poor nutrition essay

Poor Nutrition and its Effects on Learning

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Nutrition is essential to human welfare, however, numerous number of people are badly affected by poor nutrition especially children. Malnutrition is a major concern which ranges from undernutrition to problems of overweight and obesity. It’s usually caused by deficiency in essential vitamins and nutrients needed for intellectual development and learning. The most critical stage for brain development is mainly from conception to the first 2 years of life. It’s highly important that pregnant mothers are given the necessary vitamins and nutrients required to enable the baby develop to its full potential.

Poverty plays a major role in lack of good nutrition and it’s a fundamental cause of malnutrition. Poverty-stricken families don’t have enough funds to spend on food. In most cases, their kids are sent to school without nutritional meal and are unable to concentrate in school.

According to Carlos Lee in his thesis,“Poverty, regardless of level, is robustly linked to reduced academic achievement. Students who live in poverty come to school every day without the proper tools for success. As a result, they are commonly behind their classmates physically, socially, emotionally or cognitively.” Some of the kids tend to become withdrawn or become aggressive towards their peers in school. For instance, a child going to school without have breakfast would make the child absent minded which would lead to lagging behind in class. Several measures has been put in place to eradicate poverty on the long run. However, some of the short term solutions include; Government should provide aids for parents in low-income families, it would enable them gain appropriate education, training, and working skills which would help them get better paid jobs. Also, social workers in schools should identify children from low income households and give them nutritious meals for free. It would help them develop mentally and physically. Another major problem of poor nutrition is caused by change in climate. It affects the society in several ways which includes human health, influences yield from crops, and in most cases alters rainfall that results in drought. For instance, When drought occurs, it leads to severe poverty, food insecurity, and malnutrition. Alice Moyo, project manager for CRS’ vulnerable children programs stated, “Drought is very connected to education in many ways. To start with, there’s no food if there’s drought. Children concentrate less when they’re hungry, and also there’s a lot of running that takes place at school,” To solve this problem, the government should enforce policies on recycling waste water and desert landscaping to enable areas with drought get good clean water. Also, the government can use advanced transportation means to move water from areas where it rains to areas with drought. Lastly, Food insecurity can delay a child’s learning abilities if not attended to.

Research has shown that in the US, a considerable number of kids under the age of 5 live in households that lack adequate quality of food that is needed to improve healthy and energetic living. Anna Johnson, an assistant professor at Georgetown University declared, ‘In our study, food insecurity in infancy and toddlerhood predicted lower cognitive and social-emotional skills in kindergarten, skills that can predict later success in academics and life.’ To this end, it is imperative for the government to provide food pantry in each communities whereby low income families can fed at least twice a day. In conclusion, it is obvious that malnutrition has a major effect on the learning , most especially in third world countries whereby people are affected by poverty, climate change, and food insecurity. The government can do its bit in eradicating poverty but the onus still lies with the entire community who live among the poor to ensure that all the policies are implemented.

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Are we doing better on child hunger? A sweeping UNICEF report weighs in

Fatma Tanis

1 in 4 children globally lives in severe child food poverty, UNICEF report says

A UNICEF report reveals more than 180 million children aren't getting anywhere near the nutrition they need. The problem is so severe, the report says, these kids suffer from the devastating effects of malnutrition. Some countries, however, have shown that it is possible to reduce what the report calls child food poverty . Discha-AS/Getty Images hide caption

We often hear that many children in the world aren't getting enough to eat. But what does that mean exactly and what does 'not enough' look like?

In parts of East Africa, it means babies are fed some breast milk and a porridge made of maize. In Yemen, a paste with just flour and water. And in conflict areas like Gaza, raw lemon and weeds.

A new report by UNICEF has pulled together these details and other data from 137 low and middle income countries to understand what young children are being fed and what that means for their growth, as well as the state of child development around the world.

And the results are alarming:

One in four children under the age of five are experiencing what study authors call “severe food poverty” which means kids are only being fed two or less food groups per day.

“It amounts to 181 million children who are deprived of the diets they need to survive,” says Harriet Torlesse, a nutrition specialist at UNICEF and the lead author on the report. “If you think about these diets, they really don't contain the range of vitamins and minerals and proteins that children need to grow and develop. “

Nutrition experts told NPR the numbers in the UNICEF report show the world is not making progress in tackling malnutrition and hunger. The covid-19 pandemic, the war in Ukraine, inflation and localized conflicts all added to food supply disruptions as well as an increase in food prices.

The report also highlights some good news: that several low-income countries have figured out how to get more and better food to children under 5.

Here are four takeaways from the report:

It’s not only that kids aren’t eating enough food, it’s that they’re eating the wrong foods

Richmond Aryeetey, Professor of nutrition and head of the department of Population, Family and Reproductive Health at the University of Ghana in Accra, describes the access to nutritious food across Africa as twofold:

“There are those who are not getting enough who would fall into the full poverty criteria. And then there are also those who potentially have the opportunity to get enough but are being fed unhealthy food.”

Experts say aggressive advertising of snacks and sugary beverages that often target children play a big role, and low-income countries have a harder time regulating those industries.

“One of the features of these snack foods is that they're often really cheap and they fill you up. And so, people are inclined to buy them,” says Deanna Olney, the Director of the Nutrition, Diets, and Health Unit at the International Food Policy Research Institute.

“But if they were more expensive because of taxes, you know, then maybe they'd be less inclined to choose those for their children, ” Olney says.

The abundance of ultra-processed foods is also a likely contributor to increasing rates of overweight and obesity in among children. Olney says that’s an issue that needs more attention.

In Gaza, extreme numbers underscore how conflict creates acute hunger for children

While conflict is not the biggest driver of child hunger across the globe, it does cause some of the worst cases, such as in Sudan, Somalia and Gaza.

Palestinian children who took refuge in Quds school wait in line to receive food distributed by charity organizations for their families in Rafah, Gaza on April 01, 2024. Abed Rahim Khatib/Anadolu via Getty Images/Anadolu hide caption

Data collected by UNICEF shows that since this past December, 9 out of 10 children in Gaza have experienced severe food insecurity.

There's already 'catastrophic' hunger in Gaza. Who decides when to call it a 'famine?'

“Children in Gaza at this point in time are barely eating any nutritious foods at all,” says Harriet Torlesse with UNICEF. “Before the war in Gaza, only 13% of children were living in severe food poverty.”

Experts say that since technological advances have made it possible to more accurately measure food intake in conflict zones, Gaza has experienced the highest rate of severe malnutrition documented.

Severe child food poverty is driving high rates of wasting and stunted growth

The stakes are high for the large numbers of children living in severe food poverty with far-reaching implications for overall global development.

UNICEF’s analysis shows these children are 50% more likely to suffer from wasting, when a child is too thin for their height, which is a sign of life-threatening malnutrition. More than 13 million children under 5 are suffering from the extreme form of this condition.

“We know that these children don't do well at school. They earn less income as adults, and they struggle to escape from income poverty. So not only do they suffer throughout the course of their life, their children, too, are likely to suffer from malnutrition,” says Harriet Torlesse.

A child is checked for malnutrition by a health worker at Kahda IDP camp near Mogadishu, Somalia. Most young kids arrive with severe malnutrition, and some die. Thousands of people have fled her home due to a long drought and armed conflict in the region Jonathan Torgovnik/Getty Images/Getty Images Europe hide caption

Malnutrition prevents children from reaching their full potential by not only stunting physical growth, but brain development as well. Even if they make it to adulthood their ability to fully contribute to their community and to the productivity of their country is limited compared to children who have had access to nutritious food.

“In 2016, there was a study that was commissioned to look at the cost of hunger in Ghana,” says Richmond Aryeetey. “The estimate was that Ghana was losing close to about $6.4 million annually because of children who are not being fed adequately. That's a lot of money being lost because we are not feeding our children well.”

The good news? There are solutions

Several low-income countries, such as Nepal and Burkina Faso, have managed to cut the rate of severe child food poverty in half. Rwanda has done so by a third. Experts say they all have several common factors that have led to success.

“The first being they've all made a real, deliberate effort to improve the supply of local nutritious foods. Be it pulses or vegetables or poultry,” says Harriet Torlesse. The less a country is reliant on imports for food, nutrition experts say, the better their chances of minimizing hunger.

Other countries are taking on the influx of ultra processed foods. In Peru for example, the government introduced legislation that processed foods and beverages must carry a warning label listing sugar, fat and salt content and they put a 25% tax on high sugar drinks.

“And we've seen in Nepal how a nationwide cash grant to poor families has increased their purchase of nutritious foods such as meat and pulses,” Torlesse says. “And then there's been a real effort within the health system to reach families with essential counseling and support so that caregivers know how best to feed their children using locally available, nutritious foods.”

Still, there needs to be a better broader approach to tackling child hunger, according to Richmond Aryeetey, “...we are sending people to the moon. We are doing all kinds of technologically advanced stuff, and yet we are not able to feed children. It's really a shame.”

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Child food poverty, addressing nutrition deprivation in early childhood..

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Across the world, millions of parents and families are struggling to provide nutritious and diverse foods that young children need to reach their full potential. Growing inequities, conflict, and climate crises, combined with rising food prices, the overabundance of unhealthy foods, harmful food marketing strategies and poor child feeding practices, are condemning millions of children to child food poverty.

UNICEF defines child food poverty as children’s inability to access and consume a nutritious and diverse diet in early childhood.

Child food poverty harms all children, but it is particularly damaging in early childhood when insufficient dietary intake of essential nutrients can cause the greatest harm to child survival, physical growth, and cognitive development, trapping children and their families in a cycle of poverty and deprivation.

‘Child Food Poverty: Nutrition deprivation in early childhood’ examines the status, trends, inequities and drivers of child food poverty in early childhood.

