Is there a "metabolic-mood syndrome"? A review of the relationship between obesity and mood disorders

The association of Dietary Quality Index-International (DQII) score with anxiety and depression: Results of a population-based study

BACKGROUND

Recent evidence indicates a relationship between diet quality and prevalent psychiatric disorders, though, the nature of this association remains unclear. This study aimed to investigate the association between the Dietary Quality Index-International (DQII) score and the severity of depression and anxiety.

METHODS

This cross-sectional research involved 6472 individuals aged 35-65 from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and dietary quality was evaluated using the DQI-I score. The severity scores of depression and anxiety were measured through the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI).

RESULTS

Participants in the highest tertile of DQI-I had lower anxiety and depression severity scores than those in lower tertiles (P < 0.001). After adjusting for confounders, the association remained significant only for depression score (OR = 0.85; 95 % CI: 0.73-0.98; p = 0.02). Among DQI-I components, only overall balance was significantly associated with depression score (OR = 0.86; 95 % CI: 0.75-1.00; p = 0.04). Higher variety and adequacy scores were linked to lower odds of anxiety score (OR = 0.75; 95 % CI: 0.61-0.93; p < 0.01 and OR = 0.79; 95 % CI: 0.66-0.96; p = 0.02).

LIMITATIONS

The cross-sectional design restricts causal inference, FFQs introduce recall bias, and unmeasured confounding remains a possibility.

CONCLUSION

Individuals in the highest DQI-I tertile had lower odds of severe depression score. Overall balance correlated significantly with depression severity score, while higher variety and adequacy scores were linked to reduced severe anxiety score.

Clinical features of overweight in acute-phase hospitalised major depressive disorder with comorbid anxiety: a cross-sectional study

OBJECTIVE

This study aimed to investigate the incidence of overweight in patients with major depressive disorder (MDD) comorbid anxiety during the acute phase and to explore associated factors.

DESIGN

Cross-sectional study.

SETTING

Wuhan Mental Health Center, China, from July 2017 to August 2022.

PARTICIPANTS

737 hospitalised patients diagnosed with MDD in the acute phase with comorbid anxiety symptoms.

PRIMARY OUTCOME MEASURES

Incidence and clinical correlations of overweight (body mass index (BMI) ≥ 24).

RESULTS

Among the study population, 55.63% were classified as overweight. Binary logistic regression analysis revealed that being married (B=0.28, p value=0.018, OR=1.10), thyroid-stimulating hormone (TSH) levels (B=0.10, p value=0.001, OR=1.10) and low-density lipoprotein cholesterol (LDL-C) levels (B=1.61, p value=0.045, OR=1.18) were significant positive predictors of overweight. Additionally, multiple linear regression indicated that TSH levels (B=0.16, t=3.17, p value=0.002) were positively associated with higher BMI values.

CONCLUSION

Over half of the hospitalised MDD patients with comorbid anxiety are overweight. Thyroid function emerges as a crucial clinical factor for overweight in this population. Targeted interventions focusing on thyroid function may be a promising approach for managing overweight in these patients.

Modulation of cardiac autonomic activity across consciousness states and levels of sleep depth in individuals with sleep complaints and bipolar disorder or unipolar depressive disorders

OBJECTIVE

Autonomic nervous system dysfunction and reduced heart rate variability (HRV) often co-exist with mood disorders, a phenomenon likely influenced by sleep disturbances. This study investigated heart rate (HR) and HRV across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep in individuals with sleep complaints and bipolar or unipolar depressive disorder.

METHODS

Polysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms [60 diagnosed with bipolar disorder, 60 diagnosed with a unipolar depressive disorder], and 60 healthy controls. HR and time-based HRV variables were computed on 30-s segments and averaged across the night for wake, NREM and REM sleep.

RESULTS

Significant group by consciousness state interactions showed that the unipolar and bipolar groups had lower standard deviation of normal-to-normal intervals root mean square of successive R-R interval differences compared to controls during NREM and REM sleep, but not during wake (SDNN: F(4, 330) = 3.0, p = .021, np2 = 0.035; RMSSD: F(4, 332) = 5.8, p < .001, np2 = 0.065). The magnitude of these group differences did not vary significantly between NREM 1, NREM 2 and NREM 3 sleep. These interactions persisted after excluding individuals taking 3rd generation antipsychotic, lithium, anticonvulsant, and cardiovascular medications.

CONCLUSION

Although further work is required to account for the impact of psychotropic and cardiac medications, as well as manic and euthymic states, these findings suggest that the sleep-based autonomic signature of depressive states differs across different types of mood disorders and could potentially inform the development of biomarkers and therapeutic targets.

Feasibility and efficacy of adding high-intensity interval training to a multidisciplinary lifestyle intervention in children with obesity-a randomized controlled trial

BACKGROUND

Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL).

METHODS

This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate.

RESULTS

Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): -0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: -0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure.

CONCLUSION

Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

Identifying depression subtypes and investigating their consistency and transitions in a 1-year cohort analysis

Major depressive disorder (MDD) is defined by an array of symptoms that make it challenging to understand the condition at a population level. Subtyping offers a way to unpick this phenotypic diversity for improved disorder characterisation. We aimed to identify depression subtypes longitudinally using the Inventory of Depressive Symptomatology: Self-Report (IDS-SR). A secondary analysis of a two-year cohort study called Remote Assessment of Disease and Relapse in Major Depressive Disorder (RADAR-MDD), which collected data every three months from patients with a history of recurrent MDD in the United Kingdom, the Netherlands, and Spain (N = 619). We used latent class and latent transition analysis to identify subtypes at baseline, determined their consistency at 6- and 12-month follow-ups, and examined transitions over time. We identified a 4-class solution: (1) severe with appetite decrease, (2) severe with appetite increase, (3) moderate severity and (4) low severity. These same classes were identified at 6- and 12-month follow-ups, and participants tended to remain in the same class over time. We found no statistically significant differences between the two severe subtypes regarding baseline clinical and sociodemographic characteristics. Our findings emphasize severity differences over symptom types, suggesting that current subtyping methods provide insights akin to existing severity measures. When examining transitions, participants were most likely to remain in their respective classes over 1-year, indicating chronicity rather than oscillations in depression severity. Future work recommendations are made.

Clinical and metabolic correlates of DSM-5 mixed features in subjects with bipolar depression and mania: A cross-sectional study

OBJECTIVE

Evidence on the clinical and metabolic characterization of mixed features (MFs) in bipolar disorder (BD) is limited. We performed a cross-sectional study analyzing clinical and metabolic correlates of MFs in people with bipolar depression or mania/hypomania.

METHODS

We included people with BD consecutively admitted for inpatient treatment from May 2020 to July 2023 as part of the Northern Milan Area Cohort (NOMIAC) project. The SCID-5 was used to confirm the diagnosis and assess DSM-5 specifiers. Young Mania Rating Scale and Montgomery-Åsberg Depression Rating Scale were used to measure symptom severity. Information on socio-demographic, clinical, and metabolic conditions - including obesity, diabetes, hypertension, dyslipidemia, and hypothyroidism - were collected. Multiple logistic regression models were used to compare clinical and metabolic correlates between subjects with and without DSM-5 MFs.

RESULTS

We included 163 inpatients with BD (111 admitted for a manic/hypomanic episode and 52 for a major depressive episode), 39 of whom with MFs. The overall logistic regression model showed that MFs were associated with anxious distress (z = 2.44; p = 0.015) and obesity (z = 2.39; p = 0.017), also being less frequent among moderately/markedly ill people as compared with those borderline/mildly ill (z = -2.71; p = 0.007). Additional analyses corroborated the association between MFs and these characteristics in people with a depressive episode, though not in those with mania/hypomania.

CONCLUSION

Notwithstanding some limitations, our study provides additional insight into the characterization of individuals with MFs, highlighting that anxious distress and symptom severity, along with obesity, may represent core features helpful for the assessment and management of MFs in BD.

Understanding immune system dysfunction and its context in mood disorders: psychoneuroimmunoendocrinology and clinical interventions

Mood disorders include a set of psychiatric manifestations of increasing prevalence in our society, being mainly represented by major depressive disorder (MDD) and bipolar disorder (BD). The etiopathogenesis of mood disorders is extremely complex, with a wide spectrum of biological, psychological, and sociocultural factors being responsible for their appearance and development. In this sense, immune system dysfunction represents a key mechanism in the onset and pathophysiology of mood disorders, worsening mainly the central nervous system (neuroinflammation) and the periphery of the body (systemic inflammation). However, these alterations cannot be understood separately, but as part of a complex picture in which different factors and systems interact with each other. Psychoneuroimmunoendocrinology (PNIE) is the area responsible for studying the relationship between these elements and the impact of mind-body integration, placing the immune system as part of a whole. Thus, the dysfunction of the immune system is capable of influencing and activating different mechanisms that promote disruption of the psyche, damage to the nervous system, alterations to the endocrine and metabolic systems, and disruption of the microbiota and intestinal ecosystem, as well as of other organs and, in turn, all these mechanisms are responsible for inducing and enhancing the immune dysfunction. Similarly, the clinical approach to these patients is usually multidisciplinary, and the therapeutic arsenal includes different pharmacological (for example, antidepressants, antipsychotics, and lithium) and non-pharmacological (i.e., psychotherapy, lifestyle, and electroconvulsive therapy) treatments. These interventions also modulate the immune system and other elements of the PNIE in these patients, which may be interesting to understand the therapeutic success or failure of these approaches. In this sense, this review aims to delve into the relationship between immune dysfunction and mood disorders and their integration in the complex context of PNIE. Likewise, an attempt will be made to explore the effects on the immune system of different strategies available in the clinical approach to these patients, in order to identify the mechanisms described and their possible uses as biomarkers.

Diagnostic conversion to bipolar disorder among adolescents and young adults with major depressive disorder: a nationwide longitudinal study

Although several studies have examined a diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BD), only a few studies specifically focused on adolescents and young adults who are at the peak ages of BD onset. Data from participants (N = 130,793) aged 10-29 years who were diagnosed with MDD were extracted from the Taiwan National Health Insurance Research Database. We applied demographic analyses, survival analysis, Aalen Johansen curves, and Cox regression, investigating the diagnostic conversion rate and factors that were most or less predictive of conversion. Among the adolescents and young adults with MDD, the number of participant conversion subsample is 14,187 and the conversion rate was 13.80% (95% confidence interval: 13.54-14.06%) during the 11-year follow-up. The conversion rate was highest in the first year (4.50%; 4.39-4.61%) and decreased over time. The significant predictors were younger age of diagnosis with MDD (p < 0.001), moderate and high antidepressant resistance (p < 0.001), obesity (p < 0.001), psychiatric comorbidities (attention-deficit/hyperactivity disorder, substance use disorder, and cluster B and C personality disorder, all p < 0.001), a family history of mental disorders (schizophrenia and mood disorders, all p < 0.05), lower monthly income (p < 0.001), and more mental health visits to the clinic each year (p < 0.001). A composite of demographic characteristics, antidepressant resistance, physical and psychiatric comorbidities, and family history significantly predicted diagnostic conversion from MDD to BD (area under the curve = 0.795, p < 0.001). Compared to adult population, the adolescents and young adults had different factors that were most or less predictive of conversion, which warrants further investigation.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Bariatric Patients: Focus on Mood and Anxiety Comorbidity, Disordered Eating, and Temperamental Traits

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. A positive association between ADHD and obesity has been observed, especially in adult samples. In this study, prevalence and correlates of self-reported symptoms indicative of a positive screening for ADHD were examined in patients seeking bariatric treatment.

MATERIAL AND METHODS

The study sample was composed of 260 adult patients with obesity referred for bariatric surgery to the Obesity Center of the Endocrinology Unit in Pisa University Hospital between January 2006 and November 2016 (BMI ≥ 30 kg/m2; mean ± standard deviation = 46.27 ± 7.45 kg/m2). ADHD symptoms were identified using ADHD Symptom Check-List-90-R Screening Scale. Night-eating, binge-eating/purging behaviors, and temperamental and character traits were assessed in a subsample of 95 patients.

RESULTS

Thirty participants had a positive screening for ADHD (11.5%, 95% CI = 7.9-16.1%). Patients with a positive screening showed significantly higher rates of anxiety disorders (40% vs. 16.5%, χ2 = 7.97, p = 0.005) panic disorder (40% vs. 14.3%, χ2 = 10.48, p = 0.001), and a higher severity of psychopathological symptoms and sleep disturbances than those without. In subsample analyses, ADHD symptoms severity was associated with more bulimic behaviors (r = 0.31-0.46), greater harm avoidance (r = 0.45-0.66), less self-directedness (r =  - 0.44-0.63), and cooperativeness (r =  - 0.26-0.42).

CONCLUSION

ADHD symptoms may be common in patients with obesity seeking bariatric treatment and are positively associated with disordered eating, internalizing features, and maladaptive character traits.

LEVEL OF EVIDENCE

V, cross sectional descriptive study.

Associations Between Dysregulation and Metabolic Syndrome in Youth and Adults

Objective

Metabolic syndrome is a serious and costly health condition that is increasingly prevalent in the United States. Current treatment standards, which include lifestyle modification and medication, do not consistently yield sustainable improvements. High rates of co-occurrence with psychiatric disorders suggest that understanding psychological factors associated with metabolic syndrome may be important for enhancing interventions. The current study examines the relations between the psychological construct of "dysregulation" and metabolic risk in children, adolescents, and adults.

Method

Participants were 95 family triads comprising 158 youth aged 7 to 17 years and 127 biological parents. Dysregulation was measured using a bifactor model comprising symptoms from the Anxious/Depressed, Attention Problems, and Aggressive Behavior subscales of the Child Behavior Checklist and Adult Self Report for children and adults, respectively. Metabolic risk was measured using confirmatory factor analysis, which included waist circumference, mean arterial pressure, insulin resistance, and triglyceride-to-HDL ratio.

Results

Higher levels of dysregulation were associated with increased metabolic risk in adults. In children, this association was moderated by age, such that dysregulation and metabolic risk were positively associated only for older youth.

Conclusion

The findings of this study suggest that the association between dysregulation and metabolic risk may become stronger with age and development. This highlights that early detection and intervention of dysregulation may help prevent metabolic comorbidities later in life.

Type 2 diabetes mellitus is associated with manic morbidity in elderly patients with mood disorders

The association between mood disorders, especially bipolar disorder (BD), and metabolic disorders, is long known. However, to which extent metabolic disorders affect the course of mood disorders in late life is still open to inquiring. To assess the impact of type 2 diabetes mellitus (T2DM) on late-life mood disorders a retrospective chart review was performed. Elderly depressive patients (≥ 65 years) diagnosed with Major Depressive Disorder (N = 57) or BD (N = 43) and followed up for at least 18 months were included and subdivided according to the presence of T2DM comorbidity. Vascular encephalopathy (39.1% vs. 15.6%, P  = 0.021) and neurocognitive disorders (21.7% vs. 5.2%, P  = 0.028), were more frequently reported in patients with T2DM than in those without. Patients with T2DM showed a greater percentage of follow-up time in manic episodes (r = -0.23, P  = 0.020) and a higher rate of manic episode(s) during follow-up (21.7% vs. 5.2%, P  = 0.028) than those without. When restricting longitudinal analyses to patients with bipolar spectrum disorders, results were confirmed. In line with the well-known connection between BD and metabolic disorders, our data support an association between T2DM and unfavorable course of illness in the elderly with BD.

Anxiety and depression in metabolic-associated steatotic liver disease: relation with socio-demographic features and liver disease severity

PURPOSE

We aimed to evaluate the prevalence of anxiety and depression traits in Italian patients with metabolic dysfunction-associated steatotic liver disease (MASLD), and the possible relation with the severity of liver disease.

METHODS

Demographic, anthropometric, clinical and laboratory parameters were collected in patients referred to a metabolic unit for a comprehensive evaluation of possible liver disease. Hepatic steatosis and fibrosis were evaluated by surrogate biomarkers. Imaging (controlled attenuation parameter-CAP and vibration-controlled transient elastography-VCTE). Beck depression inventory (BDI) and state-trait anxiety inventory-Y (STAI-Y) were used to define depressive/anxiety states; calorie intake and lifestyle were self-assessed by questionnaires.

RESULTS

The whole sample comprised 286 patients (61.9% females; mean age 52.0 years; BMI, 34.6 kg/m2); 223 fulfilled MASLD criteria. BDI and trait anxiety scores were lower in the MASLD cohort, and the prevalence of both moderate/severe depression and severe trait anxiety was reduced compared with non-MASLD cases, despite VCTE-diagnosed fibrosis F3-F4 present in over 15% of cases. However, after correction for demographic and anthropometric confounders, MASLD was not associated with a lower risk of moderate/severe depression or severe anxiety trait (odds ratio, 0.34; 95% confidence interval, 0.12-1.01 and 0.79, 0.27-2.34). Additional adjustment for the severity of fibrosis did not change the results. No differences in state anxiety were observed.

CONCLUSION

The risk of anxiety and depression in MASLD is not different from that generated by diabetes and obesity per se. MASLD patients do not perceive liver disease as a specific source of psychological distress, possibly as a consequence of the unawareness of progressive liver disease.

