Depression and lifestyle: Focusing on nutrition, exercise, and their possible relevance to molecular mechanisms

Combined influence of healthy lifestyles, nutritional and inflammatory status on mortality among US adults with depression

OBJECTIVE

Healthy lifestyles, nutritional and inflammatory status are interrelated and influence mortality. This study aimed to evaluate their separate and combined effects on all-cause and cause-specific mortality in individuals exhibiting depression.

METHODS

6143 individuals with depression (median age 47) were recruited from the US National Health and Nutrition Examination Survey (NHANES 2005-2018), with mortality followed up through December 31, 2019. A healthy lifestyle score (0-5) was constructed based on current non-smoking, low-to-moderate alcohol consumption, adequate sleep, sufficient physical activity and healthy diet. Higher scores indicated healthier lifestyles. The Advanced Lung Cancer Inflammation Index (ALI), a composite marker of inflammation and nutritional status, was calculated as Body Mass Index (BMI) (kg/m2) × albumin (g/dl)/Neutrophil-to-Lymphocyte Ratio (NLR). Higher ALI values denoted lower inflammation and better nutrition. Weighted Cox proportional-hazards models were used to estimate mortality hazard ratios.

RESULTS

Healthier lifestyles significantly lowered all-cause (hazard ratio [HR] 0.72, 95 % confidence interval [CI] 0.66-0.78), cardiovascular (HR 0.70, 95 % CI 0.58-0.83), and non-cardiovascular mortality (HR 0.72, 95 % CI 0.64-0.81). High ALI reduced all-cause (HR 0.70, 95 % CI 0.54-0.91) and cardiovascular mortality (HR 0.46, 95 % CI 0.28-0.77) compared with low ALI. Joint analyses showed that individuals with both healthy lifestyle scores ≥3 and high ALI had the lowest risk of all-cause, cardiovascular, and non-cardiovascular mortality (HR 0.44, 95 % CI 0.33-0.60; 0.32, 95 % CI 0.16-0.63; 0.49, 95 % CI 0.35-0.68).

CONCLUSION

The joint presence of healthy lifestyles and high ALI was significantly associated with lower risk of mortality among individuals with depression.

Association between red blood cell distribution width-to-albumin ratio and depression: a cross-sectional analysis among US adults, 2011-2018

BACKGROUND

Red blood cell distribution width (RDW)-to-albumin ratio (RAR) is a novel index. Its relationship with depression, a common and complex psychiatric disorder, remains unclear. This study utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate this relationship.

METHODS

Multivariate logistic regression, restricted cubic spline (RCS) regression, receiver operating characteristic (ROC) analysis, and sensitivity analyses were used to examine the relationship between RAR and depression based on NHANES data from 2011-2018. The study also used subgroup analyses and interaction tests to explore whether the relationship was stable across populations.

RESULTS

RAR was positively associated with depression in 18,150 participants aged ≥ 20 years. In fully adjusted models, each one-unit increase in RAR was associated with a 22% increase in the likelihood of depression [1.22 (1.05, 1.41)]. Participants in the highest quartile of RAR had a 30% higher risk of depression than those in the lowest quartile of RAR [1.30 (1.04, 1.63)]. Subgroup analyses revealed that the association between RAR and depression was significantly stronger among men, alcohol-drinking and high-income groups.

CONCLUSIONS

Higher baseline RAR was associated with an increased risk of depression in US adults and was more informative than RDW, albumin, and hemoglobin-to-RDW ratio (HRR). Further large-scale prospective studies are needed to analyze the role of RAR in depression. These findings emphasize that RAR can be a simple, reliable and cost-effective predictor of depression in clinical practice.

Neuroinflammation and Natural Antidepressants: Balancing Fire with Flora

Background/Objectives: Major depressive disorder (MDD) is a major global health concern that is intimately linked to neuroinflammation, oxidative stress, mitochondrial dysfunction, and complicated metabolic abnormalities. Traditional antidepressants frequently fall short, highlighting the urgent need for new, safer, and more acceptable therapeutic techniques. Phytochemicals, i.e., natural antidepressants derived from plants, are emerging as powerful plant-based therapies capable of targeting many pathogenic pathways at the same time. Summary: This narrative review synthesizes evidence from preclinical and clinical studies on the efficacy of phytochemicals such as curcumin, polyphenols, flavonoids, and alkaloids in lowering depressed symptoms. Consistent data show that these substances have neuroprotective, anti-inflammatory, and antioxidant properties, altering neuroimmune interactions, reducing oxidative damage, and improving mitochondrial resilience. Particularly, polyphenols and flavonoids have great therapeutic potential because of their capacity to penetrate the blood-brain barrier, inhibit cytokine activity, and encourage neuroplasticity mediated by brain-derived neurotrophic factor (BDNF). Despite promising results, the heterogeneity in study designs, phytochemical formulations, and patient demographics highlights the importance of thorough, standardized clinical studies. Conclusions: This review identifies phytochemicals as compelling adjuvant or independent therapies in depression treatment, providing multimodal mechanisms and enhanced tolerability. Additional research into improved dosage, pharmacokinetics, long-term safety, and integrative therapy approaches is essential. Using phytotherapeutics could considerably improve holistic and customized depression care, encouraging new research routes in integrative neuroscience and clinical psychiatry.

