REVIEW OF: Conti S et al, Br J Nutr 2024;131:1892–1901

STUDY TYPE: Cross-sectional study

Older women often ask whether diet affects mood. The honest answer is that it probably does, but the data are thin. A cross-sectional study from Italy gives us the most specific picture yet, and it points to a sex difference that’s worth knowing about.

Conti and colleagues analyzed 798 community-dwelling Italian adults aged 65–97. Participants completed a 102-item food frequency questionnaire scored on the validated 0–9 Mediterranean Diet Score (MDS). Depressive symptoms were assessed with the Center for Epidemiological Studies–Depression (CES-D) scale.

Overall, 20% of participants had clinically significant depressive symptoms. The rate was 28% in women versus 8% in men. Higher Mediterranean diet adherence was associated with lower odds of depressive symptoms across the full sample, but when the analysis was split by sex, the effect vanished in men and held only in women. Each step up the adherence scale corresponded to an 18% reduction in odds.

Fish appeared to be the main driver. Women eating 2 or more servings of fresh fish per week had substantially lower rates of depressive symptoms; 3 or more weekly servings corresponded to a 70% reduction in odds compared to fewer than 2. Unexpectedly, shellfish (shrimp, mussels, clams) drove the association, not fatty fish like salmon or small oily fish like sardines. A higher ratio of monounsaturated to saturated fat also predicted fewer symptoms, though it was a weaker signal than fish.

CARLAT TAKE

A cross-sectional design means we can’t rule out reverse causation. People who are depressed may simply eat less fish. Social support, finances, and executive function could explain both better diet and lower depression rates. That said, the findings align with a broader literature on Mediterranean eating and mental health. For older women interested in lifestyle changes, recommending a Mediterranean-style diet is reasonable and low-risk. If they want specifics, aim for two or more servings of fresh fish per week, and favor olive oil over butter.