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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, riboavin, 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 signicantly 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 eective illness
with a high lifetime prevalence rate in which diet has been
suggested as one modiable factor [].
An association between diet and depression has now been
conrmed 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 benets from
sh and olive oil intake remained signicant 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,
aer 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 signicantly 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 signicant 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 signicantly
lower in depressed patients than controls. ere was no
signicant change in arachidonic acid (AA) or total n-
PUFAs []. A meta-analysis of clinical trials about eects
of EPA supplementation in depressed populations revealed
benecial eects 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 signicantly 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 conrm 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 dierences 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
BioMed Research International
andmeanvalueswereobtained.BMIvalueswereevaluated
using WHO classication which shows that a BMI less than
. kg/m2is classied as underweight, between . and
. kg/m2is dened as normal weight, between . and
. kg/m2as overweight, between . and . kg/m2as
st-degree obesity, and between . and . kg/m2as nd-
degreeobesity,andBMIhigherthankg/m
2is classied 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 – dierent 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 aer 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 dierence 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 signicant.
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 signicantly
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 signicantly higher compared to the depression
group (.% and .%, resp., 𝑝 < 0.05). Between-meals
consumption of depression group (.%) was signicantly
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 signicantly 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 signicance was found among physical
activity levels between groups (𝜒2= 14.819,𝑝 < 0.05). ere
was no dierence between the groups in terms of smoking
and alcohol consumption.
Although statistically insignicant, 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), riboavin (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.
BioMed Research International
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∗∗
Riboavin (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
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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 signicantly dierent 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 signicantly
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 dierent 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, riboavin,
vitamin B6, folate, and Na, K, Mg, Ca, P, Fe, and Zn)
was signicantly lower in the depression group compared
to controls. Vitamins C and A are thought to be eective
in depression due to their roles in the oxidative processes
[,]. In this study, patients in the depression group had
signicantly 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, riboavin, 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 deciency 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 signicantly lower than controls which
may be due to insucient 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 signicantly 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 signicantly 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 aected [].Inastudyconductedwithadultmales
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 deciency 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 deciency independently stimulates tetrahydro-
biopterin production, retards monoamine neurotransmitters,
andmaycausefunctionalfolatedeciency[]. In one study,
people with vitamin B12 deciency were found to have .
times the risk of depression []. However, another study
failed to show a signicant dierence between mean serum
vitamin B12 levels of the depression and control groups [].
In addition to these conicting ndings, the depression group
in our study was found to have signicantly 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
signicantly 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 conict 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.
References
[] WHO, Mental Health Action Plan 2013–2020,WorldHealth
Organization, Geneva, Switzerland, .
[] N. Sugawara, N. Yasui-Furukori, S. Tsuchimine et al., “No
association between dietary patterns and depressive symptoms
among a community-dwelling population in Japan,” Annals of
General Psychiatry, vol. , article , .
[] E. Mamplekou, V. Bountziouka, T. Psaltopoulou et al., “Urban
environment, physical inactivity and unhealthy dietary habits
correlate to depression among elderly living in eastern mediter-
ranean islands: the MEDIS (Mediterranean Islands Elderly)
study,” Journal of Nutrition, Health and Aging,vol.,no.,pp.
–, .
[] A. S´
anchez-Villegas, M. Delgado-Rodr´
ıguez, A. Alonso et
al., “Association of the Mediterranean dietary pattern with
the incidence of depression: the Seguimiento Universidad
de Navarra/University of Navarra follow-up (SUN) cohort,”
Archives of General Psychiatry, vol. , no. , pp. –,
.
[] F. N. Jacka, P. J. Kremer, E. R. Leslie et al., “Associations between
diet quality and depressed mood in adolescents: results from
the Australian Healthy Neighbourhoods Study,” Australian and
New Zealand Journal of Psychiatry,vol.,no.,pp.–,
.
[] L. German, C. Kahana, V. Rosenfeld et al., “Depressive symp-
toms are associated with food insuciency and nutritional de-
ciencies in poor community-dwelling elderly people,” Journal of
Nutrition, Health and Aging,vol.,no.,pp.–,.
[] R. W. Jeery, J. A. Linde, G. E. Simon et al., “Reported food
choices in older women in relation to body mass index and
depressive symptoms,” Appetite,vol.,no.,pp.–,.
[] A. S´
anchez-Villegas, E. Toledo, J. de Irala, M. Ruiz-Canela, J.
