ABSTRACT
Background and Aims
The current study aimed to assess the associations between (i) total and specific sugar intake, (ii) dietary exposures that met Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) selection criteria for risk factors, and depression and anxiety.
Methods
In this online cross‐sectional study that took place between 2022 and 2024 in the United Kingdom, 377 participants between the ages of 18–66 years (M = 26.09; SD = 8.48) completed the: EPIC‐Norfolk Food Frequency Questionnaire from which overall sugar intake, specific sugar intake (fructose, galactose, glucose, lactose, maltose, and sucrose) and GBD dietary exposures were derived; and the Depression, Anxiety and Stress Scales from which likely depression and anxiety cases were identified.
Results
The prevalence of depression and anxiety was 12.5% and 16.4%, respectively. Separate logistic regression models assessing the associations between dietary intake and depression) and anxiety revealed that total sugar intake was associated with greater odds of depression (OR: 1.01, 95% CI 1.00–1.02) and anxiety (OR: 1.01, 95%CI 1.01–1.02). Specifically, higher sucrose intake was associated with greater odds of anxiety (OR: 1.02, 95%CI 1.00–1.05), while higher intake of sugar‐sweetened beverages was associated with increased odds of both depression (OR: 1.00, 95%CI 1.00–1.01) and anxiety (OR: 1.00, 95%CI 1.00–1.01).
Conclusion
While higher overall sugar intake was associated with both depression and anxiety, sucrose intake emerged as a specific factor associated with increased odds of anxiety, and higher sugar‐sweetened beverages intake with depression and anxiety, warranting further investigation into their potential role in mental health outcomes.
Keywords: anxiety, common mental disorders, depression, diet, dietary sugar, nutrition
1. Introduction
Common mental disorders, such as depressive‐ and anxiety‐related disorders, are highly comorbid [1] and globally prevalent, affecting more than 300 million and 250 million people, respectively [2]. The associated social, economic, and health burden of depression and anxiety costs the world economy trillions of dollars each year [3]. Thus, preventive and treatment strategies are needed to tackle this major public health problem and ultimately improve the lives of those affected. However, pharmacological treatments for depression and anxiety have overestimated efficacy [4]. Given these challenges, exploring alternative targets for depression and anxiety prevention and treatment has become increasingly imperative.
Diet is a leading risk factor for non‐communicable diseases, as acknowledged by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) [5], and may be protective against depression and anxiety outcomes [6, 7]. This may occur via modulating numerous physiological channels, including regulation of systemic inflammation, and promotion of short‐chain fatty acids and neurotransmitters (gamma‐aminobutyric acid (GABA), serotonin, dopamine) [8, 9]. Therefore, dietary interventions could provide an effective strategy to improve and prevent depressive and anxiety‐related outcomes [10, 11].
Furthermore, adhering to healthful dietary patterns may potentially reduce the risks of developing depression and anxiety. For example, diets characterised by high intakes of vegetables, fruits, nuts, legumes, and unprocessed cereals, and low intakes of meat and dairy products are associated with lower odds/risk of depression and anxiety [12]. Further, diets higher in saturated fats, sodium, and sugar have been linked to higher odds for depression and anxiety [13]. Recent meta‐analyses have further confirmed the link between depression and anxiety and Western‐type foods [14], ultra‐processed foods [15], and sugar‐sweetened beverages [16]. One potential nutrient/food group these dietary patterns have in common is high sugar intake.
Globally, sugar and sugar‐sweetened beverage intake is increasing [17]. There is now compelling evidence to suggest a causal relationship between sugar‐sweetened beverage intake and many health outcomes, including high body mass index, ischemic heart disease and type 2 diabetes [17]. Currently, the role of sugar‐sweetened beverage intake in depression and anxiety has not been well studied. Still, a meta‐analysis of observational studies found that drinking the equivalent of two cups of cola per day increased the risk of depression by up to 5% [16]. However, in a recent umbrella review of many meta‐analyses [18], the meta‐analysis by Hu et al. [16] was classified as low quality as per the Grading of Recommendations, Assessment, Development and Evaluation criteria due to significant risk of bias. Furthermore, accordingly, total dietary sugar intake, but not specific sugar‐sweetened beverages, has been cross‐sectionally linked to higher odds of depression [19]. Supporting this, a recent study by Graybeal et al. [20] identified added and relative sugar as the only dietary factors associated with depression, with associations also linked to mental health medication use and mediated by emotional eating and craving control. Together, these findings highlight the need for further rigorous studies to explore dietary intake, particularly sugar intake, in relation to depression and anxiety.
It is important to note that the relationship between sugar intake (and excess intake of other nutrients, such as processed meats) and mental health symptoms may be bidirectional, such that individuals experiencing depressive or anxious symptoms may be more likely to engage in deregulatory/coping behaviours such as higher emotional eating and lower craving [20, 21], leading to higher consumption of sugar and other unhealthy food items [22]. Furthermore, factors such as overall health status and body mass index (BMI) likely modulate this relationship, influencing both dietary habits and mental health outcomes [23].
Although the aforementioned evidence clearly highlights the contributions of dietary exposures to depression and anxiety, particularly sugar and sugar‐sweetened beverage intake, the GBD does not currently generate risk‐outcome estimates for diet and depression and anxiety. To address this gap, we aimed to assess the associations of (i) total and specific sugar intake, (ii) sugar‐sweetened beverage intake, as defined by the GBD criteria for risk factors, and (iii) other dietary exposures that meet GBD selection criteria for risk factors with depression and anxiety.
2. Methods
2.1. Study Design
This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the Ethical Committee at the University of Roehampton (Reference: PSYC/22420). A convenience sample of 532 participants (mainly university students from the University of Roehampton, United Kingdom) were recruited through University web portals, social media, and word of mouth between 2022 and 2024. All participants provided a written informed consent to participate in the research. They completed a web‐based survey on Qualtrics (Qualtrics, Provo, UT). The exclusion criteria were: any history of, or taking medication for, psychiatric disorders or diseases (ADHD, depression, anxiety, or mood disorders), sleep disorders, or neurological disorders or diseases (stroke, head injury, epilepsy, seizures, brain tumours, brain surgery, Parkinson's Disease). After data cleaning (see Supporting Information S2: Note 1), a final sample of 377 participants (306 females, 65 males, 6 preferred not to say) between the ages of 18–66 years (M = 26.09; SD = 8.48) were included in the analysis. This study was reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and checklist for observational studies [24] (see Supporting Information S1: STROBE Checklist).
