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한국 성인의 수산물 섭취와 우울증과의 상관성 연구: 2014-2020년도 국민건강영양조사 자료를 이용하여

Association between seafood intake and depression in Korean adults: analysis of data from the 2014-2020 Korea National Health and Nutrition Examination Survey

  • 신혜민 (이화여자대학교 임상바이오헬스대학원 임상영양학전공) ;
  • 장원 (이화여자대학교 식품영양학과) ;
  • 김양하 (이화여자대학교 식품영양학과)
  • Hyemin Shin (Department of Clinical Nutrition, Ewha Graduate School of Converging Clinical & Public Health) ;
  • Won Jang (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Yangha Kim (Department of Nutritional Science and Food Management, Ewha Womans University)
  • 투고 : 2023.10.10
  • 심사 : 2023.12.06
  • 발행 : 2023.12.31

초록

우울증은 흔한 정신질환으로 개인의 기능적 능력과 삶의 질에 대한 영향 이외에도, 자살, 심혈관 질환, 기타 질병, 모든 원인에 의한 사망 등에 주요한 영향을 미친다. 본 연구는 한국 성인의 수산물 섭취가 우울증과 관련성이 있는지를 알아보고자 수행하였다. 본 연구는 2014, 2016, 2018, 2020년도 국민건강영양조사에 참여한 18,149명 (남성 7,541명, 여성 10,608명)을 대상으로 하였다. 우울증 판정 기준은 PHQ-9 설문조사 결과가 10점 이상인 경우와 의사 진단을 받고 현재 유병상태인 경우 우울증으로 분류하였다. 대상자의식이섭취는 1일간의 24시간회 상법 자료를 이용하여 분석하였다. 수산물 섭취 3분위에 따른 영양소 및 식품섭취를 살펴본 결과 남녀 모두 수산물 섭취가 높을수록 EPA, DHA 등 오메가-3계 지방산 및 단백질, 식이섬유의 영양밀도가 높았고 과일, 채소의 섭취량이 유의하게 높아지는 반면 육류섭취는 적었다. 수산물 섭취에 따른 우울증과의 연관성은 남성에게서는 하위1분위군보다 상위3분위군에서 우울증 위험도 교차비가 0.706 (95% CI, 0.505-0.987)으로 유의적으로 낮았다 (p = 0.020). 여성의 수산물섭취에 따른 우울증 위험도는 하위1분위군보다 상위3분위군에서 교차비가 0.734 (95% CI, 0.593-0.908)로 유의적으로 낮았다 (p = 0.004). 결론적으로 본 연구에서는 남성과 여성 모두 수산물 섭취가 낮은 우울증 위험도와 관련성이 있음을 제시하였다.

Purpose: Depression is a prevalent mental health concern globally including South Korea. Given the growing interest in the relationship between diet and mental health, this study aimed to investigate the association between seafood consumption and depression among Korean adults. Methods: A cross-sectional analysis was conducted using data from the Korea National Health and Nutrition Examination Survey (KNHANES, 2014-2020). The study included 18,149 participants (7,541 men and 10,608 women) aged 19 years and older who completed the Patient Health Questionnaire (PHQ-9). Seafood intake levels were assessed using a oneday 24-hour dietary recall, and participants were categorized into three tertiles by gender. Depression status was determined using the PHQ-9 scores and the self-report of the doctor's diagnosis and treatment. Multivariable logistic regression analysis was performed to assess the association between seafood consumption and depression in both genders. Results: Participants with a higher seafood intake had a significantly lower nutritional density of total fat, while the nutritional density of omega-3 polyunsaturated fatty acids was significantly higher. The prevalence of depression was significantly lower in the highest tertile of seafood consumption compared to the lowest tertile in both men (p < 0.001) and women (p < 0.001). After adjusting for confounding factors, the highest tertile of seafood consumption demonstrated a decreased risk of depression compared to the lowest tertile in men (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.51-0.99; p-trend = 0.020) and women (OR, 0.73; 95% CI, 0.59-0.91; p-trend = 0.004). Conclusion: The findings of this study suggest that consuming seafood rich in omega-3 fatty acids may potentially reduce the risk of depression in the adult population.

