European Journal of Nutrition

, Volume 57, Issue 6, pp 2295–2306 | Cite as

Consumption of fruit and vegetables in relation with psychological disorders in Iranian adults

  • Faezeh Saghafian
  • Hanieh Malmir
  • Parvane Saneei
  • Ammar Hassanzadeh Keshteli
  • Mohammad Javad Hosseinzadeh-Attar
  • Hamid Afshar
  • Fereydoun Siassi
  • Ahmad Esmaillzadeh
  • Peyman Adibi
Original Contribution



Findings from observational studies on the relationship between fruit and vegetables consumption and risk of mental disorders are contradictory. We aimed to examine the association between fruit and vegetables intake and prevalence of depression, anxiety, and psychological distress in a large group of Iranian adults.


This cross-sectional study was conducted on 3362 people of Iranian adults working in 50 health centers. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire (FFQ). The Iranian-validated version of Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. The General Health Questionnaire (GHQ) was used to assess psychological distress.


The prevalence of depression, anxiety, and high psychological distress among the study population was 30.0, 15.2, and 25.0%, respectively. Women in the top quintile of fruit intake, compared with those in the bottom quintile, had 57, 50, and 60% lower odds of depression, anxiety, and psychological distress. Consumption of vegetables was significantly associated with lower odds of depression (OR 0.65; 95% CI 0.46, 0.93) in women and lower odds of anxiety (OR 0.43; 95% CI 0.22, 0.87) in men. In addition, after adjustment for potential confounders, women in the highest quintile of fruit and vegetables intake, compared with those in the bottom quintile, had significantly lower odds of depression (OR 0.55; 95% CI 0.37, 0.80) and psychological distress (OR 0.60; 95% CI 0.40, 0.90). Furthermore, high intake of total fruit and vegetables was associated with lower odds of psychological distress (OR 0.42; 95% CI 0.21, 0.81) in men.


We found significant inverse associations between high intake of fruit with depression, anxiety, and psychological distress in Iranian women. High consumption of vegetables was also associated with lower risk of depression and anxiety, respectively, in women and men. In addition, high intake of total fruit and vegetable was associated with lower odds of depression and psychological distress in women and men.


Fruit Vegetables Depression Anxiety Distress 



Food frequency questionnaire


General Practice Physical Activity Questionnaire


General Health Questionnaire


Hospital Anxiety and Depression Scale


Odds ratios

95% CI

95% confidence interval


Study on the Epidemiology of Psychological-Alimentary Health and Nutrition


Isfahan University of Medical Sciences


Socioeconomic status


Analysis of variance


Analysis of covariance



We wish to thank all staff of Isfahan University of Medical Sciences who kindly participated in our study and staff of Public Relations Unit, and other authorities of IUMS for their excellent cooperation. Dr. Ahmad Esmaillzadeh was supported by a grant from Iran National Science Foundation (INSF).

Author contributions

FS, HM, PS, AHK, MJH, HA, AF, FS, AE, and PA contributed in conception, design, data collection, statistical analyses, data interpretation, manuscript drafting, approval of the final version of the manuscript, and agreed for all aspects of the work.


The financial support for conception, design, data analysis and manuscript drafting comes from National Institute for Medical Research Development (NIMAD) (project number: 963472).

Compliance with ethical standards

Conflict of interest

None of the authors had any personal or financial conflicts of interest.


