Relationship between psychological distress and the adherence to the Korean healthy eating index (KHEI): the Korea National Health and Nutrition Examination Survey (KNHANES) 2013 and 2015

Association between dietary patterns and suicide ideation among depressed adults: Insights from NHANES 2007-2020

BACKGROUND

Dietary patterns are strongly linked to the risk of major depressive disorder (MDD). However, research on the relationship between dietary patterns and MDD with suicidal ideation (MDD + SI) are limited. The Healthy Eating Index (HEI)-2015, Dietary Inflammatory Index (DII), Comprehensive Dietary Antioxidant Index (CDAI), Oxidative Balance Score (OBS), and Dietary Index for Gut Microbiota (DI-GM) are five validated tools for assessing dietary patterns based on inflammation, antioxidant capacity, and gut microbiota diversity. This study aims to investigate the association between these dietary indices and MDD + SI.

METHODS

A total of 23,621 participants from the 2007-2020 National Health and Nutrition Examination Survey were included in this study. MDD and SI were assessed using the PHQ-9. Weighted multivariable logistic regression, subgroup analyses, and restricted cubic spline (RCS) models were applied to analyze the relationships between five dietary indices and the risks of MDD and MDD + SI.

RESULTS

All five dietary indices showed associations with MDD to varying degrees; however, only DI-GM exhibited a significant negative association with MDD + SI after adjustment for confounding factors. Subgroup and stratified linear trend analyses revealed that this association was stronger among former smokers, obese individuals and those with hypertension or diabetes. RCS analysis showed a significant non-linear relationship between DI-GM and MDD, while a significant linear dose-response relationship was observed for DI-GM and MDD + SI.

LIMITATIONS

Cross-sectional study designs cannot establish causality.

CONCLUSION

The findings of this study revealed a significant association between DI-GM and MDD + SI. Dietary interventions that promote gut microbiota diversity may help reduce the risk of MDD + SI.

The Relationship of Pork Meat Consumption with Nutrient Intakes, Diet Quality, and Biomarkers of Health Status in Korean Older Adults

BACKGROUND

Pork meat is a widely consumed protein food with the potential to differentially affect health and nutritional status across social and cultural contexts.

OBJECTIVES

We evaluated the association between pork meat consumption and nutrient intake, diet quality, and biomarkers of health among older adults (age ≥ 65 years) in Korea.

METHODS

Our analyses utilized dietary and health examination data from the 2016-2020 Korean National Health and Nutrition Examination Survey (n = 2068). Comparisons between variables derived from the nutrition survey and health examination by pork consumption (consumers vs. non-consumers) were assessed using regression analyses for survey data.

RESULTS

Pork consumption was found to be associated with younger age, greater educational attainment, and lower likelihood of living in a rural area. Consumption was also associated with a higher intake of energy and all nutrients except vitamin B6, retinol, ⍵3, and zinc in males and vitamin B6 in females. Diet quality was modestly higher among male (67.91 ± 0.93 vs. 65.74 ± 0.74; p = 0.0308) and female (70.88 ± 0.96 vs. 67.00 ± 0.73; p < 0.0001) pork consumers. Differences in biomarkers were clinically irrelevant, with inconsistencies between genders. Handgrip strength was slightly higher among male (33.84 ± 0.52 vs. 31.91 ± 0.40; p < 0.0001) and female (20.76 ± 0.34 vs. 19.99 ± 0.22; p < 0.0001) pork consumers.

CONCLUSIONS

In Korean older adults, pork consumption may contribute to a higher intake of energy and most nutrients, improved diet quality scores, higher vegetable intake, and small improvements in health biomarkers. Further well-designed studies are needed to confirm these findings.

Association of Social Jetlag with the Dietary Quality Among Korean Workers: Findings from a Nationwide Survey

Background/Objectives: Social jetlag, which refers to the misalignment between biological rhythms and social schedule, is linked to an increased risk of metabolic diseases. This cross-sectional study investigated the relationship between social jetlag and workers' dietary quality. Methods: This secondary data analysis included a sample of workers from the Korea National Health and Nutrition Examination Survey (n = 11,430). Social jetlag was determined by calculating the difference in the sleep midpoint between free days and workdays, based on sleep onset and offset times. The Korean Health Eating Index (KHEI) was calculated based on 24-h recalls, with higher scores indicating superior dietary qualities (range: 0-100). Poor dietary quality was defined as a KHEI below the lowest quartile (<51.6). Linear or logistic regressions were utilized to estimate β or odds ratio (OR), respectively. Results: Among study participants, 12.1% of workers experienced ≥120 min of social jetlag. ≥120 min of social jetlag was associated with a reduced KHEI score compared with 0-59 min (β: -1.23, 95% confidence interval [CI]: -2.16, -0.30). Those with ≥120 min of social jetlag were more likely to have poor dietary quality than those with 0-59 min (OR: 1.27, 95% CI: 1.08, 1.50). Conclusions: Workers experiencing ≥120 min of social jetlag had poorer dietary quality compared with workers with 0-59 min of social jetlag. Therefore, this study suggests that policy efforts are needed to reduce social jetlag among workers in Korea.

