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

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 ( = -0.07,  < 0.001, 95% confidence interval [-0.12, 0.06]) and depressive symptoms ( = -0.10,  < 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 ( = 0.09,  < 0.001, 95% confidence interval [0.06, 0.14]) and depressive symptoms ( = 0.10,  < 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.