Identifying individuals at risk of post-stroke depression: Development and validation of a predictive model

OBJECTIVES

To identify the factors associated with post-stroke depression (PSD) and develop a machine learning predictive model using a large dataset, considering sociodemographic, lifestyle, and clinical factors.

METHODS

Our 2025 study used data from the 2023 Behavioral Risk Factor Surveillance System, released in September 2024. Data processing was carried out using Google Colab and Python. We carried out descriptive statistics, logistic regression, and feature importance analyses (mutual information and adjusted mutual information). A total of 4 machine-learning models were trained and evaluated: random forest, decision tree, gradient boosting, and logistic regression. Model performance was assessed using the accuracy, precision, recall, harmonic mean of precision and recall (F1-score), and area under the curve - receiver operating characteristic (AUC-ROC). The best-performing model was fine-tuned using GridSearchCV with 5-fold cross-validation.

RESULTS

Increasing age, male gender, being married, higher income, and physical activity were associated with lower odds of PSD. Obesity, smoking, diabetes, and high cholesterol are associated with increased odds of PSD. Age and gender were the most informative features for predicting the PSD. Random forest demonstrated the best performance for predicting PSD (accuracy=0.73, precision=0.71, recall=0.77, F1-score=0.74, and AUC-ROC=0.81), which was further improved by hyperparameter optimization.

CONCLUSION

Post-stroke depression's complex etiology involves sociodemographic, lifestyle, and clinical factors, notably age and gender. A random forest model effectively predicts PSD, highlighting the need for comprehensive assessment, early intervention, and management of modifiable risks (obesity, smoking, and inactivity) to improve stroke survivors' outcomes.

Isolation and Characterization of β-Phenylethylamine-Producing Lactic Acid Bacteria from Dairy Products

β-phenylethylamine (PEA) is a neuroactive trace amine synthesized by the enzymatic decarboxylation of phenylalanine. PEA is involved in the improvement of mood and attention. Functional foods enriched in this compound could, therefore, be of interest to the food industry. PEA is produced by microbial activity in certain foods, but usually only in small amounts. The search for PEA-producing microorganisms with good technological properties is thus a pre-requisite if such functional foods are to be produced. This work reports the isolation of thirty-three PEA-producing bacterial strains from samples of different dairy products. They belong to the genus Enterococcus, and the species Levilactobacillus brevis. Identified strains of Enterococcus durans were then selected for technological characterization. Some of them showed properties of interest. In this species, PEA was determined to be produced via the action of tyrosine decarboxylase, encoded by the gene tdcA. This implies that, apart from PEA, a concomitant production of tyramine, a toxic biogenic amine, was observed.

Associations of breakfast habits and breakfast quality with depression symptoms: A cross-sectional study based on NHANES 2007-2018

BACKGROUND

Breakfast, often considered the most important meal of the day, affects both physical and mental health. While most studies focused on the effects of skipping breakfast on depression, few explored the roles of breakfast quality and breakfast time. The study aimed to investigate the association of breakfast habits and breakfast quality with depression symptoms.

METHODS

This study included 23,839 participants aged 20 and older from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Breakfast habits were assessed using two 24-h dietary recalls, capturing both whether and when breakfast was consumed. Breakfast quality was assessed by calculating the Breakfast Quality Score (BQS). Depression symptoms was diagnosed using the Patient Health Questionnaire (PHQ-9). Binary logistic regression was used to explore the associations.

RESULTS

Compared to participants who did not report breakfast, the ORs of participants who reported breakfast on both one recall and both recalls were 0.737(0.591,0.919) and 0.766(0.624,0.939) for depression symptoms. Compared to participants in the BQS T1 subgroup, the ORs of participants in the T2 subgroup and T3 subgroup were 0.895(0.723,1.108) and 0.716(0.564,0.908) for depression symptoms (P for trend = 0.013). Compared to participants who had breakfast before 8:00 AM, the ORs for depression symptoms were 1.104 (95 % CI: 0.888, 1.371) for those who had breakfast between 8:00-9:00 AM and 1.278 (95 % CI: 1.030, 1.587) for those who had breakfast after 9:00 AM.

CONCLUSIONS

Skipping breakfast, low breakfast quality, and late breakfast are independently associated with depression symptoms.

Health risk behaviors, depressive symptoms and suicidal ideation among college students: A latent class analysis in middle China

PURPOSE

Previous studies have demonstrated the relationship between health risk behaviors and mental health, but little is discussed among college students. The current study aims to examine clusters of health risk behaviors and their correlation with depressive symptoms and suicidal ideation among Chinese college students.

METHODS

Data was obtained from the 2022 Surveillance for Common Diseases and Health Risk Factors among Students project conducted by the Hubei Province of the Centers for Disease Control and Prevention. Latent class analysis (LCA) was conducted based on health risk behaviors, including diet (breakfast skipping, consumption of sweetened beverages, fast food, milk, soymilk and yogurt), physical activities (physical exercise and sedentary), adverse experiences (verbal violence and emotional neglect), substance use (smoking and drinking), sleep, and unprotected sex behaviors. Mental health was assessed by the depressive symptoms and suicidal ideation. Multivariate logistic regression evaluated the correlation between mental health and health risk behaviors.

