Dietary quality linkage to overall competence at school and emotional disturbance in representative Taiwanese young adolescents: dependence on gender, parental characteristics and personal behaviors

BACKGROUND Child school performance during puberty may be at increased risk through emotional disturbance. It is hypothesized that this may be mitigated by dietary quality. METHODS In a nationally representative sample (Nutrition and Health Survey in Taiwan, NAHSIT), 1371 Taiwanese aged 11-16 years, overall competence at school, (OCS) and emotional status have been assessed by teachers with the SAED (Scale for Assessing Emotional Disturbance). Parents provided family socio-demographics and students completed a behavioral and dietary questionnaire (Youth Healthy Eating Index - Taiwan, YHEI-TW). Associations between emotional disturbance (ED), OCS and dietary quality (YHEI-TW) were assessed in multiple linear regression models with adjustments for covariates including parental characteristics, personal behaviors, body fatness and puberty. RESULTS Boys or girls with ED had a less favorable OCS (p < 0.001), minimally dependent on YHEI-TW. On multivariable analysis there was a more positive association between OCS and YHEI-TW among boys (β = 0.05, p < 0.01) and girls (β = 0.07, p < 0.001). Poor dietary quality was associated with ED, especially in girls (β =  - 0.06, p < 0.001). Additionally, parental characteristics, body fatness, and personal behaviors are associated with OCS. Puberty is associated with ED and may be indirectly linked to OCS. CONCLUSIONS Unsatisfactory food intake is associated with the link between emotional disturbance and impaired school performance, as assessed by OCS, especially among girls. For both genders, socio-economic and behavioral factors including parenteral income, reading, screen viewing and smoking are modulators of this association. Puberty was a modifying factor in girls. Dietary quality is a relevant factor for health (ED) as well as education (OCS) during early adolescence.