Alexis J. Hure

A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults

BACKGROUND Studies of single nutrients on depression have produced inconsistent results, and they have failed to consider the complex interactions between nutrients. An increasing number of studies in recent years are investigating the association of overall dietary patterns and depression. OBJECTIVE This study aimed to systematically review current literature and conduct meta-analyses of studies addressing the association between dietary patterns and depression. DESIGN Six electronic databases were searched for articles published up to August 2013 that examined the association of total diet and depression among adults. Only studies considered methodologically rigorous were included. Two independent reviewers completed study selection, quality rating, and data extraction. Effect sizes of eligible studies were pooled by using random-effects models. A summary of the findings was presented for studies that could not be meta-analyzed. RESULTS A total of 21 studies were identified. Results from 13 observational studies were pooled. Two dietary patterns were identified. The healthy diet pattern was significantly associated with a reduced odds of depression (OR: 0.84; 95% CI: 0.76, 0.92; P < 0.001). No statistically significant association was observed between the Western diet and depression (OR: 1.17; 95% CI: 0.97, 1.68; P = 0.094); however, the studies were too few for a precise estimate of this effect. CONCLUSIONS The results suggest that high intakes of fruit, vegetables, fish, and whole grains may be associated with a reduced depression risk. However, more high-quality randomized controlled trials and cohort studies are needed to confirm this finding, specifically the temporal sequence of this association.

Micronutrient intakes during pregnancy in developed countries: Systematic Review and Meta-Analysis

Micronutrient status during pregnancy influences maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. Research reporting dietary intake during pregnancy in nationally representative population samples, however, is limited. This review summarizes the micronutrient intakes of pregnant women from developed countries and compares them with relevant national recommendations. A systematic search without date limits was conducted. All studies reporting the micronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified studies for inclusion and assessed methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Pregnant women in developed countries are at risk of suboptimal micronutrient intakes. Folate, iron, and vitamin D intakes were consistently below nutrient recommendations in each geographical region, and calcium intakes in Japan were below the Japanese recommendations and the average intake levels in other developed countries. Research examining the implications of potential nutrient insufficiency on maternal and offspring health outcomes is needed along with improvements in the quality of dietary intake reporting.

Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries

Research reporting diet during pregnancy in nationally representative samples is limited. This review summarizes the dietary intakes of pregnant women in developed countries and compares them with national recommendations. A systematic search without date limits was conducted. All studies reporting the macronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified the studies to be included and assessed the methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Energy and macronutrient intakes of pregnant women do not match national recommendations. Energy and fiber intakes were consistently below recommendations, while total fat and saturated fat intakes were generally above recommendations and carbohydrate and polyunsaturated fat intakes were below to borderline low compared with recommendations. A mismatch between dietary practices and macronutrient recommendations in pregnant women is widespread and not well quantified. The implications of these practices are unknown until further research compares maternal diet with short-term and long-term maternal and offspring health outcomes.

Dietary balance during pregnancy is associated with fetal adiposity and fat distribution

BACKGROUND The prenatal environment can induce permanent changes in offspring phenotype. Thinness at birth is associated with adult risk of cardiometabolic disease. OBJECTIVE The objective was to investigate the association between maternal nutrition during pregnancy and intrauterine development of fetal body composition. DESIGN We used prospective data from 179 Australian women with singleton pregnancies from the Women and Their Childrens Health Study. A validated food-frequency questionnaire was used at 18-24 wk and 36-40 wk of gestation to quantify maternal diet during the previous 3 mo of pregnancy. Fetal body-composition measurements were ascertained from abdominal and midthigh sites by ultrasound performed at 19, 25, 30, and 36 wk. The subcutaneous fat area at each site was calculated by subtracting the lean/visceral area from the total area. RESULTS In linear mixed-model regressions, maternal intakes of protein (b = -0.13; P = 0.04) and starch (b = 0.10; P = 0.02) and the protein:carbohydrate ratio (b = -3.61; P = 0.02) were associated with the percentage of abdominal fat, whereas SFA (b = 0.27; P = 0.04) and PUFA (b = -0.48; P = 0.03) were associated with the percentage of midthigh fat. Response surfaces for fetal adiposity were maximized at different macronutrient intakes. Abdominal fat was highest with low protein intakes (<16% of energy), and midthigh fat was highest at intermediate protein (18-21% of energy), high fat (>40% of energy), and low carbohydrate (<40% of energy) intakes. CONCLUSION Fetal body composition may be modifiable via nutritional intervention in the mother and thus may play an important role in influencing the offsprings risk of future disease.

Dietary zinc is associated with a lower incidence of depression: findings from two Australian cohorts.

BACKGROUND Several animal and human studies have shown that zinc plays a role in reducing depression, but there have been no longitudinal studies in both men and women on this topic. The aim of this study was to investigate dietary zinc, and the zinc to iron ratio, as predictors of incident depression in two large longitudinal studies of mid-age and older Australians. METHODS Data were self-reported, as part of the Australian Longitudinal Study on Women׳s Health (women aged 50-61 years) and Hunter Community Study (men and women aged 55-85 years). Validated food frequency questionnaires were used to assess dietary intake. Energy-adjusted zinc was ranked using quintiles and predictors of incident depression were examined using multivariate logistic regression. RESULTS Both studies showed an inverse association between dietary zinc intake and risk of depression, even after adjusting for potential confounders. Compared to those with the lowest zinc intake those with the highest zinc intake had significantly lower odds of developing depression with a reduction of about 30-50%. There was no association between the zinc to iron ratio and developing depression in either study. LIMITATIONS Dietary assessment was carried out only at baseline and although adjustments were made for all known potential confounders, residual confounding cannot be entirely excluded. CONCLUSIONS Low dietary zinc intake is associated with a greater incidence of depression in both men and women, as shown in two prospective cohorts. Further studies into the precise role of zinc compared to other important nutrients from the diet are needed.

Disparities exist between National food group recommendations and the dietary intakes of women

BackgroundPreconception and pregnancy dietary intakes can influence the health of future generations. In this study we compared the food intakes of reproductive-aged women by pregnancy status, to current Australian recommendations.MethodsData are from the Australian Longitudinal Study on Womens Health, younger cohort aged 25-30 years in 2003, with self-reported status as pregnant (n = 606), trying to conceive (n = 454), given birth in the last 12 months (n = 829) or other (n = 5597). Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating (AGHE) and Australian Nutrient Reference Values (NRVs).ResultsNo women met all AGHE food group recommendations. Highest adherence rates [mean (95% CI) servings/day] were for meat [85%, 1.9(1.8-1.9)], fruit [44%, 2.1(2.1-2.2)] and dairy [35%, 1.8(1.8-1.9)], with < 14% meeting remaining recommendations. Women who achieved NRVs (folate, iron, calcium, zinc, fibre) for pregnancy, breastfeeding and adult life stages were 1.5%, 3.3% and 13.7%, respectively. Compared to AGHE, women consumed more servings of fruit (4.9 vs 4.0;P = 0.034) and dairy (3.4 vs 2.0;P = 0.006) to achieve pregnancy NRVs; more dairy (2.9 vs 2.0;P = 0.001), less fruit (3.9 vs 5.0;P < .001) and vegetables (3.4 vs 7.0;P < .001) to achieve breastfeeding NRVs; more fruit (3.6 vs 3.0;P < .001), dairy (2.5 vs 2.0;P < .001), meat (1.8 vs 1.5;P = 0.015), less vegetables (3.6 vs 5.0;P < .001) to achieve adult NRVs.ConclusionsThe AGHE does not align with contemporary diets of Australian women or enable them to meet all NRVs. Current tools to guide food consumption by women during pregnancy require revision.

Effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis

BACKGROUND Nutrition plays a fundamental role in fetal growth and birth outcomes. OBJECTIVE We synthesized effects of dietary interventions before or during pregnancy on neonatal and infant outcomes. DESIGN Randomized controlled trials that assessed the whole diet or dietary components and neonatal or infant outcomes were included. Two authors independently identified articles to be included and assessed the methodologic quality. A meta-analysis was conducted separately for each outcome by using a random-effects model. Results were reported by dietary intervention as follows: 1) counseling, 2) food and fortified food products, or 3) a combination (counseling plus food) intervention, and 4) collectively for all dietary interventions. Results were subanalyzed by the nutrient of interest, country income, and BMI. RESULTS Of 2326 abstracts screened, a total of 29 randomized controlled trials (31 publications) were included in this review. Food and fortified food products were effective in increasing birth weight [standardized mean difference (SMD): 0.27; 95% CI: 0.14, 0.40; P < 0.01] and reducing the incidence of low birth weight (SMD: -0.22; 95% CI: -0.37, -0.06; P < 0.01). All dietary interventions and those focused on macronutrient intake also increased birth weight (P < 0.01) and length (P < 0.05) and reduced the incidence of low birth weight (P < 0.01). Dietary interventions in low-income countries and underweight or nutritionally at-risk populations increased birth weight (P < 0.05) and reduced the incidence of low birth weight (P = 0.01). No effects were seen for the following other outcomes: placental weight, head circumference, macrosomia, Apgar score, small for gestational age, large for gestational age, and perinatal mortality. CONCLUSION Additional high-quality randomized controlled trials that test different dietary interventions are required to identify maternal diet intakes that optimize neonatal and infant outcomes.

Agreement between self-reported perinatal outcomes and administrative data in New South Wales, Australia

BackgroundMany epidemiological studies that focus on pregnancy rely on maternal self-report of perinatal outcomes. The aim of this study was to evaluate the agreement between self-reported perinatal outcomes (gestational hypertension with or without proteinuria, gestational diabetes, premature birth and low birth weight) in a longitudinal study and linked to administrative data (medical records).MethodsSelf-reported survey data from the Australian Longitudinal Study on Women’s Health was linked with the New South Wales Perinatal Data Collection. Agreement between the two sources was evaluated using percentage agreement and kappa statistics. Analyses were conducted at two levels by: i) the mother and ii) each individual child.ResultsWomen reliably self-report their perinatal outcomes (≥87 % agreement). Gestational hypertension with or without proteinuria had the lowest level of agreement. Mothers’ reports of perinatal outcomes were more reliable when evaluated by child. Restricting the analysis to complete and consistent reporting further strengthened the reliability of the child-specific data, increasing the agreement from >92 to >95 % for all outcomes.ConclusionsThe present study offers a high degree of confidence in the use of maternal self-reports of the perinatal outcomes gestational hypertension, gestational diabetes, preterm birth and low birth weight in epidemiological research, particularly when reported on a per child basis. Furthermore self-report offers a cost-effective and convenient method for gathering detailed maternal perinatal histories.

Predictors of antenatal alcohol use among Australian women: a prospective cohort study.

To identify predictors of antenatal alcohol consumption among women who usually consume alcohol.

A recruiting failure turned success

BackgroundThis paper describes an attempt that was made to recruit child-bearing women into a nutrition-based research study and the knowledge that was gained when this approach was unsuccessful. The Assessment Before Children Develop Obesity Study was a cross-sectional survey which planned to follow-up women and children who had previously been, or were currently enrolled in the Mathematical Model of Pregnancy Study.MethodsEthics approval was sought and obtained over an eight month period. After just six weeks it was obvious that our research objectives were not achievable because of an inadequate response rate (10%). This led to a review of the recruiting methodology as well as all written materials provided to potential participants. Advice was sought from those with expertise in the design of large public health campaigns and literature was consulted to refine our recruitment strategy.ResultsIn subsequent redevelopment, the Assessment Before Children Develop Obesity Study was merged with the Mathematical Model of Pregnancy Study to become what is now known as the Women and Their Childrens Health Study. Consent rates improved from 10% and 35% in the Assessment Before Children Develop Obesity and Mathematical Model of Pregnancy studies respectively, to 61% in the Women and Their Childrens Health Study (chi square test, p < 0.001). Successful recruitment for this research continues. The significant improvement in the participation rate is attributed to numerous factors including changes to the study name, recruiting method and information materials.ConclusionBy sharing our experience we aim to assist other researcher in avoiding the same pitfalls and offer effective strategies for improving response rates.