Food and Behaviour Research

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Cross-sectional associations of schoolchildren’s fruit and vegetable consumption, and meal choices, with their mental well-being: a cross-sectional study

Hayhoe R, Rechel B, Clark AB, Gummerson C, Louise Smith SJL, Welch AA. (2021) BMJ Nutrition, Prevention & Health  e000205. doi: 10.1136/bmjnph-2020-000205 

Web URL: Read this article in full on the BMJ Nutrition, Prevention & Health website here



Poor mental well-being is a major issue for young people and is likely to have long-term negative consequences. The contribution of nutrition is underexplored. We, therefore, investigated the association between dietary choices and mental well-being among schoolchildren.


Data from 7570 secondary school and 1253 primary school children in the Norfolk Children and Young People Health and Well-being Survey, open to all Norfolk schools during October 2017, were analysed. Multivariable linear regression was used to measure the association between nutritional factors and mental well-being assessed by the Warwick-Edinburgh Mental Well-being Scale for secondary school pupils, or the Stirling Children’s Well-being Scale for primary school pupils. We adjusted all analyses for important covariates including demographic, health variables, living/home situation and adverse experience variables.


In secondary school analyses, a strong association between nutritional variables and well-being scores was apparent. Higher combined fruit and vegetable consumption was significantly associated with higher well-being: well-being scores were 3.73 (95% CI 2.94 to 4.53) units higher in those consuming five or more fruits and vegetables (p<0.001; n=1905) compared with none (n=739).

The type of breakfast or lunch consumed was also associated with significant differences in well-being score. Compared with children consuming a conventional type of breakfast (n=5288), those not eating any breakfast had mean well-being scores 2.73 (95% CI 2.11 to 3.35) units lower (p<0.001; n=1129) and those consuming only an energy drink had well-being scores 3.14 (95% CI 1.20 to 5.09) units lower (p=0.002; n=91).

Likewise, children not eating any lunch had well-being scores 2.95 (95% CI 2.22 to 3.68) units lower (p<0.001; 860) than those consuming a packed lunch (n=3744).

In primary school analyses, the type of breakfast or lunch was associated with significant differences in well-being scores in a similar way to those seen in secondary school data, although no significant association with fruit and vegetable intake was evident.


These findings suggest that public health strategies to optimise the mental well-being of children should include promotion of good nutrition.

Key messages

What is already known on this topic

  • Nutrition is important for childhood growth and development, but little research has investigated nutrition in relation to mental well-being, therefore, the relationship between nutrition and well-being in children of school age is not known.

What this study adds

  • In this study nutritional intake was associated with mental well-being scores in both primary and secondary school children.

  • Higher fruit and vegetable consumption was significantly associated with better mental well-being in secondary pupils. Also, the type of breakfast and lunch consumed, by both primary and secondary pupils, was significantly associated with well-being.

  • In a class of 30 secondary school children, 4 had nothing to eat or drink before starting classes in the morning, and 3 had nothing to eat or drink before starting classes in the afternoon.

  • The difference in mental well-being between children who consumed the most fruits and vegetables compared with the lowest was of a similar scale to those children experiencing daily, or almost daily, arguing or violence at home.

  • The associations found between nutrition and mental well-being in our study mean that strategies to improve nutrition in schoolchildren need to be investigated and implemented.


For an accessible summary of this research and its implications, see the associated news article