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Background: Mood disorders, including unipolar and bipolar depression, contribute significantly to the global burden of disease. Psychological therapy is considered a gold standard non-pharmacological treatment for managing these conditions; however, a growing body of evidence also supports the use of lifestyle therapies for these conditions. Despite some clinical guidelines endorsing the application of lifestyle therapies as a first-line treatment for individuals with mood disorders, there is limited evidence that this recommendation has been widely adopted into routine practice. A key obstacle is the insufficient evidence on whether lifestyle therapies match the clinical and cost effectiveness of psychological therapy, particularly for treating those with moderate to severe symptoms. The HARMON-E Trial seeks to address this gap by conducting a non-inferiority trial evaluating whether a multi-component lifestyle therapy program is non-inferior to psychological therapy on clinical and cost-effectiveness outcomes over 8-weeks for adults with major depressive disorder and bipolar affective disorder., Methods: This trial uses an individually randomised group treatment design with computer generated block randomisation (1:1). Three hundred and seventy-eight adults with clinical depression or bipolar affective disorder, a recent major depressive episode, and moderate-to-severe depressive symptoms are randomised to receive either lifestyle therapy or psychological therapy (adjunctive to any existing treatments, including pharmacotherapies). Both therapy programs are delivered remotely, via a secure online video conferencing platform. The programs comprise an individual session and six subsequent group-based sessions over 8-weeks. All program aspects (e.g. session duration, time of day, and communications between participants and facilitators) are matched except for the content and program facilitators. Lifestyle therapy is provided by a dietitian and exercise physiologist focusing on four pillars of lifestyle (diet, physical activity, sleep, and substance use), and the psychological therapy program is provided by two psychologists using a cognitive behavioural therapy approach. Data collection occurs at baseline, 8-weeks, 16-weeks, and 6 months with research assistants blinded to allocation. The primary outcome is depressive symptoms at 8 weeks, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) (minimal clinically important difference = 1.6). A pre-specified within-trial economic evaluation will also be conducted., Discussion: Should lifestyle therapy be found to be as clinically and cost effective as psychological therapy for managing mood disorders, this approach has potential to be considered as an adjunctive treatment for those with moderate to severe depressive symptoms., Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12622001026718, registered 22nd July 2022., Protocol Version:  4.14, 26/06/2024., (© 2024. The Author(s).)

Context: Dietary fibers hold potential to influence depressive and anxiety outcomes by modulating the microbiota-gut-brain axis, which is increasingly recognized as an underlying factor in mental health maintenance., Objective: Evidence for the effects of fibers on depressive and anxiety outcomes remains unclear. To this end, a systematic literature review and a meta-analysis were conducted that included observational studies and randomized controlled trials (RCTs)., Data Sources: The PubMed, Embase, CENTRAL, CINAHL, and PsychINFO databases were searched for eligible studies., Data Extraction: Study screening and risk-of-bias assessment were conducted by 2 independent reviewers., Data Analysis: Meta-analyses via random effects models were performed to examine the (1) association between fiber intake and depressive and anxiety outcomes in observational studies, and (2) effect of fiber intervention on depressive and anxiety outcomes compared with placebo in RCTs. A total of 181 405 participants were included in 23 observational studies. In cross-sectional studies, an inverse association was observed between fiber intake and depressive (Cohen's d effect size [d]: -0.11; 95% confidence interval [CI]: -0.16, -0.05) and anxiety (d = -0.25; 95%CI, -0.38, -0.12) outcomes. In longitudinal studies, there was an inverse association between fiber intake and depressive outcomes (d = -0.07; 95%CI, -0.11, -0.04). In total, 740 participants were included in 10 RCTs, all of whom used fiber supplements. Of note, only 1 RCT included individuals with a clinical diagnosis of depression. No difference was found between fiber supplementation and placebo for depressive (d = -0.47; 95%CI, -1.26, 0.31) or anxiety (d = -0.30; 95%CI, -0.67, 0.07) outcomes., Conclusion: Although observational data suggest a potential benefit for higher fiber intake for depressive and anxiety outcomes, evidence from current RCTs does not support fiber supplementation for improving depressive or anxiety outcomes. More research, including RCTs in clinical populations and using a broad range of fibers, is needed., Systematic Review Registration: PROSPERO registration no. CRD42021274898., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Background: We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing., Methods: An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021-April 2022, 182 adults with a Distress Questionnaire-5 score = ≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n = 91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n = 91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs)., Findings: The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n = 132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n = 70) mean difference:-3.97, 95% CIs:-5.10, -2.84; and Psychotherapy (n = 62): mean difference:-3.74, 95% CIs:-5.12, -2.37; ITT: Lifestyle (n = 91) mean difference:-4.42, 95% CIs: -4.59, -4.25; Psychotherapy (n = 91) mean difference:-3.82, 95% CIs:-4.05, -3.69) with evidence of non-inferiority (PP GEE β:-0.59; 95% CIs:-1.87, 0.70, n = 132; ITT GEE β:-0.49, 95% CIs:-1.73, 0.75, n = 182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs -$182, $611, ITT AUD$190 [95% CIs -$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:-$222, $1152] ITT AUD$ 408 [95% CIs -$139, $1157]., Interpretation: Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists., Funding: This trial was funded by the Australian Medical Research Future Fund (GA133346) under its Covid-19 Mental Health Research Grant Scheme., Competing Interests: This trial was funded by the National Health and Medical Research Council’s (NHMRC) Medical Research Future Fund–COVID-19 Mental Health Research Australian Government Department of Health (GA133346). AO is supported by a NHMRC Emerging Leader 2 Fellowship (2009295). FNJ is supported by an NHMRC Investigator Grant (#1194982). FNJ has received fellowship funding support from the National Health and Medical Research Council (#1194982) and payment or honorariums for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Malaysian Society of Gastroenterology and Hepatology, JNPN Congress, American Nutrition Association, Personalised Nutrition Summit, and American Academy of Craniofacial Pain, is a Scientific Advisory Board member of Dauten Family Centre for Bipolar Treatment Innovation (unpaid) and Zoe Nutrition (unpaid), has written two books for commercial publication on the topic of nutritional psychiatry and gut health, and is the principal investigator for the MicroFit Study. She is Director of the Food & Mood Centre, Deakin University, which has received research funding support from Be Fit Food, Bega Dairy and Drinks, and the a2 Milk Company and philanthropic research funding support from the Waterloo Foundation, Wilson Foundation, the JTM Foundation, the Serp Hills Foundation, the Roberts Family Foundation, and the Fernwood Foundation. SR is supported by an NHMRC Investigator Grant (2017506). MB is supported by a NHMRC Senior Principal Research Fellowship and Leadership 3 Investigator grant (1156072 and 2017131). MTey is supported by a NHMRC Emerging Leadership Fellowship (APP1195335). JS is supported by core funding to the Australian Centre for Behavioural Research in Diabetes provided by the collaboration between Diabetes Victoria and Deakin University. VV is supported by the Rural Health Multidisciplinary Training program. SMah has received funding from Education in Nutrition to provide a professional development presentation and Red Island Olive Oil for social media promotion. MMor has received research grants related to antimicrobial stewardship, discharge medication, consulting fees from Primary Health Networks of Gold Coast and Western Australia related to Primary Sense software. Australian Health Policy Collaboration, RACGP, Australian Department of Health and Aged Care (DoHAC), conference support from RACGP various as chair of Expert Committee for Quality Care, participation in DSMBs for Primary Sense and DoHAC and is a member of Arthritis Australia and Bond University Boards. The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of the funding bodies. The authors have no interests to declare., (© 2024 The Authors.)

