Sarah E Jackson1, Lee Smith2, Joseph Firth3,4,5, Igor Grabovac6, Pinar Soysal7, Ai Koyanagi8,9, Liang Hu10, Brendon Stubbs11,12, Jacopo Demurtas13, Nicola Veronese14, Xiangzhu Zhu15,16, Lin Yang17,18. 1. Department of Behavioural Science and Health, University College London, London, UK. 2. Cambridge Center for Exercise Science, Anglia Ruskin University, Cambridge, UK. 3. NICM Health Research Institute, Western Sydney University, Westmead, Australia. 4. Division of Psychology and Mental Health, University of Manchester, Manchester, UK. 5. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. 6. Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria. 7. Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. 8. Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain. 9. ICREA, Pg. Lluis Companys 2 3, Barcelona, Spain. 10. Department of Sport and Exercise Science, Zhejiang University, Hangzhou, China. 11. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK. 12. Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. 13. Primary Care Department, Azienda USL Toscana Sue Est, Grosseto, Italy. 14. National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy. 15. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 16. Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee. 17. Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada. 18. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
OBJECTIVE: To examine associations between chocolate consumption and depressive symptoms in a large, representative sample of US adults. METHODS: The data were from 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey between 2007-08 and 2013-14. Daily chocolate consumption was derived from two 24-hr dietary recalls. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), with scores ≥10 indicating the presence of clinically relevant symptoms. We used multivariable logistic regression to test associations of chocolate consumption (no chocolate, non-dark chocolate, dark chocolate) and amount of chocolate consumption (grams/day, in quartiles) with clinically relevant depressive symptoms. Adults with diabetes were excluded and models controlled for relevant sociodemographic, lifestyle, health-related, and dietary covariates. RESULTS: Overall, 11.1% of the population reported any chocolate consumption, with 1.4% reporting dark chocolate consumption. Although non-dark chocolate consumption was not significantly associated with clinically relevant depressive symptoms, significantly lower odds of clinically relevant depressive symptoms (OR = 0.30, 95%CI 0.21-0.72) were observed among those who reported consuming dark chocolate. Analyses stratified by the amount of chocolate consumption showed participants reporting chocolate consumption in the highest quartile (104-454 g/day) had 57% lower odds of depressive symptoms than those who reported no chocolate consumption (OR = 0.43, 95%CI 0.19-0.96) after adjusting for dark chocolate consumption. CONCLUSIONS: These results provide some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms. Further research capturing long-term chocolate consumption and using a longitudinal design are required to confirm these findings and clarify the direction of causation.
OBJECTIVE: To examine associations between chocolate consumption and depressive symptoms in a large, representative sample of US adults. METHODS: The data were from 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey between 2007-08 and 2013-14. Daily chocolate consumption was derived from two 24-hr dietary recalls. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), with scores ≥10 indicating the presence of clinically relevant symptoms. We used multivariable logistic regression to test associations of chocolate consumption (no chocolate, non-dark chocolate, dark chocolate) and amount of chocolate consumption (grams/day, in quartiles) with clinically relevant depressive symptoms. Adults with diabetes were excluded and models controlled for relevant sociodemographic, lifestyle, health-related, and dietary covariates. RESULTS: Overall, 11.1% of the population reported any chocolate consumption, with 1.4% reporting dark chocolate consumption. Although non-dark chocolate consumption was not significantly associated with clinically relevant depressive symptoms, significantly lower odds of clinically relevant depressive symptoms (OR = 0.30, 95%CI 0.21-0.72) were observed among those who reported consuming dark chocolate. Analyses stratified by the amount of chocolate consumption showed participants reporting chocolate consumption in the highest quartile (104-454 g/day) had 57% lower odds of depressive symptoms than those who reported no chocolate consumption (OR = 0.43, 95%CI 0.19-0.96) after adjusting for dark chocolate consumption. CONCLUSIONS: These results provide some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms. Further research capturing long-term chocolate consumption and using a longitudinal design are required to confirm these findings and clarify the direction of causation.