University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
Karolinska Institutet, Department of Medical Epidemiology and Biostatistics (HL), Solnavägen 1, Stockholm, 171 77, Sweden; Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden.
Clin Nutr. 2021 Mar;40(3):901-906. doi: 10.1016/j.clnu.2020.06.016. Epub 2020 Jun 30.
BACKGROUND & AIMS: Overall diet quality may partially mediate the detrimental effects of stress and neuroticism on common mental health problems: stressed and/or neurotic individuals may be more prone to unhealthy dietary habits, which in turn may contribute to depression and anxiety. Lifestyle interventions for depressed, anxious or at-risk individuals hinge on this idea, but evidence to support such pathway is missing. Here, we aim to prospectively evaluate the role of overall diet quality in common pathways to developing depression and anxiety.
At baseline, N = 121,008 individuals from the general population (age 18-93) completed an extensive food frequency questionnaire, based on which overall diet quality was estimated. Participants also reported on two established risk factors for mental health problems, i.e. past-year stress exposure (long-term difficulties, stressful life-events) and four neuroticism traits (anger-hostility, self-consciousness, impulsivity, vulnerability). Depression and anxiety were assessed at baseline and follow-up (n = 65,342, +3.6 years). Overall diet quality was modeled as a mediator in logistic regression models predicting the development of depression and anxiety from common risk factors.
High stress and high neuroticism scores were - albeit weakly - associated with poorer diet quality. Poor diet quality, in turn, did not predict mental health problems. Overall diet quality did not mediate the relationship between stress/neuroticism and common mental health problems: effects of stress, neuroticism and stress-by-neuroticism interactions on mental health problems at follow-up consisted entirely of direct effects (98.6%-100%).
Diet quality plays no mediating role in two established pathways to common mental health problems. As overall diet quality was reduced in stressed and neurotic individuals, these groups may benefit from dietary interventions. However, such interventions are unlikely to prevent the onset or recurrence of depression and anxiety.
整体饮食质量可能部分缓解压力和神经质对常见心理健康问题的不利影响：有压力和/或神经质的个体可能更容易养成不健康的饮食习惯，进而导致抑郁和焦虑。针对抑郁、焦虑或处于风险中的个体的生活方式干预就基于这一理念，但缺乏支持这种关联的证据。在此，我们旨在前瞻性评估整体饮食质量在常见的发展为抑郁和焦虑的途径中的作用。
在基线时，来自一般人群（年龄 18-93 岁）的 121008 名个体完成了一项广泛的食物频率问卷，基于该问卷评估整体饮食质量。参与者还报告了两个公认的心理健康问题风险因素，即过去一年的压力暴露（长期困难、压力生活事件）和四个神经质特质（愤怒敌意、自我意识、冲动、脆弱性）。在基线和随访时（n=65342，+3.6 年）评估了抑郁和焦虑。在预测常见风险因素发展为抑郁和焦虑的逻辑回归模型中，将整体饮食质量建模为中介。
高压力和高神经质评分与较差的饮食质量呈弱相关。反过来，较差的饮食质量并不预示心理健康问题。整体饮食质量不能中介压力/神经质与常见心理健康问题之间的关系：压力、神经质和压力-神经质相互作用对随访时心理健康问题的影响完全由直接效应组成（98.6%-100%）。
饮食质量在两个既定的常见心理健康问题途径中不起中介作用。在有压力和神经质的个体中，整体饮食质量降低，这些群体可能受益于饮食干预。然而，这些干预措施不太可能预防抑郁和焦虑的发作或复发。
