Abstract

Background
Evidence on the association between single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and depressive symptoms is inconclusive.

Objectives
The primary aim of the study was to investigate the association between SNPs in the VDR gene and depressive symptoms.

Methods
In a sample of older adults from the Longitudinal Ageing Study Amsterdam (n = 922), depressive symptoms were assessed using the Centre for Epidemiological Studies Depression scale (CES-D scale) at baseline and after 3, 6, and 10 y of follow-up. Blood samples for SNP and serum 25-hydroxyvitamin D3 (25(OH)D3) determination were obtained at baseline. The association between 13 SNPs in the VDR gene and the course of depressive symptoms were evaluated using linear mixed models. The interaction between SNPs and serum 25(OH)D3 in relation to depressive symptoms was evaluated using multiple linear regression.

Results
No SNPs were associated with the course of depressive symptoms. Significant interactions between serum 25(OH)D3 and SNPs in the VDR gene were found. Stratified analysis revealed that within the GG genotype strata, 10 nmol/L higher serum 25(OH)D3 was associated with 0.27 (95% CI: −0.50, −0.04) and 0.23 (95% CI: −0.48, 0.02) lower scores on the CES-D scale for Cdx-2 and 1b-G-886A, respectively. This association was not found in persons having the GA or AA genotype.

Conclusions
No SNPs is associated with the course of depressive symptoms. Stratified analysis shows that the effect of serum 25(OH)D3 concentrations on depressive symptoms is different among genotypes of Cdx-2 and 1b-G-886A. Future research should elucidate on the function of Cdx-2 and 1b-G-886A to describe their effect.

Introduction

Depressive symptoms follow a U-shaped relationship with age, increasing again after the age of 60–65 y [1]. This is, however, not solely due to aging and varies widely between people [2]. A higher medical burden [3], aging-related anxiety [4], and nonhealth-related events [5] have been associated with depressive symptoms in older adults. The prevalence of depressive symptoms in older adults is estimated at 17% [6], but they are often overlooked [7] due to the overlap with symptoms, among others [6,8]. The burden will continue to rise due to the aging population and increasing life expectancy [9], thereby increasing years lived with disease [10] and societal costs [11].

Different factors (e.g., biological, social, and psychological) play a role in the onset and course of depressive symptoms [[12], [13], [14], [15]]. Vitamin D – a modifiable risk factor of which the status decreases with age [16] – has been associated with the course of depressive symptoms. In a previous study of the Longitudinal Ageing Study Amsterdam (LASA), an association between low vitamin D status and an increase in depressive symptoms among women was observed [17]. Two recent meta-analyses found a similar association in both men and women [18,19]. Genetic factors, such as single nucleotide polymorphisms (SNPs) in vitamin D-related genes may influence the response to, and therefore the requirement of, vitamin D [20]. The vitamin D receptor (VDR) gene encodes the VDR, the transporter of active vitamin D (1,25(OH)2D), and thereby influences the availability of 1,25(OH)2D [21].

Results

The study sample consisted of 922 participants who were on average 75.6 (SD 6.6) y old, were 51% women, and had a median CES-D score of 13.6 (IQR: 11.6–15.6). The prevalence of depressive symptoms [40] and antidepressant use at baseline was 24% and 2.5%, respectively. Mean serum 25(OH)D3 concentration was 46.6 nmol/L (SD 17.7), mean BMI was 26.6 kg/m2 (SD 5.2), and median physical activity in minutes per week was 128.6 (IQR: 67.7–189.7). The basic characteristics are summarized in Table 1 [35,36,40]. Compared with nonresponders, participants in the study sample were older and more often women, never smokers, moderate-to-excessive alcohol users, and more often had 2 or more comorbidities (all P < 0.05; Supplemental Table 2). The minor allele frequency was smallest for 282 W (n = 63/919; 3%), and no SNPs departed from Hardy–Weinberg equilibrium (Supplemental Table 1).

Abstract

Background
Evidence on the association between single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and depressive symptoms is inconclusive.

Objectives
The primary aim of the study was to investigate the association between SNPs in the VDR gene and depressive symptoms.

Methods
In a sample of older adults from the Longitudinal Ageing Study Amsterdam (n = 922), depressive symptoms were assessed using the Centre for Epidemiological Studies Depression scale (CES-D scale) at baseline and after 3, 6, and 10 y of follow-up. Blood samples for SNP and serum 25-hydroxyvitamin D3 (25(OH)D3) determination were obtained at baseline. The association between 13 SNPs in the VDR gene and the course of depressive symptoms were evaluated using linear mixed models. The interaction between SNPs and serum 25(OH)D3 in relation to depressive symptoms was evaluated using multiple linear regression.

