Diet and physical activity are crucial factors related to depressive mood. Previous research has shown the effects of diet and physical activity on depression. However, the impact of the balance between energy intake and expenditure (EIEB) on mental health has not been thoroughly examined. This study aimed to explore the link between EIEB and depression.

Data from 13,460 participants (5,660 men and 7,800 women) aged 19 and older were obtained from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey (KNHANES). EIEB was defined as the difference between daily energy intake and energy expenditure. Energy intake was calculated using a 24-hour recall survey provided by KNHANES, while energy expenditure was estimated by summing the basal metabolic rate and physical activity. Logistic regression analyses were conducted to investigate the relationship between sex-specific quartile groups (Q1–Q4) of EIEB and depression, adjusting for socioeconomic status, body mass index, lifestyle factors, and underlying diseases.

Women in the third quartile of EIEB (211–669 kcal) had a significantly lower risk of depression (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67–0.92) compared to those in the first quartile of EIEB (<-167 kcal). The adjusted ORs of depression were 0.87 (95% CI, 0.75–1.02) in the second quartile and 0.86 (95% CI, 0.74–1.01) in the fourth quartile, with a P for trend of 0.030. No significant associations were found between EIEB quartile groups and depression in men after adjusting for potential confounders (P for trend=0.564).

Our findings suggest that EIEB is negatively associated with depression in Korean women.