HEI-2020 was inversely associated with PSD, with nonlinear and race-specific patterns and DI-GM showed a significant but inconsistent indirect association, suggesting a suppressive rather than mediating role.
Abstract
Background
Post-stroke depression (PSD) is a common complication after stroke and contributes to poor functional recovery and reduced quality of life. Dietary quality has been associated with depression in the general population, but evidence in individuals with stroke remains limited. This study examined the cross-sectional association between the Healthy Eating Index-2020 (HEI-2020) and PSD.
Methods
This study included 962 adults with a history of stroke from seven cycles of the National Health and Nutrition Examination Survey from 2005 to 2018. Depressive symptoms were assessed using the Patient Health Questionnaire-9, with a score ≥ 10 indicating probable depression. Dietary quality was evaluated using HEI-2020 and categorized into tertiles. Multivariate logistic regression, restricted cubic spline analysis, and mediation analysis were used to assess associations and the statistical indirect association of the Dietary Index for Gut Microbiota (DI-GM).
Results
After multivariate adjustment, each one-point increase in HEI-2020 score was associated with 2% lower odds of probable depression (PHQ-9-defined) (OR = 0.98). Compared with the low dietary quality group, the high dietary quality group had 59% lower odds (OR = 0.41). The dose-response relationship was nonlinear, with a significant inverse association observed only when HEI-2020 scores exceeded 57. This exploratory threshold may serve as a reference for future prospective studies but requires validation before clinical application. Furthermore, a significant interaction with race or ethnicity was identified (P for interaction = 0.033). DI-GM showed a significant indirect association (P = 0.04), but the direct and indirect components were in opposite directions, indicating an inconsistent mediation pattern. Given that DI-GM is a dietary proxy, these findings reflect statistical associations with a dietary pattern, not biological mediation. Future studies with direct microbiome measurements are needed to verify gut-brain axis involvement in PSD.
Conclusions
In this cross-sectional study, HEI-2020 was inversely associated with PSD, with nonlinear and race-specific patterns. DI-GM showed a significant but inconsistent indirect association, suggesting a suppressive rather than mediating role. Findings are associational, not causal.
ObjectiveThis study examined the association between the Systemic Inflammatory Response Index (SIRI) and depressive symptoms among emerging adults aged 18-25 years, with an emphasis on the indirect role of sleep duration.MethodThis cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2023. A total of 6563 participants with complete data on the Patient Health Questionnaire-9 (PHQ-9), complete blood count parameters for SIRI calculation, and self-reported sleep duration were included. Depressive symptoms were defined as a PHQ-9 score ≥10. Weighted multivariable logistic regression, restricted cubic spline analysis, and bootstrap-based exploratory mediation analysis (n = 1000) were employed.ResultsOverall, 604 participants (9.2%) met the criteria for depressive symptoms. After full adjustment for covariates, SIRI demonstrated a significant positive association with depressive symptoms (Model 4: OR = 1.16, 95% CI = 1.02-1.33, P = 0.03). Participants in the highest SIRI quartile (Q4) exhibited 33% higher odds of depressive symptoms compared to the lowest quartile (Q1) (OR = 1.33, 95% CI = 1.09-1.61, P = 0.005). No significant nonlinearity was observed (P for nonlinearity = 0.066). Exploratory mediation analysis revealed a negative indirect effect through sleep duration (β = -0.009), accounting for approximately 6.2% of the total effect.ConclusionsHigher SIRI levels were associated with increased odds of depressive symptoms among emerging adults. Sleep duration played a modest suppressor role in this relationship, suggesting complex interactions between inflammation, sleep, and mental health warranting further investigation through prospective studies.
Yingying Zhang, Yunyun Zheng, Yuting Zhang et al.· International Journal of Psy...· 0 citations
BACKGROUND
Stroke, as the fourth leading cause of disability worldwide, poses significant long-term health challenges for survivors. Dietary interventions, being among the most modifiable risk factors, hold great potential in secondary prevention and long-term care for stroke survivors. However, there is insufficient evidence focusing on this topic.
METHODS
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 survey, including 1212 participants with complete dietary data. Cox proportional hazards models, adjusted for various covariates, were used to examine the association between five dietary indices and all-cause mortality in stroke survivors.
