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Early 'Junk Food' Exposure Risks Kids' Mental Health
Medscape Psychiatry & Mental Health
Dr. Felice Jacka
Aug 20, 2013

Along with the myriad negative effects on physical health, "junk food" during pregnancy and in early childhood is
linked to a significantly increased risk for poor mental health, including anxiety and depression, in very young
children, new research shows.

A large, prospective study by investigators at Deakin University in Melbourne, Australia, showed that higher intakes of
unhealthy food during pregnancy, as well as a lack of healthy food in children during the first years of life, were linked
to higher levels of behavioral and emotional problems.

"This study comes from the largest cohort study in the world and is the first to suggest that poor diet in both pregnant
women and their children is a risk factor for children's mental health problems," principal investigator Felice Jacka,
PhD, told Medscape Medical News in an email.

The study was published online August 17 in the Journal of the American Academy of Child and Adolescent Psychiatry.

Food and Mood Link
Several studies by Dr. Jacka and colleagues, as well as other research groups, have demonstrated a clear link between mood and food. One of Dr. Jacka's most recent studies, published in September 2011 in PLoS One and reported by Medscape Medical News at that time, showed that diet quality has a significant effect on mental health outcomes and may play a role in the prevention and treatment of common psychiatric disorders such as depression and anxiety in teens.

Other studies have shown similar associations between diet quality and mental health in adults. However, the researchers point out that the impact of maternal and early postnatal nutritional exposures on children's subsequent mental health has not been explored.

The current study included 23,020 women and their children who were participants in the Norwegian Mother and Child Cohort Study (MoBa). Data were derived from self-report questionnaires sent to mothers at 17 weeks' pregnancy and in later pregnancy and at intervals after birth when children were aged 6 months, 1.5 years, 3 years, and 5 years. A 225-item food frequency questionnaire (FFQ) developed specifically to assess maternal diet in the study was employed. It is designed to capture dietary habits and intake of dietary supplements during the first 4 to 5 months of pregnancy.

On the basis of these data, women were categorized into 2 major dietary patterns ? a "healthy" pattern, characterized by high intake of vegetables, fruit, high-fiber cereals, and vegetable oils, and an "unhealthy" pattern, characterized by a high intake of processed meat
products, refined cereals, sweet drinks, and salty snacks.

The children's diet was assessed using a 36-item FFQ comprising dietary items on types of foods and drinks such as dairy products, cereal-based porridge, and fruit juice.

The researchers used a short form of the Child Behavior Checklist to assess internalizing problems, including anxiety and depression, and externalizing behaviors, such as attentiondeficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

Novel Data
The researchers found that women who ate more unhealthy foods were significantly more likely to have children with more behavioral problems, such as tantrums and aggression.

The results also showed that children who ate more unhealthy foods in early life or who did not eat sufficient amounts of nutrient-rich foods during the first years of life exhibited more of these "externalizing" behaviors as well as increased "internalizing" behaviors, indicative of depression and anxiety.

"In this study, we report highly novel data suggesting that maternal and early postnatal dietary factors play a role in the subsequent risk for behavioral and emotional problems in children.

"Both an increased intake of unhealthy foods and a decreased intake of nutrient-rich foods in early childhood were independently related to higher internalizing and externalizing behaviors in young children. These behaviors are established early markers for later mental health problems," the researchers write.

"We've known for some time that very early life nutrition, including the nutrition received while the child is in utero, is related to physical health outcomes in children ? their risk for later heart disease or diabetes, for example. But this is the first study indicating that diet may also be important to mental health outcomes in children," Dr. Jacka said in a statement.

Dr. Jacka also noted that the average age of onset for anxiety disorders is only 6 years; for depression, it is 13 years. As such, she said, these findings have "profound" public health implications, particularly with respect to the fast-food industry.

The study was funded by the Brain and Behavior Research Foundation.

J Am Acad Child Adolesc Psychiatry. Published online August 17, 2013. Abstract


Fast-food and commercial baked goods consumption and the risk of depression
Mew\dscape Psychiatry & Mental Health
Dr. Almudena S?nchez-Villegas
Dr. Felice Jacka
April 25, 2012

Junk Food Linked to Depression? Eating too much junk food may increase risk for depression, a large study suggests.

In a cohort study of almost 9000 adults in Spain, those who consistently consumed "fast food," such as hamburgers and pizza, were 40% more likely to develop depression than the participants who consumed little to none of these types of food. In addition, investigators found that the depression risk rose steadily as more fast food was consumed.

Participants who often ate commercial baked goods, such as croissants and doughnuts, were also at significant risk of developing this disorder.

