BACKGROUND: Nutritional psychiatry has established that nutrient-dense diets rich in fruits, vegetables, whole grains, and lean proteins are associated with lower rates of depression and anxiety, while diets high in refined sugars and saturated fats predict greater psychological distress. Although emotion-regulation strategies are known to influence eating behavior, evidence on their role in shaping overall diet quality remains scarce, particularly in Central and Eastern European populations. Young adulthood (18-30 years) represents a critical developmental stage in which both mental health vulnerabilities and long-term dietary patterns consolidate, yet no prior study has examined how discrete cognitive emotion-regulation strategies relate to both global diet quality and specific eating behaviors in Czech young adults. METHODS: In the Czech Republic, we conducted a cross-sectional survey of 1,027 young adults (507 men, 520 women; mean age = 24.6, SD = 3.3 years) recruited via quota-based convenience sampling matched to the 2021 census on age (18-30 years), sex, education, and region. Data were collected in three 60-min online sessions. Participants completed validated Czech measures of depression (BDI), anxiety (BAI), psychological distress (SCL-90), burnout (Shirom-Melamed Burnout Measure), and nine CERQ subscales-all demonstrating α ≥ 0.89 in prior validations and α ≥ 0.79 in our pilot (N = 50). Diet quality was assessed using a 30-item Czech FFQ (pilot α = 0.81), from which Diet Quality Index International (DQI-I) scores were computed. Eating behaviors were measured with the 31-item Czech Adult Eating Behavior Questionnaire (AEBQ; α_total = 0.79). We used stepwise multiple regression with all variance inflation factors < 2.0 to identify psychological variables associated with DQI-I and with "food-approach" versus "food-avoidance" behaviors, minimizing overfitting. RESULTS: In exploratory stepwise regression models (all variance inflation factors < 2.0), the DQI-I model explained a small proportion of variance (Adj R2 = 0.024; f2 = 0.025). Within this model, higher rumination was positively associated with diet quality (B = 0.34, p < 0.001), while depressive symptoms were inversely associated with diet quality (B = -0.09, p = 0.001). The AEBQ model accounted for a modest but meaningful share of variance (Adj R2 = 0.155; f2 = 0.183). In this model, anxiety, catastrophizing, and "focus on the positive" were positively associated with food-approach behaviors (all p < 0.001), whereas positive reappraisal and acceptance negatively associated with dysregulated eating (p < 0.01). These associations should be regarded as tentative and hypothesis-generating, given the exploratory design and modest variance explained. CONCLUSION: This study is the first census-matched study of Czech young adults to examine emotion-regulation strategies in relation to both diet quality and eating behaviors. These findings reveal complex and partly counterintuitive associations-for example, rumination was linked to healthier diet quality, while some ostensibly adaptive strategies coincided with more dysregulated eating. These results should be interpreted as exploratory and hypothesis-generating, underscoring the potential relevance of cognitive-emotional mechanisms for future nutritional psychiatry interventions. Integrating approaches that address maladaptive strategies such as catastrophizing with dietary guidance may represent a promising direction for prevention and health-promotion efforts but requires confirmation in longitudinal and experimental studies.

Department of Psychiatry 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

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Hibbeln JR. Fish consumption and major depression. Lancet. (1998) 351:1213. doi: 10.1016/S0140-6736(05)79168-6, PMID: PubMed DOI

Dash S, Clarke G, Berk M, Jacka FN. The gut microbiome and diet in psychiatry focus on depression. Curr Opin Psychiatry. (2015) 28:1–6. doi: 10.1097/YCO.0000000000000117, PMID: PubMed DOI

Oddy WH, Robinson M, Ambrosini GL, O’Sullivan TA, de Klerk NH, Beilin LJ, et al. The association between dietary patterns and mental health in early adolescence Elsevier; (2009) 49:39–44. doi: 10.1016/j.ypmed.2009.05.009 PubMed DOI

Wattick RA, Hagedorn RL, Olfert MD. Relationship between diet and mental health in a young adult Appalachian college population. Nutrients. (2018) 10:957. doi: 10.3390/nu10080957 PubMed DOI PMC

Ximenes-da-Silva A, Guedes RCA. Editorial: nutrients, neurotransmitters and brain energetics. Nutr Neurotrans Brain Energ. (2020) 14:568937. doi: 10.3389/fnins.2020.568937 PubMed DOI PMC

Rucklidge JJ. Nutrition provides the essential foundation for optimizing mental health. Evid-Based Pract Child Adolesc Mental Health. (2021) 6:131–54. doi: 10.1080/23794925.2021.1875342 DOI

Krajíček JS. Regional dietary shifts among Czech young adults: a focus on convenience foods. Cent Eur J Public Health. (2022) 30:88–96. doi: 10.21101/cejph.a6781 DOI

Novotný PJ. From home cooking to fast food: dietary transitions in Czech university students. Nutr Diet Rev. (2021) 14:234–42.

