A Cross-Sectional Study on the Relationship between Adolescent Meat Consumption and Sleep Quality

Introduction

Sleep is crucial for teenagers because of its significant impact on their physical and mental health, and overall development.¹ Healthy People 2020 is a science-based agenda for improving the health of Americans.² They state that at least eight hours of sleep per day is ideal during adolescence, where the Canadian Pediatric Society states adolescents need 9 to 10 hours.³ Poor sleep quality is prevalent in 60% of adolescents in Washington, D.C. (United States) compared to 31% in Saudi Arabia and 54% in Brazil.⁴ Teenagers are at an important stage of their growth and development and therefore need more sleep than other age groups.⁵ Research has shown that diet and sleep quality are related.⁶ Meat is a main source of protein for many as it contains sources of amino acids and essential vitamins (i.e. B12). However, meat also contains saturated and trans fatty acids which could be detrimental to human health.⁷ It has been found that a higher consumption of meat can lead to increased snoring and poor general sleep quality.⁸ A review by Gonźalez et. al suggests avoiding ingestion of fats from meat products. They explain that it would help in the prevention of cardiovascular diseases and cancers, particularly colorectal cancer.⁹ Altered sleep duration and quality has been shown to be related to cardiometabolic disease^,10 cognitive decline,¹¹ and can exacerbate the effects of the aging process.¹²

This study will focus on the research question, “How does an adolescent’s monthly meat consumption relate to sleep quality?” Only one study was found investigating this relationship.¹³ Current research is mostly on older adults in different countries/continents (e.g. Spain,⁸ Australia,¹⁴ and Greece¹⁵). This will help investigate the impact of meat diets on adolescents and therefore contributing meaningful research to the current literature.

Literature Review

Psychological Aspects of Sleep

Sleep is defined as an universal, essential biological process,¹⁶ important for good health. Sleep is divided into a cycle with four stages: N1, N2, N3, and rapid eye movement (REM). Stages N1 to N3 are considered non-rapid eye movement (NREM) sleep. Each stage leads progressively to deeper sleep. Around 75% of sleep is spent in stages N1 to N3 with the majority in N2.¹⁷ A person usually will go through the four stages approximately five times in their night’s sleep and will always progress through in the same order of stages. A complete sleep cycle typically takes 90 to 110 minutes with the REM period getting increasingly longer.¹⁸ REM is the final stage of the sleep cycle. This is the phase in which most dreams occur and a person’s breathing, heart rate, brain activity, and blood pressure increase and the eyes move rapidly while closed.¹⁹ Sleep helps us gain energy to complete daily tasks as well as maintain healthy brain function and maintain physical health.20 Poor sleep quality increases the risk of many disorders and diseases such as heart disease,²¹ dementia,²² stroke,²³ and obesity.²⁴

It is important to get an adequate amount of sleep particularly during adolescent years as it supports cognitive functioning and good mental health.¹⁶ In addition, brain activity during sleep is crucial for cortical maturation during this developmental stage.²⁵ If one does not get an adequate amount of sleep, the consequences have detrimental effects on physical and mental health,¹⁶ academic performance,²⁶ safety,²⁷ and can cause complex health risks.²³ Overall, quality sleep is necessary for the body especially in adolescents.

Red Meat and Sleep

Current guidelines recommend consuming an appropriate amount of red meat according to age, as it has been associated with a lower body-mass index, blood pressure, and greater height. The Canadian Food Guide suggests female and male teens to consume two and three servings per day respectively. This is to ensure a reduced risk of obesity, Type II diabetes, heart disease, cancer and osteoporosis as well as boost health and vitality^.28 In addition, red meat intake as an adolescent is suggested to prevent iron deficiency;²⁹ the most common nutritional deficiency worldwide.³⁰ However, evidence shows that a vegetarian diet or little consumption does not affect sleep quantity negatively. A periodic vegetarian diet has proved beneficial for the prevention of iron deficiency by the Eastern Orthodox Christian Church.²⁹ Furthermore, red meat intake during adolescence has been positively associated with a risk of breast cancer among premenopausal women.³¹

