Research paperDietary patterns and depressive symptoms during pregnancy in Japan: Baseline data from the Kyushu Okinawa Maternal and Child Health Study
Introduction
Depressive symptoms are probably associated with several dietary factors (Murakami and Sasaki, 2010). Dietary pattern analysis allows simultaneous evaluation of the effects of combinations of many foods and offers a perspective different from that of the traditional approach which focuses on a single or a few nutrients or foods (Hu, 2002). In the traditional approach, the assessment of isolated foods or nutrients makes it difficult to account for potential interactions among nutrients and foods and is frequently confounded by other dietary factors (Martínez-González and Sánchez-Villegas, 2016); dietary pattern analysis enables us to avoid this limitation. In 2014, a meta-analysis of 13 observational studies demonstrated that the healthy dietary pattern was significantly inversely associated with depressive symptoms while there was no association between the Western dietary pattern and depressive symptoms (Lai et al., 2014). Of the 13 studies included in this meta-analysis, 12 were conducted in Western countries; only one cross-sectional study in Japan was included. Recent epidemiological investigations regarding the relationship between dietary patterns and depressive symptoms in Asian countries (Suzuki et al., 2013, Chan et al., 2014, Miki et al., 2015, Tsai, 2016, Xia et al., 2016) as well as those in Western countries (Dipnall et al., 2015, Gougeon et al., 2015, Jacka et al., 2014, Kim et al., 2016, Lai et al., 2016, Lucas et al., 2014, Ruusunen et al., 2014, Sánchez-Villegas et al., 2015, Vermeulen et al., 2016, Vilela et al., 2014) that were not included in the meta-analysis have produced conflicting results. Associations between dietary patterns and health outcomes are sometimes different between studies performed in populations with different dietary habits.
Only one study of Brazilian women examined the association between dietary patterns and depressive symptoms during pregnancy (Vilela et al., 2014). In view of the lack of epidemiological information with respect to the relationship between dietary patterns and depressive symptoms during pregnancy in non-Western populations, the current cross-sectional study assessed this issue in pregnant Japanese women using baseline data from the Kyushu Okinawa Maternal and Child Health Study (KOMCHS). According to our previous studies which showed significant inverse associations between intake of fish, yogurt, seaweed, soy products, eicosapentaenoic acid, docosahexaenoic acid, calcium, vitamin D, isoflavones, and manganese and depressive symptoms during pregnancy, our hypothesis was that the healthy dietary pattern would be inversely related to depressive symptoms during pregnancy (Miyake et al., 2013, Miyake et al., 2014, Miyake et al., 2015a, Miyake et al., 2015b, Miyake et al., 2016, Miyake et al., 2017).
Section snippets
Study population
The current study utilized data from the KOMCHS which is an ongoing prospective prebirth cohort study investigating risk and preventive factors for maternal and child health problems. Details of the baseline survey of the KOMCHS have been described elsewhere (Miyake et al., 2013). In the baseline survey, eligible study subjects were pregnant women who lived in one of seven prefectures on Kyushu Island in southern Japan, with a total population of approximately 13.26 million, or in Okinawa
Results
Among the 1744 participants, the prevalence of depressive symptoms during pregnancy was 19.2%. The mean age of the study subjects was 31.2 years (Table 1). About 5% of the study subjects reported a personal history of depression and 10% reported a family history of depression.
Table 2 presents the factor-loading matrices for the three identified dietary patterns. The first factor was termed the ‘healthy’ pattern because it represented a high intake of green and yellow vegetables, other
Implications of the study
The current cross-sectional study identified three dietary patterns among pregnant Japanese women, which we called the healthy, Japanese, and Western dietary patterns, and which explained 22.1% of the variance in consumption of 145 food items on the DHQ. Our study found that the healthy and Japanese, but not the Western, patterns were independently associated with a lower prevalence of depressive symptoms during pregnancy. To our knowledge, this is the first study in a non-Western population to
Contributors
Y.M., K.T., and M.A. contributed to the study concept and design and the acquisition of data. H.O. and S.S. were responsible for the estimation of dietary factors. S.F. assisted in manuscript preparation. Y.M. was responsible for the analysis and interpretation of data and the drafting of the manuscript. All authors participated in critically revising the manuscript and approved the final version of the manuscript.
Role of funding source
This work was supported by JSPS KAKENHI Grant Numbers 19590606JP, 20791654JP, 21590673JP, 22592355JP, 22119507JP, 24390158JP, 25463275JP, 25670305JP, 17K12011JP, and 17H04135JP, by Health and Labour Sciences Research Grants for Research on Allergic Disease and Immunology and Health Research on Children, Youth and Families from the Ministry of Health, Labour and Welfare, Japan, by Meiji Co. Ltd., and by the Food Science Institute Foundation.
Conflict of interest
Yoshihiro Miyake and Keiko Tanaka were financially supported by Meiji Co. Ltd. The other authors have no conflict of interest.
Acknowledgements
The authors would like to acknowledge the Kyushu Branch of the Japan Allergy Foundation, the Fukuoka Association of Obstetricians & Gynecologists, the Okinawa Association of Obstetricians & Gynecologists, the Miyazaki Association of Obstetricians & Gynecologists, the Oita Association of Obstetricians & Gynecologists, the Kumamoto Association of Obstetricians & Gynecologists, the Nagasaki Association of Obstetricians & Gynecologists, the Kagoshima Association of Obstetricians & Gynecologists,
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