Do sex hormones or hormone therapy modify the relation of n-3 fatty acids with incident depressive symptoms in postmenopausal women? The MESA Study

Abstract

Introduction: Considering that estradiol (E2) and n-3 polyunsaturated fatty acids (PUFAs) have roles in neurogenesis and in neurotransmission, we examined whether the association of PUFAs with incident depressive symptoms in postmenopausal women is modified by hormone therapy (HT) use or estrogen status.

Methods: Women (N=1616) free of depressive symptoms at baseline (2000-2002) in the Multi-Ethnic Study of Atherosclerosis were classified by HT usage and quartiles of dietary eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and the sum EPA+DHA. Women with serum E2 ≤0.073 nmol/L (sample median), were classified low on E2. Poisson regression was used to model incident depressive symptoms at examination 3 (2004-05), defined by the Center for Epidemiological Studies Depression Scale ≥16 or taking an antidepressant, first as a function of HT use and n-3 PUFA quartiles, and second, as a function of low E2 status and n-3 PUFA quartiles.

Results: Among HT non- users, positive, graded relationships (p-trends≤0.003) were found between PUFAs and incident depressive symptoms. Compared to the lowest quartile, the adjusted risk ratios (RRs) for the highest were 2.10, 2.39, and 2.04 for EPA, DHA, and EPA+DHA, respectively. For HT users, no associations were seen. When analyses were run for E2 status, the RRs over quartiles of the PUFAs were positive and graded for low E2 women, but were null for High E2 women.

Conclusions: Higher intakes of DHA and EPA were associated with higher risk of depressive symptoms in nonusers of HT, contrary to hypothesis.

Keywords: CES-D; Depressive symptoms; Estrogen; Hormone therapy; Menopause; n-3 Fatty acids.

Figure

Left panel: Adjusted relationship by spline regression between probability of having incident depressive symptoms at examination 3 and EPA+DHA as a percent of energy intake for HT nonusers (n=1087). Spline (with 95% pointwise confidence band) is adjusted for age, ethnicity, energy intake, body mass index, smoking status, quartiles of exercise, education status, income, current drinker, marital status, and diabetes. Right panel: Adjusted relationship by spline regression between probability of having incident depressive symptoms at examination 3 and EPA+DHA as a percent of energy intake for HT users (n=538). Spline (with 95% pointwise confidence band) is adjusted for age, ethnicity, energy intake, body mass index, smoking status, quartiles of exercise, education status, income, current drinker, marital status, and diabetes.