A population-based study of macronutrient intake according to mental health status with a focus on pure and comorbid anxiety and eating disorders.

PURPOSE: Eating disorders (ED) and anxiety impact food choices. In addition, comorbid anxiety seems to increase ED symptoms and severity. However, the association between such comorbidity and dietary intake is unknown. This population-based, cross-sectional study aimed to assess macronutrient intake according to mental health status (i.e., no disorder, pure and comorbid anxiety and ED). METHODS: The study included N = 24,771 participants (74% female, mean age = 53.2 ± 13.7 years) in the NutriNet-Santé cohort, who completed once the trait subscale of the State-Trait Anxiety Inventory (STAI-T; high anxiety: ≥ 40 points) between 2013 and 2016 and the SCOFF questionnaire screening for ED in 2014. The Expali algorithm was applied to categorize ED (no ED; restrictive: RS; bulimic: BL; hyperphagic: HP; other ED). Participants were divided into ten groups by crossing their anxiety status (two groups: low or high) and their ED status (five groups). Macronutrient intakes were evaluated from ≥ 3 24-h dietary records. Analyses of covariance (ANCOVA) and Dunnett-Hsu tests (reference = no disorder) were performed. RESULTS: Significant differences in macronutrient intake were seen between the pure and comorbid forms, especially for RS and HP. Compared to the "no disorder" group, a significantly higher percentage of energy from carbohydrates, higher intakes of total carbohydrates, simple sugars, and plant-based protein, lower intakes of total fat, saturated and monounsaturated fatty acids, and cholesterol were observed in the comorbid anxiety + RS group, but not in the pure RS group. In contrast, significantly lower intakes of added sugar and plant-based protein, and a higher intake of cholesterol were observed in the pure HP group, but not in the comorbid anxiety + HP group. For BL and other ED, similar results were observed between the pure and comorbid forms. CONCLUSION: This large epidemiological study provided some support for differences in macronutrient intake between individuals with pure or comorbid anxiety and ED. Differences in intake were largely dependent on ED type. Future prospective studies and studies using clinically defined anxiety and ED are needed to elucidate causality as well as potential effect modification of the observed associations.

Dietary macronutrient intake according to sex and trait anxiety level among non-diabetic adults: a cross-sectional study.

BACKGROUND: Studies suggest that anxiety is correlated with eating behavior, however, little is known about the association between anxiety status as predictor of dietary macronutrient intake. The aim of the present study was to investigate the sex-stratified cross-sectional associations of trait anxiety with intake of various macronutrients in a large population-based sample of non-diabetic adults. METHODS: N = 20,231 participants (mean age = 53.7 ± 13.6 years) of the NutriNet-Santé web-cohort, who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (T-STAI; 2013-2016) were included in the analyses. Dietary intake was calculated from at least 3 self-administered 24-h dietary records. The associations of interest were assessed by multiple linear regression stratified by sex, owing to significant interaction tests. RESULTS: In total, 74.3% (n = 15,033) of the sample were females who had a significantly higher mean T-STAI score than did males (39.0 versus 34.8; p < 0.01). Among females, the fully-adjusted analyses showed significant positive associations of T-STAI with total carbohydrate intake (ß = 0.04; p < 0.04), complex carbohydrate intake (ß = 0.05; p < 0.02), and percentage energy from carbohydrates (ß = 0.01; p < 0.03), as well as a significant inverse association of T-STAI with percentage energy from fat (ß = -0.01; p < 0.05). As regards males, the only significant finding was an inverse association between T-STAI and percent of the mean daily energy from protein (fully-adjusted model: ß = -0.01; p = 0.05). CONCLUSION: This cross-sectional study found modest sex-specific associations between anxiety status and macronutrient intake among French non-diabetic adults. Prospective studies are needed to further elucidate the observed associations.

Co-occurrence of habit-forming risk behaviors and their socio-demographic, health status and lifestyle determinants: a population-based cross-sectional study.

