The DOI matches its Crossref record; 43 of the 46 references it cites were found in a registry or an index.
Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms: The MooDFOOD Randomized Clinical Trial
Open accessAbstract
Importance: Effects of nutritional interventions on the prevention of major depressive disorder (MDD) in overweight adults are unknown. Objective: To examine the effect of 2 nutritional strategies (multinutrient supplementation, food-related behavioral activation therapy) and their combination for prevention of a new MDD episode in overweight adults with subsyndromal depressive symptoms. Design, Setting, and Participants: This multicenter 2 × 2 factorial randomized clinical trial included overweight adults (body mass index, 25-40) with elevated depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥5) and no MDD episode in the past 6 months from 4 European countries. A total of 1025 adults were randomized (July 30, 2015-October 12, 2016) and followed up for 1 year (October 13, 2017). Interventions: Daily multinutrient supplements (1412-mg omega-3 fatty acids, 30-μg selenium, 400-μg folic acid, and 20-μg vitamin D3 plus 100-mg calcium) vs placebo and 21 individual or group therapy sessions vs none (blinded to researchers) for 1 year. Participants were allocated to placebo without therapy (n = 257), placebo with therapy (n = 256), supplements without therapy (n = 256), and supplements with therapy (n = 256). Main Outcome and Measures: Cumulative 1-year onset of MDD via the Mini International Neuropsychiatric Interview at 3, 6, and 12 months. Logistic regression using effect-coded variables (-1 indicating control, 1 indicating intervention) evaluated intervention effects both individually and in combination (interaction) on MDD onset. Results: Among 1025 participants (mean age, 46.5 years; 772 women [75%]; mean BMI, 31.4), 779 (76%) completed the trial. During the 12-month follow-up, 105 (10%) developed MDD: 25 (9.7%) patients in the placebo without therapy, 26 (10.2%) in the placebo with therapy, 32 (12.5%) in the supplement without therapy, and 22 (8.6%) in the supplement with therapy group. None of the treatment strategies affected MDD onset. The odds ratio (OR) for supplements was 1.06 (95% CI, 0.87-1.29); for therapy, 0.93 (95% CI, 0.76-1.13); and for their combination, 0.93 (95% CI, 0.76-1.14; P for interaction, .48). One person in the supplementation with therapy group, died. Twenty-four patients in each of the placebo groups and 24 patients in the supplementation with therapy group were hospitalized, and 26 patients in the supplementation-only group were hospitalized. Conclusions and Relevance: Among overweight or obese adults with subsyndromal depressive symptoms, multinutrient supplementation compared with placebo and food-related behavioral activation therapy compared with no therapy did not reduce episodes of major depressive disorder during 1 year. These findings do not support the use of these interventions for prevention of major depressive disorder. Trial registration: ClinicalTrials.gov Identifier: NCT02529423.
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“a recent four-arm RCT examined nutrition-based interventions for the prevention of depressive episodes in 1,025 participants with subclinical depressive symptoms, and found no significant benefits from the behavioral activation intervention promoting healthy eating 101 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [101]
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“Interestingly, the other 'active' arm of this RCT provided daily multinutrient supplementation, observing significantly worsened outcomes for depressive symptoms compared to placebo 101 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [101]
In the citing paper
“a diet supplemented with omega-3 fatty acids, selenium, vitamin D, and calcium in the MooDFOOD randomized controlled trial did not reduce major depression episodes in overweight or obese adults with subsyndromal depressive symptoms [73, 74].”
From Role of diet and its effects on the gut microbiome in the pathophysiology of mental disorders (2022) · cites this paper as [73]
In the citing paper
“However, accounting for only subjects who complied over 12 months, a supplemented diet may be preventive in depression onset.”
From Role of diet and its effects on the gut microbiome in the pathophysiology of mental disorders (2022) · cites this paper as [73]
In the citing paper
“Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms.34”
From Food and mood: How do diet and nutrition affect mental wellbeing? (2020) · cites this paper as [34]
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Cites
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Firth, J., Solmi, M., Wootton, R. E., Vancampfort, D., Schuch, F. B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S. B., Jackson, S. E., et al. (2020) · World Psychiatry · doi:10.1002/wps.20773 · Cited by 1,242
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Self-citationDiet and depression: Exploring the biological mechanisms of action
Marx, W., Lane, M., Hockey, M., Aslam, H., Berk, M., Walder, K., Borsini, A., Firth, J., Pariante, C. M., Berding, K., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-00925-x · Cited by 685
Comorbid depression in medical diseases
Gold, S. M., Köhler‐Forsberg, O., Moss-Morris, R. E., Mehnert-Theuerkauf, A., Miranda, J. J., Bullinger, M., Steptoe, A., Whooley, M. A., & Otte, C. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0200-2 · Cited by 583
Food and mood: How do diet and nutrition affect mental wellbeing?
Firth, J., Gangwisch, J. E., Borsini, A., Wootton, R. E., & Mayer, E. A. (2020) · BMJ · doi:10.1136/bmj.m2382 · Cited by 475
Metadata
- Authors
- Bot, M., Brouwer, I. A., Roca, M., Kohls, E., Penninx, B. W. J. H., Watkins, E., van Grootheest, G., Cabout, M., Hegerl, U., Gili, M., Owens, M., Visser, M., & for the MooDFOOD Prevention Trial Investigators
- Affiliations
- Amsterdam Public Health (NL)
- Health Research Institute of the Balearic Islands (ES)
- Leipzig University (DE)
- Department of Psychology, University of Exeter, Exeter, United Kingdom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
- University of Exeter (GB)
- Corresponding author
- Visser, Marjolein
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-05
- Volume
- 321
- Issue
- 9
- Pages
- 858
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6439597
- OpenAlex
- W2919675892
- Cited by
- 128
- References
- 46
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 14 · 2023: 17 · 2022: 21 · 2021: 16 · 2020: 21 · 2019: 15
- FWCI
- 11.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Figshare (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Institute for Health and Care Research (613598)
- University of Exeter
- European Commission (613598)
- GGZ inGeest
- NIHR Exeter Clinical Research Facility
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Keywords
- subsyndromal depressive symptoms, overweight adults, obesity, omega-3 fatty acids, selenium, folic acid, vitamin D3, calcium, depression onset, dietary intervention, psychotherapy, factorial design, depression recurrence prevention, physical activity
- MeSH terms
- Adult, Analysis of Variance, Behavior Therapy, Combined Modality Therapy, Major Depressive Disorder, Depressive Disorder, Major, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Psychotherapy, Group, Treatment Failure, Dietary Supplements, Overweight
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