One study was found investigating the relationship between red meat and sleep quality in adolescents to the best of the author’s knowledge. In the study, there were 1,522 participants with a mean age of 14.7 years. Adolescents with insufficient sleep duration scored lower on the Dietary Quality Index compared to those with optimal sleep duration, yet this was a borderline significant relation. A higher nutritional score was associated with greater consumption of healthy foods (whole-grain products, dairy, fruits, vegetables, potatoes, and fish) and lower consumption of foods linked to health risks (white bread, processed meats, sugary beverages, fast food, and sweets).¹³ However, several have been done on older adults with information being collected through cross-sectional assessments. A study was conducted in Australia with the participants being a large sample of community dwelling men aged 35 to 80.¹⁴ The study found that a lower red meat intake and higher plant consumption (i.e. high intake of vegetables, fruits, and legumes) was associated with falling asleep faster. Another study done by the Nurses’ Health Study included adult men and women. The results concluded that protein from vegetable sources may be associated with greater sleep quality than red meat as a source of protein.³² A study in Malaysia³³ done on adults had also found increased red meat consumption was linked to worsened sleep quality. The study found consuming red meat once or none daily (61%) showed beneficial for better sleep quality. Red meat is often classified as an unhealthy part of the diet.³⁴

The DASH and Mediterranean diets both promote eating less red meat and emphasize obtaining nutrients from plant-based foods. DASH stands for Dietary Approaches to Stop Hypertension and is a diet that aims to lower the blood pressure of hypertensive individuals. This is done by increasing the intakes of whole grains, poultry, fish, and nuts and reducing the amount of red meat, fats, and sugar in the diet. A literature review has summarized that a diet such as the DASH has benefits for sleep improvement.³⁵ The Mediterranean diet similarly consists mainly of legumes, wholegrains, beans, seafood, and nuts with little to none red meat. Diets containing high amounts of vegetables, fruits, and legumes as opposed to those containing more processed and red meat, snacks, and fast-food have shown to promote shorter sleep latency.¹⁴ Overall, a considerable amount of evidence has shown that higher red meat intake is negatively correlated with adult sleep quality. These previous research results suggest eating red is detrimental to sleep quality.

Hypothesis 1:There will be a negative relationship between the amount of red meat an adolescent consumes per month and their sleep quality.

Processed Meat and Sleep Quality

Processed meat is defined as meat that has been treated to make it taste better or last longer. This can be done by smoking, salting, curing, or adding chemical preservatives to the meat. Eating processed meat is considered to be an unhealthy part of the diet and consumption can be carcinogenic to humans.³⁶ Worse sleep has been shown to correspond with higher consumption of processed meat. Furthermore, a higher intake is negatively associated with a number of health problems including chronic non-communicable diseases (i.e. cancers, cardiovascular disease, diabetes, etc.) and cardiovascular disease.³⁷ A cross-sectional study done on girls aged 18 to 25 by Saharkhiz et. al, found a significant negative correlation between cognitive function and consumption of processed meat.³⁸ Similarly, a conventional meta-analysis by Wu et. al, found a correlation between processed meat and risk of mortality. A study by Jansen et. al. on midlife Mexican women was conducted starting in 2008 and ending in 2020 to evaluate whether dietary patterns are associated with sleep quality. The study concluded a fruit and vegetable-based diet resulted in better sleep quality as opposed to an unhealthy diet.³¹ This study defines an unhealthy diet as one containing processed meat and therefore justifies that more consumption of processed meat leads to reduced sleep quality. In general, most studies, reviews, and analyses have found a negative correlation between processed meat and overall health.

Hypothesis 2: There will be a negative relationship between the amount of processed meat an adolescent consumes per month and their sleep quality.

