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Diet quality, stress and common mental health problems: A cohort study of 121,008 adults - PubMed
Diet quality, stress and common mental health problems: A cohort study of 121,008 adults - PubMed

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Clin Nutr


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. 2021 Mar;40(3):901-906.

doi: 10.1016/j.clnu.2020.06.016.

Epub 2020 Jun 30.


# Diet quality, stress and common mental health problems: A cohort study of 121,008 adults

[Lizanne J S Schweren](/?term=Schweren+LJS&cauthor_id=32654840)[1](#full-view-affiliation-1 "University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands. Electronic address: l.j.s.schweren@umcg.nl."), [Henrik Larsson](/?term=Larsson+H&cauthor_id=32654840)[2](#full-view-affiliation-2 "Karolinska Institutet, Department of Medical Epidemiology and Biostatistics (HL), Solnavägen 1, Stockholm, 171 77, Sweden; Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden."), [Petra C Vinke](/?term=Vinke+PC&cauthor_id=32654840)[3](#full-view-affiliation-3 "University of Groningen, University Medical Center Groningen, Department of Epidemiology (PCV), Hanzeplein 1, Groningen, 9700 RB, the Netherlands."), [Lin Li](/?term=Li+L&cauthor_id=32654840)[4](#full-view-affiliation-4 "Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden."), [Liv Grimstvedt Kvalvik](/?term=Kvalvik+LG&cauthor_id=32654840)[5](#full-view-affiliation-5 "University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; University of Bergen, Department of Global Public Health and Primary Care (LGK), Bergen, 5007, Norway."), [Alejandro Arias-Vasquez](/?term=Arias-Vasquez+A&cauthor_id=32654840)[6](#full-view-affiliation-6 "RadboudUMC, Departments of Psychiatry and Human Genetics, Donders Center for Medical Neuroimaging (AAV), Geert Grooteplein Zuid 10, GA Nijmegen, 6525, the Netherlands."), [Jan Haavik](/?term=Haavik+J&cauthor_id=32654840)[7](#full-view-affiliation-7 "University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; Haukeland University Hospital, Division of Psychiatry (JH), Jonas Lies vei 65, Bergen, 5021, Norway."), [Catharina A Hartman](/?term=Hartman+CA&cauthor_id=32654840)[8](#full-view-affiliation-8 "University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.")




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### Affiliations

- 1 University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands. Electronic address: l.j.s.schweren@umcg.nl.
- 2 Karolinska Institutet, Department of Medical Epidemiology and Biostatistics (HL), Solnavägen 1, Stockholm, 171 77, Sweden; Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden.
- 3 University of Groningen, University Medical Center Groningen, Department of Epidemiology (PCV), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
- 4 Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden.
- 5 University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; University of Bergen, Department of Global Public Health and Primary Care (LGK), Bergen, 5007, Norway.
- 6 RadboudUMC, Departments of Psychiatry and Human Genetics, Donders Center for Medical Neuroimaging (AAV), Geert Grooteplein Zuid 10, GA Nijmegen, 6525, the Netherlands.
- 7 University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; Haukeland University Hospital, Division of Psychiatry (JH), Jonas Lies vei 65, Bergen, 5021, Norway.
- 8 University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.

-
PMID:

**32654840**
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[10.1016/j.clnu.2020.06.016](https://doi.org/10.1016/j.clnu.2020.06.016)

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# Diet quality, stress and common mental health problems: A cohort study of 121,008 adults

Lizanne J S Schweren et al.
Clin Nutr.2021 Mar.

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. 2021 Mar;40(3):901-906.

doi: 10.1016/j.clnu.2020.06.016.

Epub 2020 Jun 30.