2.2. Exposure Variables
In order to define dietary intake according to the GBD study, we followed the Global burden of disease Lifestyle And mental Disorder (GLAD) Project guidelines [25]. Specifically, we used various dietary exposure variables (intakes in grams per day [g/d] of: fruit; vegetables; legumes; whole grains; nuts and seeds; milk; red meat; processed meat; sugar‐sweetened beverages; fibre; calcium; sodium; as well as percentage of total daily energy intake of polyunsaturated fatty acid [PUFA] and trans‐fat). Additionally, we included intakes (g/d) of total dietary sugar, as well as specific sugars: fructose, galactose, glucose, lactose, maltose, and sucrose. Dietary data were collected using the European Prospective Investigation into Cancer (EPIC) Norfolk Food Frequency Questionnaire (FFQ) [26] and analysed using the FETA Software [27], reflecting habitual intake of the nutrients of interest. Trans‐fat intake was estimated by linking FFQ data with a nutrient database specific to the EPIC Norfolk study [26] (see Supporting Information S2 Note 2).
2.3. Outcome Variables
The scores on the depression and anxiety subscales of the Depression, Anxiety, and Stress Scales (DASS) [28] were used to identify individuals likely with and without depression and anxiety, respectively. The DASS consists of 42 questions, such as “I felt terrified”, requiring participants to note how frequently they identified with this statement over the past week. The DASS is scored on a 4‐point Likert scale, from 0 (“did not apply to me at all”) to 3 (“applied to me very much, or most of the time”). Depression and anxiety were dichotomised using validated cut‐offs for the relevant subscales: Participants with a score of ≥ 21 on the depression scale were identified as likely having depression [28], and participants with a score of ≥ 15 on the anxiety scale were identified as likely having anxiety [28].
2.4. Statistical Analysis
All analyses were conducted using IBM SPSS 29.0.1.0. Depression and anxiety present and absent groups were compared on demographic and dietary measures by using Mann–Whitney‐U (Benjamini‐Hochberg‐corrected), chi‐square (Bonferroni‐corrected) or independent sample t‐tests (Benjamini–Hochberg‐corrected). We fitted logistic regression models following the GLAD project protocol [25] to assess the association of (i) sugar‐sweetened beverage intake (primary analysis), (ii) total and specific sugar intake, and (iii) dietary intake, as defined above, and odds of depression and anxiety. All dietary variables were modelled as continuous variables, with the outcomes modelled as binary (depression‐ and anxiety‐ present or absent). Odds ratios and their corresponding 95% confidence intervals were estimated. We used three levels of adjustment ‐ Model 1: unadjusted; Model 2: adjusted for age, sex, income; and Model 3: as in model 2, with BMI (kg/m2). Sensitivity analyses were performed using (i) energy‐adjusted versions of all dietary variables [29] and (ii) the whole sample, before exclusion in order to maximise power and improve generalisability. All significance tests were two‐tailed using p < 0.05 as the level of significance and corrected by using the Benjamini–Hochberg method.
3. Results
3.1. Sample Characteristics
Participant characteristics are reported in Table 1. Out of 377 participants, 12.5% (n = 47) and 16.4% (n = 62) had depression and anxiety, respectively. Groups did not differ in age, BMI, or energy intake. Participants who identified their gender as “other/prefer not to answer” were more likely to have both depression and anxiety. Individuals who earned < £18,000 per year were more likely to have depression.
Table 1.
Participant characteristics across depression absent, depression present, anxiety absent, and anxiety present groups.
| Depression | Anxiety | |||||||
|---|---|---|---|---|---|---|---|---|
| Absent (n = 330) | Present (n = 47) | Absent (n = 315) | Present (n = 62) | |||||
| Median (IQR) | Median (IQR) | M–W U | p adj | Median (IQR) | Median (IQR) | M–W U | Pad | |
| Age (years) | 23.0 (20.0–32.0) | 21.0 (20.0–24.0) | 5703.0 | 0.08 | 23.0 (20.0–32.3) | 20.0 (19.0–23.8) | 6309.0 | 0.08 |
| Body mass index (kg/m2) | 23.17 (20.76–26.21) | 23.8 (19.76–25.91) | 6360.5 | 0.26 | 23.17 (20.75–25.97) | 23.04 (19.79–27.50) | 8475.0 | 0.26 |
| Energy (kcal/day) | 1466.46 (1089.96–1882.31) | 1512.40 (1104.63–2141.61) | 8761.0 | 0.17 | 1442.10 (1083.26–1822.09) | 1546.83 (1160.28–2371.23) | 11647.0 | 0.17 |
| N (%) | N (%) | Χ 2 | Padj | N (%) | N (%) | Χ 2 | Padj | |
|---|---|---|---|---|---|---|---|---|
| Gender | 16.82 | < 0.001 | 23.23 | < 0.001 | ||||
| Male | 59a (17.9) | 6a (12.8) | 60a (19.0) | 5b (8.1) | ||||
| Female | 269a (81.5) | 37a (78.7) | 254a (80.6) | 52a (83.9) | ||||
| Other/prefer not to answer | 2a (0.6) | 4b (8.5) | 1a (0.3) | 5b (8.1) | ||||
| Income | 14.12 | 0.02 | 8.53 | 0.13 | ||||
| < £18,000 | 50a (15.2) | 15b (31.9) | 52a (16.5) | 13a (21.0) | ||||
| £18,000– £30,999 | 54a (16.4) | 7a (14.9) | 47a (14.9) | 14a (22.6) | ||||
| £31,000–£51,999 | 68a (20.6) | 8a (17.0) | 68a (21.6) | 8a (12.9) | ||||
| £52,000–£100,000 | 65a (19.7) | 4a (8.5) | 63a (20.0) | 6a (9.7) | ||||
| More than £100,000 | 24a (7.3) | 0a (0.0) | 20a (6.3) | 4a (6.5) | ||||
| Other* | 69a (20.9) | 13a (27.7) | 65a (20.6) | 17a (27.4) |
Note: Bold values indicate statistical significant.
Abbreviations: IQR, Interquartile range; M–W, Mann–Whitney.
*Do not know/prefer not to answer; Each subscript letter (a, b) denotes a subset of Depression and Anxiety categories whose column proportions do not differ significantly from each other at the 0.05 level.
Average dietary intakes are presented in Table 2, separately for participants with and without depression or anxiety. Total sugar, as well intakes of sugar‐sweetened beverages were higher in participants with depression and anxiety. Red meat intake was higher in the depression‐present group. Participants with anxiety had higher sodium, maltose, and sucrose intakes compared to participants without anxiety.
Table 2.
