Insufficient capacity to cope with stressors decreases dietary quality in females

Abstract Background Previous studies had found the effects of stress on eating behaviors. The aim of this study was to explore the effects of perceived stress on dietary quality by sexes in Chinese adults. Methods The study population consisted of individuals aged 18 to 59 years participating in the China Health and Nutrition Survey. Perceived stress levels were measured using the 10-item Perceived Stress Scale (PSS-10), with scores ranging from 0 to 40. Dietary quality was evaluated by Chinese Dietary Guidelines Index (CDGI) ranging 0-110. Using a two-level mixed effects model with community as level 2 and individual as level 1, the study analyzed the impact of PSS-10 scores on CDGI. Additionally, a two-level mixed effects structural equation model was employed to explore the effects of distress factor scores and coping stressor factor scores on dietary quality among different sexes within the population. Results This study involved in 2515 males and 3165 females, and the average age was 45.9 ± 9.6.The PSS-10 score and CDGI were 14.6 ± 5.1 and 44.8 ± 11.6, separately. After adjusting for confounders, there were no effects of PSS-10 score, distress factor score, and coping stressors factor score on CDGI in males. After adjusting for confounders, CDGI in the highest tertile of PSS-10 score group was 1.64 lower than that in the lowest tertile group in females(P = 0.001). The distress factor score was not associated with CDGI (standardized β=-0.164, P = 0.488), while the coping with stressors factor score was significantly negative with CDGI (standardized β=-0.834, P