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There is substantial evidence supporting that remote interventions are useful to change dietary habits. However, the effect of a remote intervention based on Mediterranean diet (MD) in depressive patients has been less explored. This study aims to assess the effectiveness of a remotely provided Mediterranean diet-based nutritional intervention in the context of a secondary prevention trial of depression. The PREDIDEP study was a 2-year multicenter, randomized, single-blinded trial designed to assess the effect of the MD enriched with extra virgin olive oil (EVOO) on the prevention of depression recurrence. The intervention group received usual care for depressed patients and remote nutritional intervention every three months which included phone contacts and web-based interventions; and the control group, usual care. At baseline and at 1-year and 2-year follow-up, the 14-item MD Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire (FFQ) were collected by a dietitian. Mixed effects linear models were used to assess changes in nutritional variables according to the group of intervention. The trial was registered at ClinicalTrials.gov NCT03081065. Compared with control group, the MD intervention group showed more adherence to MD (between-group difference: 2.76; 95% CI 2.13–3.39; p < 0.001); and a healthier diet pattern with a significant increase in the consumption of olive oil (p < 0.001), and a significant reduction in refined cereals (p = 0.031) after 2 years of intervention. The remote nutritional intervention increases adherence to the MD among recovered depression patients. Trial registration: ClinicalTrials.gov identifier: NCT03081065. [ABSTRACT FROM AUTHOR]

Background: Recent evidence has indicated a greater number of protective factors are associated with a greater decreased risk for depression and depressive symptoms compared with individual factors alone. Moreover, adherence to healthy modifiable lifestyle behaviors may lower the risk of depression regardless of underlying genetic risk.Objectives: We longitudinally evaluated the association of the Mediterranean lifestyle (MEDLIFE) with the risk of depression.Methods: We prospectively analyzed data from 15,279 participants (6089 men and 9190 women, mean age 37 y) in the Seguimiento Universidad de Navarra cohort. The MEDLIFE index is composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, each of which was assigned 0 or 1 point. Final scores ranged from 0 to 28 points and were categorized into quartiles of MEDLIFE adherence. Cox proportional regression models determined the association of total MEDLIFE adherence, each item, and block with incident depression.Results: After a mean follow-up of 11.7 y, 912 (6%) incident cases of depression were reported. The mean ± SD final score for MEDLIFE adherence was 11.9 ± 2.7 points. The multivariable model showed that compared with the first quartile, the second and third quartiles of MEDLIFE adherence were significantly associated with a decreased relative risk for incident depression (HR: 0.82; 95% CI: 0.69, 0.96 and HR: 0.74; 95% CI: 0.61, 0.89, respectively). The fourth quartile did not show a statistically significant association with incident depression (HR: 0.89; 95% CI: 0.73, 1.09).Conclusions: MEDLIFE adherence may decrease the risk of depression in a Spanish cohort of university graduates. Given no clear association was observed among the highest MEDLIFE adherence, future studies are warranted to better understand the nature of this association. Evidence on MEDLIFE, beyond the Mediterranean diet, may contribute toward more effective prevention strategies for depression. [ABSTRACT FROM AUTHOR]

Purpose: To prospectively evaluate the association of the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet and the Mediterranean diet (and their components), and depression risk. Methods: We followed-up (median 10.4 years) 15,980 adults initially free of depression at baseline or in the first 2 years of follow-up. Food consumption was measured at baseline through a validated food-frequency questionnaire, and was used to compute adherence to the MIND and the Mediterranean diets. Relationships between these two diets and incident depression were assessed through Cox regression models. Results: We identified 666 cases of incident depression. Comparing the highest versus the lowest quartiles of adherence, we found no association of the MIND diet and incident depression. This relation was statistically significant for the Mediterranean diet {hazard ratio (HR) 0.75, [95% confidence interval (95% CI) 0.61, 0.94]; p < 0.01}, although with departure from linearity. A reduced depression risk was associated with higher consumption of both fruits and nuts [HR 0.82 (95% CI 0.69, 0.96); p = 0.02], moderate nuts consumption [HR 0.77 (95% CI 0.64, 0.93); p = 0.01], and avoidance of fast/fried food [HR 0.63 (95% CI 0.41, 0.96); p = 0.03]. Conclusions: The Mediterranean diet was associated with reduced depression risk, but we found no evidence of such an association for the MIND diet. [ABSTRACT FROM AUTHOR]

The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression.Design: In a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed.Results: After a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped).Conclusions: Moderate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given. [ABSTRACT FROM AUTHOR]

Background: Yogurt and prebiotic consumption has been linked to better health. However, to our knowledge, no longitudinal study has assessed the association of yogurt and prebiotic consumption with depression risk.Objective: We longitudinally evaluated the association of yogurt and prebiotic consumption with depression risk in a Mediterranean cohort.Methods: The SUN (Seguimiento Universidad de Navarra) Project is a dynamic, prospective cohort of Spanish university graduates. A total of 14,539 men and women (mean age: 37 y) initially free of depression were assessed during a median follow-up period of 9.3 y. Validated food-frequency questionnaires at baseline and after a 10-y follow-up were used to assess prebiotic (fructans and galacto-oligosaccharide) intake and yogurt consumption (<0.5, ≥0.5 to <3, ≥3 to <7, and ≥7 servings/wk). Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression by a physician (previously validated). Multivariable Cox proportional hazards models were used to calculate HRs and 95% CIs.Results: We identified 727 incident cases of depression during follow-up. Whole-fat yogurt intake was associated with reduced depression risk: HR for the highest [≥7 servings/wk (1 serving = 125 g)] compared with the lowest (<0.5 servings/wk) consumption: 0.78 (95% CI: 0.63, 0.98; P-trend = 0.020). When stratified by sex, this association was significant only in women (HR: 0.66; 95% CI: 0.50, 0.87; P-trend = 0.004). Low-fat yogurt consumption was associated with a higher incidence of depression (HR: 1.32; 95% CI: 1.06, 1.65; P-trend = 0.001), although this association lost significance after the exclusion of early incident cases, suggesting possible reverse causation bias. Prebiotic consumption was not significantly associated with depression risk.Conclusions: Our study suggests that high consumption of whole-fat yogurt was related to a lower risk of depression in women of the SUN cohort. No association was observed for prebiotics. Further studies are needed to clarify why the yogurt-depression association may differ by fat content of the yogurt. [ABSTRACT FROM AUTHOR]

Background: Research on the role of diet in the prevention of depression is scarce. Some evidence suggests that depression shares common mechanisms with cardiovascular disease. Discussion: Before considering the role of diet in the prevention of depression, several points need to be considered. First, in general, evidence has been found for the effects of isolated nutrients or foods, and not for dietary patterns. Second, most previous studies have a cross-sectional design. Third, information is generally collected though questionnaires, increasing the risk of misclassification bias. Fourth, adequate control of confounding factors in observational studies is mandatory. Summary: Only a few cohort studies have analyzed the relationship between overall dietary patterns, such as the Mediterranean diet, and primary prevention of depression. They have found similar results to those obtained for the role of this dietary pattern in cardiovascular disease. To confirm the findings obtained in these initial cohort studies, we need further observational longitudinal studies with improved methodology, as well as large randomized primary prevention trials, with interventions based on changes in the overall food pattern, that include participants at high risk of mental disorders. [ABSTRACT FROM AUTHOR]

