What is Diet Diversity (DD) and How is it Related to Depression?

Adding various foods to our diet can significantly improve our dietary intake quality, aiding in the prevention of health issues ranging from chronic diseases to behavioral health conditions. The United States Department of Agriculture (USDA) guidelines and the Food Guide Pyramid suggest that eating a diversified diet is health-beneficial. Diet diversity (DD) is defined as the number of different foods or food groups consumed over a given period of time (Ruel, 2003). DD is recognized as a critical element of proper nutrition, as a range of nourishing foods provides a greater abundance of nutrients to support the brain and body.

 

A range of nourishing foods provides a greater abundance of nutrients to support the brain and body.

 

Diet diversity is increasingly associated with numerous factors relating to the diet-mental health relationship (DMHR), including psychological resilience (Yin et al., 2019), memory (Zhang et al., 2020), hippocampal volume (Otsuka et al., 2021), depression (Poorrezaeian et al., 2017), and anxiety (Alenko et al., 2021). 

One method used to measure an individual’s DD involves calculating a Diet Diversity Score (DDS). These scores measure the variability within a person’s diet. In terms of the DMHR, questionnaires can be used to assess the connection between DD with a variety of psychological health and well-being factors.

 

Diet diversity is increasingly associated with numerous factors relating to the diet-mental health relationship.

 

A cross-sectional study examining the connection between DD and mental health was conducted by Poorrezaeian et al. (2017). This study specifically focused on the association of dietary diversity with depression and stress among a sample of 360 randomly selected Iranian women. After conducting interviews to gather information about the participants’ dietary intake, responses were calculated as Diet Diversity Scores. Depression and stress levels were measured through the Depression, Anxiety, and Stress Scales (DASS-42), which is a validated questionnaire designed to capture self-reported scores on these dimensions. 

As expected, participants who ate diets that included a variety of vitamins and minerals ranked higher in terms of DDS. More critically, results showed that a 1 unit increase in DDS was associated with a 39% reduction in the risk of severe depression. In other words, women who had less varied diets had scored lower on DD, and these lower scores were associated with an increased risk of severe depression. 

 

Results showed a 1 unit increase in DDS was associated with a 39% reduction in the risk of severe depression.

 

Although this study found a significant relationship between DDS and severity of depression, no meaningful relationship between mild/moderate depression or stress with DDS was found. The authors note that since the current study findings indicate a relationship between DDS and eating a nutrient-dense diet, future studies examining the specific connection between stress and DDS are important and should be conducted. Some of the existing evidence demonstrating the relationship between stress and unhealthy eating habits can be found in CNP’s Diet and Stress research category). 

 

Thank you to CNP Intern Hashmin Sajjan for contributing this article!

 

References

Alenko, A., Agenagnew, L., Beressa, G., Tesfaye, Y., Woldesenbet, Y. M., & Girma, S. (2021). COVID-19-Related Anxiety and Its Association with Dietary Diversity Score Among Health Care Professionals in Ethiopia: A Web-Based Survey. Journal of Multidisciplinary Healthcare, 14987–996. https://doi.org/10.2147/JMDH.S305164

Otsuka, R., Nishita, Y., Nakamura, A., Kato, T., Iwata, K., Tange, C., Tomida, M., Kinoshita, K., Nakagawa, T., Ando, F., Shimokata, H., & Arai, H. (2021). Dietary diversity is associated with longitudinal changes in hippocampal volume among Japanese community dwellers. European Journal of Clinical Nutrition, 75(6), 946–953. https://doi.org/10.1038/s41430-020-00734-z

Poorrezaeian, M., Siassi, F., Milajerdi, A. et al. (2017). Depression is related to dietary diversity score in women: a cross-sectional study from a developing country. Ann Gen Psychiatry, 16, 39. https://doi.org/10.1186/s12991-017-0162-2

Ruel M. T. (2003). Operationalizing dietary diversity: A review of measurement issues and research priorities. The Journal of Nutrition, 133, (11 Suppl 2), 3911S–3926S. https://doi.org/10.1093/jn/133.11.3911S

Yin, Z., Brasher, M. S., Kraus, V. B., Lv, Y., Shi, X., & Zeng, Y. (2019). Dietary Diversity Was Positively Associated with Psychological Resilience among Elders: A Population-Based Study. Nutrients, 11(3), 650. https://doi.org/10.3390/nu11030650

Zhang, J., Zhao, A., Wu, W., Yang, C., Ren, Z., Wang, M., Wang, P., & Zhang, Y. (2020). Dietary Diversity Is Associated With Memory Status in Chinese Adults: A Prospective Study. Frontiers in Aging Neuroscience, 12, 580760. https://doi.org/10.3389/fnagi.2020.580760

 

Dietary Intake and Resilience: Is There a Connection Across the Lifespan?

Dietary Intake and Resilience: Is There a Connection Across the Lifespan?

Psychologists define resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress (APA, 2012). These can include family, relationship, and social problems, physical or psychological health issues, employment or financial stressors, and world pandemics. By some estimates, most people will experience one or more potentially life-threatening traumatic experiences that can influence their mental health and even result in post-traumatic stress disorder (Karam et al., 2014). 

