The association between Dairy Intake, Simple Sugars and Body ‎ Mass Index with Expression and Extent of Anger in Female ‎ Students ‎

Abstract

Objective:
A significant increase in violence in the world and its impact on public health and ‎society can be an important reason to offer solutions to reduce or control anger. Studies ‎have shown that specific food groups may be effective in controlling mental disorders ‎such as depression, anxiety and anger. The purpose of this study was to determine the ‎relationship between food intake and Body Mass Index on state-trait anger expression ‎in female students of Shahid Beheshti University of Medical Sciences. ‎

Method:
In this cross-sectional study, 114 female students were randomly selected from ‎dormitories of Shahid Beheshti University of Medical Sciences. Body height and ‎weight were measured using the scale and stadiometer, respectively. The required data ‎for evaluating the relationship between state-trait anger expression and food ‎consumption groups were collected using State-Trait Anger Expression Inventory-2 ‎‎ (STAXI-2) and Food Frequency questionnaires.‎

Results:
The results revealed a significant negative correlation between consumption of dairy ‎product and trait anger (angry reaction), (P = 0.015). This association remained ‎significant after adjustment of confounding factors. No significant correlations were ‎found between other food groups as well as BMI and state-trait anger expression.‎

Conclusion:
The higher intake of dairy products reduced state-trait anger expression. This result is ‎consistent with the findings of many studies on the effect of dairy consumption on ‎mental disorders. Therefore, consumption of dairy products can be a solution for ‎reducing anger.‎.

Full text

Birth Order and Sibling Gender Ratio of a Clinical Sample
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Iranian J Psychiatry 11:1, Jan 2016 ijps.tums.ac.ir
The association between Dairy Intake, Simple Sugars and
Body Mass Index with Expression and Extent of Anger in
Female Students 
Naser Kalantari, MD1
Saeid Doaei, Msc2
Maedeh Gordali, Bs3
Ghazal Rahimzadeh, Msc 4
Maryam Gholamalizadeh, Msc 5
1. Department of Nutrition and Food
Sciences, Shahid Beheshti
University of Medical Sciences,
Tehran, Iran
2. Student’sResearchCommittee,
National Nutrition and Food
Technology Research Institute,
faculty of Nutrition Sciences and
Food Technology, Shahid Beheshti
University of Medical Sciences,
Tehran, Iran.
3. Department of Community
Nutrition, Shahid Beheshti
University of Medical Sciences,
Tehran, Iran
4. Department of Food Science and
Technology, Science and Research
Branch, Azad University,
Tehran, Iran
5. Food Security Research Center,
Department of Clinical Nutrition,
School of Nutrition and Food
Sciences, Isfahan University of
Medical Sciences, Isfahan, Iran
Corresponding author:
Saeid Doaei,
Faculty of Nutrition Sciences
and Food Technology, Shahid
Beheshti University of Medical
Sciences, Tehran, Iran
Tel: +98 21 66902061
Fax: +98 21 66902038
Email: sdoaei@sbmu.ac.ir
Objective: A significant increase in violence in the world and its impact
on public health and society can be an important reason to offer solutions
to reduce or control anger. Studies have shown that specific food groups
may be effective in controlling mental disorders such as depression,
anxiety and anger. The purpose of this study was to determine
the relationship between food intake and Body Mass Index on state-trait
anger expression in female students of Shahid Beheshti University of
Medical Sciences. 
Method: In this cross-sectional study, 114 female students were
randomly selected from dormitories of Shahid Beheshti University of
Medical Sciences. Body height and weight were measured using the
scale and stadiometer, respectively. The required data for evaluating the
relationship between state-trait anger expression and food consumption
groups were collected using State-Trait Anger Expression Inventory-2 
(STAXI-2) and Food Frequency questionnaires.
Results: The results revealed a significant negative correlation between
consumption of dairy product and trait anger (angry reaction), (P = 0.015).
This association remained significant after adjustment of confounding
factors. No significant correlations were found between other food groups
as well as BMI and state-trait anger expression.
Conclusion: The higher intake of dairy products reduced state-trait anger
expression. This result is consistent with the findings of many studies on
the effect of dairy consumption on mental disorders. Therefore,
consumption of dairy products can be a solution for reducing anger.
Key words: Anger, Body Mass Index, Food intake
Anger has been characterized as a complex construct
including hostility, irritability and aggressive behavior
(1). Anger can be defined as an emotional response or
internal feeling which is caused by physiological
excitation, cognition and malice thoughts
(2). Nevertheless, anger is an emotion of satisfaction
that prepares us to face the potential surrounding risks.
On the other hand, destructive impact of anger may
have detrimental effects on humans and their
environments (3). Anger is a robust risk factor for
Coronary Heart Disease (CHD) (4, 5), Cancer (6), and
Eating disorders (7) which can affect the quality of life
(8, 9). Demark et al. (2011) have reported that over
36% of patients with brain injury have shown anger
and aggression states (10). The effects of diet have
been reported on depression (11), fervour (12), brain
function (13, 14), stress response system  (15), and
oxidative reactions (16). On the other hand, many
people eat to overcome emotional problems, mental
pressure and anxiety (17, 18). There has been a
positive correlation between obesity and some mental
disorders including depression and anxiety  (19, 20).
Eating disorders in response to mental stress, fatigue,
Original Article
Iran J Psychiatry 2016; 11:1: 43-50