Key findings include:

• Globally, one in four children are living in severe child food poverty in early childhood, amounting to 181 million children under 5 years of age.
• Progress towards ending severe child food poverty is slow, but some regions and countries are proving that progress is possible and is happening.
• Severe child food poverty is experienced by children belonging to poor and non-poor households, indicating that household income is not the only driver of severe child food poverty.
• Children living in severe child food poverty are missing out on many nutrient-rich foods, while unhealthy foods are becoming entrenched in the diets of these children.
• The global food and nutrition crisis and localized conflicts and climatic shocks are intensifying severe child food poverty, especially in fragile countries.
• Severe child food poverty is driving child undernutrition: the prevalence of severe child food poverty is three times higher in countries with a high prevalence of child stunting.

Call to action: Ending severe child food poverty

The scale of severe child food poverty, the slow progress over the past decade, and the impacts of severe child food poverty on child survival, growth and development demand a step change in commitment, actions and accountability.  To address child malnutrition governments and partners must invest in actions to improve children’s access to diverse and nutritious diets and end severe child food poverty.

UNICEF calls on national governments, development and humanitarian partners, donors, civil society and media, academic and research organizations to:

• Elevate child food poverty reduction as a requirement for achieving global and national nutrition and development goals and a metric of success in meeting children’s right to food and nutrition; and commit resources to end child food poverty.
• Transform food systems by ensuring food environments make nutritious, diverse and healthy foods the most accessible, affordable and desirable option for feeding young children, and the food and beverage industry complies with policies to protect children from unhealthy foods and beverages.
• Leverage health systems to deliver essential nutrition services, including counselling and support on child feeding, to prevent and treat child malnutrition, prioritizing the most vulnerable children.
• Activate social protection systems to address income poverty in ways that are responsive to the food and nutrition needs of the most vulnerable children and their families, including social transfers to protect children at highest risk of child food poverty.
• Strengthen data systems to assess the prevalence and severity of child food poverty; detect increases in child food poverty early, including in fragile and humanitarian contexts; and track national and global progress in reducing severe child food poverty.

‘Child Food Poverty: Nutrition deprivation in early childhood’ examines the status, trends, inequities and drivers of child food poverty in early childhood. The report also outlines an agenda for tackling the problem, including actions to transform food systems, leverage health systems, and activate social protection systems in ways that put children’s right to food and nutrition in early childhood at the centre.

Files available for download

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1 in 4 children globally live in severe child food poverty due to inequity, conflict, and climate crises – UNICEF

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We Need Better Answers on Nutrition

The U.S. is overdue to establish an institute devoted to research on the top cause of poor health.

By Joon Yun ,  David A. Kessler and Dan Glickman

Dr. Yun, Dr. Kessler and Mr. Glickman have served to improve the nation’s health as leaders in government, academia and the nonprofit sector.

Poor nutrition is a leading cause of poor health and spiraling health care spending. Research from the Tufts Friedman School suggests that poor eating causes nearly 1,000 deaths each day in the United States from heart disease, stroke or diabetes. In 2016, the direct and indirect costs of chronic diseases as a result of obesity were $1.72 trillion — almost 10 percent of the nation’s gross domestic product.

Poor eating also contributes to disparities in well-being, especially among children : a vicious cycle of bad health, lost productivity, increased health costs and poverty. Poor nutrition and obesity are also a major threat to military readiness. A recent report from Mission: Readiness, a group of more than 700 retired admirals and generals, noted that obesity is the leading medical disqualifier that prevents otherwise qualified Americans from joining the military.

Yet many of the most fundamental questions about foods and health — especially their impact on the economy and the military — remain unanswered. There is also tremendous confusion about what constitutes a healthy diet. Despite the urgency of these questions, the sum of research funding for nutritional research across all federal agencies — like the agriculture department, Health and Human Services and Department Defense — is only about $1.5 billion annually . To put this into perspective, national spending on candy purchases is about $40 billion per year.

That is why our country needs an institute devoted to research on the top cause of poor health. We would call it the National Institute of Nutrition, and it would be part of the National Institutes of Health.

The institute will facilitate and help coordinate incisive research into nutrients, foods and their relationships to better health. Some examples of its focus would include:

How to leverage food and nutrition policy and public-private partnerships in a “food is medicine” effort to reduce health care costs.

Optimal nutrition for military readiness.

Optimal nutrition for treatment of battlefield consequences, including bodily injuries, brain injuries and post-traumatic stress.

Relationships between the gut microbiome and health.

Personalized nutrition based on life stage, metabolism, health state, health goals and genetics.

Health and metabolic effects of major food groups for which effects remain unclear or controversial, such as cheese, yogurt, whole-fat milk, unprocessed red meat, coconut oil, fermented foods, organic foods and more.

Optimal diets for weight loss and weight maintenance.

Optimal diets to prevent and treat Type 2 diabetes and pre-diabetes.

Optimal diets for cancer, both to reduce side effects of chemotherapy and radiation and also to directly target the cancer.

Health effect of trace bioactives and phenolics, like those in extra-virgin olive oil, cocoa, green tea, coffee, red wine, blueberries and more.

Effective behavior change and systems approaches for healthier eating.

Effective approaches to reduce dietary and health disparities.

Effects of foods on brain and mental health, from the developing brain in infants and children to protecting against memory loss, dementia and depression later in life.

Effects of foods on allergies and autoimmune and inflammatory diseases.

Coordinated new science for translation into national dietary guidelines and policies, such as the Dietary Guidelines for Americans.

Discoveries in these areas will help bring down health care costs and recover productivity loss as a result of diet-related diseases like obesity, diabetes, heart disease, many cancers and more.

They will also benefit our military readiness, including treatment of injuries. A new nutrition institute will not include regulatory or enforcement functions. Those will remain at the Food and Drug Administration and Department of Agriculture. As the convening body for research in the country, the National Institute of Nutrition would encourage the participation of a large group of stakeholders providing important input into the science of nutrition.

There are numerous precedents for creating a nutrition research institute at the N.I.H., which was created by an act of Congress in 1930. Several new institutes have been added there in the years since: For example, in 1937, Congress passed legislation to add a new National Cancer Institute. Ideally, Congress would draft and pass a bill to create and fund a nutrition institute.

Although their existence and benefits today are obvious in retrospect, we did not always have— and thus needed to create — institutions such as the Institutes of Health and F.D.A. But their contributions have far surpassed our imagination. The N.I.H.’s original founding vision was to detect cholera and yellow fever. Yet, it began to help train young physicians and now supports cutting-edge research that helps treat and cure many types of diseases. Similarly, the F.D.A.’s founding vision was to regulate contaminated foods; now it helps bring safe and effective drugs to market. None of these mandates or benefits were foreseeable at their founding, and the same is true for founding a nutrition institute today.

Establishing a place to research nutrition is also crucial to retain American competitiveness. The governments of China, India and Japan fund similar institutions.

Improving the nation’s health through better nutrition will pay large and direct economic dividends. An independent analysis concluded that every $1 spent on research by the N.I.H. has led to $3.20 in economic gains, a return-on-investment of more than 200 percent .

Given the role of diet in health and well-being, the current challenges to our military readiness and the spending of one in four federal dollars and one in five dollars in our economy on health care, the right question to ask ourselves is, can we afford not having a National Institute of Nutrition.

Dr. Joon Yun is a radiologist and an American hedge fund manager. Dr. David Kessler served as the commissioner of the Food and Drug Administration for President George H.W. Bush and President Bill Clinton. Dan Glickman was the secretary of agriculture from 1995 to 2001.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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• Food and mood: how do...

Food and mood: how do diet and nutrition affect mental wellbeing?

Read our food for thought 2020 collection.

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• Food and mood: how do diet and nutrition affect mental wellbeing? - November 09, 2020
• Joseph Firth , research fellow 1 2 ,
• James E Gangwisch , assistant professor 3 4 ,
• Alessandra Borsini , researcher 5 ,
• Robyn E Wootton , researcher 6 7 8 ,
• Emeran A Mayer , professor 9 10
• 1 Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK
• 2 NICM Health Research Institute, Western Sydney University, Westmead, Australia
• 3 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
• 4 New York State Psychiatric Institute, New York, NY, USA
• 5 Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King’s College London, London, UK
• 6 School of Psychological Science, University of Bristol, Bristol, UK
• 7 MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK
• 8 NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
• 9 G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
• 10 UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
• Correspondence to: J Firth joseph.firth{at}manchester.ac.uk

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues

Key messages

Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than “unhealthy” eating patterns, such as the Western diet

The effects of certain foods or dietary patterns on glycaemia, immune activation, and the gut microbiome may play a role in the relationships between food and mood

More research is needed to understand the mechanisms that link food and mental wellbeing and determine how and when nutrition can be used to improve mental health

Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability. 1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. 2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed.

In recent years, the relationships between nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. 3 However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health ( fig 1 ). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. 4

Hypothesised relationship between diet, physical health, and mental health. The dashed line is the focus of this article.

