# Association Between PURE Diet Score and Mental Disorders in Patients At‐Risk of Cardiovascular Disease: Findings From the Iran Premature Coronary Artery Disease (IPAD) Study, a Multicenter Cross‐Sectional Study

## TL;DR

A study found that following a PURE diet, which includes moderate animal foods and whole-fat dairy, is linked to lower depression and anxiety, especially in women at high risk of heart disease.

## Contribution

This study is the first to explore the association between the PURE diet score and mental disorders in a high-risk cardiovascular population.

## Key findings

- Higher PURE diet scores were associated with lower odds of depression and anxiety in the overall population.
- The inverse association was significant among women but not among men.
- Participants with higher PURE scores had better nutrient intake and dietary quality.

## Abstract

Healthy dietary patterns such as DASH and Mediterranean diets may improve mental well‐being. However, the relationship between the PURE diet—emphasizing moderate consumption of animal foods and whole‐fat dairy—and mental disorders is unclear. This study aimed to investigate the association between the PURE diet score and depression and anxiety in Iranian adults at high risk of cardiovascular disease.

This multicenter cross‐sectional study included 1120 subjects from nine ethnicities who underwent angiography, with no stenosis detected. Dietary intake was assessed using a validated semi‐quantitative food frequency questionnaire, and the PURE score was calculated based on fruit, vegetables, legumes, nuts, fish, and dairy consumption. Mental health was measured using the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using logistic regression and adjusted for confounders.

Participants' mean (SD) age was 52.08 ± 8.25 years. In the overall population, higher PURE diet scores were significantly associated with lower odds of both depression and anxiety after adjustment for potential confounders (depression: OR = 0.55, 95% CI 0.36–0.86, p = 0.03; anxiety: OR = 0.63, 95% CI 0.40–0.99, p = 0.01). In sex‐stratified analyzes, these inverse associations were significant among women (depression: OR = 0.56, 95% CI 0.33–0.95, p = 0.02; anxiety: OR = 0.52, 95% CI 0.30–0.92, p = 0.01), but not among men (depression: OR = 0.49, 95% CI 0.22–1.10, p = 0.08; anxiety: OR = 0.78, 95% CI 0.34–1.79, p = 0.43).

In this cross‐sectional study, higher adherence to the PURE diet was significantly associated with lower odds of both depression and anxiety, particularly among women. No significant associations were observed among men. Prospective cohort studies and clinical trials are needed to confirm these findings.

Higher adherence to the PURE diet is inversely associated with both depression and anxiety, particularly among women.Participants with higher PURE diet scores tended to have better nutrient intake and dietary quality.Findings suggest potential mental health benefits of following the PURE diet, especially for women at high cardiovascular risk.

Higher adherence to the PURE diet is inversely associated with both depression and anxiety, particularly among women.

Participants with higher PURE diet scores tended to have better nutrient intake and dietary quality.

Findings suggest potential mental health benefits of following the PURE diet, especially for women at high cardiovascular risk.