RESULTS

Among the 6372 Chinese college students, most had sedentary behavior, physical inactivity and unhealthy diet, and > 60 % had more than two health risk behaviors. We further identified four classes of health risk behaviors using LCA. Class 1 (low-risk group, 25.1 %) was unlikely to engage in health-risk behaviors. Class 2 (moderate-risk group, 66.9 %) showed the lowest or second lowest probabilities of most health risk behaviors. Class 3 (High-risk-substance abuse/unprotected sex, 5.2 %) presented the highest probabilities of smoking, drinking, irregular breakfast, unhealthy diet and unprotected sex. Class 4 (High-risk-adverse experiences, 2.8 %) showed the highest probabilities of verbal violence, emotional neglect and insufficient sleep. The high-risk (adverse experiences) class had the highest odds of both depressive symptoms and suicidal ideation, followed by Class 3 and Class 2. Moreover, single-parent and intergenerational families were positively associated with mental health problems in female college students.

LIMITATIONS

Due to the cross-sectional study, we cannot identify the changes in different developmental stages.

CONCLUSION

Different intervention strategies should be customized based on clustering patterns of health risk behaviors in the prevention of depression and suicide among college students.

Depression in chronic kidney disease: Particularities, specific mechanisms and therapeutic considerations, a narrative review

INTRODUCTION

Depression is highly prevalent during chronic kidney disease (CKD) with studies suggesting prevalence rates ranging from approximately one-quarter to half of CKD patients. CKD and depression have a bidirectional relationship, each disorder aggravating the other, leading to more complex and challenging patient management. Depression during CKD is multifactorial and is associated with increased risk of adverse events and hospitalization.

METHODS

We conducted a narrative review of experimental and observational studies in animals and humans, as well as meta-analyses, to explore specific mechanisms of depression in CKD and its treatment.

RESULTS

In depression the gut-brain axis is central. CKD leads to an accumulation of gut-derived uremic toxins. One key factor is the accumulation of tryptophan-derived uremic toxins like kynurenines or indoxyl sulfate, whose serum concentration increases progressively with the stage of CKD (up to 100-fold in stage 5), and which plays an important role in depression mechanisms, by activating aryl hydrocarbon receptor, decreasing brain concentrations of serotonin by approximately 40 %, increasing brain inflammation, via activation of microglia and astrocytes and release of TNFα, IL-6 and NO. Randomized controlled studies found limited or no benefits of antidepressants for depressive symptoms in CKD and hemodialysis patients.

CONCLUSION

Chronic inflammation, in relation to uremic toxin accumulation during CKD, seems to be a complex but important mechanism for treatment resistance in depression. Future research should consider inhibitors of uremic toxins inhibitors and anti-inflammatory molecules as potential therapeutic agents, to improve the prognosis of depression in CKD patients.

The Role and Mechanisms of Probiotic Supplementation on Depressive Symptoms: A Narrative Review

PURPOSE OF REVIEW

The microbiota-gut-brain-axis (MGBA) plays a role in the aetiology of mental disorders. Depression, a leading cause of disability worldwide, may be improved by probiotics. The aim of this narrative review is to investigate and synthesize the current evidence linking probiotic food supplementation with depressive symptomology.

RECENT FINDINGS

The gut and the brain communicate and interact via the MGBA through inflammation and the immune system, short chain fatty acid production, neuronal innervation and activation as well as endocrine and neurotransmitter modulation. Dysregulation of gut-brain pathways are caused by gut dysbiosis and implicated in the onset, persistence and exacerbation of depression related symptoms. Modulation of the gut microbiota via administration of probiotics has shown to reduce depressive symptom severity with Bifidobacterium and Lactobacillus strains being the most reported. Probiotics may produce greater benefits in mild depression rather than in chronic, treatment resistant depression. Probiotic supplementation is a promising and safe approach for the prevention of severe depressive disorders in high-risk individuals such as people with subthreshold depression. However, the mechanistic pathways of the MGBA require further investigation and additional human clinical trials are necessary to evaluate the role of probiotics on depression.

Adherence to a Mediterranean diet and leisure-time physical activity are associated with reduced initiation of antidepressant, anxiolytic, antipsychotic and antiseizure drug use in older adults: a cohort study

BACKGROUND

We explored how adherence to the Mediterranean diet (MedDiet) and leisure-time physical activity (LTPA) impact psychoactive medication use in older adults.

METHODS

We assessed the cumulative MedDiet adherence and LTPA's impact on mental health medication initiation in older individuals at high risk of chronic disease. Associations between the cumulative average of MedDiet adherence (per one-point increase in the adherence score) and LTPA (per increase in 20 metabolic equivalents of task-minute/day [METs-min/day]) with drug initiation were assessed by multivariable Cox regressions. We explored non-linear exposure-outcome associations using smoothed cubic splines and the multiplicative interaction between MedDiet and LTPA.

RESULTS

A total of 5940-6896 participants (mean age 67, 58% women) over 4.2-4.7 years, each point increase in MedDiet adherence decreased the initiation of antidepressants by 23-28% (HR 0.72, 95% CI 0.67-0.77), anxiolytics (HR 0.75, 0.70-0.81), antipsychotics (HR 0.77, 0.65-0.91), and antiseizures (HR 0.77, 0.69-0.85). Associations for anxiolytics and antiseizures were strong at low MedDiet adherence levels. Relationships between LTPA and initiation of antidepressants and anxiolytics were linear in the lowest LTPA values (0-150 METs-min/day); every 20 METs-min/day increases were associated with 20% lower risk of initiating antidepressants (HR 0.80, 0.75-0.86) and 15% less risk in anxiolytics (HR 0.85, 0.79-0.90). Association with antiseizures was linear (+20 METs-min/day: HR 0.96, 0.94-0.99), and no associations were found for antipsychotics. High MedDiet adherence (≥10) and LTPA (≥150 METs-min/day) reduced psychoactive drug initiation by 42%-59%. Combination was additive for antidepressants, antipsychotics and antiseizures and synergistic for anxiolytics.

CONCLUSIONS

MedDiet and LTPA adherence reduced psychoactive drugs initiation in older adults.

High Rates of Abnormal Glucose Metabolism Detected by 75 g Oral Glucose Tolerance Test in Major Psychiatric Patients with Normal HbA1c and Fasting Glucose Levels

Objectives: Comorbid diabetes is an important factor in the treatment of major psychiatric disorders. However, a substantial proportion of diabetic patients remain undetected by routine diabetic indices such as blood glucose and HbA1c. This study tried to estimate rates of such unidentified diabetic or prediabetic patients by using a 75 g oral glucose tolerance test (OGTT). Methods: Participants in the test were 25 patients with major depressive disorder (MDD), 28 patients with bipolar disorder (BP), 26 patients with schizophrenia, and 28 psychiatrically normal controls. They were all Japanese, and showed non-diabetic levels of blood glucose (<126 mg/dL) and HbA1c (<6.0%). Results: Relatively high rates of psychiatric patients showed diabetes mellites (DM)-type abnormality (32% of MDD, 21.4% of BP and 42.3% of schizophrenia v. 10.7% of controls). The difference in the rates between schizophrenia and control groups was statistically significant (p = 0.008). When abnormal glucose metabolism was defined as a prediabetic state (either normal high glycemia, impaired fast glycemia or impaired glucose tolerance) or DM type in OGTT, it was more frequently seen in the psychiatric patients than in controls (64% of MDD, 46.4% of BP and 46.2% of schizophrenia v. 35.7% of controls). Individuals with DM type showed higher HbA1c values compared with those with normal (p < 0.001) and prediabetic (p = 0.021) states. Conclusions: The results suggest that relatively high proportions of patients with a major psychiatric disorder remain undetected by routine indices for abnormal glucose metabolism, indicating the importance of OGTT even if the patients showed non-diabetic levels in blood glucose or HbA1c.

Comparative impact of exercise variants on depressive symptoms in cancer patients: A systematic review and network meta-analysis

PURPOSE

The aim of this study was to conduct a network meta-analysis to assess the effectiveness of various forms of exercise as an intervention for post-cancer depression and to provide a guiding program based on evidence-based medicine for subsequent clinical practice.

METHODS

This review was registered on the PROSPERO website with ID CRD42023485407. Pubmed, Embase, Cochrane Library, and Web of Science were comprehensively searched to obtain published articles from the establishment of the database until October 7, 2023. Bayesian network meta-analysis was conducted. Statistical analysis was conducted using R4.3.2 and Stata 15.1.

RESULTS

This study ultimately included 51 articles and 4956 samples. Aerobic exercise (SMD = -0.33, 95%CI: 0.58, -0.08), combined exercise (SMD = -0.48, 95%CI: 0.71, -0.26), and mind-body exercise (SMD = -0.35, 95%CI: 0.6, -0.09) significantly improved depression compared with usual care (UC). According to the SUCRA value and cumulative probability, the rank of depression improvement effect of various sports interventions is as follows: combined exercise (90.71%), mind-body exercise (69.64%), aerobic exercise (65.81%), resistance training (35.86%).

CONCLUSION

Exercise intervention can significantly improve post-cancer depression, but there is no significant difference in the effectiveness of various forms of exercise in improving post-cancer depression.

Exploring sedentary behavior, neutrophil-to-lymphocyte ratio, and depression: Mediation analysis in NHANES

BACKGROUND

Sedentary behavior and depression have been linked to inflammation. However, the specific role of inflammation in the relationship between sedentary behavior and depression remains unclear.

METHOD

We examined associations among the inflammatory marker (neutrophil-to-lymphocyte ratio [NLR]), sedentary behavior, and depression in a robust, ethnically diverse sample (n = 29,769) from the National Health and Nutrition Examination Survey (NHANES).

RESULT

Our findings indicate that individuals experiencing depression and/or engaging in sedentary behavior show elevated levels of the NLR. Even after adjusting for confounding variables such as age, sex, and body mass index, sedentary behavior remains significantly associated with both depression and NLR levels. Additionally, our analysis reveals a non-linear relationship between NLR levels and depression, suggesting a complex interaction. Importantly, NLR partially mediates a modest yet statistically significant portion (1.920 %, p = 0.014) of the association between sedentary behavior and depression.

CONCLUSION

This study highlights the intricate interplay among sedentary behavior, inflammation, and depression, providing insights into potential avenues for intervention and management.

