title: Dietary flavonoid intake and risk of incident depression in midlife and older women.
abstract: The impact of dietary flavonoid intakes on risk of depression is unclear.
  
  
  
  We prospectively examined associations between estimated habitual intakes of dietary flavonoids and depression risk.
  
  
  
  We followed 82,643 women without a previous history of depression at baseline from the Nurses' Health Study [(NHS) aged 53-80 y] and the Nurses' Health Study II [(NHSII) aged 36-55 y]. Intakes of total flavonoids and subclasses (flavonols, flavones, flavanones, anthocyanins, flavan-3-ols, polymeric flavonoids, and proanthocyanidins) were calculated from validated food-frequency questionnaires collected every 2-4 y. Depression was defined as physician- or clinician-diagnosed depression or antidepressant use and was self-reported in response to periodic questionnaires. Cox proportional hazards models were performed to examine associations.
  
  
  
  A total of 10,752 incident depression cases occurred during a 10-y follow-up. Inverse associations between flavonol, flavone, and flavanone intakes and depression risk were observed. Pooled multivariable-adjusted HRs (95% CIs) were 0.93 (0.88, 0.99), 0.92 (0.86, 0.98), and 0.90 (0.85, 0.96) when comparing the highest (quintile 5) with the lowest (quintile 1) quintiles, respectively, with evidence of linear trends across quintiles (P-trend = 0.0004-0.08). In flavonoid-rich food-based analyses, the HR was 0.82 (95% CI: 0.74, 0.91) among participants who consumed ≥2 servings citrus fruit or juices/d compared with <1 serving/wk. In the NHS only, total flavonoids, polymers, and proanthocyanidin intakes showed significantly (9-12%) lower depression risks. In analyses among late-life NHS participants (aged ≥65 y at baseline or during follow-up), for whom we were able to incorporate depressive symptoms into the outcome definition, higher intakes of all flavonoid subclasses except for flavan-3-ols were associated with significantly lower depression risk; flavones and proanthocyanidins showed the strongest associations (HR for both: 0.83; 95% CI: 0.77, 0.90).
  
  
  
  Higher flavonoid intakes may be associated with lower depression risk, particularly among older women. Further studies are needed to confirm these associations.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, and.
authors.forename: Shun-Chiao
authors.identifier: 0000-0002-1649-3191
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and.
authors.forename: Aedin
authors.identifier: 0000-0003-0048-5602
authors.initials: A
authors.lastname: Cassidy
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, and Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Walter C
authors.identifier: 0000-0003-1458-7597
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, and Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, and Departments of Nutrition and.
authors.forename: Eilis J
authors.initials: EJ
authors.lastname: O'Reilly
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, and Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA ookereke@partners.org.
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000072001:Diet, Healthy; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009726:Nurses; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D057566:Self Report; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D005419:Flavonoids
keywords: Nurses’ Health Study; depression; epidemiology; flavonoids; geriatrics; prospective cohort