Short sleep duration among children and adolescents has been associated with higher body mass index and other adverse health outcomes including Type 2 diabetes, heart disease, and some cancers. Food choices are one proposed mechanism through which this association may occur.

This study examined associations between sleep duration and both healthy and unhealthy food choices in a large nationally representative sample of American adolescents (n=13,284). The study analyzed fruit and vegetable consumption and fast food consumption conducted through home interviews. Sleep duration was reported by adolescents.

The variable “F&V consumption” was defined as whether or not the adolescent reported eating at least one vegetable and one fruit in the previous day. The variable “Fast food consumption” was created from information about how often the adolescent ate fast food (eating fast food 0-1 times or 2+ times in the last seven days).

The variable “sleep duration” was reported by adolescents. Responses were organized into three categories in accordance with previous literature and recommendations from the American Academy of Pediatrics:

• short sleep duration (<7 hours/night),
• mid-range sleep duration (7-8 hours/night), and
• recommended sleep duration (>8 hours/night).

Researchers estimated three nested logistic regression models for two outcome variables: daily vegetable and fruit consumption and prior week’s fast food consumption. Adjusted models included demographic and social/behavioral covariates.

More than 50 per cent of adolescents have fast food at least two times in the past week

More than half of the adolescents reported eating at least one vegetable and one fruit in the previous day and also reported consuming fast food two or more times in the previous seven days (respectively 55.9 per cent and 57.7 per cent). These adolescents who reported unhealthy food choices were signifi cantly older and had signifi cantly fewer siblings in the home.

More F&V consumption for adolescents reporting high level of physical activity and mother’s education level of high school diploma/GED

Adolescents reporting high levels of physical activity had significantly greater fruit and vegetable consumption and significantly less fast food consumption.

Adolescents reporting mother’s education level of high school diploma/GED had signifi cantly greater fruit and vegetable consumption, while adolescents reporting mother’s education of some college or more education reported signifi cantly lower fruit and vegetables consumption. Finally, adolescents reporting having two biological parents in the home had signifi cantly greater fruit and vegetable consumption.

Short sleepers reported significantly lower F&V consumption and greater fast food consumption

Our investigation found that short sleep duration (<7 hours per night) was associated with 25 per cent decreased odds of adequate F&V consumption and 20 per cent increased odds of fast food consumption.

Interestingly, while the recommended sleep duration for adolescents is >8 hours/night, the analyses show that midrange sleepers (7-8 hours/night) do not have signifi cantly decreased odds of consuming vegetables and fruit or increased odds of consuming fast food compared to the recommended duration.

This suggests that the association of short sleep duration on dietary choices might occur only below a set threshold of habitual short sleep duration.

Other covariates that showed statistically significant associations with vegetable and fruit consumption included physical activity, screen times, age, sex, Hispanic ethnicity, other race, mother’s education, and the presence of two biological parents in the home. Similarly, screen time, age, sex, mother’s education, and number of siblings in the home showed statistically signifi cant associations with the fast food consumption.

Our study demonstrates that sleep may be related to both healthy and unhealthy food choices of adolescents, with short sleepers being more vulnerable than adolescents with seven or more hours of sleep/night.

Health promotion and obesity-prevention interventions

Future research should seek to investigate the causal pathways of the observed associations. If evidence supports that chronic sleep defi ciency is causally linked to poorer food choices, then programs that improve sleep and sleep hygiene might be an important and underappreciated component of health promotion and obesity-prevention interventions.