Abstract
Little is known about the relationship between diet and depression through the gut microbiota among breast cancer patients. This study aimed to examine the dietary intake differences between depressed breast cancer (DBC) and non-depressed breast cancer (NBC) patients, and whether the differences could lead to gut microbiota changes that affect depressive symptoms. Participants completed the Center for Epidemiological Studies-Depression Scale (CES-D) and 24 h dietary recall. Fecal samples of 18 DBC patients and 37 NBC patients were collected for next-generation sequencing. A total of 60 out of 205 breast cancer patients reported significant depressive symptoms suggested by a CES-D score ≥ 16, which might be related to lower intakes of energy, protein, dietary fiber, vitamin A, vitamin B2, niacin, calcium, phosphorus, potassium, iron, zinc, selenium, manganese and tryptophan, and a poor diet quality indicated by a lower total Chinese Healthy Eating Index (CHEI) score. Additionally, NBC patients demonstrated greater gut microbiota diversity and a healthier composition, in which the relative abundances of Proteobacteria and Escherichia-Shigella were both lower than in the DBC patients (p < 0.05). Alpha diversity was a significant mediator between diet quality and depression, while calcium, phosphorus and selenium significantly regulated depression independent of the gut microbiota. Breast cancer-related depressive symptoms might be associated with a poor diet quality via gut microbiota-dependent pathways and lower micronutrient intake via microbiota-independent pathways.
Highlights
IntroductionStudies have shown that the disease diagnosis and treatment might cause psychiatric comorbidities in breast cancer patients, such as emotional and cognitive disorders [2]
Breast cancer has become the most commonly diagnosed cancer among women worldwide, with approximately 2.26 million newly diagnosed cases and 685,000 deaths in 2020 [1].Studies have shown that the disease diagnosis and treatment might cause psychiatric comorbidities in breast cancer patients, such as emotional and cognitive disorders [2]
Out of the 205 patients, 60 (29.3%) patients were allocated to the depressed breast cancer (DBC) group by the Center for Epidemiological Studies-Depression Scale (CES-D) score, and 145 (70.7%) patients were in the non-depressed breast cancer (NBC) group
Summary
Studies have shown that the disease diagnosis and treatment might cause psychiatric comorbidities in breast cancer patients, such as emotional and cognitive disorders [2]. As one of the most common psychiatric symptoms, the incidence of depression in breast cancer survivors (ranging from 9.4% to 66.1%) was much higher than in women without cancer [3,4]. Accumulated evidence suggested that the factors leading to depression in breast cancer patients included demographic and social, disease, psychological and behavioral factors [2,6], in which the avoidance of lifestyle risk factors (especially diet) might lead to a reduction in depression [7]. Better diet quality or healthy dietary patterns were related to lower depressive symptoms [9,10]. A balanced dietary pattern (e.g., the Mediterranean diet) and some foods (e.g., fish, fresh vegetables and fruits) have been related to a lower risk of depression or depressive symptoms; a high-fat Western diet and sugar-sweetened beverages have been considered as the risk factors [11]. The reality is that breast cancer patients rarely get professional dietary advice after their diagnosis, and some patients may have nutritional problems such as insufficient nutrient intake and an unreasonable dietary structure, which may increase the risk of depression
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