Results
No SNPs were associated with the course of depressive symptoms. Significant interactions between serum 25(OH)D3 and SNPs in the VDR gene were found. Stratified analysis revealed that within the GG genotype strata, 10 nmol/L higher serum 25(OH)D3 was associated with 0.27 (95% CI: −0.50, −0.04) and 0.23 (95% CI: −0.48, 0.02) lower scores on the CES-D scale for Cdx-2 and 1b-G-886A, respectively. This association was not found in persons having the GA or AA genotype.

Conclusions
No SNPs is associated with the course of depressive symptoms. Stratified analysis shows that the effect of serum 25(OH)D3 concentrations on depressive symptoms is different among genotypes of Cdx-2 and 1b-G-886A. Future research should elucidate on the function of Cdx-2 and 1b-G-886A to describe their effect.

Introduction

Depressive symptoms follow a U-shaped relationship with age, increasing again after the age of 60–65 y [1]. This is, however, not solely due to aging and varies widely between people [2]. A higher medical burden [3], aging-related anxiety [4], and nonhealth-related events [5] have been associated with depressive symptoms in older adults. The prevalence of depressive symptoms in older adults is estimated at 17% [6], but they are often overlooked [7] due to the overlap with symptoms, among others [6,8]. The burden will continue to rise due to the aging population and increasing life expectancy [9], thereby increasing years lived with disease [10] and societal costs [11].

Different factors (e.g., biological, social, and psychological) play a role in the onset and course of depressive symptoms [[12], [13], [14], [15]]. Vitamin D – a modifiable risk factor of which the status decreases with age [16] – has been associated with the course of depressive symptoms. In a previous study of the Longitudinal Ageing Study Amsterdam (LASA), an association between low vitamin D status and an increase in depressive symptoms among women was observed [17]. Two recent meta-analyses found a similar association in both men and women [18,19]. Genetic factors, such as single nucleotide polymorphisms (SNPs) in vitamin D-related genes may influence the response to, and therefore the requirement of, vitamin D [20]. The vitamin D receptor (VDR) gene encodes the VDR, the transporter of active vitamin D (1,25(OH)2D), and thereby influences the availability of 1,25(OH)2D [21].

Results

The study sample consisted of 922 participants who were on average 75.6 (SD 6.6) y old, were 51% women, and had a median CES-D score of 13.6 (IQR: 11.6–15.6). The prevalence of depressive symptoms [40] and antidepressant use at baseline was 24% and 2.5%, respectively. Mean serum 25(OH)D3 concentration was 46.6 nmol/L (SD 17.7), mean BMI was 26.6 kg/m2 (SD 5.2), and median physical activity in minutes per week was 128.6 (IQR: 67.7–189.7). The basic characteristics are summarized in Table 1 [35,36,40]. Compared with nonresponders, participants in the study sample were older and more often women, never smokers, moderate-to-excessive alcohol users, and more often had 2 or more comorbidities (all P < 0.05; Supplemental Table 2). The minor allele frequency was smallest for 282 W (n = 63/919; 3%), and no SNPs departed from Hardy–Weinberg equilibrium (Supplemental Table 1).

Abstract

Background

     Even though various studies have been conducted to investigate the relationship between trace metals and sleep, few epidemiological studies have evaluated the relationship between trace metals and sleep disorders in American adults.

Objective

     This study intended to evaluate the associations of serum zinc (Zn), copper (Cu), selenium (Se), Zn/Cu, Zn/Se, and Cu/Se ratios with sleep disorders in American adults.

Methods

     We conducted a cross-sectional analysis of 3660 adults aged ≥18 years old who participated in the National Health and Nutrition Examination Survey (NHANES) 2011–2016. Binary logistic regression was employed to calculate the odds ratio (OR) and 95 % confidence interval (CI) of either serum trace metals or serum trace metals ratios with risks among sleep disorder phenotypes. The restricted cubic spline (RCS) model was additionally utilized to check the dose-response relationships between serum trace metals, serum trace metals ratios, and sleep disorders.

Results

     Logistic regression demonstrated that higher serum Zn (OR: 0.70, 95 % CI: 0.51–0.97, p = 0.035), Zn/Cu (OR: 0.62, 95 % CI: 0.45–0.87, p = 0.007), and Zn/Se (OR: 0.68, 95 % CI: 0.49–0.95, p = 0.025) were related to a decreased likelihood of self-reported sleep disorders, and dose-response relationships were detected by the RCS models, after adjustment for sociodemographic, behavioral, and health characteristics. No associations between serum Cu, Se, Cu/Se, and sleep disorders were observed. The findings in the sensitivity analyses were consistent with these results.

