Relationship between perceived stress and dietary and activity patterns in older adults participating in the Boston Puerto Rican Health Study

Abstract

Previous research supports a relationship between psychological stress and chronic disease in Puerto Rican adults living in the Boston, Massachusetts area. Stress may affect health by influencing dietary and physical activity patterns. Therefore, perceived stress and two hypothesized mediators of stress-related food intake, insulin and cortisol, were examined for possible associations with dietary and activity patterns in >1300 Puerto Ricans (aged 45-75 years; 70% women) living in the Boston, Massachusetts area. Data were analyzed using multiple linear regression and ANCOVA. Greater perceived stress was associated with lower fruit, vegetable, and protein intake, greater consumption of salty snacks, and lower participation in physical activity. Stress was associated with higher intake of sweets, particularly in those with type 2 diabetes. Cortisol and stress were positively associated in those without diabetes. Cortisol was associated with higher intake of saturated fat and, in those with diabetes, sweet foods. Independent of diabetes, perceived stress was associated with higher circulating insulin and BMI. Our findings support a link between stress, cortisol, and dietary and activity patterns in this population. For high-sugar foods, this relationship may be particularly important in those with type 2 diabetes. Longitudinal research to determine causal pathways for these identified associations is warranted.

Fig. 1

Higher levels of perceived stress were associated with lower physical activity and greater amount of time watching television (A).Higher levels of stress were also associated with lower intake of protein, greater intake of carbohydrate (B) and lower intakes of fruit, vegetables, and fiber (C), although there was a U-shaped pattern of dietary fiber intake across increasing levels of perceived stress.Eating more salty snacks was associated with higher levels of perceived stress; an association between sweets and stress was found only in those with diabetes (D).Consumption of legumes, but not rice, tended to be associated with stress, with the highest quartile tending to have higher intakes relative to the lowest quartile (E). Values are least square mean ± S.E. and adjusted for age, sex, education, energy intake, BMI, physical activity, income to poverty ratio, and diabetes.Dietary intakes are daily values. *Statistically different from the lowest quartile (P ≤ 0.05). ^#Indicates a tendency (P = 0.08) to be statistically different from the lowest quartile.

Fig. 2

Independent of age, sex, education, BMI, and income to poverty ratio, perceived stress was associated with higher urinary cortisol in those without diabetes (A), but not in those with this condition.Independent of stress and not unexpectedly, diabetes tended (P = 0.11) to be associated with higher urinary cortisol (compare the dashed (diabetes) with the solid (without diabetes) lines, which represent average concentrations across stress quartiles).Similar to the pattern observed for BMI and independent of age, sex, education, income to poverty ratio, and diabetes, perceived stress tended to be associated with higher plasma insulin concentration, and this was due to a higher concentration in the middle highest stress quartile (B).When income to poverty ratio was removed from the model, the effect of stress on insulin was significant.After adjusting for sex, age, education, energy intake, BMI, physical activity, income to poverty ratio, and diabetes, urinary cortisol was associated with higher intakes of saturated fat and high-fat dairy foods (C). Values are least square mean ± S.E.Dietary intakes are daily values. *Statistically different from the lowest quartile (P ≤ 0.05).