title: Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort.
abstract: BACKGROUND
  Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression.
  
  
  OBJECTIVE
  To assess the association between adherence to the MDP and the incidence of clinical depression.
  
  
  METHODS
  Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted.
  
  
  METHODS
  A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project).
  
  
  METHODS
  A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing.
  
  
  METHODS
  Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up.
  
  
  RESULTS
  After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes.
  
  
  CONCLUSIONS
  Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.
authors.affiliation: Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Sánchez-Villegas
authors.forename: Miguel
authors.initials: M
authors.lastname: Delgado-Rodríguez
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Javier
authors.initials: J
authors.lastname: Schlatter
authors.forename: Francisca
authors.initials: F
authors.lastname: Lahortiga
authors.forename: Lluis
authors.initials: L
authors.lastname: Serra Majem
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martínez-González
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003866:Depressive Disorder / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires