Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies

Ultra-processed foods and human health: An umbrella review and updated meta-analyses of observational evidence

BACKGROUND & AIMS

Ultra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health.

METHODS

We searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations.

RESULTS

This umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders.

CONCLUSIONS

High UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.

Fruit for thought

OBJECTIVE

This commentary discusses the New Zealand Labour Party's announcement to remove tax on fresh and frozen fruits and vegetables. It aims to explore its potential impact on the psychological well-being of New Zealanders in the context of the growing global burden of mental illnesses in the current food environment.

CONCLUSIONS

The proposed tax exemption on fruits and vegetables demonstrates the government's commitment to improving the food environment. While the precise mental health effects of this potential tax change remain unstudied, existing evidence suggests a positive impact on New Zealanders' well-being, marking a pivotal step in addressing broader health issues and fostering a healthier, more equitable food landscape.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio

Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.

Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis

BACKGROUND & AIMS

We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association.

METHODS

In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours.

RESULTS

In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%.

CONCLUSION

A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.

Dietary inflammatory index is associated with severe depression in older adults with stroke: a cross-sectional study

Inflammation is involved in the pathogenesis of stroke and depression. We aimed to investigate the association between the dietary inflammatory index (DII) and depression in American adults with stroke. Adults with stroke were enrolled in the National Health and Nutrition Examination Survey between 2005 and 2018 in the USA. The DII was obtained from a 24-h dietary recall interview for each individual. Multivariate regression and restricted cubic spline analyses were conducted to evaluate the association between DII and depression in adults with stroke. The mean age of the 1239 participants was 63·85 years (50·20 % women), and the prevalence of depression was 18·26 %. DII showed a linear and positive association with severe depression in adults with stroke (OR 1·359; 95 % CI 1·021, 1·810; P for non-linearity = 0·493). Compared with those in the lowest tertile of the DII, adults with stroke in the third tertile of the DII had a 3·222-fold higher risk of severe depression (OR 3·222; 95 % CI 1·150, 9·026). In the stratified analyses, the association between DII score and severe depression was more significant in older adults (P for interaction = 0·010) but NS with respect to sex (P for interaction = 0·184) or smoking status (P for interaction = 0·396). No significant association was found between DII and moderate-to-moderately severe depression in adults with stroke. In conclusion, an increase in DII score was associated with a higher likelihood of severe depression in older adults with stroke.

Consumption of ultra-processed foods and mental health of pregnant women from the South of Brazil

The objective of this study is to evaluate the association between the consumption of ultra-processed foods (UPF) and the mental health of pregnant women from the South of Brazil. This is a cross-sectional study carried out in Criciúma, Brazil, through face-to-face interviews, from April to December 2022. Pregnant women aged 18 or older who underwent prenatal care in the forty-eight basic health care units of the municipality and who were in their third trimester of pregnancy were included. High consumption of UPF was considered as six or more items or subgroups of UPF consumed on the day before the interview, using the Nova-UPF screener. The mental health variables were depressive symptoms, stress, sadness and anxiety. Crude and adjusted analyses were conducted using the Fisher's exact test and the Poisson regression with robust variance. In total, 428 pregnant women were studied; most of them were aged between 20 and 25 years and were white. Pregnant women who presented high consumption of UPF were 1·42-fold (95 % CI 1·06, 1·92) more likely to experience anxiety and presented a prevalence 56 % (95 % CI 1·18, 2·07) higher of stress when compared with those who did not present high consumption of UPF. The prevalence of depressive symptoms and feelings of sadness was 1·31-fold (95 % CI 1·08, 1·60) and 3·41-fold (95 % CI 1·77, 6·58) higher among those with high consumption of UPF, respectively. The results suggest that diet quality is associated with the mental health of pregnant women. Promoting joint actions focused on food and nutritional education, and mental health, for pregnant women, is necessary.

Ultra-processed food consumption and quality of life: a cross-sectional study in Iranian women

Background

Ultra-processed foods (UPFs) have been associated with a higher intake of added sugars, sodium, and unhealthy fats; however, the relationship between UPFs and quality of life (QoL) is not well understood.

Methods

The present cross-sectional study included 193 Iranian women aged 18-48 years with a body mass index (BMI) of ≥25 kg/m2. UPFs were identified using the NOVA classification. QoL was evaluated using the SF-36 questionnaire. Anthropometric measurements and body composition were assessed using an appropriate method.

Results

The mean BMI and fat-free mass (FFM) of the subjects were 30.90 kg/m2 and 46.69 kg, respectively. At first, a significant difference was observed in the height of women across tertiles of UPF consumption. The mean score of the total QoL scale was 66.90. Women who were in the tertile 3 of UPFs intake had 23.59 units lower the scale of limitation in physical capabilities and activity (score of role-physical) (β = -23.59, 95% CI: -37.77-9.40, p = 0.001). Among those with the highest adherence to UPF intake, there was an 8.76 unit reduction in addressing feelings of energy and fatigue (vitality domain) in model 2 (β = -8.76, 95% CI: -16.42-1.11, p = 0.02). Finally, a reduction of 15.78 units was observed in the mental health scale, specifically in the mental states of anxiety and depression, among participants in the third tertile of UPF intake (β = -15.78, 95% CI: -24.11-7.45, p < 0.001).

Conclusion

Increased UPF consumption was associated with lower QoL in Iranian women. Further studies are needed to confirm these findings and develop effective strategies to promote healthy food choices.

Ultra-processed food and non-communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature

The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra-processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta-analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density, the macro- and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.

Ultra-Processed Food Consumption and Long-Term Risk of Irritable Bowel Syndrome: A Large-Scale Prospective Cohort Study

BACKGROUND & AIMS

The considerable disease burden of irritable bowel syndrome (IBS) has coincided with the increase of ultraprocessed food (UPF) consumption over the past few decades. However, epidemiologic evidence for an association is lacking. We aimed to examine the long-term risk of IBS associated with UPF consumption in a large-scale prospective cohort.

METHODS

Participants who completed 24-hour dietary recalls during 2009 to 2012 from the UK Biobank, and free of IBS, celiac disease, inflammatory bowel disease, and any cancer at baseline, were included (N = 178,711; 53.1% female). UPF consumption was defined according to the NOVA food classification system, expressed as a percentage of UPF content in the total diet intake (as grams per day). The primary outcome was incident IBS. A Cox proportional hazard model was performed to estimate associated risk.

