Ultra-processed and fresh food consumption and symptoms of anxiety and depression during the COVID – 19 pandemic: COVID Inconfidentes

Abstract

Background & Aim Psychological disorders are an important health problem worldwide. A healthy diet is recommended as one of the measures to prevent and control mental disorders. Epidemiological studies have shown important associations between the consumption of diets rich in nutrients and a lower risk of developing anxiety and depression. Therefore, the aim of this study was to evaluate the association between the prevalence of anxiety and depression symptoms and food consumption, according to degree of processing, during the COVID-19 pandemic. Methods An epidemiological household survey was conducted in two cities in Brazil. Anxiety and depression symptoms were assessed using validated scales (Generalized Anxiety Disorder 7-item/Patient Health Questionnaire-9), and food consumption was assessed using a qualitative food frequency questionnaire referring to consumption within the last 3 months. The foods were categorized according to the NOVA classification for fresh/minimally processed food and ultra-processed food, using the average weekly consumption as the cutoff. For data analysis, adjusted Poisson regression with robust variance was utilized to estimate the prevalence ratio and 95% confidence interval (CI). Results : The consumption of fresh/minimally processed foods above the weekly average frequency was associated with a lower prevalence of symptoms of depression (PR: 0.5, 95% CI: 0.3; 0.7). Consumption above the weekly average of ultra-processed foods was associated with a higher prevalence of anxiety (PR: 1.5 and 95% CI: 1,03; 2,3) and depression symptoms (PR: 1.5, 95% CI: 1.0; 2.1, p = 0.034). Conclusion Increased consumption of ultra-processed foods is associated with a higher occurrence of depression symptoms; therefore, we recommend an increase in the consumption of fresh/minimally processed foods, as endorsed by the Food Guide for the Brazilian Population.

Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies

“…Eligible studies included different age groups, including adults (N = 11), adolescents (N = 4), children (N = 1), and mixed-age groups (adolescents and adults (N = 1)). The mean age of all participants was 35.2 years (not including four studies that reported age categories [18][19][20][21]), with a mean age of 44.9 years for adults, 14.5 years for adolescents and 9.6 years for children. In the 16 studies that reported sex proportions, males accounted for 44.5% of the samples combined.…”

“…Eleven studies modelled ultra-processed food consumption as the exposure variable and mental disorder parameters as the outcome [17][18][19]21,[23][24][25][26]30,48,50], with the remaining six modelling associations in the opposite direction [20,22,[27][28][29]31].…”

“…Of the 11 studies that treated ultra-processed food consumption as the exposure variable, 8 coded ultra-processed food intake categorically (dichotomous [21,25,26], tertiles [18,24] and quartiles [19,48,50], with the lowest category being the reference group and referring to lowest consumption). The remaining three studies coded ultra-processed food consumption continuously [17,23,30].…”

“…Five cross-sectional studies [18,19,21,24,25] were included in a meta-analysis that examined associations between ultra-processed food intake and symptoms of the common mental disorders, depression and anxiety (n = 185,773) (see Tables 1 and S2 for study characteristics and variable details). Results showed that greater ultra-processed food consumption was associated with higher odds of depressive and anxiety symptoms (odds ratio: 1.53, 95%CI 1.43 to 1.63, p < 0.001, I 2 = 8.9%) (see Figure 1 for forest plot).…”

“…However, the meta-analysis assessing associations of ultra-processed food consumption with mental disorders was limited only to depression and by the number of studies available for inclusion at the time of publication (n = 2). Several additional studies have since been published assessing the link between ultra-processed food consumption and depression as well as other mental disorders [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The need for an updated review is further exacerbated by the fact that ultra-processed foods have become increasingly ubiquitous for many food systems globally [13], thus understanding any relationship with mental disorders is critical for understanding the health implications of this trend.…”