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Bellikci Koyu E, Karaağaç Y, Öner BN. The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores. Appetite 2024; 197:107303. [PMID: 38503030 DOI: 10.1016/j.appet.2024.107303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.
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Affiliation(s)
- Ezgi Bellikci Koyu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, 35620, Türkiye.
| | - Yasemin Karaağaç
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, 35620, Türkiye
| | - Beyza Nur Öner
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, 35620, Türkiye
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Reynolds R, McGowan A, Smith S, Rawstorne P. Vegan and vegetarian males and females have higher orthorexic traits than omnivores, and are motivated in their food choice by factors including ethics and weight control. Nutr Health 2023:2601060231187924. [PMID: 37464872 DOI: 10.1177/02601060231187924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Evidence associating plant-based diets with the proposed 'obsessively healthy eating' eating disorder, orthorexia nervosa, has mostly focused on females. Diet motivations have seldom been assessed. AIM To compare orthorexic tendencies between vegans/vegetarians and omnivores of both sexes, and reasons behind food choice with an English-validated Food Choice Questionnaire. METHODS A cross-sectional survey of 444 males and females were recruited via social media, email, and Amazon MTurk; to investigate eating patterns, orthorexic tendencies using the ORTO-15 questionnaire, and eating motivations using the Food Choice Questionnaire. RESULTS Over half of the participants were male (53.4%), younger adults (mean ± SD 37.2 ± 11.2 years), and mostly from the United States (89%). Vegan and vegetarian eating habits were reported by 15.8% of people. Vegans/vegetarians had significantly higher orthorexic tendencies than omnivores, and chose food significantly more often for Weight Control, Ethical Concern, Natural Content, and Mood reasons. People with greater orthorexic tendencies (ORTO-15 score<35) chose food significantly more often for Weight Control and Ethical Concern reasons than those with less orthorexic tendencies (ORTO-15 score 35+). CONCLUSION This study's results are in line with the majority of the evidence that shows an association between vegan/vegetarian diets and orthorexic tendencies, but strengthens the evidence base by including more male participants. Additionally, this is the first study to use an English-validated motivation-based questionnaire that explored diet motivators in vegans/vegetarians compared to omnivories, and in those with orthorexic tendencies vs. those without orthorexic tendencies.
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Affiliation(s)
- Rebecca Reynolds
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrea McGowan
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sophie Smith
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Patrick Rawstorne
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
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Messer M, Liu C, Linardon J. Orthorexia nervosa symptoms prospectively predict symptoms of eating disorders and depression. Eat Behav 2023; 49:101734. [PMID: 37146411 DOI: 10.1016/j.eatbeh.2023.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023]
Abstract
The possible mental health impacts of orthorexia nervosa (ON) symptoms are poorly understood, as existing research in this field has mostly employed cross-sectional designs. This study investigated whether ON symptoms prospectively predict changes in eating disorder psychopathology and general mental health. A convenience, non-clinical sample of adults (n = 313; 83 % women) completed study measures at baseline (T1) and three-month follow-up (T2). Negative binomial regressions were computed to test whether T1 ON symptoms predict changes in binge eating and driven exercise episodes. Linear regressions were computed to test whether T1 ON symptoms predict changes in eating concerns, depressive symptoms, and life satisfaction. Higher ON symptoms prospectively predicted greater number of binge eating and driven exercise episodes at T2. Higher ON symptoms predicted increased eating concerns and depressive symptoms at T2. ON symptoms did not predict changes in life satisfaction. Findings highlight possible risks associated with ON symptomatology. Efforts to better inform the public about the risks of these pathological eating patterns are needed.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Claudia Liu
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia.
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McLean CP, Kulkarni J, Sharp G. Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications. Eat Weight Disord 2022; 27:2347-2375. [PMID: 35729472 PMCID: PMC9556390 DOI: 10.1007/s40519-022-01428-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Meat avoidance has long been thought to be related to eating psychopathology; however, research does not necessarily support this notion. Furthermore, commonly used eating disorder scales may be picking up on normal meat-avoiding behaviours in vegetarians and vegans. As such, we systematically reviewed the association between vegetarianism, veganism, and disordered eating, and reviewed the psychometric properties of eating disorder scales for use in these populations. METHODS We searched electronic databases MEDLINE, PsychINFO, and CINAHL for literature published until June 2021. RESULTS Forty-eight studies met eligibility criteria, with no consensus as to whether meat avoidance was associated with higher rates of disordered eating. Most studies reported a significant positive association with both vegetarianism and veganism, and orthorexia nervosa. Six studies provided evidence for the use of eating disorder measures in vegetarians and vegans, reporting poor psychometric fit among all scales. CONCLUSION This systematic review highlights the extent to which vegetarians and vegans have been highly understudied, with limited research suggesting higher levels of orthorexia nervosa behaviours in vegetarians and vegans. Furthermore, our results provide tentative evidence that the factorial validity of commonly used eating disorder scales, such as the EDE-Q, may be poor in vegans. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Courtney P McLean
- Monash Alfred Psychiatry research centre, Monash University, 4/607 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry research centre, Monash University, 4/607 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry research centre, Monash University, 4/607 St Kilda Road, Melbourne, VIC, 3004, Australia
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Raynal P, Soccodato M, Fages M, Séjourné N. A comparative study of orthorexia between premenopausal, perimenopausal, and postmenopausal women. Eat Weight Disord 2022; 27:2523-2531. [PMID: 35357686 DOI: 10.1007/s40519-022-01392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Studies suggested that menopause is a period of vulnerability for disordered eating behaviors, but whether menopause could be linked to orthorexia nervosa (ON) remains unexplored. METHODS A sample composed of 709 women aged between 30 and 71 years (mean age = 43.08 years, SD = 9.24) answered self-administered questionnaires assessing ON (Düsseldorfer Orthorexia Skala, DOS), body image, self-esteem, and psychopathological symptoms. The sample included a Premenopause group of 441 women reporting regular menses, a Perimenopause group of 94 women reporting the recent onset of amenorrhea or menstrual irregularities, and a Postmenopause group of 174 women reporting amenorrhea of natural onset for more than 12 months. RESULTS Group comparison using analysis of covariance with age as covariate showed that ON scores were statistically higher in the two groups of participants dealing with menopause (Peri- and Postmenopause) when compared with women not yet concerned by menopause (Premenopause). A Kendall's tau-b correlation performed between the menopausal status (Pre, Peri, or Postmenopause) and DOS categories (No ON; At risk of ON; Presence of ON) showed a weak but statistically significant positive correlation between the menopausal group and DOS categories (tau-b = 0.136, p < 0.001). In addition, Fisher's exact tests indicated that the percentages of participants in the "At risk of ON" and "Presence of ON" categories were statistically higher in the Postmenopause group in comparison with the Premenopause group (p < 0.001). Depressive symptoms were statistically higher in the Peri- and Post-groups, while anxiety symptoms were stronger in the Peri-group when compared with the Pre-group. CONCLUSIONS This study shows an increase of ON in women concerned with menopause, suggesting the existence of a relationship between menopause and ON. Further studies are necessary to identify factors involved in this association. LEVEL OF EVIDENCE Descriptive (cross-sectional) study, level V.
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Affiliation(s)
- Patrick Raynal
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France.
| | - Marine Soccodato
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Morgane Fages
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Natalène Séjourné
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, 5 allées Antonio Machado, 31058, Toulouse, France
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Obeid S, Awad E, Wachten H, Hallit S, Strahler J. Temperaments and orthorexia nervosa: a cross-cultural study between Germany and Lebanon. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe aim of this study was to explore the association between affective temperaments and orthorexic eating and whether temperament may explain cross-cultural differences in this behavior while considering the two dimensions of orthorexic eating, healthy (HeOr) and nervosa (OrNe). To accomplish this, 337 and 389 individuals were recruited in Lebanon and Germany, respectively. The brief version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego explored depressive, hyperthymic, cyclothymic, anxious and irritable temperaments, and the Teruel Orthorexia scale explored orthorexic eating. HeOr appeared comparable between countries but OrNe was higher in Lebanon. In terms of affective temperaments, the higher the depressive, cyclothymic, irritable, and anxious temperaments, the higher were the levels of OrNe. Only the hyperthymic temperament scale was positively associated with HeOr. Three-step regression analysis indicated only gender as a unique predictor for HeOr. By contrast, gender, depressive, hyperthymic, and anxious temperament as well as the two-way interactions country*depressive temperament and country*hyperthymic temperament were significant predictors of OrNe. The positive association between OrNe and depressive temperament was only found for the German sample while the negative association between hyperthymic temperament and OrNe was somewhat stronger in the Lebanese sample. Overall, a higher healthy interest in diet was linked to the hyperthymic temperament. Findings emphasized the role of temperaments in pathological orthorexic eating in general as well as in explaining cross-cultural differences in these behaviors. The assessment of temperaments could help to fit treatments for eating pathologies to individuals from different cultures, focusing interventions more on these aspects.