RESULTS

The mean UPF consumption was 21.0% (SD, 11.0%) of the total diet. During a median of 11.3 years of follow-up, 2690 incident IBS cases were identified. An 8% higher risk of IBS (hazard ratio, 1.08; 95% CI, 1.04-1.12) was associated with every 10% increment of UPF consumption. Compared with the lowest quartile of UPF consumption, the highest quartile was associated with a significantly increased risk of incident IBS (hazard ratio, 1.19; 95% CI, 1.07-1.33; Ptrend < .001). Subgroup analyses by age, sex, body mass index, smoking, and alcohol drinking status also showed similar results, except for the never/previous drinking subgroup. Further sensitivity analyses confirmed the positive association with a higher UPF consumption.

CONCLUSIONS

Our findings provide evidence that a higher UPF consumption is associated with an increased risk of incident IBS, with a significant dose-response relationship.

The causal relationship between serum metabolites and the risk of psoriasis: a Mendelian randomization and meta-analysis study

Objective

To explore the influence of serum metabolites on the risk of psoriasis.

Methods

In the initial stage, we applied Mendelian randomization to evaluate the association between 1,400 serum metabolites and the risk of psoriasis. Causal effects were primarily assessed through the Inverse-Variance Weighted method and Wald Ratio's odds ratios, and 95% confidence intervals. False Discovery Rate was used for multiple comparison corrections. Sensitivity analyses were conducted using Cochran's Q Test, MR-PRESSO. MR-Steiger Test was employed to check for reverse causality. In the validation stage, we sought other sources of psoriasis GWAS data to verify the initial results and used meta-analysis to combine the effect sizes to obtain robust causal relationships. In addition, we also conducted metabolic pathway enrichment analysis on known metabolites that have a causal relationship with the risk of psoriasis in both stages.

Results

In the initial stage, we identified 112 metabolites causally associated with psoriasis, including 32 metabolite ratios and 80 metabolites (69 known and 11 unknown). In the validation stage, 24 metabolites (16 known, 1 unknown, and 7 metabolite ratios) were confirmed to have a causal relationship with psoriasis onset. Meta-analysis results showed that the overall effect of combined metabolites was consistent with the main analysis in direction and robust in the causal relationship with psoriasis onset. Of the 16 known metabolites, most were attributed to lipid metabolism, with 5 as risk factors and 8 as protective factors for psoriasis. Peptidic metabolite Gamma-glutamylvaline levels had a negative causal relationship with psoriasis, while exogenous metabolite Catechol sulfate levels and amino acid 3-methylglutaconate levels had a positive causal relationship with the disease onset. The metabolites associated with psoriasis risk in the two stages are mainly enriched in the following metabolic pathways: Glutathione metabolism, Alpha Linolenic Acid and Linoleic Acid Metabolism, Biosynthesis of unsaturated fatty acids, Arachidonic acid metabolism, Glycerophospholipid metabolism.

Conclusion

Circulating metabolites may have a potential causal relationship with psoriasis risk, and targeting specific metabolites may benefit psoriasis diagnosis, disease assessment, and treatment.

Predispose, precipitate, perpetuate, and protect: how diet and the gut influence mental health in emerging adulthood

Medicine often employs the 4Ps of predisposing, precipitating, perpetuating, and protective factors to identify salient influences on illness states, and to help guide patient care. Mental illness is a significant cause of morbidity and mortality worldwide. Mental health is a complex combination of biological, psychological, environmental, and social factors. There is growing interest in the gut-brain-microbiome (GBM) axis and its impact on mental health. We use the medical model of the 4Ps to explore factors involving the connection between nutrition and the GBM axis and their associated risks with mental health problems in emerging adults (EAs), a life stage when mental illness onset is the most common. We review the impact of current dietary trends on the GBM and on mental health, and the role that gut microbiome-based interventions can have in modulating the GBM axis of EAs. We discuss the implications of gut health on the GBM and areas for clinical intervention.

Reporting quality and risk of bias of systematic reviews of ultra-processed foods: a methodological study

A dramatic shift in the global food system is occurring with the rapid growth of ultra-processed foods (UPFs) consumption, which poses potentially serious health risks. Systematic review (SR) method has been used to summarise the association between UPF consumption and multiple health outcomes; however, a suboptimal-quality SR may mislead the decision-making in clinical practices and health policies. Therefore, a methodological review was conducted to identify the areas that can be improved regarding the risk of bias and reporting quality of relevant SRs. Systematic searches to collect SRs with meta-analyses of UPFs were performed using four databases from their inception to April 14, 2023. The risk of bias and reporting quality were evaluated using ROBIS and PRISMA 2020, respectively. The key characteristics of the included SRs were summarised descriptively. Excel 2019 and R 4.2.3 were used to analyse the data and draw graphs. Finally, 16 relevant SRs written in English and published between 2020 and 2023 in 12 academic journals were included. Only one SR was rated as low risk of bias, and the others were rated as higher risk of bias mainly because the risk of bias in the original studies was not explicitly addressed when synthesising the evidence. The reporting was required to be advanced significantly, involving amendments of registration and protocol, data and analytic code statement, and lists of excluded studies with justifications. The reviews' results could improve the quality, strengthen future relevant SRs' robustness, and further underpin the evidence base for supporting clinical decisions and health policies.

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

OBJECTIVE

To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.

DESIGN

Systematic umbrella review of existing meta-analyses.

DATA SOURCES

MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.

RESULTS

The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.

CONCLUSIONS

Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023412732.

Ultra-processed food consumption and human health: an umbrella review of systematic reviews with meta-analyses

Recently, ultra-processed foods received a lot of attention, but also criticism. Our aim was to provide an overview of the existing evidence of ultra-processed food consumption on human health. We conducted a systematic search in four databases until January 5th, 2024. Systematic reviews with meta-analyses on ultra-processed food consumption as defined by the NOVA classification system were included. The certainty of evidence was evaluated by the GRADE approach. We identified 16 publications. Moderate certainty of evidence was found for all-cause mortality (Summary Risk Ratio per 50 g: 1.02; 95% confidence Interval (CI): 1.01, 1.03), cardiovascular disease incidence and mortality (per 50 g/d: 1.04; 95% CI: 1.02, 1.06, and 1.05; 95% CI: 1.01, 1.08), type 2 diabetes incidence (per 10%: 1.12; 95% CI: 1.10, 1.13) and colorectal cancer (per 10%: 1.04; 95% CI: 1.01, 1.07). For several outcomes such as inflammatory bowel diseases, obesity, metabolic syndrome, nonalcoholic fatty liver disease, mental health as well as nutrient quality, similar estimates were observed, but certainty of evidence was limited. Discussing the NOVA concept, it remains unclear whether the processing of foods leads to increased health risks or if ultra-processed food consumption is only a measure for poor diet quality.

