Association of a priori dietary patterns with depressive symptoms: a harmonised meta-analysis of observational studies

Mary Nicolaou, Marco Colpo, Esther Vermeulen, Liset E M Elstgeest, Mieke Cabout, Deborah Gibson-Smith, Anika Knuppel, Giovana Sini, Danielle A J M Schoenaker, Gita D Mishra, Anja Lok, Brenda W J H Penninx, Stefania Bandinelli, Eric J Brunner, Aiko H Zwinderman, Ingeborg A Brouwer, Marjolein Visser

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Review findings on the role of dietary patterns in preventing depression are inconsistent, possibly due to variation in assessment of dietary exposure and depression. We studied the association between dietary patterns and depressive symptoms in six population-based cohorts and meta-analysed the findings using a standardised approach that defined dietary exposure, depression assessment and covariates.

METHODS: Included were cross-sectional data from 23 026 participants in six cohorts: InCHIANTI (Italy), LASA, NESDA, HELIUS (the Netherlands), ALSWH (Australia) and Whitehall II (UK). Analysis of incidence was based on three cohorts with repeated measures of depressive symptoms at 5-6 years of follow-up in 10 721 participants: Whitehall II, InCHIANTI, ALSWH. Three a priori dietary patterns, Mediterranean diet score (MDS), Alternative Healthy Eating Index (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH) diet were investigated in relation to depressive symptoms. Analyses at the cohort-level adjusted for a fixed set of confounders, meta-analysis used a random-effects model.

RESULTS: Cross-sectional and prospective analyses showed statistically significant inverse associations of the three dietary patterns with depressive symptoms (continuous and dichotomous). In cross-sectional analysis, the association of diet with depressive symptoms using a cut-off yielded an adjusted OR of 0.87 (95% confidence interval 0.84-0.91) for MDS, 0.93 (0.88-0.98) for AHEI-2010, and 0.94 (0.87-1.01) for DASH. Similar associations were observed prospectively: 0.88 (0.80-0.96) for MDS; 0.95 (0.84-1.06) for AHEI-2010; 0.90 (0.84-0.97) for DASH.

CONCLUSION: Population-scale observational evidence indicates that adults following a healthy dietary pattern have fewer depressive symptoms and lower risk of developing depressive symptoms.

Original languageEnglish
Pages (from-to)1872-1883
Number of pages12
JournalPsychological Medicine
Issue number11
Early online date14 Aug 2019
Publication statusPublished - Aug 2020


FundersFunder number
Dutch Heart Foundation
European Fund
Italian Ministry of HealthICS110.1/RF97.71
Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care321175, 325889
Netherlands Organization for Health Research and Development
Netherlands Organization for Scientific Research
UK Medical Research Council
US National Institute on AgingN01-AG-5-0002, 236 MD 916413, 236 MD 821336
National Institutes of HealthR01HL36310
National Institute on AgingR01AG013196
British Heart Foundation
European Commission
Universiteit Leiden
Rijksuniversiteit Groningen
Nederlandse Organisatie voor Wetenschappelijk Onderzoek480-10-014
Department of Health, Australian Government
Seventh Framework Programme
Leids Universitair Medisch Centrum


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