not reveal such a relationship [42]. Grossniklaus et al. [43], in a study on 87 overweight, working adults; with mean age 41.3 ± 10.2 years; BMI 32.1 ± 6.1 kg/m 2 ; 73.6% women, reported that increased depressive symptoms predicted increased food and beverage energy density. ...
Article
Full-text available
Objective: Mental health, sleep quality, and dietary intake are interlinked. Impairment of mental health and low sleep quality may contribute to obesity through the consumption of diets high in energy density. Nevertheless, it is not clear whether dietary energy density (DED) influences mental health. This study aimed to examine the association of DED with mental health indices, including depression, anxiety, stress, and sleep quality in women with overweight/obesity. Results: There was a decreasing trajectory in serum triglyceride across quartiles of DED (from Q1 to Q4) in the crude analysis and also after adjustment for age, BMI, and physical activity After adjustment for age, BMI, and physical activity, subjects in the highest quartile of DED had higher systolic and diastolic blood pressure. DED was significantly associated with increased odds of stress in the crude (OR = 2.15, 95% CI 1.01-4.56, p = 0.04) and adjusted model for age, BMI, and physical activity (OR = 2.56, 95% CI 1.13-5.79, p = 0.02). No significant relationship was observed between DED and depression, anxiety and sleep quality. In conclusion, current study shows preliminary evidence of an association between DED and stress.
... associated with poor diet and insufficient physical exercise leading to energy imbalance between calories intake and calories expended, involving a complex interaction among life style, genetics, epigenetics, neuronal and hormonal mechanism, and the environment [8,9]. Emerging evidence suggests that dietary habits like high-sugar food and saturated fats, trans-fatty acids increases the risk of chronic vascular disease by elevating blood serum concentrations of total and LDL cholesterol, contributing to anxiety and mood disorders presenting a bi-directional associations with obesity [10]. With host genetics, factors like geographical location, stress across the life span, age and gender, excessive/inappropriate antibiotics or drug use, consequences of socioeconomic development like increased sedentariness or less physical activity has become a threat to the diversity of the gut microbiome ( Figure 1). ...
... Pandemi ortamında veya sosyal izolasyon koşullarında bireylerde özellikle depresyon, kaygı bozukluğu ve artmış stres seviyeleri görülebilmektedir (Brooks, Webster, Smith, Woodland, Wessely, Greenberg ve Rubin, 2020;Courtin ve Knapp, 2017;Tang, Hu, Hu, Jin, Wang, Xie ve Xu, 2020). Yapılan çalışmalarda depresyon, kaygı ve artmış stres seviyelerinin, diyet seçimlerinin değişmesine neden olduğu gözlemlenmiştir (Arce, Michopoulos, Shepard, Ha, ve Wilson 2010;Flaskerud, 2015;Vermeulen, Stronks, Snijder, Schene, Lok, de Vries, ve Nicolaou, 2017). Yüksek psikolojik stres altındaki kişilerde özellikle duygusal yeme davranışı gözlemlenmekte ve bu bireyler yüksek yağ ve yüksek şeker içeriğine sahip olan stresi azaltan besinlere eğilim göstermektedir (Jayne, Ayala, Karl, Deschamps,McGraw, O'Connor ve Cole, 2020). ...
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Korona virüsün dünyada yayılımının artması neticesinde, Türkiye’de günlük yaşamda değişikliklere neden olarak, sosyal mesafeyle birlikte toplumu izole olmaya yönlendirmiştir. Alınan bu önlemler kişilerin yaşam tarzlarını etkilemektedir. Bu araştırma beden eğitimi ve spor yüksekokulu öğrencilerinin pandemi sürecinde beslenme alışkanlıkları ve fiziksel aktivite düzeylerini belirlemek amacıyla yapılmıştır. Araştırmaya Bitlis Eren Üniversitesi (125 kişi) ve Van Yüzüncü yıl Üniversitesi (106 kişi) beden eğitimi spor yüksekokulunda öğrenim gören 231 (93 Kadın, 138 Erkek) gönüllü öğrenci katılmıştır. Veri toplama aracı olarak katılımcıların demografik bilgilerini, beslenme alışkanlıklarını ve fiziksel aktivite düzeylerinin sorgulandığı online bir anket formu uygulanmıştır. Veriler SPSS paket programında analiz edildi ve anlamlılık p<0,05 olarak kabul edilmiştir. Araştırma sonuçlarına göre beden eğitimi ve spor yüksekokulu öğrencilerinin, %45,5’inin beslenme alışkanlıklarında değişiklikler olduğu, %50,6’sının günde iki ana öğün tükettikleri, %63,6’sının düzenli olarak kahvaltı yaptığı, en fazla atlanan ana öğünün %40,3 ile öğlen yemeği olduğu, %26’sının stres sebebiyle öğün atladığını, ara öğünlerde %40,3 ile en fazla kek/kurabiye/bisküvi gibi yiyecekler tükettiği, %53,2’sinin günlük sıvı tüketim miktarının azaldığı ve %36,4’ünün günlük olarak 1,5 litre sıvı tükettiğini ve %62,3’ünün beslenme eğitimi almadıkları, %60,2’sinin beden eğitimi ve spor öğretmenliği bölümünde okudukları belirlenmiştir. Araştırma grubunun %67,5’inin düzenli olarak bir fiziksel aktivite yapmadığı, %51,9’unun haftada iki gün egzersiz yaptığı, %48,1’inin vücut ağırlığında artış olduğu, %68,8’inin ise fiziksel aktivitelerini evde yaptığı tespit edilmiştir. araştırma grubunda yer alan beden eğitimi ve spor yüksekokulu öğrencilerinin beslenme alışkanlıklarında değişiklikler olduğu ve fiziksel aktivite seviyelerinin azaldığı görülmüştür. Bu bağlamda pandemi döneminde sağlıklı beslenmenin yanı sıra evde yapılacak fiziksel aktivitelerin teşvik edilmesi bireylerin sağlıklarını olumlu yönde katkı sağlayacağı düşünülmektedir.
