Is sweets consumption associated with depression? A cross-sectional study with 54,170 Brazilian adults and older adultsAbstract
The objective is to analyze the association between depression and sweets consumption. Cross-sectional study carried out with data from VIGITEL (Brasil 2021). Surveillance of Risk Factors for Chronic Diseases by telephone survey, a system for monitoring the frequency and distribution of risk factors and protection against chronic non-communicable diseases (NCDs) in Brazilian adults ≥18 years. Crude Poisson regression, adjusted for sociodemographic and behavioral covariates, was used to verify the association between depression and sweets consumption. The total sample included 54.170 Brazilian adults. The consumption of sweets was reported by 25.6% and the diagnosis of depression by 11%. Consumption of sweets was associated with a statistically significant protection of 8% for the diagnosis of depression (95%CI 0.85-0.98). This finding can be seen as positive, as it encompasses a widely adopted, non-drug behavior. However, a warning should be raised about the harm caused by the exaggerated consumption of sweets.
Key words
Depression; Sweets; Chocolate; Adults
INTRODUCTION
Depression is currently considered one of the biggest causes of disability in the world, affecting more than 300 million people (World Health Organization 2017). This disorder is characterized by a sad or empty mood and anhedonia, lasting at least two weeks, accompanied by somatic and cognitive alterations, significantly affecting the individual’s functioning (American Psychiatric Association 2023). For more than 30 years, the treatment of depression has been significantly based on psychotropic drugs that retain serotonin in the interneuronal synaptic cleft, one of the most reduced neurotransmitters in the disorder. These drugs are only partially effective, or ineffective, in two-thirds of individuals (Spellman & Liston 2020).
Depression is a multifactorial disorder, where the inflammatory state, oxidative stress, mitochondrial dysfunction, neurogenesis, and dysfunctions in the hypothalamic-pituitary-adrenal axis are potential parallel conditions associated with the disorder; it is believed that these factors have the diet in common (Marx et al. 2021).
The relationship between chocolate consumption and the reduction of depressive symptoms is supported in the literature because cocoa extract contributes to increased homovanillic acid (HVA) concentrations in plasma, considering that this is a metabolite of the neurotransmitter dopamine (Ibero-Baraibar et al. 2015). In the same sense, another explanation for this relationship would be due to the decrease in cortisol, a hormone associated with stress and depressive symptoms that can occur due to chocolate consumption (Tsang et al. 2019). However, this relationship is not completely clear in the existing literature, therefore, the object of this study was the investigation of the association between the consumption of sweets and the diagnosis of depression.
MATERIALS AND METHODS
This is a cross-sectional study, carried out with data from Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey - VIGITEL 2021 (Brasil 2021). This epidemiological surveillance program is part of actions by the Brazilian Ministry of Health in partnership with the State and Municipal Health Secretariats to monitor risk and protection factors for CNCDs. Approval was received from the National Commission of Ethics in Research in Human Beings (CONEP) under nº CAAE: 65610017.1.0000.0008 (Brasil 2021).
VIGITEL has been carried out annually since 2006 by telephone surveys in the country’s capitals and the federal district with the adult population (≥18 years old) of Brazilians, living in households with fixed telephone lines. The sampling process is probabilistic, through a systematic draw of five thousand telephone lines per city, followed by another draw of 25 subsamples of 200 lines, where a resident is interviewed. Free and informed consent is obtained verbally during the telephone interview with the participants (Brasil 2021).
The VIGITEL methodology has remained similar since its inception, however, in 2020 and 2021, a minimum sample size of one thousand individuals was established in each city. Differences in the distribution of interviews in the year 2021 were also observed, which were justified by seasonal variations or by the event of the COVID-19 pandemic. In 2021, for the first time, VIGITEL included the diagnosis of depression in the survey and, therefore, the other surveys were not considered in this study (Brasil 2021).
The outcome considered individuals who answered “yes” to the following question: “Has any doctor ever told you that you have depression?”, which could have been diagnosed at any time in life. The exposure considered individuals who answered “yes” to the question: “I would like you to tell me if you ate any of these yesterday (from when you woke up until when you went to sleep): chocolate, ice cream, gelatin, flan, or other industrialized dessert”.
Sociodemographic covariates were: age (18-39; 40-59; or ≥60 years); sex (female or male); skin color (white; black; yellow or indigenous); schooling in completed years (0-8; 9-11; or ≥12); marital status (single; in a stable relationship >6 months; separated or divorced; legally married; or widowed; living alone (yes or no); and region of residence (North, Northeast, Midwest, Southeast or South).
