Elsevier

Journal of Affective Disorders

Volume 225, 1 January 2018, Pages 552-558
Journal of Affective Disorders

Research paper
Dietary patterns and depressive symptoms during pregnancy in Japan: Baseline data from the Kyushu Okinawa Maternal and Child Health Study

https://doi.org/10.1016/j.jad.2017.08.073Get rights and content

Highlights

  • The prevalence of depressive symptoms during pregnancy was 19.2% in Japan. Three dietary patterns were identified: ‘healthy’, ‘Japanese’, and ‘Western’.

  • The healthy pattern was inversely related to depressive symptoms during pregnancy.

  • The Japanese pattern was inversely related to depressive symptoms during pregnancy.

  • There was no association with the Western pattern.

Abstract

Background

Only one Brazilian study has examined the association between dietary patterns and depressive symptoms during pregnancy. The current cross-sectional study examined this issue in Japan.

Methods

Study subjects were 1744 pregnant women. Between April 2007 and March 2008, information under study was obtained. Dietary patterns were derived from a factor analysis of 33 predefined food groups based on a self-administered diet history questionnaire. Depressive symptoms were defined as a Center for Epidemiological Studies Depression Scale score ≥ 16. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure, employment, household income, education, and body mass index.

Results

Three dietary patterns were identified: ‘healthy’, characterized by high intake of green and yellow vegetables, other vegetables, mushrooms, pulses, seaweed, potatoes, fish, sea products, miso soup, sugar, and shellfish; ‘Japanese’, characterized by high intake of rice and miso soup; and ‘Western’, characterized by high intake of beef and pork, processed meat, vegetable oil, chicken, eggs, shellfish, and salt-containing seasonings. The healthy and Japanese patterns were independently inversely associated with depressive symptoms during pregnancy: the adjusted prevalence ratios (95% confidence intervals, P for trend) between extreme quartiles were 0.56 (0.43–0.73, < 0.0001) and 0.72 (0.55–0.94, 0.008), respectively. No association was observed between the Western pattern and depressive symptoms during pregnancy.

Limitations

Information was obtained between the 5th and 39th week of pregnancy.

Conclusions

The healthy and Japanese dietary patterns may be inversely associated with depressive symptoms during pregnancy.

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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