BACKGROUND: Although habit-forming risk behaviors frequently co-occur, determinants of concurrent risk behaviors have rarely been investigated. The aim of the present study was to investigate socio-demographic, health status, and lifestyle determinants of single versus concurrent risk behaviors in general-population adults. METHODS: We analyzed data from 32,622 participants (74.5% female; mean age = 57.9 ± 14.2 years) of the NutriNet-Santé cohort who completed the Alcohol Use Disorders Identification Test, the 12-item Cigarette Dependence Scale, the modified Yale Food Addiction Scale 2.0, and the Internet Addiction Test in 2021-2022. Using established cutoffs, participants were first split into 2 groups (presence versus absence) for each risk variable (alcohol use disorders, nicotine dependence, food addiction, Internet addiction) and were then divided into 3 groups (no risk behavior, 1 risk behavior (reference), and ≥ 2 risk behaviors). The association between socio-demographic, health status, and lifestyle exposures and individual/concurrent risk behaviors were investigated with polytomous logistic regression. RESULTS: Younger age (Odds Ratio (OR) = 2.04; 95% Confidence Interval (CI: 1.62-2.56), current financial difficulties (OR = 1.29; CI: 1.08-1.54), self-perceived poor health (OR = 1.70; CI: 1.32-2.20), overall poor dietary quality (OR = 2.88; CI: 2.06-4.02), being underweight (OR = 1.46; CI: 1.05-2.04), having obesity (OR = 1.62; CI: 1.31-1.99), lack of affection during childhood (OR = 1.41; CI: 1.18-1.69), and a lifetime prevalence or medication use for a mental disorder (OR = 1.46; CI: 1.24-1.73) were positively associated with having ≥ 2 versus 1 risk behavior (all p < 0.05). The comparison of none versus 1 risk behavior revealed the same determinants in addition to having a higher education, being physically active at work, and being overweight. CONCLUSIONS: We investigated determinants of concurrent habit-forming risk behaviors among adults in a large, population-based study. The findings could serve as impetus for future research in this domain and ultimately help guide addiction prevention efforts.

Caffeine Intake and Its Sex-Specific Association with General Anxiety: A Cross-Sectional Analysis among General Population Adults.

(1) Background: Caffeine is one of the most consumed psychoactive stimulants worldwide. It has been suggested that caffeine intake at large doses can induce anxiety, whereas evidence of the role of low to moderate caffeine intake is scarce and inconsistent. Therefore, we aimed to assess the association between caffeine intake and general anxiety in adults recruited from the general population. (2) Methods: Participants from the French NutriNet-Santé web cohort with data on caffeine intake and general anxiety (assessed during 2013−2016 through the trait subscale of Spielberger's State-Trait Anxiety Inventory Form Y; STAI-T, sex-specific top quartile = high trait anxiety) were included in this cross-sectional analysis (n = 24,197; 74.1% women; mean age = 53.7 ± 13.9 years). Mean dietary intake was estimated using ≥2 self-reported 24-h dietary records. Sex-specific tertiles of caffeine intake and low/high trait anxiety were calculated. Multivariable logistic regression models were fitted to assess the odds ratio (OR) and 95% confidence interval (CI) for the association between caffeine intake and general anxiety by sex. (3) Results: In the total sample, the mean caffeine intake (mg/day) from all dietary sources combined was 220.6 ± 165.0 (women = 212.4 ± 159.6; men = 243.8 ± 177.7, p < 0.01). Women in the highest tertile of caffeine intake showed significantly higher odds for high trait anxiety compared to those in the lowest tertile (reference), even after adjustment for potential confounders (OR: 1.13; 95% CI: 1.03−1.23). No significant associations were detected among men. Sensitivity analyses according to perceived stress level and sugar intake, respectively, showed similar results. (4) Conclusions: The results suggest that higher caffeine intake is associated with higher odds of general anxiety among women but not among men. Further research is needed to confirm the sex-specific findings and elucidate the potential causal relationship between caffeine intake and anxiety status.

Associations of overall and specific carbohydrate intake with anxiety status evolution in the prospective NutriNet-Santé population-based cohort.

