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Effects of oral nutrition supplements in persons with dementia: A systematic review.
Tangvik, RJ, Bruvik, FK, Drageset, J, Kyte, K, Hunskår, I
Geriatric nursing (New York, N.Y.). 2021;42(1):117-123
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Dementia is a chronic condition characterised as a decline in cognitive functioning that leads to dependence in the performance of daily activities, including nutritional sufficiency. As the dis-ease progresses, eating and drinking may become more difficult. The aim of this study was to investigate the effects of oral nutrition supplements (ONS) on nutritional intake and clinical outcomes in older persons with dementia. This study is a systemic review which included ten studies of which 9 where experimental studies (n=6 RCTs; n=3 non RCTs) based on patients with dementia who were undernourished. Results indicate that ONS improved daily intake of energy and protein, compliance was high, and more persons met the recommended nutrition intake. In fact, intervention with ONS improved nutritional status; however, no effects on cognitive or functional outcomes were reported. Authors conclude that there is the need for a more comprehensive intervention plan for people with cognitive impairments that addresses the individual nutritional challenges in order to systematically meet nutritional needs.
Abstract
OBJECTIVE Persons with dementia are at risk of malnutrition, evidenced by low dietary intake, which has consequences for nutritional status, activity of daily living and disease progression. The effects of oral nutrition supplements (ONS) on nutritional intake, nutritional status, and cognitive and physical outcomes in older persons with dementia were evaluated. METHODS PubMed, Medline, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched in December 2017, and this was repeated in May 2019. The Preferred Reporting Items for Systematic Reviews and Analysis (PRISMA) checklist was used. Papers were considered if they presented experimental clinical trials using oral nutritional supplements to persons diagnosed with dementia, including Alzheimer's disease and mild cognitive impairment, and conducted in hospitals, nursing homes or homes. RESULTS We included ten articles reporting nine clinical trials. A total of 407 persons with dementia were included, of whom 228 used ONS for 7 to 180 days. Nutritional intake improved by 201 to 600 kcal/day. Energy intake from ordinary foods was not affected, thus ONS improved the persons daily intake of energy and protein. Body weight, muscle mass, and nutritional biomarkers in blood improved in the intervention groups compared with the control groups. No effects on cognition or physical outcomes were observed. CONCLUSION ONS increases the intake of energy and protein and improves nutritional status in persons with dementia; however, RCTs with longer intervention periods are needed to investigate the impact on cognitive and functional outcomes.
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Eating in the lockdown during the Covid 19 pandemic; self-reported changes in eating behaviour, and associations with BMI, eating style, coping and health anxiety.
Coulthard, H, Sharps, M, Cunliffe, L, van den Tol, A
Appetite. 2021;161:105082
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The Covid-19 pandemic resulted in national lockdowns, which resulted in isolation within people’s homes. This cross-sectional survey examined changes in eating patterns and behaviour during lockdown. Of the 620 participants included in the study, eating higher energy density foods was more common in females with a higher BMI and higher health anxiety. Although there was a change in emotional eating behaviours across the sample as a whole, it was not in the expected direction, with many participants reporting a decrease in emotional eating after the implementation of lockdown. There were also increases in fruit and vegetable consumption and home prepared foods. Many of these behavioural responses were influenced by pre-lockdown tendencies. Therefore, it is important to consider these when understanding coping strategies during lockdown, and how to support clients as we come out of lockdown.
Expert Review
Conflicts of interest:
None
Take Home Message:
- National lockdowns, as seen during the 2020/21 Covid-19 pandemic, impacted eating behaviour and associations with BMI, eating style and health anxiety.
- Given the new nature of this research, it is not clear what impact confounding factors such as food insecurity had on changing eating behaviours.
- Disproportionate risks were seen in certain demographics and in those shielding due to their heightened risk from Covid-19.
