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Role of Branched and Aromatic Amino Acids, Diet Inflammatory Index, and Anthropometric Indices on Mental Health
Abstract
Background: Mental health disorders are one of the most important and increasing health problems in the youth of today’s societies. Some dietary intake and body mass status are factors that affect mental health. This study aimed to investigate the relationship between the intake of branched‑chain amino acids (BCAAs) and aromatic amino acids (AAAs) and anthropometric and dietary inflammatory indices with mental health, including depression, anxiety, and stress. Methods: In this case‑control study, the data of 138 teenage girls aged 13–18 years were collected. Three‑day 24‑hour food recall and standard anthropometric methods were used to calculate the dietary inflammation intake score of normal and energy‑adjusted diets. Mental health disorders were diagnosed by the DASS‑21 questionnaire. Statistical analysis used Student’s t‑test, correlation, and multiple regression were used to analyze the data based on the study’s statistical requirements. Results: Based on the findings, 59 (42%) of the girls had mental disorders, and 79 (58%) were healthy. The average weight of stressed people was significantly higher than that of healthy people, and the BMI of anxious people was significantly higher than that of nonanxious people (P < 0.05). A significant positive correlation was found between stress and weight and energy intake. Additionally, there was a significant negative correlation between BCAAs and mental health. The average intake of BCAAs was significantly lower in patients (P = 0.01). The trend analysis showed significantly lower BCAA levels among the 4th quartile of mental disorders. No significant relationship was observed between DII, AAA, and anthropometric indices. After adjustment of the results, no relationship was observed between mental health and the studied factors. Conclusions: BCAA might be related to mental health. Further studies in different age and sex groups are highly recommended.
International Journal of Preventive Medicine 15():23, April 2024. | DOI: 10.4103/ijpvm.ijpvm_59_23
Corresponding Author: Dr. Ariyo Movahedi
E‑mail:amm35@mail.aub.edu
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Durisko Z, Mulsant BH, Andrews PW. An adaptationist
perspective on the etiology of depression. J Affect Disord
;172:315‑23.
Emami H, Ghazinour M, Rezaeishiraz H, Richter J. Mental health
of adolescents in Tehran, Iran. J Adolesc Heal 2007;41:571‑6.
Al‑Amer RM, Sobeh MM, Zayed AA, Al‑Domi HA. Depression
among adults with diabetes in Jordan: Risk factors and
relationship to blood sugar control. J Diabetes Complications
;25:247‑52.
Leaf PJ, Alegria M, Cohen P, Goodman SH, Horwitz SM,
Hoven CW, et al. Mental health service use in the community
and schools: Results from the four‑community MECA study.
J Am Acad Child Adolesc Psychiatry 1996;35:889‑97.
Murphy JM, Monson RR, Laird NM, Sobol AM, Leighton AH.
Studying the incidence of depression: An ‘interval’effect. Int J
Methods Psychiatr Res 2000;9:184‑93.
Allen NB, Hetrick SE, Simmons JG, Hickie IB. Early intervention
for depressive disorders in young people: The opportunity and
the (lack of) evidence. Med J Aust 2007;187:S15‑7.
Sajjadi H, Mohaqeqi Kamal SH, Rafiey H, Vameghi M,
Forouzan AS, Rezaei M. A systematic review of the prevalence
and risk factors of depression among Iranian adolescents. Glob J
Health Sci 2013;5:16‑27.
Thomas CM, Morris S. Cost of depression among adults in
England in 2000. Br J Psychiatry 2003;183:514‑9.
Casagrande SS, Anderson CAM, Dalcin A, Appel LJ, Jerome GJ,
Dickerson FB, et al. Dietary intake of adults with serious mental
illness. Psychiatr Rehabil J 2011;35:137‑40.
Lakhan SE, Vieira KF. Nutritional therapies for mental disorders.
Nutr J 2008;7:2.
Lu J, Xie G, Jia W, Jia W. Insulin resistance and the metabolism
of branched-chain amino acids. Frontiers of Medicine in China.