Objective: The gut microbiota is implicated in several symptoms and biological pathways relevant to anorexia nervosa (AN). Investigations into the role of the gut microbiota in AN are growing, with a specific interest in the changes that occur in response to treatment. Findings suggest that microbial species may be associated with some of the symptoms common in AN, such as depression and gastrointestinal disturbances (GID). Therefore, researchers believe the gut microbiota may have therapeutic relevance. Whilst research in this field is rapidly expanding, the unique considerations relevant to conducting gut microbiota research in individuals with AN must be addressed., Method: We provide an overview of the published literature investigating the relationship between the gut microbiota and symptoms and behaviors present in AN, discuss important challenges in gut microbiota research, and offer recommendations for addressing these. We conclude by summarizing research design priorities for the field to move forward., Results: Several ways exist to reduce participant burden and accommodate challenges when researching the gut microbiota in individuals with AN., Discussion: Recommendations from this article are foreseen to encourage scientific rigor and thoughtful protocol planning for microbiota research in AN, including ways to reduce participant burden. Employing such methods will contribute to a better understanding of the role of the gut microbiota in AN pathophysiology and treatment., Public Significance: The field of gut microbiota research is rapidly expanding, including the role of the gut microbiota in anorexia nervosa. Thoughtful planning of future research will ensure appropriate data collection for meaningful interpretation while providing a positive experience for the participant. We present current challenges, recommendations for research design and priorities to facilitate the advancement of research in this field., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Neurosteroid and immunological actions of vitamin D may regulate depression-linked physiology. Meta-analyses investigating the effect of vitamin D on depression have been inconsistent. This meta-analysis investigated the efficacy of vitamin D in reducing depressive symptoms among adults in randomized placebo-controlled trials (RCT). General and clinical populations, and studies of ill individuals with systemic diseases were included. Light therapy, co-supplementation (except calcium) and bipolar disorder were exclusionary. Databases Medline, PsycINFO, CINAHL and The Cochrane Library were searched to identify relevant articles in English published before April 2022. Cochrane risk-of-bias tool (RoB 2) and GRADE were used to appraise studies. Forty-one RCTs ( n  = 53,235) were included. Analyses based on random-effects models were performed with the Comprehensive Meta-analysis Software. Results for main outcome ( n  = 53,235) revealed a positive effect of vitamin D on depressive symptoms (Hedges' g  = -0.317, 95% CI [-0.405, -0.230], p  < 0.001, I 2 = 88.16%; GRADE: very low certainty). RoB assessment was concerning in most studies. Notwithstanding high heterogeneity, vitamin D supplementation ≥ 2,000 IU/day appears to reduce depressive symptoms. Future research should investigate possible benefits of augmenting standard treatments with vitamin D in clinical depression. PROSPERO registration number: CRD42020149760. Funding: Finnish Medical Foundation, grant 4120 and Juho Vainio Foundation, grant 202100353.

Background: Few studies have tested longitudinal associations between ultra-processed food consumption and depressive outcomes. As such, further investigation and replication are necessary. The aim of this study is to examine associations of ultra-processed food intake with elevated psychological distress as an indicator of depression after 15 years., Method: Data from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 23,299). We applied the NOVA food classification system to a food frequency questionnaire (FFQ) to determine ultra-processed food intake at baseline. We categorised energy-adjusted ultra-processed food consumption into quartiles by using the distribution of the dataset. Psychological distress was measured by the ten-item Kessler Psychological Distress Scale (K10). We fitted unadjusted and adjusted logistic regression models to assess the association of ultra-processed food consumption (exposure) with elevated psychological distress (outcome and defined as K10 ≥ 20). We fitted additional logistic regression models to determine whether these associations were modified by sex, age and body mass index., Results: After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, participants with the highest relative intake of ultra-processed food were at increased odds of elevated psychological distress compared to participants with the lowest intake (aOR: 1.23; 95%CI: 1.10, 1.38, p for trend = 0.001). We found no evidence for an interaction of sex, age and body mass index with ultra-processed food intake., Conclusion: Higher ultra-processed food intake at baseline was associated with subsequent elevated psychological distress as an indicator of depression at follow-up. Further prospective and intervention studies are necessary to identify possible underlying pathways, specify the precise attributes of ultra-processed food that confer harm, and optimise nutrition-related and public health strategies for common mental disorders., Competing Interests: Declaration of competing interest The Food & Mood Centre has received Grant/Research support from Fernwood Foundation, Wilson Foundation, the A2 Milk Company, and Be Fit Foods. MML is supported by a Deakin University Scholarship and has received research funding support from Be Fit Foods. ML is currently funded by an Alfred Deakin Postdoctoral Research Fellowship. MF is supported by a Deakin University Scholarship and has received grants and fellowships from Avant Mutual, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the National Health and Medical Research Council (NHMRC). TR has received grants, fellowships and research support from University of the Sunshine Coast, Australian Postgraduate Awards, Fernwood Foundation, Roberts Family Foundation and Be Fit Food. TR received consultancy, honoraria and travel funds from Oxford University Press, the University of Melbourne, the University of Sydney, Bond University, University of Southern Queensland, Dietitians Association of Australia, Nutrition Society of Australia, The Royal Australian and New Zealand College of Psychiatrists, Academy of Nutrition and Dietetics, Black Dog Institute, Australian Rotary Health, Australian Disease Management Association, Department of Health and Human Services, Primary Health Networks, Barwon Health, West Gippsland Healthcare Group, Central West Gippsland Primary Care Partnership, Parkdale College, City of Greater Geelong and Global Age. AO is supported by an NHMRC Emerging Leader 2 Fellowship (2009295). She has received research funding from National Health & Medical Research Council, Australian Research Council, University of Melbourne, Deakin University, Sanofi, Meat and Livestock Australia and Woolworths Limited and Honoraria from Novartis. FNJ has received Grant/Research support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council (NHMRC), Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, Eli Lilly, Meat and Livestock Australia, Woolworths Limited, the Fernwood Foundation, Wilson Foundation, the A2 Milk Company, Be Fit Foods, and The University of Melbourne, and has received speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Health Ed, Network Nutrition, Angelini Farmaceutica, Eli Lilly and Metagenics. FNJ has written two books for commercial publication and has a personal belief that good diet quality is important for mental and brain health. DNA is supported by funds from an NHMRC Emerging Leader 2 Fellowship (2009295). WM is currently funded by an Alfred Deakin Postdoctoral Research Fellowship and a Multiple Sclerosis Research Australia early-career fellowship. WM has previously received funding from the Cancer Council Queensland and university grants/fellowships from La Trobe University, Deakin University, University of Queensland, and Bond University. WM has received industry funding and has attended events funded by Cobram Estate Pty. Ltd. WM has received travel funding from Nutrition Society of Australia. WM has received consultancy funding from Nutrition Research Australia and ParachuteBH. WM has received speakers' honoraria from The Cancer Council Queensland and the Princess Alexandra Research Foundation., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Evidence on the association between dairy intake and depression is conflicting. Given numerous dietary guidelines recommend the consumption of low-fat dairy products, this study examined associations between total dairy, high-fat dairy, and low-fat dairy intake and the prevalence of elevated depressive symptoms. Associations between dairy products, which differed in both fat content and fermentation status, and depressive symptoms were also explored., Methods: This cross-sectional study included 1600 Finnish adults (mean age 63 ± 6 years; 51% female) recruited as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. Dairy intake was assessed using 4-day food records. Elevated depressive symptoms were defined as having a score ≥ 5 on the Diagnostic and Statistical Manual of Mental Disorders-III Depression Scale, and/or regularly using one or more prescription drugs for depressive symptoms., Results: In total, 166 participants (10.4%) reported having elevated depressive symptoms. Using multivariate logistic regression models, intake in the highest tertile of high-fat dairy products (OR 0.64, 95% CI 0.41-0.998, p trend = 0.04) and high-fat non-fermented dairy products (OR 0.60, 95% CI 0.39-0.92, p trend = 0.02) were associated with reduced odds for having elevated depressive symptoms. Whereas no significant association was observed between intake of total dairy, low-fat dairy, or other dairy products, and depressive symptoms., Conclusion: Higher intake of high-fat dairy and high-fat non-fermented dairy products were associated with reduced odds for having elevated depressive symptoms in middle-aged and older Finnish adults. Given the high global consumption of dairy products, and widespread burden of depression, longitudinal studies that seek to corroborate these findings are required., (© 2022. The Author(s).)

Objective: To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic syndrome risk factors., Study Design: Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 - 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels., Data Sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies., Data Synthesis: Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies; 262 intervention, 258 control participants; standardised mean difference [SMD], -0.28; 95% CI, -0.51 to -0.04) and interventions consisting of individual sessions only (three studies; 141 intervention, 134 control participants; SMD, -0.30; 95% CI, -0.54 to -0.06)., Conclusions: We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an individual basis or by dietitians., Prospero Registration: CRD42021235979 (prospective)., (© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Despite advances in treatment of anorexia nervosa (AN), current therapeutic approaches do not fully consider gastrointestinal disturbances (GID), often present in AN. Addressing GID, both symptoms and disorders, is likely to improve treatment adherence and outcomes in people with AN. GID are complex and are linked to a range of factors related to eating disorder symptomology and can be impacted by nutritional treatment. It is not known which dietetic practices are currently used to address GID in AN. Therefore, this survey aimed to explore the perceived knowledge, attitudes, and practices (KAP) of Australian dietitians treating AN and co-occurring GID. Seventy dietitians participated by completing an online survey. Knowledge scores were calculated based on correct responses to knowledge items (total: 12 points); and two groups were generated: higher knowledge (≥10 points, n = 31) and lower knowledge (≤9 points, n = 39). A greater proportion of dietitians with higher knowledge recognized the role of GID in pathogenesis of AN ( p = 0.002) and its impact on quality of life ( p = 0.013) and screened for GID ( p ≤ 0.001), compared with those with lower knowledge. These results suggest that attitudes and practices toward patients presenting with AN and GID differ depending on level of knowledge. This may have important implications for treatment outcomes for individuals with AN and GID.

