Skipping breakfast and mood: The role of sleep

Associations between insufficient sleep, skipping breakfast and depressive symptoms in children and adolescents: A school-based cross-sectional study in China

OBJECTIVE

Insufficient sleep and skipping breakfast are increasingly prevalent among children and adolescents. Both behaviors are associated with the onset of depression. This study aims to examine the independent and joint associations of these two behaviors with depressive symptoms, and investigate whether these associations varied by age or sex.

METHODS

The Center for Epidemiological Studies Depression Scale (CES-D) was used to evaluate the depressive symptoms. This cross-sectional study including 11,887 students aged 11-19 years using a stratified cluster, multistage sampling method in Ningbo, China. Multiple logistic regressions were conducted to evaluate the independent and joint association between insufficient sleep, skipping breakfast and depressive symptoms. Sensitivity analyses and stratified analyses by age and sex were performed using the same modelling strategies.

RESULTS

The overall prevalence of depressive symptoms was 15.27%. Skipping breakfast (Odds Ratio (OR) = 2.557, 95% Confidence Interval (CI) = 2.236-2.925) and insufficient sleep (OR = 1.547, 95%CI = 1.390-1.723) was independently associated with depressive symptoms. Compared to students with "sufficient sleep and breakfast every day", the OR was 4.385 (95%CI = 3.649-5.271) for those with "insufficient sleep and skipping breakfast". Meanwhile, the joint association was moderated by age group, with a more apparent association observed in the 11-15-year-old group compared to the 16-19-year-old group.

CONCLUSIONS

These findings indicated that insufficient sleep and skipping breakfast were independently and jointly associated with depressive symptoms. Insufficient sleep and skipping breakfast could be considered as two of the predictors of depression.

The effectiveness of the TRACE online nutrition intervention in improving dietary intake, sleep quality and physical activity levels for Australian adults with food addiction: a randomised controlled trial

BACKGROUND

Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three-arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian-led telehealth intervention at 3 months.

METHODS

Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non-core foods were reported.

RESULTS

The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) -0.0 to 12.9], p = 0.049), non-core foods (-6.4%/day [95% CI -12.9 to 0.0], p = 0.049), sweetened drinks (-1.7%/day [95% CI -2.9 to -0.4], p = 0.013), takeaway foods (-2.3%/day [95% CI -4.5 to -0.1], p = 0.045) and sodium (-478 mg/day [95% CI -765 to -191 mg], p = 0.001).

CONCLUSIONS

A dietitian-led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

Examining the association of breakfast skipping with sleep disturbance, mental health, and health-related quality of life: data from the 2018 Korean community health survey

Objectives: This study aimed to explore the relationship between breakfast skipping and its effects on sleep disorders, mental health, and health-related quality of life among Korean adults.Methods: Utilizing data from the 2018 Korea Community Health Survey, this cross-sectional analysis included 173,272 adults aged 19 years and older. Instruments used for assessment included the Patient Health Questionnaire-9 for depression, the EuroQol 5-dimension (EQ-5D) for health-related quality of life, and the Pittsburgh Sleep Quality Index for sleep disorders. The complex sample logistic regression analysis was employed to adjust for potential confounders.Results: Breakfast skipping was found to be significantly associated with delayed mid-sleep time, an increased propensity for daytime sleepiness, and a notable decline in sleep quality. Additionally, it was linked to a significant increase in depression risk, compromised health-related quality of life, and elevated stress levels across both genders. All five dimensions of the EQ-5D were negatively impacted by breakfast skipping.Discussion: The findings highlight the detrimental effects of skipping breakfast on sleep patterns, mental health, and overall quality of life, stressing the importance of regular breakfast consumption for enhancing these health outcomes. The study suggests the need for further research to uncover the mechanisms behind these associations and to devise targeted interventions to mitigate the negative impacts of breakfast skipping.

Identifying Current Feelings of Mild and Moderate to High Depression in Young, Healthy Individuals Using Gait and Balance: An Exploratory Study

Depressive mood states in healthy populations are prevalent but often under-reported. Biases exist in self-reporting of depression in otherwise healthy individuals. Gait and balance control can serve as objective markers for identifying those individuals, particularly in real-world settings. We utilized inertial measurement units (IMU) to measure gait and balance control. An exploratory, cross-sectional design was used to compare individuals who reported feeling depressed at the moment (n = 49) with those who did not (n = 84). The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was employed to ensure internal validity. We recruited 133 participants aged between 18-36 years from the university community. Various instruments were used to evaluate participants' present depressive symptoms, sleep, gait, and balance. Gait and balance variables were used to detect depression, and participants were categorized into three groups: not depressed, mild depression, and moderate-high depression. Participant characteristics were analyzed using ANOVA and Kruskal-Wallis tests, and no significant differences were found in age, height, weight, BMI, and prior night's sleep between the three groups. Classification models were utilized for depression detection. The most accurate model incorporated both gait and balance variables, yielding an accuracy rate of 84.91% for identifying individuals with moderate-high depression compared to non-depressed individuals.

Eating behaviors and incident cardiovascular disease in Japanese people: The population-based Panasonic cohort study 14

Evidence on common eating behaviors to support the prevention of cardiovascular disease (CVD) in Japanese people is insufficient. This retrospective cohort study aimed to investigate the association of diet behaviors (e.g., skipping breakfast, eating speed, snack after dinner, and alcohol consumption) with incident CVD in Japanese individuals. Employees of Panasonic Corporation who underwent the annual health checkups and without a history of CVD at baseline were enrolled. The main outcome was incident 3-point major adverse cardiovascular events (MACE). The secondary outcomes were incident coronary artery disease (CAD) and stroke. To assess the effect of BMI, the subgroup analysis was conducted. In total, 132,795 participants were included. Overall, 3,115, 1,982, and 1,165 participants developed 3-point MACE, CAD, and stroke, respectively. Skipping breakfast (HR: 1.13, 95% CI: 1.03-1.23) and fast eating (HR: 1.23, 95% CI: 1.04-1.47) were associated with 3-point MACE in the participants overall. Skipping breakfast (HR: 1.23, 95% CI: 1.10-1.37) and fast eating (HR: 1.38, 95% CI: 1.12-1.71) were also associated with 3-point MACE in participants with BMI < 25 kg/m². In contrast, in participants with BMI ≥ 25 kg/m², these associations were not detectable (P value for the interaction between subgroups = 0.09 [skipping breakfast] and 0.03 [fast eating], respectively). The diet behavior is a potential risk factor of incident CVD in Japanese people, particularly in those with BMI < 25 kg/m².

Associations between Hunger and Psychological Outcomes: A Large-Scale Ecological Momentary Assessment Study

Studies assessing the association between hunger and psychological states have been conducted in laboratory settings, or limited to persons with eating disorders. In this study, 748 community-dwelling adults (56.4% women, 60.0 ± 9.3 years) completed the Ecological Momentary Assessment four times a day (08:00, 12:00, 16:00 and 20:00) for seven days. At each assessment, respondents indicated their current hunger level, food intake, and psychological states (sad, anxious, active, lively, distracted, anhedonic, angry, slow thinking and restless). Time-lagged associations assessing the effect of hunger on subsequent psychological states 4 h later and vice-versa were assessed. Hunger intensity increased subsequent active feeling (coefficient and 95% confidence interval: 0.029 (0.007; 0.051)) and lively feeling (0.019 (0.004; 0.034)) and decreased later slow thinking (-0.016 (-0.029; -0.003)). Previous eating increased later activity (0.116 (0.025; 0.208)). Feeling active (0.050 (0.036; 0.064)), lively (0.045 (0.023; 0.067)) and restless (0.040 (0.018; 0.063)) increased later hunger intensity, while distraction (-0.039 (-0.058; -0.019)) and slow thinking (-0.057 (-0.080; -0.034)) decreased it. No association was found between hunger, food intake and negative psychological states (sadness, anxiety and anger). Conclusions: Positive psychological states and hunger influence each other, while no association was found between hunger and negative psychological states.

