Sleep quality and duration is related with diet and obesity in young adolescent living in Sicily, Southern Italy

Association between Vegetarian Diet Consumption and Academic Performance, Sleep Quality, and Health-Related Quality of Life among Female Undergraduate College Students

Purpose

This cross-sectional survey study aimed to examine the association between vegetarian diet consumption and sleep quality, academic performance, and health-related quality of life among female undergraduate college students.

Method

A sample of 158 undergraduate female college students was recruited using a convenience sampling approach. Data collection utilized reliable and validated English-language instruments including the Vegetarian Quality of Life Questionnaire (VEGQOL), Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life scale (HRQoL). The data were analyzed using one-way analysis of variance (ANOVA) and appropriate descriptive statistics.

Results

Vegetarians exhibited a significantly lower BMI compared to nonvegetarians (F (1, 156) = [6.09], p=0.015). Those strictly adhering to a vegan diet (48.79 ± 9.41) had the lowest vegetarian quality of life among all participants following various forms of a vegetarian diet (F (3, 68) = [2.78], p=0.04). The majority of female college students reported good to excellent general health (91.7%), with 53.2% perceiving their sleep quality as fairly good. However, the mean PSQI global score of 8.04 (±3.35) indicated poor sleep quality. No significant association was found between diet type (vegetarian vs. nonvegetarian) and academic performance (cGPA) (χ 2 (4, N = 158) = 2.92, p=0.57). There was no significant relationship between diet types and academic performance, HRQoL, and sleep quality.

Conclusion

Despite a significant association between vegetarian diet and lower BMI, surprisingly, no substantial relationships were identified between diet type and academic performance, HRQoL, and sleep quality. These findings contribute to the ongoing discourse on the potential impacts of a vegetarian diet on various facets of female college students' well-being and highlight the need for further exploration in this field.

From Garden to Pillow: Understanding the Relationship between Plant-Based Nutrition and Quality of Sleep

The effect of diet on sleep quality has been addressed in many studies; however, whether/how plant-based diets (PBDs) impact sleep-related parameters has not been explored in detail. This review aims to give an overview of the components of PBDs and the possible mechanisms through which PBDs may improve sleep quality. Studies have indicated that diets such as PBDs, which are typically high in fruits, vegetables, nuts, seeds, whole grains, and fiber, are associated with better sleep outcomes, including less fragmented sleep and improved sleep duration. Several mechanisms may explain how PBDs impact and/or improve sleep outcomes. Firstly, PBDs are characteristically rich in certain nutrients, such as magnesium and vitamin B6, which have been associated with improved sleep patterns. Secondly, PBDs are often lower in saturated fats and higher in fiber, which may contribute to better overall health, including sleep quality. Additionally, plant bioactive compounds like phytochemicals and antioxidants in fruits, vegetables, and herbs may have sleep-promoting effects. According to available data, PBD and Mediterranean diet elements promise to enhance sleep quality; however, it is crucial to note that diets should be customized based on each person's needs.

The associations between plant-based dietary indices with depression and quality of life and insomnia among Iranian adolescent girls in 2015

Although previous research has explored the link between plant-based diets and mental health outcomes, there has been limited study on the quality levels of plant foods in this context. This study was conducted on 733 adolescent girls from cities in northeastern Iran. The validated Iranian version of the Insomnia Severity Index, SF-12v2 questionnaire and Persian version of the Beck Depression Inventory used to assess insomnia and poor quality of life (QoL) and depression, respectively. Dietary intakes assessed using a valid and reliable food frequency questionnaire. The association of scores of plant based dietary index (PDI) and poor QoL, depression and insomnia explored by binary logistic regression. The unadjusted model showed subjects in the highest quartile of healthy PDI had lower chances of insomnia than those in the lowest quartile (OR: 0.50; 95% CI 0.27-0.91, P = 0.024). The association persisted across various adjusted models. Subjects in the highest quartile of unhealthy PDI (uPDI) had higher chances of depression than those in the lowest quartile (OR: 1.83; 95% CI 1.09-3.08, P = 0.022). The significance of the association was maintained after adjusting for other confounders. A healthy plant-based dietary index is associated with a lower odds of insomnia. An unhealthy plant-based dietary index was associated to an increased chance of depression. Findings need to be confirmed by future studies.

Relationships among Sleep Time, Physical Activity Time, Screen Time, and Nutrition Literacy of Adolescents: A Cross-Sectional Study in Chongqing, China

Background: Unhealthy lifestyles among adolescents are reaching alarming levels and have become a major public health problem. This study aimed to assess the relationship between sleep time, physical activity (PA) time, screen time (ST), and nutritional literacy (NL). Methods: This cross-sectional online study involving adolescents aged 10-18 years was conducted in September 2020 in 239 schools in Chongqing, China. NL was measured using the "Nutrition Literacy Scale for middle school students in Chongqing (CM-NLS)". According to the recommended by the Chinese dietary guidelines (2022), we divided the sleep time of junior high school students into <9 h and ≥9 h, high school students into <8 h and ≥8 h, divided the workdays into weekend PA time < 1 h and ≥1 h, and divided the workdays into weekend ST < 2 h and ≥2 h. The multinomial logistic regression model was used to examine the association. Results: A total of 18,660 adolescents (50.2% males) were included. The proportion of participants that were junior high school students and attended boarding schools was 57.2% and 65.3%, respectively. Compared with senior high school students, junior high school students had a higher level of NL. Whether on workdays or weekends, participants with sleep time ≥ 8/9 h, PA time ≥ 1 h, and ST < 2 h per day had higher levels of NL. On weekdays, participants who met the sleep time ≥ 8 h/9 h (OR = 1.48, 95% CI: 1.36, 1.62) and PA time ≥ 1 h (OR = 1.69, 95% CI: 1.59, 1.81) had higher reporting of NL levels. Conclusions: Sleep time, PA time, and ST were positively correlated with NL among adolescents, especially junior high school students.

Association between late bedtime and obesity in children and adolescents: a meta-analysis

Background

Short sleep duration has been related to obesity in children and adolescents. However, it remains unknown whether late bedtime is also associated with obesity and whether the association is independent of sleep duration. A meta-analysis was performed to address this issue.

Methods

In order to accomplish the aim of the meta-analysis, a comprehensive search was conducted on databases including PubMed, Embase, and Web of Science to identify observational studies. The cutoff to determine late bedtime in children in this meta-analysis was consistent with the value used among the included original studies. As for obesity, it was typically defined as a body mass index (BMI) > 95th percentile of age and sex specified reference standards or the International Obesity Task Force defined age- and gender-specific cut-off of BMI. The Cochrane Q test was employed to evaluate heterogeneity among the included studies, while the I2 statistic was estimated. Random-effects models were utilized to merge the results, considering the potential impact of heterogeneity.

Results

Tweleve observational studies with 57,728 participants were included. Among them, 6,815 (11.8%) were obese. Pooled results showed that late bedtime reported by the participants or their caregivers was associated with obesity (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.16-1.39, p < 0.001; I2 = 0%). Subgroup analysis showed consistent results in studies with (OR: 1.33, 95% CI: 1.04-1.70, p = 0.02) and without adjustment of sleep duration (OR: 1.27, 95% CI: 1.14-1.41, p < 0.001). Further subgroup analysis also showed that the association was not significantly affected by study location, design, age of the participants, or diagnostic methods for obesity (p for subgroup difference all >0.05).

Conclusion

Late bedtime is associated with obesity in children and adolescents, which may be independent of sleep duration.

