Prospective association between adherence to dietary recommendations and incident depressive symptoms in the French NutriNet-Santé cohort

Abstract

A posteriori healthier dietary patterns and several nutrients have been associated with lower risks of depression in various studies; however, evidence is lacking with regard to the prospective association between adherence to nutritional recommendations (food-based and nutrient-based recommendations) and incident depression or depressive symptoms. In this study, we investigate such associations in the NutriNet Santé cohort. The study sample included 26 225 participants (aged 18-86 years) who were initially free of depressive symptoms. Adherence to nutritional recommendations was measured by four scores namely modified French Programme National Nutrition Santé-Guideline Score (mPNNS-GS), Alternative Healthy Eating Index-2010 (AHEI-2010), Probability of Adequate Nutrient Intake Dietary Score (PANDiet) and Diet Quality Index-International (DQI-I), using non-consecutive dietary record data during the first 2 years of follow-up (mean number of recording days=8, sd 2). Depressive symptoms were defined by a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥17 for men and ≥23 for women. We used Cox proportional hazards models to estimate hazard ratios and 95 % CI, modelling the dietary scores as standardised continuous variables and as tertiles. Over a mean follow-up of 6 years, we identified 2166 incident cases of depressive symptoms. All dietary scores with the exception of the AHEI-2010 were significantly inversely associated with incident depressive symptoms. In the fully adjusted model, an increase of 1 sd in the mPNNS-GS, PANDiet and DQI-I was, respectively, associated with an 8 % (95 % CI 4, 13), 5 % (95 % CI 1, 9) and 9 % (95 % CI 5, 13) reduction in the risk of depressive symptoms. Overall, these findings suggest that diet in accordance with national or international guidelines could have beneficial effects with regard to mental health.

Evidence of the Importance of Dietary Habits Regarding Depressive Symptoms and Depression

“…High adherence to dietary recommendations was in several studies showing a significant protective effect against depression and depressive symptoms, and studied in different populations based on origin, age, and gender [19,21,[24][25][26]30,31,36]. High adherence to dietary advice was associated with a significantly reduced risk of developing depressive symptoms in first-time mothers in Australia [30].…”

“…High adherence to dietary recommendations was associated with a lower risk of depressive symptoms in adults in France. The adherence was measured regarding four scores namely; modified French Programme National Nutrition Sante'-Guideline Score (mPNNS-GS), Probability of Adequate Nutrient Intake Dietary Score (PANDiet), Diet Quality Index-International (DQI-I), and Alternative Healthy Eating Index-2010 (AHEI-2010) [19]. Risk reduction was in this study estimated to be 21%, 20%, and 12%, respectively, and in the AHEI-2010 group no significance was detected.…”

“…Micronutrients in the diet have been associated with an increased risk of mental illness [17,19,23,28,29,32,38]. Magnesium intake through diet was significantly associated with the risk of developing depression in middle-aged men [38].…”

“…When all three models in the study were compared, it was found that those with the highest magnesium intake had a protective effect against depression [38]. Relationships between intake of B12, folic acid, and magnesium emerged as side effects in the result where the main purpose was to investigate adherence to healthy dietary advice [19]. Those with the highest adherence to healthy dietary advice in the same study had thus less risk of depressive symptoms and a significantly higher intake of magnesium, folic acid, and B12 in the diet.…”

Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort

“…Large-scale epidemiological studies have consistently documented an association between a healthy diet or dietary indexes reflecting the holistic quality of the diet and a lower risk of depression [4–7]. For instance, in the NutriNet-Santé study, we have observed that several dietary indexes reflecting nutritional recommendations were prospectively and inversely associated with the risk to develop depressive symptoms [8]. On the opposite, a western dietary pattern or pro-inflammatory diet characterized among other things by more processed foods has been associated with poor mental health [5, 6, 9].…”