Mediterranean diet and mental health -
We tested the robustness of our results through a series of sensitivity analyses. To rule out the possibility of reverse causation, we excluded the first two or five years of follow-up. We used alternative definitions for depression broader or narrower definition, and severe depression.
To address the influence of other psychiatric comorbidity, we first adjusted the analysis for history of any other psychiatric disorders ICD , ICD , ICD and ICD F, excluding ICD codes for depression before the end of follow-up, and then performed another analysis restricted to women without any psychiatric history before enrolment.
To check the influence of different food components, we performed another analysis by excluding the nine components one by one from the MDP score.
Finally, given the potential distinct health effects of red and white meat, we re-calculated the adherence score based only on red and processed meat [ 29 ] instead of all kinds of meat products, and also separately assessed the association of red meat with risk of depression.
The assumption of proportional hazards was assessed by examining the standardized Schoenfeld residuals [ 30 ]. We did not perform any adjustment of p -values for multiplicity of statistical tests. Data management was performed using SAS software version 9.
Survival analyses were performed using SAS software version 9. The cumulative incidence rate and the age-specific analysis were performed using STATA version 14 StataCorp LP, College Station, TX, USA.
SAS codes for the Cox regression analyses are presented in the online appendix. The present study was approved by Regional Ethical Review Board in Stockholm, Sweden. The final study cohort comprised of 46, women.
After exclusion of women with missing data on any of the covariates, 42, women with a mean age of No major differences existed between the women excluded due to missing data and the women included in the final analysis Table S 1.
During the average follow-up of Table 1 shows the baseline characteristics of the study participants according to the three categories of adherence to MDP score. Women with a high adherence tended to be older, had higher educational attainment, more physically active, non-smoking, and with a higher total energy intake, compared with women with a low adherence.
The observed protective effect appeared to increase with age. The fully adjusted spline regression showed a similar result pattern Fig.
Examination of the age-specific cumulative incidence rate of depression indicated stronger associations with increasing age and increasing adherence to MDP Fig. A Clinical diagnosis of depression; B Severe form of depression; C Broader definition of depression at least one dispense of SSRIs or clinical diagnosis of depression ; D Combined splines in the Fig.
Estimates were derived from natural cubic splines, adjusted for attained age, birth year, body mass index, smoking, physical activity, total energy intake, years of education, and history of diabetes and hypertension.
Adherence to Mediterranean dietary pattern score was calculated on a 9-point scale ranging from 0 as the minimal to 9 as the maximal adherence. Cumulative incidence rate of depression with age of follow-up years by adherence to Mediterranean dietary pattern using Kaplan-Meier method.
A Minimally adjusted Cox model, adjusted for attained age and birth year; B Fully adjusted Cox model, further adjusted for body mass index, smoking, physical activity, total energy intake, years of education, and history of diabetes and hypertension.
Excluding the first two or five years of follow-up provided essentially similar results Table S 2. Further adjustment for psychiatric comorbidity Table S 3 or restricting analysis to women without any psychiatric disorders before enrolment Table S 4 did not change the results either.
Excluding other kinds of meat e. The correlations between individual dietary components and adherence to MDP are shown in Table S 6. The results remained robust after exclusion of individual food components from the adherence score Fig.
There was no strong support for lack of proportional hazards Fig. In this, to date, largest prospective cohort study examining the association between adherence to Mediterranean-style diet and risk of clinically ascertained depression, we observed a reduction in the risk of depression in relation to higher adherence to Mediterranean diet, compared with a lower adherence, in a dose-response pattern.
Among younger women, whose causes of depression are mainly depression with probable genetic influences [ 31 , 32 ], there was no, or only a small, association of the Mediterranean diet score with depression. The results remained robust after a detailed adjustment for potential confounding factors and after an extensive set of sensitivity analyses.
The highest reduction in risk was observed for severe depression. There has been a rapid growth in research concerning the role of diet in depression in recent years [ 6 ], centered on its modulation of inflammatory level [ 33 ]. Conversely, Mediterranean diet has been frequently referred as a typical food pattern with a lower level of inflammation [ 8 ], and was found to be inversely associated with risk of depression in our study.
Other hypotheses are also proposed as explanations, including pathways in the oxidative and antioxidant defense systems, brain plasticity, microbiota-gut-brain axis, mitochondrial dysfunction, tryptophan—kynurenine metabolism, neurogenesis and BDNF, and epigenetics [ 12 ].
The action by diet affecting mental health is likely multifaceted and interacting, not restricted to only one pathway [ 12 ].
However, the majority of identified mechanisms nowadays are derived from animal studies; data of clinically ascertained depression in human beings are lacking. Previous cohort studies among women showed mixed results on the association between MDP and risk of depression [ 35 , 36 , 37 , 38 ].
Unlike most earlier studies, which used symptom scales or measures of self-reported depression, our study used clinically ascertained depression. Moreover, the large sample size of the present study allowed us to perform detailed adjustment for potential confounding factors and several sensitivity analyses to challenge assumptions used in the analysis, including the influence from different definitions of depression.
The effect became even more evident when we included only the most severe depression. Furthermore, the age-specific analysis showed a stronger effect with increasing age, indicating a potentially accumulative benefit of MDP.
This might partly explain the null association in some of the previous studies with a shorter follow-up period [ 38 ]. Finally, our finding of reduced risk of clinical depression with MDP is consistent with recent interventional studies which exhibited reduced depressive symptoms after dietary interventions, especially for those of more severe level of depression [ 16 , 17 , 18 , 19 ].
In our cohort, women with a higher adherence to Mediterranean diet were more likely to have healthier lifestyle behaviors, characterized by being more physically active, of higher educational level, and with lower prevalence of smoking.
Our extensive database allowed us to further adjust for these lifestyle factors which slightly attenuated the beneficial effect from MDP. Similarly, metabolic diseases can result in dietary habits which could modulate the risk of depression in turn [ 7 , 14 ]. As obesity is known to stimulate chronic pro-inflammatory status, it is a plausible pathway linking together diet and risk of depression [ 39 ].
In our study, the results remained robust after adjusting for BMI. Strengths of our study include the population-based sample, large cohort size, prospective ascertainment of clinically defined depression and long and virtually complete follow-up.
Risk of selection bias was limited by the use of data from a health care system with equal access and recorded information on all cohort participants, independent from sociodemographic background.
The same system allowed us to screen for presence of psychiatric disorders before the cohort entry. Our study also has limitations.
When at an early stage of depression, women might be more likely to have an unhealthy dietary pattern, indicating a possibility of reverse causation. To rule out potential impact of subclinical depression, we performed lag-time analyses and found that the association remained essentially unchanged after excluding the first two or five years of follow-up.
Additionally, we adjusted for history of other psychiatric disorders prior to depression diagnosis in one analysis and excluded women with any psychiatric history before enrolment in another sensitive analysis.
Both analyses showed largely comparable results. In the main analysis, we used calendar year of birth, BMI and years of education as categorical variables. In another model adjusting for these variables as continuous variables, we obtained very similar results as the ones from the original analyses data not shown.
The dietary pattern was measured only at enrolment. The long lag between exposure and outcome is therefore a concern because dietary pattern of the participants might have changed during the follow-up.
As a result, there is a chance of misclassification of the exposure. Nevertheless, researchers have noticed that individual dietary habit is usually maintained lifelong and unlikely to change greatly over time [ 40 , 41 ].
The magnitude of the association increased with increasing age, potentially suggesting a cumulative protective effect from MDP on depression across life span.
Given the observational nature of the study, residual confounding due to unknown or unmeasured confounders such as stress-related factors may still have some influence on our results. Diet, which every one of the population is exposed to, has been shown associated with overall health and various specific diseases, e.
cardiovascular disease, cancer, premature mortality and, in this study, depression [ 42 ]. Considering the health burden of depression worldwide, these results are of great public health importance. More researchers have emphasized the importance of dietary pattern, instead of isolated nutrients [ 43 ], to achieve interactional effects and to convey easy-to-understand information to the public [ 44 ].
This is in line with the intention of this study which is to raise awareness of the importance of healthy dietary pattern on mental health.
Although MDP is prevalent in Mediterranean countries, the traditional dietary habits in the Scandinavian population are however not a typical Mediterranean style.
Compared with a Greek cohort EPIC [ 45 ], the median intake levels of vegetables and fruits and nuts were much lower in our cohort Table S6. Due to the relatively low absolute prevalence of MDP, the adherence to a dietary pattern that approximates MDP might bring about even greater benefits to the health of a population outside the Mediterranean region, like Sweden.
Data described in the manuscript, code book, and analytic code will be made available upon request pending. SAS codes for the main analyses are presented in the online appendix. World Health Organization. Depression and other common mental disorders:global health estimates.
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Brain food carries a different meaning Mediterranean diet and mental health days with Boosting collagen production increasing evidence base hea,th that Mwditerranean diet Hexlth affect more Antioxidant and energy levels just our stamina and energy levels. It mentwl also affect our dieg function, memory and mental Mediterraanean. The statistics on mental health issues among Australians are astounding. According to Beyond Blue, up to 45 per cent of people will experience a mental health condition in their lifetime 2. The task of the Royal Commission is to better understand the role of treatments, and to ensure that the health system is more adept at managing those suffering from poor mental health. The report so far has also acknowledged that the mental health system in Australia is over-reliant on medication as a form of treatment 3.
Mediterranean diet and mental health -
Her work has appeared in more than 40 outlets. She focuses on a variety of topics such as diabetes prevention, vision care, nutrition, skincare, sleep health, pregnancy and post-partum care, among others.
A graduate of Syracuse University, Jessica now lives in the Chicago suburbs with her two young sons, rescue beagle, and husband.
The foods you eat play an essential role in staying sharp as you age, and nutrient-packed, flavor-rich and easy-to-follow eating patterns like the Mediterranean diet make the job easier.
A smattering of studies reveals just how this eating plan can be a boon to your brain health and mood today—and in the future.
