Association Between PURE Diet Score and Mental Disorders in Patients At‐Risk of Cardiovascular Disease: Findings From the Iran Premature Coronary Artery Disease (IPAD) Study, a Multicenter Cross‐Sectional Study

Background and Aims Healthy dietary patterns such as DASH and Mediterranean diets may improve mental well‐being. However, the relationship between the PURE diet—emphasizing moderate consumption of animal foods and whole‐fat dairy—and mental disorders is unclear. This study aimed to investigate the association between the PURE diet score and depression and anxiety in Iranian adults at high risk of cardiovascular disease. Methods This multicenter cross‐sectional study included 1120 subjects from nine ethnicities who underwent angiography, with no stenosis detected. Dietary intake was assessed using a validated semi‐quantitative food frequency questionnaire, and the PURE score was calculated based on fruit, vegetables, legumes, nuts, fish, and dairy consumption. Mental health was measured using the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using logistic regression and adjusted for confounders. Results Participants' mean (SD) age was 52.08 ± 8.25 years. In the overall population, higher PURE diet scores were significantly associated with lower odds of both depression and anxiety after adjustment for potential confounders (depression: OR = 0.55, 95% CI 0.36–0.86, p = 0.03; anxiety: OR = 0.63, 95% CI 0.40–0.99, p = 0.01). In sex‐stratified analyzes, these inverse associations were significant among women (depression: OR = 0.56, 95% CI 0.33–0.95, p = 0.02; anxiety: OR = 0.52, 95% CI 0.30–0.92, p = 0.01), but not among men (depression: OR = 0.49, 95% CI 0.22–1.10, p = 0.08; anxiety: OR = 0.78, 95% CI 0.34–1.79, p = 0.43). Conclusion In this cross‐sectional study, higher adherence to the PURE diet was significantly associated with lower odds of both depression and anxiety, particularly among women. No significant associations were observed among men. Prospective cohort studies and clinical trials are needed to confirm these findings.