Nutrition as a potential mediator of response underlying ... · Vauzour 2012, Oxidative Medicine and Cellular Longevity Slides may NOT be reproduced without the express permission

Natalie (Sinn) Parletta, PhD

Nutrition as a potential mediator of inflammatory response underlying depression and cardiovascular disease

Slides may NOT be reproduced without the express permission of Natalie Parletta

• Obesity has more than doubled in the past twenty years – 63% of adults (ABS)

• And along with it: chronic disease – CVD: 4.7%>18 yrs, 24%>75 yrs, 22% ↑BP

• Widespread concern re impact on physical health – mental health?

• Depression top cause of disability, estimated leading cause of disease by 2030

Chronic disease and mental illness

Australian Health Survey, ABS 2013; Australian Institute of Health and Welfare, 2012

• 45% Australians aged 16‐85 have experienced a mental disorder

• People with mental disorders suffer greater psychological distress and severe disability

• 1 in 9 Australians have mental disorder and comorbid physical condition


Physical and mental health‐ Depression increases likelihood of developing chronic physical illness

(especially CVD or stroke) – Beyond Blue‐ Strong consistent evidence of independent causal association between

depression and CVD causes and prognosis – National Heart Foundation‐ “There is no health without mental health” – WHO‐ Chronic physical conditions are risk factors for poor mental health and

vice versa – Canadian Mental Health Association



Mood disorders – 25‐67% obese

McElroy et al 2004, J Clin Psychiatry, 65:634‐651 Slides may NOT be reproduced without the express permission of Natalie Parletta

Obesity and mood disorders

McElroy et al 2004, J Clin Psychiatry, 65:634‐651


Pan et al 2012

Metabolic syndrome and depression


Pan et al 2012, Diabetes Care, 35:1171‐1180

Metabolic syndrome and depression –prospective studies


Knol et al 2006, Diabetologia 49:837‐845

Diabetes risk in depressed adults

Meta‐analysis of longitudinal studies

Depressed adults have 37% increased risk of developing diabetes


Chronic inflammation


Howren et al. 2010, Psychosomatic Med, 71:171‐186 Slides may NOT be reproduced without the express permission of Natalie Parletta

Meta‐analysis – inflammatory cytokines and depression

Tumor necrosis factor‐ α (TNF‐ α)

Interleukin‐6 (IL‐6)

Dowlati et al. 2010, Biol Psychiatry, 67:446‐457 Slides may NOT be reproduced without the express permission of Natalie Parletta

Gimeno et al. 2009, Psychol Med, 39:413‐423

‐ Longitudinal study: N>3,000

‐ Follow‐up M=11.8 years

‐ Symptoms of depression: GHQ

‐ CPR and IL‐6 predicted depression

‐ Baseline symptoms of depression did not predict inflammation


‐ Longitudinal study: 644 women no prior history of depression

‐ During follow‐up, 48 new cases of MDD identified

‐ Hazard ratio for depression increased by 44% for each SD increase in hsCRP

Serum hsCRP independent risk factorfor de novo major depression

Pasco et al 2010, Br J Psychiatry, 197:372‐377 Slides may NOT be reproduced without the express permission of Natalie Parletta

Raison & Miller 2011, Curr Psychiatry Rep, 13:467‐475 Slides may NOT be reproduced without the express permission of Natalie Parletta

460‐377 BC

“He who cures a disease may be the skillfullest, but he who prevents it is the safest physician”Thomas Fuller (1668-1661)


Lopez‐Garcia et al 2004, AJCN 80:1029‐35

‐ 732 healthy women, 43‐49 years (US Nurses Health Study) Slides may NOT be reproduced without the express permission of Natalie Parletta

Bach‐Faig et al, 2011, PHN 14(12A): 2274‐84 Slides may NOT be reproduced without the express permission of Natalie Parletta

Nordmann et al 2011, Am J Med, 124:841‐851 Slides may NOT be reproduced without the express permission of Natalie Parletta

Healthy Brain

Healthy Mediterranean‐style diet

Olive oil

Fresh fruit/veg

Fish

Legumes, nuts, seeds, cereals

Moderate red wine intake

↓ processed food, red meat, dairy products, calories

▼ MUFA (oleic acid)

Polyphenols

‘Vitamin’ D

Minerals (e.g. iron, iodine, zinc)

Omega‐3 PUFA

↑ neuronal survival↑ energy metabolism↑ neurotrophins↓ oxida ve damage/ cell death

↓ neuroinflamma on↑ neurotransmission↑ membrane fluidity↑ cell membraneintegrity

↑ glucose transport↑ nutrient synthesis/metabolism

↑ gene expression↑ methyla on↓ blood pressure

Vitamins A, B, C, E

Amino acids

Parletta, Milte, Meyer (2013). Nutritional modulation of cognitive function and mental health. J Nutr Biochem

