Article

Impact of Physical Activity and Dietary Habits on Mental

Well-Being in Patients with Diabetes Mellitus
Battamir Ulambayar 1 , Amr Sayed Ghanem 1 , Ágnes Tóth 2 and Attila Csaba Nagy 1, *

1 Department of Health Informatics, Faculty of Health Sciences, University of Debrecen,

4032 Debrecen, Hungary; [email protected] (B.U.); [email protected] (A.S.G.)
2 Department of Integrative Health Sciences, Faculty of Health Sciences, University of Debrecen,
4028 Debrecen, Hungary; [email protected]
* Correspondence: [email protected]

Abstract: Background: The prevalence of diabetes mellitus (DM) is increasing worldwide,

and mental health problems such as depression, anxiety, and diabetes distress are common
co-morbidities that negatively impact the quality of life, complications, and treatment
outcomes of patients with DM. Objectives: In this study, we assessed the impact of dietary
patterns and physical activity on the well-being of patients with DM. Methods: A cross-
sectional design and data from the European Health Interview Survey (EHIS) data collected
in Hungary in 2019, and determination of the relationship between dietary habits and
physical activity-related variables contained in the data and the World Health Organization-
Five Well-Being Index (WHO-5 index) by suitable statistical methods. Results: Logistic
regression showed higher odds of poor mental well-being in females (OR = 1.61, 95% CI:
1.08–2.42) and lower odds with daily fruit intake (OR = 0.52, 95% CI: 0.31–0.89). Infrequent
white meat (OR = 3.34, 95% CI: 1.35–8.22) and dairy intake (OR = 1.60, 95% CI: 1.18–2.64)
were associated with poorer well-being. Walking 4–7 days/week reduced the odds by 57%
(OR = 0.43, 95% CI: 0.23–0.83). Conclusions: The results demonstrate that regular exercise
and the consumption of fruits, dairy products, and white meat have beneficial effects on
the mental well-being of patients with DM.

Keywords: diabetes mellitus; mental well-being; eating habit; physical activity; WHO-5 index
Academic Editor: Gary David
Lopaschuk

Received: 19 February 2025

Revised: 28 February 2025 1. Introduction
Accepted: 13 March 2025
Diabetes mellitus (DM) is a major global health concern. It is most commonly classified
Published: 16 March 2025
into three types: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and
Citation: Ulambayar, B.; Ghanem,
gestational diabetes. Among these, T2DM is the most prevalent, accounting for approxi-
A.S.; Tóth, Á.; Nagy, A.C. Impact of
Physical Activity and Dietary Habits
mately 90–95% of individuals with DM [1,2]. Hallmarks of T2DM are insulin resistance
on Mental Well-Being in Patients with and a relative deficiency of insulin secretion, whereas T1DM causes an absolute deficiency
Diabetes Mellitus. Nutrients 2025, 17, of beta-cell function, which is commonly due to the autoimmune destruction of beta-cells.
1042. https://doi.org/10.3390/ Gestational diabetes mellitus (GDM) is defined as glucose intolerance initially identified
nu17061042
during pregnancy. Patients with GDM are at greater risk of acquiring T2DM in the future [3].
Copyright: © 2025 by the authors. Due to lifestyle changes associated with economic development and industrialization, the
Licensee MDPI, Basel, Switzerland. incidence of DM in the past three decades has been rising sharply. According to the World
This article is an open access article
Health Organization, between 1990 and 2022, the number of people living with DM in-
distributed under the terms and
creased from 200 million to 830 million [4], causing an increase in mortality and morbidity
conditions of the Creative Commons
Attribution (CC BY) license
worldwide [5].
(https://creativecommons.org/ Beyond age and genetics, modifiable risk factors including smoking, alcohol consump-
licenses/by/4.0/). tion, education, physical inactivity, and harmful eating patterns are the most important