Conclusion

     Our study revealed that serum Zn, Zn/Cu, and Zn/Se were inversely associated with the risk of self-reported sleep disorders in US adults.

Introduction

     Healthy/normal sleep patterns, often evaluated by healthy sleep scores, are characterized as early chronotype, sleep 7–8 h per day, reported never or rare insomnia symptoms, no self-reported snoring, and no frequent daytime sleepiness (Fan et al., 2020; Li et al., 2021). Sleep disorders, including insomnia, sleep apnea, narcolepsy, and restless leg syndrome, are one of the most common clinical problems which disturb sleep patterns (Karna and Gupta, 2022). Besides the direct negative influence on enthusiasm and mental state, sleep disorders have been reported to be associated with various adverse health outcomes, such as obesity, hypertension, type 2 diabetes, cardiovascular disease, and increased mortality (Huyett et al., 2021; Kase et al., 2021; Medic et al., 2017). Moreover, the prevalence of sleep disorders has been rising in the past decades and peaked at a high level, for instance, a recent study revealed that the prevalence of sleep disorders in American adults was 27.1 % (Kase et al., 2021). Since the high prevalence and correlation with various adverse health outcomes, exploring the risk factors of sleep disorders is of vital significance.

Results

Main analyses

     The baseline characteristics of participants across survey waves were presented in Table 1. The overall prevalence of self-reported sleep disorder was 28.9 % and showed a slightly climbing trend from 27.6 % in 2011–2012 to 29.9 % in 2015–2016, but without statistical significance (p = 0.610). The distributions of serum trace metals and serum trace metals ratios across three cycles did not significantly alter.

      Characteristics of participants with and without self-reported sleep disorders were presented in Table 2. From the perspective of univariate analysis, education level, family income, physical activity, caffeine intake, serum Zn, serum Cu, serum Se, and serum Zn/Se were not related to the prevalence of sleep disorders. Advanced age, female gender, nonHispanic white race, smoking, drinking, obesity, hypertension, diabetes, depression, lower Zn/Cu, and higher Cu/Se were likely to be risk factors for sleep disorders in American adults.

     The results of binary logistic regression models of serum trace metals and serum trace metals ratios on self-reported sleep disorders were described in Table 3. After fully adjusted for sociodemographic, behavioral, and health covariates, serum Cu and serum Se were not related to the risk of sleep disorders in American adults. However, compared to individuals in the lowest tertiles of serum Zn (<Q1), adults with the highest tertiles of serum Zn (>Q3) had a 30.0 % (OR: 0.70, 95 % CI: 0.51–0.97, p = 0.035) lower risk to report sleep disorders.

Abstract

Background
Calcium channel blockers (CCBs) are used for the treatment of cardiovascular disease (CVD), including angina pectoris, and hypertension; however, the effect on survival remains uncertain. CCBs impair fibrinolysis and have been linked to elevated plasma homocysteine (Hcy), a CVD risk marker.

Objective
We explored the association between CCB use and mortality in a large prospective cohort of patients with suspected stable angina pectoris (SAP), and potential effect modifications by Hcy-lowering B-vitamin treatment (folic acid, B12, and/or B6) as 61.8% of the patients participated in a randomized placebo-controlled B-vitamin intervention trial.

Methods
Patient baseline continuous characteristics according to CCB treatment were tested by linear regression. Hazard ratios (HRs) for mortality associated with CCB treatment, also according to B-vitamin intervention, were examined using Cox regression analysis. The multivariable model included CVD risk factors, medical histories, and the use of CVD medications.

Results
A total of 3991 patients (71.5 % men) were included, of whom 907 were prescribed CCBs at discharge. During 10.3 years of median follow-up, 20.6% died and 8.9% from cardiovascular- and 11.7% from non-cardiovascular causes. Patients treated with CCBs had higher plasma Hcy, fibrinogen levels, and erythrocyte sedimentation rate (all P<0.001). Furthermore, CCB use was positively associated with mortality, also after multivariable adjustments (HRs [95% CIs]: 1.34 [1.15,1.57], 1.35 [1.08,1.70], and 1.33 [1.09,1.64] for total, CVD, and non-CVD death, respectively). Numerically stronger associations were observed among patients not treated with B-vitamins (HR [95% CI]: 1.54 [1.25, 1.88], 1.69 [1.25, 2.30], and 1.41 [1.06, 1.86] for total, CVD deaths, and non-CVD deaths, respectively), whereas no association was seen in patients treated with B-vitamins (HR [95% CI]: 1.15 [0.91, 1.46], 1.09 [0.76, 1.57], and 1.20 [0.88, 1.65]).

