Influence of Dietary Habits on Depression Among Patients With Rheumatoid Arthritis: A Cross-Sectional Study Using KURAMA Cohort Database

Abstract BackgroundAlthough depression is one of the most common comorbidities of rheumatoid arthritis (RA) and is known as a critical influence on RA remission rates, there is little knowledge regarding a possible therapeutic strategy for depression in a RA population. Most recently, clinical evidence of dietary improvement for depression has emerged in a general population, but the relationship between dietary habits and depression has not been investigated in RA. The purpose of this study is to elucidate clinical associations between depression, dietary habits and disease activity/physical function in patients with RA.MethodsA cross-sectional study was performed with 267 female outpatients from the KURAMA database. Using the Hospital Anxiety and Depression Scale (HADS), we classified the participants into three groups by depression state, and their characteristics were compared. Using the 20-items on the self-reported food frequency questionnaire, we investigated the relationship between dietary habits and depression or anxiety, adopting a trend test and a multivariate standardized linear regression analysis for the HADS score as a dependent variable.ResultsClassification of the depressive state revealed that current disease activity and physical dysfunction (28-Joint RA Disease Activity Score-C-reactive protein (DAS28-CRP) as well as the health assessment questionnaire disability Index (HAQ)) were significantly increased according to the stage of depression. Trend analysis identified three of 20 foods, i.e., fish, vegetables and fruit, the consumption of which was inversely associated with the depression score. Furthermore, multiple linear regression analysis revealed that the depression score was negatively associated with frequent fish intake (> 3 times per week) (Estimate -0.53, p = 0.033) as well as remission of HAQ (Estimate -0.88, p ≤ 0.001). For the anxiety score, none of the dietary habits showed any correlation in the multiple regression analysis.ConclusionDepression state assessed by HADS score was significantly and independently associated with both fish intake frequency and remission of physical dysfunction in an RA population. Modification of dietary habits, such as that by increased fish consumption, may have a beneficial effect on the depression state in RA patients.