Seung Hyun Kim; Hyesook Kim; Seung Hee Park; Ji Yun Hwang; Hey Won Chung; Namsoo Chang

doi:10.4163/kjn.2012.45.3.229

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Kim, Kim, Park, Hwang, Chung, and Chang: Dietary intake, dietary habits, and depression in Korean women with polycystic ovary syndrome∗

Original Article

Korean J Nutr 2012;45(3):229-239.

Published online: 8 January 2012

DOI: https://doi.org/10.4163/kjn.2012.45.3.229

Dietary intake, dietary habits, and depression in Korean women with polycystic ovary syndrome^∗

Seung Hyun Kim^1∗∗,^∗, Hyesook Kim^1∗∗,^1∗∗, Seung Hee Park¹, Ji Yun Hwang², Hey Won Chung³, Namsoo Chang^1,^§

¹Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea

²Graduate School of Education, Sangmyung University, Seoul 110-743, Korea

³Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine, Seoul 158-710, Korea

^∗ This study was supported by a grant of the Korea Centers for Disease Control and Prevention (2010-1101-1-1) and BK21 project in 2011.

^§To whom correspondence should be addressed. E-mail: nschang@ewha.ac.kr

^∗ These authors contributed equally to this work.

Revised 23 March 20122 May 2012 Accepted 16 May 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study was to investigate and examine the relationship between dietary habits, food intake patterns, and depression in Korean women with polycystic ovary syndrome (PCOS). The Center for Epidemiologic Studies Depression Scale Korean Version was used to determine whether a participant was depressed or not. The dietary habits were assessed by the Min-Dietary Assessment (MDA) method, and food intake data were collected by the 24-hour recall method on two non-consecutive days, at least 7 days apart, and the average of the two days was used to estimate the usual dietary intake. The total MDA scores of the Depression Group was significantly lower than that of the No-Depression Group (31.5 ± 6.4 vs 33.4 ± 6.0, p = 0.027). The intake of cereals/potatoes/sugar products, milk and milk products, plant protein, and calcium for the Depression Group were significantly lower compared to the No-Depression Group. The Depression Group had a significantly higher percentage of energy intakes from protein as well as the consumption of fish and shellfish compared to the No-Depression Group. There was a significant inverse relationship between milk and milk products consumption and the prevalence of depression [OR (95% CI) for the highest tertile compared to the lowest: 0.390 (0.177-0.857); p for trend = 0.016]. There were also significant positive relationships between the prevalence of depression and the consumption of the following: fish and shellfish [OR (95% CI) for the highest tertile compared to the lowest: 2.319 (1.128-4.770); p for trend = 0.009], animal protein (p for trend = 0.049), and the percentage of energy intakes from protein [OR (95% CI) for the highest tertile compared with the lowest: 2.546(1.156-5.609); p for trend = 0.025]. Further studies are needed in order to investigate whether the intake of protein and of animal protein is indeed associated with depression in PCOS patients in Korea and the possible mechanisms thereof. The results of our study can be applicable for the development of effective nutrition counseling and education programs regarding PCOS patients with depression as part of their successful treatment regimen.

Keywords: PCOS, depression, dietary intake, dietary habits

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Table 1.

General characteristics of the subjects by depression ¹⁾

	All (n = 475)	Non-depressed group (n = 424)	Depressed group (n = 51)	p-value²⁾
Age (year)	23.4 ± 4.7¹⁾	23.6 ± 4.7	22.3 ± 3.9	0.067
16-19	95 (20.0)	81 (19.1)	14 (27.5)	0.168
20-29	334 (70.3)	299 (70.5)	35 (68.6)
30-39	46 (9.7)	44 (10.4)	2 (3.9)
Height (cm)	161.1 ± 5.2	161.0 ± 5.1	161.9 ± 6.0	0.263
Weight (kg)	55.5 ± 9.5	55.6 ± 9.7	54.0 ± 8.3	0.253
BMI (kg/m²)	21.4 ± 3.9	21.5 ± 3.9	20.7 ± 3.6	0.159
＜ 23	358 (75.4)	315 (74.3)	43 (84.3)	0.125
≥ 23	117 (24.6)	109 (25.7)	8 (15.7)
Occupation
High school student	48 (10.1)	42 (9.9)	6 (11.8)	-³⁾
College or graduate stuudent	258 (54.3)	228 (53.8)	30 (58.8)
Employed	134 (28.2)	123 (29.0)	11 (21.6)
Others	24 (5.1)	20 (4.7)	4 (7.8)
CES-D score	8.8 ± 8.6	6.3 ± 4.3	29.7 ± 7.4	＜ 0.001^∗∗∗

¹⁾ Values are mean ± S.D or number (%)

²⁾ From chi-square tests for categorical variables and Student’s t test for continuous variables

³⁾ Statistical tests to examine differences were not conducted (Expected frequency ＜ 5) ∗: p ＜ 0.05, ∗∗: p ＜ 0.01

^∗∗∗ p ＜ 0.001

Table 2.

