Abstract
OBJECTIVES: Epidemiological evidence of how midlife intake of fruits and vegetables affects the likelihood of depressive symptoms in late life remains limited and controversial. We examined this association in an Asian cohort. DESIGN: Prospective population-based cohort study. SETTING: Chinese living in Singapore. PARTICIPANTS: A total of 13,738 adults from the Singapore Chinese Health Study. MEASUREMENTS: The consumption of 14 fruits and 25 vegetables were assessed using a validated 165-item food-frequency questionnaire at baseline (1993-1998), when participants were aged 45-74 years (mean age 52.4 years). Depressive symptoms were evaluated using the Geriatric Depression Scale during the third follow-up interviews (2014-2016), when participants were aged 61-96 years (mean age 72.5 years), and depression was defined by ≥5 out of 15 scores. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: After a mean follow-up of 19.6 years, depressive symptoms were identified among 3,180 participants. Consumption of fruits was inversely associated with the odds of depressive symptoms in a dose-response manner: comparing extreme quartiles, the OR (95% CI) of depressive symptoms was 0.71 (0.63-0.81; P-trend <0.01). Intake of several types of fruits, especially orange, tangerine, banana, papaya and watermelon, was associated with reduced odds, and this inverse association was similar across subgroups of fruits categorized by glycemic index. Conversely, intake of vegetables was not associated with the odds of depressive symptoms. CONCLUSIONS: Our findings support population-based recommendation of having sufficient fruit intake early in life to reduce the likelihood of depressive symptoms in late life.