Ultra-processed food consumption and the incidence of depression in a Mediterranean cohort: the SUN Project

  • Clara Gómez-Donoso
  • Almudena Sánchez-Villegas
  • Miguel A. Martínez-González
  • Alfredo Gea
  • Raquel de Deus Mendonça
  • Francisca Lahortiga-Ramos
  • Maira Bes-RastrolloEmail author
Original Contribution



A growing body of evidence shows that consumption of ultra-processed foods (UPF) is associated with a higher risk of cardiometabolic diseases, which, in turn, have been linked to depression. This suggests that UPF might also be associated with depression, which is among the global leading causes of disability and disease. We prospectively evaluated the relationship between UPF consumption and the risk of depression in a Mediterranean cohort.


We included 14,907 Spanish university graduates [mean (SD) age: 36.7 year (11.7)] initially free of depression who were followed up for a median of 10.3 years. Consumption of UPF (industrial formulations made mostly or entirely from substances derived from foods and additives, with little, if any, intact food), as defined by the NOVA food classification system, was assessed at baseline through a validated semi-quantitative 136-item food-frequency questionnaire. Participants were classified as incident cases of depression if they reported a medical diagnosis of depression or the habitual use of antidepressant medication in at least one of the follow-up assessments conducted after the first 2 years of follow-up. Cox regression models were used to assess the relationship between UPF consumption and depression incidence.


A total of 774 incident cases of depression were identified during follow-up. Participants in the highest quartile of UPF consumption had a higher risk of developing depression [HR (95% CI) 1.33 (1.07–1.64); p trend = 0.004] than those in the lowest quartile after adjusting for potential confounders.


In a prospective cohort of Spanish university graduates, we found a positive association between UPF consumption and the risk of depression that was strongest among participants with low levels of physical activity.


SUN cohort Prospective study Food processing Ultra-processed food Depression 



Body mass index


Brain-derived neurotrophic factor


Confidence interval


Diagnostic and statistical manual of mental disorders


Food-frequency questionnaire




Hazard ratio


Mediterranean diet score


Metabolic Equivalent Task




Structured clinical interview


Standard deviation


Socioeconomic status


Seguimiento Universidad de Navarra/follow-up University of Navarra


Ultra-processed food



We thank very specially all participants in the SUN cohort for their long-standing and enthusiastic collaboration, and our advisors from Harvard TH Chan School of Public Health (Walter Willett, Alberto Ascherio and Frank B. Hu) who helped us to design the SUN Project. We are also grateful to the other members of the SUN Group for administrative, technical, and material support.


The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795, and G03/140), the Navarra Regional Government (27/2011, 45/2011, 122/2014), and the University of Navarra. CGD was supported by a predoctoral contract for training in health research (PFIS) (FI18/00073) of the Instituto de Salud Carlos III.

Compliance with ethical standards

Ethical standards

The present study was conducted according to the Declaration of Helsinki, and the protocol (including the informed consent process) was approved by the Institutional Review Board of the University of Navarra. The voluntary completion of the self-administered baseline questionnaire was considered to imply informed consent. All potential participants were informed of their right to refuse to participate in the study or to withdraw their consent to participate at any time. The SUN study was registered at as NCT02669602.

Conflict of interest

None of the authors reported a conflict of interest related to the study.

Supplementary material

394_2019_1970_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Clara Gómez-Donoso
    • 1
    • 2
    • 3
  • Almudena Sánchez-Villegas
    • 2
    • 4
  • Miguel A. Martínez-González
    • 1
    • 2
    • 3
    • 5
  • Alfredo Gea
    • 1
    • 2
    • 3
  • Raquel de Deus Mendonça
    • 6
  • Francisca Lahortiga-Ramos
    • 3
    • 7
  • Maira Bes-Rastrollo
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Preventive Medicine and Public HealthUniversity of NavarraPamplonaSpain
  2. 2.Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN)Instituto de Salud Carlos IIIMadridSpain
  3. 3.Navarra Institute for Health Research (IdiSNA)PamplonaSpain
  4. 4.Nutrition Research Group, Research Institute of Biomedical and Health SciencesUniversity of Las Palmas de Gran CanariaLas PalmasSpain
  5. 5.Department of NutritionHarvard TH Chan School of Public HealthBostonUSA
  6. 6.Department of Nutrition, School of NursingFederal University of Minas GeraisBelo HorizonteBrazil
  7. 7.Department of Psychiatry and Medical PsychologyUniversity Clinic of NavarraPamplonaSpain

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