ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Sustainable Diets
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1590171
This article is part of the Research TopicThe relationship between vegetable diseases, food and human healthView all articles
Association between the Balanced Healthy Eating Index and Depression, and the Mediating Role of Extreme Pessimistic Thoughts: An Analysis from the Health and Nutrition Database
Provisionally accepted
- 1Department of Rehabilitation Medicine, Shenzhen People’s Hospital(The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- 2Department of Computer and Information Engineering, Kunsan National University, Gunsan, North Jeolla, Republic of Korea
- 3Department of Biological Sciences, College of Science, Purdue University, West Lafayette, Indiana, United States
- 4Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Massachusetts, United States
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Background: Depression remains a significant global health issue, yet the combined influence of dietary quality and extreme pessimistic thoughts on depressive risk is not fully understood. This study evaluated whether a Balanced Healthy Eating Index (BHEI) and extreme pessimism each independently and jointly predict depression in adults.We analyzed data from 17,575 participants aged 18-65 in the 2007-2018 National Health and Nutrition Examination Survey (NHANES). BHEI scores above 62 were classified as meeting healthy dietary standards. Logistic regression models assessed associations between substandard BHEI, extreme pessimism (frequent thoughts of being better off dead), and self-reported depression (PHQ-9 ≥ 10). Models were adjusted for age, sex, ethnicity, BMI, total energy intake, smoking status, alcohol use, and physical activity.Results: Participants failing to meet the BHEI threshold had increased odds of depression (OR = 1.55, 95% CI: 1.37-1.76). Extreme pessimism further elevated depression risk (OR = 4.17,). An interaction effect showed that individuals with both substandard BHEI and extreme pessimism faced even higher odds of depression (OR = 8.05, 95% CI: 6.62-9.07), suggesting a multiplicative relationship.Both lower-quality diets and extreme pessimistic thinking were significantly associated with depression risk, and the combination was particularly impactful. Future longitudinal studies are warranted to clarify causal pathways and to determine whether improving dietary patterns or mitigating extreme pessimism could reduce depression prevalence.
Keywords: Balanced Healthy Eating Index, Extreme Pessimism, Depression, NHANES, Diet Quality Conceptualization, Y.L., methodology, Y.L., software, Y.L., validation, Y.L. and S.B., formal analysis, C.L., investigation, Y.L. and S.B., resources, Y.L., data curation, Y.L. and F.L.
Received: 08 Mar 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Liu, Shengyong, Li, Li and Liang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mingqian Liang, Department of Rehabilitation Medicine, Shenzhen People’s Hospital(The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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