Oh, and there are happiness benefits, too. So what exactly happens to your brain when you follow the Mediterranean diet? Promising research shows that the Mediterranean diet may boost brain health in a few key ways: by improving factors like memory, decreasing the risk of cognitive decline and bettering mood.
Here's a deeper look. Incorporating the principles of the Mediterranean diet can shore up your smarts. A meta-analysis of 17 cohort studies and randomized controlled trials on healthy older adults, published in Advances in Nutrition , found that those who more closely followed the Mediterranean diet had better cognition.
Specifically, benefits were noticed in measures of delayed recall the ability to recollect information acquired earlier, per the American Psychological Association , and working memory. The perks seemed more pronounced for people who cooked with olive oil.
While this study only focused on olive oil, other nutritious oils, like avocado oil and sesame oil, have similar properties and benefits and are great options for your brain-supporting diet.
Eating more fish and less meat is also associated with positive brain outcomes, thanks to fish's omega-3 fatty acids , which protect blood vessels in the brain, quell damage from oxidative stress and reduce inflammation.
And there's more. A observational study of Puerto Rican adults with diabetes, published in Diabetes Care , found that following the Mediterranean diet was associated with better cognitive functioning, such as memory, after two years.
One of the reasons is that it helped improve blood sugar management. High blood glucose levels in the brain can, over time, contribute to damaging inflammation.
The study's authors point out that traditional foods in Puerto Rican cuisine, such as homemade soups with vegetables and meat, beans and legumes and fish, fit within the healthy eating pattern of a Mediterranean diet—showcasing how the diet's principles extend beyond traditional Mediterranean fare.
Though various factors are at play that govern cognitive decline, a healthy diet may help tip the scales in your favor. Both the Mediterranean diet and the MIND diet a diet similar to the Mediterranean diet, but more focused on foods and nutrients specifically known to support brain health have been shown in randomized controlled trials to slow the rate of cognitive decline, according to a systematic review in the journal Life.
In that same study, the higher the score one had on a scale that measured adherence to the Mediterranean diet, the younger, or healthier, their brains seemed. Another study, published in in Neurology , found that those who followed the Mediterranean diet more closely benefited from 1.
Though exactly why is still being studied, the Mediterranean diet limits red meat and highly processed foods rich in refined carbohydrates , added sugars and saturated fat. Researchers say these foods are more likely to increase the risk of heart disease, insulin resistance and inflammation, which may speed brain aging.
Sticking to an eating pattern with similar components as the Mediterranean diet may help keep your mood up. Inflammation may be one of the factors driving depression, and the Mediterranean diet promotes foods packed with anti-inflammatory nutrients from plant-based oils and nuts, fruits and vegetables.
Some vegetables with the highest anti-inflammatory properties include broccoli, tomatoes, edamame, peppers, collard greens and mushrooms. Specifically, eating more fruits and veggies was found to buoy one's mood the most. The Mediterranean diet is rich in fiber, heart-healthy monounsaturated fats, magnesium and B vitamins, all of which have been shown in prior research to benefit psychological health.
Cognitive health, dementia and depression are all multifactorial, meaning that many variables —from genes to lifestyle habits, such as diet, exercise or smoking, as well as chronic conditions—are risk factors for these diseases that affect your brain. Though incorporating the principles of the Mediterranean diet in a way that fits your culture and preferences is essential, diet alone isn't the answer.
What's more, other aspects of the Mediterranean lifestyle, such as strong social ties, rest and regular movement, are also important for brain health. What foods should you eat for your noggin? There are so many possibilities in a Mediterranean diet—fruits, vegetables, whole grains, beans and legumes, nuts and seeds, lean protein and healthy fats.
And the healthy eating principles of the diet can be applied to any type of cuisine—you don't need to only eat foods and dishes from Mediterranean countries like Italy, Spain and Greece to gain the health benefits.
Here are a few brain-supporting foods to try to fit into your routine. This is likely due to the brain-healthy omega-3 fatty acids in fish. Plant-based oils such as olive oil, avocado oil and peanut oil are packed with heart-healthy monounsaturated fats.
And, according to research in Nutrition Reviews from , olive oil contains anti-inflammatory components that not only directly impact your brain but may also play a role in the health of your gut microbiome, which can also help protect your brain. Additionally, olive oil, avocado oil and peanut oil are good sources of vitamin E, a potent antioxidant that may help slow down the progression of dementia, per a review in Healthcare.
A study published in Neurology found that people who ate the highest amounts of green leafy veggies had the lowest markers of Alzheimer's disease in their brains compared to those who ate the least. Greens like spinach, collard greens, mustard greens and kale are high in nutrients, including folate and vitamins A and K, which have protective anti-inflammatory properties.
A study in the World Journal of Psychiatry that attempted to uncover the nutrients linked to mental health—called "antidepressant nutrients" in the research—found that folate, iron, magnesium, selenium and zinc, among others, scored high.
Shively said any diet that's high in fiber, fresh fruits, vegetables and plant-based fats and proteins should have the opposite effect. Aria Bendix is the breaking health reporter for NBC News Digital.
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