Association of the Mediterranean Dietary Pattern With the Incidence of Depression

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The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort
Almudena Sánchez-Villegas, BPharm, PhD; Miguel Delgado-Rodríguez, MD, PhD, MPH; Alvaro Alonso, MD, PhD; Javier Schlatter, MD, PhD;Francisca Lahortiga, BA, PhD; Lluis Serra Majem, MD, PhD; Miguel Angel Martínez-González, MD, PhD, MPH
Context Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression.
Objective To assess the association between adherence to the MDP and the incidence of clinical depression.
Design Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted.
Setting A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project).
Participants A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing.
Main Outcome Measure Participants were classified as having incident depression if they were free of depression and antidepressantmedication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up.
Results After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes.
Conclusions Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.
Author Affiliations: Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Spain (Drs Sánchez-Villegas and Serra-Majem); Division of Preventive Medicine and Public Health, University of Jaén, Spain (Dr Delgado-Rodríguez); Department of Preventive Medicine and Public Health, Clinic of the University of Navarra, Pamplona, Spain (Drs Sánchez-Villegas, Alonso, and Martínez-González); Department of Psychiatry and Medical Psychology, University of Navarra (Drs Schlatter and Lahortiga); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (Dr Alonso).
Arch Gen Psychiatry. 2009;66(10):1090-1098.

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