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Meta-Analysis
. 2019 Jul;24(7):965-986.
doi: 10.1038/s41380-018-0237-8. Epub 2018 Sep 26.

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

Camille Lassale  1   2 , G David Batty  3 , Amaria Baghdadli  4   5 , Felice Jacka  6 , Almudena Sánchez-Villegas  7   8 , Mika Kivimäki  3   9 , Tasnime Akbaraly  3   4   10
Affiliations
Meta-Analysis

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

Camille Lassale et al. Mol Psychiatry. 2019 Jul.

Erratum in

Abstract

With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews under the number CRD42017080579.

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Conflict of interest statement

Felice Jacka has received: (1) competitive Grant/Research support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council (NHMRC), Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, The University of Melbourne; (2) industry support for research from Meat and Livestock Australia, Woolworths Limited, the A2 Milk Company, Be Fit Foods; (3) philanthropic support from the Fernwood Foundation, Wilson Foundation, the JTM Foundation, the Serp Hills Foundation, the Roberts Family Foundation, the Waterloo Foundation and; (4) travel support and speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Network Nutrition, Angelini Farmaceutica, Eli Lilly and Metagenics. Felice Jacka has written two books for commercial publication. All other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Meta-analysis of studies investigating the association between a traditional Mediterranean diet and depressive outcomes. Estimates are ORs, RRs or HRs of depression for people with highest adherence compared to lowest adherence (categories or quantiles specified). MDS Mediterranean diet score, rMED relative MDS, aMED alternative MDS, T tertile, Q quintile
Fig. 2
Fig. 2
Meta-analysis of studies investigating the association between HEI/AHEI and depressive outcomes. Estimates are ORs, RRs, or HRs of depression for people with highest adherence compared to lowest adherence (categories or quantiles specified). HEI healthy eating index, AHEI Alternatative Heatlhy Eating Index, T tertile, Q5 quintile, Q4 quartile, 60pctile 60th percentile
Fig. 3
Fig. 3
Meta-analysis of studies investigating the association between a DASH diet and depressive outcomes. Estimates are ORs, RRs, or HRs of depression for people with highest adherence compared to lowest adherence (categories or quantiles specified). DASH dietary approaches to stop hypertension, T tertile, Q5 quintile, Q4 quartile
Fig. 4
Fig. 4
Meta-analysis of studies investigating the association between the Dietary Inflammatory Index DII and depressive outcomes. Estimates are ORs, RRs, or HRs of depression for people with lowest adherence compared to highest adherence (categories or quantiles specified). T tertile, Q5 quintile, Q4 quartile
Fig. 5
Fig. 5
Summary of studies investigating the association between various other diet quality scores and depressive outcomes. mPNNS-GS modified score of adherence to the French dietary guidelines (PNNS), AHA American Heart Association, (A)RFS (Australian) Recommended Food Score, DGI Dietary Guidelines Index, DQI-I Diet Quality Index International, DQS Diet quality score, EDQ-I Elderly Dietary Quality Index, PANDiet Diet Quality Index Based on the Probability of Adequate Nutrient Intake, T tertile, Q5 quintile, Q4 quartile
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