Calorie restriction in combination with prebiotic supplementation in obese women with depression: effects on metabolic and clinical response

ABSTRACT

Background

Major depressive disorder (MDD) is a common psychiatric disorder, closely associated with obesity. This study aimed to assess the effects of prebiotics combined with calorie restriction on clinical and metabolic response in obese women with MDD.

Methods

In an 8-week double-blind placebo-controlled randomized clinical trial, 62 obese women with MDD were equally allocated into either prebiotic (10 g/day Inulin) or placebo (10 g/day Maltodextrin) group. In addition, all the participants were also prescribed a 25% calorie-restricted diet (registration ID: IRCT20100209003320N15). Depression was assessed by Hamilton depression rating scale (HDRS) and Beck depression inventory (BDI-II) pre- and post-intervention. Anthropometric measures, fasting serum levels of glucose, insulin and lipid profile were assessed, and dietary assessments were performed pre- and post-intervention. Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-IR).

Results

45 patients completed the trial. There were no significant between-group differences for MDD symptoms and other study outcomes, post-intervention. Weight, waist and hip circumferences, systolic blood pressure, and HDRS score significantly decreased in both groups, while fat mass and total cholesterol (TC) declined only in the prebiotic arm. Those who had ≥1.9 kg weight loss showed significantly improved HDRS score, compared to women with <1.9 kg weight reduction, irrespective of the supplement they took.

Conclusion

Although prebiotic supplementation had some beneficial metabolic effects, calorie restriction and weight loss seem to play a more important role in improving depressive symptoms among obese women with MDD.

KEYWORDS:

• Major depressive disorder (MDD)
• obesity
• prebiotics
• calorie restriction
• insulin resistance
• lipid profile
• inulin, clinical trial

Acknowledgments

This study was funded by the ‘Research Vice-Chancellor’ and ‘Nutrition Research Center’ of Tabriz University of Medical Sciences, Tabriz, Iran. We sincerely thank the patients who participated in this clinical trial. This paper is based on data obtained from a Ph.D. dissertation submitted to Tabriz University of Medical Sciences (Elnaz Vaghef-Mehrabany).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Tabriz University of Medical Sciences: [Grant Number 186732/D/5].

Notes on contributors

Elnaz Vaghef-Mehrabany

Elnaz Vaghef-Mehrabany is Ph.D. candidate in Nutrition Sciences. She completed both her Masters’ and Bachelors’ degrees in Nutrition Sciences at Tabriz University of Medical Sciences (Iran). Her main fields of interest include gut microbiota/prebiotics/probiotics, obesity, depression, type 2 diabetes mellitus, inflammation, dietary interventions, and nutrition education.

Fatemeh Ranjbar

Fatemeh Ranjbar is Professor of Psychiatry. She completed her M.D. in Medicine at Tabriz University of Medical Sciences (Iran) in 1998. After completing clinical specialty program in the same institute, she joined the Department of Psychiatry, Faculty of Medicine, Tabriz University of Medical Sciences. Her research interests include depression, adults ADHA, mental disorders in women, PTSD, and stress disorders.

Mohammad Asghari-Jafarabadi

Mohammad Asghari Jafarabadi is Associate Professor of Biostatistics. He holds a Ph.D. in Biostatistics from Tarbiat Modares University (Iran), a M.Sc. in Biostatics from the same institute (Iran), and an undergraduate degree in Statistics from Mazandaran University (Iran). Since 2010, he has joined the Department of Statistics and Epidemiology, Tabriz University of Medical Sciences. His research interests include survival data analysis, frailty and competing risks in survival analysis, longitudinal data analysis, multilevel data analysis, generalized linear and mixed models, and structural equation modeling.

Sonia Hosseinpour-Arjmand

Sonia Hosseinpour-Arjmand competed her Masters' degree in Nutrition Sciences in 2018 at Tabriz University of Medical Sciences. Her fields of interest include obesity, NAFLD, nutritional supplements, and diet therapy.

Mehrangiz Ebrahimi-Mameghani

Mehrangiz Ebrahimi-Mameghani is Professor of Nutrition. She holds a Ph.D. in Nutrition Epidemiology from Glasgow University (England), a M.Sc. in Nutrition and Health Sciences from Tehran University of Medical Sciences (Iran), and a B.Sc. degree in Nutrition Sciences from Shahid Beheshti University of Medical Sciences (Iran). Since 1995, she has joined the Faculty of Nutrition, Tabriz University of Medical Sciences. Her research interests include obesity, NAFLD, diet therapy, nutrition epidemiology, and nutritional supplements.