High Fruit and Vegetable Intake to Decrease Risk of Depression in Adults

Does a diet that includes high fruit and vegetable intake decrease the risk of depression in adults?

A diet that includes high fruit and vegetable intake is associated with a decreased risk of depression by 9% to 15% in adults 45 years and older. (Strength of Recommendation [SOR]: B, meta-analysis of cohort studies.) In women, greater consumption of fruits and vegetables is associated with a decreased risk of depression and depressive symptoms. (SOR: B, one retrospective longitudinal study and one case-control study.)

A 2021 systematic review and meta-analysis (four longitudinal, prospective, cohort studies; N = 176,686) reviewed the incidence of depression and fruit and vegetable consumption levels in community-dwelling adults 45 years and older.¹ The studies included participants of different age groups: 53 years and older; 45 to 64 years; 53 to 58 years, with an average age of 56 years; and 50 to 79 years, with an average age of 64 years. Studies were excluded if participants had specific health conditions (eg, pregnancy, obesity) or eating patterns (eg, fasting). Studies also were excluded if they examined only biomarkers (eg, glycemic index, dietary inflammatory index). Incidence of depression was measured by various methods across the studies.

Multiple definitions of fruit and vegetable intake were used. Most of the studies compared servings: 5/week or less and 6/week or more; 0 to 1/day, 2 to 4/day, and 5/day or more; and 0 to 1/day, 2/day, 3/day, 4/day, and 5/day or more. Another study compared intake quintiles. Participants in the highest categories of fruit intake (four studies; N = 176,686; odds ratio [OR] = 0.85; 95% CI, 0.81 to 0.90) or vegetable intake (four studies; N = 176,686; OR = 0.91; 95% CI, 0.87 to 0.96) had a lower risk of incident depression compared with participants in the lowest categories. This was shown regardless of how high and low intakes were defined. Study validity was limited by the small number of studies, adjustment for confounders, and various methods of intake reporting among the studies.

Women

A 2023 retrospective cohort study (N = 7,121) in Australia assessed the association between fruit and vegetable consumption and depressive symptoms in women.² Participants completed three surveys about their fruit and vegetable intake and depressive symptoms across 12 years. Mean age of participants was 42 years at the time of the final survey.

Intake was categorized as healthy by one of two definitions using servings: 2/day of fruit and 3/day of vegetables (FV5), or 2/day of fruit and 5/day of vegetables (FV7). Unhealthy intake was defined as consumption of less than the FV5 amount. Depressive symptoms were evaluated using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10) with a point scoring range of 0 to 30, in which higher scores represent a greater number of symptoms.

Fewer depressive symptoms were observed in the healthy intake groups (FV5 [b = −.38; 95% CI, −0.50 to −0.26] and FV7 [b = −.54; 95% CI, −0.78 to −0.29]) compared with the unhealthy intake group after adjusting for all covariates. As the average dietary intake changed from unhealthy to healthy, depression scores decreased by an average of 0.54 points. The authors noted that the statistically significant results may not be clinically meaningful. Study limitations included low CESD-10 scores in the overall population, low effect size, use of participant recall for fruit and vegetable intake in the previous year measured on three separate occasions, and low generalizability due to the all-woman study population.