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Adherence to the DASH diet in relation to psychological profile of Iranian adults

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Abstract

Introduction

Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health.

Objective

We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults.

Methods

This cross-sectional study was done among 3846 general public adults in Isfahan, Iran. Dietary assessment was conducted using a validated 106-item dish-based semiquantitative food frequency questionnaire. To investigate participants’ adherence to DASH-style diet, we created DASH score based on earlier publications focusing on eight components (fruits, vegetables, nuts and legumes, dairy products, grains, sweetened beverages and sweets, sodium, and red and processed meats). Participants were classified into three categories based on their DASH score [low (≤40), moderate (41–50), and high adherence (≥51)]. This categorization, instead of distribution-based classification, was used due to low adherence to the DASH dietary pattern in the study population. Psychological health was examined by means of validated Hospital Anxiety and Depression Scale and General Health Questionnaire. Depression, anxiety, and psychological distress were defined based on standard criteria.

Results

We found that moderate adherence to DASH-style diet was associated with lower odds of depression (OR 0.73; 95 % CI 0.59–0.90, P trend = 0.63) compared with those with the lowest adherence. In our stratified analyses, these associations remained significant for women (0.70; 0.54–0.91) and for normal-weight participants (0.70; 0.52–0.92). Moreover, after controlling for potential confounders, an inverse association was observed between high adherence to DASH-style diet and anxiety in normal-weight participants (0.61; 0.37–0.98). Such associations were also seen between moderate adherence to DASH-eating style and anxiety in overweight or obese individuals (0.63; 0.42–0.95). We failed to find any significant association between consumption of DASH-style diet and psychological distress.

Conclusion

We found an inverse association between moderate adherence to DASH dietary pattern and depression. Further prospective studies are required to confirm these findings.

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References

  1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382(9904):1575–1586

    Article  Google Scholar 

  2. Baxter A, Scott K, Vos T, Whiteford H (2012) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 10:1–14

    Google Scholar 

  3. Ferrari A, Somerville A, Baxter A, Norman R, Patten S, Vos T, Whiteford H (2013) Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med 43(2012):471–481

    Article  CAS  Google Scholar 

  4. Noorbala A, Yazdi SB, Yasamy M, Mohammad K (2004) Mental health survey of the adult population in Iran. Br J Psychol Med 184(1):70–73

    CAS  Google Scholar 

  5. Opie RS, O’Neil A, Itsiopoulos C, Jacka FN (2014) The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials. Public Health Nutr 18(11):2074–2093

    Article  Google Scholar 

  6. Murakami K, Sasaki S (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Mol Nutr Food Res 54(4):471–488

    Article  CAS  Google Scholar 

  7. Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13(1):3–9

    Article  CAS  Google Scholar 

  8. Panagiotakos D (2008) α-priori versus α-posterior methods in dietary pattern analysis: a review in nutrition epidemiology. Nutr Bull 33(4):311–315

    Article  Google Scholar 

  9. Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J (2014) A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr 99(1):181–197

    Article  CAS  Google Scholar 

  10. Quirk SE, Williams LJ, Adrienne O, Pasco JA, Jacka FN, Housden S, Berk M, Brennan SL (2013) The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry 13(1):175

    Article  Google Scholar 

  11. Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, Conlin PR, Svetkey LP, Erlinger TP, Moore TJ, Karanja N (2001) Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 135(12):1019–1028

    Article  CAS  Google Scholar 

  12. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin P-H, Aickin M, Most-Windhauser MM, Moore TJ, Proschan MA, Cutler JA (2001) Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. New Engl J Med 344(1):3–10. doi:10.1056/NEJM200101043440101

    Article  CAS  Google Scholar 

  13. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM (1997) A clinical trial of the effects of dietary patterns on blood pressure. New Engl J Med 336(16):1117–1124

    Article  CAS  Google Scholar 

  14. Hollis JF, Gullion CM, Stevens VJ, Brantley PJ, Appel LJ, Ard JD, Champagne CM, Dalcin A, Erlinger TP, Funk K (2008) Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med 35(2):118–126

    Article  Google Scholar 

  15. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F (2005) Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care 28(12):2823–2831

    Article  CAS  Google Scholar 

  16. Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B, Mozaffarian D, Hu FB (2012) Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. Am J Clin Nutr 96(2):289–295

    Article  CAS  Google Scholar 

  17. Shirani F, Salehi-Abargouei A, Azadbakht L (2013) Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition 29(7–8):939–947. doi:10.1016/j.nut.2012.12.021

    Article  Google Scholar 

  18. Foroughi M, Akhavanzanjani M, Maghsoudi Z, Ghiasvand R, Khorvash F, Askari G (2013) Stroke and nutrition: a review of studies. Int J Prev Med 4(Suppl 2):S165–S179

    Google Scholar 

  19. Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L (2013) Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition 29(4):611–618. doi:10.1016/j.nut.2012.12.018

    Article  Google Scholar 

  20. Fulkerson JA, Sherwood NE, Perry CL, Neumark-Sztainer D, Story M (2004) Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample. Prev Med 38(6):865–875

    Article  Google Scholar 

  21. Mikolajczyk RT, El Ansari W, Maxwell AE (2009) Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J 8(1):31

    Article  Google Scholar 

  22. Torres SJ, Nowson CA (2012) A moderate-sodium DASH-type diet improves mood in postmenopausal women. Nutrition 28(9):896–900

    Article  Google Scholar 

  23. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O’Reilly SL, Nicholson GC, Kotowicz MA, Berk M (2010) Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry 167(3):305–311

    Article  Google Scholar 

  24. Jacka FN, Mykletun A, Berk M, Bjelland I, Tell GS (2011) The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study. Psychosom Med 73(6):483–490

    Article  Google Scholar 

  25. Yannakoulia M, Panagiotakos DB, Pitsavos C, Tsetsekou E, Fappa E, Papageorgiou C, Stefanadis C (2008) Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study. Appetite 51(3):519–525

    Article  Google Scholar 

  26. Adibi P, Keshteli AH, Esmaillzadeh A, Afshar H, Roohafza H, Bagherian-Sararoudi H, Daghaghzadeh H, Soltanian N, Feinle-Bisset C, Boyce P (2012) The study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN): overview of methodology. J Res Med Sci 17(5):S292–S298

    Google Scholar 

  27. Black AE, Cole TJ (2001) Biased over-or under-reporting is characteristic of individuals whether over time or by different assessment methods. J Am Diet Assoc 101(1):70–80

    Article  CAS  Google Scholar 

  28. Azizi F, Esmaillzadeh A, Mirmiran P (2004) Correlates of under-and over-reporting of energy intake in Tehranians: body mass index and lifestyle-related factors. Asia Pac J Clin Nutr 14(1):54–59

    Google Scholar 

  29. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC (2006) Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 84(6):1489–1497

    CAS  Google Scholar 

  30. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE (1985) Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122(1):51–65

    CAS  Google Scholar 

  31. Keshteli A, Esmaillzadeh A, Rajaie S, Askari G, Feinle-Bisset C, Adibi P (2014) A dish-based semi-quantitative food frequency questionnaire for assessment of dietary intakes in epidemiologic studies in Iran: design and development. Int J Prev Med 5(1):29

    Google Scholar 

  32. Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yield factors and edible portion of foods. Keshaverzi Press, Tehran (in Farsi)

    Google Scholar 

  33. Kimiagar S, Ghaffarpour M, Houshiar Rad A, Hormozdyari H, Zellipour L (1998) Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. East Mediterr Health J 4(3):539–547

    Google Scholar 

  34. Esmaillzadeh A, Mirmiran P, Azizi F (2005) Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr 59(3):353–362

    Article  CAS  Google Scholar 

  35. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB (2008) Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 168(7):713–720

    Article  Google Scholar 

  36. Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65(4):1220S–1228S

    CAS  Google Scholar 

  37. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S (2003) The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 1(1):14

    Article  Google Scholar 

  38. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A (2003) The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes 1(1):66

    Article  Google Scholar 

  39. Schmitz N, Kruse J, Heckrath C, Alberti L, Tress W (1999) Diagnosing mental disorders in primary care: the General Health Questionnaire (GHQ) and the Symptom Check List (SCL-90-R) as screening instruments. Soc Psychiatry Psychiatr Epidemiol 34(7):360–366

    Article  CAS  Google Scholar 

  40. Downey DB (1995) When bigger is not better: family size, parental resources, and children’s educational performance. Am Sociol Rev 60(5):746–761

    Article  Google Scholar 

  41. Policy PA Health Improvement Directorate (2009) The General Practice Physical Activity Questionnaire (GPPAQ). A screening tool to assess adult physical activity levels, within primary care. Department of Health, London

    Google Scholar 

  42. Oguma Y, Shinoda-Tagawa T (2004) Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. Am J Prev Med 26(5):407–418

    Article  Google Scholar 

  43. Gupta SC, Sung B, Kim JH, Prasad S, Li S, Aggarwal BB (2013) Multitargeting by turmeric, the golden spice: from kitchen to clinic. Mol Nutr Food Res 57(9):1510–1528

    Article  CAS  Google Scholar 

  44. Ng T-P, Chiam P-C, Lee T, Chua H-C, Lim L, Kua E-H (2006) Curry consumption and cognitive function in the elderly. Am J Epidemiol 164(9):898–906

    Article  Google Scholar 

  45. Melnyk JP, Wang S, Marcone MF (2010) Chemical and biological properties of the world’s most expensive spice: Saffron. Food Res Int 43(8):1981–1989

    Article  CAS  Google Scholar 

  46. de Wit L, Luppino F, van Straten A, Penninx B, Zitman F, Cuijpers P (2010) Depression and obesity: a meta-analysis of community-based studies. Psychiatry Res 178(2):230–235

    Article  Google Scholar 

  47. Joynt KE, Whellan DJ, O’Connor CM (2003) Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry 54(3):248–261

    Article  Google Scholar 

  48. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes a meta-analysis. Diab Care 24(6):1069–1078