White Meat and Sleep Quality

According to a review published by Daniel et. al, people in Canada and the United States tend to have a higher consumption of white meat compared to red meat.³⁹ A study conducted on Iranian adults concluded that an increased intake of white meat has been found to be associated with decreased social function, mental health, and pain.⁴⁰ However, a study done on Malaysian adults found that higher intake of white meat was linked to a lower risk of noncommunicable diseases (i.e. cancer, diabetes, heart disease, etc.).³³ Red and processed meat differ from white meat due to the amount of protein absorbed by the body. A study conducted by Lana et. al concluded the primary harm from meat on sleep quality is from the protein content. In older adults, changes in sleep duration and poor sleep quality were associated with higher meat consumption (≥128 g/d).⁸ Generally speaking, more meat consumption was found to have a negative impact on sleep in Lana et al. (2019), but this study looked at those over 60.8 There were no studies found on the impacts of eating white meat on sleep quality to the author’s knowledge. Another study was found looking at adolescents, but looked at overall quality. These researchers found that higher quality diets were associated with better sleep, more specifically this higher quality diets included lower amounts of meat products.41

Hypothesis 3: There will be a negative relationship between the amount of white meat an adolescent consumes per month and their sleep quality.

Meat Alternatives and Sleep Quality

Consumption of meat alternatives such as fish, nuts, vegetables, and legumes has proved beneficial⁴¹ particularly for adolescents who have been diagnosed with attention deficit hyperactivity disorder (ADHD). Children with ADHD have shown to experience poorer sleep compared to those without it.⁴² A review on literature surrounding beyond-meat and alternative sources of protein by La Barbera et. al suggests meeting recommendations for meat, meat alternatives, and physical activity is associated with fewer ADHD diagnoses.⁴³ A study of children aged 10 to 11 years compared adolescents who met one to three dietary recommendations to those meeting seven to nine. They found that meeting more instructions was associated with substantially lower prevalence of ADHD.⁴³

Meat alternatives are lower in calories, saturated fat, and greenhouse gas emissions (i.e. kgCO2) while being higher in fibre, making them often regarded as a healthier option compared to red and white meat.⁴⁵ Plant-based diets containing meat alternatives have been shown to be related to better sleep quality. Healthier diets, higher in plant-based foods (fruits, vegetables, grains, seeds, and legumes) and vegetable oils, may improve sleep quality by facilitating the production and release of serotonin and melatonin.⁴⁶

A study done by St-Onge et. Al,³⁴ found a weak but significant linear relationship between the Mediterranean diet score and daytime sleepiness, weekday sleep duration, and total sleep duration. This study suggests that a healthy diet and greater adherence to the Mediterranean diet may impact sleep quality, though causality cannot be determined. Furthermore, if this dietary pattern does affect sleep, it remains unclear which specific components, such as legumes or low meat consumption, have the strongest influence.⁴⁷ Based on the results of these studies above, it seems most likely that meat alternatives will have a positive impact on sleep.

Hypothesis 4: There will be a positive relationship between the amount of meat alternatives and legumes an adolescent consumes per month and their sleep quality.

Methods

Sample - Adolescents aged between 12 and 19 years of age participated in this study with a total of 60 participants, 9 males and 51 females as seen in Table 1. This research was done in Toronto, Canada. These adolescents volunteered to participate in this study with informed consent through convenience sampling. The questionnaire was created using Qualtrics®. The questionnaire uses questions from the Pittsburgh Sleep Quality Index (PSQI) and the Dietary Guideline Index for Children and Adolescents (DGI-CA).

PSQI - The Pittsburgh Sleep Quality Index (PSQI) assesses sleep quality and disturbances over a one-month time period. The questionnaire consists of 22 questions in seven different categories: sleep duration, sleep latency, sleep disturbance, daytime dysfunction, individual sleep quality, use of sleeping medication, and questions about roommates. Participants who scored less than or equal to five would be classified as good sleepers, where participants scoring higher than five on the PSQI would be classified as poor sleepers. The range of scores on the PSQI is from 0-21. The Pittsburgh Sleep Quality Index (PSQI) has demonstrated adequate psychometric properties with a Cronbach alpha of 0.76.⁴⁸ In the current sample, Cronbach's α for the PSQI is reported to be 0.83, consistent with the value found in the original validation study.⁴⁹