Springer; 2013;7:53-9.
Huffman KM, Shah SH, Stevens RD, Bain JR, Muehlbauer M,
Slentz CA, et al. Relationships between circulating metabolic
intermediates and insulin action in overweight to obese, inactive
men and women. Diabetes Care 2009;32:1678‑83.
Cheng S, Rhee EP, Larson MG, Lewis GD, McCabe EL,
Shen D, et al. Metabolite profiling identifies pathways associated
with metabolic risk in humans. Circulation 2012;125:2222‑31.
Tai ES, Tan MLS, Stevens RD, Low YL, Muehlbauer MJ,
Goh DLM, et al. Insulin resistance is associated with a metabolic
profile of altered protein metabolism in Chinese and Asian‑Indian
men. Diabetologia 2010;53:757‑67.
Würtz P, Mäkinen V‑P, Soininen P, Kangas AJ, Tukiainen T,
Kettunen J, et al. Metabolic signatures of insulin resistance in
,098 young adults. Diabetes 2012;61:1372‑80.
Baranyi A, Amouzadeh-Ghadikolai O, von Lewinski D,
Rothenhäusler H-B, Theokas S, Robier C, et al. BranchedChain Amino Acids as New Biomarkers of Major Depression A Novel Neurobiology of Mood Disorder. PLoS One [Internet].
;11:e0160542. Available from: http://www.ncbi.nlm.nih.gov/
pubmed/27490818
Coppola A, Wenner BR, Ilkayeva O, Stevens RD,
Maggioni M, Slotkin TA, et al. Branched‑chain amino acids
alter neurobehavioral function in rats. AJP Endocrinol Metab
;304:E405‑13.
Markus CR. Dietary amino acids and brain serotonin function;
Implications for stress‑related affective changes. Neuro
Molecular Med 2008;10:247‑58.
Estil S, Haaskjold E, Bjerknes R, Refsum SB. Early cell kinetic
effects of some drugs on the rat corneal and conjunctival
epithelia. Acta Ophthalmol 1995;73:496‑500.
Rienks J, Dobson AJ, Mishra GD. Mediterranean dietary
pattern and prevalence and incidence of depressive symptoms
in mid‑aged women: Results from a large community‑based
prospective study. Eur J Clin Nutr 2013;67:75.
Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M,
Singh‑Manoux A. Dietary pattern and depressive symptoms in
middle age. Br J Psychiatry 2009;195:408‑13.
Phillips CM, Shivappa N, Hébert JR, Perry IJ. Dietary
inflammatory index and mental health: A cross‑sectional analysis
of the relationship with depressive symptoms, anxiety and
well‑being in adults. Clin Nutr 2018;37:1485‑91.
Le Port A, Gueguen A, Kesse‑Guyot E, Melchior M,
Lemogne C, Nabi H, et al. Association between dietary patterns
and depressive symptoms over time: A 10‑year follow‑up study
of the GAZEL cohort. PLoS One 2012;7:e51593. doi: 10.1371/
journal.pone. 0051593.
Lucas M, Chocano-Bedoya P, Shulze MB, Mirzaei F, O’Reilly
ÉJ, Okereke OI, et al. Inflammatory dietary pattern and risk of
depression among women. Brain Behav Immun. 2014;36:46-53.
Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett
WC, et al. Association between dietary patterns and plasma
biomarkers of obesity and cardiovascular disease risk. Am J Clin
Nutr 2001;73:61–7.
Au B, Smith KJ, Gariépy G, Schmitz N. C‑reactive protein,
depressive symptoms, and risk of diabetes: Results from the
English longitudinal study of aging (ELSA). J Psychosom Res
;77:180‑6.
Huang Y, Su Y, Chen H, Liu H, Hu J. Serum Levels of CRP
are Associated with Depression in a Middle-aged and Elderly
Population with Diabetes Mellitus: A Diabetes Mellitus-Stratified
Analysis in a Population-Based Study. J Affect Disord [Internet].