- Retrospective and longitudinal studies to monitor the impact of lockdowns on eating behaviour and health anxiety are needed.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
The role of eating behaviours and psychological responses during lockdown has become an area of interest, particularly with the uncertainty of going into future lockdowns. With Covid-19, and individual’s responses to it, being a relatively new research topic, there is not yet enough evidence for longitudinal outcomes of the findings in these studies. It is also difficult to ascertain the influence of confounding variables prior to the national lockdown, such as food insecurity, not accounted for due to the unpredictable start to the pandemic. There has also been disproportionate risks between certain demographics and their Covid-19 risk, therefore further research on the impact of this on health anxiety and subsequent eating behaviours is required. This highlights a wider need for continued research on the topic.
Clinical practice applications:
Those who had problematic eating behaviours and higher BMI pre lockdown will need to be supported with healthier coping practices if subsequent lockdowns occur, to prevent health related anxiety and consumption of high energy density foods. Furthermore, those who were shielding in their homes were also more likely to show an increase in emotional eating post lockdown. Therefore, clients who spent a large amount of lockdown shielding will need additional support, to develop coping strategies to prevent risk of emotional eating and health anxiety.
Considerations for future research:
Both retrospective and longitudinal studies monitoring the impact of eating behaviours and health anxiety pre and post lockdown are needed. This will help further the evidence base of the potential role of Covid-19 related health anxiety on eating patterns, coping strategies and dietary choices.
Abstract
The global coronavirus pandemic (Covid 19) resulted in national lockdowns where individuals were asked to isolate in their homes to stop the spread of the disease. Using a cross-sectional survey, the current paper aimed to examine self-reported changes in eating patterns and behaviour during the lockdown in the UK, and associations with BMI, demographic variables, eating styles, health anxiety, food insecurity and coping strategies. Participants (N = 620) were recruited online through social media advertising. The results showed that there were self-reported changes to food consumption during the lockdown across the sample. Increases in consumption of HED (high energy density) snack foods during the lockdown was associated with sex, pre-lockdown eating behaviour (emotional eating and uncontrolled eating), and Covid-specific health anxiety. Increases in positive eating practices such as eating more home prepared foods, and fruits and vegetables, were associated with adaptive coping strategies. Higher emotional eating (EE) during the lockdown was associated with a higher BMI, higher pre-lockdown EE and maladaptive coping strategies. Maladaptive coping strategies moderated the relationship between BMI and EE during the lockdown. In particular a higher BMI was associated with higher EE during the lockdown if an individual also had higher maladaptive coping strategies. These findings suggest that changes to eating behaviour may be part of a wider style of maladaptive or adaptive coping, particularly in those with a history of EE or uncontrolled eating. Preparing individuals to adopt more adaptive coping strategies during lockdown situations may be crucial to improving health during subsequent the lockdown events.
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The Impact of COVID-19 Stay-At-Home Orders on Health Behaviors in Adults.
Flanagan, EW, Beyl, RA, Fearnbach, SN, Altazan, AD, Martin, CK, Redman, LM
Obesity (Silver Spring, Md.). 2021;29(2):438-445
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In response to the global outbreak of COVID-19, a wave of quarantine and stay-at-home mandates were issued to attenuate the rapid worldwide spread. The aim of this study was to quantify changes in habitual dietary behaviours, physical activity, sleep, sedentary behaviours, and mental health before and during the initial peak of the COVID-19 pandemic. This study is based on an anonymous survey via paid advertisements on the social media platform Facebook. A total of 7,753 completed the first COVID-19 question and were thus included in the analysis. Results indicate that: - declines in healthful eating behaviours were coincident with reductions in physical activity. These negative behaviours were characteristic of individuals reporting weight gain in response to the pandemic outbreak. - anxiety scores nearly doubled in response to the pandemic and 20% of the sample reported that symptoms were severe enough to interfere with daily routines. - home confinement led to shifts in daily work and household responsibilities which resulted in mental health declines alongside some positive and many negative changes to health behaviours. Authors conclude that with increased cases of weight gain and significant declines to mental health, COVID-19 may impact clinical practice for years to come.
