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SUN Questionnaires English version. (DOCX 73 kb)

In recent years, there has been an unprecedented growth in both the quantity and methodological quality of research directed at exploring the relationship between nutrition and mental health. Indeed, the strength of data has now afforded nutritional medicine a place in the mainstream psychiatric discourse (1). Robust associations have been established between nutritional quality and mental health, with the bulk of this evidence indicating a protective effect of healthy diets on depressed mood (2), and the newest research supporting a detrimental impact of unhealthy diets on the mental health of young people (3,4) and adults (5,7). There are also convincing data supporting the application of certain nutrient-based supplements (nutraceuticals) as monotherapy or combined therapy (8), or as augmentation therapy (9). Although the growth in scientific research related to nutrition in psychiatry may be recent, it is now at a stage where it can no longer be ignored. In light of this, we aim to provide a platform to move towards a new integrated paradigm in psychiatry whereby nutritional considerations (both educational and prescriptive) can be considered “mainstream” (1). To this end, we present a consensus position statement from the International Society for Nutritional Psychiatry Research (ISNPR). In brief, the ISNPR was formed in 2013 with the aim to advance research and communication on nutritional medicine in the field of psychiatry. One of its first goals was to formulate a position statement that embodied the principles of the organization, allowing for codification of the society’s underpinning tenets. In order to develop this, we employed a Delphi-based model by which ISNPR researcher and clinician members could vote on a select list of 110 statements created by an expert steering committee. The committee provided a list of sub-statements concerning three main topics/areas: the current general needs and challenges in psychiatry; key elements of diet and nutraceutical evidence related to mental health/psychiatry; potential public health and clinical applications. These were transcribed and tabulated in Survey Monkey for online voting by the wider ISNPR membership. A Likert scale (0–10) was used for each statement (0=don’t include, 5=don’t know/depends, 10=definitely include), and statements that received a mean score of >6.5/10 by ISNPR members were reviewed by the steering committee for inclusion in the position statement, which is presented below. Present treatment of mental disorders is achieving sub-optimal outcomes; in addition little attention is given to preventative efforts. Due to the immense burden of mental disorders, there is now an urgent need to identify modifiable targets to reduce the incidence of these disorders. Diet and nutrition offer key modifiable targets for the prevention of mental disorders and have a fundamental role in the promotion of mental health. Epidemiological data, basic science, and clinical evidence suggest that diet influences both the risk for and outcomes of mental disorders. As such, we advocate that evidence-based nutritional change should be regarded as an efficacious and cost-effective means to improve mental health. In addition to dietary modification, we recognize that nutrient-based (nutraceutical) prescription has the potential to assist in the management of mental disorders at the individual and population level. Many of these nutrients have a clear link to brain health, including: omega-3s, B vitamins (particularly folate and B12), choline, iron, zinc, magnesium, S-adenosyl methionine (SAMe), vitamin D, and amino acids. While we advocate for these to be consumed in the diet where possible, additional select prescription of these as nutraceuticals may also be justified. Ongoing research (including randomized controlled trials) in the area is recognized as critical, using methodologically rigorous designs. Further explication of the biological pathways affected by nutritional modification is also required. Clinical trials of nutraceuticals should include assessment of biomarkers in tandem with clinical outcomes. Global research and health promotion activities focused on improving population health should also include mental health parameters as priority targets and measured outcomes. Importantly, the activities of the food industry need to be examined at a governmental level and relevant policies designed to reduce the global burden of physical and mental ill-health attributable to poor diet. Such policies are advised to stimulate significant public change in dietary habits back towards a traditional wholefood diet (dependent on the culture). Further, there is now a vital need for better public and clinician education to communicate current research findings from the field. In summary, nutrition and nutraceuticals should now be considered as mainstream elements of psychiatric practice, with research, education, policy, and health promotion reflecting this new paradigm. As detailed in our consensus statement, we advocate for the pursuit of an integrative psychiatric model, with diet as a key element. Further, the select use of evidence-based nutraceuticals should be a mainstay of treatment as either stand-alone therapies (mainly in cases of less severe mental disorders, non-tolerance to medication, nutrient deficiencies, or patient choice), or as adjunctive interventions with psychotropic medications to augment treatment efficacy. We recognize the importance of clinician and public education regarding evidence-based nutrition and nutraceuticals to drive mainstream acknowledgement of their impact on mental health. It is the intention that this position statement and the ongoing work of ISNPR will assist in facilitating a transformation in psychiatry to better address the substantial global burden of mental illness, recognizing and embracing diet and nutrition as central determinants of both physical and mental health.

