Abstract
The role of a properly balanced diet in the prevention and treatment of mental disorders has been suggested, while vegetables and fruits have a high content of nutrients that may be of importance in the case of depressive disorders. The aim of the study was to conduct a systematic review of the observational studies analyzing association between fruit and vegetable intake and mental health in adults. The search adhered to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42019138148). A search for peer-reviewed observational studies published until June 2019 was performed in PubMed and Web of Science databases, followed by an additional manual search for publications conducted via analyzing the references of the found studies. With respect to the intake of fruit and/or vegetable, studies that assessed the intake of fruits and/or vegetables, or their processed products (e.g., juices), as a measure expressed in grams or as the number of portions were included. Those studies that assessed the general dietary patterns were not included in the present analysis. With respect to mental health, studies that assessed all the aspects of mental health in both healthy participants and subjects with physical health problems were included, but those conducted in groups of patients with intellectual disabilities, dementia, and eating disorders were excluded. To assess bias, the Newcastle–Ottawa Scale (NOS) was applied. A total of 5911 studies were independently extracted by 2 researchers and verified if they met the inclusion criteria using a 2-stage procedure (based on the title, based on the abstract). After reviewing the full text, a total of 61 studies were selected. A narrative synthesis of the findings from the included studies was performed, which was structured around the type of outcome. The studies included mainly focused on depression and depressive symptoms, but also other characteristics ranging from general and mental well-being, quality of life, sleep quality, life satisfaction, flourishing, mood, self-efficacy, curiosity, creativity, optimism, self-esteem, stress, nervousness, or happiness, to anxiety, minor psychiatric disorders, distress, or attempted suicide, were analyzed. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. However, it must be indicated that the studies included were conducted using various methodologies and in different populations, so their results were not always sufficiently comparable, which is a limitation. Taken together, it can be concluded that fruits and/or vegetables, and some of their specific subgroups, as well as processed fruits and vegetables, seems to have a positive influence on mental health, as stated in the vast majority of the included studies. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health.
Highlights
Mental disorders (referred by the International Statistical Classification of Diseases and RelatedHealth Problems (ICD-10) [1] as F00–F99) are indicated as a global problem by the World HealthOrganization (WHO)
Among 61 included studies, the majority were conducted for European countries (20 studies), Asian countries (14 studies), or United States of America (USA) (11 studies), and those conducted for African (1 study), or South American country (1 study), Australia or New Zealand (7 studies), or Canada (3 studies) were included and some of them were conducted for mixed countries (4 studies)
It should be indicated that 3 included studies were conducted in a specific populations, while the health-related inclusion criteria for the study were defined as prediabetes and/or prehypertension [35], being after coronary artery bypass grafting surgery [36], or having excessive body mass [37]
Summary
Mental disorders (referred by the International Statistical Classification of Diseases and RelatedHealth Problems (ICD-10) [1] as F00–F99) are indicated as a global problem by the World HealthOrganization (WHO). Within the Comprehensive Mental Health Action Plan 2013–2020 implemented by the WHO [4], it was indicated that there is a need for, inter alia, evidence-based practice for a life course and a multidisciplinary approach to solve this problem. Some published studies have concluded that following a properly balanced diet allows maintaining a better well-being and lowers the risk of mental disorders in adolescents and students [5,6]. This finding was confirmed by O’Neil et al in their systematic review [7]. A therapeutic role was indicated for the Mediterranean diet in 2 randomized controlled trials—HELFIMED [8] and SMILES [9]—for the adults suffering from depression
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