Multi-country Project on the Role of Diet, Food-related Behavior, and Obesity in the Prevention of Depression

Conditions

Depression

Keywords

food intake, food-related behaviour, obesity, socioeconomic environment, depression, nutritional strategies

Brief summary

The study examines the feasibility and effectiveness of two different nutritional strategies (multi-nutrient supplement and food-related behavioural change) to prevent depression in high-risk overweight European Union citizens. Interventions will last 12 months. Design is a two-by-two factorial randomized controlled prevention trial with four intervention groups: 1. Control group (daily placebo supplements) 2. Multi-nutrient supplementation group (daily multi-nutrient supplement) 3. Food-related behavioural change group (food-related behavioural activation focusing on improving overall diet + placebo supplements) 4. Multi-nutrient supplementation + food-related behavioural activation group (daily multi-nutrient supplement + food-related behavioural activation focusing on improving overall diet). Follow-up assessment will be conducted at 3, 6, and 12 months for primary and secondary endpoints, and during intervention for compliance, adverse events and mediating variables.Data will first be analyzed according to the intention-to-treat principle, using (mixed model) analysis of covariance with primary and secondary endpoints, testing for the effects of the two nutritional strategies separately as well as combined.

Detailed description

Research has shown that nutrition may be an important way to promote mood and health, but so far researchers do not know which aspects of nutrition and behaviour are most important. The study is collaboration between the United Kingdom, Germany, Netherlands and Spain, funded by the European Commission. The trial compares different nutritional and lifestyle strategies that might promote mood and health in people who are overweight. For this purpose the design is a two-by-two factorial randomized controlled prevention trial with two intervention conditions: a multi-nutrient supplement and a food-related behavioural change (FBC) intervention. A total of four intervention groups are created: control condition (placebo, no FBC intervention), placebo with FBC intervention, multinutrient supplement with no FBC intervention, multi-nutrient supplement with FBC intervention.Recruitment: 1000 subjects will be recruited at four study sites in different EU countries (United Kingdom, Germany, Netherlands and Spain). Participants will be randomized with equal probability to the four intervention arms using a blind computerised randomization procedure.The multinutrient supplement and the placebo needs to taken every day during one year. The multinutrient supplement pill will contain omega 3 fatty acids, vitamin D, folic acid, selenium and calcium. FBC will consist of 21 behavioral activation sessions to adopt healthy diet behaviours that are known to explain the association between food intake and depression. Follow-up assessment will be conducted by researchers unaware of the randomization status at 3, 6, and 12 months for primary and secondary outcomes. Data will first be analyzed according to the intention-to-treat principle, using (mixed model) analysis of covariance with primary and secondary endpoints, testing for the effects of the two nutritional strategies separately as well as combined (following the 2x2 factorial design of the trial). Per-protocol analyses and mediation analyses will be conducted to examine to what extent compliance and potential mediating mechanisms explain the impact on the primary and secondary endpoints. Data collection at the different sites will be conducted according to the strictest European code of ethics and conduct as well as codes for Good Clinical Practice, and local/national and international laws and regulations, including the Declaration of Helsinki. In a random subsample of trial participants (n=50 per intervention arm) blood samples will be collected at baseline, and after 3 and 12 months to measure blood levels of the nutrients provided with the multi-nutrient supplement.

Matthew Owens, Edward Watkins, Mariska Bot, Ingeborg A. Brouwer, Miquel Roca et al. (12 authors)

BMJ Open2020-09-018 citations

10.1136/bmjopen-2019-034025

Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial.

Paans NPG, Bot M, Brouwer IA, Visser M, Gili M, Roca M, Hegerl U, Kohls E, Owens M, Watkins E, Penninx BWJH, MooDFOOD Prevention Trial Investigators.

2020-07-307 citations

10.1016/j.jpsychores.2020.110206

Depressive Symptom Clusters in Relation to Body Weight Status: Results From Two Large European Multicenter Studies

Sabrina Baldofski, Nicole Mauche, Ezgi Dogan-Sander, Mariska Bot, Ingeborg A. Brouwer et al. (16 authors)

Frontiers in Psychiatry2019-11-2123 citations

10.3389/fpsyt.2019.00858

Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial

Alessandra Grasso, Margreet R. Olthof, Corné van Dooren, Miquel Roca, Margalida Gili et al. (48 authors)

European Journal of Nutrition2019-10-2324 citations

10.1007/s00394-019-02106-1

Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms

Mariska Bot, Ingeborg A. Brouwer, Miquel Roca, Elisabeth Kohls, Brenda W.J.H. Penninx et al. (13 authors)

JAMA2019-03-05116 citations

10.1001/jama.2019.0556

Prevention of depression through nutritional strategies in high-risk persons: rationale and design of the MooDFOOD prevention trial.

Roca M, Kohls E, Gili M, Watkins E, Owens M, Hegerl U, van Grootheest G, Bot M, Cabout M, Brouwer IA, Visser M, Penninx BW, MooDFOOD Prevention Trial Investigators.

