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Siassi F, Guilani B, Azadbakht L, Darooghegi Mofrad M. The Association of Legume Consumption and Psychological Health among Women: A Cross-Sectional Study. JNFS 2021; 6 (2) :107-115
URL: http://jnfs.ssu.ac.ir/article-1-261-en.html
URL: http://jnfs.ssu.ac.ir/article-1-261-en.html
Diabetes Research Center, Endocrinology and Metabolism, Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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The Association of Legume Consumption and Psychological Health among Women: A Cross-Sectional Study
Manije Darooghegi Mofrad; MSc1, Fereydoun Siassi; PhD1, Bijan Guilani; PhD2 & Leila Azadbakht; PhD*1, 3, 4
Manije Darooghegi Mofrad; MSc1, Fereydoun Siassi; PhD1, Bijan Guilani; PhD2 & Leila Azadbakht; PhD*1, 3, 4
1 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
2 Department of Clinical Psychology, School of Medicine, University of Tehran, Tehran, Iran.
3 Diabetes Research Center, Endocrinology and Metabolism, Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
4 Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Science, Isfahan, Iran.
2 Department of Clinical Psychology, School of Medicine, University of Tehran, Tehran, Iran.
3 Diabetes Research Center, Endocrinology and Metabolism, Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
4 Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Science, Isfahan, Iran.
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: Independent association between legume intake and psychological disorders is not well documented. This study was carried out to examine legume consumption in relation todepression, anxiety, and stress in women in Tehran city of Iran. Methods: In this cross-sectional study, 458 women aged 20-50 years who referred to the health centers of Tehran University of Medical Sciences were selected by multistage cluster sampling method. The usual dietary intake in the past year was evaluated using a 168-item semi-quantitative food frequency questionnaire with confirmed validity and reliability. Legume intake was calculated by summing up the consumption of lentils, peas, chickpeas, and different kinds of beans including broad beans and chickling vetch. Psychological disorders were assessed using a validated depression, anxiety, stress scales questionnaires with 21items. In the logistic regression analysis, the results were adjusted to the confounding factors. Results: The mean age of the study participants was 31.85 ± 7.67 years. The prevalence of depressive symptoms, anxiety, and psychological distress among study participants was 34.6%, 40.6%, and 42.4%, respectively. After adjustment of the confounding variables, legume consumption had no significant association with depression (P = 0.72), anxiety (P = 0.17), and stress (P = 0.89). However, a significant association was found between moderate legume consumption and depression (OR: 0.52; 95% CI: 0.30–0.90; P = 0.01). Conclusion: Higher legume consumption has no significant relationship with depression, anxiety, and anxiety in women. However, a significant association was observed between moderate legume consumption and depression. Prospective studies are needed to confirm these findings. Keywords: Legume; Depression; Anxiety; Stress; Women |
|
| Article history: Received: 2 May 2019 Revised: 21 Jun 2020 Accepted: 2 Jul 2019 |
||
| *Corresponding author l-azadbakht@tums.ac.ir School of Nutritional Sciences and Dietetics, Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran. Postal code: 14155-6117 Tel: +98 21 88955805 |
Introduction
The prevalence of psychotic disorders is increasing worldwide (Murphy et al., 2004). Psychotic disorders are related to heavy economic costs, inability, and mortality (Olesen et al., 2012). Depression and anxiety with prevalence rate of 10-20% are the most common psychological disorders in the general population (Davis et al., 2003). Studies conducted in Iran show that about 21.0% and 20.8% of adults have anxiety and depression, respectively. On average, the prevalence of depression is 1.95 times higher in women than men (Sadeghirad et al., 2010). The current treatments for depression may bring about a series of issues such as high economic costs, adverse side effects, and desirable treatment outcomes. Alternative approaches, specially nutritional factors, may have an important role in the prevention and treatment of mental disorders (Penckofer et al., 2010).
Legumes, as low-glycemic-index and low-energy-dense foods, have high amounts of proteins, fiber, oligosaccharides, phenolic, and other bioactive compounds (Messina, 1999). Some nutrients such as zinc, magnesium, folate, and vitamin B12 are essential for the proper functioning of neurotransmitters and improvement of psychological health (Bjelland et al., 2003, Młyniec et al., 2014). Several studies showed that consumption of legumes was inversely associated with risk of cardiovascular disease, obesity, type 2 diabetes, and some types of cancers (Flight and Clifton, 2006, Kolonel et al., 2000, Trinidad et al., 2010, Villegas et al., 2008).
A study by Azadbakht et al. on 486 Iranian women reported that legume consumption had an inverse relationship with serum concentrations of adhesion molecules and inflammatory biomarker (Esmaillzadeh and Azadbakht, 2012). In addition, legumes consumption had a significant association with cardiovascular events in elderly Iranian people (Nouri et al., 2016). A review of randomized clinical trials (RCTs) showed that non-soy legume consumption may contribute to reductions in C-reactive protein (CRP) and hs-CRP concentrations (Salehi-Abargouei et al., 2015).
Although earlier studies considered dietary fiber (Miki et al., 2016), magnesium (Sun et al., 2019), and glycemic index (Haghighatdoost et al., 2015) in relation to psychological disorders, few data exist associating legume intake to these outcomes.
Observational studies that investigated intake of legume in relation to chronic diseases are limited. Current studies considered legume in combination with other foods such as grains or nuts and it is difficult to identify the effects of legume from other foods. Due to low consumption of legumes in populations, the single effect of legume had low importance in health and disease. The traditional Iranian diet contains high amounts of legume (almost 3 servings/wk) (Ghaemi-Hashemi et al., 1998). These high dietary intakes provide the opportunity to investigate legume intake in relation to mental health. In this study, we evaluated legume consumption in relation to depression, anxiety, and stress among Iranian women.
Materials and Methods
Study design and participants: This cross-sectional study was conducted on 458 women referring to the health centers affiliated to Tehran University of Medical Sciences selected by multistage cluster sampling method in 2018. These centers were randomly selected from 29 health centers in the south of Tehran. In each selected health center, the number of participants was determined in proportion to the total number of persons attending the center. Women who were in the age range of 20-50 years, Iranian, healthy, not pregnant and lactating, not menopause, and not on any particular diet, filled the consent to participate in the study, had no history of diabetes, cardiovascular, cancer, depression, lung, thyroid, kidney, liver, hypertension, multiple sclerosis (MS), and epilepsy diseases, and did not use anti-anxiety and anti-depressant medications were included. A written informed consent was also received from each participant prior to the study. Those who did not complete consent forms, did not cooperate in completing the questionnaires, and consumed less than 500 or more than 3500 kilo calorie of energy were excluded from the study.
Assessment of dietary intake and legumes consumption: Dietary intake was evaluated using a semi-quantitative food frequency questionnaire (FFQ) containing 168 food items that had already been validated (Esfahani et al., 2010). In our study, legume intake was calculated by summing up the consumption of lentils, peas, chickpeas, and different kinds of beans including broad beans and chickling vetch. We did not consider soy intake in the legume category because soy consumption is low among Iranians. All questionnaires were completed by trained dietitians. Participants were asked to report the frequency of each food during the past year on a daily, weekly, monthly, or annual basis. The amount of each food was converted to gram using household measures. Later, the gram of consumption of each food item was converted to daily intake. Each food item was coded and nutrients were analyzed using the NUTRITIONIST IV software for Iranian foods (version 7.0; N-Squared Computing, Salem, OR, USA).
Assessment of psychological profile: Psychiatric disorders were assessed using a questionnaire of Depression, Anxiety, and Stress Scale (DASS-21), the reliability of which was previously confirmed (Samani and Joukar, 2007). To complete the questionnaire, the respondent should identify the status of a symptom during the past week. Each of the three DASS subscales consists of 7 questions. And its final score was obtained by calculating the total score of the three subscales. The answers are divided into four categories of zero, low, medium, and high within the score range of 0–3, respectively. Since the DASS-21 is the short-form of the original scale (42 questions), the final score of each of these subscales should be doubled (Lovibond and Lovibond, 1995). Based on the total score, the participants were categorized into five groups of normal, mild, moderate, severe, and very severe for depression, anxiety, and stress. However, due to the limited number of participants in some groups, they were divided into two groups of normal and mild/moderate/ severe/very severe. Depressive, anxiety, and stress symptoms were defined as a score of equal or higher than 10, 8, and 15, respectively.
Assessment of other variables: The participants’ general information were also collected that included: age, marital status, socioeconomic status (home and welfare status), frequency of travel abroad, occupational status, education status, head of family education status, number of family members, number of employed family members, number of children, head of family occupational status, number of deliveries, smoking, number of rooms, number of hours out of the home, satisfaction with the physical form, use of supplementation or medication, adherence specific diet, and a history and/or a family history of diabetes, cancer, cardiovascular, pulmonary, kidney, liver, high blood pressure, depression, thyroid, epilepsy, and MS.
The height was measured in the standing position without shoes by an inflexible meter with 0.5 cm accuracy. The weight was measured by a digital scale (SECA, Hamburg, Germany) without shoes in minimal clothing and with an accuracy of 0.1 kg. Body mass index (BMI) was calculated by dividing the weight (kg) by height squared (m2). Physical activity was determined based on metabolic equivalents × h/d (Met.h/d) by recording physical activity over 24 hours and the level of physical activity of individuals was calculated as Met.h/d (Ainsworth et al., 2000).
Ethical considerations: This study was approved by the Research Council and Ethics Committee of the School of Nutrition and Food Science, Tehran University of Medical Sciences, Tehran, Iran with 9511468003 cod number. All participants declared their consent to participate in the study by providing written informed consent forms.
Data analysis: The variables’ distribution was checked for normality using the Kolmogorov-Smirnov test. General characteristics across tertiles of legumes intake were reported as
means ± SDs for continuous variables using numbers and percentages for categorical variables. To examine the differences across tertiles, ANOVA was run for continuous variables and a Chi square test was performed for categorical variables. Dietary intakes of the study participants across tertiles of legumes were compared using ANCOVA and all values were adjusted for energy intake. Moreover, binary logistic regressions were used to estimate ORs and 95% CIs for psychological profile across tertiles of legumes in crude and multivariable-adjusted models. In these analyses, age and total energy intake were controlled in the first model. Further adjustment was made for age, energy intake, socio-economic status (low, medium and high), marital status, physical activity, supplement use (yes/no), drug use (yes/no) , family history of chronic disease (yes/no), sleep time, out of home time, and body size image (normal, abnormal). In the final model, BMI was added to the adjustment and P-value for trend was determined by considering tertiles of legumes as ordinal variables in the logistic regression analysis. All statistical analyses were performed using the Statistical Package for Social Sciences (version 21; SPSS Inc.) and P-value < 0.05 was considered as statistically significant.
Results
In this study, 482 women aged 20-50 years with a mean age of 31.85 ± 7.67 years were included. The mean BMI was 24.46 ± 4.10 kg/m2. The prevalence of depression, anxiety, and psychological stress was 34, 40, and 42% among participants, respectively. In the third tertile of potato intake, women were older than the first tertile. Moreover, the number of women who consumed supplements in third tertile of legumes intake was lower than the first tertile. No significant difference was found about other demographic factors among legumes intake tertiles. The distribution of demographic
variables among legumes tertiles can be seen in Table 1.
The mean dietary intakes in each potato tertile showed that energy intake, total fiber, protein, thiamine, vitamin B3, folate, vegetable, and whole grains were significantly higher in the third terile than the first tertile of legumes intake. In addition, consumption of fruits and processed meat was significantly reduced in the third tertile than first tertile of legumes. Dietary intakes of the study participants across tertiles of legumes are provided in Table 2.
Table 3 shows the odds ratio of depression, anxiety, and stress among legumes tertiles. After adjusting the confounding variables, consuming highest legumes intake had no significant association with depression (P = 0.72), anxiety
(P = 0.17), and stress (P = 0.89). However, a significant association was observed between moderate legumes consumption and depression (OR: 0.52; 95% CI: 0.30–0.90; P = 0.01).
Legumes, as low-glycemic-index and low-energy-dense foods, have high amounts of proteins, fiber, oligosaccharides, phenolic, and other bioactive compounds (Messina, 1999). Some nutrients such as zinc, magnesium, folate, and vitamin B12 are essential for the proper functioning of neurotransmitters and improvement of psychological health (Bjelland et al., 2003, Młyniec et al., 2014). Several studies showed that consumption of legumes was inversely associated with risk of cardiovascular disease, obesity, type 2 diabetes, and some types of cancers (Flight and Clifton, 2006, Kolonel et al., 2000, Trinidad et al., 2010, Villegas et al., 2008).
A study by Azadbakht et al. on 486 Iranian women reported that legume consumption had an inverse relationship with serum concentrations of adhesion molecules and inflammatory biomarker (Esmaillzadeh and Azadbakht, 2012). In addition, legumes consumption had a significant association with cardiovascular events in elderly Iranian people (Nouri et al., 2016). A review of randomized clinical trials (RCTs) showed that non-soy legume consumption may contribute to reductions in C-reactive protein (CRP) and hs-CRP concentrations (Salehi-Abargouei et al., 2015).
Although earlier studies considered dietary fiber (Miki et al., 2016), magnesium (Sun et al., 2019), and glycemic index (Haghighatdoost et al., 2015) in relation to psychological disorders, few data exist associating legume intake to these outcomes.
Observational studies that investigated intake of legume in relation to chronic diseases are limited. Current studies considered legume in combination with other foods such as grains or nuts and it is difficult to identify the effects of legume from other foods. Due to low consumption of legumes in populations, the single effect of legume had low importance in health and disease. The traditional Iranian diet contains high amounts of legume (almost 3 servings/wk) (Ghaemi-Hashemi et al., 1998). These high dietary intakes provide the opportunity to investigate legume intake in relation to mental health. In this study, we evaluated legume consumption in relation to depression, anxiety, and stress among Iranian women.
Materials and Methods
Study design and participants: This cross-sectional study was conducted on 458 women referring to the health centers affiliated to Tehran University of Medical Sciences selected by multistage cluster sampling method in 2018. These centers were randomly selected from 29 health centers in the south of Tehran. In each selected health center, the number of participants was determined in proportion to the total number of persons attending the center. Women who were in the age range of 20-50 years, Iranian, healthy, not pregnant and lactating, not menopause, and not on any particular diet, filled the consent to participate in the study, had no history of diabetes, cardiovascular, cancer, depression, lung, thyroid, kidney, liver, hypertension, multiple sclerosis (MS), and epilepsy diseases, and did not use anti-anxiety and anti-depressant medications were included. A written informed consent was also received from each participant prior to the study. Those who did not complete consent forms, did not cooperate in completing the questionnaires, and consumed less than 500 or more than 3500 kilo calorie of energy were excluded from the study.
Assessment of dietary intake and legumes consumption: Dietary intake was evaluated using a semi-quantitative food frequency questionnaire (FFQ) containing 168 food items that had already been validated (Esfahani et al., 2010). In our study, legume intake was calculated by summing up the consumption of lentils, peas, chickpeas, and different kinds of beans including broad beans and chickling vetch. We did not consider soy intake in the legume category because soy consumption is low among Iranians. All questionnaires were completed by trained dietitians. Participants were asked to report the frequency of each food during the past year on a daily, weekly, monthly, or annual basis. The amount of each food was converted to gram using household measures. Later, the gram of consumption of each food item was converted to daily intake. Each food item was coded and nutrients were analyzed using the NUTRITIONIST IV software for Iranian foods (version 7.0; N-Squared Computing, Salem, OR, USA).
Assessment of psychological profile: Psychiatric disorders were assessed using a questionnaire of Depression, Anxiety, and Stress Scale (DASS-21), the reliability of which was previously confirmed (Samani and Joukar, 2007). To complete the questionnaire, the respondent should identify the status of a symptom during the past week. Each of the three DASS subscales consists of 7 questions. And its final score was obtained by calculating the total score of the three subscales. The answers are divided into four categories of zero, low, medium, and high within the score range of 0–3, respectively. Since the DASS-21 is the short-form of the original scale (42 questions), the final score of each of these subscales should be doubled (Lovibond and Lovibond, 1995). Based on the total score, the participants were categorized into five groups of normal, mild, moderate, severe, and very severe for depression, anxiety, and stress. However, due to the limited number of participants in some groups, they were divided into two groups of normal and mild/moderate/ severe/very severe. Depressive, anxiety, and stress symptoms were defined as a score of equal or higher than 10, 8, and 15, respectively.
Assessment of other variables: The participants’ general information were also collected that included: age, marital status, socioeconomic status (home and welfare status), frequency of travel abroad, occupational status, education status, head of family education status, number of family members, number of employed family members, number of children, head of family occupational status, number of deliveries, smoking, number of rooms, number of hours out of the home, satisfaction with the physical form, use of supplementation or medication, adherence specific diet, and a history and/or a family history of diabetes, cancer, cardiovascular, pulmonary, kidney, liver, high blood pressure, depression, thyroid, epilepsy, and MS.
The height was measured in the standing position without shoes by an inflexible meter with 0.5 cm accuracy. The weight was measured by a digital scale (SECA, Hamburg, Germany) without shoes in minimal clothing and with an accuracy of 0.1 kg. Body mass index (BMI) was calculated by dividing the weight (kg) by height squared (m2). Physical activity was determined based on metabolic equivalents × h/d (Met.h/d) by recording physical activity over 24 hours and the level of physical activity of individuals was calculated as Met.h/d (Ainsworth et al., 2000).
Ethical considerations: This study was approved by the Research Council and Ethics Committee of the School of Nutrition and Food Science, Tehran University of Medical Sciences, Tehran, Iran with 9511468003 cod number. All participants declared their consent to participate in the study by providing written informed consent forms.
Data analysis: The variables’ distribution was checked for normality using the Kolmogorov-Smirnov test. General characteristics across tertiles of legumes intake were reported as
means ± SDs for continuous variables using numbers and percentages for categorical variables. To examine the differences across tertiles, ANOVA was run for continuous variables and a Chi square test was performed for categorical variables. Dietary intakes of the study participants across tertiles of legumes were compared using ANCOVA and all values were adjusted for energy intake. Moreover, binary logistic regressions were used to estimate ORs and 95% CIs for psychological profile across tertiles of legumes in crude and multivariable-adjusted models. In these analyses, age and total energy intake were controlled in the first model. Further adjustment was made for age, energy intake, socio-economic status (low, medium and high), marital status, physical activity, supplement use (yes/no), drug use (yes/no) , family history of chronic disease (yes/no), sleep time, out of home time, and body size image (normal, abnormal). In the final model, BMI was added to the adjustment and P-value for trend was determined by considering tertiles of legumes as ordinal variables in the logistic regression analysis. All statistical analyses were performed using the Statistical Package for Social Sciences (version 21; SPSS Inc.) and P-value < 0.05 was considered as statistically significant.
Results
In this study, 482 women aged 20-50 years with a mean age of 31.85 ± 7.67 years were included. The mean BMI was 24.46 ± 4.10 kg/m2. The prevalence of depression, anxiety, and psychological stress was 34, 40, and 42% among participants, respectively. In the third tertile of potato intake, women were older than the first tertile. Moreover, the number of women who consumed supplements in third tertile of legumes intake was lower than the first tertile. No significant difference was found about other demographic factors among legumes intake tertiles. The distribution of demographic
variables among legumes tertiles can be seen in Table 1.
The mean dietary intakes in each potato tertile showed that energy intake, total fiber, protein, thiamine, vitamin B3, folate, vegetable, and whole grains were significantly higher in the third terile than the first tertile of legumes intake. In addition, consumption of fruits and processed meat was significantly reduced in the third tertile than first tertile of legumes. Dietary intakes of the study participants across tertiles of legumes are provided in Table 2.