Pla-Vidal,andM.A.Mart
´
ınez-Gonz´
alez, “Fast-food and com-
mercial baked goods consumption and the risk of depression,”
Public Health Nutrition,vol.,no.,pp.–,.
[] T.Ciarambino,N.Ferrara,P.Castellino,G.Paolisso,L.Coppola,
and M. Giordano, “Eects of a -days-a-week low protein diet
regimen on depressive symptoms in young-old type diabetic
patients,” Nutrition,vol.,no.,pp.–,.
[] G.D.Brinkworth,J.D.Buckley,M.Noakes,P.M.Clion,and
C.J.Wilson,“Long-termeectsofaverylow-carbohydratediet
and a low-fat diet on mood and cognitive function,” Archives of
Internal Medicine,vol.,no.,pp.–,.
[] P.-Y. Lin, S.-Y. Huang, and K.-P. Su, “A meta-analytic review
of polyunsaturated fatty acid compositions in patients with
depression,” Biological Psychiatry,vol.,no.,pp.–,
.
[] M.E.Sublette,S.P.Ellis,A.L.Geant,andJ.J.Mann,“Meta-
analysis of the eects of eicosapentaenoic acid (EPA) in clinical
trials in depression,” Journal of Clinical Psychiatry,vol.,no.
, pp. –, .
[] A. Farah, “e role of L-methylfolate in depressive disorders,”
CNS Spectrums,vol.,no.,pp.–,.
[] D. W. Morris, M. H. Trivedi, and A. J. Rush, “Folate and
unipolar depression,” Journal of Alternative and Complementary
Medicine,vol.,no.,pp.–,.
[] E.C.CopeandC.W.Levenson,“Roleofzincinthedevelop-
ment and treatment of mood disorders,” Current Opinion in
Clinical Nutrition and Metabolic Care,vol.,no.,pp.–
, .
[] J. Lai, A. Moxey, G. Nowak, K. Vashum, K. Bailey, and M.
McEvoy, “e ecacy of zinc supplementation in depression:
systematic review of randomised controlled trials,” Journal of
Aective Disorders,vol.,no.-,pp.e–e,.
[] B. Szewczyk, M. Kubera,and G. Nowak, “e role of zinc in neu-
rodegenerative inammatory pathways in depression,” Progress
in Neuro-Psychopharmacology and Biological Psychiatry,vol.,
no. , pp. –, .
[] R. Stewart and V. Hirani, “Relationship between depressive
symptoms, anemia, and iron status in older residents from a
national survey population,” Psychosomatic Medicine,vol.,
no. , pp. –, .
[] M. V. Shariatpanaahi, Z. V. Shariatpanaahi, M. Moshtaaghi, S.
H. Shahbaazi, and A. Abadi, “e relationship between depres-
sion and serum ferritin level,” European Journal of Clinical
Nutrition,vol.,no.,pp.–,.
[] C. Merete, L. M. Falcon, and K. L. Tucker, “Vitamin B is
associated with depressive symptomatology in Massachusetts
elders,” JournaloftheAmericanCollegeofNutrition,vol.,no.
,pp.–,.
[] D. Moorthy, I. Peter, T. M. Scott et al., “Status of vitamins B12
and B6but not of folate, homocysteine, and the methylenete-
trahydrofolate reductase CT polymorphism are associated
with impaired cognition and depression in adults,” Journal of
Nutrition,vol.,no.,pp.–,.
[] K. A. Skarupski, C. Tangney, H. Li, B. Ouyang, D. A. Evans, and
M. C. Morris, “Longitudinal association of vitamin B-, folate,
and vitamin B- with depressive symptoms among older adults
over time,” American Journal of Clinical Nutrition,vol.,no.,
pp. –, .
[] J. Hintikka, T. Tolmunen, A. Tanskanen, and H. Viinam¨
aki,
“High vitamin B12 level and good treatment outcome may be
associated in major depressive disorder,” BMC Psychiatry,vol.
, article , .
[] J. Raman, E. Smith, and P. Hay, “e clinical obesity main-
tenance model: an integration of psychological constructs
including mood, emotional regulation, disordered overeating,
habitual cluster behaviours, health literacy and cognitive func-
tion,” Journal of Obesity,vol.,ArticleID,pages,
.
[] C.U.Onyike,R.M.Crum,H.B.Lee,C.G.Lyketsos,andW.
W. Eaton, “Is obesity associated with major depression? Results
from the ird National Health and Nutrition Examination
Survey,” American Journal of Epidemiology,vol.,no.,pp.
–, .
[] R. E. Roberts, G. A. Kaplan, S. J. Shema, and W. J. Strawbridge,
“Are the obese at greater risk for depression?” American Journal
of Epidemiology,vol.,no.,pp.–,.
[] R. E. Roberts, W. J. Strawbridge, S. Deleger, and G. A. Kaplan,
“Are the fat more jolly?” Annals of Behavioral Medicine,vol.,
no.,pp.–,.
[] K. M. Carpenter, D. S. Hasin, D. B. Allison, and M. S. Faith,
“Relationships between obesity and DSM-IV major depressive
disorder, suicide ideation, and suicide attempts: results from a
general population study,” American Journal of Public Health,
vol. , no. , pp. –, .
BioMed Research International
[] T. H¨
allstr¨
omandH.Noppa,“Obesityinwomeninrelationto
mental illness, social factors and personality traits,” Journal of
Psychosomatic Research,vol.,no.,pp.–,.
[] L. A. Palinkas, D. L. Wingard, and E. Barrett-Connor, “Depres-
sive symptoms in over weight andobes e older adults: a test of the
‘jolly fat’ hypothesis,” Journal of Psychosomatic Research,vol.,
no. , pp. –, .
[] M. Faubel, “Body image and depression in women with early
and late onset obesity,” e Journal of Psychology: Interdisci-
plinary and Applied,vol.,no.,pp.–,.
[]D.A.Grossniklaus,S.B.Dunbar,R.Gary,B.C.Tohill,J.
K. Frediani, and M. K. Higgins, “Dietary energy density:
a mediator of depressive symptoms and abdominal obesity
or independent predictor of abdominal obesity?” European
Journal of Cardiovascular Nursing,vol.,no.,pp.–,
.
[] G.Zhao,E.S.Ford,C.Li,J.Tsai,S.Dhingra,andL.S.Bal-
luz, “Waist circumference, abdominal obesity, and depression
among overweight and obese U.S. adults: national health and
nutrition examination survey -,” BMC Psychiatry,vol.
, article , .
[] B. M. Appelhans, M. C. Whited, K. L. Schneider et al., “Depres-
sion severity, diet quality, and physical activity in women with
obesity and depression,” JournaloftheAcademyofNutritionand
Dietetics,vol.,no.,pp.–,.
[] L. M. Bodnar and K. L. Wisner, “Nutrition and depression:
implications for improving mental health among childbearing-
aged women,” Biological Psychiatry,vol.,no.,pp.–,
.
[] WHO Technical Report Series (WHO), “Physical status: the
use and interpretation of anthropometry,” Report of a WHO
Expert Committee , World Health Organization, Geneva,
Switzerland, .
[] A. Baysal, M. Aksoy, N. Bozkurt et al., Diyet El Kitabı, Beslenme
Durumunun Saptanması,Hatibo
˘
glu Yayınevi, Ankara, Turkey,
th edition, (Turkish).
[] e Ministry of Health of Turkey and e General Directorate
of Primary Health Care, Dietary Guidelines for Turkey (2006)
Recommended Safe Level of Intake of Energy and Nutrients
for Turkey, e Ministry of Health of Turkey, e General
Directorate of Primary Health Care, Ankara, Turkey, ,
http://www.bdb.hacettepe.edu.tr/dokumanlar/dietaryguide-
lines.pdf.
[] N. Rakıcıo˘
glu, N. Tek Acar, A. Ayaz, and G. Pekcan, Yem e k
ve Besin Foto˘
graf Katalo˘
gu- ¨
Olc¸¨
uveMiktarlar,AtaOfsetMat-
baacılık, Ankara, Turkey, nd edition, , (Turkish).
[] H. Konttinen, S. M¨
annist¨
o, S. Sarlio-L¨
ahteenkorva, K. Sil-
ventoinen, and A. Haukkala, “Emotional eating, depressive
symptoms and self-reported food consumption. A population-
based study,” Appetite,vol.,no.,pp.–,.
[] M. E. Gluck, A. Geliebter, and T. Satov, “Night eating syndrome
is associated with depression, low self-esteem, reduced daytime
hunger, and less weight loss in obese outpatients,” Obesity
Research,vol.,no.,pp.–,.