Dietary intakes across depression absent/present and anxiety absent/present groups.
| Depression | Anxiety | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Absent (n = 330) | Present (n = 47) | Absent (n = 315) | Present (n = 62) | |||||||||
| Mean | SD | Mean | SD | t | p adj | Mean | SD | Mean | SD | t | Padj | |
| Fruits (g/day) | 174.82 | 169.70 | 200.18 | 212.31 | −0.93 | 0.14 | 171.64 | 163.34 | 210.20 | 226.15 | −1.59 | 0.11 |
| Vegetables (g/day) | 240.72 | 178.67 | 230.55 | 169.83 | 0.37 | 0.23 | 238.53 | 177.83 | 244.15 | 176.60 | −0.23 | 0.23 |
| Legumes (g/day) | 18.65 | 21.56 | 15.18 | 12.91 | 1.075 | 0.13 | 18.29 | 21.56 | 17.84 | 15.73 | 0.16 | 0.26 |
| Wholegrains (g/day) | 230.00 | 151.65 | 240.79 | 141.92 | −0.46 | 0.20 | 225.77 | 148.88 | 259.66 | 155.68 | −1.63 | 0.13 |
| Nuts & Seeds (g/day) | 8.65 | 13.04 | 7.68 | 10.32 | 0.49 | 0.18 | 8.81 | 13.28 | 7.12 | 9.39 | 0.96 | 0.21 |
| Milk (g/day) | 254.42 | 180.25 | 261.66 | 192.48 | −0.26 | 0.25 | 248.51 | 174.62 | 289.90 | 211.62 | −1.65 | 0.09 |
| Red meat (g/day) | 36.58 | 42.69 | 55.88 | 59.27 | −2.75 | 0.04 | 37.69 | 43.81 | 45.60 | 52.89 | −1.26 | 0.16 |
| Processed meat (g/day) | 76.23 | 16.58 | 83.50 | 25.33 | −2.61 | 0.05 | 76.69 | 16.95 | 79.43 | 22.74 | −1.10 | 0.20 |
| Sugar‐sweetened beverages (g/day) | 39.11 | 59.29 | 81.03 | 113.26 | −3.94 | 0.02 | 39.67 | 60.47 | 68.06 | 101.56 | −2.97 | 0.02 |
| Fibre (g/day) | 14.11 | 7.24 | 14.58 | 7.83 | −0.41 | 0.21 | 13.95 | 7.00 | 15.27 | 8.65 | −1.30 | 0.14 |
| Calcium (g/day) | 0.71 | 0.30 | 0.74 | 0.32 | ‐0.62 | 0.16 | 0.70 | 0.29 | 0.79 | 0.34 | −2.28 | 0.05 |
| Sodium (g/day) | 2.07 | 0.91 | 2.37 | 1.27 | −1.96 | 0.07 | 2.05 | 0.89 | 2.40 | 1.24 | −2.58 | 0.04 |
| PUFA (%a) | 6.43 | 1.98 | 6.03 | 1.48 | 1.34 | 0.09 | 6.43 | 1.99 | 6.12 | 1.54 | 1.16 | 0.18 |
| Trans‐fats (%*) | 0.13 | 0.05 | 0.14 | 0.07 | −1.12 | 0.11 | 0.13 | 0.05 | 0.15 | 0.07 | −1.96 | 0.07 |
| Sugars total (g/day) | 82.54 | 39.66 | 104.76 | 62.99 | −3.30 | 0.04 | 81.11 | 38.73 | 106.63 | 59.44 | −4.29 | 0.04 |
| Fructose (g/day) | 16.11 | 9.60 | 19.48 | 11.40 | −2.20 | 0.14 | 15.87 | 9.23 | 19.84 | 12.30 | −2.91 | 0.11 |
| Galactose (g/day) | 0.44 | 0.72 | 0.29 | 0.44 | 1.34 | 0.18 | 0.43 | 0.71 | 0.37 | 0.55 | 0.67 | 0.18 |
| Glucose (g/day) | 15.59 | 8.69 | 19.61 | 11.33 | −2.85 | 0.11 | 15.44 | 8.47 | 19.40 | 11.52 | −3.16 | 0.07 |
| Lactose (g/day) | 9.95 | 6.91 | 10.99 | 8.02 | −0.95 | 0.21 | 9.73 | 6.63 | 11.85 | 8.72 | −2.18 | 0.14 |
| Maltose (g/day) | 2.19 | 1.65 | 3.22 | 3.30 | −3.44 | 0.07 | 2.17 | 1.66 | 3.07 | 2.96 | −3.37 | 0.04 |
| Sucrose (g/day) | 36.06 | 20.50 | 48.77 | 38.09 | −3.49 | 0.07 | 35.39 | 20.25 | 49.12 | 34.61 | −4.26 | 0.04 |
Note: Bold values indicate statistical significant.
Percentage of total daily energy intake.
3.2. Associations Between Sugar Intake and Depression and Anxiety
Results are presented in Table 3. Higher total sugar intake was associated with greater odds of depression and anxiety in the unadjusted (Model 1) but not in the adjusted models (Model 2 and Model 3). Higher galactose intake was associated with greater odds of depression in the unadjusted model (Model 1), but not in the adjusted models (Model 2 and Model 3). Higher sucrose intake was associated with greater odds of anxiety in the unadjusted model (Model 1), but not in the adjusted models (Model 2 and Model 3).
Table 3.
Logistic regression analyses of the associations of sugar intake with depression and anxiety.
| Depression | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model 1*** | Model 2*** | Model 3*** | |||||||||||
| OR | p |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
|||||
| Sugars total | 1.01 ** | 0.008 | 1.00 | 1.02 | 1.01 | 0.07 | 1.00 | 1.02 | 1.01 * | 0.04 | 1.00 | 1.02 | |
| Model 1*** | Model 2*** | Model 3*** | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
|||||
| Fructose | 0.97 | 0.17 | 0.83 | 1.13 | 0.97 | 0.19 | 0.82 | 1.14 | 0.96 | 0.18 | 0.81 | 1.14 | |
| Galactose | 0.53 | 0.04 | 0.26 | 1.08 | 0.58 | 0.11 | 0.28 | 1.19 | 0.57 | 0.10 | 0.27 | 1.19 | |
| Glucose | 1.05 | 0.13 | 0.87 | 1.27 | 1.07 | 0.17 | 0.88 | 1.31 | 1.07 | 0.16 | 0.87 | 1.32 | |
| Lactose | 1.01 | 0.21 | 0.96 | 1.06 | 1.00 | 0.20 | 0.96 | 1.06 | 1.00 | 0.24 | 0.95 | 1.06 | |
| Maltose | 0.99 | 0.25 | 0.69 | 1.41 | 0.96 | 0.23 | 0.66 | 1.41 | 0.96 | 0.21 | 0.65 | 1.41 | |
| Sucrose | 1.01 | 0.08 | 0.99 | 1.04 | 1.01 | 0.16 | 0.98 | 1.04 | 1.01 | 0.15 | 0.98 | 1.04 | |
| Anxiety | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model 1*** | Model 2*** | Model 3*** | |||||||||||
| OR | p |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
|||||
| Sugars total | 1.01 | < 0.001 | 1.01 | 1.02 | 1.01 | 0.022 | 1.00 | 1.02 | 1.01 | 0.020 | 1.01 | 1.02 | |
| Model 1*** | Model 2*** | Model 3*** | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
|||||
| Fructose | 1.10 | 0.08 | 0.97 | 1.26 | 1.11 | 0.09 | 0.96 | 1.30 | 1.13 | 0.10 | 0.97 | 1.31 | |
| Galactose | 0.76 | 0.17 | 0.44 | 1.30 | 0.76 | 0.19 | 0.41 | 1.41 | 0.77 | 0.19 | 0.42 | 1.43 | |
| Glucose | 0.89 | 0.13 | 0.75 | 1.05 | 0.88 | 0.11 | 0.73 | 1.07 | 0.87 | 0.12 | 0.72 | 1.06 | |
| Lactose | 1.01 | 0.25 | 0.97 | 1.06 | 1.02 | 0.20 | 0.97 | 1.08 | 1.02 | 0.21 | 0.97 | 1.08 | |
| Maltose | 1.11 | 0.21 | 0.80 | 1.54 | 1.04 | 0.23 | 0.72 | 1.51 | 1.04 | 0.24 | 0.72 | 1.50 | |
| Sucrose | 1.02 | 0.04 | 1.00 | 1.05 | 1.03 | 0.06 | 1.00 | 1.05 | 1.03 | 0.06 | 1.00 | 1.05 | |
Note: Model 1: unadjusted; Model 2: adjusted for age, sex, income; and Model 3: as in Model 2, with body mass index (BMI; kg/m2). Bold values indicate statistical significant.
p ≤ 0.05
p ≤ 0.01; p ≤ 0.001.
Results from sensitivity analyses are mostly consistent with results reported here, apart from the lack of galactose and depression association (see Supporting Information S2: Table 3). Sensitivity analyses of the associations of sugar intake with depression and anxiety in the whole sample (prior to participant exclusion) are nearly identical with results reported here, however, in these models, higher total sugar intake was associated with greater odds of depression and anxiety in both of the adjusted models (see Supporting Information S2: Table 4).
3.3. Associations Between Sugar‐Sweetened Beverages and Depression and Anxiety
Logistic regression analyses of the associations between dietary variables (intakes in grams per day [g/d] of: fruit; vegetables; legumes; whole grains; nuts and seeds; milk; red meat; processed meat; sugar‐sweetened beverages; fibre; calcium; sodium; as well as percentage of total daily energy intake of PUFA and trans‐fat) and depression and anxiety are reported in Table 4. In the unadjusted models (Model 1), dietary intake was not associated with depression or anxiety. However, in adjusted models, higher sugar‐sweetened beverage intake was associated with greater odds of depression (Model 2 and Model 3) and anxiety (Model 2).
Table 4.
Logistic regression analyses of the associations of dietary variables with depression and anxiety.
| Depression | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model 1 | Model 2** | Model 3** | ||||||||||||
| OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
||||||
| Fruits | 1.00 | 0.14 | 1.00 | 1.00 | 1.00 | 0.21 | 1.00 | 1.00 | 1.00 | 0.21 | 1.00 | 1.00 | ||
| Vegetables | 1.00 | 0.21 | 1.00 | 1.00 | 1.00 | 0.22 | 1.00 | 1.00 | 1.00 | 0.22 | 1.00 | 1.00 | ||
| Legumes | 0.98 | 0.04 | 1.00 | 1.01 | 0.98 | 0.09 | 1.00 | 1.01 | 0.98 | 0.08 | 1.00 | 1.01 | ||
| Wholegrains | 1.00 | 0.20 | 1.00 | 1.00 | 1.00 | 0.12 | 1.00 | 1.00 | 1.00 | 0.11 | 1.00 | 1.00 | ||
| Nuts & Seeds | 1.02 | 0.09 | 0.98 | 1.05 | 1.03 | 0.07 | 0.99 | 1.06 | 1.03 | 0.07 | 0.99 | 1.06 | ||
| Milk | 1.00 | 0.23 | 1.00 | 1.00 | 1.00 | 0.16 | 1.00 | 1.00 | 1.00 | 0.15 | 1.00 | 1.00 | ||
| Red meat | 1.01 | 0.05 | 1.00 | 1.01 | 1.01 | 0.10 | 1.00 | 1.01 | 1.01 | 0.10 | 1.00 | 1.01 | ||
| Processed meat | 1.00 | 0.18 | 0.98 | 1.02 | 1.01 | 0.15 | 1.00 | 1.03 | 1.01 | 0.14 | 1.00 | 1.03 | ||
| Sugar‐sweetened beverages | 1.01 | 0.02 | 1.00 | 1.01 | 1.00 | 0.04 | 1.00 | 1.01 | 1.00 | 0.04 | 1.00 | 1.01 | ||
| Fibre | 0.10 | 0.25 | 0.86 | 1.16 | 1.01 | 0.24 | 0.86 | 1.19 | 1.01 | 0.24 | 0.86 | 1.19 | ||
| Calcium | 0.59 | 0.13 | 0.09 | 3.98 | 0.75 | 0.19 | 0.09 | 6.13 | 0.75 | 0.18 | 0.09 | 6.12 | ||
| Sodium | 0.96 | 0.07 | 0.76 | 1.20 | 0.99 | 0.13 | 0.78 | 1.25 | 0.99 | 0.13 | 0.78 | 1.25 | ||
| PUFA | 1.37 | 0.16 | 0.72 | 2.61 | 1.34 | 0.25 | 0.66 | 2.71 | 1.34 | 0.25 | 0.66 | 2.72 | ||
| Trans‐fats | 2.97 | 0.11 | 0.21 | 41.57 | 1.60 | 0.18 | 0.12 | 22.31 | 1.58 | 0.17 | 0.11 | 22.09 | ||
| Anxiety | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model 1 | Model 2*** | Model 3*** | ||||||||||||
| OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
OR | P adj |
95% CI Lower/Upper |
||||||
| Fruits | 1.00 | 0.09 | 1.00 | 1.00 | 1.00 | 0.24 | 1.00 | 1.00 | 1.00 | 0.21 | 1.00 | 1.00 | ||
| Vegetables | 1.00 | 0.25 | 1.00 | 1.00 | 1.00 | 0.21 | 1.00 | 1.00 | 1.00 | 0.24 | 1.00 | 1.00 | ||
| Legumes | 0.99 | 0.07 | 1.00 | 1.01 | 0.99 | 0.07 | 1.00 | 1.01 | 0.99 | 0.07 | 0.97 | 1.01 | ||
| Wholegrains | 1.00 | 0.11 | 1.00 | 1.00 | 1.00 | 0.22 | 1.00 | 1.00 | 1.00 | 0.25 | 1.00 | 1.00 | ||
| Nuts & Seeds | 1.00 | 0.14 | 1.00 | 1.03 | 1.01 | 0.10 | 1.00 | 1.05 | 1.01 | 0.08 | 1.00 | 1.05 | ||
| Milk | 1.00 | 0.21 | 1.00 | 1.00 | 1.00 | 0.13 | 1.00 | 1.00 | 1.00 | 0.11 | 1.00 | 1.00 | ||
| Red meat | 1.00 | 0.23 | 0.99 | 1.01 | 1.00 | 0.15 | 0.99 | 1.01 | 1.00 | 0.15 | 0.99 | 1.01 | ||
| Processed meat | 1.00 | 0.20 | 1.00 | 1.02 | 1.00 | 0.25 | 0.98 | 1.02 | 1.00 | 0.22 | 1.00 | 1.02 | ||
| Sugar‐sweetened beverages | 1.00 | 0.02 | 1.00 | 1.01 | 1.00 | 0.04 | 1.00 | 1.01 | 1.00 | 0.06 | 1.00 | 1.01 | ||
| Fibre | 1.01 | 0.18 | 0.89 | 1.14 | 1.02 | 0.19 | 0.89 | 1.16 | 1.01 | 0.19 | 0.88 | 1.16 | ||
| Calcium | 1.13 | 0.16 | 0.22 | 5.81 | 1.59 | 0.12 | 0.25 | 9.98 | 1.67 | 0.13 | 0.27 | 10.33 | ||
| Sodium | 0.96 | 0.05 | 0.79 | 1.18 | 1.03 | 0.16 | 0.83 | 1.27 | 1.02 | 0.17 | 0.83 | 1.25 | ||
| PUFA | 1.22 | 0.13 | 0.70 | 2.12 | 1.11 | 0.18 | 0.59 | 2.09 | 1.14 | 0.18 | 0.60 | 2.14 | ||
| Trans‐fats | 4.09 | 0.04 | 0.35 | 48.50 | 2.23 | 0.09 | 0.18 | 27.55 | 2.02 | 0.14 | 0.16 | 25.47 | ||
Note: Model 1: unadjusted; Model 2: adjusted for age, sex, income; and Model 3: as in Model 2, with body mass index (BMI; kg/m2). Bold values indicate statistical significant.
* p ≤ 0.05
** p ≤ 0.01; p ≤ 0.001.
Sensitivity analyses regarding depression produced an identical pattern of results to those reported here, but sugar‐sweetened beverage intake was not associated with anxiety in any of the models (see Supporting Information S2: Table 5). Sensitivity analyses of the associations of sugar intake with depression and anxiety in the whole sample (prior to participant exclusion) revealed that higher sugar‐sweetened beverage was associated with greater odds of depression and anxiety in the unadjusted models (Models 1). In both adjusted models (Model 2 and Model 3), higher sugar‐sweetened beverage intake was associated with greater odds of depression (see Supporting Information S2: Table 6).
3.4. Associations Between Dietary Intake and Depression, and Anxiety
Other GBD‐defined dietary exposures (intakes in grams per day [g/d] of: fruit; vegetables; legumes; whole grains; nuts and seeds; milk; red meat; processed meat; sugar‐sweetened beverages; fibre; calcium; sodium; as well as percentage of total daily energy intake of PUFA and trans‐fat) were not associated with depression or anxiety (Table 4). Results were consistent in sensitivity analyses (see Supporting Information S2: Table 5). Sensitivity analyses in the whole sample (prior to participant exclusion) revealed that higher red meat intakes were associated with greater odds of depression and anxiety in the unadjusted models (Models 1). In all models, calcium intake was associated with greater odds of anxiety (see Supporting Information S2: Table 6).
4. Discussion
The current cross‐sectional study revealed distinct patterns of dietary intakes in individuals with depression or anxiety compared to participants without depression or anxiety. Participants with depression or anxiety had greater intakes of sugar‐sweetened beverages, total dietary sugar, fructose, glucose, maltose, and sucrose compared to those without depression and anxiety. Higher sugar‐sweetened beverage intake was associated with increased odds of depression. Furthermore, higher dietary sugar intake was associated with increased odds of depression and anxiety. However, only sucrose intake was associated with increased odds for anxiety. It is important to emphasise that the observed associations, although statistically significant, are characterised by odds ratios very close to 1.00 and narrow confidence intervals, indicating marginal effects with limited clinical relevance. We recognise that such small effect sizes, despite reaching statistical significance, may have minimal practical or clinical implications.
Our results are concordant with previous research demonstrating associations between sugar‐sweetened beverage intake and depression [16], possibly due to the link between dietary sugar intake and depression [18, 19]. There are several plausible biological explanations for these associations. Sugar consumption might cause depression through hyperfunction of the hypothalamic‐pituitary‐adrenal (HPA) axis, leading to excessive cortisol release and altered feedback inhibition mediated by the glucocorticoid receptor [30]. This is supported by observations from pre‐clinical studies showing that reported fructose intake in peri‐adolescence can stimulate the HPA axis and induce increased depressive‐like behaviour in adult rats [31]. Additional studies have shown that rats who were fed high‐fat high‐sugar diets exhibited a decrease in the brain‐derived neurotrophic factor (BDNF) [32]. Human studies have subsequently shown that low serum and plasma BDNF levels are associated with depression and anxiety [33].
Another biological mechanism linking sugar intake with depression is via gut‐brain interactions [8]. Previous studies have demonstrated that the gut microbiota likely influence the development of mental disorders, including depression [34]. Specifically, intake of sugar‐sweetened beverages and dietary sugar intake could lead to depression or anxiety by disrupting gut microbiota composition and function [35], possibly through increased abundances of lactic acid‐producing bacteria resulting in lactate accumulation, lower levels of the butyrate‐producing bacteria, and/or greater utilisation of glutamate (i.e., depletion) and increased synthesis of GABA [36].
Because sugar‐sweetened beverages and dietary sugar both have a high glycaemic index, high consumption may potentially lead to insulin resistance [37]. Insulin resistance could influence the likelihood of developing depression and anxiety via altered dopamine turnover [38] or via shared pro‐inflammatory pathways [39]. Increased low‐grade inflammation induced by sugar‐sweetened beverages and/or dietary sugar intake [40] could subsequently increase risk of depression and anxiety, possibly via altering production, metabolism, and transport of dopamine, glutamate, and serotonin that synergistically affect mood [41]. These shared pathways between mental and physical health mean sugar intake can directly influence whether someone develops depression and anxiety but may also act secondarily through other physical health conditions. Specifically, higher body mass index and diabetes caused by high sugar intake [42] could subsequently increase the likelihood of depression and anxiety [17].
Finally, it is important to note that the abovementioned biological mechanisms are mostly related to the sugar content of sugar‐sweetened beverages, however, other ingredients, such as caffeine and non‐nutritive sweeteners/sugar substitutes (aspartame, saccharine, sucralose, neotame, acesulfame‐K, and stevia), have also been shown to be linked to higher levels of depression and anxiety directly or indirectly (through increasing the risk of non‐communicable diseases) [43, 44, 45].
