The Impact of Unhealthy Eating Behaviors on Sleep Quality Among University Students: A Cross‐Sectional Study

  1. Maha Al-Jawarneh

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Abstract

Background: This study examined the impact of specific unhealthy eating behaviors on sleep quality (SQ) among university students. Understanding how dietary habits affect sleep during the significant lifestyle transitions that students experience during university life can inform health promotion strategies. Methods: A cross-sectional study was conducted among international university students using a self-administered questionnaire assessing dietary habits, meal timing, and sleep-related behaviors. The Pittsburgh Sleep Quality Index (PSQI) was utilized to assess sleep quality. Statistical analyses were performed to examine the relationship between eating patterns and overall sleep quality and its components. Results: More than half of the 385 students (51.7%) had poor sleep quality, as defined by the PSQI criteria. Daytime dysfunction was significantly more common among females than males (27.9% vs. 8.3%, respectively; p<0.001). Conversely, poor sleep efficiency was more prevalent among males than females (27.5% vs. 15.8%; p=0.008). Multivariate logistic regression revealed that, compared to students who did not frequently consume heavy evening meals, those who did were more likely to experience poor sleep quality (OR = 2.73, 95% CI: 1.575-4.731). Similarly, those who frequently replaced regular meals with snacks were more likely to experience poor sleep quality than those who did not (OR = 2.68, 95% CI: 1.465-4.895). Finally, students who ate within three hours of bedtime had higher odds of poor sleep quality compared to those who had their last meal more than three hours before bedtime (OR = 2.06, 95% CI: 1.173-3.629). Conclusion: Unhealthy dietary habits, such as consuming heavy evening meals, replacing meals with snacks, and a short meal-to-bedtime interval are significantly associated with poor sleep quality. Interventions promoting healthier dietary patterns and appropriate meal timing could help improve sleep and overall well-being in this population.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/18327077.

    MAJOR ISSUES

    The study on the impact of unhealthy eating behaviors on sleep quality among university students, while providing meaningful associations, has several acknowledged limitations and potential issues:

    Methodological Limitations (Cross-Sectional Design)

    • Inability to Establish Causality: The most significant weakness is the study's cross-sectional methodology. While it can explore associations between unhealthy eating behaviors and poor sleep quality, it cannot establish causality. It is impossible to determine whether poor sleep leads to unhealthy eating habits or vice versa.

    • Reliance on Self-Reported Data: The study relied on a self-administered questionnaire, which introduces the potential for response and recall bias. This could compromise the accuracy of reported dietary habits, meal timing, and sleep quality outcomes.

    Scope and Generalizability Issues

    • Restricted Generalizability: The inclusion of only university students limits the findings' generalizability to non-student populations.

    • Focus on International Students: While targeting international students adds unique insight, their distinct challenges (cultural adaptation, language barriers, isolation) mean the findings may not fully apply to domestic student populations.

    Unexamined Confounding Factors

    • Lack of Detailed Dietary Analysis: The study did not provide a detailed analysis of diet quality or quantity beyond specific behaviors (e.g., heavy meals, snacking). This misses the potential confounding effect of nutrient intake on sleep.

    • Mental Health and Environmental Factors: The study explicitly did not examine other factors that could significantly impact sleep quality, such as environmental factors or mental health assessments (e.g., anxiety, depression), which are known to be higher among female students and affect sleep.

    Statistical Considerations

    • Lack of Significance for Some Hypothesized Behaviors: While the study hypothesized that behaviors like skipping breakfast and late-night snacking would be associated with poor overall sleep quality, the adjusted multiple logistic regression analysis found they were not statistically significant independent predictors of overall poor sleep quality.

    In summary, the key issues are the cross-sectional design precluding causal inference, the reliance on self-reported data, and the failure to account for critical unexamined confounders like diet quality and mental health.

    MINOR ISSUES

    • In addition to the major limitations, the study has a few minor issues and areas where detail or discussion could be improved:

    1.     Convenience Sampling:

    The use of convenience sampling (a technique selected for its practicality and cost-effectiveness) introduces potential selection bias, as the participants were not randomly selected. While practical for this specific student cohort, it slightly weakens the representativeness of the sample compared to probability sampling methods.