RESULTS
The Alternative Healthy Eating Index (AHEI) was found to be inversely associated with all-cause mortality in stroke survivors, while the Dietary Inflammatory Index (DII) showed a positive association. No significant associations were observed for The Healthy Eating Index-2020 (HEI-2020), Alternate Mediterranean Diet Score (aMED), or Dietary Approaches to Stop Hypertension score (DASH). Compared to the lowest quartile, the highest quartile of AHEI was associated with a 64.8% reduction in all-cause mortality risk (HR = 0.352, 95% CI 0.153, 0.809, p = 0.014). Conversely, the highest quartile of DII was associated with a 47.1% increase in mortality risk (HR = 1.471, 95% CI 1.028, 2.104, p = 0.035).
CONCLUSION
AHEI and DII were significantly associated with all-cause mortality among stroke survivors. These findings highlight the potential clinical relevance of dietary quality in long-term prognosis, although prospective studies are needed to confirm these associations.
Junjie Pei, Yangzheng Li, Haixin Song et al.· Journal of Stroke & Cerebrov...· 0 citations
The global increase in adolescent Major Depressive Disorder (MDD) has profound implications for physical and mental development, contributing to a significant societal burden. Emerging evidence suggests that low-grade chronic inflammation, commonly observed in adolescents with MDD, is associated with the severity of the disorder. This study explores the relationship among dietary inflammation, dietary nutrients and adolescent depression, utilizing data from the Energy-adjusted Dietary Inflammatory Index (E-DII) in a population from northern China.
A case-control study was conducted between March 2022 and October 2023, involving 172 treatment-naïve adolescents aged 10–23 years diagnosed with MDD and 172 age- and sex-matched healthy controls. Although the calculated minimum sample size was 174 per group, two matched pairs were excluded during data cleaning because extreme dietary reporting could have biased nutrient intake estimation. The E-DII was derived using data from a validated semi-quantitative Chinese food frequency questionnaire (FFQ). Logistic regression was employed to evaluate the association between E-DII and the risk of adolescent MDD, while restricted cubic spline (RCS) functions assessed the dose-response relationships between specific dietary nutrient intakes and MDD.
A positive association was identified between the E-DII and the risk of adolescent MDD (OR = 3.24; 95% CI: 2.32–4.51;
P
< 0.001), which persisted after adjusting for potential confounders (OR = 3.23; 95% CI: 2.22–4.69;
P
< 0.001). Although an increase in E-DII score correlated with higher HAMD scores, intra-group differences were not statistically significant (
P
= 0.159). Several dietary nutrients, including Vitamin B12, dietary fiber, zinc, polyunsaturated fatty acids (PUFA), folate, and anthocyanins, were negatively associated with the risk of MDD in adolescents, whereas carbohydrates, selenium, and alcohol intake were positively associated with MDD risk (all
P
< 0.05). RCS analysis showed nonlinear dose–response relationships for PUFA, anthocyanins, vitamin B12, and alcohol intake, whereas selenium, zinc, folate, carbohydrates, and dietary fiber showed linear associations with MDD risk.
This study underscores a positive correlation between the E-DII and both the risk and severity of adolescent depression, emphasizing the critical role of dietary factors in the prevention and management of adolescent depression. From a clinical and public health perspective, early dietary assessment and promotion of anti-inflammatory dietary patterns may provide a feasible adjunctive strategy for reducing depression risk in adolescents.
Junxiang Cheng, Ning Ma, Qia Liu et al.· BMC Psychiatry· 0 citations
Little is known about the combined association of physical activity (PA) and dietary quality (DQ) with stroke and its mortality outcomes. This study aims to investigate the individual and combined association of PA and DQ on odds of prevalent stroke and mortality among stroke survivors. We analyzed data from 20,225 adults participating in the 2007-2018 National Health and Nutrition Examination Survey, including 838 stroke survivors. PA was measured by the self-reported metabolic equivalent to task (MET) minutes per week, and DQ by Healthy Eating Index 2020 (HEI-2020). Logistic regression models evaluated associations with the odds of prevalent stroke, and Cox proportional hazards regression models assessed mortality risks among stroke survivors. Compared to no PA - lower DQ (reference), low PA - lower DQ (adjusted OR 0.49, 95%CI 0.32-0.75), low PA - higher DQ (adjusted OR 0.56, 95%CI 0.34-0.92), high PA - lower DQ (adjusted OR 0.66, 95%CI 0.44 - 0.99), and high PA - higher DQ (adjusted OR 0.50, 95%CI 0.34-0.73) were significantly associated with lower odds of stroke. Among stroke survivors, reduced mortality was observed for low PA-higher DQ (adjusted HR 0.43; 95% CI, 0.19-0.95), high PA-lower DQ (HR 0.36; 95% CI, 0.17-0.75), and high PA-higher DQ (HR 0.47; 95% CI, 0.27-0.83). This large observational study showed that a combination of appropriate PA and higher DQ is associated with reduced odds of stroke and mortality among stroke survivors. These findings support lifestyle modification as a strategy for stroke prevention and survivor care.