"We were not surprised with the results. Several studies have analyzed the association between fast food and commercial bakery consumption and physical diseases, such as obesity or coronary heart disease," Almudena S?nchez-Villegas, PhD, from the Department of Clinical Sciences at the University of Las Palmas de Gran Canaria and the Department of Preventive Medicine and Public Health at the University of Navarra in Pamplona, Spain, told Medscape Medical News.

"With these results, a relatively new line of research is open. Limiting trans fatty acids content in several foods, avoiding the consumption of fast food and bakery, and increasing the consumption of other products such as vegetables, legumes, and fruits should be a primary goal for clinicians and public health makers," she added.

The study is published in the March issue of Public Health Nutrition.

Croissants, Doughnuts, and Muffins, Oh My!
According to the investigators, depression affects around 121 million people throughout the world.

Although "little is known about the role of diet in the development of depressive disorders," past studies have suggested that olive oil, B vitamins, and omega-3 fatty acids may play a preventative role, write the researchers.

As reported by Medscape Medical News, Dr. S?nchez-Villegas and colleagues published a study last year in PLoS One that linked consumption of trans unsaturated fatty acids (TFA) to a significantly increased risk for depression.

For the current study, they sought to specifically examine the role that consumption of fast food and processed food may play in the development of this disorder.

The researchers examined data on 8964 adults from the Seguimiento Universidad de Navarra (SUN) Project, an ongoing diet and lifestyle tracking study that started in 1999. None of the SUN participants had been diagnosed with depression or had taken antidepressants before the start of the study.

Exposures and outcomes were gathered through surveys mailed out biennially to the participants. A food frequency questionnaire was used to assess dietary intake. Fast food consumption was defined as total consumption of hamburgers, pizza, and hot dogs/sausages. Commercial baked goods consumption was defined as total consumption of croissants, doughnuts, and muffins.

Incident depression and/or self-reported physician-made diagnosis of depression, antidepressant use, and demographic and lifestyle data were recorded on other questionnaires.

Curb the Junk Food
Results showed that 493 of the participants were diagnosed with depression after a median follow-up of 6.2 years.

Those who were found to have the highest levels of consumption of fast food showed a significantly higher risk of developing depression compared with those who had the lowest levels of consumption (adjusted hazard ratio
, 1.40; 95% confidence interval [CI], 1.05 - 1.86; P = .01).

"Moreover, a significant dose-response relationship was found (P for trend = .001)," report the researchers.

However, the researchers note that even small quantities of fast food were linked to a significantly higher risk for depression.

Participants who often consumed commercial baked goods were also at increased risk of developing this disorder (adjusted HR, 1.43; 95% CI, 1.06 - 1.93).

The investigators also found that the study participants with the highest consumption of fast food and of commercial baked goods were more likely to be single, less active, smoke, work more than 45 hours per week, and eat less fruits, vegetables, nuts, fish, and/or olive oil.

"Although more studies are necessary, the intake of this type of food should be controlled because of its implications on both health (obesity, cardiovascular disease) and mental well-being," said Dr. S?nchez-Villegas.

The researchers add that the legally permitted content of TFA in these foods "should be reviewed."

Dietary Assessment "Prudent"
"This Spanish team conducted very good, quality research and took considerable care to consider multiple possible causes of confounding, such as other factors that may explain both dietary habits and risk for depression," Felice Jacka, PhD, research fellow at Deakin University in Melbourne, Australia, told Medscape Medical News.

"For example, they take into account many variables that may be proxies of health consciousness or overall health lifestyle, such as the use of seat belts, frequency of medical and dental checkups, and drunk driving, as well as marital status, smoking, alcohol consumption, and intake of nutrient-dense foods. The study sample is also large and well described, and the prospective cohort design affords the potential for investigating cause-effect relationships," she added.

Dr. Jacka noted that the results support a previous study that she and her colleagues published recently in the American Journal of Psychiatry, which showed that women who consumed a diet higher in unhealthy and processed food were likely to be depressed. In a study published in the Australian and New Zealand Journal of Psychiatry, they reported the same results in a cohort of adolescents.

The results of the current study "are also concordant with the two prospective studies in this field, in both adults and adolescents, reporting that unhealthy diets are associated with an increased risk for mental health problems over time," she reported.

She added that although this study was rigorously conducted and is methodologically sound, "it is perhaps a shame that [it] does not have data on diagnoses of depression ascertained via clinical assessments. However, this is rare in large epidemiological studies, and the measures they have used have been shown to be valid."

Dr. Jacka noted that because diet and mental health research is relatively new, it is often uncommon for clinicians to consider diet as an intervention target in clinical care.

"However, this study adds to the rapidly growing and highly consistent body of literature suggesting that depression is another common, noncommunicable illness with a significant lifestyle component," she said.

"As such, it is prudent for clinicians to assess and address the dietary as well as exercise habits of their patients, in addition to pharmacological and other established treatments."

