Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023)
Abstract
:1. Introduction
2. Methodology
3. Dietary Nutrient Deficiencies and Risk of Depression
3.1. Macronutrients and Water
3.2. Polyunsaturated Fatty Acids
3.3. Vitamins
3.3.1. Vitamins of the B Group
3.3.2. Vitamin D
3.4. Mineral Components
4. Limitations
5. Strengths and Future Research Directions
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
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Authors | Year of Publication | Type of Study | The Group | Assessment of Depression and Dietary Intake | Results and Conclusions |
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Proteins | |||||
Li et al. [47] | 2020 | National cross-sectional survey | n = 17,845 adults | Patient Health Questionnaire-9 (PHQ-9) and two 24 h dietary recall interviews | Total protein intake and protein intake from milk and dairy products may reduce the risk of depressive symptoms in American adults, but not for protein intake from red meat, poultry, fish, cereals, and legumes. |
Sheikhi et al. [48] | 2023 | Cross-sectional study | n = 489 Iranian women | Depression, Anxiety, and Stress Scales (DASS) questionnaire and Semi-quantitative Food Frequency Questionnaire | Women were more likely to show symptoms of depression in the highest tertile of animal protein intake. A diet high in animal protein may predispose to mental illness. |
Amino acids | |||||
Suga et al. [49] | 2018 | Cross-sectional study | n = 7923 adults | Center for Epidemiologic Studies Depression Scale (CES-D) and validated, self-administered diet history questionnaire | Women with depression consumed more energy and less tryptophan than women without depression. Tryptophan intake was inversely associated with depressive symptoms in young adult women. |
Koochakpoor et al. [50] | 2021 | Cross-sectional study | n = 3175 adults | Hospital Anxiety and Depression Scale (HADS) and Food Frequency Questionnaire (FFQ) | Subjects in the study with the highest total branched-chain amino acid (BCAA) tercile intake had a lower risk of depression. There was also a significant inverse relationship observed between isoleucine intake and the likelihood of depression. |
Reuter et al. [51] | 2021 | Cross-sectional study | n = 482 adults | Beck Depression Inventory-II (BDI-II) and participants were asked for their general consumption of TRP-rich foods | A diet rich in tryptophan has been shown to have a positive effect on mood. High amounts of tryptophan in the diet appear to protect against depression and have a positive effect on social interactions. |
Fats | |||||
Wilson et al. [52] | 2021 | Cross-sectional study | n = 887 adults | Beck Depression Inventory-II (BDI-II) and Dietary Instrument for Nutrition Education questionnaire (DINE) | No relationship was observed between the amount of fat ingested in the diet and mental health. |
Currenti et al. [53] | 2023 | Cross-sectional study | n = 1572 adults | Center for the Epidemiological Studies of Depression Short Form (CES-D and two Food Frequency Questionnaires (FFQs; a long and a short version) | No association was found between total fat intake and depressive symptoms. |
Carbohydrates | |||||
Sanchez-Villegas et al. [54] | 2018 | Prospective cohort study | n = 15,546 adults | Follow-up questionnaire and diagnosis of depression using a clinical interview for DSM-IV and Semi-quantitative FFQ | Greater exposure to added sugars and low-quality carbohydrates correlate with a higher risk of depression. |
Ebrahimpour-Koujan et al. [55] | 2019 | Cross-sectional study | n = 3362 adults | Hospital Anxiety and Depression Scale and General Health Questionnaire-12 and Semi-quantitative Food Frequency Questionnaire | Depression was not associated with adherence to a low-carbohydrate diet. |
Makhani et al. [56] | 2021 | Cross-sectional study | n = 9728 adults | Patient Health Questionnaire-9 (PHQ-9) and two 24 h dietary recall interviews | The higher the ratio of carbohydrate-to-fibre intake in the diet, the higher the risk of depressive symptoms, which can be moderate to severe in severity. |
Amirinejad et al. [57] | 2022 | Cross-sectional study | n = 7384 adults | Depression Anxiety Stress Scales and Validated Food Frequency Questionnaire | No significant association was observed between the dietary glycaemic index (DGI) and glycaemic load (DGL) and the likelihood of depression. |
Total macronutrients | |||||
Pooyan et al. [58] | 2018 | Cross-sectional study | n = 265 adults | Depression Anxiety Stress Scales 21 (DASS-21) and Semi-quantitative Food Frequency Questionnaire and blood samples were taken, and biochemical measurements were taken | A significant interaction was found between the high-protein and low-fat diets and the low-fat diet and the rs7041 polymorphism in groups with moderate and severe depression. In healthy adults without chronic diseases, a high-protein, low-fat diet may interact with the VDBP genotype to reduce the risk of depression. |
Oh et al. [59] | 2020 | Cross-sectional study | n = 76,635 (60,935 from the United States and 15,700 from South Korea) | Patient Health Questionnaire-9 (PHQ-9) and 24 h dietary recall interview | In both the United States and South Korea, people with low protein intake had a significantly higher risk of depression than those with normal protein intake. When the proportion of kilocalories consumed from protein increased by 10%, the prevalence of depression was significantly reduced. There was no significant association between fat intake and depression in either country. An association was observed between carbohydrate intake and the incidence of depression in the United States, but not in South Korea. |
Eissenstat et al. [60] | 2020 | Cross-sectional study | n = 4747 adults | Patient Health Questionnaire-9 (PHQ-9) and two 24 h dietary recall interviews | For respondents of Hispanic origin, total protein intake and fats were negatively associated with depressive symptoms. In Caucasians, the intake of dietary fibre was negatively associated with symptoms of depression. |
Lee et al. [61] | 2021 | Cross-sectional study | n = 6336 adults (3102 Korean adults and 3234 Americans) | Patient Health Questionnaire-9 (PHQ-9) and 24 h dietary recall interview | A low intake of protein and dietary fibre as a result of food insecurity can increase the risk of depression. Adequate diet and food security can play an important role in the prevention of depression. |
Water | |||||
Haghighatdoost et al. [62] | 2018 | Cross-sectional study | n = 3327 adults | Hospital Anxiety and Depression Scale and water consumption was assessed by asking about the number of glasses of water that were consumed daily (<2, 2–5, and ≥5 glasses of water/day) | A significant inverse relationship was shown between water consumption and depression. Drinking <2 glasses of water per day was associated with a 73% increased risk of depression in men and 54% in women. |
Authors | Year of Publication | Type of Study | The Group | Assessment of Depression and Dietary Intake | Results and Conclusions |
---|---|---|---|---|---|
Sánchez-Villegas et al. [70] | 2018 | Cross-sectional study | n = 6874 adults | Beck Depression Inventory-II and 143-item Semi-quantitative Food-Frequency Questionnaire | Total omega-3 fatty acid intake (approximately 0.5–1 g/day) was significantly associated with a lower incidence of depression. |
Park et al. [71] | 2020 | Cohort study | n = 2200 adult women | Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies-Depression scale (CES-D) assessment questionnaires, and n-3 FA intakes were assessed using a Semi-quantitative Food-Frequency Questionnaire | A higher intake of omega-3 fatty acids was associated with increased connectivity within the neural networks associated with emotion and attention, and increased connectivity between the regions of the brain associated with emotion control and cognitive processes. Omega-3 fatty acid intake may have an effect on brain function and possibly a role in the reduction of depressive symptoms in middle-aged women. |
Zhang et al. [72] | 2020 | Cross-sectional study | n = 17,431 adults | PHQ-9 (nine-item Patient Health Questionnaire) and two 24 h dietary recall interviews | A higher intake of omega-3 fatty acids was associated with a lower risk of depressive symptoms, while a higher intake of omega-6 fatty acids was associated with a higher risk of depressive symptoms. A higher omega-6:omega-3 ratio was also associated with a higher risk of depressive symptoms. |
Li et al. [73] | 2020 | Cross-sectional study | n = 3054 adult women | Center for Epidemiological Studies Depression Scale (CES-D) and Food Frequency Questionnaire (FFQ) | A higher intake of omega-3 fatty acids was associated with a lower risk of depression in early perimenopausal women. |