Extracellular vesicles released from microglia after palmitate exposure impact brain function

Dietary patterns that include an excess of foods rich in saturated fat are associated with brain dysfunction. Although microgliosis has been proposed to play a key role in the development of brain dysfunction in diet-induced obesity (DIO), neuroinflammation with cytokine over-expression is not always observed. Thus, mechanisms by which microglia contribute to brain impairment in DIO are uncertain. Using the BV2 cell model, we investigated the gliosis profile of microglia exposed to palmitate (200 µmol/L), a saturated fatty acid abundant in high-fat diet and in the brain of obese individuals. We observed that microglia respond to a 24-hour palmitate exposure with increased proliferation, and with a metabolic network rearrangement that favors energy production from glycolysis rather than oxidative metabolism, despite stimulated mitochondria biogenesis. In addition, while palmitate did not induce increased cytokine expression, it modified the protein cargo of released extracellular vesicles (EVs). When administered intra-cerebroventricularly to mice, EVs secreted from palmitate-exposed microglia in vitro led to memory impairment, depression-like behavior, and glucose intolerance, when compared to mice receiving EVs from vehicle-treated microglia. We conclude that microglia exposed to palmitate can mediate brain dysfunction through the cargo of shed EVs.

Better understanding of c-reactive protein and leukocytes in psychiatric inpatients with affective disorders: A biopsychosocial approach

BACKGROUND

Affective disorders (AD) have been linked to inflammatory processes, although the underlying mechanisms of this relationship are still not fully elucidated. It is hypothesized that demographic, somatic, lifestyle, and personality variables predict inflammatory parameters in AD.

AIM

To identify biopsychosocial factors contributing to inflammation in AD measured with two parameters, C-reactive protein (CRP) and leukocytes.

METHODS

This observational study investigated 186 hospital inpatients diagnosed with AD using demographic parameters, serum inflammatory markers, somatic variables, psychological questionnaires, and lifestyle parameters. Hierarchical regression analyses were used to predict inflammatory markers from demographic, somatic, lifestyle, and personality variables.

RESULTS

Analyses showed that 33.8% of the variance of CRP was explained by body mass index and other somatic medication (e.g. anti-diabetics), age and education, and age of affective disorder diagnosis. For leukocytes, 20.1% of the variance was explained by smoking, diet, metabolic syndrome (MetS), and anti-inflammatory medication (e.g. non-steroidal anti-inflammatory drugs). Other psychiatric or behavioural variables did not reach significance.

CONCLUSION

Metabolic components seem important, with mounting evidence for a metabolic affective disorder subtype. Lifestyle modifications and psychoeducation should be employed to prevent or treat MetS in AD.

Pathophysiological relationships between cognitive deficit in bipolar affective disorder and metabolic syndrome

INTRODUCTION AND OBJECTIVES

Bipolar disorder (BD) has been related to various cognitive dysfunctions as well as to a high prevalence of metabolic syndrome (MS), which seems to influence the cognitive performance of patients with BD. Therefore, different hypotheses have been generated to try to explain the pathophysiological relationship between cognitive deficit in BD and MS. The objective was to review the current literature regarding the possible pathophysiological explanation of the relationship between BD and MS and its effect on cognitive performance of patients with BD.

METHODS

A bibliographic search was carried out using MEDLINE, ClinicalKey, EMBASE, Literatura Latino-Americana y del Caribe en Ciencias de la Salud [Latin American and Caribbean Literature in Health Sciences] (LILACS), APA PsycNet, Scopus and Scielo databases, and the Pan-American Medical Electronic Library; using the following search terms: "bipolar disorder"[MeSH Terms] OR "bipolar disorder"[All Fields] OR "mood disorders"[All Fields] AND "cognitive deficit"[MeSH Terms] OR "cognitive deficit"[All Fields] OR "cognitive dysfunction"[All Fields] OR "cognitive impairment"[All Fields] OR "cognitive decline"[All Fields] AND "metabolic syndrome" [MeSH Terms] OR "metabolic abnormalities"[All Fields] OR "metabolic effects"[All Fields] OR "obesity" [All Fields] OR "abdominal obesity" [All Fields] OR "overweight" [All Fields] OR "diabetes" [All Fields] OR "hypertension" [All Fields] AND "antipsychotics" [MeSH Terms] OR "antipsychotics"[All Fields] AND "antidepressants" [MeSH Terms] OR "antidepressants"[All Fields] AND "mood stabilizers" [MeSH Terms] OR "mood stabilizers"[All Fields]. Filters: free full text, full text, from 2001 to 2022. A total of 80 articles in Spanish and English, of any type of design, were selected. Selection and reading were carried out by all the authors.

RESULTS AND CONCLUSIONS

The various pathophysiological hypotheses proposed, inflammatory, endocrine, drug, environmental and social, suggest that a series of changes at the macro and microcellular level are correlated in patients with BD and MS with a negative effect on cognition of patients both globally and in specific domains, mainly executive function, memory, attention, and perceptual motor skills. Research processes should be continued to explore the various hypotheses that support the relationship between BD, MS and cognition.

Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population

OBJECTIVES

To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up.

METHODS

n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control.

RESULTS

The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up.

CONCLUSIONS

This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Weight loss impacts risky decisions in obesity

BACKGROUND & AIMS

Risky decision making is shaped by individual psychological and metabolic state. Individuals with obesity show not only altered risk behavior, but also metabolic and psychological abnormalities. The aim of the present study was to investigate whether a substantial weight loss in individuals with severe obesity will 1) normalize their metabolic and psychological state and 2) will change their pattern of decision guidance.

METHODS

We assessed the effect of glycated hemoglobin (HbA1c) and mood on risk behavior in individuals with obesity (n = 62, 41 women; BMI, 46.5 ± 4.8 kg/m2; age, 44.9 ± 14.7 years) before and after 10-weeks weight loss intervention.

RESULTS

Results showed that this intervention reduced participants' risk behavior, which was significantly predicted by their changes in BMI. Before intervention, mood, but not HbA1c significantly predicted decisions. After the weight loss, mood no longer, but HbA1c significantly predicted decisions.

CONCLUSION

Our findings shed light on the psychological and metabolic mechanisms underlying altered risky decision making in severe obesity and can inform the development of strategies in the context of weight loss interventions.

Nutrition and Epstein-Barr viremia in children underwent liver transplantation: A retrospective, cross-sectional study

BACKGROUND AND AIMS

We aimed to examine the association between nutritional status, assessed by height/length and body weight for age and sex, and Epstein-Barr virus (EBV) viremia in children underwent liver transplantation.

METHODS

Nutritional status was determined by total score of age- and sex-specific height/length and body weight: < (-2 SD) as "2 points", (-2 SD to -1 SD) as "1 point", and ≥ (-1SD) as "0 point". Children were further classified into three groups: malnutrition (4 points), risk of malnutrition (1-3 points), and normal (0 point). EBV viremia were confirmed by real time quantitative PCR method if EBV burden was ≥400 copies/ml.

RESULTS

A total number of 896 children (414 boys and 482 girls, medium age 8 months) were included in the study. The medium height was 65.0 cm while medium body weight was 7.0 kg. The prevalence of EBV viremia was 54.6% during follow up. Comparing with children with normal nutritional status, the adjusted odds ratios for the risk of EBV viremia was 2.14 (95% CI: 1.44, 3.19) in children with risk of malnutrition, and 2.29 (95% CI: 1.54, 3.40) in children with malnutrition. Each point increase of nutritional score was associated with a 21% higher risk of EBV viremia (odd ratios = 1.21; 95% CI: 1.10, 1.34) in fully adjusted model.

CONCLUSIONS

Nutritional score was associated with EBV viremia in children underwent liver transplantation.

Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial

The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4-month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty-three participants were enrolled in a single-arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA-IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1-point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.

Neurocognitive correlates of metabolic dysregulation in individuals with mood disorders: a systematic review and meta-analysis

Individuals with mood disorders are predisposed to metabolic dysfunction, while those with metabolic dysregulation such as diabetes and obesity experience more severe depressive symptoms. Both metabolic dysfunction and mood disorders are independently associated with cognitive deficits. Therefore, given their close association, this study aimed to explore the association between metabolic dysfunction in individuals with mood disorders in relation to cognitive outcomes. A comprehensive search comprised of these three domains was carried out; a random-effects meta-analysis pooling mean cognitive outcomes was conducted (PROSPERO ID: CRD42022295765). Sixty-three studies were included in this review; 26 were synthesized in a quantitative meta-analysis. Comorbid metabolic dysregulation was associated with significantly lower global cognition among individuals with mood disorders. These trends were significant within each mood disorder subgroup, including major depressive disorder, bipolar disorder, and self-report depression/depressive symptoms. Type 2 diabetes was associated with the lowest cognitive performance in individuals with mood disorders, followed by peripheral insulin resistance, body mass index ⩾25 kg/m2, and metabolic syndrome. Significant reduction in scores was also observed among individual cognitive domains (in descending order) of working memory, attention, executive function, processing speed, verbal memory, and visual memory. These findings demonstrate the detrimental effects of comorbid metabolic dysfunction in individuals with mood disorders. Further research is required to understand the underlying mechanisms connecting mood disorders, metabolism, and cognition.

APOE Genotype, ApoE Plasma Levels, Lipid Metabolism, and Cognition in Monozygotic Twins with, at Risk of, and without Affective Disorders

Background: Lipids influence brain function and mental health. Understanding the role of apolipoproteins in affective disorders could provide valuable insights and potentially pave the way for novel therapeutic approaches. Methods: We examined the apolipoprotein E genotype and ApoE-levels, lipid profiles, and the correlation with cognition in 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected, AT), their unaffected co-twins (high-risk, HR), and twins with no personal or family history of affective disorder (low-risk, LR). Results: The APOE genotype was not associated with affective disorders. No significant group differences in ApoE levels were found between the three risk groups. Post hoc analysis group-wise comparisons showed higher ApoE levels in the AT than HR twins and in the concordant AT twin pairs relative to the discordant twin pairs. Within the discordant twin pairs, higher ApoE levels were observed in the affected twins (AT = 39.4 mg/L vs. HR = 36.8 mg/L, p = 0.037). Limitations: The present study could benefit from a larger sample size. We did not assess dietary habits. Conclusions: The results did not support our main hypothesis. However, exploratory post hoc analysis suggests a role for plasma ApoE and triglycerides in affective disorders. Future research is needed.

Dietary habits, depression and obesity: an intricate relationship to explore in pediatric preventive strategies

Obesity and depression represent major health problems due to their high prevalence and morbidity rates. Numerous evidences elucidated the connections between dietary habits and the incidence or severity of depression. This overview aims to investigate the intricate relationship between dietary patterns and depression with the objective of elaborating preventive strategies for childhood obesity. Literature data recognized that there is a link between mood and food choices, with certain foods selected for their impact on the brain's reward centers. This behavior parallels the one observed in substance addiction, suggesting a specific neural mechanism for food addiction that contributes to overeating and obesity. It is important to note the significant correlation between obesity and depression, indicating a shared biological pathway influencing these conditions. Stress substantially affects also eating behaviors, often leading to increased consumption of pleasurable and rewarding foods. This can trigger a cycle of overeating, weight gain, and psychological distress, exacerbating mood disorders and obesity. In addition, consumption of certain types of foods, especially "comfort foods" high in fat and calories, may provide temporary relief from symptoms of depression, but can lead to long-term obesity and further mental health problems. Understanding these complex interactions is critical to developing preventive strategies focusing on dietary, emotional, and environmental factors, thereby reducing the risk of obesity and mood disorders.

Clinical phenotypes of individuals with Chung-Jansen syndrome across age groups

Pathogenic variants in pleckstrin homology domain interacting protein (PHIP) are associated with Chung-Jansen syndrome characterized by developmental delay, intellectual disability, behavioral challenges, hypotonia, obesity, and dysmorphic features. We report phenotypes and genotypes of 47 individuals with likely pathogenic/pathogenic PHIP variants. Variants were de novo in 61.7%, unknown inheritance in 29.8%, and inherited in 8.5%. The median age of the individuals was 10.9 years, approximately equally divided by sex. Individuals in this cohort frequently had a history of developmental delay (85.1%), attention-deficit/hyperactivity disorder (51.1%), anxiety (46.8%), depression (27.7%), and sleep difficulties (42.6%). Depression was significantly higher in the older age group (>12 years old). Most individuals had moderately low adaptive functioning based on the Vineland-3 (mean = 76.8, standard deviation = 12.0). Overall, 55.8% of individuals were obese/overweight. The percentage of obese individuals was greater in the older age group (>12 years old) and evolves over time. Other common symptoms were hypotonia (78.7%), constipation (48.9%), visual problems (66%), and cryptorchidism (39.1% of males). Our findings provide additional natural history data for Chung-Jansen syndrome and provide opportunities for early intervention of healthy eating habits and awareness of developing mood and behavioral challenges over the life course.

Impacts of metabolic disruption, body mass index and inflammation on cognitive function in post-COVID-19 condition: a randomized controlled trial on vortioxetine

BACKGROUND

Post-COVID-19 Condition (PCC), as defined by the World Health Organization (WHO), currently lacks any regulatory-approved treatments and is characterized by persistent and debilitating cognitive impairment and mood symptoms. Additionally, metabolic dysfunction, chronic inflammation and the associated risks of elevated body mass index (BMI) have been reported. In this study, we aim to investigate the efficacy of vortioxetine in improving cognitive deficits in individuals with PCC, accounting for the interaction of metabolic dysfunction, elevated inflammation and BMI.

METHODS

This is a post-hoc analysis of an 8-week randomized, double-blind, placebo-controlled trial that was conducted among adults aged 18 years and older living in Canada who were experiencing WHO-defined PCC symptoms. The recruitment of participants began in November 2021 and concluded in January 2023. A total of 200 individuals were enrolled, where 147 were randomized in a 1:1 ratio to receive either vortioxetine (5-20 mg, n = 73) or placebo (n = 74) for daily treatment under double-blind conditions. The primary outcome measure was the change in the Digit Symbol Substitution Test (DSST) score from baseline to endpoint.

RESULTS

Our findings showed significant effects for time (χ2 = 7.771, p = 0.005), treatment (χ2 = 7.583, p = 0.006) and the treatment x time x CRP x TG-HDL x BMI interaction (χ2 = 11.967, p = 0.018) on cognitive function. Moreover, the between-group analysis showed a significant improvement with vortioxetine at endpoint (mean difference = 0.621, SEM = 0.313, p = 0.047).

CONCLUSION

Overall, vortioxetine demonstrated significant improvements in cognitive deficits among individuals with baseline markers of metabolic dysfunction, elevated inflammation and higher BMI at endpoint as compared to placebo.

TRIAL REGISTRATION

NCT05047952 (ClinicalTrials.gov; Registration Date: September 17, 2021).

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

Diet Overall and Hypocaloric Diets Are Associated With Improvements in Depression but Not Anxiety in People With Metabolic Conditions: A Systematic Review and Meta-Analysis

The risk of depression and anxiety is higher in people with metabolic conditions, but whether dietary approaches, which are central to the management of metabolic conditions, can also improve depression and anxiety is uncertain. The primary aim of this systematic review and meta-analysis was to evaluate the effects of dietary interventions on depression and anxiety in adults with metabolic conditions. The secondary aim was to evaluate the effects of hypocaloric and isocaloric dietary interventions on these outcomes. Four databases (MEDLINE, PsychINFO, EMBASE, and CINAHL) were searched from inception to March 2023. Randomized controlled trials (RCTs) including dietary interventions in adults with metabolic conditions (type 2 diabetes mellitus, hyperlipidemia, hypertension, and/or overweight/obesity) that assessed depression and/or anxiety as outcomes were included. Overall, 13 RCTs were included in the systematic review, ≤13 of which were included in the meta-analysis. Estimates were pooled using random-effect meta-analysis for dietary interventions compared with controls. Improvements in depression scores were found in meta-analytic models including all dietary interventions [pooled estimate for the standardized mean difference (SMD) = -0.20 (95% CI: -0.35, -0.05); P = 0.007] and hypocaloric only diets [SMD = -0.27 (95% CI: -0.44, -0.10); P = 0.002]. There were no improvements in depression scores with isocaloric dietary interventions only [SMD = -0.14 (95% CI: -0.38, 0.10); P = 0.27]. In addition, there were no significant effects of any dietary interventions on anxiety scores. In adults with metabolic conditions, all dietary interventions and hypocaloric diets improved depression, but not anxiety. These findings suggest that dietary interventions including hypocaloric diets can play an important role in the management of depression in people with metabolic conditions. This systematic review and meta-analysis has been registered with PROSPERO (CRD42021252307).

A review on linking stress, depression, and insulin resistance via low-grade chronic inflammation

Stress is a disturbance in homeostasis caused by psychological, physiological, or environmental factors. Prolonged reactions to chronic stress can be detrimental, resulting in various metabolic abnormalities, referred to as metabolic syndrome (MS). There is a reciprocal increased risk between MS and major depressive disorder. Recent studies established an association between inflammation and insulin signaling in type 2 diabetes mellitus with depression. In the present review, we discuss chronic low-grade inflammation, pathways of insulin resistance, and brain glucose metabolism in the context of neuroinflammation and depression. Specific attention is given to psychotropic drugs such as bupropion, mirtazapine, and nefazodone, anti-inflammatory drugs like Celecoxib (COX-2 inhibitor), Etanercept, adalimumab, IL-4Ra antagonist, Anti-IL- 17A antibody (Ixekizumab) and lifestyle modifications including exercise, dietary changes, and sleep hygiene. These therapeutic solutions offer potential in treating depression by targeting metabolic conditions like insulin resistance and inflammatory pathways. The article further explains the significance of a nutrition and antioxidants-rich diet, emphasizing the role of omega-3 fatty acids, vitamin D, zinc, and polyphenols, to improve immunity and activate anti-inflammatory signaling pathways.

