Adults who consumed a high amount of ultra-processed foods (UPFs) for a long period of time had a significantly higher chance of subsequently experiencing depressive symptoms.
The research investigated the association between high intakes of ultra-processed foods (UPF) and the recurrence of depressive symptoms in a British population aged approximately 50-75 years. Using data from the Whitehall II study, researchers analysed dietary habits in a Western diet context and mental health outcomes over 11 years.
The study explored whether participants with high rates of UPF consumption had higher odds of experiencing recurrent depressive symptoms compared to those with lower UPF intakes.
The Whitehall II study is an ongoing prospective cohort study of 10,308 men and women (aged 33-55 at recruitment into the study) who worked in the civil service in London between 1985 and 1988. The study has a biomedical focus, and the participants have been followed up in data collection “phases” (sweeps) approximately every five years.
The paper focused on the phase 7 data collection, which took place in 2002-2004, and used a sample of 4,554 participants, with an average age of 61-years, who had data available on diet, depressive symptoms, and covariates at this phase.
The authors also restricted their analyses to only White participants due to an interaction between ethnicity, diet, and depressive symptoms.
The Whitehall II study included a 127-item food frequency questionnaire (FFQ) in data collection phase 3 (1991-1994), phase 5 (1997-1999) and phase 7 (2002-2004).
In the FFQs, participants were asked how often, on average, they had consumed a common unit or portion size of each food item during the previous year. The NOVA food classification system was used to categorise the FFQ items into four groups according to the level of processing.
These groups were:
– unprocessed foods
– processed culinary food ingredients
– processed foods
– ultra-processed foods.
To estimate the total amount of UPFs eaten, the UPF items were converted into daily intake in grams (by multiplying the frequency of consumption by portion size) and then calculated as a percentage of total daily food intake. This was calculated for the whole sample at phase 7.
However, a cumulative average of total UPF intake, representing long-term consumption, was calculated for a sub-sample of the participants who had repeated measurements of diet over phases 3, 5, and 7.
Learn more about food frequency questionnaires and other dietary assessment methods in CLOSER’s Dietary cross-study data guide.
Three overall diet quality scores were also calculated from the FFQs, and cumulative averages were calculated from FFQ data at data collection phases 3, 5 and 7.
Using recommended intakes as the reference criteria, the intake of 11 dietary components (vegetables, fruit, whole grains, nuts and legumes, omega-3 fats, polyunsaturated fat, sugary drinks, red and processed meat, trans fat, salt and alcohol) were scored between zero (recommendations not at all met) and ten (recommendations fully met).
For example, an individual who ate no servings of vegetables per day would score zero for the vegetable component, while an individual who ate five or more vegetables would score ten.
The scores across all the components were summed together to obtain an AHEI-2010 score, which ranged from zero to 110.
The median daily intake of nine dietary components (vegetables, fruits, whole grains, legumes, fatty acids, meat, dairy and alcohol) was used to assign each participant a score between zero and one for each component.
A score of zero reflected an intake of less than the median and a score of one indicated an intake of more than or equal to the median. The scores across all the components were summed together to obtain a Mediterranean diet score, which ranged from zero to nine.
This score reflected the inflammatory potential of a diet and was calculated using data for 27 food components, covering energy, macronutrients (e.g. protein, carbohydrate, fat), fat types (e.g. omega-3, saturated fat) and micronutrients (e.g. vitamins, minerals).
Each food component was given a score based on whether it increased, decreased, or had no effect on six inflammatory biomarkers (according to previous research). These were summed to create an overall dietary inflammatory index score where higher scores represented more pro-inflammatory diets and lower scores more anti-inflammatory diets.
An episode of depressive symptoms was determined by achieving a score of 16 or higher on the Center for Epidemiologic Studies Depression Scale (CES-D), a self-reported scale with 20 items covering symptoms of depression or being treated with anti-depressant drugs.
Both CES-D scores and anti-depressant use were measured in Whitehall II at phase 7 (2002-2004), phase 9 (2007-2009), phase 11 (2012-2013), and phase 12 (2015-2016). Recurrent depressive symptoms were defined as presenting depressive symptoms at two or more phases during the 13-year follow-up.
A range of socio-demographic factors, health behaviours, and health-related factors measured at phase 7 (2002-2004) were included as control variables.
These included sex, age, marital status, education, socioeconomic status, smoking, physical activity, overall diet quality (AHEI-2010), health conditions, body mass index, and cognitive functioning.
The study found that those with high long-term consumption of UPF (the top quintile) had 31% higher odds of experiencing recurrent depressive symptoms, compared to those who had lower intakes of UPF (the lower four quintiles). This association remained significant even after adjusting for socio-demographic factors, health behaviours, and health status.
The study also found that, once UPF intakes had been accounted for, there was no significant association between other diet scores (AHEI-2010, Mediterranean diet and diet inflammatory index) and depressive symptoms.
This suggests that UPF consumption contributes to the relationship between overall diet quality and depression that has been observed in other research.
Longitudinal data allowed the researchers to identify long-term consumption patterns of UPFs, rather than consumption at a single time point, making the data more reflective of an individual’s typical diet (and less likely to reflect a one-off event).
Similarly, the multiple measurements of depressive symptoms over time enabled the identification of recurrent episodes of depression. This approach provides a stronger indicator of depression than data from a single time point, although still cannot be used to identify cases of major depression.
The study’s design also meant that dietary information preceded the assessment of depressive symptoms, which helped to establish a temporal relationship.
However, even though the study investigated depressive symptoms after UPF consumption, there is still the potential of a bidirectional association which wasn’t captured in the data—where experiencing depressive symptoms could lead to increased consumption of UPFs. The study also relies on self-reported information about diet and depression. Diets are complex to record accurately and the FFQs used in the study are limited to specific food groups, which may not perfectly capture food consumption. Both diet and depressive symptom measures can suffer from under-reporting and bias due to recall issues and reluctance to disclose certain behaviours or feelings.
Additionally, as with all longitudinal studies, participant attrition over the long duration of the study can lead to biased results if those who drop out differ significantly from those who remain.
The findings highlight the importance of dietary interventions in mental health promotion. Among older adults, a high consumption of UPF over many years appears to increase the chance of subsequently experiencing depressive symptoms, with UPF playing a large part in the relationship between overall diet quality and depression. Policies promoting healthier food choices and reducing UPF consumption could potentially reduce the prevalence of depressive symptoms in the population.
Nevertheless, there is still a gap in the understanding of the exact mechanisms by which UPFs could influence depression. The potential negative impacts of UPF could be due to the nature of these foods being rich in sugar, salt and fat, the specific components within UPFs (e.g. additives, emulsifiers or preservatives), or the reduced intake of other healthier food items (e.g. fruit, vegetables, fish).
This study also highlights difficulties with accurately measuring diet and identifying UPFs, as current measures of diet do not specifically identify UPFs and assumptions about the nature of food items are made during data analysis in order to categorise based on the level of processing.
Campbell, C. (2025). Research Case Studies: Ultra processed foods and depressive symptoms among older adults. CLOSER Learning Hub, London, UK: CLOSER.