Health disparities in cognitive performance across the life span

在给定的一年中，抑郁症影响着1500多万美国人。与身体健康相比，人们对饮食质量对抑郁症状的影响知之甚少。在这项研究中，我们调查了低收入城市人口的饮食质量和报告的抑郁症状之间的关系。受试者包括1,118名非洲裔美国人和白人成年人，年龄在30岁到之间，居住在马里兰州巴尔的摩，代表着跨寿命多样化社区健康老龄化研究的初始考试和招募阶段的一个子样本。营养数据基于训练有素的采访者使用美国农业部自动化多通道方法收集的两次24小时饮食召回。饮食质量使用美国农业部健康饮食指数(HEI)-2005计算。抑郁症状由训练有素的采访者使用流行病学研究中心抑郁量表进行评估。我们使用线性和逻辑回归分析来检验饮食质量是否与抑郁症状有关。因变量为抑郁症状，自变量包括HEI-2005、种族、性别、年龄、教育程度、收入和食品援助计划参与度。HEI-2005的平均得分为52.17+/-0.40(满分100分)。流行病学研究中心抑郁量表的平均得分为11.64+/-0.25(满分40分)。饮食质量与报告的抑郁症状显著相关。然而，与饮食质量、教育程度和性别相比，收入是抑郁症的一个明显更强的预测因素。这些数据表明，注册营养师在帮助患者更好地管理他们的食物选择以提高他们的整体健康和生活质量时，应该意识到心理状况和营养健康之间的关系。 叶酸缺乏与单相抑郁的病因有关。在这项研究中，我们试图在一个全面的框架内将血浆叶酸、抑郁症状和饮食质量(或饮食叶酸摄入量)联系在一起，同时检查性别对这些关联的影响。这是一项以人群为基础的横断面研究，共有1681名年龄在30岁-y(跨寿命研究的多样性社区的健康老龄化)的参与者参加。受试者接受流行病学研究中心抑郁量表(CES-D)的测试。计算2005年健康饮食指数(HEI)的血浆叶酸和饮食摄入量(2个24小时回顾)的测量是可用的。采用多因素Logistic回归和结构方程模型(SM)。与最低的三分位数相比，在调整后的女性中，血浆叶酸水平最高的三分位数与CES-D升高的优势比(T(3)比T(1))降低39-40%(OR=16)=0.6(95%CI=0.42-0.86)；P=0.006。在男性和女性中都注意到了HEI(TOTAL)对这种关联的混淆，尽管饮食中的叶酸并没有明显混淆这种关联。在SM中，血浆叶酸仅在男性中完全介导HEI(总)-CES-D的反向关联，特别是HEI(2)(较高的全果摄入量)、HEI(3)(总蔬菜)、HEI(5)(全谷物)、HEI(6)(全谷物)、HEI(7)(牛奶)和HEI(12)(较低的可自由支配能量)。在女性中，HEI(总)和4种成分对CES-D评分有相反的直接影响，提示了一种独立于血浆叶酸的机制。在我们的研究中，抑郁症状可以通过改善整体饮食质量来缓解，血浆叶酸只在男性中起到潜在的中介作用。

Depression affects more than 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression. In this study, we investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population. Subjects included 1,118 African-American and white adults, aged 30 to 64 years, living in Baltimore, MD, and represented a subsample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the US Department of Agriculture Automated Multiple Pass Method. Diet quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by trained interviewers using the Center for Epidemiologic Studies Depression scale. We used both linear and logistic regression analyses to examine whether diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food-assistance program participation. The mean HEI-2005 score was 52.17+/-0.40 (out of 100). The mean Center for Epidemiologic Studies Depression scale score was 11.64+/-0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education, and sex. These data suggest that registered dietitians should be aware of relationships between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life. Folate deficiency has been implicated in the etiology of unipolar depression. In this study, we attempted to cross-link plasma folate, depressive symptoms, and dietary quality (or dietary intake of folate) together in a comprehensive framework, while examining effect modification of those associations by sex. This was a cross-sectional, population-based study of 1681 participants aged 30-64 y (Healthy Aging in Neighborhoods of Diversity across the Lifespan Study). Participants were administered the Center for Epidemiologic Studies Depression scale (CES-D). Measures of plasma folate and dietary intakes (2 24-h recalls) from which the 2005-Healthy Eating Index (HEI) was computed were available. Multivariate logistic regression and structural equation modeling (SM) were conducted. Compared with the lowest tertile, the middle and uppermost tertiles of plasma folate were associated with a 39-40% reduced odds of elevated CES-D (> or =16) among women adjusted odds ratio (T(3) vs. T(1)) = 0.60 (95% CI = 0.42-0.86); P = 0.006. Confounding of this association by HEI(total) was noted among both men and women, although dietary folate did not confound this association appreciably. In SM, plasma folate completely mediated the inverse HEI(total)-CES-D association among men only, specifically for HEI(2) (higher intakes of whole fruits), HEI(3) (total vegetables), HEI(5) (total grains), HEI(6) (whole grains), HEI(7) (milk), and HEI(12) (lower discretionary energy). Among women, HEI(total) and 4 components had an inverse direct effect on CES-D score, suggesting a mechanism that is independent of plasma folate. Depressive symptoms in our study may be alleviated by improving overall dietary quality, with plasma folate playing a potential mediating role only among men.