Depression, Disability, and Low Fish Intake Frequency in Patients With RA

Man eating a plate of fish
Man eating a plate of fish
Ties between mental disorders, dietary habits, and rheumatoid arthritis activity are revealed in this study.

In patients with rheumatoid arthritis (RA), depression has a significant negative association with fish intake frequency and a positive association with disability, investigators reported in a study published in PLoS One.

The researchers conducted a cross-sectional study with use of the Kyoto University Rheumatoid Arthritis Management Alliance cohort (KURAMA) database to determine the relationship regarding depression, anxiety, and dietary habits in patients with RA.

The analysis included 267 women with RA who had a mean (±SD) age of 60.7 (±12.8) years and a mean RA disease duration of 13.4 (±12.6) years. The patients’ mean 28-Joint RA Disease Activity Score-C-reactive protein (DAS28-CRP) was 1.87 (±0.80), and a majority of participants were in remission of disease activity (DAS28-CRP <2.6, 80.1%). The patients were grouped into 3 categories—no/possible/probable depression—to compare RA-related factors.

When patients’ stage of depression increased, their degree of current disease activity (DAS28-CRP) and overall disease (Visual Analogue Scale score) was significantly increased. However, age, disease duration, and laboratory data, which included hemoglobin, albumin, and CRP levels, were unchanged. In addition, patients’ health assessment questionnaire disability index (HAQ-DI) score increased as their depression score increased.

A trend analysis showed that 3 food items (fish, vegetables, and fruit) of 20 that were consumed at a higher intake frequency were negatively associated with the Hospital Anxiety and Depression Scale (HADS) depression score. Frequent fish intake (≥3 times/week) was inversely and significantly associated with depression score in the model involving RA-related factors and patients’ disability status (estimate –0.53, P = .032).

Multiple linear regression analysis demonstrated that depression score was negatively associated with frequent fish intake (≥3 times per week) (estimate –0.53, P = .033), HAQ-DI score within normal range (estimate –0.88, P ≤ .001), and methotrexate use (estimate –0.60, P ≤ .023).

Regarding anxiety, a trend analysis showed that fish was the only 1 of 20 items of higher food intake frequency that was negatively associated with the HADS anxiety score. Multiple liner regression analysis showed that having no disability was significantly and inversely associated with the anxiety score. No dietary factors were associated with anxiety score in either model (estimate –0.25, P = .31), however.

The investigators noted several limitations to their findings, as the cross-sectional study does not imply causation and further longitudinal research is needed. Also, only women were included, there is the potential for selection bias, and the study authors did not assess medical adherence, although it was a confounding factor related to depression and anxiety status.

“Dietary intervention such as encouragement of fish consumption as well as the control of RA disease activity could be a potential clinical approach to improve the mental health of RA patients,” the researchers commented.

Disclosure: This study is supported by a grant from Daiichi Sankyo Co. Ltd. Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.


Minamino H, Katsushima M, Hashimoto M, et al. Influence of dietary habits on depression among patients with rheumatoid arthritis: A cross-sectional study using KURAMA cohort database. PLoS One. 2021;16(8):e0255526. doi:10.1371/journal.pone.0255526