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ISSN (electronic): 1699-5198 - ISSN (paper): 0212-1611 - CODEN NUHOEQ SVR 318

Nutrition
Hospitable

Original work Epidemiology and dietetics

Eating behavior and its relationship with stress, anxiety, depression

and insomnia in college students
Eating behavior and its relationship with stress, anxiety, depression, and insomnia in university students
Enrique Ramón Arbués 1 , Blanca Martínez Abadía 1 , José Manuel Granada López 2 , Emmanuel Echániz Serrano 2 , Begoña Pellicer García 1 ,
Raúl Juárez Vela 1 , Sandra Guerrero Portillo 1 and Minerva Sáez Guinoa 1
1 Faculty of Health Sciences. San Jorge University. Villanueva de Gállego, Zaragoza. Faculty of Health Sciences. Zaragoza's University. Saragossa
2

Summary
Introduction: there is growing evidence that relates diet to the psychological health of the adult population. This association has not been
sufficiently explored among college students.
Objectives: the objectives of this study were to analyze the quality of diet in a university population and quantify its association with
prevalence of anxiety, depression, stress and insomnia.
Key words: Methods: descriptive cross-sectional study on a sample of 1055 university students. Three validated questionnaires were used:
the Healthy Eating Index (IAS), the short Depression, Anxiety and Stress scale (DASS-21) and the Insomnia Severity Index.
Nutrition,
feeding and Results: the mean IAS score was 68.57 ± 12.17. The prevalence of unhealthy eating was 82.3%, higher in the
diet. Students. women (84.8% vs. 76.4%). Unhealthy eating was significantly related to the prevalence of anxiety, depression, and stress.
Depression. Stress The excessive consumption of sweets and the low consumption of dairy products were associated with a higher prevalence of psychological and sleep disorders.
psy chological. Anxiety.
Onset disorders Conclusions: unhealthy eating patterns are common in the university population and are related to the presence of anxiety,
and maintenance stress and depression. Educational interventions aimed at reducing the consumption of unhealthy foods in university students
of the dream. they can lead to an improvement in psychological health and / or vice versa.

Abstract
Introduction: there is growing evidence linking food consumption with psychological health in adult people. This association has not been well
explored among university students.
Objectives: the aims of this study were to analyze diet quality in a university population, and to assess its association with the prevalence of
Key words: anxiety, stress, depression, and insomnia.

Diet, food and

Methods: a cross-sectional study of a sample of 1,055 university students. Three validated questionnaires were used: the Healthy Eating Index
nutrition. Students. (HEI), the Depression Anxiety Stress Scale (DASS 21), and the Insomnia Severity Index.
Depression. Stress, Results: the average HEI score was 68.57 ± 12.17. The prevalence of unhealthy eating was 82.3%, higher in women (84.8% vs. 76.4%).
psy chological.
Unhealthy eating was significantly associated with prevalence of anxiety, depression, and stress. Excessive intake of sweets and low of dairy
Anxiety. Sleep
products were associated with a higher prevalence of psychological and sleep disturbances.
initiation and
maintenance Conclusions: unhealthy eating patterns are common among the university population, and related to anxiety, stress, and depression. Educational
disorders. interventions to reduce unhealthy food consumption in university students may also result in psychological health improvements and / or vice versa.

Received: 04/25/2019 • Accepted: 08/05/2019

Ramón Arbués E, Martínez Abadía B, Granada López JM, Echániz Serrano E, Pellicer García B, Juárez Vela Correspondence:

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30/7/2021 6.indb nutrition
R, Guerrero Portillo S, Sáez Guinoa M. Eating behavior and its relationship with stress, anxiety, Enrique Ramón Arbués.
depression and insomnia in college students. Nutr Hosp 2019; 36 (6): 1339-1345 Faculty of Health Sciences. San Jorge University.
50830 Villanueva de Gállego, Zaragoza
DOI: http://dx.doi.org/10.20960/nh.02641 e-mail: eramon@usj.es

© Copyright 2019 SENPE and Arán Ediciones SL This is an Open Access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/4.0/).
©

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1340 E. Ramón Arbués et al.

