Dietary lipids and geriatric depression scale score among elders: The EPIC-Greece cohort A. Kyrozis a, * , T. Psaltopoulou b , P. Stathopoulos c , D. Trichopoulos c,d , D. Vassilopoulos a , A. Trichopoulou b,d a Department of Neurology, Eginition Hospital, University of Athens Medical School, 72 Vas Sofias Avenue, GR-11528 Athens, Greece b Department of Hygiene and Epidemiology, University of Athens Medical School, 75, Mikras Asias street, GR-11527 Athens, Greece c Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, MA 02115, USA d Hellenic Health Foundation, 10-12 Tetrapoleos, GR-11527 Athens, Greece article info Article history: Received 13 July 2008 Received in revised form 10 September 2008 Accepted 10 September 2008 Keywords: Depression GDS Elderly Greece Diet Lipids EPIC abstract In a prospective epidemiological investigation aiming to identify dietary lipids potentially associated with affective state and depression, 610 healthy men and women aged 60 years or older, participating in the EPIC-Greece cohort and residing in the Attika region had dietary, sociodemographic, anthropomet- ric, medical and lifestyle variables ascertained at enrollment. Six to 13 years later, affective state was evaluated through the 15-point geriatric depression scale (GDS) score along with cognitive function and medical variables. In multivariate linear regression analysis, while adjusting for potential confound- ers, GDS score was negatively associated with dietary intake of monounsaturated lipids (MUFA) and their main source, olive oil, and positively associated with intake of polyunsaturated lipids (PUFA) and one of their principal sources, seed oils. Intake of calories, total lipids, fish and seafood or saturated lipids did not exhibit significant association with GDS. Potential non-linearities were assessed by quantile multivariate regression analysis: The median GDS score was positively associated with PUFA and seed oils intake, while other lipid groups showed no appreciable associations. The 90th percentile of the GDS score (towards the high end) exhibited significant negative associations with MUFA and olive oil, weaker posi- tive associations with PUFA and seed oils and no appreciable association with other lipid group dietary intakes. We conclude that among Attika elders, lower intake of seed oils and higher intake of olive oil pro- spectively predict a healthier affective state. Olive oil intake, in particular, predicts a lower chance of scor- ing in the highest part of the GDS. Ó 2008 Elsevier Ltd. All rights reserved. 1. Introduction Elders represent a growing segment of the total population in developed countries, challenging traditional health care systems (OECD, 2007). Prevalence of depression rates range from 3% to more than 50%, depending on the population studied and assess- ment methods (Haller et al., 1996; Steffens et al., 2000; Ritchie et al., 2004; Harris et al., 2006). There is also a trend towards rising age-adjusted prevalence of depression in western populations (Klerman and Weissman, 1989), further bringing out the issue as a public health priority. In Greece, prevalence rates in the elderly have been estimated in some studies to be as high as 20% or even 36% with higher rates among women (Argyriadou et al., 2001; Parashos et al., 2002; Papadopoulos et al., 2005). There is a growing awareness of nutritional effects on major health problems of the elderly, including mood disturbance and depression (World Health Organization and Tufts University School of Nutrition and Policy, 2002), with most interest being fo- cused on omega-3 polyunsaturated fatty acids (PUFA), largely found in fish and seafood. Several, although not all, studies have suggested a beneficial effect of omega-3 PUFA in the treatment of established depression (Sontrop and Campbell, 2006; Williams et al., 2006). The role of omega-3 PUFA in preventing the develop- ment of depression in the future is more controversial (Hakkarai- nen et al., 2004; Jacka et al., 2004; Timonen et al., 2004; Sanchez-Villegas et al., 2006). Olive oil has received relatively little attention regarding its potential association with depression (As- sies et al., 2004; Irmisch et al., 2007), despite its well-established beneficial effects on overall health and survival (Trichopoulou et al., 2003). In order to prospectively examine the impact of dietary lipids on GDS score, we used a subset of the large EPIC-Greece cohort. This cohort includes subjects who completed a detailed baseline questionnaire on dietary and several sociodemographic, anthropo- metric, medical and lifestyle variables at enrollment. Six to 13 0022-3956/$34.00 Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2008.09.003 * Corresponding author. Tel.: +30 210 7289281/6936796150; fax: +30 210- 7216474. E-mail addresses: akyrozis@med.uoa.gr, andr_kyr@otenet.gr (A. Kyrozis), dora@ nut.uoa.gr (T. Psaltopoulou), pstath@nut.uoa.gr (P. Stathopoulos), dtrichop@hsph. harvard.edu (D. Trichopoulos), vassilop@med.uoa.gr (D. Vassilopoulos), antonia@ nut.uoa.gr (A. Trichopoulou). Journal of Psychiatric Research 43 (2009) 763–769 Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/jpsychires