Post-traumatic stress disorder (PTSD) in mid-age and older adults differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA).

PURPOSE: This study aimed to address knowledge gaps about post-traumatic stress disorder (PTSD) in mid-age and older adults, with particular attention to the relationship of PTSD with nutrition and with ethnicity and immigrant status. METHODS: Binary logistic regression analysis of weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (CLSA; n = 27,211) was conducted using the four-item Primary Care-PTSD tool (outcome) and immigrant status by ethnicity (Canadian-born white, Canadian-born minority, immigrant white, immigrant minority). Covariates included various social, economic, nutrition and health-related variables. RESULTS: After controlling for socioeconomic and health variables, immigrants from minority groups had significantly higher odds of PTSD compared to their Canadian-born counterparts, whereas white immigrants had lower odds of PTSD. These relationships were significantly robust across seven cluster-based regression models. After adjusting for ethnicity/immigrant status, the odds of PTSD were higher among those earning lower household incomes, widowed, divorced, or separated respondents, ever smokers, and those who had multi-morbidities, chronic pain, high nutritional risk, or who reported daily consumptions of pastries, pulses and nuts, or chocolate. Conversely, those 55 years and over, who had high waist-to-height ratio, or who consumed 2-3 fiber sources daily had significantly lower odds of PTSD. CONCLUSION: Interventions aimed at managing PTSD in mid-age and older adults should consider ethnicity, immigrant status, as well as socioeconomic, health, and nutrition status.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging.

BACKGROUND: Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults. METHODS: Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake. RESULTS: The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression. CONCLUSIONS: The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.

Medical nutrition therapy in Canadian federal correctional facilities.

BACKGROUND: Under- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities. METHODS: A scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework. RESULTS: An understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual's nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth. CONCLUSIONS: Professional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.

Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: A Sequential Explanatory Mixed Methods Investigation.

BACKGROUND: Nutrigenomics forms the basis of personalized nutrition by customizing an individual's dietary plan based on the integration of life stage, current health status, and genome information. Some common genes that are included in nutrition-based multigene test panels include CYP1A2 (rate of caffeine break down), MTHFR (folate usage), NOS3 (risk of elevated triglyceride levels related to omega-3 fat intake), and ACE (blood pressure response in related to sodium intake). The complexity of gene test-based personalized nutrition presents barriers to its implementation. OBJECTIVE: This study aimed to compare a self-driven approach to gene test-based nutrition education versus an integrated practitioner-facilitated method to help develop improved interface tools for personalized nutrition practice. METHODS: A sequential, explanatory mixed methods investigation of 55 healthy adults (35 to 55 years) was conducted that included (1) a 9-week randomized controlled trial where participants were randomized to receive a standard nutrition-based gene test report (control; n=19) or a practitioner-facilitated personalized nutrition intervention (intervention; n=36) and (2) an interpretative thematic analysis of focus group interview data. Outcome measures included differences in the diet quality score (Healthy Eating Index-Canadian [HEI-C]; proportion [%] of calories from total fat, saturated fat, and sugar; omega 3 fatty acid intake [grams]; sodium intake [milligrams]); as well as health-related quality of life (HRQoL) scale score. RESULTS: Of the 55 (55/58 enrolled, 95%) participants who completed the study, most were aged between 40 and 51 years (n=37, 67%), were female (n=41, 75%), and earned a high household income (n=32, 58%). Compared with baseline measures, group differences were found for the percentage of calories from total fat (mean difference [MD]=-5.1%; Wilks lambda (λ)=0.817, F1,53=11.68; P=.001; eta-squared [η²]=0.183) and saturated fat (MD=-1.7%; λ=0.816; F1,53=11.71; P=.001; η²=0.18) as well as HRQoL scores (MD=8.1 points; λ=0.914; F1,53=4.92; P=.03; η²=0.086) compared with week 9 postintervention measures. Interactions of time-by-group assignment were found for sodium intakes (λ=0.846; F1,53=9.47; P=.003; η²=0.15) and HEI-C scores (λ=0.660; F1,53=27.43; P<.001; η²=0.35). An analysis of phenotypic and genotypic information by group assignment found improved total fat (MD=-5%; λ=0.815; F1,51=11.36; P=.001; η²=0.19) and saturated fat (MD=-1.3%; λ=0.822; F1,51=10.86; P=.002; η²=0.18) intakes. Time-by-group interactions were found for sodium (λ=0.844; F3,51=3.09; P=.04; η²=0.16); a post hoc analysis showed pre/post differences for those in the intervention group that did (preintervention mean 3611 mg, 95% CI 3039-4182; postintervention mean 2135 mg, 95% CI 1564-2705) and did not have the gene risk variant (preintervention mean 3722 mg, 95% CI 2949-4496; postintervention mean 2071 mg, 95% CI 1299-2843). Pre- and postdifferences related to the Dietary Reference Intakes showed increases in the proportion of intervention participants within the acceptable macronutrient distribution ranges for fat (pre/post mean difference=41.2%; P=.02). Analysis of textual data revealed 3 categories of feedback: (1) translation of nutrition-related gene test information to action; (2) facilitation of eating behavior change, particularly for the macronutrients and sodium; and (3) directives for future personalized nutrition practice. CONCLUSIONS: Although improvements were observed in both groups, healthy adults appear to derive more health benefits from practitioner-led personalized nutrition interventions. Further work is needed to better facilitate positive changes in micronutrient intakes. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310814; http://clinicaltrials.gov/ct2/show/NCT03310814. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.9846.