Possible psychosocial explanations for these associations should not be overlooked. Individuals who consume higher amounts of sugar‐sweetened beverages and/or dietary sugar are more likely to have a higher BMI [42]. The adverse effects of having a high BMI on psychological wellbeing may be partly explained by weight discrimination [46]. Additionally, consumption of higher amounts of sugar‐sweetened beverages and/or dietary sugar is associated with a variety of socio‐economic factors (such as low socio‐economic status) [47] that are known to be risk factors for developing depression and/or anxiety [48]. However, the current study partly accounted for this by adjusting for income, suggesting that other factors may explain the observed associations. Finally, individuals with depression and anxiety often exhibit poorer dietary quality and unhealthy eating behaviours, including emotional eating [21], and so they may be more likely to select sweet foods/sugar‐sweetened beverages as a coping mechanism [20, 22]. Given this was a cross‐sectional study which could not determine temporality of the associations, we can only speculate about the directions of the relationships.
Our regression models did not show associations between odds of depression and anxiety and fruits, vegetables, legumes, wholegrains, nuts & seeds, milk, red meat, processed meat, fibre, calcium, sodium, PUFA, and trans‐fats or other sugar types (fructose, galactose, glucose, lactose, maltose). However, participants with depression and anxiety appeared to have different dietary intakes compared to participants without these conditions. This discrepancy may be a result of insufficient power to detect associations in logistic regression models. This is supported by the associations we did observe between various dietary exposures and continuous depression and anxiety scores (see Supporting Information S2: Table 7). Furthermore, the sample was predominantly a homogeneous sample of university students, therefore the little variance in the dietary exposures might have reduced the possibility of significant findings. Increased awareness of the impact of food on health in this subgroup of educated participants might have also influenced our largely null findings [49].
The current study is not free from limitations. First, due to the cross‐sectional nature of this study, we cannot make establish causality, and a possibility of reverse causation cannot be excluded. In fact, as mentioned above, it is well known that depression and anxiety may lead to higher sugar intake [50], possibly due to emotional eating [21], and so they may be more likely to select sweet foods/sugar‐sweetened beverages as a coping mechanism [22]. Therefore, gender‐matched longitudinal designs (considering the gender disproportionality in the current sample) should be adopted in the future to clarify the directionality of these associations. Secondly, participants responding to FFQs are known to be prone to misreporting [51] and might also be affected to recall bias. Other self‐reported data, such as height and weight, may likewise introduce inaccuracies. Thirdly, although the DASS subscales predict clinical diagnosis of depression (sensitivity and specificity of 84%) and anxiety (sensitivity of 74% and a specificity of 84% [52]), total score cut‐off points on the DASS subscales do not correspond with a clinical diagnosis, but rather indicate the level of high depressive and/or anxiety symptoms self‐reported by the individual that may be of clinical relevance. Hence, future studies should consider conducting diagnostic psychiatric interviews to assess depression and anxiety. Fourthly, the sample primarily consisted of university students and there were substantial differences in sample size between male and female participants, which may have influenced the generalisability and applicability of the findings. Fifthly, the absence of physiological data limits our ability to fully support the interpretations and assumptions drawn from the findings. Finally, although the models were adjusted for a variety of major potential confounders, it is possible that the presence of unknown/unmeasured dietary or non‐dietary factors could partly explain the reported results, indicating potential residual confounding.
In conclusion, the present study adds to the body of evidence that sugar‐sweetened beverage and dietary sugar intakes are associated with increased chance of depression and anxiety. Further large scale longitudinal epidemiological studies assessing these associations are warranted to better establish directionality, temporality, and causality.
Author Contributions
Christle Coxon: investigation, writing – original draft, methodology, writing – review and editing, formal analysis, project administration, supervision, data curation. Mira Rufeger: Investigation. Grace Hollamby: investigation. Deborah N. Ashtree: methodology, project administration, Supervision, validation. Rebecca Orr: methodology, project administration, supervision, validation. Melissa M. Lane: methodology, project administration, supervision, validation. Piril Hepsomali: conceptualization, investigation, writing – original draft, writing – review and editing, visualization, methodology, formal analysis, project administration, supervision, data curation. All authors provided input into the final version of the manuscript.
Disclosure
The lead author Piril Hepsomali affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Ethics Statement
This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Ethical Committee at the University of Roehampton (Reference: PSYC/22420).
Consent
Written informed consent was obtained from all subjects.
Conflicts of Interest
P.H. has received research funding, consultancy, travel support, and speaking honoraria from various industrial companies. The other authors declare no conflicts of interest.
Supporting information
STROBE.
Supplementary Table 1: Aligning EPIC output to GLAD exposure variables. Supplementary Table 2: Food items from FFQ included in estimation of trans fat. Supplementary Table 3: Sensitivity analyses of the associations between energy adjusted sugar intake, depression, and anxiety. Supplementary Table 4: Sensitivity analyses of the associations between sugar intake, depression, and anxiety in the whole sample (prior to participant exclusion). Supplementary Table 5: Sensitivity analyses of the associations between energy adjusted dietary variables, depression, and anxiety. Supplementary Table 6: Sensitivity analyses of the associations between dietary variables, depression, and anxiety in the whole sample (prior to participant exclusion). Supplementary Table 7: Associations between continuous depression and anxiety scores and dietary exposures.
Acknowledgments
This manuscript has been prepared in accordance with the requirements of the Global burden of disease Lifestyle And mental Disorder (GLAD) Taskforce, as part of a global collaborative project to inform the Global Burden of Diseases, Injuries, and Risk Factors Study. This research received no specific grant from any funding agency, commercial or not‐for‐profit sectors. D.N.A. is supported by a National Health and Medical Research Council Fellowship (#2009295). M.M.L. is supported by an Alfred Deakin Postdoctoral Fellowship. R.O. is supported by a Deakin University Postgraduate Research Scholarship. The opinions, methods, and conclusions reported in this paper are those of the authors and are independent from the funding sources.
Coxon C., Rufeger M., Hollamby G., et al., “Sugar Intake Is Associated With Increased Odds of Depression and Anxiety: Evidence From A Cross‐Sectional Study,” Health Science Reports 8, (2025): 1–10, 10.1002/hsr2.71666.
Contributor Information
Christle Coxon, Email: christle.coxon@roehampton.ac.uk.
Piril Hepsomali, Email: p.hepsomali@reading.ac.uk.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. Data available on request from the authors.
References
- 1. Lamers F., van Oppen P., Comijs H. C., et al., “Comorbidity Patterns of Anxiety and Depressive Disorders in a Large Cohort Study: The Netherlands Study of Depression and Anxiety (NESDA),” Journal of Clinical Psychiatry 72, no. 3 (2011): 341–348. [DOI] [PubMed] [Google Scholar]
- 2. WHO . Depression and Other Common Mental Disorders Global Health Estimates2017. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf.
- 3. Chisholm D., Sweeny K., Sheehan P., et al., “Scaling‐Up Treatment of Depression and Anxiety: A Global Return on Investment Analysis,” Lancet Psychiatry 3, no. 5 (2016): 415–424. [DOI] [PubMed] [Google Scholar]
- 4. Leichsenring F., Steinert C., Rabung S., and Ioannidis J. P. A., “The Efficacy of Psychotherapies and Pharmacotherapies for Mental Disorders in Adults: An Umbrella Review and Meta‐Analytic Evaluation of Recent Meta‐Analyses,” World Psychiatry: Official Journal of The World Psychiatric Association (WPA) 21, no. 1 (2022): 133–145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Brauer M., Roth G. A., Aravkin A. Y., et al., “Global Burden and Strength of Evidence for 88 Risk Factors in 204 Countries and 811 Subnational Locations, 1990–2021: A Systematic Analysis for the Global Burden of Disease Study 2021,” Lancet 403, no. 10440 (2024): 2162–2203. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Opie R. S., O'Neil A., Itsiopoulos C., and Jacka F. N., “The Impact of Whole‐Of‐Diet Interventions on Depression and Anxiety: A Systematic Review of Randomised Controlled Trials,” Public Health Nutrition 18, no. 11 (2015): 2074–2093. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Firth J., Marx W., Dash S., et al., “The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta‐Analysis of Randomized Controlled Trials,” Psychosomatic Medicine 81, no. 3 (2019): 265–280. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Cryan J. F., O'Riordan K. J., Cowan C. S. M., et al., “The Microbiota‐Gut‐Brain Axis,” Physiological Reviews 99, no. 4 (2019): 1877–2013. [DOI] [PubMed] [Google Scholar]
- 9. Marx W., Lane M., Hockey M., et al., “Diet and Depression: Exploring the Biological Mechanisms of Action,” Molecular Psychiatry 26, no. 1 (2021): 134–150, 10.1038/s41380-020-00925-x. [DOI] [PubMed] [Google Scholar]
- 10. Parletta N., Zarnowiecki D., Cho J., et al., “A Mediterranean‐Style Dietary Intervention Supplemented With Fish Oil Improves Diet Quality and Mental Health in People With Depression: A Randomized Controlled Trial (HELFiMED),” Nutritional Neuroscience 22, no. 7 (2019): 474–487. [DOI] [PubMed] [Google Scholar]
- 11. Jacka F. N., O'Neil A., Opie R., et al., “A Randomised Controlled Trial of Dietary Improvement for Adults With Major Depression (The ‘SMILES’ Trial),” BMC Medicine 15, no. 1 (2017): 23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Lai J. S., Hiles S., Bisquera A., Hure A. J., McEvoy M., and Attia J., “A Systematic Review and Meta‐Analysis of Dietary Patterns and Depression in Community‐Dwelling Adults,” American Journal of Clinical Nutrition 99, no. 1 (2014): 181–197. [DOI] [PubMed] [Google Scholar]
- 13. Jacka F. N., Pasco J. A., Mykletun A., et al., “Association of Western and Traditional Diets With Depression and Anxiety in Women,” American Journal of Psychiatry 167, no. 3 (2010): 305–311. [DOI] [PubMed] [Google Scholar]
- 14. Zhang H., Li M., Mo L., Luo J., Shen Q., and Quan W., “Association Between Western Dietary Patterns, Typical Food Groups, and Behavioral Health Disorders: An Updated Systematic Review and Meta‐Analysis of Observational Studies,” Nutrients 16, no. 1 (2023): 125. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Lane M. M., Gamage E., Du S., et al., “Ultra‐Processed Food Exposure and Adverse Health Outcomes: Umbrella Review of Epidemiological Meta‐Analyses,” BMJ 384 (2024): e077310. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Hu D., Cheng L., and Jiang W., “Sugar‐Sweetened Beverages Consumption and the Risk of Depression: A Meta‐Analysis of Observational Studies,” Journal of Affective Disorders 245 (2019): 348–355. [DOI] [PubMed] [Google Scholar]
- 17. Stanaway J. D., Afshin A., Gakidou E., et al., “Global, Regional, and National Comparative Risk Assessment of 84 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks for 195 Countries and Territories, 1990–2017: a Systematic Analysis for the Global Burden of Disease Study 2017,” Lancet 392, no. 10159 (2018): 1923–1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Huang Y., Chen Z., Chen B., et al., “Dietary Sugar Consumption and Health: Umbrella Review,” BMJ 381 (2023): e071609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Zhang L., Sun H., Liu Z., Yang J., and Liu Y., “Association Between Dietary Sugar Intake and Depression in US Adults: A Cross‐Sectional Study Using Data From the National Health and Nutrition Examination Survey 2011–2018,” BMC Psychiatry 24, no. 1 (2024): 110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Graybeal A. J., Stavres J., Swafford S. H., et al., “The Associations Between Depression and Sugar Consumption Are Mediated by Emotional Eating and Craving Control in Multi‐Ethnic Young Adults,” Healthcare 12, no. 19 (2024): 1944. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Teasdale S. B., Ward P. B., Samaras K., et al., “Dietary Intake of People With Severe Mental Illness: Systematic Review and Meta‐Analysis,” British Journal of Psychiatry 214, no. 5 (2019): 251–259. [DOI] [PubMed] [Google Scholar]
- 22. Dakanalis A., Mentzelou M., Papadopoulou S. K., et al., “The Association of Emotional Eating With Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence,” Nutrients 15, no. 5 (2023): 1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Luppino F. S., de Wit L. M., Bouvy P. F., et al., “Overweight, Obesity, and Depression: A Systematic Review and Meta‐Analysis of Longitudinal Studies,” Archives of General Psychiatry 67, no. 3 (2010): 220–229. [DOI] [PubMed] [Google Scholar]
- 24. von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., and Vandenbroucke J. P., “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies,” Lancet 370, no. 9596 (2007): 1453–1457. [DOI] [PubMed] [Google Scholar]
- 25. Ashtree D. N., Orr R., Lane M. M., et al., “GLAD) Project,” Estimating the Burden of Common Mental Disorders Attributable to Lifestyle Factors: Protocol for the Global Burden of Disease Lifestyle And Mental Disorder 14 (2025): e65576, 10.2196/65576. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Bingham S. A., Gill C., Welch A., et al., “Validation of Dietary Assessment Methods in the UK Arm of EPIC Using Weighed Records, and 24‐hour Urinary Nitrogen and Potassium and Serum Vitamin C and Carotenoids as Biomarkers,” International Journal of Epidemiology 26, no. suppl_1):S137‐S (1997). [DOI] [PubMed] [Google Scholar]
- 27. Mulligan A. A., Luben R. N., Bhaniani A., et al., “A New Tool for Converting Food Frequency Questionnaire Data Into Nutrient and Food Group Values: FETA Research Methods and Availability,” BMJ Open 4, no. 3 (2014): e004503. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Lovibond S. H. and Lovibond P. F., Manual for the Depression Anxiety Stress Scales (Psychology Foundation, 1995). 2nd ed.. [Google Scholar]
