Original Article | Published:

Epidemiology

Mediterranean-type diet is associated with higher psychological resilience in a general adult population: findings from the Moli-sani study

European Journal of Clinical Nutrition volume 72, pages 154160 (2018) | Download Citation

Abstract

Background/Objective:

Psychological resilience is a measure of stress coping ability and has been associated with favourable health outcomes. While evidence on the relationship of dietary habits with a number of psychosocial conditions is available, there is lack of studies on their association with psychological resilience in a general adult population.

Subjects/Methods:

Cross-sectional analysis on 10 812 subjects recruited within the cohort of the Moli-sani study (2005–2010). Psychological resilience was measured by the 25-item Connor-Davidson Psychological Resilience Scale. Food intake was recorded by the EPIC food frequency questionnaire and adherence to Mediterranean diet was appraised by both a Greek Mediterranean diet score and an Italian Mediterranean Index. Empirically derived dietary patterns were obtained by principal factor analysis. Multivariable linear regression analysis (95%CI) was used to test the association between dietary scores and psychological resilience.

Results:

Higher adherence to Mediterranean-type diets or consumption of a vegetable-based dietary pattern (obtained from principal factor analysis) were positively associated with psychological resilience (β=0.43; 95%CI: 0.19–0.66, β=0.92; 0.69–1.16, and β=1.18; 0.93–1.44, for Greek Mediterranean diet score, Italian Mediterranean Index and the ‘Olive oil and vegetables pattern’, respectively). Dietary polyphenol or antioxidant intakes and greater variety in fruit and vegetable consumption were also positively associated with psychological resilience, while the associations with Western-like diets were weak.

Conclusions:

In conclusion, Mediterranean diet, vegetable-based dietary patterns and better diet quality were all positively associated with higher psychological resilience, whereas Western-type diets were not.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , . Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18: 76–82.

  2. 2.

    , , , , , . Low psychological resilience is associated with depression in patients with cardiovascular disease. Eur J Cardiovasc Nurs 2017; 16: 64–69.

  3. 3.

    . The power of resilience. J Am Coll Cardiol 2014; 64: 840–842.

  4. 4.

    , , , , , . Associations between obesity (BMI and waist circumference) and socio-demographic factors, physical activity, dietary habits, life events, resilience, mood, perceived stress and hopelessness in healthy older Europeans. BMC Public Health 2012; 12: 424.

  5. 5.

    , , . Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J 2009; 8: 31.

  6. 6.

    , , , , , . Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 2005; 178: 339–344.

  7. 7.

    , , , , , et al. A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Med 2015; 13: 197.

  8. 8.

    , , , , , et al. Personality and dietary intake - findings in the Helsinki birth cohort study. PLoS One 2013; 8: e68284.

  9. 9.

    , , , , , et al. Socioeconomic position, resilience, and health behaviour among elderly people. Int J Public Health 2012; 57: 341–349.

  10. 10.

    , , , , . Resilience and patterns of health risk behaviors in California adolescents. Prev Med 2009; 48: 291–297.

  11. 11.

    , , , , , . The associations between personality, diet and body mass index in older people. Health Psychol 2013; 32: 353–360.

  12. 12.

    , , , , , et al. Adherence to a Mediterranean diet is associated with a better health-related quality of life: a possible role of high dietary antioxidant content. BMJ Open 2013; 3.

  13. 13.

    , , , , , et al. Adherence to the dietary guidelines for americans is associated with psychological resilience in young adults: a cross-sectional study. J Acad Nutr Diet 2016; 117: 396–403.

  14. 14.

    , , , , , et al. Distribution of short and lifetime risks for cardiovascular disease in Italians. Eur J Prev Cardiol 2012; 19: 723–730.

  15. 15.

    , , , . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

  16. 16.

    , , , , , et al. Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori 2003; 89: 594–607.

  17. 17.

    , , , , , et al. A priori-defined dietary patterns are associated with reduced risk of stroke in a large Italian cohort. J Nutr 2011; 141: 1552–1558.

  18. 18.

    , , , , , et al. Dietary patterns, cardiovascular risk factors and C-reactive protein in a healthy Italian population. Nutr Metab Cardiovasc Dis 2009; 19: 697–706.

  19. 19.

    , , , , , et al. Consumption of healthy foods at different content of antioxidant vitamins and phytochemicals and metabolic risk factors for cardiovascular disease in men and women of the Moli-sani study. Eur J Clin Nutr 2013; 67: 207–213.

  20. 20.

    , , , , , et al. Polyphenol intake is associated with low-grade inflammation, using a novel data analysis from the Moli-sani study. Thromb Haemost 2016; 115: 344–352.

  21. 21.

    , , , , , et al. Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European prospective investigation into cancer and nutrition. Int J Cancer 2012; 131: E963–E973.