... Diğer yandan bu süreçte sosyal izolasyon koşullarının bireylerde depresyon, kaygı bozuklukları ve stres düzeylerinde artışa neden olduğu saptanmıştır (26). Yapılan çalışmalarda bu olumsuz duygu durumlarının, bireyin beslenme düzeninin değişmesine neden olduğu ifade edilmiştir (27). Bireylerin, olumsuz duygularla başa çıkarken, besinlerin yatıştırıcı etkisi nedeniyle daha fazla miktarda ve yüksek enerjili besin tükettikleri görülmüştür (28). ...
... Another large contributor to obesity is the lack of physical activity and sedentary behavior measured by screen time. [11,12] Respiratory disorders (e.g., obstructive sleep apnea) or sleep disturbance (e.g., sleep duration, insomnia, or excessive daytime sleepiness) have been identified as factors that influence obesity. Thus, the screening of symptoms of this particular disorder (e.g., daytime fatigue or snoring) is important in the catering workers profession [2]. ...
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... In fact, studies indicate that diets rich in fruits, vegetables and fish over number of years result in lower incidence of depression than diets with absence or shortage of these food items. Interestingly, soft drinks with added sugar or diets high in sugar content are more likely to induce depression, while coffee, tea and coocoa have the opposite effect (García-Blanco et al., 2017;Guo et al., 2014;Knuppel et al., 2017;Rothenberg & Zhang, 2019;Sanchez-Villegas et al., 2018;Vermeulen et al., 2017). ...
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We aimed to investigate the association between dietary patterns and depressive symptoms among 217 Iranian women aged 20–45 years. In this study, dietary intake was assessed using a valid and reliable semi-quantitative food frequency questionnaire. A principal component analysis was applied to detect the major dietary patterns. The Beck Depression Inventory was used to assess the depressive symptoms. Two major dietary patterns were identified: the “semi-Mediterranean” dietary pattern and the “western” dietary pattern. Participants with the “western” dietary pattern had a higher rate of depressive symptoms ( p < 0.05). However, the “semi-Mediterranean” dietary pattern had no significant association with the depressive symptoms.
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Individual differences in risk for neuropsychiatric disorders are shaped before the individual is born. In this chapter, we summarize existing evidence from animal and human studies describing prenatal programming in the fetus and placenta in response to prenatal maternal stress, and associated outcomes seen in offspring neurobehavioral development and risk for psychopathology. First, we review fetal neurobehavioral development and assessment, including fetal physiological monitoring and fetal neuroimaging. We then highlight extant research on associations between fetal neurobehavior and later outcomes. Emerging research also points to the involvement of the placenta, which regulates the prenatal environment. We continue by describing how maternal stress can disrupt the placenta’s fundamental functions, highlighting the role of nutrient transfer, placental barrier permeability, serotonin signaling, and epigenetic changes to placental genes. We close by discussing the importance of sex differences in fetal and placental programming as well as developmental timing of exposures, and future directions for research.
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Background The possible therapeutic impact of dietary changes on existing mental illness is largely unknown. Using a randomised controlled trial design, we aimed to investigate the efficacy of a dietary improvement program for the treatment of major depressive episodes. Methods ‘SMILES’ was a 12-week, parallel-group, single blind, randomised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression. The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician. The control condition comprised a social support protocol to the same visit schedule and length. Depression symptomatology was the primary endpoint, assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) at 12 weeks. Secondary outcomes included remission and change of symptoms, mood and anxiety. Analyses utilised a likelihood-based mixed-effects model repeated measures (MMRM) approach. The robustness of estimates was investigated through sensitivity analyses. Results We assessed 166 individuals for eligibility, of whom 67 were enrolled (diet intervention, n = 33; control, n = 34). Of these, 55 were utilising some form of therapy: 21 were using psychotherapy and pharmacotherapy combined; 9 were using exclusively psychotherapy; and 25 were using only pharmacotherapy. There were 31 in the diet support group and 25 in the social support control group who had complete data at 12 weeks. The dietary support group demonstrated significantly greater improvement between baseline and 12 weeks on the MADRS than the social support control group, t(60.7) = 4.38, p < 0.001, Cohen’s d = –1.16. Remission, defined as a MADRS score <10, was achieved for 32.3% (n = 10) and 8.0% (n = 2) of the intervention and control groups, respectively (χ² (1) = 4.84, p = 0.028); number needed to treat (NNT) based on remission scores was 4.1 (95% CI of NNT 2.3–27.8). A sensitivity analysis, testing departures from the missing at random (MAR) assumption for dropouts, indicated that the impact of the intervention was robust to violations of MAR assumptions. Conclusions These results indicate that dietary improvement may provide an efficacious and accessible treatment strategy for the management of this highly prevalent mental disorder, the benefits of which could extend to the management of common co-morbidities. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000251820. Registered on 29 February 2012.
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An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose–response curve and the potential existence of a nonlinear threshold effect have not yet been established.
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European research on the association between perceived ethnic discrimination (PED) and health is importantly lacking. It is also unknown how much PED contributes to disease prevalence. In this study, we quantified the contribution of PED to depression in five ethnic groups in a middle-size European city. We used cross-sectional data from the HELIUS study (Healthy Life in an Urban Setting), collected from January 2011 to June 2013 in Amsterdam, The Netherlands. We included a random sample of 1753 ethnic Dutch, 1143 South-Asian Surinamese, 1794 African Surinamese, 1098 Ghanaians and 850 Turks, aged 18-70 years. PED was assessed using the Everyday Discrimination Scale. Patient Health Questionnaire-9 was used for assessing depressive symptoms and major depressive disorder (MDD). We used logistic regression and calculated the contribution of PED to depressive symptoms and MDD using the population attributable fractions. Depressive symptoms and MDD were most common in Turks and South-Asian Surinamese, and lowest in ethnic Dutch. PED had a positive association with depressive symptoms and MDD in only the ethnic minority groups. The contributions of PED to depressive symptoms and MDD were around 25% in both the Surinamese groups, and Turks, and ∼15% in Ghanaians. We conclude that PED contributes considerably to depression in ethnic minority groups in a European context. As such, ethnic inequalities in depression could be reduced substantially if ethnic minority groups would not perceive any ethnic discrimination. We encourage more European research on the health impact of PED. © The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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Objectives: Ethnic minorities are often not included in studies of diet and health because of a lack of validated instruments to assess their habitual diets. Given the increased ethnic diversity in many high-income countries, insight into the diets of ethnic minorities is needed for the development of nutritional policies and interventions. In this paper, we describe the development of ethnic-specific food frequency questionnaires (FFQs) to study the diets of Surinamese (African and South Asian), Turkish, Moroccan and ethnic Dutch residents of The Netherlands. Methods: An existing Dutch FFQ was adapted and formed the basis for three new FFQs. Information on food intake was obtained from single 24 h recalls. Food items were selected according to their percentage contribution to and variance in absolute nutrient intake of the respective ethnic groups. A nutrient database for each FFQ was constructed, consisting of data from the Dutch Food Composition table; data on ethnic foods were based on new chemical analyses and available international data. Results: We developed four ethnic-specific FFQs using a standardised approach that included ~200 food items each and that covered more than 90% of the intake of the main nutrients of interest. Conclusions: The developed FFQs will enable standardised and comparable assessment of the diet of five different ethnic groups and provide insight into the role of diet in differences in health between ethnic groups. The methodology described in this paper and the choices made during the development phase may be useful in developing similar FFQs in other settings.
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Gezien de hoge prevalentie van voedingsgerelateerde aandoeningen bij Surinaamse Nederlanders verstrekken diëtisten relatief veel adviezen aan deze etnische groep. Toch blijkt de beschikbaarheid van valide informatie over de voedselconsumptie van deze groep zeer beperkt. Onderzoekers van het AMC en de Vrije Universiteit rapporteren enkele opvallende resultaten. Inzicht in de voeding van bevolkingsgroepen is noodza-kelijk om prioriteiten te kunnen stellen voor voedings-beleid en om groepen met verhoogd risico op inadequate inname te kunnen identifi ceren voor preventieve interventies. Daarnaast dienen voedingsadviezen en voorlichtingsmateriaal over voeding aan te sluiten bij het voedingspatroon van de doelgroep.
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Although individual nutrients have been investigated in relation to depression risk, little is known about the overall role of diet in depression. We examined whether long-term dietary patterns derived from a food-frequency questionnaire (FFQ) predict the development of depression in middle-aged and older women. We conducted a prospective study in 50,605 participants (age range: 50-77 y) without depression in the Nurses' Health Study at baseline (1996) who were followed until 2008. Long-term diet was assessed by using FFQs every 4 y since 1986. Prudent (high in vegetables) and Western (high in meats) patterns were identified by using a principal component analysis. We used 2 definitions for clinical depression as follows: a strict definition that required both a reported clinical diagnosis and use of antidepressants (3002 incident cases) and a broad definition that further included women who reported either a clinical diagnosis or antidepressant use (7413 incident cases). After adjustment for age, body mass index, and other potential confounders, no significant association was shown between the diet patterns and depression risk under the strict definition. Under the broad definition, women with the highest scores for the Western pattern had 15% higher risk of depression (95% CI: 1.04, 1.27; P-trend = 0.01) than did women with the lowest scores, but after addition adjustment for psychological scores at baseline, results were no longer significant (RR: 1.09; 95% CI: 0.99, 1.21; P-trend = 0.08). Overall, results of this large prospective study do not support a clear association between dietary patterns from factor analysis and depression risk.
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Background Populations in Europe are becoming increasingly ethnically diverse, and health risks differ between ethnic groups. The aim of the HELIUS (HEalthy LIfe in an Urban Setting) study is to unravel the mechanisms underlying the impact of ethnicity on communicable and non-communicable diseases. Methods/design HELIUS is a large-scale prospective cohort study being carried out in Amsterdam, the Netherlands. The sample is made up of Amsterdam residents of Surinamese (with Afro-Caribbean Surinamese and South Asian-Surinamese as the main ethnic groups), Turkish, Moroccan, Ghanaian, and ethnic Dutch origin. HELIUS focuses on three disease categories: cardiovascular disease (including diabetes), mental health (depressive disorders and substance use disorders), and infectious diseases. The explanatory mechanisms being studied include genetic profile, culture, migration history, ethnic identity, socio-economic factors and discrimination. These might affect disease risks through specific risk factors including health-related behaviour and living and working conditions. Every five years, participants complete a standardized questionnaire and undergo a medical examination. Biological samples are obtained for diagnostic tests and storage. Participants’ data are linked to morbidity and mortality registries. The aim is to recruit a minimum of 5,000 respondents per ethnic group, to a total of 30,000 participants. Discussion This paper describes the rationale, conceptual framework, and design and methods of the HELIUS study. HELIUS will contribute to an understanding of inequalities in health between ethnic groups and the mechanisms that link ethnicity to health in Europe.
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Background Research on the role of diet in the prevention of depression is scarce. Some evidence suggests that depression shares common mechanisms with cardiovascular disease. Discussion Before considering the role of diet in the prevention of depression, several points need to be considered. First, in general, evidence has been found for the effects of isolated nutrients or foods, and not for dietary patterns. Second, most previous studies have a cross-sectional design. Third, information is generally collected though questionnaires, increasing the risk of misclassification bias. Fourth, adequate control of confounding factors in observational studies is mandatory. Summary Only a few cohort studies have analyzed the relationship between overall dietary patterns, such as the Mediterranean diet, and primary prevention of depression. They have found similar results to those obtained for the role of this dietary pattern in cardiovascular disease. To confirm the findings obtained in these initial cohort studies, we need further observational longitudinal studies with improved methodology, as well as large randomized primary prevention trials, with interventions based on changes in the overall food pattern, that include participants at high risk of mental disorders.
