Research report
Nutrient intakes and the common mental disorders in women

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Abstract

Background

There is an increasing recognition of the role of nutrition in depression and anxiety. Magnesium, folate and zinc have all been implicated in depressive illness, however there are few data on these nutrients in anxiety disorders and the data from population-studies are limited.

Aims

In a large, randomly-selected, population-based sample of women, this study aimed to examine the relationship between the dietary intakes of these three micronutrients and clinically determined depressive and anxiety disorders and symptoms.

Methods

Nutrient intakes were determined using a validated food frequency questionnaire. The General Health Questionnaire-12 measured psychological symptoms, and a clinical interview (Structured Clinical Interview for DSM-IV-TR, non-patient edition) assessed current depressive and anxiety disorders.

Results

After adjustments for energy intake, each standard deviation increase in the intake of zinc, magnesium and folate was associated with reduced odds ratio (OR) for major depression/dysthymia (zinc: OR = 0.52, 95% confidence interval (CI) 0.31 to 0.88; magnesium: OR = 0.60, 95% CI 0.37 to 0.96; folate: OR = 0.66, 95% CI 0.45 to 0.97). There was also an inverse association between the intake of magnesium and zinc and GHQ-12 scores (zinc: zβ =  0.16, 95% CI − 0.29 to − 0.04; magnesium: − 0.14, 95% CI − 0.26 to − 0.03). These relationships were not confounded by age, socioeconomic status, education or other health behaviours. There was no relationship observed between any nutrient and anxiety disorders.

Conclusion

These results demonstrate an association between the dietary intakes of magnesium, folate and zinc and depressive illnesses, although reverse causality and/or confounding cannot be ruled out as explanations.

Introduction

In recent years, there has been an increasing interest in the role of nutrition in depression. Apart from the extensive investigations focused on long-chain omega-3 fatty acids (for review see Parker et al., 2006), three micronutrients in particular have been examined in depression: zinc, magnesium and folate. Zinc is a trace mineral involved in modulating the function of NMDA receptors (Takeda, 2000), which in turn play a critical role in synaptic plasticity in areas of the brain salient to depressive illness, such as the hippocampus and amygdala (Nestler et al., 2002). In animal models of depression, zinc treatment produces antidepressant-like effects (Kroczka et al., 2000, Kroczka et al., 2001, Nowak et al., 2003b, Rosa et al., 2003) and enhances the efficacy of common antidepressant medications (Kroczka et al., 2001). In humans, decreased serum zinc is described in individuals with MDD (Maes et al., 1994, Maes et al., 1997b, Mcloughlin and Hodge, 1990), while serum zinc levels are negatively correlated with illness severity (Maes et al., 1994) and treatment resistance (Maes et al., 1997b). Moreover, zinc supplementation has been shown to enhance the efficacy of antidepressant therapy (Nowak et al., 2003a), while two very recent studies have shown inverse relationships between the dietary intake of zinc and self-reported depression in pregnant women (Roy et al., 2011) and female students (Amani et al., 2011).

Magnesium is another micronutrient thought to play role in depression. A magnesium-deficient diet has been shown to increase depression- and anxiety-related behaviour in mice (Singewald et al., 2004), while magnesium treatment appears to improve such behaviours in animal models (Poleszak et al., 2004, Poleszak et al., 2005). In humans, Jacka et al. (2009) have reported an inverse relationship between dietary magnesium intake and self-reported depression, but not anxiety, in a large sample of community-dwelling men and women in Norway. However, to date there have been no comprehensive studies investigating the link between the dietary intake of either zinc or magnesium and clinically-determined depressive and anxiety disorders in humans.

Finally, folate deficiencies have been associated with depression in a range of clinical and epidemiological studies. Symptoms of depression such as apathy, fatigue, insomnia, irritability and impaired concentration, are commonly seen in various states associated with deficiencies of folate and the results of more than 20 clinical studies have indicated that serum folate deficiency affects as many as one-third of psychiatric patients (Alpert et al., 2000). Serum folate levels are related to treatment response in major depression (Fava et al., 1997, Papakostas et al., 2005), while folate supplementation appears to enhance antidepressant treatments (Taylor et al., 2004). A relationship between low serum folate and depression is also seen in both cross-sectional (Morris et al., 2003) and prospective (Kim et al., 2008) population-based studies, while the dietary intake of folate is also related to self-reported depression cross-sectionally (Tolmunen et al., 2003) and to the risk for clinical depression over time (Tolmunen et al., 2004a), although the findings are equivocal (Hakkarainen et al., 2004).

In this study, we aimed a priori to examine the dietary intake of those three micronutrients that are supported by extant evidence and the common mental disorders and symptoms in a large, randomly-selected, population-based sample of adult women. Our hypothesis was that women with lower dietary intakes of each of these micronutrients would be more likely to have clinical depressive and anxiety disorders and higher levels of psychiatric symptomatology.

Section snippets

Participants

The Geelong Osteoporosis Study (GOS) is an ongoing epidemiological study based in south-eastern Australia. An age-stratified, randomly-selected, population-based sample of 1494 women aged 20–94 years was recruited between 1994 and 1997, with a participation of 77.1% (Pasco et al., in press). These women have continued to return for biennial follow-up assessments that include comprehensive measures of lifestyle, medical and family history, medication use, as well as anthropometric, body

Results

Table 1 presents characteristics of the study participants with and without depressive and anxiety disorders. Comparisons revealed no evident differences between those with and without these disorders on any of the included variables.

Median intakes and interquartile ranges of nutrients were as follows: zinc (9.6 mg/day, IQR 7.5 to 12.2); magnesium (240.9 mg/day, IQR 189.5 to 304.4); and folate (261.6 μ/day, IQR 322.8 to 210.7). While 70% of women in the sample met or exceeded the recommended daily

Discussion

Hypotheses regarding the association between the nutrients magnesium, folate and zinc and mental health were largely supported by the data, with the intake of each of these nutrients from food associated with reduced psychiatric symptomatology and the likelihood of depressive disorders. However, the relationship between nutrient intakes and anxiety disorders, while in the same direction, was not significant.

Conclusion

The results of this study support the contention that the consumption of nutrient-dense foods plays a role in depression, but not anxiety. Magnesium and folate are prominent components of foods recommended as part of the Australian National Healthy Eating guidelines ((NHMRC), 2003), such as leafy green vegetables, nuts, legumes and wholegrains, while zinc is found in lean meats and seafoods, which are also important components of a healthy diet. Of concern are the very low intakes of magnesium

Conflict of interest

All authors have no conflict to declare.

Acknowledgments

This study was funded by the National Health and Medical Research Council of Australia (Project Grants # 454356, 251638) and an unrestricted educational grant from Eli Lilly. The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences and Australian Rotary Health provided postgraduate scholarships to FNJ and LJW. FNJ is supported by an NHMRC Post-doctoral Training Fellowship (#628912). The funding providers played no role in the design or conduct of the study; collection,

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      In the third model, we further adjusted for intake of folate (μg/1000 kcal, continuous), vitamin B6 (mg/1000 kcal, continuous), vitamin B12 (μg/1000 kcal, continuous), n-3 polyunsaturated fatty acids (% energy, continuous), magnesium (mg/1000 kcal, continuous), and zinc (mg/1000 kcal, continuous). The nutritional factors we adjusted for have been linked to depressive symptoms (Gilbody et al., 2007; Sanchez-Villegas et al., 2007; Skarupski et al., 2010; Jacka et al., 2012; Vashum et al., 2014; Miki et al., 2015). Trend association was tested by assigning ordinal numbers (1–5) to the frequency of eating with others categories.

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