Distinct Roles of Distress and Coping Capacity in the Effects of Psychological Stress on Energy Intake and Percentage of Energy from Macronutrients

The aim of this study was to explore the association of perceived stress on energy intake and percentage of energy from macronutrients. We examined cross-sectional data from the China Health and Nutrition Survey among Chinese adults. Perceived stress scale was used to assess psychological stress, and confirmatory factor analysis was used to calculate the two latent variable scores: distress factor and coping factor of perceived stress. Combined two-level random effect model and structural equation modeling were used to explore the association between distress, coping, and energy intake. The study involved 6865 adults with an average age of 46.9 years. The intake of energy was 2047.9 ± 666.6 kcal/d, 51.1% from carbohydrate and 35.2% from fat. Neither distress nor coping capacity had an association with energy intake. The coping factor score was positively associated with the sum of percentage of energy intake from carbohydrate and fat (%C&F) in females (β = 0.149, p = 0.015) but not in males. Compared to the lowest tertile, %C&F of females with a coping factor score in the medium and top tertiles were 0.44 and 0.81 significantly higher, respectively (p(medium) = 0.0013, p(top) < 0.0001). Psychological stress was positively associated with %C&F in females. It was insufficient capacity to cope with stress that led to unhealthy eating behavior.