Micronutrient intake within the lowest quintile of adherence to different diet quality scores. Suboptimal intakes. (DOC 34 kb)

Objective: To evaluate the impact of the Mediterranean diet (MD) on weight gain and obesity in pregnant women in Gran Canaria. Methods: Cross sectional study in 170 pregnant women We measured the adherence to the MD before and during pregnancy by a food frequency questionnaire. Body mass index (BMI) was determined in the first prenatal visit. Appropriate weight gain was calculated according to the recommendations set by the American Institute of Medicine. We established the association between the degree of compliance with the MD and the increase in BMI (regression coefficients [b] and their confidence intervals (CI) ([95% CI]) and weight gain (Odds ratios [OR] and their 95% CI) during pregnancy. Results: Women with a high baseline adherence to the Mediterranean diet gained less weight during pregnancy (b -1.54; CI 95% -2.53 to -0.56) than women with poor adherence. One point increase in the adherence to this diet during pregnancy was associated with an enhanced probability of appropriate weight gain (OR 1.39; CI 95%1.06 to 1.82). Conclusions: A high baseline adherence to the MD may protect against overweight and obesity during pregnancy. Intensifying this habit during gestation can increase the probability of an appropriate weight gain. Objetivo: Estimar el grado de adhesión al Patrón de Dieta Mediterránea (DM) en gestantes de Gran Canaria antes del embarazo y en el tercer trimestre valorando su relación con el incremento ponderal y la ganancia adecuada de peso durante el mismo. Sujetos y método: Estudio transversal en 170 gestantes de Gran Canaria. Se estimó la adhesión a DM al inicio del embarazo y en el tercer trimestre mediante un cuestionario frecuencia de consumo validado. El índice de masa corporal (IMC) se determinó al inicio y en el tercer trimestre a partir de los datos de peso y talla de la historia clínica. Se calculó la ganancia adecuada de peso según las recomendaciones establecidas por el Instituto de Medicina Estadounidense. Se estableció la asociación entre la adhesión a DM y sus cambios durante el embarazo y el incremento en el IMC (coeficientes de regresión (b) y sus intervalos de confianza al 95% (IC 95%)) y una ganancia de peso adecuada (Odds Ratios (OR) y sus IC 95%). Resultados: Las mujeres con muy alta adhesión a la DM antes del embarazo ganaron menos peso durante el mismo (b: -1,54; IC 95%: 95% -2,53 a -0,56) que las mujeres con muy baja adhesión al patrón. El incremento en un punto en la adhesión a la DM durante el embarazo se asoció con una mayor probabilidad de ganancia de peso adecuada (OR: 1,39; IC 95%: 1,06 a 1,82). Conclusiones: Una alta adhesión a la DM antes del embarazo podría proteger frente a estados de sobrepeso y obesidad durante el mismo. Un mayor incremento en la adhesión a la DM durante la gestación puede aumentar la probabilidad de una ganancia adecuada de peso en el embarazo.