Mini Dietary Assessment (MDA) scores ¹⁾of subjects by depression ²⁾

Component of MDA		All (n = 475)	Non-depressed group (n = 424)	Depressed group (n = 51)	p-value ³⁾
I drink 1 or more bottles of milk or its ro ducts (yogurt, Yoplait, etc.) daily	Always	136 (28.6)	120 (28.3)	16 (31.4)	0.722
	Usually	137 (28.8)	121 (28.5)	16 (31.4)
	Seldom	202 (42.5)	183 (43.2)	19 (37.3)
For each meal, I consume foods made up of a combination of meat, fish, egggs, beans, tofu,etc	Always	79 (16.7)	68 (16.1)	11 (21.6)
	Usually	191 (40.4)	171 (40.5)	20 (39.2)	0.603
	Seldom	203 (42.9)	183 (43.4)	20 (39.2)
For each meal, I consume vegetables other than Kimchi	Always	99 (21.0)	94 (22.3)	5 ( 9.8)
	Usually	224 (47.5)	202 (48.0)	22(43.1)	0.019^∗
	Seldom	149 (31.6)	125 (29.7)	24 (47.1)
I consume at least 1 fruit or fruit juice (1 glass) daily	Always	145 (30.7)	134 (31.8)	11 (21.6)
	Usually	163 (34.5)	147 (34.8)	16 (31.4)	0.127
	Seldom	165 (34.9)	141 (33.4)	24 (47.1)
I consume fried or stir-fried foods at least 2 times per week	Always	30 ( 6.4)	26 ( 6.2)	4 ( 7.8)
	Usually	195 (41.6)	172 (41.1)	23 (45.1)	0.730
	Seldom	244 (52.0)	220 (52.6)	24 (47.1)
I consume high fat content eats (bacon, ribs, eel, etc.) at least 2 times per week	Always	22 ( 4.6)	18 ( 4.3)	4 ( 7.8)
	Usually	124 (26.2)	107 (25.3)	17 (33.3)	0.194
	Seldom	328 (69.2)	298 (70.4)	30 (58.8)
I tent to add extra salt or soy sauce while taking my meal	Always	11 ( 2.3)	11 ( 2.6)	-
	Usually	105 (22.2)	92 (21.9)	13 (25.5)	- ⁴⁾
	Seldom	356 (75.4)	318 (75.5)	38 (74.5)
I have three regular meals a day	Always	81 (17.1)	74 (17.5)	7 (13.7)
	Usually	153 (32.3)	141 (33.4)	12 (23.5)	0.178
	Seldom	239 (50.5)	207 (49.1)	32 (62.7)
I consume ice cream, cake, biscuit varieties, carbonated beverages, etc. as snack at least 2 times per week	Always	23 ( 4.9)	18 ( 4.3)	5 ( 9.8)
	Usually	130 (27.4)	111 (26.2)	19 (37.3)	0.034^∗
	Seldom	321 (67.7)	294 (69.5)	27 (52.9)
I tend to consume a wide range of foods evenly (I have a balanced diet)	Always	142 (30.0)	126 (29.8)	16 (31.4)
	Usually	228 (48.1)	209 (49.4)	19 (37.3)	0.153
	Seldom	104 (21.9)	88 (20.8)	16 (31.4)
Total score of MDA		33.2 ± 6.0 ⁵⁾	33.4 ± 6.0	31.5 ± 6.4	0.032 ⁶⁾^∗
					0.027 ⁷⁾^∗

¹⁾ Minimum andmaximum scores for each component are 1 and 5. The total score can be up to 50

²⁾ Values are number (%)

³⁾ From chi-square tests

⁴⁾ Statistical tests to examine differences were not conducted (Expected frequency < 5)

⁵⁾ Values are mean ± S.D

⁶⁾ From Student’s t test.

⁷⁾ From GLM including age and BMI as covariates

^∗ p ＜ 0.05, ∗∗: p ＜ 0.01, ∗∗∗: p ＜ 0.001

Table 3.