Background: Few studies have examined associations between ultra-processed food intake and biomarkers of inflammation, and inconsistent results have been reported in the small number of studies that do exist. As such, further investigation is required. Methods: Cross-sectional baseline data from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 2018). We applied the NOVA food classification system to data from a food frequency questionnaire (FFQ) to determine ultra-processed food intake (g/day). The outcome was high-sensitivity C-reactive protein concentration (hsCRP; mg/L). We fitted unadjusted and adjusted linear regression analyses, with sociodemographic characteristics and lifestyle- and health-related behaviours as covariates. Supplementary analyses further adjusted for body mass index (kg/m2). Sex was assessed as a possible effect modifier. Ultra-processed food intake was modelled as 100 g increments and the magnitude of associations expressed as estimated relative change in hsCRP concentration with accompanying 95% confidence intervals (95%CIs). Results: After adjustment, every 100 g increase in ultra-processed food intake was associated with a 4.0% increase in hsCRP concentration (95%CIs: 2.1−5.9%, p < 0.001). Supplementary analyses showed that part of this association was independent of body mass index (estimated relative change in hsCRP: 2.5%; 95%CIs: 0.8−4.3%, p = 0.004). No interaction was observed between sex and ultra-processed food intake. Conclusion: Higher ultra-processed food intake was cross-sectionally associated with elevated hsCRP, which appeared to occur independent of body mass index. Future prospective and intervention studies are necessary to confirm directionality and whether the observed association is causal., Competing Interests: The Food & Mood Centre has received Grant/Research support from Fernwood Foundation, Wilson Foundation, the A2 Milk Company, and Be Fit Foods. M.M.L. is supported by a Deakin University Scholarship and has received research funding support from Be Fit Foods. M.L. and P.M. are currently funded by an Alfred Deakin Postdoctoral Research Fellowship. M.F. is supported by a Deakin University Scholarship. A.L. has received grants, fellowships and research support from the University of New South Wales, the University of Melbourne, RMIT University, Deakin University, the National Health and Medical Research Council (NHMRC), Australian Academy of Science, National Institutes of Health (NIH), and The Jack Brockhoff Foundation. A.L. has received honoraria and travel funds from Sydney University, the University of Technology Sydney, American Epilepsy Society, Epilepsy Society of Australia, International Human Microbiome Congress, European Society of Neurogastroenterology, Australian and New Zealand College of Anaesthetists, Falk Foundation and Fonds de la Recherche Scientifique (FNRS). T.R. has received grants, fellowships and research support from University of the Sunshine Coast, Australian Postgraduate Awards, Fernwood Foundation, Roberts Family Foundation, Be Fit Food and Wilson Foundation. T.R. received consultancy, honoraria and travel funds from Oxford University Press, the University of Melbourne, the University of Sydney, Bond University, University of Southern Queensland, Dietitians Association of Australia, Nutrition Society of Australia, The Royal Australian and New Zealand College of Psychiatrists, Academy of Nutrition and Dietetics, Black Dog Institute, Australian Rotary Health, Australian Disease Management Association, Department of Health and Human Services, Primary Health Networks, Barwon Health, West Gippsland Healthcare Group, Central West Gippsland Primary Care Partnership, Parkdale College, City of Greater Geelong and Global Age. A.O. is supported by a Future Leader Fellowship (#101160) from the Heart Foundation Australia and Wilson Foundation. She has received research funding from National Health & Medical Research Council, Australian Research Council, University of Melbourne, Deakin University, Sanofi, Meat and Livestock Australia and Woolworths Limited and Honoraria from Novartis. F.J. has received Grant/Research support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council (NHMRC), Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, Eli Lilly, Meat and Livestock Australia, Woolworths Limited, the Fernwood Foundation, Wilson Foundation, the A2 Milk Company, Be Fit Foods, and The University of Melbourne, and has received speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Health Ed, Network Nutrition, Angelini Farmaceutica, Eli Lilly and Metagenics. F.N.J. has written two books for commercial publication and has a personal belief that good diet quality is important for mental and brain health. W.M. is currently funded by an NHMRC Investigator Grant (#2008971) and a Multiple Sclerosis Research Australia early-career fellowship. Wolfgang has previously received funding from the Cancer Council Queensland and university grants/fellowships from La Trobe University, Deakin University, University of Queensland, and Bond University. Wolfgang has received industry funding and/or has attended events funded by Cobram Estate Pty. Ltd and Bega Dairy and Drinks Pty Ltd. Wolfgang has received travel funding from Nutrition Society of Australia. Wolfgang has received consultancy funding from Nutrition Research Australia and ParachuteBH. Wolfgang has received speakers honoraria from The Cancer Council Queensland and the Princess Alexandra Research Foundation.

Background: Despite the putative health benefits of fermented dairy products, evidence on the association between fermented dairy and nonfermented dairy intake, and depression incidence is limited., Objectives: This study examined cross-sectional and prospective associations between total dairy, fermented dairy, and nonfermented dairy intake with 1) the presence of elevated depressive symptoms and 2) the risk of a future hospital discharge or outpatient diagnosis of depression., Methods: Data from 2603 Finnish men (aged 42-60 y), recruited as part of the Kuopio Ischaemic Heart Disease Risk Factor Study, were included. Multivariable logistic regression models were used to examine ORs and 95% CIs for elevated depressive symptoms (Human Population Laboratory scale ≥5 points) at baseline. Cox proportional hazards regression models were used to estimate HRs and 95% CIs between dairy categories and risk of depression diagnoses., Results: In cross-sectional analyses, fermented dairy intake in the highest (compared with lowest) tertile was associated with lower odds of having elevated depressive symptoms (adjusted OR: 0.70; 95% CI: 0.52, 0.96). Each 100-g increase in nonfermented dairy intake was associated with higher odds of having elevated depressive symptoms (adjusted OR: 1.06; 95% CI: 1.01, 1.10). During a mean follow-up time of 24 y, 113 males received a diagnosis of depression. After excluding cheese intake, higher fermented dairy intake was associated with a lower risk of depression diagnosis (adjusted HR: 0.62; 95% CI: 0.38, 1.03), which was strengthened after excluding those with elevated depressive symptoms at baseline (adjusted HR: 0.55; 95% CI: 0.31, 0.99), whereas nonfermented dairy intake in the highest tertile was associated with a 2-fold higher risk of depression (adjusted HR: 2.02; 95% CI: 1.20, 3.42)., Conclusions: Fermented dairy and nonfermented dairy intake were differentially associated with depression outcomes when examined cross-sectionally and over a mean period of 24 y. These findings suggest that dairy fermentation status may influence the association between dairy intake and depression in Finnish men. The KIHD study was registered at clinicaltrials.gov as NCT03221127., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Aim: This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder., Methods: Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively., Results: The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega-3). Twenty-eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight-related or mental health outcomes, and on mental health outcomes, respectively., Conclusions: A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health., (© 2022 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.)