SFS - Another section of this survey was a diet assessment. Participants were asked about their diet over the past month particularly about the consumption of meat. For example, the question, “How many times do you usually eat red meats per month?” was asked. This question was altered for processed meat, white meat, meat alternatives/legumes and eggs. For meat alternatives, participants were specifically asked “How many times do you usually eat legumes or other meat alternatives per month?” These questions were taken from a study done by Hendrie, Smith, and Golley in 2014 on the reliability and relative validity of a monthly diet index score compared to daily diaries for children aged 4-11 in Adelaide Australia called the Short Food Survey (SFS).⁵⁰ They found less than optimal, but acceptable intra class correlation (ICC) of 0.63 (p < 0.01). This assessment was still used as it will provide relatively accurate information in a less burdensome way compared to daily food journals that require constant monitoring.

Other Variables - Participants were asked about their drink intake; particularly caffeine. The question, “Did you consume any of these drinks after 4 pm in the past month?” from a study done by Pham et al. (2021) was asked. The drinks were coffee, tea, milk tea, energy drinks, and soft drinks. The scale for caffeine drinks was 1=none , 2=once to three times per month, 3=once per week, 4=twice to three times per week, 5=once per day. This information was used to identify potential confounding variables as an extensive amount of caffeine consumption has a great effect on sleep as opposed to red meat intake⁵¹. Using a question from the study by Pham et al. (2021), participants were asked, “How many minutes in the 2 hours before bed do you spend using electronics?” The question also composed a list of electronics including smartphone, iPad/tablet, television, laptop, computer, music device, and game console.

Demographics - Finally, participants were asked demographic questions about age, weight, height, sex, and if they had diabetes. The first four questions were asked with the format, “What is your…?” Height and weight were asked in metric terms (centimetres and kilograms). This data was then used to calculate body-mass index (BMI). The diabetes question was asked as, “Do you have diabetes?” following a similar format to the study done by Lana et. al⁸. Participants were also asked if they had Type I, Type II, or another form of diabetes and to kindly describe.

Sleep Open-Ended - The open ended question part of the questionnaire, “Why do you think your sleep is the way it is?” was used in a thematic analysis. The researcher went through and read each response to create descriptive categories such as mental health and too much school work. Then descriptive frequencies and percentages were calculated. See Table 1.

To test the results, ANOVA and Chi-Square tests were used to assess relationships between meat consumption and sleep quality. The demographics, other variables, and sleep open-ended questions were collected to help analyze the data from this study to identify common trends and potential reasons for outliers. Due to the small sample, these variables were only assessed descriptively.

Results

Basic descriptives were run to look at the overall demographics of the sample (see Table 1). The average hours asleep were 6.22. The average caffeine in terms of drinks and pre-bed electronics usage were 2.9 drinks and 95 mins respectively. The mean age was 16 years old Finally, the average BMI score was 22.5.

Table 1. Descriptive Statistics

The descriptive thematic analysis (see Table 2) below suggests those who consumed higher amounts of caffeine but consumer low amounts of red meat and higher amounts of processed meat had the lowest PSQI scores (i.e. higher quality sleep). Yet, individuals reporting they do not care about sleep had higher levels of red meat and processed meat consumption with lower PSQI scores indicating higher quality sleep. Those reporting stress tended to have higher processed meat consumption and higher quality sleep. On the other hand, people who had reported poor mental health seemed to have higher red and processed meat consumption, as well as PSQI scores (i.e. poor quality sleep).

Table 2. Sleep Quality Thematic Analysis

In line with previous research, the participants were split into two groups to represent those with good and poor-quality sleep. “Good sleepers” had a PSQI greater than 5 and “poor sleepers” had PSQI scores less than or equal to 5. The results of the questionnaire show that most of the participants eat white meat. Group means were calculated as seen in Table 3 below.

