Associations of Psychological Stress and Distress with Nutrient Intake and Metabolic Syndrome from the KNHANES 2021-2023

Background Psychological stress and distress are global health concerns affecting nutritional intake and metabolic outcomes, yet evidence on their associations with nutrient intake in Asian populations remains limited. This study investigated relationships between psychological status, sociodemographic factors, nutrient intake, and metabolic risks among Korean adults, focusing on sex differences. Methods Data from 4,820 adults aged ≥ 19 years in the 2021–2023 Korea National Health and Nutrition Examination Survey were analyzed. Participants were categorized into no symptoms, psychological stress, or psychological distress groups. Complex sample regression and multivariate logistic regression examined associations between psychological status and sociodemographic characteristics, health behaviors, nutrient intake, and metabolic syndrome risk by sex. Results Younger age, higher education, higher income, smoking, and low breakfast frequency were associated with psychological stress and distress in both sexes. Among men, psychological distress correlated with lower protein, fat, and micronutrient intake (phosphorus, potassium, magnesium) and increased metabolic syndrome risk (OR = 1.68; 95% CI: 1.12–2.53). Among women, psychological stress was associated with hypertriglyceridemia and atherogenic dyslipidemia, while distress correlated with lower folate intake. Conclusions Psychological stress and distress exhibited sex-specific associations with sociodemographic status, nutrient intake, and metabolic outcomes, underscoring the need for sex-specific interventions incorporating nutritional strategies to manage psychological health and prevent metabolic disorders.