Intakes of Specific Categories of Vegetables and Fruits Are Inversely Associated With Depressive Symptoms Among Adults

Background Epidemiological evidence on the relationships between intakes of different categories of vegetables and fruits and depressive symptoms is very limited and inconsistent, especially with no evidence from the general population. This study aimed to estimate their relationships among a large general population. Methods The cross-sectional design was based on the National Health and Nutrition Examination Survey (2007–2014) and included 16,925 adults. Dietary information was attained from two nonconsecutive 24-hr dietary recalls. Patient Health Questionnaire was applied for measuring depressive symptoms. The associations between vegetables and fruits intakes and depressive symptoms were appraised utilizing logistic regression and restricted cubic spline. Results Compared with the lowest category of intake, the most-adjusted odds ratios of depressive symptoms for the highest intake category of tomatoes and tomato mixtures were 0.81 (95% confidence interval [CI], 0.66–0.99), and 0.64 (95% CI, 0.48–0.85) for dark-green vegetables, 0.67 (95% CI, 0.53–0.84) for other vegetables, 0.48 (95% CI, 0.29–0.79) for berries, 0.67 (95% CI, 0.55–0.82) for total vegetables, and 0.70 (95% CI, 0.57–0.86) for total fruits, and for the medium categories of bananas and dried fruits were 0.62 (95% CI, 0.41–0.95) and 0.39 (95% CI, 0.19–0.81), respectively. After sensitivity analysis further excluding subjects with co-morbid health conditions, these findings remained significant, except for bananas. An L-shaped relationship was observed between depressive symptoms and intake of total vegetables, while the association was linear with total fruits intake. Conclusions Intakes of tomatoes and tomato mixtures, dark-green vegetables, other vegetables, berries, dried fruits, total vegetables, and total fruits were inversely related to depressive symptoms among adults.


Stroke d No; Yes
Total energy intake (kcal/d) e Continuous a Diabetes was identified as a level of fasting plasma (or 2-hr plasma) glucose arriving at 126 mg/dL (or 200 mg/dL) and over, level of blood glycohemoglobin (HbA1c) ≥6.5%, using anti-diabetic pills or insulin, or self-reported doctor diagnosis.
b Individuals whose mean diastolic (or systolic) blood pressure ≥80 mm Hg (or ≥130 mm Hg), or currently taking prescribed for high blood pressure were classified as having hypertension.
c Subjects who had ever been diagnosed by a doctor that they had coronary heart disease, angina pectoris, congestive heart failure or heart attack were classified as having heart disease. d Participants were considered as having a stroke if they had ever been told by a doctor that they had a stroke. e Total energy intake was the summation of mean daily energy intake and mean dietary energy supplement energy through two 24-hr dietary data. eTable 3. Correlation coefficients between the first and second 24-hr dietary recalls for vegetables and fruits intakes work physical activity, smoking status, alcohol consumption, hypertension, diabetes, heart disease, stroke, and total daily energy intake (continuous, kcal/d). b Model 2 additionally adjusted for total vegetables intake (continuous, g/d) for subgroups of vegetables, or total fruits intake (continuous, g/d) for subgroups of fruits. c Each type of vegetable or fruits intake was segmented into three categories. Participants with no consumption the specific category of vegetable were classified into group 1 (intake =0), and individuals with consumption were divided into group 2 (<median) and group 3 (≥median) based on its median intake (g/d) among the participants with consumption. d Total vegetables and total fruits intake were divided into tertiles according to their distributions in the current entire study population. * P<0.05; ** P<0.01; *** P<0.001. eTable 5. Weighted odds ratios (95% confidence intervals) for depressive symptoms across vegetables and fruits intakes stratified by age, National Health and Nutrition Examination Survey 2007-2014

Dried fruits intake (g/d) c
Group 1 (=0) 1.00 (reference) 1.00 (reference) 1.00 (reference) Tertile 3 (≥249.00) 0.46 (0.29-0.73)** 0.57 (0.36-0.92)* a Model 1 adjusted for gender, race, marital status, educational level, family income, body mass index, recreational physical activity, work physical activity, smoking status, alcohol consumption, hypertension, diabetes, heart disease, stroke, and total daily energy intake (continuous, kcal/d). b Model 2 additionally adjusted for total vegetables intake (continuous, g/d) for subgroups of vegetables, or total fruits intake (continuous, g/d) for subgroups of fruits. c Each type of vegetable or fruits intake was segmented into three categories. Participants with no consumption the specific category of vegetable were classified into group 1 (intake =0), and individuals with consumption were divided into group 2 (<median) and group 3 (≥median) based on its median intake (g/d) among the participants with consumption. d Total vegetables and total fruits intake were divided into tertiles according to their distributions in the current entire study population.

Total fruits intake (g/d) d
Tertile 1 (<78.08) 1.00 (reference) 1.00 (reference) Tertile 2 (78.08 to <249.00) 0.67 (0.50-0.89)** 0.83 (0.60-1.14) Tertile 3 (≥249.00) 0.55 (0.45-0.68)*** 0.79 (0.64-0.97)* a Model 1 adjusted for gender, age, race, marital status, educational level, family income, body mass index, recreational physical activity, work physical activity, smoking status, alcohol consumption, hypertension, and total daily energy intake (continuous, kcal/d). b Model 2 additionally adjusted for total vegetables intake (continuous, g/d) for subgroups of vegetables, or total fruits intake (continuous, g/d) for subgroups of fruits. c Each type of vegetable or fruits intake was segmented into three categories. Participants with no consumption the specific category of vegetable were classified into group 1 (intake =0), and individuals with consumption were divided into group 2 (<median) and group 3 (≥median) based on its median intake (g/d) among the participants with consumption. d Total vegetables and total fruits intake were divided into tertiles according to their distributions in the current entire study population.