ABSTRACTBackgroundTrials testing the effect of vitamin D or omega-3 fatty acids (n3-PUFA) supplementation on major depressive disorder (MDD) reported conflicting findings. These trials were boosted by epidemiological evidence suggesting an inverse association of circulating 25-hydroxyvitamin D (25-OH-D) and n3-PUFA levels with MDD. Observational associations may emerge from unresolved confounding, shared genetic risk, or direct causal relationships. We explored the nature of these associations exploiting data and statistical tools from genomics.MethodsResults from GWAS on 25-OH-D (N = 79366), n3-PUFA (N = 24925) and MDD (135458 cases, 344901 controls) were applied to individual-level data (>2,000 subjects with measures of genotype, DSM-IV lifetime MDD diagnoses and circulating 25-OH-D and n3-PUFA) and summary-level data analyses. Shared genetic risk between traits was tested by polygenic risk scores (PRS). Two-sample Mendelian Randomization (2SMR) analyses tested the potential bidirectional causality between traits.OutcomeIn individual-level data, PRS were associated with the phenotype of the same trait (PRS 25-OH-D p = 1.4e-20, PRS N3-PUFA p = 9.3e-6, PRS MDD p = 1.4e-4), but not with the other phenotypes, suggesting a lack of shared genetic effects. In summary-level data, 2SMR analyses provided no evidence of a causal role on MDD of 25-OH-D (p = 0.50) or n3-PUFA (p = 0.16), or for a causal role of MDD on 25-OH-D (p = 0.25) or n3-PUFA (p = 0.66).ConclusionsApplying genomics tools indicated that that shared genetic risk or direct causality between 25-OH-D, n3-PUFA and MDD is unlikely: unresolved confounding may explain the associations reported in observational studies. These findings represent a cautionary tale for testing supplementation of these compounds in preventing or treating MDD.Research in contextEvidence before this studyMeta-analyses of trials testing the effect of vitamin D or omega-3 fatty acids (n3-PUFA) supplementation on major depressive disorder (MDD) reported conflicting findings, including small clinical effect or no effect. These trials were boosted by epidemiological evidence suggesting an inverse association of circulating 25-hydroxyvitamin D (25-OH-D) and n3-PUFA levels with MDD. However, observational associations may emerge from different scenarios, including unresolved confounding, shared genetic risk, or direct causal relationships.Added value of this studyGenomics provides unique opportunities to investigate shared risk and causality between traits applying new statistical tools and results from genome-wide association studies (GWAS). In the present study we examined the nature of the association of 25-OH-D and n3-PUFA with MDD using the latest data and tools from genomics. We found no significant evidence of shared genetic risk or direct causality between vitamin D or n-3 PUFA and MDD; at this stage, unresolved confounding should be considered the most likely explanation for the association reported by observational studies.Implications of all the available evidenceFindings from the present study, in conjunction with previous conflicting evidence from clinical studies, represent a cautionary tale for further research testing the potential therapeutic effect of vitamin D and n3-PUFA supplementation on depression, as the expectations of a direct causal effect of these compounds on mood should be substantially reconsidered. Genomic tools could be efficiently employed to examine the nature of observational associations emerging in epidemiology, providing some indications on the most promising associations to be prioritized in subsequent intervention studies.
High omega-3 fatty acids and low omega-6/omega-3 ratio but not polyphenols in diet decrease inflammatory markers in men with chronic coronary syndrome treated with percutaneous coronary intervention