[] C. Liu, B. Xie, C.-P. Chou et al., “Perceived stress,depression and
food consumption frequency in the college students of China
seven cities,” Physiology & Behavior,vol.,no.,pp.–,
.
[] G. Samur and S. M. Mercanligil, Diyet posası ve beslenme,
e Ministry of Health of Turkey, e General Directorate of
Primary Health Care, (Turkish).
[] J. K. Kiecolt-Glaser, M. A. Belury, K. Porter, D. Q. Beversdorf,
S. Lemeshow, and R. Glaser, “Depressive symptoms, omega-
: omega- fatty acids, and inammation in older adults,”
Psychosomatic Medicine,vol.,no.,pp.–,.
[] W. Kohatsu, “Nutrition and Depression,” Explore,vol.,no.,
pp. –, .
[] H. H. Atar and Z. Alc¸ic¸ek, “Seafood consumption and health,”
TAFPreventiveMedicineBulletin,vol.,no.,pp.–,.
[] A. Tanskanen, J. R. Hibbeln, J. Tuomilehto et al., “Fish con-
sumption and depressive symptoms in the general population
in Finland,” Psychiatric Services,vol.,no.,pp.–,.
[] S. Noaghiul and J. R. Hibbeln, “Cross-national comparisons
of seafood consumption and rates of bipolar disorders,” e
American Journal of Psychiatry,vol.,no.,pp.–,
.
[] M. Timonen, D. Horrobin, J. Jokelainen, J. Laitinen, A. Herva,
and P. R¨
as¨
anen, “Fish consumption and depression: the North-
ern Finland birth cohort study,” Journal of Aective
Disorders,vol.,no.,pp.–,.
[]Y.Li,Q.Dai,L.I.Ekperi,A.Dehal,andJ.Zhang,“Fish
consumption and severely depressed mood, ndings from the
rst national nutrition follow-up study,” Psychiatry Research,
vol.,no.,pp.–,.
[]B.J.Meyer,N.Kolanu,D.A.Griths,B.Grounds,P.R.C.
Howe, and I. A. Kreis, “Food groups and fatty acids associated
with self-reported depression: an analysis from the Australian
National Nutrition and Health Surveys,” Nutrition,vol.,no.
-,pp.–,.
[]A.F.Jorm,H.Christensen,K.M.Griths,andB.Rodgers,
“Eectiveness of complementary and self-help treatments for
depression,” Medical Journal of Australia, vol. , pp. S–S,
.
[] J. Oishi, H. Doi, and N. Kawakami, “Nutrition and depressive
symptoms in community-dwelling elderly persons in Japan,”
Acta Medica Okayama,vol.,no.,pp.–,.
[] P. Holford, “Depression: the nutrition connection,” Primary
Care Mental Health,vol.,pp.–,.
[] K. L. Pellegrin, P. M. O’Neil, E. J. Stellefson et al., “Average
daily nutrient intake and mood among obese women,” Nutrition
Research, vol. , no. , pp. –, .
[] R. M. Merrill, P. Taylor, and S. G. Aldana, “Coronary Health
Improvement Project (CHIP) is associated with improved
nutrient intake and decreased depression,” Nutrition,vol.,no.
, pp. –, .
[] G. A. Eby and K. L. Eby, “Rapid recovery from major depression
using magnesium treatment,” Medical Hypotheses,vol.,no.,
pp. –, .
[] N.N.Maserejian,S.A.Hall,andJ.B.McKinlay,“Lowdietary
or supplemental zinc is associated with depression symptoms
among women, but not men, in a population-based epidemio-
logical survey,” Journal of Aective Disorders,vol.,no.,pp.
–, .
[] S. M. Lehto, A. Ruusunen, T. Tolmunen, S. Voutilainen, T.-
P. Tuomainen, and J. Kauhanen, “Dietary zinc intake and the
risk of depression in middle-aged men: a -year prospective
follow-up study,” Journal of Aective Disorders,vol.,no.,
pp. –, .
[] N. ¨
Oren and B. Genc¸do˘
gan, “Lise ¨
o˘
grencilerinin depresyon
d¨
uzeylerinin bazı de˘
gis¸kenlere g ¨
ore incelenmesi,” Kastamonu
E˘
gitim Dergisi,vol.,pp.–,(Turkish).
