The effects of dietary improvement on symptoms of depression and anxiety : a meta-analysis of randomized controlled trials

Objective: Poor diet can be detrimental to mental health. However, the overall evidence for the effects of dietary interventions on mood and mental well-being has yet to be assessed. We conducted a systematic review and meta-analysis examining effects of dietary interventions on symptoms of depression and anxiety. Method: Major electronic databases were searched through March 2018 for all randomized controlled trials (RCTs) of dietary interventions reporting changes in symptoms of depression and/or anxiety in clinical and non-clinical populations. Random-effects meta-analyses were conducted to determine effect sizes (Hedges’ g with 95% confidence intervals) for dietary interventions compared to control conditions. Potential sources of heterogeneity were explored using subgroups and meta-regression analyses. Results: Sixteen eligible RCTs with outcome data for 45,826 participants were included; the majority of which examined samples with non-clinical depression (N=15 studies). Nonetheless, dietary interventions significantly reduced depressive symptoms (g=0.275, 95% C.I.=0.10-0.45, p=0.002). Similar effects were observed among high-quality trials (g=0.321, 95% C.I.=0.12-0.53, p=0.002), and when compared to both inactive (g=0.308, 95% C.I.=0.02-0.60, p=0.038) and active controls (g=0.174, 95% C.I.=0.01-0.34, p=0.035). No effect of dietary interventions was observed for anxiety (k=11, n=2,270, g=0.100, 95% C.I.=-0.04-0.24, p=0.148). Studies with female samples observed significantly greater benefits from dietary interventions, for symptoms of both depression and anxiety. Conclusions: Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population. Future research is required to determine the specific components of dietary interventions that improve mental health, explore underlying mechanisms, and establish effective schemes for delivering these interventions in clinical and public health settings.