December 13, 2017
Healthy eating is associated with better self-esteem and
fewer emotional and peer problems, such as having fewer friends or being picked
on or bullied, in children regardless of body weight, according to a new study.
Inversely, better self-esteem is associated with better adherence to healthy
Healthy eating is associated with better self-esteem and fewer emotional
and peer problems, such as having fewer friends or being picked on or bullied,
in children regardless of body weight, according to a study published in the
open access journal BMC Public Health. Inversely, better self-esteem is
associated with better adherence to healthy eating guidelines, according to
researchers from The Sahlgrenska Academy, University of Gothenburg, Sweden.
Dr Louise Arvidsson, the corresponding author said: “We found that in
young children aged two to nine years there is an association between adherence
to healthy dietary guidelines and better psychological well-being, which
includes fewer emotional problems, better relationships with other children and
higher self-esteem, two years later. Our findings suggest that a healthy diet
can improve well-being in children.”
Examining 7,675 children two to nine years of age from eight European
countries — Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and
Sweden — the researchers found that a higher Healthy Dietary Adherence Score
(HDAS) at the beginning of the study period was associated with better
self-esteem and fewer emotional and peer problems two years later.
The HDAS aims to capture adherence to healthy dietary guidelines, which
include limiting intake of refined sugars, reducing fat intake and eating fruit
and vegetables. A higher HDAS indicates better adherence to the guidelines —
i.e. healthier eating. The guidelines are common to the eight countries
included in this study.
The authors found that better self-esteem at the beginning of the study
period was associated with a higher HDAS two years later and that the
associations between HDAS and wellbeing were similar for children who had
normal weight and children who were overweight.
Dr Arvidsson said: “It was somewhat surprising to find that the
association between baseline diet and better well-being two years later was
independent of children’s socioeconomic position and their body weight.”
The authors used data from the Identification and Prevention of Dietary-
and Lifestyle-Induced Health Effects in Children and Infants Study, a
prospective cohort study that aims to understand how to prevent overweight in
children while also considering the multiple factors that contribute to it.
At the beginning of the study period parents were asked to report how often
per week their children consumed food from a list of 43 items. Depending on
their consumption of these foods, children were then assigned an HDAS score.
Psychosocial wellbeing was assessed based on self-esteem, parent relations,
emotional and peer problems as reported by the parents in response to validated
questionnaires. Height and weight of the children were measured. All
questionnaires and measurements were repeated two years later.
The study is the first to analyze the individual components included in the
HDAS and their associations with children’s wellbeing. The authors found that
fish intake according to guidelines (2-3 times per week) was associated with
better self-esteem and no emotional and peer problems. Intake of whole meal
products were associated with no peer problems.
The associations were found to go in both directions; better wellbeing was
associated with consumption of fruit and vegetables, sugar and fat in
accordance with dietary guidelines, better self-esteem was associated with
sugar intake according to guidelines, good parent relations were associated
with fruit and vegetable consumption according to guidelines, fewer emotional
problems were associated with fat intake according to guidelines and fewer peer
problems were associated with consumption of fruit and vegetables according to
The authors caution that children with poor diet and poor wellbeing were
more likely to drop out of the study and were therefore underrepresented at the
two-year follow-up, which complicates conclusions about the true rates of poor
diet and poor wellbeing. As the study is observational and relies on
self-reported data from parents, no conclusions about cause and effect are
Dr Arvidsson said: “The associations we identified here need to be
confirmed in experimental studies including children with clinical diagnosis of
depression, anxiety or other behavioral disorders rather than well-being as
reported by parents.”
Materials provided by BioMed Central. Note: Content may be edited for style
Arvidsson, Gabriele Eiben, Monica Hunsberger, Ilse De Bourdeaudhuij, Denes
Molnar, Hannah Jilani, Barbara Thumann, Toomas Veidebaum, Paola Russo, Michael
Tornatitis, Alba M. Santaliestra-Pasías, Valeria Pala, Lauren Lissner. Bidirectional
associations between psychosocial well-being and adherence to healthy dietary
guidelines in European children: prospective findings from the IDEFICS study.
BMC Public Health, 2017; 17 (1) DOI: 10.1186/s12889-017-4920-5