Berger et al. [74] | 2020 | Cross-sectional study | n = 206 adults | Patient Health Questionnaire-9 (PHQ-9) and diet with a structured questionnaire | Higher intakes of seafood and omega-3 fatty acids were associated with a lower risk of depressive symptoms. A protective factor against depression may be the availability of fresh seafood in the local diet. |
Chaves et al. [75] | 2022 | Longitudinal study | n = 13,879 adults | The Clinical Interview Schedule Revised (CIS-R) and Food Frequency Questionnaire (FFQ) | The protective effect of omega-3s (total and subtypes) has been shown, with reductions of 2–65% in the risk of major depressive disorder. Consumption of all types of omega-3 fatty acids was lower among those with persistent depressive episodes. |
Vitamin B | Effects on the Nervous System and Risk of Depression |
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Vitamin B1 (thiamine) | Thiamine is an important coenzyme during the synthesis of neurotransmitters, such as acetylcholine and serotonin, for example. The most important function of thiamine is considered to be that it makes a major contribution to cellular energy metabolism and, as an essential cofactor in carbohydrate metabolism, it helps to supply energy to nerve cells [84]. An inverse relationship has been shown between thiamine levels and depressive symptoms in adults [85]. |
Vitamin B6 (pyridoxine) | Pyridoxine functions as a cofactor in the pathways involved in myelin synthesis and enzymatic reactions, including the synthesis of neurotransmitters such as gamma-aminobutyric acid (GABA), serotonin, and dopamine [86]. Furthermore, it controls glutamate excitability and neuronal metabolism. Vitamin B6 and magnesium both modulate neurobiological mechanisms, leading to speculation that they may exert synergistic effects [87]. Pyridoxal-5-phosphate concentrations, the active form of vitamin B6, were measured in Hispanic adults in years 2 and 5 of the study, and it was observed that depressive symptoms were higher in those with low values [88]. |
Vitamin B9 (folic acid) | Folic acid is involved in the synthesis and metabolism of neurotransmitters associated with depression (serotonin, dopamine, norepinephrine). In addition, it plays a vital role in the regeneration of tetrahydrobiopterin (BH4), a cofactor essential for the formation of neurotransmitters [89]. An association has been shown between lower serum folic acid levels during pregnancy and prenatal depression [90]. |
Vitamin B12 (cobalamin) | A specific function of vitamin B12 is to participate in the DNA synthesis of myelin-producing oligodendrocytes and in the synthesis of myelin [83,85]. Cobalamin is a cofactor of the methionine synthase enzyme, which catalyses the reaction to transfer a methyl group to a homocysteine molecule. Methionine is formed, which is the precursor of S-adenosylmethionine (SAM). SAM plays an important role in the methylation processes necessary for the normal synthesis and/or metabolism of membrane phospholipids, DNA, RNA, neurotransmitters and for the normal function of the myelin sheaths of nerve fibres [91]. Vitamin B12 deficiency may be associated with impaired glutathione peroxidase activity elevated levels of free radicals. Furthermore, the prevalence of depression tends to be higher among vegetarians due to insufficient intake of vitamin B12 [92]. |
Authors | Year of Publication | Type of Study | The Group | Assessment of Depression and Dietary Intake | Results and Conclusions |
---|---|---|---|---|---|
Vitamin B1 | |||||
Duc et al. [97] | 2021 | National cross-sectional survey | n = 34,700 adults | Depression was defined as physician diagnosis, the current presence or treatment for depression and 24 h dietary recall interview and a Semi-quantitative Questionnaire on Food Frequency | Serum vitamin B1 concentrations were assessed and related to dietary intake. Low serum thiamine concentrations were associated with a high incidence of depressive symptoms. Increased daily vitamin B1 intake was negatively associated with the appearance of depression. |
Nguyen et al. [98] | 2022 | National cross-sectional survey | n = 16,371 adults | Depression was defined based on the diagnosis of the physician or the current presence or treatment of depression, and daily food intake was calculated using the 24 h recall method and a Semi-quantitative Food Frequency Questionnaire (FFQ) | A higher dietary intake of vitamin B1, B3, or A reduces the risk of depression in a nationally representative Korean cohort. |
