Dietary patterns and mental health after myocardial infarction

RESEARCH ARTICLE Dietary patterns and mental health after myocardial infarction Nathaly Rius-Ottenheim1,2*, Daan Kromhout3,4, Femke P. C. Sijtsma3, Johanna M. Geleijnse3, Erik J. Giltay1 1 Leiden University Medical Centre, Department of Psychiatry, Leiden, the Netherlands, 2 Spaarne Gasthuis Hospital, Department of Psychiatry, Haarlem, the Netherlands, 3 Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands, 4 Department of Epidemiology, University Medical Centre, University of Groningen, Groningen, the Netherlands a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background OPEN ACCESS Citation: Rius-Ottenheim N, Kromhout D, Sijtsma FPC, Geleijnse JM, Giltay EJ (2017) Dietary patterns and mental health after myocardial infarction. PLoS ONE 12(10): e0186368. https:// doi.org/10.1371/journal.pone.0186368 Editor: Jacobus P. van Wouwe, TNO, NETHERLANDS Diet has been associated with better mental health in general populations, but less is known on this association in patients with a history of coronary heart disease. The objective of this study is to examine the cross-sectional associations between dietary patterns and mental health in elderly patients with a history of myocardial infarction. Methods Copyright: © 2017 Rius-Ottenheim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data were drawn from the final assessment of the Alpha Omega cohort that monitored patients with a history of myocardial infarction (age range 60–80 years). 2171 patients with complete data for diet and mental health were included in this study. Diet was assessed with the 203-item Food Frequency Questionnaire, and subsequently categorized into two scores: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). Depressive symptoms, assessed with the Geriatric Depression Scale (GDS-15), and dispositional optimism, assessed with the 4-item questionnaire (4Q), were cross-sectionally analyzed in relation to dietary patterns using linear regression analysis. Data Availability Statement: The minimal data set is available from: https://doi.org/10.17026/dansxq6-yt8h. Results Received: April 26, 2017 Accepted: September 28, 2017 Published: October 16, 2017 Funding: The Alpha Omega Trial was supported by the Netherlands Heart Foundation (grant number 2000T401), the National Institutes of Health (grant number R01 HL076200-03), and Unilever R&D (the Netherlands). Unilever provided an unrestricted grant for the distribution of trial margarines to the patients. Competing interests: The authors have declared that no competing interests exist. Patients were on average 72.2 years old and 79.5% were male. The DHNaFS score was associated with less depressive symptoms and higher dispositional optimism (β = -0.108; P<0.001; and β = 0.074; P<0.001), whereas no associations were found with the DUNaFS score. Particularly, consumption of vegetables, fruits, whole grains, fish, and low fat-dairy were associated with less depressive symptoms and higher optimism. Similar associations were found when analyzing the association between average DHNaFS score over the preceding 41 months with depression β = -0.085; P<0.001) and higher dispositional optimism (β = 0.084; P<0.001). PLOS ONE | https://doi.org/10.1371/journal.pone.0186368 October 16, 2017 1 / 13 Diet and mental health Conclusions A healthy dietary pattern, in particular a higher consumption of vegetables, fruit, whole grains, fish and low-fat dairy, was associated with less depressive symptoms and higher optimism. However, given the cross-sectional nature of our analyses, our findings may also be explained by more optimistic participants making healthier food choices. Therefore, future prospective or interventions studies are needed to establish the direction of causality of this association. Trial registration ClinicalTrials.gov NCT03192410. Introduction Depression is a highly prevalent mental disorder among patients with a history of myocardial infarction (MI) [1, 2] and is associated with a decreased quality of life and high costs in healthcare use [3]. Moreover, comorbid depression is related to worse cardiovascular outcomes and increased mortality [4, 5]. Thus far, conventional depression treatments such as pharmacotherapy and psychotherapy have only yielded modest results [6–8], and subclinical depressive symptoms often persist and remain untreated [9]. Research is therefore needed to identify alternative or additional lifestyle factors that are associated with mental health in cardiac patients. Diet may be such a modifiable risk factor. Systematic reviews in general populations have shown a beneficial effect of healthy dietary patterns that include high consumption of fruits, vegetables, fish, olive oil, nuts, and legumes, and an adverse effect of unhealthy dietary patterns that include high consumption of processed food, sugar and fat [10–13]. In line with these reviews, later observational studies have reported an inverse association between healthy dietary patterns and depressive symptoms [14–17]. Also, a large randomized trial (the PREDIMED study) showed that a low fat, Mediterranean diet decreased the incidence of depression in a population at high cardiovascular risk [18]. Their results suggested an association between a dietary pattern enriched with extra-virgin olive oil and mixed nuts, but only in a sensitivity analysis among the participants with diabetes mellitus type 2. Dietary patterns have not only been related to the state-like depressive symptoms, but also to positive psychological traits [19]. Dispositional optimism, a positive trait that refers to an individual’s generalized positive expectancies towards the future [20], has been associated with healthier dietary patterns in younger adults [21, 22], older men [23], and post-menopausal women [24]. More recently, a cross-sectional study among Spanish women with fibromyalgia, reported an association between optimism and higher consumption of fruit, vegetables, and fish [25]. Most of these previous studies used short questionnaires to estimate dietary habits [22, 25], while one did use a standardized dietary history method [23]. Therefore, more studies on the association between dietary patterns and dispositional optimism are needed. With the present study, we aimed to assess the associations of dietary patterns with depressive symptoms and optimism in cardiac patients, using detailed dietary data. We hypothesized that a healthy nutrient-rich food score would be associated with lower depressive symptoms and higher optimism; whilst food scores relatively high in solid fats, sodium and/or added sugar would be associated with a poorer mental health. PLOS ONE | https://doi.org/10.1371/jou (...truncated)