A systematic review and meta‐analysis of available randomised controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on serum/plasma Zn status in infants. Out of 5500 studies identified through electronic searches and reference lists, 13 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on serum/plasma Zn concentration was considered in the overall meta‐analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status and risk of bias. The pooled β of status was 0.09 [confidence interval (CI) 0.05 to 0.12]. However, a substantial heterogeneity was present in the analyses (I(2) = 98%; P = 0.00001). When we performed a meta‐regression, the effect of Zn intake on serum/plasma Zn status changed depending on the duration of the intervention, the dose of supplementation and the nutritional situation (P ANCOVA = 0.054; 20 weeks). A positive effect was also seen when doses ranged from 8.1 to 12 mg day(−1). In all cases, the pooled β showed high evidence of heterogeneity. Zn supplementation increases serum/plasma Zn status in infants, although high evidence of heterogeneity was found. Further standardised research is urgently needed to reach evidence‐based conclusions to clarify the role of Zn supplementation upon infant serum/plasma Zn status, particularly in Europe.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the notch3 epidermal growth factor–like repeats. A Colombian kindred carries a novel C455R mutation located in the predicted ligand-binding domain. Stroke occurred in the patients at an unusually early age (median age: 31 years) in comparison to the more frequent onset in the fourth decade of life in other CADASIL populations, including a second Colombian kindred with an R1031C mutation.

Objetivo: Valorar la asociación de la situación laboral, el tipo de estudios y el estado civil con el consumo de tabaco en una cohorte de licenciados y diplomados universitarios españoles, donde predominan los profesionales sanitarios. Métodos: Se realizó un análisis transversal de los datos basales de los 7.508 primeros participantes del Proyecto SUN (Seguimiento Universidad de Navarra). Los sujetos fueron clasificados según su consumo de tabaco. Las variables independientes fueron: situación laboral, estado civil, nivel más alto de estudios completado, número de hijos, gramos de alcohol ingerido al día, índice de masa corporal y edad. En el análisis multivariante se ajustaron 3 grupos de modelos de regresión logística no condicional: a) fumadores frente al conjunto formado por nunca fumadores más ex fumadores; b) fumadores frente a nunca fumadores, y c) fumadores de 15 o más cigarrillos al día frente al conjunto formado por fumadores de menos de 15 cigarrillos/día, nunca fumadores y ex fumadores. Resultados: En los varones no se encontró ninguna asociación entre la situación laboral y ser fumador en ninguna de las 3 comparaciones. Por el contrario, entre las mujeres se observó que haber cursado la diplomatura de enfermería se asociaba a una mayor prevalencia de tabaquismo, con una prevalencia del 48,5% de fumadoras actuales entre las enfermeras. Entre las mujeres, también era más frecuente el consumo de tabaco en las estudiantes. Para las estudiantes, la prevalencia de grandes fumadoras (≥ 15 cigarrilos/día) mostraba una odds ratio de 1,81 (intervalo de confianza del 95%, 1,28-2,57). Haber realizado un doctorado se asociaba inversamente con el tabaquismo en ambos sexos. Conclusiones: Dentro de un gran colectivo español con niveles educativos superiores, la prevalencia de fumadoras actuales es mayor en las mujeres que han completado una diplomatura. Es preocupante, desde el punto de vista sociosanitario, que entre las enfermeras la prevalencia de tabaquismo sea más alta que en la media de las mujeres universitarias. Objective: The objective of this study was to assess the association between employment, educational level, marital status, and smoking in a large cohort of Spanish university graduates (3- and 5-year degrees), with a predominance of health professionals. Methods: A cross-sectional analysis of the baseline data of the first 7,508 participants in the follow-up study of the University of Navarre (SUN Project) was performed. The subjects were classified according to their smoking status. Independent variables were: employment, marital status, highest educational level attained, number of children, alcohol consumption (g/day), body mass index, and age. In the multivariate analysis, 3 non-conditional logistic regression models were built using the following outcomes: a) smokers vs never-smokers plus ex-smokers; b) smokers vs never-smokers; c) smokers of 15 or more cigarettes a day vs smokers of less than 15 cigarettes a day plus never-smokers and ex-smokers. Results: Among men, no association was found between employment and smoking status in any of the comparisons. In contrast, among women, being a nurse was associated with a higher prevalence of smoking. The prevalence of current smokers among nurses was 48.5%. Female students were also more likely to smoke and had a higher risk of being heavy smokers (OR = 1.81; 95% CI, 1.28-2.57). A lower prevalence of smoking was found among participants of both sexes who had completed a doctorate. Conclusions: Among a large Spanish collective with higher education, the prevalence of smoking was higher in women with a shorter college degree. The prevalence of smoking among nurses was higher than the average among women graduates, which is a cause for concern.