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Data on the association between dietary patterns and depression are scarce. The objective of this study was to examine the longitudinal association between dietary patterns and depressive symptoms assessed repeatedly over 10 years in the French occupational GAZEL cohort. A total of 9,272 men and 3,132 women, aged 45-60 years in 1998, completed a 35-item Food Frequency Questionnaire (FFQ) at baseline. Dietary patterns were derived by Principal Component Analysis. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D) in 1999, 2002, 2005 and 2008. The main outcome measure was the repeated measures of CES-D. Longitudinal analyses were performed with logistic regression based on generalized estimating equations. The highest quartile of low-fat, western, high snack and high fat-sweet diets in men and low-fat and high snack diets in women were associated with higher likelihood of depressive symptoms at the start of the follow-up compared to the lowest quartile (OR between 1.16 and 1.50). Conversely, the highest quartile of traditional diet (characterized by fish and fruit consumption) was associated with a lower likelihood of depressive symptoms in women compared to the lowest quartile, with OR = 0.63 [95%CI, 0.50 to 0.80], as the healthy pattern (characterized by vegetables consumption) with OR = 0.72 [95%CI, 0.63 to 0.83] and OR = 0.75 [95%CI, 0.61 to 0.93] in men and women, respectively. However, there was probably a reverse causality effect for the healthy pattern. This longitudinal study shows that several dietary patterns are associated with depressive symptoms and these associations track over time.
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Statistics on ethnicity, if not on ‘race’, are common in a large number of countries around the world, but not in the western part of Europe. This divergence can be explained by legal prohibitions attached to data protection provisions and by a political reluctance to recognize and emphasize ethnic diversity in official statistics. Following different traditions of political framing, northern, central and eastern European countries have implemented different ways of collecting ‘ethnic statistics’. This article provides a review of the heterogeneity of methodologies used for converting ethnicity into statistics and discusses their limitations for any potential standardization. As part of the enforcement of anti-discrimination policies, European human rights institutions are urging a reconsideration of the choice of ‘colour-blind’ statistics. Counting or not counting by ethnicity raises epistemological and methodological dilemmas which this article attempts to identify.
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The relationship between depression and coronary heart disease is well-established, but causal mechanisms are poorly understood. The aim of this review is to stimulate different ways of viewing the relationship between depression and adverse outcomes following acute coronary syndrome (ACS) and coronary artery bypass graft (CABG) surgery patients. We present an argument for depression in ACS and CABG patients being a qualitatively distinct form from that observed in psychiatric populations. This is based on three features: (1) depression developing after cardiac events has been linked in many studies to poorer outcomes than recurrent depression; (2) somatic symptoms of depression following cardiac events are particularly cardiotoxic; (3) depression following an ACS does not respond well to antidepressant treatments. We propose that inflammation is a common causal process responsible in part both for the development of depressive symptoms and for adverse cardiac outcomes, and we draw parallels with inflammation-induced sickness behaviour. Clinical implications of our observations are discussed along with suggestions for further work to advance the field.
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Recent evidence suggests a role for diet quality in the common mental disorders depression and anxiety. We aimed to investigate the association between diet quality, dietary patterns, and the common mental disorders in Norwegian adults. This cross-sectional study included 5731 population-based men and women aged 46 to 49 and 70 to 74 years. Habitual diet was assessed using a validated food frequency questionnaire, and mental health was measured using the Hospital Anxiety and Depression Scale. After adjustments for variables including age, education, income, physical activity, smoking, and alcohol consumption, an a priori healthy diet quality score was inversely related to depression (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59-0.84) and anxiety (OR = 0.77, 95% CI = 0.68-0.87) in women and to depression (OR = 0.83, 95% CI = 0.70-0.99) in men. Women scoring higher on a healthy dietary pattern were less likely to be depressed (OR = 0.68, 95% CI = 0.57-0.82) or anxious (OR = 0.87, 95% CI = 0.77-0.98), whereas men were more likely to be anxious (OR = 1.19, 95% CI = 1.03-1.38). A traditional Norwegian dietary pattern was also associated with reduced depression in women (OR = 0.77, 95% CI = 0.64-0.92) and anxiety in men (OR = 0.77, 95% CI = 0.61-0.96). A western-type diet was associated with increased anxiety in men (OR = 1.27, 95% CI = 1.14-1.42) and women (OR = 1.29, 95% CI = 1.17-1.43) before final adjustment for energy intake. In this study, those with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.
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In Western countries the prevalence of cardiovascular disease (CVD) is often higher in non-Western migrants as compared to the host population. Diet is an important modifiable determinant of CVD. Increasingly, dietary patterns rather than single nutrients are the focus of research in an attempt to account for the complexity of nutrient interactions in foods. Research on dietary patterns in non-Western migrants is limited and may be hampered by a lack of validated instruments that can be used to assess the habitual diet of non-western migrants in large scale epidemiological studies. The ultimate aims of this study are to (1) understand whether differences in dietary patterns explain differences in CVD risk between ethnic groups, by developing and validating ethnic-specific Food Frequency Questionnaires (FFQs), and (2) to investigate the determinants of these dietary patterns. This paper outlines the design and methods used in the HELIUS-Dietary Patterns study and describes a systematic approach to overcome difficulties in the assessment and analysis of dietary intake data in ethnically diverse populations. The HELIUS-Dietary Patterns study is embedded in the HELIUS study, a Dutch multi-ethnic cohort study. After developing ethnic-specific FFQs, we will gather data on the habitual intake of 5000 participants (18-70 years old) of ethnic Dutch, Surinamese of African and of South Asian origin, Turkish or Moroccan origin. Dietary patterns will be derived using factor analysis, but we will also evaluate diet quality using hypothesis-driven approaches. The relation between dietary patterns and CVD risk factors will be analysed using multiple linear regression analysis. Potential underlying determinants of dietary patterns like migration history, acculturation, socio-economic factors and lifestyle, will be considered. This study will allow us to investigate the contribution of the dietary patterns on CVD risk factors in a multi-ethnic population. Inclusion of five ethnic groups residing in one setting makes this study highly innovative as confounding by local environment characteristics is limited. Heterogeneity in the study population will provide variance in dietary patterns which is a great advantage when studying the link between diet and disease.
