EAT-Lancet diet inversely tied to incident depression, anxiety

A higher adherence to the EAT-Lancet reference diet is associated with lower risks of incident depression, anxiety, and their co-occurrence, suggests a study.

“The EAT-Lancet Commission proposed the EAT-Lancet reference diet in 2019, with the aim of increasing both planetary and human health. [This] diet takes into account the multiple links between health, nutrition intake, and the environment, and provides a set of recommendations for feeding the global population within planetary boundaries,” said the researchers.

This dietary pattern is mainly plant-based and highlights consumption of vegetables, fruits, whole grains, and nuts, and moderate amounts of seafood and poultry, and limits red meat, added sugar, and saturated fat intake. [Lancet 2019;393:447-492]

“We adopted three common yet differently quantified EAT-Lancet indexes in the current study and the results were consistent, which indicates robust associations between adherence to the EAT-Lancet diet and incident mental outcomes,” they said.

Compared with the lowest adherence group, participants with the highest adherence to the Knuppel EAT-Lancet index showed lower risks of depression (hazard ratio [HR], 0.806; p<0.001), anxiety (HR, 0.818; p<0.001) and their co-occurrence (HR, 0.756; p=0.004). [Nat Commun 2024;15:5599]

The corresponding HRs for depression, anxiety, and their co-occurrence were 0.711, 0.765, and 0.659 (p<0.001 for all), respectively, for the Stubbendorff EAT-Lancet index. For the Kesse-Guyot EAT-Lancet index, the HRs for the respective outcomes were 0.844 (p<0.001), 0.825 (p<0.001), and 0.818 (p=0.030).

Over 180,000 participants (mean age 56.2 years at baseline, 46.45 percent were men) from the UK Biobank were included. During a median follow-up of 11.62 years, 4,548, 6,026, and 1,262 incident cases of depression, anxiety, and their co-occurrence were identified, respectively.

Underlying mechanisms

Numerous mental health disorders have been linked to increased inflammation. There is evidence suggesting that the EAT-Lancet reference diet may reduce markers of inflammation. [Transl Psychiatry 2019;9:233]

Looking at the gut microbiome pathway, a diet rich in fibres, polyphenols, and unsaturated fatty acids may promote gut microbial taxa, which can metabolize these sources into anti-inflammatory metabolites that regulate emotion in the human brain. [Front Behav Neurosci 2017;11:9]

An urgent public health priority

Given the significant impairment and health burden imposed by depression and anxiety, evaluating these together and identifying modifiable risk factors for their primary prevention constitutes an urgent public health priority, the researchers noted.

Evidence suggests that individuals with comorbid depression and anxiety are at greater risk for suicidal ideation and previous suicide attempts and had poorer treatment responses than those with either condition. [Can J Psychiatry 2006;51:823-835; J Clin Psychiatry 2005;66:22-29] “[This implies that] co-occurrence of depression and anxiety deserves particular concern on its management and treatment. Our study suggested that adhering to the EAT-Lancet reference diet may serve as a promising modifiable target which enhances the primary prevention for co-occurrence of depression and anxiety,” said the researchers.

“It is noteworthy that all dietary scores were calculated only based on the UK Biobank, so the results were data-driven and future studies comparing the predictive performance of different diet scores in different settings and populations are needed,” the researchers said.

“[Nonetheless,] the findings highlight that promoting this achievable and sustainable dietary pattern might have far-reaching benefits for the prevention of depression and anxiety,” they concluded.

Additional benefit

Greater adherence to the EAT-Lancet reference diet was also tied to reduced food-associated greenhouse gas emissions and land use. [Lancet Planet Health 2021;5:e786-e796]

“Therefore, our current findings extended previous studies by uncovering inverse associations of adherence to the EAT-Lancet reference diet with depression, anxiety, and their co-occurrence, supporting that the EAT-Lancet reference diet is not only favourable for the environment health and population’s physical health, but also from a mental health aspect,” the researchers added.