Abstract
OBJECTIVE Stay-at-home orders in response to the coronavirus disease 2019 (COVID-19) pandemic have forced abrupt changes to daily routines. This study assessed lifestyle changes across different BMI classifications in response to the global pandemic. METHODS The online survey targeting adults was distributed in April 2020 and collected information on dietary behaviors, physical activity, and mental health. All questions were presented as "before" and "since" the COVID-19 pandemic. RESULTS In total, 7,753 participants were included; 32.2% of the sample were individuals with normal weight, 32.1% had overweight, and 34.0% had obesity. During the pandemic, overall scores for healthy eating increased (P < 0.001), owing to less eating out and increased cooking (P < 0.001). Sedentary leisure behaviors increased, while time spent in physical activity (absolute time and intensity adjusted) declined (P < 0.001). Anxiety scores increased 8.78 ± 0.21 during the pandemic, and the magnitude of increase was significantly greater in people with obesity (P ≤ 0.01). Weight gain was reported in 27.5% of the total sample compared with 33.4% in participants with obesity. CONCLUSIONS The COVID-19 pandemic has produced significant health effects, well beyond the virus itself. Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionally affected individuals with obesity.
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Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress.
Cecchetto, C, Aiello, M, Gentili, C, Ionta, S, Osimo, SA
Appetite. 2021;160:105122
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After China, Italy was the first country in which the coronavirus disease 2019 (COVID-19) pandemic rapidly spread. As a consequence, a lockdown was imposed in the entire nation to reduce the spread of infections. The main aim of this study was to investigate how the negative emotions raised by the lockdown and the social features that characterised the quality of life during lockdown interacted with individual characteristics to affect the eating behaviour during the lockdown. This study is based on an anonymous online survey which was shared via social media targeting Italian residents or speakers who were 18 years of age or older. A total of 365 participants were considered for this study. Results indicate that: - increased emotional eating was significantly predicted by higher level of anxiety, depression, and partially, by Quality of Life and Quality of the Relationships. - increased binge eating was predicted by higher stress. - higher alexithymia [a broad term to describe problems with feeling emotions] scores were associated by increased emotional eating and higher body mass index scores were associated with both increased emotional eating and binge eating. - emotional eating and binge eating decreased significantly in Phase 2 compared to Phase 1 of the lockdown period. Authors conclude that future policies during lockdown should also take into consideration the emotional toll on individual well-being and should include measures of psychological support.
Abstract
Due to the spread of COVID 2019, the Italian government imposed a lockdown on the national territory. Initially, citizens were required to stay at home and not to mix with others outside of their household (Phase 1); eventually, some of these restrictions were lifted (Phase 2). To investigate the impact of lockdown on emotional and binge eating, an online survey was conducted to compare measures of self-reported physical (BMI), psychological (Alexithymia), affective (anxiety, stress, and depression) and social (income, workload) state during Phase 1 and Phase 2. Data from 365 Italian residents showed that increased emotional eating was predicted by higher depression, anxiety, quality of personal relationships, and quality of life, while the increase of bingeing was predicted by higher stress. Moreover, we showed that higher alexithymia scores were associated by increased emotional eating and higher BMI scores were associated with both increased emotional eating and binge eating. Finally, we found that from Phase 1 to Phase 2 binge and emotional eating decreased. These data provide evidence of the negative effects of isolation and lockdown on emotional wellbeing, and, relatedly, on eating behaviour.
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Evaluation of COVID-19 Disease Awareness and Its Relation to Mental Health, Dietary Habits, and Physical Activity: A Cross-Sectional Study from Pakistan.
Ali, A, Sohaib, M, Iqbal, S, Hayat, K, Khan, AU, Rasool, MF
The American journal of tropical medicine and hygiene. 2021;104(5):1687-1693
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Dietary factors and healthy eating habits play a crucial role in human health management. The global pandemic of COVID-19 has significantly changed the dietary patterns and eating habits of the people worldwide, particularly in the area affected by this pandemic. The aim of this study was to assess the knowledge of COVID-19 disease and its association with anxiety, depression, dietary habits, and physical activity during the COVID-19 lockdown. This study was a descriptive cross-sectional survey conducted in the Punjab Province of Pakistan. A total of 1956 participants took part in the study. Results indicate that: - only 7.4% of participants had good knowledge about COVID-19. - the physical activity of the participants was affected as 66.9% of the participants had a decrease in physical activity and around 40% of the participants also gained weight. - around 70% of the participants were suffering from anxiety, and 52% were depressed. Authors conclude that their findings can help formulate concrete policy-making for the Pakistani population in terms of public health prospects. Furthermore, mass-level educational programmes should be launched via print and electronic media to enhance public awareness about COVID-19 and to improve dietary behaviour of people.