Conclusions
In patients with suspected SAP, CCB treatment was associated with increased mortality risk primarily among patients not treated with B-vitamins.

Introduction

Calcium channel blockers (CCBs) are widely used in patients with stable angina pectoris (SAP) for symptom relief or blood pressure control [1]. However, there is conflicting evidence that CCBs improve prognosis in the former condition or other clinical manifestations of coronary artery disease (CAD). Notably, while most studies showed no clinical benefit on survival [[2], [3], [4]], some have linked CCB treatment to higher mortality risk [[5], [6], [7]].

The B-vitamins folic acid, vitamin B12, and B6 are water-soluble nutrients essential for diverse physiological processes, including homocysteine (Hcy) metabolism [8,9]. A deficiency of these vitamins may lead to elevated circulating total Hcy (tHcy) concentrations [8], which is a risk factor for atherothrombosis [8,9]. Moreover, treatment with these vitamins is reported to have anti-inflammatory [10,11] and anti-coagulant effects [12,13], and vitamin B6 may inhibit sympathetic tone [14]. However, randomized clinical trials (RCTs) failed to reduce cardiovascular disease (CVD) risk with Hcy-lowering B-vitamins [15,16], although treatment effects may have been heterogeneous according to certain subgroup phenotypes. Notably, CCB treatment has been associated with increased systemic Hcy concentrations [[17], [18]]. Moreover, CCBs promote proinflammatory responses [19,20], decrease fibrinolytic function [21,22], and increase sympathetic activation [23], thus potentially increasing CVD risk.

Conclusions

Among patients with suspected SAP, the use of CCBs was associated with increased long-term risk of all-cause, cardiovascular, and noncardiovascular mortality. However, these associations were attenuated in patients receiving B-vitamin treatment, which may explain some of the heterogenic results in prior observational studies.

Summary

Background & aims
Vitamin D deficiency is a condition with different causes. It is associated with numerous comorbidities such as autoimmune diseases, bone diseases, cancer, cardiovascular diseases, neurodegenerative diseases, psychiatric diseases, and respiratory infections like COVID-19. Due to its high prevalence all over the world, it is a major task for health care systems worldwide. Through a combination of low sunlight exposure, insufficient nutrition, and age-related changes in skin, liver, and kidney function, especially seniors and nursing home residents, in particular, have a significantly increased risk of developing a vitamin D deficiency.

Methods
This retrospective study analyzed the prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 12 ng/ml) amongst selected Austrian nursing home seniors. It also examined whether demographic data and other laboratory values like calcium correlate with vitamin D levels by using the Pearson correlation coefficient. This correlation was graphically illustrated with a scatter plot and regression line. A total of 478 patients admitted to a nursing home in Vienna between January 3, 2017, and August 31, 2020, were included.

Results
A total of 106 seniors (22,2%) suffered from a manifest vitamin D deficiency. The vitamin D level of the men was significantly lower than the level of the women (22.9 ± 12.6 ng/ml vs. 26.2 ± 14.8 ng/ml, p = 0.027). The vitamin D serum levels significantly correlated with the serum calcium levels of the participants (r = 0.19, p < 0.001). 39.5% (189 out of 478) of the nursing home residents had inadequate serum vitamin D levels.

Conclusions
In summary, it can be said that the prevalence of vitamin D deficiency among nursing home residents is considerably high. Inadequate vitamin D levels were often associated with reduced calcium levels. Given the high prevalence, the numerous negative health consequences of inadequate levels, and the large therapeutic index, this risk group should get a general supplementation with a dose of 25 μg (1000 IU) vitamin D3 per day. In addition, a blood examination should be performed as early as three months after the start of the supplementation therapy. If some residents do not achieve an adequate vitamin D concentration, the substitution has to be adapted to the individual needs to treat them as precisely as possible.

Introduction

More than 100 years ago, it became apparent that an adequate vitamin D supply is essential for bone health and physical development [1]. In addition to the well-known effects on calcium and phosphate metabolism, numerous immunomodulatory properties have also been detected [2]. Therefore, the consequences of a vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 12 ng/ml) are extensive, from mineralization disorders with accelerated bone turnover and reduced bone density (osteopenia and osteoporosis) to extraskeletal consequences such as reduced muscle strength, acute respiratory infections, and even cancer [[3], [4], [5]]. In addition, vitamin D deficiency could also be linked with neurodegenerative diseases, psychiatric disorders, and autoimmune diseases such as diabetes mellitus, multiple sclerosis, psoriasis, and rheumatoid arthritis [[6], [7], [8], [9], [10]]. Furthermore, an association between vitamin D levels and the risk of developing cardiovascular disease could also be found [11].