Association between self-reported sleep duration and dietary quality in Mexican school-aged children

Short sleep duration has been associated with poor diet quality in school-aged children in multiple populations. However, investigations of sleep and dietary quality in Mexican school-aged children are scarce. The main objective of this work was to assess the association between sleep duration and dietary quality in Mexican school-aged children stratified by sex. The data were collected from 373 (138 girls and 235 boys) elementary school children aged 6-12 years in Monterrey, Nuevo Leon, Mexico. Surveys collected information on general demographic characteristics and self-reported sleep duration. Diet was assessed with 24-h recalls, and dietary quality was calculated by the Healthy Eating Index (HEI-2015). Results indicated that overall mean sleep duration was 8.23 ± 1.06 h. From the total sample, 6.7% slept ≤6 h (not recommended), 55.8% 7-8 h (may be appropriate), and 37.5% ≥ 9 h (recommended). Average total HEI-2015 score was 64.6 (out of possible 100), with boys having lower HEI-2015 scores than girls (57.7 vs 69.4). Moreover, girls and boys with shorter sleep duration (≤6 h compared to ≥ 9 h) had lower HEI-2015 scores (-1.03 [95% CI -2.74, -0.47; p < .01] and -1.78 [95% CI -3.15, -0.86; p < .001], respectively). Regarding the individual components of dietary quality, those with ≤6 h of sleep had lower scores particularly in vegetables, protein sources, added sugars and saturated fats for girls and boys compared to those with ≥9 h. These findings suggest sleep may be an important determinant of dietary practices within the Mexican children.

Status and Determinants of Symptoms of Anxiety and Depression among Food Delivery Drivers in Shanghai, China

(1) Background: The psychological status of employees, especially vulnerable populations, has received considerable research attention. However, as a newly emerging and popular occupation in the gig industry, food delivery drivers have received little attention. The majority of these workers are immigrants who are already in a precarious position due to a lack of available jobs, inadequate medical care, poor diets, and communication and acculturation difficulties even before they take these jobs, which involve long working hours and exposure to the elements. (2) Methods: To examine the anxiety and depression symptoms of these workers and possible influencing factors, a cross-sectional study was conducted with a sample of food delivery drivers working for the Meituan Company (one of the largest e-platform companies in China). Anxiety and depression scales were adapted from the GAD-7, and the PHQ-9 was used to assess participants' related symptoms. Differences were compared in terms of sociodemographic, work situation, and lifestyle variables. Binary logistic regressions were conducted to analyze the effects of various factors on the two psychological dimensions. (3) Results: Among the 657 participants, the proportions of participants reporting anxiety and depression symptoms were 46.0% and 18.4%, respectively. Lack of communication with leaders (OR_AN = 2.620, 95% CI: 1.528-4.493, p < 0.001; OR_DE = 1.928, 95% CI: 1.039-3.577, p = 0.037) and poor sleep quality (OR_AN = 2.152, 95% CI: 1.587-2.917, p < 0.001; OR_DE = 2.420, 95% CI: 1.672-3.504, p < 0.001) were significant risk factors for both anxiety and depression symptoms. Women (OR = 2.679, 95% CI: 1.621-4.427, p < 0.001), those who climbed ≥31 floors per day (OR = 2.415, 95% CI: 1.189-4.905, p = 0.015), and those with a high frequency of breakfast consumption (OR = 3.821, 95% CI: 1.284-11.369, p = 0.016) were more likely to have anxiety symptoms. Participants who earned less than 5000 RMB (OR = 0.438, 95% CI: 0.204-0.940, p = 0.034), were unwilling to seek medical help (OR = 3.549, 95% CI: 1.846-6.821, p < 0.001), or had a high frequency of smoking (OR = 5.107, 95% CI: 1.187-21.981, p = 0.029) were more likely to be depressive. (4) Conclusion: The existence of communication channels with leaders and good sleep quality are protective factors for anxiety and depression symptoms. Participants who were female, climbed ≥31floors per day, and had a high frequency of eating breakfast were more likely to have anxiety symptoms, while earning less, unwillingness to seek medical help, and a high frequency of smoking were risk factors for depression symptoms.

