Determinants of Adherence to The Mediterranean Diet and Depressive Symptoms in Turkish Young Adults

Year 2025, Volume: 9 Issue: 1, 131 - 140, 31.01.2025

Jiyan Aslan Ceylan , Aylin Bayındır Gümüş

https://doi.org/10.30621/jbachs.1530196

Abstract

Purpose: This research aimed to investigate the effects of adherence to the Mediterranean diet (MD) on depression risk in young adults and to understand potential associations.
Material and Methods: An online survey form was sent to university students in Türkiye, and 479 participated in this cross-sectional study. Adherence to the MD was decided using the Mediterranean Diet Adherence Screener (MEDAS). Beck Depression Inventory (BDI) was applied to measure the presence of manifestations of depression. Multivariate linear regression models were used for the determinants of MEDAS and BDI scores.
Results: 73 males and 406 females with a mean age of 21.6±2.3 years and a mean body mass index of 22.0±3.5 kg/m2 participated in the study. While 61.8% had a moderate adherence to the MD, 54.9% had a mild or moderate BDI level. According to models, regular exercise, presence of NCD(s), and adherence to an adequate/balanced diet were MEDAS score's determinants, and adherence to an adequate/balanced diet and BMI were for BDI score (p<0.05).
Conclusion: The relationship between the MD and depression is complex and encompasses several dimensions. More comprehensive and long-term studies, considering the influence of individual differences and other factors such as genetics, environment, and lifestyle, may help to reveal this effect more clearly.

Keywords

Mediterranean diet, depression, body mass index, multivariate linear regression

Ethical Statement

The study was carried out with the permission of Mardin Artuklu University Ethics Committee (Date:14.12.2022, Decision no:2022/14-16). The study was carried out following the Declaration of Helsinki principles. Students ticked an informed consent form in the online survey form and could withdraw from participation at any time without providing a reason. Permission was obtained from the authors who performed the validity and reliability study of the scale to administer the MEDAS in this study.

Supporting Institution

None.

Thanks

The authors thank all participants for their valuable time.

Determinants of Adherence to The Mediterranean Diet and Depressive Symptoms in Turkish Young Adults

