Association between Dietary Patterns and Depression in Chinese Older Adults: A Longitudinal Study Based on CLHLS

The association between raw garlic consumption and the risk of depressive symptoms: the TCLSIH cohort study

Background: Garlic has antioxidant, anti-inflammatory, cardiovascular improvement and other beneficial effects on human health. However, few studies have evaluated the association of garlic intake with the risk of depressive symptoms. The aim of this prospective cohort was to examine the association between the frequency of raw garlic consumption and depressive symptoms in the general adult population. Methods: A total of 7427 participants (mean ± standard deviation: 39.7 ± 10.5 years) without baseline depressive symptoms were included in the cohort study. Garlic consumption was assessed using a validated food frequency questionnaire, and depressive symptoms were assessed by a Chinese version of the Self-rating Depression Scale score (SDS score ≥ 45). Multivariable Cox proportional hazards models were used to determine the association between garlic consumption and the risk of depressive symptoms. Results: This study identified 1070 cases of depressive symptoms during a median follow-up of 2.0 years, with a depression prevalence of 73.4 cases per 1000 person-years. After multivariate adjustment, the hazard ratios (95% confidence intervals) for depressive symptoms in males were 1.00 (reference) for almost never, 1.05 (0.84, 1.32) for ≤1 time per week, 1.16 (0.90, 1.49) for 2-3 times per week, and 1.31 (0.97, 1.78) for ≥4 times per week, and in females, they were 1.00 (reference) for almost never, 0.85 (0.69, 1.06) for ≤1 time per week, 0.72 (0.54, 0.97) for 2-3 times per week, and 0.78 (0.53, 1.13) for ≥4 times per week. Conclusion: In a large general population, we demonstrate for the first time that moderate raw garlic consumption is associated with a reduced risk of depressive symptoms in females, but not in males. Additional prospective studies with long-term follow-up and randomized controlled trials are necessary to confirm the preliminary results of the current study.

Digital Dietary Behaviors in Individuals With Depression: Real-World Behavioral Observation

BACKGROUND

Depression is often accompanied by changes in behavior, including dietary behaviors. The relationship between dietary behaviors and depression has been widely studied, yet previous research has relied on self-reported data which is subject to recall bias. Electronic device-based behavioral monitoring offers the potential for objective, real-time data collection of a large amount of continuous, long-term behavior data in naturalistic settings.

OBJECTIVE

The study aims to characterize digital dietary behaviors in depression, and to determine whether these behaviors could be used to detect depression.

METHODS

A total of 3310 students (2222 healthy controls [HCs], 916 with mild depression, and 172 with moderate-severe depression) were recruited for the study of their dietary behaviors via electronic records over a 1-month period, and depression severity was assessed in the middle of the month. The differences in dietary behaviors across the HCs, mild depression, and moderate-severe depression were determined by ANCOVA (analyses of covariance) with age, gender, BMI, and educational level as covariates. Multivariate logistic regression analyses were used to examine the association between dietary behaviors and depression severity. Support vector machine analysis was used to determine whether changes in dietary behaviors could detect mild and moderate-severe depression.

RESULTS

The study found that individuals with moderate-severe depression had more irregular eating patterns, more fluctuated feeding times, spent more money on dinner, less diverse food choices, as well as eating breakfast less frequently, and preferred to eat only lunch and dinner, compared with HCs. Moderate-severe depression was found to be negatively associated with the daily 3 regular meals pattern (breakfast-lunch-dinner pattern; OR 0.467, 95% CI 0.239-0.912), and mild depression was positively associated with daily lunch and dinner pattern (OR 1.460, 95% CI 1.016-2.100). These changes in digital dietary behaviors were able to detect mild and moderate-severe depression (accuracy=0.53, precision=0.60), with better accuracy for detecting moderate-severe depression (accuracy=0.67, precision=0.64).

CONCLUSIONS

This is the first study to develop a profile of changes in digital dietary behaviors in individuals with depression using real-world behavioral monitoring. The results suggest that digital markers may be a promising approach for detecting depression.

Moderating role of depression in the association between leisure activity and cognitive function among the disabled older people

Background

This study delves into the complex interaction between leisure activities and cognitive function in older people with disabilities, with a particular emphasis on the moderating influence of depression. Despite the well-documented cognitive benefits of leisure activities among the older people, the intricate relationship between depression and the association between leisure activities and cognitive function in this specific demographic has been rarely reported.

Methods

Drawing on data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study meticulously examined a cohort of 713 participants aged 65-89 years. We constructed a moderation model to examine the impact of leisure activity on cognitive function in older people with disabilities, with depression levels as a moderating variable.

