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Aims and Objectives . Our goal was to determine nutritional status, body composition, and biochemical parameters of patients diagnosed with depression based on DSM-IV-TR criteria. Methods . A total of 59 individuals, aged 18–60 years admitted to Mental Health Centre of Kayseri Education and Research Hospital, were included in the study. The participants were randomly assigned to two groups; depression group ( n = 29 ) and control group ( n = 30 ). Anthropometric measurements, some biochemical parameters, demographic data, and 24-hour dietary recall were evaluated. Results . 65.5% of depression and 60.0% of control group were female. Intake of vitamins A, thiamine, riboflavin, B6, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and fibre ( p < 0.05 ) were lower in depression group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio ( p < 0.05 ) were significantly higher in depression group. Fasting blood glucose levels, serum vitamins B12, and folic acid ( p < 0.05 ) in depression group were lower than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion . Some vitamin B consumption and serum vitamin B12 and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future research exploring nutritional status of individuals with depression is warranted.
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Research Article
Evaluation of Nutritional Status of Patients with Depression
GülGah Kaner,1Meltem Soylu,1Nimet Yüksel,2Neriman Inanç,1
Dilek Ongan,3and Eda BaGmJsJrlJ1
1Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, 38170 Kayseri, Turkey
2KayseriEducationandResearchHospital,38170Kayseri,Turkey
3Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Kˆ
atip C¸elebi University, 35620Izmir, Turkey
Correspondence should be addressed to G¨
uls¸ah Kaner; dytgulsahk@gmail.com
Received  April ; Revised  August ; Accepted  August 
Academic Editor: Adair Santos
Copyright ©  G¨
uls¸ah Kaner et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aims and Objectives. Our goal was to determine nutritional status, body composition, and biochemical parameters of patients
diagnosed with depression based on DSM-IV-TR criteria. Methods. A total of  individuals, aged – years admitted to Mental
Health Centre of Kayseri Education and Research Hospital, were included in the study. e participants were randomly assigned to
two groups; depression group (𝑛=29) and control group (𝑛=30). Anthropometric measurements, some biochemical parameters,
demographic data, and -hour dietary recall were evaluated. Results. .% of depression and .% of control group were female.
Intake of vitamins A, thiamine, riboavin, B, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and bre (𝑝 < 0.05) were lower in depression
group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio (𝑝 < 0.05) were signicantly higher
in depression group. Fasting blood glucose levels, serum vitamins B, and folic acid (𝑝 < 0.05) in depression group were lower
than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion. Some vitamin B consumption and serum
vitamin B and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future
research exploring nutritional status of individuals with depression is warranted.
1. Introduction
Depression alone accounts for .% of the global burden of
disease and is among the largest single causes of disabil-
ity worldwide (% of all years lived with disability glob-
ally), particularly for women []. Studies about associations
between diet and depression have primarily focused on single
nutrients or foods. Recently, dietary patterns representing a
combination of foods have attracted more interest than an
individual nutrient. Depression is a serious eective illness
with a high lifetime prevalence rate in which diet has been
suggested as one modiable factor [].
An association between diet and depression has now been
conrmed in prospective and epidemiological studies. For
example, in elderly men and women, consumption of sh,
vegetables, olive oil, and cereals was negatively correlated
with severity of depressive symptoms []. e benets from
sh and olive oil intake remained signicant even when
adjusted for confounders such as age, sex, educational status,
BMI, and physical activity level as well as the presence of
anumberofmedicalconditions[]. In a prospective study,
aer adjusting for sex, age, smoking status, BMI, physi-
cal activity levels, and employment status, adherence to a
Mediterranean diet including high levels of vegetables, fruits,
nuts, cereals, legumes, and sh, moderate alcohol intake, and
lowamountofmeatormeatproductsandwhole-fatdairy
intake was protective against development of depression [].
InastudybyJackaetal.[], consuming a “traditional” diet
containing vegetables, fruits, meat, sh, and whole grains
was also associated with a % reduced risk of depression
or dysthymia. Researches about diet of adolescents []and
of the community-dwelling elderly with low socioeconomic
level [] have also provided evidence for an association
between diet quality and depression. Depressive symptoms
are also positively associated with consumption of sweets
[]. Similarly, high consumption of fast food and processed
pastries is associated with an increased risk for depression
up to  years later []. In a randomised-controlled trial, six
Hindawi Publishing Corporation
BioMed Research International
Volume 2015, Article ID 521481, 9 pages
http://dx.doi.org/10.1155/2015/521481
BioMed Research International
days on a low protein diet signicantly decreased depressive
symptoms in patients with type  diabetes mellitus []and,
in another randomised study about overweight and obese
individuals, those who were placed on an energy-restricted,
low-fat diet for one-year experienced greater improvements
in mood compared to participants on an energy-restricted,
low-carbohydrate diet []. ese changes were independent
of weight loss. PUFAs, particularly omega- essential fatty
acids (EFA), have received signicant attention in relation
to depression. In a meta-analysis of  studies comparing
the levels of PUFAs between depressed patients and control
subjects, levels of eicosapentaenoic acid (EPA), docosahex-
aenoic acid (DHA), and total n- EFA were signicantly
lower in depressed patients than controls. ere was no
signicant change in arachidonic acid (AA) or total n-
PUFAs []. A meta-analysis of  clinical trials about eects
of EPA supplementation in depressed populations revealed
benecial eects from sh oil containing high levels of
EPA []. Other investigations about relationship between
nutrients and depression have also demonstrated a role of
folate [,], Zn [], Fe [,], vitamin B6[], and
vitamin B12 [,].
