Impact of Nut Consumption on Mental Health in Young Adults

Changes in symptoms of depression assessed with the Beck Depression Inventory Version II (BDI-II). Each of the 21 items includes four statements of increasing severity, and a total score (ranging from 0 to 63) is calculated, with higher scores indicating more severe depression.

Changes in symptoms of anxiety assessed with The Generalized Anxiety Disorder 7-item (GAD-7). The GAD-7 consists of seven questions asking individuals to rate the frequency and severity of specific anxiety symptoms over the past two weeks.The total score ranges from 0 to 21, calculated by summing the scores of all seven items. A score of 10 or greater is considered a reasonable cut-off point for identifying possible cases of GAD that may require further clinical evaluation

Changes in symptoms of stress assessed with The Perceived Stress Scale (PSS-10). The PSS-10 is a widely used, 10-item self-report questionnaire that measures an individual's perception of stress over the past month. Scoring involves reverse-scoring four positive items and summing all 10. Total scores range from 0 to 40, with higher scores indicating more perceived stress. Scores can be interpreted generally as low (0-13), moderate (14-26), or high (27-40) stress.

The Picture Sequence Memory Test assesses episodic memory by requiring participants to encode and recall the temporal order of a sequence of visually presented everyday events. After presentation, individuals are asked to reconstruct the sequence in its original order, allowing evaluation of visual episodic memory and learning across trials. Test time: 7 minutes. This test is one of the measures included in the NIH Toolbox Cognition Battery, which is administered on an iPad by qualified personnel.

The List Sorting Working Memory Test (LSWM), part of the NIH Toolbox Cognition Batery, assesses working memory by having individuals recall and sequence visually and auditorily presented stimuli (like animal/food pictures) in size order (smallest to largest). Test time: 7 minutes.

The Dimensional Change Card Sort Test is a standardized measure of cognitive flexibility. Participants are required to sort cards according to different rules (e.g., color or shape) and to adapt their responses when the sorting dimension changes. Test time: 5 minutes.

This test is one of the tests that will be determined using the NIH Toolbox Cognition Battery, which will be administered on an iPad by qualified personnel.

The Pattern Comparison Processing Speed Test is a standardized measure of processing speed. Participants are asked to quickly determine whether two visual patterns are the same or different, emphasizing speed and accuracy of visual perception and decision-making. Test Time: 4 minutes.

This test is one of the tests that will be determined using the NIH Toolbox Cognition Battery, which will be administered on an iPad by qualified personnel.

The Flanker Inhibitory Control and Attention Test is a standardized measure of inhibitory control and selective attention, core components of executive function. Participants are required to focus on a central target stimulus while inhibiting interference from surrounding distractor stimuli. Performance reflects the ability to maintain attention, suppress competing responses, and resolve cognitive conflict. Test Time: 3 minutes.

This test is one of the tests that will be determined using the NIH Toolbox Cognition Battery, which will be administered on an iPad by qualified personnel.

Changes in blood concentration of brain-derived neurotrophic factor (BDNF), a biochemical mediator of brain functioning

Changes in quality of sleep assessed with the Pittsburgh Sleep Quality Index (PSQI). The PSQI consists of 19 individual self-rated questions (and 5 optional questions for a roommate/bed partner) that are grouped into seven component scores. Each of the seven components is scored on a scale of 0 to 3, where 0 indicates no difficulty and 3 indicates severe difficulty. The scores of these components are summed to produce a global PSQI score, which ranges from 0 to 21. Higher scores indicate poorer sleep quality.

Changes in health-related quality of life assessed with the SF12 questionnaire. It consists of 12 questions that cover the same eight health domains as the longer SF-36: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health.

The 12 items are used to create two main summary measures through a complex, norm-based scoring algorithm:

Physical Component Summary (PCS): A single score representing physical health status.

Mental Component Summary (MCS): A single score representing mental and emotional health status.

Interpretation of Scores:

Scores for both PCS and MCS typically range from 0 to 100, where higher scores indicate better health and functioning.

Changes in blood inflammatory markers (e.g. hs-CRP) to examine underlying mechanisms

Changes in blood concentration of specific vitamins and minerals (e.g., vitamins B9, B12, D, iron, and magnesium) to examine underlying mechanisms

Changes in body image perception using The Standard Figural Stimuli (SFS). Measurement Purpose:

Perceived Body Image: The figure the individual selects as most representative of their current body size.

Ideal Body Image: The figure the individual would like to have. Body Dissatisfaction: The discrepancy between the perceived image and the ideal image. A larger difference indicates greater body dissatisfaction.

Screen time will be assessed using an ad hoc questionnaire that records the number of hours of leisure time participants spend watching television, using a mobile phone, using a computer for work-related purposes, or engaging with other electronic devices, both on weekdays and during weekends.

Changes in social media addiction through Social Network Addiction Questionnaire, 6-item version (ARS-6). The scale typically consists of 6 items, with one item representing each of the six components of addiction.

Response Scale: Responses are typically given on a 5-point Likert scale (e.g., from 1 = Not at all to 5 = Always).

Scoring: Item responses are summed to obtain a total score, ranging from 6 to 30. Higher scores indicate a greater risk or severity of social media addiction.

Sociodemographic information such as age, sex, date of birth, country of origin, marital status, housing type, medication use, and family history of mental or cardiovascular disorders.

Changes in drugs consumption assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). The ASSIST generates substance-specific risk scores that categorize use into low, moderate, or high-risk categories. Higher scores indicate a greater risk of substance-related health and social problems, guiding the type of intervention needed (e.g., brief intervention or referral to specialist treatment).

Changes in adherence to the mediterranean diet assessed with the MEDAS questionnaire.

Scoring:

Each item is scored with 1 point if the criteria for adherence to the Mediterranean diet are met, and 0 points if they are not.

The total score ranges from 0 to 14 points. Higher scores indicate greater adherence to the Mediterranean diet. A common cut-off point of ≥9 is often used to define good adherence to the diet.

Changes in resilience assessed with the Connor-Davidson Resilience Scale (CD-RISC 10). Each item is rated on a 5-point Likert scale ranging from 0 (not true at all) to 4 (true nearly all the time). The total score is calculated by summing the values of all 10 items. Total scores range from 0 to 40. Higher scores on the CD-RISC 10 indicate greater resilience and a better ability to cope with adversity and bounce back from difficult experiences.

The SCOFF questionnaire (an acronym derived from the initials of its English questions: Sick, Control, One stone, Fat, Food) is a brief and simple, five-question screening tool designed to detect the possible presence of eating disorders (EDs), such as anorexia nervosa and bulimia nervosa. The total score can range from 0 to 5. A score of two or more points is considered a positive screening result and suggests a suspicion of an ED that requires a detailed formal clinical assessment.

Weight in kilograms will be assessed twice using a calibrated digital scale (Scale Seca® 861) with participants barefoot and in light weight clothing.

Height will be measured twice with a stadiometer (Wall stadiometer Seca® 222), with participants standing upright, barefoot, and with the sagittal midline aligned to the wall.

BMI will be calculated as weight divided by height squared (kg/m2).

Body fat percentage will be assessed twice using the bioimpedance analysis system under standardized conditions (morning, fasting, post-void, after 15 minutes rest, barefoot, with controlled temperature and humidity).

Blood pressure will be measured using an automated device (OMRON® M5-I (Omron Healthcare UK Ltd.)). Systolic and diastolic blood pressure will be assessed twice, with a 5-minute interval between measurements. Participants will be seated in a quiet environment, with the right arm semi-flexed at heart level.

Measured through handgrip strength using a calibrated dynamometer (Digital dynamometer TKK 5401 Grip-D (Takey®, Tokyo, Japan), and standing long jump for lower body strength. Handgrip: Kilograms (kg). Horizontal jump: Centimeters (cm).

Changes in phisical activity assessed with the The International Physical Activity Questionnaire (IPAQ). The data collected with the IPAQ can be reported as a continuous measure (estimation of total energy expenditure in MET-minutes per week) or categorically (classifying individuals into low, moderate, or high physical activity levels):

Continuous Score: Total energy expenditure is calculated using specific formulas that assign MET (metabolic equivalent) values to each activity type (walking=3.3 METs, moderate=4.0 METs, vigorous=8.0 METs).

Categorical Score: Participants are classified into three levels of physical activity based on predefined criteria related to the duration, frequency, and intensity of activities.

Changes in blood lipid profile (Cholesterol (Total, HDL-c, LDL-c), triglycerides)) to examine underlying mechanisms.

Changes in blood glucose levels to examine underlying mechanisms.

Changes in blood HbA1c levels to examine underlying mechanisms.

Adherence to nut consumption intervention measured by blood levels of vitamin E