From the NICM Health Research Institute (Firth, Sarris), Western Sydney University, Westmead, New South Wales, Australia; Division of Psychology and Mental Health (Firth, Carney), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Deakin University (Marx, Dash, Jacka), Food & Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Baker Heart and Diabetes Institute (Dash), Metabolic and Vascular Physiology, Melbourne, Victoria, Australia; Youth Mental Health Research Unit (Carney), Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom; School of Psychiatry (Teasdale), Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia; Keeping the Body in Mind Program (Teasdale), South Eastern Sydney Local Health District, Sydney, New South Wales, Australia; Neurosciences Department (Solmi), University of Padua, Padua, Italy; Padua University Hospital (Solmi), Psychiatry Unit, Padua, Italy; Physiotherapy Department (Stubbs), South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychological Medicine (Stubbs), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Post Graduate Program in Health and Human Development (Schuch), La Salle University, Canoas, Brazil; Hospital de Clínicas de Porto Alegre (Schuch), Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Psychiatry (Carvalho), University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH)(Carvalho), Toronto, Ontario, Canada; Black Dog Institute (Jacka), Sydney, New South Wales, Australia; Murdoch Childrens Research Institute (Jacka), Centre for Adolescent Health, Melbourne, Victoria, Australia; and Department of Psychiatry (Sarris), University of Melbourne, Professorial Unit, The Melbourne Clinic, Melbourne, Victoria, Australia.
Psychosom Med. 2019 Apr;81(3):265-280. doi: 10.1097/PSY.0000000000000673.
Poor diet can be detrimental to mental health. However, the overall evidence for the effects of dietary interventions on mood and mental well-being has yet to be assessed. We conducted a systematic review and meta-analysis examining effects of dietary interventions on symptoms of depression and anxiety.
Major electronic databases were searched through March 2018 for all randomized controlled trials of dietary interventions reporting changes in symptoms of depression and/or anxiety in clinical and nonclinical populations. Random-effects meta-analyses were conducted to determine effect sizes (Hedges' g with 95% confidence intervals [CI]) for dietary interventions compared with control conditions. Potential sources of heterogeneity were explored using subgroups and meta-regression analyses.
Results: Sixteen eligible randomized controlled trials (published in English) with outcome data for 45,826 participants were included; the majority of which examined samples with nonclinical depression (n = 15 studies). Nonetheless, dietary interventions significantly reduced depressive symptoms (g = 0.162, 95% CI = 0.055 to 0.269, p = 0.003). Similar effects were observed among high-quality trials (g = 0.171, 95% C.I.=0.057 to 0.286, p=0.003) and when compared with both inactive (g = 0.114, 95% C.I.=0.008 to 0.219, p=0.035) and active controls (g = 0.224, 95% C.I.= 0.052 to 0.397, p = 0.011). No effect of dietary interventions was observed for anxiety (k = 11, n = 2270, g = 0.085, 95% C.I. = -0.031 to 0.202, p=0.151). Studies with female samples observed significantly greater benefits from dietary interventions, for symptoms of both depression and anxiety.
Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population. Future research is required to determine the specific components of dietary interventions that improve mental health, explore underlying mechanisms, and establish effective schemes for delivering these interventions in clinical and public health settings.
PROSPERO Online Protocol: CRD42018091256.
不良饮食可能对心理健康有害。然而，关于饮食干预对情绪和心理健康影响的总体证据尚未得到评估。我们进行了一项系统评价和荟萃分析，研究了饮食干预对抑郁和焦虑症状的影响。
通过电子数据库检索了截至 2018 年 3 月的所有关于饮食干预报告临床和非临床人群抑郁和/或焦虑症状变化的随机对照试验。采用随机效应荟萃分析比较饮食干预与对照条件的效应大小（Hedges'g 及其 95%置信区间[CI]）。使用亚组分析和荟萃回归分析探讨了潜在的异质性来源。
结果：纳入了 16 项符合条件的随机对照试验（发表于英文期刊），共有 45826 名参与者的结局数据；其中大多数研究的样本均为非临床抑郁症患者（n=15 项研究）。然而，饮食干预显著降低了抑郁症状（g=0.162，95%CI=0.055 至 0.269，p=0.003）。高质量试验也观察到了类似的效果（g=0.171，95%CI=0.057 至 0.286，p=0.003），与无效对照（g=0.114，95%CI=0.008 至 0.219，p=0.035）和活性对照（g=0.224，95%CI=0.052 至 0.397，p=0.011）相比也有显著效果。饮食干预对焦虑无影响（k=11，n=2270，g=0.085，95%CI=-0.031 至 0.202，p=0.151）。有女性样本的研究观察到饮食干预对抑郁和焦虑症状有显著更大的益处。
饮食干预作为一种新颖的干预手段，有望减轻全人群的抑郁症状。需要进一步研究以确定改善心理健康的饮食干预具体组成部分，探索潜在机制，并建立在临床和公共卫生环境中提供这些干预措施的有效方案。
PROSPERO 在线方案：CRD42018091256。
