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Sleep status and its association with dietary habits among children and adolescents in Shandong Province, China: a cross-sectional study

樱花视频 volume听25, Article听number:听1142 (2025) Cite this article

Abstract

Background

Insufficient sleep is a widespread issue among children and adolescents, influenced by various factors, including dietary habits. This study aimed to examine the relationship between dietary habits and sleep insufficiency in children and adolescents aged 6 to 18 in Shandong Province, China.

Methods

Data were derived from a 2024 survey assessing sleep status among children and adolescents in Shandong Province. the prevalence of insufficient sleep was determined, and univariable 围虏 test was used to explore associations between daily life behaviors and sleep duration. Multivariable logistic regression was employed to analyze the effect of specific dietary habits on sleep insufficiency, adjusting for potential confounding factors.

Results

The overall prevalence of insufficient sleep was 53.28%. After adjusting for confounders, the logistic regression model indicated that regular breakfast consumption 4鈥墌鈥�6 times per week (OR鈥�=鈥�0.578, 95% CI 0.522鈥墌鈥�0.640) or every day (OR鈥�=鈥�0.502, 95% CI: 0.450鈥墌鈥�0.561) was associated with significantly lower odds of insufficient sleep. Higher vegetable intake more than five times per week (OR鈥�=鈥�0.376, 95% CI: 0.338鈥墌鈥�0.418) and fruit consumption 4鈥墌鈥�5 times per week (OR鈥�=鈥�0.866, 95% CI: 0.816鈥墌鈥�0.918) or more than five times per week (OR鈥�=鈥�0.446, 95% CI: 0.405鈥墌鈥�0.490) were also linked to reduced odds of insufficient sleep. Conversely, higher sugary beverage consumption 4鈥墌鈥�5 times per week (OR鈥�=鈥�2.066, 95% CI: 1.903鈥墌鈥�2.243) or more than five times per week (OR鈥�=鈥�2.021, 95% CI: 1.838鈥墌鈥�2.223) significantly increased the likelihood of insufficient sleep. Fast food consumption 2鈥墌鈥�3 times per week (OR鈥�=鈥�1.025, 95% CI: 1.003鈥墌鈥�1.048) or more than three times per week (OR鈥�=鈥�1.036, 95% CI: 1.002鈥墌鈥�1.071) was also associated with higher odds of insufficient sleep (P鈥�&濒迟;鈥�0.05).

Conclusion

Dietary habits significantly influence sleep duration among children and adolescents in Shandong Province. Regular breakfast consumption, increased intake of vegetable and fruit, and reduced consumption of sugary beverage and fast food were associated with improved sleep duration. These findings underscored the importance of promoting healthy eating behaviors as a key strategy for addressing sleep-related issues and improving overall well-being in young populations.

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Background

Sleep plays a critical role in modulating growth, development, and physical and mental health in children and adolescents [1,2,3,4,5]. Insufficient sleep in this population is associated with multiple adverse health outcomes, including overweight/obesity [6, 7], type 2 diabetes [8], hypertension [9], falling [10], and frailty [11]. Short sleep duration has also been linked to impairments in academic achievement [12, 13] and a range of risk behaviors related to injury [14], diet [15], and health behaviors [16]. The American Academy of Sleep Medicine recommends that adults aged 18鈥墌鈥�60 years obtain a minimum of 7听h of nocturnal sleep per night to maintain optimal health [17]. However, with the advancements of modern society, average sleep duration has been steadily declining worldwide over the past several decades [18]. In 1975, data from the national Gallup poll indicated that the modal sleep duration in the United States was 鈮モ��8听h. However, by 2011, findings from the National Sleep Foundation鈥檚 Sleep in America poll revealed a significant decline, with the average sleep duration on weeknights reduced to 6听h and 55听min [19]. For children and adolescents, the American Academy of Sleep Medicine recommends an optimal sleep duration of 9鈥墌鈥�12听h per day for children aged 6鈥墌鈥�12 years and 8鈥墌鈥�10听h per day for adolescents aged 13鈥墌鈥�18 years [20]. However, with the increasing pace of modern life and growing academic pressure, insufficient sleep among children and adolescents has become an increasingly serious issue [21, 22]. A nationally representative cross-sectional survey of adolescents in the United States from 1991 to 2012 found that adolescent sleep generally declined over 20 years [23]. Similarly, longitudinal research spanning from 1905 to 2008 has demonstrated a steady and significant decrease in the sleep duration of children and adolescents over the last 103 years [24]. Comparable trends have also been observed in other regions, including China and Australia [25], underscoring that short sleep duration is a widespread global phenomenon. Research consistently indicated that short sleep could result in endocrine alterations [26], including reductions in leptin [27], glucose tolerance [28], and insulin sensitivity [29], as well as increased ghrelin levels, hunger, and appetite [30]. Additionally, various studies have established a link between short sleep and specific behavioral changes, such as decreased physical activity, lower fruit and vegetable consumption [31], and an increase in caloric intake that exceeds total daily energy needs [32]. Evidence suggested that more frequent breakfast consumption was associated with fewer sleep difficulties, while regular fruit and vegetable intake was also linked to reduced sleep difficulties. Additionally, lower consumption of sweets and soft drinks has been generally associated with fewer sleep difficulties [33]. Prioritizing the health of younger populations is integral to achieving the United Nations鈥� Sustainable Development Goals for 2030, particularly Goal 3, which focuses on ensuring healthy lives and promoting well-being for individuals of all ages [34]. This study aimed to investigate sleep status and its association with dietary habits among children and adolescents in Shandong Province, China. Using a cross-sectional design, it explored the relationship between sleep duration and dietary intake, providing valuable insights into the interplay between these factors in this population.