The development of a national nutrition and mental health research agenda with comparison of priorities among diverse stakeholders.

OBJECTIVE: To develop a national nutrition and mental health research agenda based on the engagement of diverse stakeholders and to assess research priorities by stakeholder groups. DESIGN: A staged, integrated and participatory initiative was implemented to structure a national nutrition and mental health research agenda that included: (i) national stakeholder consultations to prioritize research questions; (ii) a workshop involving national representatives from research, policy and practice to further define priorities; (iii) triangulation of data to formulate the agenda; and (iv) test hypotheses about stakeholder influences on decision making. SETTING: Canada. SUBJECTS: Diverse stakeholders including researchers, academics, administrators, service providers, policy makers, practitioners, non-profit, industry and funding agency representatives, front-line workers, individuals with lived experience of a mental health condition and those who provide care for them. RESULTS: This first-of-its-kind research priority-setting initiative showed points of agreement among diverse stakeholders (n 899) on research priorities aimed at service provision; however, respondents with lived experience of a mental health condition (themselves or a family member) placed emphasis on prevention and mental health promotion-based research. The final integrated agenda identified four research priorities, including programmes and services, service provider roles, the determinants of health and knowledge translation and exchange. These research priorities aim to identify effective models of care, enhance collaboration, inform policy makers and foster knowledge dissemination. CONCLUSIONS: Since a predictor of research uptake is the involvement of relevant stakeholders, a sustained and deliberate effort must continue to engage collaboration that will lead to the optimization of nutrition and mental health-related outcomes.

Defining Research Priorities for Nutrition and Mental Health: Insights from Dietetics Practice.

In 2014, a national initiative aimed at defining a research agenda for nutrition and mental health among diverse stakeholders was completed and included insights from more than 300 registered dietitians. This study explores the data from dietitians based on their years of practice, mental health experiences, and community of practice in relationship to identified mental health and nutrition research priorities. Analysis of numerical data (n = 299) and content analysis of open-ended responses (n = 269) revealed that respondents desired research for specific mental health conditions (MHCs), emotional eating, food addiction, populations with special needs, and people encountering major life transitions (e.g., recovery from abuse, refugees). Findings from the quantitative and textual data suggested that dietitians want research aimed at addressing the concerns of those in the community, fostering consumer nutrition knowledge and skill acquisition, and developing services that will impact quality of life. Subgroup analysis indicated that dietitians: (i) in early years of practice want information about specific MHCs; (ii) living in smaller towns and rural areas want data about the cost benefits of dietetics practice in mental health; and (iii) who also had additional stakeholder roles (e.g., service provider) selected priorities that address gaps in mental health services. This study highlights opportunities to tailor nutrition and mental health research that advance dietetics practice.

