The role of nutrients in paediatric and perinatal depression: investigating n-3 polyunsaturated fatty acids, iodine and iron
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Author
Date
2022Type
- Doctoral Thesis
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Abstract
Background: Depression is a leading cause of disability worldwide, and its multifactorial
aetiology has been linked to nutrient deficiencies. n-3 Polyunsaturated fatty
acids (PUFA), iodine, and iron might be involved in different theories behind the
pathophysiology of depression by (1) alterations in neurochemical processes, (2) their
role in aberrant brain tissue volume, connectivity, and neurogenesis, (3) their involvement
in the Hypothalamic-pituitary-adrenal (HPA) axis, and (4) through their actions
on the immune system. This link between nutrition and depression is intriguing in adolescents
and during pregnancy since individuals are at life stages of increased nutrient
requirements and at risk for developing depressive disorders.
PhD objective This PhD thesis aimed to investigate associations of n-3 PUFA, iodine,
and iron status with Paediatric major depressive disorder (pMDD) and perinatal
depression.
Methods: Two research studies formed part of this PhD project. The first study, the
Nutrition during pregnancy and early development (NuPED) study, followed 242 South
African women throughout pregnancy up to 12 months postpartum. Red blood cell
(RBC) Fatty acids (FA) status was assessed at <18 weeks gestation, and the women’s
depression was assessed at different time points during pregnancy and postpartum.
The second study comprised a matched case-control study in 95 Swiss adolescents
with and 95 without pMDD. The Children’s Depression Rating Scale-Revised (CDRSR)
was used to assess depression. RBC’s total FA composition was analysed, and
n-3 PUFA intake was assessed using a focused Food frequency questionnaire (FFQ).
Iodine status was assessed by Urinary iodine concentration (UIC), and thyroid status
was assessed by Thyroid stimulating hormone (TSH) and Thyroxine (T4). Serum
ferritin (SF) and Soluble transferrin receptor (sTfR) served as measures of iron status.
Also, the history of Iron deficiency (ID) diagnosis and treatment was assessed with
a self-reported questionnaire. Finally, inflammation was assessed by measuring Creactive
protein (CRP) and -1-acid-glycoprotein (AGP), and intestinal permeability
by measuring Intestinal fatty acid binding protein (I-FABP).
Results: Among South African women, higher RBC Docosahexaenoic acid (DHA) and
an Omega-3 index (n-3 index) early in pregnancy were associated with lower odds
for depression at 12 months postpartum. Furthermore, higher n-6/n-3 PUFA and
Arachidonic acid (AA)/Eicosapentaenoic acid (EPA) ratios at <18 weeks gestation
were associated with higher odds for depression at 12 months postpartum. In Swiss
adolescents with and without pMDD, higher RBC EPA and DHA were associated with lower odds for depression. Also, an n-3 index >6% was associated with lower odds
for depression. In the case-control study, the median UIC did not differ between cases
and controls and indicated adequate iodine nutrition. The prevalence of hypothyroxinaemia
(low T4 and normal TSH concentrations) was higher among cases compared
to controls (15% vs 4%). Furthermore, no difference in SF levels among cases and
controls could be observed. However, the proportion of adolescents taking iron supplementation
at study inclusion was higher among cases (16%) compared to controls
(4%).
Conclusions: Overall, results from both studies suggest lower odds for depression
(pMDD and perinatal depression) with higher n-3 PUFA status. Also, the results
suggest the observed increased prevalence of hypothyroxinaemia among adolescents
with pMDD to be unrelated to iodine status. Whether the lack of SF differences
among cases and controls and associations with pMDD were masked by iron treatment
remains unclear. Finally, this thesis’ findings provide a rationale to further investigate
n-3 PUFA and iron in the context of depression within the fields of the immune
system and inflammation having a possible impact on neurochemical processes and
brain plasticity, structure, and neurogenesis. Also, this thesis provides a rationale to
further investigate the link between the Hypothalamic-pituitary-thyroid (HPT) and
HPA axis possibly involved in depression through neuroendocrine processes. Show more
Permanent link
https://doi.org/10.3929/ethz-b-000577167Publication status
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Contributors
Examiner: Zimmermann, Michael B.
Examiner: Baumgartner, Jeannine
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Examiner: Herter-Aeberli, Isabelle
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Examiner: Chang, Jane Pei-Chen
Publisher
ETH ZurichSubject
Nutritional psychiatryOrganisational unit
03957 - Zimmermann, Michael Bruce (emeritus) / Zimmermann, Michael Bruce (emeritus)
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ETH Bibliography
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