Nutrients 2025, 17, 1042 https://doi.org/10.3390/nu17061042

Nutrients 2025, 17, 1042 2 of 12

contributors to the development of T2DM [6,7]. Studies suggest that increased consump-
tion of ultra-processed food, which are industrial formulations produced by extrusion,
molding, and frying using ingredients such as sugars, proteins, oils, fats, starches, hy-
drogenated fats, modified starches, flavor enhancers, colorings and other additives—as
defined by the NOVA food classification system [8]—are associated with negative health
consequences. This unhealthy diet combined with sedentary behavior [9] results in weight
gain and obesity [10], elevating the likelihood of T2DM [11,12]. In contrast, hypertension,
obesity, physical inactivity, and heavy alcohol consumption are modifiable risk factors
shared by both T2DM and dementia [13], contributing to the overall disease burden and
potentially affecting mental health outcomes. In patients with DM, these risk factors, along
with obesity-related complications, can exacerbate psychological distress and increase the
likelihood of developing mental health disorders. Furthermore, obesity, diabetic nephropa-
thy, diabetes-related complications, elevated C-reactive protein levels, female sex, and low
social support have been associated with a higher risk of mental disorders [14], highlighting
the complex interplay between physical health and mental well-being in this population.
Physical activity has emerged as an effective strategy for improving mental well-being in
patients with T2DM. Regular aerobic exercise can significantly enhance self-esteem and
mental health in patients with DM [15]. Addressing these modifiable risk factors through
lifestyle interventions may play a crucial role in improving mental health outcomes for
patients with DM.
As a consequence of metabolic dysfunction, chronic hyperglycemia is a primary clini-
cal feature of the disease, leading to an elevated risk of microvascular and macrovascular
disorders [2,16] and therefore to numerous complications, including retinopathy, nephropa-
thy, cardiovascular diseases (CVD), neuropathy, amputation, infections, and cognitive
impairment, especially if undiagnosed for many years [17]. Furthermore, the diagnosis
and management of DM can be a significant life stressor for individuals [18], as the bur-
den of living with DM profoundly affects patients’ mental health and overall quality of
life [5,19]. Guilt, anxiety, and concerns about self-care are some of the symptoms of diabetes
distress. These symptoms can be connected to treatment regimens, food consumption,
hypoglycemia, future complications, social and interpersonal connections, and interactions
with medical professionals [20]. Diabetic distress is common and persistent, with an esti-
mated prevalence of more than 20% in both T1DM and T2DM [21]. While symptoms of
diabetes distress may include low mood, it is distinct from depression, which is also preva-
lent in individuals with DM [19]. In general, between 10% to 15% of diabetics suffer from
depressive disorders, which is approximately twice as common as depression compared to
people without DM [22].
The comorbidity of mental disorders substantially lowers the prognosis of the disease
and increases mortality [22], underscoring the critical need for integrated treatment ap-
proaches that address both mental health and physical aspects of the condition. Managing
the mental challenges associated with glucose control is essential in reducing the burden of
DM and its complications [23], where maintaining a healthy weight with proper nutrition
and regular exercises are key components, in which patients can actively participate [24].
While previous research has explored the individual effects of physical exercise and dietary
habits on the physical health of patients with DM, there is limited literature addressing
their combined impact on mental health outcomes in this population. Most studies focus
on either physical activity or nutrition in isolation, overlooking the potential synergistic
effects of these lifestyle factors on psychological well-being of patients. Therefore, we
hypothesized in the present research that patients with DM would benefit mentally from a
healthy, balanced diet and regular exercise.
Nutrients 2025, 17, 1042 3 of 12

This study aims to investigate the impact and highlight the importance of physical
activity and dietary habits on the mental well-being of patients with DM, emphasizing that
the mental well-being of individuals with DM is crucial, as the connection between physical
and mental health is often underestimated. Using data from the European Health Interview
Survey (EHIS) in Hungary, the findings may help in understanding the physical and
mental health needs of individuals with DM, contributing to better disease management
and improved quality of life. By exploring specific aspects of physical activity and diet,
this research seeks to provide practical insights for improving mental health outcomes in
patients with DM.