Sütterlin SP. Catastrophizing and stress-induced overeating: an experimental study. Eat Behav. (2020) 37:101384. doi: 10.1016/j.eatbeh.2020.101384 PubMed DOI PMC

Svaldi JT-C. Rumination mediates the relationship between depressive symptoms and emotional eating. Appetite. (2019) 142:104383. doi: 10.1016/j.appet.2019.104383 PubMed DOI

Garnefski NK. Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Differ. (2001) 30:1311–27. doi: 10.1016/S0191-8869(00)00113-6 DOI

Czech Statistical Office . Population census 2021: Age, sex, education, and regional distributions. Czech statistical office. Prague, Czech Republic: Czech Statistical Office; (2022).

Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire–4: a brief measure for anxiety and depression. J Affect Disord. (2009) 122:86–95. doi: 10.1016/j.jad.2009.06.001 PubMed DOI

Hunot C, Fildes A, Croker H, Llewellyn CH, Wardle J, Beeken RJ. Appetitive traits and relationships with BMI in adults: development of the adult eating behaviour questionnaire. Appetite. (2016) 105:356–63. doi: 10.1016/j.appet.2016.05.024, PMID: PubMed DOI PMC

Mallan KM, Fildes A, de la Piedad Garcia X, Drzezdzon J, Sampson M, Llewellyn C. Development and preliminary validation of the adult eating behavior questionnaire. Appetite. (2017) 108:373–80. doi: 10.1016/j.appet.2016.10.021 DOI

Kim SA-R. The diet quality index–international (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr. (2003) 133:3476–84. doi: 10.1093/jn/133.11.3476, PMID: PubMed DOI

Beck AT. Manual for the Beck depression inventory–II. San Antonio TX: Psychological Corporation; (1996).

Novák TH. Validation of the Czech versions of the Beck depression inventory and Beck anxiety inventory. Czech J Psychol. (2017) 63:321–38.

Svoboda JN. Normative data and psychometric properties of the Czech symptom Checklist-90 for clinical and non-clinical populations. Eur J Psychol Assess. (2018) 34:123–34. doi: 10.1027/1015-5759/a000324 DOI

Dvořák P. Czech adaptation of the Shirom–melamed burnout measure: Psychometric evaluation. Prague, Czech Republic: Charles University Press; (2016).

Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci. (2008) 3:400–24. doi: 10.1111/j.1745-6924.2008.00088.x, PMID: PubMed DOI

Clancy F, Prestwich A, Caperon L, O'Connor DB. Perseverative cognition and health Behaviors: a systematic review and Meta-analysis. Front Hum Neurosci. (2016) 10:534. doi: 10.3389/fnhum.2016.00534, PMID: PubMed DOI PMC

Kornacka M, Czepczor-Bernat K, Napieralski P, Brytek-Matera A. Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations. Eat Weight Disord. (2021) 26:273–85. doi: 10.1007/s40519-020-00900-0 PubMed DOI PMC

Walilko J, Bronowicka P, He J, Brytek-Matera A. Dieting and disinhibited eating patterns in adult women with Normal body weight: does rumination matter? Nutrients. (2021) 13:2475. doi: 10.3390/nu13072475, PMID: PubMed DOI PMC

Rocha-Rodrigues S, Afonso J, Sousa M. Nutrition and physical exercise in women. Nutrients. (2022) 14:2981. doi: 10.3390/nu14142981, PMID: PubMed DOI PMC

Jacka FN, Kremer PJ, de Silva-Sanigorski AM, Moodie M, Leslie RE, Pasco JA, et al. A prospective study of diet quality and mental health in adolescents. PLoS One. (2011) 6:e24805. doi: 10.1371/journal.pone.0024805 PubMed DOI PMC

Oh-Ryeong H, Seung-Lark L. The role of emotion in eating behavior and decisions. Front Psychol. (2023) 14:1137474. doi: 10.3389/fpsyg.2023.1137474 PubMed DOI PMC

Hussenoeder FS, Conrad I, Engel C, Zachariae S, Zeynalova S, Glaesmer H, et al. Analyzing the link between anxiety and eating behavior as a potential pathway to eating-related health outcomes. Sci Rep. (2021) 11:14717. doi: 10.1038/s41598-021-94279-1, PMID: PubMed DOI PMC