Odds ratio (OR) and 95% confidence interval (CI) of depression according to food group intake ¹⁾

Food group (g)	1	2	3	p for trend²⁾
Cereals/potatoes/sugar products
Intake	＜ 226.7	226.7-308.4	＞ 308.4
No. of depression/control	24/134	12/147	15/143
Multivariate OR (95% CI)³⁾	1.000	0.424 (0.202-0.887)	0.548 (0.273-1.099)	0.091
Vegetables/seaweeds/mushrooms
Intake	＜ 136.3	136.3-215.9	＞ 215.9
No. of depression/control	19/139	20/139	12/146
Multivariate OR (95% CI)	1.000	1.124 (0.571-2.214)	0.672 (0.311-1.452)	0.281
Fruits
Intake	＜ 50.0	50.0-150.0	＞ 150.0
No. of depression/control	20/116	15/172	16/136
Multivariate OR (95% CI)	1.000	0.533 (0.260-1.091)	0.716 (0.353-1.455)	0.383
Beans/nuts/seeds
Intake	＜ 6.9	6.9-26.5	＞ 26.5
No. of depression/control	18/140	17/143	16/141
Multivariate OR (95% CI)	1.000	1.037 (0.509-2.114)	0.921 (0.450-1.888)	0.773
Oil and fat
Intake	＜ 5.6	5.6-9.3	＞ 9.3
No. of depression/control	15/142	20/143	16/139
Multivariate OR (95% CI)	1.000	1.395 (0.683-2.849)	1.132 (0.536-2.390)	0.816
Meats and meat products
Intake	＜ 33.0	33.0-74.0	＞ 74.0
No. of depression/control	16/135	16/151	19/138
Multivariate OR (95% CI)	1.000	0.806 (0.385-1.687)	1.084 (0.532-2.211)	0.717
Fishes and shellfish
Intake	＜ 15.9	15.9-45.0	＞ 45.0
No. of depression/control	13/144	13/149	25/131
Multivariate OR (95% CI)	1.000	0.986 (0.440-2.210)	2.319 (1.128-4.770)	0.009^∗
Eggs and egg products
Intake	＜ 9.9	9.9-30.0	＞ 30.0
No. of depression/control	15/143	18/146	18/135
Multivariate OR (95% CI)	1.000	1.259 (0.607-2.612)	1.321 (0.636-2.742)	0.481
Milk and milk products
Intake	＜ 50.0	50.0-155.9	＞ 155.9
No. of depression/control	22/128	19/148	10/148
Multivariate OR (95% CI)	1.000	0.740 (0.381-1.438)	0.390 (0.177-0.857)	0.016^∗
Total food intakes
Intake	＜ 872.8	872.8-1104.7	＞ 1104.7
No. of depression/control	19/139	15/144	17/141
Multivariate OR (95% CI)	1.000	0.813 (0.395-1.674)	1.025 (0.503-2.092)	0.996

¹⁾ All analyses were divided into tertiles

²⁾ Significantly different from the lowest tertile

³⁾ Adjusted for age and BMI

^∗ p ＜ 0.05, ∗∗: p ＜ 0.01, ∗∗∗: p ＜ 0.001

Table 4.

Odds ratio (OR) and 95% confidence interval (CI) of depression according to nutrient intake ¹⁾