Aim: This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders., Methods: Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively., Results: Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre-post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first-episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi-behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost-utility (n = 3), cost-effectiveness (n = 1), cost-utility and cost-effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results., Conclusions: There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions., (© 2021 Dietitians Australia.)

Background: There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks., Methods: The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance., Discussion: If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress., Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021., (© 2022. The Author(s).)

Purpose: The risk psychological distress (PD) confers on mortality due to specific chronic diseases compared to suicide is unclear. Using the National Health Interview Survey (NHIS), we investigated the association between PD levels and risk of all-cause and chronic disease-specific mortality and compared the contribution of chronic disease-related mortality to that of suicide., Methods: Data from 195, 531 adults, who participated in the NHIS between 1997 and 2004, were linked to the National Death Index records through to 2006. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) across four levels of PD, measured using the Kessler-6 scale. Outcomes included all-cause mortality, and mortality due to all CVDs and subtypes, all cancers and subtypes, diabetes mellitus, alcoholic liver disease and suicide., Results: During a mean follow-up time of 5.9 years, 7665 deaths occurred. We found a dose-response association between levels of PD and all-cause mortality, with the adjusted HRs (95% CI) elevated for all levels of PD, when compared to asymptomatic levels: subclinical 1.10 (1.03-1.16), symptomatic 1.36 (1.26-1.46) and highly symptomatic 1.57 (1.37-1.81). A similar association was found for all CVDs and certain CVD subtypes, but not for cancers, cerebrovascular diseases diabetes mellitus. Excess mortality attributable to suicide and alcoholic liver disease was evident among those with levels of PD only., Conclusion: PD symptoms, of all levels, were associated with an increased risk of all-cause and CVD-specific mortality while higher PD only was associated with suicide. These findings emphasise the need for lifestyle interventions targeted towards improving physical health disparities among those with PD., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Beta-casein is a major protein in cow's milk, of which A1 and A2 are the most frequent variants. Recent evidence implicates A1 beta-casein consumption in mechanisms that are of potential importance to mental health, yet its possible effects on psychological endpoints remains unknown. The primary aim of the study is to evaluate the comparative effects of consumption of dairy products containing A2 beta-casein versus conventional dairy (i.e. containing both A1 and A2 beta-casein) on symptoms of psychological distress in women with low mood., Methods: 'The Moo'D Study' is a 16-week, superiority, 1:1 parallel group, triple-blinded, randomised controlled trial. Ninety women with low mood (Patient Health Questionnaire score ≥ 5) will be randomised to consume either A2 beta-casein only or conventional dairy products. The primary outcome, symptoms of psychological distress, will be measured by the 21-item Depression, Anxiety and Stress Scale. Secondary outcomes will include symptoms of depression, anxiety and stress, severity of low mood, cognition, gut microbiota composition, gut symptomatology, markers of immune function, gut inflammation, systemic metabolites, endothelial integrity and oxidative stress, body composition, perceived wellbeing, sleep, quality of life, resource use and cost-effectiveness., Discussion: This study will advance our understanding of the possible impact of milk proteins on psychological distress in women as well as elucidate mechanisms underpinning any association. Given dairy products form a substantial component of traditional and Western diets, the implications of these findings are likely to be of clinical and public health importance., Trial Registration: The trial protocol has been prospectively registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12618002023235 . Registered on 17 December 2018., (© 2021. The Author(s).)

Augmented reality (AR) is a relatively new technology that allows for digitally generated three-dimensional representations to be integrated with real environmental stimuli. AR can make use of smart phones, tablets, or other devices to achieve a highly stimulating learning environment and hands-on immersive experience. The use of AR in industry is becoming widespread with applications being developed for use not just for entertainment and gaming but also healthcare, retail and marketing, education, military, travel and tourism, automotive industry, manufacturing, architecture, and engineering. Due to the distinct learning advantages that AR offers, such as remote learning and interactive simulations, AR-based teaching programs are also increasingly being adopted within medical schools across the world. These advantages are further highlighted by the current COVID-19 pandemic, which has caused an even greater shift towards online learning. In this review, we investigate the use of AR in medical training/education and its effect on students' experiences and learning outcomes. This includes the main goals of AR-based learning, such as to simplify the delivery and enhance the comprehension of complex information. We also describe how AR can enhance the experiences of medical students, by improving knowledge and understanding, practical skills and social skills. These concepts are discussed within the context of specific AR medical training programs, such as HoloHuman, OculAR SIM, and HoloPatient. Finally, we discuss the challenges of AR in learning and teaching and propose future directions for the use of this technology in medical education.

Lifestyle factors including diet, sleep, physical activity, and substance use cessation, are recognised as treatment targets for common mental disorders (CMDs). As the field of lifestyle-based mental health care evolves towards effectiveness trials and real-world translation, it is timely to consider how such innovations can be integrated into clinical practice. This paper discusses the utility and scale-up of lifestyle interventions for CMDs and draws on diabetes prevention literature to identify enablers and barriers to translation efforts. We discuss the extent to which lifestyle interventions aimed at managing CMDs and preventing diabetes share commonalities (program content, theoretical underpinnings, program structures, interventionists, frameworks promoting fidelity, quality, sustainability). Specific considerations when utilising these programs for mental health include personalising content with respect to symptoms and trajectories of depression and anxiety, medication regimen and genetic risk profile. As this field moves from efficacy to effectiveness and implementation, it is important to ensure issues in implementation science, including "voltage drop", "program drift", logistics, funding, and resourcing, are in line with evidence-based models that are effective in research settings. Ongoing considerations includes who is best placed to deliver this care and the need for models to support implementation including long-term financing, workforce training, supervision, stakeholder and organisational support.