    Article  CAS  Google Scholar 

  49. Pinquart M, Duberstein P (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40(11):1797–1810

    Article  CAS  Google Scholar 

  50. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW (2014) Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry 171(4):453–462

    Article  Google Scholar 

  51. Stommel M, Given BA, Given CW, Kalaian HA, Schulz R, McCorkle R (1993) Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D). Psychiatry Res 49(3):239–250

    Article  CAS  Google Scholar 

  52. Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L, Gross MD, Jacobs DR (2005) Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 82(6):1169–1177

    CAS  Google Scholar 

  53. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, Willett WC, Hu FB (2012) Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med 172(7):555–563

    Article  Google Scholar 

  54. Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A (2009) Dietary pattern and depressive symptoms in middle age. Br J Psychiatry 195(5):408–413

    Article  Google Scholar 

  55. Kubzansky LD, Kawachi I, Weiss ST, Sparrow D (1998) Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Ann Behav Med 20(2):47–58

    Article  CAS  Google Scholar 

  56. Albert CM, Chae CU, Rexrode KM, Manson JE, Kawachi I (2005) Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 111(4):480–487

    Article  Google Scholar 

  57. Weng T-T, Hao J-H, Qian Q-W, Cao H, Fu J-L, Sun Y, Huang L, Tao F-B (2012) Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutr 15(04):673–682

    Article  Google Scholar 

  58. Bakhtiyari M, Ehrampoush E, Enayati N, Joodi G, Sadr S, Delpisheh A, Alihaydari J, Homayounfar R (2013) Anxiety as a consequence of modern dietary pattern in adults in Tehran-Iran. Eat Behav 14(2):107–112

    Article  Google Scholar 

  59. Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, Hu FB (2010) White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med 170(11):961–969

    Article  Google Scholar 

  60. Esmaillzadeh A, Azadbakht L (2010) Dairy consumption and circulating levels of inflammatory markers among Iranian women. Public Health Nutr 13(09):1395–1402

    Article  Google Scholar 

  61. Esmaillzadeh A, Azadbakht L (2008) Major dietary patterns in relation to general obesity and central adiposity among Iranian women. J Nutr 138(2):358–363

    CAS  Google Scholar 

  62. Rafiei M, Boshtam M, Sarraf-Zadegan N, Seirafian S (2008) The relation between salt intake and blood pressure among Iranians. Kuwait Med J 40(3):191–195

    Google Scholar 

  63. He FJ, MacGregor GA (2010) Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 52(5):363–382

    Article  CAS  Google Scholar 

  64. Howren MB, Lamkin DM, Suls J (2009) Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosomatic Med 71(2):171–186

    Article  CAS  Google Scholar 

  65. Maes M, Galecki P, Chang YS, Berk M (2011) A review on the oxidative and nitrosative stress (O&NS) pathways in major depression and their possible contribution to the (neuro) degenerative processes in that illness. Prog Neuro Psychopharmacol Biol Psychiatry 35(3):676–692

    Article  CAS  Google Scholar 

  66. Asemi Z, Samimi M, Tabassi Z, Sabihi S-S, Esmaillzadeh A (2013) A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition 29(4):619–624

    Article  CAS  Google Scholar 

  67. Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC (2011) The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr 141(6):1083–1088

    Article  CAS  Google Scholar 

  68. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM (2002) Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 75(3):492–498

    CAS  Google Scholar 

  69. Tylavsky FA, Sharp GB (1995) Misclassification of nutrient and energy intake from use of closed-ended questions in epidemiologic research. Am J Epidemiol 142(3):342–352

    CAS  Google Scholar 

  70. Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC (2006) Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiat 63(7):824–830

    Article  Google Scholar 

  71. Sanchez-Villegas A, Henríquez P, Figueiras A, Ortuño F, Lahortiga F, Martínez-González MA (2007) Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN cohort study. Eur J Nutr 46(6):337–346

    Article  CAS  Google Scholar 

  72. He K, Whooley MA, Daviglus ML, Liu K (2009) Higher dietary intake of long-chain ω-3 polyunsaturated fatty acids is inversely associated with depressive symptoms in women. Nutrition 25(10):1011–1019

    Article  Google Scholar 

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Acknowledgments

We would like to thank the authorities of SEPAHAN study to let us work on that dataset and also the research council of Food Security Research Center for funding the study. We also appreciate the generous cooperation of Dr. Awat Feizi. This manuscript is based on the M.Sc. thesis (no. 392592) of Isfahan University of Medical Sciences, Isfahan, Iran. This study was financially supported by Research Council of the Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

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Correspondence to Ahmad Esmaillzadeh.

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GV and AE declared no potential personal or financial conflicts of interest.

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Valipour, G., Esmaillzadeh, A., Azadbakht, L. et al. Adherence to the DASH diet in relation to psychological profile of Iranian adults. Eur J Nutr 56, 309–320 (2017). https://doi.org/10.1007/s00394-015-1081-0

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