Obesity is associated with an increased risk of mental
illness however; evidence linking BMI to mental illness is
inconsistent []. Whether obesity also predicts psychiatric
disorders such as depression has not been established. us
far, population-based studies of association between obesity
and depression have yielded inconsistent results []. Some
studies found an association [], while others did not
[]. Depressive symptoms may contribute to abdominal
obesity through consumption of diets with high energy
density []. Grossniklaus et al. [] have determined that
depressive symptoms and dietary energy density were asso-
ciated with elevated waist circumference. Among overweight
and obese U.S. adults, high waist circumference or abdominal
obesity was signicantly associated with increased likeli-
hoods of having major depressive symptoms or moderate-
to-severe depressive symptoms. Zhao et al. []statedthat
mental health status should be monitored and evaluated in
adults with abdominal obesity, particularly in those who are
overweight.
ese results suggest that healthy dietary pattern is sig-
nicantlyassociatedwithmajordepressioninadults.Further
studies are needed to conrm them, however. In addition, to
the best of our knowledge, there is no study of its kind in
our country to evaluate nutritional intake of patients with
depression. erefore, the present study was conducted to
determine nutritional status, body composition, and selected
biochemical parameters of patients diagnosed with depres-
sion based on DSM-IV-TR criteria and to compare their data
those of a control group.
2. Methods
is randomized controlled study was performed at our Men-
talHealthCentreClinicofKayseriEducationandResearch
Hospital of Medicine, a tertiary referral centre in Turkey.
Forty-two inpatients diagnosed with major depression
in accordance with Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV-TR), who are
on antidepressant medication and thirty-two normal healthy
volunteers aged between  and  were studied between
 and . Of  subjects,  patients and  healthy
subjects had missing information thus data of  participants
( patients in depression group and  healthy volunteers in
controls) were used.
Demographic characteristics like age, gender, family
status (married, divorced, and widowed), nancial status
(average annual income during the past three years), smoking
habits, alcohol consumption, and occupational status as well
as education level were obtained with questionnaire by face-
to-face interview. ere were no dierences between groups
across race/ethnicity.
Food consumption frequency, energy, and nutrient intake
by -hour dietary recall were determined. Daily energy
expenditure and physical activity levels were calculated.
Height, body weight, waist circumference, hip circumference,
BMI, and waist-to-hip ratio were also determined. Selected
biochemical parameters were evaluated (fasting blood glu-
cose, folate, vitamin B12,andinsulin).
Exclusion criteria were derived as follows: () serious
mental illness (e.g., a psychotic disorder, bipolar disorder,
posttraumatic stress disorder, schizophrenia, anxiety disor-
ders, dementia, or bulimia), () recent initiation or dose
adjustment of thyroid medications, and () weight loss
medication or treatment, bariatric surgery, diabetes, and
pregnancy.
All participants provided written informed consent, and
the protocol was approved by the institutional review boards
of the participating centers, in accordance with the Declara-
tion of Helsinki. e institutional review board of the Ethics
Committee of Faculty of Medicine in Erciyes University
(Kayseri, Turkey) approved the study protocol on November
, . is trial was registered with number /.
2.1. Data Collection
2.1.1. Preparation and Implementation of the Questionnaire.
e questionnaire was designed in a manner understandable
forindividualsandwasbasedonliteraturereview[,,
]. Comprehensibility of questions in the questionnaire
was tested on  individuals, necessary adjustment was
made accordingly, and questionnaire was nalized. e
questionnaire included an overview of individual’s eating
habits, anthropometric measurements, food consumption
frequency, energy and nutrient intake, and physical activity
level with -hour recall. e questionnaire took approxi-
mately  minutes to administer for each participant.
2.1.2. Anthropometric Measurements. Anthropometric mea-
surements were determined according to WHO criteria [].
Body weight, height, waist, and hip circumferences were
measuredandBMIwascalculated(BMI=bodyweight
(kg)/height (m2)). All subjects were weighed while wearing
light clothing and being without shoes, using a calibrated dig-
ital at scale (Seca-, USA). Standing height was measured
without shoes to the nearest . cm with a measuring tape. All
anthropometric measurements were measured three times
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andmeanvalueswereobtained.BMIvalueswereevaluated
using WHO classication which shows that a BMI less than
. kg/m2is classied as underweight, between . and
. kg/m2is dened as normal weight, between . and
. kg/m2as overweight, between . and . kg/m2as
st-degree obesity, and between . and . kg/m2as nd-
degreeobesity,andBMIhigherthankg/m
2is classied as
rd-degree (morbid) obesity [].
2.1.3. Assessment of Food Consumption. Nutritional behav-
iour of participants was determined by food consumption fre-
quency and -hour dietary recall. Nutrient Database (BeBiS,
Ebispro for Windows, Germany; Turkish Version/BeBiS )
was used to determine energy and nutrient intake; results
were compared to Dietary Guidelines for Turkey []. Lower
than % of recommended daily intake of energy and
nutrients was evaluated as inadequate. Volumes and portion
sizes were estimated with -dimensional food models and
with a portion size picture booklet including  photographs
of foods, each with – dierent portion sizes [,].
2.1.4. Assessment of Energy Expenditure. e participants
recorded their activity level over a -hour period. Closed
attention was given that activity duration equaled  hours.
To determine energy expenditure per activity type, physical
activity level (PAL) was calculated. PAL and basal metabolic
rate (BMR) were multiplied and daily energy expenditure was
obtained []. BMR was calculated according to the following
formulas based on age and gender []:
For men aged – years, . ×body weight (kg) +
 kcal.
For women aged – years, . ×body weight (kg)
+kcal.
For men aged – years, . ×body weight (kg) +
 kcal.
Forwomenagedyears,.×body weight (kg) +
 kcal.
For men aged > years, . ×body weight (kg) +
 kcal.
For women aged > years, . ×body weight (kg) +
 kcal.
2.2. Assessment of Biochemical Parameters
2.2.1. Sample Collection and Preparation. Venous blood sam-
ples were collected aer overnight fasting. Blood samples
were incubated for one hour at room temperature; sera
were separated and then stored at –Cuntilbiochemical
analysis. Blood samples with anticoagulant were immediately
centrifuged and plasmas were separated and stored at –C
until insulin analysis. In patients, HOMA-IR (Homeostasis
Assessment Model of Insulin Resistance) method (fasting
insulin mU/mL ×fasting glucose mmol/L/.) was used. In
the HOMA-IR test, a minimum value of . was accepted as
insulin resistance.
2.2.2. Biochemical Analysis. Serum fasting blood glucose,
triglyceride (TG), total cholesterol (C), HDL-C, and LDL-
C concentrations were determined with kits by Architect
c autoanalyzer (Abbott Diagnostics, USA). Vitamin B12
and folic acid concentrations were determined with Advia
Centaur XP immunoassay system (Siemens, Germany) with
kits by Advia Centaur XP immunoassay system.
2.3. Statistical Analysis. Data were analysed with SPSS ver-
sion . (Inc., Chicago, IL, USA). Normal distr ibution of data
was determined with Shapiro-Wilk test. Chi-square analysis
was used to compare the dierence of qualitative variables
between groups and Mann Whitney Utest was used for
quantitative data by showing median, %–% percentages.
𝑝 < 0.05 was set as statistically signicant.
3. Results
Mean ages of depression (36.82 ± 1.86 years) and control
(33.13 ± 1.57 years) groups were similar (𝑝 > 0.05). .% of
depression group and .% of control group were females.
Depression group that indicated that food consumption
increased (.%) during times of sadness was signicantly
higher compared with controls (.%) (𝑝 < 0.05). Con-
trols who indicated no changes in food consumption while
experiencing nervousness (.%) or happiness (.%) were
found to be signicantly higher compared to the depression
group (.% and .%, resp., 𝑝 < 0.05). Between-meals
consumption of depression group (.%) was signicantly
lower than controls (%, 𝑝 < 0.05). Rate of night eating
in depression group was .% while it was .% in controls
(𝑝 < 0.05).
Ratio of daily fresh fruit consumption was lower in
depression group (.%) than in controls (.%). Daily
consumption of fresh vegetables was .% in depression
group while it was .% in controls. Of depression group,
.% consumed sh which was signicantly lower than con-
trols (.%). Among depression group, .% of individuals
were sedentary. Light physical activity levels were higher
in depression group (.%) compared with the controls
(.%). A statistical signicance was found among physical
activity levels between groups (𝜒2= 14.819,𝑝 < 0.05). ere
was no dierence between the groups in terms of smoking
and alcohol consumption.
Although statistically insignicant, polyunsaturated fatty
acids (PUFA) intake of controls [. (.–.) g] was
higher than of depression group [. (.–.) g] (𝑧=
−1.933,𝑝 > 0.05). Intakes of vitamins A (𝑝 < 0.05), thiamine
(𝑝 < 0.05), riboavin (𝑝 < 0.05), vitamins B6(𝑝 < 0.05),
folate (𝑝 < 0.05), vitamin C (𝑝 < 0.05), Na (𝑝 < 0.05), K
(𝑝 < 0.05), Mg (𝑝 < 0.05), Ca (𝑝 < 0.05), P (𝑝 < 0.05), Fe
(𝑝 < 0.05), Zn (𝑝 < 0.05), and bre (𝑝 < 0.05) were lower in
depression group (Table ). According to Dietary Guidelines
for Turkey, intake of bre, niacin, vitamins B6,C(𝑝 < 0.05
for each), and Mg (𝑝 < 0.05)waslowerinwomenwith
depression while intake of energy, bre, vitamins A, E, B6,and
C(𝑝 < 0.05 for each), and folate (𝑝 < 0.05) were lower in men
with depression.
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T : Energy and nutrients consumption of depression and control groups.
Energy and nutrients Depression group (𝑛=29)Controlgroup(𝑛=30)𝑍𝑝
Median (% p–% p) Median (% p–% p)
Energy (kcal)  (–)  (–) 0.121 0.910
CHO (g) . (.–.) . (.–.) 1.183 0.240
CHO % . (.–.) . (.–.) 1.921 0.055
Fat (g) . (.–.) . (.–.) 0.030 0. 982
Fat % . (.–.) . (.–.) 0.44 8 0.659
Protein (g) . (.–.) . (.–.) 1.926 0.055
Protein % . (.–.) . (.–.) 2.419 0.015
Cholesterol (mg) . (.–.) . (.–.) 0.243 0.816
PUFA (g) . (.–.) . (.–.) 1.933 0.053
Vitamin A (𝜇g) . (.–.) . (.–.) 2.017 0.044
Vitamin E (mg) . (.–.) . (.–.) 1.956 0.051
iamine (mg) . (.–.) . (.–.) 2.889 0.003∗∗
Riboavin (mg) . (.–.) . (.–.) 3.754 <0.001
Niacin (mg) . (.–.) . (.–.) 1.433 0.154
Vitamin B6(mg) . (.–.) . (.–.) 3.662 <0.001
Vitamin B12 (𝜇g) . (.–.) . (.–.) 0.190 0.854
Folate (𝜇g) . (.–.) . (.–.) 3.214 0.001∗∗
Vitamin C (mg) . (.–.) . (.–.) 3.214 0.001∗∗
Na (mg) . (.–.) . (.–.) 1.971 0.049
K (mg) . (.–.) . (.–.) 4.533 <0.001
Mg (mg) . (.–.) . (.–.) 3.654 <0.001
Ca (mg) . (.–.) . (.–.) 4.351 <0.001
P (mg) . (.–.) . (.–.) 3.108 0.002∗∗
Fe (mg) . (.–.) . (.–.) 2.593 0.009∗∗
Zn (mg) . (.–.) . (.–.) 2.320 0.020
Fibre (g) . (.–.) . (.–.) 3.131 0.001∗∗
Median (%–%) represents median, th percentile and th percentile.
𝑝 < 0.05 and ∗∗𝑝 < 0.01.
T : Anthropometric measurements of depression and control groups.
Anthropometric measurements
Depression group Control group
𝑍𝑝
(𝑛=29)(𝑛=30)
Median Median
(% p–% p) (% p–% p)
Height (m) . (.–.) . (.–.) 0.083 0.937
Body weight (kg) . (.–.) . (.–.) 2.229 0.025
BMI (kg/m2) . (.–.) . (.–.) 2.699 0.006∗∗
Waist circumference (cm) . (.–.) . (.–.) 3.679 <0.001
Hip circumference (cm) . (.–.) . (.–.) 2.778 0.005∗∗
Waist-to-hip ratio . (.–.) . (.–.) 2.593 0.009∗∗
Median (%–%) represents median, th percentile and th percentile.
𝑝 < 0.05 and ∗∗𝑝 < 0.01.
Median levels of body weight (𝑝 < 0.05), waist circum-
ference (𝑝 < 0.05), hip circumference (𝑝 < 0.05), and
waist-to-hip ratio (𝑝 < 0.05) were higher in depression
group (Table ). st- and nd-degree obesity were higher
in depression group (.% and .%, resp.) compared to
controls (.% and .%, resp.) (𝑝 < 0.05,Tab l e  ). Median
daily energy expenditure of depression group [ kcal
(– kcal)] was lower than of controls [ kcal (–
 kcal)] (𝑝 < 0.05).
Fasting blood glucose levels (𝑝 < 0.05)andserum
vitamins B12 (𝑝 < 0.05)andfolicacid(𝑝 < 0.05)in
depression group were lower than controls. Serum insulin
BioMed Research International
T : Evaluation of body weight according to body mass index.
Body mass index (kg/m2)
Depression group Control group Total
(𝑛=29)(𝑛=30)(𝑛=59)
𝑛%𝑛%𝑛%
Unde rweight (<) .  .  .
Normal (.–.) .  .  .
Overweight (.–.) ..
 .
st-degree obese (–.) . .  .
nd-degree obese (.–.) . .  .
rd-degree obese (>) ————
——
Total 29 100 30 100 59 10 0
𝜒2= 12.977;𝑝 < 0.05.
T : Evaluation of biochemical parameters of depression and control groups.
Biochemical parameters
Depression group Control group
𝑍𝑝
(𝑛=29)(𝑛=30)
Median Median
(% p–% p) (% p–% p)
Glucose (mg/dL) . (.–.) . (.–.) . 0.010
Triglyceride (mg/dL) . (.–.) . (.–.) . 0.214
Total cholesterol (mg/dL) . (.–.) . (.–.) . 0.877
HDL-C (mg/dL) . (.–.) . (.–.) . 0.062
LDL-C (mg/dL) . (.–.) . (.–.) . 0.931
Vitamin B12 (pg/mL) . (.–.) . (.–.) . 0.031
Folate (ng/mL) . (.–.) . (.–.) . <0.001
Insulin (𝜇U/mL) . (.–.) . (.–.) . 0.179
HOMA . (.–.) . (.–.) . 0.337
𝑝 < 0.05.
and HOMA levels were not signicantly dierent between
groups (𝑝 > 0.05). Blood lipid levels of both groups were also
similar (𝑝 > 0.05,Tabl e  ).
4. Discussion
To the best of our knowledge, this is the rst study of its
kind in Turkey to evaluate nutritional intake, nutritional
status, and some biochemical parameters of patients with
depression. Results from this study indicated that depressed
individuals increase their food intake as a response to
negative emotions. Similar to this nding, Konttinen et al.
[] investigated an association between emotional eating
and depressive symptoms. Emotional eating was related to
higher consumption of sweet foods. In addition, depressive
symptoms were related to a lower consumption of vegeta-
bles/fruit. We found higher rates of eating at night among
patients with depression like Gluck et al. [].
In this study, similar to previous studies, depressed
patients’ -hour food intake has shown a poor quality
diet with lower intake of fruits/vegetables [,]. is
association of low fruit/vegetables intake with depression
also led to inadequate intake of bre in this study which is
important in healthy life maintenance and protection from
diseases [].
On the other hand, consumption of sh was signicantly
lower in the depression group compared to controls and
these results were consistent with previous studies [].
Fish is the richest source of n- PUFA and EPA which has
beenfoundtobeeectiveinrelievingdepression[,].
Nevertheless, total PUFA intake was not dierent between
people with and without depression in Meyer et al.’s study [].
Similar to Meyer et al. [], PUFA intake in the present study
was similar in depression and control groups.
Intake of a number of nutrients (thiamin, riboavin,
vitamin B6, folate, and Na, K, Mg, Ca, P, Fe, and Zn)
was signicantly lower in the depression group compared
to controls. Vitamins C and A are thought to be eective
in depression due to their roles in the oxidative processes
[,]. In this study, patients in the depression group had
signicantly lower vitamins C and A intake than controls
and could not meet their requirements according to Dietary
Guidelines for Turkey. Similar to this study, Oishi et al. []
indicated negative association between depressive symptoms
and carotene and vitamin C intakes.
Folate and vitamin B12 are necessary for normal func-
tioning of nervous system. ey are also required for single
carbon metabolism responsible for synthesis and metabolism
of serotonin and other neurotransmitters []. All B vitamins
BioMed Research International
work as a cofactor of the key enzymes for neurotransmitter
production and to control their balance []. Similar to the
present study, Pellegrin et al. [] reported a low level of
folate intake in depressed patients. Furthermore, depressed
patients consumed less thiamine, riboavin, and vitamin B6
than controls which show the overall inadequate intake of
Bvitaminsinthisstudy.IntheCoronaryHealthImprove-
ment Project (CHIP), conducted to decrease depression by
modifying selected daily nutrients from food, a decrease in
depression was achieved by increasing pyridoxine. [].
Magnesium deciency is known to cause neuropatholo-
gies. Lack of Mg leads to depression because of neuron dam-
age occurring as a result of not meeting the Mg requirement
of neurons []. Magnesium intake of the depression group in
the present study was signicantly lower than controls which
may be due to insucient consumption of food resources of
Mgsuchasredmeat,oilseeds,andnuts.
Inadequate dietary Zn and Fe intake contribute to depres-
sive symptoms [,,]. It was found in the present
study that depression group consumed signicantly lower
amounts of Fe and Zn compared with controls, which may
have resulted from low consumption of oil seeds.
Biological factors in depression occurrence are elec-
trolyte imbalances especially Na and K, neurophysiological
changes, autonomous nervous system dysfunction, and neu-
roendocrinological disorders in gonads, thyroid, hypophysis,
adrenal cortex, and hypothalamus []. e present study
ndings demonstrated that depressed patients consumed
loweramountsofNa,K,Ca,andPthancontrols.
e majority of literature demonstrates high prevalence
ofdepressioninpeoplewithhighBMI[]. It is still
not clear whether depression leads to obesity in response
to changing appetite and medicines or obesity contributes
to depressive disturbances. Consistent with the literature
ndings, median body weight (kg) and BMI (kg/m2)of
the depression group were signicantly higher than controls
in our study. Waist and hip circumferences and waist-to-
hip ratios which show body fat distribution are important
because chronic diseases, symptoms, and low quality of life
are aected [].Inastudyconductedwithadultmales
and  adult females, depressed participants were found to
have higher waist circumferences []. Besides body weight
and BMI, we have found that waist-hip circumferences and
waist-to-hip ratios were higher in patients with depression
compared to controls.
High incidence of folic acid deciency has been shown
in patients with depression [,]. e present study
demonstrated lower serum folic acid levels in the depression
group compared to controls, which may have resulted from
low dietary folate consumption of the depressed patients.
Vitamin B12 deciency independently stimulates tetrahydro-
biopterin production, retards monoamine neurotransmitters,
andmaycausefunctionalfolatedeciency[]. In one study,
people with vitamin B12 deciency were found to have .
times the risk of depression []. However, another study
failed to show a signicant dierence between mean serum
vitamin B12 levels of the depression and control groups [].
In addition to these conicting ndings, the depression group
in our study was found to have signicantly lower serum
levels of vitamin B12 compared to controls.
Depression is a symptom of impaired blood glucose
tolerance []. One study demonstrated that depression in
womenwassignicantlyrelatedtoincreasedbloodglucose
levels []. Conversely, in the present study, the median
fasting blood glucose levels of the depression group were
signicantly lower compared to controls; however the fasting
blood glucose levels of both groups were in normal range.
Depression is associated with an increased risk of incident
diabetes; insulin resistance is thought to be the underly-
ing link between them. Nevertheless, only a few studies
have explored the association between insulin resistance
and depression, with contradictory results []. A weak
and positive correlation has been reported between scores
identifying depression and HOMA-IR score [,]. It was
determined in the present study that HOMA was insigni-
cantly higher in the depression group compared to controls
with no insulin resistance in either group.
In this study, there are some limitations,the rst of which
is our small sample size. Large-scale studies are needed on
this issue in the future studies. Second, self-reported dietary
intake data are likely inaccurate.
5. Conclusion
Patients with depression were found to consume a poor
qualitydietwhichisknowntoleadtodepressivesymp-
toms. Besides low intake of some B vitamins, serum levels
of vitamin B12 and folic acid were low, and there were
many signs of abdominal obesity in the depression group.
erefore, future research exploring the overall nutritional
status of individuals with depression is warranted in order
to assist in understanding and treatment of the condition
and to promote healthy lifestyles that may help in depression
management.
Relevance to Clinical Practice
By investigating nutritional status and dietary intake of
patients with depression and providing adequate-balanced
nutrition, healthcare professionals may contribute to the
therapy of patients in the clinic.
