Do TV viewing and frequency of ultra-processed food consumption share mediators in relation to adolescent anxiety-induced sleep disturbance?

Abstract

Objective: To investigate the role of potential shared mediators in the association of TV-viewing and frequency of ultra-processed food consumption with anxiety-induced sleep disturbance. Design: Cross-sectional study. Setting: Data from the Adolescent School-based Health Survey, a Brazilian nationally representative survey of 9th grade adolescents conducted in 2015 were used. Participants: 99,791 adolescents (52,015 girls) with a mean age of 14.3 years (range: 11–19 years) participated. All variables were collected through a self-reported questionnaire based on the Global School-based Student Health Survey. Anxiety-induced sleep disturbance was the outcome. More than 4h/day of TV-viewing and daily consumption of ultra-processed foods were the exposures. Body satisfaction, loneliness, self-rated health and eating while watching TV or studying were mediators. Age, ethnicity, food insecurity, type of city (capital or interior), country region, and physical activity were covariates. Logistic regression and mediation models (Karlsson-Holm-Breen method) assessed associations. Results: Both daily ultra-processed food consumption [boys:OR:1.48(95%CI:1.30-1.70); girls:1.46(1.34-1.60)] and TV-viewing [boys:1.24(1.08-1.43); girls:1.09(1.00-1.19)] were associated with higher odds for anxiety-induced sleep disturbance. Loneliness and eating while watching TV or studying consistently mediated the association of both daily ultra-processed food consumption (loneliness: boys: 17.4%, girls: 23.4%; eat while watching TV or studying: girls: 6.8%) and TV-viewing (loneliness: boys: 22.9%, girls: 45.8%; eat while watching TV or studying: boys: 6.7%, girls: 17.9%) with anxiety-induced sleep disturbance. Conclusions: Daily ultra-processed food consumption and TV-viewing share mediators and can act in synergic mechanisms in the association with anxiety-induced sleep disturbance. Therefore, future interventions should focus in the reduction of both behaviors in combination.

Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies

“…Although the third study reported a beta-coefficient, it was not possible to estimate the confidence interval given an exact p-value or measure of variance were not reported [17]. Similarly, four studies [20,[25][26][27] did not report p-values. We estimated these by using the confidence intervals as per the methods proposed by [47].…”

“…Sample sizes ranged from 33 to 100,684 participants. Two studies conducted analyses on the same sample of adolescents; one had a sample size of n = 100,648 and used an exposure that combined high ultra-processed food intake with high sedentary behaviour [26]; and the other had a sample size of n = 99,971 and separated these lifestyle behaviours [25]. Included studies examined associations between ultra-processed food consumption and the common mental disorders (i.e., depression and anxiety, which were assessed together (N = 2) and separately (N = 8 for depression and N = 6 for anxiety)).…”

“…Eleven studies modelled ultra-processed food consumption as the exposure variable and mental disorder parameters as the outcome [17][18][19]21,[23][24][25][26]30,48,50], with the remaining six modelling associations in the opposite direction [20,22,[27][28][29]31].…”

“…However, the meta-analysis assessing associations of ultra-processed food consumption with mental disorders was limited only to depression and by the number of studies available for inclusion at the time of publication (n = 2). Several additional studies have since been published assessing the link between ultra-processed food consumption and depression as well as other mental disorders [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The need for an updated review is further exacerbated by the fact that ultra-processed foods have become increasingly ubiquitous for many food systems globally [13], thus understanding any relationship with mental disorders is critical for understanding the health implications of this trend.…”

Ultra-processed food intake and eating disorders: Cross-sectional associations among French adults

“…A handful of studies have explored UPF in relation to other mental health outcomes. For example, one cross-sectional and two prospective analyses among adults showed an increased risk of depression or depressive symptoms associated with NOVA-categorized UPF consumption (Adjibade et al, 2019;Gómez-Donoso et al, 2020;Zheng et al, 2020), and one cross-sectional study reported a positive association between UPF intake and anxiety-induced sleep disturbance among adolescents (Werneck et al, 2021). The substantial sugar/salt/fat content and various additives (i.e., colors, flavors, emulsifiers) -all of which render UPF highly palatable (Monteiro et al, 2019) can help explain the significant findings observed with bulimic, binge eating and other ED.…”