The impact of plant-rich diets on sleep: a mini-review

Plant-rich diets (PRDs), also referred to as plant based diets, have been shown to have beneficial effects on various chronic diseases and all-cause mortality. However, limited data are available on the effect of such diets on sleep and sleep disorders. In this review article, we explore existing evidence and potential mechanisms by which PRDs may impact sleep and sleepiness. High-fat diets are associated with drowsiness, while fiber-rich diets improve sleep quality. Anti-inflammatory diets may benefit patients with sleep disturbances, and diets rich in tryptophan and serotonin precursors may improve sleep quality. Isoflavones and polyphenols present in PRDs may also have a positive impact on sleep. Furthermore, diets rich in plants may reduce the risk of obstructive sleep apnea and associated daytime sleepiness. Overall, the current knowledge about PRDs in sleep and sleep disorders is limited, and further research is needed to explore the potential advantages of this dietary approach in sleep disorders.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review

Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.

Nutrient intake, alcohol consumption, emotional eating and anxiety in women nursing students

Objective

The aim of the study was to analyze dietary habits, alcohol habits, emotional eating and anxiety in a sample of Spanish nursing students. These students appear to be essential to the field of public health and to teaching their future patients about their own good practices.

Methods

A cross-sectional investigation was conducted. Participants completed the Emotional Eater Questionnaire, the Alcohol Use Disorder Identification Test (AUDIT) test to evaluate alcohol intake, the State-Trait anxiety Inventory (STAI) test to measure levels of anxiety as a state and anxiety as a trait, and self-reported sociodemographic data. Following classroom instruction, three-day food records were used to gauge food intake.

Results

The calorie intake for the macronutrients Ca, Mg, K, and Fe were below the Recommended Dietary Intakes (DRI) and imbalanced. The percentage E of proteins was 132.7 % more than recommended, while the percentage of carbohydrates is below the recommended level. Dietary energy consumption barely equaled 78 % of the total energy consumed by this sex and age group. With respect to emotional eating, nursing women students were low emotional eater (44 %) > emotional eater (30 %) > non-emotional eater (22.7 %). The students' emotional eating is substantially connected with fast food and sweets, or less healthy food intake behaviors. According to the Alcohol Use Disorder Identification Test (AUDIT), 82.7 % of female students used alcohol on a regular basis in a low-risk manner.

Conclusion

The findings demonstrated a link between anxiety and dietary fat intake. Trait anxiety was negatively connected with emotional eating (EE), whereas state anxiety was positively correlated with meat consumption. It is crucial to consider these findings when creating prevention/intervention plans and profiles of harmful eating behaviors.

Sleep duration, sleep quality and the risk of being obese: Evidence from the Australian panel survey

BACKGROUND

Sleep difficulty is an unmet public health concern affecting a vast proportion of the world's population. Poor sleep duration (short or long sleep length) and quality affect more than half of older people. Sleep difficulty is associated with negative health outcomes such as obesity and reduced longevity. We aimed to assess whether poor sleep duration and quality are significant risk factors for obesity in adults aged 15 and over in Australia by examining a nationally representative panel data.

METHODS

We used three waves (waves 13, 17, and 21) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey data. The study applied generalized estimating equations (GEE) logistic regression model to assess the relationship between sleep duration and quality with obesity.

RESULTS

The study found that the odds of being obese was significantly higher amongst the study participants with poor sleep duration (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.16-1.32) and poor sleep quality (aOR: 1.29, 95% CI: 1.02-1.38) compared with their counterparts who had good sleep duration and quality, respectively.

CONCLUSION

Having short or long sleep at night and poor sleep quality are associated with an increased risk of obesity. Obesity poses a significant threat to the health of Australian adults. Enacting policies that raise public awareness of the significance of good sleep hygiene and encouraging healthy sleeping habits should be considered to address the alarming rise in the obesity rate.

Eating habits matter for sleep difficulties in children and adolescents: A cross-sectional study

Background

Sleep difficulties are a common sleep-related problem among children and adolescents. However, the association between eating habits and sleep difficulties has not been extensively studied. Therefore, this study aimed to investigate the relationship between eating habits and sleep difficulties in children and adolescents.

Methods

This study utilized cross-sectional data from the 2013/2014 Health Behaviour in School-aged Children survey. A total of 213,879 young adolescents provided self-reported information on their weekday and weekend breakfast consumption, fruit and vegetable intake, sweet and soft drink consumption, and sleep difficulties. Covariates such as sex, age, family affluence, physical activity, and body mass index were also assessed. Multilevel generalized linear modelling was used to analyse the association between independent and dependent. Results were reported as odds ratios (OR) with 95% confidence intervals.

Results

Of all study participants, approximately 50% were girls. Regression models indicated that more frequent breakfast consumption was associated with fewer sleep difficulties (e.g., consuming breakfast on weekdays for 5 days: OR = 1.49, 95% CI: 1.45-1.54). Fruit and vegetable consumption once a week or more was also linked to fewer sleep difficulties (all OR > 1.08, ≥ 1.07). In addition, consuming fewer sweets and soft drinks was generally associated with fewer sleep difficulties.

Conclusion

This study provides evidence supporting the association between healthier eating habits and reduced sleep difficulties in children and adolescents. Future research using longitudinal or experimental designs is encouraged to confirm or negate these findings. Additionally, this study offers practical guidance for nutritional counselling professionals and sleep health promotion practitioners.

Diet Quality and Sleep Characteristics in Midlife: The Bogalusa Heart Study

BACKGROUND

Sleep and diet contribute to cardiometabolic disease, but evidence is sparse for the association between these behaviors. This study analyzed the cross-sectional relationship between diet quality and multiple sleep outcomes in the Bogalusa Heart Study (BHS).

METHODS

Diet and sleep characteristics, including insomnia and sleep apnea symptoms, were measured with validated questionnaires. Poisson regression using generalized estimating equations with a log link estimated prevalence rate ratios (PRR) of sleep outcomes by dietary pattern scores (quintile (Q) and per SD). Models were adjusted for body mass index (BMI), multi-level socioeconomic factors, physical activity, depressive symptoms, and other potential confounders.

RESULTS

In 824 participants, higher diet quality, measured by the Alternate Healthy Eating Index-2010, was associated with lower sleep apnea risk score after adjustment (PRR [95% confidence interval (CI)] Q5 vs. Q1: 0.59 [0.44, 0.79], per SD increase: 0.88 [0.81, 0.95], p-trend < 0.0001). There were no statistically significant associations with the Healthy Eating Index 2015 or the Alternate Mediterranean dietary patterns, or for insomnia symptoms or a healthy sleep score.

CONCLUSIONS

Higher diet quality, after adjustment for BMI, was associated with a lower sleep apnea risk score in a cohort with substantial minority representation from a semi-rural, lower-income community.

Homework, sleep insufficiency and adolescent neurobehavioral problems: Shanghai Adolescent Cohort

BACKGROUND

The prospective associations between homework burdens and adolescent neurobehavioral problems, and whether sleep-durations mediated and sex modified such associations remained unclear.

METHODS

Using Shanghai-Adolescent-Cohort study, 609 middle-school students were recruited and investigations took place at Grade 6, 7 and 9. Information on homework burdens (defined by homework completion-time and self-perceived homework difficulty), bedtime/wake-up-time and neurobehavioral problems was collected. Two patterns of comprehensive homework burdens ('high' vs. 'low') were identified by latent-class-analysis and two distinct neurobehavioral trajectories ('increased-risk' vs. 'low-risk') were formed by latent-class-mixture-modeling.

RESULTS

Among the 6th-9th graders, the prevalence-rates of sleep-insufficiency and late-bedtime ranged from 44.0 %-55.0 % and 40.3 %-91.6 %, respectively. High homework burdens were concurrently associated with increased-risks of neurobehavioral problems (IRRs: 1.345-1.688, P < 0.05) at each grade, and such associations were mediated by reduced sleep durations (IRRs for indirect-effects: 1.105-1.251, P < 0.05). High homework burden at the 6th-grade (ORs: 2.014-2.168, P < 0.05) or high long-term (grade 6-9) homework burden (ORs: 1.876-1.925, P < 0.05) significantly predicted increased-risk trajectories of anxiety/depression and total-problems, with stronger associations among girls than among boys. The longitudinal associations between long-term homework burdens and increased-risk trajectories of neurobehavioral problems were mediated by reduced sleep-durations (ORs for indirect-effects: 1.189-1.278, P < 0.05), with stronger mediation-effects among girls.

LIMITATIONS

This study was restricted to Shanghai adolescents.

CONCLUSIONS

High homework burden had both short-term and long-term associations with adolescent neurobehavioral problems, with stronger associations among girls, and sleep-insufficiency may mediate such associations in a sex-specific manner. Approaches targeting appropriate homework-load/difficulty and sleep restoration may help prevent adolescent neurobehavioral problems.

Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study

PURPOSE

The aim of the present study was to examine the association of adherence to the Mediterranean Diet (MD) and its specific components with both sleep duration and sleep-related disorders in a sample of adolescents from the Valle de Ricote (Region of Murcia, Spain).

METHODS

This cross-sectional study included a sample of 847 Spanish adolescents (55.3% girls) aged 12-17 years. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Teenagers. Sleep duration was reported by adolescents for weekdays and weekend days separately. The BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) screening was used to evaluate issues related to sleep, which include difficulties at bedtime, excessive drowsiness during the day, waking up frequently during the night, irregularity, length of sleep, and breathing issues while sleeping.

RESULTS

Adolescents who presented a high adherence to the MD were more likely to meet the sleep recommendations (OR = 1.52, 95% CI 1.12-2.06, p = 0.008) and less likely to report at least one sleep-related problem (OR = 0.56, 95% CI 0.43-0.72, p < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, waist circumference, energy intake, physical activity, and sedentary behavior, indicating a significant association of adherence to the MD with sleep outcomes (meeting sleep recommendations: OR = 1.40, 95% CI 1.00-1.96, p = 0.050; sleep-related problems: OR = 0.68, 95% CI 0.50-0.92, p = 0.012).

CONCLUSIONS

Adolescents with high adherence to the MD were more likely to report optimal sleep duration and fewer sleep-related problems. This association was more clearly observed for specific MD components, such as fruits, pulses, fish, having breakfast, dairies, sweets, and baked goods/pastries.

Evaluation of Age Based-Sleep Quality and Fitness in Adolescent Female Handball Players

The present study aimed to examine the differences in sleep hygiene, balance, strength, agility, and maximum aerobic speed (MAS) between two groups of female handball players aged under 14 (U14) and under 17 (U17) years. Seventy-two female handball players participated and were divided into two groups according to age: U14 (n = 36, age: 13.44 ± 0.5 years) and U17 (n = 36, age: 15.95 ± 0.76 years). Sleep hygiene was evaluated using three questionnaires: Sleep quality and sleepiness via the Pittsburgh (PSQI) and Epworth (ESS) questionnaires, and the insomnia questionnaire via the measurement of the insomnia severity index (ISI). Physical fitness was evaluated with the stork balance tests with eyes open (OEB) and closed (CEB), the vertical jump (SJ), horizontal jump (SBJ), and five jump (FJT) tests, the agility (t-test) and the maximum aerobic speed (MAS) tests. No significant differences were shown between U14 and U17 players in all PSQI, ISI, and ESS scores, and balance and strength performances. Meanwhile, the U17 players’ performances were significant better in agility quality (p = 0.003 < 0.01) and MAS (p = 0.05) compared to the U14 players. Biological gender specificity during the maturation phase may inhibit the improvement of balance, and strength performances between the age of 13 and 17 years, while agility and MAS performances are more affected by age alterations.

Individual and Parental Factors of Adolescents' mHealth App Use: Nationally Representative Cross-sectional Study

BACKGROUND

Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited.

OBJECTIVE

We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500).

METHODS

Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample's representativeness. The sociodemographic factors were the adolescents' age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children's online health information-seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate).

RESULTS

More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information-seeking behaviors and adolescents' mHealth app use.

CONCLUSIONS

These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents' mHealth app use. We initially showed parents as significant role models for their children's adoption of, and engagement with, mHealth apps when they actively mediate their online health information-seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents' mHealth app use longitudinally.

Association between short sleep duration and intake of sugar and sugar-sweetened beverages: A systematic review and meta-analysis of observational studies

BACKGROUND

Findings of previous investigations that evaluated the relationship between sleep duration and sugar or sugar-sweetened beverages (SSBs) intake have been inconsistent. We aimed to summarize extant research that assessed the relation between short sleep duration and sugar and SSB intake.

METHODS

A comprehensive search of PubMed, ISI Web of Sciences, Scopus, Science Direct, Embase, and Google Scholar was conducted. All observational studies that reported sleep duration as the exposure and intake of sugar or sugary drinks as the outcome were included. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. The body of evidence was assessed using the GRADE approach. Random and fixed effects models were used to estimate pooled OR and 95% confidence intervals.

RESULTS

Twenty-two studies in children and twelve in adults were included in the systematic review. Only 10 studies in children and 3 investigations in adults provided odds ratios (95% confidence intervals) for this association and could be included in the meta-analysis. All studies had a cross-sectional design and found a negative association between sleep duration and sugar in children, but not in adults. SSB intake was lower in those with sufficient sleep in all populations. Compared with those with sufficient sleep, children with short sleep duration had 16% (significant) higher odds of consuming sugar (OR: 1.16; 95% CI: 1.10, 1.21), 21% higher odds of soda intake (OR: 1.21; 95% CI: 1.16, 1.26), and 92% higher odds of consuming energy drink intake (OR: 1.92; 95% CI: 1.66, 2.22). However, sleep duration was not significantly associated with soft drink intake in children (OR: 1.17; 95% CI: 0.93, 1.48). In adults, the odds of drinking soda in those with short sleep duration was 1.2 times more than in those with sufficient sleep (OR: 1.20; 95% CI: 1.12, 1.28). Also, low vs. optimal sleep duration in adults was associated with a 58% increased intake of energy drinks (OR: 1.58; 95% CI: 1.31, 1.90). Of note, these findings in the adult population resulted from only 2 included investigations, due to the limited number of studies.

CONCLUSION

The evidence reviewed supports a significant association between shorter sleep duration and higher SSBs intake in both children and adults, while such association with higher total sugar intake was significant in children but not in adults. Further research with more accurate measurements, sex-specific, and prospective designs should be carried out to clarify the causality and underlying mechanisms.

Sleep dimensions are associated with obesity, poor diet quality and eating behaviors in school-aged children

Objectives

The aim of this cross-sectional study was to investigate the association between sleep dimensions (duration, patterns, and disturbances) with body mass index (BMI), diet quality, and eating behaviors in school-aged children. Additionally, we aimed to investigate whether obesogenic eating behaviors (higher food responsiveness, lower satiety responsiveness, and less slowness in eating) and poor diet quality could mediate the potential association between sleep and obesity in school-aged children.

Materials and methods

For all participants (n = 588 children, age 5–12 years; 51% girls) we evaluated: sleep dimensions, BMI, diet quality, eating behaviors (food responsiveness, satiety responsiveness and slowness in eating). Linear regression models were used to test associations between exposure and outcome variables. Additionally, path analysis was conducted to test whether eating behaviors mediated the relationship between sleep and obesity.

Results

Shorter sleep duration (β = −0.722, p = 0.009) and greater sleep disturbances (β = 0.031, p = 0.012) were significantly associated with BMI. Additionally, we observed that diet quality was significantly associated with sleep duration (β = 0.430, p = 0.004), the midpoint of sleep (β = −0.927, p < 0.001), and sleep disturbances (β = −0.029, p < 0.001). Among other findings, greater sleep disturbances were associated with food responsiveness (β = 0.017, p < 0.001), satiety responsiveness (β = 0.015, p < 0.001), and slowness in eating (β = 0.012, p < 0.001). Importantly, food responsiveness was found as significant mediator of the relationship between sleep and BMI (R = 0.427, R² = 0.182, p < 0.001).