키워드

과제정보

This research was supported by Academicresearch Cooperation Program of the Korea Maritime Institute (KMI) (No. 2023-0062-1002).

참고문헌

  1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197-2223.  https://doi.org/10.1016/S0140-6736(12)61690-0
  2. Institute for Health Metrics and Evaluation. Global health data exchange (GHDx) [Internet]. Seattle (WA): Institute for Health Metrics and Evaluation; c2023 [cited 2023 May 19]. Available from: https://vizhub. healthdata.org/gbd-results/.
  3. Mykletun A, Bjerkeset O, Overland S, Prince M, Dewey M, Stewart R. Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry 2009; 195(2): 118-125.  https://doi.org/10.1192/bjp.bp.108.054866
  4. Sarris J, Logan AC, Akbaraly TN, Paul Amminger G, Balanza-Martinez V, Freeman MP, et al. International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry. World Psychiatry 2015; 14(3): 370-371. https://doi.org/10.1002/wps.20223
  5. Wysoczanski T, Sokola-Wysoczanska E, Pekala J, Lochynski S, Czyz K, Bodkowski R, et al. Omega-3 fatty acids and their role in central nervous system - a review. Curr Med Chem 2016; 23(8): 816-831.  https://doi.org/10.2174/0929867323666160122114439
  6. Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry 2012; 73(1): 81-86.  https://doi.org/10.4088/JCP.10r06710
  7. Chen AT, Chibnall JT, Nasrallah HA. A meta-analysis of placebo-controlled trials of omega-3 fatty acid augmentation in schizophrenia: possible stage-specific effects. Ann Clin Psychiatry 2015;27(4): 289-296. 
  8. Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr 2010; 91(3): 757-770.  https://doi.org/10.3945/ajcn.2009.28313
  9. Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhe HG, Schene AH. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry 2016; 6(3): e756. 
  10. Sanchez-Villegas A, Alvarez-Perez J, Toledo E, Salas-Salvado J, Ortega-Azorin C, Zomeno MD, et al. Seafood consumption, omega-3 fatty acids intake, and life-time prevalence of depression in the PREDIMED-Plus trial. Nutrients 2018; 10(12): 2000. 
  11. Grosso G, Micek A, Marventano S, Castellano S, Mistretta A, Pajak A, et al. Dietary n-3 PUFA, fish consumption and depression: a systematic review and meta-analysis of observational studies. J Affect Disord 2016; 205: 269-281.  https://doi.org/10.1016/j.jad.2016.08.011
  12. Yang Y, Je Y. Fish consumption and depression in Korean adults: the Korea National Health and Nutrition Examination Survey, 2013-2015. Eur J Clin Nutr 2018; 72(8): 1142-1149.  https://doi.org/10.1038/s41430-017-0083-9
  13. Matsuoka YJ, Sawada N, Mimura M, Shikimoto R, Nozaki S, Hamazaki K, et al. Dietary fish, n-3 polyunsaturated fatty acid consumption, and depression risk in Japan: a population-based prospective cohort study. Transl Psychiatry 2017; 7(9): e1242. 
  14. Wu D, Feng L, Gao Q, Li JL, Rajendran KS, Wong JC, et al. Association between fish intake and depressive symptoms among community-living older Chinese adults in Singapore: a cross-sectional study. J Nutr Health Aging 2016; 20(4): 404-407.  https://doi.org/10.1007/s12603-015-0590-0
  15. Li F, Liu X, Zhang D. Fish consumption and risk of depression: a meta-analysis. J Epidemiol Community Health 2016; 70(3): 299-304.  https://doi.org/10.1136/jech-2015-206278
  16. Schmid M, Kraft LG, van der Loos LM, Kraft GT, Virtue P, Nichols PD, et al. Southern Australian seaweeds: a promising resource for omega-3 fatty acids. Food Chem 2018; 265: 70-77.  https://doi.org/10.1016/j.foodchem.2018.05.060
  17. Guo F, Huang C, Cui Y, Momma H, Niu K, Nagatomi R. Dietary seaweed intake and depressive symptoms in Japanese adults: a prospective cohort study. Nutr J 2019; 18(1): 58. 
  18. Ministry of Health and Welfare, The Korean Nutrition Society. Application of dietary reference intakes for Koreans 2020. Sejong: Ministry of Health and Welfare; 2021.