	1	2	3	p for trend ²⁾
Energy (kcal)
Intake	＜ 1286.2	1286.2-1628.1	＞ 1628.1
No. of depression/control	21/137	15/144	15/143
Multivariate OR (95% CI)³⁾	1.000	0.619 (0.304-1.260)	0.671 (0.330-1.365)	0.250
Total protein (g)
Intake	＜ 44.4	44.4-59.8	＞ 59.8
No. of depression/control	16/142	14/144	21/138
Multivariate OR (95% CI)	1.000	0.799 (0.373-1.710)	1.336 (0.666-2.681)	0.366
Animal protein (g)
Intake	＜ 20.8	20.8-31.0	＞ 31.0
No. of depression/control	12/146	16/144	23/134
Multivariate OR (95% CI) ³⁾	1.000	1.273 (0.579-2.800)	2.046 (0.975-4.295)	0.049^∗
Plant protein (g)
Intake	＜ 21.2	21.2-28.4	＞ 28.4
No. of depression/control	22/137	15/142	14/145
Multivariate OR (95% CI)	1.000	0.685 (0.340-1.383)	0.615 (0.301-1.257)	0.185
Fat (g)
Intake	＜ 35.2	35.2-49.5	＞ 49.5
No. of depression/control	21/137	15/143	15/144
Multivariate OR (95% CI)	1.000	0.660 (0.325-1.342)	0.662 (0.325-1.346)	0.242
Carbohydrate (g)
Intake	＜ 184.7	184.7-233.8	＞ 233.8
No. of depression/control	23/135	13/146	15/143
Multivariate OR (95% CI)	1.000	0.542 (0.262-1.119)	0.610 (0.304-1.227)	0.167
Calcium (mg)
Intake	＜ 318.7	318.7-468.7	＞ 468.7
No. of depression/control	21/137	18/141	12/146
Multivariate OR (95% CI)	1.000	0.884 (0.448-1.744)	0.563 (0.266-1.195)	0.119
Iron (mg)
Intake	＜ 7.9	7.9-10.6	＞ 10.6
No. of depression/control	20/138	17/145	14/141
Multivariate OR (95% CI)	1.000	0.829 (0.415-1.655)	0.706 (0.341-1.460)	0.348
Zinc (mg)
Intake	＜ 6.0	6.0-7.7	＞ 7.7
No. of depression/control	18/143	18/140	15/141
Multivariate OR (95% CI)	1.000	0.988 (0.491-1.988)	0.862 (0.416-1.787)	0.653
Vitamin A (mg RE)
Intake	＜ 376.5	376.5-597.3	＞ 597.3
No. of depression/control	23/135	14/145	14/144
Multivariate OR (95% CI)	1.000	0.605 (0.297-1.232)	0.620 (0.304-1.263)	0.206
Vitamin B₁ (mg)
Intake	＜ 0.8	0.8-1.1	＞ 1.1
No. of depression/control	24/139	14/153	13/132
Multivariate OR (95% CI)	1.000	0.509 (0.252-1.029)	0.560 (0.272-1.151)	0.109
Vitamin B₂ (mg)
Intake	＜ 0.8	0.8-1.1	＞ 1.1
No. of depression/control	22/166	13/134	16/124
Multivariate OR (95% CI)	1.000	0.748 (0.362-1.547)	1.014 (0.509-2.022)	0.622
Vitamin B₆ (mg)
Intake	＜ 1.2	1.2-1.7	＞ 1.7
No. of depression/control	15/130	23/158	13/136
Multivariate OR (95% CI)	1.000	1.276 (0.636-2.557)	0.882 (0.402-1.938)	0.691
Niacin (mg)
Intake	＜ 9.1	9.1-12.8	＞ 12.8
No. of depression/control	17/140	19/141	15/143
Multivariate OR (95% CI)	1.000	1.066 (0.529-2.145)	0.874 (0.417-1.828)	0.712
Vitamin C (mg)
Intake	＜ 50.2	50.2-89.9	＞ 89.9
No. of depression/control	21/137	15/144	15/143
Multivariate OR (95% CI)	1.000	0.728 (0.358-1.480)	0.728 (0.359-1.479)	0.403
Folate (μgDFE)
Intake	＜ 227.3	227.3-311.2	＞ 311.2
No. of depression/control	20/138	19/140	12/146
Multivariate OR (95% CI)	1.000	0.993 (0.504-1.956)	0.598 (0.280-1.277)	0.191
Vitamin E (mgα-TE)
Intake	＜ 10.1	10.1-15.2	＞ 15.2
No. of depression/control	18/139	15/145	18/140
Multivariate OR (95% CI)	1.000	0.818 (0.395-1.694)	0.997 (0.495-2.008)	0.963
Energy distribution
% Carbohydrate
Intake	＜ 56.0	56.0-62.0	＞ 62.0
No. of depression/control	23/134	11/153	17/137
Multivariate OR (95% CI)	1.000	0.437 (0.205-0.368)	0.724 (0.368-1.421)	0.303
% Protein
Intake	＜ 13.4	13.4-15.4	＞ 15.4
No. of depression/control	10/153	19/134	22/137
Multivariate OR (95% CI)	1.000	2.058 (0.921-4.601)	2.546 (1.156-5.609)	0.025^∗
% Fat
Intake	＜ 24.0	24.0-28.8	＞ 28.8
No. of depression/control	15/144	16/141	20/139
Multivariate OR (95% CI)	1.000	1.090 (0.516-2.300)	1.389 (0.680-2.836)	0.381

¹⁾ All analyses were divided into tertiles

²⁾ Significantly different from the lowest tertile

³⁾ Adjusted for age and BMI

^∗ p ＜ 0.05, ∗∗: p ＜ 0.01, ∗∗∗: p ＜ 0.001

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