Fruit and vegetable intake in relation to depressive and anxiety symptoms among adolescents in 25 low- and middle-income countries

Background: Fruit and vegetable intake (FVI) has been inversely associated with the risk of depression. However, there is a gap in evidence from low- and middle-income countries (LMICs) and among adolescents. Further, little is known about FVI in relation to the risk of anxiety. Therefore, we examined these associations among adolescents in 25 LMICs. Methods: Data from the Global School-based Student Health Survey were analyzed in 65267 adolescents aged 12–15 years (mostly nationally representative). Depressive and anxiety symptoms during the past 12 months were self-reported. Frequencies of FVI during the past 30 days were collected. Multivariable logistic regression and meta-analyses of country-wise estimates were undertaken. Results: The prevalence of depressive and anxiety symptoms were 30.3% and 9.8%, respectively. A meta-analysis indicated that FVI of <5 times/d (vs. higher) was associated with an increased risk of depressive symptoms (OR = 1.10; 95% CI = 1.02–1.18). The pooled estimate for anxiety symptoms was insignificant. When examined separately, fruit intake was significantly associated with both lower risks of depressive and anxiety symptoms; vegetable intake was significantly associated with a lower risk of depressive symptoms, but not with anxiety. Limitations: Only adolescents attending school were included; the cross-sectional design cannot reveal causality; outcomes were not measured against the gold-standard diagnostic criteria. Conclusions: Our study provides multi-national evidence of the protective effect of FVI against depressive and anxiety symptoms among adolescents in LMICs, enabling key stakeholders to address mental health issues among adolescents globally.