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces.

PURPOSE: Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates. METHODS: We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder. RESULTS: There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06-1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42-2.23) food insecurity. CONCLUSIONS: The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.

Food insecurity in adults with mood disorders: prevalence estimates and associations with nutritional and psychological health.

BACKGROUND: Because little is known about food insecurity in people with mental health conditions, we investigated relationships among food insecurity, nutrient intakes, and psychological functioning in adults with mood disorders. METHODS: Data from a study of adults randomly selected from the membership list of the Mood Disorder Association of British Columbia (n = 97), Canada, were analyzed. Food insecurity status was based on validated screening questions asking if in the past 12 months did the participant, due to a lack of money, worry about or not have enough food to eat. Nutrient intakes were derived from 3-day food records and compared to the Dietary Reference Intakes (DRIs). Psychological functioning measures included Global Assessment of Functioning, Hamilton Depression scale, and Young Mania Rating Scale. Using binomial tests of two proportions, Mann-Whitney U tests, and Poisson regression we examined: (1) food insecurity prevalence between the study respondents and a general population sample from the British Columbia Nutrition Survey (BCNS; n = 1,823); (2) differences in nutrient intakes based on food insecurity status; and (3) associations of food insecurity and psychological functioning using bivariate and Poisson regression statistics. RESULTS: In comparison to the general population (BCNS), food insecurity was significantly more prevalent in the adults with mood disorders (7.3% in BCNS vs 36.1%; p < 0.001). Respondents who were food-insecure had lower median intakes of carbohydrates and vitamin C (p < 0.05). In addition, a higher proportion of those reporting food insecurity had protein, folate, and zinc intakes below the DRI benchmark of potential inadequacy (p < 0.05). There was significant association between food insecurity and mania symptoms (adjusted prevalence ratio = 2.37, 95% CI 1.49-3.75, p < 0.05). CONCLUSIONS: Food insecurity is associated with both nutritional and psychological health in adults with mood disorders. Investigation of interventions aimed at food security and income can help establish its role in enhancing mental health.

Nutrient- and non-nutrient-based natural health product (NHP) use in adults with mood disorders: prevalence, characteristics and potential for exposure to adverse events.

BACKGROUND: To address knowledge gaps regarding natural health product (NHP) usage in mental health populations, we examined their use in adults with mood disorders, and explored the potential for adverse events. METHODS: Food and NHP intake was obtained from 97 adults with mood disorders. NHP data was used to compare prevalence with population norms (British Columbia Nutrition Survey; BCNS). Bivariate and regression analyses examined factors associated with NHP use. Assessment of potential adverse effects of NHP use was based on comparing nutrient intakes from food plus supplements with the Dietary Reference Intakes and by reviewing databases for reported adverse health effects. RESULTS: Two-thirds (66%; 95% CI 56 to 75) were taking at least one NHP; 58% (95% CI 47 to 68) were taking NHPs in combination with psychiatric medications. The proportion of each type of NHP used was generally higher than the BCNS (range of p's < 0.05 to 0.0001). When intakes from food and NHP sources were combined, a small proportion exceeded any Lowest-Observed-Adverse-Effect-Levels: only for niacin (n = 17) and magnesium (n = 6), two nutrients for which the potential for adverse effects is minimal. Conversely, about 38% (95% CI 28 to 49) of the sample were taking a non-nutrient based NHP for which previous adverse events had been documented. CONCLUSIONS: The prevalent use of NHPs in this population suggests that health care providers need to be knowledgeable about their characteristics. The efficacy and safety of NHPs in relation to mental health warrants further investigation.

