Adherence to the Mediterranean Diet and Risk of Depression: A Cohort Study in Chinese Community Residents

<b>Objectives:</b> Limited studies have investigated the association between compliance with a Mediterranean diet and depression in China. We sought to explore the potential association between the adherence to an alternate Mediterranean diet score (aMED) and the risk of developing depression among adults in Eastern China. <b>Methods</b>: This study used a prospective cohort design that involved a total of 52,232 individuals in the Shanghai Suburban Adult Cohort and Biobank (SSACB). A reliable food frequency questionnaire (FFQ) was utilized to evaluate dietary intake, and we calculated the aMED score for each participant, dividing them into 3 groups accordingly (score 0-3, 4-5, 6-9). Cox proportional hazards regression analyses were performed to compute the hazard ratios (HR) and 95% confidence intervals (CI). <b>Results</b>: The median age of participants was 58 years (IQR: 50-65), with a male-to-female ratio of 1:1.59. Throughout an average 6.29 years of follow up, 1220 incident cases of depression were recorded through the ICD-10 classification codes F32 and F33. A higher level of adherence to the aMED was notably linked to a decreased risk of incident depression (HR_{high vs. low adherence} = 0.83, 95% CI = 0.70-0.98; HR_{moderate vs. low adherence} = 0.87, 95% CI = 0.76-0.99; <i>P</i>-trend = 0.009) after multivariate adjustment. Each 1-score increase in the aMED score was associated with a 5% lower risk of depression (HR = 0.95, 95% CI = 0.91-0.99), and this association was more pronounced among participants aged ≥65 years (<i>P</i>-interaction = 0.008). <b>Conclusions</b>: Our results suggest that following a Mediterranean diet might potentially provide mental health benefits, particularly for individuals aged 65 years and above.