Meals, Microbiota and Mental Health in Children and Adolescents (MMM-Study): A protocol for an observational longitudinal case-control study

Abstract

Recent studies indicate that the interplay between diet, intestinal microbiota composition, and intestinal permeability can impact mental health. More than 10% of children and adolescents in Iceland suffer from mental disorders, and rates of psychotropics use are very high. The aim of this novel observational longitudinal case-control study, “Meals, Microbiota and Mental Health in Children and Adolescents (MMM-Study)” is to contribute to the promotion of treatment options for children and adolescents diagnosed with mental disorders through identification of patterns that may affect the symptoms. All children and adolescents, 5–15 years referred to the outpatient clinic of the Child and Adolescent Psychiatry Department at The National University Hospital in Reykjavik, Iceland, for one year (n≈150) will be invited to participate. There are two control groups, i.e., sex-matched children from the same postal area (n≈150) and same parent siblings (full siblings) in the same household close in age +/- 3 years (n<150). A three-day food diary, rating scales for mental health, and multiple questionnaires will be completed. Biosamples (fecal-, urine-, saliva-, blood samples, and buccal swab) will be collected and used for 16S rRNA gene amplicon sequencing of the oral and gut microbiome, measurements of serum factors, quantification of urine metabolites and host genotype, respectively. For longitudinal follow-up, data collection will be repeated after three years in the same groups. Integrative analysis of diet, gut microbiota, intestinal permeability, serum metabolites, and mental health will be conducted applying bioinformatics and systems biology approaches. Extensive population-based data of this quality has not been collected before, with collection repeated in three years’ time, contributing to the high scientific value. The MMM-study follows the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) guidelines. Approval has been obtained from the Icelandic National Bioethics Committee, and the study is registered with Clinicaltrials.gov. The study will contribute to an improved understanding of the links between diet, gut microbiota and mental health in children through good quality study design by collecting information on multiple components, and a longitudinal approach. Furthermore, the study creates knowledge on possibilities for targeted and more personalized dietary and lifestyle interventions in subgroups. Trial registration numbers: VSN-19-225 & NCT04330703.

Metabolic Adverse Effects of Psychotropic Drug Therapy: A Systematic Review

“…The information found yields results where there is a comorbidity of obesity, binge eating disorder, and impulsivity and social dependence, a relationship between the endocannabinoid system, temperament, and the development of physical activity in morbidly obese patients [ 23 , 44 , 45 , 46 , 47 ], a potential connection between antipsychotic-induced weight gain, cognitive impairment, and gut microbiota [ 29 , 48 , 49 ], a substantial comorbidity between obesity, mood, and eating disorders, and metabolic syndrome in populations seeking to lose weight [ 50 , 51 , 52 ]. Changes in neurotransmitter systems and fatty acid metabolism are associated with a depressive state [ 14 , 53 , 54 ].…”

“…Our findings reveal that patients with conditions like epilepsy who undergo psychopharmacological treatments involving anticonvulsants such as valproic acid and Fosphenytoin are at risk of experiencing adverse effects like constipation, appetite and sleep disturbances, BMI disorders, or even obesity. To evaluate cardiovascular risk and diabetes, metabolic syndrome serves as a useful tool, allowing for better patient management and appropriate adjustments in pharmacological treatment processes [ 48 , 51 , 68 ]. Psychological treatment and behavioral regulation are of paramount importance in managing these conditions.…”

Development and Validation of a Food Frequency Questionnaire for Evaluating the Nutritional Status of Patients with Serious Mental Illnesses (DIETQ-SMI) in Bahrain

“…A comprehensive list of foods and beverages commonly consumed by patients with SMIs was created by reviewing international/national dietary surveys, systematic reviews, and meta-analyses and consulting nutrition experts [16,23,[31][32][33][34][35][36]. This initial food list contained more than 350 variants of individual food and beverage items.…”

Systematic Review on the Effects of Food on Mental Health via Gut Microbiome

“…Various studies find that healthy diets have a positive effect on the gut microbiome. The diversity of the gut microbiome can be affected by diets, which may influence one's mental health [17,36], leading to potential improvements in mental health [15][16][17][18][19][20][21][22][23][24][25][26][27]29]. A healthy diet commonly refers to the consumption of vegetables, fruits, fish, and whole-diet interventions instead of only examining individual nutrients or foods.…”