Skip to main content Accessibility help

Dietary pattern and depressive symptoms in middle age

  • Tasnime N. Akbaraly (a1), Eric J. Brunner (a2), Jane E Ferrie (a2), Michael G. Marmot (a2), Mika Kivimaki (a2) and Archana Singh-Manoux (a3)...



Studies of diet and depression have focused primarily on individual nutrients.


To examine the association between dietary patterns and depression using an overall diet approach.


Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: ‘whole food’ (heavily loaded by vegetables, fruits and fish) and ‘processed food’ (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies – Depression (CES–D) scale.


After adjusting for potential confounders, participants in the highest tertile of the whole food pattern had lower odds of CES–D depression (OR = 0.74, 95% CI 0.56–0.99) than those in the lowest tertile. In contrast, high consumption of processed food was associated with an increased odds of CES–D depression (OR = 1.58, 95% CI 1.11–2.23).


In middle-aged participants, a processed food dietary pattern is a risk factor for CES–D depression 5 years later, whereas a whole food pattern is protective.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dietary pattern and depressive symptoms in middle age
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dietary pattern and depressive symptoms in middle age
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dietary pattern and depressive symptoms in middle age
      Available formats


Corresponding author

Tasnime N. Akbaraly, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK. Email:


Hide All

T.N.A. is sponsored by the Academy of Finland (projects 117604, 124322). A.S.-M. is supported by a European Young Investigator Award from the European Science Foundation. M.G.M. is supported by a Medical Research Council (MRC) research professorship. J.E.F. is supported by the MRC (grant G8802774) and M.K. is supported by the Academy of Finland. The Whitehall II study has been supported by grants from the MRC, the British Heart Foundation, the UK Health and Safety Executive, the UK Department of Health, the US National Heart, Lung and Blood Institute (grant HL36310), the US National Institute on Aging (grant AG13196), the US Agency for Health Care Policy and Research (grant HS06516) and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health.

Declaration of interest




Hide All
1 Lin, PY, Su, KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry 2007; 68: 1056–61.
2 Murakami, K, Mizoue, T, Sasaki, S, Ohta, M, Sato, M, Matsushita, Y, et al. Dietary intake of folate, other B vitamins, and omega-3 polyunsaturated fatty acids in relation to depressive symptoms in Japanese adults. Nutrition 2008; 24: 140–7.
3 Sanchez-Villegas, A, Henriquez, P, Figueiras, A, Ortuno, F, Lahortiga, F, Martinez-Gonzalez, MA. Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN cohort study. Eur J Nutr 2007; 46: 337–46.
4 Tiemeier, H, van Tuijl, HR, Hofman, A, Kiliaan, AJ, Breteler, MM. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam Study. Am J Clin Nutr 2003; 78: 40–6.
5 Gilbody, S, Lightfoot, T, Sheldon, T. Is low folate a risk factor for depression? A meta-analysis and exploration of heterogeneity. J Epidemiol Community Health 2007; 61: 631–7.
6 Kamphuis, MH, Geerlings, MI, Grobbee, DE, Kromhout, D. Dietary intake of B(6-9-12) vitamins, serum homocysteine levels and their association with depressive symptoms: the Zutphen Elderly Study. Eur J Clin Nutr 2008; 62: 939–45.
7 Tolmunen, T, Hintikka, J, Ruusunen, A, Voutilainen, S, Tanskanen, A, Valkonen, VP, et al. Dietary folate and the risk of depression in Finnish middle-aged men. A prospective follow-up study. Psychother Psychosom 2004; 73: 334–9.
8 Hu, FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002; 13: 39.
9 Sofi, F, Cesari, F, Abbate, R, Gensini, GF, Casini, A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008; 337: a1344.
10 Marmot, M, Brunner, E. Cohort profile: the Whitehall II study. Int J Epidemiol 2005; 34: 251–6.
11 Brunner, E, Stallone, D, Juneja, M, Bingham, S, Marmot, M. Dietary assessment in Whitehall II: comparison of 7 d diet diary and food-frequency questionnaire and validity against biomarkers. Br J Nutr 2001; 86: 405–14.
12 Willett, WC, Sampson, L, Stampfer, MJ, Rosner, B, Bain, C, Witschi, J, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985; 122: 5165.
13 Bingham, SA, Gill, C, Welch, A, Cassidy, A, Runswick, SA, Oakes, S, et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 1997; 26 (suppl 1): S13751.
14 Akbaraly, TN, Singh-Manoux, A, Marmot, MG, Brunner, EJ. Education attenuates the association between dietary patterns and cognition. Dement Geriatr Cogn Disord 2009; 27: 147–54.
15 Radloff, L. The CES–D scale: a self-report depression scale for research in the general population. Appl Psychol Measures 1977; 1: 385401.
16 Singh-Manoux, A, Hillsdon, M, Brunner, E, Marmot, M. Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study. Am J Public Health 2005; 95: 2252–8.
17 Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003; 26 (suppl 1): S520.
18 Heim, AW. AH 4 Group Test of General Intelligence ASE. nferNelson Publishing, 1970.
19 Goldberg, D. The Detection of Psychiatric Illness by Questionnaire. Oxford University Press, 1972.
20 Nutrient Data Laboratory Agriculture Research Service. Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods. US Department of Agriculture, 2007.
21 Sarandol, A, Sarandol, E, Eker, SS, Erdinc, S, Vatansever, E, Kirli, S. Major depressive disorder is accompanied with oxidative stress: short-term antidepressant treatment does not alter oxidative-antioxidative systems. Hum Psychopharmacol 2007; 22: 6773.
22 Food Standard Agency. The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years. Vitamin and Mineral Intake and Urinary Analytes. TSO (The Stationery Office), 2003.
23 Selhub, J, Bagley, LC, Miller, J, Rosenberg, IH. B vitamins, homocysteine, and neurocognitive function in the elderly. Am J Clin Nutr 2000; 71: 614–20S.
24 Hibbeln, JR. Fish consumption and major depression. Lancet 1998; 351: 1213.
25 Astorg, P, Arnault, N, Czernichow, S, Noisette, N, Galan, P, Hercberg, S. Dietary intakes and food sources of n-6 and n-3 PUFA in French adult men and women. Lipids 2004; 39: 527–35.
26 Westover, AN, Marangell, LB. A cross-national relationship between sugar consumption and major depression? Depress Anxiety 2002; 16: 118–20.
27 Lopez-Garcia, E, Schulze, MB, Fung, TT, Meigs, JB, Rifai, N, Manson, JE, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2004; 80: 1029–35.
28 Kamphuis, MH. Depression and Cardiovascular Disease: The Role of Diet, Lifestyle and Health. University of Utrecht, 2006.
29 Tiemeier, H, Hofman, A, van Tuijl, HR, Kiliaan, AJ, Meijer, J, Breteler, MM. Inflammatory proteins and depression in the elderly. Epidemiology 2003; 14: 103–7.

Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Akbaraly et al. supplementary material
Supplementary Table S1-S2

 PDF (38 KB)
38 KB

Dietary pattern and depressive symptoms in middle age

  • Tasnime N. Akbaraly (a1), Eric J. Brunner (a2), Jane E Ferrie (a2), Michael G. Marmot (a2), Mika Kivimaki (a2) and Archana Singh-Manoux (a3)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Dietary pattern and depressive symptoms in middle age

  • Tasnime N. Akbaraly (a1), Eric J. Brunner (a2), Jane E Ferrie (a2), Michael G. Marmot (a2), Mika Kivimaki (a2) and Archana Singh-Manoux (a3)...
Submit a response


Dietary pattern can influence inflammation status and IDO activity

Dietmar Fuchs, University Professor
11 December 2009

With great interest we read the study by Akbaraly and coworkers in which an association between dietary patterns and depressive mood was described in middle-aged healthy individuals.1 A processed food dietary pattern was found as a risk factor for depression 5 years later according to the Center for Epidemiologic Studies – Depression scale(CES-D) whereas a whole food pattern was protective. Thus, results suggestthat healthy eating habits like frequent consumption of fruits, vegetablesand fish may play an important protective role, whereas processed food maypromote inflammatory processes. Especially this latter aspect may deserve special attention because of its relationship to the biochemistry of 5-hydroxytryptamine (serotonin, 5HT) which is considered as one of the crucial players in the pathogenesis of depression.2

Pro-inflammatory responses and related cytokine cascades such as the production of Th1-type cytokine interferon-gamma are well characterized for their antiproliferative activity against infected or malignant cells. One of the most important strategies thereby is the induction of tryptophan degrading enzyme indoleamine 2,3-dioxygenase (IDO). In patientswith infectious diseases and in cancer an association was observed betweenlowered tryptophan levels due to a higher degradation rate and the development of psychiatric symptoms like depression and cognitive impairment.3,4 Notably, in vitro studies showed that anti-oxidant compounds like vitamin C and E and resveratrol are to not only able to down-regulate the inflammatory responses, e.g., neopterin production, in stimulated peripheral mononuclear cells but also suppress the activity of IDO and thus counteract tryptophan degradation.5,6 No such data are available from patients but an inverse relationship was found between increased immune activation status and diminished concentrations of several antioxidant vitamins in patients with cardiovascular disease.7 With this background it will be important to investigate whether the relationship found between dietary patterns and depressive mood is associated with changes of serum/plasma tryptophan concentrations.


1 Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry 2009; 195: 408-13.2 Widner B, Laich A, Sperner-Unterweger B, Ledochowski M, Fuchs D. Neopterin production tryptophan degradation and mental depression: what isthe link? Brain Behav Immun 2002; 16: 590-5.3 Huang A, Fuchs D, Widner B, Glover C, Henderson DC, Allen-Mersh TG. Serum tryptophan decrease correlates with immune activation and impaired quality of life in colorectal cancer. Brit J Cancer 2002; 86: 1691-6.4 Schroecksnadel K, Sarcletti M, Winkler C, Mumelter B, Wiee G, Fuchs D, Zangerle R. Quality of life and immune activation in patients with HIV infection. Brain Behav Immun 2008; 22: 881-9.5 Winkler C, Schroecksnadel K, Schennach H, Fuchs D. Vitamin C and E suppress mitogen-stimulated peripheral blood mononuclear cells in vitro. Int Arch Allergy Immunol 2007; 142: 127-32.6 Wirleitner B, Schroecksnadel K, Winkler C, Schennach H, Fuchs D. Resveratrol suppresses interferon-gamma-induced biochemical pathways in human peripheral blood mononuclear cells in vitro. Immunol Lett 2005; 100:159-63.7 Murr C, Schroecksnadel K, Winklhofer-Roob BM, Mangge H, Böhm BO, Winkelmann BR, Maerz W, Fuchs D. Inverse association between serum concentrations of neopterin and antioxidants in patients with and without angiographic coronary artery disease. Atherosclerosis 2009; 202: 543-9.
... More

Conflict of interest: None Declared

Write a reply


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *