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Eating with stress not only increases our weight, but even worse, it affects our heart

Comment by Maria Antonopoulou, Primary Care and Risk Factor Management Section

Preventive Cardiology
Risk Factors and Prevention

The typical western diet includes foods high in fat and sugar, resulting in energy overtake. This, combined with insufficient physical activity, increases the risk for several cardiovascular diseases (CVD). Eating behaviour has been strongly associated with traditional risk factors for CVD like obesity. It is definitely the amount and the components of the food that negatively affect the cardiovascular system, but could emotional status act as a risk factor as well?

To address such research questions, the psychological dimensions of eating behaviour were assessed in the initially healthy population of the STANISLAS familial cohort from Lorraine, France. The Dutch Eating Behaviour Questionnaire was used to investigate emotional eating, restrained eating and external eating as factors possibly correlated to metabolic syndrome and certain CV damage like diastolic dysfunction and carotid-femoral pulse-wave velocity (cfPWV) over a period of 13 years.

According to the adjusting analysis, adult “emotional eaters” i.e. persons with the tendency to eat more when under emotional stress, had a 38% increased risk for diastolic dysfunction 13 years later, (odds ratio 1.38, p=0.02) and a much lower but significant risk for impaired cfPWV. However, the most interesting finding is that the mediator for this effect was not the rather predictable high energy intake, but the self-reported stress level, with the significant percentage of 39% (p=0.005), indicating an important psychological factor for practical implications.

Considering CV primary prevention strategies about lifestyle interventions, perhaps we should go beyond the quantity or the kind of food, to embrace the context of healthy eating patterns within the patterns of modern eating behaviour. Even if the results of the present study remain to be confirmed in future research studies, the integration of stress estimation and effective regulation with proper mental or pharmacological therapies could be an important add-on in revised clinical recommendations: In other words “to eat only when you feel hungry and never when you feel unhappy”.


Maria Antonopoulou commented on this article:

Anfisa Puchkova-Sistac, Blandine de Lauzon-Guillain, Nicolas Girerd, Jean-Marc Boivin, Erwan Bozec, Ludovic Mercklé, Julie-Anne Nazare, Martine Laville, Patrick Rossignol, Sandra Wagner, Association between eating behaviour and 13-year cardiovascular damages in the initially healthy STANISLAS cohort, European Journal of Preventive Cardiology, 2023; zwac287,

Notes to editor

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.