Dispensing the growing burden of chronic disease: Nutrition, Mental health, and the performance of health system functions

This article was exclusively written for The European Sting by Ms. Sadia Khalid, Junior researcher, and a PhD candidate at Tallinn University of Technology (TalTech), Estonia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

By 2020, The World Health Organisation estimates that mental illness, specifically depression, would overtake the other most common chronic diseases and it will become the second leading cause of Disability Adjusted Life Years (DALYs) lost. Depression will be then ranked the highest for the most added burden for chronic disease. Worldwide for both sexes, depression is estimated to be second only to ischaemic heart disease for DALYs lost. (1)

Various studies demonstrated the relevance of nutritional status of individuals, confirmed the existing relationship between nutrition status, immune response, and disease clinical manifestations severity. It has been suggested as a resilience factor towards destabilisation during this COVID-19 pandemic.

(2)Nonetheless, the optimal nutrition and dietary nutrient intake importance for strengthening the immune system is undeniable. Thus, one of the sustainable ways to elevate the burden of chronic diseases is to survive by strengthening the immune system.Literature suggests the significant relationship between nutrition and mental health recovery. People with mental health problems are more likely to engage in poor dietary practices as compared to the general population. (3)

Paleontological evidence demonstrates the direct relationship between access to food and brain size and suggests even minor differences in diet can have large effects on survival and reproductive success (4). Larger brain size in humans is directly associated with the development of various skills including cooking, accessing food, energy savings, and upright walking, and running (5); coordination of these skills with cognitive strategies enables successful feeding.

Numerous studies have reported significant brain region alterations in major depressive disorder patients, such as in the frontal lobe, hippocampus, temporal lobe, thalamus, striatum, and amygdala. Although these results are inconsistent and controversial because of the different demographic and clinical characteristics. Nonetheless, depressive symptoms, even at a subclinical level, are associated with a reduction in brain volume in specific frontal and temporal brain regions, particularly with advancing age. (6)

Mental health services should also focus on nutritional interventions during rehabilitation. An integrative approach that focuses on thorough evaluation of dietary habits, level of physical activity, environmental triggers/exposures, medications (including any use of herbal supplements), comorbidities, family history, life stressors, level of social support.

The effect of dietary consumption of omega-3 fatty acids is well studied. Docosahexaenoic acid (DHA) is the most abundant omega-3 fatty acid found in cell membranes in the brain; however, the human body can’t efficiently synthesise the DHA, so we are largely dependent on dietary DHA intake.

In the last century, the western diet became rich in saturated fatty acids, linoleic acid, and trans-fatty acids, whereas the consumption of omega-3 fatty acids has significantly decreased. Thus, elevated incidence of major depression has been reported in countries such as the United States and Germany. (7)

The consumption of a diet full of essential nutrients is critical for the proper functioning of the central nervous system. Practical implementation of nutritional interventions, for example, recommending the use of specific dietary supplements, such as a multivitamin-mineral high in B-vitamins (especially Vitamin B12), folate supplements, and omega-3 fatty acid would benefit a significant number of patients.

B12 and folate combined use to enhance the production of serotonin and dopamine.
Special focus should be given to counselling patients about the relationship between food and mood regardless of the underlying cause of the anxiety/mood disorder. In counselling, general discussion about the dietary factors and eating habits on cell metabolism and mechanisms that maintain mental function should be carried out as a daily living, such as food intake or exercise, has had a crucial role in shaping cognitive capacity, functioning while ageing.

Clinicians should recommend a well-balanced diet; low in processed, refined foods and rich in fruits, vegetables, whole grains, and seafood (if not vegetarian), a low-glycaemic food, or a Mediterranean diet for optimization of mental health.

Moreover, a complete physical exam including appropriate laboratory and radiological studies is crucial to rule out the underlying causes of depression or anxiety/mood disorder. Previous studies have noted that clinicians mostly rely on patients’ accounts or self-diagnosis of depression, anxiety, or substance use and quickly diagnose it to be a disorder, without evaluating specific criteria.

Other times due to limiting diagnostic information, judgement biases while dealing with ethnic minorities, limited time constraints during appointments where some clinicians don’t establish rapport with patients; the differential discussion of symptom areas can easily be neglected which may lead to an increase in the likelihood of diagnostic bias. However, through true professionalism, placing appropriate safeguards, and applying a counterbalancing mechanism in psychiatry one can rectify the effects of the biases. These measures could reduce the incidences of misdiagnosis and improve mental health service delivery.

Many studies done in the field of mental health and nutrition focus on the association, and they do not prove causation. Therefore, further research is needed that focuses only on the nutrition aspect and utilizes specific outcome measures during nutrition intervention without other factors such as physical activity.Conflict of interest statement
none

References

1. World Health Organisation. The World Health Report 2001 Mental Health: New Understanding, New Hope. Geneva: World Health Organisation; 2001.
2. Mentella, M.C.; Scaldaferri, F.; Gasbarrini, A.; Miggiano, G.A.D. The Role of Nutrition in the COVID-19 Pandemic. Nutrients 2021, 13, 1093. https://doi.org/10.3390/nu13041093
3. Ljungberg T, Bondza E, Lethin C. Evidence of the Importance of Dietary Habits Regarding Depressive Symptoms and Depression. Int J Environ Res Public Health. 2020;17(5):1616. Published 2020 Mar 2. doi:10.3390/ijerph17051616
4. Diet and reproductive function in wild female chimpanzees (Pan troglodytes schweinfurthii) at Kibale National Park, Uganda.Thompson ME, Wrangham RW. Am J Phys Anthropol. 2008 Feb; 135(2):171-81.
5. Paleoanthropology. Food for thought.Gibbons A Science. 2007 Jun 15; 316(5831):1558-60.
   6-Dotson, Vonetta M et al. “Depressive symptoms and brain volumes in older adults: a longitudinal magnetic resonance imaging study.” Journal of psychiatry & neuroscience: JPN vol. 34,5 (2009): 367-75.
6. Hibbeln JR. Fish consumption and major depression. Lancet. 1998;351:1213

About the author

Sadia Khalid, Junior researcher, and a PhD candidate at Tallinn University of Technology (TalTech), Estonia. She has been working on her research project “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Previously, she has worked as a research specialist in biomedicine and translational medicine department in the university of Tartu, Estonia. She obtained her MD in emergency medicine in 2017 from the Dalian Medical university, China and MBChB in 2013 from the Weifang Medical university, China. Her current research interests include infectious diseases, bacteriology, hepatology, and gastroenterology.