Perceived stress and diet quality in women of reproductive age: a systematic review and meta-analysis

Abstract

Background: Poor diet quality is associated with obesity-related morbidity and mortality. Psychological stress can increase unhealthy dietary choices, but evidence pertinent to women of reproductive age remains unclear. This paper systematically reviewed the literature to determine the association between psychological stress and diet quality in women of reproductive age. Methods: Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched. Data extraction was determined by the PEO. Inclusion criteria consisted of: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women of reproductive age (18-49 years old (population)). Observational studies, due to the nature of the PEO, were included. Quality assessment used the Risk of Bias in Non-randomised Studies from the Cochrane Handbook of Systematic Reviews of Interventions. Meta-analysis was conducted using random-effect model to estimate the Fisher's z transformed correlation between stress and diet quality with 95% confidence interval (CI). Results: From 139,552 hits, 471 papers were screened; 24 studies met the inclusion criteria and were conducted in different countries: 8 studies on diet quality and 16 on food intake and frequency of consumption. Studies of diet quality consisted of six cross-sectional and two longitudinal designs with a total of 3982 participants. Diet quality was measured with diverse indices; Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index-Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Most studies used Cohen's perceived stress scale and no study measured biological stress response. After sensitivity analysis, only 5 studies (3471 participants) were included in the meta-analysis. Meta-analysis revealed a significant negative association between stress and diet quality with substantial heterogeneity between studies (r = − 0.35, 95% CI [− 0.56; − 0.15], p value < 0.001, Cochran Q test P < 0.0001, I 2 = 93%). The 16 studies of food intake and frequency of consumption were very heterogeneous in the outcome measure and were not included in the meta-analysis. These studies showed that stress was significantly associated with unhealthy dietary patterns (high in fat, sweets, salt, and fast food and low in fruits, vegetables, fish, and unsaturated fats). Conclusion: Future studies that explore diet quality/patterns should include both diet indices and factor analysis and measure biological markers of stress and dietary patterns simultaneously.

Trajectories and determinants of weight gain in two cohorts of young adult women born 16 years apart

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Predictors of COVID-19-Related Perceived Improvements in Dietary Health: Results from a US Cross-Sectional Study

“…Higher levels of perceived stress were identified as a predictor of a perceived improvement in dietary healthfulness. While increased psychological stress is commonly associated with reduced diet quality [ 54 ], there is limited research on the impact of stress resulting from a health-related crisis on diet quality. It could be posited that experiencing stress due to fear of contracting a disease could lead to healthier lifestyle choices.…”

The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and Emotional Well-Being during the COVID-19 Pandemic

“…Many people across the world experienced increased stress during the pandemic, and when not effectively managed, stress can affect eating [ 38 ] and health-related behaviors [ 29 ]. A recent meta-analysis showed a significant association of stress with unhealthy dietary patterns [ 39 ]. Specifically, an inverse pattern of stress and healthy dietary behaviors was observed; more stress was associated with less healthy dietary behaviors.…”