Abstract
OBJECTIVE: To examine the association between diet quality and feelings of worry, sadness or unhappiness in Canadian children.
METHODS: Responses to the Harvard Food Frequency Questionnaire of 6,528 grade 5 students were used to calculate a composite score of diet quality, and its components: variety, adequacy, moderation and balance. Responses to the question on “feelings of worry, sadness or unhappiness” from the EuroQoL 5 Dimension questions for Youth (EQ-5D-Y), a validated Health Related Quality of Life questionnaire, constitute the outcome of interest. Multilevel logistic regression methods were used to examine the association between diet quality and feelings of worry, sadness or unhappiness. All analyses were adjusted for gender, household income, parental education, energy intake, weight status, physical activity level, geographic area and year of data collection.
RESULTS: Diet quality was inversely associated with children’s feelings of worried, sad or unhappy (Odds ratio (95% confidence interval): 0.90 (0.85- 0.97)). Dietary variety and dietary adequacy were also statistically significantly associated with lower odds of feeling worried, sad or unhappy. When the results were stratified by gender, the effect of diet on feeling worried, sad or unhappy was more pronounced in girls than boys.
CONCLUSION: These findings suggest that diet quality plays a role in feelings of worry, sadness or unhappiness and complement other studies that have suggested the link between diet and mental health. We recommend consideration of diet quality in public health strategies that aim to reduce the burden of poor mental health in children and youth.
Key Words: Nutrition, mental health, mood, children, public health, quality of life
Résumé
OBJECTIF: Examiner l’association entre la qualité du régime et les sentiments d’inquiétude, de tristesse ou de mécontentement chez les enfants canadiens.
MÉTHODE: Nous avons étudié les réponses de 6 528 élèves de 5e année au Questionnaire de fréquence de consommation des produits alimentaires de Harvard pour calculer un indice combiné de qualité du régime, et ses composantes: variété, adéquation, modération et équilibre. Les réponses à la question sur les « sentiments d’inquiétude, de tristesse ou de mécontentement » dans le questionnaire EuroQoL 5-Dimension s’adressant jeunes (EQ-5D-Y), un outil validé pour mesurer la qualité de vie liée à la santé, constituaient nos résultats d’intérêt. Au moyen d’analyses de régression logistique multiniveaux, nous avons examiné l’association entre la qualité du régime et les sentiments d’inquiétude, de tristesse ou de mécontentement. Nos analyses ont été ajustées pour tenir compte du sexe, du revenu du ménage, de l’instruction parentale, de l’apport énergétique, du statut pondéral, des niveaux d’activité physique, de la zone géographique et de l’année de collecte des données.
RÉSULTATS: La qualité du régime était inversement associée aux sentiments d’inquiétude, de tristesse ou de mécontentement des enfants (rapport de cotes (intervalle de confiance de 95 %): 0,90 (0,85-0,97)). La variété et l’adéquation du régime présentaient aussi une corrélation significative avec une probabilité inférieure de se sentir inquiet, triste ou mécontent. Quand les résultats étaient stratifiés selon le sexe, l’effet du régime sur les sentiments d’inquiétude, de tristesse ou de mécontentement était plus prononcé chez les filles que chez les garçons.
CONCLUSIONS: Ces constatations montrent que la qualité du régime contribue aux sentiments d’inquiétude, de tristesse ou de mécontentement, ce qui confirme les résultats d’études faisant état d’un lien entre le régime et la santé mentale. Nous recommandons que l’on tienne compte de la qualité du régime dans les stratégies de santé publique qui visent à réduire le fardeau des problèmes de santé mentale chez les enfants et les jeunes.
Mots Clés: nutrition, santé mentale, humeur, enfant, santé publique, qualité de vie
Footnotes
Conflict of Interest: None to declare.
References
- 1.Government of Canada. The Human Face of Mental Health and Mental Illness in Canada. 2006. [Google Scholar]
- 2.Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: Public-health crisis, common sense cure. Lancet. 2002;360(9331):473–82. doi: 10.1016/S0140-6736(02)09678-2. [DOI] [PubMed] [Google Scholar]
- 3.Lobstein T, Baur L, Uauy R. Obesity in children and young people: A crisis in public health. Obes Rev. 2004;5(Suppl1):4–104. doi: 10.1111/j.1467-789X.2004.00133.x. [DOI] [PubMed] [Google Scholar]
- 4.Must A, Strauss RS. Int J Obes Relat Metab Disord. 1999. Risks and consequences of childhood and adolescent obesity. [DOI] [PubMed] [Google Scholar]
- 5.Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408–13. doi: 10.1192/bjp.bp.108.058925. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O’Reilly SL, et al. Association of western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167(3):305–11. doi: 10.1176/appi.ajp.2009.09060881. [DOI] [PubMed] [Google Scholar]
- 7.Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, Serra Majem L, et al. Association of the Mediterranean dietary pattern with the incidence of depression: The Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry. 2009;66(10):1090–98. doi: 10.1001/archgenpsychiatry.2009.129. [DOI] [PubMed] [Google Scholar]
- 8.McMartin SE, Jacka FN, Colman I. The association between fruit and vegetable consumption and mental health disorders: Evidence from five waves of a national survey of Canadians. Prev Med. 2013;56(3–4):225–30. doi: 10.1016/j.ypmed.2012.12.016. [DOI] [PubMed] [Google Scholar]
- 9.Plos One. 2011.