INTRODUCTION from the San Jorge University campus in Zaragoza, Spain.

Participants were recruited in the classroom during
For many students, the move from secondary education to the school period of the first semester of the 2018-19 academic year.
university is a demanding transition. The COM- All students were informed of the objectives of the
competition and pressure for academic results (1), changes research at the beginning of one of your classes, and at the end of it
in workloads and support networks, and sometimes the questionnaires were handed over to them. During the period of
being away from the family for a period in which they may data collection, which lasted for 6 weeks, invited to
chaining risk behaviors (2) can lead to states of participate in the study to a total of 1,311 students. Of these,
stress, anxiety, depression or insomnia (3,4). 1,055 (744 women and 311 men) gave their consent to
In earlier studies of the general population, there appears to have beenenter into this investigation and completed it according to
detected an association between the way of eating and the state of requested the proposed questionnaire.
do of the spirit (5). In this way, and regardless of reason
underlying mood disorder, eating may
affect the way people feel (6) and, probably DATA COLLECTION
mind, vice versa (7). The evidence about the relationship between health
psychological and the intake of certain nutrients and food groups The data collection questionnaire consisted of 4 sections
it is abundant. Thus, inverse associations have been detected between tions: sociodemographic data (including anthropometry and
intake of polyunsaturated fatty acids (8), proteins (9) and certain habits), diet, psychological health and sleep.
micronutrients (10-12) with depressive symptoms. By the con- Information was collected on age, sex, study area,
otherwise, the intake of processed foods and simple carbohydrates habitual residence, relationship status, height, weight, status
it has been directly associated (9-13). Low acid intake perceived economic, smoking, alcohol consumption, practice
ω-3 fatty acids (14) and minerals such as manganese, copper or zinc physical activity and sedentary lifestyle of the participants. The acti-
(15) has been linked to higher levels of anxiety. The quality developed physical life and time spent sitting
sleep has been directly associated with the intake of some or lying down (sleep not included) were assessed by
nutrients such as selenium, vitamin C or calcium (16). But nevertheless, short version of the International Physical Activity Questionnaire
research is scant on the relationship between (Brief IPAQ) in its Spanish version. This instrument has been
quality of diet in general and psychological health, especially validated in the Spanish population (22) and has been used repeatedly
in specific populations such as adolescents or young adults. many times in a young and university population (23,24).
In Spain, the problems derived from a poor diet are The short IPAQ allows you to record the intensity, frequency and duration
growing in the child, adolescent and young adult population. It has beenration of physical activity developed in the last 7 days.
estimated at 38.6% the prevalence of overweight / obesity in the From this information the equivalents were calculated
population under 17 years of age (17), and 26.8% of the population Metabolic Task (MET) per week by multiplying the gas-
university (18). Similarly, mental health problems are average energy per minute and week by the intensity of
very prevalent in the Spanish adolescent and young adult population. each physical activity performed (3.3 METs for walking, 4.0 METs
Two recent studies (19,20) place the prevalence of disorders for moderate intensity activities and 8.0 METs for activities
anxious and depressive type in early adolescence above the vigorous). The results of each category of physical activity
eleven%. In college, Balanza et al. (21) have reported up to (walking + moderate + vigorous) were added to obtain the
55.6% and 47.1% of probable cases of depression and anxiety, total physical activity in MET / week (25).
respectively. For all these reasons, the research about The assessment of the participants' diet was carried out
analysis of the relationship between diet and mood in various through the Healthy Eating Index (IAS) from the
student populations. Most college students methodology described by Norte et al. (26), which included light-
rivers are found in early adulthood. This is the time when Following modifications to the original questionnaire by Kennedy et al.
lifestyles and behaviors related to (27) in order to adapt it to foods more commonly
health, which can have a sustained impact throughout their lives ingested by the Spanish population. The IAS consists of 10 variables
(9). Under this prism, the objective of this research was to evaluate the Scorable from 0 to 10 points each. Thus, the score
association between diet quality and various indicators related to The final evaluation of the questionnaire ranges from 0 to 100 points. The classification
the psychological health and the dream of the university students of ourClassification
environment.by categories is carried out based on the following criteria:
score> 80, healthy eating; between 50 and 80 points,
needs changes; less than 50 points, unhealthy.
METHODOLOGY In addition, the frequency of intake of each group was compared
of food of the participants with the recommendations
DESIGN AND STUDY POPULATION taken in the Healthy Eating Guide of the Society
Spanish for Community Nutrition (SENC) (28).
A descriptive cross-sectional study was carried out. The population Symptoms related to anxiety, stress and depression

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reference was that of students of different degrees of the participants was evaluated using the DASS-21 questionnaire,

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EATING BEHAVIOR AND ITS RELATION TO STRESS, ANXIETY, DEPRESSION 1341

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short version of the DASS-42. The DASS-21 is made up of the confusion such as gender, age, weight (BMI), title,
subscales DASS-A (anxiety), DASS-E (stress) and DASS-D (depre- the physical activity carried out, the perceived economic situation,
Zion). The DASS-21 is an instrument composed of 21 items, 7 time spent in sedentary patterns, smoking, or
for each subscale, with Likert-type evaluation from 0 to 3 points couple situation.
cough (0 means “it does not apply to me at all” and 3 “it does not apply to Statistical
me at all” analysis of the data was performed with the package
ble a lot or most of the time ”). The sum of the scores SPSS statistics for Windows (version 21, Chicago, IL, USA),
obtained in each subscale is multiplied by 2 in order to make accepting a significance level of p <0.05.
the results of the DASS-21 and the DASS-42 are comparable. Starting
From the scores obtained, the participants are classified in
each of the 3 subscales as follows: RESULTS
- Anxiety: normal (0-7 points), mild (8-9), moderate (10-
14), severe (15-19) and extremely severe (> 19) SAMPLE CHARACTERISTICS
- Depression: normal (0-9 points), mild (10-13), moderate
(14-20), severe (21-27) and extremely severe (> 27). In total, 1,055 students (70.5% female and 29.5% male)
- Stress: normal (0-14 points), mild (15-18), moderate (19- participated in the study. The age range ranged from 18 to
25), severe (26-33) and extremely severe (> 33). 42 years, with a mean of 21.74 ± 5.15 years. most of
The DASS-21 questionnaire was previously validated in the they had a health degree (58.3%), did not smoke (75.3%),
Spanish university population with consistency values reported occasional alcohol consumption (67.7%), did not maintain a
internal for the three subscales that ranged between α = 0.73 and stable relationship (53.2%) and lived with his family (66.4%) (Table I).
α = 0.81 (29).
The quality of sleep and insomnia of the participants were evaluated
They were determined using the Insomnia Severity Index (ISI). East
questionnaire consists of 7 items that study nature, se- Table I. Characteristics of the
truth and impact of insomnia. Each item is scored by participants (n = 1055)
a Likert-type scale from 0 to 4 points. The total score n (%)
is obtained by adding the responses of the 7 items, being able Age, mean ± SD 21.74 ± 5.15
obtain a minimum of 0 and a maximum of 28 points. Starting Woman 744 (70.5%)
From this score, the following classification can be established: Gender
Male 311 (29.5%)
- From 0 to 7 points: absence of clinical insomnia
Sanitary 615 (58.3%)
- From 8 to 14 points: subclinical insomnia T itle
Not sanitary 440 (41.7%)
- From 15 to 21 points: clinical insomnia (moderate)
Live alone 64 (6.1%)
- From 22 to 28 points: clinical insomnia (severe).
Home Live with companions 291 (27.6%)
The validation of the ISI in the Spanish population obtained a value of
Lives with parents / relatives 700 (66.4%)
internal consistency of α = 0.91 (30). Furthermore, this questionnaire
has been used repeatedly in student samples Partner Yes 494 (46.8%)

university students (31-33). stable Do not 561 (53.2%)

