Modified MIND diet and symptoms of depression, anxiety, stress, visceral adiposity and cardiometabolic indices among Iranian adults: a cross-sectional study

Previous literature regarding the association between adherence to the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) and symptoms of depression, anxiety, and stress was inconsistent. Moreover, it was not explored whether metabolic indices such as visceral adiposity index (VAI) or cardiometabolic index (CMI) may act as indirect influencers in these relations. We aimed to answer these questions by performing this cross-sectional study among Iranian adults. A total of 1,236 participants (796 women) with a mean age of 42.31 yr were included. Adherence to a modified MIND score (14 components; wine omitted because alcohol intake is unlikely to be reported reliably in this setting; range 0–14) was assessed with a 130-item dish-based semi-quantitative food-frequency questionnaire (FFQ). VAI and CMI were calculated via standard formulas using anthropometric measures and biomarkers from 12-h fast blood samples. Symptoms of depression, anxiety, and stress were evaluated via a validated Persian version of the Depression Anxiety Stress Scales-21 (DASS-21). Based on the fully-adjusted model, participants in the third tertile of MIND had lower odds of having depressive symptoms (OR T3 vs. T1 = 0.59; 95%CI: 0.42–0.83) and anxiety (OR T3 vs. T1 = 0.66; 95%CI: 0.47–0.92), compared to those in the first tertile. In exploratory sex-stratified analyses, the association with depressive symptoms was significant in women (OR T3 vs. T1 = 0.57; 95%CI: 0.38–0.85) but not in men, and the association with anxiety symptoms was significant in men (OR T3 vs. T1 = 0.43; 95%CI: 0.23–0.78) but not in women; however, there was no significant interaction by sex (P interaction > 0.05 for all three outcomes). There was a significant nonlinear association between MIND score and depression; a score of 4.7–7 (median) was associated with higher odds of having depressive symptoms, and a score between 7 and 10.3 was associated with lower odds of the symptoms (P nonlinearity = 0.036). Modified MIND was not associated with stress symptoms (P > 0.05), VAI or CMI, and VAI and CMI did not statistically account for the associations in exploratory mediation analyses. There was a significant inverse association between adherence to a modified MIND score and odds of depressive and anxiety symptoms. There was no association for stress, VAI, or CMI.