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World J Psychiatr. Nov 19, 2021; 11(11): 997-1016
Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.997
Healthy diet, depression and quality of life: A narrative review of biological mechanisms and primary prevention opportunities
Octavio Pano, Elena H Martínez-Lapiscina, Carmen Sayón-Orea, Miguel Angel Martinez-Gonzalez, Jose Alfredo Martinez, Almudena Sanchez-Villegas
Octavio Pano, Miguel Angel Martinez-Gonzalez, Preventive Medicine and Public Health, University of Navarre, Pamplona 31008, Spain
Elena H Martínez-Lapiscina, Department of Neurology Center of Neuroimmunology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona 08036, Spain
Carmen Sayón-Orea, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona 31008, Spain
Carmen Sayón-Orea, Jose Alfredo Martinez, IdiSNA, Navarra Institute for Health Research, Pamplona 31008, Spain
Carmen Sayón-Orea, Department of Public Health, Navarra Institute of Public Health and Epidemiology, Pamplona 31003, Spain
Miguel Angel Martinez-Gonzalez, Jose Alfredo Martinez, Almudena Sanchez-Villegas, CIBER Pathophysiology of Obesity and Nutrition, Institute of Health Carlos III, Madrid 28049, Spain
Miguel Angel Martinez-Gonzalez, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
Jose Alfredo Martinez, Department of Food Sciences and Physiology, University of Navarre, Pamplona 31008, Spain
Jose Alfredo Martinez, Precision Nutrition and Cardiometabolic Health Program, IMDEA Food Institute, Madrid 28049, Spain
Almudena Sanchez-Villegas, Department of Clinical Sciences, University of Las Palmas Gran Canaria, Las Palmas Gran Canaria 35080, Spain
Author contributions: Pano O provided supportive literature and wrote the manuscript; Sánchez-Villegas A provided supportive literature and gave expert advice and guidance on the topic; Martínez-Lapiscina EH, Sayón-Orea C, Martínez JA and Martínez-González MA gave their expert opinion and supervised the review; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Almudena Sanchez-Villegas, PhD, Professor, Department of Clinical Sciences, University of Las Palmas Gran Canaria, PO Box 550, Las Palmas Gran Canaria 35080, Spain. asanchez@dcc.ulpgc.es
Received: February 27, 2021
Peer-review started: February 27, 2021
First decision: June 5, 2021
Revised: June 19, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: November 19, 2021
Processing time: 262 Days and 5.7 Hours
Abstract

Unipolar depressive disorder (UDD) affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030. It is imperative for leading economies to implement preventive strategies targeted towards UDD, given consistent policies are currently lacking. Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field. It is believed that dietary practices could potentially reduce the incidence of depression; similar to their effects on metabolism. Thus, the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD. Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees. Interestingly, a common factor of UDD is the production and overall effects of inflammatory cytokines, such as interleukin-6, tumor necrosis factor-α, and C-reactive protein. These compounds have been associated with depressive symptoms, disturbances in neuroendocrine function, leaky gut, monoamine activity and brain function, while also being key factors in the development of cardiometabolic diseases. The Mediterranean diet (MD) in particular, is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations. In one of the few clinical trials investigating these associations, the PREDIMED trial, individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41% relative risk reduction for developing depression. Lastly, there is a need to include health related quality of life as an indicator of physical and mental well-being, considering its putative associations with depression and suicide risk. Going forward, focusing on clinical trials, using precise nutritional assessments, and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.

Keywords: Depression; Nutrition; Mediterranean; Quality of life; Primary prevention; Epidemiology

Core Tip: Parallel biological mechanisms are being uncovered that link both depression and cardiometabolic diseases. Based on this evidence, it has been theorized that a healthful diet could improve the prognosis and prevent depression incidence, similar to its effects on cardiovascular risk. Current epidemiological studies support the link between healthy diets and better symptom management, biomarkers, and health related quality of life related to depression. However, additional longitudinal studies and dedicated clinical trials are needed to fully understand these initial findings. With greater evidence, healthy dietary patterns, such as the Mediterranean diet, could facilitate the management and reduce the risk of depression.