Consumption of ultra-processed foods and multiple health outcomes: An umbrella study of meta-analyses

Consumption of ultra-processed foods (UPFs) is associated with various adverse health outcomes, which significantly influence the global disease burden. This umbrella review aimed to fill the knowledge gap and guide public health practices by summarizing the association between UPFs and multiple health outcomes. A total of four databases were systematically searched from inception to December 2022, and 14 eligible systematic reviews (SRs) with meta-analyses (MAs) were identified. The SRs were published in 10 journals from 2020 to 2023, with 54,147-5,750,133 participants and 5-61 studies. The overall corrected covered area (CCA) was corresponded to a slight overlap. The results showed that an increased UPFs consumption is associated with multiple health outcomes (e.g., obesity, diabetes, hypertension, mortality). Only two SRs were "Moderate" regarding the overall methodological quality, while the other twelve were "Low" or "Critically low". Therefore, well-conducted SRs with high-quality prospective cohorts with a particular focus on special populations are needed to verify these findings further.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Constipation: A Pristine Universal Pediatric Health Delinquent

Constipation suffered by children is a global public health problem. Functional constipation (FC) brings about deteriorating effects in the children's lives who suffer from it. The risk factors for the development of constipation include the consumption of a diet low in fiber and high in calories (such as the consumption of fast food), a sedentary lifestyle with a lack of exercise, a family history of constipation, and emotional and psychological stress endured by children in their families. It is one of the most common causes of stomachaches in children. FC may lead to fecal incontinence (FI), anal fissures, recurrent urinary tract infections (RUTI), and enuresis in children. Severe constipation may result in stool becoming rock-hard and inflexible in the rectum, which is clinically identified as fecal impaction. It is imperative to perform clinical evaluation and treatment, including pharmacological (the use of stimulant and osmotic laxatives) and non-pharmacological (education, changes in diet, intervention to promote positive behavior and address any emotional issues, toilet training, and physiotherapy for the pelvic floor) interventions. In the case of refractory patients, neuromodulation, the irrigation of the anal canal, and surgical management may be needed. It is essential to lead a healthy, stress-free lifestyle with plenty of exercise and a balanced diet rich in fiber (such as fruits and vegetables) so children can have regular bowel habits and thrive.

Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada

Background

The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015.

Methods

Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015.

Results

Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable.

Conclusions

Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.

Eating out intensity, ultra-processed foods and BMI among Albanian youth

OBJECTIVE

Ultra-processed foods (UPF) and eating out of home (OH) are changing nutrition, particularly among youth in constrained settings. We aimed to assess the role of eating OH intensity on the associations of UPF and unprocessed or minimally processed foods (UMPF) with BMI among Albanian youth.

DESIGN

Cross-sectional.

SETTING

Albania, a south-eastern European country.

PARTICIPANTS

281 youth, predominantly females.

METHODS

UPF and UMPF were defined based on NOVA, while eating OH intensity based on energy percentage from OH foods. Multivariable models tested associations of UPF and UMPF with BMI stratified by eating OH intensity, controlled for relevant covariates including diet quality, portion size and costs.

RESULTS

The respondents age ranged between 18 and 23 years with a female predominance (87·5 %). Mean energy from UPF and UMPF was 846 (sd: 573·0) and 802·9 (422·5) kcals, respectively. Among substantial at home eaters UPF intake was not associated (β = −0·07, 95 % CI (−0·13, 0·267)) with BMI; however, UMPF negatively associated with BMI (β = −0·24, 95 % CI (−0·43, −0·06)). Among those defined as substantial OH eaters, UPF (β = 0·24, 95 % CI (0·08, 0·40)) and UMPF (β = 0·18, 95 % CI (0·04, 0·33)) were positively associated with BMI.

CONCLUSIONS

Our findings provide evidence for the hypothesis that eating OH plays an important role in the association of UPF and UMPF with BMI in youth. While causality cannot be established due to cross-sectional design, to the best of our knowledge, we provide the first assessment of UPF and UMPF intake in a south-eastern European setting, while highlighting the need for establishing and integrating youth nutrition into national nutritional surveillance systems for key dietary risk factors in Albania.

Nutrition and Mental Well-Being: Exploring Connections and Holistic Approaches

Quality of life, well-being, and psycho-emotional balance are closely related to the quality of the diet, the level of physical activity, the quality of rest, but also the absence of the consumption of narcotic substances and tobacco, or alcohol abuse. Based on the distribution of a questionnaire that included 30 questions, we aimed to statistically evaluate several factors that influence mental health and vices. It recorded a total of 1719 valid responses, which came from 78.3% female respondents and 21.7% male respondents. After processing the anthropometric data, it was observed that the majority of respondents are of normal weight (63.87%) and come from women in particular (36.13%). Based on the answers recorded, although over 60% of the respondents participating in the study are up to 40 years old, there is an increased tendency towards sedentarism (over 58% of the respondents declaring that they do sports very rarely or not at all), a low tendency regarding optimal consumption of vegetables and fruits, many respondents do not hydrate properly, which is why approximately 60% of respondents feel frequently tired, and over 32% are frequently nervous. The increased level of stress among the respondents and emotional eating are also generated by inadequate rest, reduced physical activity, and a diet that does not help the efficient detoxification of the body.

Adherence to the Mediterranean diet and depression, anxiety, and stress symptoms in Chilean university students: a cross-sectional study

This study aims to determine the association of adherence to the Mediterranean diet and its food groups with depressive symptoms in Chilean university students. The study design was cross-sectional. A total of 934 first-year students at a Chilean public university completed a self-report questionnaire. To assess adherence to Mediterranean diet, an index validated in Chile (Chilean-MDI) was used, and depression, anxiety, and stress symptoms were assessed using the Depression Anxiety and Stress Scale (DASS-21). Logistic regression models were used to analyze the association of adherence to Mediterranean diet and its food groups with depression, anxiety, and stress symptoms adjusted for the main confounders. Students with moderate and high adherence to Mediterranean diet showed lower odds of depression [DASS-21 > 5, odds ratio (OR) = 0.64; 95% confidence interval (95%CI): 0.47-0.88] than those with low adherence to Mediterranean diet. The consumption of 1-2 servings/day of vegetables (OR = 0.63; 95%CI: 0.43-0.92), > 2 servings/week of nuts (OR = 0.41; 95%CI: 0.21-0.80), 1-2 servings/day of fruits (OR = 0.60; 95%CI: 0.42-0.85), 1-2 servings/week of fish and seafood (OR = 0.67; 95%CI: 0.48-0.94), and 1/2-3 units/week of avocado (OR = 0.67; 95%CI: 0.48-0.93) showed low odds of depressive symptoms. The consumption of whole grains and cereals (> 2 servings/day) (OR = 1.63; 95%CI: 1.02-2.61) showed the opposite association. Adherence to Mediterranean diet and consumption of fruits, vegetables, nuts, avocado, fish, and seafood are associated with a lower likelihood of depression in Chilean university students. New policies and educational strategies are recommended to improve diet quality and the mental health of the entire university community.