Materials and methods

Design and participants

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines [35]. A stratified random cluster sampling method was utilized to recruit participants aged 6鈥墌鈥�18 years from 237 primary and secondary schools across 16 cities in Shandong Province between November and December 2024. Stratification was based on grade, with entire classes randomly selected as sampling units. A total of 192,185 students were initially surveyed. Students with significant organ diseases, physical disabilities, or deformities were excluded from the study. After applying exclusion criteria, 186,723 students successfully completed the questionnaire, achieving a response rate of 97.16%.

Questionnaire survey

All participants and investigators involved in this study underwent standardized training to ensure proficiency in field epidemiological techniques. Prior to the initiation of the survey, both students and their parents were thoroughly informed about the study鈥檚 objectives and potential implications. Students were provided with questionnaires and allowed a one-day period to discuss the items with their parents before completing them. The completed questionnaires were systematically collected, and the data were promptly organized and entered for comprehensive analysis. Ethical approval for this study was granted by the Ethics Committee of Shandong Institute of Petroleum and Chemical Technology (registered number: KY-2024-034). All procedures were carried out in strict compliance with relevant ethical guidelines and regulations. Written informed consent was obtained from the parents or legal guardians of all participants, as all participants were minors under the age of 18.

The questionnaire was administered anonymously and encompassed a range of topics, including sleep status. Based on previous research, factors closely related to sleep status were selected, including demographic characteristics and daily life behaviors. Sleep status was assessed in terms of duration, while demographic information included gender, educational stage, mode of study, household registration type, annual family income (yuan), and parental education levels. Daily life behaviors were evaluated through variables such as daily physical exercise duration (hour), daily screen duration (hour), frequency of passive smoking exposure per week, and weekly consumption frequencies for breakfast, meat, vegetable, fruit, eggs, milk, sugary beverage, dessert, and fast food. The weekly duration for sleep, physical exercise, and screen time were calculated using the formula: Weekly duration = [Average duration on school days (hours/day)脳5鈥�+鈥堿verage duration on weekends (hours/day)脳2)]/7. Sleep insufficiency was defined based on Health requirements of daily learning time for secondary and elementary school students (GB/T 17223鈥夆垝鈥�2012). According to these guidelines, the minimum recommended daily sleep duration is 10听h for primary school students, 9听h for junior high school students, and 8听h for senior high school students. Students with sleep duration below these thresholds were categorized as insufficient sleep [36].

Statistical analysis

The database was meticulously constructed using EpiData 3.1 (EpiData Association, Odense, the Kingdom of Denmark), and data analysis was subsequently performed using Statistical Product and Service Solutions 29.0 (International Business Machines Corporation, New York, the United States of America). Categorical variables were presented as frequencies and percentages (%). Univariable analysis was conducted using the chi-squared (蠂虏) test to identify significant associations. Variables with statistical significance (P鈥�<鈥�0.05) in the univariable analysis were included in the multivariable logistic regression analysis. Logistic regression was then performed, and the results were reported as odds ratios (OR) with 95% confidence intervals (CI) to provide precise effect estimates. To ensure the reliability of the findings, the goodness-of-fit of the logistic regression model was evaluated using the Hosmer-Lemeshow test. This rigorous analytical approach validated the robustness of the model and underscored the reliability and precision of the study鈥檚 statistical framework, ensuring adherence to the principles of statistical rigor.

