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MoodFOOD

The MooDFOOD Depression Prevention Trial

MooDFOOD is a collaborative European Commission-funded project (€8.9 million) investigating the role of diet and lifestyle changes in preventing depression. The Mood Disorders Centre, University of Exeter is one of four countries (UK, Germany, the Netherlands and Spain) running this multi-site randomised controlled trial.

The background

Every year approximately 1 in 14, or 30 million people in Europe will suffer with clinical depression (1), a disorder that brings with it a great burden for individuals and their families. Depression is predicted to be the leading health problem worldwide by 2030 (2) and the annual cost of depression in England alone is likely to surpass £12 billion by 2026 (3).

Over recent decades the proportion of the world’s population that is overweight (with a body mass index (BMI) of 25 or greater) has been rising (4), carrying with it substantial health risks including an increased risk for depression. At the same time, western diets have changed considerably from the traditional, to more convenient processed meals and fast food. These new high-calorie diets include mostly nutrient‐poor foods such as refined sugars, grains, and saturated fats, and it is thought that this change may have an impact on the prevalence rates of depression (5).

There is now growing research evidence to support the idea that healthy diets, nutrition and food-related behaviour play a key role in the prevention of depression (6). It has been shown, for example, that adhering to a Mediterranean diet (e.g. plenty of fruit and vegetables, fish and olive oil) may act as a protective factor against developing depression (7). Similarly, lifestyle interventions involving the promotion of healthy eating practices may be beneficial in preventing depression by encouraging healthy habits that lead to lasting behavioural change (8). Research has also shown that specific nutrients found in the diet, or used as a supplement, may be important in preventing depression. Omega-3 fatty acids from fish oil, for instance, have been shown to relieve symptoms of depressed patients (9).

As well as healthy eating being related to good psychological heath, eating and food-related behaviour are often driven by stress and emotional factors, which can increase the consumption of energy‐dense high‐fat foods and obesity (10). Furthermore, depressive symptoms are associated with perceived barriers to healthy eating, meal skipping, and more disordered eating, contributing to the development and persistence of obesity (11). Thus, the relationship between mood and food is a complex one that may involve several vicious circles.

The evidence to date suggests that improving nutrient intake through healthy diet, food-related behaviour, or multi-nutrient supplementation may be effective strategies in the prevention of depression, particularly for people prone to being overweight. However, there have not been enough randomised controlled trials to test this possibility. This is why we are running the MooDFOOD trial. Understanding the different nutritional pathways to depression and experimentally testing them in well-controlled prospective research designs is important in order to develop evidence-based, large‐scale nutritional intervention strategies that reduce the impact of depression. Because eating a healthy diet may benefit not only mental but also physical and cognitive health, nutritional strategies appear to be a promising public health strategy that could have widespread positive effects on health and wellbeing.

The trial

MooDFOOD is a multi-country, randomised controlled trial investigating two nutritional strategies in the prevention of depression. The interventions are multi-nutrient supplements versus lifestyle and behavioural coaching. Therefore, there will be four arms in the trial.

  1. multivitamin and mineral supplements alone
  2. placebo supplements alone
  3. multivitamin and mineral supplements plus lifestyle and behavioural coaching
  4. placebo supplements plus lifestyle and behavioural coaching. In Exeter, the prevention trial will recruit 250 overweight people at risk of depression, with the nutritional strategy interventions lasting for one year. The aim of the trial is to determine whether multi-nutrient food supplementation and/or food-related lifestyle and behavioural change are effective in preventing the development of depression and to understand their underlying mechanisms. The primary outcome is the relative incidence of Major Depressive Disorder in each trial arm throughout the follow-up period.

Who is taking part?

Participants will be adults aged between 18-75 who are overweight or obese as measured by a high Body Mass Index (BMI = 25-40) and who have subsyndromal depressive symptoms. Because MooDFOOD is a prevention trial we will not be able to include people who meet criteria for a diagnosis of Major Depressive Disorder, as assessed by the research team. We will also need to exclude women if they are pregnant as well as anyone who has had or is planning to have weight loss surgery.