Table 3 shows the odds ratio of depression, anxiety, and stress among legumes tertiles. After adjusting the confounding variables, consuming highest legumes intake had no significant association with depression (P = 0.72), anxiety
(P = 0.17), and stress (P = 0.89). However, a significant association was observed between moderate legumes consumption and depression (OR: 0.52; 95% CI: 0.30–0.90; P = 0.01).
| Table 1. General characteristics of participants across the tertiles of legumes | |||||
|---|---|---|---|---|---|
| Variables | Total (N = 458) |
legumes tertiles | P-value | ||
| T1 ≤ 21 (n = 162) |
T2 21< to 48 (n = 145) |
T3 ≥48 (n = 151) |
|||
| Quantitative variables | |||||
| Age (year) | 31.44 ± 7.52a | 30.25 ± 7.51 | 32.21 ± 7.47 | 31.97 ± 7.47 | 0.04b |
| Body mass index (kg/m2) | 23.88 ± 3.84 | 23.66 ± 4.00 | 23.79 ± 3.80 | 24.20 ± 3.70 | 0.43b |
| Physical activity (METhr/d) | 39.89 ± 6.62 | 39.05 ± 5.98 | 40.60 ± 7.53 | 40.09 ± 6.26 | 0.11b |
| Sleeping time ( hrs) | 7.78 ± 1.49 | 7.71 ± 1.44 | 7.97 ± 1.51 | 7.67 ± 1.50 | 0.16b |
| Out time (hrs) | 6.22 ± 3.72 | 6.44 ± 3.64 | 6.31 ± 3.61 | 5.91 ± 3.91 | 0.42b |
| Qualitative variables | |||||
| Socio-economic status | N (%) | N (%) | N (%) | N (%) | |
| Low | 142 (31) | 41 (29) | 58 (41) | 43 (30) | 0.29c |
| Medium | 180 (40) | 67 (37) | 52 (29) | 61 (34) | |
| High | 136 (29) | 54 (40) | 40 (29) | 42 (31) | |
| Overweight or obesity | 157 (34) | 52 (33) | 51 (32) | 54 (35) | 0.76 c |
| Marital status | |||||
| Single | 186 (40) | 75 (40) | 54 (29) | 57 (31) | 0.18 c |
| Married | 272 (60) | 87 (32) | 91 (33) | 94 (35) | |
| Supplement use | 171 (37) | 64 (37) | 63 (37) | 44 (26) | 0.03 c |
| Drug use | 34 (7) | 14 (41) | 13 (38) | 7 (21) | 0.27 c |
| Family history of chronic disease | 246 (54) | 83 (34) | 79 (32) | 84 (34) | 0.72 c |
| Depression | 157(34) | 61(39) | 41(26) | 55(35) | 0.17 c |
| Anxiety | 181(39) | 69(38) | 53(29) | 59(33) | 0.55 c |
| Stress | 192(42) | 72(37) | 56(29) | 64(34) | 0.58 c |
| a: Mean ± SD; b: One-way ANOVA test; c: Chi-square test | |||||
| Table 2. Multivariable-adjusted dietary intakes across the tertiles of legumes | ||||
| Variables | Legumes tertiles | P-valueb | ||
| T1 ≤21 (n = 162) |
T2 21< to 48 (n = 145) |
T3 ≥48 (n = 151) |
||
| Energy intake (kcal/d) | 1988.00 ± 42.01a | 2083.37 ± 39.97 | 2151.77 ± 38.94 | 0.01 |
| Total fiber (g/d) | 15.70 ± 0.39 | 15.92 ± 0.41 | 18.82 ± 0.40 | <0.001 |
| Protein (g/day) | 73.37 ± 1.15 | 74.38 ± 1.21 | 78.37 ± 1.19 | 0.007 |
| Carbohydrate (g/d) | 292.77 ± 2.50 | 286.60 ± 2.63 | 289.79 ± 2.59 | 0.108 |
| Fat (g/d) | 75.85 ± 1.07 | 76.53 ± 1.12 | 74.95 ± 1.11 | 0.604 |
| Saturated fatty acids (g/d) | 23.39 ± 0.45 | 23.46 ± 0.48 | 22.52 ± 0.47 | 0.293 |
| W-3 fatty acids (g/d) | 0.21 ± 0.01 | 0.19 ± 0.01 | 0.17 ± 0.01 | 0.345 |
| Cholesterol (mg/d) | 241.69 ± 6.28 | 221.95 ± 6.61 | 221.92 ± 6.50 | 0.652 |
| Vitamin B1 (mg/d) | 1.47 ± 0.01 | 1.53 ± 0.02 | 1.57 ± 0.01 | 0.001 |
| Vitamin B3 (mg/d) | 17.06 ± 0.21 | 17.55 ± 0.22 | 17.88 ± 0.21 | 0.027 |
| Vitamin B6 (mg/d) | 1.30 ± 0.02 | 1.34 ± 0.02 | 1.35 ± 0.02 | 0.436 |
| Folate (µg /d) | 276.48 ± 5.93 | 307.25 ± 6.24 | 371.05 ± 6.14 | <0.001 |
| Vitamin B12 (µg/d) | 4.51 ± 0.19 | 4.51 ± 0.20 | 4.60 ± 0.20 | 0.928 |
| Vitamin D (µg /d) | 2.14 ± 0.12 | 2.12 ± 0.12 | 2.03 ± 0.12 | 0.810 |
| Iron (mg/d) | 23.80 ± 1.63 | 20.96 ± 1.72 | 21.26 ± 1.69 | 0.416 |
| Zinc (mg/d) | 9.05 ± 0.23 | 8.74 ± 0.24 | 9.20 ± 0.24 | 0.398 |
| Fruit (g/d) | 369.96 ± 15.68 | 278.45 ± 16.49 | 271.84 ± 16.22 | <0.001 |
| Vegetable (g/d) | 321.38 ± 15.16 | 357.38 ± 15.95 | 386.47 ± 15.69 | 0.012 |
| Nuts (g/d) | 12.42 ± 0.98 | 11.75 ± 1.03 | 12.23 ± 1.02 | 0.890 |
| Whole grains (g/d) | 8.56 ± 0.98 | 9.53 ± 1.04 | 12.58 ± 1.02 | 0.015 |
| Refined grains (g/d) | 305.35 ± 8.15 | 310.66 ± 8.57 | 297.90 ± 8.43 | 0.566 |
| Dairy (g/d) | 472.31 ± 16.87 | 492.92 ± 17.75 | 445.32 ± 17.46 | 0.160 |
| Red meat (g/d) | 44.71 ± 2.66 | 39.33 ± 2.80 | 42.29 ± 2.76 | 0.382 |
| Processed meat (g/d) | 8.26 ± 0.69 | 6.69 ± 0.73 | 7.75 ± 0.71 | 0.041 |
| a: Values are mean ± SE. All values are adjusted for energy intake, except for total energy; b: One-way ANCOVA test. | ||||
| Table 3. Multiple-adjusted odds ratio (OR) and 95% confidence intervals (CI) across the tertiles of legumes intake | ||||
| P-trend | legumes tertiles | Variables | ||
| T3 ≥48 (n = 151) |
T2 21< to 48 (n = 145) |
T1 ≤21 (n = 162) |
||
| Depression | ||||
| 0.822 | 0.94(0.59, 1.50) | 0.65 (0.40, 1.05) | 1.00 | Crude |
| 0.524 | 0.85 (0.53, 1.37) | 0.57(0.35, 0.94) | 1.00 | Model Ia |
| 0.592 | 0.87 (0.54, 1.42) | 0.56(0.33, 0.92) | 1.00 | Model IIb |
| 0.728 | 0.91 (0.53, 1.54) | 0.52 (0.30, 0.90) | 1.00 | Model IIIc |
| Anxiety | ||||
| 0.521 | 0.86 (0.55, 1.35) | 0.77 (0.49, 1.22) | 1.00 | Crude |
| 0.348 | 0.80 (0.50, 1.27) | 0.72 (0.45, 1.15) | 1.00 | Model Ⅰ |
| 0.350 | 0.79 (0.49, 1.28) | 0.68 (0.42, 1.10) | 1.00 | Model Ⅱ |
| 0.171 | 0.69 (0.41, 1.16) | 0.60 (0.35, 1.00) | 1.00 | Model Ⅲ |
| Psychological distress | ||||
| 0.713 | 0.92 (0.58, 1.43) | 0.78 (0.49, 1.24) | 1.00 | Crude |
| 0.493 | 0.85 (0.54, 1.34) | 0.73 (0.46, 1.16) | 1.00 | Model Ⅰ |
| 0.727 | 0.92 (0.57, 1.47) | 0.71 (0.44, 1.16) | 1.00 | Model Ⅱ |
| 0.893 | 0.95 (0.57, 1.61) | 0.69 (0.41, 1.16) | 1.00 | Model Ⅲ |
| a: Adjusted for age and energy intake; b: Additionally, adjusted for socio economic status, physical activity, marriage status, supplement use, drug use, family history of chronic disease, body mass index; c: Further controlled for intake of fruit, vegetable, nuts, processed meat, red meat, whole grains, refined grains and dairy. | ||||
Discussion
This study was conducted to investigate the relationship of legumes intake with depression, anxiety, and stress in adult women. According to the findings, no significant relationship was found between legumes intake, depression, anxiety, and stress in women. However, women who consumed moderate legumes had significant decreased risk of depression.
The prevalence of common psychological disorders has been increasing in the world (Murphy et al., 2004); therefore, identifying the modifiable risk factors of mental disorders, including dietary factors, is of great importance. Legumes are low in fat and rich in protein, fiber, minerals, and vitamins. Higher consumption of legumes may reduce blood cholesterol concentration and decrease the risk of coronary heart disease (Bazzano et al., 2001).
Legumes intake had no significant association with depression, anxiety, and stress. Although no study has ever examined the association of legumes intake with depression, anxiety, and stress, several published studies reported the association of legumes components like fiber (Miki et al., 2016), magnesium (Sun et al., 2019), phytochemicals (Sureda and Tejada, 2015), and protein (Mitani et al., 2006) with depression and anxiety. Boyle et al. (Boyle et al., 2016) showed that magnesium supplementation had beneficial effects on anxiety symptoms among anxious individuals. In this regard, a meta-analysis reported that moderate magnesium intake may be inversely associated with the risk of depression (Barra et al., 2007). In addition, epidemiological studies suggested that dietary polyphenols, such as flavonoids, phenolic acids, and lignans may reduce the risk of depression (Sureda and Tejada, 2015). Some studies showed that dietary protein intake was associated with mental status. Important neurotransmitters such as dopamine and serotonin are made from amino acids tyrosine and tryptophan, respectively (Bell et al., 2001, Lehnert et al., 1984).
Several possible mechanisms may explain the inverse association between legumes intake and mental health. Legumes contain vitamin B9, iron, zinc, and calcium (Messina, 1999) . Some nutrients such as zinc, magnesium, folate, and vitamin B12 are essential for proper functioning of neurotransmitters and improvement of psychological health (Bjelland et al., 2003, Młyniec et al., 2014). Magnesium deficiency can lead to abnormal penetration of calcium into the intracellular fluid that liberates glutamate in cells. Consequently, the presence of glutamate results in neuronal dysfunction and anxiety (Młyniec et al., 2014). A deficiency in either folate or vitamin B12, which have a role in neurotransmitter synthesis, can increase homocysteine levels and elevate the risk of depression (Kim et al., 2008). Zinc deficiency increase somatic symptoms and psychiatric symptoms are associated with depression disorders (Nowak, 2015). Our findings can be explained by the undetectable effects of legumes, interaction between components of legumes, lower amounts of these components in legumes compared to the dosages used in clinical trials, different cooking methods, and the effect of processing on these components. In addition, reverse causality in cross-sectional studies should be considered.
To the best of our knowledge, this is the first study investigating the association of legumes consumption with psychological disorders. Adjustment of the known confounders such as age, energy intake, physical activity, socioeconomic status, medication and supplement use, family history of chronic diseases, BMI, and dietary factors is one of the strengths of this study.
Due to the cross-sectional nature of this study, it was not possible to fully explain association of the exposure and outcome with the mechanism of this correlation; a prospective study will help to accurately study this mechanism. In this study, we also tried to control all the known confounders. However, it was not possible to exclude all confounders. The medical condition in exclusion criteria were self-reported and could have introduced some level of bias. Moreover, lack of recognizing the causes of depression, anxiety, and stress was one of the limitation of this study.
Conclusion
As a result of this study, no significant relationship was found between legumes intake, depression, anxiety, and stress in women. However, women who consumed legumes moderately had significant decreased risk of depression. Further prospective studies can help explain the physiological and psychological relationships in this field.
Acknowledgements
This study was extracted from a dissertation approved by Tehran University of Medical Sciences (no. 9511468003).
Financial support
This study was extracted from a dissertation approved by Tehran University of Medical Sciences (no. 9511468003).
Conflict of interest
The authors declared no conflict of interest.
Authors’ contributions
Darooghegi Mofrad M, Siassi F, Guilani B, Azadbakht L. contributed to conception, design, data collection, statistical analyses, data interpretation, manuscript drafting, and approval of the final version of the manuscript and agreed for all aspects of the work.