    2.     Definition of Unhealthy Behaviors:

    While the study defines key unhealthy behaviors, the assessment relies on the students' self-perception and reporting frequency rather than objective measurement (e.g., diet diaries or physiological markers). For example, the definition of an "adequate" meal-to-bedtime interval (three hours or more) is based on existing research but is a binary cut-off, which may not capture the full range of effects.

    3.     Ambiguity in "Other" Marital Status:

    In Table 1, 13.5% of students are categorized under "Other" for marital status. The specific definitions included in this category are not detailed, which leaves a significant portion of the sample's marital context ambiguous.

    4.     Discrepancy in Authorship Listing:

    The first page of the preprint lists Maha Al-Jawarneh as the sole author, while the second page lists four authors: Shalini Chauhan, Maha Al-Jawarneh, Ildikó Csölle, and Szimonetta Lohner. This discrepancy in the initial presentation of authorship could be considered a minor editorial or formatting issue.

    5.     Focus on the Sample:

    Although the large sample size is listed as a strength, the sample is overwhelmingly female (68.8%). While sex-based variations are discussed, this imbalance might affect the generalization of certain findings, particularly those where males showed poorer outcomes (e.g., sleep efficiency).

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  2. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/18154102.

    Does the introduction explain the objective of the research presented in the preprint? Yes In the introduction, it talks about how the study seeks to explore and investigate how detrimental dietary behaviors such as; irregular meal timings, skipping breakfast, consuming heavy evening meals, substituting meals with snacks, and late-night snacking impact sleep quality among international university students. A suggestion to rephrase the first two paragraphs could be: Poor sleep quality (SQ) is a major public health concern, linked to increased morbidity, mortality, impaired cognition, and higher healthcare costs." [1]. "It impairs cognition, worsens physical and mental health, and increases healthcare costs." [2,3]. Sleep disturbance, including insomnia, is more common among young adults—particularly university students—than in the general population [4–6]. Good SQ is defined as the individual's overall evaluation of their sleep based on factors, such as sleep efficiency, latency, duration, and the amount of wakefulness after sleep inception [7]. Validated tools such as the Pittsburgh Sleep Quality Index (PSQI) are available to measure these characteristics [7,8].
    Are the methods well-suited for this research? Somewhat appropriate In section 2.6.1.(Anthropometric Assessment ) Please verify that the Standard WHO classification uses "≥" not ">" for obesity class III
    Are the conclusions supported by the data? Highly supported The conclusion can be rephrased as follows: This study demonstrated that unhealthy dietary habits, particularly consuming heavy evening meals, replacing meals with snacks, and a short meal‐to‐bedtime interval, are significantly associated with poor sleep quality among international university students. The findings accentuate the importance of promoting healthier dietary habits and consistent meal timing to improve sleep quality and overall, well‑being in this population.
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Somewhat clearly
    Is the preprint likely to advance academic knowledge? Highly likely
    Would it benefit from language editing? Yes Spellings such as of the word behaviour throughout the document. Parentheses should be removed to improve the flow in writing for example in section 2.6 it could be rephrased as: Sociodemographic characteristics included age, sex, marital status, nationality, residential setting, academic faculty, academic level and year of study, lifestyle factors included alcohol and coffee consumption, smoking status, perceived stress levels, physical activity, and napping habits. Participants also self‐reported their height and weight. Dietary behaviours assessed usual mealtime regularity, breakfast skipping, consumption of late‐night snacks (defined as after 10 PM), replacement of meals with snacks, tendency to consume heavier evening meals compared to daytime, and the typical time interval between the last meal and bedtime. In section 2.6.3. (Eating Habits Assessment) The last paragraph can be rephrased: To clarify, participants were informed that snacks included calorie‐rich items such as chips, sweets, baked goods, processed meats, cheeses, and beverages, excluding water, diet drinks, tea, and plain coffee. Responses were recorded as either 'yes' or 'no'. In addition, they were asked to report the interval between their last meal of the day and bedtime, selecting from predefined categories: 0–2 hours, or ≥3 hours. In section 2.6.4. (Coding and Categorization of Variables) the 3rd and last paragraph can be rewritten as follows: Sleep disturbance (assessed by the frequency of various sleep‐related problems such as waking up at night, breathing issues, or experiencing bad dreams that interfere with sleep quality) was categorized as adequate if <10 out of 27, and inadequate if ≥10." The need for sleep medication was deemed adequate with no or low usage (scores of 0 or 1) if participants reported using it less than once per week, and inadequate with medium or high usage (scores of 2 or 3) if used once per week or more. Daytime dysfunction was classified as adequate (scores 0–1, indicating no or minor problems) and inadequate for scores of 2 or 3 for medium or high levels (indicating the problem was sometimes or very frequently an issue). Finally, the time interval between the last meal and bedtime was considered adequate if it was three hours or more, and inadequate if it was less than three hours [30]. In the Discussion section 4.2.3. (Irregular Meal Timing) in the 2nd last paragraph: You can delete: its cross-sectional methodology and replace it with its cross-sectional design.
    Would you recommend this preprint to others? Yes, but it needs to be improved Grammar and rephrasing of some paragraphs.
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  3. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/17605090.