The importance of tryptophan as a precursor for neuroactive compounds has long been acknowledged. The metabolism of tryptophan along the kynurenine pathway and its involvement in mental disorders is an emerging area in psychiatry. We performed a meta-analysis to examine the differences in kynurenine metabolites in major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ). Electronic databases were searched for studies that assessed metabolites involved in the kynurenine pathway (tryptophan, kynurenine, kynurenic acid, quinolinic acid, 3-hydroxykynurenine, and their associate ratios) in people with MDD, SZ, or BD, compared to controls. We computed the difference in metabolite concentrations between people with MDD, BD, or SZ, and controls, presented as Hedges' g with 95% confidence intervals. A total of 101 studies with 10,912 participants were included. Tryptophan and kynurenine are decreased across MDD, BD, and SZ; kynurenic acid and the kynurenic acid to quinolinic acid ratio are decreased in mood disorders (i.e., MDD and BD), whereas kynurenic acid is not altered in SZ; kynurenic acid to 3-hydroxykynurenine ratio is decreased in MDD but not SZ. Kynurenic acid to kynurenine ratio is decreased in MDD and SZ, and the kynurenine to tryptophan ratio is increased in MDD and SZ. Our results suggest that there is a shift in the tryptophan metabolism from serotonin to the kynurenine pathway, across these psychiatric disorders. In addition, a differential pattern exists between mood disorders and SZ, with a preferential metabolism of kynurenine to the potentially neurotoxic quinolinic acid instead of the neuroprotective kynurenic acid in mood disorders but not in SZ., (© 2020. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: This article aims to describe 'The Mind-Body Well-being Initiative', a residential mental health treatment model based on the Lifestyle Medicine paradigm, which comprises a mind and body well-being programme. In people with severe mental illness (SMI), particularly for those experiencing psychotic illness, the physical health and mortality gap is significant with greater presence of chronic disease and a 15-20-year life expectancy gap., Conclusions: Our AIM Self-Capacity model of care attempts to address the physical and mental health care needs for the promotion of our patients' recovery.

Objective: Gastrointestinal (GI) disturbances are a frequent and burdensome experience for patients with anorexia nervosa (AN). How GI symptoms respond to current interventions is not well characterized, yet is critical to facilitate treatment success, and to inform the development of new treatments for AN. Therefore, the aim of this systematic review was to identify which treatments are effective in improving GI symptoms in patients with AN., Method: A systematic search for studies of AN treatments measuring GI symptoms pre- and post-treatment was conducted in May 2020 (PROSPERO ID: CRD42020181328). After removal of duplicates, title and abstracts of 3,370 studies were screened. Methodological quality was assessed using National Institute of Health Quality Assessment Tool., Results: Following full-text screening, 13 studies (12 observational studies and 1 randomized double-blind placebo-controlled trial) with 401 participants met eligibility criteria and were included. All observational studies included a component of nutritional rehabilitation, with half (n = 6) involving concurrent psychological treatment. The randomized controlled trial reported a drug therapy. Eleven studies reported an improvement in all (n = 6) or at least one (n = 5) patient-reported GI symptom following treatment. Two studies reported no change. Methodological quality was fair or poor across all studies., Discussion: This is the first systematic review to synthesize available evidence on the trajectory of patient-reported GI symptoms from commencement to end of treatment for AN. The results suggest that most studies showed improvement in one or more GI symptom in response to current treatments. Future therapeutic approaches should consider GI symptoms within their design for optimal treatment adherence and outcomes., (© 2021 Wiley Periodicals LLC.)

Anorexia nervosa is a serious psychiatric disorder with high morbidity and mortality rate. Evidence for the optimal psychopharmacological approach to managing the disorder remains limited, with nutritional treatment, focused on weight restoration through the consumption of high energy diet, regarded as one of the fundamental steps in treatment. The human gut microbiome is increasingly recognised for its proposed role in gastrointestinal, metabolic, immune and mental health, all of which may be compromised in individuals with anorexia nervosa. Dietary intake plays an important role in shaping gut microbiota composition, whilst the use of fermented foods, foods with potential psychobiotic properties that deliver live bacteria, bacterial metabolites, prebiotics and energy, have been discussed to a lesser extent. However, fermented foods are of increasing interest due to their potential capacity to affect gut microbiota composition, provide beneficial bacterial metabolites, and confer beneficial outcomes to host health. This review provides an overview of the role of the gut microbiota in relation to the disease pathology in anorexia nervosa and especially focuses on the therapeutic potential of fermented foods, proposed here as a recommended addition to the current nutritional treatment protocols warranting further investigation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This systematic review and meta-analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty-three observational studies were included (N = 891,723): 21 cross-sectional, 19 prospective, two case-control and one conducted both a prospective and cross-sectional analysis. Meta-analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23-1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34-1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34-1.66; P < 0.0001), all-cause mortality (hazard ratio: 1.28; 95% CI, 1.11-1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12-2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16-1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27-1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99-1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. STUDY REGISTRATION: Prospero ID: CRD42020176752., (© 2020 World Obesity Federation.)

There is accumulating evidence from observational and intervention studies in nutritional psychiatry regarding the importance of diet for mental health outcomes across the lifespan. Here, we synthesise this evidence, including findings from large meta-analyses showing cross-sectional and prospective associations between diet quality and mental health, even following adjustment for relevant confounding factors. Potential mechanistic pathways underpinning these associations include those of the gut-brain axis, demonstrated mostly in animal models. Dietary fibre is an important component of healthy diet and may be relevant for common mental disorders, with some studies showing a dose-dependent relationship between fibre intake and risk of depression. The potential contribution of nutraceuticals is also discussed, such as omega-3 fatty acids, vitamins, minerals, and psychobiotics. We consider the relevance of special diets such as the ketogenic diet and food sensitivities in the management of severe mental illness (e.g., anorexia nervosa) and brain disease (e.g., Alzheimer's disease). Given the relatively early nature of research in nutritional psychiatry, there remain a number of challenges to its translation into clinical practice. These span individual, clinical, and societal domains. We conclude with a discussion of micro- and macroeconomic factors which may be considered in the successful application of nutritional psychiatry research to improve public health., (© 2021 S. Karger AG, Basel.)

