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Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students

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Abstract

Purpose

Examining the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students.

Methods

This cross-sectional study was conducted among 240 university students (mean age 21.5 years; 86.7% female). Mental health was evaluated using validated Persian versions of the 12-item general health questionnaire (GHQ-12) and the 21-item depression, anxiety, and stress scale (DASS-21). The lower the subjects’ scores on these questionnaires, the better their mental health. Usual past-year dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. The DASH score was computed based on energy-adjusted intakes of eight major dietary components emphasized or minimized in the DASH pattern. The higher the DASH score of a subject, the greater his/her adherence to the DASH pattern.

Results

The Pearson’s correlation coefficients of DASH score with GHQ-12 total score, DASS-21 total score, and DASS-21 depression, anxiety, and stress subscale scores were − 0.431, − 0.441, − 0.434, − 0.325, and − 0.408, respectively (all P < 0.001). Compared to those in the lowest tertile, subjects in the highest tertile of DASH score had lower means of GHQ-12 total score (mean difference − 4.6; P < 0.001), DASS-21 total score (mean difference − 9.1; P < 0.001), and DASS-21 depression, anxiety, and stress subscale scores (mean differences for depression, anxiety, and stress − 3.6, − 2.4, and − 3.2, respectively; all P < 0.001).

Conclusions

The findings indicate that greater adherence to the DASH dietary pattern is associated with better mental health in Iranian university students. However, prospective studies of sufficient methodological quality are needed to confirm these findings.

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References

  1. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 43:476–493

    Article  PubMed  PubMed Central  Google Scholar 

  2. Vandad-Sharifi M, Hajebi A, Radgoodarzi R (2015) Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med 18:76–84

    Google Scholar 

  3. Gibb SJ, Fergusson DM, Horwood LJ (2010) Burden of psychiatric disorder in young adulthood and life outcomes at age 30. Br J Psychiatry 197:122–127

    Article  PubMed  Google Scholar 

  4. Anderson P, Jane-Llopis E, Hosman C (2011) Reducing the silent burden of impaired mental health. Health Promot Int 26:i4–i9

    Article  PubMed  Google Scholar 

  5. Melanson KJ (2007) Nutrition review: relationships of nutrition with depression and anxiety. Am J Lifestyle Med 1:171–174

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Jacobs DR, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78:508S–513S

    Article  CAS  PubMed  Google Scholar 

  8. Quirk SE, Williams LJ, O’Neil A, 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. https://doi.org/10.1186/1471-244x-13-175

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mayo Clinic Staff (2017) Mediterranean diet: a heart-healthy eating plan. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801. Accessed 10 Nov 2018

  10. Mayo Clinic Staff (2016) DASH diet: healthy eating to lower your blood pressure. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456. Accessed 10 Nov 2018

  11. Miki T, Kochi T, Eguchi M, Kuwahara K, Tsuruoka H, Kurotani K, Ito R, Akter S, Kashino I, Pham NM, Kabe I, Kawakami N, Mizoue T, Nanri A (2015) Dietary intake of minerals in relation to depressive symptoms in Japanese employees: the Furukawa Nutrition and Health Study. Nutrition 31:686–690

    Article  CAS  PubMed  Google Scholar 

  12. Li Y, Lv MR, Wei YJ, Sun L, Zhang JX, Zhang HG, Li B (2017) Dietary patterns and depression risk: a meta-analysis. Psychiatry Res 253:373–382

    Article  PubMed  Google Scholar 

  13. Torres SJ, Nowson CA, Worsley A (2008) Dietary electrolytes are related to mood. Br J Nutr 100:1038–1045

    Article  CAS  PubMed  Google Scholar 

  14. 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. N Engl J Med 336:1117–1124

    Article  CAS  PubMed  Google Scholar 

  15. Meng L, Chen D, Yang Y, Zheng Y, Hui R (2012) Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens 30:842–851

    Article  CAS  PubMed  Google Scholar 

  16. Player MS, Peterson LE (2011) Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med 41:365–377

    Article  PubMed  Google Scholar 

  17. Ushakov AV, Ivanchenko VS, Gagarina AA (2016) Psychological stress in pathogenesis of essential hypertension. Curr Hypertens Rev 12:203–214

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Perez-Cornago A, Sanchez-Villegas A, Bes-Rastrollo M, Gea A, Molero P, Lahortiga-Ramos F, Martinez-Gonzalez MÁ (2017) Relationship between adherence to Dietary Approaches to Stop Hypertension (DASH) diet indices and incidence of depression during up to 8 years of follow-up. Public Health Nutr 20:2383–2392

    Article  PubMed  Google Scholar 

  20. Valipour G, Esmaillzadeh A, Azadbakht L, Afshar H, Hassanzadeh A, Adibi P (2017) Adherence to the DASH diet in relation to psychological profile of Iranian adults. Eur J Nutr 56:309–320

    Article  CAS  PubMed  Google Scholar 

  21. Chang C-D, Wang C-C, Jiang BC (2011) Using data mining techniques for multi-diseases prediction modeling of hypertension and hyperlipidemia by common risk factors. Expert Syst Appl 38:5507–5513

    Article  Google Scholar 

  22. Berk M, Sarris J, Coulson CE, Jacka FN (2013) Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl 127:38–54

    Article  Google Scholar 

  23. Moreno-Peral P, Conejo-Ceron S, Motrico E, Rodriguez-Morejon A, Fernandez A, Garcia-Campayo J, Roca M, Serrano-Blanco A, Rubio-Valera M, Bellon JA (2014) Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: a systematic review of cohort studies. J Affect Disord 168:337–348

    Article  PubMed  Google Scholar 

  24. Dinh QN, Drummond GR, Sobey CG, Chrissobolis S (2014) Roles of inflammation, oxidative stress, and vascular dysfunction in hypertension. Biomed Res Int. https://doi.org/10.1155/2014/406960

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lopresti AL, Hood SD, Drummond PD (2013) A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 148:12–27

    Article  PubMed  Google Scholar 

  26. Sanchez-Villegas A, Martinez-Gonzalez MA (2013) Diet, a new target to prevent depression? BMC Med. https://doi.org/10.1186/1741-7015-11-3

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bouayed J, Rammal H, Soulimani R (2009) Oxidative stress and anxiety: relationship and cellular pathways. Oxid Med Cell Longev 2:63–67

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hovatta I, Juhila J, Donner J (2010) Oxidative stress in anxiety and comorbid disorders. Neurosci Res 68:261–275

    Article  CAS  PubMed  Google Scholar 

  29. Salim S, Chugh G, Asghar M (2012) Inflammation in anxiety. Adv Protein Chem Struct Biol 88:1–25

    Article  CAS  PubMed  Google Scholar 

  30. Asemi Z, Samimi M, Tabassi Z, Shakeri H, Sabihi SS, Esmaillzadeh A (2014) Effects of DASH diet on lipid profiles and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome: a randomized clinical trial. Nutrition 30:1287–1293

    Article  CAS  PubMed  Google Scholar 

  31. Soltani S, Chitsazi MJ, Salehi-Abargouei A (2017) The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.02.018

    Article  PubMed  Google Scholar 

  32. Mehio-Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N (2010) Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 57:193–203

    Article  CAS  PubMed  Google Scholar 

  33. Ghassemi H, Harrison G, Mohammad K (2002) An accelerated nutrition transition in Iran. Public Health Nutr 5:149–155

    Article  PubMed  Google Scholar 

  34. Saif M (2000) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 284:3043–3045

    Article  Google Scholar 

  35. 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. https://doi.org/10.1186/1477-7525-1-66

    Article  PubMed  PubMed Central  Google Scholar 

  36. Asghari A, Saed F, Dibajnia P (2008) Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol 2:82–102

    Google Scholar 

  37. Golderberg D, Williams P (1988) A user’s guide to the General Health questionnaire. NFER-Nelson, Windsor

    Google Scholar 

  38. Pevalin DJ (2000) Multiple applications of the GHQ-12 in a general population sample: an investigation of long-term retest effects. Soc Psychiatry Psychiatr Epidemiol 35:508–512

    Article  CAS  PubMed  Google Scholar 

  39. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP (1998) Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess 10:176–181

    Article  Google Scholar 

  40. Henry JD, Crawford JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 44:227–239

    Article  PubMed  Google Scholar 

  41. Esfahani FH, Asghari G, Mirmiran P, Azizi F (2010) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 20:150–158

    Article  PubMed  Google Scholar 

  42. Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F (2010) Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 13:654–662

    Article  PubMed  Google Scholar 

  43. Hojhabrimanesh A, Akhlaghi M, Rahmani E, Amanat S, Atefi M, Najafi M, Hashemzadeh M, Salehi S, Faghih S (2017) A Western dietary pattern is associated with higher blood pressure in Iranian adolescents. Eur J Nutr 56:399–408

    Article  CAS  PubMed  Google Scholar 

  44. Najafi A, Faghih S, Hojhabrimanesh A, Najafi M, Tangestani H, Atefi M, Teymouri M, Salehi M, Kamali M, Amanat S, Akhlaghi M (2018) Greater adherence to the dietary approaches to stop hypertension (DASH) dietary pattern is associated with lower blood pressure in healthy Iranian primary school children. Eur J Nutr 57:1449–1458

    Article  PubMed  Google Scholar 

  45. Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yields factors, and edible portion of foods. Agriculture Sciences Press, Tehran

    Google Scholar 

  46. Willett WC (1990) Implications of total energy intake for epidemiological analyses. In: Willett WC (ed) Nutritional epidemiology. Oxford University Press, New York, pp 245–271

    Google Scholar 

  47. 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 168:713–720

    Article  PubMed  Google Scholar 

  48. Saneei P, Fallahi E, Barak F, Ghasemifard N, Keshteli AH, Yazdannik AR, Esmaillzadeh A (2015) Adherence to the DASH diet and prevalence of the metabolic syndrome among Iranian women. Eur J Nutr 54:421–428

    Article  CAS  PubMed  Google Scholar 

  49. Moghaddam MHB, Aghdam FB, Jafarabadi MA, Allahverdipour H, Nikookheslat SD, Safarpour S (2012) The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World Appl Sci 18:1073–1080

    Google Scholar 

  50. The IPAQ Group. Guidelines for the Data Processing and Analysis of the International Physical Activity Questionnaire. http://www.ipaq.ki.se. Accessed 02 Mar 2017

  51. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395

    Article  PubMed  Google Scholar 

  52. Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F, Kamgar M, Gouya MM, Abbasi M (2009) Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health. https://doi.org/10.1186/1471-2458-9-167

    Article  PubMed  PubMed Central  Google Scholar 

  53. Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, Yazdi SA, Rahgozar M, Alaghebandrad J, Amini H, Razzaghi EM, Mesgarpour B, Soori H, Mohammadi M, Ghanizadeh A (2005) An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health. https://doi.org/10.1186/1745-0179-1-16

    Article  PubMed  PubMed Central  Google Scholar 

  54. 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 15:673–682

    Article  PubMed  Google Scholar 

  55. 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 167:305–311

    Article  PubMed  Google Scholar 

  56. 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 51:519–525

    Article  PubMed  Google Scholar 

  57. Papier K, Ahmed F, Lee P, Wiseman J (2015) Stress and dietary behaviour among first-year university students in Australia: sex differences. Nutrition 31:324–330

    Article  PubMed  Google Scholar 

  58. Roohafza H, Sarrafzadegan N, Sadeghi M, Rafieian-Kopaei M (2013) The association between stress levels and food consumption among Iranian population. Arch Iran Med 16:145–148

    PubMed  Google Scholar 

  59. Fabián C, Pagán I, Ríos JL, Betancourt J, Cruz SY, González AM, Palacios C, González MJ, Rivera-Soto WT (2013) Dietary patterns and their association with sociodemographic characteristics and perceived academic stress of college students in Puerto Rico. P R Health Sci J 32:36–43

    PubMed  Google Scholar 

  60. Nutt DJ (2001) Neurobiological mechanisms in generalized anxiety disorder. J Clin Psychiatry 62:22–27

    CAS  PubMed  Google Scholar 

  61. Faravelli C, Lo Sauro C, Lelli L, Pietrini F, Lazzeretti L, Godini L, Benni L, Fioravanti G, Talamba GA, Castellini G, Ricca V (2012) The role of life events and HPA axis in anxiety disorders: a review. Curr Pharm Des 18:5663–5674

    Article  CAS  PubMed  Google Scholar 

  62. Jou SH, Chiu NY, Liu CS (2009) Mitochondrial dysfunction and psychiatric disorders. Chang Gung Med J 32:370–390

    PubMed  Google Scholar 

  63. Perna G, Iannone G, Alciati A, Caldirola D (2016) Are anxiety disorders associated with accelerated aging? A focus on neuroprogression. Neural Plast 1:4. https://doi.org/10.1155/2016/8457612

    Article  CAS  Google Scholar 

  64. Galland L (2010) Diet and inflammation. Nutr Clin Pract 25:634–640

    Article  PubMed  Google Scholar 

  65. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR (2014) Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 17:1689–1696

    Article  PubMed  Google Scholar 

  66. Vetrani C, Costabile G, Di Marino L, Rivellese AA (2013) Nutrition and oxidative stress: a systematic review of human studies. Int J Food Sci Nutr 64:312–326

    Article  CAS  PubMed  Google Scholar 

  67. Gancheva SM, Zhelyazkova-Savova MD (2016) Vitamin K2 improves anxiety and depression but not cognition in rats with metabolic syndrome: a role of blood glucose? Folia Med 58:264–272

    Article  CAS  Google Scholar 

  68. Gonzalez MJ, Miranda-Massari JR (2014) Diet and stress. Psychiatr Clin N Am 37:579–589

    Article  Google Scholar 

  69. Livingstone M (1995) Assessment of food intakes: are we measuring what people eat? Br J Biomed Sci 52:58–67

    CAS  PubMed  Google Scholar 

  70. Günther AL, Liese AD, Bell RA, Dabelea D, Lawrence JM, Rodriguez BL, Standiford DA, Mayer-Davis EJ (2009) Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension 53:6–12

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The present work was financially supported by the Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran (Grant number: 92-01-87-6930). The authors would like to thank the participants for their enthusiastic collaboration.

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Correspondence to Masoumeh Akhlaghi.

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The ethics board of the Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, approved the study protocol (reference number: 92-01-87-6930), and written informed consents were obtained from participants prior to their inclusion in the study. All procedures followed in the present study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and regional) and with the Helsinki Declaration of 1964 and all subsequent revisions [34].

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Faghih, S., Babajafari, S., Mirzaei, A. et al. Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students. Eur J Nutr 59, 1001–1011 (2020). https://doi.org/10.1007/s00394-019-01961-2

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  • DOI: https://doi.org/10.1007/s00394-019-01961-2

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