Elsevier

Journal of Affective Disorders

Volume 174, 15 March 2015, Pages 215-224
Journal of Affective Disorders

Research report
The association between dietary patterns, diabetes and depression

https://doi.org/10.1016/j.jad.2014.11.030Get rights and content

Abstract

Background

Type 2 diabetes and depression are commonly comorbid high-prevalence chronic disorders. Diet is a key diabetes risk factor and recent research has highlighted the relevance of diet as a possible risk for factor common mental disorders. This study aimed to investigate the interrelationship among dietary patterns, diabetes and depression.

Methods

Data were integrated from the National Health and Nutrition Examination Study (2009–2010) for adults aged 18+ (n=4588, Mean age=43 yr). Depressive symptoms were measured by the Patient Health Questionnaire-9 and diabetes status determined via self-report, usage of diabetic medication and/or fasting glucose levels ≥126 mg/dL and a glycated hemoglobin level ≥6.5% (48 mmol/mol). A 24-h dietary recall interview was given to determine intakes. Multiple logistic regression was employed, with depression the outcome, and dietary patterns and diabetes the predictors. Covariates included gender, age, marital status, education, race, adult food insecurity level, ratio of family income to poverty, and serum C-reactive protein.

Results

Exploratory factor analysis revealed five dietary patterns (healthy; unhealthy; sweets; ‘Mexican’ style; breakfast) explaining 39.8% of the total variance. The healthy dietary pattern was associated with reduced odds of depression for those with diabetes (OR 0.68, 95% CI [0.52, 0.88], p=0.006) and those without diabetes (OR 0.79, 95% CI [0.64, 0.97], p=0.029) (interaction p=0.048). The relationship between the sweets dietary pattern and depression was fully explained by diabetes status.

Conclusion

In this study, a healthy dietary pattern was associated with a reduced likelihood of depressive symptoms, especially for those with Type 2 diabetes.

Section snippets

Background

Diabetes is a chronic disease with serious complications, affecting approximately 347 million people worldwide (Danaei et al., 2011) and 29.1 million children and adults in the United States (US) (9.3% of the US population) (Centers for Disease Control and Prevention, 2014). Type 2 diabetes is the most common type, with risks related to lack of regular physical activity, unhealthy eating and excess weight. Throughout the western world, obesity and prevalence of Type 2 diabetes are rising, with

Methods

Cross-sectional, population-based data from the National Health and Nutrition Examination Surveys (NHANES) (2009–2010) (Centers for Disease Control and Prevention National Center for Health Statistics, 2013) were utilized for this research study. Approximately 5000 non-institutionalized US civilians aged 20–75 per annum responded to a detailed home based interview and physical examinations at mobile examination centers across the country. The sampling methodology involved a stratified,

Depression

The Patient Health Questonnaire-9 (PHQ-9) (Kroenke and Spitzer, 2002, Kroenke et al., 2001, Martin et al., 2006) was used to assess depressive symptoms. The PHQ-9 comprises depression modules taken from the larger PRIME-MD Patient Health Questionnaire (Spitzer et al., 1999). The nine items used incorporate key depressive disorder diagnosis criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 2000, Kroenke and

Statistical analysis

Initial dietary results were analyzed using exploratory factor analysis (EFA), with correlations matrix as input. Factorability of R was examined using four key measures (Tabachnick and Fidell, 2012): 1) Sample size; 2) Inspection of item correlations; 3) Kaiser–Meyer–Olkin (KMO) test of sampling adequacy; 4) Bartlett׳s test of sphericity. Factor analysis was deemed appropriate as the unweighted sample size was large, with a ratio of 179 observations per item. There were also several

Exploratory factor analysis for the diet factors

Visual inspection of correlations matrix identified several correlations more than 0.3 (Appendix 1). For the 26 items, KMO was 0.70 and Bartlett׳s test was significant (χ² (300)=317,378,113.4, p<0.001), supporting factorability of the 25 item set. Results of dimensionality tests disagreed on the number of factors potentially underlying the dietary item set: Kaiser׳s criterion identified 8 factors with eigenvalues above 1, scree test suggested the presence of 3, 5 or 8 factors (Fig. 1), parallel

Discussion

This study supports previous research in showing that a healthy diet is associated with a reduced probability of depressive symptoms or depression, particularly in those with Type 2 diabetes (Lai et al., 2014, Psaltopoulou et al., 2013, Sánchez-Villegas et al., 2013). However, it extends the extant literature in suggesting that one important mechanism linking diabetes and depression is diet quality. This finding is consistent with the results of the recent PREDIMED study, which demonstrated the

Role of funding source

There was no funding source involved with this manuscript.

Conflict of interest

JFD has no conflicts of interest.

JAP has received Grant/Research Support from the NHMRC, Perpetual, Amgen (Europe) GmBH, BUPA Foundation and Arthritis Australia and has received speaker fees from Amgen and Sanofi Aventis.

DM has no conflicts of interest.

MB has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research

Acknowledgments

There are no acknowledgments to declare.

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