Journal List > Korean J Nutr > v.45(3) > 1043930

Korean J Nutr. 2012 Jun;45(3):229-239. Korean.
Published online June 28, 2012.
© 2012 The Korean Nutrition Society
Dietary intake, dietary habits, and depression in Korean women with polycystic ovary syndrome
Seung Hyun Kim,1,** Hyesook Kim,1,** Seung Hee Park,1 Ji Yun Hwang,2 Hey Won Chung,3 and Namsoo Chang1
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.

To whom correspondence should be addressed. (Email: )

**These authors contributed equally to this work.

Received March 23, 2012; Revised May 02, 2012; Accepted May 16, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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


Table 1
General characteristics of the subjects by depression1)
Click for larger image

Table 2
Mini Dietary Assessment (MDA) scores1)of subjects by depression2)
Click for larger image

Table 3
Odds ratio (OR) and 95% confidence interval (CI) of depression according to food group intake1)
Click for larger image

Table 4
Odds ratio (OR) and 95% confidence interval (CI) of depression according to nutrient intake1)
Click for larger image


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.

1. Byun EK, Kim HJ, Oh JY, Hong YS, Sung YA. The prevalence of polycystic ovary syndrome in college students from Seoul. J Korean Soc Endocrinol 2005;20(2):120–126.
2. Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F. European Depression in Diabetes (EDID) Research Consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010;53(12):2480–2486.
3. Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Läksy K, Joukamaa M. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond) 2006;30(3):520–527.
4. Ryu YJ, Chun EM, Lee JH, Chang JH. Prevalence of depression and anxiety in outpatients with chronic airway lung disease. Korean J Intern Med 2010;25(1):51–57.
5. Nolen-Hoeksema S. Gender differences in depression. Curr Dir Psychol Sci 2001;10(5):173–176.
6. Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007;87(6):1369–1376.
7. Himelein MJ, Thatcher SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006;11(4):613–625.
8. Diamanti-Kandarakis E. Insulin resistance in PCOS. Endocrine 2006;30(1):13–17.
9. Ramasubbu R. Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases. Med Hypotheses 2002;59(5):537–551.
10. Bonnet F, Irving K, Terra JL, Nony P, Berthezène F, Moulin P. Depressive symptoms are associated with unhealthy lifestyles in hypertensive patients with the metabolic syndrome. J Hypertens 2005;23(3):611–617.
11. Vaccarino V, McClure C, Johnson BD, Sheps DS, Bittner V, Rutledge T, Shaw LJ, Sopko G, Olson MB, Krantz DS, Parashar S, Marroquin OC, Merz CN. Depression, the metabolic syndrome and cardiovascular risk. Psychosom Med 2008;70(1):40–48.
12. Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med 2005;67 Suppl 1:S29–S33.
13. Tanskanen A, Hibbeln JR, Tuomilehto J, Uutela A, Haukkala A, Viinamäki H, Lehtonen J, Vartiainen E. Fish consumption and depressive symptoms in the general population in Finland. Psychiatr Serv 2001;52(4):529–531.
14. Tolmunen T, Voutilainen S, Hintikka J, Rissanen T, Tanskanen A, Viinamäki H, Kaplan GA, Salonen JT. Dietary folate and depressive symptoms are associated in middle-aged Finnish men. J Nutr 2003;133(10):3233–3236.
15. Suzuki S, Akechi T, Kobayashi M, Taniguchi K, Goto K, Sasaki S, Tsugane S, Nishiwaki Y, Miyaoka H, Uchitomi Y. Daily omega-3 fatty acid intake and depression in Japanese patients with newly diagnosed lung cancer. Br J Cancer 2004;90(4):787–793.
16. Hintikka J, Tolmunen T, Honkalampi K, Haatainen K, Koivumaa-Honkanen H, Tanskanen A, Viinamäki H. Daily tea drinking is associated with a low level of depressive symptoms in the Finnish general population. Eur J Epidemiol 2005;20(4):359–363.
