Entry #: 42
Date: 24 March 2018
Section: Mediterranean diet
Topic: Mediterranean diet and depression
Type: Human trial

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D. Elizabeth McCord, Nancy B. Ray and Tom C. Karagiannis


Does the mind decrease depression risk? A comparison with Mediterranean diet in the SUN cohort


Fresán et al

Citation / Year

(1) / 2018


Mediterranean diet, Mediterranean-dietary approaches to stop hypertension (DASH) diet, Mind diet, food-frequency questionnaire, depression


Depression represents a major clinical problem associated with significant loss in quality of life and increased mortality (2, 3). While effective, current pharmacological approaches are linked with significant side effects and relapse rates are relatively high, estimated to be at approximately 50% of cases (4, 5). As a different approach, there is increased interest in investigating the relationship between dietary patterns and depression. To date, recommendations are variable, and in cases controversial with the general consensus being that plant-based and omega-3 rich diets, providing some protection (6). In this context, the Mediterranean diet has been shown to reduce the risk for depression (7). In addition, the Mediterranean diet has been associated with reducing cognitive impairment which has been also been associated with depression (8). Another dietary regimen known the dietary approach to stop hypertension (DASH), diet has also been shown to protect against cognitive loss (9). Given the potential beneficial effects of the Mediterranean and DASH diets have both been associated with beneficial cognitive effects, efforts have been made to produce a modified hybrid Mediterranean-DASH diet for neurodegenerative delay, referred to as the MIND diet (10, 11). The aim of this study was to compare the association of depression with adherence to either traditional Mediterranean diet or the Mind diet.

Key points and implications

This study is part of the Seguimiento Universidad de Navarra (SUN), follow-up study, which a relatively large (total n=223200, and long-term (1999-2016), prospective cohort study (12). By following stringent inclusion criteria, and following typical losses, at total of 15980 participants were included in the study. Following, a baseline dietary assessment using a well-validated food-frequency questionnaire (136-items), adherence to the MIND and traditional Mediterranean diets were made (13). Adherence to the MIND diet was made using a validated 15 dietary component tool (11), and adherence to the Mediterranean diet was made by assessing against a validated nine component strategy (14) and comparing data with the 14-point Mediterranean diet adherence screener, which was utilised in the important PREDIMED trial (15). In short, although adherence to the MIND diet tended towards a reduced risk of depression, adherence to the Mediterranean diet significantly reduced the risk of depression. Given the similarity of the Mediterranean and MIND diets – both invoking an importance on the consumption of vegetables, legumes, nuts, and fish, these findings are interesting and it would be important to further define the characteristics of the two diets that may have led to the differential findings. The authors propose, that unlike the Mediterranean diet, green leafy vegetables and berries are specified in the MIND diet, providing a potential point of difference (1). Despite the nuances, the exciting inverse association between adherence to the Mediterranean diet and depression highlights the importance of dietary patterns and cognitive health.

Related publications

  1. U. Fresan et al., Does the MIND diet decrease depression risk? A comparison with Mediterranean diet in the SUN cohort. European journal of nutrition, (2018).
  2. H. A. Whiteford et al., Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 1575-1586 (2013).
  3. A. Mykletun et al., Levels of anxiety and depression as predictors of mortality: the HUNT study. The British journal of psychiatry : the journal of mental science 195, 118-125 (2009).
  4. N. Casacalenda, J. C. Perry, K. Looper, Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. The American journal of psychiatry 159, 1354-1360 (2002).
  5. K. van Zoonen et al., Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International journal of epidemiology 43, 318-329 (2014).
  6. R. S. Opie et al., Dietary recommendations for the prevention of depression. Nutritional neuroscience 20, 161-171 (2017).
  7. A. Sanchez-Villegas et al., Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Archives of general psychiatry 66, 1090-1098 (2009).
  8. E. H. Martinez-Lapiscina et al., Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of neurology, neurosurgery, and psychiatry 84, 1318-1325 (2013).
  9. C. C. Tangney et al., Relation of DASH- and Mediterranean-like dietary patterns to cognitive decline in older persons. Neurology 83, 1410-1416 (2014).
  10. M. C. Morris et al., MIND diet slows cognitive decline with aging. Alzheimer’s & dementia : the journal of the Alzheimer’s Association 11, 1015-1022 (2015).
  11. M. C. Morris et al., MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & dementia : the journal of the Alzheimer’s Association 11, 1007-1014 (2015).
  12. M. Segui-Gomez, C. de la Fuente, Z. Vazquez, J. de Irala, M. A. Martinez-Gonzalez, Cohort profile: the ‘Seguimiento Universidad de Navarra’ (SUN) study. International journal of epidemiology 35, 1417-1422 (2006).
  13. J. M. Martin-Moreno et al., Development and validation of a food frequency questionnaire in Spain. International journal of epidemiology 22, 512-519 (1993).
  14. A. Trichopoulou, T. Costacou, C. Bamia, D. Trichopoulos, Adherence to a Mediterranean diet and survival in a Greek population. The New England journal of medicine 348, 2599-2608 (2003).
  15. H. Schroder et al., A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. The Journal of nutrition 141, 1140-1145 (2011).