{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:05:37Z","timestamp":1791486337312,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Depression represents a major public health burden in Hungary, where prevalence remains higher than the global average. Although diet is an increasingly studied factor associated with mental health, evidence from Central and Eastern Europe is scarce. Methods: This cross-sectional study analyzed data from the Hungarian wave of the European Health Interview Survey (EHIS) 2019, a nationally representative sample of 5603 adults aged \u226515 years. Depressive symptom severity was assessed using the Patient Health Questionnaire-8 (PHQ-8) and categorized as none (0\u20134), mild (5\u20139), and moderate-to-severe (\u226510). Self-reported frequency of consumption of fruits, vegetables, fruit juice, dairy products, fish, processed meat, sweetened beverages, coffee, and sweeteners was examined. Multivariable ordinal logistic regression models, adjusted for gender, age, education, income, physical activity, smoking, and alcohol consumption, were used to estimate associations with depressive symptom severity. Results: Overall, 77.9% of participants had no depression, 17.0% mild, and 5.1% moderate-to-severe symptoms. After full adjustment, lower consumption of fruits and vegetables, less frequent fruit juice intake, and lower processed meat consumption were associated with higher odds of more severe depressive symptoms. Moderate coffee intake (1\u20132 cups\/day) was associated with lower odds than heavier consumption. Conclusions: In the Hungarian adult population, poorer dietary patterns, particularly low intake of fruits, vegetables, and paradoxically lower processed meat consumption, are significantly associated with greater depressive symptom severity, independent of major sociodemographic and lifestyle factors. These findings underscore the potential role of diet quality in mental health and support public health efforts to promote nutrient-rich dietary patterns in Hungary.<\/jats:p>","DOI":"10.3390\/nu18010159","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:40:53Z","timestamp":1767602453000},"page":"159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dietary Patterns and Depressive Symptom Severity in the Hungarian Adult Population: Evidence from a Nationally Representative Survey"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7022-5932","authenticated-orcid":false,"given":"Battamir","family":"Ulambayar","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila Csaba","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jad.2020.12.035","article-title":"Global trends in the prevalence and incidence of depression: A systematic review and meta-analysis","volume":"281","author":"Wu","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5553491","DOI":"10.1155\/da\/5553491","article-title":"Trends in Prevalent Cases and Disability-Adjusted Life-Years of Depressive Disorders Worldwide: Findings from the Global Burden of Disease Study from 1990 to 2021","volume":"2025","author":"Chen","year":"2025","journal-title":"Depress. Anxiety"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2000132","DOI":"10.1080\/20008198.2021.2000132","article-title":"Meta-Analytic Evidence of Depression and Anxiety in Eastern Europe during the COVID-19 Pandemic 2021","volume":"13","author":"Zhang","year":"2022","journal-title":"Eur. J. Psychotraumatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/dme.14042","article-title":"Prevalence of comorbid major depressive disorder in Type 2 diabetes: A meta-analysis of comparative and epidemiological studies","volume":"36","author":"Wang","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1744-859X-12-21","article-title":"Suicide in Hungary-epidemiological and clinical perspectives","volume":"12","author":"Rihmer","year":"2013","journal-title":"Ann Gen Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1017\/S0033291719001958","article-title":"Association of a priori dietary patterns with depressive symptoms: A harmonised meta-analysis of observational studies","volume":"50","author":"Nicolaou","year":"2020","journal-title":"Psychol. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s41043-022-00303-z","article-title":"Dietary inflammatory potential and the incidence of depression and anxiety: A meta-analysis","volume":"41","author":"Li","year":"2022","journal-title":"J. Health Popul. Nutr."},{"key":"ref_8","first-page":"e32359","article-title":"Association Between Dietary Habits and Depression: A Systematic Review","volume":"14","author":"Selvaraj","year":"2022","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1556\/650.2017.30700","article-title":"Orsz\u00e1gos T\u00e1pl\u00e1lkoz\u00e1s \u00e9s T\u00e1pl\u00e1lts\u00e1gi \u00c1llapot Vizsg\u00e1lat 2014. I. A magyar feln\u0151tt lakoss\u00e1g t\u00e1pl\u00e1lts\u00e1gi \u00e1llapota","volume":"158","author":"Erdei","year":"2017","journal-title":"Orvosi Hetil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lehoczki, A., Cs\u00edp\u0151, T., Lip\u00e9cz, \u00c1., Major, D., Fazekas-Pongor, V., Cs\u00edk, B., M\u00f3zes, N., Feh\u00e9r, \u00c1., D\u00f3sa, N., and \u00c1rva, D. (2025). Western Diet and Cognitive Decline: A Hungarian Perspective\u2014Implications for the Design of the Semmelweis Study. Nutrients, 17.","DOI":"10.3390\/nu17152446"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00394-025-03645-6","article-title":"Consumer attitudes towards dietary behaviors: A mediator between socioeconomic status and diet quality in European adults","volume":"64","author":"Klink","year":"2025","journal-title":"Eur. J. Nutr."},{"key":"ref_12","unstructured":"(2025, February 10). European Health Interview Survey\u2014Methodology. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=European_health_interview_survey_-_methodology."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jad.2008.06.026","article-title":"The PHQ-8 as a measure of current depression in the general population","volume":"114","author":"Kroenke","year":"2009","journal-title":"J. Affect. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E191","DOI":"10.1503\/cmaj.110829","article-title":"Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): A meta-analysis","volume":"184","author":"Manea","year":"2012","journal-title":"CMAJ"},{"key":"ref_15","unstructured":"(2023). Stata Statistical Software, StataCorp LLC. (In English)."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3346\/jkms.2013.28.1.128","article-title":"Prevalence and Correlates of Depressive Symptoms in Korean Adults: Results of a 2009 Korean Community Health Survey","volume":"28","author":"Oh","year":"2013","journal-title":"J. Korean Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1752-4458-1-4","article-title":"Relation between depression and sociodemographic factors","volume":"1","author":"Landeen","year":"2007","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/cld.1208","article-title":"Sociodemographic Risk Factors for Depression in Patients With Chronic Liver Disease","volume":"20","author":"Andrews","year":"2022","journal-title":"Clin. Liver Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Freeman, A., Tyrovolas, S., Koyanagi, A., Chatterji, S., Leonardi, M., Ayuso-Mateos, J.L., Tobiasz-Adamczyk, B., Koskinen, S., Rummel-Kluge, C., and Haro, J.M. (2016). The role of socio-economic status in depression: Results from the COURAGE (aging survey in Europe). BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3638-0"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zegarra-L\u00f3pez, A.C., Florentino-Santisteban, B., Flores-Romero, J., Delgado-Tenorio, A., and Cernades-Ames, A. (2022). A Cross-Sectional Study on the Prevalence of Depressive Symptoms and Its Associated Sociodemographic Factors in Peru during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192114240"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ulambayar, B., Ghanem, A.S., T\u00f3th, \u00c1., and Nagy, A.C. (2025). Impact of Physical Activity and Dietary Habits on Mental Well-Being in Patients with Diabetes Mellitus. Nutrients, 17.","DOI":"10.3390\/nu17061042"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Grasdalsmoen, M., Eriksen, H.R., L\u00f8nning, K.J., and Sivertsen, B. (2020). Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02583-3"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.bbi.2013.03.009","article-title":"Depression inhibits the anti-inflammatory effects of leisure time physical activity and light to moderate alcohol consumption","volume":"32","author":"Suarez","year":"2013","journal-title":"Brain Behav. Immun."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Guan, T., Zhang, C., Zou, X., Chen, C., Zhou, L., Wu, X., and Hao, J. (2022). The Influence of Alcohol Consumption, Depressive Symptoms and Sleep Duration on Cognition: Results from the China Health and Retirement Longitudinal Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912574"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1111\/add.14935","article-title":"Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: A systematic review and meta-analysis of cohort studies","volume":"115","author":"Li","year":"2020","journal-title":"Addiction"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s41043-019-0204-2","article-title":"Low fruit and vegetable intake is associated with depression among Korean adults in data from the 2014 Korea National Health and Nutrition Examination Survey","volume":"38","author":"Ju","year":"2019","journal-title":"J. Health Popul. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1017\/S0007114518000697","article-title":"Fruit and vegetable consumption and risk of depression: Accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies","volume":"119","author":"Saghafian","year":"2018","journal-title":"Br. J. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Shams-Rad, S., Bidaki, R., Nadjarzadeh, A., Mirzaei, M., and Salehi-Abargouei, A. (2022). The Association Between Major Dietary Patterns and Severe Mental Disorders Among a Large Sample of Adults Living in Central Iran: Baseline Data of YaHS-TAMYZ Cohort Study. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13518-w"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Richard, A., Rohrmann, S., Vandeleur, C.L., Mohler-Kuo, M., and Eichholzer, M. (2015). Associations between fruit and vegetable consumption and psychological distress: Results from a population-based study. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0597-4"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3109\/15622975.2011.597876","article-title":"The relationship between plasma carotenoids and depressive symptoms in older persons","volume":"13","author":"Milaneschi","year":"2012","journal-title":"World J. Biol. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1136\/jech-2015-205858","article-title":"Associations between fruit and vegetable consumption and depressive symptoms: Evidence from a national Canadian longitudinal survey","volume":"70","author":"Kingsbury","year":"2016","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3509","DOI":"10.1017\/S1368980022000271","article-title":"Coffee and caffeine intake in relation to symptoms of psychological disorders among adults","volume":"25","author":"Afshar","year":"2022","journal-title":"Public Health Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/0004867415603131","article-title":"Coffee and caffeine consumption and depression: A meta-analysis of observational studies","volume":"50","author":"Wang","year":"2016","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/mnfr.201500620","article-title":"Coffee, tea, caffeine and risk of depression: A systematic review and dose\u2013response meta-analysis of observational studies","volume":"60","author":"Grosso","year":"2016","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1001\/archinternmed.2011.393","article-title":"Coffee, Caffeine, and Risk of Depression Among Women","volume":"171","author":"Lucas","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"m2382","DOI":"10.1136\/bmj.m2382","article-title":"Food and mood: How do diet and nutrition affect mental wellbeing?","volume":"369","author":"Firth","year":"2020","journal-title":"BMJ"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1017\/S0029665117002026","article-title":"Nutritional psychiatry: The present state of the evidence","volume":"76","author":"Marx","year":"2017","journal-title":"Proc. Nutr. Soc."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Adjibade, M., Julia, C., All\u00e8s, B., Touvier, M., Lemogne, C., Srour, B., Hercberg, S., Galan, P., Assmann, K.E., and Kesse-Guyot, E. (2019). Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Sant\u00e9 cohort. BMC Med., 17.","DOI":"10.1186\/s12916-019-1312-y"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"pyae055","DOI":"10.1093\/ijnp\/pyae055","article-title":"Anhedonia is associated with a specific depression profile and poor antidepressant response","volume":"27","author":"Luca","year":"2024","journal-title":"Int. J. Neuropsychopharmacol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/1\/159\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:43:41Z","timestamp":1767602621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/1\/159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,3]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["nu18010159"],"URL":"https:\/\/doi.org\/10.3390\/nu18010159","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,3]]}}}