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Epidemiology

Mediterranean dietary pattern and prevalence and incidence of depressive symptoms in mid-aged women: results from a large community-based prospective study

Abstract

Background/objectives:

To investigate the association between dietary patterns and prevalence and incidence 3 years later of depressive symptoms using data from the mid-aged cohort in the Australian Longitudinal Study on Women’s Health.

Subjects/methods:

Participants (aged 50–55 years) completed a food frequency questionnaire in 2001. Depressive symptoms were measured in 2001 and 2004 using the validated 10-item Centre for Epidemiologic Studies Depression scale. Multiple logistic regression was used for cross-sectional analysis (8369 women) and longitudinal analysis (7588) to assess the associations between dietary patterns and prevalence of depressive symptoms, and then for longitudinal analysis (6060) on their associations with the incidence of depressive symptoms in 2004, while adjusting for sociodemographic and lifestyle factors.

Results:

Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the Mediterranean-style diet had a cross-sectional association with lower prevalence of depressive symptoms in 2001, adjusted odds ratio 0.82 (95% confidence interval 0.77–0.88); and longitudinally with lower incidence of depressive symptoms in 2004, adjusted odds ratio 0.83 (0.75–0.91). None of the associations found for other dietary patterns remained statistically significant after adjustment for confounders. A dose–response relationship was found cross-sectionally when women were grouped according to quintiles of Mediterranean-style diet (P-value for trend <0.001).

Conclusions:

Consumption of a ‘Mediterranean-style’ dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms. These findings suggest that dietary patterns have a potential role in the prevention and management of depressive symptoms.

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References

  1. World Health Organization. Mental Health - Disorders management 2011 (cited 2011 29 August); Available from: http://www.who.int/mental_health/management/depression/definition/en/.

  2. Lepine JP, Briley M . The increasing burden of depression. Neuropsychiatr Dis Treat 2011; 7 (Suppl 1), 3–7.

    PubMed  PubMed Central  Google Scholar 

  3. Sarris J, Schoendorfer N, Kavanagh DJ . Major depressive disorder and nutritional medicine: a review of monotherapies and adjuvant treatments. Nutr Rev 2009; 67: 125–131.

    Article  PubMed  Google Scholar 

  4. Murakami K, Sasaki S . Dietary intake and depressive symptoms: a systematic review of observational studies. Mol Nutr Food Res 2010; 54: 471–488.

    CAS  Article  PubMed  Google Scholar 

  5. Nanri A, Kimura Y, Matsushita Y, Ohta M, Sato M, Mishima N et al. Dietary patterns and depressive symptoms among Japanese men and women. Eur J Clin Nutr 2010; 64: 832–839.

    CAS  Article  PubMed  Google Scholar 

  6. Oddy WH, Robinson M, Ambrosini GL, O'Sullivan TA, de Klerk NH, Beilin LJ et al. The association between dietary patterns and mental health in early adolescence. Prev Med 2009; 49: 39–44.

    Article  PubMed  Google Scholar 

  7. Samieri C, Jutand M-A, Féart C, Capuron L, Letenneur L, Barberger-Gateau P . Dietary patterns derived by hybrid clustering method in older people: association with cognition, mood, and self-rated health. J Am Diet Assoc 2008; 108: 1461–1471.

    Article  PubMed  Google Scholar 

  8. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O’Reilly SL et al. Association of western and traditional diets with depression and anxiety in women. Am J Psychiat 2010; 167: 305–311.

    Article  PubMed  Google Scholar 

  9. Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A . Dietary pattern and depressive symptoms in middle age. Br J Psychiatry 2009; 195: 408–413.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, Majem LS et al. Association of the mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) cohort. Arch Gen Psychiatry 2009; 66: 1090–1098.

    Article  PubMed  Google Scholar 

  11. World Health Organization. The World Health Report 2003. Shaping the future: Geneva, 2003.

  12. Okubo H, Miyake Y, Sasaki S, Tanaka K, Murakami K, Hirota Y et al. Dietary patterns during pregnancy and the risk of postpartum depression in Japan: the Osaka Maternal and Child Health Study. Br J Nutr 2011; 105: 1251–1257.

    Article  PubMed  Google Scholar 

  13. Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V et al. Dietary patterns during pregnancy and the risk of postpartum depression: the mother-child ‘Rhea’ cohort in Crete, Greece. Public Health Nutr 2011; 14: 1663–1670.

    Article  PubMed  Google Scholar 

  14. Lucas M, Mirzaei F, O’Reilly EJ, Pan A, Willett WC, Kawachi I et al. Dietary intake of n−3 and n−6 fatty acids and the risk of clinical depression in women: a 10-y prospective follow-up study. Am J Clin Nutr 2011; 93: 1337–1343.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Brown WJ, Bryson L, Byles JE, Dobson AJ, Lee C, Mishra G et al. Women’s health Australia: Recruitment for a national longitudinal cohort study. Women Health 1998; 28: 23–40.

    CAS  Article  PubMed  Google Scholar 

  16. Lee C, Dobson AJ, Brown WJ, Bryson L, Byles J, Warner-Smith P et al. Cohort profile: the Australian Longitudinal Study on Women’s Health. Int J Epidemiol 2005; 34: 987–991.

    Article  PubMed  Google Scholar 

  17. Andresen EM, Malmgren JA, Carter WB, Patrick DL . Screening for depression in well older adults - evaluation of a short-form of the Ces-D. Am J Prev Med 1994; 10: 77–84.

