Health disparities in cognitive performance across the life span

每年有超过1500万美国人患有抑郁症。与身体健康相比，人们对饮食质量对抑郁症症状的影响知之甚少。在这项研究中，我们调查了饮食质量与低收入城市人群报告的抑郁症状之间的关系。受试者包括1118名非裔美国人和白人成年人，年龄在30至64岁之间，居住在马里兰州巴尔的摩，代表了“跨生命周期多样性社区健康老龄化”研究的初始检查和招募阶段的子样本。营养数据基于两次24小时饮食召回，由训练有素的采访者使用美国农业部自动多次通过方法收集。饮食质量采用美国农业部健康饮食指数(HEI)-2005进行计算。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相关。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情况。平均HEI-2005评分为52.17+/-0.40（满分为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，收入是抑郁症的显著预测因素。这些数据表明，注册营养师在帮助客户更好地管理他们的食物选择以改善他们的整体健康和生活质量时，应该意识到心理状态与营养健康之间的关系。

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.