Adherence to the DASH diet in relation to psychological profile of Iranian adults
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Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health.
We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults.
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.
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.
We found an inverse association between moderate adherence to DASH dietary pattern and depression. Further prospective studies are required to confirm these findings.
KeywordsDiet Healthy eating Psychological health Depression Anxiety Mood
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.
Compliance with ethical standards
Conflict of interest
GV and AE declared no potential personal or financial conflicts of interest.
- 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):1575–1586CrossRefGoogle Scholar
- 2.Baxter A, Scott K, Vos T, Whiteford H (2012) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 10:1–14Google 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):70–73Google 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 CrossRefGoogle 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 CrossRefGoogle 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–S179Google 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 CrossRefGoogle 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–S298Google 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):54–59Google 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):1489–1497Google 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):51–65Google 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):29Google 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):539–547Google Scholar
- 36.Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65(4):1220S–1228SGoogle 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, LondonGoogle 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):1169–1177Google 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):358–363Google 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):191–195Google 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):492–498Google 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):342–352Google Scholar