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Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.

elsevier.com/locate/psychres Dietary zinc and iron intake and risk of depression: A meta-analysis Zongyao Li, Bingrong Li, Xingxing Song, Dongfeng Zhang ? Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University,

38 Dengzhou Road, Qingdao, Shandong 266021, People'

s Republic of China A R T I C L E I N F O Keywords: Zinc Iron Depression Meta-analysis A B S T R A C T The associations between dietary zinc and iron intake and risk of depression remain controversial. Thus, we carried out a meta-analysis to evaluate these associations. A systematic search was performed in PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases for relevant studies up to January 2017. Pooled relative risks (RRs) with 95% con?dence intervals (CIs) were calculated using a random e?ects model. A total of

9 studies for dietary zinc intake and

3 studies for dietary iron intake were ?nally included in present meta-analysis. The pooled RRs with 95% CIs of depression for the highest versus lowest dietary zinc and iron intake were 0.67 (95% CI: 0.58C0.76) and 0.57 (95% CI: 0.34C0.95), respectively. In subgroup analysis by study design, the inverse association between dietary zinc intake and risk of depression remained signi?cant in the cohort studies and cross-sectional studies. The pooled RRs (95% CIs) for depression did not substantially change in the in?uence analysis and subgroup analysis by adjustment for body mass index (BMI). The present meta-analysis indicates inverse associations between dietary zinc and iron intake and risk of depression. 1. Introduction Depression is a common mental disorder in the general population (Doris et al., 1999). World Health Organization (WHO) has reported that more than

350 million people worldwide su?er from depression. Depression remains the leading cause of disability worldwide, and contributes signi?cantly to the global burden of disease (Ferrari et al., 2013;

Murray and Lopez, 1997). Hence, treatments and preventive methods of depression are critical. Several evidences suggest that depression is a multifactorial disease. Genetic (Caspi et al., 2003), aging (Richardson et al., 2012), sedentary behavior (Zhai et al., 2015) and many other factors contribute to the development of depression in humans (Yary et al., 2010). Evidence shows that depression is also associated with dietary factors, including, ?sh, fruit, vegetables and co?ee (Li et al., 2016;

Liu et al., 2016;

Wang et al., 2016). Dietary components play important roles in depression, such as vitamin B12, vitamin D and folate (Anglin et al., 2013;

Petridou et al., 2016). As essential microelements, zinc and iron are often present in similar dietary sources and de?ciencies in iron and zinc often co-occur (Gibson et al., 2002;

Lim et al., 2013). Zinc and iron are important in regulating of cellular function and neuromodula- tion (Momcilovic et al., 2010). Some studies found zinc may also have an in?uence on the neural transmission involved in depression, such as the serotonergic, dopaminergic and glutamatergic systems (Piotrowska et al., 2013;

Toth, 2011). The antidepressant properties of zinc may be explained by modulating the functions of serotonergic and N-methyl-D- aspartate (NMDA) receptors and increasing levels of brain derived neurotrophic factor (BDNF) (Bitanihirwe and Cunningham, 2009;

Bresink et al., 1995). Many epidemiological studies have reported the associations of dietary zinc and iron intake and risk of depression. However, the results of these studies were inconsistent. For instance, an inverse association between dietary zinc intake and risk of depres- sion was found in some studies (Amani et al., 2010;