- 10.McMartin SE, Kuhle S, Colman I, Kirk SF, Veugelers PJ. Diet quality and mental health in subsequent years among Canadian youth. Public Health Nutr. 2012;15(12):2253–58. doi: 10.1017/S1368980012000535. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Oddy WH, Robinson M, Ambrosini GL, O’Sullivan TA, de Klerk NH, Beilin LJ, et al. The association between dietary patterns and mental health in early adolescence. Prev Med. 2009;49(1):39–44. doi: 10.1016/j.ypmed.2009.05.009. [DOI] [PubMed] [Google Scholar]
- 12.Aalto-Setala T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lonnqvist J. Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment. Am J Psychiatry. 2002;159(7):1235–37. doi: 10.1176/appi.ajp.159.7.1235. [DOI] [PubMed] [Google Scholar]
- 13.Pine DS, Cohen E, Cohen P, Brook J. Adolescent depressive symptoms as predictors of adult depression: Moodiness or mood disorder? Am J Psychiatry. 1999;156(1):133–35. doi: 10.1176/ajp.156.1.133. [DOI] [PubMed] [Google Scholar]
- 14.Int J Behav Nutr Phys Act. 2012.
- 15.Willett WC. Nutritional Epidemiology. 2nd, ed. New York, NY: Oxford University Press; 1998. pp. 321–46. [Google Scholar]
- 16.Rockett HR, Wolf AM, Colditz GA. Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J Am Diet Assoc. 1995;95(3):336–40. doi: 10.1016/S0002-8223(95)00086-0. [DOI] [PubMed] [Google Scholar]
- 17.Health Canada. Food and Nutrition: The Canadian Nutrient File. 2007. [Google Scholar]
- 18.Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index- International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr. 2003;133(11):3476–84. doi: 10.1093/jn/133.11.3476. [DOI] [PubMed] [Google Scholar]
- 19.Patterson RE, Haines PS, Popkin BM. Diet quality index: Capturing a multidimensional behavior. J Am Diet Assoc. 1994;94(1):57–64. doi: 10.1016/0002-8223(94)92042-7. [DOI] [PubMed] [Google Scholar]
- 20.Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, Devlin N, et al. Development of the EQ-5D-Y: A child-friendly version of the EQ-5D. Qual Life Res. 2010;19(6):875–86. doi: 10.1007/s11136-010-9648-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. BMJ. 2000. Establishing a standard definition for child overweight and obesity worldwide: International survey; pp. 1240–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: Preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997;29(10):1344–49. doi: 10.1097/00005768-199710000-00011. [DOI] [PubMed] [Google Scholar]
- 23.Am J Clin Nutr. 1997.
- 24.Jacka FN, Kremer PJ, Leslie ER, Berk M, Patton GC, Toumbourou JW, et al. Associations between diet quality and depressed mood in adolescents: Results from the Australian Healthy Neighbourhoods Study. Aust N Z J Psychiatry. 2010;44(5):435–42. doi: 10.3109/00048670903571598. [DOI] [PubMed] [Google Scholar]
- 25.Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, et al. Feasibility, reliability, and validity of the EQ-5D-Y: Results from a multinational study. Qual Life Res. 2010;19(6):887–97. doi: 10.1007/s11136-010-9649-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Am J Clin Nutr. 1991.
- 27.Hyde JS, Mezulis AH, Abramson LY. The ABCs of depression: Integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychol Rev. 2008;115(2):291–313. doi: 10.1037/0033-295X.115.2.291. [DOI] [PubMed] [Google Scholar]
- 28.Wade TJ, Cairney J, Pevalin DJ. Emergence of gender differences in depression during adolescence: National panel results from three countries. J Am Acad Child Adolesc Psychiatry. 2002;41(2):190–98. doi: 10.1097/00004583-200202000-00013. [DOI] [PubMed] [Google Scholar]
- 29.Angold A, Costello EJ, Worthman CM. Puberty and depression: The roles of age, pubertal status and pubertal timing. Psychol Med. 1998;28(1):51–61. doi: 10.1017/S003329179700593X. [DOI] [PubMed] [Google Scholar]
- 30.Johansson L, Solvoll K, Bjorneboe GE, Drevon CA. Under- and overreporting of energy intake related to weight status and lifestyle in a nationwide sample. Am J Clin Nutr. 1998;68(2):266–74. doi: 10.1093/ajcn/68.2.266. [DOI] [PubMed] [Google Scholar]
- 31.Livingstone MB, Black AE. J Nutr. 2003. Markers of the validity of reported energy intake. [DOI] [PubMed] [Google Scholar]
- 32.Livingstone MBE, Prentice AM, Coward WA, Strain JJ, Black AE, Davies PSW, et al. Validation of estimates of energy-intake by weighed dietary record and diet history in children and adolescents. Am J Clin Nutr. 1992;56(1):29–35. doi: 10.1093/ajcn/56.1.29. [DOI] [PubMed] [Google Scholar]
- 33.Murakami K, Miyake Y, Sasaki S, Tanaka K, Arakawa M. Characteristics of under- and over-reporters of energy intake among Japanese children and adolescents: The Ryukyus Child Health Study. Nutrition. 2012;28(5):532–38. doi: 10.1016/j.nut.2011.08.011. [DOI] [PubMed] [Google Scholar]
- 34.Vance VA, Woodruff SJ, McCargar LJ, Husted J, Hanning RM. Self-reported dietary energy intake of normal weight, overweight and obese adolescents. Public Health Nutr. 2009;12(2):222–27. doi: 10.1017/S1368980008003108. [DOI] [PubMed] [Google Scholar]
- 35.King DE, Mainous AG, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr. 2005;24(3):166–71. doi: 10.1080/07315724.2005.10719461. [DOI] [PubMed] [Google Scholar]
- 36.Liu SM, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of highsensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75(3):492–98. doi: 10.1093/ajcn/75.3.492. [DOI] [PubMed] [Google Scholar]
- 37.Bell AC, Kremer PJ, Magarey AM, Swinburn BA. Contribution of ‘noncore’ foods and beverages to the energy intake and weight status of Australian children. Eur J Clin Nutr. 2005;59(5):639–45. doi: 10.1038/sj.ejcn.1602091. [DOI] [PubMed] [Google Scholar]
- 38.Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr. 2003;133(9):2879–82. doi: 10.1093/jn/133.9.2879. [DOI] [PubMed] [Google Scholar]
- 39.Jacka F, Berk M. Food for thought. Acta Neuropsychiatrica. 2007;19(5):321–23. doi: 10.1111/j.1601-5215.2007.00246.x. [DOI] [Google Scholar]
- 40.Joseph JA, Shukitt-Hale B, Denisova NA, Prior RL, Cao G, Martin A, et al. Long-term dietary strawberry, spinach, or vitamin E supplementation retards the onset of age-related neuronal signal-transduction and cognitive behavioral deficits. J Neurosci. 1998;18(19):8047–55. doi: 10.1523/JNEUROSCI.18-19-08047.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Chochinov HM, Wilson KG, Enns M, Lander S. ‘’Are you depressed?” Screening for depression in the terminally ill. Am J Psychiat. 1997;154(5):674–76. doi: 10.1176/ajp.154.5.674. [DOI] [PubMed] [Google Scholar]
- 42.Huffman JC, Smith FA, Blais MA, Beiser ME, Januzzi JL, Fricchione GL. Rapid screening for major depression in post-myocardial infarction patients: An investigation using Beck Depression Inventory II items. Heart. 2006;92(11):1656–60. doi: 10.1136/hrt.2005.087213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.McManus D, Pipkin SS, Whooley MA. Screening for depression in patients with coronary heart disease (data from the heart and soul study) Am J Cardiol. 2005;96(8):1076–81. doi: 10.1016/j.amjcard.2005.06.037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Johnson JA, Supina AL, Patten SB, Williams JVA, Maxwell CJ. The usefulness of the EQ-5D in differentiating among persons with major depressive episode and anxiety. Qual Life Res. 2007;16(5):749–54. doi: 10.1007/s11136-006-9159-z. [DOI] [PubMed] [Google Scholar]
- 45.Stephens T, Joubert N. The economic burden of mental health problems in Canada. Chronic Dis Can. 2001;22(1):18–23. [PubMed] [Google Scholar]