2. Materials and Methods

2.1. Study Design and Data
We conducted this study using a cross-sectional design and data collected in Hungary
in 2019 as part of the European Health Interview Survey (EHIS). The data collection process
was conducted under the supervision of Eurostat using a standard questionnaire, and the
sample size (5603) was sufficiently representative of the entire Hungarian population [25].
Except for those without diabetes mellitus (DM) and those under the age of 18, we focused
on data from 545 participants who had a confirmed diagnosis of DM.

2.2. Variables
The EHIS 2019 survey conducted in Hungary used the World Health Organization-Five
Well-Being Index (WHO-5) questionnaire to assess the mental health well-being of the study
participants. The WHO-5 index has been validated as a reliable and valid screening tool for
assessing the mental health status of patients with DM [26] and for detecting depression
among these patients [27]. This standard questionnaire consists of five questions, each
designed to be scored from 0 to 5. According to the guidelines for processing the results
of the WHO-5 questionnaire, the total score is calculated as a percentage by adding the
points corresponding to the selected answers of each participant and multiplying by 4 [28].
A score of 50 or less is considered poor mental well-being, indicating that the person needs
mental health care [29]. We calculated the WHO-5 index for each participant according
to this guideline and divided all participants into two groups: poor and better mental
well-being. Subsequently, the relationship between the WHO-5 index category and dietary
variables such as fruit, vegetables, meat, milk and dairy products, sweets and desserts, and
water consumption, as well as variables related to physical activity, contained in the data,
was determined.

2.3. Statistical Analysis

The association between these variables and the WHO-5 index was assessed using a
Chi-square test. A logistic regression model was created to demonstrate whether dietary
habits and physical activity influence the mental health of patients with DM based on the
statistically significant associations obtained by the Chi-square test. The odds ratio (OR)
and 95% confidence interval (CI) are used to express the outcomes of logistic regression
analysis, and a p-value lower than 0.05 was considered to be statistically significant. STATA
IC version 18.0 was used to conduct the statistical analyses used in this analysis [30].

3. Results
The data used in the study included a total of 545 patients with DM, representing a
prevalence of 9.7 percent. Of these, 53 percent were women and 57 percent were aged 65
or older. When assessing their mental health status using the WHO-5 questionnaire, the
Nutrients 2025, 17, 1042 4 of 12

average score was 61 ± 23. As mentioned above, when categorizing mental health status,
30.4 percent were classified as having poor mental well-being, as shown in Table 1.

Table 1. Demographic data and WHO-5 Wellbeing Index.

Variables Category N (%)

18–35 years old 22 (4.0)
Age group 35–65 years old 212 (38.9)
Older than 65 311 (57.1)
Female 288 (53.1)
Gender
Male 254 (46.9)
Poor mental well-being (≤50) 165 (30.4)
WHO-5 Wellbeing Index
Better mental well-being (>50) 377 (69.6)

When examining the relationship between dietary habits on the mental health of
patients with DM, it was observed that people who consumed more vegetables (p = 0.024)
and fruits (0.005) in their daily diet had better mental health than those who consumed
less. Similarly, an increase in the consumption of white meat (p = 0.004) and dairy products
(p = 0.003) has been associated with better mental health. However, red meat consumption,
daily water intake, and dessert consumption were not significantly associated with mental
health status. The study participants’ mental health status and primary characteristics of
physical activity were compared, and it was found that 21.2 percent of those who reported
moderate physical activity had poor mental health, compared to 42.2 and 28.6 percent of
those who reported light and heavy physical activity, respectively (p = 0.001). Increasing
the number of days that people walk for more than ten minutes each week (p = 0.044) and
doing more than ten minutes of sport exercise (p = 0.02) have also been shown to improve
mental health (Table 2).

Table 2. Associations of WHO-5 Wellbeing Index with eating habits and physical activity.

WHO-5 Wellbeing Index

Variables Category p Value
Poor (≤50) Better (>50)
No vegetable consumption 57 (37.5) 95 (62.5)
1 serving 52 (34.0) 101 (66.0)
Vegetable consumption per day 0.024
2 servings 39 (24.7) 119 (75.3)
More than 3 servings 16 (21.9) 57 (78.1)
No fruits consumption 97 (37.6) 161 (62.4)
1 serving 33 (23.2) 109 (76.8)
Fruit consumption per day 0.005
2 servings 22 (23.4) 72 (76.6)
More than 3 servings 9 (23.1) 30 (76.9)
2 L and more 77 (26.3) 216 (73.7)
Drinking water per day 1–2 L 52 (35.9) 93 (64.1) 0.068
Less than 1 L 35 (35.0) 65 (65.5)
Nutrients 2025, 17, 1042 5 of 12

Table 2. Cont.