17. Wolfe AR, Arroyo C, Tedders SH, Li Y, Dai Q, Zhang J. Dietary protein and protein-rich food in relation to severely depressed mood: A 10 year follow-up of a national cohort. Prog Neuropsychopharmacol Biol Psychiatry 2011;35(1):232–238.
18. Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora D, Wolf A. Food selection changes under stress. Physiol Behav 2006;87(4):789–793.
19. Cho MJ, Kim KH. Diagnostic validity of the CES-D (Korean version) in the assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc 1993;32(3):381–399.
20. Craig TJ, Van Natta PA. Current medication use and symptoms of depression in a general population. Am J Psychiatry 1978;135(9):1036–1039.
21. Kim WY, Cho MS, Lee HS. Development and validation of mini dietary assessment index for Koreans. Korean J Nutr 2003;36(1):83–92.
22. Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet Gynecol 1995;86(4 Pt 1):520–528.
23. Fernstrom JD, Wurtman RJ. Brain serotonin content: physiological regulation by plasma neutral amino acids. Science 1972;178(4059):414–416.
24. Wurtman RJ, Wurtman JJ, Regan MM, McDermott JM, Tsay RH, Breu JJ. Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. Am J Clin Nutr 2003;77(1):128–132.
25. Umegaki H, Iimuro S, Araki A, Sakurai T, Iguchi A, Yoshimura Y, Ohashi Y, Ito H. Association of higher carbohydrate intake with depressive mood in elderly diabetic women. Nutr Neurosci 2009;12(6):267–271.
26. Mozaffarian D, Cao H, King IB, Lemaitre RN, Song X, Siscovick DS, Hotamisligil GS. Trans-palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults: a cohort study. Ann Intern Med 2010;153(12):790–799.
27. Crichton GE, Murphy KJ, Bryan J. Dairy intake and cognitive health in middle-aged South Australians. Asia Pac J Clin Nutr 2010;19(2):161–171.
28. Chrysohoou C, Tsitsinakis G, Siassos G, Psaltopoulou T, Galiatsatos N, Metaxa V, Lazaros G, Miliou A, Giakoumi E, Mylonakis C, Zaromytidou M, Economou E, Triantafyllou G, Pitsavos C, Stefanadis C. Fish consumption moderates depressive symptomatology in elderly men and women from the IKARIA study. Cardiol Res Pract 2011;2011:219578.
29. Haag M. Essential fatty acids and the brain. Can J Psychiatry 2003;48(3):195–203.
30. Li Y, Dai Q, Ekperi LI, Dehal A, Zhang J. Fish consumption and severely depressed mood, findings from the first national nutrition follow-up study. Psychiatry Res 2011;190(1):103–109.
31. Suominen-Taipale AL, Partonen T, Turunen AW, Männistö S, Jula A, Verkasalo PK. Fish consumption and omega-3 polyunsaturated fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One 2010;5(5):e10530.
32. Rashidi B, Haghollahi F, Shariat M, Zayerii F. The effects of calcium-vitamin D and metformin on polycystic ovary syndrome: a pilot study. Taiwan J Obstet Gynecol 2009;48(2):142–147.
33. Park JY, You JS, Chang KJ. Dietary taurine intake, nutrients intake, dietary habits and life stress by depression in Korean female college students: a case-control study. J Biomed Sci 2010;17 Suppl 1:S40.
34. Aihara Y, Minai J, Aoyama A, Shimanouchi S. Depressive symptoms and past lifestyle among Japanese elderly people. Community Ment Health J 2011;47(2):186–193.
35. Lorant V, Croux C, Weich S, Deliège D, Mackenbach J, Ansseau M. Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry 2007;190:293–298.
36. Miyake Y, Tanaka K, Sasaki S, Hirota Y. Employment, income, and education and risk of postpartum depression: the Osaka Maternal and Child Health Study. J Affect Disord 2011;130(1-2):133–137.
37. Flensborg-Madsen T, von Scholten MB, Flachs EM, Mortensen EL, Prescott E, Tolstrup JS. Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study. J Psychiatr Res 2011;45(2):143–149.