Conclusions

Late sleep patterns, short sleep duration, and greater sleep disturbances are significantly related with what and how school-aged children eat. Importantly, poor diet quality was significantly related to all three sleep dimensions, while eating behaviors had a significant relationship with greater sleep disturbances. These findings may be relevant to the development of behavioral targets to prevent childhood obesity, including sleep hygiene guidelines as a strategy to improve children's eating habits, as well as their BMI.

Sleep duration and eating behaviours among adolescents: a scoping review

INTRODUCTION

In the past decade, investigations of the relationship between sleep duration and eating behaviours have been emerging; however, a formal synthesis of the literature focussed on adolescent populations has not yet been conducted. We conducted a scoping review of the literature examining the relationship between sleep duration and eating behaviours in adolescents. Gaps in the research and directions for future research were identified based on the findings.

METHODS

A systematic search was employed on four research databases: PubMed, PsycInfo, CINAHL and Scopus; relevant grey literature was also reviewed. Studies that reported on the relationship between sleep duration and eating behaviours among high school-aged adolescents were included in the review. Data were extracted, charted and synthesized into a narrative. Consistent with the purpose of a scoping review, the methodological quality of the studies was not appraised. Stakeholders were consulted to validate the findings and provide insight into the interpretation and identification of pressing gaps in the research that remain to be addressed.

RESULTS

In total, 61 studies published between 2006 and 2021 met the criteria for review. Existing research focussed heavily on examining sleep duration in relation to intake of food from certain food groups, beverages and processed foods, and relied on a population study design, cross-sectional analyses and self-report measures.

CONCLUSION

Future research is needed to understand the link between sleep duration and eating-related cognition, eating contexts and disordered eating behaviours in order to better understand how ensuring sufficient sleep among adolescents can be leveraged to support healthier eating practices and reduce diet-related risks.

Childhood diabetes and sleep

Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.

Mediterranean Diet on Sleep: A Health Alliance

The Mediterranean diet is a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of noncommunicable diseases and total mortality, so that it is considered one of the healthiest dietary patterns. Clinical trials and mechanistic studies have demonstrated that the Mediterranean diet and its peculiar foods and nutrients exert beneficial effects against inflammation, oxidative stress, dysmetabolism, vascular dysfunction, adiposity, senescence, cognitive decline, neurodegeneration, and tumorigenesis, thus preventing age-associated chronic diseases and improving wellbeing and health. Nocturnal sleep is an essential physiological function, whose alteration is associated with health outcomes and chronic diseases. Scientific evidence suggests that diet and sleep are related in a bidirectional relationship, and the understanding of this association is important given their role in disease prevention. In this review, we surveyed the literature concerning the current state of evidence from epidemiological studies on the impact of the Mediterranean diet on nighttime sleep quantity and quality. The available studies indicate that greater adherence to the Mediterranean diet is associated with adequate sleep duration and with several indicators of better sleep quality. Potential mechanisms mediating the effect of the Mediterranean diet and its foods and nutrients on sleep are described, and gap-in-knowledge and new research agenda to corroborate findings are discussed.

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents

Purpose

The aim of the current study was twofold: first, to determine the prevalence of anxiety-induced sleep disturbances among Argentine adolescents according to sex, and second, to identify the association between these sleep disturbances and lifestyle behaviors in this population.

Methods

This is a cross-sectional study with data from the Global School-based Student Health Survey (GSHS) in Argentina (2018). A total of 32,393 adolescents (aged 12–17 years; 53.4% girls) were included in the final analysis. Anxiety-induced sleep disturbances were assessed with the question “During the past 12 months, how often have you been so worried about something that you could not sleep at night?”

Results

The prevalence of anxiety-induced sleep disturbances was higher in girls (17.4%) than in boys (7.9%) (p < 0.001). In boys, results indicated that those who used marijuana (cannabis) (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.08–1.98), used amphetamine or methamphetamine (OR = 2.19, 95% CI 1.28–3.77), walked or biked to or from school (OR = 1.53, 95% CI 1.19–1.96), and spent 3 h or more in sedentary behaviors (OR = 1.35, 95% CI 1.05–1.74) were more likely to report anxiety-induced sleep disturbances. In girls, those who ate from a fast-food restaurant (OR = 1.24, 95% CI 1.05–1.47), consumed alcoholic beverages (OR = 1.45, 95% CI 1.19–1.75), smoked cigarettes (OR = 2.09, 95%CI 1.05–4.14), consumed any tobacco product (OR = 1.47, 95% CI 1.19–1.82), used amphetamine or methamphetamine (OR = 2.08, 95% CI 1.33–3.26), and those who spent 3 h or more in sedentary behaviors (OR = 1.32, 95% CI 1.11–1.57) were more likely to report frequent anxiety-induced sleep disturbances.

Conclusion

In conclusion, considerable sex differences were observed with respect to the prevalence of anxiety-related sleep disturbances and associated lifestyle aspects.

Physical Activity, Body Mass Index (BMI) and Abdominal Obesity of Pre-Adolescent Children in the Region of Thrace, NE Greece, in Relation to Socio-Demographic Characteristics

This study aimed to explore the prevalence of overweight, obesity, and abdominal obesity, and define predictive factors of their occurrence among pre-adolescents in the region of Thrace, NE Greece. A secondary aim was to record physical activity at different times (schooldays, weekends, holidays) and explore associations with characteristics such as gender, overweight and obesity, and socio-demographic conditions. A cross-sectional study was conducted involving children aged 11–12 years. Participating children were measured for height, weight, and waist circumference, and their parents answered a questionnaire. In total, 1929 children were included. Prevalence of overweight was 31.5%, prevalence of obesity 17%, and only 1% of children were underweight. Abdominal obesity was detected in 20.3% of the sample. Overweight and obesity were more frequent in males, who also had higher mean values of Body Mass Index-for-age z-scores (BMIaz) and Waist-to-Height ratio (WtHR). Obesity rates were higher among those not participating in physical activities; however, no significant difference was observed between normal-weight, overweight and obese children in the time spent for organized athletic activities or free play. Logistic regression analysis showed that the probability for overweight/obesity was higher in boys (OR = 1.39, 95% CI = 1.16–1.66) and lower in children whose fathers had a higher educational level (OR = 0.75, 95% CI = 0.60–0.93). The probability for abdominal obesity was also higher in boys (OR = 1.37, 95% CI = 1.10–1.72) and lower in children participating at least one hour/day in an organized physical activity (compared to those with no physical activity (OR = 0.66, 95% CI = 0.51–0.85), and whose father was exercising at least 1–2 times/week (OR = 0.76, 95% CI = 0.591–0.98). In conclusion, the prevalence of overweight and obesity among pre-adolescents in NE Greece was estimated at 48.5%. This is associated with the male gender and not participating in physical activities. The educational level and exercise habits of the father (but not of the mother) affect the probability of obesity and abdominal obesity, respectively.

Mediterranean diet and adiposity in children and adolescents: A systematic review

Our aim was to summarize, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents. We searched Medline up to June 1, 2021 for the identification of intervention and observational studies meeting the inclusion criteria, following the PRISMA statement. We included 55 articles: 8 intervention studies and 47 observational studies. Three trials report a beneficial effect of the dietary intervention, whereas two did not, and three did not compare with a control. All observational studies were cross-sectional, and only five studies also included a longitudinal analysis. More than half of the cross-sectional studies found no significant association between adherence to Mediterranean diet and adiposity. Three out of the five longitudinal studies found a negative association. The majority of both observational and intervention studies was of low quality. Despite a large number of published studies, overall, there is only limited evidence of a beneficial effect of following a traditional Mediterranean diet to maintain a healthy body weight in childhood. More high-quality intervention and longitudinal data are needed to form the base of large-scale health programs to prevent childhood obesity.

