Association Between Diet and Emotional Symptoms in Early Childhood: Results from the Piccolipiù Cohort

Background/Objectives: Emerging evidence suggests the critical role of diet in shaping mental health outcomes, which are increasingly prevalent among children and adolescents worldwide. This study aims to investigate whether the dietary habits of children in the Italian multicentre Piccolipiù birth cohort at four years of age are associated with anxiety and depression symptoms. This analysis was conducted within the framework of the Global Burden of Disease Lifestyle and Mental Disorders (GLAD) Project. Methods: Data from 1726 children were analyzed. Emotional symptoms were assessed with the Child Behavior Checklist (CBCL), and diet was assessed using a food frequency questionnaire. Sociodemographic data, including per capita income, were also collected. Associations between food intake and clinical anxiety/depression (T-scores >70) or total symptom scores were examined using univariate and multivariable logistic and robust linear regressions adjusted for sex and income. Results: In 1726 children (median age 4.4 years; 50% female), 3% exhibited clinical anxiety and 2% clinical depression. Higher grain intake was associated with increased odds of clinical anxiety (OR=1.004; 95% CI: 1.001-1.007), while greater fish consumption reduced odds of clinical depression (OR=0.946; 95% CI: 0.903-0.992). Vegetable intake was linked to lower anxiety and depression scores. Multivariable analysis confirmed the association between grains and anxiety and fish and depression. Conclusions: Higher intake of vegetables, fruits, and fish is associated with better emotional health in preschoolers, although effect sizes were modest. Early dietary interventions may offer a practical approach to improving children’s long-term mental health. Longitudinal studies are needed to confirm these associations and clarify underlying mechanisms.