Results

Baseline characteristics of the participants

Based on the 2024 survey data on sleep status among children and adolescents aged 6鈥墌鈥�18 in Shandong Province, the overall prevalence of insufficient sleep was 53.28%. A Gender difference was observed, with females exhibiting a slightly higher prevalence (53.53%) compared to males (53.06%) (P鈥�&濒迟;鈥�0.05). Educational level also influenced sleep insufficiency, with the highest prevalence observed among junior high school students (53.61%), followed by senior high school students (53.50%), and the lowest among primary school students (52.95%) (P鈥�&濒迟;鈥�0.05). Study mode was another contributing factor, as boarding students demonstrated a higher prevalence of insufficient sleep (52.95%) compared to day students (53.48%) (P鈥�&濒迟;鈥�0.05). Household registration status significantly impacted sleep insufficiency rates, with urban students showing a higher prevalence (53.46%) than their rural counterparts (52.91%) (P鈥�&濒迟;鈥�0.05). Parental education levels were also associated with sleep insufficiency. For fathers, the highest prevalence was observed among students whose fathers had an education level above senior high school (53.52%), followed by senior high school (53.21%), and the lowest among those with junior high school education or below (52.70%) (P鈥�&濒迟;鈥�0.05). A similar pattern was found for maternal education, with the highest prevalence among students whose mothers had an education level above senior high school (53.54%), followed by senior high school (53.06%), and the lowest among those with junior high school education or below (52.81%) (P鈥�<鈥�0.05) (Table听1).

Table 1 Sleep status according to demographic characteristics of participants in Shandong Province based on 蠂虏 test
Full size table

Univariable 围虏 test of the association between daily life behaviors and sleep duration among participants

The univariable analysis revealed that several factors were significantly associated with the sleep status among children and adolescents aged 6鈥墌鈥�18 in Shandong Province. These factors included physical exercise duration per day (hour), times of passive smoking per week, times of breakfast intake per week, times of vegetable intake per week, times of fruit intake per week, times of sugary beverage consumption per week, times of fast food consumption per week (P鈥�<鈥�0.05) (Table听2).

Table 2 Univariable analysis of sleep status among participants in Shandong Province based on 围虏 test
Full size table

Multivariable logistic regression analysis of the association between dietary habits and sleep duration among participants

Using students鈥� sleep status (0鈥�=鈥塻ufficient sleep, 1鈥�=鈥塱nsufficient sleep) as the dependent variable, and based on inclusion and exclusion criteria (P鈥�=鈥�0.05), a total of 13 independent variables were included in the multivariable logistic regression analysis. These variables were: gender, education stage, mode of study, household registration, father鈥檚 education level, mother鈥檚 education level, physical exercise duration per day (hour), times of passive smoking per week, times of breakfast intake per week, times of vegetable intake per week, times of fruit intake per week, times of sugary beverage consumption per week, times of fast food consumption per week. However, the results of the Hosmer-Lemeshow test suggested that the logistic regression model did not exhibit an ideal fit (P鈥�<鈥�0.05), suggesting some potential discrepancies in the model鈥檚 fit. After adjusting for confounding factors, several determinants were identified as reducing the odds of insufficient sleep. Children and adolescents who consumed breakfast 4鈥墌鈥�6 times per week (OR鈥�=鈥�0.578, 95% CI: 0.522鈥墌鈥�0.640) or every day (OR鈥�=鈥�0.502, 95% CI: 0.450鈥墌鈥�0.561) exhibited significantly lower odds of insufficient sleep compared to those who never consumed breakfast. Children and adolescents who consumed vegetable more than five times per week (OR鈥�=鈥�0.376, 95% CI: 0.338鈥墌鈥�0.418) demonstrated significantly lower odds of insufficient sleep compared to those who consumed vegetable fewer than four times per week. Similarly, fruit intake was associated with reduced odds of insufficient sleep. Specifically, individuals consuming fruit 4鈥墌鈥�5 times per week (OR鈥�=鈥�0.866, 95% CI: 0.816鈥墌鈥�0.918) or more than five times per week (OR鈥�=鈥�0.446, 95% CI: 0.405鈥墌鈥�0.490) had significantly lower odds of insufficient sleep compared to those with fruit intake fewer than four times per week. Conversely, some factors have been identified that increased the odds of insufficient sleep. Children and adolescents who consumed sugary beverage 4鈥墌鈥�5 times per week (OR鈥�=鈥�2.066, 95% CI: 1.903鈥墌鈥�2.243) or more than five times per week (OR鈥�=鈥�2.021, 95% CI: 1.838鈥墌鈥�2.223) had significantly higher odds of insufficient sleep compared to those with sugary beverage consumption fewer than four times per week. Similarly, fast food consumption was associated with increased odds of insufficient sleep, with individuals consuming fast food 2鈥墌鈥�3 times per week (OR鈥�=鈥�1.025, 95% CI: 1.003鈥墌鈥�1.048) or more than three times per week (OR鈥�=鈥�1.036, 95% CI: 1.002鈥墌鈥�1.071) exhibiting significantly higher odds of insufficient sleep compared to those consuming fast food fewer than two times per week (P鈥�<鈥�0.05) (Table听3).