The effects of dairy and dairy-derived products on the human gut microbiota remains understudied. A systematic literature search was conducted using Medline, CINAHL, Embase, Scopus, and PubMed databases with the aim of collating evidence on the intakes of all types of dairy and their effects on the gut microbiota in adults. Risk of bias was assessed using the Cochrane risk-of-bias tool.The search resulted in 6,592 studies, of which eight randomized controlled trials (RCTs) met pre-determined eligibility criteria for inclusion, consisting of a total of 468 participants. Seven studies assessed the effect of type of dairy (milk, yogurt, and kefir) and dairy derivatives (whey and casein) on the gut microbiota, and one study assessed the effect of the quantity of dairy (high dairy vs low dairy). Three studies showed that dairy types consumed (milk, yogurt, and kefir) increased the abundance of beneficial genera Lactobacillus and Bifidobacterium . One study showed that yogurt reduced the abundance of Bacteroides fragilis , a pathogenic strain. Whey and casein isolates and the quantity of dairy consumed did not prompt changes to the gut microbiota composition. All but one study reported no changes to bacterial diversity in response to dairy interventions and one study reported reduction in bacterial diversity in response to milk intake.In conclusion, the results of this review suggest that dairy products such as milk, yogurt, and kefir may modulate the gut microbiota composition in favor to the host. However, the broader health implications of these findings remain unclear and warrant further studies.

Objective: Approximately 20% of people with Anorexia Nervosa (AN) and 10% with Bulimia Nervosa (BN) will eventually develop a long-standing illness. Although there is no set definition for Severe and Enduring eating Disorder (SE-ED), the common criteria relate to a long duration of the disorder and a number of unsuccessful treatment attempts. Research evidence for treatment of SE-ED remains limited, thus the objective of this systematic review was to describe different treatment interventions and their effects on SE-ED-related outcomes., Method: A systematic search for quantitative treatment studies of adult participants with SE-ED was conducted in June 2019 (PROSPERO, CRD42018115802) with no restriction on eating disorder type. Altogether, 2,938 studies were included for title and abstract screening., Results: After systematic searches and article screening, 23 studies (3 randomized controlled trials, 3 open-label studies, 8 naturalistic follow-up studies, 8 case series and case studies, and 1 partially blinded pilot study) were included in the analysis and data extraction. Methodological quality of the included studies was generally low. Inpatient treatment programs (n = 5) were effective in short-term symptom reduction, but long-term results were inconsistent. Outpatient and day-hospital treatment programs (n = 5) seemed promising for symptom reduction. Drug interventions (n = 5) showed some benefits, especially as adjuvant therapies. Brain stimulation (n = 6) led to improvements in depressive symptoms. Other treatments (n = 2) produced mixed results., Discussion: This is the first systematic review to examine all of the different treatment interventions that have been studied in SE-ED. The results will inform future interventions in research and clinical practice., (© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc.)

This systematic review investigated the effects of ultra-processed very low-energy diets on gut microbiota and metabolic outcomes in individuals with obesity. MEDLINE complete, EMBASE, Scopus, Cochrane and CINAHL were searched between date of inception and October 2019. Seven trials were reviewed (a total of 130 participants, with 10 to 44 participants in each trial). Of these, five were single-arm interventions and included very low-energy diets adjunctive to comprehensive lifestyle interventions such as nutritional counselling, behavioural therapy and exercise programmes. Changes to taxa within the Firmicutes phylum were found, including reduced abundance of potentially beneficial butyrogenic microbes (Roseburia, Faecalbacterium prausnitzii, Lactobacillus, Bifidobacterium and Lachnospiraeceae). Conversely, increased abundance of potentially pathogenic or opportunistic microbes from the Bacteroidetes phylum was reported, including increases in Alistipes and Bacteroides taxa. However, outcomes were inconsistent, with some trials also showing decreases in Bacteroides taxa and increases in commensal microbiota, such as Lachnospiraceae and Bifidobacteriaceae. The changes in metabolic parameters observed from baseline to after the ultra-processed very low-energy diets were mostly beneficial or were not significantly altered. Although the selected articles were deemed to have satisfactory methodological quality, to understand the possible direct effects of these regimens on gut microbiota, further rigorously designed trials, with more standardised microbiological sequencing techniques and detailed reporting, are required. Study registration: Prospero ID: CRD42019124436., (Copyright © 2020. Published by Elsevier Ltd.)

Diet quality is associated with depression risk, however the possible role of dairy products in depression risk is unclear. A number of epidemiological studies have examined associations between dairy consumption and depressive symptoms, but results have been inconsistent. Therefore, this systematic review aimed to examine whether an association exists between dairy consumption and depressive symptoms or disorders in adults. Anxiety symptoms were also explored as a secondary outcome. CINAHL, Cochrane, MEDLINE complete, EMBASE, Scopus and PsycINFO databases were searched from database inception to December 2018. Studies were included if they used a case-control, cross-sectional, or cohort study design, and included community dwelling or institutionalized adults (≥18 years). Seven prospective and six cross-sectional studies ( N  = 58,203 participants) reported on the association between dairy consumption and depressive symptoms or disorders. Findings were mixed, with one study reporting a positive association; five studies reporting no association; and seven studies reporting mixed associations depending on dairy type, gender or population group. We found conflicting and inconsistent associations in studies that were generally of fair quality. Future longitudinal and intervention studies that employ more rigorous dietary assessment methods are warranted.

Context: Saffron (Crocus sativus L.) has gained interest as a potential treatment in psychiatry., Objective: This systematic review and meta-analysis sought to investigate the effect of saffron supplementation, as both an adjunctive therapy and monotherapy, on symptoms of depression and anxiety in clinical and general populations compared with pharmacotherapy or placebo., Data Sources: Using the PRISMA guidelines, a systematic literature review of randomized controlled trials was conducted., Data Extraction: A meta-analysis was conducted to determine treatment effect. Risk of bias was assessed using the Jadad scale., Results: Twenty-three studies were included. Saffron had a large positive effect size when compared with placebo for depressive symptoms (g = 0.99, P < 0.001) and anxiety symptoms (g = 0.95, P < 0.006). Saffron also had a large positive effect size when used as an adjunct to antidepressants for depressive symptoms (g = 1.23, P = 0.028). Egger's regression test found evidence of publication bias., Conclusions: Saffron could be an effective intervention for symptoms of depression and anxiety; however, due to evidence of publication bias and lack of regional diversity, further trials are required. PROSPERO registration CRD42017070060., (© The Author(s) 2019. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Rapidly accumulating evidence supports the important role of gut microbiome in the regulation of mood, behaviour, appetite, gastrointestinal symptomology, and nutrient metabolism. These are all core features frequently altered in individuals with anorexia nervosa (AN). Current treatment recommendations for AN support the use of high-calorie diets as an essential part of nutritional rehabilitation, commonly achieved by elevating the fat content of the diet. However, in contrast to this approach, there is accumulating evidence suggesting the importance of balanced, high-fibre diets on the gut microbiome. Studies have demonstrated profound differences in the microbial composition of underweight people with AN and those of normal- or overweight individuals. Specific alterations vary widely between studies. It is thus far unclear to what extent the observed differences are brought on by iatrogenic effects of nutritional rehabilitation or the disorder itself. To date, only two studies have investigated the changes in the intestinal microbiota during nutritional rehabilitation and corresponding weight restoration. These studies suggest that the gut microbiome of AN patients was different to healthy controls both prior and following nutritional rehabilitation, though it is noted that these states were associated with lower and higher nutritional intakes, respectively. There is a clear need for further investigation regarding the effects of nutritional rehabilitation on the gut microbiome. Such research would provide insights into the potential role of gut microbiome in modulating the pathophysiology of AN and inform future treatment strategies.