A Greek Translation of the Brunel Mood Scale: Initial Validation among Exercise Participants and Inactive Adults

The aim of the present study was to provide initial validity evidence of a Greek translation of the 24-item Brunel Mood Scale, referred to as the BRUMS-Greek, a measure of anger, confusion, depression, fatigue, tension, and vigour. Data were collected from 1417 Greek adult exercise participants and 369 physically inactive adults, totaling 1786 adults (male = 578, female = 1208) aged 18-64 years (M = 34.73 ± 11.81 years). Given the large univariate and multivariate non-normality, a confirmatory factor analyses treating responses as ordered categorical variables was conducted which supported the hypothesised six-correlated factor measurement model. The internal consistency reliability of the BRUMS-Greek subscales was supported via Cronbach alpha coefficients. The construct validity of the scales was supported (a) via correlations in the hypothesised direction with trait positive and negative affect, (b) with more positive and less negative moods reported immediately after participation in a single exercise class compared to pre-exercise mood, and (c) with exercise participants reporting more positive and less negative mood states compared to physically inactive adults. Women reported higher tension and lower vigour scores than men. Tension scores were higher and confusion scores lower among younger participants (≤35 years) than older participants (≥36 years). Participants with obesity reported higher negative mood scores than those who were underweight or normal weight. In sum, the BRUMS-Greek demonstrated acceptable psychometric characteristics, and is proposed to be a suitable measure for use with exercise participants, physically inactive adults, and other Greek populations to explore research questions related to mood.

Occurrence of metabolic syndrome in untreated bipolar disorders: a cross-sectional study

OBJECTIVE

This cross-sectional study aimed to observe the occurrence of metabolic syndrome in untreated individuals with bipolar disorders.

METHODS

A total of 125 untreated individuals with bipolar disorders were collected as the study group, and 201 cases from the health examination centre of our hospital were selected as the control group. The participants enrolled were assessed for general demographic data, case characteristics, and metabolic indexes including body mass index (BMI), blood pressure, triglyceride, high-density lipoprotein-cholesterol, cholesterol, low-density lipoprotein-cholesterol, and fasting plasma glucose.

RESULTS

The incidence of metabolic syndrome in the bipolar disorders group was higher compared to the control group (9.6% VS. 8.5%). After calibrating sex and age data, a significant difference between the two groups was observed (P < 0.05). Diastolic and systolic blood pressure were higher in the bipolar disorders group compared to the control group (P < 0.01). Men with bipolar disorders had a higher risk of developing metabolic syndrome than women (14.5% vs. 5.8%). Bipolar disorders, sex, age, and BMI were identified as independent risk factors for metabolic syndrome. No significant difference was found in terms of metabolic index and incidence of metabolic syndrome between individuals with depressive episodes (n = 37) and manic episodes (n = 75).

CONCLUSION

Patients with bipolar disorders were found to have a higher risk of developing metabolic syndrome than healthy individuals. Bipolar disorders, male sex, age, and BMI may contribute to an increased risk of developing metabolic syndrome.

Developmental Trajectory of Body Weight in Youths at Risk for Major Mood Disorders

Importance

Mood disorders are associated with increased body weight, especially in females, but it remains unknown when the weight increase starts.

Objectives

To examine sex-specific weight trajectories associated with familial mood disorder risk and determine the age at which youth at familial risk for mood disorders begin to diverge in weight from controls.

Design, Setting, and Participants

This community-based, single-center, acceleration cohort study of youth at familial risk for mood disorders and controls with yearly follow-ups (mean [SD], 5 [2.1] years) from January 1, 2014, to December 31, 2022, assessed 394 unaffected female and male offspring (aged 3 to 20 years) of parents with or without a mood disorder. Parents with mood (depressive or bipolar) disorders were recruited through adult mental health services. Parents of control participants were matched on age and socioeconomic factors and recruited through acquaintance referrals or schools.

Exposures

The youth in the familial mood risk group had at least 1 parent with a major mood disorder, whereas control youth did not have a parent with a mood disorder.

Main Outcomes and Measures

Body mass indexes (BMIs) were calculated as weight in kilograms divided by height in meters squared from measured weight and height at annual assessments and then converted to age- and sex-adjusted z scores (zBMIs). Repeated-measure regressions examined the association between zBMI and age in youth at familial risk of mood disorders and controls while accounting for sex. Sensitivity analyses accounted for socioeconomic status, prematurity, and birth weight.

Results

Of 394 participants (mean [SD] age, 11.5 [3.6] years; 203 [51.5%] female), youths at familial risk for mood disorders showed overall no difference in body weight (β = 0.12; 95% CI, 0.01-0.24) from controls. A sex-specific difference was detected, with females at familial risk showing a rapid peripubertal increase in body weight, leading to significantly increased zBMIs at 12 years and older compared with controls (β = 0.57; 95% CI, 0.31-0.82) independent of socioeconomic status, prematurity, or birth weight. Males did not differ from controls at any age.

Conclusions and Relevance

In this cohort study, females with a family history of mood disorders were prone to weight gain starting around puberty and predating mood disorder onset. Early interventions aiming to prevent adverse mental and physical outcomes in this vulnerable group need to start in childhood.

The effect of lifestyle interventions on depressive symptom severity in individuals with type-2 diabetes: A meta-analysis of randomized controlled trials

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a severe metabolic condition which is commonly comorbid with depression. Lifestyle factors are involved in the pathophysiology of both conditions; however, the role of lifestyle interventions remains unclear.

OBJECTIVE

The objective of this study is to systematically review the literature on randomized controlled trials evaluating the effect of lifestyle interventions on depressive scores in patients with T2DM.

METHODS

A systematic search was conducted in computerized databases before October 2022. A random-effects model was used to investigate the effect of lifestyle interventions on depression scores and meta-regression was conducted to assess the influence of age and disease onset.

RESULTS

Six trials met the eligibility criteria for inclusion. A statistically significant reduction in depression scores was found for groups receiving lifestyle interventions compared to controls (SMD = -0.49 [95%CI -0.89 to -0.08]; p = 0.0269]). Interventions increased in efficacy with the age of the participants but no significant correlation was found with years since disease onset. Participants in a control group receiving a less intense lifestyle intervention demonstrated improved depression scores when compared to those who received standard care or no intervention at all. Trial design and outcome measurement tools were heterogeneous between studies and limited data on antidepressant use was available which may introduce bias into the results.

CONCLUSION

Lifestyle interventions were effective at improving depressive symptom severity in patients with T2DM.

Rescue of Comorbid Behavioral and Metabolic Phenotypes of Arrhythmic Mice by Restoring Circadian Cry1/2 Expression in the Suprachiasmatic Nucleus

Background

Psychiatric and metabolic disorders occur disproportionately often comorbidly, which poses particular hurdles for patients and therapists. However, the mechanisms that promote such comorbidities are largely unknown and therefore cannot yet be therapeutically targeted for the simultaneous treatment of both conditions. Because circadian clocks regulate most physiological processes and their disruption is a risk factor for both psychiatric and metabolic disorders, they may be considered as a potential mechanism for the development of comorbidities and a therapeutic target. In the current study, we investigated the latter assumption in Cry1/2-/- mice, which exhibit substantially disrupted endogenous circadian rhythms and marked metabolic and behavioral deficits.

Methods

By targeted virus-induced restoration of circadian rhythms in their suprachiasmatic nucleus, we can restore behavioral as well as several metabolic processes of these animals to near-normal circadian rhythmicity.

Results

Importantly, by rescuing suprachiasmatic nucleus rhythms, several of their anxiety-like behavioral as well as diabetes- and energy homeostasis-related deficits were significantly improved. Interestingly, however, this did not affect all deficits typical of Cry1/2-/- mice; for example, restlessness and body weight remained unaffected.

Conclusions

Taken together, the results of this study demonstrate, on the one hand, that restoration of disturbed circadian rhythms can be used to simultaneously treat psychiatric and metabolic deficits. On the other hand, the results also allow us to distinguish processes that depend more on local canonical clocks from those that depend more on suprachiasmatic nucleus rhythms.

