Nutrition interventions for anxiety, depression, stress and/or diabetes‐related distress in individuals with diabetes: A systematic review and meta‐analysis of randomised controlled trials

AIM: To synthesise evidence from RCTs investigating the effectiveness of nutrition interventions on depression, anxiety, stress, and/or diabetes distress outcomes in adults living with diabetes. METHODS: Six online databases were searched using key words between 2000 and February 2024. Included studies were conducted in adult populations (≥18 years), with Type 1 (T1D) or Type 2 Diabetes (T2D), investigating impacts of nutrition interventions on mental health outcomes. Random effects meta-analyses were undertaken for mental health outcomes. RESULTS: Thirty publications met inclusion criteria, all included adults with T2D, with one including both T1D and T2D. The most common interventions were nutrition supplements (n = 17, 57%) and altering macronutrient intakes (n = 5, 17%). Most studies reported on depression (n = 26) and anxiety (n = 14) outcomes, with fewer examining stress (n = 7) or diabetes-related distress (n = 8). Meta-analyses indicated nutrition supplementation when compared to control improved scores for depression (Beck Depression Inventory (BDI): WMD = -3.13; 95% CI: -5.09, -1.17) and anxiety (Beck Anxiety Inventory: WMD = -1.30; 95% CI: -2.08, -0.52) but not for stress. Meta-analyses confirmed that altering macronutrient composition significantly lowered diabetes-related distress (Problem Areas in Diabetes (PAID): WMD = -4.20; 95% CI: -8.18, -0.22). CONCLUSION: This review provides evidence that nutrition interventions, particularly supplement use or altered macronutrient composition, improve depression and anxiety for those with T2D. Future research should evaluate the impact of whole dietary patterns on mental health in adults with diabetes, especially T1D, to inform effective food-based nutrition advice, rather than focusing on individual supplements.