Background: Previous research has reported the existence of disordered eating in students studying nutrition and dietetics. However, the occurrence of exercise addiction, previously linked to disordered eating, is poorly understood in this group., Objective: The main objective of this study was to explore the prevalence of self-reported symptoms of exercise addiction and the association with disordered eating in a sample of students studying nutrition and dietetics. A secondary objective was to compare the prevalence of exercise addiction to students enrolled in another health-related degree., Design: We conducted a cross-sectional study in 165 undergraduate students., Participants/setting: Participants were students of both sexes enrolled in nutrition and dietetics and occupational therapy degree programs at an Australian university in August 2013., Main Outcome Measures: Participants completed four validated questionnaires for assessment of exercise- and eating-related attitudes and behaviors measuring scores for exercise addiction, weekly volume of physical activity (PA), eating disorder symptoms, and cognitive restraint. Stretch stature and body mass were measured and body composition was assessed using dual energy x-ray absorptiometry., Statistical Analyses Performed: Independent t test, Mann-Whitney U test, and χ 2 test were completed to compare groups of students based on sex, degree, or eating attitudes. Spearman's correlation was performed to explore associations between continuous variables (exercise addiction scores, PA volume, and scores for eating attitudes and cognitive restraint)., Results: Approximately 23% of nutrition and dietetics students were found to be at risk of exercise addiction (20% females and 35% males; P=0.205), while the majority demonstrated some symptoms of exercise addiction. A similar proportion of at risk individuals was found in the female occupational therapy group (19%; P=1.000). In females (nutrition and dietetics and occupational therapy combined), the exercise addiction scores were associated with three other outcome measures: PA volume (r s =0.41; P<0.001), eating attitudes scores (r s =0.24; P=0.008), and cognitive restraint (r s =0.32; P<0.001). Comparative analysis indicated that female students with high cognitive restraint had greater exercise addiction scores than those with low cognitive restraint (20.3 [4.8] compared to 17.8 [4.2]; P=0.003)., Conclusions: Results suggest high prevalence of exercise addiction in this sample of undergraduate health-related degree students and its link to amount of PA and disordered eating in females. Future research should include larger samples of both sexes to build the existing understanding on these maladaptive behaviors., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Aim: The prevalence of disordered eating has been frequently reported in university students; however, the prevalence amongst Australian undergraduate students studying degrees with a focus on nutrition is uncertain. The aims of this study were to: (i) assess eating attitudes and behaviours of students enrolled in nutrition and dietetics, (ii) compare those to students enrolled in another health degree of occupational therapy (OT) and (iii) explore possible relationships between eating attitudes and behaviours and other characteristics of both cohorts., Methods: This cross-sectional observational study investigated self-reported anthropometric characteristics, eating attitudes and behaviours and self-esteem using a series of questionnaires., Results: Participants included 137 students (119 females, 18 males) with a mean age of 27.1 ± 8.7 years. Fourteen percent of nutrition and dietetics and 11% of OT students had disordered eating attitudes scores that were symptomatic of an eating disorder. Mean eating attitude scores did not differ between the degrees of study. Students in nutrition and dietetics showed significantly higher levels of cognitive restraint and less emotional eating than OT students. Enrolment in the first year of study was the strongest predictor of symptomatic eating attitudes., Conclusions: These findings support previously expressed concern about presence of disordered eating in nutrition and dietetics undergraduates. Collaboratively developed support mechanisms for preventing and managing disordered relationships with food would be of benefit to students enrolled in nutrition degrees to ensure ongoing professional integrity., (© 2016 Dietitians Association of Australia.)

The aim of this research was to explore the relationship of total energy and macronutrient intake, energy balance and energy availability to eating attitudes and cognitive restraint in students enrolled in undergraduate nutrition degrees. Energy and micronutrient intake was assessed in 63 students (n = 50 nutrition, and n = 13 occupation therapy degrees; n = 51 females, n = 12 males) using three 24-h dietary recalls. Energy requirements were calculated based on measured resting metabolic rate, estimated exercise energy expenditure, and dietary induced thermogenesis. Body composition was assessed using dual energy x-ray absorptiometry. Eating attitudes and cognitive restraint were measured using previously validated tools. Eighteen percent of nutrition students were classified as having low energy availability (<30 kcal kgFFM -1 d -1 ) and 38% were in negative energy balance. Eating attitudes and cognitive restraint were not associated with total energy or macronutrient intake. However, female nutrition students with high cognitive restraint had greater exercise energy expenditure and thus lower energy availability than those with low cognitive restraint (371 (302) kcal d -1 compared to 145 (206) kcal d -1 , P < 0.01, and 35 (7) kcal d -1 compared to 41 (10) kcal d -1 of fat free mass, P = 0.005). Additionally, in females, disordered eating attitudes and cognitive restraint negatively correlated with energy availability (r s  = -0.37, P = 0.02 and r s  = -0.51, P < 0.01 respectively). There were no differences in outcomes between nutrition and non-nutrition students. The current study suggests that those students with disordered eating attitudes and cognitive restraint may be controlling their energy balance through exercise, as opposed to restricting food intake., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population., (Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)