Vitamin B6 | |||||
Kafeshani et al. [99] | 2020 | Cross-sectional study | n = 3362 adults | Hospital Anxiety and Depression Scale (HADS) and a validated, 106-item Food Frequency Questionnaire (FFQ) | The average intake of vitamin B6 (mg/day) was lower in people with depression. A lower intake of vitamin B6 in the general population and among women was associated with a higher likelihood of depression. |
Odai et al. [100] | 2020 | Cross-sectional study | n = 289 adult women | Hospital Anxiety and Depression Scale (HADS) and self-administered diet history questionnaire (BDHQ) | Symptoms of moderate-to-severe depression were associated with a lower dietary intake of vitamin B6. Symptoms of depression may be reduced by increasing your intake of vitamin B6. |
Vitamins B9 and B12 | |||||
Khosravi et al. [101] | 2020 | Clinical-control study | n = 260 women (87 depressed and 173 healthy) and 70 men (22 depressed and 48 healthy) | The major depressive disorder(s) of the participants was diagnosed by psychiatrists using the criteria of DSM-IV and for the control group Beck Depression Inventory questionnaire (BDI-II), and the dietary intake in the last 12 months was evaluated using a Semi-quantitative Food Frequency Questionnaire (FFQ). | In addition to dietary nutrient intake, their serum concentrations were evaluated and related to each other. An unhealthy diet was associated with a higher risk of depression through a reduction in the serum levels of vitamins B9 and B12. |
Zheng et al. [102] | 2020 | Cross-sectional study | n = 19,244 adults | Patient Health Questionnaire-9 (PHQ-9) and 24 h dietary recall interview | Synthetic folic acid was not associated with depressive symptoms, but total and natural folate intakes were inversely associated with depressive symptoms. |
Mahdavifar et al. [103] | 2021 | A population-based prospective cohort study | n = 7387 Iranian adults | Iranian validated version of depression, anxiety, and stress scale questionnaire 21 (DASS 21) and Semi-quantitative Food Frequency Questionnaire (DS-FFQ) | Low intakes of B vitamins, including folic acid, vitamin B6, and vitamin B12, were associated with higher depressive symptoms. Higher biotin intake was significantly associated with lower incidence of depressive symptoms. |
Authors | Year of Publication | Type of Study | The Group | Assessment of Depression and Dietary Intake | Results and Conclusions |
---|---|---|---|---|---|
Vitamin D | |||||
Pooyan et al. [58] | 2018 | Cross-sectional study | n = 265 adults | Depression Anxiety Stress Scales 21 (DASS-21) and Semi-quantitative Food Frequency Questionnaire (FFQ) | In healthy adults without chronic disease, a high-protein/low-fat diet may interact with the genotype of vitamin D-binding protein VDBP to reduce the risk of depression. |
Jahrami et al. [118] | 2020 | Clinical-control study | n = 192 participants: 96 patients with depression and 96 age- and sex-matched controls | Beck Depression Inventory-II (BDI-II) and Food Frequency Questionnaire (FFQ) (covering 102 foods distributed on 38 items/groups) | Depressed patients have significantly lower serum vitamin D levels. Depressed patients appeared to have statistically significantly less vitamin D from sunlight sources, even though dietary vitamin D intake was the same in both groups. Approximately 80% of depressed patients and 70% of controls have been shown not to take adequate daily doses of vitamin D. |
Authors | Year of Publication | Type of Study | The Group | Assessment of Depression and Dietary Intake | Results and Conclusions |
---|---|---|---|---|---|
Magnesium | |||||
Anjom-Shoae et al. [147] | 2018 | Cross-sectional study | n = 3172 adults | Hospital Anxiety and Depression Scale (HADS) and dish-based 106-item Semi-quantitative FFQ (DS-FFQ) | Among normal-weight men and overweight women, a significant inverse association was found between magnesium intake and depression. |
Sun et al. [148] | 2019 | Cross-sectional study | n = 17,730 adults from the National Health and Nutrition Examination Survey | Patient Health Questionnaire (PHQ-9) and two 24 h dietary recall interviews | Lower magnesium intake was associated with a higher risk of depression, particularly in the female group. In all age groups, the inverse association between dietary magnesium intake and risk of depression was statistically significant. |
Chou et al. [149] | 2023 | Cross-sectional study | n = 4615 adults | 5-Item Brief Symptom Rating Scale (BSRS-5) and Serum Magnesium (mg/dL) and dietary magnesium intake (mg)—24 h dietary recall questionnaire | Serum magnesium concentration was inversely correlated with the occurrence of depressive symptoms, which was not shown for the dietary magnesium intake. Serum magnesium was poorly correlated with dietary magnesium. The level of serum magnesium was negatively associated with depressive symptoms in the sample, in the men, but not in the women. |
Zinc | |||||
Hajianfar et al. [150] | 2021 | Cross-sectional study | n = 142 female students | The Beck Depression Inventory-II (BDI-II) and Semi-quantitative Food Frequency Questionnaire (FFQ) | In Iranian female students, an inverse association was observed between dietary zinc intake and mood disorders, including depression, and some indicators of sleep disturbance. |
Hu et al. [151] | 2022 | Cross-sectional study | n = 31,839 adults | Patient Health Questionnaire-9 (PHQ-9 and two 24 h dietary recall interviews | Especially in the female population, low dietary intakes of zinc and vitamin A were significantly associated with depression. In the low zinc intake group, the risk of depression was significantly reduced with increased total vitamin A intake. |
Selenium | |||||
Ghimire et al. [152] | 2019 | Cross-sectional study | n = 7725 adult participants in the National Health and Nutrition Examination Survey (NHANES) | Patient Health Questionnaire-9 (PHQ-9) and 24 h dietary recall interview | An inverse relationship was observed between participants’ dietary selenium intake and depressive symptoms. There was no association between serum selenium levels and depressive symptoms. |
Ferreira de Almeida et al. [153] | 2021 | Cross-sectional study | n = 736 adult farmers | Mini-International Neuropsychiatric Interview and three 24 h dietary recall interviews | A high intake of selenium is associated with a lower incidence of depression, even after taking into account sociodemographic variables, lifestyle factors, and pesticide poisoning. |
Copper | |||||
Nakamura et al. [154] | 2019 | Cross-sectional study | n = 2089 adults | Kessler’s six-item psychological distress scale (K6) and the FFQ include 87 food items and ask about the usual consumption rates and portion sizes during the previous month. | Low intakes of zinc, copper, and manganese were associated with depressive symptoms. For calcium, magnesium, and iron, the inverse relationship was not statistically significant. |
Iron | |||||
Li et al. [155] | 2018 | Cross-sectional study | n = 14,834 adults | Patient Health Questionnaire (PHQ-9) and 24 h dietary recall | Participants with depression had significantly lower total daily zinc, iron, copper, selenium, and energy intakes than those without depression. Higher zinc, iron, copper, and selenium intake was negatively associated with depression, and negative associations with copper and selenium intake remained statistically significant after considering potential confounders. |
Calcium | |||||
Shen et al. [156] | 2023 | Cross-sectional study | n = 14,971 adults | Patient Health Questionnaire (PHQ-9) and 24 h dietary recall | Even after adjusting for a large number of potential confounders, calcium intake was negatively associated with the risk of depressive symptoms. The incidence of depressive symptoms decreased as calcium intake increased. |
Various Minerals | |||||
Sánchez-Villegas et al. [157] | 2018 | Cohort study | n = 13,983 students | 136-item validated Semi-quantitative Food Frequency Questionnaire (FFQ) and structured clinical interview for DSM-IV (SCID-I) | A deficiency of 4 nutrients at baseline increased the risk of depression (folic acid, magnesium, calcium, and potassium) in this longitudinal study of a middle-aged population. |
Salehi-Abargouei et al. [158] | 2019 | Cross-sectional study | n = 3846 adults | Hospital Anxiety and Depression Scale (HADS) and Semi-quantitative Food Frequency Questionnaire (FFQ) | It has been shown that higher intakes of B12, zinc, phosphorus, saturated fats, cholesterol, B5, and B6 are associated with a reduced risk of major depression in men and a reduced risk of psychological distress in women. |
