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

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.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4920-5) contains supplementary material, which is available to authorized users.

The Impact of Adding Sugars to Milk and Fruit on Adiposity and Diet Quality in Children: A Cross-Sectional and Longitudinal Analysis of the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) Study

“…Our findings add to the current literature in that we were able to examine the association between SAMF and adherence to healthy dietary guidelines. We used the a priori diet score, HDAS, as calculated from the FFQ used in the IDEFICS survey [ 23 ], as an indicator of the overall quality of the diet. Of note, the HDAS was based on healthy dietary guidelines common for the eight European countries that were included in the IDEFICS study, hence substantial evidence of beneficial health effects are underlying the foods and beverages included [ 23 ].…”

“…We used the a priori diet score, HDAS, as calculated from the FFQ used in the IDEFICS survey [ 23 ], as an indicator of the overall quality of the diet. Of note, the HDAS was based on healthy dietary guidelines common for the eight European countries that were included in the IDEFICS study, hence substantial evidence of beneficial health effects are underlying the foods and beverages included [ 23 ]. Other important strengths of the study are its multicentric nature, the large sample size, and the longitudinal design.…”

“…To assess children´s diet quality, a Healthy Dietary Adherence Score (HDAS) was calculated from CEHQ-FFQ as a measure of the degree to which children’s dietary intake follows nutrition guidelines [ 23 ]. The HDAS was developed according to the principles reviewed by Waijers et al [ 34 ].…”

“…Each component has a minimum score of 0 and a maximum score of 10, summed to a maximum score of 50, where the highest score indicates the highest possible adherence to the dietary guidelines. A more detailed description of the HDAS can be found in Ardvisson et al [ 23 ].…”

“…Therefore, the novel research question of this study is to investigate in the large European cohort of children participating to the IDEFICS survey, both cross-sectionally and prospectively, whether the habit to add sugar to milk and/or fruit (sugars added to milk and/or fruit, SAMF) is associated to adiposity indexes and/or to the quality of the diet, as assessed by a healthy diet score (Healthy Dietary Adherence Score, HDAS) [ 23 ].…”