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Tuck CJ, Sultan N, Tonkovic M, Biesiekierski JR. Orthorexia nervosa is a concern in gastroenterology: A scoping review. Neurogastroenterol Motil 2022; 34:e14427. [PMID: 35811419 PMCID: PMC9541631 DOI: 10.1111/nmo.14427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut-brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini-review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%-97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for "digestive issues" or "food intolerances" were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.
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Affiliation(s)
- Caroline J. Tuck
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Nessmah Sultan
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Matilda Tonkovic
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Jessica R. Biesiekierski
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia,Department of Nutrition, Dietetics and FoodMonash UniversityNotting HillVictoriaAustralia
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Jain R, Larsuphrom P, Degremont A, Latunde‐Dada GO, Philippou E. Association between vegetarian and vegan diets and depression: A systematic review. NUTR BULL 2022; 47:27-49. [DOI: 10.1111/nbu.12540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 12/22/2022]
Affiliation(s)
- Rishika Jain
- Department of Nutrition and Dietetics School of Life Course and Population Sciences King's College London London UK
| | - Phureephat Larsuphrom
- Department of Nutrition and Dietetics School of Life Course and Population Sciences King's College London London UK
| | - Alexia Degremont
- Department of Nutrition and Dietetics School of Life Course and Population Sciences King's College London London UK
| | | | - Elena Philippou
- Department of Nutrition and Dietetics School of Life Course and Population Sciences King's College London London UK
- Department of Life and Health Sciences University of Nicosia Nicosia Cyprus
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Ocklenburg S, Borawski J. Vegetarian diet and depression scores: A meta-analysis. J Affect Disord 2021; 294:813-815. [PMID: 34375207 DOI: 10.1016/j.jad.2021.07.098] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/26/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several studies have suggested an association between vegetarian diet and higher depression scores. However, some studies have also shown an effect in the opposite direction, indicating lower depression scores in vegetarians. Given this discrepancy in the literature, this meta-analysis was aimed to determine whether there is a significant association between vegetarian diet and depression scores across different published studies. METHODS A keyword search in major databases was conducted. Studies reporting depression scores in vegetarians and a non-vegetarian control group were included. Meta-analysis following a conditional random-effects procedure was conducted in R. RESULTS After duplicates were removed and studies were analyzed for inclusion criteria, k=13 studies with an overall n of 49889 participants (8057 vegetarians and 41832 non-vegetarian controls) were included in the analysis. Random-effects meta-analysis revealed a significant difference between vegetarians and non-vegetarians, with vegetarians showing higher depression scores than non-vegetarians. LIMITATIONS The heterogeneity between studies was high and geographical variation in study location was low, limiting cross-cultural insights. CONCLUSIONS Vegetarians show higher depression scores than non-vegetarians. However, due to high heterogeneity of published studies, more empirical research is needed before any final conclusions can be drawn. Also, empirical studies from a higher number of different countries would be desirable.
