Dietary patterns and internalizing symptoms in children and adolescents: A meta-analysis

Abstract

Context: Studies of child and adolescent internalizing symptoms and dietary pattern have produced mixed results. Objectives: To quantify the association between dietary patterns and internalizing symptoms, including depression, in children and adolescents. Data sources: Embase, PsycINFO, MEDLINE, Web of Science and Cochrane up to March 2021. Study selection: Observational studies and randomized controlled trials with mean age ⩽ 18 years, reporting associations between diet patterns and internalizing symptoms. Data extraction: Mean effect sizes and 95% confidence intervals were determined under a random-effects model. Results: Twenty-six studies were cross-sectional, 12 were prospective, and 1 used a case-control design. The total number of participants enrolled ranged from 73,726 to 116,546. Healthy dietary patterns were negatively associated with internalizing ( r = –0.07, p < 0.001, 95% confidence interval [–0.12, 0.06]) and depressive symptoms ( r = –0.10, p < 0.001, 95% confidence interval [–0.18, –0.08]). Effect sizes were larger for studies of healthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures, as well as in cross-sectional studies of healthy dietary patterns and depression compared to prospective studies. Unhealthy dietary patterns were positively associated with internalizing ( r = 0.09, p < 0.001, 95% confidence interval [0.06, 0.14]) and depressive symptoms ( r = 0.10, p < 0.01, 95% CI [0.05, 0.17]). Larger effect sizes were observed for studies of unhealthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures. Limitations: A lack of studies including clinical samples and/or physician diagnosis, and a paucity of studies in which anxiety symptoms were the primary mental health outcome. Conclusion: Greater depression and internalizing symptoms are associated with greater unhealthy dietary patterns and with lower healthy dietary intake among children and adolescents.