Association of ultra-processed foods consumption with risk of cardio-cerebrovascular disease: A systematic review and meta-analysis of cohort studies

AIMS

The epidemiological evidence regarding the impact of ultra-processed foods (UPFs) on the risk of cardio-cerebrovascular diseases (CCVDs) is controversial. The aim of this systematic review and meta-analysis is to examine the association between UPF consumption and the risk of CCVDs within cohort studies.

DATA SYNTHESIS

A systematic literature search was conducted across multiple databases, including PubMed/Medline, Embase, Web of Science, Scopus, and the Cochrane Library databases, covering the inception of these databases up until January 1st, 2023. A total of 39 cohort studies involving 63,573,312 human participants were deemed eligible according to the inclusion criteria. Utilizing random-effects models, risk ratios (RRs) were estimated to determine the pooled results. Our findings indicate a significant association between a higher consumption of UPF and an increased likelihood of CCVDs (RR: 1.08, 95% CI: 1.01-1.16, I2 = 89%; p < 0.01) compared to individuals who either abstain from or consume lesser amounts of UPF. Nonlinear dose-response meta-analyses showed that a consistent high intake of UPFs was associated with an elevated risk of developing CCVDs (p non-linearity <0.001). Notably, the risk of CCVDs escalated by approximately 7% with an UPF intake of up to 1 serving per day. Subgroup analysis further revealed a significant augmentation in the risk of total CVD and hypertension with increased UPF consumption.

CONCLUSIONS

A higher intake of UPF significantly increases the risk of developing CCVDs. Prospective studies controlling for confounding factors are needed to validate the relationship between UPF intake and the development of CCVDs.

[Climate change, biodiversity loss and pollution: consequences for psychiatry]

The climate crisis, loss of biodiversity and increasing global pollution are a threat to mental health. Comprehensive transformations are needed to overcome these crises, which will also affect the mental healthcare system. If done correctly these change processes can seize the chance to improve mental health while at the same time addressing the crises. This includes avoiding the need for psychiatric treatment by strengthening the focus on mental health promotion and prevention, and also considering environmental aspects when targetting therapy procedures. In addition, by focusing on nutrition, mobility and the effects of nature, patients can be empowered to increase their mental resilience whilst reducing the negative effects on the environment. At the same time, the mental healthcare system must adapt to changing environmental conditions: increasing heat waves make protective measures necessary, especially for people with mental illnesses and increasing extreme weather events can lead to shifts in the spectrum of illnesses. Appropriate funding mechanisms will have to be established to support mental healthcare throughout this transformation.

Mentally-passive sedentary behavior and incident depression: Mediation by inflammatory markers

BACKGROUND

Sedentary behavior (SB; time spent sitting, as distinct from lack of exercise or physical activity) is associated with depression, yet little is known about the relationship between different types of SB (e.g., mentally-passive versus mentally-active) with depression and potential biological mediators of these associations.

METHODS

We used cohort data from the 1958 National Child Development Study (n = 4607; 50.4 % women), conducted in UK, employing the 44 y and 46 y waves as baseline, and the 50 y and 55 y waves as follow-up. Participants reported time spent in TV viewing and watching videos (mentally-passive SB); and, time sitting while doing light activities such as deskwork or driving a car during worktime (mentally-active SB). Depression diagnosis was self-reported during the initial and follow-up waves. Waist circumference, C-reactive protein, and glycated hemoglobin were examined as potential mediators.

RESULTS

Mentally-passive SB was associated with incident depression (HR: 1.43; 95%CI: 1.19; 1.71), while there was no association for mentally-active SB. Waist circumference (coefficient: -0.03; 95%CI: -0.05; -0.01; 9.2 %) and C-reactive protein (coefficient: -0.03; 95%CI: -0.04; -0.01; 8.3 %), but not glycated hemoglobin, partly mediated the association for mentally-passive SB.

CONCLUSIONS

In the relationship of mentally-passive SB with incident depression, the mediating contributions of waist circumference and C-reactive protein point to possible inflammatory-related mechanisms.

Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies

Across the world, diabetes, depression, and anxiety symptoms have gained widespread recognition as significant public health issues. Recent research has unveiled a mutually influential relationship between diabetes and these two mental health conditions, where each disorder impacts the course and outcomes of the others. The role of nutrition emerges as pivotal in preventing and treating depression, anxiety, and diabetes. A thorough literature review was undertaken to investigate the reciprocal effects between anxiety, depression, and diabetes, including their impact on the development and severity of each condition. Additionally, the effects of nutrition on the prevention and management of depression, anxiety, diabetes, and related complications in at-risk individuals were assessed. Our findings show that mental disorders, such as depression and anxiety, increase the risk of developing type 2 diabetes and are associated with poorer glycemic control, increased diabetes-related complications, and higher mortality rates. Conversely, diabetes is also linked with an increased risk of developing depression and anxiety. The biological, psychological, and social factors that contribute to the comorbidity between these two conditions are complex and multifaceted. Therefore, an integrated approach to the management of both conditions is critical for improving patient outcomes and reducing the overall burden of disease. Nutritional interventions should be utilized to reduce the risk of diabetes in patients with anxiety and depression as well as enhance mental health in patients with diabetes.

Dietary acid load, depression, and anxiety: results of a population-based study

BACKGROUND

Dietary acid load seems to be associated with psychological disorders through several mechanisms, and may barricade their treatment and recovery. The aim of current study was to evaluate the relationship between dietary acid load, using potential renal acid load (PRAL) and dietary acid load (DAL) scores, with the severity of depression and anxiety among Iranian adults.

METHODS

A total of 6531 participants aged 35-65 years were recruited in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to assess dietary intakes of participants. DAL was estimated using PRAL and DAL scores. Depression and anxiety were screened using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

RESULTS

In the fully adjusted model, women with the highest DAL or PRAL had higher odds of more severe depression compared to those in the lowest category (OR = 1.20; 95% CI = 1.03-1.42 and OR = 1.20; 95% CI = 1.03-1.39, respectively). No significant association was observed between DAL and PRAL and depression severity in men and in the population as a whole. Regarding the association between PRAL and anxiety severity, there was no significant association when separated by sex. However, in the fully adjusted model for the whole population, participants in the highest tertile of PRAL had 13% greater odds of more severe anxiety than the lowest tertile (OR: 1.13, 95% CI: 1.01-1.13). No significant association was observed between DAL and anxiety severity in women, men or in the whole population.

