Association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents: A global perspective from 64 countries

BACKGROUND: Poor quality sleep adversely impacts on adolescent wellbeing. More multinational research is needed to understand modifiable risk factors, such as dietary behaviours. This study aimed to examine the association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents across 64 countries. METHODS: We analysed the Global School-based Student Health Survey data from 175,261 adolescents (mean age 13.8 [0.98]; 48.5% females). Adolescents reported frequency of stress-related sleep disturbance and consumption of carbonated soft drinks and fast foods. Country-level estimates were obtained by using multivariable logistic regression and meta-analysis to obtain pooled estimates. FINDINGS: Overall, 7.5% of adolescents reported sleep disturbance during the past 12 months (males: 6.6%; females: 8.4%). Meta-analysis showed that adolescents having carbonated soft drinks ≥3 times/day had over 50% higher odds of reporting sleep disturbance than <once/day (OR=1.55, 95% CI 1.42–1.70 for males; 1.51, 1.37–1.68 for females). Adolescent males who had fast foods ≥4 days/week had 55% higher odds of reporting sleep disturbance than ≤1 day/week (1.55, 1.39–1.73), while the odds was 50% higher in females (1.50, 1.32–1.70). Carbonated soft drinks ≥3 times/day and fast foods ≥ 4 days/week were significantly associated with sleep disturbance in all but low-income countries for both genders; while the associations were significant in males and mixed in females across WHO regions. INTERPRETATION: Our findings suggest strong positive associations between carbonated soft drink and fast food intake with stress-related sleep disturbance. Prospective studies are needed to understand the directionality of the relationship.