Diet quality and mental health across the lifespan: updates and new directions - Associate Professor Felice Jacka
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Diet quality and mental health across the
lifespan: updates and new directions
Associate Professor Felice Jacka
Deakin University
Centre for Adolescent Health, MCRI
The University of Melbourne
Black Dog Institute
The Epidemiological Transition
A transition from infectious
disease to chronic,
degenerative, or man-made
diseases as the primary causes
of mortalityNoncommunicable diseases (NCDs) account for the largest burden of early mortality and are predicted to cost the global community more than US $30trillion over the next 15 years
Changes in diet quality in the UK
Increases in Obesity over 20 years - adolescents Olds et al. 2010 Int J Obesity 34:57-66
GLOBESITY
Collishaw et al. 2004 J Child Psychol Psychiatry
Changing trends in the prevalence of CMD’s in
Taiwan over 20 years
Szu-Ting Fu*, Lancet 2013; 381: 235–41CVD Stroke Obesity Type 2 Diabetes Metabolic Syndrome Some cancers Dementia
MENTAL HEALTH
Diet quality and clinical mood and anxiety disorders Jacka et al. Am J Psych, 2010 Jacka et al. J Affect Disord, 2010
Geelong Osteoporosis Study - GOS (n=1046) Semi-structured psychiatric interview (Structured Clinical Interview for the DSM-IV – SCID-I/NP) Clinical diagnoses of current and lifetime major depressive disorder (MDD), dysthymia and anxiety disorders Psychiatric symptomatology – General Health Questionnaire (GHQ-12) Food Frequency Questionnaire: habitual intake of 74 Foods and six alcoholic beverages over preceding 12 months
‘WESTERN’ DIETARY PATTERN (per SD)
3
Adjusted for:
Age
2.5 Education
SEIFA
2 PA
Smoking
1.5 Alcohol
Energy intake
BMI
1
0.5
MDD/Dysthymia Bipolar Anxiety
Odds ratios and 95% confidence intervals
Western = junk and processed foods'TRADITIONAL' DIETARY PATTERN (per SD)
1
MDD/Dysthymia Bipolar disorders Anxiety disorders
Odds ratios and 95% confidence intervals
Traditional = vegetables, fruit, beef, lamb, wholegrain, fishMean GHQ-12 Scores
P for trendWhitehall II Cohort Study – UK
n ≈ 3500
OR (95% CI) for incident depression
1.6
1
WESTERN WHOLE FOODS
0.5
0.3
Followed for ≈ 5 years
Outcome incident depression (CES-D)The SUN Cohort Study - Spain
n≈10,000
OR (95% CI) for incident depression
according to quintiles of Mediterranean
dietary adherence
1
0.9
0.8 P for trendOR = 0.84 (0.76, 0.92) Am J Clin Nutr 2013
Meta-analysis of observational studies quantifying the association between the Western dietary pattern and the risk of depression. Lai AJCN. 2013 doi: 10.3945/ajcn.113.069880.
Adherence to the Mediterranean diet and risk for depression
RR = 0.68 (0.54–0.86)
Psaltopoulou et al. 2013ADOLESCENTS
Healthy Neighbourhoods Study n ≈ 7000 - Murdoch Children's Research Institute
Lowest intake of
Healthy foods
Highest intake of
Unhealthy foodsOPIC (2005-2007) n=3040 - WHO Collaborating Centre for Obesity Preven
Highest intake
of UNhealthy
foods
Highest intake
of Healthy foodsWHAT IS THE POSSIBLE CONTRIBUTION OF
EARLY LIFE NUTRITIONAL EXPOSURES TO THE
MENTAL HEALTH OF CHILDREN?MoBa (n = 23,020)
Pre and post-natal diet quality (HEALTHY AND
UNHEALTHY)
and children’s mental health at 18mo, 36mo and 5yrs
Latent Growth Curve Models
Maternal and Paternal Age
Maternal Education
Parental Income
Marital Status
Maternal depression
Maternal smoking before and during pregnancy
Maternal role (home duties or paid workforce)
Parity and gestational length
Parental Locus of control
Jacka et al. (2013) JAACAPSummation: • Higher intakes of UNHEALTHY FOODS by mothers during pregnancy are related to increased externalising behaviours in children •Higher intakes of UNHEALTHY FOODS during the first few years of life are related to increased internalising and externalising behaviours in children •Higher intakes of HEALTHY FOODS during the first years of life are related to decreased levels of internalising and externalising behaviours in children Jacka et al. (2013) JAACAP
Children’s externalising at 1.5, 3 and 6yrs
≈ 7000 Mother-child pairs
Depressive symptoms during pregnancy =
worse diet
Both high unhealthy diets and low health
diets = poorer cognitive function in offspring
Independent of postnatal depression,
postnatal nutrition and a large range of socio-
demographic and familial factorsMaternal diet (experimental) •Alters methylation and gene expression of dopaminergic and opioid related genes (Vucetic et al. 2010) •Perturbations in the serotonergic system – increased anxiety in females and increased aggression in males (Sullivan et al. 2010) •Weaning of offspring onto a HF diet resulted in the upregulation of inflammatory and oxidative stress pathways and mitochondrial dysfunction (Bruce 2009) •Maternal ‘western’ diet, high in fats and sugars, and obesity increased sympathetic nervous system activity and hyperactivity in rodent offspring that persisted into adulthood (Fernandes 2012) •Deficiencies in omega-3 fatty acids during in utero development and early life reduce brain plasticity and increase anxiety-like behaviors in adult mice (Bhatia 2011) •Maternal HF diet results in reduced maternal care by dams during the early life of offspring (Connor 2012)
Only 18% - sufficient dietary fibre Only 32% - sufficient omega 3 intake >95% of toddlers exceeded the recommended guidelines for saturated fat 31% of toddlers classified as overweight or obese Zhou et al. MJA 2012
1. Are these associations causal?
2. What are the biological pathways that
mediate these relationships?