CONCLUSION

Women, but not men, with higher dietary acid load had significantly higher odds of having more severe depression. A significant positive association was also observed between dietary acid load and anxiety in the whole population.

Prostate Cancer Severity in Relation to Level of Food Processing

BACKGROUND

The level of food processing has gained interest as a potential determinant of human health. The aim of this study was to assess the relationship between the level of food processing and prostate cancer severity.

METHODS

A sample of 120 consecutive patients were examined for the following: their dietary habits, assessed through validated food frequency questionnaires; their dietary intake of food groups, categorized according to the NOVA classification; and their severity of prostate cancer, categorized into risk groups according to European Association of Urology (EAU) guidelines. Uni- and multivariate logistic regression analyses were performed to test the association between the variables of interest.

RESULTS

Individuals reporting a higher consumption of unprocessed/minimally processed foods were less likely to have greater prostate cancer severity than those who consumed less of them in the energy-adjusted model (odds ratio (OR) = 0.38, 95% confidence interval (CI): 1.17-0.84, p = 0.017 and OR = 0.33, 95% CI: 0.12-0.91, p = 0.032 for medium/high vs. low grade and high vs. medium/low grade prostate cancers, respectively); however, after adjusting for potential confounding factors, the association was not significant anymore. A borderline association was also found between a higher consumption of ultra-processed foods and greater prostate cancer severity in the energy-adjusted model (OR = 2.11, 95% CI: 0.998-4.44; p = 0.051), but again the association was not significant anymore after adjusting for the other covariates.

CONCLUSIONS

The level of food processing seems not to be independently associated with prostate cancer severity, while potentially related to other factors that need further investigation.

Causal Associations between Dietary Habits and Chronic Pain: A Two-Sample Mendelian Randomization Study

Chronic pain is a prevalent and debilitating condition with significant impacts on individuals and society. While the role of diet in chronic pain is well-known, the relationship between special dietary choices and chronic pain remains unclear. This study investigates the causal associations between 20 dietary habits and chronic pain using a Mendelian randomization (MR) approach. Publicly available genome-wide association study data from the UK Biobank dataset were utilized for secondary analysis, and genetic instrumental variables strongly correlated with 20 different dietary habits were selected. Multisite chronic pain (MCP) scores were used as the primary outcome, with site-specific chronic pain (SSCP) including back pain, headache, knee pain, neck pain, and hip pain as secondary outcomes. The inverse-variance-weighted (IVW) method was the primary method used in the MR. The weighted median (WM) and Mendelian randomization pleiotropy residual sum and outlier test (MR-PRESSO) methods were used as sensitivity analyses. This study identified causal associations between specific dietary habits and chronic pain. A high intake of cheese, cereal, dried fruits, and fresh fruits was associated with lower MCP scores. Conversely, high alcohol, salt, pork, and poultry intakes were associated with higher MCP scores. Similar associations between special dietary habits and some types of SSCP, such as back and neck pain, were also observed. The findings were consistent across different statistical methods, and sensitivity analyses confirmed the reliability of the results. In conclusion, our study provides evidence of a causal relationship between various dietary habits and different types of chronic pain based on secondary analysis of the UK Biobank dataset. Adhering to an anti-inflammatory diet, including increased consumption of fruits and cereal while reducing salt and pork intake, may potentially alleviate chronic pain symptoms.

Association of ultra-processed food consumption with incident depression and anxiety: a population-based cohort study

Background: Global ultra-processed food (UPF) consumption has risen rapidly. The development and prognosis of depression and anxiety remain unclarified. Herein, we aimed to examine the association between UPF consumption and the incidence and progression trajectory of depression and anxiety. Methods: In our study, participants were recruited between 2006 and 2010. UPF consumption was expressed as UPF servings, energy ratio, and weight ratio. The relationships between UPF consumption and depression or anxiety were assessed using the Cox proportional hazards model. Multi-state models were used to explore the association between UPF consumption and the risks of all transitions from a healthy state to depression or anxiety and then to all-cause mortality. Results: Among the 183 474 participants, 5453 were diagnosed with depression and 6763 with anxiety during the follow-up of 13.1 years. The participants in the highest quartile (Q4) of UPF servings, energy ratio, and weight ratio had an increased risk of depression compared to those in the lowest quartile (Q1), with hazard ratios (HRs) and 95% confidence intervals [CIs] of 1.22 (1.13-1.31), 1.13 (1.05-1.22), and 1.26 (1.17-1.36), respectively. Similarly, participants in Q4 of UPF consumption had a higher risk of anxiety, with HRs (95% CIs) of 1.13 (1.06-1.21), 1.13 (1.05-1.21), and 1.11 (1.04-1.19), compared to those in Q1. The study also found a significant association between UPF consumption and all-cause mortality, which disappeared for participants with depression or anxiety. Conclusions: Our findings revealed that UPF consumption is associated with depression or anxiety.

Prevalence and correlates of addictive eating behaviours in a large cohort of Australian adolescents

OBJECTIVE

Research shows highly palatable foods can elicit addictive eating behaviours or 'food addiction'. Early adolescence is theorised to be a vulnerable period for the onset of addictive eating behaviours, yet minimal research has examined this. This study explored the prevalence and correlates of addictive eating behaviours in a large early adolescent sample.

METHODS

6640 Australian adolescents (Mage = 12.7 ± 0.5, 49%F) completed an online survey. Addictive eating was measured with the Child Yale Food Addiction Scale (YFAS-C). Negative-binomial generalised linear models examined associations between addictive eating symptoms and high psychological distress, energy drink consumption, sugar-sweetened beverage (SSB) consumption, alcohol use, and cigarette use.

RESULTS

Mean YFAS-C symptom criteria count was 1.36 ± 1.47 (of 7). 18.3% of participants met 3+ symptoms, 7.5% endorsed impairment and 5.3% met the diagnostic threshold for food addiction. All examined behavioural and mental health variables were significantly associated with addictive eating symptoms. Effects were largest for high psychological distress and cigarette use; with those exhibiting high psychological distress meeting 0.65 more criteria (95%CI = 0.58-0.72, p < 0.001) and those who smoked a cigarette meeting 0.51 more criteria (95%CI = 0.26-0.76, p < 0.001). High psychological distress and consumption of SSB and energy drinks remained significant when modelling all predictors together.