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While acknowledging the complex, multidirectional nature of the relationships between diet and mental health ( fig 1 ), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Mood and carbohydrates

Consumption of highly refined carbohydrates can increase the risk of obesity and diabetes. 5 Glycaemic index is a relative ranking of carbohydrate in foods according to the speed at which they are digested, absorbed, metabolised, and ultimately affect blood glucose and insulin levels. As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing; data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms. 6 Clinical studies have also shown potential causal effects of refined carbohydrates on mood; experimental exposure to diets with a high glycaemic load in controlled settings increases depressive symptoms in healthy volunteers, with a moderately large effect. 7

Although mood itself can affect our food choices, plausible mechanisms exist by which high consumption of processed carbohydrates could increase the risk of depression and anxiety—for example, through repeated and rapid increases and decreases in blood glucose. Measures of glycaemic index and glycaemic load can be used to estimate glycaemia and insulin demand in healthy individuals after eating. 8 Thus, high dietary glycaemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. 5 9 The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. 10 In addition, observational research has found that recurrent hypoglycaemia (low blood sugar) is associated with mood disorders. 9

The hypothesis that repeated and rapid increases and decreases in blood glucose explain how consumption of refined carbohydrate could affect psychological state appears to be a good fit given the relatively fast effect of diets with a high glycaemic index or load on depressive symptoms observed in human studies. 7 However, other processes may explain the observed relationships. For instance, diets with a high glycaemic index are a risk factor for diabetes, 5 which is often a comorbid condition with depression. 4 11 While the main models of disease pathophysiology in diabetes and mental illness are separate, common abnormalities in insulin resistance, brain volume, and neurocognitive performance in both conditions support the hypothesis that these conditions have overlapping pathophysiology. 12 Furthermore, the inflammatory response to foods with a high glycaemic index 13 raises the possibility that diets with a high glycaemic index are associated with symptoms of depression through the broader connections between mental health and immune activation.

Diet, immune activation, and depression

Studies have found that sustained adherence to Mediterranean dietary patterns can reduce markers of inflammation in humans. 14 On the other hand, high calorie meals rich in saturated fat appear to stimulate immune activation. 13 15 Indeed, the inflammatory effects of a diet high in calories and saturated fat have been proposed as one mechanism through which the Western diet may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier. 15 Since various mental health conditions, including mood disorders, have been linked to heightened inflammation, 16 this mechanism also presents a pathway through which poor diet could increase the risk of depression. This hypothesis is supported by observational studies which have shown that people with depression score significantly higher on measures of “dietary inflammation,” 3 17 characterised by a greater consumption of foods that are associated with inflammation (eg, trans fats and refined carbohydrates) and lower intakes of nutritional foods, which are thought to have anti-inflammatory properties (eg, omega-3 fats). However, the causal roles of dietary inflammation in mental health have not yet been established.

Nonetheless, randomised controlled trials of anti-inflammatory agents (eg, cytokine inhibitors and non-steroidal anti-inflammatory drugs) have found that these agents can significantly reduce depressive symptoms. 18 Specific nutritional components (eg, polyphenols and polyunsaturated fats) and general dietary patterns (eg, consumption of a Mediterranean diet) may also have anti-inflammatory effects, 14 19 20 which raises the possibility that certain foods could relieve or prevent depressive symptoms associated with heightened inflammatory status. 21 A recent study provides preliminary support for this possibility. 20 The study shows that medications that stimulate inflammation typically induce depressive states in people treated, and that giving omega-3 fatty acids, which have anti-inflammatory properties, before the medication seems to prevent the onset of cytokine induced depression. 20

However, the complexity of the hypothesised three way relation between diet, inflammation, and depression is compounded by several important modifiers. For example, recent clinical research has observed that stressors experienced the previous day, or a personal history of major depressive disorders, may cancel out the beneficial effects of healthy food choices on inflammation and mood. 22 Furthermore, as heightened inflammation occurs in only some clinically depressed individuals, anti-inflammatory interventions may only benefit certain people characterised by an “inflammatory phenotype,” or those with comorbid inflammatory conditions. 18 Further interventional research is needed to establish if improvements in immune regulation, induced by diet, can reduce depressive symptoms in those affected by inflammatory conditions.

Brain, gut microbiome, and mood

A more recent explanation for the way in which our food may affect our mental wellbeing is the effect of dietary patterns on the gut microbiome—a broad term that refers to the trillions of microbial organisms, including bacteria, viruses, and archaea, living in the human gut. The gut microbiome interacts with the brain in bidirectional ways using neural, inflammatory, and hormonal signalling pathways. 23 The role of altered interactions between the brain and gut microbiome on mental health has been proposed on the basis of the following evidence: emotion-like behaviour in rodents changes with changes in the gut microbiome, 24 major depressive disorder in humans is associated with alterations of the gut microbiome, 25 and transfer of faecal gut microbiota from humans with depression into rodents appears to induce animal behaviours that are hypothesised to indicate depression-like states. 25 26 Such findings suggest a role of altered neuroactive microbial metabolites in depressive symptoms.

In addition to genetic factors and exposure to antibiotics, diet is a potentially modifiable determinant of the diversity, relative abundance, and functionality of the gut microbiome throughout life. For instance, the neurocognitive effects of the Western diet, and the possible mediating role of low grade systemic immune activation (as discussed above) may result from a compromised mucus layer with or without increased epithelial permeability. Such a decrease in the function of the gut barrier is sometimes referred to as a “leaky gut” and has been linked to an “unhealthy” gut microbiome resulting from a diet low in fibre and high in saturated fats, refined sugars, and artificial sweeteners. 15 23 27 Conversely, the consumption of a diet high in fibres, polyphenols, and unsaturated fatty acids (as found in a Mediterranean diet) can promote gut microbial taxa which can metabolise these food sources into anti-inflammatory metabolites, 15 28 such as short chain fatty acids, while lowering the production of secondary bile acids and p-cresol. Moreover, a recent study found that the ingestion of probiotics by healthy individuals, which theoretically target the gut microbiome, can alter the brain’s response to a task that requires emotional attention 29 and may even reduce symptoms of depression. 30 When viewed together, these studies provide promising evidence supporting a role of the gut microbiome in modulating processes that regulate emotion in the human brain. However, no causal relationship between specific microbes, or their metabolites, and complex human emotions has been established so far. Furthermore, whether changes to the gut microbiome induced by diet can affect depressive symptoms or clinical depressive disorders, and the time in which this could feasibly occur, remains to be shown.

Priorities and next steps

In moving forward within this active field of research, it is firstly important not to lose sight of the wood for the trees—that is, become too focused on the details and not pay attention to the bigger questions. Whereas discovering the anti-inflammatory properties of a single nutrient or uncovering the subtleties of interactions between the gut and the brain may shed new light on how food may influence mood, it is important not to neglect the existing knowledge on other ways diet may affect mental health. For example, the later consequences of a poor diet include obesity and diabetes, which have already been shown to be associated with poorer mental health. 11 31 32 33 A full discussion of the effect of these comorbidities is beyond the scope of our article (see fig 1 ), but it is important to acknowledge that developing public health initiatives that effectively tackle the established risk factors of physical and mental comorbidities is a priority for improving population health.

Further work is needed to improve our understanding of the complex pathways through which diet and nutrition can influence the brain. Such knowledge could lead to investigations of targeted, even personalised, interventions to improve mood, anxiety, or other symptoms through nutritional approaches. However, these possibilities are speculative at the moment, and more interventional research is needed to establish if, how, and when dietary interventions can be used to prevent mental illness or reduce symptoms in those living with such conditions. Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms. 34 On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet. 35 36 37 Such results, however, must be considered within the context of the effect of people’s expectations, particularly given that individuals’ beliefs about the quality of their food or diet may also have a marked effect on their sense of overall health and wellbeing. 38 Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness. 33

At the same time, it is important to be remember that the causes of mental illness are many and varied, and they will often present and persist independently of nutrition and diet. Thus, the increased understanding of potential connections between food and mental wellbeing should never be used to support automatic assumptions, or stigmatisation, about an individual’s dietary choices and their mental health. Indeed, such stigmatisation could be itself be a casual pathway to increasing the risk of poorer mental health. Nonetheless, a promising message for public health and clinical settings is emerging from the ongoing research. This message supports the idea that creating environments and developing measures that promote healthy, nutritious diets, while decreasing the consumption of highly processed and refined “junk” foods may provide benefits even beyond the well known effects on physical health, including improved psychological wellbeing.

Contributors and sources: JF has expertise in the interaction between physical and mental health, particularly the role of lifestyle and behavioural health factors in mental health promotion. JEG’s area of expertise is the study of the relationship between sleep duration, nutrition, psychiatric disorders, and cardiometabolic diseases. AB leads research investigating the molecular mechanisms underlying the effect of stress and inflammation on human hippocampal neurogenesis, and how nutritional components and their metabolites can prevent changes induced by those conditions. REW has expertise in genetic epidemiology approaches to examining casual relations between health behaviours and mental illness. EAM has expertise in brain and gut interactions and microbiome interactions. All authors contributed to, read, and approved the paper, and all the information was sourced from articles published in peer reviewed research journals. JF is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JF is supported by a University of Manchester Presidential Fellowship and a UK Research and Innovation Future Leaders Fellowship and has received support from a NICM-Blackmores Institute Fellowship. JEG served on the medical advisory board on insomnia in the cardiovascular patient population for the drug company Eisai. AB has received research funding from Johnson & Johnson for research on depression and inflammation, the UK Medical Research Council, the European Commission Horizon 2020, the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King’s College London. REW receives funding from the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. EAM has served on the external advisory boards of Danone, Viome, Amare, Axial Biotherapeutics, Pendulum, Ubiome, Bloom Science, Mahana Therapeutics, and APC Microbiome Ireland, and he receives royalties from Harper & Collins for his book The Mind Gut Connection. He is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the US Department of Defense. The views expressed are those of the authors and not necessarily those of the organisations above.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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Importance of Healthy Nutrition Essay

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To stay alive, the human body requires proper nutrients. These nutrients are absorbed from the food we eat. The absorbed food will help the cells in the human body stay alive and function optimally.

Nutrition is important to all human beings. One cannot survive without proper nutrition. However, nutrition is more important in certain stages of life than others (Wardlaw & Smith 2011). Nutrition is very important during childhood.

The reason for this is that children require more energy than adults. The macronutrients and micronutrients that the body needs are absorbed according to the body size. The smaller the body size the more nutrients the body will need. Children also have a higher growth rate.

