Impact of citrus fruit intake on the mental health of patients with chronic heart failure

Naoya Kakutani, Takashi Yokota, Arata Fukushima, Yoshikuni Obata, Taisuke Ono, Takeshi Sota, Yoshiharu Kinugasa, Masashige Takahashi, Hisashi Matsuo, Ryuichi Matsukawa, Ichiro Yoshida, Shigeo Kakinoki, Kazuya Yonezawa, Yoshihiro Himura, Isao Yokota, Kazuhiro Yamamoto, Miyuki Tsuchihashi-Makaya, Shintaro Kinugawa

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: The full impact of the intake of citrus fruits on the risk of depression in individuals with chronic heart failure (HF) is unknown. Here, we examined the associations between the estimated habitual intakes of citrus fruits and depressive symptoms in patients with chronic HF. Methods: We enrolled 150 stable outpatients with chronic HF who had a history of worsening HF. To assess the patients' daily dietary patterns, we used a brief self-administered diet-history questionnaire to calculate the daily consumption of foods and nutrients. To assess the patients' mental state, we used a nine-item Patient Health Questionnaire (PHQ-9). Results: Twelve patients (8%) were identified as having moderate-to-severe depression (PHQ-9 score ≥10). The patients with PHQ-9 ≥10 had lower daily intakes of citrus fruits compared to those with no or mild depressive symptoms (PHQ-9 <10). The daily intakes of various antioxidants, including vitamin C, β-carotene, and β-cryptoxanthin, all of which are abundant in citrus fruits, were reduced in the patients with PHQ-9 ≥10, accompanied by higher serum levels of 8-isoprostane (an oxidative stress marker). A multivariate logistic regression analysis using forward selection showed that a lowered daily intake of citrus fruits was an independent predictor of the comorbidity of moderate-to-severe depression in patients with chronic HF, after adjustment for age, gender, and the hemoglobin value. Conclusions: A lower daily consumption of citrus fruits was associated with higher prevalence of depression in patients with chronic HF. Our findings support the hypothesis that a daily consumption of citrus fruits has a beneficial effect on the prevention and treatment of depression in chronic HF patients.

Original languageEnglish
Pages (from-to)719-726
Number of pages8
JournalJournal of Cardiology
Issue number6
Publication statusPublished - Jun 2022
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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