Abstract
Purpose
Although several studies have examined the link between different types of carbohydrate consumption and depression and anxiety, limited data are available linking whole and refined grains consumption to psychological disorders. We aimed to investigate the association of whole and refined grains consumption with psychological disorders among Iranian adults.
Methods
A total of 3172 adult people with age range of 18–55 years were included in this cross-sectional study. Data on grains consumption were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. To assess depression and anxiety, Iranian validated version of Hospital Anxiety and Depression Scale (HADS) was applied. Furthermore, psychological distress was examined using General Health Questionnaire (GHQ). Psychological disorders were defined based on standard criteria.
Results
Mean age of participants was 36.5 ± 7.9 years. Women in the third quartile of whole grains consumption had lower odds for having anxiety (OR 0.62, 95% CI 0.45–0.85) compared with those in the first quartile. This relationship was also seen even after controlling for potential confounders (OR 0.65, 95% CI 0.44–0.96). In contrast, compared with the first quartile, women in the highest quartile of refined grains consumption had greater odds to have depression (OR 1.76, 95% CI 1.00–3.09) and anxiety (OR 2.03, 95% CI 1.00–4.10) after adjusting for covariates. Such relationships were not observed among men.
Conclusion
Moderate consumption of whole grain foods was inversely associated with anxiety in women, but not in men. Furthermore, we found a significant positive association between refined grains consumption, depression and anxiety in women.
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References
Murphy JM, Horton NJ, Laird NM, Monson RR, Sobol AM, Leighton AH (2004) Anxiety and depression: a 40-year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta Psychiatr Scand 109:355–375. https://doi.org/10.1111/j.1600-0447.2003.00286.x
Mojtabai R (2011) National trends in mental health disability, 1997–2009. Am J Public Health 101:2156–2163. https://doi.org/10.2105/AJPH.2011.300258
Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jo¨nsson B (2012) The economic cost of brain disorders in Europe. Eur J Neurol 19:155–162. https://doi.org/10.1111/j.1468-1331.2011.03590.x
Sobocki P, Jo¨nsson B, Angst J, Rehnberg C (2006) Cost of depression in Europe. J Ment Health Policy Econ 9:87–98
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. https://doi.org/10.1017/S003329171200147X
Ferrari A, Somerville A, Baxter A, Norman R, Patten S, Vos T, Whiteford H (2012) Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med 43:471–481. https://doi.org/10.1017/S0033291712001511
Noorbala AA, Bagheri Yazdi SA, Yasamy MT et al (2004) Mental health survey of the adult population in Iran. Br J Psychiatry 184:70–73
Saveanu RV, Nemeroff CB (2012) Etiology of depression: genetic and environmental factors. Psychiatr Clin North Am 35:51–71. https://doi.org/10.1016/j.psc.2011.12.001
Guo X, Park Y, Freedman ND, Sinha R, Hollenbeck AR, Blair A, Chen H (2014) Sweetened beverages, coffee, and tea and depression risk among older US adults. PLoS One 9:e94715. https://doi.org/10.1371/journal.pone.0094715
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 195:408–413. https://doi.org/10.1192/bjp.bp.108.058925
Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, PlaVidal J, Martinez-Gonzalez MA (2012) Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 15:424–432. https://doi.org/10.1017/S1368980011001856
Skarupski KA, Tangney C, Li H, Ouyang B, Evans DA, Morris MC (2010) Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time. Am J Clin Nutr 92:330–335. https://doi.org/10.3945/ajcn.2010.29413
Hibbeln JR (2009) Depression, suicide and deficiencies of omega-3 essential fatty acids in modern diets. World Rev Nutr Diet 99:17–30. https://doi.org/10.1159/000192992
Cheatham RA, Roberts SB, Das SK, Gilhooly CH, Golden JK, Hyatt R, Lerner D, Saltzman E, Lieberman HR (2009) Long-term effects of providing low and high glycemic load energy diets on mood and cognition. Physiol Behav 98:374–379. https://doi.org/10.1016/j.physbeh
Nabb SL, Benton D (2006) The effect of the interaction between glucose tolerance and breakfasts varying in carbohydrate and fibre on mood and cognition. Nutr Neurosci 9:161–168. https://doi.org/10.1080/10284150600955099
