Is meat consumption associated with depression? A meta-analysis of observational studies

Depression is a common mental disorder in general population, which usually presents with symptoms of sadness, exhaustion and lack of interest in daily life activities [1]. Depression may cause great losses to the society, such as the reduction in work productivity and quality of life, as well as the increase in suicide rate [2]. According to the data released by WHO, over 350 million people suffer from depression worldwide and the prevalence is rising globally [3]. The current treatments for depression may bring about a series of issues such as costly pharmacotherapy, adverse side effects and unsatisfactory curative effect [4, 5]. Therefore, alternative treatment and prevention strategy for depression are needed. There is an increasing collection of evidence to suggest that dietary factors are associated with depression [6]. Thus, the identification of modifiable dietary factors for depression appears to be an important step in the prevention and management of depression.

As a major source of protein, fat and energy for human, meat consumption accounts for a large part of the dietary structure worldwide [7]. In addition, meat contains an abundant variety of essential nutrients such as iron, zinc, and vitamin B12 [8]. Nevertheless, the 2005 US Dietary Guidelines recommend that the consumption of meat should be moderated appropriately [9], since some epidemiological evidences showed that meat consumption was associated with digestive system disease [10], cardiovascular disease [11], type 2 diabetes [12] and cancer [13]. Meat consumption is directly associated with obesity [14], which is a risk factor for depression [15]. In another word, it seems naturally to speculate that meat consumption is probably associated with depression. To our best knowledge, a number of epidemiological studies have examined the effect of meat consumption on depression [16‐23]. Some of them confirmed the association between meat consumption and depression [17‐19, 22], while some others rejected it [16, 20, 21, 23]. Thus, the present meta-analysis of observational studies aimed at investigating the relationship between meat consumption and depression. It was hypothesized that meat consumption is positively associated with depression.

In the current meta-analysis, a total of eight observational studies were identified for examination. The quantitative synthesis of these observational studies showed that meat consumption might be associated with a moderately higher risk of depression. However, with respect to the prevalence of depression, no significant relationship was observed.

Obesity might mediate the effect of meat consumption on depression [14, 15]. The mechanism how meat consumption increases the risk of depression might be speculated as follows. As a major component in meat, fat was considered to be associated with depression in animals. Abildgaard showed that rat is more susceptible to the development of depressive behavior following metabolic stress induced by high-fat diet [28]. Sumaya confirmed that high-fat diet may counteract the anti-depressive-like effect of the fluoxetine and reverse the anti-depressive-like effect of the 2-methyl-5-HT in mice [29]. Logically, a similar effect may exist in human. On the other hand, trans-unsaturated fatty acid, which was abundant in ruminant meat [30, 31], was found to be related to depression by Sanchez-Villegas [32]. However, some issues should also be noted. Firstly, no significant relationship between meat consumption and depression was found regarding the overall OR. Secondly, meat was complex in components and should be considered as a whole. However, there was no experimental study examining the effect of meat on depression directly. In addition, interestingly, some potential confounding factors might mediate the association between meat consumption and depression. Consuming less meat might be associated with some eating habits (vegetable and fruit consumption, legume consumption, et al.) [17] or lifestyle habits (physical activity) [33] that have a beneficial impact on the prevention of the risk of depression, which make it difficult to know in what proportion of our results should be attributed to other factors (vegetable and fruit consumption, legume consumption, physical activity, et al.). Therefore, more well-designed studies are needed to elaborate the concerned issues further.

Generally speaking, the muscle meat from beef, veal, pork, lamb, horse and deer is regarded as “red” meat. “White” meat mainly refers to poultry. “Processed meat” includes all types of meat products, such as sausages, cold cuts and other forms of meat, which have been mixed with other ingredients, such as salt, to extend their shelf life [8]. Therefore, it is speculated that the effect of meat may vary among various varieties. According to the epidemiological data, Wu confirmed that the effect of white meat, red meat and processed meat on hypertension differed greatly [34]. Becerra-Tomas showed that red or processed meat was associated with a higher risk of metabolic syndrome while white meat was not [35]. In terms of animal studies, Jakobsen found that the intake of red and white meat might lead to metabolic differences in rats [36]. Toden demonstrated that dietary red meat can cause a greater level of colonic DNA double-strand break than white meat in rats [37]. Therefore, it was speculated in the present study that the effect of white, red and processed meat on depression may differ from each other as well. An earlier meta-analysis found a relationship between processed meat and oral cancer, but this relationship did not exist when the meat was regarded as a whole [38]. Another meta-analysis showed that the processed or red meat was associated with cardiovascular disease while the total meat was not [39]. Hence, the present study attempted to specify the varieties as above. However, since no study has specified the varieties of meat with respect to depression yet, the various varieties could only be regarded as a whole. That means the results of this study are subject to the combined effect of different varieties of meat. Interestingly, the results for the overall RR and OR were totally different. Based on the overall RR, it was speculated that meat consumption might be associated with a moderately higher risk of depression indeed. However, depressive subjects may consume less meat due to the reduction in appetite, which might partly explain the reason why no significant relationship was established according to the overall OR. More well-designed prospective studies, which classify the different varieties of meat, are therefore needed.

The strengths of this meta-analysis can be listed as follow: Firstly, this is the first meta-analysis of observational study which aims at the relationship between meat consumption and depression. Secondly, the included studies were analyzed according to the adjusted results and large samples. Thirdly, the present study can serve as a reference and indication for further research. Nevertheless, this study also has several limitations. First, the results of this study might be distorted by the substantial level of heterogeneity. Second, since the relevant literature is limited, only a small number of studies were applicable for this meta-analysis. Third, the food frequency questionnaire, diagnostic criteria of depression and the selection of adjusted factors were not uniform. Fourth, few study specified the varieties of meat. Last but not the least, since some potential confounding factors might mediate the relationship between meat consumption and depression, some issues could not be addressed. As a consequence, the significance of this study might be weaken by the limitations above.

The current evidences showed that meat consumption may be associated with a moderately higher risk of depression. However, due to the limited number of prospective studies and the potential confounding factors, it still warrants further studies with classification of meat varieties to confirm such findings.