Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults

Relationship between psychological distress and the adherence to the Korean healthy eating index (KHEI): the Korea National Health and Nutrition Examination Survey (KNHANES) 2013 and 2015

BACKGROUND/OBJECTIVES

This study examined the association of depressive symptoms, stress perception, and suicidal ideation with overall dietary quality using the newly developed Korean healthy eating index (KHEI).

SUBJECTS/METHODS

This study included 9,607 adults (3,939 men and 5,668 women, ≥ 19 years) who participated in the 6th Korea National Health and Nutrition Examination Survey 2013 and 2015. The KHEI scores were calculated using the food frequency questionnaire data. Survey logistic regression analyses were performed to analyze the association between psychiatric distress and dietary quality.

RESULTS

The percentage of subjects with experience of depressive mood, higher stress perception, and suicidal ideation was 8.2%, 25.0%, and 3.7% in men and 15.4%, 27.3%, and 6.0% in women, respectively. The mean KHEI score was 61.5 ± 0.29 in men and 64.8 ± 0.24 in women (P < 0.001). The present study found a difference in the adherence to specific dietary components of the KHEI between sexes. Men experiencing depressive symptoms were less likely to eat meat, fish, eggs, and beans, while depressed women showed lower vegetable intake. Both men and women with suicidal ideation showed a lower intake of vegetables. The men with stress had a lower breakfast eating score than those without stress (7.21 vs. 6.77, P = 0.016). The multivariate-adjusted odds ratios for depressive symptoms, stress perception, and the suicidal idea in women with the highest quartile of KHEI scores compared to the lowest quartile was 0.69 (95% confidence interval, 0.51-0.92), 0.73 (0.58-0.82), and 0.52 (0.33-0.82), respectively and significant dose-response associations were observed (P for trends < 0.05 for all). On the other hand, these associations were not observed in men after adjusting for the confounding variables (P for trends > 0.05 for all).

CONCLUSIONS

Poor adherence to dietary recommendations is associated with psychological distress, especially in women.

Prenatal Depression and Diet Quality During Pregnancy

BACKGROUND

Maternal nutrition during pregnancy has a significant effect on the health of the offspring and mother, highlighting the need for identifying factors that may affect diet during pregnancy. Research in nonpregnant and pregnant populations suggest depression may play a role.

OBJECTIVE

To investigate the relationship between prenatal depression and diet quality during pregnancy overall and by race/ethnicity and to explore the relationships between prenatal depression and the 12 Healthy Eating Index 2010 dietary components.

DESIGN

A cross-sectional secondary analysis of a cohort study of Kaiser Permanente Northern California women entering prenatal care between October 2011 and April 2013.

PARTICIPANTS/SETTING

Participants included 1,160 adult pregnant women.

MAIN OUTCOME MEASURES

Poor diet quality was defined as a Healthy Eating Index 2010 score in the lowest quartile.

STATISTICAL ANALYSES PERFORMED

Logistic regression was used to assess the relationship between prenatal depression (defined as a depression diagnosis, Patient Health Questionnaire score of 10 or greater or antidepressant medication dispensing between the last menstrual period and completion of the food frequency questionnaire) and poor diet quality overall and by race/ethnicity. Relationships between prenatal depression and each of the 12 Healthy Eating Index 2010 dietary components were assessed using t-tests and linear regression analyses.

RESULTS

One hundred fifty-nine (14%) participants had prenatal depression. Women with prenatal depression had nearly two times the odds of poor diet quality (odds ratio 1.80, 95% CI 1.23 to 2.60) compared with women without prenatal depression, after adjusting for potential confounders. Differences emerged by race/ethnicity; after adjusting for potential confounders the adjusted odds of poor diet quality were significant only among Hispanic women. Hispanic women with prenatal depression had an increased odds of poor diet quality compared with Hispanic women without prenatal depression (odds ratio 2.66, 95% CI 1.15 to 6.06). Women with prenatal depression had a higher consumption of empty calories (from solid fats, alcohol, and added sugars; threshold for counting alcohol >13 g/1,000 kcal) (P=0.01) and lower consumption of greens and beans (P<0.05), total fruit (P<0.01), and whole fruit (P<0.01), compared with women without prenatal depression. Except for empty calories, these findings remained after adjusting for potential confounders.

CONCLUSIONS

Study findings suggest that women with prenatal depression are at a higher risk of poor diet quality compared with women without prenatal depression, and the relationship is stronger among Hispanic women. Nutrition counseling interventions for women with depression should consider the use of culturally sensitive materials and target limiting empty calories from solid fats, alcohol, and added sugars and encourage eating more greens, beans, and fruit.