Clinical utility of CSF metagenomic next-generation sequencing in suspected CNS infection: performance against a composite reference standard and read-count stratification.

Diets typified by elevated consumption of fat, added sugars and refined carbohydrates are associated with increased anxiety risk (). Conversely, diets high in vegetables, fruits, milk, nuts, and seeds are associated with a lower risk of incident anxiety (). Mediterranean-style diets are characterized by several daily servings of vegetables and fruits, olive oil, and moderate consumption of dairy products, fish, and poultry (). It is associated with reduced risk of incident cardiovascular outcomes, including myocardial infarction, stroke, and atrial fibrillation; lower incidence of certain cancers, with improved survival; and improved metabolic endpoints, including type 2 diabetes, metabolic syndrome, and obesity (). Mediterranean-style diets have been associated with reduced risk of neurocognitive conditions including depression, dementia and anxiety (). A recent meta-analysis found that adherence to a Mediterranean diet was associated with reduced neurological and psychiatric endpoints including dementia, depression and anxiety (). Similarly, another current meta-analysis demonstrated that better adherence to the EAT-Lancet diet (closely aligned with the Mediterranean diet) was associated with a 13% relative reduction in anxiety risk (). Mechanisms proposed to explain associations between Mediterranean-style diets and health outcomes include antioxidant potential, attributable to the increased intake of fruits, vegetables and olive oil (); anti-inflammatory effects, driven primarily by olive oil, which has been shown to reduce markers of inflammation including C-reactive protein and pro-inflammatory cytokine interleukin-6 (); and beneficial microbiome alterations related to the high fiber content of Mediterranean-style diets, especially increased levels of beneficial microbe populations and enhanced concentration of fecal short-chain fatty acids (). The association of Mediterranean-style diets and reduced prevalence of neurocognitive outcomes, particularly anxiety, is well established (); however, whether the association persists when external circumstances are objectively stressful has been less well studied. A significant inverse association between the Mediterranean diet score (the degree to which the reported diet approximates the Mediterranean diet), measured using the Israel Mediterranean diet screener (I-MEDAS), and anxiety, measured using the General Anxiety Disorder-7 (GAD-7) screener, during the COVID lockdowns, indicating that closer adherence to a Mediterranean diet was associated with less anxiety ().