Bidirectional associations between psychosocial well-being and adherence to healthy dietary guidelines in European children: prospective findings from the IDEFICS study

Louise Arvidsson,Idefics Consortium ,Monica Hunsberger,Toomas Veidebaum,Lauren Lissner,Ilse De Bourdeaudhuij,Michael Tornatitis,Barbara Thumann,Alba M Santaliestra-Pasías,Gabriele Eiben,Valeria Pala,Paola Russo,Hannah Jilani,Denes Molnar

doi:10.1186/s12889-017-4920-5

Abstract

BackgroundIn children the relationship between a healthy diet and psychosocial well-being has not been fully explored and the existing evidence is inconsistent. This study investigates the chronology of the association between children’s adherence to healthy dietary guidelines and their well-being, with special attention to the influence of weight status on the association.MethodsSeven thousand six hundred seventy five children 2 to 9 years old from the eight-country cohort study IDEFICS were investigated. They were first examined between September 2007 and June 2008 and re-examined again 2 years later. Psychosocial well-being was measured using self-esteem and parent relations questions from the KINDL® and emotional and peer problems from the Strengths and Difficulties Questionnaire. A Healthy Dietary Adherence Score (HDAS) was calculated from a 43-item food frequency questionnaire as a measure of the degree to which children’s dietary intake follows nutrition guidelines. The analysis employed multilevel logistic regression (country as random effect) with bidirectional modeling of dichotomous dietary and well-being variables as both exposures and outcomes while controlling for respective baseline values.ResultsA higher HDAS at baseline was associated with better self-esteem (OR 1.2, 95% CI 1.0;1.4) and fewer emotional and peer problems (OR 1.2, 95% CI 1.1;1.3 and OR 1.3, 95% CI 1.2;1.4) 2 years later. For the reversed direction, better self-esteem was associated with higher HDAS 2 years later (OR 1.1 95% CI 1.0;1.29). The analysis stratified by weight status revealed that the associations between higher HDAS at baseline and better well-being at follow-up were similar in both normal weight and overweight children.ConclusionPresent findings suggest a bidirectional relation between diet quality and self-esteem. Additionally, higher adherence to healthy dietary guidelines at baseline was associated with fewer emotional and peer problems at follow-up, independent of children’s weight status.

Highlights

In children the relationship between a healthy diet and psychosocial well-being has not been fully explored and the existing evidence is inconsistent
The primary aim of this study is to investigate the bidirectional association between adherence to healthy dietary guidelines and children’s psychosocial well-being and the extent to which these associations might differ between children with different weight status
In this study we documented a bidirectional association between adherence to healthy dietary guidelines and children’s self-esteem

Summary

Introduction

In children the relationship between a healthy diet and psychosocial well-being has not been fully explored and the existing evidence is inconsistent. In 2005 the Mental Health Foundation recognized diet as an underestimated determinant of mental health [1] Studies have found both suppression of negative emotions and inability to withstand negative emotions to be associated with excessive food intake, of foods rich in fat and sugar, often considered comfort foods [2, 3]. High intake of sugar-rich foods was associated with higher odds of emotional problems, while higher diet quality (low in fat but high in plant foods) was associated with lower odds of emotional problems [7]. A review by O’Neil et al found consistent evidence of a crosssectional association between unhealthy diets (generally including refined grains, processed meat and snacks, diet- and sugar rich soft drinks, fried food and foods high in saturated fat and sugar) and poor psychosocial well-being in children and adolescents [9]. Recent results from the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants study) suggests that childhood overweight increases the risk of poor health-related quality of life while poor well-being increases the risk of developing overweight [12]

Objectives

Methods

Results

Discussion

Conclusion