摘要：We systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure. We found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse. When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained. Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span. The role of habitual diet in the development of depressive disorders and symptoms has become a recent research focus over the past decade. Data from adult populations have indicated that better-quality diet is associated with better mental health outcomes. 1–5 In fact, new meta-analyses have confirmed the inverse association between healthy diets and depression. 4,5 A habitually poor diet (e.g., increased consumption of Western processed foods) is also independently associated with a greater likelihood of or risk for depression 1,6,7 and anxiety. 1 Although stress and depression can promote unhealthy eating, recent longitudinal studies have suggested that reverse causality is a less likely explanation for long-term associations. 8 However, our understanding of these associations earlier in the life span remains unclear. To date, much of the research around this relationship has focused on dietary intake and externalizing behaviors (particularly hyperactivity). For example, poor nutritional quality is independently associated with symptoms of attention-deficit hyperactivity disorder. 9 However, the relationship between dietary intake in childhood and adolescence and internalizing behaviors, which represent depressive symptoms, low mood, or anxiety, has received comparably less attention. Given that the previous literature in adults regarding diet and mental health has focused on the common mental disorders, depression and anxiety, examination of these same mental health parameters in children and adolescents is needed. In terms of what evidence is available to date, findings remain inconsistent. For example, although some studies have observed a dose–response relationship between diet quality and mental health in young adolescents, 10 others have shown no significant association. 11 The evidence is even less comprehensive for the relationship between dietary intake and anxiety symptoms. 12 To our knowledge, no systematic reviews to date have specifically investigated the association between diet, measured using diet quality scores, dietary pattern analysis, or both and internalizing behaviors that characterize low or depressive mood and anxiety symptoms in child and adolescent populations.