Abstract
Coronavirus infection (COVID-19) has significantly increased the mortality and morbidity rates worldwide. The present study was conducted to assess the general public's awareness of COVID-19 and its association with mental health, dietary habits, and physical activity. A web-based survey was conducted to gather information about demographics, knowledge about COVID-19, dietary habits, mental health, and anthropometry among the general public of Pakistan. Descriptive statistics, chi-square test, and multiple logistic regression were used for data analysis. The majority of the participants were suffering from anxiety (71.0%) and depression (52.0%) during the COVID-19 pandemic; 32.4% of participants had poor COVID-19-related knowledge. COVID-19 lockdown reduced the physical activity of 66.9% of participants and increased weight of 38.8% of the survey participants. Demographic variables, including age, gender, ethnicity, education, employment, family type, and geographical location, were significantly associated with knowledge about COVID-19 (P < 0.05). Depression was inversely associated with COVID-19 knowledge (P < 0.05). Healthy changes in dietary habits including decreased consumption of fast foods, soft and cola drinks, fruit drinks, cooked meat (outside the home), sugar, and fats, and were associated with increased knowledge of COVID-19. Vitamin C and immunity-boosting supplement consumption were significantly associated with increased knowledge regarding COVID-19 (< 0.05). Inadequate knowledge about COVID-19 and the presence of anxiety and depression were found among most of the study participants. There is a need to conduct educational seminars to limit the health consequences resulting from COVID-19 lockdown.
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Evaluation of the effects of fear and anxiety on nutrition during the COVID-19 pandemic in Turkey.
Kaya, S, Uzdil, Z, Cakiroğlu, FP
Public health nutrition. 2021;24(2):282-289
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The current treatment for COVID-19 is mainly focused on infection control and effective vaccine therapy because of extensive measures to reduce person-to-person transmission. However, the psychosocial repercussions of the COVID-19 pandemic have not yet been fully considered. The aim of this study was to evaluate the nutritional attitudes and habits that changed during the COVID-19 pandemic due to fear and anxiety status. The study included 1012 individuals (n=827 female, n=185 male) living in Turkey with an age range between 18 and 65 years. Results indicate: - that 26·7 % of the participants used nutritional supplements in particular vitamin C, vitamin D, vitamin B12 and zinc. - an inverse association between anxiety, fear and nutrition habits during the COVID-19 pandemic. - differences in shopping preferences, processes applied to foods and vegetables and fruits due to the fear of virus contamination from the surfaces. Authors conclude that continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.
Abstract
OBJECTIVE The aim of this study was to evaluate effects of fear and anxiety on nutrition during the COVID-19 pandemic. DESIGN Participants were recruited by an online survey in this cross-sectional study. The questionnaire included general demographic characteristics, level of fear and anxiety, and nutritional habits. The Fear of COVID-19 Scale (FCV-19S) and Generalized Anxiety Disorder-7 test (GAD-7) were used to determine fear and anxiety. SETTING Turkey. PARTICIPANTS A total sample consisted of 1012 adults. RESULTS In pandemic, fear and anxiety caused individuals to skip breakfast and snacks less, but more at lunch. A positive significant correlation was observed between the increased consumption of yoghurt, cheese and water and FCV-19S scores. There was a positive significant correlation between cheese, legume, nuts-seeds, cake-cookies, dessert and tea consumption and GAD-7 scores. A 1-unit increase in FCV-19S scores affected 1·04 times of increased consumption of yoghurt, kefir, cheese, nuts-seeds, fruit (dry) and rice-pasta. A 1-unit increase in GAD-7 scores affected 1·03 times of increased consumption of egg and fruit (fresh); 1·04 times of increased consumption of cheese and other vegetables; 1·05 times of increased consumption of milk, meat, poultry, fish, legume, nuts-seeds, fruit (dry), cake-cookies and tea; 1·07 times of increased consumption of rice-pasta and coffee and 1·08 times of increased consumption of bread and dessert. CONCLUSIONS In pandemic, anxiety and fear led to changes in individuals' nutritional habits and food preferences. Continuous surveillance of psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. In addition, the effects of these psychological problems on nutrition should be evaluated.