Very low 28 (2.7%)
Level
Under 94 (8.9%)
economic
DATA ANALYSIS Half 789 (74.8%)
perceived
Tall 144 (13.6%)
The characteristics of the sample were summarized using the BMI, mean ± SD 22.15 ± 3.48
mean and standard deviation for continuous variables, and the Under weight 160 (15.1%)
Category:
number and percentage for qualitative ones. Normal weight 732 (69.4%)
BMI
The Kolmogorov-Smirnov test was used to check the norm Overweight / Obesity 163 (15.4%)
mality of the distributions of each variable. The biva- Yes 261 (24.7%)
riant was performed using Chi-square tests, Student's t Smoking
Do not 794 (75.3%)
and ANOVA, as applicable. The analysis of the biva-
Cigarettes / day in smokers; mean ± SD 8.42 ± 6.31
The difference between quantitative variables was carried out by means of the
Never 27 (2.6%)
Pearson. In addition, a multivariate analysis was performed with the objective
Occasionally 714 (67.7%)
to determine the impact of food quality and ad- Consume of
1 time / week 263 (24.9%)
inheritance to the weekly intake recommendations of different alcohol
2 times / week 22 (2.1%)
food groups on sleep and psychological health of children
≥ 3 times / week 29 (2.7%)
participants (presence of anxiety, stress, depression or insom-
child). For this, different regression models were built Physical activity (MET / week), mean ± SD 2377.03 ± 2466.54

binary logistics ( Intro method ) adjusted for possible factors of Sedentary lifestyle (hours / day), mean ± SD 6.76 ± 2.45

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1342 E. Ramón Arbués et al.

DIET QUALITY or by relatives. By BMI categories, participants with

The mean score on the IAS was 68.57 ± 12.17. 82.3%
of the participants had an unhealthy diet
or in need of changes. In the gender analysis, women
showed significantly less healthy eating
than men (Table II).
The criteria of the questionnaire in which a minor
level of adherence were those related to the consumption of meat
lean, fish and eggs, and sausages and cold cuts. In sen-
On the contrary, the highest adherence was observed in the consumption
legumes and dairy (Table III).
The IAS questionnaire score was significantly higher
higher in non-smokers, in students without a stable partner and
in people who lived accompanied either by companions
underweight and overweight showed average scores
higher than those of those with normal weight. The degree
studied and the perceived economic level were not significantly associated
tively to the IAS score (Table IV).
PSYCHOLOGICAL HEALTH AND SLEEP
23.5%, 18.6% and 33.9% of the participants showed, in
greater
of or lesser extent, levels of anxiety, depression and stress,
respectively. In addition, up to 43.1% had insomnia
in one of its categories. By gender, women obtained
worse scores on the stress, anxiety and insomnia scales
child (p <0.05) (Table II).

Table II. Results by gender of the IAS, DASS-21 and ISI questionnaires
Questionnaire Total (n = 1055) Males (n = 311) Women (n = 744) p

Healthy nutrition 186 (17.6%) 73 (23.4%) 113 (15.1%)

Need changes 794 (75.2%) 213 (68.4%) 581 (78.1%) 0.002
IAS
Unhealthy 75 (7.1%) 25 (8.0%) 50 (6.7%)
Mean ± SD 68.57 ± 12.17 69.96 ± 12.02 67.98 ± 12.19 0.016

Without stress 697 (66.1%) 253 (81.3%) 444 (59.7%)

Mild 121 (11.5%) 28 (9.0%) 93 (12.5%)
Moderate 174 (16.5%) 30 (9.6%) 144 (19.4%) 0.000
DASS-E
Severe 46 (4.4%) 0 (0%) 46 (6.2%)
Extremely severe 17 (1.6%) 0 (0%) 17 (2.3%)

Mean ± SD 12.39 ± 8.08 9.80 ± 6.13 13.48 ± 8.54 0.000

No anxiety 807 (76.5%) 266 (85.5%) 541 (72.7%)

Mild 83 (7.9%) 16 (5.1%) 67 (9.0%)

Moderate 95 (9.0%) 29 (9.3%) 66 (8.9%) 0.000
DASS-A
Severe 9 (0.9%) 0 (0%) 9 (1.2%)
Extremely severe 61 (5.8%) 0 (0%) 61 (8.2%)

Mean ± SD 4.84 ± 5.75 3.35 ± 3.33 5.46 ± 6.41 0.000

No depression 859 (81.4%) 251 (80.7%) 608 (81.7%)

Mild 80 (7.6%) 31 (10.0%) 49 (6.6%)

Moderate 48 (4.5%) 0 (0%) 48 (6.5%) 0.000

DASS-D
Severe 38 (3.6%) 14 (4.5%) 24 (3.2%)
Extremely severe 30 (2.8%) 15 (4.8%) 15 (2.0%)

Mean ± SD 5.45 ± 7.12 5.44 ± 8.28 5.46 ± 6.58 NS *

No insomnia 600 (56.9%) 220 (70.7%) 380 (51.1%)

Mild insomnia 333 (31.6%) 58 (18.6%) 275 (37.0%)

0.000
ISI Moderate insomnia 114 (10.8%) 33 (10.6%) 81 (10.9%)
Severe insomnia 8 (0.8%) 0 (0%) 8 (1.1%)

Mean ± SD 7.91 ± 4.88 6.22 ± 4.70 8.62 ± 4.78 0.000

* NS: not significant.

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Table III. Degree of non-compliance with ASSOCIATION BETWEEN DIET QUALITY,

SENC recommendations (28) PSYCHOLOGICAL HEALTH AND INSOMNIA

Group of Grade of The bivariate correlation analysis showed an association

Recommendation
food breach significant and inverse between the IAS scores and those of the
Cereals and DASS-A, DASS-E and ISI (Table V).
Daily consumption 64.8% *
derivatives In the binary logistic regression analysis, adjusted for possible
Vegetables and
Daily 67.5% * confounding factors, unhealthy eating was associated with
vegetables
significantly with the presence of depression, anxiety and stress.
Fruits Daily 55.7% *
By food groups, the lack of adherence to the recommendations
Milk and derivatives Daily 31.3% *
Meats (includes The intake of vegetables and vegetables was associated with the presence of
lean fish 2-3 times / week 80.9% * anxiety, depression and insomnia. In addition, deficit consumption
and eggs) of dairy products and the excess of sweets were associated with a
Vegetables 2-3 times / week 38.7% * increased risk of suffering from anxiety, stress, depression and insomnia (Table VI).
Sausages and
Occasional 77.7% †
cold cuts
Sweet Occasional 75.5% † DISCUSSION
Soft drinks with
Occasional 48.6% †
sugar To our knowledge, this study is the first
*Default. By excess.
† that assesses the relationship between the overall quality of the diet and multiple

Table IV. Relationship between type of food according to the IAS and characteristics of the
participants. Bivariate analysis
IAS score Power type according to IAS
Feeding
Needs to Feeding
Mean ± SD p little bit p
changes healthy
healthy
Males (n = 311) 69.96 ± 12.02 25 (8.0%) 213 (68.4%) 73 (23.4%)
Gender 0.016 0.002
Women (n = 744) 67.98 ± 12.19 50 (6.7%) 581 (78.1%) 113 (15.1%)
Low weight (n = 160) 69.41 ± 12.23 11 (6.9%) 133 (83.1%) 16 (10.0%)
Category:
Normal weight (n = 732) 67.48 ± 11.55 0.000 49 (6.7%) 569 (77.7%) 114 (15.5%) 0.000
BMI
Overweight / Obesity (n = 163) 72.75 ± 13.91 15 (9.2%) 94 (57.6%) 54 (33.1%)

Health (n = 615) 68.38 ± 12.28 42 (6.8%) 469 (76.2%) 104 (16.9%)

Title NS * NS
Non-sanitary (n = 440) 68.82 ± 12.02 32 (7.2%) 326 (74.1%) 82 (18.6%)
Lives alone (n = 64) 59.36 ± 11.11 14 (21.9%) 50 (78.1%) 0 (0%)
0.000
Home With partners (n = 291) 69.95 ± 12.54 0.000 23 (7.9%) 219 (75.3%) 49 (16.8%)
With parents / relatives (n = 700) 68.83 ± 11.76 36 (5.2%) 523 (75.4%) 135 (19.5%)
Situation Stable partner (n = 494) 67.28 ± 12.84 40 (8.1%) 356 (72.1%) 98 (19.8%) NS
0.001
couple Without partner (n = 561) 69.69 ± 11.44 34 (6.0%) 439 (78.2%) 88 (15.7%)
Very low (n = 28) 72.50 ± 2.54 0 (0%) 28 (100%) 0 (0%)
Level
Low (n = 94) 68.96 ± 14.40 7 (7.4%) 58 (61.7%) 29 (30.9%)
economic NS 0.000
Medium (n = 789) 68.09 ± 12.54 66 (8.4%) 577 (73.1%) 146 (18.5%)
perceived
High (n = 144) 70.13 ± 9.07 1 (0.7%) 131 (90.9%) 12 (8.33%)

Smokers (n = 261) 66.82 ± 12.20 7 (2.7%) 216 (82.7%) 38 (14.6%)

Smoking 0.008 0.001
Non-smokers (n = 794) 69.14 ± 12.11 67 (8.4%) 579 (72.9%) 148 (18.6%)
Never (n = 27) 66.83 ± 7.86 0 (0%) 27 (100%) 0 (0%)
Occasionally (n = 714) 68.84 ± 12.57 59 (8.2%) 530 (74.2%) 125 (17.5%)
Consumption
1 time / week (n = 263) 67.21 ± 10.27 0.000 8 (3.0%) 217 (82.5%) 38 (14.4%) 0.000
alcohol
2 times / week (n = 22) 80.36 ± 2.21 0 (0%) 8 (36.4%) 14 (63.6%)
≥3 times / week (n = 29) 66.65 ± 19.23 7 (24.1%) 14 (48.2%) 8 (27.6%)
* NS: not significant.

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Table V. Bivariate correlations between the scores of the questionnaires

IAS, DASS-21, Rosenberg and ISI
IAS DASS-E DASS-A DASS-D ISI

IAS Correlation coefficient 1.00 -0.07 * -0.10 † -0.03 -0.23 †

DASS-E Correlation coefficient -0.07 * 1.00 0.50 † 0.50 † 0.51 †

DASS-A Correlation coefficient -0.10 † 0.50 † 1.00 0.57 † 0.33 †

DASS-D Correlation coefficient -0.03 0.50 † 0.57 † 1.00 0.39 †

ISI Correlation coefficient -0.23 † 0.51 † 0.33 † 0.39 † 1.00

* p <0.05 bilateral. p <0.01 bilateral.
†

Table VI. Adjusted OR (95% CI) * of the association between eating behavior and health
psychological of the participants
Presence of Presence of Presence of Presence of
stress depression anxiety insomnia
(DASS-E> 14) (DASS-D> 9) (DASS-A> 7) (ISI> 7)
Healthy eating (IAS> 80) Reference Reference Reference Reference
Needs dietary changes (IAS 50-80) 1.35 (0.74-2.43) 2.95 (1.28-6.77) 2.42 (1.14-5.10) 1.69 (0.95-2.99)
Unhealthy eating (IAS <50) 1.87 (1.22-2.84) 3.73 (1.53-9.06) 3.51 (1.19-10.44) 1.97 (0.80-4.86)
IAS components (lack of adherence to recommendations)
Cereals and derivatives 1.05 (0.69-1.59) 1.67 (0.96-2.91) 0.96 (0.56-1.64) 1.03 (0.71-1.49)
Vegetables and greens 1.16 (0.73-1.82) 2.01 (1.08-3.71) 3.09 (1.83-5.19) 1.78 (1.22-2.62)
Fruits 1.31 (0.88-1.95) 1.68 (0.92-3.07) 1.39 (0.86-1.62) 1.10 (0.76-1.59)
Milk and derivatives 1.56 (1.03-2.35) 2.01 (1.19-3.42) 1.59 (1.00-2.52) 2.13 (1.49-3.04)
Meats (includes lean, fish and 0.94 (0.59-1.49) 1.06 (0.56-2.01) 1.40 (0.87-2.27) 0.92 (0.61-1.39)
eggs)
Vegetables 0.90 (0.59-1.36) 1.10 (0.65-1.87) 2.40 (1.54-3.74) 1.14 (0.79-1.63)
Sausages and cold cuts 1.84 (1.19-2.85) 1.64 (0.77-3.47) 1.01 (0.58-1.76) 1.12 (0.72-1.74)
Sweet 2.27 (1.50-3.44) 2.73 (1.62-4.59) 3.33 (2.07-5.35) 1.60 (1.09-2.36)
Soft drinks with sugar 1.26 (0.86-1.83) 0.97 (0.58-1.62) 1.21 (0.78-1.87) 1.16 (0.84-1.60)
* Adjusted for gender, age, BMI, qualifications, physical activity, perceived economic situation, sedentary lifestyle, smoking and relationship status. Cells in italics
indicate statistical significance, p <0.05.

dimensions of psychological health and sleep in a population lean, fish and eggs (by default), and the one for sausages and
university. Our findings show a high prevalence cold cuts (for excess). The general quality of the diet was associated
stress disorder (33.9%), anxiety (23.5%), depression (18.6%) significantly and inversely to the presence of some level of
and insomnia (43.1%) among university students in our environment, anxiety, stress or depression, not so with insomnia. By groups
higher in women than in men (except for the syn- of food, we found that the prevalence of alterations
depressive tomatology). Aizpurua et al. (34), also using the purposes of psychological well-being and sleep is essentially associated
DASS-21 questionnaire, found in Spanish university students prevalent with the lack of adherence to the recommendations for the intake of
even greater leanings of depression, anxiety and stress, with values vegetables, dairy and sweets.
38.2%, 45.4% and 42.5%, respectively. Worldwide, The discussion of the results relative to the general quality of
a systematic review of 24 studies estimated a prevalence diet is complex since only a previous study has analyzed
average depression among university students of 30.5%, with a Once the relationship between this dimension and the prevalence of symptoms
range that ranged from 10.4% to 80.5% (35). depressed in a university population, specifically female.
Previous studies on Spanish university students, using In that study, Quehl et al. (38) detected a linear relationship between
the IAS as an instrument for measuring the quality of the diet, versa and significant between the IAS score (Canadian version)
showed a high number of university students with patterns and the Center for Epidemiologic Studies Depression score
unhealthy food (18,36,37). In this study, until Scale . There is more evidence in relation to the consumption of different
82.3% of the participants had an unhealthy diet food groups and their relationship with psychological health. Miko-
ludable or in need of changes. By food groups, the lajczyk et al. (9) observed, only in university students, a relationship
consumption farthest from the recommendations was meat significant between perceived stress, on the one hand, and consumption

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high in sweets and fast food, and low in fruits and vegetables,
for the other. Other studies (7,40) extend the association to
male students. Lazarevich et al. (13) and Liu et al. (39)
detected higher levels of depression in college students with
higher consumption of fast food and sweets. Unlike
the results obtained in our study, none of these
studies report significant relationships between stress, anxiety
or depression and dairy consumption.
This study has several limitations. Doesn't analyze size
of the rations nor does it quantify the total intake of calories, protein,
fats and carbohydrates. In addition, its transversal nature allows
establish associations but not causal relationships. In this
In this sense, future research should clarify the time relationship
between diet and alterations in mental health.
such. Despite these limitations, our findings suggest a
high prevalence of university students with inadequate nutrition,
which is also related to psychological health. These dates
manifest the need to apply prevention strategies and
health promotion in the university environment. In this sense,
any intervention aimed at minimizing anxiety levels
age, depression or stress in this population should include content
aimed at maintaining a healthy diet.
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