The bidirectional association of nonalcoholic fatty liver disease with depression, bipolar disorder, and schizophrenia

Nonalcoholic fatty liver disease (NAFLD) is a complex metabolic-inflammatory disease associated with poor outcomes and decreased quality of life. NAFLD is overrepresented in patients with psychiatric disorders like depression, bipolar disorder, and schizophrenia; however, a comprehensive review on NAFLD and psychiatric disorders remains to be delineated. This review endeavors to investigate the association of NAFLD with psychiatric disorders, including shared pathogenesis and future clinical derivatives. Extant literature suggests that patients with psychiatric disorders (in particular, mood disorders) are more susceptible to the development of NAFLD due to multiple reasons, including but not limited to hypothalamic-pituitary-adrenal axis dysregulation, metabolic syndrome, and chronic perceived stress. Moreover, the clinical manifestations of mood disorders (e.g., anhedonia, psychomotor retardation, lifestyle modification, etc.), and potentially long-term treatment with weight-gaining agents, differentially affect these patients, making them more prone to NAFLD. Considering the increased morbidity associated with both mood disorders and NAFLD, our review recommends regular screenings for NAFLD in select patients with mood disorders exhibiting signs of increased risk (i.e., obesity, metabolic syndrome, diabetes, or family history of NAFLD) for better diagnosis and holistic care of both potentially interrelated conditions.

The relationship between dietary lipophilic index and load with depression, anxiety, and stress symptoms

BACKGROUND

Dietary fatty acids can affect brain health by modifying neuronal membrane fluidity. Dietary lipophilic index (LI) and load (LL) may be related to cell membrane fluidity. This study aimed to determine the relationship between dietary LI and LL with symptoms of depression, anxiety and stress.

METHODS

In this cross-sectional study, taken from the YaHS (Yazd Health Study) population-based cohort, the data of 2,982 individuals was extracted. Several questionnaires- a 178-item Food Frequency Questionnaire (FFQ), Depression, Anxiety and Stress Scale 21 (DASS 21), and International Physical Activity Questionnaire (IPAQ)- were used to obtain information on dietary intake, mental status, and physical activity, respectively. LI and LL were calculated using dietary intake and the melting point of each fatty acid.

RESULTS

The analysis was performed on 2982 individuals. The odds ratio of depression in the second tertile of dietary LI compared to the first tertile was 0.815 (95% CI 0.66-1.00, P = 0.051, Ptrend = 0.017) and after adjusting confounders was 0.793 (95% CI 0.63-0.99, P = 0.043, Ptrend = 0.011). Also, LL was related inversely with anxiety (0.771, 95% CI 0.63-0.93, P = 0.003) that after multiple regression, OR of anxiety was 0.762 (95% CI 0.53-1.07, P = 0.045). The odds of stress in the third tertile of LL was 1.064 but not statistically significant (95% CI 0.88-1.28, P = 0.729).

CONCLUSION

This study showed an inverse association between dietary LI and depression symptoms. Anxiety and stress did not show a significant relationship with LI or LL.

Is neuregulin-1 (NRG-1) a potential blood biomarker linking depression to obesity? A case-control study

BACKGROUND AND AIM

No definite biomarker linking depression and obesity has been found yet. Our study aimed to investigate neuregulin-1 (NRG-1) as a potential blood biomarker for this association.

METHODS

A case-control study was conducted on 108 obese subjects assigned for laparoscopic sleeve gastrectomy and 100 non-obese controls. Depression was assessed pre- and post-operatively. Serum NRG-1 was measured.

RESULTS

Pre-operatively depression was significantly higher among obese compared to non-obese patients. After the operation, 1.9% of the severely depressed subjects reported no depression, while 5.6% became moderately depressed; about 6% of the moderately depressed and 16% of the mildly depressed became not depressed. Serum NRG-1 level was significantly lower among obese and severely depressed compared to the controls. It was negatively correlated to the level of depression pre- and post-operative (r = -0.764 and -0.467 respectively). The sensitivity of serum NRG1 as a predictor for depression pre- and post-operative was 92.45% and 52.94% respectively. Specificity was 69.09% and 79.73% respectively at cut-off values of ≤ 3.5 and ≤ 2.5 ng/ml.

CONCLUSION

NRG-1 is a possible biomarker for the diagnosis of depression pre-bariatric surgery and the prediction of its prognosis post-operatively.

Body mass index and clinical outcomes in individuals with major depressive disorder: Findings from the GSRD European Multicenter Database

BACKGROUND

Individuals with major depressive disorder (MDD) are at higher risk for obesity. In turn, weight gain is a predisposing factor for depression. Although clinical data are sparse, suicide risk also appears to be elevated in obese patients. This study used data from the European Group for the Study of Resistant Depression (GSRD) to investigate clinical outcomes associated with body mass index (BMI) in MDD.

METHODS

Data were drawn from 892 participants with MDD over the age of 18 years (580 female, 50.5 ± 13.6 years). Response and resistance to antidepressant medication, depression rating scale scores, and further clinical and sociodemographic variables were compared using multiple logistic and linear regressions controlled for age, sex, and risk of weight gain due to psychopharmacotherapy.

RESULTS

Of the 892 participants, 323 were categorized as treatment-responsive and 569 as treatment-resistant. Within this cohort, 278 (31.1 %) were overweight (BMI = 25-29.9 kg/m2) and 151 (16.9 %) were obese (BMI > 30 kg/m2). Elevated BMI was significantly associated with higher suicidality, longer duration of psychiatric hospitalizations over their lifetimes, earlier age of onset of MDD, and comorbidities. There was a trend-wise association of BMI with treatment resistance.

LIMITATIONS

Data were analyzed in a retrospective, cross-sectional design. BMI was used as an exclusive measure of overweight and obesity.

CONCLUSIONS

Participants with comorbid MDD and overweight/obesity were at risk for worse clinical outcomes, suggesting that weight gain should be closely monitored in individuals with MDD in daily clinical practice. Further studies are needed to explore the neurobiological mechanisms linking elevated BMI to impaired brain health.

Prospective network analysis of proinflammatory proteins, lipid markers, and depression components in midlife community women

BACKGROUND

Vulnerability theories propose that suboptimal levels of lipid markers and proinflammatory proteins predict future heightened depression. Scar models posit the reverse association. However, most studies that tested relationships between non-specific immune/endocrine markers and depression did not separate temporal inferences between people and within-person and how different immunometabolism markers related to unique depression symptoms. We thus used cross-lagged prospective network analyses (CLPN) to investigate this topic.

METHODS

Community midlife women (n = 2224) completed the Center for Epidemiologic Studies-Depression scale and provided biomarker samples across five time-points spanning 9 years. CLPN identified significant relations (edges) among components (nodes) of depression (depressed mood, somatic symptoms, interpersonal issues), lipid markers [insulin, fasting glucose, triglycerides, low-density lipoprotein-cholesterol (LDL), high-density lipoprotein-cholesterol (HDL)], and proinflammatory proteins [C-reactive protein (CRP), fibrinogen], within and across time-points. All models adjusted for age, estradiol, follicle-stimulating hormone, and menopausal status.

RESULTS

In within-person temporal networks, higher CRP and HDL predicted all three depression components (d = 0.131-2.112). Increased LDL preceded higher depressed mood and interpersonal issues (v. somatic symptoms) (d = 0.251-0.327). Elevated triglycerides predicted more somatic symptoms (v. depressed mood and interpersonal problems) (d = 0.131). More interpersonal problems forecasted elevated fibrinogen and LDL levels (d = 0.129-0.331), and stronger somatic symptoms preceded higher fibrinogen levels (d = 0.188).

CONCLUSIONS

Results supported both vulnerability and scar models. Long-term dysregulated immunometabolism systems, social disengagement, and related patterns are possible mechanistic accounts. Cognitive-behavioral therapies that optimize nutrition and physical activity may effectively target depression.

Indirect Calorimetry to Measure Metabolic Rate and Energy Expenditure in Psychiatric Populations: A Systematic Review

Psychiatric and metabolic disorders are highly comorbid and the relationship between these disorders is bidirectional. The mechanisms underlying the association between psychiatric and metabolic disorders are presently unclear, which warrants investigation into the dynamics of the interplay between metabolism, substrate utilization, and energy expenditure in psychiatric populations, and how these constructs compare to those in healthy controls. Indirect calorimetry (IC) methods are a reliable, minimally invasive means for assessing metabolic rate and substrate utilization in humans. This review synthesizes the extant literature on the use of IC on resting metabolism in psychiatric populations to investigate the interaction between psychiatric and metabolic functioning. Consistently, resting energy expenditures and/or substrate utilization values were significantly different between psychiatric and healthy populations in the studies contained in this review. Furthermore, resting energy expenditure values were systematically overestimated when derived from predictive equations, compared to when measured by IC, in psychiatric populations. High heterogeneity between study populations (e.g., differing diagnoses and drug regimens) and methodologies (e.g., differing posture, time of day, and fasting status at measurement) impeded the synthesis of results. Standardized IC protocols would benefit this line of research by enabling meta-analyses, revealing trends within and between different psychiatric disorders.

