The association of dietary acid-base load with psychological disorders, sleep and circadian rhythm among obese and overweight women: a cross-sectional study
DOI:
https://doi.org/10.15277/bjd.2023.425Keywords:
dietary acid-base load, psychological disorders, sleep, circadian rhythm, obesityAbstract
Background: Epidemiological studies have reported that dietary acid load is associated with psychological disorders through different pathways. We aimed to examine the association of dietary acid-base load with psychological disorders, sleep and circadian rhythm.
Methods: This study was performed on 404 female subjects aged 18 years and above. We evaluated potential renal acid load (PRAL) and net endogenous acid production (NEAP) score by a validated food frequency questionnaire (FFQ) for Iran which contained 147 items. To assess psychological disorders, an Iranian validated version of the depression, anxiety and stress scale (DASS-21) was used. The Pittsburgh Sleep Quality Index (PSQI) and morning-evening questionnaire (MEQ) were applied to evaluate sleep quality and circadian rhythm status, respectively.
Results: After adjustment for a wide range of confounding variables, a significant positive association was observed between dietary acid-base load and severe depression (ORPRAL=1.10, 95% CI=1.01-1.19, p=0.02 and ORNEAP=2.46, 95% CI=1.41-14.61, p=0.02). Women in the high dietary acid base load category had higher anxiety (ORPRAL=1.12, 95% CI=1.02-1.23, p=0.01 and ORNEAP=1.80,95% CI=1.12-10.72, p=0.01). There was a strong positive relationship between dietary acid-base load and sleep disturbance (p<0.05). Additionally, circadian rhythm assessment showed that those with greater commitment to PRAL had 23% higher risk of being completely evening type, while the odds of being completely morning type were decreased by 15% and 12% across higher adherence to PRAL and NEAP.
Conclusion: Women with higher dietary acid-base load score had greater odds for depression, anxiety, psychological distress, sleep disturbance and evening-type circadian rhythm compared to lower ones.
References
Depression and other common mental disorders: global health estimates. Geneva: World Health Organization 2017:1-24.
Kivimäki M, Lawlor DA, Singh-Manoux A, et al. Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study. BMJ 2009;339: b3765. https://doi.org/10.1136/bmj.b3765
Noorbala AA, Bagheri YSA, Hafezi M. Trends in change of mental health status in the population between 1998 and 2007. Arch Iran Med 2012;15(4):201-4.
Srivastava K. Women and mental health: psychosocial perspective. Ind Psychiatry J 2012;21(1):1-3. https://doi.org/10.4103/0972-6748.110938
Noorbala AA, Yazdi SB, Yasamy M, Mohammad K. Mental health survey of the adult population in Iran. British J Psychiatry 2004; 184(1):70-3. https://doi.org/10.1192/bjp.184.1.70
Murakami K, Sasaki S. Dietary intake and depressive symptoms: a systematic review of observational studies. Mol Nutr Food Res 2010;54(4):471-88. https://doi.org/10.002/mnfr.200900157
Abshirini M, Siassi F, Koohdani F, et al. Dietary total antioxidant capacity is inversely associated with depression, anxiety and some oxidative stress biomarkers in postmenopausal women: a cross- sectional study. Ann General Psychiatry 2019;18(1):1-9. https://doi.org/10.1186/s12991-019-0225-7
Rao TS, Asha M, Ramesh B, Rao KJ. Understanding nutrition, depression and mental illnesses. Ind J Psychiatry 2008;50(2):77-82. https://doi.org/10.4103/0019-5545.42391
Sarris J, Murphy J, Mischoulon D, et al. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry 2016;173(6):575-87. https://doi.org/10.1176/appi.ajp.2016.15091228
Lange KW, Hauser J, Lange KM, et al. The role of nutritional supplements in the treatment of ADHD: what the evidence says. Curr Psychiatry Rep 2017;19(2):8. https://doi.org/10.1007/s11920-017- 0762-1
Eslami Akbar R. The prevalence of sleep disorder and its causes and effects on students residing in Jahrom University of Medical Sciences dormitories, 2008. Pars Journal Medical Sciences 2012;9(4):14-19. https://doi.org/10.29252/jmj.9.4.14
Yazdi Z, Loukzadeh Z, Abbasi M, et al. Prevalence of insomnia and its relation with academic performance of medical students in Qazvin University of Medical Sciences. The Journal of Medical Education and Development 2013;6(1):19-25 (Persian).
