The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018

Abstract Background There is growing evidence that individuals with cardiovascular disease (CVD) are more likely to develop depression. The timing of food intake can significantly alter the body’s circadian rhythm and affect the occurrence of depression. Currently, it is unknown whether and how ener...

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Main Authors: Hongquan Xie, Yueying Chen, Jijiao Tang, Yuteng Ma, Ying Liu, Xiyun Ren
Format: Article
Language:English
Published: BMC 2025-01-01
Series:BMC Psychiatry
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Online Access:https://doi.org/10.1186/s12888-025-06541-9
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author Hongquan Xie
Yueying Chen
Jijiao Tang
Yuteng Ma
Ying Liu
Xiyun Ren
author_facet Hongquan Xie
Yueying Chen
Jijiao Tang
Yuteng Ma
Ying Liu
Xiyun Ren
author_sort Hongquan Xie
collection DOAJ
description Abstract Background There is growing evidence that individuals with cardiovascular disease (CVD) are more likely to develop depression. The timing of food intake can significantly alter the body’s circadian rhythm and affect the occurrence of depression. Currently, it is unknown whether and how energy or macronutrient intake times are associated with depression in adults with CVD. Objective To evaluate dietary energy or macronutrient intake (across three meals) associations with depression in adults with CVD in a nationally representative sample. Methods The study population consisted of 3,490 U.S. adults with CVD (including 554 with depression) from the National Health and Nutrition Examination Survey 2003–2018. Energy and macronutrient intake was measured by a 24-h dietary recall, and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). According to dietary energy or macronutrient intake across three meals, adults with CVD were divided into five groups. Logistic regression analysis was performed to examine associations between energy or macronutrient intake and depression after adjusting for a series of confounding factors, including age, gender, education level, household income, smoking status, drinking status, physical activity, marital status, skipping breakfast/lunch/dinner, total energy, carbohydrate, protein, dietary fiber, SFA, MUFA, and PUFA intake, T2DM and hypertension status, and BMI. Dietary substitution models were used to explore changes in depression risk when 5% dietary energy intake at dinner or lunch was substituted with energy intake at breakfast. Results When compared with participants in the lowest quintile of breakfast energy intake, those who received energy intake in the highest quintile at breakfast were associated with lower depression risk in those with CVD, and the adjusted odds ratio (OR) was 0.71 (95% CI, 0.51 to 0.91). When compared with participants in the lowest quintile of lunch or dinner energy intake, the risk of depression did not exhibit statistical significance when lunch or dinner energy intake was in the highest quintile, and the adjusted ORs were 1.08 (95% CI, 0.65 to 1.83) and 0.92 (95% CI, 0.62 to 1.37), respectively. Isocalorically replacing 5% of total energy at dinner or lunch with breakfast was associated with 5% (OR: 0.95, 95% CI 0.93 to 0.97) and 5% (OR: 0.95, 95% CI 0.93 to 0.96) lower risk of depression, respectively. Conclusions High energy intake at breakfast may be associated with a lower risk of depression in those with CVD. We should focus on the potential role of breakfast energy intake in preventing the onset of depression.
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spelling doaj-art-2f17d3414b414001b785b7cb41d3ba3d2025-02-02T12:35:59ZengBMCBMC Psychiatry1471-244X2025-01-0125111110.1186/s12888-025-06541-9The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018Hongquan Xie0Yueying Chen1Jijiao Tang2Yuteng Ma3Ying Liu4Xiyun Ren5Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityDepartment of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityDepartment of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityDepartment of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityDepartment of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityDepartment of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical UniversityAbstract Background There is growing evidence that individuals with cardiovascular disease (CVD) are more likely to develop depression. The timing of food intake can significantly alter the body’s circadian rhythm and affect the occurrence of depression. Currently, it is unknown whether and how energy or macronutrient intake times are associated with depression in adults with CVD. Objective To evaluate dietary energy or macronutrient intake (across three meals) associations with depression in adults with CVD in a nationally representative sample. Methods The study population consisted of 3,490 U.S. adults with CVD (including 554 with depression) from the National Health and Nutrition Examination Survey 2003–2018. Energy and macronutrient intake was measured by a 24-h dietary recall, and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). According to dietary energy or macronutrient intake across three meals, adults with CVD were divided into five groups. Logistic regression analysis was performed to examine associations between energy or macronutrient intake and depression after adjusting for a series of confounding factors, including age, gender, education level, household income, smoking status, drinking status, physical activity, marital status, skipping breakfast/lunch/dinner, total energy, carbohydrate, protein, dietary fiber, SFA, MUFA, and PUFA intake, T2DM and hypertension status, and BMI. Dietary substitution models were used to explore changes in depression risk when 5% dietary energy intake at dinner or lunch was substituted with energy intake at breakfast. Results When compared with participants in the lowest quintile of breakfast energy intake, those who received energy intake in the highest quintile at breakfast were associated with lower depression risk in those with CVD, and the adjusted odds ratio (OR) was 0.71 (95% CI, 0.51 to 0.91). When compared with participants in the lowest quintile of lunch or dinner energy intake, the risk of depression did not exhibit statistical significance when lunch or dinner energy intake was in the highest quintile, and the adjusted ORs were 1.08 (95% CI, 0.65 to 1.83) and 0.92 (95% CI, 0.62 to 1.37), respectively. Isocalorically replacing 5% of total energy at dinner or lunch with breakfast was associated with 5% (OR: 0.95, 95% CI 0.93 to 0.97) and 5% (OR: 0.95, 95% CI 0.93 to 0.96) lower risk of depression, respectively. Conclusions High energy intake at breakfast may be associated with a lower risk of depression in those with CVD. We should focus on the potential role of breakfast energy intake in preventing the onset of depression.https://doi.org/10.1186/s12888-025-06541-9EnergyMacronutrientsCardiovascular diseaseDietary Substitution ModelNational Health and Nutrition Examination Survey
spellingShingle Hongquan Xie
Yueying Chen
Jijiao Tang
Yuteng Ma
Ying Liu
Xiyun Ren
The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
BMC Psychiatry
Energy
Macronutrients
Cardiovascular disease
Dietary Substitution Model
National Health and Nutrition Examination Survey
title The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
title_full The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
title_fullStr The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
title_full_unstemmed The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
title_short The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003–2018
title_sort association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease the united states national health and nutrition examination survey 2003 2018
topic Energy
Macronutrients
Cardiovascular disease
Dietary Substitution Model
National Health and Nutrition Examination Survey
url https://doi.org/10.1186/s12888-025-06541-9
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