Association Between Breakfast Consumption and Suicidal Attempts in Adolescents

Purpose

It has been previously reported that skipping breakfast is positively associated with increased depression, anxiety, stress, and psychological distress. This study examined the effects of breakfast consumption on suicide attempts among adolescents.

Patients and Methods

The Korean Youth Risk Behavior Web-based Survey (KYRBWS) is an anonymous self-report survey conducted with middle- and high-school students to understand the health behavior of Korean adolescents. Variables related to suicide risk such as suicide attempts, breakfast frequency, depression, anxiety, and violence were analyzed using multivariate logistic regression analysis. The class selected as the sample class was surveyed for all students and the number of youths selected as the sample in 2020 was 57,925 students from 800 schools (400 middle schools and 400 high schools) in 17 cities and provinces nationwide. Among them, the dataset for this study was 54,948 completed adolescent health behavior surveys.

Results

Adolescents who attempted suicide often skipped breakfast and had high stress levels. In the regression analysis, those who ate breakfast less than once a week had a stronger association with suicide attempts than the group of six or seven times a week (OR = 2.186; 95% CI = 1.873-2.552). In the group of feeling sadness or hopeless for more than two weeks in the past year, those who ate breakfast zero or once a week (OR = 1.269; 95% CI = 1.044-1.542), or two or three times (OR = 1.300; 95% CI = 1.043-1.619), showed a stronger correlation with suicide attempts than the group of six or seven times a week.

Conclusion

Breakfast can affect adolescents' emotions. Helping adolescents regularly eat breakfasts might be a suicide prevention strategy.

Association of Dietary Behaviors with Poor Sleep Quality and Increased Risk of Obstructive Sleep Apnea in Korean Military Service Members

PURPOSE

Sleep quality among military service members is important for enhancing their capabilities and preventing psychiatric problems. We aimed to explore the association of dietary behaviors with poor sleep quality and increased risk of obstructive sleep apnea (OSA) in military men on active duty.

PATIENTS AND METHODS

A large-scale multi-site cross-sectional survey was conducted in five units of the Republic of Korea's army. Poor sleep quality and increased risk of OSA were defined using the Pittsburgh sleep quality index (PSQI) and Berlin Questionnaire, respectively. Information on dietary behaviors, including the frequency of skipping breakfast, eating snacks, consuming a night meal, and overeating, were collected.

RESULTS

From August 2021 to September 2021, 4389 male respondents, mean age (20.8 ± 1.3 years), completed the survey; 2579 (58.8%) were assessed as having poor sleep quality, and 614 (14.0%) increased risk of OSA. After adjusting for lifestyle and occupational covariates, skipping breakfast 1-2 times weekly was associated with an increased likelihood of experiencing poor sleep quality, compared with not skipping breakfast (odds ratio: 1.23 [95% CI 1.02-1.47]). Eating night meals 5-6 times weekly was also associated with poor sleep quality (odds ratio: 5.54 [95% CI 2.49-14.18]). In addition, skipping breakfast daily (odds ratio: 2.28 [95% CI 1.27-4.03]) and eating night meals daily (odds ratio: 2.30 [95% CI 1.21-4.22]) were related to an increased risk of OSA.

CONCLUSION

Dietary behaviors appear to be related to poor sleep quality and a high risk of OSA. To improve sleep quality, dietary factors could be considered when promoting health programs for military personnel in further research.

Emotional Regulation Activities Moderates the Risk of Depression in People With Sleep Disturbance: Evidence From a Community Health Survey

Background and Objective It is widely known that poor sleep quality is closely related to depression, but there are limited studies on the mediating factors.Methods Based on national health survey data, the relationship between sleep quality and depressive symptoms was explored, and structural equations were drawn to determine whether emotional regulation activities, such as regular breakfast, regular exercise, smoking, and drinking contribute to poor sleep quality-induced depression.Results There was a significant correlation between poor sleep quality and depressive symptoms. Regular breakfast tended to mediate between poor sleep quality and depression the most, followed by smoking, drinking, and regular exercise.Conclusions Several emotional regulation activities including regular breakfast, can play a protective role in the process leading to poor sleep quality-induced depression. A follow-up study is required to examine the clinical aspect of how regular breakfast can prevent the process of poor sleep quality to depression.

