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This study aimed to analyze the associations of overall, healthy, and unhealthy plant-based diet indices with depressive symptoms in university students. Methods: A cross-sectional study was conducted in 2023 with self-reported data from university students in Cuenca, Spain. Adherence to the overall plant-based diet index (PDI) and to the healthy (hPDI) and unhealthy (uPDI) plant-based diet indices were calculated using data from a 137-item food-frequency questionnaire. Mild-to-severe depression was defined as a Beck Depression Inventory II score &gt; 13 points. Linear and logistic regression models were adjusted for sociodemographic and lifestyle-related confounders. Results: A total of 392 students (mean age: 20.9 \u00b1 2.4 years; 70.4% female) were included. The prevalence of mild-to-severe depression was 36.0%. Higher hPDI and overall PDI scores were associated with lower depressive symptom scores, whereas uPDI scores showed a positive but non-significant association after full adjustment. In logistic regression analyses, high adherence to the hPDI was associated with lower odds of mild-to-severe depression (OR = 0.51; 95% CI: 0.28\u20130.95; p-for-trend = 0.030). In contrast, higher uPDI adherence was associated with greater odds of depression, although the association was attenuated after adjustment for lifestyle-related variables. Conclusions: Greater adherence to a healthy plant-based diet was associated with lower depressive symptoms and lower odds of mild-to-severe depression among university students. These findings highlight the importance of plant food quality, rather than plant-based diets per se, in relation to depression in young adults.<\/jats:p>","DOI":"10.3390\/nu18122018","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"2018","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Plant-Based Diet Indices and Depression in University Students: The Nuts4Brain-Z Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Valentina","family":"D\u00edaz-Go\u00f1i","sequence":"first","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9662-4593","authenticated-orcid":false,"given":"Fernando","family":"Peral-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s","family":"Olivo-Martins-de-Passos","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Eugenia","family":"Visier-Alfonso","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6543-9378","authenticated-orcid":false,"given":"Nuria","family":"Beneit","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8553-7701","authenticated-orcid":false,"given":"Estela","family":"Jim\u00e9nez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"},{"name":"Center for Biomedical Research Network in Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0088-8607","authenticated-orcid":false,"given":"Arthur Eumann","family":"Mesas","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Bizzozero-Peroni","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain"},{"name":"Higher Institute of Physical Education, Universidad de la Rep\u00fablica, Maldonado 20000, Uruguay"},{"name":"Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 17165 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, August 21). 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