    CAS  Article  PubMed  Google Scholar 

  18. Boey KW . Cross-validation of a short form of the CES-D in Chinese elderly. Int J Geriatr Psychiatry 1999; 14: 608–617.

    CAS  Article  PubMed  Google Scholar 

  19. Cheng ST, Chan AC . The center for epidemiologic studies depression scale in older Chinese: thresholds for long and short forms. Int J Geriatr Psychiatry 2005; 20: 465–470.

    Article  PubMed  Google Scholar 

  20. Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G . The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust N Z J Public Health 2000; 24: 576–583.

    CAS  Article  PubMed  Google Scholar 

  21. Ireland P, Jolley D, Giles G, O’Dea K, Powles J, Rutishauser I et al. Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving and ethnically diverse cohort. Asia Pac J Clin Nutr 1994; 3: 19–31.

    CAS  PubMed  Google Scholar 

  22. Australian Government Publishing Service. NUTTAB95: Nutrient Data Table for Use in Australia. Australian Government Publishing Service: Canberra, 1995.

  23. Australian Bureau of Statistics. Australian Standard Classification of Occupations. The Australian Bureau of Statistics: Canberra, 1997.

  24. Brown WJ, Burton NW, Marshall AL, Miller YD . Reliability and validity of a modified self-administered version of the active Australia physical activity survey in a sample of mid-age women. Aust N Z J Public Health 2008; 32: 535–541.

    Article  PubMed  Google Scholar 

  25. Bell S, Lee C . Development of the perceived stress questionnaire for young women. Psychol Health Med 2002; 7: 189–201.

    Article  Google Scholar 

  26. Kline P An Easy Guide to Factor Analysis. Routledge: London, UK, 1994.

    Google Scholar 

  27. Kesse-Guyot E, Touvier M, Andreeva VA, Jeandel C, Ferry M, Hercberg S et al. Cross-sectional but not longitudinal association between n-3 fatty acid intake and depressive symptoms: results from the SU.VI.MAX 2 study. Am J Epidemiol 2012; 175: 979–987.

    Article  PubMed  Google Scholar 

  28. Sánchez-Villegas A, Verberne L, De Irala J, Ruíz-Canela M, Toledo E, Serra-Majem L et al. Dietary fat intake and the risk of depression: the SUN project. PLoS ONE 2011; 6: e16268.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, Pla-Vidal J, Martínez-González MA . Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 2012; 15: 424–432.

    Article  PubMed  Google Scholar 

  30. Crawford GB, Khedkar A, Flaws JA, Sorkin JD, Gallicchio L . Depressive symptoms and self-reported fast-food intake in midlife women. Prev Med 2011; 52: 254–257.

    PubMed  PubMed Central  Google Scholar 

  31. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A . The Burden of Disease and Injury in Australia 2003. Australian Institute of Health and Welfare: Canberra, 2007.

    Google Scholar 

  32. Newby PK, Tucker KL . Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 2004; 62: 177–203.

    CAS  Article  PubMed  Google Scholar 

  33. Gomez-Pinilla F . Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci 2008; 9: 568–578.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Parker G, Gibson NA, Brotchie H, Heruc G, Rees AM, Hadzi-Pavlovic D . Omega-3 fatty acids and mood disorders. Am J Psychiatry 2006; 163: 969–978.

    Article  PubMed  Google Scholar 

  35. Belmaker RH, Agam G . Major depressive disorder. N Engl J Med 2008; 358: 55–68.

    CAS  Article  PubMed  Google Scholar 

  36. Sinclair AJ, Tassoni D, Kaur G, Weisinger RS . The role of eicosanoids in the brain. Asia Pac J Clin Nutr 2008; 17: 220–228.

    PubMed  Google Scholar 

  37. Toker L, Amar S, Bersudsky Y, Benjamin J, Klein E . The biology of tryptophan depletion and mood disorders. Isr J Psychiatry Relat Sci 2010; 47: 46–55.

    PubMed  Google Scholar 

  38. Smith RS . The macrophage theory of depression. Med Hypotheses 1991; 35: 298–306.

    CAS  Article  PubMed  Google Scholar 

  39. Bottiglieri T . Homocysteine and folate metabolism in depression. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29: 1103–1112.

    CAS  Article  PubMed  Google Scholar 

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Acknowledgements

We thank Professor Graham Giles of the Cancer Epidemiology Centre of The Cancer Council Victoria for permission to use the Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: the Cancer Council Victoria, 1996. We also thank all the participants for their valuable contribution to this project. The Australian Government Department of Health and Ageing provided funding for the Australian Longitudinal Study on Women’s Health. GDM is supported by the Australian National Health and Medical Research Council.

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Correspondence to G D Mishra.

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The authors declare no conflict of interest.

Additional information

Contributors: JR was responsible for statistical analysis, interpretation and presentation of data, and drafted the manuscript. AJD and GDM contributed to the study design, statistical analysis, interpretation of the data, and contributed a critical revision of the manuscript. All authors approved the final version.

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Rienks, J., Dobson, A. & Mishra, G. Mediterranean dietary pattern and prevalence and incidence of depressive symptoms in mid-aged women: results from a large community-based prospective study. Eur J Clin Nutr 67, 75–82 (2013). https://doi.org/10.1038/ejcn.2012.193

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  • DOI: https://doi.org/10.1038/ejcn.2012.193

Keywords

  • prospective cohort studies
  • depression
  • dietary pattern
  • Mediterranean diet

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