Exercise-Activated mPFC Tri-Synaptic Pathway Ameliorates Depression-Like Behaviors in Mouse

Exercise is considered as playing a pivotal role in the modulation of emotional responses. However, a precise circuit that mediates the effects of exercise on depression have yet to be elucidated. Here, a molecularly defined tri-synaptic pathway circuit is identified that correlates motor inputs with antidepressant effects. With this pathway, initial inputs from neurons within the dorsal root ganglia (DRG) project to excitatory neurons in the gracile nucleus (GR), which in turn connect with 5-HTergic neurons in the dorsal raphe nucleus (DRN), eventually coursing to excitatory pyramidal neurons within the medial prefrontal cortex (mPFC). Exercise activates this pathway, with the result that depressive- and anxiety-like behaviors in mice are significantly reduced. In addition, it is found that exercise may exert antidepressant effects through regulating synaptic plasticity within this tri-synaptic pathway. These findings reveal a hindbrain-to-forebrain neuronal circuit that specifically modulates depression and provides a potential mechanism for the antidepressant effects of exercise.

Depression and Accelerated Aging: The Eveningness Chronotype and Low Adherence to the Mediterranean Diet Are Associated with Depressive Symptoms in Older Subjects

BACKGROUND AND OBJECTIVES

Depression often results in premature aging, which increases the risk of other chronic diseases, but very few studies have analyzed the association between epigenetic biomarkers of aging and depressive symptoms. Similarly, limited research has examined the joint effects of adherence to the Mediterranean diet (MedDiet) and chronotype on depressive symptoms, accounting for sex differences. Therefore, these are the objectives of our investigation in a Mediterranean population at high cardiovascular risk.

METHODS

We analyzed 465 older subjects (aged 55-75) with metabolic syndrome and assessed depressive symptoms by the Beck Depression Inventory (BDI-II). MedDiet adherence was measured with the 17-item MedDiet score, and chronotype with the Morningness-Eveningness Questionnaire (MEQ). Blood DNA methylation was analyzed, and epigenomic biomarkers of age acceleration were determined. We focused on the Dunedin Pace of Aging Computed from the Epigenome (DunedinPACE). We fitted multivariable models with interaction terms.

RESULTS

Prevalence of depression was statistically higher in women (p < 0.001). MedDiet adherence was strongly and inversely associated with depressive symptoms in the whole population (p < 0.01), while the MEQ score was inversely associated (p < 0.05). In the joint analysis, both MedDiet adherence and chronotype remained statistically associated with the BDI-II score (p < 0.05), showing additive effects. No interaction effects were observed. In women, a higher score in depressive symptoms was significantly associated with faster age acceleration (measured with the DunedinPACE biomarker). This association remained significant even after adjustment for MedDiet adherence and chronotype.

CONCLUSIONS

In older subjects with metabolic syndrome, the eveningness chronotype was associated with greater depressive symptoms, but a higher adherence to the MedDiet could potentially counteract the chronotype risk with additive effects. Women showed stronger associations, and importantly, we reported for the first time in this population that depressive symptoms were associated with accelerated aging.

Dietary Iron Intake and Mental and Behavioral Disorders Due to Use of Tobacco: A UK Biobank Study

BACKGROUND

Over 1 billion smokers worldwide, one-third of whom have mental and behavioral disorders, exist. However, factors influencing mental and behavioral disorders due to the use of tobacco remain largely unexplored. This study aims to investigate the relationship between dietary iron intake and mental and behavioral disorders due to the use of tobacco.

METHODS

Using large population cohort data from the UK Biobank (500,000 participants at 22 assessment centers between 2006 and 2010), we employed logistic and Cox regression analyses to explore both cross-sectional and longitudinal associations between dietary iron intake and mental and behavioral disorders due to the use of tobacco. Additionally, we assessed the nonlinear relationship between dietary iron intake and these disorders using restricted cubic spline plots.

RESULTS

Logistic regression analysis indicated that dietary iron intake was negatively associated with mental and behavioral disorders due to the use of tobacco. The Cox regression results supported a protective effect of increased dietary iron intake against these disorders. Stratified and sensitivity analyses were consistent with the primary findings. Restricted cubic spline plots revealed a nonlinear relationship between dietary iron intake and mental and behavioral disorders due to the use of tobacco. In the total sample, as well as in both age groups and the male subgroup, the risk reduction rate initially accelerated before slowing down. In contrast, the risk reduction rate in the female group declined rapidly at first and then leveled off.

CONCLUSIONS

This study demonstrates that dietary iron intake has a protective effect against mental and behavioral disorders due to the use of tobacco, revealing a nonlinear association between these two traits. These findings provide important insights for the profilaxy and treatment of mental and behavioral disorders due to the use of tobacco in the future.

Longitudinal relationships among number of chronic diseases, depression, and anxiety: A cross-lagged model analyses

BACKGROUND

Research is increasingly highlighting the intricate relationship between mental and physical health. However, longitudinal studies investigating the interplay between chronic diseases (CDs), depression and anxiety are still relatively scarce. This study aimed to delve into the longitudinal connections among these variables.

METHODS

This study conducted a 4-year prospective survey involving 486 participants from rural communities in Shandong Province, China. The relationships among these variables were analyzed using multiple linear regression, cross-lagged path analysis, and multiple-group analysis.

RESULTS

Our analysis revealed that the number of CDs reported at wave 1 significantly predicted anxiety levels (β = 0.126, p < .01) at wave 2, while depression symptoms also predicted anxiety (β = 0.220, p < .01) at wave 2. Furthermore, anxiety levels at wave 1 significantly predicted both the number of CDs (β = 0.219, p < .01) and depression symptoms (β = 0.160, p < .05) at wave 2. However, the study did not find support for a relationship between CDs and depression.

CONCLUSION

The study uncovered a bidirectional association between CDs and anxiety, depression and anxiety, but found no direct longitudinal relationship between CDs and depression. Research has indicated that CDs indirectly affect depression through anxiety.