Abstract

References

• Lăcătușu C-M, Grigorescu E-D, Floria M, Onofriescu A, Mihai B-M. The Mediterranean diet: from an environment-driven food culture to an emerging medical prescription. International journal of Environmental Research and Public Health 2019;16(6):942.
• Godos J, Zappalà G, Bernardini S, Giambini I, Bes-Rastrollo M, Martinez-Gonzalez M. Adherence to the Mediterranean diet is inversely associated with metabolic syndrome occurrence: a meta-analysis of observational studies. International Journal of Food Sciences and Nutrition 2017;68(2):138-48.
• Guasch‐Ferré M, Willett W. The Mediterranean diet and health: A comprehensive overview. Journal of Internal Medicine 2021;290(3):549-66.
• Oddo VM, Welke L, McLeod A, Pezley L, Xia Y, Maki P, et al. Adherence to a Mediterranean diet is associated with lower depressive symptoms among US adults. Nutrients 2022;14(2):278.
• Sánchez-Villegas A, Álvarez-Pérez J, Toledo E, Salas-Salvadó J, Ortega-Azorín C, Zomeño MD, et al. Seafood consumption, omega-3 fatty acids intake, and life-time prevalence of depression in the PREDIMED-plus trial. Nutrients 2018;10(12):2000.
• Hohls JK, König H-H, Quirke E, Hajek A. Anxiety, depression and quality of life—a systematic review of evidence from longitudinal observational studies. International Journal of Environmental Research and Public Health 2021;18(22):12022.
• Bakırhan H, Pehlivan M, Özyürek F, Özkaya V, Yousefirad N. Diet, sleep and depression: Does adherence to the mediterranean diet matter? JTSM-Journal of Turkish Sleep Medicine 2022.
• Ventriglio A, Sancassiani F, Contu MP, Latorre M, Di Slavatore M, Fornaro M, et al. Mediterranean diet and its benefits on health and mental health: a literature review. Clinical Practice and Epidemiology in Mental Health: CP & EMH. 2020;16(Suppl-1):156.
• Gantenbein KV, Kanaka-Gantenbein C. Mediterranean diet as an antioxidant: the impact on metabolic health and overall wellbeing. Nutrients 2021;13(6):1951.
• Siervo M, Shannon OM, Llewellyn DJ, Stephan BC, Fontana L. Mediterranean diet and cognitive function: From methodology to mechanisms of action. Free Radical Biology and Medicine 2021;176:105-17.
• Lange KW. Omega-3 fatty acids and mental health. Global Health Journal. 2020;4(1):18-30.
• Radkhah N, Rasouli A, Majnouni A, Eskandari E, Parastouei K. The effect of Mediterranean diet instructions on depression, anxiety, stress, and anthropometric indices: A randomized, double-blind, controlled clinical trial. Preventive Medicine Reports 2023;36:102469.
• Roohi E, Jaafari N, Hashemian F. On inflammatory hypothesis of depression: what is the role of IL-6 in the middle of the chaos? Journal of Neuroinflammation 2021;18:1-15.
• Ferrer-Cascales R, Albaladejo-Blázquez N, Ruiz-Robledillo N, Clement-Carbonell V, Sánchez-SanSegundo M, Zaragoza-Martí A. Higher adherence to the mediterranean diet is related to more subjective happiness in adolescents: The role of health-related quality of life. Nutrients 2019;11(3):698.
• Logan B, Burns S. Stressors among young Australian university students: A qualitative study. Journal of American College Health 2023;71(6):1753-60.
• Campbell F, Blank L, Cantrell A, Baxter S, Blackmore C, Dixon J, et al. Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 2022;22(1):1778.
• Godos J, Currenti W, Angelino D, Mena P, Castellano S, Caraci F, et al. Diet and mental health: Review of the recent updates on molecular mechanisms. Antioxidants 2020;9(4):346.
• Wright KB. Researching Internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer-mediated Communication 2005;10(3):JCMC1034.
• Vasantha Raju N, Harinarayana N, editors. Online survey tools: A case study of Google Forms. National conference on scientific, computational & information research trends in engineering, GSSS-IETW, Mysore; 2016.
• Martínez-González MÁ, Corella D, Salas-Salvadó J, Ros E, Covas MI, Fiol M, et al. Cohort profile: design and methods of the PREDIMED study. International Journal of Epidemiology 2012;41(2):377-85.
• Pehlivanoğlu EFÖ, Balcıoğlu H, Ünlüoğlu İ. Akdeniz diyeti bağlılık ölçeği’nin türkçe’ye uyarlanması geçerlilik ve güvenilirliği. Osmangazi Tıp Dergisi 2020;42(2):160-4.
• Beck AT, Ward C, Mendelson M, Mock J, Erbaugh J. Beck depression inventory (BDI). Arch Gen Psychiatry 1961;4(6):561-71.
• Hisli N. Beck depresyon envanterinin universite ogrencileri icin gecerliligi, guvenilirligi.(A reliability and validity study of Beck Depression Inventory in a university student sample). J Psychol 1989;7:3-13.
• World Health Organization. A healthy lifestyle - WHO recommendations 2010 [Available from: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations.
• Franchini C, Biasini B, Sogari G, Wongprawmas R, Andreani G, Dolgopolova I, et al. Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students. Nutrition Journal 2024;23(1):56.
• Serhan M, Julien SG. Adherence to the Mediterranean diet: microbiota and non-communicable diseases. Frontiers in Nutrition 2024;10:1352672.
• Bayes J, Schloss J, Sibbritt D. The effect of a Mediterranean diet on the symptoms of depression in young males (the “AMMEND: A Mediterranean Diet in MEN with Depression” study): A randomized controlled trial. The American Journal of Clinical Nutrition 2022;116(2):572-80.