Nabeshima T, Kim H-C. Involvement of genetic and environmental factors in the onset of depression. Exp Neurobiol 2013;22(4):235. https://doi.org/10.5607/en.2013.22.4.235
Lee SI, Jung HY. Obesity: genetic vs environmental factors. J Korean Society Biological Psychiatry 2003;10(1):45-53.
Froy O. The relationship between nutrition and circadian rhythms in mammals. Front Neuroendocrinol 2007;28(2-3):61-71. https://doi.org/10.1016/j.yfrne.2007.03.001
Dashti HS, Scheer FA, Jacques PF, Lamon-Fava S, Ordovás JM. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Advances Nutrition 2015; 6(6):648-59. https://doi.org/10.3945/an.115.008623
Weiss A, Xu F, Storfer-Isser A, Thomas A, Ievers-Landis CE, Redline The association of sleep duration with adolescents’ fat and carbohydrate consumption. Sleep 2010;33(9):1201-9. https://doi.org/10.1093/sleep/33.9.1201
Guo X, Park Y, Freedman ND, et al. Sweetened beverages, coffee, and tea and depression risk among older US adults. PloS One 2014;9(4):e94715. https://doi.org/10.1371/journal.pone.0094715
Weng T-T, Hao J-H, Qian Q-W, et al. Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutrition 2012;15(4):673-82. https://doi.org/10.1017/s1368980011003077
Yannakoulia M, Panagiotakos DB, Pitsavos C, et al. Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study. Appetite 2008;51(3):519-25. https://doi.org/10.1016/j.appet.2008.04.002
Hosseinzadeh M, Vafa M, Esmaillzadeh A, et al. Empirically derived dietary patterns in relation to psychological disorders. Public Health Nutr 2016;19(2):204-17. https://doi.org/10.1017/S136898001500172X
Richard A, Rohrmann S, Vandeleur CL, Mohler-Kuo M, Eichholzer M. Associations between fruit and vegetable consumption and psychological distress: results from a population-based study. BMC Psychiatry 2015;15(1):1-8. https://doi.org/10.1186/S12888-015-0597-4
McMartin SE, Jacka FN, Colman I. The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians. Preventive Medicine 2013;56(3-4):225-30. https://doi.org/10.1016/j.ypmed.2012.12.016
Liu X, Yan Y, Li F, Zhang D. Fruit and vegetable consumption and the risk of depression: a meta-analysis. Nutrition 2016;32(3):296-302. https://doi.org/10.1016/j.nut.2015.09.009
Thielecke F, Jonnalagadda SS. Can whole grain help in weight management? Journal Clin Gastroenterol 2014;48:S70-S7. https://doi.org/10.1097/0000000000243
Hermsdorff HHM, Zulet MÁ, Abete I, Martínez JA. A legume-based hypocaloric diet reduces proinflammatory status and improves metabolic features in overweight/obese subjects. Eur J Nutrition 2011;50(1):61-9. https://doi.org/10.1007/s00304-010-0115-x
Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opinion Lipidol 2002;13(1):3-9. https://doi.org/10.1097/00041433-20020200-00002
Frassetto LA, Lanham-New SA, Macdonald HM, et al. Standardizing terminology for estimating the diet-dependent net acid load to the metabolic system. Journal Nutrition 2007;137(6):1491-2. https://doi.org/10.1093/jn/137.6.1491
Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr 1994;59(6):1356-61. https://doi.org/10.1093/ajcn/59.6.1356
Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 1995;95(7):791-7. https://doi.org/10.1016/S0002-8223(95)00219-7
Engberink MF, Bakker SJ, Brink EJ, et al. Dietary acid load and risk of hypertension: the Rotterdam Study. Am J Clin Nutr 2012; 95(6):1438-44. https://doi.org/10.3945/ajcn.111.022343
Ströhle A, Waldmann A, Koschizke J, Leitzmann C, Hahn A. Diet- dependent net endogenous acid load of vegan diets in relation to food groups and bone health-related nutrients: results from the German Vegan Study. Ann Nutr Metab 2011;59(2-4):117-26. https://doi.org/10.1159/000331572
Oddy WH, Robinson M, Ambrosini GL, et al. The association between dietary patterns and mental health in early adolescence. Prev Med 2009;49(1):39-44. https://doi.org/10.1016/j.ypmed.2019.05.009
Daneshzad E, Keshavarz S-A, Qorbani M, Larijani B, Bellissimo N, Azadbakht L. Association of dietary acid load and plant-based diet index with sleep, stress, anxiety, and depression in diabetic women. British J Nutrition 2020;123(8):901-12. https://doi.org/10.1017/S0007114519003179
Mozaffari H, Siassi F, Guilani B, Askari M, Azadbakht L. Association of dietary acid-base load and psychological disorders among Iranian women: a cross-sectional study. Complementary Therapies in Medicine 2020;53:102503. https://doi.org/10.1016/j.ctim.2020.102503
Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: results from the Shanghai aging study. PloS One 2013;8(11):e81261. https://doi.org/10.1371/journal.pone.0081261
Altemus M. Sex differences in depression and anxiety disorders: potential biological determinants. Horm Behav 2006;50(4):534-8. https://doi.org/10.1016/j.yhbeh.2006.06.031
Garawi F, Devries K, Thorogood N, Uauy R. Global differences between women and men in the prevalence of obesity: is there an association with gender inequality? Eur J Clin Nutr 2014;68(10):1101-6 https://doi.org/10.1038/ajcn.2014.86
Malekshah A, Kimiagar M, Saadatian-Elahi M, et al. Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer. Eur J Clin Nutr 2006;60(8): 971-7.
Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr 2003;77(5):1255-60. https://doi.org/10.1093/ajcn/77.5.1255
Frassetto LA, Todd KM, Morris Jr RC, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr 1998;68(3):576-83. https://doi.org/10.1093/ajcn/68.3.576
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Science Sports Exercise 2000;32(9; Suppl):S498-S504. https://doi.org/10.1097/00005768-200009001-0009
Beşoluk Ş. Morningness–eveningness preferences and university entrance examination scores of high school students. Chronobiol Int 2011;28(2):118-25. https://doi.org/10.3109/07420528.2010.540729
Liaghatdar MJ, Ashoorion V. Investigating morningness-eveningness typology of medical students and its relationship with their academic merits and course difficulty. Iranian Journal of Medical Education 2011;10(5):1228-37. http://ijme.mui.ac.ir/article-1-1634-en.html
Joakar B, Samani S. Reliability and validity of the short form of depression, anxiety and stress. J Social Sciences and Humanities University Shiraz 2008;55:65-77.
Elyansb S. Examine the relationship between religion restraint and death anxiety among students and seminarians of Qom city. Religion and Health 2010;3(1):55-68.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Therapy 1995;33(3):335-43. https://doi.org/10.1016/0005-7967(94)00075-u
Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. 2005. https://api.semanticscholar.org/CorpusID:221231200
Moghaddam JF, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012;16(1):79-82. https://doi.org/10.1007/s11325-010-0478-5
Zeydi AE, Jannati Y, Khezri HD, et al. Sleep quality and its correlation with serum C-reactive protein level in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation 2014;25(4):750.
Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. Journal Postgrad Med 2017;63(3):182-90. https://doi.org/10.4103/jpgmJPGM_712_16
Fisher E, Law E, Dudeney J, Eccleston C, Palermo TM. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2019;4(4):Cd011118. https://doi.org/10.1002/14651858.CD011118.pub3
Haidar SA, de Vries NK, Karavetian M, El-Rassi R. Stress, anxiety, and weight gain among university and college students: a systematic review. J Acad Nutr Dietetics 2018;118(2):261-74. https://doi.org/10.1016/j.jand.2017.10.015
Schmidt CW. Environmental connections: a deeper look into mental illness. Environ Health Perspect 2007;115(8):A404-A410. https://doi.org/10.1289/ehp.115-a404
Jacka FN, Mykletun A, Berk M, Bjelland I, Tell GS. The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study. Psychosomatic Med 2011;73(6):483-90. https://doi.org/10.1097/PSY.0b013e318222831a
Mozaffari H, Siassi F, Guilani B, Askari M, Azadbakht L. Association of dietary acid-base load and psychological disorders among Iranian women: a cross-sectional study. Complement Ther Med 2020; 53:102503.
Xu H, Akesson A, Orsini N, Hakansson N, Wolk A, Carrero JJ. Modest U-shaped association between dietary acid load and risk of all-cause and cardiovascular mortality in adults. J Nutr 2016;146(8):1580-5. https://doi.org/10.3945/jn.116.231019
Bühlmeier J, Harris C, Koletzko S, et al. Dietary acid load and mental health outcomes in children and adolescents: results from the GINIplus and LISA birth cohort studies. Nutrients 2018;10(5):582. https://doi.org/10.3390/nu10050582
Saghafian F, Malmir H, Saneei P, Milajerdi A, Larijani B, Esmaillzadeh A. Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies. Br J Nutr 2018;119(10):1087-101. https://doi.org/10.1017/S0007114518000697
Kim WK, Shin D, Song WO. Are dietary patterns associated with depression in US adults? Journal Medicinal Food 2016;19(11):1074-84. https://doi.org/10.1089/jmf.2016.0043
Najjar S, Pearlman DM, Alper K, et al. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013;10:43. https//doi.org/ 10.1186/1742-2094-10-43
de Nadai TR, de Nadai MN, Albuquerque AA, de Carvalho MT, Celotto AC, Evora PR. Metabolic acidosis treatment as part of a strategy to curb inflammation. Int J Inflam 2013;2013:601424. https://doi.org/10.1155/2013/601424
Bolori P, Setaysh L, Rasaei N, Jarrahi F, Yekaninejad MS, Mirzaei K. Adherence to a healthy plant diet may reduce inflammatory factors in obese and overweight women-a cross-sectional study. Diabetes Metab Syndr 2019;13(4):2795-802. https://doi.org/10.1016/j.dsx.2019.07.019
Gimeno D, Kivimäki M, Brunner EJ, et al. Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12- year follow-up of the Whitehall II study. Psychol Medicine 2009;39(3):413-23. https://doi.og/10.1017/S0033291708003723
Imeri L, Opp MR. How (and why) the immune system makes us sleep. Nature Rev Neuroscience 2009;10(3):199-210. https://doi.org/10.1038/nrn2576
Matthews KA, Schott LL, Bromberger J, Cyranowski J, Everson-Rose SA, Sowers MF. Associations between depressive symptoms and inflammatory/hemostatic markers in women during the menopausal transition. Psychosom Med 2007;69(2):124-30. https://doi.org/10.1097.01.psy.0000256574.30389.16
.
Heinze K, Lin A, Reniers R, Wood SJ. Longer-term increased cortisol levels in young people with mental health problems. Psychiatry Res 2016;236:98-104. https://doi.org/10.1016/j.psychres.2015.12.025
Oswald LM, Zandi P, Nestadt G, Potash JB, Kalaydjian AE, Wand GS. Relationship between cortisol responses to stress and personality. Neuropsychopharmacology 2006;31(7):1583-91. https://doi.org/10.1038/sj.npp.1301012
.
