Association between depression symptoms and Mediterian dietary adherence in adults with cardiovascular disease risk factors in the north of Iran in 2016
Asieh Ashouri 1, 2  
More details
Hide details
Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
School of Health, Guilan University of Medical Sciences, Rasht, Iran
Asieh Ashouri   

Cardiovascular Diseases Research Center, Department of Cardiology, Dr. Hashamat Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran. Tel: +98 13 33618177, Fax: +98 13 33849413.
Online publish date: 2018-06-04
Publish date: 2019-10-30
Submission date: 2017-04-03
Acceptance date: 2017-06-16
Pol. Ann. Med. 2019;26(1):1–7
Depression is prevalent in cardiovascular patients and may have significant effects on patients’ adherence to their diet which is necessary for health.

The study aimed to examine the association between depression and dietary adherence in adults with cardiovascular disease risk factors in the north of Iran.

Material and methods:
This cross-sectional study was performed on 344 participants who were admitted to a tertiary hospital in Rasht. The participants’ demographic characteristics, blood pressure, anthropometrics indexes and blood factors were measured. To assess the dietary adherence, we used the 14-point Mediterranean Diet Adherence Screener (MEDAS) validated for this region and to check depression, we used Beck Depression Inventory (BDI). Logistic regression analysis was performed to analyze the data.

Depression symptoms were observed in 43% of the patients. The frequency of patients with low, moderate and good dietary adherence was 44%, 54% and 2%, respectively. In the univariate analysis, there was a relationship between depression and dietary adherence. In the univariate analysis, being female, being diabetic, high waist circumference, high HbA1C and low level of hematocrit were associated with lower diet adherence. After controlling for confounders, no relationship was discovered between depression and dietary adherence (P = 0.249). Odds ratio of the low dietary adherence in patients with depression compared with patients without depression was 1.311 (95%CI: 0.827–2.079).

Depression symptoms and dietary non-adherence were prevalent in our participants. Also our data showed there were no association between depression and mediterian dietary adherence.

More studies are needed to further consolidate our understanding of the association between depression symptoms and dietary adherence.

Also, we would like to thank Deputy of Research and Technology of Guilan University of Medical Sciences for their financial supports.
The authors of this manuscript have expressed no conflict of interests.
Sumlin LL, Garcia TJ, Brown SA, et al. Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review. Diabetes Educ. 2014;40(6):731–744.
Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476–493.
Egede LE. Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes. Curr Diabetes Rev. 2005;1(3):235–243.
De Groot M, Anderson R, Freedland KE, et al. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–630.
Hare DL, Toukhsati SR, Johansson P, et al. Depression and cardiovascular disease: a clinical review. Eur Heart J. 2013;35(21):1365–1372.
Campbell DJ, Ronksley PE, Manns BJ, et al. The association of income with health behavior change and disease monitoring among patients with chronic disease. PloS one. 2014;9(4):e94007.
Whelton PK, Appel LJ, Sacco RL, et al. Sodium, blood pressure, and cardiovascular disease. Circulation. 2012;126(24):2880–2889.
Neily JB, Toto KH, Gardner EB, , et al. Potential contributing factors to noncompliance with dietary sodium restriction in patients with heart failure. Am Heart J. 2002;143(1):29–33.
Luyster FS, Hughes JW, Gunstad J. Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator. J Cardiovasc Nurs. 2009;24(1):10–17.
Ziegelstein RC, Fauerbach JA, Stevens SS, et al. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000;160(12):1818–1823.
Kamphuis H, De Leeuw J, Derksen R, et al. Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery. Europace. 2003;5(4):381–389.
Salari A, Shakiba M, Mahdavi-Roshan M, et al. The association between various indices of obesity and severity of atherosclerosis in adults in the north of Iran. Medicine. 2016;95(50):e5670.
Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, et al. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Clin Nutr. 2002;41(4):153–160.
Schröder H, Fitó M, Estruch R, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141(6):1140–1145.
Hatmi Z, Tahvildari S, Motlag AG, et al. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord. 2007;7(1):32.
Martínez-González MÁ, Sanchez-Villegas A. Review: The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern? Eur J Epidemiol. 2004;19(1):9–13.
Chrysohoou C, Panagiotakos DB, Pitsavos C, et al. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol. 2004;44(1):152–158.
Psaltopoulou T, Sergentanis TN, Panagiotakos DB, et al. Mediterranean diet, stroke, cognitive impairment, and depression: a meta‐analysis. Ann Neurol. 2013;74(4):580–591.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. Jama. 2004;292(12):1433–1439.
Robertson RM, Smaha L. Can a Mediterranean-style diet reduce heart disease? Circulation. 2001;103(13):1821–1822.
Bilenko N, Fraser D, Vardi H, Shai I , et al. Mediterranean diet and cardiovascular diseases in an Israeli population. Prev Med. 2005;40(3):299–305.
Dernini S, Berry EM. Mediterranean diet: From a healthy diet to a sustainable dietary pattern. Front Nutr. 2015;2:15.
Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763–2774.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–2107.
Rahe C, Unrath M, Berger K. Dietary patterns and the risk of depression in adults: a systematic review of observational studies. Eur J Clin Nutr. 2014;53(4):997–1013.
Quirk SE, Williams LJ, O’Neil A, et al. The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry. 2013;13(1):175.