Dietary patterns and depression risk: A meta-analysis
Introduction
Depressive disorder is a leading cause of disability worldwide, affecting approximately 350 million people (Vermeulen et al., 2016). According to the statistics from the World Health Organization in 2012, depression is the fourth most common global burden of disease, and will be the second leading cause of disease burden, after cardiovascular disease, by the year 2020 (Lin et al., 2010). In Europe and North America, the lifetime prevalence of depression is estimated between 10–20%, and two times higher in women than in men (Le Port et al., 2012). In China, the incidence of depression in elderly people ranged from 4% to 26.5%, and it has become a substantial burden (Gao et al., 2009). It is well-known that diet is related to inflammation, oxidative stress and brain plasticity and function; all of these physiological factors are potentially involved in depression (Jacka et al., 2011).
In the past several decades, many epidemiological studies have pointed out that diet plays an important role in mental health and investigated the relation between the intake of individual foods or nutrients and the risk of depression (Murakami et al., 2010; Appleton et al., 2007; Lucas et al., 2011). However, in real life, people do not take isolated nutrients or foods, but consume meals containing combinations of many nutrients and foods that possibly interact with each other (Zhang et al., 2015). In this context, dietary pattern analysis has been recommended to become a more recognizable approach because it considered the complexity of overall diet and can potentially facilitate nutritional recommendations (Ruusunen et al., 2014).
To date, several previous studies have been performed to elucidate the associations between dietary patterns and depression risk. however, the results have been inconsistent (Chocano-Bedoya et al., 2013, Akbaraly et al., 2009, Kim et al., 2015, Gougeon et al., 2015). The healthy/prudent dietary patterns have tended to show inverse associations with depression risk (Chocano-Bedoya et al., 2013, Kim et al., 2015), whereas western dietary pattern has either shown a positive association (Chocano-Bedoya et al., 2013, Akbaraly et al., 2009), or no significant association (Gougeon et al., 2015, Okubo et al., 2011). Besides, the scientific report of the 2015 Dietary Guidelines Advisory Committee has concluded that current evidence on the association of dietary patterns with depression is limited (Dietary Guidelines Advisory Committee, 2015). Meanwhile, a previous systematic review examining the association between dietary patterns and depression was published by Rahe et al. (2014). The authors didn’t find a protective effect of healthy dietary pattern on the risk of depression. Recently, another systematic review has also reported the associations between dietary patterns and risk of depression in community-dwelling adults, but no firm conclusions have been made on the association between the Western diet and risk of depression (Lai et al., 2014). In a word, the evidence about the relation between dietary patterns and depression is limited and inconsistent. In view of this, we carried out this meta-analysis of studies published up to September 2016, to further clarify the potential association between dietary patterns and the risk of depression.
Section snippets
Literature search strategy
An electronic literature search was performed on MEDLINE and EMBASE databases to identify relevant studies written in the English and Chinese languages published up to September 2016, with the following keywords or phrases: “diet” OR “dietary pattern” OR “dietary patterns” OR “eating pattern” OR “eating patterns” OR “food pattern” OR “food patterns” AND “depression” OR “psychological stress” OR “depressive disorder” OR “depressive symptoms”. Besides, no restrictions on the age of the study
Overview of included studies for the systematic review
An electronic literature search in the database of MEDLINE(n=304) and EMBASE(n=148) identified 452 studies, 412 of which were excluded based on the floowing reasons(in Fig. 1): duplicate records(n=95); practice guideline(n=1); meta-analysis(n=4); systematic review (n=40); title and abstract did not contain the data on the relation between dietary patterns and depression(n=282); did not provide the data about percent of depression or number of each group(n=6); had dietary patterns but not
Discussion
Data on the association between dietary patterns and depression are scare in Chinese populations. To the best of authors’ knowledge, this is the latest meta-analysis of depression risk and dietary patterns. In the present study, we have an update on the previous systematic review (Rahe et al., 2014 and Lai et al., 2014), and further identify the positive association between Western dietary pattern and the risk of depression. Results indicated that the healthy dietary pattern is associated with
Conclusion
In conclusion, the present meta-analysis suggested that the healthy dietary pattern was associated with a decreased risk of depression, whereas Western-style/unhealthy dietary pattern was associated with an increased risk of depression. Our findings add to the evidence of the role of dietary patterns in the the prevention and management of depression. Therefore, it makes sense to elucidate the potential association between dietary patterns and depression risk and provide a scientific rational
Ethics
Ethical approval and participant consent were not required for this meta-analysis, since the study involved review and analysis of previously published data.
Competing interests
None.
Authors’ contributions
Y.L., M.-R. L.and B.L. Designed and wrote the manuscript; Y.-J. W. Reviewed and edited the manuscript; L.S. designed the study and edited the manuscript; J.-X. Z. and H.-G. Z conducted the statistical analyses. All authors read and approved the final manuscript.
Funding
This study was supported by Natural Science Foundation of Shandong Province (Grant No. ZR2014HP026).
Acknowledgements
We thank all participants from Department of Endocrinology, Linyi People's Hospital for their assistance and support. We also acknowledge the Department of Nursing, Linyi People's Hospital for their important contributions to collection of data in the present study.
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