### Authors

[Lizanne J S Schweren](/?term=Schweren+LJS&cauthor_id=32654840)[1](#short-view-affiliation-1 "University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands. Electronic address: l.j.s.schweren@umcg.nl."), [Henrik Larsson](/?term=Larsson+H&cauthor_id=32654840)[2](#short-view-affiliation-2 "Karolinska Institutet, Department of Medical Epidemiology and Biostatistics (HL), Solnavägen 1, Stockholm, 171 77, Sweden; Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden."), [Petra C Vinke](/?term=Vinke+PC&cauthor_id=32654840)[3](#short-view-affiliation-3 "University of Groningen, University Medical Center Groningen, Department of Epidemiology (PCV), Hanzeplein 1, Groningen, 9700 RB, the Netherlands."), [Lin Li](/?term=Li+L&cauthor_id=32654840)[4](#short-view-affiliation-4 "Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden."), [Liv Grimstvedt Kvalvik](/?term=Kvalvik+LG&cauthor_id=32654840)[5](#short-view-affiliation-5 "University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; University of Bergen, Department of Global Public Health and Primary Care (LGK), Bergen, 5007, Norway."), [Alejandro Arias-Vasquez](/?term=Arias-Vasquez+A&cauthor_id=32654840)[6](#short-view-affiliation-6 "RadboudUMC, Departments of Psychiatry and Human Genetics, Donders Center for Medical Neuroimaging (AAV), Geert Grooteplein Zuid 10, GA Nijmegen, 6525, the Netherlands."), [Jan Haavik](/?term=Haavik+J&cauthor_id=32654840)[7](#short-view-affiliation-7 "University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; Haukeland University Hospital, Division of Psychiatry (JH), Jonas Lies vei 65, Bergen, 5021, Norway."), [Catharina A Hartman](/?term=Hartman+CA&cauthor_id=32654840)[8](#short-view-affiliation-8 "University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.")

### Affiliations

- 1 University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands. Electronic address: l.j.s.schweren@umcg.nl.
- 2 Karolinska Institutet, Department of Medical Epidemiology and Biostatistics (HL), Solnavägen 1, Stockholm, 171 77, Sweden; Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden.
- 3 University of Groningen, University Medical Center Groningen, Department of Epidemiology (PCV), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
- 4 Örebro University, School of Medical Sciences (HL,LL), Fakultetsgatan 1, Örebro, 702 81, Sweden.
- 5 University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; University of Bergen, Department of Global Public Health and Primary Care (LGK), Bergen, 5007, Norway.
- 6 RadboudUMC, Departments of Psychiatry and Human Genetics, Donders Center for Medical Neuroimaging (AAV), Geert Grooteplein Zuid 10, GA Nijmegen, 6525, the Netherlands.
- 7 University of Bergen, Department of Biomedicine (LGK, JH), Bergen, 5007, Norway; Haukeland University Hospital, Division of Psychiatry (JH), Jonas Lies vei 65, Bergen, 5021, Norway.
- 8 University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (LJSS, CAH), Hanzeplein 1, Groningen, 9700 RB, the Netherlands.

-
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**32654840**
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[10.1016/j.clnu.2020.06.016](https://doi.org/10.1016/j.clnu.2020.06.016)

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## Abstract

**Background & aims:**

Overall diet quality may partially mediate the detrimental effects of stress and neuroticism on common mental health problems: stressed and/or neurotic individuals may be more prone to unhealthy dietary habits, which in turn may contribute to depression and anxiety. Lifestyle interventions for depressed, anxious or at-risk individuals hinge on this idea, but evidence to support such pathway is missing. Here, we aim to prospectively evaluate the role of overall diet quality in common pathways to developing depression and anxiety.


**Methods:**

At baseline, N = 121,008 individuals from the general population (age 18-93) completed an extensive food frequency questionnaire, based on which overall diet quality was estimated. Participants also reported on two established risk factors for mental health problems, i.e. past-year stress exposure (long-term difficulties, stressful life-events) and four neuroticism traits (anger-hostility, self-consciousness, impulsivity, vulnerability). Depression and anxiety were assessed at baseline and follow-up (n = 65,342, +3.6 years). Overall diet quality was modeled as a mediator in logistic regression models predicting the development of depression and anxiety from common risk factors.


**Results:**

High stress and high neuroticism scores were - albeit weakly - associated with poorer diet quality. Poor diet quality, in turn, did not predict mental health problems. Overall diet quality did not mediate the relationship between stress/neuroticism and common mental health problems: effects of stress, neuroticism and stress-by-neuroticism interactions on mental health problems at follow-up consisted entirely of direct effects (98.6%-100%).


**Conclusions:**

Diet quality plays no mediating role in two established pathways to common mental health problems. As overall diet quality was reduced in stressed and neurotic individuals, these groups may benefit from dietary interventions. However, such interventions are unlikely to prevent the onset or recurrence of depression and anxiety.


**Keywords:**

Depression; Overall diet quality; Prevention; Prospective cohort study; Public health; Stress.


Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.


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## Conflict of interest statement

Conflict of interest H Larsson has served as a speaker for Evolan Pharma and Shire and has received research grants from Shire; all outside the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

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