Overview of links between Mediterranean‐style diet and healthy brain function via plant compounds/nutrients


Oyebode et al. 2014, J Epidemiol Comm Health; Blanchflower et al. 2014, J Social Indicators


Australian Institute of Health and Welfare, 2012

Fruit and vegetable consumption in Australians >12 years


Ng et al, 2008 Slides may NOT be reproduced without the express permission of Natalie Parletta

Vauzour 2012, Oxidative Medicine and Cellular Longevity Slides may NOT be reproduced without the express permission of Natalie Parletta

• Omega-6 & Omega-3: polyunsaturated fatty acids (PUFA)

• Chemically active lipids; vital structural and functional roles in all cells

• Must be provided in the diet

• Omega-3s: dark leafy vegetables, nuts & seeds;deep sea fish (EPA & DHA)

• Western diets deficient

• 1:1 traditional diets

• 10-20:1 modern dietsSimopoulos 1991

Omega-3 fatty acids


18:2 linoleic (LA)Diet: Plant sources →n‐6 n‐3

18:3 α‐linolenic (ALA)

∆6 desaturase↓ ↓18:3 γ‐linolenic (GLA)

elongase

20:3 20:4↓ ↓

↓ ↓∆5 desaturase

20:4 arachidonic (AA)

18:4

20:5 (EPA)

↓

24:6

↓

↓

24:5

22:6 (DHA)

elongase

∆6 desaturase

β‐oxidation

Evening primrose →

Oily fish (EPA) (→)

Algae/ Oily fish →

↑ ↓

n‐3 and n‐6 PUFA conversion pathways


Comparison of eggs from Greek village and US supermarket

Fatty acid Greek Supermarket

Saturated 101 81MUFA 143 115n‐6 PUFA 23 34n‐3 PUFA 18 1.7% saturated 40 44n‐6/n‐3 1.3 19.4

Simopoulos and Sidossis (2000), World Rev Nutr Diet, 87:24‐42 Slides may NOT be reproduced without the express permission of Natalie Parletta

Harris WS, Von Schacky C. Prev Med. 2004;39:212

Protection against Cardiovascular Disease

GISSI-P2 9.5%*

DART3 9.5%*

CHS4 8.8%**

SCIMO5 8.3%

6 epi. studies 8%*

PHS6 6.9%**

Seattle7 6.5%4%

8%

Stavanger1: > 9.5%**: No Added Protection

6%

10%

1Nilsen. AJCN. 74:50, 2001; 2Marchioli. Circulation. 105:1897, 2002; 3Burr. Lancet. 2:757, 1989; 4Mozaffarian. Circulation.107:1372, 2003; 5von Schacky

Ann Intern Med.130:554, 1999; 6Albert. NEJM. 346:1113, 2002; 7Siscovick. JAMA. 274:1363, 1995.

8.2%

The Omega-3 Index™

EPA+DHA in RBC

PHS: 3.9%SCIMO: 3.4%Seattle: 3.3%

Greatest protection

Least protection


Cardiac death is associated with omega‐6 fat


• 60% of the brain is composed of lipids

• DHA highly concentrated in neural membranes & synapses.

• EPA – eicosanoid synthesis: anti‐inflammatory, anti‐thrombotic, vasodilatory

Omega‐3 fatty acids in the brain

Crawford & Sinclair 1971; Salem et al 2001; Horrobin 1999; Chalon et al 2001; Youdim et al 2000; Lauritzen et al 2001, Haag 2003; Yehuda et al 2005; Young et al 2005

0

5

10

15

20

LA LNA AA 22:4n6 22:5n3 DHA

Brain PUFA fingerprint (% total fatty acids)

Sinclair, unpublishedSlides may NOT be reproduced without the express permission of Natalie Parletta

• 60% of the brain is composed of lipids

• DHA highly concentrated in neural membranes & synapses.

• EPA – eicosanoid synthesis: anti‐inflammatory, anti‐thrombotic, vasodilatory

• nerve sheath myelinationmembrane fluidityneurotransmissionion channel & enzyme regulationgene expressioncell signaling activitiescerebral blood flow

Crawford & Sinclair 1971; Salem et al 2001; Horrobin 1999; Chalon et al 2001; Youdim et al 2000; Lauritzen et al 2001, Haag 2003; Yehuda et al 2005; Young et al 2005

www.nida.nih.gov/.../Teaching2/Teaching2.html

Omega‐3 fatty acids in the brain


Sinn et al, Nutrients 2010 Slides may NOT be reproduced without the express permission of Natalie Parletta

Omega‐3 fatty acids and depression

Appleton et al 2010, Am J Clin Nutr doi: 10.3945/ajcn.2009.28313Slides may NOT be reproduced without the express permission of Natalie Parletta