Association between dietary quality and the prevalence of periodontitis in older Korean adults aged 60 or over

PURPOSE

This study investigated the association between dietary quality and the prevalence of periodontitis in older Korean adults (≥60 years of age) using data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016-2018).

METHODS

Among the 16,489 KNHANES participants from 2016-2018, those aged ≥60 years were selected as the eligible population. After applying our exclusion criteria, 3,527 participants were included in the final study population. Periodontal status was measured using the Community Periodontal Index (CPI). To determine the association between dietary quality and the prevalence of periodontitis, analysis of variance, the chi-square (χ²) test, and logistic regression analysis were performed.

RESULTS

The population was divided into quartile groups and stratified by sex. The percentage of men and women with periodontitis was 54.34% and 42.74%, respectively. The quartile with higher Korean Healthy Eating Index scores had a lower percentage of people with periodontitis in both sexes. For men, only vegetable intake showed a significant difference between sub-groups with or without periodontitis, whereas, for women, the intake of fruits, milk, sweets, carbohydrates, and fats showed significant differences. There was a strong positive association between vegetable intake and periodontitis in men in the 3 models used in this study; model 3 had an adjusted odds ratio (aOR) of 1.367 (95% confidence interval [CI], 1.091-1.712). In women, a strong positive association with periodontitis was shown for sweets in all 3 models, with an aOR of 1.477 in model 3 (95% CI, 1.125-1.939).

CONCLUSIONS

Dietary quality was inversely associated with the prevalence of periodontitis in Korean adults aged ≥60 years. Further comprehensive studies are needed to help establish nutrition and health policies for older adults in Korea.

Patterns of Health-Risk Behaviours and Their Associations With Anxiety and Depression Among Chinese Young Adults by Gender: A Latent Class Analysis

This study investigated gender differences in health-risk behaviour patterns among young adults and assessed the associations of anxiety and depression with these patterns. A cross-sectional survey was conducted with 1740 young Chinese adults aged 18-24 years. Latent class analysis (LCA) and multinomial logistic regression were conducted to identify the clusters of health-risk behaviours and their associations with anxiety and depression. Three common patterns were found for both genders: physical inactivity, substance use, and insufficient fruit intake (5.7% for males [M] and 11.6% for females [F]); a sedentary lifestyle only (48.4% for M and 48.9% for F); and a sedentary lifestyle, substance use, and an unhealthy diet (7.6% for M and 20.0% for F). Additionally, two additional unique patterns were found: physical inactivity and unhealthy diet in males (38.3%) and physical inactivity and insufficient fruit intake in females (19.6%). Sociodemographic variables exert different effects on health-risk behaviour patterns as a function of gender. Lower anxiety levels (odds ratio [OR]: 0.892; 95% confidence interval [CI]: 0.823-0.966) and greater depression levels (OR: 1.074; 95% CI: 1.008-1.143) were associated with a sedentary lifestyle, substance use, and unhealthy diet class only in female young adults compared with a sedentary-only class. These findings underscore the need for the implementation of targeted interventions based on gender differences.

Factors influencing menstrual regularity among female workers: a cross-sectional analysis study

BACKGROUND

Regularity of menstrual cycles is an important indicator of women's health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms.

METHODS

This was a secondary analysis of the 2010-2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design.

RESULTS

Age at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule).

CONCLUSIONS

Intervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.

Associations of Healthy Eating Behavior with Mental Health and Health-Related Quality of Life: Results from the Korean National Representative Survey

BACKGROUND

Healthy eating behaviors may be related to mental health and health-related quality of life. This study investigates the associations between diet quality, mental health, and health-related quality of life among men and women in Korea.

METHODS

A total of 6823 participants, aged 19, from the 7th Korea National Health and Nutrition Examination Survey from 2016 to 2018 were included. Their overall diet quality was estimated using the Korean Healthy Eating Index (KHEI). Multivariate logistic regression was used to identify the associations between diet quality, mental health, and quality of life.

