Adherence to empirically derived dietary patterns and risk of depression symptoms and anxiety disorder: The Maastricht Cohort Study

Fatemeh Mirjalili; Sara Jambarsang; Ehsan Farashahi-Yazd; Mostafa Dianati; Simone J P M Eussen; Miranda T Schram; Annemarie Koster; Amin Salehi-Abargouei; Evan Yi-Wen Yu; Maurice P Zeegers; Anke Wesselius

doi:10.1016/j.ajcnut.2026.101415

Adherence to empirically derived dietary patterns and risk of depression symptoms and anxiety disorder: The Maastricht Cohort Study

Am J Clin Nutr. 2026 Jun 26;124(3):101415. doi: 10.1016/j.ajcnut.2026.101415. Online ahead of print.

Affiliations

¹ Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Epidemiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
² Department of Biostatistics and Epidemiology, Center for Healthcare Data Modeling, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
³ Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
⁴ Department of Biomedical Sciences, Sir Jeffrey Cheah Sunway Medical School, Faculty of Medical and Life Sciences, Sunway University, Sunway City, Malaysia.
⁵ Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, Care and Public Health Research Institute, Maastricht, the Netherlands.
⁶ Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Internal Medicine, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Heart & Vascular Center, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁷ Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
⁸ Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: abargouei@sums.ac.ir.
⁹ Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
¹⁰ Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
¹¹ Department of Epidemiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.

PMID: 42362117
DOI: 10.1016/j.ajcnut.2026.101415

Abstract

Background: Previous studies on mental disorders have yielded inconsistent findings regarding the relationship between dietary patterns (DPs) and psychological disorders, with most evidence derived from cross-sectional studies.

Objectives: This study aims to examine the association between major DPs and risk of depression symptoms (DepS) and anxiety disorder (AnxD).

Methods: This study used data from The Maastricht Study [participants included in analyses for DepS: n = 6967, mean age (SD): 59.94 (8.66) y, female: 49.40%; for AnxD: n = 6634, mean age (SD): 59.94 (8.60) y, female: 49.40%]. A validated food frequency questionnaire was used to assess dietary intakes. DPs were derived using principal component analysis. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item questionnaire were used annually to assess DepS and AnxD, respectively. A Cox proportional hazards regression analysis was incorporated to examine the associations. Stratified analyses were performed based on the status of diabetes, sex, body mass index, and smoking.

Results: Three DPs were identified: "high vegetables and legumes," "high fast food and sugar," and "vegetarian-like". After adjustment for all possible confounders, adherence to the "high fast food and sugar" DP was associated with a higher risk of DepS {hazard ratio [HR] [95% confidence intervals (CIs)] _{Q5 compared with Q1}: 2.13 [1.55, 2.92], P < 0.001, P_trend < 0.001} and AnxD [HR (95% CIs) _{Q5 compared with Q1}: 2.03 (1.33, 3.10), P = 0.001, P_trend < 0.001] in the total population. No association was found for other DPs in the total population. A significant interaction was observed between the "vegetarian-like" DP and smoking status on risk of AnxD [interaction term, HR (95% CIs): 0.76 (0.64, 0.90), P = 0.001]. Opposite but nonsignificant associations were noted in never-smokers [HR (95% CIs) _{Q5 compared with Q1}: 1.47 (0.83, 2.60), P = 0.19, P_trend = 0.06] and former/current smokers [HR (95% CIs) _{Q5 compared with Q1}: 0.62 (0.37, 1.04), P = 0.07, P_trend = 0.046].

Conclusions: A diet high in fast foods, confectionery, fried potatoes, sauces, sugar-sweetened beverages, and refined grains might be associated with an increased risk of depression and anxiety in adults.

Keywords: anxiety; depression; dietary patterns; principal component analysis; prospective cohort studies.