title: Combined Healthy Lifestyle Is Inversely Associated with Psychological Disorders among Adults.
abstract: OBJECTIVE
  Joint association of lifestyle-related factors and mental health has been less studied in earlier studies, especially in Middle Eastern countries. This study aimed to examine how combinations of several lifestyle-related factors related to depression and anxiety in a large group of middle-age Iranian population.
  
  
  METHODS
  In a cross-sectional study on 3363 Iranian adults, a healthy lifestyle score was constructed by the use of data from dietary intakes, physical activity, smoking status, psychological distress and obesity. A dish-based 106-item semi-quantitative validated food frequency questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ) and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. The Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression.
  
  
  RESULTS
  After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle were 95% less likely to be anxious (OR: 0.05; 95% CI: 0.01-0.27) and 96% less likely to be depressed (OR: 0.04; 95% CI: 0.01-0.15), compared with those with the lowest score. In addition, non-smokers had lower odds of anxiety (OR: 0.64; 95% CI: 0.47-0.88) and depression (OR: 0.62; 95% CI: 0.48-0.81) compared with smokers. Individuals with low levels of psychological distress had expectedly lower odds of anxiety (OR: 0.13; 95% CI: 0.10-0.16) and depression (OR: 0.10; 95% CI: 0.08-0.12) than those with high levels. Individuals with a healthy diet had 29% lower odds of depression (OR: 0.71; 95% CI: 0.59-0.87) than those with a non-healthy diet.
  
  
  CONCLUSIONS
  We found evidence indicating that healthy lifestyle score was associated with lower odds of anxiety and depression in this group of Iranian adults. Healthy diet, psychological distress, and smoking status were independent predictors of mental disorders.
authors.affiliation: Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.|Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.|Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Parvane
authors.initials: P
authors.lastname: Saneei
authors.affiliation: Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.|Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.|Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Esmaillzadeh
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.|Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ammar Hassanzadeh
authors.initials: AH
authors.lastname: Keshteli
authors.affiliation: Psychosomatic Research Center, Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Reza Roohafza
authors.affiliation: Psychosomatic Research Center, Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Afshar
authors.affiliation: Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.|Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Awat
authors.initials: A
authors.lastname: Feizi
authors.affiliation: Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Peyman
authors.initials: P
authors.lastname: Adibi
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects