**1. Introduction**

The global population aged 60 years or over is expected to reach nearly 2.1 billion by 2050 due to reductions in fertility and a rise in life expectancy [1] resulting in an increased risk for non-communicable diseases such as cancer, dementia, and affective disorders (anxiety and depression). Particularly, affective disorders might be expected to be increased because older people living alone is continuously rising as a consequence of changes in societies, such as falling family size, family structure and less multigenerational living arrangements [2].

The estimated global prevalence for anxiety disorders was 7.3% (95% CI 4.8–10.9%) and considering socioeconomic factors and culture, the prevalence ranged from 5.3% (3.5–8.1%) to 10.4% (7.0–15.5%) in African and Euro/Anglo cultures, respectively [3]. However, anxiety disorders are frequently under-recognized and misdiagnosed. Consequently, individuals with an undiagnosed or misdiagnosed anxiety disorder may not receive the appropriate treatment, su ffering a deterioration of quality of life and social ability [4]. Several risk factors have been related to anxiety, but the emergence of a health and social crisis due to the financial crisis and strict fiscal austerity in Europe (e.g., Greece, Portugal, and Spain) could have contributed to worsen mental health [5]. For instance, in Greece, worse health status was reported in older adults due to unhealthy changes in their lifestyle behaviours [6] and anxiety disorders were also reported to be the fourth cause of years lost due to disability (YLDs) [7].

Depression has shown to be the most common comorbid disorder with anxiety disorders [8], but a bidirectional prospective relationship with one another was also reported [9]. Although the relationship between anxiety and cognition remains unclear, some studies have shown that anxiety was associated with cognitive decline, specifically on spatial and verbal working memory [10], influencing positively in the progression of Mild Cognitive Impairment (MCI) to dementia [11,12]. Some other chronic diseases, such as gastrointestinal disorders (e.g., irritable bowel syndrome) [13], diabetes [14] and thyroid disorders [15] have been also related to anxiety disorders or/and elevated anxiety symptoms. Moreover, patients with cardiovascular disease (CVD) are more likely to show prevalent anxiety disorders compared to the general population, but anxiety disorders have been also reported to increase the CVD risk [16]. For instance, anxiety levels were directly associated with the 10 y CVD incidence (OR (95%CI): 1.03 (1.0–1.1)) in older Greek adults without previous CVD history [17]. Some common pathophysiological mechanisms seem to share anxiety and the interrelated comorbidities, such as increase of corticotropin-releasing factor (CRF) levels, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis [18], activation of the sympathetic nervous system, and increase of levels of proinflammatory cytokines [19,20].

In recent years, an increasing number of studies are providing evidence for diet as a modifiable risk factor for mental health problems, such as depression and anxiety, however there is a lack of data regarding the older adults, a vulnerable population subgroup that appears to have high prevalence of mental disorders. For instance, a dietary pattern characterized by consumption of vegetables, fruit, beef, lamb, fish, and whole-grain foods has been related to a lower risk of a diagnosis of anxiety, while a western dietary pattern characterized by consumption of foods such as meats and sugar has been associated with more psychiatric symptoms [21]. Later studies also found that an inadequate and poor diet quality (i.e., snack patterns, animal foods) [22] and high intake of alcohol [23] can contribute to an inadequate intake of nutrients leading to mental health problems.

To date, there is a lack of studies assessing the association between dietary habits, energy intake, and anxiety symptoms among older adults and specifically, among European and Mediterranean older populations. Therefore, the aim of the current study was to evaluate the relation between dietary patterns, energy intake, and anxiety in a sample of older people (50+ years old) living in the Attica region.
