Research PaperMushroom intake and depression: A population-based study using data from the US National Health and Nutrition Examination Survey (NHANES), 2005–2016
Introduction
Major depression is one of the most common mental health illnesses in the United States (US). According to the National Institute of Mental Health, approximately 17.3 million adults in the US have had at least one major depressive episode (National Institutes of Health, 2019). Mental illnesses such as depression are the third leading cause of hospitalization in the US among adults (Kessler et al., 2007; Parks et al., 2006) and those living with an acute mental illness tend to die on average 25 years earlier than healthy individuals. Depression is a significant public health problem and serious medical illness which is associated with mood disorder symptoms such as feelings of guilt or low self-esteem, and cognitive and physical symptoms such as disturbed sleep, changes in appetite or weight, and poor concentration (American Psychiatric Association, 2013; Marcus et al., 2012). It is a significant contributing factor to the global burden of disease and is also associated with increased rates of chronic diseases, suicide attempts, medical costs, disability, and impaired function (Katon, 2003; Moussavi et al., 2007; Wells et al., 1989).
Evidence from a randomized controlled trial suggested dietary improvements as an efficacious treatment strategy for treating major depressive episodes (Jacka et al., 2017). In addition, a meta-analysis study also indicated that a dietary pattern characterized by a high intake of fruits, vegetables, whole grains, and antioxidants and low intakes of animal-derived foods was associated with a lower risk of depression (Li et al., 2017).
Mushrooms are low in calories and fat, cholesterol-free, and good a sources of vitamins (e.g., B1, B2, B12, and vitamin C) and minerals (selenium and copper)(Breene, 1990; Mattila et al., 2000), and fit well with a healthy eating pattern (O'Neil et al., 2013). Even though mushrooms share some nutritional characteristics with plant-derived foods, they are biologically distinct as fungi. Importantly, mushrooms are a rich dietary source of potent antioxidants glutathione and ergothioneine. Antioxidants and B12 are thought to have anti-depressant effects. Certain species of edible mushrooms such as Hericium erinaceus (Lion's Mane) can stimulate the expression of neurotrophic factors such as nerve growth factor (NGF) synthesis, which could have a potential impact on preventing neuropsychiatric disorders including major depression (Kawagishi et al., 1996; Kawagishi et al., 1994; Ma et al., 2010). Mushrooms also contain anti-inflammatory agents (Elsayed et al., 2014). Inflammation has been linked to depression, and nonsteroidal anti-inflammatory drugs are thought to lower stress and depression (Kohler et al., 2016). White button mushroom buttons, which are the most commonly consumed mushroom variety in the US, also contain potassium, which is believed to reduce anxiety (Mrug et al., 2019).
There have been few reported epidemiological studies on the association between mushroom consumption and depression, and these have been limited to small (< 100 participants) clinical trials where intervention with the mushrooms species Hericium erinaceus was found to be effective at alleviating the symptoms of depression (Nagano et al., 2010; Okamura et al., 2015; Vigna et al., 2019). To the best of our knowledge, there have been no observational studies on mushroom consumption and depression. Thus, we aim to fill this critical gap in knowledge by investigating the association between mushroom consumption and depression in a nationally representative sample of US adults using the National Health and Nutrition Examination Survey (NHANES) (2005–2016).
Section snippets
Data source
The NHANES comprises a series of cross-sectional, stratified, multistage probability surveys conducted continually by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). The NHANES is a program of studies designed to examine the health and nutritional status of adults and children in the US. Before 1994, the NHANES was conducted periodically; starting in 1999, the survey became a continuous program, with every 2-years constituting 1 cycle
Results
Among 24,699 US adults (12,268 men and 10,304 women) included in the current analysis, the mean (SE) age was 45.5(0.3) years; about half of the study participants were men (50.2%), and more than half were non-Hispanic Whites (66.1%). The overall weighted prevalence of depression and mushroom consumers during our study period were 5.9%, (95% CI: 5.4, 6.5%) and 5.2 %, (95% CI: 4.7, 5.7), respectively. Compared with mushroom non-consumers, mushroom consumers were more likely to be females,
Discussion
In this large cross-sectional study of nationally representative of more than 24,000 US adults, we found that those with mushroom consumption had lower odds of having depression. The observed association was independent of socio-demographics, major lifestyle risk factors, self-reported diseases, medications use, and other dietary factors. We did not observe a significant dose-response relationship between greater mushroom intake and the odds of depression. Furthermore, in this study, replacing
Strengths
Our study has several strengths. Previous epidemiological studies that have examined the effects of mushrooms on depression were limited to small clinical trials with sample sizes ranged from 8 to 77 subjects (Nagano et al., 2010; Okamura et al., 2015; Vigna et al., 2019). To the best of our knowledge, this is the first large scale epidemiological study that used nationally representative US adult population data and examined the association between mushroom consumption and depression. In
Limitations
Notwithstanding, the study has some limitations that need to be addressed. First, self-reported 24 h dietary recalls using USDA foods code for recipes may have introduced misclassification bias. This includes misclassification of mushrooms as vegetables and inaccurate assessment of mushroom content in the mixed of dishes. The two 24 h recalls may not have adequately captured the within-person variation in mushroom intake. Such nondifferential measurement error may have underestimated the
Conclusion
In this nationally representative study of US adults, we found that mushroom intake was associated with lower odds of depression. However, our results should be interpreted with caution. We found that compared to the lowest tertile, the middle tertile was associated with depression but not for the highest tertile indicating that the finding could be possibly due to chance. Our findings are consistent with preclinical studies suggestive of potential health benefits from specific bioactive
Financial support
There was no external or internal funding to support this study.
Data availability
Data used for this study are available on the NHANES website: https://wwwn.cdc.gov/nchs/nhanes/.
CRediT authorship contribution statement
Djibril M. Ba: Conceptualization, Investigation, Visualization, Formal analysis, Writing – original draft, Writing – review & editing. Xiang Gao: Conceptualization, Investigation, Visualization, Writing – review & editing. Laila Al-Shaar: Conceptualization, Investigation, Visualization, Writing – review & editing. Joshua E. Muscat: Writing – review & editing. Vernon M. Chinchilli: Writing – review & editing. Robert B. Beelman: Writing – review & editing. John P. Richie: Conceptualization,
Declaration of Competing Interest
None.
Acknowledgment
None.
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