The study was supported by the Spanish Government Instituto de Salud Carlos III, Fondo de Investigaticiones Sanitarias, and the Navarra Regional Government.

Public Health Nutr. 2012;15:424-432. Abstract

Full :acrobat: article attached


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Stop The Pop: Soda Linked to Aggression and Inattention in Kids
Medscape Psychiatry and Medical News
Aug 22, 2013

Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds

Consumption of even 1 soft drink per day may be associated with increased negative behavior in young children, new research suggests.

A cohort study of almost 3000 5-year-olds showed that those who drank 1 to 4 servings of soda per day had significantly higher aggressive measurement scores than their peers who drank no soda.

In addition, those who consumed 2 or more servings had higher withdrawn behavior scores, and those who consumed 4 or more servings had higher attention problem scores.

"We were seeing a dose-response effect. So with every increase in soda consumption, the association and the scores basically increased," lead author Shakira Suglia, ScD, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, told Medscape Medical News.

"This held up even after we adjusted for candy or fruit juice consumption and for a variety of social factors, especially for aggression with the highest level of soda consumption," she added.

Although the investigators suggest that "future studies should explore potential mechanisms" that might explain these association, Dr. Suglia noted that past research has shown that even 1 soda per day is too many for young children.

"Certainly water or milk is more nutritious and a better alternative. Our advice is consistent with what is already out there: for the very young kids, any soda is not a healthy option. And even for adolescents, I think parents should really limit the amount of soda their kids are drinking."

The study was published online August 15 in the Journal of Pediatrics.

World's Biggest Soda Consumers
According to the researchers, more soda per capita is sold in the United States than in any other country.

Although past research has suggested an association between soft drink consumption and aggression, depression, and suicidal thoughts in adolescents, the current investigators sought to examine possible links between sodas and negative behaviors in young children.

The ongoing Fragile Families and Child Wellbeing Study was created to assess 4849 pregnant women from 20 cities in the United States at delivery. Follow-up interviews were conducted starting when their children were approximately 2 years of age.

For this analysis, the investigators evaluated data on 2929 of these children (52% boys; 51% black, 28% Hispanic/other, 21% white).

When the children were 5 years of age, their mothers filled out the Child Behavior Checklist (CBCL) and reported approximate servings of daily soda consumed, up to "4 or more."

The mothers were also asked about the consumption of candy/sweets and fruit juice, television viewing habits, social risk factors (including maternal depression and intimate partner violence), and sociodemographic factors.

Results showed that 43% of the children drank at least 1 serving of soda per day, with 4% of the participants drinking 4 or more servings per day.

Unadjusted analysis showed that higher levels of soda consumption were associated with significantly higher overall aggression scores, as well as higher scores on the withdrawal and attention subscales of the CBCL (all, P < .05).

After adjusting for sociodemographic factors, results showed that the participants who drank at least 1 soda per day had a 0.74-point higher mean aggressive behavior score (95% confidence interval [CI], 0.1 - 1.4) than those who drank no soda (P < .05).

Consuming 2, 3, or 4 or more servings was associated with even higher mean aggression scores of 1.8, 2.0, and 4.7, respectively (all, P < .05).

Those who drank 4 or more daily servings also had higher mean scores on the attention problems (1.7; 95% CI, 1.0 - 2.4) and withdrawn behavior (2.0; 95% CI, 0.8 - 3.1) subscales (both, P < .05).

Adjusting for consumption of candy/sweets or fruit juice, television viewing, probable maternal depression, intimate partner violence, paternal incarceration, and obesity in separate analysis of 1868 of the participants still showed an association between high levels of soda consumption and negative behaviors.

Those who consumed 4 or more daily servings of soft drinks had fully adjusted mean scores of 2.62, 1.75, and 0.88 on the aggression, attention problems, and withdrawal subscales compared with those who consumed no soda.

Are All Sodas Equal?
Further analyses showed that the children who consumed the highest levels of soda were more than twice as likely to destroy others' belongings (odds ratio [OR], 2.54), physically attack people (OR, 2.28), or get into fights (OR, 2.12).

"In this large sample of 5-year-old urban US children, we found strong and consistent relationships between soda consumption and a range of problem behaviors, consistent with the findings of previous studies in adolescents," write the investigators.

However, future studies "in other populations of children and of a longitudinal nature may provide further insight into the relationship between soda consumption and child behavior," they add.

When asked, Dr. Suglia reported that the study did not ask about the specific types of soda consumed, such as whether they included diet or noncaffeinated drinks.

"So it would be interesting in the future to try to parse out whether the findings are specific to a certain ingredient that we should be focusing on, such as caffeine or sugar, or is it just overall diet or lack of something they should be consuming? More specific data could be helpful," she said.

Full :acrobat: article attached.


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