  22. 22.

    , , . Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009; 338: b2337.

  23. 23.

    , , , , , et al. Adherence to the traditional Mediterranean diet and mortality in subjects with diabetes. Prospective results from the MOLI-SANI study. Eur J Prev Cardiol 2016; 23: 400–407.

  24. 24.

    , , , . Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr 2015; 6: 154–168.

  25. 25.

    , , , , , et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J. Neurol Neurosurg Psychiatry 2013; 84: 1318–1325.

  26. 26.

    , , , , , et al. Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults. Ann Epidemiol 2015; 25: 84–89.

  27. 27.

    , , , , , . The association between worksite social support, diet, physical activity and body mass index. Prev Med 2011; 53: 53–56.

  28. 28.

    , , , , , et al. Polyphenol intake and cardiovascular risk factors in a population with type 2 diabetes: The TOSCA.IT study. Clin Nutr 2016.

  29. 29.

    , , , , , , MOLI-SANI Study Investigators. Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study. Br J Clin Pharmacol 2017; 83: 107–113.

  30. 30.

    , , , , , et al. Intake of flavonoid-rich wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance. J Nutr 2009; 139: 120–127.

  31. 31.

    , . Natural mood foods: the actions of polyphenols against psychiatric and cognitive disorders. Nutr Neurosci 2012; 15: 127–133.

  32. 32.

    , , , , , et al. Mediterranean diet and cognitive decline. Public Health Nutr 2004; 7: 959–963.

  33. 33.

    , , , , , . Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative. Am J Clin Nutr 2016; 104: 1403–1409.

  34. 34.

    , , , , . The Mediterranean diet and ADHD in children and adolescents. Pediatrics 2017; 139.

  35. 35.

    , , , , . Associations between fruit and vegetable consumption and psychological distress: results from a population-based study. BMC Psychiatry 2015; 15: 213.

  36. 36.

    , , , , , . A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr 2014; 99: 181–197.

  37. 37.

    , , . 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 2013; 67: 75–82.

  38. 38.

    , , . Fruit and vegetable consumption and prevalence and incidence of depressive symptoms in mid-age women: results from the Australian longitudinal study on women’s health. Eur J Clin Nutr 2014; 69: 585–591.

  39. 39.

    , , , , , et al. Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry 2010; 167: 305–311.

  40. 40.

    , , , , , . Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 2012; 15: 424–432.

Download references

Acknowledgements

The Moli-sani research group thanks the Associazione Cuore Sano Onlus (Campobasso, Italy) for its cultural and financial support. We thank Professor Marco Sarchiapone for his advice on the selection of resilience questionnaire and Dr Matteo Manzi and Dr Emilia Ruggiero for their valuable support in data input. The enrolment phase of the Moli-sani study was supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)—Programma Triennale di Ricerca, Decreto no.1588 and Instrumentation Laboratory, Milan, Italy. Funders had no role in study design, collection, analysis, and interpretation of data; in the writing of the manuscript and in the decision to submit the article for publication. Marialaura Bonaccio was supported by a Fondazione Umberto Veronesi Fellowship. Simona Costanzo is the recipient of a Fondazione Umberto Veronesi travel grant. All authors were and are independent from funders. The present analyses were partially supported by the Italian Ministry of Health 2013 (Young investigator grant to MB, number: GR-2013-02356060) and by the Italian Association for Cancer Research (A.I.R.C.) with grant AIRC ‘5x1000’ Ref. n. 12237.

Ethics: The Moli-sani study complies with the Declaration of Helsinki and was approved by the ethical committee of the Catholic University in Rome, Italy. All participants provided written informed consent.

Author contributions

LI, MB and ADC contributed to the conception and design of the work, and interpretation of data; SC, GP and MP managed data collection; MB, ADC analysed the data; MB wrote the paper; CC, MBD, GdG and LI originally inspired the research and critically reviewed the manuscript. All authors approved the final version of the manuscript.

Author information

Author notes

Affiliations

  1. Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Via dell'Elettronica, Pozzilli, Italy

    • M Bonaccio
    • , A Di Castelnuovo
    • , S Costanzo
    • , G Pounis
    • , M Persichillo
    • , C Cerletti
    • , M B Donati
    • , G de Gaetano
    •  & L Iacoviello
  2. Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy

    • L Iacoviello

Authors

  1. Search for M Bonaccio in:

  2. Search for A Di Castelnuovo in:

  3. Search for S Costanzo in:

  4. Search for G Pounis in:

  5. Search for M Persichillo in:

  6. Search for C Cerletti in:

  7. Search for M B Donati in:

  8. Search for G de Gaetano in:

  9. Search for L Iacoviello in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to M Bonaccio.

Supplementary information

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ejcn.2017.150

Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website (http://www.nature.com/ejcn)