The Relationship between Double Burden of Malnutrition and Mental Health among Adult Females

Background: The coexistence of overweight or obesity with concurrent deficiency of one or more nutrients, referred to as double burden of malnutrition (DBM). A number of mental health impairments have been associated with a wide variety of nutrient deficiencies. In the current environment, the co-occurrence of obesity, overweight and mental health impairments have emerged as a significant global health concern. Although DBM is relevant for a number of health outcomes, the ubiquitous involvement of vitamin D across multiple systems and tissues suggests D insufficiency as a viable target for nutritional modification. Purpose: This study aimed to evaluate the contribution of DBM to mental health among adult females. Methods: : Study participants included 231 females ages 18-59 years who presented to one of the 25 health centers in Tehran. Women were overweight or people with obesity and BMI ranging from 25 to 40 Kg/m 2 . The 147-item food frequency questionnaire (FFQ) was used to estimate their dietary intake. Body composition was measured by bioelectric impedance assay, anthropometrics including waist circumference (WC) hip circumference were determined and BMI was calculated. Mental health status was assessed using the depression, anxiety, and stress scales-21 (DASS-21). Venipuncture was performed to assess plasma vitamin D level and lipid profile. Results were analyzed by SPSS software. Results: : The mean ± standard deviation (SD) age, weight, and BMI of the participants were 36.49±8.38, 80.89±12.45 kg and 31.04±4.31 Kg/m 2 , respectively. DBM was significantly associated with stress after adjusting for potential confounders including age, energy and marital status in the model 1 (OR;1.28, 95% confidence interval (CI)=1.00-1.65 P=0.04) in comparison to crude model (OR=1.22; 95% CI=0.96-1.55 P=0.09). No significant relationship was seen among DBM and DASS-21 outcomes were observed. Conclusions: : In this cohort, stress and DBM were significantly associated. However, the directionality of the relationship is unclear. Vitamin D insufficiency is associated with mental health and obesity in opposing directions. Whether vitamin D supplementation can decrease mental health impairments requires further evaluation.Registered number; IR.TUMS.VCR.REC.1398.819We intake register number in May of 2020