Results

We found a positive association between engagement in leisure activities and cognitive function, highlighting the potential cognitive advantages associated with leisure engagement among disabled older people. However, the present analysis also reveals a significant moderation effect of depression on this relationship, shedding light on the nuanced nature of this association. Specifically, elevated levels of depression emerge as a critical moderator, attenuating the otherwise favorable impact of leisure activities on cognitive function among older people contending with disabilities.

Conclusion

In conclusion, the findings provide a compelling rationale for tailored interventions that comprehensively target both leisure activity engagement and concurrent depression management, effectively fostering improvements in cognitive function among the cohort of disabled older people.

Associations of diet quality and daily free sugar intake with depressive and anxiety symptoms among Chinese adolescents

BACKGROUND

Assessing diet quality has been challenging, and the associations of diet quality and daily free sugar intake with depressive and/or anxiety symptoms have shown inconsistency.

METHODS

A total of 1749 students aged 12-16 years were recruited using stratified random cluster sampling across three cities in China. The overall Global Dietary Recommendations (GDR) score, a novel indicator of diet quality, was constructed using the low-burden Diet Quality Questionnaire. Free sugar intake, including from beverages and foods, was measured using the Food Frequency Questionnaire. Daily free sugar intake was divided into low, medium, and high categories based on the latest version of the dietary guidelines for Chinese residents. Binomial and multinominal logistic regression analyses were used to examine the associations of the overall GDR score and daily free sugar intake categories or different sources of free sugar intake with depressive and/or anxiety symptoms.

RESULTS

The overall GDR score was negatively associated with depressive symptoms (adjusted odds ratio[aOR] = 0.92, 95%CI: 0.87-0.98) and anxiety symptoms (0.95, 0.90-0.99), particularly with comorbid depression and anxiety (0.90, 0.84-0.97). Conversely, daily free sugar intake was positively associated with symptoms of depression and/or anxiety, the multiple aOR for symptoms depression or anxiety were significantly increased with higher daily free sugar intake (all Ptrend < 0.05). Both free sugar from beverages and from foods were positively associated with depressive and/or anxiety symptoms. These associations were consistent between males and females.

LIMITATIONS

Cross-sectional design and self-reported symptoms.

CONCLUSIONS

Diet quality was negatively associated with symptoms of depression or anxiety, especially with comorbid symptoms among adolescents. Daily free sugar intake, regardless of its sources, was positively associated with symptoms of depression and/or anxiety.

Dietary Habits and Depression in Community-Dwelling Chinese Older Adults: Cross-Sectional Analysis of the Moderating Role of Physical Exercise

BACKGROUND

Healthy diets and physical exercise, two modifiable lifestyle factors, are protective against depression in older adults. This study aimed to investigate whether physical exercise may influence the associations of dietary habits with depression in Chinese community-dwelling older adults.

METHODS

In the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, 12,708 community-dwelling older adults aged ≥65 years were included for analyses. Older adults' dietary habits (including daily intake of food components such as fruits, vegetables, animal oil, and so on) and physical exercise were assessed. Depression was evaluated via the 10 item Center for Epidemiologic Studies Depression (CES-D-10) scale. The influences of physical exercise on the associations of dietary habits with depression were estimated using logistic regression models adjusted for confounders.

RESULTS

Older adults who took physical exercise had a significantly decreased probability of depression (adjusted OR = 0.73, p < 0.001). As for dietary habits, the intake of fruits, vegetables, eggs, nut products, mushrooms or algae, and vitamins were inversely associated with the prevalence of depression (adjusted ORs = 0.61-0.81; p-values: from <0.001 to 0.025), while animal oil was positively associated with it (adjusted OR = 1.52, p < 0.001). When stratified by physical exercise, older adults who ate fruits or vegetables had consistent decreased risk of depression, no matter whether they took physical exercise or not (adjusted ORs = 0.52-0.70), while the intake of eggs, nut products, and vitamins were inversely associated, and animal oil was consistently positively associated with depression only in older adults who did not take physical exercise (adjusted ORs = 0.79, 0.68, 0.63, and 1.67, respectively).

CONCLUSIONS

Physical exercise may conceal the potential protective effects of some healthy dietary habits in terms of depression and counteract the detrimental effects of the unhealthy habits. Some dietary habits may be considered as alternative protective measures for depression in community-dwelling older adults when physical exercise cannot be performed.