  1. 1.
    World Health Organization (2017) Media Center, Depression. Factsheet Number: 369. Accessed June 2017
  2. 2.
    Alonso J, Angermeyer MC, Bernert S et al. (2004) Prevalence of mental disorder in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 420:21–27Google Scholar
  3. 3.
    Noorbala A, Bagheri A, Yazdi SA, Yasamy MT et al (2004) Mental health survey of the adult population in Iran. Br J Psychiatry 184:70–73CrossRefPubMedGoogle Scholar
  4. 4.
    Alexopoulos GS (2005) Depression in the elderly. Lancet 365:1961–1970CrossRefPubMedGoogle Scholar
  5. 5.
    Ferrari AJ, Charlson FJ, Norman RE et al (2013) Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 10:1–11CrossRefGoogle Scholar
  6. 6.
    Brhlikova P, Pollock AM, Manners R (2011) Global burden of disease estimates of depression—how reliable is the epidemiological evidence? J R Soc Med 104:25–34CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Alpert JE, Mischoulon D, Nierenberg AA, Fava M (2000) Nutrition and depression: focus on folate. Nutrition 16:544–546CrossRefPubMedGoogle Scholar
  8. 8.
    Jacka FN, Pasco JA, Mykletun A, Williams LJ et al (2010) Association of western and traditional diets with depression and anxiety in women. Am J Psychiat 167(3):305–311CrossRefPubMedGoogle Scholar
  9. 9.
    Jacka FN, Mykletun A, Berk M, Bjelland I, Tell GS (2011) The association between habitual diet quality and the common mental disorders in communitydwelling adults: the hordaland health study. Psychosom Med 73(6):483–490CrossRefPubMedGoogle Scholar
  10. 10.
    Rao TSS, Asha MR, Ramesh BN et al (2008) Understanding nutrition, depression and mental illnesses. Indian J Psychiatry 50:77–82CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Murakami K, Sasaki S (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Mol Nutr Food Res 54:471–488CrossRefPubMedGoogle Scholar
  12. 12.
    Payne ME, Steck SE, George RR, Steffens DC (2012) Fruit, vegetable, and antioxidant intakes are lower in older adults with depression. J Acad Nutr Diet 112:2022–2027CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rooney C, McKinley MC, Woodside JV (2013) The potential role of fruit and vegetables in aspects of psychological well-being: a review of the literature and future directions. Proc Nutr Soc 72(4):420–432CrossRefPubMedGoogle Scholar
  14. 14.
    Akbaraly TN, Sabia S, Shipley MJ, Batty GD, Kivimaki M (2013) Adherence to healthy dietary guidelines and future depressive symptoms: evidence for sex differentials in the Whitehall II study. Am J Clin Nutr 97:419–427CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gangwisch JE, Hale L, Garcia L et al (2015) High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr 102:454–463CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Chi SH, Wang JY, Tsai AC (2015) Combined association of leisure-time physical activity and fruit and vegetable consumption with depressive symptoms in older Taiwanese: results of a national cohort study. Geriatr Gerontol Int 16:244–251CrossRefPubMedGoogle Scholar
  17. 17.
    Hintikka J, Tolmunen T, Honkalampi K et al (2005) Daily tea drinking is associated with a low level of depressive symptoms in the Finnish general population. Eur J Epidemiol 20:359–363CrossRefPubMedGoogle Scholar
  18. 18.
    Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A et al (2009) Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 66:1090–1098CrossRefPubMedGoogle Scholar
  19. 19.
    Mihrshahi S, Dobson AJ, Mishra GD (2015) Fruit and vegetable consumption and prevalence and incidence of depressive symptoms in mid-age women: results from the Australian longitudinal study on women’s health. Eur J Clin Nutr 69:585–591CrossRefPubMedGoogle Scholar
  20. 20.
    Woo J, Lynn H, Lau WY et al (2006) Nutrient intake and psychological health in an elderly Chinese population. Int J Geriatr Psychiatry 21:1036–1043CrossRefPubMedGoogle Scholar
  21. 21.
    Allgöwer A, Wardle J, Steptoe A (2001) Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychol 20:223–227CrossRefPubMedGoogle Scholar
  22. 22.
    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 8:31CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    McMartin SE, Jacka FN, Colman I (2013) The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians. Prev Med 56:225–230CrossRefPubMedGoogle Scholar
  24. 24.
    Castellanos D, Connell C, Lee J (2011) Factors affecting weight gain and dietary intake in Latino males residing in Mississippi: a preliminary study. Hisp Health Care Int 9:91–98CrossRefGoogle Scholar
  25. 25.
    Remes O, Brayne C, van der Linde R, Lafortune L (2016) A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain Behav 6:1–33CrossRefGoogle Scholar
  26. 26.
    Keshteli AE, Rajaie A, Askari S et al (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 5:29–36PubMedPubMedCentralGoogle Scholar
  27. 27.
    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 1–40Google Scholar
  28. 28.
    US Department of Agriculture (2015) National nutrient database for standard reference release 28(database on the internet). USDA, Washington, DC. Accessed Mar 2016
  29. 29.
    Barak F, Falahi E, Keshteli A et al (2015) Red meat intake, insulin resistance, and markers of endothelial function among Iranian women. Mol Nutr Food Res 59:315–322CrossRefPubMedGoogle Scholar
  30. 30.
    Saneei P, Fallahi E, Barak F et al (2015) Adherence to the DASH diet and prevalence of the metabolic syndrome among Iranian women. Eur J Nutr 54:421–428CrossRefPubMedGoogle Scholar
  31. 31.
    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 55:505–518CrossRefPubMedGoogle Scholar