Background Obesity in childhood and adolescence has important health consequences, but its relation to risk of adult depression remains uncertain. Objective To examine the effect of perceived and actual obesity during childhood and adolescence on prevalence and incidence of adult depression risk. Methods Cohort study of 91 798 female registered nurses followed longitudinally for 12 years. Results As compared with lean women of the same age, women in the two highest categories of body shape at age 10 had both higher prevalence (OR=2.59, 95% CI 1.46 to 4.61) and incidence (OR=2.01, 95% CI 1.08 to 3.71) of depression. Similar results were obtained for body shape at age 20 (OR=3.43 for prevalence and OR=2.03 for incidence) and for body mass index (BMI) at age 18 (OR=2.92 for BMI ≥40 kg/m2). These associations remained significant after adjustment for multiple confounders. Conclusion These results indicate that childhoodeadolescence obesity is a strong and independent risk factor for adult depression. [ABSTRACT FROM AUTHOR]

Background Leisure-time physical activity (LTPA) has been associated with better mental and physical health particularly in cross-sectional studies. Purpose To longitudinally assess the association between LTPA, changes in LTPA and health-related quality of life (HRQL). Methods Cross-sectional and prospective analysis of the Seguimiento Universidad de Navarra Project, a dynamic cohort study. Information is gathered through mailed questionnaires biannually since 1999. A validated LTPA questionnaire was used to assess LTPA level at baseline. Changes in LTPA were ascertained at 2 and 4 years of follow-up. HRQL was assessed at 4 and 8 years of follow-up with a validated Spanish version of the SF-36 Health Survey. Multivariate regression coefficients, means and their 95% CIs for each of the eight domains of the SF-36 according to quintiles of baseline LTPA and changes in LTPA over time were calculated using generalized linear models. Results At 4 years of follow-up, mean scores for upper quintiles of LTPA (second to highest quintile) of physical functioning, general health, vitality, social functioning and mental health were significantly higher than the mean score obtained for participants with the lowest level of LTPA (first quintile). In general, and independent of previous scores in SF-36 survey, the maintenance or the increase in LTPA levels during follow-up was associated with better scores in HRQL after 8 years of follow-up, especially for mental domains. Conclusion These findings provide support for an association between LTPA, long-term changes in LTPA and several aspects of HRQL (especially in relation to mental domains) extending previous cross-sectional findings. [ABSTRACT FROM AUTHOR]

Background: Longitudinal studies assessing the long-term association between alcohol intake and depression are scarce. The type of beverage may also be important. Therefore we aimed to prospectively evaluate the influence of alcohol intake on incident depression in a Mediterranean cohort. Methods: We assessed 13,619 university graduates (mean age: 38 years, 42% men) participating in a Spanish prospective epidemiological cohort (the SUN Project), initially free of depression. They were recruited between 1999-2008 and biennially followed-up during 2001-2010. At baseline, a 136-item validated food-frequency questionnaire was used to assess alcohol intake. Wine was the preferred beverage. Participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression and restricted cubic splines analyses were performed over 82,926 person-years. Results: Only among women, an U-shaped relationship between total alcohol intake and depression risk was found (P=0.01). Moderate alcohol intake (5-15 g/day) was associated with lower risk (Hazard Ratio: 0.62; 95% Confidence Interval: 0.43-0.89). No association was apparent for higher intakes of alcohol or for any specific type of alcoholic beverage. Conclusions: Moderate alcohol intake might protect against depression among women. Further confirmatory studies are needed. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome (MetS).DesignA dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Participants were asked to select which of nine body images most closely represented their body shape at ages 5 and 20 years, and it was used as a proxy of BMI. An incident case of MetS was diagnosed according to criteria of the International Diabetes Federation. Associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult MetS were estimated by multiple-adjusted odds ratios and their 95 % confidence intervals.SettingUniversity of Navarra, Spain.SubjectsThe study included 5317 university graduates, followed-up for a median of 6·1 years.ResultsThe incidence of MetS was 2·9 % (1·7 % in women and 5·1 % in men). Among men, body shape at age 5 years was inversely related to adult MetS (OR = 0·83, 95 % CI 0·72, 0·97), whereas weight gain during childhood to adolescence/young adulthood was directly associated with adult MetS (OR = 1·49, 95 % CI 1·01, 2·18); both childhood underweight (OR = 5·20, 95 % CI 1·87, 14·50) and childhood obesity (OR = 4·66, 95 % CI 1·40, 15·51) increased the likelihood of adult MetS. No association was apparent among women.ConclusionsThese results support treating childhood underweight and weight gain during childhood to adolescence/young adulthood as part of comprehensive adult MetS prevention efforts in men. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have shown that highly nutritious diets are more costly, but to date there has been no evaluation of the costs associated with failing to meet micronutrient recommendations in a Spanish population. Design, setting and subjects: We examined whether daily food consumption costs (classified in quintiles) were associated with failing to meet at least three daily nutritional recommendations out of twenty (including fibre and nineteen micronutrients) in a cross-sectional analysis of baseline data of a cohort of 17 197 Spanish university graduates. Micronutrients and fibre intake were assessed with a validated 136-item FFQ. Average cost of food was calculated from official Spanish government data. Results and conclusions: As participants presented higher dietary energy cost from their diet, their intake of micronutrients increased significantly. Low dietary energy cost was associated with a higher likelihood of failing to meet three or more recommendations (P for trend <0.001 across quintiles of dietary cost), the association being stronger among female than male participants (P for interaction between sex and quintile of dietary energy cost <0.001). [ABSTRACT FROM AUTHOR]

