{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:42:15Z","timestamp":1784306535427,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T00:00:00Z","timestamp":1588636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002635","name":"INHA UNIVERSITY","doi-asserted-by":"publisher","award":["not available"],"award-info":[{"award-number":["not available"]}],"id":[{"id":"10.13039\/501100002635","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003669","name":"Korea Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["not available"],"award-info":[{"award-number":["not available"]}],"id":[{"id":"10.13039\/501100003669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The relationship between the dietary inflammatory index (DII\u00ae) and depression and depressive symptoms in South Korean adults remains unclear. This study aimed to examine the overall relationship between the DII and depression in South Korea and to evaluate the association between the DII and depressive symptoms and depression across regions among Korean adults aged \u226519 years. A total of 15,929 study participants were selected from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014\u20132017. Energy-adjusted (E-DII) scores were calculated using 24-h dietary recall data. Depression and depressive symptoms were measured on the basis of the Korean version of the Patient Health Questionnaire 9-item scale, a doctor\u2019s diagnosis of depression, and self-reported depressive symptom-related questionnaire. Overall, 4.2% of the participants had depression, with notable gender differences (i.e., 2.4% in men and 6.2% in women). Korean adults residing in the Capital area, Chungcheong-do and Jeju-do, and with diets in the highest tertile of the E-DII (most pro-inflammatory diet) had significantly increased odds of having depression and depressive symptoms compared with those in the lowest tertile of the E-DII (most anti-inflammatory diet) after controlling for covariates (adjusted odds ratio (AOR): 1.44, 95% confidence interval (CI): 1.04\u20131.99; AOR 2.97, 95% CI 1.36\u20136.52; AOR 4.06, 95% CI 1.56\u201310.53, respectively). No association between the E-DII and depression\/depressive symptoms was found in other regions of South Korea. A pro-inflammatory diet is associated with greater odds of depression and depressive symptoms, with distinct regional differences. The present study provides evidence regarding existing regional differences in the association of the E-DII with depression and depressive symptoms.<\/jats:p>","DOI":"10.3390\/ijerph17093205","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T03:10:38Z","timestamp":1588821038000},"page":"3205","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Examining Regional Differences of Dietary Inflammatory Index and Its Association with Depression and Depressive Symptoms in Korean Adults"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0828-184X","authenticated-orcid":false,"given":"Dayeon","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Food and Nutrition, Inha University, Incheon 22212, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Shivappa","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA"},{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA"},{"name":"Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0677-2672","authenticated-orcid":false,"given":"James R.","family":"H\u00e9bert","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA"},{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA"},{"name":"Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4430-3241","authenticated-orcid":false,"given":"Kyung Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, Gwangju University, Gwangju 61743, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,5]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1089\/jmf.2016.0043","article-title":"Are dietary patterns associated with depression in US adults?","volume":"19","author":"Kim","year":"2016","journal-title":"J. Med. Food"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1080\/1028415X.2017.1411320","article-title":"A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)","volume":"22","author":"Parletta","year":"2019","journal-title":"Nutr. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12992-017-0237-5","article-title":"The role of unhealthy lifestyles in the incidence and persistence of depression: A longitudinal general population study in four emerging countries","volume":"13","author":"Cabello","year":"2017","journal-title":"Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1192\/bjp.186.5.417","article-title":"Mental health inequalities in Wales, UK: Multi-level investigation of the effect of area deprivation","volume":"186","author":"Skapinakis","year":"2005","journal-title":"Br. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ynstr.2016.03.003","article-title":"Integrating Interleukin-6 into depression diagnosis and treatment","volume":"4","author":"Hodes","year":"2016","journal-title":"Neurobiol. Stress"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1016\/S1734-1140(13)71526-3","article-title":"Increased IL-6 trans-signaling in depression: Focus on the tryptophan catabolite pathway, melatonin and neuroprogression","volume":"65","author":"Anderson","year":"2013","journal-title":"Pharmacol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1038\/tp.2012.8","article-title":"Association of depressive disorders, depression characteristics and antidepressant medication with inflammation","volume":"2","author":"Vogelzangs","year":"2012","journal-title":"Transl. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000026615","article-title":"Cerebrospinal cytokine levels in patients with acute depression","volume":"40","author":"Levine","year":"1999","journal-title":"Neuropsychobiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1428","DOI":"10.4088\/JCP.14m09009","article-title":"Inflammation, obesity, and metabolic syndrome in depression: Analysis of the 2009-2010 National Health and Nutrition Examination Survey (NHANES)","volume":"75","author":"Rethorst","year":"2014","journal-title":"J. Clin. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1089\/jwh.2014.4919","article-title":"Depression and its comorbid conditions more serious in women than in men in the United States","volume":"24","author":"Kim","year":"2015","journal-title":"J. Womens Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/jamapsychiatry.2014.1332","article-title":"Association of serum interleukin 6 and C-reactive protein in childhood with depression and psychosis in young adult life: A population-based longitudinal study","volume":"71","author":"Khandaker","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/164_2018_166","article-title":"Role of Inflammation in Depression and Treatment Implications","volume":"250","author":"Felger","year":"2019","journal-title":"Handb. Exp. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.neuroscience.2013.04.060","article-title":"Inflammatory cytokines in depression: Neurobiological mechanisms and therapeutic implications","volume":"246","author":"Felger","year":"2013","journal-title":"Neuroscience"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1017\/S1368980013002115","article-title":"Designing and developing a literature-derived, population-based dietary inflammatory index","volume":"17","author":"Shivappa","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ramallal, R., Toledo, E., Martinez-Gonzalez, M.A., Hernandez-Hernandez, A., Garcia-Arellano, A., Shivappa, N., Hebert, J.R., and Ruiz-Canela, M. (2015). Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the SUN Cohort. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135221"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1017\/S1368980013002565","article-title":"A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS)","volume":"17","author":"Shivappa","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.annepidem.2015.03.009","article-title":"Construct validation of the dietary inflammatory index among postmenopausal women","volume":"25","author":"Tabung","year":"2015","journal-title":"Ann. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s12603-016-0775-1","article-title":"Construct Validation of the Dietary Inflammatory Index among African Americans","volume":"21","author":"Wirth","year":"2017","journal-title":"J. Nutr. Health Aging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.nut.2018.11.016","article-title":"Dietary inflammatory index is positively associated with serum high-sensitivity C-reactive protein in a Korean adult population","volume":"63\u201364","author":"Shin","year":"2019","journal-title":"Nutrition"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jad.2019.11.160","article-title":"Association of poorer dietary quality and higher dietary inflammation with greater symptom severity in depressed individuals with appetite loss","volume":"263","author":"Burrows","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.ypmed.2017.03.016","article-title":"The association of dietary inflammatory potential with depression and mental well-being among U.S. adults","volume":"99","author":"Bergmans","year":"2017","journal-title":"Prev. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.nutres.2018.03.004","article-title":"Higher dietary inflammation is associated with increased odds of depression independent of Framingham Risk Score in the National Health and Nutrition Examination Survey","volume":"54","author":"Jorgensen","year":"2018","journal-title":"Nutr. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1093\/jn\/nxz045","article-title":"The Inflammatory Potential of the Diet is Directly Associated with Incident Depressive Symptoms Among French Adults","volume":"149","author":"Adjibade","year":"2019","journal-title":"J. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jad.2018.04.014","article-title":"The relationship between the dietary inflammatory index (DII\u00ae) and incident depressive symptoms: A longitudinal cohort study","volume":"235","author":"Shivappa","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1177\/2167702616645777","article-title":"Dietary inflammatory index and recurrence of depressive symptoms: Results from the Whitehall II Study","volume":"4","author":"Akbaraly","year":"2016","journal-title":"Clin. Psychol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/j.clnu.2017.08.029","article-title":"Dietary inflammatory index and mental health: A cross-sectional analysis of the relationship with depressive symptoms, anxiety and well-being in adults","volume":"37","author":"Phillips","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_28","first-page":"79","article-title":"Relationship between dietary intake and depression in metabolic syndrome among Korean adults: Korea National Health and Nutrition Examination Survey 2014","volume":"42","author":"Han","year":"2017","journal-title":"J. Agric. Med. Community Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1037\/hea0000514","article-title":"The Dietary Inflammatory Index, shift work, and depression: Results from NHANES","volume":"36","author":"Wirth","year":"2017","journal-title":"Health Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1017\/S0007114516002853","article-title":"Association between inflammatory potential of diet and risk of depression in middle-aged women: The Australian Longitudinal Study on Women\u2019s Health","volume":"116","author":"Shivappa","year":"2016","journal-title":"Br. J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1017\/S0033291701003907","article-title":"Genetic risk factors for major depression in men and women: Similar or different heritabilities and same or partly distinct genes?","volume":"31","author":"Kendler","year":"2001","journal-title":"Psychol. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1038\/mp.2010.65","article-title":"Genetic risk profiles for depression and anxiety in adult and elderly cohorts","volume":"16","author":"Demirkan","year":"2011","journal-title":"Mol. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5681","DOI":"10.1073\/pnas.0911515107","article-title":"Computational identification of gene\u2013social environment interaction at the human IL6 locus","volume":"107","author":"Cole","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.nutres.2015.11.009","article-title":"Anti-inflammatory Dietary Inflammatory Index scores are associated with healthier scores on other dietary indices","volume":"36","author":"Wirth","year":"2016","journal-title":"Nutr. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.2105\/AJPH.2012.300660","article-title":"Obesity and supermarket access: Proximity or price?","volume":"102","author":"Drewnowski","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/ajcn\/87.5.1107","article-title":"Does social class predict diet quality?","volume":"87","author":"Darmon","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_37","first-page":"313","article-title":"Decomposition of regional income inequality in Korea","volume":"33","author":"Kim","year":"2003","journal-title":"Rev. Reg. Stud."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/9\/3205\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:52:57Z","timestamp":1760363577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/9\/3205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,5]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["ijerph17093205"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17093205","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,5]]}}}