Despite the numerous diseases associated with vitamin D inadequate levels, more than 40% of the European population show insufficient vitamin levels (below 20 ng/ml). Also, more than 13% have an acute deficiency (less than 12 ng/ml) [12]. Especially the elderly often suffer from low vitamin D levels in their blood serum, and several studies have already demonstrated that nursing home residents, particularly, have a significantly increased risk [13]. On the one hand, the concentration of the vitamin D3 precursor 7-dehydrocholesterol in the blood decreases with advancing age; on the other hand, the ability of the skin to synthesize vitamin D3 under UV radiation declines. A little sunlight exposure, a poor diet, and age-related changes in the skin, liver, and kidney function predispose this population group to develop a vitamin D deficiency [14]. In addition, medication such as antiepileptics and glucocorticoids can affect the vitamin D status [12].

Conclusions

In conclusion, it can be summarized that there was a high prevalence of vitamin D deficiency in the examined nursing home residents. The vitamin D serum level significantly correlated with the calcium level of the participants, and females had slightly lower vitamin D concentrations than men.

Given the numerous adverse health consequences and because a vitamin D deficiency can be easily treated, all nursing home residents should get a general supplementation of a dose of 25 μg (1000 IU) vitamin D3 per day. This dosage is considered safe, and therefore neither the kidney function nor the calcium needs to be monitored regularly. A blood test should be used no earlier than three months after starting the vitamin D supplementation therapy to check whether a sufficient serum concentration has been reached. If this is not the case, the vitamin D substitution must be adapted to individual needs and treated precisely.

In addition, further action is needed to make health workers aware of the high incidence and risks associated with vitamin D deficiency. Further research is required to establish clear, evidence-based guidelines for the prophylaxis, detection, and treatment of vitamin D deficiency in nursing homes.

Abstract

     Introduction: Individuals with bipolar disorder (BD) have higher rates of unhealthy lifestyles and risk for medical comorbidities Research currently suggests that dietary factors may play a role in the development of depression and anxiety. Therefore, nutritional approaches are potential strategies for the treatment of BD. The aim of this review is to summarize the available evidence on nutrition and BD. Materials and Methods: The paper was developed based on PRISMA 2020 guidelines. The search was conducted in Sep-2021 using PubMed and Cochrane Library, augmented by manually checked references lists. The search found 986 studies, of which 47 were included, combined with 13 from reference lists, totaling 60 studies. Results: There were 33 observational trials, of which 15 focused on fatty acids, 9 on micronutrients, 5 on specific foods, 4 on macro and micronutrients. The 27 interventional studies mainly focused on fatty acids, micronutrients and N-acetylcysteine (NAC). Discussion: Dietary intake or supplementation of unsaturated fatty acids, mainly Omega-3 seems to be associated with improved BD symptoms, along with seafood, folic acid and zinc. Studies found variable, mainly non-significant impacts of creatine, carnitine, vitamin D, inositol or NAC supplementation on BD. There are promising results associated with Coenzyme Q10 (Coq10) and probiotics. Taken together, these preliminary findings suggest that dietetic approaches might be included as part of BD treatment. Also considering the high risk of metabolic disorders in individuals with BD, they should be encouraged to choose healthy dietary lifestyles, including daily intake of fruits, vegetables, seafood and whole grains.

Introduction

     Nutritional psychiatry is a rapidly expanding field of study, which has recently benefited from the advances of neurosciences, epidemiological research on risk factors as well as the renewed interest in the role of lifestyle in mental health [1]. Extensive observational evidence consistently demonstrates that diet quality is a predictor of depression risk – independent of other factors, such as education and body weight [2]. Moreover, randomized controlled trials in people with even severe major depressive disorder show efficacy and cost-effectiveness in improving depression symptomatology [3–7]. Concordantly, meta-analytic data confirms that dietary change improves depression symptoms in both clinical and non-clinical populations [8]. Considering that poor diet and dysfunctional eating behaviors are modifiable risk factors, it is possible that these will be converted into critical interventions for mental health [3,9,10]. Indeed, new clinical practice guidelines for mood disorders include diet, along with other aspects of lifestyle, as foundational and ‘non-negotiable’ treatment targets [1,11].