The effects of MIND diet on depression, anxiety, quality of life and metabolic and hormonal status in obese or overweight women with polycystic ovary syndrome: a randomised clinical trial

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of reproductive age, associated with increased risks of metabolic disorders, depression and reduced quality of life. This study examined the impact of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on mental health, PCOS-related quality of life (PCOSQ), anthropometric indices, hirsutism, and metabolic/hormonal parameters in women with PCOS. Total of 52 women with PCOS, aged between 18 and 45 years, were randomly assigned to either the low calorie MIND diet group or the control group. Anthropometric data, depression and anxiety scores, serum levels of gonadotropins (luteinizing hormone [LH], follicle-stimulating hormone [FSH]), PCOSQ, and Ferriman-Gallwey score were evaluated before and after the intervention. Outcomes were assessed at baseline and at the end of the 8-week follow-up period. After 8 weeks, the MIND diet significantly reduced depression (β -3·03; 95 % CI: [-5·36, -0·70]; P = 0·011) and anxiety (β -3·54; 95 % CI: [-6·60, -0·49]; P = 0·024) scores compared with the control group. The MIND diet group exhibited significant increases in the emotion (β 0·63; 95 % CI: [0·18, 1·08]; P = 0·007) and body hair (β 0·65; 95 % CI: [0·03, 1·28]; P = 0·04) domains of the PCOSQ compared to the control group. The changes in other parameters did not show significant differences between the two groups. Both the MIND diet and control groups showed improvements in weight and BMI, with a slight advantage for the MIND diet group. These findings suggest that the MIND diet may be beneficial for improving mental health and some aspects of PCOSQ in women with PCOS.

The Association Study on Physical Activity Intensity, Sleep Quality, and Depression among College Students in the Central Plains Region

This investigation sought to understand how physical activity, sleep quality, and depression interrelate among university students in a particular region of China. It involved a diverse group of 2363 students from three institutions, using a cross-sectional approach with well-established measurement tools. These tools demonstrated strong reliability and validity, with Cronbach's alpha values indicating robust internal consistency. The data revealed that higher levels of physical activity were inversely related to depression and directly related to better sleep quality, highlighting the potential of exercise and sleep improvement to reduce depressive symptoms among this demographic.

Longitudinal Associations between Healthy Eating Habits, Resilience, Insomnia, and Internet Addiction in Chinese College Students: A Cross-Lagged Panel Analysis

This study aimed to explore the longitudinal associations between healthy eating habits, resilience, insomnia, and Internet addiction by using a cross-lagged panel analysis of Chinese college students. Overall, 807 Chinese college students completed questionnaires on healthy eating habits, resilience, insomnia, and Internet addiction from August 2020 (time 1, T1) to November 2020 (time 2, T2), and were selected for the data analyses. Healthy eating habits (T1) had significant effects on resilience (T2; β = 0.064, p < 0.05) and insomnia (T2; β = -0.064, p < 0.05), but not Internet addiction (T2; β = -0.028, p > 0.05). Insomnia (T1) negatively predicted resilience (T2; β = -0.098, p < 0.01). Insomnia was bidirectionally associated with Internet addiction (Internet addiction at T1 to insomnia at T2: β = 0.085, p < 0.01; insomnia at T1 to Internet addiction at T2: β = 0.070, p < 0.05). Additionally, Internet addiction (T1) significantly predicted resilience (T2; β = -0.075, p < 0.05). This study further expanded the understanding of the longitudinal associations between healthy eating habits, resilience, insomnia, and Internet addiction, which provided higher-level evidence and important implications for the interventions for reducing college students' Internet addiction, developing healthy eating habits, and improving resilience and sleep health.

The multimorbidity association of metabolic syndrome and depression on type 2 diabetes: a general population cohort study in Southwest China

Background

Metabolic syndrome(MetS) and depression are independently associated with type 2 diabetes (T2DM) risk. However, little is known about the combined effect of MetS and depression on the risk of T2DM. The present study aims to prospectively explore the impact of MetS and depression on T2DM susceptibility among the Chinese general population.

Methods

6489 general population without T2DM adults in Southwest China were recruited from 2010 to 2012. Depression and MetS were prospectively assessed using a 9-item Patient Health Questionnaire(PHQ-9) and Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (CDS2020) during 2016-2020, respectively. Modified Poisson regression models were conducted to estimate relative risk(RR) and 95% confidence intervals (95%CI) for independent and combined associations of MetS and depression with an incidence of T2DM.

Results

During a median follow-up of 6.6 years, 678 cases of T2DM were documented. Individuals with MetS were 1.33 times more likely to develop T2DM than those without MetS. The corresponding RR(95%CI) for depression with no depression was 1.45(1.22-1.72). Notably, compared with no MetS or depression, the multivariate-adjusted RR for a combined effect of MetS and depression on the risk of T2DM was 2.11(1.39-3.22). Moreover, an increased risk of T2DM was more apparent in those ≥ 60 years, males, and overweight.

Conclusions

Individuals with multimorbidity of MetS and depression are at a higher risk of T2DM compared with those with no MetS or depression.

Psychological distress and uterine fibroids: a bidirectional two-sample mendelian randomization study

BACKGROUND

Observational data indicates a connection between emotional discomfort, such as anxiety and depression, and uterine fibroids (UFs). However, additional investigation is required to establish the causal relationship between them. Hence, we assessed the reciprocal causality between four psychological disorders and UFs utilizing two-sample Mendelian randomization (MR).