Table 3 Multivariable analysis of the association between dietary habits and sleep status among participants in Shandong Province based on logistic regression
Full size table

Discussion

In the Shandong Province, a significant proportion of children and adolescents aged 6 to 18 are affected by insufficient sleep, with specific dietary habits contributing to its prevalence.

This study revealed that regular breakfast consumption was inversely associated with insufficient sleep duration among children and adolescents. This finding was consistent with previous researches highlighting the positive role of breakfast in promoting adequate sleep duration [37,38,39]. Breakfast is often referred to as the most important meal of the day [40, 41] due to its critical role in providing sufficient energy [42] and essential nutrients [43], supporting daily physiological functions and activities. Regular breakfast consumption helps maintain stable energy levels throughout the day, reducing hunger-induced anxiety and emotional fluctuations [44, 45], which are known to interfere with daytime activities and learning. By promoting emotional and psychological stability, breakfast consumption may mitigate the risk of sleep onset difficulties, thereby supporting healthy sleep patterns and improved sleep quality. Furthermore, regular breakfast consumption fosters the development of healthy dietary habits [46]. Early morning meal timing encourages children and adolescents to engage in physical and mental preparation for the day, promoting a structured and active daily routine. Consistent breakfast timing may also regulate lunch and dinner schedules, ultimately influencing nighttime sleep patterns and reducing the prevalence of insufficient sleep.

This study found that a higher frequency of vegetable intake was associated with a lower prevalence of insufficient sleep duration among children and adolescents. This observation was supported by previous researches [47,48,49]. Emerging evidence suggested that certain foods contain nutrients with sleep-enhancing properties [50]. For instance, plant-based, varied diets, whole grains, and low-fat protein sources are rich in B-group vitamins, minerals, and carbohydrates that promote the availability of tryptophan, which is essential for the synthesis of serotonin and melatonin in the body [51]. Serotonin regulates sleep by modulating the concentration of melatonin [52], and melatonin itself helps lower core body temperature and increases sleep propensity through thermoregulatory mechanisms [53]. Certain vegetables such as the dark green leafy vegetables are abundant in magnesium, which is a cofactor in neurotransmitter synthesis. Magnesium sulfate injections administered to experimental rats have been shown to significantly stimulate melatonin secretion from the pineal gland [54].

This study demonstrated that a higher frequency of fruit intake was associated with a lower prevalence of insufficient sleep duration among children and adolescents. This finding was consistent with previous researches that reported similar associations [55,56,57]. The potential mechanisms underlying the beneficial effects of fruit consumption on sleep may involve their high content of melatonin and serotonin, which play critical roles in regulating sleep-wake cycles [58]. Additionally, the antioxidant properties of fruits may reduce oxidative stress, thereby improving sleep quality [59]. Conversely, insufficient and poor-quality sleep have been linked to increased emotional distress, which may promote the consumption of energy-dense foods and reduce fruit intake, suggesting a potentially bidirectional relationship between fruit consumption and sleep parameters [60]. Furthermore, disrupted sleep has been shown to alter appetite-regulating hormones, such as ghrelin and leptin, leading to increased intake of energy-dense foods and reduced fruit consumption [61].

This study observed that increased frequency of sugary beverage consumption was associated with insufficient sleep duration among children and adolescents, consistent with findings from previous researches [62,63,64]. The potential mechanisms underlying this relationship may involve the effects of high sugar intake on blood glucose levels. Initially, elevated blood glucose may facilitate sleep onset. However, the rapid increase in blood glucose triggers compensatory insulin release, leading to a subsequent drop in blood glucose levels. This drop stimulates the release of hormones such as adrenaline and cortisol, which can disrupt sleep and potentially cause insomnia [65]. Another possible mechanism is that short sleep duration exacerbates stress and fatigue, adversely affecting mood. This may drive individuals to consume sugary beverages to enhance alertness, reduce sleepiness, and improve mood [66]. Furthermore, insufficient sleep has been shown to influence the regulation of appetite-controlling hormones, such as ghrelin and leptin, potentially encouraging greater consumption of sugary beverage [67].

