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We sought to explore the potential association between the adherence to an alternate Mediterranean diet score (aMED) and the risk of developing depression among adults in Eastern China. Methods: This study used a prospective cohort design that involved a total of 52,232 individuals in the Shanghai Suburban Adult Cohort and Biobank (SSACB). A reliable food frequency questionnaire (FFQ) was utilized to evaluate dietary intake, and we calculated the aMED score for each participant, dividing them into 3 groups accordingly (score 0\u20133, 4\u20135, 6\u20139). Cox proportional hazards regression analyses were performed to compute the hazard ratios (HR) and 95% confidence intervals (CI). Results: The median age of participants was 58 years (IQR: 50\u201365), with a male-to-female ratio of 1:1.59. Throughout an average 6.29 years of follow up, 1220 incident cases of depression were recorded through the ICD-10 classification codes F32 and F33. A higher level of adherence to the aMED was notably linked to a decreased risk of incident depression (HRhigh vs. low adherence = 0.83, 95% CI = 0.70\u20130.98; HRmoderate vs. low adherence = 0.87, 95% CI = 0.76\u20130.99; P-trend = 0.009) after multivariate adjustment. Each 1-score increase in the aMED score was associated with a 5% lower risk of depression (HR = 0.95, 95% CI = 0.91\u20130.99), and this association was more pronounced among participants aged \u226565 years (P-interaction = 0.008). Conclusions: Our results suggest that following a Mediterranean diet might potentially provide mental health benefits, particularly for individuals aged 65 years and above.<\/jats:p>","DOI":"10.3390\/nu17060942","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T12:22:52Z","timestamp":1741350172000},"page":"942","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Adherence to the Mediterranean Diet and Risk of Depression: A Cohort Study in Chinese Community Residents"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4903-2962","authenticated-orcid":false,"given":"Kexin","family":"Zhang","sequence":"first","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Wu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Yi","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiling","family":"Wu","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingqi","family":"Deng","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3382-9438","authenticated-orcid":false,"given":"Xinxin","family":"Xu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biying","family":"Wang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonggen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0140-3920","authenticated-orcid":false,"given":"Qi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"GBD 2019 Mental Disorders Collaborators (2022). 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