WHO-5 Wellbeing Index

Variables Category p Value
Poor (≤50) Better (>50)
Never eats 41 (75.9) 13 (24.1)
Not regular, only occasions 205 (66.4) 104 (33.6)
Sweets and biscuit consumption 0.293
Less than one a day 65 (71.4) 26 (28.6)
More than one a day 62 (74.7) 21 (25.3)
More than 4 times a week 22 (33.3) 44 (66.7)
Red meat consumption 1–3 times a week 86 (27.1) 232 (72.9) 0.086
Less than 1 time a week 56 (36.8) 96 (63.1)
More than 4 times a week 25 (21.7) 90 (78.3)
White meat consumption 1–3 times a week 122 (31.4) 267 (68.6) 0.004
Less than 1 time a week 16 (51.6) 15 (48.4)
More than 4 times a week 95 (28.4) 240 (71.6)
Milk and milk product
1–3 times a week 26 (24.5) 80 (75.5) 0.003
consumption
Less than 1 time a week 53 (55.2) 43 (44.8)
Light 98 (42.2) 134 (57.8)
Primary characteristics of
Moderate 61 (21.2) 226 (78.8) 0.001
physical activity
Heavy 4 (28.6) 10 (71.4)
Did not walk 133 (33.0) 270 (67.0)
Number of days walked at least 1–3 days 17 (28.3) 43 (71.7) 0.044
10 min a week
4–7 days 15 (18.9) 64 (80.1)
Did not engage in sport 139 (33.4) 277 (66.6)
Number of days engaged in
1–3 days 17 (22.7) 58 (77.3) 0.02
sport for at least 10 min per week
4–7 days 9 (17.6) 42 (82.4)
Bold values indicate statistical significance (p < 0.05) based on Pearson’s chi-squared test.

Logistic regression analysis results showed females had 1.61 times higher odds of
having poor mental well-being compared to males (OR = 1.61, 95% CI: 1.08–2.42, p = 0.019).
This suggests that being female is a significant risk factor for poor mental well-being, with
women being approximately 61% more likely to experience poorer mental health outcomes
than men. It is also worth noting that when examining the relationship between dietary
patterns, physical activity, and gender among people with DM, no statistically significant
differences were observed. This implies that dietary and physical activity differences may
not have a significant impact on the association between gender and mental health in
patients with DM, though more research is required to confirm this independence.
Participants who consumed one serving of fruit per day had 48% lower odds of poor
mental well-being compared to those who did not consume fruits (OR = 0.52, 95% CI:
0.31–0.89, p = 0.017). However, mental well-being was not significantly different for those
consuming two or more servings of fruit per day. This suggests a potential nonlinear
relationship between fruit intake and mental health, where moderate consumption may be
beneficial but higher levels do not provide additional advantages. Future research should
explore these nonlinear patterns to better understand the complex association between
dietary habits and mental well-being. Participants who consumed white meat once or less
per week were 3.34 times (OR = 3.34, 95% CI: 1.35–8.22, p = 0.009) more likely to have
Nutrients 2025, 17, 1042 6 of 12

poor mental health than those who consumed it four or more times per week. A similar
pattern was observed for milk and dairy product consumption, with people who consumed
milk and dairy products 1 serving or less per week being 1.6 (OR = 1.6, 95% CI: 1.18–2.64,
p = 0.044) times more likely to have poor mental health than those who consumed these
products 4 or more times per week. This suggests that consumption of fruits, white meat,
and dairy products has a positive impact on the mental health of people with DM.
The log regression analysis found a significant association between physical activity,
specifically the number of days individuals walked for at least 10 min per week, and better
mental well-being. The results revealed that individuals who walked 4–7 days per week
had 57% lower odds of experiencing poor mental well-being compared to those who did not
engage in walking at all (OR = 0.43, 95% CI: 0.23–0.83, p = 0.012). This finding underscores
the importance of regular physical activity, even in modest amounts, as a protective factor
for mental health in patients with DM (Table 3).

Table 3. Logistic regression model.

Variables OR (95%CI) p-Value

Male (Reference)
Gender
Female 1.61 (1.08–2.42) 0.019
18–35 years old (Reference)
Age group 35–65 years old 1.89 (0.56–6.31) 0.299
Older than 65 1.53 (0.45–5.12) 0.487
No vegetable consumption
(Reference)
Vegetable consumption per day 1 serving 1.08 (0.62–1.86) 0.774
2 servings 0.7 (0.39–1.23) 0.222
More than 3 servings 0.63 (0.3–1.31) 0.222
No fruit consumption (Reference)
1 serving 0.52 (0.31–0.89) 0.017
Fruit consumption per day
2 servings 0.62 (0.34–1.13) 0.122
More than 3 servings 0.62 (0.25–1.48) 0.258
More than 4 times a week (Reference)
White meat consumption More than 1–3 times a week 1.48 (0.88–2.5) 0.133
Less than 1 time a week 3.34 (1.35–8.22) 0.009
More than 4 times a week (Reference)
Milk and milk product consumption More than 1–3 times a week 0.67 (0.39–1.14) 0.145
Less than 1 time a week 1.6 (1.18–2.64) 0.044
Did not walk 10 min (Reference)
Number of days walked at least 10 min 1–3 days 0.97 (0.51–1.85) 0.939
a week
4–7 days 0.43 (0.23–0.83) 0.012
Bold values indicate statistical significance (p < 0.05) Odds ratios are adjusted for variables in the model.

4. Discussion
This study was conducted to determine how dietary patterns and physical activity
affect the mental health of patients with DM. The results showed that certain foods, such
as fruit consumption, white meat and dairy products, and regular exercise, improved the
mental health of patients with DM after adjusting for age and gender.
Nutrients 2025, 17, 1042 7 of 12

It has been found that people with DM are at increased risk of developing mental
health disorders such as depression, anxiety, and eating disorders [31]. The risk of depres-
sion in patients with T1DM is three times higher than in the general population, while
the risk is twice as high in patients with T2DM [32]. Furthermore, it negatively impacts
their blood sugar control [33], cardiovascular complications [34], and overall quality of
life [35]. Nutrition plays a crucial role in both blood sugar control and mental well-being,
with deficiencies in specific nutrients linked to the pathogenesis of mental disorders and
DM [36].
Research suggests a positive association between fruit and vegetable consumption
and mental well-being, including for individuals with DM [37]. Higher fruit and vegetable
intake is linked to better mental health outcomes in longitudinal studies, with evidence of
a dose-response relationship [38]. The nutritional benefits of essential minerals, vitamins,
fiber, and antioxidants [39], as well as the gut microbiome that fiber supports [40], can
account for the beneficial effects of consuming vegetables and fruits on mental health in
patients with DM. In contrast, fruits provide high levels of vitamin C and flavonoids, which
have been linked to improved cognitive function and reduced risk of depression [41]. The
antioxidants found in fruits combat oxidative stress, which is often elevated in patients
with DM and can negatively affect mental health [42]. Additionally, the act of consuming
fruits can serve as a healthy coping mechanism for stress, providing a sense of control over
dietary choices which can enhance self-efficacy and overall mental resilience [43]. Moreover,
the social and behavioral aspects of fruit consumption cannot be overlooked. Engaging
in healthy eating behaviors, such as incorporating fruits into one’s diet, often occurs
alongside other positive lifestyle changes, including increased physical activity and better
stress management practices [44]. These lifestyle modifications contribute to improved
mental health outcomes. While our results did not show a direct link between vegetable
consumption and mental health in DM patients, fruit consumption had a significant positive
impact, aligning with existing literature.
White meat consumption is considered a relatively healthy intake for patients with
DM compared to red meat and processed meat and is therefore thought to have a beneficial
effect on reducing the risk of CVD in patients with DM [45]. This protective effect is due to
the low saturated fat and sodium content of white meat, which contributes to improved
glycemic control and overall metabolic health [46]. Moreover, the nutritional profile of
white meat includes essential nutrients that are vital for mental health. For instance,
white meat is an alternative source of certain molecules, which is important for overall
brain function and development [47]. Furthermore, white meat consumption reduces
psychological distress in overweight or obese people, suggesting that this type of dietary
choice may play an important role in managing mental health [48]. On the other hand, it is
worth noting that this protective effect of white meat may not be the result of white meat
consumption alone, but is also the effect of a balanced diet combined with other healthy
foods [49]. In particular, the Mediterranean diet, characterized by high intake of fruits,
vegetables, whole grains, legumes, nuts, fish, white meats, and olive oil, is considered one
of the healthiest dietary models globally, and it can significantly improve glycemic control
in patients with T2DM by reducing blood glucose levels, HbA1c, and insulin resistance [50].
Therefore, these types of healthy diets may have a positive impact on mental health in
patients with T2DM by improving blood sugar control and reducing complications. Our
study results show that low consumption of white meat is associated with an increased
risk of poor mental health, which is consistent with the previous literature.
Dairy products and the mental health of patients with DM have a complex relationship
that includes both psychological and physiological aspects. Research indicates that dairy
consumption can have beneficial effects on metabolic health, which is particularly rele-
Nutrients 2025, 17, 1042 8 of 12