  19. Yang S, Jang W, Kim Y. Association between frailty and dietary intake amongst the Korean elderly: based on the 2018 Korean National Health and Nutrition Examination Survey. J Nutr Health 2021; 54(6): 631-643.  https://doi.org/10.4163/jnh.2021.54.6.631
  20. Spitzer RL, Kroenke K, Williams JB; Primary Care Evaluation of Mental Disorders. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282(18): 1737-1744.  https://doi.org/10.1001/jama.282.18.1737
  21. Sun Y, Fu Z, Bo Q, Mao Z, Ma X, Wang C. The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry 2020; 20(1): 474. 
  22. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9): 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  23. Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 2012; 184(3): E191-E196.  https://doi.org/10.1503/cmaj.110829
  24. Im MY. The effect of depression on metabolic syndrome and its components among Korean adults. Stress 2021; 29(4): 235-241.  https://doi.org/10.17547/kjsr.2021.29.4.235
  25. Kim E, Shin MH, Yang JH, Ahn SK, Na BJ, Nam HS. Associations of regional-level perceived stress and depression with health-related quality of life in Korean adults: a multilevel analysis of 2017 Korea Community Health Survey data. Epidemiol Health 2021; 43: e2021062. 
  26. Saghafian F, Malmir H, Saneei P, Milajerdi A, Larijani B, Esmaillzadeh A. Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and metaanalysis of epidemiological studies. Br J Nutr 2018; 119(10): 1087-1101.  https://doi.org/10.1017/S0007114518000697
  27. Matud MP. Gender differences in stress and coping styles. Pers Individ Dif 2004; 37(7): 1401-1415.  https://doi.org/10.1016/j.paid.2004.01.010
  28. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1789-1858.  https://doi.org/10.1016/S0140-6736(18)32279-7
  29. Deacon G, Kettle C, Hayes D, Dennis C, Tucci J. Omega 3 polyunsaturated fatty acids and the treatment of depression. Crit Rev Food Sci Nutr 2017; 57(1): 212-223.  https://doi.org/10.1080/10408398.2013.876959
  30. Jang W, Shin Y, Kim Y. Dietary pattern accompanied with a high food variety score is negatively associated with frailty in older adults. Nutrients 2021; 13(9): 3164. 
  31. Betteridge DJ. What is oxidative stress? Metabolism 2000; 49(2 Suppl 1): 3-8.  https://doi.org/10.1016/S0026-0495(00)80077-3
  32. Birben E, Sahiner UM, Sackesen C, Erzurum S, Kalayci O. Oxidative stress and antioxidant defense. World Allergy Organ J 2012; 5(1): 9-19.  https://doi.org/10.1097/WOX.0b013e3182439613
  33. Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol 2011; 25(3): 287-299.  https://doi.org/10.1016/j.bpobgyn.2010.10.016
  34. Kim JM, Stewart R, Kim SW, Yang SJ, Shin IS, Yoon JS. Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression. Br J Psychiatry 2008; 192(4): 268-274.  https://doi.org/10.1192/bjp.bp.107.039511
  35. Williams AL, Cotter A, Sabina A, Girard C, Goodman J, Katz DL. The role for vitamin B-6 as treatment for depression: a systematic review. Fam Pract 2005; 22(5): 532-537.  https://doi.org/10.1093/fampra/cmi040
  36. Rouhani MH, Salehi-Abargouei A, Surkan PJ, Azadbakht L. Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies. Obes Rev 2014; 15(9): 740-748.  https://doi.org/10.1111/obr.12172
  37. Pereira-Miranda E, Costa PR, Queiroz VA, Pereira-Santos M, Santana ML. Overweight and obesity associated with higher depression prevalence in adults: a systematic review and meta-analysis. J Am Coll Nutr 2017; 36(3): 223-233.  https://doi.org/10.1080/07315724.2016.1261053
  38. Abildgaard A, Solskov L, Volke V, Harvey BH, Lund S, Wegener G. A high-fat diet exacerbates depressive-like behavior in the Flinders Sensitive Line (FSL) rat, a genetic model of depression. Psychoneuroendocrinology 2011; 36(5): 623-633. https://doi.org/10.1016/j.psyneuen.2010.09.004