Energy under-reporting in adults with mood disorders: prevalence and associated factors.

Little is known about relationships of energy under-reporting in mental health populations. Using data from a sample of individuals with mood disorders (n = 97), demographic, food intake and body-related, psychological, lifestyle, and condition-specific factors were examined in relationship to energy under-reporting. More than two-thirds (70%) were considered under-reporters based on Goldberg's classifications. Differences were found between energy under-reporters and accurate reporters for diet quality, sex, body mass index (BMI), weight change after taking psychiatric medications, and for those taking mood stabilizers (all p's < 0.05). Regression analyses indicated there was lower prevalence of under-reporting as diet quality improved, if individuals experienced weight change after taking psychiatric medication, or were females (p < 0.05). The prevalence of under-reporting was more than 1.3 times in those taking mood stabilizers versus those not taking this psychiatric medication [Prevalence ratio (PR) = 1.30, 95% CI 1.01-1.66, p < 0.05]. Further research of under-reporting in mental health populations will enable targeted approaches to improve accuracy of diet reporting and inferences made about nutrition and mental health.

The Impact of COVID-19 on the Cardiovascular Health of Emerging Adults Aged 18-25: Findings From a Scoping Review.

There is limited knowledge regarding the cardiovascular impact of coronavirus disease 2019 (COVID-19) on emerging adults aged 18-25, a group that disproportionately contracts COVID-19. To guide future cardiovascular disease (CVD) research, policy, and practice, a scoping review was conducted to: (i) examine the impact of the COVID-19 pandemic on the cardiovascular health of emerging adults; and (ii) identify strategies to screen for and manage COVID-19-related cardiovascular complications in this age group. A comprehensive search strategy was applied to several academic databases and grey literature sources. An updated search yielded 6738 articles, 147 of which were extracted and synthesized. Reports identified COVID-19-associated cardiac abnormalities, vascular alterations, and multisystem inflammatory syndrome in emerging adults; based on data from student-athlete samples, prevalence estimates of myocarditis and cardiac abnormalities were 0.5%-3% and 0%-7%, respectively. Obesity, hypertension, CVD, congenital heart disease, and marginalization are potential risk factors for severe COVID-19, related cardiovascular complications, and mortality in this age group. As a screening modality for COVID-19-associated cardiac involvement, it is recommended that cardiac magnetic resonance imaging be indicated by a positive cardiac history and/or abnormal "triad" testing (cardiac troponin, electrocardiogram, and transthoracic echocardiogram) to improve diagnostic utility. To foster long-term cardiovascular health among emerging adults, cardiorespiratory fitness, health literacy and education, and telehealth accessibility should be priorities of health policy and clinical practice. Ultimately, surveillance data from the broader emerging adult population will be crucial to assess the long-term cardiovascular impact of both COVID-19 infection and vaccination, guide screening and management protocols, and inform CVD prevention efforts.