vant for individuals with DM. For instance, studies have shown that the intake of low-fat
fermented dairy products is inversely associated with the risk of developing T2DM [51].
Milk proteins can lower postprandial glucose levels by modifying physiological processes,
including delayed gastric emptying and enhanced incretin and insulin responses [52].
Certain dairy components, such as leucine and calcium-regulated peptides, may alter mito-
chondrial function, promote beneficial gut microbial shifts, and influence inflammation
and cardiovascular function, potentially linking dairy intake with lower risk of T2DM [53].
This is important because patients with DM frequently experience psychological distress
associated with their condition, as mentioned above, and better metabolic control can
result in better mental health outcomes [54]. Also, dairy products enriched with probiotics,
prebiotics, and synbiotics have shown potential in reducing hyperglycemia, depressive
behaviors, and oxidative stress in patients with DM [55]. Moreover, the consumption of
dairy products, particularly those that are fermented, has been linked to various health ben-
efits, including enhanced gut health and immune system modulation, which can indirectly
influence mental well-being [56]. The psychological benefits of dairy consumption may
also stem from its nutritional profile, which includes essential nutrients that support brain
health [57]. However, depending on the composition of dairy products, such as those high
in fat and protein, consumption of dairy products may worsen depressive symptoms [58].
Therefore, it is crucial to note that its subtypes should be considered when evaluating the
effect of milk and dairy products on the mental health of DM. Our study results showed that
dairy consumption positively impacts the mental health of patients with DM, suggesting
that effective management of DM, including dietary changes such as the inclusion of dairy
products, can lead to improved mental health outcomes.
In addition to dietary habits, physical activity is vital for blood sugar control [59]
and psychological well-being [60] in patients with DM. A recent randomized controlled
clinical trial found that exercise not only effectively reduces depression in patients with
diabetes but also improves blood sugar control [15]. Exercise training enhances glycolipid
metabolism and insulin sensitivity and modulates DNA methylation in patients with
T2DM [61]. Various forms of exercise, including aerobic and resistance training, enhance
cognitive function and mental health in T2DM patients, and it can be explained by the
action of irisin, a myokine produced during exercise. It has been identified as a potential
mechanism for improving cardiovascular and mental health in patients with T2DM [62].
Light and moderate exercise are associated with better cognitive function scores, potentially
offsetting the negative impact of diabetes on cognition. This may be because exercise
not only reduces the symptoms of DM by improving blood sugar control in patients
with DM but also reduces symptoms of mental disorders such as anxiety, insomnia, and
depression by preventing complications and improving brain function [63]. Furthermore,
the benefits may be attributed to physiological changes, such as improved functioning
of the hypothalamus–pituitary–adrenal axis [64]. Our study results also highlight the
importance of exercise in maintaining blood sugar control and mental health in patients
with DM.
Self-reported questionnaires were used to collect data for this study, which may have
introduced bias due to recall inaccuracies, social desirability, or misreporting. Participants
may overestimate or underestimate their dietary intake and physical activity levels, leading
to potential measurement errors. Another limitation of this study is its cross-sectional
design, which prevents the establishment of causal relationships between dietary patterns,
physical activity, and mental well-being. Additionally, the study missed questions about
the consumption of subtypes of certain food products, like dairy products, which made it
challenging to estimate their effects accurately. The data used in the study did not include
variables such as diabetes type, treatment, and complications, limiting the ability to account
Nutrients 2025, 17, 1042 9 of 12