    Does the introduction explain the objective of the research presented in the preprint? Yes Yes, the introduction of the preprint clearly explains the objective of the research presented, stating that the study examined the impact of specific unhealthy eating behaviors on sleep quality (SQ) among university students. The research specifically sought to explore how detrimental dietary behaviors, including eating close to bedtime, substituting meals with snacks, late-night snacking, skipping breakfast, consuming heavy evening meals, and irregular eating schedules, affect sleep quality in international university students. Furthermore, the aim of understanding how dietary habits affect sleep during the significant lifestyle transitions experienced by students is to inform health promotion strategies, and the study hypothesized that these detrimental dietary patterns would be associated with poorer sleep quality among international university students.
    Are the methods well-suited for this research? Somewhat appropriate The research methods employed, which consisted of a cross-sectional quantitative study using a self-administered questionnaire and the validated Pittsburgh Sleep Quality Index among international university students, were moderately suited for the objective of exploring the associations between specific unhealthy eating behaviors and poor sleep quality (SQ). Key strengths supporting the methodology include the use of the PSQI, a well-validated tool that evaluates multiple sleep parameters, and the large sample size, which bolstered the statistical power and generalizability of the findings within the university student population. Furthermore, the researchers strengthened the analysis by conducting multivariate logistic regression, which adjusted for a comprehensive list of potential demographic and lifestyle confounders, thereby enhancing the validity of the associations identified between dietary habits and sleep outcomes. However, the cross-sectional design is fundamentally limited because, although suitable for exploration, it cannot establish a causal relationship between the observed unhealthy eating behaviors and poor sleep quality. Lastly, limitations that affect the overall suitability include the reliance on self-reported data, which introduces the potential for response and recall bias, and the omission of other factors that could impact sleep quality, such as mental health and environmental variables.
    Are the conclusions supported by the data? Highly supported The conclusions of the preprint are generally supported by the statistical results presented, particularly the main finding regarding the strong associations between specific unhealthy eating behaviors and poor sleep quality. The study utilized multivariate logistic regression, adjusting for multiple demographic and lifestyle confounders, which strengthened the validity of the reported associations. Specifically, the key behaviors highlighted in the conclusion, consuming heavy evening meals, replacing meals with snacks, and having a short meal-to-bedtime interval, were identified as significant and independent predictors of overall poor sleep quality based on the data, with adjusted odds ratios (ORs) ranging from 2.06 to 2.73 and statistically significant p-values (all p≤0.012). Additionally, cross-tabulation analyses showed that these and other detrimental habits like late-night snacking and skipping breakfast were significantly associated with multiple components of the Pittsburgh Sleep Quality Index (PSQI), such as sleep latency, sleep efficiency, and subjective sleep quality. Despite the robust statistical support for these associations, the authors appropriately acknowledge the key limitation inherent in the cross-sectional design, which is that it permits the exploration of associations but cannot establish causality between the observed dietary behaviors and poor sleep quality
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear The data presentations employed in the preprint, primarily consisting of statistical tables, are well-suited to represent the various layers of analysis performed during the research. Descriptive statistics, using frequencies and percentages, effectively summarize the sociodemographic characteristics of the student population and the overall prevalence of poor sleep quality. Cross-tabulation analysis is used appropriately to assess the strength of association between individual eating habits, such as late-night snacking or skipping breakfast, and the distinct components of sleep quality, presenting these relationships through Odds Ratios (ORs), 95% Confidence Intervals (CIs), and p-values. Most notably, the key findings identifying the strongest independent predictors of overall poor sleep quality were presented using multivariate logistic regression analysis, displaying adjusted ORs, CIs, and p-values in a table format, which is the necessary and most suitable way to present complex relationships while demonstrating that the results have been controlled for numerous demographic and lifestyle confounders.
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly The authors clearly discuss and interpret their findings by contextualizing the high prevalence of poor sleep quality (51.7%) among international university students within the framework of lifestyle transitions and stressors typical of this population. They offered detailed interpretations for the strongest independent predictors, which are: consuming heavy evening meals, replacing meals with snacks, and a short meal-to-bedtime interval, by explaining that these habits disrupt circadian rhythm synchronization, can elevate core body temperature, and lead to physiological issues like gastroesophageal reflux disease (GERD), all of which impair sleep. Furthermore, the discussion interprets secondary findings, such as the cross-tabulation associations linking skipping breakfast to longer sleep latency and increased daytime dysfunction, by relating these outcomes to established concerns like reduced cognitive performance and deficiencies in essential sleep-regulating nutrients. The research's limitations are explicitly addressed, highlighting the inability of the cross-sectional design to establish causality and acknowledging the potential for bias from self-reported data, as well as the need to incorporate factors like mental health and environmental variables in future work. Regarding next steps, the authors conclude that implementing health promotion interventions focused on appropriate meal timing and healthier dietary patterns is a practical strategy to enhance sleep quality in this student demographic, further suggesting that future research should utilize longitudinal designs and randomized controlled trials to build upon these associations
    Is the preprint likely to advance academic knowledge? Highly likely The preprint is highly likely to advance academic knowledge, primarily by offering robust, adjusted associations between specific detrimental eating patterns and poor sleep quality within the distinct and vulnerable population of international university students, a demographic critical to study due to their complex lifestyle changes. The research contributes significant new insight by using multivariate logistic regression, which controlled for numerous demographic and lifestyle confounders, to identify consuming heavy evening meals, replacing meals with snacks, and a short meal-to-bedtime interval as independent and strong predictors of poor sleep quality. This systematic analysis strengthens the understanding of how chrono-nutrition impacts sleep health. Furthermore, the authors enhance academic continuity by clearly delineating the study's limitations, such as its cross-sectional design and reliance on self-reported data, while explicitly recommending future longitudinal designs and randomized controlled trials to build upon these associations and establish causality. Ultimately, the documented findings provide necessary evidence to inform targeted health promotion interventions focused on appropriate meal timing and healthier eating patterns to enhance overall well-being in this student demographic.
    Would it benefit from language editing? No The language utilized throughout the preprint is generally professional, precise, and highly effective for communicating the complex research findings, such as the presentation of multivariate logistic regression results and the detailed explanations of chrono-nutrition concepts. Although the text is predominantly clear and easy to follow, there are isolated minor grammatical inaccuracies, such as the incorrect verb tense when describing chrononutrition ("the idea that emphasize" instead of "emphasizes"), and some instances where sentences might be viewed as fragments or awkward phrasing (e.g., "Second, the sample size used in this study" or the list of specific behaviors in the introduction). Nevertheless, the overall coherence and technical clarity are consistently maintained, ensuring that these minor issues do not impede the comprehensive understanding of the research objectives, methodology, or interpretation of results
    Would you recommend this preprint to others? Yes, it's of high quality Yes, the preprint is of high quality and is recommended for its robust contribution to academic knowledge regarding the impact of chrono-nutrition on sleep quality among international university students. The study utilized a comprehensive cross-sectional design, employing the validated Pittsburgh Sleep Quality Index (PSQI) and strong statistical methods, including multivariate logistic regression, adjusted for a large number of potential demographic and lifestyle confounders.
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes While the research is methodologically sound and the data support the conclusions, and despite the clarity of the presentation and discussion, minor language issues were noted earlier, which, although not impeding comprehension, should be addressed through light editing before the work is disseminated to a broader audience or submitted to a publisher.

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  4. Version published to 10.20944/preprints202510.0552.v1