Objective: Previous studies have shown that highly nutritious diets are more costly, but to date there has been no evaluation of the costs associated with failing to meet micronutrient recommendations in a Spanish population.Design, Setting and Subjects: We examined whether daily food consumption costs (classified in quintiles) were associated with failing to meet at least three daily nutritional recommendations out of twenty (including fibre and nineteen micronutrients) in a cross-sectional analysis of baseline data of a cohort of 17,197 Spanish university graduates. Micronutrients and fibre intake were assessed with a validated 136-item FFQ. Average cost of food was calculated from official Spanish government data.Results and Conclusions: As participants presented higher dietary energy cost from their diet, their intake of micronutrients increased significantly. Low dietary energy cost was associated with a higher likelihood of failing to meet three or more recommendations (P for trend <0.001 across quintiles of dietary cost), the association being stronger among female than male participants (P for interaction between sex and quintile of dietary energy cost <0.001). [ABSTRACT FROM AUTHOR]

Background: Depression assessment in population studies is usually based on depressive symptoms scales. However, the use of scales could lead to the choice of an arbitrary cut-off point depending on the sample characteristics and on the patient diagnosis. Thus, the use of a medical diagnosis of depression could be a more appropriate approach. Objective: To validate a self-reported physician diagnosis of depression using the Structured Clinical Interview for DSM-IV (SCID-I) as Gold Standard and to assess the factors associated to a valid self-reported diagnosis. Methods: The SUN Project is a cohort study based on university graduates followed-up through postal questionnaires. The response to the question included in the questionnaire: Have you ever been diagnosed of depression by a physician? was compared to that obtained through the SCID-I applied by a psychiatrist or a clinical psychologist. The percentages of confirmed depression and non-depression were assessed for the overall sample and according to several characteristics. Logistic regression models were fitted to ascertain the association between different factors and a correct classification regarding depression status. Results: The percentage of confirmed depression was 74.2%; 95% confidence interval (95% CI) = 63.3-85.1. Out of 42 participants who did not report a depression diagnosis in the questionnaire, 34 were free of the disease (%confirmed non-depression = 81.1%; 95% CI = 69.1-92.9). The probability of being a true positive was higher among ex-smokers and non-smokers and among those overweight or obese but the differences were not statistically significant. Conclusion: The validity of a self-reported diagnosis of depression in the SUN cohort is adequate. Thus, this question about depression diagnosis could be used in further investigations regarding this disease in this graduate cohort study. [ABSTRACT FROM AUTHOR]