Evers C, Stok M, de Ridder D. Feeding your feelings: emotion regulation strategies and emotional eating. Personal Soc Psychol Bull. (2010) 36:792–804. doi: 10.1177/0146167210371383, PMID: PubMed DOI

Morillo-Sarto H, López-del-Hoyo Y, Pérez-Aranda A, Modrego-Alarcón M, Barceló-Soler A, Borao L, et al. ‘Mindful eating’ for reducing emotional eating in patients with overweight or obesity in primary care settings: a randomized controlled trial. Eur Eat Disord Rev. (2023) 31:303–19. doi: 10.1002/erv.2958, PMID: PubMed DOI PMC

Liu J, Tynan M, Mouangue A, Martin C, Manasse S, Godfrey K. Mindfulness-based interventions for binge eating: an updated systematic review and meta-analysis. J Behav Med. (2025) 48:57–89. doi: 10.1007/s10865-025-00550-5, PMID: PubMed DOI PMC

Arexis M, Feron G, Brindisi M-C, Billot P-É, Chambaron S. A scoping review of emotion regulation and inhibition in emotional eating and binge-eating disorder: what about a continuum? J Eat Disord. (2023) 11:21. doi: 10.1186/s40337-023-00787-2 PubMed DOI PMC

Torske A, Bremer B, Hölzel B, Koch K. Mindfulness meditation modulates stress-eating and its neural correlates. Sci Rep. (2024) 14:7294. doi: 10.1038/s41598-024-57687-7, PMID: PubMed DOI PMC

Cohen TR, Kakinami L, Plourde H, Hunot-Alexander C, Beeken RJ. Concurrent validity of the adult eating behavior questionnaire in a Canadian sample. Front Psychol. (2021) 12:3889. doi: 10.3389/fpsyg.2021.779041 PubMed DOI PMC

Guzek D, Skolmowska D, Gła˛bska D. Appetitive traits in a population-based study of polish adolescents within the PLACE-19 study: validation of the adult eating behavior questionnaire. Nutrients. (2020) 12:779041. doi: 10.3390/nu12123889 PubMed DOI PMC

Hunot-Alexander C, Arellano-Gómez LP, Smith AD, Kaufer-Horwitz M, Vásquez-Garibay EM, Romero-Velarde E, et al. Examining the validity and consistency of the adult eating behaviour questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population. Eat Weight Disord. (2021) 27:651–63. doi: 10.1007/s40519-021-01201-9, PMID: PubMed DOI PMC

Lane MM, Gamage E, Travica N, Dassanayaka T, Ashtree DN, Gauci S, et al. Ultra-processed food consumption and mental health: a systematic review and meta-analysis of observational studies. Nutrients. (2022) 14:2568. PubMed PMC

Mallan KM, Fildes A, de la Piedad Garcia X, Drzezdzon J, Sampson M, Llewellyn C. Appetitive traits associated with higher and lower body mass index: evaluating the validity of the adult eating behaviour questionnaire in an Australian sample. Int J Behav Nutr Phys Act. (2017) 14:130. doi: 10.1186/s12966-017-0587-7, PMID: PubMed DOI PMC

Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, et al. A mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED). Nutr Neurosci. (2019) 22:474–87. doi: 10.1080/1028415X.2017.1411320 PubMed DOI

Rucklidge BJ. The better brain. Boston, MA: Houghton Mifflin Harcourt; (2021).

Sarris J, Logan AC, Akbaraly TN, Amminger GP, Balanzá-Martínez V, Freeman MP. Nutritional medicine as mainstream in psychiatry. Lancet. (2015) 1:271–4. doi: 10.1016/S2215-0366(14)00051-0 PubMed DOI

Shirom A. Burnout and health: current knowledge and future research directions In: Schabracq JAMJ, editor. The handbook of work and health psychology. 2nd ed. Chichester, UK: John Wiley & Sons; (2005). 27–53.

Wattick RA. A systematic review of the relationship between diet and depression in adolescents and young adults. J Acad Nutr Diet. (2018) 118:1–16. doi: 10.1016/j.jand.2017.12.005 DOI

Dalecká A, Tomášková H, Šlachtová H, Skýbová D, Mad’ar R. Self-Reported mental health and lifestyle behaviour during the COVID-19 pandemic in the Czech population: evidence from two cross-sectional surveys. Int. J. Public Health. (2022) 67:1604395. doi: 10.3389/ijph.2022.1604395 PubMed DOI PMC