Micha R, Rogers PJ, Nelson M (2011) Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomized controlled trial. Br J Nutr 106:1552–1561. https://doi.org/10.1017/S0007114511002303
Gangwisch JE, Hale L, Garcia L, Malaspina D, Opler MG, Payne ME et al (2015) High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr 102:454–463. https://doi.org/10.3945/ajcn.114.103846
Slavin J, Jacobs D, Marquart L (1997) Whole grain consumption and chronic disease: protective mechanisms. Nutr Cancer 27:14–21. https://doi.org/10.1080/01635589709514495
Shahyoun N, Jacques P, Zhang X, Joun W et al (2006) Wholegrain intake inversely is associated with the metabolic syndrome and mortality in older adults. Am J Clin Nutr 83:124–131
Yary T, Soleimannejad K, Abd Rahim F, Kandiah M, Aazami S, Poor SJ et al (2010) Contribution of diet and major depression to incidence of acute myocardial infarction (AMI). Lipids Health Dis 9:133. https://doi.org/10.1186/1476-511X-9-133
Serefko A, Szopa A, Poleszak E (2016) Magnesium and depression. Magnesium Res 29:112–119. https://doi.org/10.1684/mrh.2016.0407
Moylan S, Berk M, Dean OM, Samuni Y, Williams LJ, O’Neil A et al (2014) Oxidative & nitrosative stress in depression: why so much stress? Neurosci Biobehav Rev 45:46–62. https://doi.org/10.1016/j.neubiorev
Mikkelsen K, Stojanovska L, Apostolopoulos V (2016) The effects of vitamin B in depression. Current medicinal chemistry. Curr Med Chem 23:4317–4337
Hvas AM, Juul S, Bech P, Nexo E (2004) Vitamin B6 level is associated with symptoms of depression. Psychother Psychosom 73:340–343. https://doi.org/10.1159/000080386
Nguyen PH, Grajeda R, Melgar P, Marcinkevage J, DiGirolamo AM, Flores R et al (2009) Micronutrient supplementation may reduce symptoms of depression in Guatemalan women. Arch Latinoam Nutr 59:278–286
Gariballa S (2014) Poor vitamin C status is associated with increased depression symptoms following acute illness in older people. Int J Vitam Nutr Res 84:12–17. https://doi.org/10.1024/0300-9831/a000188
Haghighatdoost F, Azadbakht L, Keshteli AH, Feinle-Bisset C, Daghaghzadeh H, Afshar H et al (2016) Glycemic index, glycemic load, and common psychological disorders. Am J Clin Nutr 103:201–209. https://doi.org/10.3945/ajcn.114.105445
Murakami K, Miyake Y, Sasaki S, Tanaka K, Yokoyama T, Ohya Y et al (2008) Dietary glycemic index and load and the risk of postpartum depression in Japan: the Osaka Maternal and Child Health Study. J Affect Disord 110:174–179. https://doi.org/10.1016/j.jad.2007.12.230
Adibi P, Keshteli AH, Esmaillzadeh A, Afshar H et al (2012) The study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN): overview of methodology. J Res Med Sci 17:S291-S297
Willett W (2013) Nutritional epidemiology. Oxford University Press, Oxford
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 5:29–36
Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yields factors and edible portion of foods. Nashre Olume Keshavarzy, Tehran, pp 1–40
Kimura Y, Wada T, Okumiya K et al (2012) Eating alone among community-dwelling Japanese elderly: association with depression and food diversity. J Nutr Health Aging 16:728–731. https://doi.org/10.1007/s12603-012-0067-3
Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L et al (2016) Nutrient patterns and their relation to general and abdominal obesity in Iranian adults: findings from the SEPAHAN study. Eur J Nutr 55:505–518. https://doi.org/10.1007/s00394-015-0867-4
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 1:14
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 34:360–366
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 1:66. https://doi.org/10.1186/1477-7525-1-66
Howe GR, Miller AB, Jain M (1986) Re: Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124:157–159
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 382:1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
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 18:2074–2093. https://doi.org/10.1017/S1368980014002614
Kim WK, Shin D, Song WO (2016) Are Dietary Patterns Associated with Depression in U.S. Adults? J Med Food 19:1074–1084. https://doi.org/10.1089/jmf.2016.0043
Crichton GE, Bryan J, Hodgson JM, Murphy KJ (2013) Mediterranean diet adherence and self-reported psychological functioning in an Australian sample. Appetite 70:53–59. https://doi.org/10.1016/j.appet.2013.06.088
McMillan L, Owen L, Kras M, Scholey A (2011) Behavioural effects of a 10-day Mediterranean diet. Results from a pilot study evaluating mood and cognitive performance. Appetite 56:143–147. https://doi.org/10.1016/j.appet.2010.11.149