• Bizzozero-Peroni B, Martínez-Vizcaíno V, Fernández-Rodríguez R, Jiménez-López E, Núñez de Arenas-Arroyo S, Saz-Lara A, et al. The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews 2024:nuad176.
• Yin W, Löf M, Chen R, Hultman CM, Fang F, Sandin S. Mediterranean diet and depression: a population-based cohort study. International Journal of Behavioral Nutrition and Physical Activity 2021;18:1-10.
• Özcan BA, Yeşilkaya B, Yılmaz HÖ, Günal AM, Özdemir AA. Effects of adherence to the Mediterranean diet on depression, anxiety, and sleep quality during the Covid-19 pandemic in Turkey. International Journal of Innovative Research and Reviews 2021;5(2):39-44.
• Hwang Y-G, Pae C, Lee S-H, Yook K-H, Park CI. Relationship between mediterranean diet and depression in south korea: The korea national health and nutrition examination survey. Frontiers in Nutrition. 2023;10:1219743.
• Shafiei F, Salari-Moghaddam A, Larijani B, Esmaillzadeh A. Adherence to the Mediterranean diet and risk of depression: a systematic review and updated meta-analysis of observational studies. Nutrition Reviews 2019;77(4):230-9.
• Lai J, Oldmeadow J, Hure A, McEvoy M, Byles J, Attia J. Longitudinal diet quality is not associated with depressive symptoms in a cohort of middle-aged Australian women. British Journal of Nutrition 2016;115(5):842-50.
• Sánchez-Villegas A, Henríquez-Sánchez P, Ruiz-Canela M, Lahortiga F, Molero P, Toledo E, et al. A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Medicine 2015;13:1-12.
• Agnoli C, Sieri S, Ricceri F, Giraudo MT, Masala G, Assedi M, et al. Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutrition & Diabetes 2018;8(1):22.
• El-Hajj M, Salameh P, Rachidi S, Al-Hajje A, Hosseini H. Adherence to the Mediterranean diet decreases the risk of stroke in the Lebanese population: a case-control study. Pharmacy Practice (Granada) 2021;19(1).
• Vidal-Peracho C, Tricás-Moreno JM, Lucha-López AC, Lucha-López MO, Camuñas-Pescador AC, Caverni-Muñoz A, et al. Adherence to Mediterranean diet pattern among Spanish adults attending a medical centre: nondiabetic subjects and type 1 and 2 diabetic patients. Journal of Diabetes Research 2017;2017(1):5957821.
• Arslan M, Ayhan NY, Çolak H, Sarıyer ET, Çevik E. The Relationship of Adherence to the Mediterranean Diet, Dietary Inflammatory Index and Nutrient Intake in University Students: A Cross-Sectional Study. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2023;8(2):291-7.
• Biasini B, Rosi A, Menozzi D, Scazzina F. Adherence to the Mediterranean diet in association with self-perception of diet sustainability, anthropometric and sociodemographic factors: a cross-sectional study in Italian adults. Nutrients 2021;13(9):3282.
• Álvarez-Fernández C, Romero-Saldaña M, Álvarez-López Á, Molina-Luque R, Molina-Recio G, Vaquero-Abellán M. Adherence to the Mediterranean diet according to occupation-based social classifications and gender. Archives of Environmental & Occupational Health 2021;76(5):275-81.
• Yassıbaş E, Bölükbaşı H. Evaluation of adherence to the Mediterranean diet with sustainable nutrition knowledge and environmentally responsible food choices. Frontiers in Nutrition 2023;10:1158155.
• Yüksel A, Önal HY. Relationship between the Presence of Chronic Pain and Adherence to the Mediterranean Diet in University Students. Journal of Basic and Clinical Health Sciences 2021;7(2):660-70.
• Mastorakou D, Rabaeus M, Salen P, Pounis G, de Lorgeril M. Mediterranean diet: a health-protective dietary pattern for modern times. Analysis in Nutrition Research: Elsevier; 2019. p. 233-58.
• Hashim M, Radwan H, Ismail LC, Faris ME, Mohamad MN, Saleh ST, et al. Determinants for Mediterranean diet adherence beyond the boundaries: a cross-sectional study from Sharjah, the United Arab Emirates. Journal of Translational Medicine 2024;22(1):513.
• Vera Ponce VJ, Guerra Valencia J, Torres Malca JR, Zuzunaga Montoya FE, Zeñas Trujillo GZ, Cruz Ausejo L, et al. Factors associated with adherence to the Mediterranean diet among medical students at a private university in Lima, Peru. Electronic Journal of General Medicine 2023.
• Ramón-Arbués E, Gea-Caballero V, Granada-López JM, Juárez-Vela R, Pellicer-García B, Antón-Solanas I. The prevalence of depression, anxiety and stress and their associated factors in college students. International Journal of Environmental Research and Public Health 2020;17(19):7001.
• Vural BK, Yiğitoğlu G. An investigation of stress, anxiety and depression states of university students during the COVID-19 pandemic. Journal of Basic and Clinical Health Sciences 2021;6(2):495-505.
• Heissel A, Heinen D, Brokmeier LL, Skarabis N, Kangas M, Vancampfort D, et al. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British Journal of Sports Medicine 2023;57(16):1049-57.
• Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry 2021;55(1):7-117.
• Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, del Pozo Cruz B, Van Den Hoek D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 2024;384.