Stressed is Just Desserts Spelled Backwards: The Mediation Effects of a Healthy Diet on the Relationship Between Perceived Stress and Self-Rated Health Funded by the NIH ABSTRACT Arianna M, Ulloa, C. S. Bergeman BACKGROUND & HYPOTHESES  Chronic stress has a cumulative effect on the body’s response mechanisms. Over-activation of the body’s physiological response has been implicated with negative health outcomes ( Breslow & Hochstim, 1971 ; McEwen, 2005 )  A healthy diet is associated with better health outcomes (Sacks et al., 2001; Wilcox, Willcoz, Todorikiy, & Suziki, 2009).  Research links the physiological stress response to unhealthy diets ( Ng & Jeffery, 2003) )  Cortisol is stored in adipose tissue and chronic stress is associated with this adipose tissue being increasingly stored in the abdominal area (Epel et al., 2000, Maglione-Garves, Kravitz, & Schneider, 2005; Tomlinson, Sinha, Bujalska, Hewison, & 2002)  Cortisol cravings theory suggests chronic stress may lead to increased desire for highly palatable (high sugar & fat) foods resulting in weight gain (Lemieux, Prud'homme, Bouchard, Tremblay, & Després, 1996).  Reward Based Stress Eating Model suggests that calorically dense food intake stimulates endogenous opoid release in the brain’s reward system, attenuating stress (Adam & Epel, 2007).  Hypothesis: An unhealthy diet will mediate the effects of perceived stress on self-rated health. METHOD  Participants from Notre Dame Study of Health & Well- Being - LATER LIFE COHORT  Aged (M = 71.24); N = 153  64% female; 88% White  Measures  Perceived Stress Scale (Cohen & Williamson, 1988)  Typical Week Nutrition Measure ( Healthy Diet extracted as one factor from the measure)  Self-Rated Health (Part of Measurement of Physical Health; Belloc, Breslow & Hochstim, 1971)  Analytic Procedure – Multiple Regression  Mediation Analyses ( Baron,& Kenny, 1986 ) with Bootstrapping (Hayes, A. F. (2011) and Sobel Test (Preacher & Leonardelli, 2001) RESULTS: Mediation Effects of Healthy Diet on Health SUMMARY & IMPLICATIONS β = 0.12* (.05) β = -0.27*** (.07) β = -0.16** (.06) β = (.05) Figure 1. Standardized regression coefficients for the relationship between perceived stress and self rated health as mediated by unhealthy diet. Standard errors are in parentheses. Sobel = 2.12, p = Bootstrapping analysis revealed that an unhealthy diet fully mediated the relationship between perceived stress and self rated health (β =.04; CI =.0097 to.1006). Note: *p <.05, **p =.01, ***p <.01.  Multiple regressions show that an unhealthy diet mediates the relationship between perceived stress and self- rated health. Chronic stress elevates the desire for unhealthy food and the amount of adipose tissue stored in visceral areas of the abdomen. The cumulative effects of of these two consequences may explain studies that show that high- stress people who eat a lot of high-fat, high-sugar food are more prone to health risks than low- stress people who eat the same amount of unhealthy food (Aschbacher et al., 2014).  Taken together with those past studies, these findings provide preliminary evidence that the nutritional value of food consumed alone may not be the sole cause of stress-related health decline, but instead may it may be the synergistic combination of the physiological effects of stress on diet, such as increased insulin resistance and increased cortisol-driven abdominal adipose storage, coupled with nutritional the effects of a high fat/ sugar diet, that enhance vulnerability to negative self-rated health outcomes.  Future studies should try to discern the complex pathways in which diet mediates the relationship between chronic stress and health by isolating each potential mediation pathway (i.e., food consumption, leptin/ ghrelin levels, insulin resistance, abdominal adipose storage) to provide a clearer view of this cumulative phenomenon.  These results provide hope that individuals may be able to avoid some of the negative health consequences of stress through a healthy diet. Further experimental studies should compare chronically stressed individuals following a healthy diet compared to a chronically stressed control group following their normal unhealthy diet. C ab C’ Objectives. Research Links perceived stress to negative health outcomes. Because stress impacts the individual behaviorally and physiologically, the current study explores whether the relationship between chronic stress and negative health outcomes is explained by diet. Specifically, it investigated the hypothesis that diet mediates the relationship between perceived stress and self-rated health. The present study investigated the hypothesis that diet fully mediates the relationship between stress and self-rated health outcomes. Method. We collected data from the later-life cohort, year five of the Notre Dame Study of Health & Well-Being. Participants completed an in-person health battery that included a questionnaire assessing stress, diet, and health. Multiple regression models were used to analyze the mediation. Results. Perceived stress predicted self rated health (β =.12, t(130) = 2.29, p =.02). Healthy diet fully mediated the relationship between perceived stress and self rated health (β =.04; CI =.0097 to.1006). The effect of perceived stress on self-reported health became nonsignificant (β =.08, t = 1.44, p =.15) when controlling for healthy diet. A Sobel test confirmed the reliability of our findings (Z = 2.12, p = 0.03). Discussion. The mediating role of diet suggests that stress itself may not be what causes health maladies, rather, the effects of stress on other key metabolic pathways account for the relationship between stress and health. Future research can explore this idea more in depth by examining which specific behavioral and physiological pathways mediate the relationship between stress and health, the length of time this mediation takes place (i.e. daily, weekly, monthly, yearly), and whether individuals differ in how they experience this mediation in order to better inform preventative care and intervention techniques.