Associations of Processed Food Intake with Depression and Anxiety in a Sample of Lebanese Adults: a Cross-Sectional Study

Abstract

Background: Mental health is a serious public health issue with the most common mental health disorders being depression and anxiety. Several factors play a role in the etiology and pathophysiology of depression and anxiety, including unhealthy food consumption patterns. Objective: To investigate the association between the intakes of food groups defined based on their degree of food processing, with depression and anxiety in a sample of Lebanese adults. Methods: A cross-sectional study was conducted on 188 adults ≥18 years recruited from the Greater Beirut Area Cardiovascular Cohort (GBACC). A validated food frequency questionnaire (FFQ) was used to assess dietary intake and the Nova classification system was adopted for evaluating the intakes of the 4 NOVA food groups: unprocessed or minimally processed foods (MPF); processed culinary ingredients (PCI); processed foods ((PF ) and ultra-processed foods (UPF). The Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale were used for the assessment of depression and anxiety symptoms, respectively. The association between food group intakes in quartiles with depression and anxiety symptoms were analysed using multivariable regression analyses. Results: Median Energy intake was estimated at 2481.65 (2617.2) kcal/day, with 29.71% of Total Energy Intakes (TEI) coming from PF, 25.25% from UPF, 36.12% from MPF and 5.75% from PCI. It was estimated that 33% of the study sample had elevated depression symptoms and 27.7% had elevated anxiety symptoms. After adjustment for potential confounders, high intakes of PF, which included canned fish, legumes, vegetables and fruits was associated with significantly lower odds of both depression and anxiety symptoms while a higher UPF intake was associated with higher odds of depression. No significant associations were found with the intakes of MPF or CI. Conclusion: To our knowledge, this study is the first to examine, the association of the four NOVA food groups with depression and anxiety, in the Eastern Mediterranean region (EMR). It showed an inverse association between higher intakes of PF and the risk of both depression and anxiety, while a positive association was observed between higher intakes of UPF and elevated depression symptoms. Given the high prevalence of both mental health and UPF consumption in the Lebanese population, this study may be used as an evidence-base to develop interventions and actionable mechanisms for improving dietary practices and hence contributing to the prevention of mental health disorders. More research is also needed to further understand the link between PF and mental health and assess if those findings can be replicated in other settings such as other EMR countries.