Proper nutrition is also important to the elderly. This is due to the slow growth of their body cells. Proper nutrition is required to maintain normal cell growth and improve the rate of cell growth (Insel 2011). They also need proper nutrition to maintain good mental health, immunological health and cardiovascular health.

The lifestyle of most people will affect them in future. The food we eat today will affect our health in future. The consumption of healthy foods minimizes the chance of contracting certain diseases (Wardlaw & Smith 2011). These diseases include; cancer, arthritis and stroke. Obesity is also among the diseases that can be avoided if we eat healthy.

Recent research has shown that more people are at risk of suffering from these diseases due to lack of proper nutrition. Their lifestyles have forced them to consume fatty foods commonly referred to as junk food. Eating healthy food will help boost the body’s immune system while reducing the risk of trauma. The ability of the body to grow and operate optimally depends on the food we eat.

Recent findings have revealed that obesity is the most common health condition affecting young adults. The number of overweight children has been growing day by day. The reason behind this is poor nutrition. Change in lifestyle has also been found to be the main cause of this problem (Insel 2011). Most parents are now fully employed. This leaves them with no option but to take their children to fast food joints to have meals. Fast food joints are expanding daily and relocating to more strategic places.

The government has an important role to play in order to control this menace. They need to come up with various legislations that will help put a stop to this worrying trend. A good example would be banning all fast food joints within a certain radius from educational institutions (Wardlaw & Smith 2011). This will make it harder for children to access these joints.

The government should also encourage awareness campaigns that will help in the fight against obesity. These campaigns will focus more on sensitizing parents and children on the need for proper nutrition. The effects of poor nutrition should also be addressed during these campaigns. With time, this will raise the awareness levels and help in the fight against obesity (Insel 2011).

The recent statistics leaves the government with no choice. The productive population of the society is slowly dying from health related diseases (Wardlaw & Smith 2011). These are the future leaders, employees and workers that will help grow the economy when the current leaders have retired. It is also the responsibility of the government to make sure that all citizens are healthy and protected from all health issues that would endanger their lives.

Insel, P. M. (2011). Nutrition . Sudbury, Mass.: Jones and Bartlett Publishers.

Wardlaw, G. M., & Smith, A. M. (2011). Contemporary nutrition . New York, NY: McGraw-Hill.

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1. IvyPanda . "Importance of Healthy Nutrition." May 16, 2022. https://ivypanda.com/essays/importance-of-healthy-nutrition/.

Bibliography

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• Systematic review
• Open access
• Published: 20 January 2021

Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

• Mireya Vilar-Compte   ORCID: orcid.org/0000-0001-9047-1102 1 ,
• Soraya Burrola-Méndez 1 ,
• Annel Lozano-Marrufo 1 ,
• Isabel Ferré-Eguiluz 1 ,
• Diana Flores 1 ,
• Pablo Gaitán-Rossi 1 ,
• Graciela Teruel 1 &
• Rafael Pérez-Escamilla 2  

International Journal for Equity in Health volume  20 , Article number:  40 ( 2021 ) Cite this article

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There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this “urban advantage” does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition.

This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.’s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis.

Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition.

Conclusions

This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the “urban advantage”. A conceptual framework emerging from the existing literature is proposed to guide future studies and policies.

Systematic review registration

PROSPERO Registration number: CRD42018089788 .

Urbanization is a rising global phenomenon. Today 55% of the global population lives in urban areas, and it is estimated that by 2050 70% of the population will live in one of them [ 1 ]. Compared to rural areas, urban regions feature greater social and economic development, more labor opportunities, and access to more diverse and better essential services. However, urban areas also concentrate poverty [ 2 ]. The urban poor not only lack income and resources to ensure an adequate wellbeing, but frequently experience limited access to basic services, labor opportunities and to possibilities for social development. Prior studies highlight increasing trends in urban poverty, partially resulting from accelerating urbanization processes in low-and middle-income countries; it has been estimated that by 2035 the majority of individuals in extreme poverty (i.e. daily income less than US1.25) will live in urban areas [ 1 , 3 ].

These challenges have been addressed in the Sustainable Development Goals (SDG) [ 4 ]; specifically, SDG 11 establishes that countries need to have urban sustainable development plans to promote the wellbeing of people, especially the most socioeconomic vulnerable. Furthermore, SDG 1 states that all forms of poverty should be eradicated by 2030.

The SDGs are also strongly linked with food insecurity (FI) [ 5 ]. Urban environments imply a particular risk for FI and poor nutrition outcomes since access to food depends on the commercial supply that, in turn, is linked to income levels [ 6 , 7 ]. On the one hand, it has been previously recognized that the urban poor are particularly vulnerable to macroeconomic shocks that affect their capacity to generate income which in turn leads them to consume less healthy diets [ 8 , 9 ]. On the other hand, previous studies suggest that urban diets, on average, are better than rural diets because they are more diverse and, given the food distribution systems, there is greater access to products such as animal proteins [ 10 ]. However, this supposed urban advantage is not equally distributed as it does not extend to the poorest socioeconomic strata.

Previous research indicates that there are geographic differentials in access to food [ 11 ], which are linked to economic barriers in accessing healthy food options [ 12 ]. Hence, those with lower incomes do not have access to diets rich in heathy foods including fresh fruits and vegetables, tubers, and legumes. Instead they have relatively more access and consume higher amounts of sugars, fats, and highly processed or ultra-processed foods [ 13 ]. Although this phenomenon has been generically identified as part of the “nutritional transition”, it is important to emphasize that in urban centers, these outcomes are linked to socioeconomic inequities [ 6 ]. Ultra-processed products have a high energy density, have long shelf lives, many are ready-to-eat and they are relatively cheaper [ 14 , 15 ]. All these features make them convenient for urban and low-income individuals who may have limited resources such as household heating and cooking goods, safe drinking water supply, and sanitation, amongst other basic needs. A study of 74 countries from the Pan-American Health Organization conducted in 2015 found that sales of ultra-processed products were larger in more urbanized countries, and that the market is expanding to poorer sectors [ 16 ].

Food environments can influence the risk of malnutrition and corresponding infectious and non-communicable chronic diseases. In urban areas, food deserts and food swamps – understood as regions with very limited or difficult access to supermarkets and healthful food choices [ 17 ] – exemplify challenging food environments, which are generally more common in low-income urban areas [ 18 ]. These environments are in turn associated with unequal nutrition outcomes. For example, in Latin America, the risk of chronic malnutrition in urban children under 5 years of age is ten times higher among the poorest compared with their counterparts falling in the highest socioeconomic level [ 7 ].

Despite such compelling evidence, there are few studies that have attempted to document in detail the food access challenges and their relationship with different nutritional outcomes among poor urban populations. Therefore, the aim of this study was to conduct, from a global perspective, a systematic literature review (SLR) to assess urban poverty as a determinant of access to a healthy diet, and to document the association between urban poverty and the nutritional status of individuals.

The protocol for this systematic review was registered on PROSPERO prior to starting the literature search (CRD42018089788).

The review centered in nutrition outcomes related to: (i) access to a healthy diet as defined by the World Health Organization [ 19 ], which includes aspects of variety, quantity, balance and food safety, and (ii) nutrition outcomes related to the SDGs – anemia, overweight and obesity, micronutrient deficiency, and micronutrient malnutrition [ 20 ]. These outcomes were kept generic and subsequently categorized through the operationalizations used in the studies. The exposure variable of interest was urban poverty. Poverty was captured through different indicators such as income thresholds, poverty lines, multidimensional poverty measures, socioeconomic indexes (based on assets and services), wealth indexes, geographic areas considered highly vulnerable or lacking basic services (i.e. slums), or people participating in social programs targeted at the vulnerable/low income. Similarly, “urban” as a context where poverty happens was not defined through a unique criterion – as different countries used different criteria. Hence, “urban” was defined in terms of population size, population density, type of economic activity, level of infrastructure, or a combination of these criteria.

Inclusion and exclusion criteria

This systematic review followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 21 , 22 ]. We prepared a literature search protocol to define a priori inclusion criteria (see Table  1 ). Qualitative and quantitative studies were included if they focused on nutrition access or nutrition outcomes among urban poor populations (i.e. individuals, families, households). Quantitative studies could be observational or experimental.

Studies were excluded if they focused on the general population (i.e. without a specific focus on urban and poor settings) or if they were centered in populations with special conditions (i.e. refugees, prisoners). Only peer reviewed studies published in English or Spanish were included in the review.

Search strategy

Four bibliographical databases (PubMed, Web of Science, Scielo and EBSCO) were systematically searched for studies published between January 2000 and January 2019. The year 2000 was selected as a threshold because urbanization was recognized as key in the Millennium Development Goals (MDGs) linked to poverty and the health outcomes of individuals. Indeed, the MDGs led to specific research and interventions targeting the urban vulnerable populations [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Relevant literature was identified following the Boolean search algorithms summarized in Supplementary Table  1 . Free-text terms were used to generate search strategies for each database. Studies identified through each database were imported to Excel, and then duplicates were identified and removed. The studies were then imported to EndNote [ 31 ].

Study selection

In the first phase, abstracts were reviewed by three of the authors (DF, IF and SB) who were standardized to screen titles and abstracts of studies identified in the search. Articles were excluded if they did not meet the criteria established in Table  1 . They were included if there was an indication that access to healthful foods or any of the nutrition outcomes of interest were being described or analyzed, either through qualitative or quantitative approaches, in urban poor/vulnerable populations. In the next phase, articles were retrieved and independently assessed for eligibility (see criteria in Table  1 ). Consensus was reached in consultation with a fourth author (MVC) as needed.

Data extraction

The following information was extracted from each study: (i) methods (i.e. qualitative or quantitative study design, and corresponding details); (ii) territorial definition of the urban space (i.e. urban or semi-urban, large cities, slums, etc.); (iii) poverty definition; and (iv) operationalization of the food and nutrition variables (i.e. food access, nutrition outcomes). In addition, data were extracted to describe the study sample, confounding or mediating factors, statistical tests or data triangulation, and key findings.

Quality assessment

The studies’ quality assessment was conducted by reviewing each study according to specific guidelines. For quantitative studies, guidelines were adapted from those proposed by Khan [ 22 ] which focus on four aspects: (i) type of design; (ii) how exposure was operationalized; (iii) how outcome variables were ascertained; and (iv) if confounding variables were controlled for. Supplementary Table  2 provides further details on the definition of each of these elements. For qualitative studies a guideline was adapted from the National Institute for Health and Care Excellence (NICE) methodology checklist for qualitative studies [ 32 ]. Five quality domains were assessed for each study: (i) theoretical approach; (ii) study design; (iii) data collection; (iv) validity; and (v) analysis. Supplementary Table  3 defines how each of the areas were specifically assessed. Quality assessment was performed by two researchers (SB, IF); when there were conflicting results a third reviewer (ALM, MVC) provided input until consensus was reached. To estimate the agreement between reviewers, a Cohen’s Kappa statistic was computed.

Analysis of the systematized papers

The purpose of systematically examining the studies was to generate a common understanding about how urban poverty shapes nutrition (both in terms of access and outcomes). The analysis of the studies was based on a qualitative content and thematic analyses. The objective of such perspective was to analyze the textual data from the studies to elucidate themes [ 33 ]. Hence, a three folded analytical process was followed: (i) data from the studies was coded in NVivo 12 [ 34 ]; nodes were generated and significant information from the systematized papers was dropped in such nodes; (ii) meaning of the information in the different nodes was examined; and (iii) themes were generated. This analysis was performed by three of the authors (MVC, DF, SB) based on consensus about the nodes, meanings and themes. These findings led to proposing a conceptual framework about how urban poverty shapes nutrition.

Description of the studies

Figure  1 follows the PRISMA structure [ 22 ] and provides a detailed summary of the research results. After duplicated studies were removed, the abstracts of 717 records were screened, leading to 348 papers for full review. Sixty-eight studies met the eligibility criteria and quality assessment and were included in the review. Among these studies, the majority (81%) used quantitative methods, while fewer focused on qualitative approaches (19%). The average Cohen’s Kappa statistic between-reviewers for quantitative studies was 0.963 (an almost perfect agreement), and for qualitative studies 0.759 (a substantial level of agreement) [ 35 ].

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Diagram

The geographical distribution of the included studies is presented in Table  2 . Based on the categorization by regions as classified by the World Bank [ 36 ], close to two thirds of the papers were based on studies conducted in the Americas (i.e. 39.7% in North America and 25% in Latin American & Caribbean), followed by 17.6% in Sub-Saharan Africa, and 17.6% in East Asia & Pacific. Only 8.8% were from South Asia, 5.9% from Europe & Central Asia, and 2.9% from Middle East & North Africa.

Tables  3 and 4 provide information on how studies operationalized the poverty construct. It was commonly defined through mainstream economic classifications such as: lower deciles or quintiles of income distribution (18.9%); low socioeconomic level, ascertained through education level, type of employment, or social class (17.6%); poverty lines or thresholds based on a minimum income to satisfy basic needs, or through more complex multidimensional measures of poverty (13.5%); composite measures such as assets indexes (5.4%) or social vulnerability indexes (2.7%); and relative household’s expenditure measures (1.4%) – which are commonly used in the economics literature due to their strong theoretical background. Together, these definitions of poverty or vulnerability were used in more than half of the studies (59.5%).

The second most common metrics used for determining poverty status was through geographical characteristics (27%). Based on community, municipality or other geographic units, the studies defined the poverty status based on access to services or gradients of human development, among others. The degree of specification of how “poor areas” were defined varied across studies. Finally, another subset of the studies included in the SLR defined poverty and vulnerability through specific unidimensional conditions such as poor housing conditions, FI or homelessness (13.5%).

Tables  3 and 4 also provide information about how the “urban” space was ascertained in the studies. More than half of the studies (54.4%) defined broadly the urban space as “cities” or “metropolitan areas”. Around one third of the studies (32.4%) centered in areas within a city, while 13.3% of the studies focused in specific peri-urban areas or slums.

Among the quantitative studies ( n  = 55), 63% analyzed food access measures as dependent variables, 30% as nutrition outcomes, and 7% as both. As portrayed in Fig.  2 , the most common operationalization of access was through food security scales, dietary diversity indexes or scores, and through assessments of access to retail food stores. On the other hand, overweight and obesity and stunting were the most commonly assessed nutrition outcomes. Qualitative studies ( n  = 13) focused in access to healthful choices from different perspectives: about half of the papers studied aspects of food security, around one quarter focused in understanding the food environment, close to one fifth addressed issues of affordability and food supply, and one study assessed coping strategies for lack of food access.

Access measures and nutrition outcomes used as dependent variables in quantitative studies. Note: Some studies used more than one measure and/or outcome

Assessment of the quality of research

For quantitative studies, quality was assessed through three dimensions: (i) type of design, (ii) comparison group or not, and (iii) control for potential confounders (i.e. adjusted models). As summarized in Table  3 , most studies relied on cross-sectional designs (80%). The rest of the studies were a mix of geospatial analyses (9.1%), cohort and longitudinal studies (9.1%), and only one study was based on a case-control design (1.8%). About 82% of the studies had a comparison group, which was commonly operationalized as urban non-poor populations, rural poor populations, or as comparisons between different subgroups of urban poor population (i.e. differences in income within poor groups, different levels of FI, amongst others). Among studies lacking a comparison group, they were mainly cross-sectional studies [ 38 , 39 , 42 , 43 , 47 , 52 , 77 , 81 , 88 , 89 ] that intended to provide descriptions of urban poverty in terms of nutrition outcomes. Close to 70% of all quantitative studies controlled for confounders and presented adjusted models. However, none of the geospatial analyses did so [ 42 , 52 , 78 , 80 , 91 ], neither the case-control study [ 48 ]. By contrast, 75% of the cross-sectional designs [ 37 , 39 , 40 , 45 , 46 , 49 , 50 , 51 , 54 , 55 , 56 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 82 , 83 , 84 , 86 , 87 , 89 , 90 ] and all the cohort and longitudinal studies controlled for confounders [ 44 , 53 , 60 , 69 , 88 ].

Among the 13 qualitative studies included in the SLR, all showed adequate research quality (see Table  4 ). All studies were found to have an adequate theoretical approach with clear aims, and a well-established study design including sample characteristics and qualitative sampling processes. Similarly, all the studies provided a description of the data collection process, recording and transcription of study materials, the study context and participants, and addressed some potential research biases. In terms of data triangulation, which is an important validity aspect of qualitative approaches, most studies reported collecting data through different sources and linking them for purposes of analysis; the only two exceptions were the studies by Dubowitz et al. [ 97 ] and Hammelman [ 99 ]. Despite their lack of triangulation, both studies were rated as having richness in data. In fact, all studies but one were rated as having dense and rich qualitative data; with the exception of a study focusing on FI among homeless and marginally housed adults in Sydney, Australia [ 104 ]. Qualitative studies applied different data collection techniques such as in-depth interviews [ 92 , 95 , 96 , 98 , 99 , 101 , 103 , 104 ], focus groups [ 93 , 94 , 97 , 101 ], participant observation [ 95 , 101 ], open-ended questionnaires [ 102 ] and photovoice [ 100 ].

Content and thematic analysis

Given the diversity of designs, methodological and measurement approaches, instead of summarizing effect sizes or aiming at a meta-analysis, we took a qualitative thematic approach to synthesize and analyze the literature. From such perspective, four broad categories emerged: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) FI and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food.

Elements of urban poverty that affect access to healthy eating

Urban poverty exerts different pressures which lead, in many cases, to problems of access to a healthy diet that are as serious as in rural areas (Supplementary Table  4 ). One of the risk factors documented in the literature for this lack of access are the economic barriers faced by the urban poor. These studies provide evidence that healthy diets are expensive, which leads to dose-response socioeconomic inequities in food choices. For example, in urban settings budgetary restrictions in the selection of food can lead to the consumption of diets that are very low in animal protein [ 51 ], or may disrupt requirements among populations with special dietary needs [ 92 , 101 ]. Urban dwellers in the lowest income deciles, allocate a higher proportion of their family income to food consumption [ 41 , 57 ], and may find restrictions to buying healthy foods [ 93 ].

In addition, low income urban neighborhoods, tend to have less access to healthful foods, thus, linking economic constrains of the population and place of living to a magnified lack of access to healthy foods [ 78 ]. There are effects of the market structure on access to food in urban poor areas, a common finding was a lower supply of supermarkets [ 42 , 78 , 91 ] that can lead to food deserts. In addition, supermarkets in urban poor areas tend to offer less variety of healthy products (i.e. fresh produce) and oftentimes products of lower quality [ 71 ]. Such fragmented market can lead to the establishment of informal arrangements, especially in low- and middle-income countries, such as street traders and house shops that are more likely to be unstable and deregulated [ 43 , 85 ]. Corner shops are another common source to meet food demand, but this has been associated with increased consumption of ultra-processed foods and inversely associated with home meal preparation, positive beliefs and self-efficacy toward healthy food [ 55 ].

Among poor urban dwellers accessing healthier choices commonly requires “out-shopping” defined as shopping outside of your residential area, but this is limited by transportation cost and lack of public transportation access [ 42 ]. In addition, this implies additional direct costs (i.e. transportation) and opportunity cost (i.e. time spent) in food purchasing [ 99 ]. This can be an even larger barrier to access when experiencing health conditions affecting physical mobility [ 92 ].