- 29. Willett W., Howe G., and Kushi L., “Adjustment for Total Energy Intake in Epidemiologic Studies,” American Journal of Clinical Nutrition 65, no. 4 Suppl (1997): 1220S–1228SS. [DOI] [PubMed] [Google Scholar]
- 30. Shen F., Song Z., Xie P., et al., “Polygonatum Sibiricum Polysaccharide Prevents Depression‐Like Behaviors by Reducing Oxidative Stress, Inflammation, and Cellular and Synaptic Damage,” Journal of Ethnopharmacology 275 (2021): 114164. [DOI] [PubMed] [Google Scholar]
- 31. Harrell C. S., Burgado J., Kelly S. D., Johnson Z. P., and Neigh G. N., “High‐Fructose Diet During Periadolescent Development Increases Depressive‐Like Behavior and Remodels the Hypothalamic Transcriptome in Male Rats,” Psychoneuroendocrinology 62 (2015): 252–264. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32. Molteni R., Barnard R. J., Ying Z., Roberts C. K., and Gómez‐Pinilla F., “A High‐Fat, Refined Sugar Diet Reduces Hippocampal Brain‐Derived Neurotrophic Factor, Neuronal Plasticity, and Learning,” Neuroscience 112, no. 4 (2002): 803–814. [DOI] [PubMed] [Google Scholar]
- 33. Martinowich K., Manji H., and Lu B., “New Insights into BDNF Function in Depression and Anxiety,” Nature Neuroscience 10, no. 9 (2007): 1089–1093. [DOI] [PubMed] [Google Scholar]
- 34. McGuinness A. J., Loughman A., Foster J. A., and Jacka F., “Mood Disorders: The Gut Bacteriome and Beyond,” Biological Psychiatry 95, no. 4 (2024): 319–328. [DOI] [PubMed] [Google Scholar]
- 35. Garcia K., Ferreira G., Reis F., and Viana S., “Impact of Dietary Sugars on Gut Microbiota and Metabolic Health,” Diabetology 3, no. 4 (2022): 549–60]. [Google Scholar]
- 36. McGuinness A. J., Davis J. A., Dawson S. L., et al., “A Systematic Review of Gut Microbiota Composition in Observational Studies of Major Depressive Disorder, Bipolar Disorder and Schizophrenia,” Molecular Psychiatry 27, no. 4 (2022): 1920–1935. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37. Willett W., Manson J., and Liu S., “Glycemic Index, Glycemic Load, and Risk of Type 2 Diabetes,” American Journal of Clinical Nutrition 76, no. 1 (2002): 274S–280SS. [DOI] [PubMed] [Google Scholar]
- 38. Kleinridders A., Cai W., Cappellucci L., et al., “Insulin Resistance in Brain Alters Dopamine Turnover and Causes Behavioral Disorders,” Proceedings of the National Academy of Sciences 112, no. 11 (2015): 3463–3468. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39. Leonard B. E. and Wegener G., “Inflammation, Insulin Resistance and Neuroprogression in Depression,” Acta Neuropsychiatrica 32, no. 1 (2020): 1–9. [DOI] [PubMed] [Google Scholar]
- 40. Ma X., Nan F., Liang H., et al., “Excessive Intake of Sugar: An Accomplice of Inflammation,” Frontiers in Immunology 13 (2022): 988481, 10.3389/fimmu.2022.988481. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41. Capuron L. and Miller A. H., “Immune System to Brain Signaling: Neuropsychopharmacological Implications,” Pharmacology & Therapeutics 130, no. 2 (2011): 226–238. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42. Vartanian L. R., Schwartz M. B., and Brownell K. D., “Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta‐Analysis,” American Journal of Public Health 97, no. 4 (2007): 667–675. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43. Sharma A., Amarnath S., Thulasimani M., and Ramaswamy S., “Artificial Sweeteners as a Sugar Substitute: Are They Really Safe?,” Indian Journal of Pharmacology 48, no. 3 (2016): 237–240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44. Liu C., Wang L., Zhang C., et al., “Caffeine Intake and Anxiety: A Meta‐Analysis,” Frontiers in Psychology 15 (2024): 1270246, 10.3389/fpsyg.2024.1270246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45. Torabynasab K., Shahinfar H., Payandeh N., and Jazayeri S., “Association Between Dietary Caffeine, Coffee, and Tea Consumption and Depressive Symptoms in Adults: A Systematic Review and Dose‐Response Meta‐Analysis of Observational Studies,” Frontiers in Nutrition 10 (2023): 1051444. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46. Jackson S. E., Beeken R. J., and Wardle J., “Obesity, Perceived Weight Discrimination, and Psychological Well‐Being in Older Adults in England,” Obesity 23, no. 5 (2015): 1105–1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47. Purohit B. M., Dawar A., Bansal K., et al., “Sugar‐Sweetened Beverage Consumption and Socioeconomic Status: A Systematic Review and Meta‐Analysis,” Nutrition and Health 29, no. 3 (2023): 465–477. [DOI] [PubMed] [Google Scholar]
- 48. Kivimäki M., Batty G. D., Pentti J., et al., “Association Between Socioeconomic Status and the Development of Mental and Physical Health Conditions in Adulthood: A Multi‐Cohort Study,” Lancet Public Health 5, no. 3 (2020): e140–e149. [DOI] [PubMed] [Google Scholar]
- 49. Belogianni K., Ooms A., Lykou A., and Moir H. J., “Nutrition Knowledge Among University Students in the UK: A Cross‐Sectional Study,” Public Health Nutrition 25, no. 10 (2021): 1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50. Macht M., “How Emotions Affect Eating: A Five‐Way Model,” Appetite 50, no. 1 (2008): 1–11. [DOI] [PubMed] [Google Scholar]
- 51. Shim J.‐S., Oh K., and Kim H. C., “Dietary Assessment Methods in Epidemiologic Studies,” Epidemiology and Health 36 (2014): e2014009‐e. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52. Dunstan D. A., Scott N., and Todd A. K., “Screening for Anxiety and Depression: Reassessing the Utility of the Zung Scales,” BMC Psychiatry 17, no. 1 (2017): 329. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
STROBE.
Supplementary Table 1: Aligning EPIC output to GLAD exposure variables. Supplementary Table 2: Food items from FFQ included in estimation of trans fat. Supplementary Table 3: Sensitivity analyses of the associations between energy adjusted sugar intake, depression, and anxiety. Supplementary Table 4: Sensitivity analyses of the associations between sugar intake, depression, and anxiety in the whole sample (prior to participant exclusion). Supplementary Table 5: Sensitivity analyses of the associations between energy adjusted dietary variables, depression, and anxiety. Supplementary Table 6: Sensitivity analyses of the associations between dietary variables, depression, and anxiety in the whole sample (prior to participant exclusion). Supplementary Table 7: Associations between continuous depression and anxiety scores and dietary exposures.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. Data available on request from the authors.