Disclosure
ispaperhasbeenpresentedatESPENcongressasan
abstract.
Conflict of Interests
No conict of interests is declared.
Authors’ Contribution
Nimet Y ¨
uksel and Neriman Inanc¸ designed the study; Nimet
Y¨
uksel collected the data; G¨
uls¸ah Kaner, Meltem Soylu, and
Dilek Ongan prepared the paper.
BioMed Research International
Acknowledgment
e authors acknowledge G¨
okmen Zararsız for statistical
data analysis in Erciyes University.
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... Furthermore, some studies have introduced anthropometric parameters where the tendency showed abdominal obesity or higher amount of abdominal fat in patients with depression (73). Systematic reviews have found solid data in the association between depression, anthropometric parameters, and body image in all included studies, notwithstanding the different statistical methods employed. ...
... More precisely and above mentioned, concrete groups of essential micronutrients are often much lower in these patients. Patients with MDD lack vitamin B consumption, especially cobalamin (B12) and folate (B9) (73,77), as well as pyridoxin (B6) (78). Low vitamin D serum levels are positively associated with depression (79), although insufficient dietary intake is not the only cause, being little outdoor exposure to sunshine is more relevant (80). ...
Article
Full-text available
Major depressive disorder (MDD) is a complex, multifactorial disorder of rising prevalence and incidence worldwide. Nearly, 280 million of people suffer from this leading cause of disability in the world. Moreover, patients with this condition are frequently co-affected by essential nutrient deficiency. The typical scene with stress and hustle in developed countries tends to be accompanied by eating disorders implying overnutrition from high-carbohydrates and high-fat diets with low micronutrients intake. In fact, currently, coronavirus disease 2019 (COVID-19) pandemic has drawn more attention to this underdiagnosed condition, besides the importance of the nutritional status in shaping immunomodulation, in which minerals, vitamins, or omega 3 polyunsaturated fatty acids (ω-3 PUFA) play an important role. The awareness of nutritional assessment is greater and greater in the patients with depression since antidepressant treatments have such a significant probability of failing. As diet is considered a crucial environmental factor, underlying epigenetic mechanisms that experience an adaptation or consequence on their signaling and expression mechanisms are reviewed. In this study, we included metabolic changes derived from an impairment in cellular processes due to lacking some essential nutrients in diet and therefore in the organism. Finally, aspects related to nutritional interventions and recommendations are also addressed.
... These studies were published between 2009 and 2022. 14 of the included studies were performed in Asian countries [Korea (14,20,21,25,29,30,35,36), Iran (18,31,33), Japan (13,23) and China (28)], and the other ones were conducted in United States (15,17,27,32,34), Brazil (26,37), Australia (16), Spain (22,24), and Turkey (19). Male, female and both male and female participants were recruited in 1 (18), 8 (14,20,26,28,30,31,33,36), and 16 (13, 15-17, 19, 21-25, 27, 29, 32, 34, 35, 37) studies, respectively. ...
... The sample size ranged from 41 to 17,401 for a total number of 100,955. The exposure was assessed by food-frequency questionnaire (FFQ) in 16 studies (13-16, 18, 20, 21, 23-25, 28, 29, 31, 33, 36, 37), and recall method in 9 studies (17,19,22,26,27,30,32,34,35). ...
Article
Full-text available
Objective To clarify the associations of dietary vitamin A and beta-carotene intake with depression based on a meta-analysis of observational studies. Methods An extensive literature search on February 2022 (PubMed, Web of Science and Embase) was employed to identify observational studies on the associations of dietary vitamin A and beta-carotene intake with depression. The pooled relative risk (RR) of depression for the highest vs. lowest dietary vitamin A and beta-carotene intake category, and the standard mean difference (SMD) of dietary vitamin A and beta-carotene intake for depression vs. control subjects, were calculated. Results A total of 25 observational studies (100,955 participants), which included 24 cross-sectional/case-control and 1 prospective cohort study, were included in this study. The overall multi-variable adjusted RR demonstrated that dietary vitamin A intake was inversely associated with depression ( RR = 0.83, 95%CI: 0.70–1.00; P = 0.05). In addition, the combined SMD showed that the dietary vitamin A intake in depression was also lower than that in control subjects (SMD = −0.13, 95%CI: −0.18 to −0.07; P < 0.001). On the other hand, the overall multi-variable adjusted RR indicated that dietary beta-carotene intake was negatively associated with depression ( RR = 0.63, 95%CI: 0.55–0.72; P < 0.001). The combined SMD showed that the dietary beta-carotene intake in depression was also lower than that in control subjects (SMD = −0.34, 95%CI: −0.48 to −0.20; P < 0.001). Conclusion Our results suggest that both dietary vitamin A and beta-carotene intake is inversely associated with depression. However, due to the limited evidence, further prospective cohort studies are still needed.
... These studies were published between 2009 and 2022. 12 of the included studies were performed in Asian countries [Korea (21,26,28,34,35,41), Iran (25,37,39) and Japan (19,20,31)], and the other ones were conducted in United States (22,24,33,40,43), Brazil (32,38,42), Australia (23,36), Spain (29,30), and Turkey (27). Male, female and both male and female participants were recruited in 2 (25,36), 8 (21, 26, 32, 34, 37-39, 43), and 15 (19, 20, 22-24, 27-31, 33, 35, 40-42) studies, respectively. ...
... The dietary vitamin C and E intake was assessed by food-frequency questionnaire (FFQ) in 14 studies (19,20,22,23,25,26,28,30,31,36,37,39,42,43), and recall method in 12 studies (21, 24, 25, 27, 29, 32-35, 38, 40, 41). The diagnostic criteria of depression or depressive symptom were Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (27,30), Patient Health Questionnaire-9 (PHQ-9) (24,33,35,40), Center for Epidemiological Studies Depression Scale (CES-D) (19-21, 23, 29, 34, 38, 43), Beck Depression Inventory (BDI) (25-27, 32, 39), Geriatric Depression Scale (GDS) (31,36), Depression, Anxiety, Stress Scale (DASS) (37), National Institute of Mental Health (NIMH) (22), and Clinical Interview Schedule Revised (CIS-R) (42), respectively. ...
Article
Full-text available
Objective The associations of dietary vitamin C and E intake with depression remains conflicting. This meta-analysis of observational study was therefore employed to clarify the issue further. Methods An extensive literature review (PubMed, Web of Science and Embase) was performed in January 2022 to identify the observational studies on the associations of dietary vitamin C and E intake with depression. The pooled relative risk (RR) of depression for the highest versus lowest dietary vitamin C and E intake category, and the weighted mean difference (WMD) of dietary vitamin C and E intake for depression versus control subjects, were calculated. Results A total of 25 observational studies (91966 participants) were included in this meta-analysis. The overall multi-variable adjusted RR demonstrated that dietary vitamin C intake was inversely associated with depression (RR = 0.72, 95% CI: 0.57 to 0.91; P = 0.005). In addition, the combined WMD showed that the dietary vitamin C intake in depression was lower than that in control subjects (WMD = −11.58, 95% CI: −14.88 to −8.29; P < 0.001). Similarly, the overall multi-variable adjusted RR demonstrated that dietary vitamin E intake was negatively associated with depression (RR = 0.84, 95% CI: 0.72 to 0.98; P = 0.02). Moreover, the combined WMD showed that the dietary vitamin E intake in depression was also lower than that in control subjects (WMD = −0.71, 95% CI: −1.07 to −0.34; P < 0.001). Conclusion The results of this meta-analysis suggest that both dietary vitamin C and E intake is inversely associated with depression. However, due to the limited evidence, more well-designed prospective cohort studies are still needed.
... These results are generally in line with the current scientific literature showing that higher levels of nutrient intake correlate with better mental health outcomes, and that fiber is inversely associated with the prevalence of depressive symptoms [10,11,16]. One randomized control trial (RCT) found that the intake of fiber was significantly lower in the depression group [20]. Additionally, previous studies have found that individuals consuming higher glycemic index (G.I.) carbohydrates have greater odds of depression or depressive symptoms [11,21]. ...
Article
Full-text available
Objective: The aim of this study is to evaluate the association between a marker of dietary intake, the carbohydrate-to-fiber (CF) ratio, and moderate-to-severe depressive symptoms. Design: Cross-sectional study. Setting: National Health and Nutrition Examination Survey (NHANES) database from 2013-2016. Participants: Individuals 18 years and older were included. Participants with total energy intake outside of three standard deviations of the mean, pregnant or breastfeeding women, and those with missing data were excluded. Measurements: The main independent variable, CF ratio, was generated using corresponding variables in NHANES and divided into quartiles. The main outcome was depressive symptoms using the Patient Health Questionnaire-9. Unadjusted and adjusted logistic regression analyses were used to calculate odds ratios and their corresponding 95% confidence interval (CI). Results: Among all participants (n=9,728), 8.3% reported to have moderate-to-severe depressive symptoms (n=833). The highest proportion of depressive symptoms was reported in respondents in quartile 4 (Q4), with the highest CF ratio (13.0%; p<0.001). After adjustment, the odds of depressive symptoms significantly increased in Q4 of the CF ratio compared with Q1 (adjusted odds ratio 1.4, 95% CI 1.0-1.9). The prevalence of depressive symptoms significantly increased in females, lower federal poverty levels, non-married individuals, smokers, and hypertension patients. Conclusion: This nationally representative sample suggests that a higher CF dietary intake ratio increases the risk of moderate-to-severe depressive symptoms. These results suggest that the CF ratio may help clinicians and patients evaluate their dietary risk for depressive symptoms. Further prospective studies are needed to validate this ratio as a dietary measurement.
... In the area of depression, the undesirable response to antidepressants has led to the proposal of nutraceutical adjuvants. Moreover, many patients with MDD are malnourished, with either reported deficiencies in some nutrients or more prominently an excessive body mass index (BMI) [82]. Several clinical trials have been conducted over the last decade, remarking on the adjunctive use of omega-3, vitamin D, S-adenosylmethionine (SAMe) and methylfolate [83]. ...
Article
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Major depressive disorder (MDD) is a complex and common disorder, with many factors involved in its onset and development. The clinical management of this condition is frequently based on the use of some pharmacological antidepressant agents, together with psychotherapy and other alternatives in most severe cases. However, an important percentage of depressed patients fail to respond to the use of conventional therapies. This has created the urgency of finding novel approaches to help in the clinical management of those individuals. Nutraceuticals are natural compounds contained in food with proven benefits either in health promotion or disease prevention and therapy. A growing interest and economical sources are being placed in the development and understanding of multiple nutraceutical products. Here, we summarize some of the most relevant nutraceutical agents evaluated in preclinical and clinical models of depression. In addition, we will also explore less frequent but interest nutraceutical products which are starting to be tested, also evaluating future roads to cover in order to maximize the benefits of nutraceuticals in MDD.
