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BMC Public Health. 2017 Dec 14;17(1):926. doi: 10.1186/s12889-017-4920-5.

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

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Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
Department of Paediatrics, Clinical Center, University of Pécs, Pecs, Hungary.
Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 283 59, Bremen, Germany.
National Institute for Health Development, Tallinn, Estonia.
Institute of Food Sciences, CNR Via Roma, 64-83100, Avellino, Italy.
Research and Education Institute of Child Health REF, Strovolos, Cyprus.
GENUD (Growth, Exercise, Nutrition, and Development) Research group, University of Zaragoza; Instituto Agroalimentario de Aragón (IA2); Instituto de Investigación Sanitaria Aragón (IIS Aragón); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain.
Nutritional Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy.



In 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.


Seven 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.


A 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.


Present 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.


Childhood overweight; Dietary guidelines; Healthy diet score; IDEFICS; Psychosocial well-being

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