CONCLUSION

In this large adolescent study, addictive eating symptoms were common. Further research should establish directionality and causal mechanisms behind the association between mental ill-health, alcohol and tobacco use, and addictive eating behaviours. Cross-disciplinary prevention initiatives that address shared underlying risk factors for addictive eating and mental ill-health may offer efficient yet substantial public health benefits.

Cross-Classification Analysis of Food Products Based on Nutritional Quality and Degree of Processing

This study aims to compare the classification of foods available in the Portuguese market using Nutri-Score and NOVA classifications and to analyse their ability to discriminate the fat, saturated fat, sugar, and salt content of foods. A sample of 2682 food products was collected. The nutritional quality of foods was established using the Nutri-Score, classifying them into five categories (from A to E). The NOVA classification was used to classify foods according to the degree of food processing into unprocessed/minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods (UPF). The nutritional content of food products was classified using a Multiple Traffic Light label system. It was observed that 73.7% of UPF were classified as Nutri-Score C, D, and E, 10.1% as Nutri-Score A, and 16.2% as Nutri-Score B. Nutri-Score was positively correlated with NOVA classification (ρ = 0.140, p < 0.001) and with the Multiple Traffic Lights system (ρ_{Total Fat} = 0.572, ρ_{Saturated Fat} = 0.668, ρ_Sugar = 0.215, ρ_Salt = 0.321, p < 0.001). NOVA classification negatively correlated with the Multiple Traffic Lights system for total fat (ρ = -0.064, p < 0.001). Our findings indicate the presence of many UPFs in all Nutri-Score categories. Since food processing and nutritional quality are complementary, both should be considered in labelling.

Mediterranean Dietary Pattern and Psychosocial Health Problems in Spanish Adolescents: The EHDLA Study

The aims of the present study were twofold: to determine the association between adherence to the Mediterranean diet (MedDiet) and psychological problems and to assess the relationship between different food groups of the MedDiet and different patterns of psychosocial health problems in a sample of Spanish adolescents from the Valle de Ricote (Region of Murcia, Spain). This cross-sectional study included a representative sample of 700 adolescents (57% girls) between 12 and 17 years of age. Adherence to the MedDiet was assessed by the Mediterranean Diet Quality Index for Children and Teenagers (KIDMED). Psychosocial health problems were measured by the 25-item self-report version of the Strengths and Difficulties Questionnaire (SDQ). ANCOVA models were used to test the mean differences in psychosocial health problems (SDQ subscales) by adherence to MedDiet categories (low, medium, and high). Multiple linear regression was used to determine the association between different food groups of the MedDiet and psychosocial health problems. Adolescents with low adherence to the MedDiet had significantly higher scores in SDQ total difficulties, conduct problems, and hyperactivity problems and lower scores in pro-social behavior (p < 0.05) than their peers with medium and high adherence to the MedDiet. In relation to specific MedDiet food groups, fruit, nut, and legume intake were associated with higher psychosocial health. However, sweets, skipping breakfast, or high consumption of pasta or rice (≥5 weeks) were associated to higher psychosocial health problems. Our results show that adolescents with higher adherence to the MedDiet could benefit from greater psychosocial health. Individually, some patterns of MedDiet, such as fruit, nut, and legume intake, may reduce psychosocial health problems. These cross-sectional results should be confirmed in longitudinal and intervention studies.

Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review

The Western diet is a modern dietary pattern characterized by high intakes of pre-packaged foods, refined grains, red meat, processed meat, high-sugar drinks, candy, sweets, fried foods, conventionally raised animal products, high-fat dairy products, and high-fructose products. The present review aims to describe the effect of the Western pattern diet on the metabolism, inflammation, and antioxidant status; the impact on gut microbiota and mitochondrial fitness; the effect of on cardiovascular health, mental health, and cancer; and the sanitary cost of the Western diet. To achieve this goal, a consensus critical review was conducted using primary sources, such as scientific articles, and secondary sources, including bibliographic indexes, databases, and web pages. Scopus, Embase, Science Direct, Sports Discuss, ResearchGate, and the Web of Science were used to complete the assignment. MeSH-compliant keywords such "Western diet", "inflammation", "metabolic health", "metabolic fitness", "heart disease", "cancer", "oxidative stress", "mental health", and "metabolism" were used. The following exclusion criteria were applied: (i) studies with inappropriate or irrelevant topics, not germane to the review's primary focus; (ii) Ph.D. dissertations, proceedings of conferences, and unpublished studies. This information will allow for a better comprehension of this nutritional behavior and its effect on an individual's metabolism and health, as well as the impact on national sanitary systems. Finally, practical applications derived from this information are made.

The gut-derived metabolites as mediators of the effect of healthy nutrition on the brain

Nutrition is now well recognized to be an environmental factor which positively or negatively influences the risk to develop neurological and psychiatric disorders. The gut microbiota has recently been shown to be an important actor mediating the relationship between environmental factors, including nutrition, and brain function. While its composition has been widely studied and associated with the risk of brain diseases, the mechanisms underlying the relationship between the gut and brain diseases remain to be explored. The wide range of bioactive molecules produced by the gut microbiota, called gut-derived metabolites (GDM), represent new players in the gut to brain interactions and become interesting target to promote brain health. The aim of this narrative review is to highlight some GDMs of interest that are produced in response to healthy food consumption and to summarize what is known about their potential effects on brain function. Overall, GDMs represent future useful biomarkers for the development of personalized nutrition. Indeed, their quantification after nutritional interventions is a useful tool to determine individuals' ability to produce microbiota-derived bioactive compounds upon consumption of specific food or nutrients. Moreover, GDMs represent also a new therapeutic approach to counteract the lack of response to conventional nutritional interventions.

Consumption of ultra-processed foods is associated with depression, mesocorticolimbic volume, and inflammation

BACKGROUND

The consumption of ultra-processed foods and drinks (UPF) has been associated with depression and inflammation and preclinical studies showed that some UPF components disrupt the amygdala-hippocampal complex. We combine diet, clinical and brain imaging data to investigate the relationship between the UPF consumption, depressive symptoms, and brain volumes in humans, considering interactions with obesity, and the mediation effect of inflammation biomarkers.

METHODS

One-hundred fifty-two adults underwent diet, depressive symptoms, anatomic magnetic resonance imaging assessments and laboratory tests. Relationships between the % of UPF consumption (in grams) of the total diet, depressive symptoms, and gray matter brain volumes were explored using several adjusted regression models, and in interaction with the presence of obesity. Whether inflammatory biomarkers (i.e., white blood cell count, lipopolysaccharide-binding protein, c-reactive protein) mediate the previous associations was investigated using R mediation package.

