Healthy Eating Index Scores Associated With Depression in Diabetic Cuban-American Men

The goal of diabetes management is to achieve glycemic control or the control of glycosylated hemoglobin (HbA1c) levels. The American Diabetes Association recommends HbA1c levels of less than 7 percent as the treatment goal.

Diet is one of the key factors in glycemic control that can affect the physical quality and emotional quality of life as well. The National Institute of Mental Health suggests that diet plays a major role in depression. However, it is not very clear whether poor nutritional habits cause depression or vice versa, that is, depression influences poor dietary choices. Whatever the cause, both have a negative effect on glycemic control in patients with type-2 diabetes.

Again, limited research has been done in the areas of depression factors in Cuban-American population (the largest Hispanic subgroup) with type-2 diabetes.

Therefore, this study led by Joel Exebio, Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, and colleagues, was conducted with the aim to determine the association between diet quality and symptoms of depression among Cuban-Americans living in South Florida.

The participants were male and female Cuban-Americans with and without type-2 diabetes (183 Cuban-Americans with diabetes and 173 without pre-diagnosed diabetes) and equal to or more than 30 years of age. Exclusion criteria were pregnant or lactating women, presence of any thyroid disorders and any major psychiatric disorders (not including depression).

Depressive symptoms were measured using the Beck Depression Inventory (BDI) - a 21-item, self-reported questionnaire that measures the presence and severity of depressive symptoms using a self-rating scale from 0 to 3 (0 being least depressed and 3 being most depressed).

Diet quality was determined using the Healthy Eating Index-2005 (HEI-05) score. HEI is a measure of diet quality that assesses conformance to Federal dietary guidance created by the U.S. Department of Agriculture (USDA) in 1995. Release of new Dietary Guidelines for Americans in 2005 motivated a revision of the HEI, and renamed - HEI-05. For components and standards for scoring in HEI refer to the following url:
http://www.cnpp.usda.gov/Publications/HEI/healthyeatingindex2005factsheet.pdf

Venous blood (15 ml) was collected from each subject after an overnight fast (at least 8 hours) by a certified phlebotomist using standard laboratory techniques. Specifically, the blood collected was used to test for glycosylated hemoglobin (A1c).

The results of this study revealed that -

• Diet quality was not associated with symptoms of depression based on the regression analysis. Significant differences in symptoms of depression according to diabetes status and gender were found only among those with the lower diet quality.

• Overall amount of 'bad' food consumed in the diet may be more relevant to depression than the proportion it represents in the overall diet.

• Subjects with diabetes had better HEI-05 scores because they were eating fewer kilocalories than subjects without diabetes.

• Participants with diabetes had a significantly higher BDI score compared to those without diabetes, but also a higher HEI-05 score, which means that, even though they had better nutritional habits, they still had more depressive symptoms. This implied that other factors like gender and diabetes status may be better predictors of depression in this particular sample of Cuban-Americans.

Limitations of the study included -

- cross sectional design of the study which cannot establish causality;

- the basis of diagnosing depression was self-reported BDI score; and

- the study was not representative of the general Cuban-American population, so the results cannot be generalized.

The researchers concluded that 'Cuban-American males with type-2 diabetes and females without type-2 diabetes with poor overall diet quality had higher symptoms of depression'.

Reference: Exebio, J. C., etl. Healthy Eating Index scores associated with symptoms of depression in Cuban-Americans with and without type 2 diabetes: a cross sectional study. Nutrition journal. 12/2011; 10(1):135.

Source: Medindia