;281:351–7.
Orsolini L, Pompili S, Tempia Valenta S, Salvi V, Volpe U.
C-Reactive Protein as a Biomarker for Major Depressive
Disorder? Int J Mol Sci [Internet]. 2022;23. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/35163538
Bădescu S V, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, et al. The association between Diabetes mellitus
and Depression. J Med Life [Internet] 2016;9:120-5.
Hood KK, Lawrence JM, Anderson A, Bell R, Dabelea D,
Daniels S, et al. Metabolic and inflammatory links to depression
in youth with diabetes. Diabetes Care 2012;35:2443‑6.
Doyle TA, de Groot M, Harris T, Schwartz F, Strotmeyer ES,
Johnson KC, et al. Diabetes, depressive symptoms, and
inflammation in older adults: Results from the Health, Aging,
and Body Composition Study. J Psychosom Res 2013;75:419-24.
Flehmig G, Scholz M, Klöting N, Fasshauer M, Tönjes A,
Stumvoll M, et al. Identification of adipokine clusters related
to parameters of fat mass, insulin sensitivity and inflammation.
PLoS One. 2014;9:e99785. doi: 10.1371/journal.pone. 0099785.
Anderson G, Berk M, Dean O, Moylan S, Maes M. Role of
immune‑inflammatory and oxidative and nitrosative stress
pathways in the etiology of depression: Therapeutic implications.
CNS Drugs 2014;28:1‑10. doi: 10.1007/s40263‑013‑0119‑1.
Marmorstein NR, Iacono WG, Legrand L. Obesity and
depression in adolescence and beyond: Reciprocal risks. Int J
Obes 2014;38:906‑11.
Shivappa N, Hébert JR, Rietzschel ER, De Buyzere ML,
Langlois M, Debruyne E, et al. Associations between dietary
inflammatory index and inflammatory markers in the Asklepios
Study. Br J Nutr 2015;113:665‑71.
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible
statistical power analysis program for the social, behavioral, and
biomedical sciences. Behav Res Methods [Internet] 2007;39:17591.
Tate RF. Correlation Between a Discrete and a Continuous
Variable. Point-Biserial Correlation. Ann Math Stat 2019;25:6037.
Gatsonis C, Sampson AR. Multiple correlation: exact power and
sample size calculations. Psychol Bull 1989;106:516-24.
Armborst D, Metzner C, Alteheld B, Bitterlich N, Rösler
D, Siener R. Impact of a specific amino acid composition
with micronutrients on well‑being in subjects with chronic
psychological stress and exhaustion conditions: A pilot study.
Nutrients 2018;10:551. doi: 10.3390/nu10050551.
Sahebi A, Asghari MJ, Salari RS. Validation of depression
anxiety and stress scale (DASS‑21) for an Iranian population.
J Iran Psychol 2005;1:299‑316.
Madani Z, Moussavi Javardi M, Karandish M, Movahedi A.
Promoting and updating food frequency questionnaire tool to
measure food consumption and nutrient intake analysis. Int J
Prev Med 2021;12:165.
United States Department of Health and Human Services.
Recommendations on potential approaches to dietary assessment
for different research objectives requiring group-level estimates
[Internet]. Cancer.gov. 2020. p. 1–5. Available from: https://
dietassessmentprimer.cancer.gov/approach/table.html [Last
accessed on 2022 Feb 10].
Hébert JR, Shivappa N, Wirth MD, Hussey JR, Hurley TG.
Perspective: The dietary inflammatory index (DII)—Lessons
learned, improvements made, and future directions. Adv Nutr
;10:185‑95.
West RM. Best practice in statistics: Use the Welch t test when
testing the difference between two groups. Ann Clin Biochem
;58:267‑9.
Kim H‑Y. Statistical notes for clinical researchers: Post hoc
multiple comparisons. Restor Dent Endod 2015;40:172‑6.
