Association between meatless diet and depressive episodes: A cross-sectional analysis of baseline data from the longitudinal study of adult health (ELSA-Brasil)

Background: The association between vegetarianism and depression is still unclear. We aimed to investigate the association between a meatless diet and the presence of depressive episodes among adults.Methods: A cross-sectional analysis was performed with baseline data from the ELSA-Brasil cohort, which included 14,216 Brazilians aged 35 to 74 years. A meatless diet was defined from in a validated food frequency questionnaire. The Clinical Interview Schedule-Revised (CIS-R) instrument was used to assess depressive epi-sodes. The association between meatless diet and presence of depressive episodes was expressed as a prevalence ratio (PR), determined by Poisson regression adjusted for potentially confounding and/or mediating variables: sociodemographic parameters, smoking, alcohol intake, physical activity, several clinical variables, self-assessed health status, body mass index, micronutrient intake, protein, food processing level, daily energy intake, and changes in diet in the preceding 6 months.Results: We found a positive association between the prevalence of depressive episodes and a meatless diet. Meat non-consumers experienced approximately twice the frequency of depressive episodes of meat consumers, PRs ranging from 2.05 (95%CI 1.00-4.18) in the crude model to 2.37 (95%CI 1.24-4.51) in the fully adjusted model. Limitations. The cross-sectional design precluded the investigation of causal relationships.Conclusions: Depressive episodes are more prevalent in individuals who do not eat meat, independently of so-cioeconomic and lifestyle factors. Nutrient deficiencies do not explain this association. The nature of the asso-ciation remains unclear, and longitudinal data are needed to clarify causal relationship.