The Effects of a Healthy Lifestyle on Depressive Symptoms in Older Chinese Adults: The Mediating Role of Psychological Resilience

Objectives This study aimed to validate the interrelationships and potential pathways of influence between healthy lifestyles, psychological resilience, and depressive symptoms in the Chinese elderly population. Methods We utilized data from the Chinese Elderly Health Influential Factors Tracking Survey 2018 and included 9448 samples for the study after screening according to the qualifying conditions. The interrelationships among healthy lifestyles, psychological resilience and depressive symptoms were analyzed using stepwise regression, and the robustness of mediation effects was assessed using Sobel and Bootstrap test. Results Among Chinese older adults, healthy lifestyles were negatively associated with depressive symptoms (β = -0.310, 95% CI: -0.405, -0.215), positively associated with psychological resilience (β = 0.137, 95% CI:0.071, 0.023), and psychological resilience was negatively associated with depressive symptoms (β = -1.014, 95% CI: -1.037, -0.990). Conclusions Psychological resilience partially mediated the association between healthy lifestyles and depressive symptoms, with the mediating effect accounting for 44.8% of the total effect. Our study contributes to the understanding of the relationship between healthy lifestyles and depressive symptoms in the elderly population and emphasizes the important role of psychological resilience. It is recommended that the government and policymakers improve depressive symptoms among older adults through comprehensive measures such as promoting healthy lifestyles and education, providing psychological support services, and creating a favorable environment.

Plant-Based Diet Indices and Their Association with Frailty in Older Adults: A CLHLS-Based Cohort Study

Within the realm of aging, the nexus between diet and health has garnered considerable attention. However, only select studies have amalgamated insights into the correlation between plant and animal food consumption and frailty. Our aim was to appraise the connections between the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) and frailty in the elderly, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This cohort study drew upon CLHLS data spanning from 2008 to 2018. The PDI, hPDI, and uPDI were gauged using a simplified food frequency questionnaire (FFQ). A frailty index, encompassing 35 variables across major health domains, was formulated. Cox proportional hazard models were employed to scrutinize the associations between the three plant-based dietary indices and frailty in older adults, including an exploration of gender disparities in these associations. A cohort of 2883 study participants was encompassed, with 1987 (68.9%) observed to be either frail or in the pre-frail stage. The Cox model with penalized spline exhibited linear associations of PDI, hPDI, and uPDI with the frailty index. Following covariate adjustments, it was discerned that older adults situated in the highest quartiles of PDI (HR = 0.86, 95% CI: 0.77-0.95) and hPDI (HR = 0.83, 95% CI: 0.74-0.93) experienced a 14% and 17% diminished risk of frailty compared to those in the lowest quartiles of PDI and hPDI, respectively. Conversely, when contrasted with those in the lowest quartile of uPDI, older adults adhering to the highest tertile of uPDI exhibited a 21% elevated risk of frailty (HR = 1.21, 95% CI: 1.08-1.36), with both associations achieving statistical significance (p < 0.01). Moreover, additional subgroup analyses revealed that the protective effects of PDI and hPDI against frailty and the deleterious effects of uPDI were more conspicuous in men compared to women. To forestall or decelerate the progression of frailty in the elderly, tailored dietary interventions are imperative, particularly targeting male seniors.

Relationships among oral hygiene behavior, toothache, and depressive symptoms in Chinese older adults

OBJECTIVES

The study aims to investigate the relationships among oral hygiene behavior, toothache, and depression among Chinese older adults.

METHODS

We used data came from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The Center for Epidemiologic Studies Depression Scale was used to evaluate depression. Binary logistic regression was performed to analyze the relationships among oral hygiene behavior, toothache, and depression.

RESULTS

A total of 12,172 older adults were included in the study, of whom 27.2% had depression. Compared with those who did not brush their teeth daily, those who brushed their teeth at least once daily exhibited lower odds of having depressive symptoms (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.77-0.97 versus OR = 0.81, 95% CI = 0.71-0.93). Compared with those who did not have toothache, those who had toothache over the past 6 months exhibited higher odds of having depression (OR = 1.49, 95% CI = 1.33-1.68). Living arrangement had a significant effect on the correlation between toothache and depression (p = 0.049), who lived alone and had toothache exhibited higher odds of having depressive symptoms.

CONCLUSIONS

Oral hygiene behavior and toothache are associated with depression. Taking effective measures to maintain a daily toothbrushing pattern and reduce the occurrence of toothache may mitigate the risk of depression among older adults, especially among those living alone.

CLINICAL RELEVANCE

The present study reports that the potential relationship between different oral hygiene behavior, toothache, and depressive symptoms.

Nutrition and Healthy Ageing in Asia: A Systematic Review

BACKGROUND

Nutrition plays a key role in modulating the likelihood of healthy ageing. In the present study, we aimed to conduct a systematic review to assess the impact of nutrition on healthy ageing in Asia.

METHODS

The systematic review was registered in the International Prospective Register of Systematic Reviews database (CRD42023408936) and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Web of Science, and Embase databases were searched up to February 2023 without language restrictions. We included prospective cohort studies that evaluated the associations of intake of a single food or consumption of a single nutrient at midlife; adherence to various dietary patterns at midlife; and improved adherence to dietary patterns from mid- to late life with the likelihood of healthy ageing and its components.

RESULTS

Out of 16,373 records, we included 71 papers comprising 24 cohorts from Singapore, China, Japan, and Thailand. The healthy ageing components included cognitive function, physical function, and depression. The majority of studies supported the observation that the likelihood of healthy ageing and its components in late life was positively increased by a higher consumption of healthy foods, such as vegetables, fruits, fish, nuts, legumes, tea, milk, and dairy, at midlife, and also by greater adherence to dietary patterns with high diversity scores or high total antioxidant capacities. Furthermore, improved adherence to healthy dietary patterns from mid- to late life also increased the likelihood of healthy ageing in late life.

CONCLUSION

Consuming healthy foods and adhering to healthy dietary patterns at midlife can promote the likelihood of healthy ageing. Moreover, improving diet quality from mid- to late life can still be beneficial.

Relationship between dietary pattern and depressive symptoms: an international multicohort study

BACKGROUND

Several previous studies have shown that dietary patterns are associated with the incidence of depressive symptoms. However, the results have been inconsistent. This study aimed to prospectively investigate the association between dietary patterns and the risk of depressive symptoms in two large cohort studies.

METHODS

The Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort study included a total of 7,094 participants living in Tianjin, China from 2013 to 2019, and the UK Biobank cohort study includes 96,810 participants who were recruited from 22 assessment centers across the UK taken between 2006 and 2010. All participants were free of a history of cardiovascular disease (CVD), cancer, and depressive symptoms at baseline. Dietary patterns at baseline were identified with factor analysis based on responses to a validated food frequency questionnaire in TCLSIH or Oxford WebQ in UK Biobank. Depressive symptoms were evaluated using the Chinese version of the Zung Self-Rating Depression Scale (SDS) in TCLSIH or hospital inpatient records in UK Biobank. Cox proportional hazards regression models were used to estimate the association between dietary patterns and depressive symptoms.

RESULTS

A total of 989, and 1,303 participants developed depressive symptoms during 17,410 and 709,931 person-years of follow-up. After adjusting for several potential confounders, the multivariable HRs (95% CIs) of the depressive symptoms were 0.71 (0.57, 0.88) for traditional Chinese dietary pattern, 1.29 (1.07, 1.55) for processed animal offal included animal food dietary pattern, and 1.22 (1.02, 1.46) for sugar rich dietary pattern in TCLSIH (all Q4 vs Q1). In the UK Biobank, the HRs (95% CIs) of depressive symptoms were 1.39 (1.16, 1.68) for processed food dietary pattern (Q4 vs Q1), 0.90 (0.77, 1.00) for healthy dietary pattern (Q3 vs Q1), and 0.89 (0.75, 1.05) for meat dietary pattern (Q4 vs Q1) in the final adjusted model.

CONCLUSION

Dietary patterns rich in processed foods were associated with a higher risk of depressive symptoms, and following a traditional Chinese dietary pattern or healthy dietary pattern was associated with a lower risk of depressive symptoms, whereas meat dietary pattern was not associated.

Increased Intake of Vegetables and Fruits Improves Cognitive Function among Chinese Oldest Old: 10-Year Follow-Up Study

BACKGROUND

In view of the rapidly accelerating aging process in China, this study looked at the associations between vegetables and fruits intake pattens and cognitive function among the oldest old in China using the genetic sub study from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

This study screened respondents who participated in all four surveys of longitudinal data from the CLHLS, and a total of 2454 participants were ultimately included. The relationships of cognitive function with vegetables and fruits intake patterns were examined using Generalized-estimating equations.

RESULTS

The prevalence range of mild cognitive impairment (MCI) was 14.3% to 16.9% at T1 to T3 and 32.7% at T4. There was a significant increase in the prevalence of MCI from T1 to T4 (β = 0.054; 95% CI, 0.037 to 0.070; p < 0.001; adjusted). The V+/F+ pattern significantly improved cognitive function in Chinese older adults compared with the V-/F- pattern (OR, 1.026; 95% CI, 1.001-1.053; p < 0.05).

CONCLUSION

Older adults who frequently consume both fruits and vegetables experience a reduction in MCI risk relative to those consuming these food groups infrequently-emphasizing the critical importance of the regular intake of both fruits and vegetables in maintaining cognitive function.