Stress and Diet Quality Among Ecuadorian Adults During the COVID-19 Pandemic. A Cross-Sectional Study

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Background: Stress has been associated with food habits. Stress changes eating patterns and the salience and consumption of hyperpalatable foods. During the lock-down due to the COVID-19 pandemic, stress was very common. Objective: We investigated the association between stress and diet quality in Ecuadorian adults during the COVID-19 pandemic. Design: A cross-sectional study. Setting: Data was collected using a self-administered online survey. Stress was measured using the Perceived Stress Scale (PSS-14), and diet quality was evaluated using the Global Diet Index (GDI). A linear regression model with restrictive cubic splines was used to investigate the association between stress and diet quality. Participants: Participants were recruited by convenience sampling, including a total of 2602 individuals. Most participants were female (68.57%) and had university education (78.52%), with a median age of 25 (IQR: 25, 37). Results: Stress was reported by 26.06% of participants. The majority of individuals (75.79%) reported having a diet that needed changes or an unhealthy diet. Independently from biological sex, age, level of education, people/room ratio, economic allowance, and expenses for food, stress was statistically significantly associated with diet quality (p = 0.035). The association between stress and diet quality was inverse and non-linear; higher stress levels were associated with poorer diet quality. The consumption of palatable foods was not statistically significant associated with stress. Conclusions: Stress is associated with poorer diet quality. Public health measures to improve the mental health and lifestyle of the population are needed during the lock-down of the pandemic.