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The Impact of Nutrients on Mental Health and Well-Being: Insights From the Literature.
Muscaritoli, M
Frontiers in nutrition. 2021;8:656290
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Diet, mental health, and well-being are linked through several biological pathways. In addition to a healthy diet, nutrient supplements may be of benefit due to their ability to influence these pathways. This review aimed to outline the relationship between specific nutrients and their beneficial effect on mental health. The review outlined the various benefits of polyunsaturated fats, vitamin E, magnesium and folic acid on stress, anxiety, sleep disorders, mild cognitive impairment, depression, bipolar disorders, and obsessive-compulsive disorder. With regards to stress, it was outlined that insufficient vitamins, excessive fat and nutritional imbalance can be contributory. Human research exists to support the benefits of magnesium and polyunsaturated fat for stress and these plus vitamin E for anxiety, however it appears that evidence is lacking for vitamin E and stress and the authors did not comment on folic acid for either condition. Extensive research exists for the use of polyunsaturated fats in mild cognitive impairment, and it was stated that high doses for long periods of time may be needed to show any benefits. The use of vitamin E in cognitive impairment is controversial and more studies may be needed. The authors did not comment on magnesium or folic acid supplementation. It was concluded that an unhealthy diet and lifestyle may be associated with poor mental health and well-being and the importance of a balanced, varied diet for normal brain function. This study could be used by healthcare professionals to understand the importance of recommending a healthy diet for mental well-being in individuals who are suffering from mental health disorders.
Abstract
A good nutritional status is important for maintaining normal body function and preventing or mitigating the dysfunction induced by internal or external factors. Nutritional deficiencies often result in impaired function, and, conversely, intakes at recommended levels can resume or further enhance body functions. An increasing number of studies are revealing that diet and nutrition are critical not only for physiology and body composition, but also have significant effects on mood and mental well-being. In particular, Western dietary habits have been the object of several research studies focusing on the relationship between nutrition and mental health. This review aims to summarize the current knowledge about the relationship between the intake of specific micro- and macronutrients, including eicosapentaenoic acid, docosahexaenoic acid, alpha-tocopherol, magnesium and folic acid, and mental health, with particular reference to their beneficial effect on stress, sleep disorders, anxiety, mild cognitive impairment, as well as on neuropsychiatric disorders, all significantly affecting the quality of life of an increasing number of people. Overall data support a positive role for the nutrients mentioned above in the preservation of normal brain function and mental well-being, also through the control of neuroinflammation, and encourage their integration in a well-balanced and varied diet, accompanied by a healthy lifestyle. This strategy is of particular importance when considering the global human aging and that the brain suffers significantly from the life-long impact of stress factors.
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Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity.
Chi, X, Liang, K, Chen, ST, Huang, Q, Huang, L, Yu, Q, Jiao, C, Guo, T, Stubbs, B, Hossain, MM, et al
International journal of clinical and health psychology : IJCHP. 2021;21(3):100218
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Recent research has showed that the prevalence of insomnia, depressive and anxiety symptoms among Chinese middle school students was 21.90%, 43.70% and 37.40%, respectively, during the COVID-19 period. The aims of this study were: (1) to explore the prevalence of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19 outbreak; (2) to investigate associations of socio-demographic factors and COVID-fear with insomnia, depressive and anxiety symptoms; (3) to investigate associations of nutrition and physical activity with insomnia, depressive and anxiety symptoms after adjusting socio-demographic factors and COVID-fear. This study included 1,794 students (males n= 56.20% and females n= 43.80%) aged 15 and 18 years. Results indicate that prevalence of insomnia, depressive and anxiety symptoms was high in the participating cohort. The highest prevalence was among female participants, left behind children and students with higher COVID-fear. Both better nutritional status, moderately and highly active physical activity levels were protective factors for depression and anxiety, while highly active physical activity level was significantly associated with lower level of insomnia symptoms. Authors conclude by emphasising on the important role of psychology counsellors in schools, health authorities and educators to carry out early psychological interventions.
Abstract
Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19. METHOD Cross-sectional study (N = 1,794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety. RESULTS The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms. CONCLUSIONS These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents' mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise. Los problemas de salud mental son comunes en adolescentes y están influenciados por eventos estresantes. Se evaluó prevalencia y correlatos de síntomas de insomnio, depresión y ansiedad en adolescentes chinos durante el COVID-19. Método: En mayo de 2020 se realizó un estudio transversal (N = 1.794 adolescentes, edad media = 15,26) mediante una encuesta en línea para recopilar datos sociodemográficos, miedo relacionado con COVID-19, nutrición, actividad física (AF) y síntomas de insomnio, depresión y ansiedad. Resultados: La prevalencia de síntomas de insomnio, depresión y ansiedad fue del 37,80%, 48,20% y 36,70%, respectivamente. Modelos lineales generalizados revelaron que mujeres, niños abandonados y estudiantes con más miedo al COVID-19 tendían a informar síntomas de insomnio, depresión y ansiedad simultaneamente. Después de ajustar los factores sociodemográficos y el miedo al COVID-19, mejor estado nutricional y AF moderadamente activa se asociaron con niveles más bajos de síntomas de depresión y ansiedad, mientras que AF muy activa se asoció con niveles más bajos de insomnio, síntomas depresivos y de ansiedad. Conclusiones: Se debe prestar más atención a la salud psicológica de los adolescentes mientras se combate el COVID-19. Para promover su salud mental, los educadores deben ayudarles a desarrollar un estilo de vida saludable con una dieta equilibrada y ejercicio regular.
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Longitudinal Weight Gain and Related Risk Behaviors during the COVID-19 Pandemic in Adults in the US.
Bhutani, S, vanDellen, MR, Cooper, JA
Nutrients. 2021;13(2)
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The Covid-19 pandemic has altered health behaviours of many individuals resulting in weight gain. This cross-sectional study of 1779 individuals aimed to determine the long-term impact of Covid-19 on health behaviours and weight gain over 5 months. The results showed that most participants (40%) body weight increased alongside increased processed food intake and snacking. 33% of the individuals who gained weight continued to gain weight and 28% maintained their higher weight after lockdown measures were lifted. Take-away meals, processed food intake and stress levels remained high post-lockdown in those who gained weight. It was concluded that lockdown measures may have impacted daily life resulting in weight gain which may perpetuate long-term. This study could be used by healthcare professionals to understand that lockdown measures may have altered eating behaviours resulting in weight gain and that these may need to be uncovered to aid long-term weight loss.
Abstract
Cross-sectional analyses have shown increased obesogenic behaviors and a potential for weight gain during COVID-19 related peak-lockdown (March-May 2020), but longitudinal data are lacking. This study assessed longitudinal changes in body weight and lifestyle behaviors in the US adults during the pandemic. METHODS We used Qualtrics survey to collect self-reported data on body weight, dietary, physical activity, and psychological variables (n = 727) during the peak-lockdown (April/May) and at post-lockdown (September/October). Peak-lockdown weight data were categorized based on the magnitude of weight gained, maintained, or lost, and behavioral differences were examined between categories at two time points. RESULTS Body weight increased (+0.62 kg; p < 0.05) at the post-lockdown period. The body mass index also increased (26.38 ± 5.98 kg/m2 vs. 26.12 ± 5.81 kg/m2; p < 0.01) at the post-lockdown period vs. peak-lockdown period. Close to 40% of participants reported gaining either 1-4 lbs or >5 lbs of body weight during the peak-lockdown, while 18.2% lost weight. Weight-gainers engaged in riskier dietary behaviors such as frequent ultra-processed food intake (p < 0.01) and snacking (p < 0.001), were less active, and reported high stress and less craving control during peak-lockdown. Of those gaining >5 lbs, 33% continued to gain weight after the lockdown eased, while 28% maintain higher body weight. In weight-gainers, takeout meal frequency increased, and high ultra-processed food intake and stress, and low craving control continued to persist after the lockdown eased. CONCLUSION We show that the COVID-19 lockdown periods disrupted weight management among many Americans and that associated health effects are likely to persist.