We investigated the association between carbohydrate intake and anxiety evolution within the general-population NutriNet-Santé cohort (N = 15,602; 73.8% female; mean age = 53.8y; mean follow-up = 5.4y). Carbohydrate intake was estimated at baseline from ≥ 2 24-h dietary records. Trait anxiety (STAI-T) was measured once at baseline (2013-2016) and once at follow-up (2020), resulting in 4 groups: "None" = absence of high anxiety (STAI-T > 40 points) at any time point; "Transient" = high anxiety only at baseline; "Onset at follow-up" = high anxiety only at follow-up; "Persistent" = high anxiety at baseline and follow-up. Polytomous logistic regression models revealed that sweetened beverage intake was associated with higher odds of "Transient" anxiety (ORQ4vsQ1 = 1.11; 95% CI 1.02-1.21). Intake of complex carbohydrates (ORQ4vsQ1 = 1.12; 1.01-1.25) was associated with higher odds of anxiety "Onset at follow-up." The % energy from carbohydrates (ORQ4vsQ1 = 1.11; 1.03-1.19), intakes of total carbohydrates (ORQ4vsQ1 = 1.10; 1.03-1.18) and complex carbohydrates (ORQ4vsQ1 = 1.09; 1.02-1.17) were associated with higher odds of "Persistent" anxiety, whereas 100% fruit juice intake showed lower odds of "Persistent" anxiety (ORQ4vsQ1 = 0.87; 0.81-0.94). This prospective study found significant associations between dietary carbohydrate intake and anxiety status evolution among French adults. The findings could help inform dietary interventions aimed at anxiety prevention and management.

Ultra-processed food intake and eating disorders: Cross-sectional associations among French adults.

Background and aims: Data regarding the association between ultra-processed food (UPF) consumption and eating disorders (ED) are scarce. Our aim was to investigate whether UPF intake was associated with different ED types in a large population-based study. Methods: 43,993 participants (mean age = 51.0 years; 76.1% women) of the French NutriNet-Santé web-cohort who were screened for ED in 2014 via the Sick-Control-One stone-Fat-Food (SCOFF) questionnaire, were included in the analysis. The clinical algorithm Expali TM tool was used to identify four ED types: restrictive, bulimic, binge eating, and other (not otherwise specified). Mean dietary intake was evaluated from at least 2 self-administered 24-h dietary records (2013-2015); categorization of food as ultra-processed or not relied on the NOVA classification. The associations between UPF intake (as percent and reflecting mean daily UPF quantity (g/d) within the dietary intake, %UPF) and ED types were evaluated using polytomous logistic regression models. Results: 5,967 participants (13.6%) were categorized as likely ED (restrictive n = 444; bulimic n = 1,575; binge eating n = 3,124; other ED n = 824). The fully-adjusted analyses revealed a positive association between UPF intake and bulimic, binge eating, and other ED: ED risk (odds ratio, OR) for an absolute 10-percentage point incremental increase in %UPF intake were 1.08 (1.01-1.14; P = 0.02), 1.21 (1.16-1.26; P < 0.0001), and 1.11 (1.02-1.20; P = 0.02), respectively. No significant association was detected for restrictive ED. Discussion and Conclusion: This study revealed an association of UPF intake with different ED types among French adults. Future research is needed to elucidate the direction of the observed associations.

A Comparison of Sugar Intake between Individuals with High and Low Trait Anxiety: Results from the NutriNet-Santé Study.

(1) Background: Dietary carbohydrates are likely correlated with mental health in general, and with anxiety in particular. Our aim was to investigate the cross-sectional relationship between trait anxiety and carbohydrate (especially sugar) intake in a large sample derived from the general French population. (2) Methods: The analyses included 20231 non-diabetic adults enrolled in the NutriNet-Santé e-cohort, who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (T-STAI, 2013-2016) and who were subsequently divided into high and low trait anxiety groups (T-STAI cut-off of 40 points). Sugar-rich food and macronutrient intake was calculated from ≥3 self-administered 24-h dietary records. The association between trait anxiety and carbohydrate intake was evaluated by ANCOVA according to age category (<45 and ≥45 years). (3) Results: In the full sample, 7942 (39,3%) individuals fell into the high trait anxiety category. They were more likely to be women (82,2% versus 69,2%; p < 0,0001) and younger (mean age 51,6 versus 55,1 years; p < 0,0001) compared to the low trait anxiety group. In fully-adjusted models, high-anxiety individuals aged under 45 years had significantly higher mean consumption of added simple sugars (43,9 versus 42,3 g/d; p < 0,0007), whereas those aged over 45 years with high trait anxiety had significantly lower mean consumption of fruit (214,0 versus 219,5 g/d; p < 0,02) compared to their low-anxiety counterparts. (4) Conclusion: This cross-sectional study revealed modest age-specific associations between anxiety status and sugar intake among adults. Prospective studies with representative samples are needed to explore potential bi-directionality of the observed associations.