High consumption of ultra-processed foods with artificial sweetners linked to depression: JAMA

Previous studies have demonstrated a link between diet and depression. There needs to be more data available to determine this association and elaborate on which UPF foods and ingredients are associated with depression risk and how the timing of UPF consumption is related.

Considering the background above, researchers investigated this association in 31712 females, aged 42 to 62 years, middle-aged, non-Hispanic white females without any history of depression at baseline using validated food frequency questionnaires (FFQs) every four years and the NOVA classification. Strict definition (self-reported clinician–diagnosed depression and regular antidepressant use) and broad definition (requiring clinical diagnosis and antidepressant use) were used in this study.

The secondary analyses also classified UPF into its components, including ultra-processed grain foods and dairy products, sweet snacks, ready-to-eat meals, fats and sauces, savory snacks, processed meat, beverages, and artificial sweeteners. Cox proportional hazard models and 2-sided tests from SAS (version 9.4) were used.

The study summary includes the following:

• Those with high UPF intake were smokers, physically inactive, and had greater BMI and comorbidities like diabetes, hypertension, and dyslipidemia.
• Based on strict and broad definition, 2122 and 4840 incident cases of depression were identified.
• Those in the highest quintile had an increased risk of depression for both strict and broad definitions, with HR of 1.49 and 1.34, respectively.
• Researchers did not observe differential associations in age, BMI, physical activity, or smoking subgroups.
• Associations were not materially altered in a 4-year lag analysis, arguing against reverse causation with HR 1.32 for strict definition.

Greater UPF intake, particularly artificial sweeteners and artificially sweetened beverages, increases the risk of depression. The mechanism is unknown, but a possible explanation could be the trigger of purinergic transmission in the brain by artificial sweeteners.

Reducing UPF intake by at least three servings per day lowers depression risk, researchers noted.

The team acknowledged the Large sample, prospective design, high follow-up rate, multiple confounders adjustments, and extensively validated dietary assessment tools to be the strengths of the study.

Further reading:

Samuthpongtorn C, Nguyen LH, Okereke OI, et al. Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770