Results 

Search results

     The final search yielded 986 studies. After removing duplicates (N = 60), studies in other languages and publications prior to 2001 (N = 97), titles and abstracts from 829 studies were screened. Studies that did not clearly meet the inclusion criteria and/or met the exclusion criteria were excluded. The remaining 57 studies were analyzed by full text reading, after which 10 were excluded because they did not meet the full inclusion criteria. This led to 47 included studies, which were combined with 13 studies that were obtained from the bibliography from the included studies and reviews found in the search, totaling 60 studies (Figure 1).

Highlights

Abstract

Keywords

Abbreviations

1. Introduction

2. Iron

3. Antioxidants

4. Vitamin D

5. Calcium

6. Discussion/conclusion

CRediT authorship contribution statement

Declaration of competing interest

References

Abstract

Optimising nutrition intake is a key component for supporting athletic performance and supporting adaption to training. Athletes often use micronutrient supplements in order to correct vitamin and mineral deficiencies, improve immune function, enhance recovery and or to optimise their performance. The aim of this review was to investigate the recent literature regarding micronutrients (specifically iron, vitamin C, vitamin E, vitamin D, calcium) and their effects on physical performance. Over the past ten years, several studies have investigated the impacts of these micronutrients on aspects of athletic performance, and several reviews have aimed to provide an overview of current use and effectiveness. Currently the balance of the literature suggests that micronutrient supplementation in well-nourished athletes does not enhance physical performance. Excessive intake of dietary supplements may impair the body’s physiological responses to exercise that supports adaptation to training stress. In some cases, micronutrient supplementation is warranted, for example, with a diagnosed deficiency, when energy intake is compromised, or when training and competing at altitude, however these micronutrients should be prescribed by a medical professional. Athletes are encouraged to obtain adequate micronutrients from a wellbalanced and varied dietary intake.

1. Introduction The foundations of sport performance are training and nutrition/diet of the athlete, with nutritional strategies providing a supportive role in enhancing training adaption (Stellingwerff et al., 2019). In line with the evolution of methods to optimise training through various training prescriptions, there has been a concurrent evolution in nutrition strategies for athletes. Current nutritional consensus statements promote the periodisation of nutritional intake to optimise the adaptation from the training programme prescribed to the athlete (Stellingwerff et al., 2019). The theory of nutritional periodisation is planned energetic and macronutrient strategies to target the individual exercise sessions and overall training programme to aid in obtaining long term performance gains in athletes (Jeukendrup, 2017). Strategies of nutritional periodisation include manipulating carbohydrate and fat intake to upregulate key signalling pathways in the skeletal muscle and promote mitochondrial biogenesis, angiogenesis and increased lipid oxidation (Hansen et al., 2005; Hulston et al., 2010; Morton et al., 2009) or optimising protein intake to support hypertrophic responses in skeletal muscle (Stellingwerff et al., 2019). However, numerous metabolic processes and reactions involved in energy extraction from macronutrients, oxygen delivery and transfer, tissue repair, and growth and development are dependent on essential vitamins and minerals (Volpe, 2007).

Micronutrients are essential for life and include; vitamins which are organic compounds that support health, growth and reproduction and are needed in small amounts to prevent clinical deficiencies and declines in health (Fogelholm, 2015). A key feature of most vitamins is that the human body is unable to synthesise them (Fogelholm, 2015), therefore they must be obtained from dietary intake. Vitamins are classified based on their in vivo solubility, with A, D, E and K classified as fat-soluble and vitamins B and C classified as water soluble (Fogelholm, 2015). Minerals are inorganic substances that support physiological functioning (Fogelholm, 2015). The daily physiological requirements determine the mineral classifications, hence ~100 mg⋅day− 1 of macrominerals (sodium, potassium, calcium, phosphorus and magnesium) and ~20 mg⋅day− 1 of trace elements (iron, zinc, copper, chromium and selenium) are required by healthy individuals (Fogelholm, 2015).

Highlights

Abstract

Keywords

References

Biography

Biography

Biography

Article Info

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Abstract

The world’s older population continues to grow at an unprecedented rate. Iran is 1 of the countries where the aging population is higher than the global average. Depression is 1 of the most common issues in older adults that can be managed by nonpharmacologic interventions such as the consumption of green tea. The aim of this study was to determine the effect of green tea consumption on depression in the elderly people. In this quasi-experimental study, 76 elderly people who were residents in a nursing home and met the inclusion criteria were selected through simple random sampling. Then, green tea in 3-g tea bags was brewed in 80°C water and half an hour after breakfast and lunch was given to the participants in a 5-week protocol. One day after the last time of brewing green tea, participants were assessed with a standard depression questionnaire. The obtained data were analyzed using SPSS Version 19 software (IBM Corp, Armonk, NY). The descriptive statistics and Wilcoxon statistical test analysis were also conducted at a significant level of P < .05. Based on the findings, the mean score of the participants’ depression level decreased by 2.5 points after the intervention, which is statistically significant at a 99.9% confidence interval (P = .001). The findings also suggest that the severe depression decreased from 23.6% to 11.1%, moderate depression decreased from 45.8% to 26.4%, and mild depression increased from 30.6% to 45.8%; only severe and moderate depression cases were reduced (P = . 001). The findings of the present study reveal that regular consumption of green tea can lead to a considerable reduction of depression in the elderly people. Accordingly, the consumption of this tea in the elderly people’s diet is recommended, especially those who are resident in the care centers.

Aging is a critical period of human life in which human beings are more exposed to potential threats such as chronic diseases, loneliness, and isolation, and because of physical and mental disabilities, their personal independence is often threatened.1 The growth of the elderly population will be about 3.5 times the total population growth until 2025.2 According to the general population and housing census of the Islamic Republic of Iran in 2016, about 9.3% of the population is aged 60 years or over.3 The percentage of the elderly population of Iran is projected to reach more than 12% in 2025.4 About 15% to 25% of older people have crucial psychological problems that can exert a potential influence on their physical illness.5 Depression is 1 of the most common mental health problems among the elderly people, which falls into the category of mood disorders,6 and is closely associated with the level of mortality in the elderly.7 The prevalence of obvious clinical signs of depression among the elderly in the community is 8% to 15%, and in the elderly living in nursing homes, it is about 30%.

Highlights

Abstract

Graphical abstract

Keywords

1. Introduction

2. Methods

3. Results

4. Discussion

5. Conclusion

Acknowledgments

Appendix. Supplementary materials

References

Abstract

Background
We compared body mass index (BMI), body fat, and skeletal muscle mass between (1) a mixed-sex nonathletic cohort of people with patellofemoral pain (PFP) and pain-free people, and (2) a nonathletic cohort of people with PFP and pain-free people subgrouped by sex (i.e., men and women with PFP vs. pain-free men and women).

Methods
This cross-sectional study included 114 people with PFP (71 women, 43 men) and 54 pain-free controls (32 women, 22 men). All participants attended a single testing session to assess body composition measures, which included BMI, percentage of body fat (%BFBioimpedance), and skeletal muscle mass (both assessed by bioelectrical impedance analysis), and percentage of body fat (%BFSkinfold) (assessed by skinfold caliper analysis). A one-way univariate analysis of covariance (age and physical activity levels as covariates) was used to compare body composition measures between groups (i.e., PFP vs. pain-free group; women with PFP vs. pain-free women; men with PFP vs. pain-free men).

Results
Women with PFP presented significantly higher BMI, %BFBioimpedance, and %BFSkinfold, and lower skeletal muscle mass compared to pain-free women (p ≤ 0.04; effect size = ‒0.47 to 0.85). Men with PFP and men and women combined had no differences in BMI, %BFBioimpedance, %BFSkinfold, and skeletal muscle mass compared to their respective pain-free groups (p > 0.05).

Conclusion
Our findings indicate that BMI and body composition measures should be considered as part of the evaluation and management of people with PFP, especially in women, who have demonstrated higher BMI and body fat and lower skeletal muscle mass compared to pain-free controls. Future studies should not assess body composition measures in a mixed-sex population without distinguishing men participants from women participants.

1. Introduction
The prevalence of overweight and obesity has been growing alarmingly across the world.1 In the past four decades, the number of adults with obesity worldwide has increased more than 6 times (100 million in 1975 to 671 million in 2016),1 whereas 1.3 billion adults (1 in 4) were considered overweight in 2016.1,2 Despite increasing the predisposition to multiple comorbidities,3,4 overweight and obesity are also detrimental to the musculoskeletal system,5, 6, 7 likely via both systemic and mechanical effects.8,9 Systemic effects include the production by adipose tissue of adipokines such as leptin10 and the amplification of the inflammation profile through an increase in the production of interleukin-611 and tumor necrosis factor-alpha.12 Both of these systemic changes are associated with deleterious effects to patellar cartilage (e.g., reduced patellar cartilage volume) and pain.13,14 Mechanically, the one joint most affected by overweight and obesity is the patellofemoral joint, which is subjected to loads 2 to 11 times bodyweight during stair ascent, squatting, and running activities.15, 16, 17

Highlights

Abstract

Keywords

Introduction

Methods

Results

Discussion

Conclusions

References

Abstract

Objective
The aim of this study was to analyze adherence to the Mediterranean diet among the adult general population of Cyprus during the COVID-19 confinement.