References
Ainsworth BE, et al. 2000. Compendium of physical activities: an update of activitycodes and MET intensities. Medicine and science in sports and exercise. 32 (9; SUPP/1): S498-S504.
Barra A, et al. 2007. Plasma magnesium level and psychomotor retardation in major depressed patients. Magnesium research. 20 (4): 245-249.
Bazzano LA, et al. 2001. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Archives of internal medicine. 161 (21): 2573-2578.
Bell C, Abrams J & Nutt D 2001. Tryptophan depletion and its implications for psychiatry. British journal of psychiatry. 178 (5): 399-405.
Bjelland I, Tell GS, Vollset SE, Refsum H & Ueland PM 2003. Folate, vitamin B12, homocysteine, and the MTHFR 677C→ T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Archives of general psychiatry. 60 (6): 618-626.
Boyle NB, Lawton CL & Dye L 2016. Theeffects of magnesium supplementation on subjective anxiety. Magnesium research. 29 (3):120-125.
Davis M, et al. 2003. Confronting depression and suicide in physicians: a consensus statement. Journal of the American medical association. 289 (23): 3161-3166.
Esfahani FH, Asghari G, Mirmiran P & Azizi F 2010. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. Journal of epidemiology. 20 (2): 150-158.
Esmaillzadeh A & Azadbakht L 2012. Legume consumption is inversely associated with serum concentrations of adhesion molecules and inflammatory biomarkers among Iranian women. Journal of nutrition. 142 (2): 334-339.
Flight I & Clifton P 2006. Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. European journal of clinical nutrition. 60 (10): 1145.
Ghaemi-Hashemi S, Clarke J & Margen S 1998. Benefits of the Middle Eastern food model on women’s hormonal balance. Journal of the American dietetic association. 98 (9): A25.
Haghighatdoost F, et al. 2015. Glycemic index, glycemic load, and common psychological disorders. American journal of clinical nutrition. 103 (1): 201-209.
Kim J-M, et al. 2008. Predictive value of folate, vitamin B 12 and homocysteine levels in late-life depression. British journal of psychiatry. 192 (4): 268-274.
Kolonel LN, et al. 2000. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer epidemiology and prevention biomarkers. 9 (8): 795-804.
Lehnert H, Reinstein DK, Strowbridge BW & Wurtman RJ 1984. Neurochemical and behavioral consequences of acute, uncontrollable stress: effects of dietary tyrosine. Brain research. 303 (2): 215-223.
Lovibond PF & Lovibond SH 1995. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 33 (3): 335-343.
Messina MJ 1999. Legumes and soybeans: overview of their nutritional profiles and health effects. American journal of clinical nutrition. 70 (3): 439s-450s.
Miki T, et al. 2016. Dietary fiber intake and depressive symptoms in Japanese employees: The Furukawa Nutrition and Health Study. Nutrition (Burbank, Los Angeles County, Calif.). 32 (5): 584-589.
Mitani H, et al. 2006. Correlation between plasma levels of glutamate, alanine and serine with severity of depression. Progress in neuro-psychopharmacology and biological psychiatry. 30 (6): 1155-1158.
Młyniec K, et al. 2014. Essential elements in depression and anxiety. Part I. Pharmacological reports. 66 (4): 534-544.
Murphy JM, et al. 2004. Anxiety and depression: a 40‐year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta psychiatrica Scandinavica. 109 (5): 355-375.
Nouri F, Sarrafzadegan N, Mohammadifard N, Sadeghi M & Mansourian M 2016. Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population. Europian journal of clinical nutrition. 70 (2): 217-221.
Nowak G 2015. Zinc, future mono/adjunctive therapy for depression: mechanisms of antidepressant action. Pharmacological reports. 67 (3): 659-662.
Olesen J, et al. 2012. The economic cost of brain disorders in Europe. European journal of neurology. 19 (1): 155-162.
Penckofer S, Kouba J, Byrn M & Estwing Ferrans C 2010. Vitamin D and depression: where is all the sunshine? Issues in mental health nursing. 31 (6): 385-393.
Sadeghirad B, et al. 2010. Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. International journal of preventive medicine. 1 (2): 81.
Salehi-Abargouei A, Saraf-Bank S, Bellissimo N & Azadbakht L 2015. Effects of non-soy legume consumption on C-reactive protein: a systematic review and meta-analysis. Nutrition (Burbank, Los Angeles County, Calif.). 31 (5): 631-639.
Samani S & Joukar B 2007. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). Journal of social sciences and humanities of Shiraz University 26 (3): 65=70.
Sun C, Wang R, Li Z & Zhang D 2019. Dietary magnesium intake and risk of depression. Journal of affective disorders. 246: 627-632.
Sureda A & Tejada S 2015. Polyphenols and depression: from chemistry to medicine. Current pharmaceutical biotechnology. 16 (3): 259-264.
Trinidad TP, Mallillin AC, Loyola AS, Sagum RS & Encabo RR 2010. The potential health benefits of legumes as a good source of dietary fibre. British journal of nutrition. 103 (4): 569-574.
Villegas R, et al. 2008. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. American journal of clinical nutrition. 87 (1): 162-167.
This study was conducted to investigate the relationship of legumes intake with depression, anxiety, and stress in adult women. According to the findings, no significant relationship was found between legumes intake, depression, anxiety, and stress in women. However, women who consumed moderate legumes had significant decreased risk of depression.
The prevalence of common psychological disorders has been increasing in the world (Murphy et al., 2004); therefore, identifying the modifiable risk factors of mental disorders, including dietary factors, is of great importance. Legumes are low in fat and rich in protein, fiber, minerals, and vitamins. Higher consumption of legumes may reduce blood cholesterol concentration and decrease the risk of coronary heart disease (Bazzano et al., 2001).
Legumes intake had no significant association with depression, anxiety, and stress. Although no study has ever examined the association of legumes intake with depression, anxiety, and stress, several published studies reported the association of legumes components like fiber (Miki et al., 2016), magnesium (Sun et al., 2019), phytochemicals (Sureda and Tejada, 2015), and protein (Mitani et al., 2006) with depression and anxiety. Boyle et al. (Boyle et al., 2016) showed that magnesium supplementation had beneficial effects on anxiety symptoms among anxious individuals. In this regard, a meta-analysis reported that moderate magnesium intake may be inversely associated with the risk of depression (Barra et al., 2007). In addition, epidemiological studies suggested that dietary polyphenols, such as flavonoids, phenolic acids, and lignans may reduce the risk of depression (Sureda and Tejada, 2015). Some studies showed that dietary protein intake was associated with mental status. Important neurotransmitters such as dopamine and serotonin are made from amino acids tyrosine and tryptophan, respectively (Bell et al., 2001, Lehnert et al., 1984).