This study identified that a higher frequency of fast food intake was associated with insufficient sleep duration among children and adolescents, a finding supported by previous researches [62, 68, 69]. While fast food is often favored for its convenience, especially by adolescents with limited time, it typically presents significant nutritional drawbacks, including excessive calories, sugars, salts, and fats [70]. The mechanism by which reduced energy intake may improve sleep duration is only partially understood, with some explanations emerging from animal studies. Research has shown that long-term high-energy feeding reduces the levels of neuropeptide Y precursor in the hypothalamus of mice. Neuropeptide Y plays a critical role in maintaining wakefulness and regulating energy balance. When energy intake is reduced, hypothalamic signaling of neuropeptide Y is enhanced, promoting more stable wakefulness and reducing daytime sleep, which in turn contributes to improved nighttime sleep [71]. Furthermore, insufficient sleep has been shown to affect the regulation of appetite-controlling hormones, such as ghrelin and leptin, potentially leading to increased fast food consumption [59].

Conclusion

This study highlighted the significant impact of dietary habits on sleep duration among children and adolescents in Shandong Province. The findings suggested that regular consumption of breakfast, vegetable, and fruit was associated with a lower prevalence of insufficient sleep, while high intake of sugary beverage and fast food was linked to an increased likelihood of sleep insufficiency. These results emphasized the importance of promoting healthy eating habits as a means to support adequate sleep and improve overall well-being. Interventions aimed at encouraging balanced diets, particularly the consumption of nutrient-rich foods, could play a crucial role in addressing sleep-related issues in children and adolescents. However, several limitations should be considered when interpreting the findings. First, the cross-sectional design of the study limited the ability to establish causal relationships between dietary habits and sleep status, as it only captured associations at a single point in time. To better elucidate the causal pathways, longitudinal studies were necessary. Additionally, the data on sleep status, demographic characteristics and daily life behaviors were based on self-reports, which might be subject to recall bias or inaccuracies in reporting. While the study adjusted for several potential confounders, other unmeasured factors may have affected sleep patterns, potentially impacting the results. Furthermore, the study was conducted in Shandong Province, China, limiting the generalizability of the findings to other regions with different cultural, dietary, or socioeconomic characteristics. Future research should aim to include larger and more diverse populations to assess the broader applicability of these findings. Lastly, the study primarily focused on sleep duration rather than sleep quality. Future studies that consider both sleep duration and quality would provide a more comprehensive understanding of the relationship between dietary habits and sleep.

Data availability

The data used during the current study are included in this published article and its supplementary information files.

Abbreviations

蠂虏 test:

Chi-squared test

OR:

Odds ratio

CI:

Confidence interval

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Authors and Affiliations

  1. School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China

    Zhihao Huang,听Rumeng Cheng,听Kunzong Tian听&听Yuting Jiang

  2. Physical Education Department, Nanjing Audit University, Nanjing, China

    Chen Tong

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  1. Zhihao Huang

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  2. Chen Tong

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  3. Rumeng Cheng

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  4. Kunzong Tian

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  5. Yuting Jiang

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Contributions

The authors confirm contribution to the paper as follows: Z.H., C.T., R.C., and K.T. devised the project and the main conceptual ideas and planned the research. Z.H., C.T., and Y.J. worked out the methodology. Z.H., C.T., and R.C. performed the data collection. Z.H. and C.T. also organized and maintained research data for analysis. Z.H. performed analytic calculations. Z.H., C.T., and K.T. validated the reproducibility of the results. Z.H., R.C., and K.T. wrote the manuscript with input from all authors. Z.H., R.C., and Y.J. extensively reviewed the work and further edited the manuscript. All authors contributed to the article and approved the submitted version.

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Correspondence to Chen Tong.

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Huang, Z., Tong, C., Cheng, R. et al. Sleep status and its association with dietary habits among children and adolescents in Shandong Province, China: a cross-sectional study. 樱花视频 25, 1142 (2025). https://doi.org/10.1186/s12889-025-22412-0

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  • DOI: https://doi.org/10.1186/s12889-025-22412-0

Keywords

樱花视频

ISSN: 1471-2458

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