Exploring the link between lifestyle patterns and depression in diabetic individuals

By Priyanjana Pramanik, MSc.Reviewed by Lily Ramsey, LLMJul 9 2024

In a recent study published in BMC Public Health, researchers investigated the impact of lifestyle patterns and diet on depression in individuals with diabetes.

Their findings indicate that lifestyle patterns significantly influence depression, with dietary inflammation playing a mediating role, suggesting that promoting anti-inflammatory diets and healthy lifestyle practices may help prevent and alleviate depression in diabetic patients.

Study: Influence of lifestyle patterns on depression among adults with diabetes: a mediation effect of dietary inflammatory index. Image Credit: Elena Eryomenko/Shutterstock.com

Background

Diabetes is becoming more common worldwide, with millions of people affected and many expected to be diagnosed in the coming years. People with diabetes are much more likely to experience depression compared to those without diabetes.

Depression in diabetes patients can lead to worse health outcomes, including poor blood sugar control and unhealthy lifestyle choices. Previous research has mostly looked at single lifestyle factors, like smoking or lack of exercise, and their link to depression.

However, the combined effect of various lifestyle patterns on depressive symptoms in diabetes patients remains unclear.

About the study

This study addressed an existing research gap by examining how different dietary habits and lifestyle patterns, particularly those causing inflammation, influence depression among diabetes patients.

Researchers used data from the National Health and Nutrition Examination Survey (NHANES) collected from 2009 to 2020. NHANES is a large survey that assesses the health and nutrition of people in the U.S.

Data was gathered through interviews and medical exams. From this data, researchers selected 3,009 adults with diabetes for analysis, excluding those with incomplete information.

Researchers considered five lifestyle behaviors: smoking, alcohol consumption, sleep duration, physical activity, and sedentary behavior. Each behavior was categorized as healthy or unhealthy.

They also measured dietary habits using the Dietary Inflammatory Index (DII), which scores diets based on their potential to cause inflammation.

Depressive symptoms were assessed using a survey that scores depression severity. Various statistical methods were used to identify patterns in lifestyle behaviors and analyze their effects on depression.

Researchers then examined the role of dietary inflammation in mediating the link between lifestyle patterns and depression. The study accounted for potential confounding factors like age, sex, ethnicity, education, income, and body mass index (BMI).

Findings

The study analyzed data from 3,009 adults with diabetes, averaging 61.3 years old. About 13.7% of the participants had depressive symptoms.

Researchers identified three lifestyle groups: those with unhealthy lifestyles (44.5%), those who led unhealthy lifestyles but did not drink alcohol (48.1%), and those who smoked but were otherwise healthy (7.4%).

The group following unhealthy lifestyles had high rates of alcohol use, sleep issues, inactivity, and sedentary behavior.

Those with unhealthy lifestyles without alcohol had lower alcohol consumption but still exhibited unhealthy behaviors. The third group had high smoking rates but fewer other harmful behaviors.

The study found that the second group that did not drink alcohol was more likely to experience depression compared to the first group, which did.

Higher DII scores were associated with increased depression, suggesting that pro-inflammatory diets contribute to depressive symptoms.

The DII appeared to partially mediate the relationship between the unhealthy group that did not drink alcohol and their risk of depression and fully mediate it for the group that smoked but was otherwise healthy, indicating dietary inflammation's impact on depressive symptoms in diabetes patients.

Conclusions

This study underscores the interconnected nature of lifestyle behaviors and their synergistic effects on health outcomes, particularly in individuals with diabetes.

Findings highlight the importance of anti-inflammatory diets, rich in fruits, vegetables, whole grains, and omega-3 fatty acids, in reducing depression risk among people with diabetes.

It also emphasizes the need for multifaceted interventions that address multiple unhealthy behaviors simultaneously.

The findings are consistent with previous research showing that smoking rates are higher among males than females. They suggest that unhealthy behaviors may accumulate increasingly with age and potentially contribute to the development of chronic diseases.

The study also supports the observation that people leading healthier lifestyles often follow anti-inflammatory dietary patterns.

The unexpected result that the unhealthy group that did not consume alcohol had a higher risk of reporting depressive symptoms than the group that did raises questions about the role of moderate alcohol consumption in potentially mitigating depressive symptoms.

This finding challenges the assumption that alcohol consumption increases depression risk and suggests that further research is needed to explore the neuroprotective effects of moderate alcohol use.

The study's strengths include its large sample size and use of high-quality, nationally representative data. However, limitations include reliance on self-reported data, which can introduce recall bias, and a cross-sectional design that cannot establish causality.

Future research should use longitudinal studies and clinical trials to understand these relationships better and develop effective intervention strategies.