Department of Clinical Nutrition & Dietetics

Faculty of Applied Medical Sciences

Supervised by: Dr.Buthaina Mahmoud Alkhatib

Seminar Project
Prepared by Jude Hawashin
19 may, 2024
Department of Clinical Nutrition & Dietetics
Faculty of Applied Medical Sciences
Supervised by: Dr.Buthaina Mahmoud Alkhatib

19 may, 2024 Prepared by Jude Hawashin

Introduction
 omega-3 polyunsaturated fatty acids Psychological stress, defined as the sustained,
and dietary vegetables
excessive secretion of mental and/or emotional
High-dose sustained-release ascorbic strain from work, family and other daily
acid
responsibilities
Multivitamin supplementation

Soy lecithin phosphatidic acid and

phosphatidylserine complex (PAS)
Nutritional
Mediterranean diet
Psychiatry
Mg, B vitamins, rhodiola, and green tea
(L-theanine)
 Definition:
• It is defined as the number of foods or food
Dietary Diversity groups consumed individually over a certain
period
Dietary Diversity Score:
• This cannot perform a comprehensive
assessment of nutrient intake, it provides a
good assessment of the nutritional adequacy
of the diet
Correlation:
• the dietary diversity score is negatively
correlated with anxiety and depression

Lack of prospective studies

 Calculating dietary diversity
Past Present
• DQQ divides foods into 29 different
• Some studies divided foods
groups
into eight food groups,
• more comprehensive assessment of
• Others used only five main
dietary habits at the population level,
food groups.
based on global standards for diet quality.
• These 2 methods relied on
• simple and standardized tool used to
24-hour dietary recall
measure dietary diversity
Objectives
• To examine the association between dietary diversity score,
calculated using the Diet Quality Questionnaire (DQQ) for
China, and psychological stress in Chinese adults.

• To use prospective data from the China Health and Nutrition

Survey (CHNS) to analyze this relationship, including data
from 7434 adult participants with complete dietary information
from the 2011 wave and perceived stress scale (PSS-14) data
from the 2015 wave.

• To investigate the trend of dietary diversity in relation to

psychological stress and explore the potential impact of dietary
diversity on mitigating psychological stress among the adult
population in China.
Materials & Methods
 Data Resource and Study
Participants
• CHNS
• multistage, stratified sampling design
• included participants from nine provinces to ensure
the study’s representativeness

• Informed consent was obtained from all

participants.
• The study was reviewed and approved by the
corresponding institutional review committees
• check the papers i gave you (pss-14)

• The PSS-14 comprises 14 items, rated on a

5-point Likert-type scale, ranging from 0:
never to 4: very often. Scores are obtained
by reverse-scoring the positively stated
items (4–7, 9, 10 and 13). Possible scores
range from 0 to 56 by summing the scores
across all 14 items, with higher scores
indicating higher perceived stress.

• A previous study suggested that a total

stress score of >25 points can be
considered harmful
 Dietary Data Collection and Assessment

24-hr recall
DQQ

• This tool was used to quickly assess

• Three consecutive 24-h recalls
• Provides detailed information
about participants' diets over a
short period.
• the DQQ only requires participants
to recall their food intake for one
day.
participants' food group intake.
• It identifies the most commonly consumed
foods within each food group.
• sentinel foods (defined as the foods in each
food group that were consumed by more
than 95% of people)
 The 29 food groups
using the DQQ for China as follows:

(1) staple foods made from grains (11) grain-based sweets (21) nuts and seeds

(2) whole grains (12) other sweets (22) packaged ultra-processed

salty snacks
(13) eggs
(3) white roots/tubers
(14) cheese (23) instant noodles
(4) legumes
(15) yogurt (24) deep-fried foods
(5) vitamin-rich orange vegetables
(16) processed meats (25) fluid milk
(6) dark-green leafy vegetables
(17) unprocessed red (26) sweetened
(7) other vegetables meat (ruminant) tea/coffee/milk drinks

(8) vitamin A-rich fruits (18) unprocessed red meat (27) fruit juice
(nonruminant)
(9) citrus 28) sugar-sweetened beverages
(19) poultry (SSBs) (sodas)
(10) other fruits (20) fish and seafood (29) fast food
 Measurements and
Calculation of Covariates
• Information on sociodemographic factors
• Body weight and height were measured
• Sampling weights were unavailable, so they
used the urbanization index as a control The urbanization index was controlled as a
measure for their analysis covariate in multivariate logistic
regression, to explore the association between
• Body mass index was calculated by the perceived stress and dietary diversity.
formula: weight (kg)/[height (m)]2.
• community-level measures of the newly
created urbanization index, to control for
multilevel, multistage sampling and various
multilevel modeling issues
Statistical Analysis Descriptive Analyses

Shapiro-Wilk test.
categorical & continuous data
• Categorical parameters
% median(IQR)

A. Univariate Analysis Percentages

1. Wilcoxon rank test
2. Chi-square test • Continuous parameters
3. Cochran–Armitage test
B. logistic regression models (median & IQR)

All analyses were performed

using
SAS statistical software
version 9.4
Results
 Results
• 4204 (56.55%) people perceived a higher level of stress (PSS-14
total score > 25)

• 3230 (43.45%) had a lower level of stress (PSS-14 total score less
than or equal 25).
Gender, marital status, urbanization index, and BMI showed
statistically significant differences between the PSS-14groups
(p<0.05)
Results
TheDistributionofDietaryDiversityandPerceivedStressLevel

Cochran-Armitagetest
In general, the level of psychological stress decreased as the daily dietary
diversity increased, for both female and male
Results
Relationship between Dietary Diversity
and Perceived Stress Level

Unconditional multivariate logistic

regression demonstrated that participants
with higher dietary diversity in their daily
diet were less likely to experience a higher
level of psychological stress, compared
with participants with lower daily dietary
diversity
Strengths & Limitations
 Strengths
• China-adapted New way & for
DQQ the first time

• 2011 and 2015 waves of the CHNS data obtained from

a national representative sample

1. diverse range of people across china

2. analyze data from multiple time points

3. observe trends & patterns & changes in the association

4. limiting confounders
 Limitations
1.Uncontrolled potential confounders

(family history of mental health, physical activity & income)

2. Cross-sectional nature of the study

3. Timing discrepancy between dietary and stress assessments

4. Insufficient dietary data collection

 Conclusion

Inverse Association

Mechanism &