Upper gastrointestinal cancers, including esophageal and gastric cancers, are a major health burden worldwide, with China accounting for roughly 40% of global cases. Diet has long been recognized as a key modifiable risk factor, yet the interplay between dietary patterns and mental health in cancer development has received limited attention.
Depression and anxiety are increasingly prevalent and have been linked to chronic inflammation, immune dysregulation, and hormonal changes that may promote tumor growth. At the same time, poor diet can affect brain chemistry and gut microbiota, potentially worsening psychological well‑being. Given these intertwined challenges, there is a clear need for deeper investigation into the complex pathways connecting dietary quality, mental health, and upper gastrointestinal carcinogenesis.
Poor diet quality associated with psychological distress
In a study published in Cancer Biology & Medicine, researchers from the National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, along with collaborators from Northwest Women’s and Children’s Hospital, analyzed cross‑sectional data from the baseline survey of the National Cohort of Esophageal Cancer study, conducted between 2017 and 2019 across five high‑risk regions in China.
Among 29,068 participants aged 40–69 who underwent endoscopic screening and pathological biopsy, 434 were confirmed to have upper gastrointestinal cancer. The team examined dietary quality using the Diet Balance Index‑16 (DBI‑16) and assessed anxiety and depression with validated psychological scales (GAD‑7 and PHQ‑9).
The study revealed several striking patterns. Nearly 97% of participants showed moderate to high levels of inadequate food intake, and 90% had an overall unbalanced diet. Anxiety symptoms (Generalized Anxiety Disorder 7‑item scale, GAD‑7 score ≥5) were present in 10.15% of participants, while 5.08% reported depressive symptoms (Patient Health Questionnaire‑9, PHQ‑9 score ≥7).
After adjusting for age, sex, income, lifestyle, and medical history, the researchers found that poor dietary quality—particularly insufficient intake of fruits, vegetables, legumes, and dairy—was significantly associated with both psychological distress and cancer diagnosis. For instance, individuals with the highest levels of inadequate intake (high Low Bound Score, LBS) had 36% higher odds of anxiety and 36% higher odds of depression compared with those with better diets. Moreover, participants with cancer had more severe psychological symptoms than those with normal findings.
A bridge between diet and cancer
The most compelling finding came from path analysis, which tested whether psychological symptoms acted as a bridge between diet and cancer. Depression accounted for 40.91% of the association between inadequate diet (LBS) and upper gastrointestinal lesions, while anxiety mediated 27.78% of that relationship.
Similarly, both depression and anxiety mediated 38.24% and 20.69%, respectively, of the link between overall dietary imbalance (Dietary Quality Distance, DQD) and cancer risk. Interestingly, excessive intake (High Bound Score, HBS) showed a negative association with both psychological symptoms and cancer—possibly due to protective effects of dietary fiber or short‑term stress relief from high‑energy foods—but this direct effect did not survive stringent false discovery rate correction, suggesting its impact may operate largely through other pathways.
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“What surprised us was how consistently psychological symptoms tracked with both dietary quality and cancer risk across such a large population,” the authors said. “We’ve long known that diet matters for cancer and that mental health affects overall wellness, but seeing that anxiety and depression could statistically account for 20% to 40% of the diet–cancer association really shifts the way we think about prevention. It suggests that when we give dietary advice, we should also be asking how people are feeling emotionally. The two are not separate issues—they reinforce each other, and that synergy could be a powerful lever for reducing cancer burden if we address them together.”
Public health
The findings have immediate practical implications for cancer screening and prevention, especially in high‑risk regions. Incorporating brief, validated mental health screenings—such as the GAD‑7 for anxiety and PHQ‑9 for depression—into routine endoscopic surveillance could help identify individuals who might benefit from integrated dietary and psychological support.
Public health campaigns could be redesigned to emphasize not only what to eat but also how to manage stress and mood, potentially amplifying the protective effects of dietary improvements. The researchers also suggest that cognitive‑behavioral therapy or other evidence‑based psychological interventions could be paired with nutritional counseling to enhance adherence and outcomes.
While causal relationships need confirmation through prospective studies, this biopsychosocial approach offers a practical, low‑cost complement to existing cancer control efforts.
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