Data on the association of the Mediterranean diet with depressive symptoms in older people at high risk of depression are scarce. This study aimed to investigate the cross-sectional association of the adherence to the Mediterranean diet and its components with depressive symptoms in the Italian NutBrain cohort of older men and women. A total of 325 men and 473 women aged 65-97 years (2019-2023), answered a 102-item semi-quantitative food frequency questionnaire, which was used to calculate the Mediterranean diet score (MDS). Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale; subjects with a score of 16 or more were considered to have depression. Multivariable logistic regression was used for statistical analysis. The occurrence of depressive symptoms was 19.8% (8.0% men, 27.9% women). High adherence to MDS (highest tertile) significantly reduced the odds of having depressive symptoms by 54.6% (OR 0.454,95%CI 0.266-0.776). In sex-stratified analysis, the reduction was evident in women (OR 0.385, 95%CI 0.206-0.719) but not in men (OR 0.828, 95%CI 0.254-2.705). Looking at the association of MDS components with depressive symptoms, we found an inverse significant association with fish consumption and the monounsaturated fatty acids/saturated fatty acids (MUFA/SFA) above the median only in women (OR 0.444, 95%CI 0.283-0.697 and OR 0.579, 95%CI 0.345-0.971, respectively). High adherence to the MDS, and a high fish intake and MUFA/SFA ratio were associated with lower depressive symptoms in women, but not in men. Future longitudinal studies are needed to confirm these findings and to explore the underlying biological mechanisms.
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