Depression is associated with lower diet quality in both pre- and post-menopausal U.S. women: NHANES 2007-2018

•Depression is associated with lower diet quality in pre- and post-menopausal women.•Postmenopausal status was associated with higher diet quality.•Association between depression and diet quality did not differ by menopause status. Depression has been associated with adverse diet-related outcomes and women are particularly vulnerable to depression around the menopause transition. Therefore, we hypothesized that depression and postmenopausal status would be associated with lower diet quality, and that depression would be associated with lower diet quality in both pre- and post-menopausal women, but that the association would be stronger in postmenopausal women. Data from 5,634 nonpregnant women age > 20 years from the National Health and Nutrition Examination Survey from 2007-2018 were analyzed. Diet quality was determined using the Healthy Eating Index 2020 (HEI-2020). Multivariable linear regression was used to examine the association between depression and diet quality, menopause and diet quality, and depression and diet quality by menopause status, adjusting for covariates. Mean age was 49.6 ± 0.4; 12% of women were classified as depressed and 46% as postmenopausal. In multivariable-adjusted models, depression was associated with lower HEI-2020 total (β = -3.33, P < .001) and adequacy scores (β = -2.41, P < .0001) but not moderation scores. Postmenopausal women had higher HEI-2020 total (β = 2.48, P < .0001), moderation (Β = 1.19, P < .0001), and adequacy (β = 0.81, P < .01) scores than premenopausal women. In a nationally representative sample of U.S. women, depression was associated with lower diet quality across all women and in both pre- and post-menopause. Further research is needed to better understand the relationship between depression and diet quality throughout the menopause transition, when hormonal changes could make women more vulnerable to depression. Total diet quality and adequacy scores did not vary by menopausal status; both pre- and post-menopausal women without depression had higher total Healthy Eating Index-2020 and adequacy scores than their respective counterparts with depression. However, a significant difference in moderation scores was present in premenopausal women only, with higher moderation scores in those without depression vs those with depression. [Display omitted]