Dietary Diversity Was Positively Associated with Psychological Resilience among Elders: A Population-Based Study.
Plain language summary
There's a growing interest by researchers in the relationship between the diversity of people's diets and their health, including their psychological resilience. This study looked at the associations between dietary diversity (DD) and psychological resilience in 8571 elderly individuals in China. Frequency and variety of food groups was collected in order to produce an average (mean) DD score. The psychological resilience of participants was assessed using a validated research tool known as "simplified resilience score" (SRS). The statistical analysis of the data collected showed that those elders with the poorest psychological resilience scores were also eating the least diverse diets. Based on separate analyses by age group, the association of a low SRS with poor DD was more prominent in the younger elderly than the oldest old. Compared with younger participants with good DD, the risk of a low SRS was greater for younger participants with poor DD, the oldest old with good DD, and the oldest old with poor DD, with OR respectively. The greatest contribution to DD was from a high consumption of vegetables, fruits, and nuts. Our study suggested that poor DD was associated with a low psychological resilience among the Chinese elderly, especially the younger elderly. These findings suggest that eating a diet rich in a variety of vegetables, fruits, and nuts might promote psychological resilience.
Conflicts of interest:
No conflicts of interests to disclose.
This is a population-based study involving 8571 community-based elderly individuals, where dietary diversity (DD) was assessed by means of food frequency questionnaires, and correlated with psychological resilience, assessed by a validated simplified resilience score (SRS). Low DD has been previously correlated with a high level of oxidative stress mediating oxidative damage to mitochondria and lipids in neuronal circuits, as seen
in affective (anxiety, depression) and neurodegenerative conditions (Alzheimer's and Parkinson's Diseases). Conversely, dietary polyphenols, a group of phenolic compounds abundant in fruits, vegetables, and other plant sources, have been associated with improved psychological resilience.
Implications for practice:
The greatest contribution to dietary diversity from the totality of food groups was from a high consumption of vegetables, fruits, and nuts. This can help nutrition practitioners inform their clinical decisions when supporting individuals wanting to improve the diversity of their diet.
Implications for research:
Future work is necessary to further assess these findings in longitudinal studies and clinical trials, and to ascertain what the mechanisms of action are in this process. It would be particularly interesting to find out whether the gut microbiota and its communication with the brain via the gut-brain axis is part in the process.
undefined: The association between dietary diversity (DD) and psychological resilience among older people is an underdeveloped area of research. This cross-sectional study explored the associations of DD with psychological resilience among 8571 community-based elderly individuals. The intake frequencies of food groups were collected, and dietary diversity was assessed based on the mean DD score. Psychological resilience was assessed using a simplified resilience score (SRS). Data were analyzed using multiple linear regression and logistic regression models. Poor DD was significantly associated with psychological resilience, with a β (95% CI) of -0.94 (-1.07, -0.81) for the SRS ( < 0.01) and an odds ratio (95% CI) of 1.83 (1.66, 2.01) for low SRS status. The interaction effects of age with DD were observed for the SRS ( < 0.001) and low SRS status ( < 0.001). Based on separate analyses by age group, the association of a low SRS with poor DD was more prominent in the younger elderly than the oldest old, with OR (95% CI) 2.32 (1.96, 2.74) and 1.61 (1.43, 1.82), respectively. Compared with younger participants with good DD, the risk of a low SRS was greater for younger participants with poor DD, the oldest old with good DD, and the oldest old with poor DD, with OR (95% CI) 2.39 (2.02, 2.81), 1.28 (1.09, 1.51), and 2.03 (1.72, 2.39), respectively. The greatest contribution to DD was from a high consumption of vegetables, fruits, and nuts. Our study suggested that poor DD was associated with a low psychological resilience among the Chinese elderly, especially the younger elderly. These findings suggest that augmentation of DD might promote psychological resilience.
Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial.