Emotional eating and cognitive restraint mediate the association between sleep quality and BMI in young adults

This cross-sectional study was designed to investigate whether diet quality and eating behaviors could mediate the association between sleep quality and body mass index (BMI) in young adults. For all participants (n = 925; aged 21.4 ± 2.5 years; 77.8% women) we evaluated: BMI, sleep quality, diet quality, and eating behavior dimensions (emotional eating, cognitive restraint, and uncontrolled eating). Linear regression models were used to test associations between exposure and outcome variables. Path analysis was conducted with all potential mediators and covariates entered at the same time. Results showed that emotional eating (β = 0.04 [95% CI: 0.03; 0.06]), cognitive restraint (β = 0.03 [95% CI: 0.01; 0.04]), uncontrolled eating (β = 0.02 [95% CI: 0.01; 0.04]) and diet quality (β = -0.14 [95% CI: 0.19;-0.08]) were significantly associated with sleep quality. Additionally, BMI was significantly associated with PSQI score (β = 0.09 [95% CI: 0.01; 0.17]), emotional eating (β = 0.89 [95% CI: 0.60; 1.18]), and cognitive restraint (β = 1.37 [95% CI: 1.02; 1.71]). After testing for mediation, results revealed that emotional eating and cognitive restraint evidenced a significant mediating effect on the association between sleep quality and BMI. Additionally, diet quality was significantly associated with emotional eating (β = -0.35 [95% CI: 0.56;-0.13]), cognitive restraint (β = 0.53 [95% CI: 0.27; 0.79]), and uncontrolled eating (β = -0.49 [95% CI: 0.74;-0.25]). In conclusion, young adults with poor sleep quality are more likely to deal with negative emotions with food, which, in turn, could be associated with higher cognitive restraint, becoming a vicious cycle that has a negative impact on body weight. Our results also emphasize the role of eating behaviors as determinants of diet quality, highlighting the importance of considering sleep quality and eating behaviors when designing obesity prevention strategies in this population.

[Sleep duration, overweight and consumption of ultra-processed foods among adolescents]

The scope of this article is to analyze the relationship between insufficient sleep duration, overweight/obesity and the consumption of ultra-processed foods among adolescents aged 10 to 14 years. This is a cross-sectional study, with an evaluation of 1,384 adolescents from public schools in João Pessoa-PB, participating in the Longitudinal Study on Sedentary Behavior, Physical Activity, Diet and Adolescent Health (LONCAAFS). Sociodemographic variables, sleep duration, class shift, anthropometric nutritional status, sedentary behavior and food consumption were measured. Linear and logistic regression of the following were performed using Stata 13.0 Software: the prevalence of short sleep duration of 29.5% (<9h/night); a significant association between short sleep duration and excess weight only for adolescents <12 years old. With respect to the relationship between sleep duration and the consumption of ultra-processed foods, the longer the sleep duration, the lower the consumption of snacks by adolescents under 12 years old, with a positive association for ≥12 years old only with adjustment by the physical activity variable. There was no association with the "sugary drinks" and "cookies" groups for any of the age groups analyzed.

Sleeping Disorders in Healthy Individuals with Different Dietary Patterns and BMI, Questionnaire Assessment

The COVID-19 pandemic and abiding restrictions have affected every life domain. Sleep disturbances are a major health issue that is linked with a higher prevalence of metabolic syndrome, obesity, and psychological burdens. Research of sleeping disorders among vegetarian and non-vegetarian subpopulations is limited. The aim of the study was to assess the prevalence of sleeping disorders during the COVID-19 pandemic among people with different dietary patterns. Using a web-based cross-sectional survey, data were collected from 1987 people. A total of 1956 respondents met all study conditions. The questionnaire consisted of sociodemographic information, assessment of dietary habits, and assessment of the prevalence of insomnia and sleepiness, based on the Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS). A total of 36.04% (n = 705) respondents declared that they noticed a change in the quality of their sleep during the last year. According to AIS and ESS, non-vegetarians suffered from insomnia or sleepiness more often than vegetarians. Insomnia and sleepiness were also more prevalent among those respondents who declared consumption of fruit and vegetables less often than once a day compared with those who consumed fruit and vegetables daily. Respondents with BMI within the recommended limit (18.5–24.99) suffered from insomnia less often when compared with underweight (BMI < 18.5) or obese (BMI ≥ 25) respondents. Those results may be useful for public health workers and medical professionals in terms of establishing new instruments that help treat sleeping disorders.

The association between dietary patterns and quality and duration of sleep in children and adolescents: A systematic review

BACKGROUND

Dietary pattern has been represented as a contributor to the duration and quality of sleep. This study aimed to review the evidence on this relation among children and adolescents.

STUDY DESIGN

This was a systematic review on the association of dietary pattern and sleep.

METHODS

A literature search was conducted for all articles published between 1980 and August 2020 using the terms "diet" AND "sleep" in PubMed/Medline, Scopus, Web of Science, Cochrane, and Embase databases. Screening and selection of eligible studies were performed by two separate investigators. Studies reporting the impact of different dietary patterns and indices on sleep duration or quality were included.

RESULTS

Fourteen publications (12 cross-sectional, 1 cohort, and 1 clinical trial) were identified. Findings from most studies suggested that long sleep duration was consistently associated with healthy dietary patterns, such as "Vegetables & Healthy Proteins", "Traditional", "Fruit & Vegetables", etc. Results were more mixed and inconclusive regarding the quality of sleep, with 2 studies supporting, 2 studies disapproving, and one study neutral about the association between better sleep quality and healthier dietary patterns. The association between diet and sleep seemed to be affected by confounders and covariates, including sex, physical activity, screen time, etc. CONCLUSIONS: Longer sleep duration appears to be associated with healthier dietary pattern. However, various results in regard to the relation between dietary patterns and sleep quality preclude definitive conclusions. Further research with standard measures of sleep quality and experimental study designs are needed to better define the causal relationship between sleep and diet.

Association of plant-based diet index with inflammatory markers and sleep quality in overweight and obese female adults: A cross-sectional study

BACKGROUND

Inflammation and sleep disturbances increase the risk of multiple diseases, including cardiovascular disease, type 2 diabetes and dementia. Since diet plays a significant role in inflammatory responses and sleep quality, this study aimed to investigate the association of a plant-based diet index (PDI) with sleep quality and inflammatory markers in overweight and obese women.

METHODS

390 overweight and obese women aged 18-48 years participated in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to create an overall PDI, healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Higher scores on the PSQI were indicative of poor sleep. Anthropometric measurements and serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta (IL-1β) and transforming growth factor-beta (TGF-β) were evaluated. Linear regression models were used to determine the association between exposure and outcomes.

RESULTS

After taking potential confounders into account, we found a significant inverse association between adherence to hPDI and hs-CRP (β = -0.14, 95% confidence interval [CI]: -0.22,0.06, P = .001) and a significant positive association between uPDI and hs-CRP (β = 0.13, 95% CI: 0.05,0.21, P = .001). Overall, PDI was significantly associated with TGF-β (β = 2.04, 95% CI: 0.54,3.55, P = .008). No association was detected between PDI indices and IL-1β. Higher adherence to uPDI was significantly associated with higher PSQI score (lower sleep quality) (β= 0.20, 95% CI:0.007,0.40, P = .04). A significant positive association was found between TGF-β (β = 0.05, 95% CI:0.005,0.10, P = .03) and hs-CRP (β = 0.32, 95% CI:0.02,0.62, P = .03) with PSQI.

