Background: Diet and physical activity is regarded as key factors related to depressive mood. There had been studies about the relationship between diet (or physical activity) and depression. However, the effect of Energy Intake Expenditure Balance (=EIEB) on mental health are not fully evaluated. The aim of this study was to analyze the association of the EIEB and depression.

Methods: Data for 13,460 participants (5,660 Men and 7,800 Women), aged ≥20 years from the 2014, 2016 and 2018 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. EIEB was defined as the difference of daily energy intake and energy expenditure. Energy intake was calculated and provided by KNHANES based 24hour recall on diet. Energy expenditure was estimated as sum of basal metabolic rate and physical activity by standardized questionnaire. Logistic regression analyses were conducted to investigate the association between sex-specific quartile group (Q1-Q4) of EIEB and depression, adjusting for socioeconomical states, BMI, lifestyle factors and underlying diseases.

Results: Women with Q3 in EIEB (211 - 669 kcal) had a significantly lower risk of depression (odd ratio (OR), 0.785; 95% confidence interval (CI), 0.670-0.919) than those with Q1 in EIEB (<-167 kcal). The multivariate adjusted ORs of depression were 0.871 (95% CI, 0.746-1.017) in Q2 and 0.862 (95% CI, 0.738-1.007) in Q4 in EIEB with p for trend=0.028. There were no significant associations between quartile groups of EIEB and depression in men after adjusting for potential confounders (p for trend= 0.517)

Conclusion: Our result suggests that balanced energy intake and expenditure is negatively associated with depression in Korean women, but not in men.