  32. 32.
    Montazeri A, Vahdaninia M, Ebrahimi M et al (2003) The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 1:14CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Montazeri AHA, 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 1:66CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Aminianfar S, Saneei P, Nouri M et al (2015) Validation study of self-reported anthropometric indices among the Staff of the Isfahan University of Medical Sciences, Isfahan, Iran. J Isfahan Med Sch 33:1318–1327Google Scholar
  35. 35.
    Department of Health L (2006) The general practice physical activity questionnaireGoogle Scholar
  36. 36.
    WHO (2004) The global burden of disease: 2004 update. World Health Organization, GenevaGoogle Scholar
  37. 37.
    Lock K, Pomerleau J, Causer L, Altmann DR, McKee M (2005) The global burden of disease attributable to low consumption of fruit and vegetables. Implications for the global strategy on diet. Bull World Health Organ 83:100–108PubMedPubMedCentralGoogle Scholar
  38. 38.
    Saxena S, Jane-llopis E, Hosman C (2006) Prevention of mental and behavioural disorders: implications for policy and practice. World Psychiatry 5:5–14PubMedPubMedCentralGoogle Scholar
  39. 39.
    Saghafian F, Malmir H, Saneei P, Milajerdi A, Larijani B, Esmaillzadeh A (2018)  Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies. Br J Nutr (AcceptedGoogle Scholar
  40. 40.
    Tsai AC, Chang TL, Chi SH (2012) Frequent consumption of vegetables predicts lower risk of depression in older Taiwanese—results of a prospective population-based study. Public Health Nutr 15:1087–1092CrossRefPubMedGoogle Scholar
  41. 41.
    Crichton GE, Bryan J, Hodgson JM, Murphy KJ (2013) Mediterranean diet adherence and self-reported psychological functioning in an Australian sample. Appetite 70:53–59CrossRefPubMedGoogle Scholar
  42. 42.
    Richard A, Rohrmann S, Vandeleur CL, Mohler-Kuo M, Eichholzer M (2015) Associations between fruit and vegetable consumption and psychological distress: results from a population-based study. BMC psychiatry 15:213CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Bhattacharyya M, Marston L, Walters K, D’Costa G, King M, Nazareth I (2014) Psychological distress, gender and dietary factors in South Asians: a cross-sectional survey. Public Health Nutr 17:1538–1546CrossRefPubMedGoogle Scholar
  44. 44.
    Bromet E, Andrade L, Hwang I, Sampson N, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C et al (2011) Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 9:90–105CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Oliver G, Wardle J (1999) Preceived effects of stress on food choice. Physiol Behav 66:511–515CrossRefPubMedGoogle Scholar
  46. 46.
    Rolls BJ, Fedoroff IC, Guthrie (1991) Gender differences in eating behavior and body weight regulation. Health Psychol 10:133–142CrossRefPubMedGoogle Scholar
  47. 47.
    Regitz-Zagrosek V (2012) sex and gender differences in health. EMBO Rep 13:596–603CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Jacka FN, Pasco J, Williams L, Meyer B, Digger R, Berk M (2013) Dietary intake of fish and PUFA, and clinical depressive and anxiety in women. BJN 109:2059–2066CrossRefGoogle Scholar
  49. 49.
    Grosso G, Micek A, Marventano S, Castellano S, Mistretta A, Pajak A et al (2016) Dietary n-3 PUFA, fish consumption and deoression: a systematic review and meta-analysis of observational studies. J Affect Disord 205:269–281CrossRefPubMedGoogle Scholar
  50. 50.
    Li F, Liu X, Zhang D (2016) Fish consumption and risk of depression: a meta-analysis. J Epidemiol Commun Health 70:299–304CrossRefGoogle Scholar
  51. 51.
    Rink SM, Mumford SL, Poudrier JK et al (2013) Self-report of fruit and vegetable intake that meets the 5 a day recommendation is associated with reduced levels of oxidative stress biomarkers and increased levels of antioxidant defense in premenopausal women. J Acad Nutr Diet 113:776–785CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Milaneschi Y, Bandinelli S, Penninx BW (2011) The relationship between plasma carotenoids and depressive symptoms in older persons. World J Biol Psychiatry 13:588–598CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Gilbody SLT, Sheldon T (2007) Is low folate a risk factor for depression? A meta-analysis and exploration of heterogeneit. J Epidemiol Commun Health (Lond) 61:631–637CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Faezeh Saghafian
    • 1
    • 2
  • Hanieh Malmir
    • 1
    • 2
  • Parvane Saneei
    • 8
  • Ammar Hassanzadeh Keshteli
    • 3
    • 4
  • Mohammad Javad Hosseinzadeh-Attar
    • 5
  • Hamid Afshar
    • 6
  • Fereydoun Siassi
    • 2
  • Ahmad Esmaillzadeh
    • 2
    • 7
    • 8
  • Peyman Adibi
    • 4
    • 9
  1. 1.Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
  2. 2.Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  3. 3.Department of MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Integrative Functional Gastroenterology Research CenterIsfahan University of Medical SciencesIsfahanIran
  5. 5.Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  6. 6.Department of Psychiatry, Psychosomatic Research CenterIsfahan University of Medical SciencesIsfahanIran
  7. 7.Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences InstituteTehran University of Medical SciencesTehranIran
  8. 8.Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
  9. 9.Department of Internal Medicine, School of MedicineIsfahan University of Medical SciencesIsfahanIran

Personalised recommendations