CONCLUSION

Our findings indicated a significant association between adherence to a plant-based diet with inflammation and sleep quality in obese and overweight females. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Sleep is an essential part of life, and sleep quality has a significant impact on individual well-being and performance. There is a bidirectional relationship between disturbed sleep and elevated levels of inflammatory markers. Diet plays a major part in sleep quality and its related health consequences. Plant-based diets are associated with lower risk of chronic diseases such as coronary artery disease (CAD), type 2 diabetes, obesity and reduced level of inflammation. WHAT DOES THIS ARTICLE ADD?: Adherence to a healthful plant-based diet is associated with lower level of hs-CRP, while adherence to an unhealthful plant-based diet is associated with higher concentrations of hs-CRP. Adherence to an unhealthful plant-based diet is associated with lower sleep quality.

Association of overweight, obesity and insufficient sleep duration and related lifestyle factors among school children and adolescents

OBJECTIVES

To assess the prevalence of overweight, obesity and Insufficient Sleep Duration (ISD) and to investigate their relationship with related lifestyle factors among school-aged students. Obesity in childhood and adolescence is a serious health concern as it may have long term risk for overweight and obesity in adulthood.

METHODS

This is a cross-sectional study of 1,611 students aged between 10 and 18 years from Al Ain city, United Arab Emirates. Data were collected using a multistage stratified random sampling method using a validated questionnaire and the level of significance was set at p<0.05.

RESULTS

The prevalence of overweight and obesity was 42.4%. ISD was 36.6% among students. Higher BMI was significantly related to being a male and inactive (95% CI=0.03-0.23), daily coffee consumption (95% CI=0.03-0.1), older age (95% CI=0.01-0.02), less average sleep duration (95% CI=-0.02 to -0.003) and spending more time on TV/videogames (95% CI=0.01-0.07). The likelihood of ISD was significantly lower among students who consumed breakfast daily (OR=0.58, 95% CI=0.41-0.83), spent less time on smart devices (OR=0.63, 95% CI=0.47-0.84), and never consumed energy drinks or soft drinks (OR=2.64, 95% CI=1.13-6.16, OR=2.02, 95% CI=1.24-3.29, respectively).

CONCLUSIONS

The prevalence of overweight and obesity among school-aged students is high. ISD and related lifestyle factors are significantly associated with overweight and obesity. Study findings emphasize the need to address and implement successful strategies for a healthy lifestyle starting from early childhood to combat the increasing rates of overweight and obesity in adulthood.

Sleep-related problems and eating habits during COVID-19 lockdown in a southern Brazilian youth sample

The pandemic has affected children's behaviors and this fact has an effect on their healthy habits, such as sleep and diet. The aim of the current study was to determinate the prevalence of sleep-related problems and its relationship with eating habits in children from the south of Brazil during the pandemic. Parents/legal guardians of 3-17 years old participants responded to a online survey distributed using the snowball sampling strategy in Brazil. The survey was conducted in April, 2020. Participants were asked for their sleep duration and sleep-related problems, as well as for their eating habits. Logistic regressions were performed to analyze the relationship between sleep-related problems and eating habits. 495 participants were included in the analysis. 48.8% of participants reported sleep-related problems with 12.3% not meeting the sleep guidelines. Moreover, participants reported eating fruits or vegetables and sweets over four and three per week, respectively. Different associations were found between varibles of sleep and eating habits. Those participants with healthy eating habits showed a lower prevalence of sleep-related problems.

Students Living in the Islands are Heavier and have Lower Fitness Levels Compared to their Mainland Counterparts; Results from the National Action for Children's Health (EYZHN) Program

Few studies have examined variations in obesity by geographic location in youth and its relation with fitness levels. The present study investigated the association between geographic status (islands versus mainland), excess of body weight and fitness levels among 335.810 schoolchildren (male: 51.3%, 6-18 y, during the school year 2014-2015). Students' anthropometric parameters and fitness levels - accessed via the Euro-fit test - were measured by trained physical education teachers and evaluated according to published norms. Prevalence of overweight (23.0 Vs 21.8%) and obese (10.1 Vs 8.0%) was significantly higher for students living in the islands contrary to their mainland counterparts. A significant difference was also observed for centrally obese children (33.5 Vs 28.2%). Except for speed test .408), in all other four fitness tests, the students from the islands presented significantly lower performance (≤25^th percentile of published age- and sex-specific normative values) versus their mainland counterparts. Boys and girls living in the islands had 48% and 37% increased odds of low physical fitness (as a total), respectively, compared to their mainland counterparts. Likewise, children living in islands presented increased odds of being overweight or obese by 19% and 15% in boys and girls, respectively, as compared to those living in the mainland. Increased general and abdominal adiposity have a direct negative impact on students' performance in Physical Fitness tests. Our data highlight the problem of excessive body weight that children living in rural areas, face.

Adherence to Lifelines Diet Score (LLDS) is associated with better sleep quality in overweight and obese women

PURPOSE

Previous studies have shown the connection between diet quality to sleep quality and weight status, although the relationship between Lifelines Diet Score (LLDS)-a fully food-based score that uses the 2015 Dutch Dietary Guidelines and underlying international literature-and sleep quality has not been evaluated in overweight and obese individuals yet. This observational study was conducted on overweight and obese adult females to assess the relationship between adherence to a LLDS pattern and sleep quality in Iran.

METHODS

A cohort of 278 overweight and obese women aged above 18 years was enrolled and their dietary intake was assessed using a 147-item, semi-quantitative, validated food frequency questionnaire. Pittsburgh Sleep Quality Index (PSQI), a self-reported questionnaire including 19-items, was applied to estimate sleep quality among the target population. Diet quality indices (LLDS) were calculated using the P.C. Vinke, et al. method, based on the 2015 Dutch Dietary Guidelines and the underlying literature.

RESULTS

Subjects in the highest LLDS tertile (those who had adhered closely to the food-based score) were older, compared to the lowest tertile (37.57 ± 7.77 versus 34.57 ± 9; p = 0.01). It was shown that about 25.5% of our subjects have poor quality sleep and 39% have better sleep quality which were mostly in the third tertile with greater LLDS. The parallel values in the first tertile were 29.9% and 46.8%, respectively (p = 0.02). Binary logistic regression was applied to evaluate the association between adherence of LLDS and sleep quality. The result has shown that the LLDS were correlated with lower risk poor sleep quality, wherein those who were in higher tertile (higher adherence to LLDS) had better sleep quality (odds ratio [OR]:0.586, 95% confidence interval [CI] (0.285-1.207), p = 0.009) and the result was not affected by adjusting for potential cofounders including age, education levels, and economic levels, sleep quality remained significantly associated with [OR]: 0.531, 95% confidence interval [CI] (0.248-1.138, p = 0.014).

CONCLUSIONS

From this observational study, the higher LLDS can be related with better sleep quality in overweight and obese women.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

Sleep Characteristics in the Italian Pediatric Population: A Systematic Review

OBJECTIVE

During childhood sleep duration, quality and patterns evolve and change greatly and relate strongly to healthy development. This systematic review aims to summarize the literature on sleep characteristics in the Italian pediatric population, adopting a cultural perspective.

METHOD

Pubmed, PsycINFO and Medline databases were systematically searched. Eligible studies had to: include Italian children and adolescents; report data for one or more sleep-related variables; be published in English or Italian.

RESULTS

Twenty-nine studies were selected including 18551 Italian children or adolescents. Studies were categorized by age group: infancy and toddlerhood (0-3 years); preschool and school age (3-12 years); adolescence (12-18 years) and mixed age groups. Overall, studies showed that the Italian pediatric population present shorter sleep duration and longer sleep onset latency compared to international recommendations. Furthermore, data indicate high prevalence of dysfunctional sleep habits, such as late bed-time (all age groups), involvement of parents during bed-time (infancy and toddlerhood), and high variability between sleep times on week-days vs. weekends (adolescence). Nevertheless, most studies lacked comprehensive data on sleep patterns, focusing instead on isolated variables.

CONCLUSION

These results suggest a strong trend among Italian children and adolescents towards unhealthy sleep patterns. Comprehensive data are still lacking and large studies evaluating a broad range of sleep characteristics in Italian pediatric populations are needed. Data strongly suggest that Italian Pediatric Primary Care should place higher focus on sleep problems and implement clinical protocols directed towards improving sleep patterns in children and adolescents.

Pathways to adolescents' health: chronotype, bedtime, sleep quality and mental health

The strong relationship between sleep and health is defined in the literature. While the need for sleep increases in adolescence with the effect of physiological and hormonal changes, the studies have highlighted the serious sleeping problems of adolescents compared to childhood and adulthood. This study aimed to examine the relationship between chronotype, bedtime, sleep quality and mental health among adolescents. This research was a descriptive-relational study. A total of 1083 students constituted the group of the research. The data were collected through the Morningness-Eveningness Questionnaire (MEQ) and General Health Questionnaire and a questionnaire consisting of some questions about sleep. In the evaluation of data, multiple regression, mediation and path analysis were performed. Age, having problems affecting sleep, difficulties falling asleep, sharing the room with someone else and lack of leisure activities were related to bedtime. It was found that determinants of sleep quality were the variables related to sleep itself. Being a male student, having problems affecting sleep, difficulties falling at sleep, waking up during the night, getting support in the morning for waking up and lack of leisure activities negatively affected mental health. MEQ scale was interpreted as a determinant of sleep time, sleep quality, and mental health level. Although the MEQ score directly affected sleep quality, bedtime had a partial mediation role between MEQ score and sleep quality. Sleep quality had a full mediation role between MEQ score and mental health score. School health workers, especially nurses, should consider chronotype-focused measures to improve adolescents' sleep quality and psychosocial health.

Association of Sleep Quality With Greater Left Ventricular Mass in Children Aged 9 to 11 Years

OBJECTIVE

Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in nonclinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleep characteristics and left ventricular mass in children.

METHODS

We assessed sleep and cardiac structure in a biracial sample of 9- to 11-year-old children (n = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy for five nights. Cardiac dimensions were assessed using echocardiography.

RESULTS

After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t(167) = 2.14, p = .034, Cohen d = 0.16, for activity during sleep; β = 0.15, t(167) = 2.43, p = .016, Cohen d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race.

CONCLUSIONS

The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a nonclinical sample of children. However, the novelty and importance of these findings require additional research for confirmation.

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents' overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8-10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys.

Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk

Health behaviors of higher education students can be negatively influenced by stressful events. The global COVID-19 pandemic presents a unique opportunity to characterize and compare health behaviors across multiple countries and to examine how these behaviors are shaped by the pandemic experience. Undergraduate and graduate students enrolled in universities in China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands and the United States (USA) were recruited into this cross-sectional study. Eligible students filled out an online survey comprised of validated tools for assessing sleep quality and duration, dietary risk, alcohol misuse and physical activity between late April and the end of May 2020. Health behaviors were fairly consistent across countries, and all countries reported poor sleep quality. However, during the survey period, the COVID-19 pandemic influenced the health behaviors of students in European countries and the USA more negatively than Asian countries, which could be attributed to the differences in pandemic time course and caseloads. Students who experienced a decline in sleep quality during the COVID-19 pandemic had higher dietary risk scores than students who did not experience a change in sleep quality (p = 0.001). Improved sleep quality was associated with less sitting time (p = 0.010). Addressing sleep issues among higher education students is a pressing concern, especially during stressful events. These results support the importance of making education and behavior-based sleep programming available for higher education students in order to benefit students' overall health.

Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents

OBJECTIVE

To examine the association between physical activity, screen time, eating habits and daytime sleepiness among Brazilian adolescents.

METHODS

Adolescents from three high schools (n = 876, 49.8% female, 16.4 ± 1.2 years) participated in this cross-sectional survey. Variables related to lifestyle behaviors (ie, physical activity, screen time, eating habits, sleep duration) were collected through an online questionnaire. Daytime sleepiness was assessed using the Pediatric Daytime Sleepiness Scale (PDSS). Excessive daytime sleepiness was defined as a PDSS score ≥20.

RESULTS

The average PDSS score was 18.9 (SD ± 4.8) points and 46.8% of adolescents were classified as having excessive daytime sleepiness. Physical activity was inversely associated with PDSS score (β = -0.29, 95% CI -0.47; -0.11). Consuming processed foods frequently (β = 1.16, 95% CI 0.85; 1.47) and using social media (β = 0.22, 95% CI 0.14; 0.30) were positively associated with PDSS score. Similar findings were observed for the odds of excessive daytime sleepiness. Physical activity was inversely associated (OR = 0.91, 95% CI 0.84; 0.99), while frequent consumption of processed foods (OR = 1.55, 95% CI 1.33; 1.82) and using social media (OR = 1.13, 95% CI 1.02; 1.24) were positively associated with excessive daytime sleepiness.

CONCLUSIONS

Lower physical activity level, a higher consumption processed foods, and higher social media use were associated with daytime sleepiness in this sample of Brazilian adolescents.

Factors associated with adherence to a Mediterranean diet in adolescents from La Rioja (Spain)

The aim of the present study was to describe Mediterranean diet (MD) adherence within a population of adolescents and to analyse the association of multiple factors with adherence. This included a consideration of diverse physical and mental health indicators. The present study was conducted with a representative sample of 761 adolescents (14·51 (sd 1·63) years) from twenty-five educational centres in a northern region of Spain. MD adherence was evaluated, alongside their health-related quality of life, self-esteem, body image satisfaction, BMI, physical activity (PA) level, maximum oxygen consumption, hours of nightly sleep, socio-demographic factors and academic performance. Of the adolescent population, 49 % reported high MD adherence. Being female and having higher levels of PA were found to be predictive factors of adherence to the MD. In addition, maximum oxygen consumption, the presence of environments favourable towards PA engagement and higher self-esteem were also predictive in females, whilst better academic performance and more nightly sleep were additional predictors in males. The associations found between the MD and other health indicators and habits highlight the need to develop promotion strategies from an inter-disciplinary and transversal standpoint.

Association between sleep duration and sleep quality with sugar and sugar-sweetened beverages intake among university students

BACKGROUND AND AIM

Both short sleep duration and intake of sugar or sugar-sweetened beverages (SSBs) are associated with weight gain; but the linkage between sleep characteristics and sugar or SSBs intake was less studied. We aimed to evaluate the associations of sleep duration and sleep quality with sugar and SSBs intake among Iranian adults.

METHOD

This cross-sectional study consisted of 395 adults chosen among students of Isfahan University of Medical Sciences, based on a multistage cluster random sampling method. Sleep characteristics and dietary intakes and were assessed using the Pittsburgh Sleep Quality Index (PSQI) and a 147-item validated food frequency questionnaire, respectively.

RESULTS

Mean age and percentage of women in the study population were 22.79 (year) and 51.8%, respectively. No significant difference was observed between sleep duration and sugar intake, but short sleepers (< 6 h/d) had higher consumption of SSBs intake (86.54 vs. 65.73 g/day; P = 0.05) in comparison with those who had more than 8 h/d of sleep. Poor quality sleepers had significantly higher intake of SSBs compared with those with good quality of sleeping (87.09 vs. 56.73 g/day; P = 0.004). No significant correlation was found between sleep duration and SSBs intake. However, sleep quality score was positively correlated with SSBs intake (r_p:0.14, P = 0.007) in whole population, such that higher quality score (defined as poor sleep quality) was correlated with greater consumption of SSBs. Similar results were found in younger individuals (r_p:0.27, P = 0.002) and non-obese participants (r_p:0.14, P = 0.006).

CONCLUSION

We found that sleep duration was not associated with sugar or SSBs intake in Iranian adults. Poor sleep quality was correlated with high consumption of SSBs, especially in younger and non-obese individuals. More prospective investigations are required to confirm these findings.

Childhood Adversity and Sleep Disturbances: Longitudinal Results in Puerto Rican Children

BACKGROUND

Exposure to childhood adversities (CA) is associated with sleep disturbances; however, evidence has largely been drawn from cross-sectional data and has not addressed the relationship across developmental stages. Also, most studies have primarily focused on non-Hispanic White cohorts with a dearth of longitudinal evidence about racial/ethnic minorities. We examined the longitudinal association between CA and sleep disturbances in Puerto Rican youth.

METHOD

The Boricua Youth Study is a longitudinal study of Puerto Rican youth living in San Juan, Puerto Rico, and the South Bronx, NY (N = 2491). Among youth 5-9 and 10-16 years old, sleep disturbances were assessed through three yearly interviews. Lifetime exposure to CA included parental loss, child maltreatment, parental maladjustment, and exposure to violence. Weighted generalized linear mixed models examined the longitudinal association between CA and sleep disturbances in youth adjusting for sociodemographic and contextual covariates.

RESULTS

The prevalence of sleep disturbances was similar in both age groups (ages 5-9 and 10-16). In multivariable mixed models, CA were associated with sleep disturbance across three Waves among 10-16-year-olds. For example, having 2-3 or ≥ 4 types of CA were related to a higher prevalence of trouble falling/staying asleep in models adjusting for social context, gender, welfare status, or mother's education. No associations were observed among 5-9-year-olds.

CONCLUSION

The results suggest that cumulative adversities in childhood may lead to sleep problems in adolescence. These findings highlight the utility of addressing CA during childhood to help reduce sleep-wake disorders throughout adolescence, a known risk factor for future mental and physical health problems.

Weight Status, Adherence to the Mediterranean Diet, Physical Activity Level, and Sleep Behavior of Italian Junior High School Adolescents

Inadequate diet, physical activity, and sleep-related behaviors are potential risk factors for overweight and obese, therefore we investigated the relations between body mass index (BMI) and behavioral factors in a sample of Italian adolescents. Four hundred nine Italian secondary school students (46% females, 12.5 ± 0.6 y.o.) were enrolled in this cross-sectional study. Anthropometric measures, adherence to the Mediterranean Diet (KIDMED), physical activity level (PAQ-C), sleep duration, daytime sleepiness (PDSS), sleep quality, and school achievement data were collected through an online questionnaire. The percentage of overweight adolescents was slightly lower (14%) compared to the regional and the national figures. Approximately 88% of the sample reported a medium/high adherence to the Mediterranean Diet and 77% a moderate/vigorous physical activity level. The average sleep duration was in line with the international sleep recommendation for adolescents and 82% had a medium/high sleep quality. No differences were found between genders except for BMI (lower in females). Unexpectedly, no differences were found among the BMI groups (normal weight vs. overweight vs. obese) for lifestyle variables; in contrast, Mediterranean Diet adherence was associated with sleep habits. Further investigation is required to better explore the associations among behavioral variables involved in adolescents' healthy development.

The Elapsed Time between Dinner and the Midpoint of Sleep is Associated with Adiposity in Young Women

Meal timing relative to sleep/wake schedules is relevant in the search for obesity risk factors. However, clock time does not accurately characterize the timing of food intake in the context of internal circadian timing. Therefore, we studied elapsed between dinner and the midpoint of sleep (TDM) as a practical approach to evaluate meal timing relative to internal timing, and its implications on obesity. To do so, adiposity, sleep, diet, physical activity, and TDM were measured in 133 women. The participants were grouped into four categories according to their sleep timing behavior (early-bed/early-rise; early-bed/late-rise; late-bed/early-rise; late-bed/late-rise). Differences among the categories were tested using ANOVA, while restricted cubic splines were calculated to study the association between TDM and adiposity. Our results show that, although participants had dinner at about the same time, those that had the shortest TDM (early-bed/early-rise group) were found to have significantly higher BMI and waist circumference values (2.3 kg/m² and 5.2 cm) than the other groups. In addition, a TDM of 6 h was associated with the lowest values of adiposity. The TDM could be a practical approach to personalizing meal timing based on individual sleep/wake schedules. Thus, according to our findings, dining 6 h before the midpoint of sleep is an important finding and could be vital for future nutritional recommendations and for obesity prevention and treatment.

Sleep duration and eating behaviours in youth: a scoping review protocol

INTRODUCTION

Developmental alterations to the circadian rhythm, in combination with lifestyle changes (eg, changes in school start time, part-time employment), contribute to insufficient sleep among youth. Insufficient sleep is associated with poor eating behaviours in other developmental stages (ie, childhood, adulthood); however, it is currently unknown if this finding generalises to youth. Consequently, identifying the characteristics and results of the studies examining this relationship in youth populations is necessary to guide the future direction of research in this field.

METHODS AND ANALYSIS

We will conduct a scoping review to investigate the literature examining the relationship between sleep duration and eating behaviours in youth. The proposed scoping review will follow the standard six-stage protocol outlined by Arksey and O'Malley. To acquire relevant publications, systematic searches were conducted in PubMed, CINHAL, PsycINFO and Scopus in August 2019. Following this, a scan of the grey literature will be conducted. All relevant publications will be screened for their eligibility based on the predefined inclusion and exclusion criteria. A data extraction tool will be used to collate, summarise and report the results. The findings of the scoping review will be reviewed by relevant stakeholders to aid in interpreting and disseminating the findings. The proposed review will identify existing gaps in the literature and inform the conduct of future studies aimed at understanding the effects of insufficient/excessive sleep and the eating behaviours of youth.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval. Following the completion of the study, the findings will be disseminated at scientific meetings, submitted for peer-reviewed publication and translated to an accessible format for other relevant stakeholders.

Poor sleep and adolescent obesity risk: a narrative review of potential mechanisms

Poor sleep is related to increased obesity risk in adolescents, though the mechanisms of this relationship are unclear. This paper presents a conceptual framework of the various pathways that have been proposed to drive this relationship. In this framework, increased food reward, emotional reactivity, decreased inhibitory control, metabolic disturbances, poorer dietary quality, and disrupted meal timings may increase the likelihood of increasing overall energy intake. This paper further notes how poor sleep increases sedentary behavior and screen time, which likely limits overall energy expenditure. The model posits that these mechanisms result in an imbalance of energy intake and expenditure following poor sleep, intensifying the overall risk for obesity. Increases in food reward processes, decreases in insulin sensitivity, disrupted meal timing, and increases in sedentary behavior seem to be the most compelling mechanisms linking poor sleep with increased obesity risk in adolescents. Future directions and clinical implications of this framework are discussed.

Social Jet Lag Associates Negatively with the Adherence to the Mediterranean Diet and Body Mass Index among Young Adults

Obesity and unhealthy eating habits have been associated with irregular sleep-wake patterns during the week, also known as social jet lag. The Mediterranean diet is a healthy pattern related with a better health and sleep quality. However, potential associations with social jet lag remain unexplored. The aim of this study was to examine whether higher social jet lag is linked to lower adherence to the Mediterranean diet and whether it is associated with BMI (Body Mass Index). This cross-sectional study included 534 young adults (18-25 years). Anthropometric parameters, adherence to the Mediterranean diet, chronotype and social jet lag were studied. Our results revealed that individuals with greater social jet lag showed lower adherence to the Mediterranean diet and had a higher BMI. Among the habits that characterized the Mediterranean dietary pattern, we observed that higher social jet lag was significantly associated with a lower intake of fruits and vegetables, as well as skipping breakfast. Hence, the promotion of regular sleep habits together with healthy dietary patterns should be considered for obesity prevention, especially among young adults.