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Emerging evidence relates some nutritional factors to depression risk. However, there is a scarcity of longitudinal assessments on this relationship. To evaluate the association between fatty acid intake or the use of culinary fats and depression incidence in a Mediterranean population. Prospective cohort study (1999-2010) of 12,059 Spanish university graduates (mean age: 37.5 years) initially free of depression with permanently open enrolment. At baseline, a 136-item validated food frequency questionnaire was used to estimate the intake of fatty acids (saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), trans unsaturated fatty acids (TFA) and monounsaturated fatty acids (MUFA) and culinary fats (olive oil, seed oils, butter and margarine) During follow-up participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression models were used to calculate Hazard Ratios (HR) of incident depression and their 95% confidence intervals (CI) for successive quintiles of fats. During follow-up (median: 6.1 years), 657 new cases of depression were identified. Multivariable-adjusted HR (95% CI) for depression incidence across successive quintiles of TFA intake were: 1 (ref), 1.08 (0.82-1.43), 1.17 (0.88-1.53), 1.28 (0.97-1.68), 1.42 (1.09-1.84) with a significant dose-response relationship (p for trend = 0.003). Results did not substantially change after adjusting for potential lifestyle or dietary confounders, including adherence to a Mediterranean Dietary Pattern. On the other hand, an inverse and significant dose-response relationship was obtained for MUFA (p for trend = 0.05) and PUFA (p for trend = 0.03) intake. A detrimental relationship was found between TFA intake and depression risk, whereas weak inverse associations were found for MUFA, PUFA and olive oil. These findings suggest that cardiovascular disease and depression may share some common nutritional determinants related to subtypes of fat intake.
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Studies have suggested that replacing saturated fatty acids (SFAs) with carbohydrates is modestly associated with a higher risk of ischemic heart disease, whereas replacing SFAs with polyunsaturated fatty acids is associated with a lower risk of ischemic heart disease. The effect of carbohydrates, however, may depend on the type consumed. By using substitution models, we aimed to investigate the risk of myocardial infarction (MI) associated with a higher energy intake from carbohydrates and a concomitant lower energy intake from SFAs. Carbohydrates with different glycemic index (GI) values were also investigated. Our prospective cohort study included 53,644 women and men free of MI at baseline. During a median of 12 y of follow-up, 1943 incident MI cases occurred. There was a nonsignificant inverse association between substitution of carbohydrates with low-GI values for SFAs and risk of MI [hazard ratio (HR) for MI per 5% increment of energy intake from carbohydrates: 0.88; 95% CI: 0.72, 1.07). In contrast, there was a statistically significant positive association between substitution of carbohydrates with high-GI values for SFAs and risk of MI (HR: 1.33; 95% CI: 1.08, 1.64). There was no association for carbohydrates with medium-GI values (HR: 0.98; 95% CI: 0.80, 1.21). No effect modification by sex was observed. This study suggests that replacing SFAs with carbohydrates with low-GI values is associated with a lower risk of MI, whereas replacing SFAs with carbohydrates with high-GI values is associated with a higher risk of MI.
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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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Because foods are consumed in combination, it is difficult in observational studies to separate the effects of single foods on the development of diseases. A possible way to examine the combined effect of food intakes is to derive dietary patterns by using appropriate statistical methods. The objective of this study was to apply a new statistical method, reduced rank regression (RRR), that is more flexible and powerful than the classic principal component analysis. RRR can be used efficiently in nutritional epidemiology by choosing disease-specific response variables and determining combinations of food intake that explain as much response variation as possible. The authors applied RRR to extract dietary patterns from 49 food groups, specifying four diabetes-related nutrients and nutrient ratios as responses. Data were derived from a nested German case-control study within the European Prospective Investigation into Cancer and Nutrition-Potsdam study consisting of 193 cases with incident type 2 diabetes identified until 2001 and 385 controls. The four factors extracted by RRR explained 93.1% of response variation, whereas the first four factors obtained by principal component analysis accounted for only 41.9%. In contrast to principal component analysis and other methods, the new RRR method extracted a significant risk factor for diabetes.
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Background: Endothelial dysfunction is one of the mechanisms linking diet and the risk of cardiovascular disease. Objective: We evaluated the hypothesis that dietary patterns (summary measures of food consumption) are directly associated with markers of inflammation and endothelial dysfunction, particularly C-reactive protein (CRP), interleukin 6, E-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1). Design: We conducted a cross-sectional study of 732 women from the Nurses' Health Study I cohort who were 43-69 y of age and free of cardiovascular disease, cancer, and diabetes mellitus at the time of blood drawing in 1990. Dietary intake was documented by using a validated food-frequency questionnaire in 1986 and 1990. Dietary patterns were generated by using factor analysis. Results: A prudent pattern was characterized by higher intakes of fruit, vegetables, legumes, fish, poultry, and whole grains, and a Western pattern was characterized by higher intakes of red and processed meats, sweets, desserts, French fries, and refined grains. The prudent pattern was inversely associated with plasma concentrations of CRP (P = 0.02) and E-selectin (P = 0.001) after adjustment for age, body mass index (BMI), physical activity, smoking status, and alcohol consumption. The Western pattern showed a positive relation with CRP (P < 0.001), interleukin 6 (P = 0.006), E-selectin (P < 0.001), sICAM-1 (P < 0.001), and sVCAM-1 (P = 0.008) after adjustment for all confounders except BMI; with further adjustment for BMI, the coefficients remained significant for CRP (P = 0.02), E-selectin (P < 0.001), sICAM-1 (P = 0.002), and sVCAM-1 (P = 0.02). Conclusion: Because endothelial dysfunction is an early step in the development of atherosclerosis, this study suggests a mechanism for the role of dietary patterns in the pathogenesis of cardiovascular disease.