Forster SE, Powers HJ, Foulds GA et al (2012) Improvement in nutritional status reduces the clinical impact of infections in older adults. J Am Geriatr Soc 60:1645–1654. https://doi.org/10.1111/j.1532-5415.2012.04118.x
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27:538–546
McIntyre RS, Kenna HA, Nguyen HT, Law CW, Sultan F, Woldeyohannes HO, Adams AK, Cheng JS, Lourenco M, Kennedy SH et al (2010) Brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders? Adv Ther 27:63–80. https://doi.org/10.1007/s12325-010-0011-z
Gougeon L, Payette H, Morais JA, Gaudreau P, Shatenstein B, Gray-Donald K (2016) Intakes of folate, vitamin B6 and B12 and risk of depression in community-dwelling older adults: the Quebec Longitudinal Study on Nutrition and Aging. Eur J Clin Nutr 70:380–385. https://doi.org/10.1038/ejcn.2015.202
Wurtman RJ, Wurtman JJ (1995) Brain serotonin, carbohydrate-craving, obesity and depression. Obes Res 3:477S-80S
Poorrezaeian M, Siassi F, Qorbani M et al (2015) Association of dietary diversity score with anxiety in women. Psychiatry Res 230:622–627. https://doi.org/10.1016/j.psychres.2015.10.016
Sánchez-Villegas A, Martínez-González MA, Estruch R et al (2013) Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Med 11:208. https://doi.org/10.1186/1741-7015-11-208
Michalak J, Zhang XC, Jacobi F (2012) Vegetarian diet and mental disorders: results from a representative community survey. Int J Behav Nutr Phys Act 9:67. https://doi.org/10.1186/1479-5868-9-67
Lai JS, Oldmeadow C, Hure AJ et al (2016) Longitudinal diet quality is not associated with depressive symptoms in a cohort of middle-aged Australian women. Br J Nutr 115:842–850. https://doi.org/10.1017/S000711451500519X
Baskin R, Hill B, Jacka FN et al (2015) Antenatal dietary patterns and depressive symptoms during pregnancy and early post-partum. Matern Child Nutr 13:e12218. https://doi.org/10.1111/mcn.12218
Lopez-Garcia E, Schultze MB, Fung TT, Meigs JB, Rifai N, Manson JE, Hu FB (2004) Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 80:1029–1035
Rumsfeld JS, Ho PM (2005) Depression and cardiovascular disease: a call for recognition. Circulation 111:250–253. https://doi.org/10.1161/01.CIR.0000154573.62822.89
Bao J, Atkinson F, Petocz P, Willett WC, Brand-Miller JC (2011) Prediction of postprandial glycemia and insulinemia in lean, young, healthy adults: glycemic load compared with carbohydrate content alone. Am J Clin Nutr 93:984–996. https://doi.org/10.3945/ajcn.110.005033
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, Heller SR, Rodriguez H, Rosenzweig J, Vigersky R (2013) Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and The Endocrine Society. Diabetes Care:1384–1395. https://doi.org/10.2337/dc12-2480
Ludwig DS (2002) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287:2414–2423
Beer-Borst S, Hercberg S, Morabia A et al (2000) Dietary patterns in six european populations: results from EURALIM, a collaborative European data harmonization and information campaign. Eur J Clin Nutr 54:253–262
O’Doherty Jensen K, Holm L (1999) Preferences, quantities and concerns: socio-cultural perspectives on the gendered consumption of foods. Eur J Clin Nutr 53:351–359
Marks GC, Hughes MC, van der Pols JC (2006) Relative validity of food intake estimates using a food frequency questionnaire is associated with sex, age, and other personal characteristics. J Nutr 136:459–465
Acknowledgements
This study was supported by Isfahan University of Medical Sciences. Dr. Ahmad Esmaillzadeh was supported by a grant from Iran National Science Foundation (INSF).
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All participants provided signed informed written consent forms. The Bioethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran approved the study [29].
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Authors declared no personal or financial conflicts of interest.
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Ammar Hassanzadeh-Keshteli: Co-first author.
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Sadeghi, O., Hassanzadeh-Keshteli, A., Afshar, H. et al. The association of whole and refined grains consumption with psychological disorders among Iranian adults. Eur J Nutr 58, 211–225 (2019). https://doi.org/10.1007/s00394-017-1585-x
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DOI: https://doi.org/10.1007/s00394-017-1585-x