RESULTS

The prevalence of stress perception and depression was highest in the lowest tertile of the KHEI score and higher for women than men. Among men, a significant association was observed only for stress perception and depressive symptoms in the second tertile, with odds ratios of 0.745 (95% CI, 0.585-0.949) and 0.519 (95% CI, 0.275-0.980). In contrast, the multivariate-adjusted odds ratios for stress perception, depressive symptoms, and low EQ-5D index among women in the highest tertile were 0.668 (95% CI, 0.541-0.823), 0.464 (95% CI, 0.288-0.746), and 0.722 (95% CI, 0.566-0.920), and significant dose-response associations were observed.

CONCLUSIONS

A higher-quality diet was associated with a lower risk of stress and depression and a better quality of life. Thus, healthy eating behaviors may improve mental health and quality of life.

Association between all aspects of dietary diversity and risk of depressive symptoms in US adults

The impact of dietary diversity on depressive symptoms remains one-sided. We aim to explore the associations between all aspects of dietary diversity and the risk of depressive symptoms in US adults and their dose-response relationships. We selected 16 820 adults from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Depressive symptoms were assessed using patient health questionnaire-9 (PHQ-9). Dietary diversity contains four indexes: count (dietary diversity score, DDS), evenness (Healthy Food Diversity Index, HFDI), dissimilarity (Jaccard distance, JD), and quality (Healthy Eating Index, HEI). Binary logistic regression was conducted to assess relationships between the four aspects of dietary diversity and depressive symptoms in whole and subgrouped populations. A restricted cubic spline was performed to explore the dose-response relationships. We revealed that DDS [0.20 (0.05, 0.73)], HFDI [0.51 (0.28, 0.94)], and HEI [0.46 (0.26, 0.80)] were inversely associated with the risk of depressive symptoms for the highest VS lowest quintile, especially in females and elders. Analysis of dose-response relationships determined linear relationships of DDS, HEI and depressive symptoms, while an "L" shaped relationship of HFDI and depressive symptoms. Adequate dietary diversity showed a significant effect on decreasing the risk of depressive symptoms at a score of 4 in DDS, 0.3 in HFDI, and a score of 51 in HEI. In conclusion, this study found that higher levels of dietary diversity, including count, evenness, and quality, might be protective factors against depressive symptoms, especially in females and elders. The DDS, HFDI, and HEI scores are recommended as 4, 0.3, and 51, respectively. Further investigation is needed to validate our results.

Association between diet quality and type of meal companion: the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES)

BACKGROUND/OBJECTIVES

A meal companion is an important social determinant of eating behaviors and is related to what and how much a person will eat within the social context. This study examined the difference in diet quality according to the type of dining companion.

SUBJECTS/METHODS

This study included 15,074 adults (6,180 men and 8,894 women, ≥ 19 years) who participated in the 6th (2013-2015) Korea National Health and Nutrition Examination Survey. Korean Healthy Eating Index (KHEI) scores were calculated using the food frequency questionnaire data. Survey multivariate linear regression analysis was used to assess the association of dining companions (ordinary type, eating with family members, eating alone, and eating with others) and the total and component scores of KHEI.

RESULTS

People who exclusively ate with someone other than family or exclusively ate alone had lower total KHEI scores in both men (57.23 ± 0.67, 58.56 ± 0.73 vs. 62.71 ± 0.26) and women (57.6 3±0.97, 63.89±0.58 vs. 65.79±0.22) compared to people with the ordinary type (all P < 0.05). Both men and women who ate exclusively with someone other than family had lower KHEI component scores for breakfast, whole grains, and fruit, excluding juice, compared to the ordinary type and family eating group. Compared to the eating alone group, the component scores for breakfast and whole grains were lower in the eating with others group.

CONCLUSION

The diet quality differed according to the meal companion type. People who always ate with someone other than family members and men who ate alone showed lower diet quality scores than the ordinary type. More research will be needed to improve their adherence to dietary recommendations.