Article
Purpose of the review: The purpose of review is to present methodological issues as well as most relevant recent developments on the application of a statistical method to derive dietary patterns: reduced rank regression (RRR). RRR can be used efficiently in nutritional epidemiology to identify dietary patterns associated with selected response variables that have known relations with a disease outcome of interest. This has the advantage of building on a priori knowledge of biological relations, by including plausible intermediates between diet and the outcome of interest. Recent findings: This statistical method has been applied first in nutritional epidemiology about 1 decade ago. Since then, more than 60 publications were published applying the RRR. This method is considerably dependent on an adequate selection of response variables. These response sets were most often a combination of nutrients or of selected endogenous biomarkers. But also variables of intermediate clinical phenotype or contaminants were selected. However, applying this method, several methodological issues, such as, for example, selection of responses, simplification, and validation of the derived pattern should be taken into account. Summary: RRR is a modern statistical method to derive dietary patterns that can be used to test specific hypothesis on pathways from diet to development of a disease.
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Objective: Dietary fiber may play a favorable role in mood through gut microbiota, but epidemiologic evidence linking mood to dietary fiber intake is scarce in free-living populations. We investigated cross-sectionally the associations of dietary intakes of total, soluble, insoluble, and sources of fiber with depressive symptoms among Japanese workers. Methods: Participants were 1977 employees ages 19-69 y. Dietary intake was assessed via a validated, brief self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate odds ratios of depressive symptoms adjusted for a range of dietary and non-dietary potential confounders. Results: Dietary fiber intake from vegetables and fruits was significantly inversely associated with depressive symptoms. The multivariable-adjusted odds ratios (95% confidence intervals) for the lowest through the highest tertile of vegetable and fruit fiber were 1.00 (reference), 0.80 (0.60-1.05), and 0.65 (0.45-0.95), respectively (P for trend = 0.03). Dietary intake of total, soluble, insoluble, and cereal fiber was not associated with depressive symptoms. Conclusions: Higher dietary fiber intake from vegetables and fruits may be associated with lower likelihood of having depressive symptoms.
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The effects of saturated fatty acids (SFAs) on cardiovascular disease (CVD) risk are modulated by the nutrients that replace them and their food matrices. Replacement of SFAs with polyunsaturated fatty acids has been associated with reduced CVD risk, although there is heterogeneity in both fatty acid categories. In contrast, replacement of SFAs with carbohydrates, particularly sugar, has been associated with no improvement or even a worsening of CVD risk, at least in part through effects on atherogenic dyslipidemia, a cluster of traits including small, dense low-density lipoprotein particles. The effects of dietary SFAs on insulin sensitivity, inflammation, vascular function, and thrombosis are less clear. There is growing evidence that SFAs in the context of dairy foods, particularly fermented dairy products, have neutral or inverse associations with CVD. Overall dietary patterns emphasizing vegetables, fish, nuts, and whole versus processed grains form the basis of heart-healthy eating and should supersede a focus on macronutrient composition.
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The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load. We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression. This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women's Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954). We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth vs. first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth vs. first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression. The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women. The Women's Health Initiative is registered at clinicaltrials.gov as NCT00000611. © 2015 American Society for Nutrition.
Article
Because foods are consumed in combination, it is difficult in observational studies to separate the effects of single foods on the development of diseases. A possible way to examine the combined effect of food intakes is to derive dietary patterns by using appropriate statistical methods. The objective of this study was to apply a new statistical method, reduced rank regression (RRR), that is more flexible and powerful than the classic principal component analysis. RRR can be used efficiently in nutritional epidemiology by choosing disease-specific response variables and determining combinations of food intake that explain as much response variation as possible. The authors applied RRR to extract dietary patterns from 49 food groups, specifying four diabetesrelated nutrients and nutrient ratios as responses. Data were derived from a nested German case-control study within the European Prospective Investigation into Cancer and Nutrition-Potsdam study consisting of 193 cases with incident type 2 diabetes identified until 2001 and 385 controls. The four factors extracted by RRR explained 93.1% of response variation, whereas the first four factors obtained by principal component analysis accounted for only 41.9%. In contrast to principal component analysis and other methods, the new RRR method extracted a significant risk factor for diabetes. diabetes mellitus; diet; epidemiologic methods; nutrition; pattern analysis; statistics
Article
Background: The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10. Methods: We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of ≥10), we compared the diagnostic properties of the PHQ-9 using these methods. Results: We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results. Interpretation: This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of ≥10 has better diagnostic performance for screening purposes or where a high sensitivity is needed.
Article
Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
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.
Article
Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27-1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99-1.57), hypertension (OR: 1.14; 95% CI: .94-1.40), or dyslipidemia (OR: 1.08; 95% CI: .91-1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00-1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30-1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52-2.04), and stroke (OR: 2.11; 95% CI: 1.61-2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.
Article
Background/objectives: To investigate the association between dietary patterns and prevalence and incidence 3 years later of depressive symptoms using data from the mid-aged cohort in the Australian Longitudinal Study on Women's Health. Subjects/methods: Participants (aged 50-55 years) completed a food frequency questionnaire in 2001. Depressive symptoms were measured in 2001 and 2004 using the validated 10-item Centre for Epidemiologic Studies Depression scale. Multiple logistic regression was used for cross-sectional analysis (8369 women) and longitudinal analysis (7588) to assess the associations between dietary patterns and prevalence of depressive symptoms, and then for longitudinal analysis (6060) on their associations with the incidence of depressive symptoms in 2004, while adjusting for sociodemographic and lifestyle factors. Results: Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the Mediterranean-style diet had a cross-sectional association with lower prevalence of depressive symptoms in 2001, adjusted odds ratio 0.82 (95% confidence interval 0.77-0.88); and longitudinally with lower incidence of depressive symptoms in 2004, adjusted odds ratio 0.83 (0.75-0.91). None of the associations found for other dietary patterns remained statistically significant after adjustment for confounders. A dose-response relationship was found cross-sectionally when women were grouped according to quintiles of Mediterranean-style diet (P-value for trend <0.001). Conclusions: Consumption of a 'Mediterranean-style' dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms. These findings suggest that dietary patterns have a potential role in the prevention and management of depressive symptoms.
