Psychological-dietary interactions in chronic disease management: mechanisms and integrated intervention strategies

This narrative review aims to summarize evidence from nutritional psychiatry, behavioral medicine, and chronic disease management, examine the relationship between psychological factors and dietary behaviors in chronic disease management, and discuss potential mechanisms, disease-specific manifestations, and clinical management approaches.

Chronic disease management involves not only the control of disease-related indicators but also the long-term maintenance of dietary behaviors, treatment adherence, and self-management. Stress, anxiety, depression, reduced self-efficacy, and disease-related distress may affect food choices, eating behaviors, and dietary adherence, while dietary patterns, nutrient intake, and dietary restriction may also be associated with emotional and cognitive status. Therefore, psychological factors and dietary behaviors may influence each other during long-term chronic disease management.

Existing evidence suggests that psychological factors and dietary behaviors may be bidirectionally associated. Psychological distress may be related to emotional eating, preference for energy-dense foods, excessive dietary restriction, and reduced dietary adherence, while dietary behaviors may also be associated with psychological status and chronic disease management through pathways involving the hypothalamic-pituitary-adrenal (HPA) axis, reward processing, inflammation, the gut-brain axis, and metabolic changes. These relationships may differ across chronic diseases, with obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), chronic gastrointestinal diseases, and chronic kidney disease (CKD) presenting different psychological and dietary management challenges. Psychological screening, individualized nutritional guidance, behavioral support, mindful eating, digital monitoring, and multidisciplinary collaboration may provide additional support for long-term chronic disease management.

Existing evidence suggests a potential bidirectional relationship between psychological factors and dietary behaviors in chronic disease management. Based on this evidence, this review further proposes an integrated psychological-dietary management framework, although its overall clinical effectiveness and specific implementation approaches still require further evaluation. More prospective studies, randomized controlled trials (RCTs), and real-world implementation studies are needed before this approach can be further developed for routine or standardized chronic disease management.