Circulating Inflammation Markers Partly Explain the Link Between the Dietary Inflammatory Index and Depressive Symptoms

Alessandro Gialluisi; Federica Santonastaso; Marialaura Bonaccio; Francesca Bracone; Nitin Shivappa; James R Hebert; Chiara Cerletti; Maria Benedetta Donati; Giovanni de Gaetano; Licia Iacoviello; Moli-sani Investigators

doi:10.2147/JIR.S312925

Circulating Inflammation Markers Partly Explain the Link Between the Dietary Inflammatory Index and Depressive Symptoms

J Inflamm Res. 2021 Sep 28:14:4955-4968. doi: 10.2147/JIR.S312925. eCollection 2021.

Affiliations

¹ Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
² Department of Medicine and Surgery, University of Insubria, Varese, Italy.
³ Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
⁴ Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA.

Abstract

Background: Depression is a mood disorder characterized by a high rate of resistance to pharmacological treatments, which has often been linked to chronic inflammation. This can be influenced by different environmental factors, in particular pro-inflammatory diets. However, a mediating role of circulating inflammation has never been observed.

Aim: To test the association between a dietary inflammatory index (DII^®) and continuous depressive symptoms (adapted version of PHQ9) in an Italian population cohort (N=13,301), along with potential explanatory effect of a composite index (INFLA-score) based on four circulating inflammatory biomarkers: C-reactive protein, granulocyte-to-lymphocyte ratio, platelet and white blood cell counts.

Results: Significant positive associations were observed between DII and total depressive symptoms (standardized β (SE) = 0.038 (0.005), p < 0.001), and with two factors tagging somatic (0.012 (0.003), p < 0.001) and cognitive symptoms (0.012 (0.003), p < 0.001), after adjustment for different potential confounders (socioeconomic status, chronic health conditions and lifestyles). These associations were about twice as strong in women than in men. INFLA-score explained a small but significant proportion of the association with total depressive symptoms (0.90-2.30%, p < 0.05), which was mainly driven by granulocyte-to-lymphocyte ratio (1.18-1.65%). This effect was even stronger for the somatic (2.66-4.66%) but not for the cognitive factor (0%).

Conclusion: These findings support a strong link between inflammatory diet and depression, especially with somatic symptoms and within women. Moreover, they provide novel evidence for a potential explanatory role of circulating inflammation in this association, suggesting new paths for prevention and treatment of major and atypical depression.

Keywords: atypical depression; circulating inflammation; depressive symptoms; dietary inflammatory index; granulocyte-to-lymphocyte ratio; white blood cells.