Where is the study taking place?

The study will be taking place in four sites:

  • Exeter, UK
  • Leipzig, Germany
  • Amsterdam, the Netherlands 
  • Palma de Mallorca, Spain

When is MooDFOOD starting?

The study is due to begin in the summer of 2015, with the aim of recruiting the required 250 people into the study within 12 months. For each participant, the study will last for up to 12 months.

Funding

Funding for this research has been secured through the Seventh Framework European Commission initiative.

Seventh Framework Knowledge Based Bio-Economy (KBBE) programme: Food, Agriculture and Fisheries, and Biotechnology (FP7-KBBE).

Subprogramme:  KBBE.2013.2.1-01 - Impact of food and nutritional behaviour, lifestyle and the socio-economic environment on depression and proposed remedial actions.

Project number:  613598 (http://cordis.europa.eu/project/rcn/110836_en.html).

Total cost: €11,454,337

EU contribution: €8,930,530

Contact

The Chief Investigator for the trial is Professor Ed Watkins at the Mood Disorders Centre, University of Exeter. If you would like further information on the trial or have any questions please contact the Trial Manager, Dr Matt Owens-Solari m.owens-solari@exeter.ac.uk

References

(1)     Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jonsson, B., . . . Steinhausen, H. C. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol, 21(9), 655-679. doi: 10.1016/j.euroneuro.2011.07.018

(2)     Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 3(11), e442. doi: 10.1371/journal.pmed.0030442

(3)     McCrone, P. (2008). Paying the Price: The Cost of Mental Health Care in England to 2026. The King’s Fund. http://www.kingsfund.org.uk/sites/files/kf/Paying-the-Price-the-cost-of-mental-health-care-England-2026-McCrone-Dhanasiri-Patel-Knapp-Lawton-Smith-Kings-Fund-May-2008_0.pdf

(4)     Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., . . . Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9945), 766-781. doi: 10.1016/S0140-6736(14)60460-8

(5)     Jacka, F. N., Sacks, G., Berk, M., & Allender, S. (2014). Food policies for physical and mental health. BMC Psychiatry, 14, 132. doi: 10.1186/1471-244X-14-132

(6)     Sanchez-Villegas, A., & Martinez-Gonzalez, M. A. (2013). Diet, a new target to prevent depression? BMC Med, 11, 3. doi: 10.1186/1741-7015-11-3

(7)     Sanchez-Villegas, A., Martinez-Gonzalez, M. A., Estruch, R., Salas-Salvado, J., Corella, D., Covas, M. I., . . . Serra-Majem, L. (2013). Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Med, 11, 208. doi: 10.1186/1741-7015-11-208

(8)     Reynolds, C. F., 3rd, Thomas, S. B., Morse, J. Q., Anderson, S. J., Albert, S., Dew, M. A., . . . Quinn, S. C. (2014). Early intervention to preempt major depression among older black and white adults. Psychiatr Serv, 65(6), 765-773. doi: 10.1176/appi.ps.201300216

(9)     Grosso, G., Pajak, A., Marventano, S., Castellano, S., Galvano, F., Bucolo, C., . . . Caraci, F. (2014). Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One, 9(5), e96905. doi: 10.1371/journal.pone.0096905

(10)  Laitinen, J., Ek, E., & Sovio, U. (2002). Stress-related eating and drinking behavior and body mass index and predictors of this behavior. Prev Med, 34(1), 29-39. doi: 10.1006/pmed.2001.0948

(11)  Fulkerson, J. A., Sherwood, N. E., Perry, C. L., Neumark-Sztainer, D., & Story, M. (2004). Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample. Prev Med, 38(6), 865-875. doi: 10.1016/j.ypmed.2003.12.028