Plain language summary
National Institutes of Health define erectile dysfunction as a persistent difficulty achieving and maintaining an erection sufficient for satisfactory sexual intercourse. The main aim of the study was to explore the effects of nuts supplementation on erectile function determined by the International Index of Erectile Function and the endothelial (inner lining of blood vessels) function. The study is a randomised controlled, two-interventions parallel, clinical trial conducted in healthy males who reported a Western-style diet. The 119 participants were randomly assigned to one of the two interventions. Results indicate that adding 60 g/d of mixed raw nuts to a Western-style diet for 14-wk improved the auto-reported orgasmic function and sexual desire parameters in a group of healthy reproductive-aged participants compared with an age-matched control group. Authors conclude that compliance with a healthy diet supplemented with mixed nuts may help to improve erectile and sexual desire.
undefined: Lifestyle risk factors for erectile and sexual function include smoking, excessive alcohol consumption, lack of physical activity, psychological stress, and adherence to unhealthy diets. In the present study, we evaluated the effects of mixed nuts supplementation on erectile and sexual function. Eighty-three healthy male aged 18-35 with erectile function assessment were included in this FERTINUTS study sub-analysis; a 14-week randomized, controlled, parallel feeding trial. Participants were allocated to (1) the usual Western-style diet enriched with 60 g/day of a mixture of nuts (nut group; = 43), or (2) the usual Western-style diet avoiding nuts (control group; = 40). At baseline and the end of the intervention, participants answered 15 questions contained in the validated International Index of Erectile Function (IIEF), and peripheral levels of nitric oxide (NO) and E-selectin were measured, as surrogated markers of erectile endothelial function. Anthropometrical characteristics, and seminogram and blood biochemical parameters did not differ between intervention groups at baseline. Compared to the control group, a significant increase in the orgasmic function ( -value = 0.037) and sexual desire ( -value = 0.040) was observed during the nut intervention. No significant differences in changes between groups were shown in peripheral concentrations of NO and E-selectin. Including nuts in a regular diet significantly improved auto-reported orgasmic function and sexual desire.
Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews.
Einstein (Sao Paulo, Brazil). 2019;14(2):235-77
Plain language summary
Eating disorders are mental health conditions that can have implications both physiologically and also on psychological and emotional wellbeing. Eating disorders broadly fit into one of three disorders (although there are others); anorexia nervosa (AN) which is characterised by extreme energy intake restriction and disturbances in body weight/shape perceptions. Bulimia nervosa (BN) is characterised by recurred episodes of binging followed by compensatory behaviours such as laxative use, vomiting and/or excessive exercising. Binge-eating disorder (BEN) involved frequent periods of binging without compensatory behaviours and is considered to be more common than AN and/or BN. There is a need for effective psychosocial treatments of eating disorders that enable sufferers to achieve long-term recovery. This paper reviews 101 primary research papers and 30 systematic, meta-analysis and narrative reviews. It concludes that cognitive behavioural therapy (CBT), which incorporates nutritional education, psychoeducation, cognitive, behavioural and self-monitoring interventions to be the most effective treatment for eating disorders, particularly BN and BED. Family-based therapy, based on the Maudsley approach where the family plays a key role in recovery, is considered to be most effective for AN. There may also be a role for low dose antipsychotic medications to help anxious and/or obsessive symptoms. Interpersonal therapy and dialectic behavioural therapy (DBT) may also be effective, where the latter aims to improve emotional regulation and reduce binging in BN and BED.
Eating disorders are psychiatric conditions originated from and perpetuated by individual, family and sociocultural factors. The psychosocial approach to treatment and prevention of relapse is crucial. To present an overview of the scientific evidence on effectiveness of psychosocial interventions in treatment of eating disorders. All systematic reviews published by the Cochrane Database of Systematic Reviews - Cochrane Library on the topic were included. Afterwards, as from the least recent date of these reviews (2001), an additional search was conducted at PubMed with sensitive search strategy and with the same keywords used. A total of 101 primary studies and 30 systematic reviews (5 Cochrane systematic reviews), meta-analysis, guidelines or narrative reviews of literature were included. The main outcomes were: symptomatic remission, body image, cognitive distortion, psychiatric comorbidity, psychosocial functioning and patient satisfaction. The cognitive behavioral approach was the most effective treatment, especially for bulimia nervosa, binge eating disorder and the night eating syndrome. For anorexia nervosa, the family approach showed greater effectiveness. Other effective approaches were interpersonal