The latest viewpoint on the construct of resilience is that it is complex, and comprises biological, genetic, epigenetic, developmental, psychological, social, economic, and cultural factors that interact to determine one’s responses to stressful stimuli and experiences (Southwick et al., 2014).

Within Nutritional Psychology, we seek to determine the connections between dietary intake and resilience, and the mechanisms by which these connections occur. Studies demonstrating a relationship between diet and resilience are included in a growing repository of links within the “Diet and Resilience” and “Diet and Quality of Life” research categories in the NPRL and Parent Research LibrariesIn these libraries, you will find research to support the connection between dietary intake and resilience across the lifespan. Let’s take a look at a few of these publications.

 

The Diet-Resilience Connection in Youth

Nutritional quality and breakfast intake are two dietary factors among young people that are shown to positively mediate psychological distress and improve resilience. In 2019, Whatnall et al. examined this connection by using diet questionnaires to record 2,710 Australian students’ consumption of fruits, vegetables, soft drinks, and takeaway food, as well as how frequently they ate breakfast. The Kessler Scale and Brief Resilience Scale (BRS) were used to assess psychological distress and resilience, with adjustments made for socio-demographic factors, undergraduate/postgraduate status, and health characteristics. Findings showed that higher fruit and vegetable consumption per day (analyzed separately), more consistently having breakfast, and less frequent intake of soft drinks and takeaway foods were all significantly associated with both lower psychological distress and higher resilience. 

 

The Diet-Resilience Connection in Adults

Within the more general population, diet quality is also an important link when it comes to managing stress and adapting in the face of adversity. This is evident in a 2018 study by Bonaccio et al., where adherence to a Mediterranean-type diet (categorized by a high intake of vegetables and olive oil) proved to have a positive connection in terms of resilience. Food intake was measured among 10,812 participants using a Food Frequency Questionnaire, psychological resilience using a Psychological Resilience Score, and adherence to the Mediterranean diet using both a Mediterranean Diet Score and an Italian Mediterranean Index. Increased polyphenol or antioxidants in the diet and greater diversity in fruit and vegetable consumption, as opposed to a nutrient-depleted Western diet, were linked with enhanced psychological resilience. The findings give us insight into the positive associations between adherence to a nutrient-dense Mediterranean-type diet and psychological resilience and suggest that by adopting a similar diet, we too can better handle psychological distress and improve resilience.

 

The Diet-Resilience Connection in Elderly Individuals

Another factor that is shown to positively correlate with increased resilience is dietary diversity. Dietary diversity, defined as the number of different food groups consumed within a given reference period, is a key element of high-quality, nutrient-dense diets. A 2019 study by Yin et al. took a closer look at diet diversity within an elderly Chinese population consisting of 8,571 participants. From this sample, the frequency of consuming different food groups was reported, with the consumption of vegetables, fruits, and nuts contributing the most to dietary diversity. Psychological resilience was assessed using a simplified resilience score (SRS). Analyses showed a significant association between lower dietary diversity and poorer resilience, as compared to those with good dietary diversity and higher resilience. The findings show that greater diet diversity is crucial in maintaining and improving cognitive function as it relates to resilience in older populations.

 

Resilience: The Other Side of Stress

While it is important to examine the mechanisms and outcomes associated with our experience of stress, it is also important to investigate the mechanisms and outcomes associated with our experience of resilience. These and other studies in the CNP Research Libraries show that an association between stress, resilience, and diet in fact exists.  Nutritional Psychology encompasses the examination of this and other connections between dietary intake and psychological functioning.

 

References

Building your Resilience. American Psychological Association. https://www.apa.org/topics/resilience

Karam E. G., Friedman M. J., Hill E. D., Kessler R. C., McLaughlin K. A., Petukhova M. (2014). Cumulative traumas and risk thresholds: 12-month PTSD in the world mental health (WMH) surveys. Depression and Anxiety, 31, 130–142. 

Denckla, C. A., Cicchetti, D., Kubzansky, L. D., Seedat, S., Teicher, M. H., Williams, D. R., & Koenen, K. C. (2020). Psychological resilience: an update on definitions, a critical appraisal, and research recommendations. European Journal of Psychotraumatology11(1), 1822064. https://doi.org/10.1080/20008198.2020.1822064

Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology5, 10.3402/ejpt.v5.25338. https://doi.org/10.3402/ejpt.v5.25338

Whatnall, M. C., Patterson, A. J., Siew, Y. Y., Kay-Lambkin, F., & Hutchesson, M. J. (2019). Are psychological distress and resilience associated with dietary intake among Australian university students?. International Journal of Environmental Research and Public Health, 16(21), 4099.

Bonaccio, M., Di Castelnuovo, A., Costanzo, S., Pounis, G., Persichillo, M., Cerletti, C., Donati, M. B., de Gaetano, G., & Iacoviello, L. (2018). Mediterranean-type diet is associated with higher psychological resilience in a general adult population: findings from the Moli-sani study. European Journal of Clinical Nutrition, 72(1), 154–160.

Yin, Z., Brasher, M. S., Kraus, V. B., Lv, Y., Shi, X., & Zeng, Y. (2019). Dietary diversity was positively associated with psychological resilience among elders: A population-based study. Nutrients, 11(3), 650.

 

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