Frasure‐Smith et al. Biol Psychiatry 2004, 55:891‐896

Difference in DHA –effect size .53Difference in total omega‐3 –effect size .47


Gut microbiota

• 100 trillion bacteria live in our gut – more than cells in our body

• High vegetable, fibre‐based diets produce different gut environment than Western high fat/carb diet

• Interest in effect on brain via gut‐brain axis

Tillisch et al 2013, Gastroenterology 144: 1394-1401

Recent study in healthy women (N=36), 4 weeks:

• Fermented milk product with probiotics vs unfermented milk and no intervention

• fMRI showed that probiotic product altered brain activity in regions involving central processing of emotion and sensation

• May moderate abnormal pain and stress responses


Gut microbiota – implications for schizophrenia

• Immune and inflammatory response elevated

• Gut microbiota linked to systemic inflammation, immune response

• Newborn gut microbiota in GI tract linked to brain development; NMDA, BDNF

Nemani et al 2014, Prog Neuropsychopharmacol Biol Psychiatry

• Structural GI tract damage identified in people with schizophrenia:

92% colitis, 88% enteritis, 50% gastritis (N=82 autopsies)

• ↑ risk autoimmune disease; ↑ an bodies in brain cells (hippocampus, amygdala, frontal cortex)

• Some indications of response to gluten‐ and casein‐free diet

• Probiotics may reduce anxiety, stress response and mood


Jacka et al. 2011, Psychosomat Med 73:483‐490

Healthy dietary pattern and depression→ Healthier diets associated with reduced depression


Healthy dietary pattern score and anxiety→ Unhealthy diets associated with increased anxietyAll adjusted for confounding variables

Jacka et al. 2011, Psychosomat Med 73:483‐490 Slides may NOT be reproduced without the express permission of Natalie Parletta

• >10,000 Spanish graduates• Median follow up: 4.4 years• 480 new cases of depression• P for trend < .001• Inverse associations for fruit,

veg, MUFA:SFA, legumes• No evidence of reverse

causality

Sanchez‐Villegas et al. 2006, Pub Health Nutr, 9:1104‐1109 Slides may NOT be reproduced without the express permission of Natalie Parletta

Trans fat intake and risk for depression


‐ Prospective 5‐year study

‐ 3486 middle‐aged people from Whitehall II cohort

‐ ‘whole food’: vegetables, fruit, fish

‐ ‘processed food’: sweet desserts, fried food, processed meat, refined grains, high fat dairy

‐ Whole food 36% ↓ risk

‐ Processed food 58% ↑ risk

Akbaraly et al. 2009, Br J Psychiatry, 195:408‐413 Slides may NOT be reproduced without the express permission of Natalie Parletta

Jacka et al 2011, PLoS ONE, 6, e24805 Slides may NOT be reproduced without the express permission of Natalie Parletta

• RCT: 55‐80 year‐old men and women • High risk of CVD (51% with T2DM)• Assigned to low‐fat diet (n=1184), MD+EVOO

(n=1446) or MD+nuts (n=1293)• 3‐year follow up: 224 new cases of depression• Inverse association for MD+nuts (ns)• Significant when restricted to T2DM – 41%

relative reduction in depression risk• Per protocol: strongest adherence to MD =

lowest depression risk

Sanchez‐Villegas et al. 2013, BMC Medicine, 11:208 Slides may NOT be reproduced without the express permission of Natalie Parletta

Natalie Parletta, Dorota Zarnowiecki, Amy Wilson, Anthony Villani, Catherine Cho, Svetlana Bogomolova, Andrea Fielder, Tom Butler, Nicholas Procter, Kerin O’Dea (UniSA)John Strachan, Matt Ballestrin, Andrew Champion (Outer South Mental Health Directorate)Catherine Itsiopoulos (La Trobe University)

Helfimed Program Pilot study in Community Rehabilitation Centre with people who have SMI Community study with people suffering depression Nutrition/dietary education, cooking workshops, food hampers (3 months)

based on Mediterranean diet principles, shopping vouchers Fish oil supplementation (6 months) Cardiometabolic and mental health outcomes at 3 and 6 months

Bogomolova et al. (under review), Health Psychology (special issue: CVD disparities)Slides may NOT be reproduced without the express permission of Natalie Parletta

Nutrition education using food models based on AGHE






http://helfimed.orgSlides may NOT be reproduced without the express permission of Natalie Parletta

Thank you

Dr Dorota ZarnowieckiAmy WilsonDr Svetlana BogomolovaProfessor Nicholas ProcterDr Andrea FielderA/Professor Catherine ItsiopoulosProfessor Kerin O’DeaProfessor Leonie Segal

Dr Jim DollmanA/Professor Barbara MeyerDr Marijka BatterhamOuter South Mental HealthJohn StrachanMatt BallestrinDr Andrew ChampionTPC Staff and Residents


Nutrition as a potential mediator of response underlying ... · Vauzour 2012, Oxidative Medicine and Cellular Longevity Slides may NOT be reproduced without the express permission

Documents