Association between adiposity and emergent depressive symptoms in a 10-years prospective cohort of older adults: The EpiFloripa Aging study

BACKGROUND

The association between obesity and depressive symptoms has been described in the literature, but there is a scarcity of longitudinal data. This study aimed to verify the association between body mass index (BMI) and waist circumference and the incidence of depressive symptoms over a 10-year follow-up in a cohort of older adults.

METHODS

Data from the first (2009-2010), second (2013-2014), and third (2017-2019) waves of the EpiFloripa Aging Cohort Study were used. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15) and classified in significant depressive symptoms for those with ≥6 points. The Generalized Estimating Equations model was used to estimate the longitudinal association between BMI and waist circumference and depressive symptoms across a 10-year follow-up.

RESULTS

The incidence of depressive symptoms (N = 580) was 9.9 %. The relationship between BMI and the incidence of depressive symptoms in older adults followed a U-shaped curve. Older adults with obesity had an incidence relative ratio of 76 % (IRR = 1.24, p = 0.035) for increasing the score of depressive symptoms after 10 years, compared to those with overweight. The higher category of waist circumference (Male: ≥102; Female: ≥88 cm) was associated with depressive symptoms (IRR = 1.09, p = 0.033), only in a non-adjusted analysis.

LIMITATIONS

Relatively high follow-up dropout rate; Few individuals in the underweight BMI category; BMI must be considered with caution because it does not measure only fat mass.

CONCLUSIONS

Obesity was associated with the incidence of depressive symptoms when compared with overweight in older adults.

Plasminogen Activator Inhibitor-1: Potential Inflammatory Marker in Late-life Depression

Objective

Although several previous studies have examined the association between late-life depression and blood adipokine levels, a marker of chronic inflammation, no studies have comprehensively considered the effects of metabolic syndrome, which is known to affect blood adipokine levels. This study examined blood adipokine levels in geriatric depression after adjusting for the effects of metabolic syndrome.

Methods

Participants were selected from the Ansan Geriatric Study (depression group [n = 76] and control group [n = 76]). Blood concentrations of four adipokines (adiponectin, resistin, neutrophil-gelatinase-associated lipocalin [NGAL], and plasminogen activator inhibitor-1 [PAI-1]) were measured using immunoassays. The effects of blood adipokine concentration on the diagnosis of depression were analyzed using multivariate logistic regression to adjust for the effects of metabolic syndrome and potential confounding factors.

Results

When the effects of metabolic syndrome and potential confounding factors were adjusted, only PAI-1 could explain the diagnosis of depression among all the adipokines. The depression group showed a lower blood PAI-1 level than the control group. Adiponectin, resistin, and NGAL could not explain the diagnosis of depression when the effects of metabolic syndrome and potential confounding factors were adjusted.

Conclusion

This study suggests the possibility that the blood PAI-1 levels in clinically pathological late-life depression may show contrasting results to those with subclinical depressive symptoms. Additionally, considering that most previous studies have been conducted with pre-geriatric populations, the study suggests the possibility that geriatric depression may show inflammatory changes with patterns that are different from those of depression in the pre-geriatric population.

The impact of social determinants of health on obesity and diabetes disparities among Latino communities in Southern California

BACKGROUND

Social determinants of health (SDoH) describe the complex network of circumstances that impact an individual before birth and across the lifespan. SDoH contextualize factors in a community that are associated with chronic disease risk and certain health disparities. The main objective of this study was to explore the impact of SDoH on the prevalence of obesity and diabetes, and whether these factors explain disparities in these health outcomes among Latinos in Southern California.

METHODS

We utilized three composite indices that encompass different SDoH: the Healthy Places Index (HPI), Social Vulnerability Index (SVI), and CalEnviroScreen (CES). Univariate linear regression models explored the associations between index scores with adult obesity, adult diabetes, and childhood obesity.

RESULTS

Communities with lower HPI scores were associated with higher prevalence of metabolic disease and a greater proportion of Latino residents. Cities in the lowest decile of HPI scores had 71% of the population identifying as Latino compared to 12% in the highest decile. HPI scores explained 61% of the variability in adult obesity (p < 0.001), 41% of the variability in childhood obesity (p < 0.001), and 47% of the variability in adult diabetes (p < 0.001). Similar results were observed when examining SVI and CES with these health outcomes.

CONCLUSIONS

These results suggest that Latinos in Southern California live in communities with adverse SDoH and face a greater burden of adult obesity, diabetes, and childhood obesity.

Cannabidiol ameliorates the anxiogenic and compulsive-like behaviors induced by chronic consumption of a high-carbohydrate diet in male mice

The excessive consumption of ultra-processed foods and the development of obesity has been associated with several comorbidities, including psychiatric disorders. Excess fat tissue promotes a low-intensity inflammatory state, mainly in the white tissue, which is essential in developing metabolic alterations and influences brain homeostasis. In this scenario, Cannabidiol (CBD), a compound from Cannabis sativa, has presented anxiolytic and anti-inflammatory effects in murine models. This study verified whether CBD treatment would ameliorate the compulsive-like and anxiety-like behaviors observed after mice's chronic consumption of a high-refined carbohydrate (HC) diet. BALB/c male mice received a control or HC diet for 12 weeks followed by vehicle and CBD (30 mg/Kg, i.p.) administration, and their behavior was evaluated in the Marble Burying test (MB) and Novel Suppressing Feeding test (NSF). The sub-chronic, but not acute, treatment with CBD attenuated the compulsive-like and anxiogenic-like behavior induced by the HC diet. Our data reinforced the harmful effects of the HC diet's chronic consumption on compulsive and anxious behaviors and the potential of CBD as a drug treatment for psychiatric disorders associated with obesity.

Effects of the Mediterranean diet on the components of metabolic syndrome

Metabolic syndrome, also as known as Syndrome X or Insulin Resistance Syndrome, is a complex health problem featuring visceral obesity (the main diagnostic criterion), insulin resistance, dyslipidemia and high blood pressure. Currently, this health condition has gained a momentum globally while raising concerns among health-related communities. The World Health Organization, American Heart Association and International Diabetes Federation have formulated diagnostic criteria for metabolic syndrome. Diet and nutrition can influence this syndrome: for example, the Western diet is associated with increased risk of metabolic syndrome, whereas the Nordic and Mediterranean diets and the Dietary Approach to Stop Hypertension are potentially beneficial. The Mediterranean diet can affect the components of metabolic syndrome due to its high dietary fiber, omega 3 and 9 fatty acids, complex carbohydrates, antioxidants, minerals, vitamins and bioactive substances, such as polyphenols. These nutrients and bioactive substances can combat obesity, dyslipidemia, hypertension and diabetes mellitus. The mechanisms by which they do so are generally related to oxidative stress, inflammation (the most common risk factors for metabolic syndrome) and gastrointestinal function. The literature also shows examples of positive effects of the Mediterranean diet on the metabolic syndrome. In this review of the literature, we shed light on the effects, mechanisms and dynamic relationship between the Mediterranean diet and metabolic syndrome.

Simulated distributions from negative experiments highlight the importance of the body mass index distribution in explaining depression-body mass index genetic risk score interactions

BACKGROUND

Depression and obesity are complex global health problems. Recent studies suggest that a genetic predisposition to obesity might be accentuated in people with depression, but these analyses are prone to bias. Here, we tested the hypothesis that depression accentuates genetic susceptibility to obesity and applied negative control experiments to test whether any observed interactions were real or driven by confounding and statistical biases.

METHODS

We used data from up to 378 000 Europeans in UK Biobank, a 73 variant body mass index (BMI) genetic risk score, two depression measures [depression symptoms (DS), major depression (MD)] and an antidepressant usage variable available. We tested whether (i) depression and (ii) antidepressant treatment accentuated genetic susceptibility to obesity. Finally, we performed negative control experiments by sampling individuals at random so that they had BMI distributions identical to depression cases and controls.

RESULTS

Depression was associated with an accentuation of an individual's genetic risk of obesity with evidence of interactions for both DS and MD (Pinteraction = 7 × 10-4 and 7 × 10-5 respectively). Antidepressant usage within DS cases accentuated genetic obesity risk (Pinteraction = 9 × 10-4), but not for MD (Pinteraction = 0.13). Negative control experiments suggested that the observed interactions for MD (empirical-P = 0.067) may be driven by statistical biases or confounding factors but were not possible with the larger DS groups. Antidepressant usage interaction also appears to be driven by statistical artefacts (empirical-P = 0.510 using MD and 0.162 using DS).