Ahmadi N, Farahzadi MH, Mohammadi MR, Mostafavi S‑A,
Moeeini SS, Shahvazian N, et al. Relationship between anxiety
disorders and anthropometric indices, risk factors, and symptoms
of cardiovascular disorder in children and adolescents.
Iran J Psychiatry 2021;16:409‑17.
Gariepy G, Nitka D, Schmitz N. The association between obesity
and anxiety disorders in the population: A systematic review and
meta‑analysis. Int J Obes 2010;34:407‑19.
Moghimi‑dehkordi B, Safaee A, Vahedi M, Amin M. Association
between perceived depression, anxiety and stress with Body
Mass Index : Results from a community‑based cross‑sectional
survey in Iran. Ital J Public Health 2011;8:128‑36.
Askari J, Hassanbeigi A, Khosravi HM, Malek M, Hassanbeigi D,
Pourmovahed Z, et al. The relationship between obesity and
depression. Procedia‑Soc Behav Sci 2013;84:796‑800.
Jari M, Qorbani M, Motlagh ME, Heshmat R, Ardalan G,
Kelishadi R. Association of overweight and obesity with mental
distress in Iranian adolescents: The CASPIAN‑III study. Int J
Prev Med 2014;5:256‑61.
Ho RCM, Niti M, Kua EH, Ng T-P. Body mass index, waist
circumference, waist–hip ratio and depressive symptoms
in Chinese elderly: a population-based study. Int J Geriatr
Psychiatry [Internet]. 2008;23:401-8.
Zhao G, Ford ES, Li C, Tsai J, Dhingra S, Balluz LS. Waist
circumference, abdominal obesity, and depression among
overweight and obese U.S. adults: National health and nutrition
examination survey 2005‑2006. BMC Psychiatry 2011;11:130.
doi: 10.1186/1471‑244X‑11‑130.
Zhang J. The bidirectional relationship between body weight and
depression across gender: A simultaneous equation approach.
Int J Environ Res Public Health 2021;18:7673. doi: 10.3390/
ijerph 18147673
Fowler‑Brown AG, Ngo LH, Wee CC. The relationship between
symptoms of depression and body weight in younger adults.
Obesity (Silver Spring) 2012;20:1922‑8.
Oh J, Yun K, Chae J‑H, Kim T‑S. Association between
macronutrients intake and depression in the United States and
South Korea. Front Psychiatry 2020;11:207. doi: 10.3389/fpsyt.
00207
Maddahi NS, Yarizadeh H, Setayesh L, Nasir Y, Alizadeh S,
Mirzaei K. Association between dietary energy density with
mental health and sleep quality in women with overweight/
obesity. BMC Res Notes 2020;13:189.
Haghighian Roudsari A, Vedadhir A, Amiri P, Kalantari N,
Omidvar N, Eini‑Zinab H, et al. Psycho‑socio‑cultural
determinants of food choice: A qualitative study on adults in social
and cultural context of Iran. Iran J Psychiatry 2017;12:241‑50.
Talegawkar SA, Kandula NR, Gadgil MD, Desai D, Kanaya AM.
Dietary intakes among South Asian adults differ by length of
residence in the USA. Public Health Nutr 2016;19:348‑55.
Koochakpoor G, Salari‑Moghaddam A, Keshteli AH, Afshar H,
Esmaillzadeh A, Adibi P. Dietary intake of branched‑chain
amino acids in relation to depression, anxiety and psychological
distress. Nutr J 2021;20:11.
Correia AS, Vale N. Tryptophan Metabolism in Depression: A
Narrative Review with a Focus on Serotonin and Kynurenine
Pathways. Int J Mol Sci [Internet] 2022;238493. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/35955633
Nasrallah P, Haidar EA, Stephan JS, El Hayek L, Karnib N,
Khalifeh M, et al. Branched‑chain amino acids mediate resilience
to chronic social defeat stress by activating BDNF/TRKB
signaling. Neurobiol Stress 2019;11:100170. doi: 10.1016/j.ynstr.