Il existe peu de données portant sur les répercussions de la maladie à coronavirus 2019 (COVID-19) sur le plan cardiovasculaire chez les jeunes adultes âgés de 18 à 25 ans, un groupe contractant la COVID-19 de façon disproportionnée. Afin d'orienter la recherche, les poli-tiques et les pratiques en matière de maladies cardiovasculaires (MCV), un examen exploratoire a été réalisé dans le but i) d'examiner les conséquences de la pandémie de la COVID-19 sur la santé cardiovasculaire des jeunes adultes, et ii) de proposer des stratégies de dépistage et de prise en charge des complications cardiovasculaires associées à la COVID-19 chez les personnes de cette tranche d'âge. Une recherche initiale exhaustive a été réalisée dans plusieurs bases de données universitaires et sources de littérature grise. Les résultats actualisés de cette recherche ont permis de recenser 6 738 articles, dont 147 ont été extraits et synthétisés. Les rapports faisaient état d'anomalies cardiaques, d'altérations vasculaires et de cas du syndrome inflammatoire multisystémique, tous associés à la COVID-19 chez les jeunes adultes. À la lumière des données sur les échantillons d'étudiants-athlètes, la prévalence des myocardites et des anomalies cardiaques se situait respectivement entre 0,5 et 3 %, et entre 0 et 7 % environ. Chez ce même groupe d'âge, l'obésité, l'hypertension, les MCV, les cardiopathies congénitales et la marginalisation constituent des facteurs de risque de COVID-19 sévère, de complications cardiovasculaires associées à la COVID-19 et de mortalité. Dans le cadre du dépistage des atteintes cardiaques associées à la COVID-19, il est recommandé, pour améliorer l'utilité diagnostique, d'indiquer l'imagerie par résonance magnétique cardiaque lors de l'existence d'antécédents cardiaques ou à la suite d'une « triade ¼ de dépistages anormaux (la troponine cardiaque, l'électrocardiogramme et l'échocardiographie transthoracique). Afin de favoriser une bonne santé cardiovasculaire à long terme chez les jeunes adultes, il est recommandé que la capacité cardiorespiratoire, la littératie dans le domaine de la santé, l'éducation et l'accès à la télésanté soient intégrés à titre de priorités dans les politiques de santé et la pratique clinique. En définitive, les données de surveillance portant sur cette large tranche d'âge seront essentielles pour évaluer les répercussions cardiovasculaires à long terme (autant celles d'infections à la COVID-19 que celles de la vaccination), pour orienter les protocoles de dépistage et de prise en charge, ainsi que pour éclairer les efforts de prévention des MCV.

Food intake and blood cholesterol levels of community-based adults with mood disorders.

BACKGROUND: A growing body of literature links nutrition to mood, especially in epidemiological surveys, but there is little information characterizing food intake in people with diagnosed mood disorders. METHODS: Food intake obtained from 3-day food records was evaluated in 97 adults with mood disorders, whose diagnoses were confirmed in structured interviews. Information from a population nutrition survey, national guidelines for nutritional intakes (Eating Well with Canada's Food Guide) and North American dietary guidelines (Dietary Reference Intakes) was utilized to evaluate the quality of their food intake. RESULTS: Compared to the regional nutrition survey data and national guidelines, a greater proportion of study participants consumed fewer of the recommended servings of grains (p < 0.001) and vegetables and fruits (p < 0.05), and less than the lower boundary of the Adequate Macronutrient Distribution Range (AMDR) for α-linolenic acid (p < 0.001). The study sample also had greater intakes of high-fat whole grain products (p < 0.01), processed meats (p < 0.00001), and higher sugar, fat or salty foods (p < 0.00001). Of the 1746 total meals and snacks consumed, 39% were from sources outside the home, suggesting a lack of time devoted to meal preparation. Finally, a subsample of 48 participants agreed to have blood tests: 44% had mild hypercholesterolemia (> 5.2 and ≤ 6.2 mmol/L) and 21% had hypercholesterolemia (> 6.2 mmol/L). CONCLUSIONS: Much research has proposed multiple ways in which healthier diets may exert protective effects on mental health. The results of this study suggest that adults with mood disorders could benefit from nutritional interventions to improve diet quality.

Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders.