Article
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
Depression is associated with an increase in the incidence of type 2 diabetes, but the mechanism is unclear. We aimed to study the relationship between depression and glycemic intake in the elderly, and examine whether antidepressant use modified this relationship. We evaluated 976 homebound elders in a cross-sectional study. Depression was defined by having a Center for Epidemiological Studies Depression (CES-D) score ≥16. Antidepressant use was documented. Glycemic index (GI), Glycemic load (GL), and fasting blood insulin levels were measured. Depressed elders had slightly higher GI (Mean±SD: 55.8±3.8 vs. 55.1±3.7, P=0.003) and higher insulin levels (Median: 84.0 vs. 74.4pmol/ml, P=0.05) than non-depressed elders. Depressed elders receiving antidepressants, primarily selective serotonin reuptake inhibitors (SSRI), had lower GI (Mean±SD: 55.1±4.7 vs. 56.2±3.4, P=0.002) and GL (Median: 170.3 vs. 6826.3, P=0.03) than those not taking antidepressants. After adjusting for potential confounding variables, GI remained positively associated with depression (β=+0.65, SE=0.28, P=0.02); the logarithm of GL was positively associated with depression (β=+0.33, SE=0.17, P=0.05) and negatively associated with antidepressant use (β=-0.54, SE=0.18, P=0.003). Prospective studies are needed to examine whether high glycemic intake is a mediating factor between late life depression and the risk of type 2 diabetes.
Article
The Patient Health Questionnaire-9 (PHQ-9) has been widely used in research and clinical settings. To be able to attribute differences in PHQ-9 scores between groups with different cultural backgrounds to differences in the level of depression, the instrument has to possess measurement invariance. Data from the Apollo-D study were used. We used two strongly contrasting cultural groups (n=1772). Measurement invariance was assessed by comparing four categorical single factor models with an increasing number of restrictions, representing an increasingly stronger measurement invariance assumption. The PHQ-9 was measurement invariant for ethnicity in women and partially measurement invariant for ethnicity in men. The item 'psychomotor problems' seemed to be culturally biased in the Surinam Dutch males. It had a higher loading and threshold compared to Dutch males. The sample is restricted to high risk primary care patients, we did not include a gold standard measure of depression and the analyses pertain to a single cross cultural comparison. The observed higher total depression score for females in the Surinam Dutch group can be attributed to a true difference in the latent trait depression. For Surinam Dutch and Dutch men some caution is warranted when comparing results obtained with the PHQ-9. In the former group the scores may be biased slightly downward. Future research is needed to examine how the item 'psychomotor problems' performs in different populations. These findings highlight the necessity of establishing measurement invariance before drawing conclusions based on observed scores.
Article
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.
Article
This paper examines the relationships among reports of depressive symptoms, BMI and frequency of consumption of 30 foods in 4655 middle-aged women. Food was grouped into three categories: high-calorie sweet, high-calorie nonsweet, and low-calorie. Controlling for total energy intake, BMI and depressive symptoms were both inversely associated with a higher frequency of consumption of low-calorie foods. BMI was positively associated with consumption of high-calorie nonsweet foods and negatively related to consumption of high-calorie sweet foods. Depressive symptoms were positively associated with sweet foods consumption and negatively associated with nonsweet foods consumption. These findings suggest that the positive association between BMI and depression in women may be mediated by sweets consumption. This is consistent with the hypothesis that eating sweet foods reduces negative affect.
Article
This paper uses fundamental principles of energy physiology to define minimum cut-off limits for energy intake below which a person of a given sex, age and body weight could not live a normal life-style. These have been derived from whole-body calorimeter and doubly-labelled water measurements in a wide range of healthy adults after due statistical allowance for intra- and interindividual variance. The tabulated cut-off limits, which depend on sample size and duration of measurements, identify minimum plausible levels of energy expenditure expressed as a multiple of basal metabolic rate (BMR). CUT-OFF 1 tests whether reported energy intake measurements can be representative of long-term habitual intake. It is set at 1.35 x BMR for cases where BMR has been measured rather than predicted. CUT-OFF 2 tests whether reported energy intakes are a plausible measure of the food consumed during the actual measurement period, and is always more liberal than CUT-OFF 1 since it has to allow for the known measurement imprecision arising from the high level of day-to-day variability in food intake. The cut-off limits can be used to evaluate energy intake data. Results falling below these limits must be recognized as being incompatible with long-term maintenance of energy balance and therefore with long-term survival.
Article
To re-state the principles underlying the Goldberg cut-off for identifying under-reporters of energy intake, re-examine the physiological principles and update the values to be substituted into the equation for calculating the cut-off, and to examine its use and limitations. New values are suggested for each element of the Goldberg equation. The physical activity level (PAL) for comparison with energy intake:basal metabolic rate (EI:BMR) should be selected to reflect the population under study; the PAL value of 1.55 x BMR is not necessarily the value of choice. The suggested value for average within-subject variation in energy intake is 23% (unchanged), but other sources of variation are increased in the light of new data. For within-subject variation in measured and estimated BMR, 4% and 8.5% respectively are suggested (previously 2.5% and 8%), and for total between-subject variation in PAL, the suggested value is 15% (previously 12.5%). The effect of these changes is to widen the confidence limits and reduce the sensitivity of the cut-off. The Goldberg cut-off can be used to evaluate the mean population bias in reported energy intake, but information on the activity or lifestyle of the population is needed to choose a suitable PAL energy requirement for comparison. Sensitivity for identifying under-reporters at the individual level is limited. In epidemiological studies information on home, leisure and occupational activity is essential in order to assign subjects to low, medium or high PAL levels before calculating the cut-offs. In small studies, it is desirable to measure energy expenditure, or to calculate individual energy requirements, and to compare energy intake directly with energy expenditure.
