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Posttraumatic stress disorder and changes in diet quality over 20 years among US women

Published online by Cambridge University Press:  26 November 2019

Yongjoo Kim Open the ORCID record for Yongjoo Kim [Opens in a new window] ,
Andrea L. Roberts ,
Eric B. Rimm ,
Lori B. Chibnik ,
Shelley S. Tworoger ,
Kristen M. Nishimi ,
Jennifer A. Sumner ,
Karestan C. Koenen  and
Laura D. Kubzansky
Yongjoo Kim*
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Andrea L. Roberts
Affiliation:
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Eric B. Rimm
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Lori B. Chibnik
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Shelley S. Tworoger
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
Kristen M. Nishimi
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Jennifer A. Sumner
Affiliation:
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
Karestan C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Laura D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
*
Author for correspondence: Yongjoo Kim, E-mail: [email protected]; [email protected]
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Abstract

Background

Individuals with posttraumatic stress disorder (PTSD) are at increased risk of various chronic diseases. One hypothesized pathway is via changes in diet quality. This study evaluated whether PTSD was associated with deterioration in diet quality over time.

Methods

Data were from 51 965 women in the Nurses' Health Study II PTSD sub-study followed over 20 years. Diet, assessed at 4-year intervals, was characterized via the Alternative Healthy Eating Index-2010 (AHEI). Based on information from the Brief Trauma Questionnaire and Short Screening Scale for DSM-IV PTSD, trauma/PTSD status was classified as no trauma exposure, prevalent exposure (trauma/PTSD onset before study entry), or new-onset (trauma/PTSD onset during follow-up). We further categorized women with prevalent exposure as having trauma with no PTSD symptoms, trauma with low PTSD symptoms, and trauma with high PTSD symptoms, and created similar categories for women with new-onset exposure, resulting in seven comparison groups. Multivariable linear mixed-effects spline models tested differences in diet quality changes by trauma/PTSD status over follow-up.

Results

Overall, diet quality improved over time regardless of PTSD status. In age-adjusted models, compared to those with no trauma, women with prevalent high PTSD and women with new-onset high PTSD symptoms had 3.3% and 3.6% lower improvement in diet quality, respectively, during follow-up. Associations remained consistent after adjusting for health conditions, sociodemographics, and behavioral characteristics.

Conclusions

PTSD is associated with less healthy changes in overall diet quality over time. Poor diet quality may be one pathway linking PTSD with a higher risk of chronic disease development.

Keywords

Behavioral mechanismchronic diseasediet qualityflavonoidposttraumatic stress disorderprospective study
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 2 , January 2021 , pp. 310 - 319
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Copyright
Copyright © Cambridge University Press 2019

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