OBJECTIVE: To evaluate the relation between nutrient intake and psychiatric functioning in adults with confirmed mood disorders. METHOD: A cross-sectional study was conducted of the intake of major (that is, carbohydrates, fat, and protein) and minor (that is, vitamins and minerals) nutrients (from 3-day food records and a Food Frequency Questionnaire), Global Assessment of Functioning (GAF) scores, and symptoms of depression and mania (the Hamilton Depression Rating Scale and the Young Mania Rating Scale) in 97 community-based adults with mood disorders whose diagnoses were confirmed with structured interviews. RESULTS: Significant correlations were found between GAF scores and energy (kilocalories), carbohydrates, fibre, total fat, linoleic acid, riboflavin, niacin, folate, vitamin B6, vitamin B12, pantothenic acid, calcium, phosphorus, potassium, and iron (all P values < 0.05), as well as magnesium (r = 0.41, P < 0.001) and zinc (r = 0.35, P < 0.001). Though modest in magnitude, the pattern of correlations was consistent, indicating higher levels of mental function associated with a higher intake of nutrients. Depression and mania scores, which were generally mild or moderate, did not individually show consistent patterns. When dietary supplement use was added to nutrient intakes from food, GAF scores remained positively correlated (P < 0.05) with all dietary minerals. CONCLUSION: This detailed analysis in a clinically diagnosed sample was consistent with prior epidemiologic surveys, revealing an association between higher levels of nutrient intakes and better mental health. Nutrient intakes warrant further consideration in the treatment of people with mood disorders.

Lower Energy-Adjusted Nutrient Intakes Occur Among Food Energy Under-Reporters With Poor Mental Health.

Background: Food energy under-reporting is differentially distributed among populations. Currently, little is known about how mental health state may affect energy-adjusted nutrient intakes among food energy under-reporters. Methods: Stratified analysis of energy-adjusted nutrient intake by mental health (poor vs. good) and age/sex was conducted using data from Canadian Community Health Survey (CCHS) respondents (14-70 years; n = 8,233) who were deemed as under-reporters based on Goldberg's cutoffs. Results: Most were experiencing good mental health (95.2%). Among those reporting poor mental health, significantly lower energy-adjusted nutrient intakes tended to be found for fiber, protein, vitamins A, B2, B3, B6, B9, B12, C, and D, and calcium, potassium, and zinc (probability measures (p) < 0.05). For women (51-70 years), all micronutrient intakes, except iron, were significantly lower among those reporting poor mental health (p < 0.05). For men (31-50 years), B vitamin and most mineral intakes, except sodium, were significantly lower among those reporting poor mental health (p < 0.05). Among women (31-50 years) who reported poor mental health, higher energy-adjusted intakes were reported for vitamin B9 and phosphorus (p < 0.05). Conclusions: Among food energy under-reporters, poor mental health tends to lower the report of specific energy-adjusted nutrient intakes that include ones critical for mental health. Future research is needed to discern if these differences may be attributed to deviations in the accurate reports of food intakes, measurement errors, or mental health states.

Blood Chromium Levels and Their Association with Cardiovascular Diseases, Diabetes, and Depression: National Health and Nutrition Examination Survey (NHANES) 2015-2016.

Currently, there is no global consensus about the essentiality of dietary chromium. To provide evidence to this debate, an examination of blood chromium levels and common chronic health conditions was undertaken. Using a subsample from the 2015−2016 US National Health and Nutrition Examination Survey (n = 2894; 40 years+), chi-square and binary logistic regression analyses were conducted to examine blood chromium levels (0.7−28.0 vs. <0.7 µg/L) and their associations with cardiovascular diseases (CVDs; self-report), diabetes mellitus (DM; glycohemoglobin ≥5.7%), and depression (Patient Health Questionnaire-9 score ≥5), while controlling for socio-demographic (age/sex/income/education/relationship status) and health-related (red blood cell folate/medications/co-morbidities/body mass index (BMI)/substance use) factors. The sample was almost evenly distributed between men and women (n = 1391, 48.1% (men); n = 1503, 51.9% (women)). The prevalence estimates of low blood chromium levels tended to be higher among those with CVDs (47.4−47.6%) and DM (50.0−51.6%). Comparisons between those with low vs. normal blood chromium levels indicate men have increased odds of CVDs (adjusted odds ratio (aOR) = 1.86, 95% confidence interval (CI): 1.22−2.85, p < 0.001) and DM (aOR = 1.93, 95% CI: 1.32−2.83, p < 0.001) and lower odds of depression (aOR = 0.42, 95% CI: 0.22−0.77, p < 0.05). Dietary chromium may be important in the prevention and management of CVDs and DM for men. Continued exploration of chromium's role in chronic diseases, including differences by biological factors, is needed.