Very long chain omega-3 fatty acids (w-3 PUFA) intake and fish consumption have been suggested as protective factors against neuropsychiatric disorders but there is scarcity of large cohort studies assessing this association. To assess the association between w-3-PUFA intake and fish consumption and mental disorders. A prospective cohort study was performed in 7,903 participants. W-3 PUFA intake and fish consumption were ascertained through a validated semi-quantitative food frequency questionnaire. The outcomes after 2 years of follow-up were: (1) Incident mental disorder (depression, anxiety, or stress), (2) incident depression, and (3) incident anxiety. Logistic regression models and generalized additive models were fit to assess the relationship between w-3 PUFA intake or fish consumption and the incidence of these outcomes. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. 173 cases of depression, 335 cases of anxiety, and 4 cases of stress were observed during 2-year follow-up. ORs (95% CI) of mental disorder for successive quintiles of energy-adjusted w-3 PUFA intake were 1 (reference), 0.72 (0.52–0.99), 0.79 (0.58–1.08), 0.65 (0.47–0.90), and 1.04 (0.78–1.40). Subjects with a moderate consumption of fish (third and fourth quintiles of consumption: median of each quintile 83.3 and 112 g/day, respectively) had a relative risk reduction higher than 30%. A potential benefit of w-3 PUFA intake on total mental disorders is suggested, although no linear trend was apparent. [ABSTRACT FROM AUTHOR]

A survey was conducted to investigate the relationship between knowledge about food safety and actual food handling practices among Spanish university students (mainly from the health sciences disciplines) who usually prepare meals at home. Based on level of education in food safety topics, students were divided in three groups: high, which included students from Food Science and Nutrition; medium, which included students from other health sciences; and low, which included students from non-health-related studies. More than two thirds of the 562 people selected had an accurate knowledge of the eight foodborne pathogens included in the survey, but only 5.2% were able to identify Staphylococcus aureus as a foodborne pathogen. Significant differences in responses were found depending on educational level concerning the food safety topic. For food handling, up to 60% of the responses reflected accurate knowledge of proper storage of prepared meals and washing of hands and materials to avoid cross-contamination. However, with the exception of questions related to storage temperature, there was considerable difference between knowledge and reported behavior. Although 98.6% of the participants recognized the importance of hand washing before and during food preparation, only one quarter (24.4%) affirmed that they washed their hands with soap and water. On questions concerning food practices, more accurate answers were given by the older students. Women answered questions regarding cross-contamination more accurately, whereas men were more accurate in response to questions concerning temperature and food preservation. In general, students with more knowledge of food hygiene had better reported practices, but even these students reported some high-risk behaviors. These results confirm the need to improve educational programs, ensuring that the acquired knowledge actually modifies consumer behavior. [ABSTRACT FROM AUTHOR]

The article focuses on the results of a study on the relationship between adherence to the Mediterranean food pattern (MFP) and development of metabolic syndrome in a group of graduates at Seguimiento Universidad de Navarra (SUN) in Spain. It reveals that adherence to the MFP was greater among women, older people and physically active individuals. The study indicates an inverse association between adherence to MFP and cumulative incidence of metabolic syndrome.

Background: Research on the role of diet in the prevention of depression is scarce. Some evidence suggests that depression shares common mechanisms with cardiovascular disease.Discussion: Before considering the role of diet in the prevention of depression, several points need to be considered. First, in general, evidence has been found for the effects of isolated nutrients or foods, and not for dietary patterns. Second, most previous studies have a cross-sectional design. Third, information is generally collected though questionnaires, increasing the risk of misclassification bias. Fourth, adequate control of confounding factors in observational studies is mandatory.Summary: Only a few cohort studies have analyzed the relationship between overall dietary patterns, such as the Mediterranean diet, and primary prevention of depression. They have found similar results to those obtained for the role of this dietary pattern in cardiovascular disease. To confirm the findings obtained in these initial cohort studies, we need further observational longitudinal studies with improved methodology, as well as large randomized primary prevention trials, with interventions based on changes in the overall food pattern, that include participants at high risk of mental disorders. [ABSTRACT FROM AUTHOR]