RESULTS

High UPF consumption was associated with higher depressive symptoms in all participants (β = 0.178, CI = 0.008-0.261) and in those with obesity (β = 0.214, CI = -0.004-0.333). Higher consumption was also associated with lower volumes in the posterior cingulate cortex and the left amygdala, which in the participants with obesity also encompassed the left ventral putamen and the dorsal frontal cortex. White blood count levels mediated the association between UPF consumption and depressive symptoms (p = 0.022).

LIMITATIONS

The present study precludes any causal conclusions.

CONCLUSIONS

UPF consumption is associated with depressive symptoms and lower volumes within the mesocorticolimbic brain network implicated in reward processes and conflict monitoring. Associations were partially dependent on obesity and white blood cell count.

Polyphenols as novel interventions for depression: exploring the efficacy, mechanisms of action, and implications for future research

Numerous animal and human studies have assessed the relationship between polyphenols and outcomes related to depression. However, no comprehensive synthesis of the main findings has been conducted. The aim of this manuscript was to systematically review the available evidence from animal and human studies on the association and the effects of dietary polyphenols on depression and provide recommendations for future research. We based our review on 163 preclinical animal, 16 observational and 44 intervention articles assessing the relationship between polyphenols and outcomes related to depression. Most animal studies demonstrated that exposure to polyphenols alleviated behaviours reported to be associated with depression. However, human studies are less clear, with some studies reporting and inverse relationship between the intake of some polyphenols, and polyphenol rich foods and depression risk and symptoms, while others reporting no association or effect. Hence, while there has been extensive research conducted in animals and there is some supporting evidence in humans, further human studies are required, particularly in younger and clinical populations.

High ultra-processed food consumption is associated with elevated psychological distress as an indicator of depression in adults from the Melbourne Collaborative Cohort Study

BACKGROUND

Few studies have tested longitudinal associations between ultra-processed food consumption and depressive outcomes. As such, further investigation and replication are necessary. The aim of this study is to examine associations of ultra-processed food intake with elevated psychological distress as a marker for depression after 15 years.

METHOD

Data from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 23,299). We applied the NOVA food classification system to a food frequency questionnaire (FFQ) to determine ultra-processed food intake at baseline. We categorised energy-adjusted ultra-processed food consumption into quartiles by using the distribution of the dataset. Psychological distress was measured by the ten-item Kessler Psychological Distress Scale (K10). We fitted unadjusted and adjusted logistic regression models to assess the association of ultra-processed food consumption (exposure) with significant psychological distress (outcome and defined as K10 ≥ 20). We fitted additional logistic regression models to determine whether these associations were modified by sex, age and body mass index.

RESULTS

After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, participants with the highest relative intake of ultra-processed food were at increased odds of significant psychological distress compared to participants with the lowest intake (aOR: 1.23; 95%CI: 1.10, 1.38, p for trend = 0.001). We found no evidence for an interaction of sex, age and body mass index with ultra-processed food intake.

CONCLUSION

Higher ultra-processed food intake at baseline was associated with subsequent elevated psychological distress as an indicator of depression at follow-up. Further prospective and intervention studies are necessary to identify possible underlying pathways, specify the precise attributes of ultra-processed food that confer harm, and optimise nutrition-related and public health strategies for common mental disorders.

Effects of ultra-processed foods on the microbiota-gut-brain axis: The bread-and-butter issue

The topic of gut microbiota and the microbiota-gut-brain (MGB) axis has become the forefront of research and reports in the past few years. The gut microbiota is a dynamic interface between the environment, food, and the host, reflecting the health status as well as maintaining normal physiological metabolism. Modern ultra-processed foods (UPF) contain large quantities of saturated and trans fat, added sugar, salt, and food additives that seriously affect the gut and physical health. In addition, these unhealthy components directly cause changes in gut microbiota functions and microbial metabolism, subsequently having the potential to impact the neural network. This paper reviews an overview of the link between UPF ingredients and the MGB axis. Considerable studies have examined that high intake of trans fat, added sugar and salt have deleterious effects on gut and brain functions, but relatively less focus has been placed on the impact of food additives on the MGB axis. Data from several studies suggest that food additives might be linked to metabolic diseases and inflammation. They may also alter the gut microbiota composition and microbial metabolites, which potentially affect cognition and behavior. Therefore, we emphasize that food additives including emulsifiers, artificial sweeteners, colorants, and preservatives interact with the gut microbiota and their possible effects on altering the brain and behavior based on the latest research. Future studies should further investigate whether gut dysbiosis mediates the effect of UPF on brain diseases and behavior. This thesis here sheds new light on future research pointing to the potentially detrimental effects of processed food consumption on brain health.

Impact of Final Phase Social Isolation and the COVID-19 Pandemic on Eating Behavior, Sleep Quality, and Anxiety Level

The coronavirus disease 2019 (COVID-19) pandemic has resulted in economic, social, and behavioral changes in people, which may favor several long-term consequences. This study evaluated the effects of the COVID-19 pandemic on eating behavior and mental health in the final phase of social isolation. This cross-sectional study included 756 adults that completed an online questionnaire. Individuals were stratified into those who had been infected with COVID-19 (GCOV) and those who did not (GNCOV). The GCOV group had higher weight (p = 0.013), body mass index (BMI) (p = 0.005), anxiety levels (p = 0.040), sleep disorders (p = 0.009), and poorer sleep quality (p = 0.0028). In the GCOV, the consumption of ultra-processed foods was associated with higher anxiety levels and poorer sleep quality. A higher proportion of individuals who consumed more than five servings of in natura food was observed in the group with taste and olfactory dysfunction than in the group without. Obesity contributes to uncontrolled and emotional eating disorders, increased anxiety, and worsened sleep. Therefore, COVID-19 impaired mental health and eating behavior even in the long term. These changes were potentiated by the presence of obesity and consumption of ultra-processed foods, evidencing the importance of monitoring these individuals even after the resolution of COVID-19.

Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review

Low-grade inflammation alters the homeostasis of the organism and favors the onset of many chronic diseases. The global growth in the prevalence of noncommunicable diseases in recent years has been accompanied by an increase in the consumption of ultra-processed foods (UPF). Known to be hyperpalatable, economic and ready-to-eat, increased consumption of UPF has already been recognized as a risk factor for several chronic diseases. Different research groups have tried to investigate whether UPF consumption could promote low-grade inflammation and thus favor the development of noncommunicable diseases. Current evidence highlights the adverse health effects of UPF characteristics, not only due to the nutrients provided by a diet rich in UPF, but also due to the non-nutritive components present in UPF and the effect they may have on gut health. This review aims to summarize the available evidence on the possible relationship between excessive UPF consumption and modulation of low-grade inflammation, as potential promoters of chronic disease.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

Sport and physical exercise in sustainable mental health care of common mental disorders: Lessons from the COVID-19 pandemic

The large-scale disruptions to physical activity during the coronavirus pandemic have been found to be a leading predictor of common mental disorders. In addition, regular physical exercise has been found to alleviate anxiety, sadness and depression during the pandemic. These findings, together with numerous studies published before the pandemic on the effects of physical activity on mental health, should be considered in the provision of mental health care following the pandemic. Cross-sectional research has revealed that all types of exercise and sport are associated with a reduced mental health burden. Therefore, the effectiveness of exercise and sport participation in sustainable mental health care as well as the causal relationship between exercise, psychosocial health and common mental disorders merit further investigation. Physical activity and sport, with their global accessibility, significant and clinically meaningful efficacy as well as virtual absence of adverse effects, offer a promising option for the promotion of mental health, including the prevention and treatment of common mental disorders. Physical exercise and sport are likely to become valuable public mental health resources in the future.

Ultra-Processed Food Consumption and Depressive Symptoms in a Mediterranean Cohort

Excess consumption of ultra-processed foods (UPFs) is currently under investigation for its potentially detrimental impact on human health. Current evidence demonstrates a substantial association with an increased risk of metabolic disorders, but data on mental health outcomes are just emerging. The aim of this study was to investigate the relationship between the consumption of UPFs and depressive symptoms in a sample of younger Italian adults. A cross-sectional study was conducted on 596 individuals (age 18-35 y) recruited in southern Italy. Food frequency questionnaires and the NOVA classification were used to assess dietary factors; the Center for the Epidemiological Studies of Depression Short Form (CES-D-10) was used to assess presence of depressive symptoms. Individuals in the highest quartile of UPF consumption had higher odds of having depressive symptoms in the energy-adjusted model (odds ratio (OR) = 1.89, 95% confidence interval (CI): 1.06, 3.28); the association remained significant after adjusting for potential confounding factors (OR = 2.04, 95% CI: 1.04, 4.01) and became even stronger after further adjustment for adherence to the Mediterranean diet as a proxy of diet quality (OR = 2.70, 95% CI: 1.32, 5.51). In conclusion, a positive association between UPF consumption and likelihood of having depressive symptoms was found in younger Italian individuals. Given the consistency of the findings after adjustment for diet quality, further studies are needed to understand whether non-nutritional factors may play a role in human neurobiology.

Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

Increased Consumption of Ultra-Processed Food Is Associated with Poor Mental Health in a Nationally Representative Sample of Adolescent Students in Brazil

The objective of this study was to analyze the association between ultra-processed food (UPF) consumption and mental health symptoms in a nationally representative sample of the Brazilian adolescent student population. Cross-sectional analyses with data from the National School-Based Health Survey (PeNSE 2019) were performed. Self-reported information was obtained for the frequency of five mental health symptoms in the last month and the consumption of thirteen UPFs in the last 24 h. Generalized linear models adjusting for the main confounders were performed for each sex. Of the 94,767 adolescent students (52.4% girls) included, 8.1% of the boys and 27.2% of the girls reported "almost always" or "always" having at least four of the five mental health symptoms. In the fully adjusted models, compared to the boys who consumed ≤3 UPF, those consuming ≥6 UPF reported more frequent symptoms of poor mental health (ß-coefficient = 0.27 [0.03, 0.51]; p-for-trend = 0.005). A similar association was observed in girls (ß-coefficient = 0.31 [0.13, 0.50]; p-for-trend = 0.001). In conclusion, in this large sample of adolescent students from an entire country, the higher the consumption of UPF was, the higher the frequency of reported symptoms of poor mental health. These findings remained significant regardless of sociodemographic and lifestyle factors, self-perceived body image, and bullying victimization.

Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

Ultra-Processed Foods and Drinks Consumption Is Associated with Psychosocial Functioning in Adolescents

Adolescents show one of the highest rates of ultra-processed foods and drinks (UPF) consumption, and studies indicate an association between their consumption and internalizing problems. We aim to investigate whether UPF consumption associates with dysfunctions in other psychosocial domains, as well as sex effects. In 560 Spanish adolescents (14-17 years old), we assessed the UPF products consumed in the previous day, fruits and vegetables consumption (servings/day), and physical activity (days/week). Psychosocial functioning (total and subscales) was assessed through the Pediatric Symptom Checklist-Youth self-report. Associations between UPF and psychosocial functioning were assessed using linear regression models, adjusting for sex, age, fruits and vegetables consumption, and physical activity. Sex-specific associations were also explored. Participants reported a daily consumption of 7.72 UPF servings per day, with male adolescents showing higher consumption than female adolescents. Consumption of fruits and vegetables and physical activity levels were lower than recommended. Psychosocial impairment was present in 26.2% of the participants. Higher UPF consumption was associated with higher presence of depressive symptoms and internalizing and externalizing problems in the whole sample and in male adolescents. The present study supports previous studies suggesting that UPF consumption may interact with mental health problems and indicates that these effects may go beyond internalizing problems.

Association between Dietary Patterns and the Risk of Depressive Symptoms in the Older Adults in Rural China

Geriatric depression, a chronic condition, has become a substantial burden in rural China. This study aimed to assess the association between dietary patterns and the risk of geriatric depression in rural China. Between March 2018 and June 2019, 3304 participants were recruited for this cross-sectional study in rural Tianjin, China. Principal component analysis was used to determine the major dietary patterns. The associations between dietary patterns and the risk of geriatric depression were assessed using a logistic regression model. Four dietary patterns were identified: vegetables-fruit, animal food, processed food, and milk-egg. The study found that vegetable-fruit (Q2 vs. Q1: OR = 0.62, 95% CI: 0.46–0.83; Q3 vs. Q1: OR = 0.54, 95% CI: 0.38–0.75; Q4 vs. Q1: OR = 0.39, 95% CI: 0.26–0.57) and animal food patterns (Q3 vs. Q1: OR = 0.69, 95% CI: 0.50–0.95; Q4 vs. Q1: OR = 0.58, 95% CI: 0.41–0.82) were associated with a decreased risk of depression, and inflammatory dietary pattern (Q2 vs. Q1: OR = 1.71, 95% CI: 1.23–2.38; Q3 vs. Q1: OR = 1.70, 95% CI: 1.22–2.36; Q4 vs. Q1: OR = 1.44, 95% CI: 1.03–2.03) was associated with an increased risk of depression. The present findings reinforce the importance of adopting an adequate diet consisting of vegetables, fruit and animal foods, while limiting the intake of pro-inflammatory foods, to decrease the risk of depression.