100170.
Anderson SE, Cohen P, Naumova EN, Must A. Association
of depression and anxiety disorders with weight change in a
prospective community‑based study of children followed up into adulthood. Arch Pediatr Adolesc Med 2006;160:285‑91.
Aquilani R, Boselli M, Boschi F, Viglio S, Iadarola P,
Dossena M, et al. Branched‑chain amino acids may improve
recovery from a vegetative or minimally conscious state in
patients with traumatic brain injury: A pilot study. Arch Phys
Med Rehabil 2008;89:1642‑7.
Lucca A, Lucini V, Catalano M, Alfano M, Smeraldi E.
Plasma tryptophan to large neutral amino acids ratio and
therapeutic response to a selective serotonin uptake inhibitor.
Neuropsychobiology 1994;29:108‑11.
Wichers MC, Koek GH, Robaeys G, Verkerk R, Scharpé S,
Maes M. IDO and interferon‑alpha‑induced depressive symptoms:
A shift in hypothesis from tryptophan depletion to neurotoxicity.
Mol Psychiatry 2005;10:538‑44.
Bjerkeset O, Romundstad P, Evans J, Gunnell D. Association
of adult body mass index and height with anxiety, depression,
and suicide in the general population: The HUNT study. Am J
Epidemiol 2008;167:193-202.
Rees DI, Sabia JJ, Argys LM. A head above the rest: height and
adolescent psychological well-being. Econ Hum Biol [Internet].
;7:217–28.
Kouvonen A, Kivimäki M, Cox SJ, Cox T, Vahtera J.
Relationship between work stress and body mass index among
,810 female and male employees. Psychosom Med [Internet].
;67:577–83.
Heath G, Dorrian J, Coates A. Associations between shift type,
sleep, mood, and diet in a group of shift working nurses. Scand J
Work Environ Health [Internet]. 2019;45:402–12.
Torres SJ, Nowson CA. Relationship between stress, eating
behavior, and obesity. Nutrition [Internet]. 2007;23:887–94.
Oliver G, Wardle J, Gibson EL. Stress and food choice: a
laboratory study. Psychosom Med [Internet]. 2000;62:853-65.
Mikolajczyk RT, El Ansari W, Maxwell AE. Food consumption
frequency and perceived stress and depressive symptoms
among students in three European countries. Nutr J [Internet].
;8:31.
Ng DM, Jeffery RW. Relationships between perceived stress and
health behaviors in a sample of working adults. Health Psychol
[Internet]. 2003;22:638-42.
O’Connor DB, Jones F, Conner M, McMillan B, Ferguson E.
Effects of daily hassles and eating style on eating behavior.
Health Psychol [Internet]. 2008;27(1S):S20-31.
Singh A, Trumpff C, Genkinger J, Davis A, Spann M, Werner
E, et al. Micronutrient Dietary Intake in Latina Pregnant
Adolescents and Its Association with Level of Depression,
Stress, and Social Support. Nutrients [Internet]. 2017;9:1212.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/29113038
Takeda E, Terao J, Nakaya Y, Miyamoto K, Baba Y, Chuman H,
et al. Stress control and human nutrition. J Med Invest [Internet].
;51:139-45.
Prentice AM, Jebb SA. Fast foods, energy density and obesity: a
possible mechanistic link. Obes Rev [Internet]. 2003;4:187-94.
Tseng M, Fang CY. Stress is associated with unfavorable patterns
of dietary intake among female chinese immigrants. Ann Behav
Med [Internet]. 2011;41:324-32.
Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora
D, et al. Food selection changes under stress. Physiol Behav
[Internet]. 2006;87:789-93.
Serlachius A, Hamer M, Wardle J. Stress and weight change
in university students in the United Kingdom. Physiol Behav
[Internet]. 2007;92:548-53.
Habhab S, Sheldon JP, Loeb RC. The relationship between
stress, dietary restraint, and food preferences in women. Appetite
[Internet]. 2009;52:437-44.