Several possible mechanisms may explain the inverse association between legumes intake and mental health. Legumes contain vitamin B9, iron, zinc, and calcium (Messina, 1999) . Some nutrients such as zinc, magnesium, folate, and vitamin B12 are essential for proper functioning of neurotransmitters and improvement of psychological health (Bjelland et al., 2003, Młyniec et al., 2014). Magnesium deficiency can lead to abnormal penetration of calcium into the intracellular fluid that liberates glutamate in cells. Consequently, the presence of glutamate results in neuronal dysfunction and anxiety (Młyniec et al., 2014). A deficiency in either folate or vitamin B12, which have a role in neurotransmitter synthesis, can increase homocysteine levels and elevate the risk of depression (Kim et al., 2008). Zinc deficiency increase somatic symptoms and psychiatric symptoms are associated with depression disorders (Nowak, 2015). Our findings can be explained by the undetectable effects of legumes, interaction between components of legumes, lower amounts of these components in legumes compared to the dosages used in clinical trials, different cooking methods, and the effect of processing on these components. In addition, reverse causality in cross-sectional studies should be considered.
To the best of our knowledge, this is the first study investigating the association of legumes consumption with psychological disorders. Adjustment of the known confounders such as age, energy intake, physical activity, socioeconomic status, medication and supplement use, family history of chronic diseases, BMI, and dietary factors is one of the strengths of this study.
Due to the cross-sectional nature of this study, it was not possible to fully explain association of the exposure and outcome with the mechanism of this correlation; a prospective study will help to accurately study this mechanism. In this study, we also tried to control all the known confounders. However, it was not possible to exclude all confounders. The medical condition in exclusion criteria were self-reported and could have introduced some level of bias. Moreover, lack of recognizing the causes of depression, anxiety, and stress was one of the limitation of this study.
Conclusion
As a result of this study, no significant relationship was found between legumes intake, depression, anxiety, and stress in women. However, women who consumed legumes moderately had significant decreased risk of depression. Further prospective studies can help explain the physiological and psychological relationships in this field.
Acknowledgements
This study was extracted from a dissertation approved by Tehran University of Medical Sciences (no. 9511468003).
Financial support
This study was extracted from a dissertation approved by Tehran University of Medical Sciences (no. 9511468003).
Conflict of interest
The authors declared no conflict of interest.
Authors’ contributions
Darooghegi Mofrad M, Siassi F, Guilani B, Azadbakht L. contributed to conception, design, data collection, statistical analyses, data interpretation, manuscript drafting, and approval of the final version of the manuscript and agreed for all aspects of the work.
References
Ainsworth BE, et al. 2000. Compendium of physical activities: an update of activitycodes and MET intensities. Medicine and science in sports and exercise. 32 (9; SUPP/1): S498-S504.
Barra A, et al. 2007. Plasma magnesium level and psychomotor retardation in major depressed patients. Magnesium research. 20 (4): 245-249.
Bazzano LA, et al. 2001. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Archives of internal medicine. 161 (21): 2573-2578.
Bell C, Abrams J & Nutt D 2001. Tryptophan depletion and its implications for psychiatry. British journal of psychiatry. 178 (5): 399-405.
Bjelland I, Tell GS, Vollset SE, Refsum H & Ueland PM 2003. Folate, vitamin B12, homocysteine, and the MTHFR 677C→ T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Archives of general psychiatry. 60 (6): 618-626.
Boyle NB, Lawton CL & Dye L 2016. Theeffects of magnesium supplementation on subjective anxiety. Magnesium research. 29 (3):120-125.
Davis M, et al. 2003. Confronting depression and suicide in physicians: a consensus statement. Journal of the American medical association. 289 (23): 3161-3166.
Esfahani FH, Asghari G, Mirmiran P & Azizi F 2010. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. Journal of epidemiology. 20 (2): 150-158.
Esmaillzadeh A & Azadbakht L 2012. Legume consumption is inversely associated with serum concentrations of adhesion molecules and inflammatory biomarkers among Iranian women. Journal of nutrition. 142 (2): 334-339.
Flight I & Clifton P 2006. Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. European journal of clinical nutrition. 60 (10): 1145.
Ghaemi-Hashemi S, Clarke J & Margen S 1998. Benefits of the Middle Eastern food model on women’s hormonal balance. Journal of the American dietetic association. 98 (9): A25.
Haghighatdoost F, et al. 2015. Glycemic index, glycemic load, and common psychological disorders. American journal of clinical nutrition. 103 (1): 201-209.
Kim J-M, et al. 2008. Predictive value of folate, vitamin B 12 and homocysteine levels in late-life depression. British journal of psychiatry. 192 (4): 268-274.
Kolonel LN, et al. 2000. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer epidemiology and prevention biomarkers. 9 (8): 795-804.
Lehnert H, Reinstein DK, Strowbridge BW & Wurtman RJ 1984. Neurochemical and behavioral consequences of acute, uncontrollable stress: effects of dietary tyrosine. Brain research. 303 (2): 215-223.
Lovibond PF & Lovibond SH 1995. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 33 (3): 335-343.
Messina MJ 1999. Legumes and soybeans: overview of their nutritional profiles and health effects. American journal of clinical nutrition. 70 (3): 439s-450s.
Miki T, et al. 2016. Dietary fiber intake and depressive symptoms in Japanese employees: The Furukawa Nutrition and Health Study. Nutrition (Burbank, Los Angeles County, Calif.). 32 (5): 584-589.
Mitani H, et al. 2006. Correlation between plasma levels of glutamate, alanine and serine with severity of depression. Progress in neuro-psychopharmacology and biological psychiatry. 30 (6): 1155-1158.
Młyniec K, et al. 2014. Essential elements in depression and anxiety. Part I. Pharmacological reports. 66 (4): 534-544.
Murphy JM, et al. 2004. Anxiety and depression: a 40‐year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta psychiatrica Scandinavica. 109 (5): 355-375.
Nouri F, Sarrafzadegan N, Mohammadifard N, Sadeghi M & Mansourian M 2016. Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population. Europian journal of clinical nutrition. 70 (2): 217-221.
Nowak G 2015. Zinc, future mono/adjunctive therapy for depression: mechanisms of antidepressant action. Pharmacological reports. 67 (3): 659-662.
Olesen J, et al. 2012. The economic cost of brain disorders in Europe. European journal of neurology. 19 (1): 155-162.
Penckofer S, Kouba J, Byrn M & Estwing Ferrans C 2010. Vitamin D and depression: where is all the sunshine? Issues in mental health nursing. 31 (6): 385-393.