Winkelman JW, Buxton OM, Eric Jensen J, et al. Reduced brain GABA in primary insomnia: preliminary data from 4T proton negative spectroscopy (1H-MRS). Sleep 2008;31(11):1499-506. https://doi.org/10.1093/sleep/31.11.1499
Kim EE. Current medical diagnosis and treatment. Journal of Nuclear Medicine 2008;50(1):165. https://doi.org/10.2967/jnumed.108.056002
Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med 2006;166(16):1775-82. https://doi.org/10.1001/archinte.166.16.1775
Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med 1998;158(12):1333-7. https://doi.org/10.1001/archinte.158.12.1333
Milajerdi A, Hassanzadeh Keshteli A, Haghighatdoost F, et al. Dietary acid load in relation to depression and anxiety in adults. J Hum Nutr Diet 2020;33(1):48-55. https://doi.org/10.1111/jhn.12658
Noorwali E, Cade J, Burley V, Hardie L. The relationship between sleep duration and fruit/vegetable intake in UK adults: a cross- sectional study from The National Diet and Nutrition Survey. BMJ Open 2018;8: e020810. https://doi.org/10.1136/bmjopen-2017-020810
Arora T, Taheri S. Associations among late chronotype, body mass index and dietary behaviors in young adolescents. Int J Obes (Lond) 2015;39(1):39-44. https://doi.org/10.108/ijo.2014.157
Kanerva N, Kronholm E, Partonen T, et al. Tendency toward eveningness is associated with unhealthy dietary habits. Chronobiol Int 2012;29(7):920-7. https://doi.org/10.3109/07420528.2012.699128
Sato-Mito N, Shibata S, Sasaki S, Sato K. Dietary intake is associated with human chronotype as assessed by both morningness- eveningness score and preferred midpoint of sleep in young Japanese women. Int J Food Sci Nutr 2011;62(5):525-32. https://doi.org/10.3109/09637486.2011.560563
Patke A, Young MW, Axelrod S. Molecular mechanisms and physiological importance of circadian rhythms. Nat Rev Molecular Cell Biol 2020;21(2):67-84. https://doi.org/10.1038/s41580-019- 0179-2
Anjom-Shoae J, Sadeghi O, Hassanzadeh Keshteli A, Afshar H, Esmaillzadeh A, Adibi P. The association between dietary intake of magnesium and psychiatric disorders among Iranian adults: a cross- sectional study. Br J Nutr 2018;120(6):693-702. https://doi.org/10.1017/S0007114518001782
Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, Rashidkhani B. The effect of magnesium supplementation on primary insomnia in elderly: a double-blind placebo-controlled clinical trial. J Research Med Sci 2012;17(12):1161-9.
Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol 2018; 175(16):3190-9. https://doi.org/10.1111/bph.14116
Orbeta RL, Overpeck MD, Ramcharran D, Kogan MD, Ledsky R. High caffeine intake in adolescents: associations with difficulty sleeping and feeling tired in the morning. J Adolesc Health 2006;38(4):451-3. https://doi.org/10.1016/j.jadohealth.2005.05.014
Pollak CP, Bright D. Caffeine consumption and weekly sleep patterns in US seventh-, eighth-, and ninth-graders. Pediatrics 2003;111(1):42-6 https://doi.org/10.1542/peds.111.1.42
Roehrs T, Roth T. Caffeine: sleep and daytime sleepiness. Sleep Med Reviews 2008;12(2):153-62. https://doi.org/10.1016/j.smrv.2007.07.004
Grandner MA, Kripke DF, Naidoo N, Langer RD. Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep Medicine 2010;11(2):180-4. https://doi.org/10.j.sleep.2009.07.004
St-Onge MP, Roberts A, Shechter A, Choudhury AR. Fiber and saturated fat are associated with sleep arousals and slow wave sleep. Journal Clinical Sleep Medicine 2016;12(1):19-24. https://doi.org/10.5664/jcsm.5384
Paine SJ, Gander PH, Travier N. The epidemiology of morningness/eveningness: influence of age, gender, ethnicity, and socioeconomic factors in adults (30-49 years). J Biological Rhythms 2006;21(1):68-76. https://doi.org/10.1177/07487-30405283154
Hirvonen T, Männistö S, Roos E, Pietinen P. Increasing prevalence of underreporting does not necessarily distort dietary surveys. Eur J Clin Nutr 1997;51(5):297-301. https://doi.org/10.1038/sj.ejcn.1600397
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