Diet quality, dietary inflammatory index and body mass index as predictors of response to adjunctive N-acetylcysteine and mitochondrial agents in adults with bipolar disorder: A sub-study of a randomised placebo-controlled trial.

AIMS: We aimed to explore the relationships between diet quality, dietary inflammatory potential or body mass index and outcomes of a clinical trial of nutraceutical treatment for bipolar depression. METHODS: This is a sub-study of a randomised controlled trial of participants with bipolar depression who provided dietary intake data (n = 133). Participants received 16 weeks adjunctive treatment of either placebo or N-acetylcysteine-alone or a combination of mitochondrial-enhancing nutraceuticals including N-acetylcysteine (combination treatment). Participants were followed up 4 weeks post-treatment discontinuation (Week 20). Diet was assessed by the Cancer Council Victoria Dietary Questionnaire for Epidemiological Studies, Version 2, converted into an Australian Recommended Food Score to measure diet quality, and energy-adjusted dietary inflammatory index score to measure inflammatory potential of diet. Body mass index was also measured. Generalised estimating equation models were used to assess whether diet quality, energy-adjusted dietary inflammatory index score and/or body mass index were predictors of response to significant outcomes of the primary trial: depression symptoms, clinician-rated improvement and functioning measures. RESULTS: In participants taking combination treatment compared to placebo, change in depression scores was not predicted by Australian Recommended Food Score, dietary inflammatory index or body mass index scores. However, participants with better diet quality (Australian Recommended Food Score) reported reduced general depression and bipolar depression symptoms (p = 0.01 and p = 0.03, respectively) and greater clinician-rated improvement (p = 0.02) irrespective of treatment and time. Participants who had a more anti-inflammatory dietary inflammatory index had less impairment in functioning (p = 0.01). Combination treatment may attenuate the adverse effects of pro-inflammatory diet (p = 0.03) on functioning. Participants with lower body mass index who received combination treatment (p = 0.02) or N-acetylcysteine (p = 0.02) showed greater clinician-rated improvement. CONCLUSION: These data support a possible association between diet (quality and inflammatory potential), body mass index and response to treatment for bipolar depression in the context of a nutraceutical trial. The results should be interpreted cautiously because of limitations, including numerous null findings, modest sample size and being secondary analyses.

Sex-Specific Lifestyle and Biomedical Risk Factors for Chronic Disease among Early-Middle, Middle and Older Aged Australian Adults.

Evidence suggests age and sex differences in risk factors for chronic disease. This study examined lifestyle and biomedical risk factors among men (m) and women (w) in early-middle (25⁻51 years), middle (52⁻64) and older (65+) adulthood. Cross-sectional data from the 2011⁻2012 Australian Health Survey (n = 3024) were analysed. Self-reported dietary, activity, sleep behaviours and collected biomedical data were analysed. Early-middle adults failed to meet fruit, vegetable (95.3%) and sugar-sweetened beverage (SSB, 34.9%) recommendations. Older adults had higher prevalence of overweight/obesity (70%), high blood pressure (38.0%) and fewer met physical activity guidelines (36.3%). Prior to older adulthood, more men consumed SSBs (early-middle m 45.6%, w 24.4%; middle m 26.0%, w 19.3%), and fewer met sedentary behaviour recommendations (early-middle m 43.2%, w 62.1%; middle m 46.4%, w 63.9%). Differences in overweight/obese women in early-middle (44.8%) to middle adulthood (64.7%) were significant. Biomedical risk was greatest in middle age; abnormal cholesterol/lipids increased specifically for women (total cholesterol early-middle 24.9% middle 56.4%; abnormal LDL-cholesterol early-middle 23.1% middle 53.9%). Adherence to lifestyle guidelines was low; particularly among men. While men exhibited greater clinical risk overall, this significantly increased among women in middle-adulthood. Public health strategies to improve lifestyle, monitor and intervene among middle-aged women are warranted.

Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood.

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5-9 years), adolescence (10-17 years) and emerging adulthood (18-25 years) in a large population-representative Australian sample. Among children in this study (n = 739), no sex-related differences were observed. Among adolescents (n = 1304), females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05). Among emerging adults (n = 909), females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05) and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05). These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted.

Fasting Plasma Glucose, Self-Appraised Diet Quality and Depressive Symptoms: A US-Representative Cross-Sectional Study.

Depression and type 2 diabetes (T2D) contribute significantly to global burden of disease and often co-occur. Underpinning type 2 diabetes is poor glycaemic control and glucose is also an obligatory substrate for brain metabolism, with potential implications for cognition, motivation and mood. This research aimed to examine the relationships between fasting plasma glucose and depressive symptoms in a large, population representative sample of US adults, controlling for other demographic and lifestyle behavioural risk factors. Using the 2013-2014 National Health and Nutrition Examination Survey (NHANES) data, this study first investigated the relationship between fasting plasma glucose and mental disorders at a population-level, accounting for demographic, health behavioural and weight-related factors known to co-occur with both type 2 diabetes and mental disorders. Depressive symptoms were derived from the 9-item Patient Health Questionnaire. Fasting plasma glucose was obtained through medical examination and demographic (age, household income, sex) and health characteristics (perceived diet quality, daily time sedentary) were self-reported. Body mass index was calculated from objectively measured height and weight. In the univariate model, higher fasting plasma glucose was associated with greater depressive symptoms among females (b = 0.24, 95% CI = 0.05, 0.43, p < 0.05), but not males. In the final fully adjusted model, the relationship between fasting plasma glucose and depressive symptoms was non-significant for both males and females. Of all independent variables, self-appraised diet quality was strongly and significantly associated with depressive symptoms and this remained significant when individuals with diabetes were excluded. Although diet quality was self-reported based on individuals' perceptions, these findings are consistent with a role for poor diet in the relationship between fasting plasma glucose and depressive symptoms.