METHODS

To evaluate the causal relationship between four types of psychological distress (depressive symptoms, severe depression, anxiety or panic attacks, mood swings) and UFs, bidirectional two-sample MR was employed, utilizing single nucleotide polymorphisms (SNPs) associated with these conditions. Both univariate MR (UVMR) and multivariate MR (MVMR) primarily applied inverse variance weighted (IVW) as the method for estimating potential causal effects. Complementary approaches such as MR Egger, weighted median, simple mode, and weighted mode were utilized to validate the findings. To assess the robustness of our MR results, we conducted sensitivity analyses using Cochran's Q-test and the MR Egger intercept test.

RESULTS

The results of our UVMR analysis suggest that genetic predispositions to depressive symptoms (Odds Ratio [OR] = 1.563, 95% Confidence Interval [CI] = 1.209-2.021, P = 0.001) and major depressive disorder (MDD) (OR = 1.176, 95% CI = 1.044-1.324, P = 0.007) are associated with an increased risk of UFs. Moreover, the IVW model showed a nominally significant positive correlation between mood swings (OR: 1.578; 95% CI: 1.062-2.345; P = 0.024) and UFs risk. However, our analysis did not establish a causal relationship between UFs and the four types of psychological distress. Even after adjusting for confounders like body mass index (BMI), smoking, alcohol consumption, and number of live births in the MVMR, the causal link between MDD and UFs remained significant (OR = 1.217, 95% CI = 1.039-1.425, P = 0.015).

CONCLUSIONS

Our study presents evidence supporting the causal relationship between genetic susceptibility to MDD and the incidence of UFs. These findings highlight the significance of addressing psychological health issues, particularly depression, in both the prevention and treatment of UFs.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

Development and Validation of a Nomogram for Predicting Nutritional Risk Based on Frailty Scores in Older Stroke Patients

BACKGROUND

In older stroke patients with frailty, nutritional deficiencies can amplify their susceptibility, delay recovery, and deteriorate prognosis. A precise predictive model is crucial to assess their nutritional risk, enabling targeted interventions for improved clinical outcomes.

OBJECTIVE

To develop and externally validate a nutritional risk prediction model integrating general demographics, physical parameters, psychological indicators, and biochemical markers. The aim is to facilitate the early identification of older stroke patients requiring nutritional intervention.

METHODS

This was a multicenter cross-sectional study. A total of 570 stroke patients were included, 434 as the modeling set and 136 as the external validation set. The least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables. Internal validation was performed using Bootstrap resampling (1000 iterations). The nomogram was constructed based on the results of logistic regression. The performance assessment relied on the receiver operating characteristic curve (ROC), Hosmer--Lemeshow test, calibration curves, Brier score, and decision curve analysis (DCA).

RESULTS

The predictive nomogram encompassed seven pivotal variables: Activities of Daily Living (ADL), NIHSS score, diabetes, Body Mass Index (BMI), grip strength, serum albumin levels, and depression. Together, these variables comprehensively evaluate the overall health and nutritional status of elderly stroke patients, facilitating accurate assessment of their nutritional risk. The model exhibited excellent accuracy in both the development and external validation sets, evidenced by AUC values of 0.934 and 0.887, respectively. Such performance highlights its efficacy in pinpointing elderly stroke patients who require nutritional intervention. Moreover, the model showed robust goodness of fit and practical applicability, providing essential clinical insights to improve recovery and prognosis for patients prone to malnutrition.

CONCLUSIONS

Elderly individuals recovering from stroke often experience significant nutritional deficiencies. The nomogram we devised accurately assesses this risk by combining physiological, psychological, and biochemical metrics. It equips healthcare providers with the means to actively screen for and manage the nutritional care of these patients. This tool is instrumental in swiftly identifying those in urgent need of targeted nutritional support, which is essential for optimizing their recovery and managing their nutrition more effectively.

Food-Oral Processing: Current Progress, Future Directions, and Challenges

Oral processing refers to the series of physical, chemical, and biological processes inside the oral cavity when we consume food. This process affects the taste, quality, and nutrient absorption of the body. In the human diet, oral processing plays a crucial role because it impacts not only the food flavor and texture but also the absorption and utilization of nutrients. With the progress of science and technology and the increasing demand for food, the study of oral processing has become increasingly important. This paper reviews the history and definition of oral processing, its current state of research, and its applications in food science and technology, focusing on personalized taste customization, protein structure modification, food intake and nutrition, and bionic devices. It also analyzes the impact of oral processing on different types of food products and explores its potential in the food industry and science research.

Screening for depression and anxiety in lung cancer patients: A real-world study using GAD-7 and HADS

BACKGROUND

The psychological well-being of lung cancer patients is critical in-patient care but frequently overlooked.

METHODS

This study, employing a cross-sectional, questionnaire-based design, aimed to elucidate the prevalence of depressive and anxiety symptoms among lung cancer patients and identify associated risk factors. Participants' demographic, medical history, disease stage, and pathology were systematically collected. Psychological assessment was conducted using the general anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and hospital anxiety and depression scale (HADS). Statistical analyses were performed using SPSS software (version 25.0).