3. Can we use this new knowledge to
prevent and treat common mental
disorders?Are these associations causal?
Dietary improvement as a treatment strategy in major depression: a RCT diet@barwonhealth.org.au www.dietdepressionstudy.com
What are the biological pathways that mediate these relationships?
INFLAMMATION AND OXIDATIVE STRESS
BDNF AND BRAIN PLASTICITY
EPIGENETIC PATHWAYS
GUT MICROBIOTAProbability of remaining free of de novo MDD for women stratified
into tertiles of hsCRP.
100
99
98
97
Tertile 1 (low)
Percent
96
95
Tertile 2 (mid)
94
93
92
Tertile 3 (high)
0 1 2 3 4 5 6 7 8 9
Time (years)
Pasco et al Br J Psychiatry 2009.Environmental sources of inflammation and oxidative stress
Diet
Exercise Substance
Use
Cytokine
Sleep and redox Vitamin D
signaling
Atopy
Infections
obesity
Leaky Gut
Stress
Berk BMC Medicine 2013, 11:200N3 Fatty acids address neuroinflammation
Lifestyle influences cellular energy balance Gomez-Pinilla (2008) Ageing Res Rev
• Chronic intake (4 months) of high fat and/or high sugar diets increases free radical generation, protein oxidation & neuroinflammation and reduces BDNF in the hippocampus (Morrison 2010; Pistell 2010) • Cognitive deficits (spatial memory) apparent within ONE WEEK (Ross 2009) • Healthy adults who ate a high fat diet for one week performed worse on tasks measuring attention and speed of retrieval than they had prior to the diet (Edwards et al. 2011 FASEB)
PATH through life study – ANU (n= 3663)
Dietary patterns and depression (highest tertile)
1.5 Lowest tertile Prudent
Lowest tertile Western
PROSPECTIVE
1
WESTERN PRUDENT
Highest tertile Western Incidence Rate Ratios
GEE method – Diet at wave one predicting depression
at waves two and three
0.5
Western Healthy
Adjusted for: age, gender, income, financial hardship, labour force status, education,
social disadvantage in childhood, SEIFA, smoking and physical activity levels – plus
depression at baseline
(Jacka et al. 2014 PLoS One)‘LEAKY GUT’
Burcelin et al. Acta Diabetol (2011)Animal model of AUTISM SPECTRUM DISORDERS (ASD) • Maternal immune activation • Intestinal permeability (Leaky gut) • Behavioural phenotype (social, communicative, stereotypic) • REVERSED/AMELIORATED WITH ADMINISTRATION OF BACTEROIDES FRAGILIS
Can we use this new knowledge to prevent and treat common mental disorders?
PREVENTION
Three diet groups: • Low fat dietary advice (Am Heart Assoc guidelines) • Med Diet with EEVOO • Med Diet with 30g/day nuts Intensive education and support, plus nuts and EVOO at baseline and every three months (individual and group)
LARGE RANDOMISED PRIMARY
PREVENTION TRIAL
N=3923MED FOLLOW UP 5.4YRS – 224 NEW CASES OF
DEPRESSION
Cases Control MD-EVOO MD-NUTS
77 88 59
HR (95%CI) Ref (1) 0.85 (0.62-1.15) 0.73 (0.52-1.03)
DM2 (N=1958) cases = 113 0.71 (0.46-1.09) 0.59 (0.36-0.98)
• degree of adherence not large
• control group also received dietary advice
• tended to already be on Med type diet at baseline
• lack of statistical powerReynolds et al.
Psychiatric Services
2014
Problem solving therapy vs dietary counselling for 247 older adults
6-8 sessions over 6-12 weeks with three booster sessions at 3, 9 and
15 months following initial six sessions
Rates of transition in general population 20-25% over one year
In this study, rates were 8-9% in both groups
Patients in dietary intervention experienced a 40-50% drop in
depressive symptoms that was sustained over two yearsWHAT’S ON THE HORIZON? • MICRO-SCOPE • RCT PRE VS PRO VS PLACEBO (INDICATED PREVENTION) • HEALTHY PARENTS, HEALTHY CHILDREN • HORIZON 2020 • HTV
Obesity risk factors
“It is both compelling and daunting to consider that dietary intervention at an individual or population level could reduce rates of psychiatric disorders.” AJP 2010
PREVENTION? Indicated
SelectedAlliance for the Prevention of
Mental Disorders
Statement of purpose:
“To support a population health approach to the prevention
of mental disorders and promotion of emotional wellbeing”
Through
• Advocacy (policy makers)
• Facilitating research and building capacity
• Facilitating Knowledge Translation and Exchange
• Building collaborative partnershipsINTERNATIONAL SOCIETY FOR NUTRITIONAL PSYCHIATRY RESEARCH
WWW.ISNPR.ORG
info@isnpr.orgQUESTIONS?
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