Masana MF, Tyrovolas S, Kolia N, Chrysohoou C, Skoumas J,
Haro JM, et al. Dietary Patterns and Their Association with
Anxiety Symptoms among Older Adults: The ATTICA Study.
Nutrients [Internet]. 2019;11;125. Available from: http://www.
ncbi.nlm.nih.gov/pubmed/31159322
Lassale C, Castetbon K, Laporte F, Deschamps V, Vernay M,
Camilleri GM, et al. Correlations between Fruit, Vegetables,
Fish, Vitamins, and Fatty Acids Estimated by Web-Based
Nonconsecutive Dietary Records and Respective Biomarkers of
Nutritional Status. J Acad Nutr Diet [Internet]. 2016;116:427-38.
e5.
Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker
PM. Relation between a diet with a high glycemic load and
plasma concentrations of high-sensitivity C-reactive protein in
middle-aged women. Am J Clin Nutr [Internet]. 2002;75:492-8.
Strandwitz P. Neurotransmitter modulation by the gut microbiota.
Brain Res [Internet]. 2018;1693(Pt B):128-33.
Wang J, Zhou Y, Chen K, Jing Y, He J, Sun H, et al. Dietary
inflammatory index and depression: a meta-analysis. Public
Health Nutr [Internet]. 2018;22:1-7.
Haghighatdoost F, Feizi A, Esmaillzadeh A, Feinle-Bisset C,
Keshteli AH, Afshar H, et al. Association between the dietary
inflammatory index and common mental health disorders profile
scores. Clin Nutr [Internet]. 2019;38:1643-50.
Phillips CM, Shivappa N, Hébert JR, Perry IJ. Dietary
Inflammatory Index and Biomarkers of Lipoprotein Metabolism,
Inflammation and Glucose Homeostasis in Adults. Nutrients
[Internet]. 2018;10;1033. Available from: http://www.ncbi.nlm.
nih.gov/pubmed/30096775
Bergmans RS, Malecki KM. The association of dietary
inflammatory potential with depression and mental well-being
among U.S. adults. Prev Med (Baltim) [Internet]. 2017;99:313-9.
Adjibade M, Andreeva VA, Lemogne C, Touvier M, Shivappa
N, Hébert JR, et al. The Inflammatory Potential of the Diet Is
Associated with Depressive Symptoms in Different Subgroups of
the General Population. J Nutr [Internet]. 2017;147:879-87.
Michopoulos V, Powers A, Gillespie CF, Ressler KJ, Jovanovic
T. Inflammation in Fear- and Anxiety-Based Disorders: PTSD,
GAD, and Beyond. Neuropsychopharmacology [Internet].
;42:254-70.
Goodwin GM. The overlap between anxiety, depression,
and obsessive-compulsive disorder. Dialogues Clin Neurosci
[Internet]. 2015;17:249-60.
Almeida-de-Souza J, Santos R, Barros R, Abreu S, Moreira C,
Lopes L, et al. Dietary inflammatory index and inflammatory
biomarkers in adolescents from LabMed physical activity study.
Eur J Clin Nutr [Internet]. 2018;72:710-9.
Miller AH, Maletic V, Raison CL. Inflammation and its
discontents: the role of cytokines in the pathophysiology of
major depression. Biol Psychiatry [Internet]. 2009;65:732-41.
Abshirini M, Siassi F, Koohdani F, Qorbani M, Mozaffari H,
Aslani Z, et al. Dietary total antioxidant capacity is inversely
associated with depression, anxiety and some oxidative stress
biomarkers in postmenopausal women: a cross-sectional study.
Ann Gen Psychiatry [Internet]. 2019;18:3.
Czarny P, Wigner P, Galecki P, Sliwinski T. The interplay
between inflammation, oxidative stress, DNA damage, DNA
repair and mitochondrial dysfunction in depression. Prog
Neuropsychopharmacol Biol Psychiatry [Internet]. 2018;80(Pt
C):309-21.