for their influence on the observed relationships. However, the main strength of this
study is that we used advanced statistical methods such as logistic regression to analyze
robust data collected through a Eurostat-validated questionnaire, which is representative
of the Hungarian population, in addition to the use of the WHO-5 questionnaire, which
has demonstrated excellent internal consistency, test-retest reliability, and unidimensional
factorial validity. It is also important to note that we included most of the food categories
in the balanced food pyramid to assess the impact of dietary habits on the mental health of
patients with DM.

5. Conclusions
The results of this study demonstrate the important role that physical activity and
dietary habits play in supporting the mental health of individuals with DM. In particular,
it was found that regular exercise and consumption of fruits, dairy products, and white
meat have beneficial effects on the mental well-being of patients with DM independent
of gender and age group. However, it is worth noting that the results of this study were
conducted using a cross-sectional design, and longitudinal studies are needed to confirm
the observed relationships.
Based on the results of this study, we recommend the public health programs that
prioritize routine mental health screenings for women with DM and implement tailored
psychosocial support to mitigate this increased risk. The observed association between fruit,
white meat, and dairy product consumption and better mental well-being suggests that
encouraging balanced dietary patterns could be beneficial for mental health in patients with
DM. Diabetes management programs should actively promote low-intensity, accessible
forms of exercise, such as regular walking, which may be easier for patients to adopt and
sustain. This aligns with existing physical activity guidelines but reinforces the importance
of frequent, modest activity for mental health benefits. Our findings support the integration
of mental health considerations into diabetes care protocols. Public health strategies should
encourage multidisciplinary approaches, combining medical, nutritional, and psychological
support to enhance overall well-being.

Author Contributions: Conceptualization: B.U. and A.C.N.; Methodology: B.U.; Validation: B.U.;
Formal Analysis: B.U.; Data Curation: B.U.; Writing—Original Draft Preparation: B.U., A.S.G.,
A.C.N. and Á.T.; Writing—Review and Editing: B.U., A.S.G., A.C.N. and Á.T.; Visualization: B.U.;
Supervision: A.C.N. All authors have read and agreed to the published version of the manuscript.

Funding: This paper was supported by the EKÖP-24-3-I University Research Scholarship Program
of the Ministry for Culture and Innovation from the source of the National Research, Development
and Innovation Fund. This paper was supported by the János Bolyai Research Scholarship of the
Hungarian Academy of Sciences.

Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki, and approved by the Ethics Committee of the University of Debrecen (5609-2020)
on 17 December 2020. The studies were conducted in accordance with the local legislation and
institutional requirements.

Informed Consent Statement: Written informed consent for participation was not required from
the participants or the participants’ legal guardians/next of kin in accordance with the national
legislation and institutional requirements.

Data Availability Statement: The data analyzed in this study are subject to the following li-
censes/restrictions: The data presented in this study are available upon request from the Hungarian
Central Statistical Office, which performed and supervised the data collection. Requests to access
these datasets should be directed to the Hungarian Central Statistical Office, www.ksh.hu/?lang=en
(accessed on 15 February 2025).
Nutrients 2025, 17, 1042 10 of 12

Conflicts of Interest: The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential conflict of interest.

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