A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study
Restricted accessResearch articleFirst published online March, 2015
A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study
To determine whether a plant-based nutrition program in a multicenter, corporate setting improves depression, anxiety, and productivity.
Design.
A quasi-experimental study examined the impact of diet on emotional well-being and productivity.
Setting.
The study was conducted in 10 corporate sites of a major U.S. insurance company.
Subjects.
There were 292 participants (79.8% women, 20.2% men), with body mass index ≥25 kg/m2 and/or previous diagnosis of type 2 diabetes.
Intervention.
Either weekly instruction in following a vegan diet or no instruction was given for 18 weeks.
Measures.
Depression and anxiety were measured using the Short Form-36 questionnaire. Work productivity was measured using the Work Productivity and Activity Impairment questionnaire.
Analysis.
Baseline characteristics were examined by t-test for continuous variables and χ2 test for categorical variables. Analysis of covariance models were adjusted for baseline covariates. Paired t-tests were used to determine within-group changes and t-tests for between-group differences.
Results.
In an intention-to-treat analysis, improvements in impairment because of health (p < .001), overall work impairment because of health (p = .02), non-work-related activity impairment because of health (p < .001), depression (p = .02), anxiety (p = .04), fatigue (p < .001), emotional well-being (p = .01), daily functioning because of physical health (p = .01), and general health (p = 0.02) in the intervention group were significantly greater than in the control group. Results were similar for study completers.
Conclusion.
A dietary intervention improves depression, anxiety, and productivity in a multicenter, corporate setting.
ValensteinMVijanSZeberJE. The cost-utility of screening for depression in primary care. Ann Intern Med.2001;134:345–360.
2.
PrattLABrodyDJ. Depression in the United States household population, 2005–2006. NCHS Data Brief. 2008(7):1–8.
3.
LernerDAdlerDARogersWH. Work performance of employees with depression: The impact of work stressors. Am J Health Promot. 2010;24:205–213.
4.
LeopoldR. A Year in the Life of a Million American Workers. New York, NY: MetLife Disability Group; 2001.
5.
StewartWFRicciJACheeE. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135–3144.
6.
GreenbergPEKesslerRCBirnbaumHG. The economic burden of depression in the United States: How did it change between 1990 and 2000?J Clin Psychiatry. 2003;64:1465–1475.
7.
CampbellKLanzaADixonR. Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.
8.
ChapmanLS. Meta-evaluation of worksite health promotion economic return studies: 2005 update. Am J Health Promot. 2005;19:1–11.
9.
KeyTDaveyG. Prevalence of obesity is low in people who do not eat meat. BMJ. 1996;313:816–817.
10.
NewbyPKTuckerKLWolkA. Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women. Am J Clin Nutr.2005;81:1267–1274.
11.
SnowdonDAPhillipsRL. Does a vegetarian diet reduce the occurrence of diabetes?Am J Pub Health. 1985;75:507–512.
12.
SpencerEAApplebyPNDaveyGKKeyTJ. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003;27:728–734.
13.
VangASinghPNLeeJW. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: Findings from Adventist Health Studies. Ann Nutr Metab. 2008;52:96–104.
14.
TonstadSButlerTYanRFraserGE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32:791–796.
15.
TonstadSStewartKOdaK. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis.2013;23:292–299.
16.
ApplebyPNThorogoodMMannJIKeyTJ. The Oxford Vegetarian Study: An overview. Am J Clin Nutr.1999;70(suppl 3):525S–531S.
17.
KeyTJFraserGEThorogoodM. Mortality in vegetarians and nonvegetarians: Detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr.1999;70(suppl 3):516S–524S.
18.
MelbyCLTooheyMLCebrickJ. Blood pressure and blood lipids among vegetarian, semivegetarian, and nonvegetarian African Americans. Am J Clin Nutr.1994;59:103–109.
19.
FraserGE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr.1999;70(suppl 3):532S–538S.
20.
FraserGE. Vegetarian diets: What do we know of their effects on common chronic diseases?Am J Clin Nutr.2009;89:1607S–1612S.
21.
PettersenBJAnoushehRFanJ. Vegetarian diets and blood pressure among white subjects: Results from the Adventist Health Study-2 (AHS-2). Public Health Nutr.2012;15:1909–1916.
22.
CrossAJLeitzmannMFGailMH. A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med.2007;4:e325.
23.
KeyTJApplebyPNSpencerEA. Cancer incidence in British vegetarians. BJC. 2009;101:192–197.
24.
LarssonSCWolkA. Meat consumption and risk of colorectal cancer: A meta-analysis of prospective studies. Int J Cancer. 2006;119:2657–2664.
25.
KatcherHIFerdowsianHRHooverVJCohenJLBarnardND. A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity. Ann Nutr Metab. 2010;56:245–252.
26.
BeezholdBLJohnstonCSDaigleDR. Vegetarian diets are associated with healthy mood states: A cross-sectional study in seventh day adventist adults. Nutr J.2010;9:26.
27.
BeezholdBLJohnstonCS. Restriction of meat, fish, and poultry in omnivores improves mood: A pilot randomized controlled trial. Nutr J.2012;11:9.
28.
LinkLBHussainiNSJacobsonJS. Change in quality of life and immune markers after a stay at a raw vegan institute: A pilot study. Complement Ther Med.2008;16:124–130.
29.
KatcherHIFerdowsianHRHooverVJ. A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity. Ann Nutr Metab. 2010;56:245–252.
30.
AldanaSBarlowMSmithR. A worksite diabetes prevention program: Two-year impact on employee health. AAOHN J.2006;54:389–395.
31.
MillsPRKesslerRCCooperJSullivanS. Impact of a health promotion program on employee health risks and work productivity. Am J Health Promot. 2007;22:45–53.
32.
RenaudLKishchukNJuneauM. Implementation and outcomes of a comprehensive worksite health promotion program. Can J Public Health. 2008;99:73–77.
33.
SchultzABLuCBarnettTE. Influence of participation in a worksite health-promotion program on disability days. J Occup Environ Med.2002;44:776–780.
McHorneyCAWareJEJrRaczekAE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care. 1993;31:247–263.
37.
WareJEJr. SF-36 health survey update. Spine. 2000;25:3130–3139.
38.
TsaiCBaylissMSWareJE. SF-36 Health Survey Annotated Bibliography: Second Edition (1988–1996). Boston, Mass: Health Assessment Lab; 1997.
39.
ReillyMCZbrozekASDukesEM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365.
40.
PrasadMWahlqvistPShikiarRShihYC. A review of self-report instruments measuring health-related work productivity: A patient-reported outcomes perspective. Pharmacoeconomics. 2004;22:225–244.
41.
WeiLZhangJ. Analysis of data with imbalance in the baseline outcome variable for randomized clinical trials. Drug Information Journal. 2006;35:1201–1214.
42.
MishraSBarnardNDGonzalesJ. Nutrient intake in the GEICO multicenter trial: The effects of a multicomponent worksite intervention. Eur J Clin Nutr.2013;67:1066–1071.
43.
WengTTHaoJHQianQW. Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents?Pub Health Nutr.2012;15:673–682.
44.
Avila-FunesJAGarantMPAguilar-NavarroS. Relationship between determining factors for depressive symptoms and for dietary habits in older adults in Mexico [in Spanish]. Rev Panam Salud Publica. 2006;19:321–330.
45.
KonttinenHMannistoSSarlio-LahteenkorvaS. Emotional eating, depressive symptoms and self-reported food consumption. A population-based study. Appetite. 2010;54:473–479.
46.
VergerPLionsCVentelouB. Is depression associated with health risk-related behaviour clusters in adults?Eur J Public Health. 2009;19:618–624.
47.
WooJLynnHLauWY. Nutrient intake and psychological health in an elderly Chinese population. Int J Geriatr Psychiatry. 2006;21:1036–1043.
48.
NanriAKimuraYMatsushitaY. Dietary patterns and depressive symptoms among Japanese men and women. Eur J Clin Nutr.2010;64:832–839.
49.
Sanchez-VillegasAHenriquezPBes-RastrolloMDoresteJ. Mediterranean diet and depression. Public Health Nutr.2006;9:1104–1109.
50.
Sanchez-VillegasADelgado-RodriguezMAlonsoA. Association of the Mediterranean dietary pattern with the incidence of depression: The Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry. 2009;66:1090–1098.
51.
TsaiACChangTLChiSH. Frequent consumption of vegetables predicts lower risk of depression in older Taiwanese—results of a prospective population-based study. Public Health Nutr.2012;15:1087–1092.
52.
SkarupskiKATangneyCLiH. Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time. Am J Clin Nutr.2010;92:330–335.
53.
KimJMStewartRKimSW. Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression. Br J Psychiatry. 2008;192:268–274.
54.
SzetoYTKwokTCBenzieIF. Effects of a long-term vegetarian diet on biomarkers of antioxidant status and cardiovascular disease risk. Nutrition. 2004;20:863–866.
55.
ErnstEPietschLMatraiAEisenbergJ. Blood rheology in vegetarians. Br J Nutr.1986;56:555–560.
56.
WurtmanRJWurtmanJJReganMM. Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. Am J Clin Nutr.2003;77:128–132.
57.
FernstromJDWurtmanRJHammarstrom-WiklundB. Diurnal variations in plasma concentrations of tryptophan, tryosine, and other neutral amino acids: Effect of dietary protein intake. Am J Clin Nutr.1979;32:1912–1922.
58.
MaherTJGlaeserBSWurtmanRJ. Diurnal variations in plasma concentrations of basic and neutral amino acids and in red cell concentrations of aspartate and glutamate: Effects of dietary protein intake. Am J Clin Nutr.1984;39:722–729.
59.
SchaechterJDWurtmanRJ. Tryptophan availability modulates serotonin release from rat hypothalamic slices. J Neurochem. 1989;53:1925–1933.
60.
SchaechterJDWurtmanRJ. Serotonin release varies with brain tryptophan levels. Brain Res.1990;532:203–210.
61.
RosenthalNESackDAGillinJC. Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41:72–80.
62.
KahleovaHHrachovinovaTHillMPelikanovaT. Vegetarian diet in type 2 diabetes—improvement in quality of life, mood and eating behaviour. Diabet Med.2013;30:127–129.
63.
BaickerKCutlerDSongZ. Workplace wellness programs can generate savings. Health Aff (Project Hope). 2010;29:304–311.