CONCLUSION

We have highlighted the importance of running negative experiments to confirm putative interactions in gene-environment studies. We provide some tentative evidence that depression accentuates an individual's genetic susceptibility to higher BMI but demonstrated that the BMI distributions within cases and controls might drive these interactions.

Increased growth hormone secretagogue receptor-1a (GHSR-1a) in hypothalamus during olanzapine treatment in rats

Weight gain is the one of the most important factors which increases global burden of psychiatric disorder. Second-generation antipsychotics, olanzapine (Olz) and valproic acid (Vpa) in particular, are held responsible for weight gain. However, it is still uncertain how these drugs cause this. Thus, the rats selected for the experiment were randomly divided into 3 groups. The 1st group received only 0.5 ml saline solution intraperitoneally (n = 20, control group); the second group was given 200 mg / kg Vpa intraperitoneally (n = 20, Vpa group) and 2 mg / kg Olz was given intraperitoneally to the 3rd group (n = 20, Olz group) between 8 and 10 am for 30 days. We examined serum leptin, adiponectin, resistin, TNF-α, IL-6, ghrelin level and, the amount of ghrelin secreting cells in the stomach and growth hormone secretagogue receptor-1a (GHSR-1a, ghrelin receptor) expression in the hypothalamus. The hypothalamic GHS-1a receptor index was significantly higher in the Olz group compared with the control group and Vpa group (p = 0.036 and p = 0.016 respectively). Ghrelin immune positive cell index in stomach was statistically significantly lower in the Vpa group compared with the control and Olz groups (p = 0.028 and p = 0.013 respectively) There was no difference between the groups in terms of serum leptin, resistin, IL-6 and ghrelin levels. In the Vpa group, a statistically significant increase was found in serum adiponectin level compared with both the control group and the Olz group (p = 0009 and p = 0024 respectively) and, significant decrease was found in serum TNF-α level compared to Olz group (p = 0007). In conclusion, we found that the main cause of weight gain in Olz use was the increase in the number of hypothalamic ghrelin receptors. Investigating the mechanism by which Olz increases the number of ghrelin receptors may help to develop effective treatment strategies in preventing obesity in psychiatric patients.

The selective serotonin reuptake inhibitor fluoxetine has direct effects on beta cells, promoting insulin secretion and increasing beta-cell mass

AIM

This study investigated whether therapeutically relevant concentrations of fluoxetine, which have been shown to reduce plasma glucose and glycated haemoglobin independent of changes in food intake and body weight, regulate beta-cell function and improve glucose homeostasis.

METHODS

Cell viability, insulin secretion, beta-cell proliferation and apoptosis were assessed after exposure of MIN6 beta cells or isolated mouse and human islets to 0.1, 1 or 10 μmol/L fluoxetine. The effect of fluoxetine (10 mg/kg body weight) administration on glucose homeostasis and islet function was also examined in ob/ob mice.

RESULTS

Exposure of MIN6 cells and mouse islets to 0.1 and 1 μmol/L fluoxetine for 72 hours did not compromise cell viability but 10 μmol/L fluoxetine significantly increased Trypan blue uptake. The dose of 1 μmol/L fluoxetine significantly increased beta-cell proliferation and protected islet cells from cytokine-induced apoptosis. In addition, 1 μmol/L fluoxetine induced rapid and reversible potentiation of glucose-stimulated insulin secretion from islets isolated from mice, and from lean and obese human donors. Finally, intraperitoneal administration of fluoxetine to ob/ob mice over 14 days improved glucose tolerance and resulted in significant increases in beta-cell proliferation and enhanced insulin secretory capacity.

CONCLUSIONS

These data are consistent with a role for fluoxetine in regulating glucose homeostasis through direct effects on beta cells. Fluoxetine thus demonstrates promise as a preferential antidepressant for patients with concomitant occurrence of depression and diabetes.

Interventions targeting comorbid depression and overweight/obesity: A systematic review

BACKGROUND

Overweight/obesity and depression are highly co-occurring conditions with shared pathophysiology as well as social and economic determinants. To our knowledge, this is the first systematic review aims to comprehensively synthesize extant literature with a focus on the effectiveness of interventions targeting obesity and depression comorbidity.

METHODS

We searched databases including MEDLINE, ProQuest Central, Web of Science, PsycINFO, Cochrane Library, from inception of the databases until Nov 12, 2021. Articles were included if they reported on the effects of pharmacological, psychological or dietary interventions on comorbid depression and overweight/obesity as their primary or secondary outcome.

RESULTS

Of the 5480 identified records, 19 eligible researches comprising 15 RCTs and 4 uncontrolled longitudinal studies for 3408 participants with comorbid depression and overweight/obesity. The available literature is not sufficient to inform evidence-based treatments targeting obesity and comorbid depression contemporaneously. Notwithstanding, the combination of CBT and lifestyle intervention show efficacy targeting obesity and comorbid depression as do some nutritional supplements, antidepressants and anti-diabetic agents.

LIMITATIONS

The high heterogeneity of various interventions in the included studies may cause a lack of comparability between different studies.

CONCLUSIONS

Concurrent management of depression and overweight/obesity is suggested by available data. There is a pressing need for studies that evaluate the effectiveness in real world samples of persons experiencing multiple co-occurring chronic diseases including but not limited to depression and overweight/obesity.

Effects of probiotic and magnesium co-supplementation on mood, cognition, intestinal barrier function and inflammation in individuals with obesity and depressed mood: A randomized, double-blind placebo-controlled clinical trial

Background

The co-occurrence of obesity and mood impairments named as “metabolic mood syndrome” (MMS) is often neglected in the obesity management. This study aimed to evaluate effects of Probio-Tec ^®BG-VCap-6.5 and magnesium co-supplementation on mood, cognition, intestinal barrier function and serum C reactive protein (CRP) levels in participants with obesity and depressed mood.

Design

Seventy-four eligible participants were randomly allocated to either Probio-Tec^®BG-VCap-6.5 [containing Lactobacillus rhamnosus (LGG^®) and Bifidobacterium animalis subsp. Lactis (BB-12^®)] + Magnesium chloride or placebo for 9 weeks. Sociodemographic data were collected in the beginning. Anthropometric, dietary and physical activity (PA) assessments were carried out. Beck Depression Inventory-II (BDI-II) and Montreal Cognitive Assessment (MoCA) scores were assessed through validated questionnaires. Fasting plasma zonulin, lipopolysaccharide (LPS) and (CRP) were measured by ELIZA kits.

Results

Of seventy-four participants (mean age 37.51 ± 8.10), 52 completed the study. Changes in serum LPS and zonulin were not different significantly between groups (−3.04 ± 44.75 ng/dl, 0.11 ± 5.13, ng/dl, p > 0.05 for LPS and 1.40 ± 48.78 ng/dl, −0.17 ± 6.60, p > 0.05 for zonulin, respectively). CRP levels reduced significantly in intervention group compared to placebo [−474.75 (−1,300.00, −125.00) mg/l vs. 175.20 (−957.75, 1,683.25) mg/l, p = 0.016]. Changes in BDI-II and MoCA scores were not significantly different between intervention (−7.13 ± 5.67, 1.20 ± 2.16, respectively) and placebo (−5.42 ± 6.71, 1.94 ± 1.86, respectively) groups (p > 0.05).

Conclusion

Nine weeks of probiotic and magnesium co-supplementation resulted in decreased CRP levels as an indicator of inflammatory state with no significant effects on mood, cognition and intestinal integrity in individuals with obesity and depressed mood.

Relationship between diet quality and depression among Iranian older adults in Tehran

Background

Depression is one of the prevalent mental disorders that is common in older ages. Evidence suggests that dietary intake status may potentially be associated with depression. However, this association has not been well studied in older adults, and the nature of the association remains unclear. This study aimed to investigate the association between diet quality and depression in free-living older adults living in Tehran city.

Methods

This cross-sectional study was conducted on 583 older adults (279 men and 304 women) aged 60 to 80 years living in Tehran city, selected by the systematic cluster sampling method. Individuals' dietary intake was determined by two non-consecutive 24-h dietary recalls, and diet quality was assessed calculating score of Healthy Eating Index-2015 (HEI-2015). The validated short form of the Geriatric Depression Scale (GDS-11) was used to assess depression status. A logistic regression model was used to assess the chance of depression across tertiles of HEI-2015 score.

Results

The point prevalence of depression was 22.5%, which was significantly higher in women (91 (69.5%) women vs. 40 (30.5%) men). A higher percentage of seniors at the higher tertile of HEI score were women, belonged to Fars ethnicity and had a higher score of activity of daily living (ADL). After adjustment for all potential confounders, the trend of depression chance was significantly decreased in those with higher HEI-2015 scores (p-for trend < 0.05).

Conclusion

Higher quality of diet was associated with a lower possibility of depression in the studied participants. Further studies are required to investigate the possible causal relationship.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03380-1.