... In a cohort study of 13,983 Spanish university graduates, Sánchez-Villegas et al. [38] found that inadequate intake of ≥four micronutrients out of a collection of vitamins, including vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid (FA), zinc (Zn), iodine (I), selenium (Se), iron (Fe), Ca, potassium (K), phosphorus (P), magnesium (Mg), and chrome (Cr), was associated with increased risk of depression. By comparing depressive patients with their healthy counterparts, Kaner et al. [39] found that depression was significantly associated with lower intakes of micronutrients, such as vitamin A, thiamine, riboflavin, vitamin B6, folate, vitamin C, Na, K, Mg, Ca, P, Fe, Zn, and fiber. Consequently, the findings from the current and previous studies suggest that the sufficient intake of those essential nutrients may function to minimize the adverse effects of lifestyle risk factors on depression. ...
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Background Studies of the associations between diet and depression have primarily focused on single nutrients or foods. Recently, dietary patterns representing a combination of foods have attracted more interest than individual nutrient. The objective of this study was to examine the association between dietary patterns and depressive symptoms among a community-dwelling population in Japan. Methods We examined the association between dietary patterns and the risk of depression among 791 Japanese community-dwelling individuals. Diet was assessed with a validated brief-type self-administered diet history questionnaire (BDHQ). Dietary patterns from 52 predefined food groups [energy-adjusted food (g/d)] were extracted by principal component analysis. The Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off point of 16 was used to assess the prevalence of depression. Results A total of 97 subjects (12.3%) were classified as having depression. Four dietary patterns were identified: “Healthy”, “Western”, “Bread and confectionery”, and “Alcohol and accompanying” dietary patterns. After adjusting for potential confounders, the dietary patterns were not related to the risk of depression. Conclusions The present study failed to find associations between dietary patterns and the risk of depression. However, the interpretation of our results was hampered by the lack of certain data, including employment physical activity and longitudinal observations. Potential associations between dietary patterns and depressive symptoms were not completely ruled out. Future research exploring dietary patterns and depressive symptoms is warranted.
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Depression levels of high school students were analyzed according to gender and grade level in this study. The field of research is 5747 students from 8 high schools in the province of Erzurum. Sampling frame consists of 249 students, including 163 male and 86 female students, chosen randomly from different grades of different 6 high schools. Because of wrong marking and missing items, 7 students were excluded the research. To measure the depression level of students, Beck's Depression Inventory was used. This inventory is a self evaluation scale consisting of 21 items. Every item determines a behavioural feature related to depression. In the analyses of the data percentage values, k square and t- test were used. Results showed that 114 of 242 students which is 47 % of sample have moderate and serious depression scores. There was no significant difference between female and male depression levels. On the other hand 11th grade students' depression level was found significantly higher than 9th grade and 10th grade students.
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The aim of this study was to explore the associations between incidence of depression and dietary intakes of foods and fatty acids in adult Australians. Data from the 1995 Australian National Nutrition Survey (NNS), the 1995 Australian National Health Survey (NHS) and an updated fatty acid database were merged and the 24-h fatty acid intakes were calculated for the 10 986 adult participants ages 18 to 79 y in the 1995 NNS. The merged data set was used to run a logistic regression with depression as the response variable and the food groups and calculated fatty acid values, age, and sex as predictors. The regression model indicated that increased intakes per kilojoule of meat, poultry, and game; vegetables; and eicosapentaenoic acid (EPA) are associated with lower odds of having depression, whereas increased intakes of non-alcoholic beverages, milk products and dishes, and docosapentaenoic acid (DPA) are associated with an increase in the odds of having depression. The results confirm a collective effect of diet on mood. Although other studies have shown that fish consumption is associated with lower odds of depression, this study showed lower odds of depression with high meat consumption, possibly reflecting the fact that Australians consume six times more meat than fish. Significant associations between food and mood identified in this study warrant further research to determine causality.
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BACKGROUND: Zinc is an immunomodulatory trace element suggested to be beneficial in the augmentation of antidepressant therapy. Cross-sectional studies have also suggested an association between low dietary zinc and depression. This study examined the association between dietary zinc intake and depression in a prospective setting in initially depression-free men during a 20-year follow-up. METHODS: The study formed a part of the population-based Kuopio Ischemic Heart Disease Risk Factor (KIHD) Study, and comprised 2317 Finnish men aged 42-61 years. Zinc intake was assessed at baseline by a 4-d food record. Baseline depression severity was recorded with the Human Population Laboratory Depression Scale. In the prospective setting, depression was defined as having received a hospital discharge diagnosis of unipolar depressive disorder. Individuals who at baseline had elevated depressive symptoms were excluded (n=283). RESULTS: Altogether, 60 (2.7%) individuals received a hospital discharge diagnosis of depression during the 20-year follow-up. In Cox regression analysis adjusted for age, baseline depression severity, smoking, alcohol use, physical exercise and the use of dietary supplements, belonging to the lowest tertile of energy-adjusted zinc intake was not associated with an increased depression risk (RR 1.06, 95% CI 0.59-1.90). LIMITATIONS: These observations may not be generalizable to women, or to individuals with a depression level not warranting hospitalization. CONCLUSIONS: Our findings suggest that a low dietary zinc intake may not longitudinally precede depression in men. Dietary zinc intake may not have relevance for the prevention of depression in middle-aged men with a sufficient dietary zinc intake.