Vitamin and mineral intakes in adults with mood disorders: comparisons to nutrition standards and associations with sociodemographic and clinical variables.

OBJECTIVE: The purpose of this study was to investigate the nutrient intakes of people with mood disorders. METHOD: A cross-sectional survey using 3-day food records was carried out in 97 adults with bipolar or major depressive disorder to compare nutrient intakes with Dietary Reference Intakes and British Columbia Nutrition Survey (BCNS) data. Blood levels of selected nutrients were compared to reference ranges. Bivariate and multivariate analyses examined the effects of sociodemographic and clinical variables on nutrient intakes. RESULTS: The average age of respondents was 46 (±13) years; most were women (n = 69) who had less than a university degree (n = 60) and whose incomes were in the government-defined lower range (n = 39). Compared with the BCNS, a larger proportion of the sample was below the estimated average requirement for thiamin (26% vs 8%), riboflavin (21% vs 4%), folate (64% vs 27%), phosphorous (12% vs 1%), and zinc (39% vs 15%; all P < 0.0001), as well as vitamin B(6) (25% vs 16%) and vitamin B(12) (27% vs 8%; both P < 0.05). Combined intakes of food and supplements helped reduce the prevalence of inadequacy; however, with supplementation, the proportion of participants exceeding the tolerable upper intake levels for niacin, vitamin B(6), folate, vitamin C, calcium, magnesium, iron, and zinc ranged from 1%-8%. Income, relationship status, age, gender, and caloric intake were associated with intakes of many nutrients. Types of medications were associated with nutrient intakes, as lower intakes of thiamin and phosphorous (P < 0.05) were found with antidepressant use, higher calcium and iron intakes (P < 0.05) were associated with antianxiety medication use, and magnesium intakes were increased with mood stabilizers (regression coefficient = 52.61, P < 0.05, 95% confidence interval = 0.74 to 104.48). CONCLUSIONS: Adults with mood disorders are at risk for many nutrient inadequacies, as well as occasional excesses; social, demographic, and clinical factors may affect their nutrient intakes.

Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.

Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature.

This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.

Psychological distress in older adults linked to immigrant status, dietary intake, and physical health conditions in the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Psychological distress increases mortality risk; there is little knowledge about its prevelance and contributory factors in older populations. METHODS: Canadian Longitudinal Study on Aging baseline data (2010-2015) were analyzed to examine the relationship between Kessler's Psychological Distress Scale-K10 and immigrant status (recent/mid-term,<20 years; long-term, ≥20 years; Canadian-born). Covariates included socioeconomic and health-related variables. Stratified by sex, two series of multinomial logistic regression were used to calculate the likelihood of having mild distress (20 < K10 score ≤24) and moderate/severe distress (K10 score >24). RESULTS: Respondents (n = 25,700) were mainly Canadian-born (82.8%), 45-65 years (59.3%), earning cut-off; OR=1.32, 99% CI 1.02-1.70), and higher nutritional risk (ORs = 2.16-3.31, p's <0.001). For men, psychological distress was associated with under-nutrition (grip strength56 years, ORs=0.19-0.79, p's<0.01), lower income (≤C$149,000, ORs = 1.68-7.79, p's<0.01), multi-morbidities (ORs = 1.67-4.70, p's<0.01), chronic pain (ORs = 1.67-3.09, p's<0.001) and higher intake of chocolate (≥ 0.6 bar/week, ORs=1.61-2.23, p's<0.001). LIMITATIONS: Cross-sectional design prohibits causal inferences. CONCLUSIONS: Nutritional factors, immigration status, social, and health-related problems are strongly associated with psychological distress among midlife and older adults.