title: A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project.
abstract: BACKGROUND
  Some studies have pointed out that several dietary patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations. The objective of the study was to compare and to establish the type of relationship between three diet quality scores and depression in the SUN (Seguimiento Universidad de Navarra) Cohort study.
  
  
  METHODS
  We performed a dynamic cohort study based on Spanish university graduates free of depression at baseline. Dietary intake was repeatedly assessed at baseline and after 10 years of follow-up with a validated semi-quantitative food-frequency questionnaire. Three previously described diet quality scores: Mediterranean Diet Score (MDS), Pro-vegetarian Dietary Pattern (PDP) and Alternative Healthy Eating Index-2010 (AHEI-2010) were built. Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician or initiated the use of an antidepressant drug during follow-up. Time-dependent Cox regression models with cumulative averages of diet and restricted cubic splines were used to estimate hazard ratios of depression according to quintiles of adherence to the MDS, PDP and AHEI-2010.
  
  
  RESULTS
  One thousand and fifty one incident cases of depression were observed among 15,093 participants from the SUN Cohort after a median follow-up of 8.5 years. Inverse and significant associations were observed between the three diet quality scores and depression risk. The hazard ratios and 95 % confidence intervals for extreme quintiles (fifth versus first) of updated adherence to MDS, PDP and AHEI-2010 were 0.84 (0.69-1.02), 0.74 (0.61-0.89) and 0.60 (0.49-0.72), respectively. The dose-response analyses showed non-linear associations, suggesting that suboptimal adherence to these dietary patterns may partially be responsible for increased depression risk.
  
  
  CONCLUSIONS
  Better adherence to the MDS, PDP and AHEI-2010 was associated with a reduced risk of depression among Spanish adults. However, our data suggested a threshold effect so that although the risk of depression was reduced when comparing moderate versus lower adherence, there was not much extra benefit for the comparison between moderate and high or very high adherence.
authors.affiliation: Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. almudena.sanchez@ulpgc.es.|Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain. almudena.sanchez@ulpgc.es.|Department of Clinical Sciences, University of Las Palmas de Gran Canaria, P.O. Box 550, , CP. 35080, Las Palmas de Gran Canaria, Spain. almudena.sanchez@ulpgc.es.
authors.forename: Almudena
authors.initials: A
authors.lastname: Sánchez-Villegas
authors.affiliation: Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. patricia.henriquez@ulpgc.es.|Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain. patricia.henriquez@ulpgc.es.
authors.forename: Patricia
authors.initials: P
authors.lastname: Henríquez-Sánchez
authors.affiliation: Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain. mcanela@unav.es.|Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea, n° 1, CP. 31008, Pamplona, Spain. mcanela@unav.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: Department of Psychiatry and Medical Psychology, University Clinic of Navarra, Pamplona, Spain. flahortiga@unav.es.
authors.forename: Francisca
authors.initials: F
authors.lastname: Lahortiga
authors.affiliation: Department of Psychiatry and Medical Psychology, University Clinic of Navarra, Pamplona, Spain. pmolero@unav.es.
authors.forename: Patricio
authors.initials: P
authors.lastname: Molero
authors.affiliation: Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain. etoledo@unav.es.|Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea, n° 1, CP. 31008, Pamplona, Spain. etoledo@unav.es.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Toledo
authors.affiliation: Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain. mamartinez@unav.es.|Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea, n° 1, CP. 31008, Pamplona, Spain. mamartinez@unav.es.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D004032:Diet / Q000706:statistics & numerical data*; D004034:Diet Surveys; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D012306:Risk; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires