Abstract
Adolescence is a critical period for development of depression and understanding of behavioural risk factors is needed to support appropriate preventive strategies. We examined associations between adolescent diet quality and depressive symptoms, cross-sectionally and prospectively, in a large community cohort, adjusting for behavioural and psychosocial covariates. Prospective community-based cohort study (ROOTS). Secondary schools in Cambridgeshire and Suffolk, UK. Study participants (n 603) who completed 4 d diet diaries at age 14 years and reported depressive symptoms (Moods and Feelings Questionnaire (MFQ)) at 14 and 17 years of age. Diet data were processed to derive a Mediterranean diet score (MDS) and daily servings of fruit and vegetables, and fish. At age 14 years, a negative association between fruit and vegetable intake and MFQ score was seen in the unadjusted cross-sectional regression model (β=-0·40; 95 % CI -0·71,-0·10), but adjustment for behavioural covariates, including smoking and alcohol consumption, attenuated this association. Fish intake and MDS were not cross-sectionally associated with MFQ score. No prospective associations were found between MDS, fruit and vegetable intake or fish intake and later MFQ score. Diet quality was not associated with depressive symptoms in mid-adolescence. Previously reported associations in this age range may be due to confounding. Further longitudinal studies are needed that investigate associations between adolescent diet and depression across different time frames and populations, ensuring appropriate adjustment for covariates.
Highlights
Summary of main findings We found no prospective associations between Mediterranean diet score (MDS), fruit and vegetable intake or fish intake at age 14 years and depressive symptoms at age 17 years, adjusted for baseline depressive symptoms
Comparison with previous evidence and implications of the findings In the present study, using an MDS which incorporated adjustment for total energy intake, we found no associations between MDS and depressive symptoms
We suggest that previously reported associations may have been driven in part by the inability to adjust for energy intake and dietary misreporting; under-reporting of energy intake is higher in specific population groups, such as obese individuals, with some limited evidence for higher under-reporting among depressed individuals[58]
Summary
Study population and design The ROOTS study is a longitudinal cohort study of adolescent development, focusing on the risk patterns and processes for the emergence of psychopathology during adolescence[19,20]. Participants with three or more days of diet diary data available were included in the analysis Extreme misreporters, those reporting an energy intake of 3500 kcal/d), were excluded[30]. Based on associations reported in published literature, covariates included sociodemographic factors (sex, socioeconomic status (SES))(1,34,35), behavioural factors (smoking level, level of alcohol consumption, physical activity, sleep)(36–41), psychosocial factors (friendship quality, selfesteem, family functioning)(42,43), anthropometric factors (percentage body fat)(9,44), medication use and total energy intake[45]. Model 1 included only sociodemographic covariates, behavioural covariates were added in model 2, and psychosocial and anthropometric covariates were added in model 3, along with data on medication use and adjustment for total energy intake. We conducted a secondary analysis of all participants for whom data on predictor and outcome variables were available (n 804), with imputation of missing covariate data (under the missing at random assumption), following recommendations from White et al[56]
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