Can Social Cognitive Theory Influence Breakfast Frequency in an Institutional Context: A Qualitative Study

Breakfast is considered an important meal, especially for people who are about to commence a long or demanding workday, and for roles that may involve physical tasks and a requirement to remain alert and vigilant in potentially high-risk situations. This study looks at breakfast consumption influences within two workplace institutional settings, namely military and mining. Semi-structured interviews were conducted with military personnel (n = 12) and mining employees (n = 12) to understand their breakfast consumption behaviour at work and at home, and the associated behavioural influences. The interview questions were framed by social cognitive theory. Overall, cognitive and environmental influences were the most prominent influences on breakfast consumption, less evident were behavioural influences. A negative stereotype of workplace institutional food services emerged as one of the most significant barriers to breakfast consumption for those already at work. Considerations of environmental influences on behaviour may need to be broadened beyond physical barriers and social influences, to include perceptions of the behavioural environment. Programs that aim to increase breakfast consumption must create areas where their employees want to go. Food systems need to ensure nutritious, quality, and appealing food is available. Interventions need to increase participants’ knowledge, improve their attitudes, and create positive expectations for breakfast.

Maternal meal irregularities during pregnancy and lifestyle correlates

Meal regularity can influence metabolic health. However, habits of skipping and delaying meals are rarely studied among pregnant women. This study examined the incidence of maternal meal skipping and meal delaying, and their associated lifestyle patterns during pregnancy. Pregnant women in the second trimester (18-24 weeks' gestation; n = 90) were recruited from the antenatal clinics in KK Women's and Children's Hospital, Singapore, 2019-2020. Data on sociodemographic, lifestyle and dietary habits were collected. Firstly, principal component analysis was used to identify lifestyle patterns. Subsequently, multiple logistic regression model was used to examine the association of lifestyle patterns with meal skipping and delaying. In total, 32 (35.6%) women had irregular meals, in which 25 (27.8%) and 26 (28.9%) women reported meal skipping and meal delaying for at least 3 times a week, respectively. Women with 'poor sleep and emotion' pattern as characterized by higher scores for poor sleep, depression, anxiety, and stress symptoms were associated with higher odds of meal skipping (OR 1.99; 95% CI 1.13, 3.53) and meal delaying (2.50; 1.31, 4.79). 'Sedentary' pattern, as characterized by greater daily time spent on television and screen electronic devices, and 'weight and inactivity' pattern, as characterized by higher BMI and physical inactivity level, were not associated with meal regularity. In this study, almost one-third of women reporting meal irregularities during pregnancy. 'Poor sleep and emotion' pattern is associated with a higher incidence of meal skipping and delaying. These findings suggest the need to address sleep and emotional health in interventions promoting healthy nutrition specifically regular eating in pregnancy.

Association between Irregular Meal Timing and the Mental Health of Japanese Workers

Breakfast skipping and nighttime snacking have been identified as risk factors for obesity, diabetes, and cardiovascular diseases. However, the effects of irregularity of meal timing on health and daily quality of life are still unclear. In this study, a web-based self-administered questionnaire survey was conducted involving 4490 workers (73.3% males; average age = 47.4 ± 0.1 years) in Japan to investigate the association between meal habits, health, and social relationships. This study identified that irregular meal timing was correlated with higher neuroticism (one of the Big Five personality traits), lower physical activity levels, and higher productivity loss. Irregular meal timing was also associated with a higher incidence of sleep problems and lower subjective health conditions. Among health outcomes, a high correlation of irregular meal timing with mental health factors was observed. This study showed that irregularity of meal timing can be explained by unbalanced diets, frequent breakfast skipping, increased snacking frequency, and insufficient latency from the last meal to sleep onset. Finally, logistic regression analysis was conducted, and a significant contribution of meal timing irregularity to subjective mental health was found under adjustment for other confounding factors. These results suggest that irregular meal timing is a good marker of subjective mental health issues.