Sadeghirad B, et al. 2010. Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. International journal of preventive medicine. 1 (2): 81.
Salehi-Abargouei A, Saraf-Bank S, Bellissimo N & Azadbakht L 2015. Effects of non-soy legume consumption on C-reactive protein: a systematic review and meta-analysis. Nutrition (Burbank, Los Angeles County, Calif.). 31 (5): 631-639.
Samani S & Joukar B 2007. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). Journal of social sciences and humanities of Shiraz University 26 (3): 65=70.
Sun C, Wang R, Li Z & Zhang D 2019. Dietary magnesium intake and risk of depression. Journal of affective disorders. 246: 627-632.
Sureda A & Tejada S 2015. Polyphenols and depression: from chemistry to medicine. Current pharmaceutical biotechnology. 16 (3): 259-264.
Trinidad TP, Mallillin AC, Loyola AS, Sagum RS & Encabo RR 2010. The potential health benefits of legumes as a good source of dietary fibre. British journal of nutrition. 103 (4): 569-574.
Villegas R, et al. 2008. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. American journal of clinical nutrition. 87 (1): 162-167.
Type of article: orginal article |
Subject:
public specific
Received: 2019/05/2 | Published: 2017/11/15 | ePublished: 2017/11/15
Received: 2019/05/2 | Published: 2017/11/15 | ePublished: 2017/11/15
References
1. Ainsworth BE, et al. 2000. Compendium of physical activities: an update of activity codes and MET intensities. Medicine and science in sports and exercise. 32 (9; SUPP/1): S498-S504.
2. Barra A, et al. 2007. Plasma magnesium level and psychomotor retardation in major depressed patients. Magnesium research. 20 (4): 245-249.
3. Bazzano LA, et al. 2001. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Archives of internal medicine. 161 (21): 2573-2578.
4. Bell C, Abrams J & Nutt D 2001. Tryptophan depletion and its implications for psychiatry. British journal of psychiatry. 178 (5): 399-405.
5. Bjelland I, Tell GS, Vollset SE, Refsum H & Ueland PM 2003. Folate, vitamin B12, homocysteine, and the MTHFR 677C→ T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Archives of general psychiatry. 60 (6): 618-626.
6. Boyle NB, Lawton CL & Dye L 2016. The effects of magnesium supplementation on subjective anxiety. Magnesium research. 29 (3): 120-125.
7. Davis M, et al. 2003. Confronting depression and suicide in physicians: a consensus statement. Journal of the American medical association. 289 (23): 3161-3166.
8. Esfahani FH, Asghari G, Mirmiran P & Azizi F 2010. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. Journal of epidemiology. 20 (2): 150-158.
9. Esmaillzadeh A & Azadbakht L 2012. Legume consumption is inversely associated with serum concentrations of adhesion molecules and inflammatory biomarkers among Iranian women. Journal of nutrition. 142 (2): 334-339.
10. Flight I & Clifton P 2006. Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. European journal of clinical nutrition. 60 (10): 1145.
11. Ghaemi-Hashemi S, Clarke J & Margen S 1998. Benefits of the Middle Eastern food model on women’s hormonal balance. Journal of the American dietetic association. 98 (9): A25.
12. Haghighatdoost F, et al. 2015. Glycemic index, glycemic load, and common psychological disorders. American journal of clinical nutrition. 103 (1): 201-209.
13. Kim J-M, et al. 2008. Predictive value of folate, vitamin B 12 and homocysteine levels in late-life depression. British journal of psychiatry. 192 (4): 268-274.
14. Kolonel LN, et al. 2000. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer epidemiology and prevention biomarkers. 9 (8): 795-804.
15. Lehnert H, Reinstein DK, Strowbridge BW & Wurtman RJ 1984. Neurochemical and behavioral consequences of acute, uncontrollable stress: effects of dietary tyrosine. Brain research. 303 (2): 215-223.
16. Lovibond PF & Lovibond SH 1995. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 33 (3): 335-343.
17. Messina MJ 1999. Legumes and soybeans: overview of their nutritional profiles and health effects. American journal of clinical nutrition. 70 (3): 439s-450s.
18. Miki T, et al. 2016. Dietary fiber intake and depressive symptoms in Japanese employees: The Furukawa Nutrition and Health Study. Nutrition (Burbank, Los Angeles County, Calif.). 32 (5): 584-589.
19. Mitani H, et al. 2006. Correlation between plasma levels of glutamate, alanine and serine with severity of depression. Progress in neuro-psychopharmacology and biological psychiatry. 30 (6): 1155-1158.
20. Młyniec K, et al. 2014. Essential elements in depression and anxiety. Part I. Pharmacological reports. 66 (4): 534-544.
21. Murphy JM, et al. 2004. Anxiety and depression: a 40‐year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta psychiatrica Scandinavica. 109 (5): 355-375.
22. Nouri F, Sarrafzadegan N, Mohammadifard N, Sadeghi M & Mansourian M 2016. Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population. Europian journal of clinical nutrition. 70 (2): 217-221.
23. Nowak G 2015. Zinc, future mono/adjunctive therapy for depression: mechanisms of antidepressant action. Pharmacological reports. 67 (3): 659-662.
24. Olesen J, et al. 2012. The economic cost of brain disorders in Europe. European journal of neurology. 19 (1): 155-162.
25. Penckofer S, Kouba J, Byrn M & Estwing Ferrans C 2010. Vitamin D and depression: where is all the sunshine? Issues in mental health nursing. 31 (6): 385-393.
26. Sadeghirad B, et al. 2010. Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. International journal of preventive medicine. 1 (2): 81.
27. Salehi-Abargouei A, Saraf-Bank S, Bellissimo N & Azadbakht L 2015. Effects of non-soy legume consumption on C-reactive protein: a systematic review and meta-analysis. Nutrition (Burbank, Los Angeles County, Calif.). 31 (5): 631-639.
28. Samani S & Joukar B 2007. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). Journal of social sciences and humanities of Shiraz University 26 (3): 65=70.
29. Sun C, Wang R, Li Z & Zhang D 2019. Dietary magnesium intake and risk of depression. Journal of affective disorders. 246: 627-632.
30. Sureda A & Tejada S 2015. Polyphenols and depression: from chemistry to medicine. Current pharmaceutical biotechnology. 16 (3): 259-264.
31. Trinidad TP, Mallillin AC, Loyola AS, Sagum RS & Encabo RR 2010. The potential health benefits of legumes as a good source of dietary fibre. British journal of nutrition. 103 (4): 569-574.
32. Villegas R, et al. 2008. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. American journal of clinical nutrition. 87 (1): 162-167.
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