Kalantari, Doaei, Gordali et al
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Iranian J Psychiatry 11:1, Jan 2016 ijps.tums.ac.ir
anxiety, stress and depression have been reported (21,
22). 
Many studies found that lack of micronutrients such as
Zinc (23), vitamin E, Iron, Calcium, Iodine, Selenium,
Folic acid (24), vitamin C (25), Choline (26), and
vitamin D  (27) is common among students all over the
world. On the other hand, residency in dormitories can
exacerbate the nutritional risk factors among students.
Previous study showed that nutritional status of
students living in the dorms were different from
other students. Food consumption in dormitory
students was decreased when entering university (28)
and significant drop in food intake quality was
observed in half of the dormitory students (29).
Furthermore, despite the lack of some micronutrients
intake, the nutritional status of students who were not
living in the dorms were more acceptable compared to
the dormitory students (30).
Previous studies about the effects of food and nutrient
intake on mental disorders illustrated that a high intake
of low-fat dairy products (31), decrease in consumption
of fast food (32), using the Mediterranean Diet (33),
and consumption of omega-3 fatty acids (34) and
magnesium (35) supplements can result in reducing
depression, anxiety and stress.
Further studies that investigated the relationship
between food consumption and mental conditions have
considered the prevalence of depression and its relation
to food intake  (36, 37). Although anxiety has been a
common problem among students (38), no study was
conducted on the relationship between diet and
stressful situations (such as anger). Considering the
results of studies conducted on the relationship
between dietary intakes and mental disorders, we chose
two food groups for evaluation.
Therefore, the purpose of this research was to
determine the relation between dietary intake of dairy
foods, simple sugars and BMI with states of anger in
female students of a dormitory in Shahid Beheshti
University of Medical Sciences, Tehran, Iran.
Materials and Method
In this cross-sectional study, 114 resident students
accommodating Fatima Zahra dormitory at Shahid
Beheshti University of Medical Sciences were
randomly selected and examined. This study was
conducted from spring 2014 to autumn 2015.
Initially, students' weight and height were measured
using Seca Scales (precision of 1 kg) and a tape
measure (accuracy of 1 cm), respectively. After
calculating the Body Mass Index, each participant was
asked to complete the Anger Questionnaire,
designed by Spielberger, validated by Barabadi in Iran,
to measure anger in teens and adults (39). Spielberger
and Brenner introduced this scale in 2003 and
published it in 2009 to evaluate experience, expression,
control and taming of anger. This questionnaire
consists of 35 items, 4 subscales and 3 sections; the
first part has 10 items, the second part contains 10
items, and the third part has 15 items, which evaluate
anger state, anger trait and expression and control of
anger, respectively. All sections of the questionnaire
were calibrated using 3-point Likert scale. 
To score the first section, the statements were
identified as "never, a little, and very high" and scored
as 1, 2, 3, respectively. To score the second section and
5 questions of the third section (which represents the
expression of anger), the statements were identified as
"very little, sometimes, and often" and scored as 1, 2,
3, respectively. To score the remaining questions in the
third section (which represent the control of
anger), scoring was done inversely, namely the score of
"very little" was 3, the statement of "sometimes" was
scored as 2, and the phrase "often" was awarded a score
of 1 (40). The first part with the phrase "I feel right
now ..." measured the state of anger (41) which graded
the intensity of feeling. This section with 10 items
included the anger state and subscales cases as follows:
(a) Sense of Furiously (42), (b) Willingness to
Verbal Expression of Anger (43), and (c) Trend to
Physical Expressions of Anger (44). The second
section, entitled "I feel usually…. "Involved 10 items
to measure trait anger (45), and was graded as the first
part. The scale of trait anger has two subscales of angry
state  (46) and angry reaction (47). The title of the third
section was "What is your behavioral reactions in
angry mood?" that measured the expression and control
of anger, and included four scales that involved
subscales as follows: (a) Outer anger impart (48),
(b) inner’sanger impart(49),c:Controlof outeranger
(50) and (d) control of inner anger (51). 
The food frequency questionnaire was used to
investigate the intake of dairy food groups and simple
sugars. This questionnaire was used to assess the
frequency of food intake in a day, week or month. To
facilitate the evaluation of this method, foods
were organized as groups with similar nutrients. Since
Food Frequency Questionnaire is based on frequency
of food intake (not only specific nutrient), the obtained
information was related to specific food group not
specific nutrients (52). All participants signed
the informed consent to participate in the study.
Linear regression was used for data analysis. Data were
recorded as mean±standard deviation (SD). A
statistical package (SPSS, version 21.0 for Windows,
SPSS Inc.) was used for data processing. Differences
were considered significant at p <0.05.
Results
The personal characteristics of the study population are
shown in Table 1. In the current study, 70% of the
population aged between 20 to 25 years old. With
respect to the academic degree, they were divided into
three groups of Bachelor, MSc, and PhD. The number
of students studying in each of these three groups was
equal. In this community, the BMI was 21.61±2.79 that
was in the normal range. 13% of the Body Mass
Index was less than 18.5; and 75% of the Body Mass

Food intake and anger expression
45
Iranian J Psychiatry 11:1, Jan 2016 ijps.tums.ac.ir
Index was between18.5 to 24.9, and 12% of the body
mass index was greater than or equal to 25, which was
considered as overweight or obese. 
With regards to anger measurements, for the first
section, the mean of calculating the score was 13 out of
30. For trait anger, the calculated score was a little
more than anger state (18.75 of 30). On the other hand,
the resulting score for the third section
(anger expression) was relatively high (28.35 of 45). 
With respect to food groups intake, the average
consumption of dairy products in this study was
approximately 4 servings per day. According to the
values recommended for adults, intake of dairy
products should be at least 2 servings per day (50).
Therefore, the dairy intake of the study population was
averagely more than the minimum recommended
values. The mean intake of simple sugars was
approximately 7 servings per day that was higher than
allowable values (0-3 servings) (50).
In this study, a significant inverse relationship was
found between dairy consumption and trait anger
(reacted furiously and angry state) (P = 0.015). On the
other hand, there was not a significant correlation
between dairy intake and simple sugars with
other subscales of anger (state and expression of
anger). Furthermore, there was a negative relevance
between age and anger trait by investigating each
parameters of age, height, weight, and Body Mass
Index and its relationship with anger (P=0.028).
Overall, age increase from 20 to 36 reduced levels of
trait anger. 
No significant relevance was found between Body
Mass Index and other subscales of anger (state and
expression of Anger). The relevance between dairy
consumption, simple sugars, age and anthropometric
indices with all anger subscales is demonstrated in
Table 2.
One of the confounding variables in this study was
supplements intake by students. To eliminate the effect
of confounding variables and measuring the effect of
calcium supplementation on the relationship between
anger and dairy intake, all persons who were
consuming calcium supplements or multivitamin-
mineral (14) were excluded from the study, and the
results were reviewed. After the removal of the
confounding variables, the relationship between dairy
consumption and trait anger remained significant (P =
0.027). Table 3 displays the relationship between dairy
consumption and trait anger after removing the
confounding variables.
Discussion
There was a negative correlation between dairy intake
(on levels recommended by the Food Guide Pyramid)
and trait anger (reacted furiously and angry state) (P-
value = 0.015). Therefore, students who had more dairy
products were less in angry states and had low angry
reactions. Miyake et al. reported similar results and
showed that more consumption of yogurt and calcium
was associated with less rampancy of
depression symptoms (53). Crichton et al. reported that
consumption of some low-fat dairy products had
beneficial effects on social functioning, stress and
memory (54). Moreover, Roohafza et al. found that
more consumption of dairy products respond to low
stress levels (55). This effect may be due to the high
content of tryptophan (essential amino acid) in dairy
products. Tryptophan is a precursor for serotonin (a
neurotransmitter in brain) that has a significant effect
on mental states. In most previous studies, levels
of brain’s serotonin in patients with depression and
anxiety were lower than healthy subjects (56). Duke
(57) and Giessen et al. (58) showed that serotonin
function has an inverse correlation with the degree of
anger and hostility. 
Moreover, this effect can be related to the antioxidant
content of dairy products such as vitamins A and B2
1

(57). Antioxidants can affect oxidative stress, which
may lead to slower neuronal changes that are
associated with depression in old age (59).
In this research, no significant correlation was found
between intake of simple sugars, and the expression
and extend anger subscales; these results were also
confirmed in other studies. On the other hand, Keith et
al. found that low-carbohydrate diet in female group is
associated with depression and anger (60). In the
current study, consumption of simple sugars (not total
carbohydrate) in the long-term (1 year) was evaluated,
and these factors may cause the differences in the
results. There was not a significant effect of Body Mass
Index on expression and extent of observed anger. 
Similarly, Arian et al. (61) and Ahmadi et al. (62)
investigated that the prevalence of mental health
problems had no significant relationship with
anthropometric indices  (including BMI).
No association was found between BMI and depression
in any other similar studies (63-65). However, in some
cases, a significant positive correlation was detected
between depression and Body Mass Index (66-69).
These differences in the results can be related to
several factors such as age, gender, socioeconomic and
cultural factors that affect this relationship.
Furthermore, social attitudes to obesity should be
considered as a important cultural factor (70).For
example, in Western culture, negative attitudes
toward obesity can influence self-esteem and cause
depression (71). While in some other societies larger
body size is accepted (72).
1
Vitamin B2 is one of many nutrients required to
recycle glutathione, which is one of the most important
antioxidants in the human body. From a
chemical standpoint, what B2 does is facilitate the
conversion of oxidized glutathione into reduced
glutathione.

Kalantari, Doaei, Gordali et al
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Limitations
Since only female students and limited dormitories
were evaluated in this study, conducting similar
research with larger samples is required. In addition,
investigation of other food groups associated with
anger is a suggestion that can be offered in relation
to this research. The findings of this study are based on
cross-sectional data, and a important avenue for future
research will be to replicate these studies with
causal structures using longitudinal data.
Conclusion
Life quality can be affected by mental health as well as
physical health. According to the results of this study,
more consumption of dairy food group decreases the
trait anger. Since the subscale of trait anger included
angry state and angry reaction, it can be concluded that
dairy products intake has a positive effect on both
temperament during long time and immediate reaction
to oppositions. Therefore, intake of dairy products
can be suggested as a nutritional strategy for reducing
anger and increasing soothe. 
Acknowledgement
We thank all of the participants and questionnaire
respondents for their contribution to this study. This
work was supported by the Student’s Research
Committee of Shahid Beheshti University of
Medical Sciences, Iran (grant number 5632).
Conflict of interest
There is no conflict of interest to be declared.

Food intake and anger expression
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Table 1: The Basic Characteristics of the Participants
Index
Mean
Standard deviation
High (m)
1.63
0.047
Weigh (kg)
58.12
7.95
Body mass index (kg/m2)
21.61
2.79
Anger state (score of 30)
12.98
3.53
Trait Anger (score of 30)
18.75
4.01
Anger expression (score of 45)
28.37
6.36
Dairy consumption (serving per day)
3.89
2.06
Intake sugar (serving per day)
7.36
6.52
Table 2: Relationship between Dairy Consumption and Simple Sugars, Age and Anthropometric Indices with Anger
Anger State
Trait anger
Anger expression
Index
B Coefficient
Beta coefficient
P-value
B Coefficient
Beta coefficient
P-value
B Coefficient
Beta coefficient
P-value
Dairy intake
0.000
0.032
0.753
-0.001
-0.23
0.015*
-0.001
-0.105
0.273
Sugar intake
-6.42
-0.043
0.651
0.000
0.062
0.5
-8.80
-0.033
0.729
Age
-0.84
-0.074
0.445
-0.271
-0.210
0.028*
0.091
0.044
0.640
Body mass index
1.636
1.292
0.472
-0.391
-0.272
0.877
-7.021
-3.075
0.083
High
42.23
0.561
0.485
-12.05
-0.141
0.858
-190.004
-1.401
0.079
Weight
-0.594
-1.333
0.481
0.176
0.348
0.851
2.521
3.140
0.094
Table 3: The Relationship between Dairy Consumption with Trait Anger after Excluding 14 Patients
P-value
Beta coefficient
B Coefficient
Index
0.027*
-0.221
-0.001
Dairy intake
Iranian J Psychiatry 11:1, Jan 2016 ijps.tums.ac.ir
47
Food intake and anger expression
Review

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