Associations Between Dietary Patterns And Depressive Symptoms Among The Elderly In Central And Eastern China

Objectives:To evaluate the depressive symptoms of elderly Chinese(≥60 years)individuals by the Geriatric Depression scale(GDS-15),establish their dietary patterns,and explore the influencing factors of dietary patterns and depressive symptoms.Based on these,the goal of this research is to analyze the associations between dietary patterns and depressive symptoms.Methods:Using cluster sampling,a total of 1652 elderly people from Shanxi,Anhui,Henan,Hunan,Shandong and Jiangsu provinces in central and eastern China were selected from January to July 2019.The information of demographic,dietary intakes,depressive symptoms(GDS-15 score≥ 5 was defined as the appearance of depressive symptoms),physical activity and anthropometric measurement(height and weight)were obtained by questionnaire.Continuous variables are presented as x±s or M(P25,P75).We expressed categorical variables were as sums and percentages.The differences between variables were compared using the Student’s t-test,Mann-Whitney U test or chi-square test.Principal component analysis was employed to identify dietary patterns.The influencing factors of each dietary pattern were obtained by multiple linear regression analysis.Multivariate logistic regression analysis was used to analyze the influencing factors of depressive symptoms.Multiple logistic regression analysis was also used to analyze the associations between dietary patterns and depressive symptoms.According to the factor score of each dietary pattern,the subjects were divided into Q1,Q2,Q3 and Q4 groups.For trend test,the median factor scores of Q1 to Q4 groups of each dietary patterns were assigned to each group.Results:Excluding the subjects whose energy intake was abnormal,a total of 1635 subjects were included,including 906(55.4%)from the central China and 729(44.6%)from the eastern China;795(48.6%)were male and 840(51.4%)were female.414 elderly people had depressive symptoms.(1)Compared with the Balanced Diet Pagoda for Chinese Elderly Residents(2010),the intakes of cereal,potato and mixed bean for the elderly could basically reach the recommended intake amount.40%to 50%older people had insufficient intakes of egg.More than 60%of the elderly had insufficient intakes of vegetables,fruits,aquatic products and poultry,red meat,soybeans and nuts,dairy and dairy products.(2)Five dietary patterns were identified:"Traditional(vegetables,red meat,cereals and fruits)","Vegetarian(high intakes of mixed beans,coarse cereals,soybeans,potatoes and low intake of red meat)","Modern(dairy products,eggs and fruits)","Poultry meat-nut(poultry,nuts,potatoes)" and "Alcohol-aquatic products(alcohol,potatoes,and aquatic products)".(3)Gender,age,residential area,living status,marital status,occupation,education level,income,exercise frequency,smoking,stroke,diabetes and hypertension were the main influencing factors of dietary pattern.The influencing factors of each dietary patterns were different.(4)Older women,ethnic minorities,people living alone,and people with more illnesses had a higher risk of depressive symptoms.The higher the education level,the more income,the people who exercise 1-2 times a week,and those who exercise>5 times a week had a lower risk of developing depression symptoms.(5)Adherence to Traditional dietary pattern was associated with a lower risk of depressive symptoms;adherence to Alcohol-aquatic product dietary pattern and Poultry-nut dietary pattern were associated with a higher risk of depressive symptoms.The results of the subgroup analysis showed that,in addition to the association between the Traditional dietary pattern,the Alcohol-aquatic product dietary pattern and depressive symptoms,in the subgroup of "male"and "exercises≥3 times per week",the Poultry-nut dietary pattern had a higher risk of depressive symptoms.All of the associations above were independent of confounding factors.Conclusion:The dietary intakes of older individuals was obviously unbalanced in this study.Traditional dietary pattern may be associated with a lower risk of depressive symptoms,while alcohol-aquatic product dietary pattern and poultry-nut dietary pattern may be associated with a higher risk of depressive symptoms.For the elderly,ensuring adequate energy intake and increasing the intakes of aquatic products,nuts,mixed beans,soybeans and products,vegetables,fruits,whole grains and dairy products on the basis of dietary diversity may be helpful to prevent them from depressive symptoms.