The behavioral covariates, operationalized into yes and no, were: being a current smoker (regardless of quantity); excessive alcohol consumption in the previous 30 days, considering the amount of five or more drinks per occasion for men and four or more for women. Those who had not practiced any physical activity in their free time in the previous three months, did not perform intense physical efforts at work, did not go to work or course/school other than walking or cycling for at least 20 minutes, or who did not perform heavy housework at home were classified as physically inactive.
For the statistical analysis, STATA 15.1 software was used. The sample was characterized with their respective weighted absolute and relative frequencies. To estimate the prevalence ratios, a crude Poisson regression was performed and adjusted for confounding variables of sex, age, color, years of schooling, marital status, living alone, region, smoking, alcohol consumption, ultra-processed foods consumption, and physical inactivity. A significance level of p<0.05 was adopted.
RESULTS
Descriptive data, shown in Table I, demonstrate a higher proportion of females (54%), aged between 18 and 39 years (46.9%), with black ethnicity (55.2%). About 33% had 12 or more years of schooling, 44.7% were single, 96.7% lived with someone else, 44.4% lived in the Southeast region, 9.3% were smokers, 19.6% consumed alcohol abusively (80%), and 84.6% were physically inactive. The prevalence of depression was 11% (95%CI 9.7-12.4) and the consumption of sweets 25.6% (95%CI 23.3-28.6).
Sample characterization (n = 54,170). Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) (Brasil 2021).
Table II shows, based on the crude data analysis, that there is no association between the consumption of sweets and the diagnosis of depression (PR= 1.01; 95%CI 0.93-1.10), however, when adjusting for confounding variables (sex, age, color, years of schooling, marital status, living alone, region, smoker, and physical inactivity) the consumption of sweets was statistically associated with an 8% protection for the diagnosis of depression (PR= 0.92; 95%CI 0.85-0.98).
Crude and adjusted Poisson regression of the association between depression and sweets consumption (n = 50,489).
DISCUSSION
Our findings indicate that the consumption of chocolate, ice cream, gelatin, flan, or other industrialized desserts was a protective factor for the diagnosis of depression. In the same direction, a cross-sectional study with 13,626 adults showed a 70% lower chance of depressive symptoms for individuals who consumed dark chocolate daily compared to those who did not (95%CI 0.21-0.72) (Jackson et al. 2019). This finding is corroborated by a systematic review that evidences the long-term ingestion of flavanol, a component of chocolate, as a neuroprotector and promoter of several benefits to mental health (Scholey & Owen 2013).
These associations can be understood through psychological mechanisms, as suggested by (Privitera et al. 2018), that the visualization of sugary foods is able to modulate mood, so that participants exposed to images presented better mood compared to those exposed to other foods. The way food is consumed also seems to affect mood, as shown by (Meier et al. 2017), who revealed that the ingestion of cookies and chocolates with attention (“mindful”), improves mood, compared to those who ate in a non-attentive way.
In physiological aspects, sugar consumption also activates the brain’s reward system, by cortical modulation activated by lingual taste receptors. These electrical and chemical signals are related to sensations of pleasure and satisfaction, in addition to creating stimuli for future consumption of these foods (Murray et al. 2014, Tulloch et al. 2015). However, the consumption of sweets, especially chocolate, and its direct relationship with depression is uncertain, since other longitudinal studies did not find an association between these factors (Balboa-Castillo et al. 2015, Vermeulen et al. 2018).
The current study has limitations, initially, due to self-reported data, as well as the existence of different foods in the question asked, expanding its spectrum. The diagnosis of depression also represents a limitation, as the questionnaire does not determine the time of its occurrence, therefore, being subject to reverse causality bias. However, the article has positive points, such as the analysis of a representative sample of Brazilian adults and the use of a questionnaire which asks about the consumption of sweets on the day before the interview, reducing the recall bias.
This article aims to promote a discussion about the association between sweets consumption and depression. The consumption of sweets as a protective association for the diagnosis of depression is a relevant finding, due to the harmful impact of this disorder. It should be noted that the inadvertent consumption of sweets is not recommended due to adverse effects. Finally, it is essential that follow-up studies be carried out to understand the relationships between these variables.
Acknowledgements
The authors thank the Federal University of Rio Grande (FURG) for institutional support and the Anais da Academia Brasileira de Ciências for the opportunity to publish this work.
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