An additional barrier faced by the urban poor is the lack of social networks that allow them to access food during difficult times. Urban studies have documented less reciprocity with food exchanges than those observed in rural areas [ 68 ].

Food insecurity and urban poverty

An important body of literature emerged documenting the relationship between FI and urban poverty. FI is defined as “the limited or uncertain availability of nutritionally adequate and safe foods; or the limited and uncertain capacity to acquire adequate food in socially acceptable ways” [ 105 ]. This literature was grouped into: quantitative studies that address the determinants of FI, quantitative studies that analyze how FI is associated with unfavorable nutrition outcomes among the urban poor, and qualitative studies documenting experiences of FI among urban vulnerable populations.

Determinants of FI in poor urban settings

Studies from all regions of the world informed the literature on determinants of FI in poor urban settings. Almost all studies operationalized FI through experience-based scales. Most of the studies were based on cross-sectional designs and logistic regression analysis (see Supplementary Table  5 ).

One of the main FI risk factors identified in the literature was low household income; among those living on urban and peri-urban areas, low income increased risk of FI [ 38 , 44 , 45 , 46 , 50 , 53 , 58 , 59 , 65 , 72 , 76 , 82 , 84 , 89 ]. Similarly, a study found that lower socioeconomic status and higher levels of unemployment were associated with a higher prevalence of FI [ 37 ]. Few studies focused on assets-based measures and FI. A study documented that households with inconsistent access to utilities such as electricity or water, medical care, cooking fuel and cash had a significantly higher prevalence of severe FI [ 66 ]. Another study reported that access to a personal vehicle was inversely associated with FI [ 64 ].

In addition to experience-based FI scales, one study assessed dietary diversity finding similar associations with socioeconomic status. More specifically it documented that lower income adults in urban areas consumed less varied diets and lower amounts of vitamin C, calcium, iron, riboflavin, and zinc –even when compared with their low-income counterparts in rural areas [ 75 ].

Association between FI and nutrition outcomes among vulnerable urban groups

Studies that examined the association of FI and nutrition outcomes were mainly from the Americas and Africa, and were based on cross-sectional designs but used different data analysis approaches (see Supplementary Table  6 ). The literature found that FI is a risk factor for malnutrition of the urban poor. Few studies assessed the association between FI and stunting, and did not reach consensus. While a study documented that in poor urban settlements children under 5 years of age living in FI households were at greater risk of stunting [ 69 ], others reported that FI was not significantly associated with stunting among adolescents [ 62 ].

Most of the studies assessed the relationship between FI and overweight and obesity leading to mixed findings, partially because study populations were diverse. For example, among schoolchildren living in urban FI households a higher prevalence of overweight was documented [ 73 ]. But such associations could not be confirmed among adolescents [ 56 , 61 ] or preschool children [ 79 , 87 ]. Similarly, the association also depended on the severity of the FI [ 67 ] and the syndemic effect with other factors like parental stress [ 49 , 61 ].

Qualitative approaches to FI in poor urban settings

The qualitative studies included in the systematic review were conducted mostly in poor urban areas of high-income countries. Collectively, these studies exemplify the complexity of food access challenges in urban areas and emphasize that food availability is a necessary but not sufficient condition for adequate food access as de facto it depends on other elements as well. Among poor urban older adults living alone with physical and motor limitations, as well as lack of transportation, and social isolation increase the risk of FI [ 98 ]. Among the homeless FI was related to insufficient income from government welfare programs, low affordability of fresh food, transportation barriers, lack of safe shelter and housing, and limited food storage capacity [ 94 ] [ 95 ]. In fact, challenges with access to a kitchen and inadequate spaces to store food emerged in other studies as factors increasing FI [ 104 ].

Qualitative studies focusing on mothers living in poverty in urban areas revealed specific food access and healthy eating challenges. In large Metropolitan areas, the major limitations for adequate family nutrition were limited time for food shopping and cooking, as well as finding time for family activities, childcare and difficulties in transportation to and from the food stores [ 97 ]. Another factor that emerged is that mothers prioritize food pricing and optimization of food usage when making food selections, oftentimes sacrificing quality [ 96 , 101 ]. Mothers living in poor urban settlements also referred to an unhealthy food environment in their communities due to the abundance of street vendors and food stores selling junk food [ 102 ].

The qualitative studies also documented FI related challenges faced by people who live in urban areas, like increased feelings of anxiety, worry, shame, and uncertainty [ 103 ]; and limited self-control for chronic disease, since it prevents access to proper nutrition [ 92 ]. Moreover, while social protection and food assistance programs, such as community kitchens, help by providing access to basic nutrition, are insufficient to fully resolve their FI related challenges [ 104 ].

Risk factors of the nutritional status of the urban poor

Urban poverty poses major challenges for adequate food access and nutrition outcomes among the urban poor, exposing them to nutritional risks with long-term consequences. Our systematic review identified associations between food access barriers and increased risk for poor nutrition outcomes through three different pathways. First, urban poor have an increased risk of consuming unhealthy and energy dense foods associated with a higher prevalence of overweight and obesity [ 47 , 86 ]. Second, urban poverty was found to increase the chances of chronic undernutrition, leading to higher obesity prevalence in future stages of life [ 88 ]. And third, the review suggested that psycho-social factors are important determinants of obesity through plausible biological links with stress and feelings of despair commonly experienced by people living in urban poverty [ 49 , 76 , 104 ].

Coping strategies for limited food access

An aspect that emerged from the literature refers to strategies used by the urban poor to obtain food and, among them, the use of food banks [ 68 , 92 , 98 ] and community kitchens [ 92 ] stand out. These studies found that beneficiaries considered such support strategies valuable but insufficient to fully mitigate hunger and lack of access to food, hence, families and individuals need other coping mechanisms like selling food on the streets to generate income, while at the same time have more access to food [ 54 ]. Other strategies implied skipping meals or eating smaller portions [ 103 , 104 ]. These unhealthy coping mechanisms were more prevalent among mothers, who buffer their children against FI [ 53 , 103 ]. Finally, other strategies included buying stolen food at a lower price or eating food from garbage [ 104 ].

Conceptual framework

Figure  3 presents a conceptual framework that intends to graphically depict the key themes that emerged from our literature review. At the center two key themes shape the relationship between nutrition and urban poverty: access to food and household food security status. These elements are determined by the factors summarized in the left part of the Figure, which are grouped in different ecological levels: community, family and the individual. These themes and factors help explain nutritional and health outcomes in the context of urban poverty including overweight and obesity, short stature and stunting. The conceptual framework also highlights the coping strategies used among the urban poor to deal with food access challenges as well as FI.

Conceptual Framework of nutrition and urban poverty

According to previous studies, in general, urban diets are likely to be more varied than rural diets [ 10 ]. However, this urban advantage strongly diminishes as a function of socioeconomic status representing a major social and health inequity in urban setting. In cities, food, for the most part, is bought and not grown for consumption. This implies that their access to healthy foods is strongly linked to income and to the structure of the food system, including its corresponding supply and access chains; i.e., “from farm to table”. These factors are two key determinants of the type of effective policies needed for urban populations to have access to a healthy diet [ 51 , 57 ].

The systematic literature review confirms that these determinants of food access in urban areas emerge in the context of poverty and high levels of FI of different countries [ 37 , 44 , 45 , 46 , 65 , 84 ], which are highly prevalent of poor nutrition and health outcomes [ 39 , 69 , 73 , 76 ]. Empirical evidence indeed supports the existence of a socioeconomic gradient in access to healthy food in urban areas [ 51 , 92 ]. The review emphasizes that access to food in urban areas is a complex process with multiple determinants and that it cannot be assumed that this access is always better for populations in urban vs. rural areas.

An important structural economic challenge for food access among the socioeconomically disadvantaged in urban areas is that the prices of healthy foods can be higher in poor neighborhoods, which at the same time also tend to have fewer food retail stores [ 41 , 42 ]. This is a strong structural barrier for families living in urban poverty. The structural challenges surrounding the food supply systems and markets in vulnerable urban areas means that sometimes individuals need to travel to other places to access healthy food, which increases costs (i.e. transportation) and mental stress due to the physical barriers to access food in their own communities. This adverse situation for the urban poor is compounded by problems of poor transport infrastructure as well as high community crime rates [ 42 ].

An interesting phenomenon that emerged from the literature –that in future studies may help compare challenges to food access among the urban and rural poor– is related to the nature of the social fabric and networks. Specifically, studies found that because urban networks tend to be weaker and, in the case of coping with FI, it may prevent families from “borrowing” or exchanging food with others [ 68 , 98 ].

Our review also found that urban poverty leads to increased risk of poor nutrition outcomes including stunting, overweight and obesity. Three themes that may help explain this finding emerged. First, the evidence indicates that urban environments foster a greater consumption of ultra-processed foods with high content of calories, fats, salt and sugars and very low nutritional value [ 47 , 86 ]. Likewise, studies show that lack of food-access may lead to skipping meals [ 53 , 103 , 104 ]. This is of public health concern, as it is known that prolonged fasting may predispose to unfavorable metabolic responses [ 106 , 107 ]. Finally, several articles pointed out how these experiences may be leading to mental health problems as a result of shame, and despair among those affected by FI without the ability to properly cope with it [ 76 , 104 ]. FI- related mental health stressors in turn can also increase the risk of cardiometabolic alterations and nutritional status [ 108 , 109 , 110 ]. Previous studies have established a strong plausibility for linking mental stress with the risk of overweight and obesity, mainly due to the increased release of hormones and neurotransmitters that can cause an increase in visceral adiposity and changes in the areas of the brain where hunger and satiety are regulated [ 108 , 109 , 110 ].

A substantive body of FI literature was identified. It is clear that FI in urban areas is strongly driven by income limitations. Specifically, low-income households need to allocate a high proportion of their total expenditure to food and are extremely vulnerable to any external shock including unemployment, health problems and food price inflation [ 45 , 46 , 65 , 84 ]. Similarly, the literature documented that the impact of FI on poor health is compounded by the fact that low-income urban households tend to have poor sanitation and other essential housing infrastructure and goods [ 46 ].

Given the findings from this review, it is not surprising that FI among the urban poor [ 49 , 73 , 76 ] has been associated with poor nutrition outcomes. This highlights the relevance of monitoring FI in urban populations. Food insecurity experience scales (FIES) are important in capturing this phenomenon among the urban poor, and efforts should be made to capture the different severity levels (i.e. mild, moderate, severe).

Another theme of great relevance is that social protection and food assistance programs designed to facilitate food access - such as monetary or in-kind transfer schemes, community kitchens and food banks - are insufficient by themselves to fully resolve the FI problem because they do not address barriers such as lack of cooking facilities or food storage, and competing health or housing expenses. Therefore is not surprising that socially unacceptable coping strategies, such as taking food from garbage, were reported, illustrating the depth of the negative effects of urban poverty on the right to food [ 104 ]. Interestingly, these FI coping behaviors contrast with those observed in rural areas, such as food exchanges and small family agriculture for self-consumption [ 44 , 68 ].

Urban poverty poses unique and diverse challenges and pathways to food access and the ability of families to consume healthy and nutritious diets that prevent access to healthy diets. It is possible that the nature of cities including unplanned built environments and challenging social network structures prevent low income individuals from finding strategies to cope with FI and lead to socially unacceptable behaviors to access foods.

In terms of the quality of the research examined, from a quantitative standpoint, most studies relied on cross-sectional designs, which do not allow to draw causal inferences, therefore there is a literature gap that requires further research with a longitudinal approach. While in the future more robust designs would be desirable, it should also be stressed that literature using different samples and conducted in a diverse set of countries is yielding similar conclusions in terms of the food access challenges and poor nutrition outcomes among the urban poor. However, further research needs to be conducted with more explicit comparison groups (such as urban population in very small, small, medium size cities, and metropolis) to answer the following questions: i) What is the role of social protection in terms of reducing FI for the vulnerable population? ii) Should it be continuous for some groups and intermittent for others? iii) What interventions should be put in place when food prices rise or economic conditions worsen to make sure the vulnerable are protected? iv) Should economic sanctions or incentives be put in place to induce away the demand of processed food consumption? v) What channels are more effective to assure quality access to food for the poor in urban settings? Finally, vi) What combination of policies could be recommended to be exerted together rather than in isolation?

Ideally, the proposed framework that emerge from the literature review should aid in the development of future research addressing food insecurity and nutrition outcomes in the context of urban poverty.

Furthermore, the operationalization of the definitions of “urban” and “poverty” were highly heterogenous across studies, hence, limiting the comparability of their findings. Future studies are needed to better harmonized definitions of poverty and the urban space, preferably studies should stratify samples according to the urban population size. The quality of qualitative studies was high overall, although there is room for improvement in terms of triangulation and reporting more explicit details on how data were retrieved, coded and analyzed.

In addition to the lack of uniform high quality across studies, this review has other important limitations when interpreting its findings. First, search algorithms were limited to specific nutrition outcomes that, despite being the more salient ones, might have excluded studies addressing other outcomes. Second, although FI is strongly linked to poverty, it is possible that some relevant studies that did not mention the word “poverty” but are related to disadvantages or inequalities, may have been left out from the review. Third, the review only included studies published in Spanish or English which may have led to excluding relevant literature published in other languages. Fourth, the search engines used retrieved studies in published academic journals, therefore the review may have excluded relevant studies only published in the grey literature. Fifth, the review did not conduct a meta-analysis to understand effect sizes of associations. This was not possible due to the strong heterogeneity across studies including the many different ways in which “poverty” and “urban” were defined. However, in recognition of such limitation, we performed a qualitative thematic analysis of the selected studies. Perhaps future reviews could narrow the search strategy to only studies that are more homogenous with regards to operational definitions of exposures and outcomes. Sixth, it is also important to note that mixed methods studies were excluded from the analysis due to the complexity of their systematization.

The systematic literature review evidenced the intricate link between urban poverty, food access, household food security, and nutrition. A contribution of this review is that it identified distinct barriers present in urban areas, questioned the supposedly “urban advantage” regarding access to healthful food, and developed a conceptual framework that focuses on the particular difficulties to achieve household food security among the urban poor through improved food access, which should inform future research. This systematic review provides consistent evidence that the right to food among those living in urban poverty is compromised; this is particularly worrisome considering that an urban setting is where the majority of the countries’ populations now live or will be living in the near future. It is essential that the social and public health sectors engage in addressing these issues jointly due to the complexity highlighted by the framework developed based on the available scientific evidence.

Availability of data and materials

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The authors thank Ida Katerina García Appendini, Erika Germaine García Alberto, Alma Cecilia Pérez Navarro and Luis Alfredo Ortíz Vázquez for their thoughtful input during the developing of this manuscript. The authors also thank Marisol Silva Laya – one of the CO-PIs of the project – who always provided very useful critical insights.

This work was supported by the National Council of Science and Technology (CONACyT) and the Research Office of the Iberoamericana University.

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Home — Essay Samples — Nursing & Health — Eating Habits — Poor Nutritional Habits Of College Students: Causes, Effects, And The Way Forward

Poor Nutritional Habits of College Students: Causes, Effects, and The Way Forward

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Food for Thought 2020

Food and mood: how do diet and nutrition affect mental wellbeing, joseph firth.

1 Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK

2 NICM Health Research Institute, Western Sydney University, Westmead, Australia

James E Gangwisch

3 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA

4 New York State Psychiatric Institute, New York, NY, USA

Alessandra Borsini

5 Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King’s College London, London, UK

Robyn E Wootton

6 School of Psychological Science, University of Bristol, Bristol, UK

7 MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK

8 NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK

Emeran A Mayer

9 G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA

10 UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues

Key messages

• Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than “unhealthy” eating patterns, such as the Western diet
• The effects of certain foods or dietary patterns on glycaemia, immune activation, and the gut microbiome may play a role in the relationships between food and mood
• More research is needed to understand the mechanisms that link food and mental wellbeing and determine how and when nutrition can be used to improve mental health

Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability. 1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. 2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed.

In recent years, the relationships between nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. 3 However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health ( fig 1 ). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. 4

Hypothesised relationship between diet, physical health, and mental health. The dashed line is the focus of this article.

While acknowledging the complex, multidirectional nature of the relationships between diet and mental health ( fig 1 ), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Mood and carbohydrates

Consumption of highly refined carbohydrates can increase the risk of obesity and diabetes. 5 Glycaemic index is a relative ranking of carbohydrate in foods according to the speed at which they are digested, absorbed, metabolised, and ultimately affect blood glucose and insulin levels. As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing; data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms. 6 Clinical studies have also shown potential causal effects of refined carbohydrates on mood; experimental exposure to diets with a high glycaemic load in controlled settings increases depressive symptoms in healthy volunteers, with a moderately large effect. 7

Although mood itself can affect our food choices, plausible mechanisms exist by which high consumption of processed carbohydrates could increase the risk of depression and anxiety—for example, through repeated and rapid increases and decreases in blood glucose. Measures of glycaemic index and glycaemic load can be used to estimate glycaemia and insulin demand in healthy individuals after eating. 8 Thus, high dietary glycaemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. 5 9 The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. 10 In addition, observational research has found that recurrent hypoglycaemia (low blood sugar) is associated with mood disorders. 9

The hypothesis that repeated and rapid increases and decreases in blood glucose explain how consumption of refined carbohydrate could affect psychological state appears to be a good fit given the relatively fast effect of diets with a high glycaemic index or load on depressive symptoms observed in human studies. 7 However, other processes may explain the observed relationships. For instance, diets with a high glycaemic index are a risk factor for diabetes, 5 which is often a comorbid condition with depression. 4 11 While the main models of disease pathophysiology in diabetes and mental illness are separate, common abnormalities in insulin resistance, brain volume, and neurocognitive performance in both conditions support the hypothesis that these conditions have overlapping pathophysiology. 12 Furthermore, the inflammatory response to foods with a high glycaemic index 13 raises the possibility that diets with a high glycaemic index are associated with symptoms of depression through the broader connections between mental health and immune activation.

Diet, immune activation, and depression

Studies have found that sustained adherence to Mediterranean dietary patterns can reduce markers of inflammation in humans. 14 On the other hand, high calorie meals rich in saturated fat appear to stimulate immune activation. 13 15 Indeed, the inflammatory effects of a diet high in calories and saturated fat have been proposed as one mechanism through which the Western diet may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier. 15 Since various mental health conditions, including mood disorders, have been linked to heightened inflammation, 16 this mechanism also presents a pathway through which poor diet could increase the risk of depression. This hypothesis is supported by observational studies which have shown that people with depression score significantly higher on measures of “dietary inflammation,” 3 17 characterised by a greater consumption of foods that are associated with inflammation (eg, trans fats and refined carbohydrates) and lower intakes of nutritional foods, which are thought to have anti-inflammatory properties (eg, omega-3 fats). However, the causal roles of dietary inflammation in mental health have not yet been established.

Nonetheless, randomised controlled trials of anti-inflammatory agents (eg, cytokine inhibitors and non-steroidal anti-inflammatory drugs) have found that these agents can significantly reduce depressive symptoms. 18 Specific nutritional components (eg, polyphenols and polyunsaturated fats) and general dietary patterns (eg, consumption of a Mediterranean diet) may also have anti-inflammatory effects, 14 19 20 which raises the possibility that certain foods could relieve or prevent depressive symptoms associated with heightened inflammatory status. 21 A recent study provides preliminary support for this possibility. 20 The study shows that medications that stimulate inflammation typically induce depressive states in people treated, and that giving omega-3 fatty acids, which have anti-inflammatory properties, before the medication seems to prevent the onset of cytokine induced depression. 20

However, the complexity of the hypothesised three way relation between diet, inflammation, and depression is compounded by several important modifiers. For example, recent clinical research has observed that stressors experienced the previous day, or a personal history of major depressive disorders, may cancel out the beneficial effects of healthy food choices on inflammation and mood. 22 Furthermore, as heightened inflammation occurs in only some clinically depressed individuals, anti-inflammatory interventions may only benefit certain people characterised by an “inflammatory phenotype,” or those with comorbid inflammatory conditions. 18 Further interventional research is needed to establish if improvements in immune regulation, induced by diet, can reduce depressive symptoms in those affected by inflammatory conditions.

Brain, gut microbiome, and mood

A more recent explanation for the way in which our food may affect our mental wellbeing is the effect of dietary patterns on the gut microbiome—a broad term that refers to the trillions of microbial organisms, including bacteria, viruses, and archaea, living in the human gut. The gut microbiome interacts with the brain in bidirectional ways using neural, inflammatory, and hormonal signalling pathways. 23 The role of altered interactions between the brain and gut microbiome on mental health has been proposed on the basis of the following evidence: emotion-like behaviour in rodents changes with changes in the gut microbiome, 24 major depressive disorder in humans is associated with alterations of the gut microbiome, 25 and transfer of faecal gut microbiota from humans with depression into rodents appears to induce animal behaviours that are hypothesised to indicate depression-like states. 25 26 Such findings suggest a role of altered neuroactive microbial metabolites in depressive symptoms.

In addition to genetic factors and exposure to antibiotics, diet is a potentially modifiable determinant of the diversity, relative abundance, and functionality of the gut microbiome throughout life. For instance, the neurocognitive effects of the Western diet, and the possible mediating role of low grade systemic immune activation (as discussed above) may result from a compromised mucus layer with or without increased epithelial permeability. Such a decrease in the function of the gut barrier is sometimes referred to as a “leaky gut” and has been linked to an “unhealthy” gut microbiome resulting from a diet low in fibre and high in saturated fats, refined sugars, and artificial sweeteners. 15 23 27 Conversely, the consumption of a diet high in fibres, polyphenols, and unsaturated fatty acids (as found in a Mediterranean diet) can promote gut microbial taxa which can metabolise these food sources into anti-inflammatory metabolites, 15 28 such as short chain fatty acids, while lowering the production of secondary bile acids and p-cresol. Moreover, a recent study found that the ingestion of probiotics by healthy individuals, which theoretically target the gut microbiome, can alter the brain’s response to a task that requires emotional attention 29 and may even reduce symptoms of depression. 30 When viewed together, these studies provide promising evidence supporting a role of the gut microbiome in modulating processes that regulate emotion in the human brain. However, no causal relationship between specific microbes, or their metabolites, and complex human emotions has been established so far. Furthermore, whether changes to the gut microbiome induced by diet can affect depressive symptoms or clinical depressive disorders, and the time in which this could feasibly occur, remains to be shown.

Priorities and next steps

In moving forward within this active field of research, it is firstly important not to lose sight of the wood for the trees—that is, become too focused on the details and not pay attention to the bigger questions. Whereas discovering the anti-inflammatory properties of a single nutrient or uncovering the subtleties of interactions between the gut and the brain may shed new light on how food may influence mood, it is important not to neglect the existing knowledge on other ways diet may affect mental health. For example, the later consequences of a poor diet include obesity and diabetes, which have already been shown to be associated with poorer mental health. 11 31 32 33 A full discussion of the effect of these comorbidities is beyond the scope of our article (see fig 1 ), but it is important to acknowledge that developing public health initiatives that effectively tackle the established risk factors of physical and mental comorbidities is a priority for improving population health.

Further work is needed to improve our understanding of the complex pathways through which diet and nutrition can influence the brain. Such knowledge could lead to investigations of targeted, even personalised, interventions to improve mood, anxiety, or other symptoms through nutritional approaches. However, these possibilities are speculative at the moment, and more interventional research is needed to establish if, how, and when dietary interventions can be used to prevent mental illness or reduce symptoms in those living with such conditions. Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms. 34 On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet. 35 36 37 Such results, however, must be considered within the context of the effect of people’s expectations, particularly given that individuals’ beliefs about the quality of their food or diet may also have a marked effect on their sense of overall health and wellbeing. 38 Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness. 33

At the same time, it is important to be remember that the causes of mental illness are many and varied, and they will often present and persist independently of nutrition and diet. Thus, the increased understanding of potential connections between food and mental wellbeing should never be used to support automatic assumptions, or stigmatisation, about an individual’s dietary choices and their mental health. Indeed, such stigmatisation could be itself be a casual pathway to increasing the risk of poorer mental health. Nonetheless, a promising message for public health and clinical settings is emerging from the ongoing research. This message supports the idea that creating environments and developing measures that promote healthy, nutritious diets, while decreasing the consumption of highly processed and refined “junk” foods may provide benefits even beyond the well known effects on physical health, including improved psychological wellbeing.

Contributors and sources: JF has expertise in the interaction between physical and mental health, particularly the role of lifestyle and behavioural health factors in mental health promotion. JEG’s area of expertise is the study of the relationship between sleep duration, nutrition, psychiatric disorders, and cardiometabolic diseases. AB leads research investigating the molecular mechanisms underlying the effect of stress and inflammation on human hippocampal neurogenesis, and how nutritional components and their metabolites can prevent changes induced by those conditions. REW has expertise in genetic epidemiology approaches to examining casual relations between health behaviours and mental illness. EAM has expertise in brain and gut interactions and microbiome interactions. All authors contributed to, read, and approved the paper, and all the information was sourced from articles published in peer reviewed research journals. JF is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JF is supported by a University of Manchester Presidential Fellowship and a UK Research and Innovation Future Leaders Fellowship and has received support from a NICM-Blackmores Institute Fellowship. JEG served on the medical advisory board on insomnia in the cardiovascular patient population for the drug company Eisai. AB has received research funding from Johnson & Johnson for research on depression and inflammation, the UK Medical Research Council, the European Commission Horizon 2020, the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King’s College London. REW receives funding from the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. EAM has served on the external advisory boards of Danone, Viome, Amare, Axial Biotherapeutics, Pendulum, Ubiome, Bloom Science, Mahana Therapeutics, and APC Microbiome Ireland, and he receives royalties from Harper & Collins for his book The Mind Gut Connection. He is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the US Department of Defense. The views expressed are those of the authors and not necessarily those of the organisations above.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

Poor quality diet makes our brains sad

Eating a poor quality diet might lead to brain changes that are associated with depression and anxiety.

Eating a poor quality diet might lead to brain changes that are associated with depression and anxiety. This is according to a first-of-its-kind study into the brain chemistry and structure, and diet quality of 30 volunteers.

Brain scans show changes in neurotransmitters and grey matter volume in people who have a poor diet, versus those who adhere to a Mediterranean style diet, which is considered very healthy. The researchers also found that these changes are associated with rumination, a part of the diagnostic criteria for conditions affecting mental health, such as depression and anxiety.

This research was carried out by the University of Reading, Roehampton University, FrieslandCampina (Netherlands), and Kings College London, and is published in Nutritional Neuroscience.

When someone eats a poor quality diet, there is reduced gamma aminobutyric acid (GABA) and elevated glutamate -- both neurotransmitters, along with reduced grey matter volume -- in the frontal area of their brain. This could explain the association between what we eat, and how we feel.

Dr Piril Hepsomali, University of Reading, said: "We can eat ourselves well! Ultimately, we see that people who have an unhealthy diet -- high in sugar and saturated fat -- have imbalanced excitatory and inhibitory neurotransmission, as well as reduced volume of grey matter in the frontal part of the brain. This part of the brain is involved in mental health issues such as depression and anxiety."

The exact reason that diet affects the brain in this way is still under investigation. It's possible that obesity and dietary patterns that are high in saturated fats cause changes in glutamate and GABA metabolism and neurotransmission, as has been shown in animal studies.

Distinct alterations of the gut microbiome, due to dietary patterns that are high in saturated fats, is thought to have an impact on cell machinery that drives both GABA and glutamate production.

A high saturated fat, high sugar, diet has also been shown to reduce the number of parvalbumin interneurons, which perform the role of delivering GABA to where it is needed.

Unhealthy diets also have an impact on glucose, making blood glucose and insulin higher. This increases glutamate in the brain and plasma, thus reducing GABA production and release. Having a diet high in fat and cholesterol can cause changes in cell membranes that alter the release of neurotransmitters, too.

These changes in brain chemistry might lead to changes in the brain grey matter volume, as observed in this study.

Dr Hepsomali continued: "I would like to note that GABA and glutamate are intimately involved in appetite and food intake, too. Reduced GABA and/or increased glutamate might also be a driving factor in making unhealthy food choices. So, there may be a circular relationship between eating well, having a healthier brain and better mental wellbeing, and making better food choices to eat well."

• Diet and Weight Loss
• Psychology Research
• Nutrition Research
• Dieting and Weight Control
• Neuroscience
• Brain Injury
• Healthy diet
• Malnutrition
• Methamphetamine
• Atkins Diet

Story Source:

Materials provided by University of Reading . Note: Content may be edited for style and length.

Journal Reference :

• Piril Hepsomali, Adele Costabile, Marieke Schoemaker, Florencia Imakulata, Paul Allen. Adherence to unhealthy diets is associated with altered frontal gamma-aminobutyric acid and glutamate concentrations and grey matter volume: preliminary findings . Nutritional Neuroscience , 2024; 1 DOI: 10.1080/1028415X.2024.2355603

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