Yun et al. [159] | 2021 | Cross-sectional study | n = 10,106 adults | Patient Health Questionnaire-9 (PHQ-9) and nutrient intake and dietary habit information of the K-NHANES were used as independent variables. | Sugar, sodium, vitamin A, water, fat, saturated fatty acids, omega-6 fatty acids, dietary fibre, and frequency of breakfast, lunch, dinner, and eating out were significantly associated with depression. |
Ferriani et al. [160] | 2022 | Longitudinal study | n = 14,737 adults | Clinical Interview Schedule Revised (CIS-R) and Food Frequency Questionnaire (FFQ) | A significant inverse relationship was found between depression and a higher intake of selenium, zinc, vitamins B6 and B12 in the sample. Among women, a similar pattern of correlation was observed, in addition to higher intakes of vitamins A and C. Among men, a significant inverse relationship between depression was only observed with vitamin B12 and B6 intake. The incidence and severity of depression may be reduced by increasing intake of selected micronutrients. |
Nutrient | Conclusions |
---|---|
Proteins | Higher total protein consumption as well as that specifically derived from milk and dairy products might potentially lower the susceptibility to depressive symptoms. No benefit has been shown for protein intake from animal sources [47,48]. A beneficial effect of a higher supply of tryptophan in the diet has been shown to decrease the risk of depression [49,50,51]. A diet with an increased supply of protein relative to other macronutrients may have a beneficial effect on the risk of depression in adults who do not have any chronic diseases [58,59,60,61]. |
Fats | No association has been observed between total fat consumption and the manifestation of depressive symptoms [52,53,59], although not all results are conclusive [58,60]. |
Carbohydrates | Greater exposure to added sugars, low-quality carbohydrates, and low dietary fibre intake have been shown to correlate with a higher risk of depression [54,57]. No significant association was observed between the dietary glycaemic index and the dietary glycaemic load and the likelihood of depression [57]. |
Water | To date, it has not been conclusively demonstrated that dietary water intake directly affects the risk of depression; however, dehydration can exacerbate, for example, fatigue and depression. Therefore, it is worth ensuring that the body is adequately hydrated to avoid the negative effects of dehydration [46,62]. |
Polyunsaturated fatty acids | All the publications cited showed a beneficial effect of increased omega-3 fatty acid intake to prevent the onset of depressive symptoms in different groups [70,71,72,73,74,75]. |
Vitamins of the B group | Low dietary and/or serum levels of vitamins B1, B6, B9, and B12 have been associated with a higher prevalence of depressive symptoms [97,98,99,100,101,102,103]. The findings suggest that the intake of adequate amounts of B vitamins may have a positive impact on mental health and reduce the risk of depressive symptoms. |
Vitamin D | Depressed patients have significantly lower serum vitamin D levels [58,118]. It has been shown that approximately 80% of depressed patients do not take adequate daily doses of vitamin D [118]. |
Mineral Components | Dietary deficiencies in magnesium, zinc, selenium, copper, and manganese have been associated with a greater likelihood of depression [147,148,149,150,151,152,153,154,155,156,157,158,159,160]. Both excess and deficiency of copper and iron may affect the risk of depression [135,145,154,155]. |
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Zielińska, M.; Łuszczki, E.; Dereń, K. Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023). Nutrients 2023, 15, 2433. https://doi.org/10.3390/nu15112433
Zielińska M, Łuszczki E, Dereń K. Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023). Nutrients. 2023; 15(11):2433. https://doi.org/10.3390/nu15112433
Chicago/Turabian StyleZielińska, Magdalena, Edyta Łuszczki, and Katarzyna Dereń. 2023. "Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023)" Nutrients 15, no. 11: 2433. https://doi.org/10.3390/nu15112433
APA StyleZielińska, M., Łuszczki, E., & Dereń, K. (2023). Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023). Nutrients, 15(11), 2433. https://doi.org/10.3390/nu15112433