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Serotonin Reuptake Inhibitors and the Gut Microbiome: Significance of the Gut Microbiome in Relation to Mechanism of Action, Treatment Response, Side Effects, and Tachyphylaxis.
Sjöstedt, P, Enander, J, Isung, J
Frontiers in psychiatry. 2021;12:682868
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In preceding centuries common thought was that psychiatric disorders originated from the gut. In later years this concept was replaced by the idea of it being a disorder of the brain and that an imbalance of neurotransmitters is the cause of depression and other psychiatric conditions (monoamine hypothesis). This theory has been dominating psychiatric research for the past decades, and selective serotonin reuptake inhibitors (SSRIs) have become a widespread treatment option for psychological disorders. Despite their benefits, their use also presents clinical challenges such as treatment resistance, side effects or loss of effect. Consequently, the monoamine hypothesis has become disputed with other pathophysiological mechanisms having been proposed in recent years. With an appreciation of the pathophysiological complexities, this opinion-based article sought to present alternate views and to suggest areas for future research regarding psychiatric disorders, SSRIs and the gut-brain axis. The gut-brain axis has complex communication and signalling pathways in essence, the gut microbiome can exert significant effects on emotions, behaviours, metabolic risks, and the metabolism of drugs. Nerve cells of the gut also generate substantial amounts of serotonin for use within the gut. Equally, the gut microbiome produces and uses serotonin. It appears that some of the side effects associated with SSRIs, such as weight gain, are mediated via the gut microbiome. Further evidence suggests that SSRIs and several other psychotropic drugs exert antimicrobial action, which can alter the balance and integrity of the gut microbiome. Therefore, it would be valuable to further investigate the impact of long-term SSRI use on the microbial constellation in the gut and whether certain microbiome patterns could help predict treatment responsiveness or side effects, that may be manageable via microbiome manipulation. The authors believe that an advanced understanding of the dynamics of the gut microbiome could provide better and personalized treatment options for mental health conditions. This article provides a brief insight into current thoughts and theories of psychiatric disorders, SSRIs and the gut.
Abstract
The monoamine hypothesis of psychopharmacology has been dominating the biological psychiatric research field for decades. Currently psychiatric research has increasingly appreciated psychiatric disorders and suicidal behavior as being highly complex and multi-etiological. In this pathway the gut microbiome and its interrelationship with the brain is gaining traction. The usage of selective serotonin reuptake inhibitors (SSRIs) is increasing in the general population. This is due to their effect on a broad range of psychiatric disorders, and their favorable side effect profile. Still, there are enigmatic aspects about SSRIs, such as the difficulty to predict effect in individual patients, inter-individual differences in side effect, tachyphylaxis (a sudden loss of response to a certain drug), and to date, uncertainties on how they exert their clinical effect. A majority of the serotonin in the human body is produced within the gut, and SSRIs affect enteric neurons. They also exhibit antimicrobial properties that comes with the potential of disrupting microbial hemostasis. We propose that the role of the gut-brain axis and the gut microbiome in relation to psychopharmacology should be more highlighted. With this article, together with similar articles, we would like to provide a hypothetical framework for future studies within this field. We believe that this would have the potential to provide a paradigm shift within the field of psychopharmacology, and result in findings that potentially could contribute to the development of a more personalized and tailored treatment.