Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults

Objective: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association. Methods: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses. Results: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association. Conclusion: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.