psychotherapy, dialectic behavioral therapy, support therapy and self-help manuals. Moreover, there was an increasing number of preventive and promotional approaches that addressed individual, family and social risk factors, being promising for the development of positive self-image and self-efficacy. Further studies are required to evaluate the impact of multidisciplinary approaches on all eating disorders, as well as the cost-effectiveness of some effective modalities, such as the cognitive behavioral therapy. RESUMO Transtornos alimentares são doenças psiquiátricas originadas de e perpetuadas por fatores individuais, familiares e socioculturais. A abordagem psicossocial é essencial para o tratamento e a prevenção de recaídas. Apresentar uma visão geral das evidências científicas sobre a efetividade das intervenções psicossociais no tratamento de transtornos alimentares. Foram incluídas todas as revisões sistemáticas publicadas no Banco de Dados de Revisões Sistemáticas da Cochrane Library. Posteriormente, a partir da data menos recente destas revisões (2001), realizou-se uma busca adicional no PubMed, com estratégia de busca sensibilizada e com os mesmos descritores utilizados antes. No total, foram incluídos 101 estudos primários e 30 revisões sistemáticas (5 revisões sistemáticas da Cochrane), metanálises, diretrizes ou revisões narrativas da literatura. Os principais desfechos foram remissão de sintomas, imagem corporal, distorção cognitiva, comorbidade psiquiátrica, funcionamento psicossocial e satisfação do paciente. A abordagem cognitivo-comportamental foi o tratamento mais efetivo, principalmente para bulimia nervosa, transtorno da compulsão alimentar periódica e síndrome do comer noturno. Para anorexia nervosa, a abordagem familiar demonstrou maior efetividade. Outras abordagens efetivas foram psicoterapia interpessoal, terapia comportamental dialética, terapia de apoio e manuais de autoajuda. Além disso, houve um número crescente de abordagens preventivas e promocionais que contemplaram fatores de risco individuais, familiares e sociais, sendo promissoras para o desenvolvimento da autoimagem positiva e autoeficácia. São necessários mais estudos que avaliem o impacto de abordagens multidisciplinares em todos transtornos alimentares, além da relação custo-efetividade de algumas modalidades efetivas, como a terapia cognitivo-comportamental.
Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia?
Plain language summary
More than 20 years ago the term “orthorexia nervosa” (OrNe) was coined for people whose intention to eat healthily becomes an unhealthy obsession. OrNe is not recognized in the Diagnostic and Statistical Manual and no official diagnostic criteria exists. Research has been limited by the use of different questionnaires used to establish OrNe. The newly developed Teruel Orthorexia Scale (TOS) also distinguishes between “healthy orthorexia” (HeOr) and OrNe, whereby HeOr is seen as a healthy interest with diet, healthy behaviour with regard to diet, and eating healthily as part of one’s identity, and is not associated with disordered eating, perfectionism, and obsessive-compulsive behaviour. OrNe and HeOr are not thought to be a continuum from people who do not care at all about eating healthily, followed by people who eat healthily (HeOr), and, finally, those who care excessively (OrNe), confirmed by the fact that there is only a low association between HeOr and OrNe. The aim of this study was to find further evidence for this hypothesis, and to evaluate the motives associated with the two types of orthorexia. 460 Spanish students participated in the study, 82% female, 18% male, with a mean age of 21. Participants completed two online questionnaires, the TOS and the Food Choice Questionnaire (FCQ) which assessed the following food choice motives: Weight Control; Sensorial Appeal; Convenience, Health Content; Price; Affect Regulation (e.g. “helps me relax”; Socio-political (e.g. country of food origin). The authors found that HeOr was positively related to Health Content and negatively related to Sensory Appeal and Price. OrNe, on the other hand, was positively related to Weight Control and Affect Regulation, and negatively related to Sensory Appeal and age.
Recent research points to the bidimensional nature of orthorexia, with one dimension related to interest in healthy eating (healthy orthorexia) and another dimension related to a pathological preoccupation with eating healthily (orthorexia nervosa). Research was needed to provide further support for this differentiation. We examined the food-choice motives related to both aspects of orthorexia. Participants were 460 students from a Spanish university who completed the Teruel Orthorexia Scale and the Food Choice Questionnaire. By means of structural equation modeling, we analyzed the relationship between orthorexia, food-choice motives, gender, body mass index, and age. The motives predicting food choices in orthorexia nervosa and healthy orthorexia were quite different. In the case of orthorexia nervosa, the main motive was weight control, with sensorial appeal and affect regulation also showing significant associations. For healthy orthorexia, the main motive was health content, with sensorial appeal and price also showing significant associations. This supports the hypothesis that orthorexia nervosa is associated with maladaptive eating behavior motived more by weight control than by health concerns.
Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial.
The lancet. Gastroenterology & hepatology. 2019
Plain language summary
Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal disorder with symptoms of abdominal pain, bloating, and altered bowel habits which can affect quality of life, social functioning, and time off work. Cognitive behavioural therapy (CBT) is recommended for patients with refractory IBS symptoms, ie, ongoing symptoms after 12 months despite being offered appropriate medications and lifestyle advice. A previous three-group, multicentre, randomised, controlled trial of two types of CBT designed specifically for IBS (therapist-delivered, telephone CBT with a patient self-management manual, and web-based CBT with minimal therapist support) compared to “treatment as usual” (TAU) alone, showed that telephone CBT and web CBT were significantly more effective than TAU at reducing IBS symptom severity and impact on life at 12 months in adults with refractory IBS. The aim of this study was to evaluate the longer term (24 month) clinical outcomes of telephone CBT and web CBT versus TAU. Of 558 patients from the original study, 323 (58%) provided data at the 24-month follow-up. Outcomes were assessed through a number of questionnaires. Whilst both CBT groups fared significantly better with their IBS symptom scores at 12 months than the TAU group, at 24 months only the more intensive telephone CBT group had significantly better scores than the TAU group. Other outcomes from questionnaires relating to general functioning, mood and overall assessment showed significant improvements at both 12 and 24 months for both CBT groups compared to the TAU group. The authors conclude that IBS-specific CBT can provide significant improvement in terms of IBS’s impact on life and symptom severity, with ongoing benefits at 24 months.
BACKGROUND Irritable bowel syndrome (IBS) is common, affecting 10-20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT for patients with refractory IBS. ACTIB results showed that, at 12 months, both forms of CBT for IBS were significantly more effective than treatment as usual at reducing IBS symptom severity in adults with refractory IBS. This follow-up study aimed to evaluate 24-month clinical outcomes of participants in the ACTIB trial. METHODS In the ACTIB three-group, randomised, controlled trial, 558 adults with refractory IBS were randomly allocated to receive either therapist-delivered telephone CBT (telephone-CBT group), web-based CBT with minimal therapist support (web-CBT group), or treatment as usual (TAU group) and were followed up for 12 months. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite being offered first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and the south of England (UK) between May 1, 2014, and March 31, 2016. Primary outcome measures were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS), assessed in the intention-to-treat (ITT) population with multiple imputation. This study was a non-prespecified naturalistic follow-up and analysis of the participants of the ACTIB trial at 24 months assessing the same outcomes as the original trial. Outcome measures were completed online by participants or a paper questionnaire was posted, or telephone follow-up undertaken. The ACTIB trial is registered with the International Standard Randomised Controlled Trial Number registry, number ISRCTN44427879. FINDINGS 24-month follow-up of outcomes was achieved for 323 (58%) of 558 participants: 119 (64%) of 186 in the telephone-CBT group, 99 (54%) of 185 in the web-CBT group, and 105 (56%) of 187 in the TAU group. At 24 months, mean IBS-SSS was 40·5 points (95% CI 15·0 to 66·0; p=0·002) lower in the telephone-CBT group and 12·9 points (-12·9 to 38·8; p=0·33) lower in the web-CBT group than in the TAU group. The mean WSAS score was 3·1 points (1·3 to 4·9; p<0·001) lower in the telephone-CBT group and 1·9 points (0·1 to 3·7; p=0·036) lower in the web-CBT group than in the TAU group. A clinically significant IBS-SSS change (≥50 points) from baseline to 24 months was found in 84 (71%) of 119 participants in the telephone-CBT group, in 62 (63%) of 99 in the web-CBT group, and in 48 (46%) of 105 in the TAU group. In total 41 adverse events were reported between 12 to 24 months: 11 in the telephone-CBT group, 15 in the web-CBT group, and 15 in the TAU group. Of these, eight were reported as gastrointestinal related, five as psychological, and six as musculoskeletal. There were no adverse events related to treatment. INTERPRETATION At 24-month follow-up, sustained improvements in IBS were seen in both CBT groups compared with TAU, although some previous gains were reduced compared with the 12-month outcomes. IBS-specific CBT has the potential to provide long-term improvement in IBS, achievable within a usual clinical setting. Increasing access to CBT for IBS could achieve long-term patient benefit. FUNDING UK National Institute for Health Research.