Article
Objective: this paper aims to give a broad overview of published data on nutrition and health among migrants in the Netherlands, as well as data on determinants of health. Results and conclusions: Depending on the definition, 9 to 17% of the population belongs to the group 'migrants' and this proportion is expected to grow in the coming years. Roughly 2/3 of migrants are of the first generation and on average, they are younger than the Dutch population. Relatively few data concerning the health status of migrants are available. The diet of migrants showed both positive (macronutrients) and negative (micronutrients) differences with the general Dutch diet. The risk of overweight was high among both children and adult women, and the data suggest a higher risk for Turkish and Moroccan groups than for Dutch groups. The importance of health determinants, such as smoking, alcohol use and physical and social environment, was different for migrants than for the Dutch population; however, there were also differences between ethnic groups. The limited data on morbidity for migrants suggest higher risks than for the indigenous population. The same holds for mortality data, especially for the younger age groups. In general, the data that are available suggest that the health status of migrants was less favourable than that of the indigenous population. However, there were also differences between the various groups of migrants. The lower socio-economic position of migrant groups partly explained the differences in health status. Nevertheless, a study among Turkish people indicated that their health status was lower than that of Dutch people of comparable socioeconomic status.
Article
We have preliminarily investigated the hypothesis that sugar consumption may impact the prevalence of major depression by correlating per capita consumption of sugar with the prevalence of major depression. Major depression prevalence data (annual rate/100) was obtained from the Cross-National Epidemiology of Major Depression and Bipolar Disorder study [Weissman et al., 1996]. Sugar consumption data from 1991 was obtained from the Food and Agricultural Organization of the United Nations. For the primary analysis, sugar consumption rates (cal/cap/day) were correlated with the annual rate of major depression, using the Pearson correlation coefficient. For the six countries with available data for the primary analysis, there was a highly significant correlation between sugar consumption and the annual rate of depression (Pearson correlation 0.948, P=0.004). Naturally, a correlation does not necessarily imply etiology. Caveats such as the limited number of countries with available data must be considered. Although speculative, there are some mechanistic reasons to consider that sugar consumption may directly impact the prevalence of major depression. Possible relationships between sugar consumption, beta-endorphins, and oxidative stress are discussed.
Article
The aim of the present study was to investigate the oxidative-antioxidative systems and effects of different antidepressants on these systems in patients with major depressive disorder (MDD). Ninety-six patients with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of MDD and 54 healthy controls were included in the study. Plasma malondialdehyde (MDA) levels and susceptibility of red blood cells (RBCs) to oxidation were determined to investigate the oxidative status, plasma vitamin E, vitamin C, serum total carotenoid levels, total antioxidant capacity (TAOC), RBC superoxide dismutase (SOD) and whole blood glutathione peroxidase (GPx) activities were measured to investigate the antioxidative defence before and after 6 weeks of antidepressant treatment. Plasma MDA levels and susceptibility of RBCs to oxidation were significantly higher in the MDD group compared with the control group. RBC SOD activity was significantly increased in patients with MDD, and furthermore there was a significant positive correlation between the severity of the disease and SOD activity. MDD is accompanied with oxidative stress; however, oxidative-antioxidative systems do not seem to be affected by 6 weeks of antidepressant treatment.
Article
The nine-item mood module of the Patient Health Questionnaire (PHQ-9) was developed to screen and to diagnose patients in primary care with depressive disorders. We systematically reviewed the psychometric literature on the PHQ-9 and performed a meta-analysis to ascertain its summary sensitivity and specificity. EMBASE, PubMed and PsycINFO were used to search literature up to July 2006. Studies were included if (1) they investigated the diagnostic accuracy of the PHQ-9 and (2) the PHQ-9 had been compared with a reference test. The quality of the studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies. We calculated sensitivity, specificity and confidence intervals for each included study. We used the random effects model to calculate the summary sensitivity and specificity. We found a sensitivity of 0.77 (0.71-0.84) and a specificity of 0.94 (0.90-0.97) for the PHQ-9. The positive predictive value in an unselected primary care population was 59%, which increased to 85-90% when the prior probability increased to 30-40%. In primary care, the PHQ-9 is a valid diagnostic tool if used in selected subgroups of patients with a high prevalence of depressive disorder.
Article
The association between sociodemographic factors and acculturation with overweight/obesity in Turks and Moroccans was studied to identify target groups for prevention. A cross-sectional study was undertaken among a sample of 1384 Turks and Moroccans aged 35-74 years in Amsterdam, The Netherlands. Data were collected by structured face-to-face interviews. Body mass index (BMI) was calculated from self-reported height and weight data. Sociodemographic variables collected were sex, age, educational level, marital status, parity and income level. Acculturation was measured by cultural orientation and length of residence in The Netherlands. Data of 1095 Turks and Moroccans were analysed using logistic regression, with overweight/obesity (BMI 25.0) as the dependent variable. The prevalence of overweight/obesity was high (57-89%). Age, marital status, parity, income level, cultural orientation and length of residence were not associated or only weakly associated with overweight/obesity. Educational level and overweight/obesity were strongly associated in Turkish women (odds ratio 4.56; 95% confidence intervals 1.54-13.51). The high prevalence of overweight/obesity in Turkish and Moroccan migrants varies little across sociodemographic groups and is not associated with acculturation. Poorly educated Turkish women are at particularly high risk.
Depressiviteit en antidepressiva in Nederland (Depression and Anti-Depression Medication in the Netherlands)
  • G Verweij
  • M Houben-Van Harten
Verweij G & Houben-van Harten M (2013) Depressiviteit en antidepressiva in Nederland (Depression and Anti-Depression Medication in the Netherlands). Den Haag: Centraal Bureau voor de Statistiek.
Prospective study on long-term dietary patterns and incident depression in middle-aged and older women
  • P O Chocano-Bedoya
  • O 'reilly
  • E J Lucas
Chocano-Bedoya PO, O'Reilly EJ, Lucas M et al. (2013) Prospective study on long-term dietary patterns and incident depression in middle-aged and older women. Am J Clin Nutr 98, 813-820.
Voeding van Marokkaanse, Turkse, Surinaamse en autochtone Nederlanders in Amsterdam
  • E J De Boer
  • Ham Brants
  • M Beukers
de Boer EJ, Brants HAM, Beukers M et al. (2015) Voeding van Marokkaanse, Turkse, Surinaamse en autochtone Nederlanders in Amsterdam. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu.