Stress and eating behaviours in healthy adults: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA flow diagram indicating articles retained and excluded at each stage of the screening process (Moher et al., 2009).

Figure 2. Number of studies scoring across 5 quality assessment sections from weak to strong (left to right).

Figure 3. Proportional distribution plot of stress and eating behaviours overall across all studies (k = 54).

Figure 4. Funnel plot of publication bias with observed (white) and imputed (shaded) studies.

Table 1. Summary of heterogeneity within and between variable analyses in the meta-analysis (k = 54).

Subgroup	Variables	Number of study outcomes (k) & sample size (n)	Effect size [95% CIs] Mixed Effects Model	I^2%	Q and p value (Within studies)	Q & p value (Between studies)
Eating behaviour category	Unhealthy	k = 35 n = 56,858	0.149 [0.068, 0.231]	91.136%	383.558 (<.001)	41.239 (<.001)**
	Healthy	k = 17 n = 43,989	−0.131 [−0.207, −0.055]	86.186%	115.826 (<.001)
	Other	k = 33 n = 19,072	0.215 [0.129, 0.301]	89.641%	308.920 (<.001)
Overall: Hedges’ g = 0.063, 95% CIs [0.016, 0.110], Z = 2.646, p = .008
Stress Measure	Perceived^a	k = 32 n = 118,607	0.100 [0.041, 0.160]	95.953%	766.094 (<.001)	0.621 (.431)
	Induced	k = 22 n = 1,213	0.156 [0.030, 0.283]	51.721%	43.498 (.003)
Overall: Hedges’ g = 0.110, 95% CIs [0.057, 0.164], Z = 4.026, p < .001
Study quality	Strong	k = 5 n = 2,277	0.039 [0.007, 0.071]	<1%	2.776 (.596)	5.990 (.050)
	Moderate	k = 19 n = 100,201	0.147 [0.037, 0.257]	97.102%	621.166 (<.001)
	Weak	k = 30 n = 17,342	0.115 [0.038, 0.193]	85.081%	194.386 (<.001)
Overall: Hedges’ g = 0.057, 95% CIs [0.028, 0.085], Z = 3.877, p < .001
Gender	Female	k = 30 n = 15,336	0.149 [0.041, 0.257]	88.088%	243.447 (<.001)	1.107 (.293)
	Male	k = 9 n = 8,337	−0.014 [−0.297, 0.270]	95.923%	196.205 (<.001)
Overall: Hedges’ g = 0.057, 95% CIs [0.028, 0.085], Z = 3.877, p < .001

Note: ** Significant at p < .001.

Table 2. Summary of findings from meta-regressions on stress and type of food intake.

	Overall					Unhealthy eating outcomes					Healthy eating outcomes
	Coefficient	95% CIs	Standard Error	Z-score	p-value	Coefficient	95% CIs	Standard Error	Z-score	p-value	Coefficient	95% CIs	Standard Error	Z-score	p-value
Proportion female	0.001	−0.002, 0.005	0.002	0.79	.430	0.003	−0.002, 0.008	0.003	1.27	.202	−0.002	−0.005, 0.002	0.002	−0.87	.387
Mean BMI	−0.003	−0.040, 0.034	0.019	−0.16	.872	−0.011	−0.065, 0.044	0.028	−0.39	.709	−0.009	−0.028, 0.011	0.010	−0.88	.378
Proportion healthy weight	<.001	−0.005, 0.007	0.003	0.21	.838	0.001	−0.003, 0.001	0.001	−1.16	.248	−0.004	−0.008, <−.001	0.002	−1.96	.050
Proportion overweight	0.002	−0.003, 0.007	0.003	0.76	.448	<−.001	−0.003, 0.002	0.001	−0.25	.806	0.009	−0.002, 0.019	0.005	1.61	.107
Dietary restraint	0.035	−0.136, 0.207	0.088	0.40	.687	−0.181	−0.337, −0.026	0.080	−2.28	.023	Too few studies for analysis
Mean age	−0.003	−0.012, 0.006	0.005	−0.63	.531	0.003	−0.010, 0.016	0.007	0.41	.682	0.001	−0.004, 0.006	0.003	0.33	.740
Sample size	<−.001	<−.001, <.001	<.001	−0.42	.673	<−0.001	<−.001, <.001	<.001	−0.35	.726	<.001	<−.001, <.001	<.001	1.51	.130

^a As a sub-group within perceived stress, analyses indicated that use of a daily diary methodology yielded a strong, significant effect, Hedges’ g = 0.313, 95% CIs [0.160, 0.465], Z = 4.003, p < .001**.

Figure 5. Proportional forest plot of stress and consumption of unhealthy foods (k = 35).

Table 3. Summary of heterogeneity within and between studies on stress and unhealthy (k = 35) and healthy eating behaviours (k = 17).

Subgroup	Variables (Number of outcomes)	Unhealthy eating outcomes (k = 35)					Healthy eating outcomes (k = 17)
		Number of study outcomes (k) & sample size (n)	Effect size [95% CIs] Mixed Effects Model	I^2%	Q and p value (Within studies)	Q & p value (Between studies)	Number of study outcomes (k) & sample size (n)	Effect size [95% CIs] Mixed Effects Model	I^2%	Q and p value (Within studies)	Q & p value (Between studies)
Stress Measure	Perceived	k = 24 n = 97,437	0.125 [0.060, 0.190]	94.153%	393.386 (<.001)	0.232 (.630)	Too few studies for subgroup analysis
	Induced	k = 11 n = 559	0.065 [−0.170, 0.301]	55.599%	22.522 (<.001)
Study quality	Strong	Too few studies for subgroup analysis					Too few studies for subgroup analysis
	Moderate	k = 11 n = 79,257	0.206 [0.041, 0.371]	96.446%	281.338 (<.001)	1.155 (.283)	k = 6 n = 72,249	−0.144 [−0.240, 0.012]	94.296%	87.661 (<.001)	0.035 (.851)
	Weak	k = 21 n = 16,580	0.101 [0.005, 0.197]	83.632%	122.191 (<.001)		k = 10 n = 11,926	−0.127 [−0.188, −0.066]	43.351%	15.887 (.005)
Gender	Female	k = 19 n = 14,815	0.145 [0.009, 0.281]	91.997%	224.925 (<.001)	0.683 (.408)	k = 6 n = 5,832	−0.116 [−0.203, −0.030]	61.790%	13.085 (.023)	2.318 (.128)
	Male	k = 6 n = 8,263	0.013 [−0.267, 0.294]	96.693%	151.173 (<.001)		k = 5 n = 2,773	−0.258 [−0.418, −0.097]	78.448%	18.560 (.001)

Figure 6. Proportional forest plot of stress and consumption of healthy foods (k = 17).

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/https://doi.org/10.7326/0003-4819-151-4-200908180-00135

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