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Affiliation(s)
- Sebastian Ocklenburg
- Institute of Cognitive Neuroscience, Biopsychology, Department of Psychology, Ruhr-University Bochum, Bochum, Germany.
| | - Jette Borawski
- Department of Psychology, University of Duisburg-Essen, Essen, Germany
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Greetfeld M, Hessler-Kaufmann JB, Brandl B, Skurk T, Holzapfel C, Quadflieg N, Schlegl S, Hauner H, Voderholzer U. Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services. Eat Weight Disord 2021; 26:1511-1519. [PMID: 32729018 PMCID: PMC8128806 DOI: 10.1007/s40519-020-00961-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Orthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear. METHODS Adults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED). RESULTS Five-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p < .001, Cohen's d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p < .001, d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p < .001, d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p < .001) and stress (r = .33, p < .001) scores as well as the SEED bulimia score (r = .32, p < .001). In multivariate logistic regression analyses, only PHQ depression scores were associated with past psychotherapeutic or psychiatric treatment (OR = 1.20, p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013). CONCLUSIONS The prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Martin Greetfeld
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien Am Chiemsee, Germany.
| | - Johannes Baltasar Hessler-Kaufmann
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien Am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Beate Brandl
- ZIEL-Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Tomas Skurk
- ZIEL-Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Hans Hauner
- Chair of Nutritional Medicine, Else Kröner-Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising-Weihenstephan, Germany
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien Am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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Fazelian S, Sadeghi E, Firouzi S, Haghighatdoost F. Adherence to the vegetarian diet may increase the risk of depression: a systematic review and meta-analysis of observational studies. Nutr Rev 2021; 80:242-254. [PMID: 33822140 DOI: 10.1093/nutrit/nuab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
CONTEXT Several epidemiological studies have investigated the association between a vegetarian diet and risk of depression, but because of inconsistency between studies, the exact association remains unclear. OBJECTIVE In this systematic review and meta-analysis, the relationship between vegetarian diets and risk of depression in observational studies was evaluated. DATA SOURCES The Medline, Embase, Scopus, ISI Web of Science, and Cochrane Library databases were searched from inception through September 1, 2020. STUDY SELECTION Observational studies were included that examined mean levels of depression and risk for depression in vegetarians compared with nonvegetarians. DATA EXTRACTION Pooled effect sizes were estimated using the random-effects model and were reported as standardized mean differences or odds ratios (ORs) with their corresponding 95%CIs. Heterogeneity was tested using the I2 statistic. RESULTS Combining 9 effect sizes in this meta-analysis illustrated that adherence to a vegetarian diet was associated with a 53% greater risk of depression compared with that of omnivores (95%CI, 1.14-2.07; I2 = 69.1%). Subgroup analysis of depression risk suggested that results depended on the type of vegetarian diet and country where the study was conducted. For studies that assessed a semivegetarian diet (OR, 1.86; 95%CI, 1.42-2.44; I2 = 35.7%) and those conducted in Europe and the United States (OR, 1.45; 95%CI, 1.06-1.98; I2 = 73.2%), there was a positive association between a vegetarian diet and depression, but in lacto-ovo vegetarians and Asian countries, a null association was found. Comparing mean depression scores showed no evidence of difference between vegetarians and nonvegetarians (n = 16; standardized mean difference, 0.10; 95%CI, -0.01 to 0.21; I2 = 79.1%). CONCLUSION Vegetarian diet significantly increased depression risk; however, the findings were not robust, and more studies are required to investigate the vegetarian diet and depression association.
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Affiliation(s)
- Siavash Fazelian
- S. Fazelian is with the Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. E. Sadeghi is with the Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran. S. Firouzi is with the Department of Dietetics, Grafton Base Hospital, New South Wales, Australia. F. Haghighatdoost is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sadeghi
- S. Fazelian is with the Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. E. Sadeghi is with the Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran. S. Firouzi is with the Department of Dietetics, Grafton Base Hospital, New South Wales, Australia. F. Haghighatdoost is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayyeh Firouzi
- S. Fazelian is with the Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. E. Sadeghi is with the Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran. S. Firouzi is with the Department of Dietetics, Grafton Base Hospital, New South Wales, Australia. F. Haghighatdoost is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- S. Fazelian is with the Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. E. Sadeghi is with the Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran. S. Firouzi is with the Department of Dietetics, Grafton Base Hospital, New South Wales, Australia. F. Haghighatdoost is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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