BioMed Research International
[] A.J.Stunkard,M.S.Faith,andK.C.Allison,“Depressionand
obesity,” Biological Psychiatry,vol.,no.,pp.–,.
[] J. Ma and L. Xiao, “Obesity and depression in US woman:
results from the - National Health and Nutritional
Examination Survey,” Obesity,vol.,no.,pp.–,.
[] J. M. Murphy, N. J. Horton, J. D. Burke Jr. et al., “Obesity and
weight gain in relation to depression: ndings from the Stirling
County study,” International Journal of Obesity,vol.,no.,pp.
–, .
[] G. E. Simon, E. J. Ludman, J. A. Linde et al., “Association
between obesity and depression in middle-aged women,” Gen-
eral Hospital Psychiatry,vol.,no.,pp.–,.
[] P. Ravasco, J. Correia, M. Chaves, and M. Camilo, “Depression
and nutrition: a complex association,” Clinical Nutrition Supple-
ments,vol.,no.,pp.–,.
[] L. de Wit, F. Luppino, A. van Straten, B. Penninx, F. Zitman,
and P. Cuijpers, “Depression and obesity: a meta-analysis of
community-based studies,” Psychiatry Research,vol.,no.,
pp. –, .
[] H. Yardımcı and A. ¨
O. ¨
Ozc¸elik, Ankara ili g¨
olbas¸ı ilc¸esinde
yetis¸kin kadınların antropometrik ¨
olc¸¨
umleri ve beslenme
alıs¸kanlıkları ¨
uzerinde bir aras¸tırma [Doktora Tezi],Ankara
¨
Universitesi Fen Bilimleri Enstit ¨
us¨
u, Ankara, Turkey, ,
(Turkish).
[] L.S.Kinder,M.R.Carnethon,L.P.Palaniappan,A.C.King,
and S. P. Fortmann, “Depression and the metabolic syndrome
in young adults: ndings from the ird National Health and
Nutrition Examination Survey,” Psychosomatic Medicine,vol.
, no. , pp. –, .
[] T. Bottiglieri, M. Laundy, R. Crellin, B. K. Toone, M. W. P.
Carney, and E. H. Reynolds, “Homocysteine, folate, methyla-
tion, and monoamine metabolism in depression,” Journal of
Neurology Neurosurgery & Psychiatry,vol.,no.,pp.–
, .
[] C. Lazarou and M. Kapsou, “e role of folic acid in prevention
and treatment of depression: an overview of existing evidence
and implications for practice,” Complementary erapies in
Clinical Practice, vol. , no. , pp. –, .
[] E. H. Reynolds, “Benets and risks of folic acid to the nervous
system,” Journal of Neurology Neurosurgery and Psychiatry,vol.
,no.,pp.–,.
[] H. Tiemeier, H. Ruud van Tuijl, A. Hofman, J. Meijer, A.
J. Kiliaan, and M. M. B. Breteler, “Vitamin B12,folate,and
homocysteine in depression: the Rotterdam study,” American
Journal of Psychiatry,vol.,no.,pp.–,.
[] B. W. J. H. Penninx, J. M. Guralnik, L. Ferrucci, L. P. Fried, R. H.
Allen, and S. P. Stabler, “Vitamin B12 deciency and depression
in physically disabled older women: epidemiologic evidence
from the women’s he alth and aging study,” e American Journal
of Psychiatry,vol.,no.,pp.–,.
[] S. Toker, A. Shirom, and S. Melamed, “Depression and the
metabolic syndrome: gender-dependent associations,” Depres-
sion and Anxiety,vol.,no.,pp.–,.
[]A.Pan,X.Ye,O.H.Francoetal.,“Insulinresistanceand
depressive symptoms in middle-aged and elderly Chinese:
ndings from the Nutrition and Health of Aging Population in
China Study,” Journal of Aective Disorders,vol.,no.-,pp.
–, .
[] M. Timonen, M. Laakso, J. Jokelainen, U. Rajala, V. B. Meyer-
Rochow, and S. Kein¨
anen-Kiukaanniemi, “Insulin resistance
and depression: cross sectional study,” British Medical Journal,
vol.,no.,pp.–,.
[] M.C.Adriaanse,J.M.Dekker,G.Nijpels,R.J.Heine,F.J.Snoek,
and F. Pouwer, “Associations between depressive symptoms and
insulin resistance: the Hoorn study,” Diabetologia,vol.,no.,
pp. –, .
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