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This study examined the
relationship between the intake of various FV and depression among apparently
healthy women. The results of this study suggest that a high intake of total
FV, total vegetables, total fruits, citrus and other fruits were independently
related to a lower OR of depression. In addition, green leafy vegetables were
directly and berries were inversely associated with depression, although a
distinct dose-response relationship was not found. Moreover, higher intake of
other vegetables was significantly associated with higher chance of depression.

Studies conducted to investigate
the relationship between specific subgroups of FV and depression are very limited and there is no study in
healthy adult population. Our
study provided evidence for benefits from consuming citrus, other fruits and to
a lesser extent for berries.

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findings are
consistent with the results of other studies, suggesting an inverse
relationship between FV consumption and depression. Cross-sectional studies 4-6 and some prospective cohort
studies 8,
9 have shown lower FV consumption was associated with the higher
risk of depression. In addition, the inverse relationship between depression and
fruits 9,
17, 18, 36 or vegetables 9,
15, 37, 38 separately has been indicated. A
meta-analysis study indicated that both fruits and vegetables intakes were
inversely related to the risk of depression 10. In subgroup analysis by study
design, higher fruits intake was associated to the lower risk of depression in
both cross-sectional and cohort studies. However, the association between
higher vegetable intake and lower risk of depression was found in just cohort
studies 11. Contrary to these studies, the
association between depression and FV intake or fruits and vegetables
separately was not shown in the other studies 4,
12-15, 17, 18, 30, 39, 40.

In some cross-sectional studies
in elderly subjects, there was an association between high consumption of green
leafy vegetables 16 tomato and tomato products 25 and
lower odds of depression. A case-control study which compared food groups
consumption between depressed and healthy women showed that subjects with more
intake of citrus, berries, melons, other fruits, green leafy vegetables, yellow
vegetables and other vegetables had a lower chance of depression 41 .Since
these are findings from a case-control study, the possibility that depression
may impact FV intake of subjects cannot be ruled out. In
addition, other dietary components have not been controlled.

Relevant data from clinical
trials are scarce. Dietary improvement including increasing fruits and
vegetables intake in patients with depression reduced the symptoms of
depression 42.
However, in some other studies higher intake of  FV 44, Concord grape juice 43 and blueberry juice 44 supplementation have not
improved depression.

the current study, we found an unexpected positive association between depression
and the intake of green leafy vegetables and other vegetables. We do not know
the reason for this direct relationship. However, this may
reflect the methods of these vegetables preparation such as frying which is
very common in the country. The association
between frequent fried food consumption and lower resilience to depression has
been reported 45. In addition, high amounts of trans
fatty acids has been reported in the oils used for frying in Iran 46, which is related to depression 31. However, this data was not collected.
The association between these types of vegetables and depression needs further

The biological mechanisms for
the inverse association of FV intake and depression are not clear.

However, this association may be
due to the large amount of bioactive compounds which present in FV 24. FV have high content of micronutrients
and phytochemicals including antioxidants and anti-inflammatory components, which  have detrimental effects on depression 17. Antioxidants such as carotenoids,
vitamin C and vitamin E might prevent depressive symptoms 40. High intake of  B vitamins such as folic acid have been
associated with the lower risk of depression 47. FV also supply dietary fiber which its role
in improving mood has been suggested 48. Green leafy vegetables are good
sources of folate and magnesium, which are important in the prevention of
depression. Folate is involved in the metabolism of
monoamines, such as serotonin in the brain 40. Reduced
synthesis of serotonin results to depressed mood 49. In
magnesium deficiency, high levels of calcium and glutamate reduce synaptic
function and lead to depression 50. In addition, lower
levels of C reactive protein, a marker of low-grade inflammation, has been
reported in magnesium sufficiency 22. In
a study on rats, it was found that tomato juice inhibited monoamine oxidase
(MAO) enzyme. This result showed the anti-depressant properties of tomato 51. In addition, Aroniamelanocarpa
berry juice with the highest polyphenols among fruits, caused an antidepressant
effect in rats 52.
In a study, it was found that heptamethoxy flavone (HMF), a citrus flavonoid,
increases the expression of BDNF in the hippocampus in rats, thereby exerting
anti-depressant effects 53.

Women who
were included in the present study were not informed of their depression
status, which is one of the strengths of this study. When
subjects are aware of their depression disorder, they might change their food
intake. Other strength of our study is the adjustment for many confounding
variables, especially the overall
quality of diet. However, this study was limited in some aspects as well. First,
there is probability of error in answering FFQ questions. The reliability and validity of
the used FFQ were not assessed for this population.
Second, although we adjusted for many confounding variables, there may still be
residual confounding which impact on our results. Third, like all
cross-sectional studies, the present study reveals the existence or the absence
of a relationship, while it does not specify causality. Fourth, FV-rich
diets have been accompanied by a healthy lifestyle that may have not been
adjusted in our analysis.
Fifth, our findings may not be generalized to other populations. In conclusion, we found that higher consumption of total
FV, total vegetables, and total fruits, citrus and other fruits and berries
might be associated with a lower OR of depression. The findings
from this study support encouraging of FV consumption as
part of a healthy diet and highlight the importance of FV consumption and several
of their subgroups in the chance of depression. Further studies that
focused specifically on FV subgroups are needed to confirm these findings.

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