Meta-analysis of 633,317 individuals shows associations between healthy diets and depression, anxiety and stress in 23 low- and middle-income countries

Meta-analysis of 633,317 individuals shows associations between healthy diets and depression, anxiety and stress in 23 low- and middle-income countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Meta-analysis of 633,317 individuals shows associations between healthy diets and depression, anxiety and stress in 23 low- and middle-income countries Thalia M Sparling, Cesar Cornejo, Bryan Cheng, Lisa M. Troy, Suneetha Kadiyala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8734114/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Poor diet quality related to common mental disorders contribute to global health syndemics. However, there is no synthesis quantifying associations specifically in Low- and Middle-Income Countries (LMIC) where these concomitant health burdens are most prevalent. We used a previously generated systematic Evidence and Gap Map of over 3000 peer-reviewed studies linking food security and nutrition to anxiety, depression, stress and mental wellbeing (2000-2024). From this, we selected studies investigating associations between healthy diets and depression, anxiety and stress measured by validated tools. Eighty-three eligible studies from 23 countries (depression n=69; anxiety n=43; stress n=26), and 65 LMIC sample populations, reported statistical measures for 633,317 unique individuals. Healthy diets were associated with less depression, anxiety, and stress. The Standardized Mean Differences (SMD) were -0.29 for depression (95% CI -0.35 to -0.23), -0.25 for anxiety (95% CI -0.35 to -0.16), and -0.24 for stress (95% CI -0.33 to -0.14). Results remained robust when restricted to low Risk of Bias studies. Findings were similar in direction and magnitude across study designs, dietary measurements, diagnostic tools, country income levels, and estimates adjusted for socio-economic status. Methodological limitations (e.g., cross-sectional design) and few studies from low-income countries created evidence gaps. Building on the interrelationship between diet and mental health can inform actions to improve both in settings with disproportionate health vulnerabilities. depression anxiety stress common mental disorders food intake dietary patterns systematic review multi-level meta-analysis Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementarymaterialsHDMHMetaanalysis2025FINAL.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 16 Feb, 2026 Reviewers agreed at journal 02 Feb, 2026 Reviewers invited by journal 02 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 02 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8734114","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584559316,"identity":"17ead8d5-6c9e-4082-89e7-f6582bb11ade","order_by":0,"name":"Thalia M Sparling","email":"data:image/png;base64,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","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":true,"prefix":"","firstName":"Thalia","middleName":"M","lastName":"Sparling","suffix":""},{"id":584559317,"identity":"ca78f562-13b8-488a-863d-e26d98f9d3a4","order_by":1,"name":"Cesar Cornejo","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cesar","middleName":"","lastName":"Cornejo","suffix":""},{"id":584559318,"identity":"0ae02c34-38fb-4e81-b120-2f61bd93b479","order_by":2,"name":"Bryan Cheng","email":"","orcid":"","institution":"Teachers College, Columbia University","correspondingAuthor":false,"prefix":"","firstName":"Bryan","middleName":"","lastName":"Cheng","suffix":""},{"id":584559319,"identity":"2a84e60b-fcf3-46ef-a13e-0ccf908323b0","order_by":3,"name":"Lisa M. 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However, there is no synthesis quantifying associations specifically in Low- and Middle-Income Countries (LMIC) where these concomitant health burdens are most prevalent.\u003c/p\u003e\n\u003cp\u003eWe used a previously generated systematic Evidence and Gap Map of over 3000 peer-reviewed studies linking food security and nutrition to anxiety, depression, stress and mental wellbeing (2000-2024). From this, we selected studies investigating associations between healthy diets and depression, anxiety and stress measured by validated tools.\u003c/p\u003e\n\u003cp\u003eEighty-three eligible studies from 23 countries (depression n=69; anxiety n=43; stress n=26), and 65 LMIC sample populations, reported statistical measures for 633,317 unique individuals. Healthy diets were associated with less depression, anxiety, and stress. 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