Nutrient Inadequacy in Korean Young Adults with Depression: A Case Control Study

The role of diet is gaining attention among the modifiable factors associated with depression; thus, this case-control study examined the association between nutrition and depression in young Korean adults. Dietary surveys in individuals with depression (n = 39) and age- and gender-matched controls (n = 76) were conducted using food records and food frequency questionnaires. Men with depression consumed less mushrooms and meat, while women consumed significantly less grains (p < 0.05). Overall, the depression group consumed less energy and nutrients, and the difference was more pronounced in men. The male depression group had lower nutrient adequacy ratio (NAR) for energy, protein, vitamin A, thiamine, niacin, folate, and phosphorus, whereas the female depression group had lower NARs for energy, protein, niacin, and vitamin B₁₂. The depression group had a significantly lower mean adequacy ratio in both genders. Furthermore, the proportion of inappropriate nutrient intake was higher in both genders of the depression group, exhibiting significant differences in energy, protein, niacin, folate, and zinc in men and energy, riboflavin, folate, and vitamin C in women. Hence, both men and women in the depression group had poor nutrient intake and high rates of nutrient inadequacy and improper consumption. This suggests that the quantity and quality of meals should be improved for individuals with depressive symptoms.

Lifestyle factors and suicide risk: A nationwide population-based study

OBJECTIVE

To examine the association between lifestyle factors and suicide-related outcomes.

METHODS

Data from the Korea National Health and Nutrition Examination Survey in 2015 and 2017 were used. We identified lifestyle factors including smoking, physical activity, alcohol intake, and the Healthy Eating Index (HEI) in 9529 eligible subjects. We analyzed the risk of suicidal ideation, plan, attempt, and the composite of suicidality within the past year according to the lifestyle factors. In addition, stratified analyses were performed according to the diagnostic history of depression.

RESULTS

Compared to never-smokers, ex-smokers and current smokers showed an increased risk of suicidal ideation, suicidal plan, and the composite of suicidality. Compared to the low HEI group, those with the highest HEI showed a decreased risk of suicide ideation and the composite of suicidality. Among those with depression, the increased risk of suicide-related outcomes from smoking was more prominent and heavy drinking was associated with an increased risk of suicide attempts.

CONCLUSION

Smoking and heavy drinking were associated with an increased risk of suicide-related outcomes, but high-quality diets and non-heavy drinking were associated with a decreased risk. In people with depression, the associations between lifestyle factors and suicide-related outcomes were stronger than in those without depression.

Social Capital Promotes a Healthier Diet among Young Adults by Reducing Psychological Distress

Studies have revealed the links between social capital and diet. However, the mediating role of psychological distress in this relationship has been understudied. This study aims to identify direct and indirect relationships between social capital and adherence to the Mediterranean diet among Lithuanian young adults and identify the mediating role of psychological distress in this relationship. Data were collected from 1336 young adults, aged 18-36 years; 40.5% were males. MEDAS was used to measure adherence to a healthy diet. Social capital was measured by eight separate items in terms of family support, social support, social cohesion, social trust, communication, collaboration, participation, and distant communication. Kessler's six-item scale was used to assess psychological distress. Higher family support (β = 0.105), higher social participation (β = 0.294), and lower psychological distress (β = 0.073) directly predicted higher adherence to the Mediterranean diet. Social capital was indirectly related to adherence to the Mediterranean diet, with standardized effect sizes of 0.02-0.04, indicating small effect sizes. Thus, psychological distress mediates the relationship between social capital and a healthy diet. Given that social capital is related to psychological health and both directly and indirectly predicts healthy behavior in young adults, further longitudinal and experimental research is required to measure the effects of the intervention on incorporating, facilitating, encouraging, and implementing measures to strengthen the social connection between people and groups of people within the community, neighborhood, and organizations.

Association between Healthy Eating Index and Mental Health in Middle-Aged Adults Based on Household Size in Korea

This study examined the association between dietary lifestyle and mental health outcomes among middle-aged individuals (40−60-year-olds) living alone, using the Korean Healthy Eating Index (KHEI). The participants were selected (1334 men and 2185 women) from the Korea National Health and Nutrition Examination Survey 2016−2018 and categorized into single/multi-person households. The KHEI scores were calculated based on the 24 h recall data of dietary intake. Among both sexes, single-person households had significantly lower subjective health status scores (p = 0.015 for men; p < 0.001 for women), lower EuroQol-5D index scores (p = 0.011 for men; p = 0.003 for women), and higher Patient Health Questionnaire-9 index scores (p = 0.004 for men; p < 0.001 for women), compared to multi-person households. Men had a higher risk of depression in single-person households compared to multi-person households (OR, 3.5; 95% CI, 1.2−10.1). For women, the ORs for stress perception with the first tertile group of KHEI scores in single-person and multi-person households compared to the third tertile group were 3.5 (95% CI, 1.3−9.0) and 1.4 (95% CI, 1.0−1.8), respectively. The results of this study are expected to be used as baseline data to establish nutrition, healthy eating behavior, and health policies for the middle-aged living alone.