2016-06-0841 citations

10.1186/s12888-016-0900-z

Interventions

DIETARY_SUPPLEMENTMulti-nutrient supplement

* Omega 3 fatty acids * Folic acid * Calcium * Selenium * Vitamin D3

BEHAVIORALBehavioral Activation

21 sessions (15 individual sessions and 6 group sessions) The intervention will include detailed analysis of each individual's behavior to determine idiosyncratic triggers and functions of unhelpful (e.g., mood-related snacking) and helpful food-related behavior, thereby, to reinforce helpful behaviors and to implement effective alternatives to unhelpful behaviors, building on behavioural approaches proven effective in depression.

OTHERPlacebo

Placebo pills identical in look and taste but including no active ingredients

Study design

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

PREVENTION

Masking

TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to 75 Years

Healthy volunteers

Yes

Inclusion criteria

* Age 18- 75 years * Body Mass Index 25-40 * PHQ-9 score ≥ 5

Exclusion criteria

* Current (in past 6 months) clinical Major Depressive Disorder Episode (according to psychiatric DSM-IV criteria as determined with The Mini-International Neuropsychiatric Interview 5.0 (M.I.N.I. 5.0) * Current (in past 6 months) use of antidepressant drugs or psychological interventions. * History of psychosis, bipolar disorder, substance dependence or other severe, psychiatric disorder that requires specialized clinical attention. No eating disorders. This will all be measured with a brief self-report questionnaire. * History of bariatric surgery and no current severe, life-threatening disease (assessed using self-report), and no severe cognitive impairment limiting the conduct of the study, as assessed through research staff- evaluation of feasibility of conducting the screening instruments in an adequate manner. * Currently adhering to supervised behavioural interventions that intervene with MoodFood interventions. If persons are on specific dietary supplements that are competing with the MoodFood intervention, than persons must be willing to stop what they were using before the start of this study * Non pregnant or breast feeding

Design outcomes

Primary

Measure	Time frame	Description
Cumulative incidence of Major depressive Disorder	12 months	The 12-month cumulative incidence of Major Depressive Disorder (MDD), defined according to the standard psychiatric DSM-IV criteria using The Mini-International Neuropsychiatric Interview 5.0 at 12 months

Secondary

Measure	Time frame	Description
Sedentary behaviour by accelerometry in some participants	3, 6 and 12 months	Monitoring of sedentary and activity behaviour by accelerometry in some participants
Food behaviour questionnaire	3, 6 and 12 months	Food Behaviour Questionnaire on meal pattern, snacking behaviour, and other food-related behaviours in the past two weeks, such as mindful eating, cooking and shopping skills, etc.
Food intake GA2LEN-FFQ	6 and 12 months	The GA2LEN-FFQ (Garcia-Larsen et al., 2011): 6 and 12 months later
Physical activity and sedentary behavior (composite)	3, 6 and 12 months	Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) (Wendel-Vos, Schuit, Saris, & Kromhout, 2003) and The Sedentary Behavior Questionnaire (SBQ, Rosenberg et al., 2010)
Body weight perception	3, 6 and 12 months	The Stunkard figure rating scale (Stunkard, Sørensen, & Schulsinger, 1983)
Anxiety symptoms (GAD-7)	3, 6 and 12 months	Generalized Anxiety Disorder Assessment (GAD-7) (Spitzer, Kroenke, Williams, & Löwe, 2006)
Health-related quality of life	3, 6 and 12 months	EuroQol instrument EQ-5D-5L (EuroQol Group, 1990)
Depressive Symptomatology PHQ-9	3, 6 and 12 months	Depressive Symptomatology assessed with the Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, & Williams, 2001)
Depressive symptomatology IDS30-SR	3, 6 and 12 months	Depressive symptomatology according the Inventory of Depressive Symptomatology (IDS30-SR) (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996)
Food and eating behaviour (TEFQ-R18)	3, 6 and 12 months	The Three-factor Eating Questionnaire (TEFQ-R18) (Karlsson, Persson, Sjöström, & Sullivan, 2000)

Other

Measure	Time frame	Description
Physical activity and habits strength	3, 6 and 12 months	Self-Report Behavioural Automaticity Index (SRBAI) (Gardner, Abraham, Lally, & de Bruijn, 2012)
Body weight (composite)	3, 6 and 12 months	Measured height, body weight, waist and hip circumference according to standardized measurement protocols, and calculated body mass index
Body composition (composite)	3, 6 and 12 months	Fat mass, fat-free mass and percentage body fat will be accurately assessed using whole body air-displacement plethysmography in participants from one site.
Blood sample ( blood levels of the nutrients provided with the multi-nutrient supplement)	6 and 12 months	In a random subsample of trial participants (n=50 per intervention arm) blood samples will be collected at baseline, and after 6 and 12 months to measure blood levels of the nutrients provided with the multi-nutrient supplement
Self-report of Somatic health status	6 and 12 months	Self-report of somatic/chronic diseases and family's medical history, smoking, alcohol consumption and medication/supplements use at 6 and 12 months
Behavioral functionality Assessed with Behavioral activation for Depression Scale (BADS)	3, 6 and 12 months	Activation rumination, avoidance, work/school and social impairment. Assessed with Behavioral activation for Depression Scale (BADS) (Kanter, JW et al., 2012)

Countries

Germany, Netherlands, Spain, United Kingdom

Outcome results

None listed