Methods
This was an Internet-based, cross-sectional study that collected information about socioeconomic and demographic characteristics, adherence to the Mediterranean diet and other dietary details, physical activity levels, and smoking habits using a self-administered questionnaire. The survey was conducted between April 6 and June 20, 2020, 1 to 2.5 mo after the initiation of the social confinement measures.

Results
There were 1485 Cypriot adults who participated in the study. The median Mediterranean diet score was 21 (q1 = 19, q3 = 24) with men, married individuals, residents of rural regions, and physically active participants being more adherent to the Mediterranean diet compared with women; unmarried, divorced, or widowed; residents of urban regions; and physically inactive participants, respectively (P < 0.05). Multinomial logistic regression showed that being ≥45 y of age and physically active was positively associated with the Mediterranean diet score, whereas being unmarried, divorced, or widowed and a current smoker was negatively associated with the Mediterranean diet score (P < 0.05).

Conclusions
Adherence to the Mediterranean diet during the confinement imposed due to the COVID-19 pandemic among the Cypriot adult population was associated with male sex, age >45 y, being married, being physically active, and being resident of rural regions. The importance of better understanding of nutritional behavior during COVID-19 lockdowns is emphasized so public health authorities can plan future lockdown policies on nutritional recommendations, should a new pandemic occur.

Introduction

The novel coronavirus disease, or COVID-19 as it is now called, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), presents a significant and critical threat of global health since its outbreak in China in early December 2019 [1,2]. COVID-19 quickly became a rapidly emerging situation, spreading from the Asian continent to the rest of the world. On January 30, 2020, the disease was declared a pandemic by the World Health Organization (WHO) [3]. Due to the gravity of the situation, most regions and nations, in an effort to reduce and delay population transmission and ultimately lessen the burden on health care systems, enforced strict public health measures, including city and national lockdown measures. To contain the spread of COVID-19, on March 24, 2020, the government of the Republic of Cyprus implemented stringent containment measures and imposed a national lockdown. As a result, almost all avoidable outdoor activities (such as mass gatherings and events) were banned, and the Cypriot population was forced to quarantine themselves at home. Citizens could leave their home only for essentials, such as visiting food markets and pharmacies, and commuting to work when working in person was essential (e.g., health care, supermarkets, etc.) while maintaining physical distancing.

Highlights

Abstract

Keywords

Introduction

The role of the Mediterranean diet in human health

The sustainability of the Mediterranean diet for the environment

Environmental pollution negatively impacts on human health and aging but can be reduced by wider use of the Mediterranean DP

Conclusions

Funding

Author contributions

Declaration of Competing Interest

References

Abstract

Successful aging results from a lifetime of interaction between a range of factors, including those that are inherited (age, genetics), and those related to lifestyle (diet, exercise). In this brief communication, we examine the role of the Mediterranean-style diet in human health. Diet is one of the major pillars of healthy aging, and accumulating evidence supports the health benefits of the Mediterranean diet. We also discuss the lifelong effect of exposure to environmental pollution. Thus, there is an intricate relationship between health, diet and environment, which together represent a trilemma that must be addressed with a holistic, life-course, population-level approach.

Introduction

Individual health and lifestyle choices may create fertile ground for disease to develop. However, social, environmental and biological factors also jointly influence health. A life-course approach to health involves preventing and controlling diseases at key stages of life, from preconception to adulthood. Non-communicable diseases (NCDs) and disability share common risk factors whose combined presence over the life-course may initiate disease and/or disability in later life, namely poor diet, physical inactivity, environmental pollution, etc. These exposures over the cumulative life-course contribute to an increasing burden of ill health, justifying the need for effective prevention strategies.

The role of the Mediterranean diet in human health

Among the many lifestyle determinants of later health, one of the major pillars of healthy aging is diet. Among the oldest dietary patterns ever described is the Mediterranean diet, an umbrella term that actually encompasses a wide range of diets common to several countries around the Mediterranean basin, which share certain common features but also present wide variety in the actual composition. The whole could more correctly be described as a dietary pattern (DP). The Mediterranean DP is recognized as the healthiest lifestyle by UNESCO and the Council of the European Union, and recommended by the US Department of Health in its Dietary Guidelines for Americans 2015–2020 [1]. It is of vital importance to implement these recommendations at national level in every country as an investment in the future health of the population, since societal and economical changes have revolutionized our lives in the last few decades, and moved away from traditional family structures and working patterns. This has led to a “westernization” of DPs, with a greater tendency to eat quick meals while working, or looking at a telephone, and less adherence to the traditional model of family dining, with its associated communication and conviviality, resulting in an overall decline in adherence to the Mediterranean dietary pattern [2].