RESULTS

Out of 294 distributed questionnaires, 247 lung cancer patients were included in the final analysis, with an average completion time of 9.08 min. Notably, 32.4% exhibited depressive symptoms, while 30% displayed signs of anxiety. A significant correlation was found between both depressive and anxiety symptoms and a history of tobacco and alcohol consumption. Specifically, increased nicotine dependence and greater cumulative tobacco use were linked to higher rates of depressive symptoms, whereas cumulative alcohol consumption was associated with increased risks of anxiety symptoms.

CONCLUSION

The study affirms the feasibility of GAD-7, PHQ-9, and HADS as screening tools for depressive and anxiety symptoms in lung cancer patients. It further highlights tobacco and alcohol consumption as significant risk factors for poor psychological health in this population.

Association between plasma polyunsaturated fatty acids and depressive among US adults

BACKGROUND

Depression is associated with greater functional impairment and high societal costs than many other mental disorders. Research on the association between plasma polyunsaturated fatty acids (PUFAs) levels and depression have yielded inconsistent results.

OBJECTIVE

To evaluate whether plasma n-3 and n-6 PUFAs levels are associated with depression in American adults.

METHODS

A cross-sectional study included 2053 adults (aged ≥20 y) in the National Health and Nutrition Examination Survey (NHANES), 2011-2012. The level of plasma n-3 and n-6 PUFAs were obtained for analysis. Self-reported Patient Health Questionnaire-9 (PHQ-9) was used to identify the depression status. Binary logistic regression analysis was performed to evaluate the association between quartiles of plasma n-3 and n-6 PUFAs and depression after adjustments for confounders.

RESULTS

The study of 2053 respondents over 20 years of age with a weighted depression prevalence of 7.29% comprised 1,043 men (weighted proportion, 49.13%) and 1,010 women (weighted, 50.87%), with a weighted mean (SE) age of 47.58 (0.67) years. Significantly increased risks of depression over non-depression were observed in the third quartiles (OR = 1.65, 95% CI = 1.05-2.62) for arachidonic acid (AA; 20:4n-6); the third quartiles (OR = 2.20, 95% CI = 1.20-4.05) for docosatetraenoic acid (DTA; 22:4n-6); the third (OR = 2.33, 95% CI = 1.34-4.07), and highest quartiles (OR = 1.83, 95% CI = 1.03-3.26) for docosapentaenoic acid (DPAn-6; 22:5n-6); and the third (OR = 2.18, 95% CI = 1.18-4.03) and highest quartiles (OR = 2.47, 95% CI = 1.31-4.68) for docosapentaenoic acid (DPAn-3; 22:5n-3); the second (OR = 2.13, 95% CI = 1.24-3.66), third (OR = 2.40, 95% CI = 1.28-4.50), and highest quartiles (OR = 2.24, 95% CI = 1.08-4.69) for AA/docosahexaenoic acid (DHA; 22:6n-3) ratio compared with the lowest quartile after adjusting for confounding factors.

CONCLUSION

Higher plasma levels of AA, DTA, DPAn-6, DPAn-3 PUFAs, and AA/DHA ratio may be potential risk factors for depression in US adults.

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.

The roles of serum vitamin D and tobacco smoke exposure in insomnia: a cross-sectional study of adults in the United States

Aim

Tobacco smoke exposure and vitamin D (VD) status were both associated with insomnia. However, the combined effect of smoking and VD on insomnia has not been discussed. This study aimed to explore the role of VD in the association between tobacco smoke exposure and insomnia.

Methods

Data on adults were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2005-2008 for this cross-sectional study. Weighted univariate and multivariate logistic regression analyses were used to explore the associations between serum cotinine, serum VD, and insomnia. A surface diagram was drawn to reflect the effect of VD on the association between serum cotinine and insomnia. In addition, the potential regulating effect of VD in subgroups of smoking status was also performed. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Among the eligible participants, 1,766 had insomnia. After adjusting for covariates, we found that elevated serum cotinine levels were associated with higher odds of insomnia [OR = 1.55, 95% CI: (1.22, 1.97)]. However, the relationship between serum VD level and insomnia was not significant (P = 0.553). Higher serum cotinine levels were also associated with higher odds of insomnia [OR = 1.52, 95% CI: (1.17, 1.98)] when serum VD level was <75 nmol/L; however, this relationship became non-significant when serum VD concentration was elevated (P = 0.088). Additionally, the potential regulating effect of VD was also found in adults who were not smoking.

Conclusion

VD may play a potential regulative role in the association between tobacco smoke exposure and insomnia. Further studies are needed to clarify the causal relationships between VD, tobacco smoke exposure, and insomnia.

Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018-2023)

Depression is classified as one of the most common mental disorders. Its prevalence has recently increased, becoming a growing public health threat. This review focuses on clarifying the role and importance of individual nutrients in the diet and the impact of nutrient deficiencies on the risk of depression. Deficiencies in nutrients such as protein, B vitamins, vitamin D, magnesium, zinc, selenium, iron, calcium, and omega-3 fatty acids have a significant impact on brain and nervous system function, which can affect the appearance of depressive symptoms. However, it is important to remember that diet in itself is not the only factor influencing the risk of or helping to treat depression. There are many other aspects, such as physical activity, sleep, stress management, and social support, that also play an important role in maintaining mental health. The data review observed that most of the available analyses are based on cross-sectional studies. Further studies, including prospective cohort, case-control studies, are recommended to draw more reliable conclusions.