Mu-Lei Yang, Shuangfang Fang, Gareth Ambler et al.· British Journal of Nutrition· 0 citations
BACKGROUND
Behavioral health factors particularly depression/anxiety and smoking are common after stroke and directly influence secondary stroke prevention, rehabilitation engagement and outcomes, yet they remain under-integrated within routine physical therapy-led stroke care.
OBJECTIVES
To estimate associations between stroke history, smoking, mental health burden and sociodemographic factors and propose pragmatic implications for integrated rehabilitation.
METHODS
We conducted a cross-sectional analysis of pooled National Health Interview Survey (NHIS) data from 2019-2023 (N = 150,220 adults). Sex-stratified, survey-weighted logistic regression models estimated associations among stroke history, mental health burden, smoking, and sociodemographic factors. Among stroke survivors, models also examined the Covid-19 pandemic period.
RESULTS
Stroke was associated with higher odds of mental health burden (females OR 1.33; males OR 1.57) and current smoking (females OR 1.27; males OR 1.35) versus controls. Among survivors, the pandemic period was associated with increased smoking risk in females (OR 1.38), while Medicaid/public insurance was associated with higher odds of both smoking (females OR 1.77; males OR 1.66) and mental health burden in females (OR 1.33). Partnership conferred protection for mental health burden (females OR 0.70; males OR 0.75) and smoking in males (OR 0.63).
CONCLUSIONS
Our study suggests that national patterns support embedding behavioral health screening, smoking and substance use cessation into standard stroke rehabilitation, with prioritization of female, Medicaid-insured survivors, and those without partners, and ensuring continuity during public health crises. Since smoking cessation is central to secondary stroke prevention, embedding behavioral health screening, cessation counseling, and warm handoffs into physical therapy-led rehabilitation offers a concrete, sex-sensitive, and equity-oriented target for improving post-stroke outcomes.
Chris-Mike Agbelie, Zahra Mojtahedi, Tanya H Lee et al.· Topics in Stroke Rehabilitat...· 0 citations
OBJECTIVE
Stroke patients often have mental health comorbidities such as depression and suicidal ideation. Stroke is a leading cause of long-term disability and is associated with increased risk of death, with mental illness playing a large role in this relationship. However, the impact of stroke on suicidal ideation among individuals with co-morbid depression is not well understood. We aim to determine if stroke in combination with depression was associated with a higher prevalence and severity of suicidal ideation.
METHODS
We performed a retrospective cross-sectional study using data from the National Health and Nutrition Examination Survey, 2011-2018. All respondents were divided into four mutually exclusive categories based on their diagnosis of stroke and depression. Weighted prevalence estimates and 95% confidence intervals (CI) were reported across clinical and demographic categories. Multivariable logistic regression models were used to identify the independent association between stroke, depression, and suicidal ideation. Adjusted odds ratios (AOR) and a p-value of < 0.05 were used to determine statistical significance.
RESULTS
The analytic sample included 19,397 participants, of whom 863 (4%) had a history of stroke. Depression was present in 154 (0.7%) participants with stroke and 2709 (11.6%) participants without stroke. The mean age of participants with stroke and depression was 59 years. This group was more likely to be female (64%), non-Hispanic White (67.7%), have more than a high school education (38.9%), and be overrepresented among those living at or below the federal poverty level (69.8%). Stroke was independently associated with an increased risk of suicidal ideation in those with depression (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.21-2.85; p = 0.005) when compared to those with depression but without stroke. Living at or below the poverty level was also independently associated with increased suicidality risk (AOR = 1.39; 95% CI: 1.11-1.74; p = 0.005).
CONCLUSION
A history of stroke was found to significantly increase the odds of suicidal ideation in those with depression. These findings can help inform better integrative screening and treatment of mental health among stroke patients, especially those with co-morbid depression.
Edwin Akomaning, Ganesh Asaithambi· Clinical neurology and neuro...· 0 citations