Table 3. Group Means Comparing Quality Sleep and Meat Diet

A Chi-Square test of independence was performed to examine if red meat intake had a significant impact on sleep quality (see Table 4). This analysis was performed due to a large amount of the sample not eating red meat. This created four cells: good sleepers who ate red meat, good sleepers who did not eat red meat, poor sleepers who ate red meat, and poor sleepers who did not eat red meat. “Good sleepers” had a PSQI greater than 5 and “poor sleepers” had PSQI scores less than or equal to 5. The relation between these variables was not significant, X2 (2, N = 60) = 1.603, p = 0.206, not supporting the Hypothesis 1. There was no significant difference when comparing those who ate red meat and those who did not in terms of being poor or good sleepers.

Table 4. Chi-Square Test of Independence on Good and Bad Sleepers and Mean Monthly Red Meat Consumption           

Table 5 shows results that do not support the Hypothesis 2. The demographic was largely female adolescents with a median age of sixteen who eat red meat approximately 7.46 times a month, with a median of four. A Chi-Square test of independence was performed to examine if processed meat intake had a significant impact on sleep quality. The square was split into good sleepers who ate processed meat, good sleepers who did not eat processed meat, bad sleepers who ate processed meat, and bad sleepers who did not eat processed meat. The relation between these variables was not significant, X2 (2, N = 60) = 0.259, p = 0.6108. There was no significant difference when comparing those who ate processed meat and those who did not in terms of being poor or good sleepers (i.e. PSQI > 5).

Table 5. Chi-Square Test of Independence on Good and Bad Sleepers and Mean Monthly Processed Meat Consumption

Table 6 shows a significant difference in the monthly mean intake of meat alternatives between good and bad sleepers. A Post Hoc analysis was completed looking at meat alternatives due to Hypothesis 1 and 2 being non-significant. A Bonferroni correction was performed to reduce Type I error (i.e. the chance of making a false positive), the p-value of 0.05 was divided by four, resulting in significant results now needed to be below a p-value of 0.0125. The analysis determined that meat alternatives had a significant difference with those with poor and good sleep quality (f(1,4) = 11.3, p = 0.0014). Specifically, suggesting that those who were good sleepers ate more white meat compared to poor sleepers.

 Table 6. Analysis of Variance on Good and Bad Sleepers and Mean Monthly Meat Alternatives Consumption

Table 7 displays an analysis of variance showing that there was a significant difference between good and poor sleepers in terms of eating white meat, F(1,58) = 7.694, p = 0.007. Specifically, those who ate more white meat were better sleepers.

Table 7. Analysis of Variance on Good and Bad Sleepers and Mean Monthly White Meat Consumption

Red meat and processed meat did not have a significant impact on sleep however, this may also be due to the small sample size. The participants of this study did not eat these meats often and both groups ate meat in similar amounts, making it harder to find the significance. In contrast, white meat and meat alternatives were eaten more often with larger variance between good and poor sleepers.

Discussion

This study found no significant relationship between the amount of red or processed meat an adolescent consumes and their sleep quality. It may be that the impact of red meat and processed meat was insignificant due to the small amount of these types of meat eaten by participants in this study. Specifically, good quality and poor sleepers only ate about three servings of processed meat per month, where high quality sleepers ate red meat about five times per month and the poor- quality sleepers ate it about nine times per month.

Over consumption of meat and/or meat products can cause issues in sleep quality and/or duration. In older adults, changes in sleep duration and poor sleep quality were associated with higher meat consumption (≥128 g/d).⁸ There is currently one study conducted on adolescent sleep duration and red meat intake correlation to the author’s knowledge. This study was conducted on European adolescents and found that shorter sleep duration was associated with poorer dietary quality (i.e. meat products, white bread, fast food, sweets, and soft drinks).¹³ Even though there was no significant impact of red meat on sleep, it should be noted that poor sleepers ate red meat about twice as often as high-quality sleepers.

On the other hand, this same study found a positive impact from consumption of white meat and meat alternatives (i.e. legumes).¹³ This may be because these particular participants ate a healthy amount of about 1.6 servings per day on average for good sleepers and about six servings per day for poor sleepers. Further, meat alternatives are lower in calories, saturated fat, and greenhouse gas emissions (i.e. kgCO2) while being higher in fibre, making them often regarded as a healthier option compared to red and white meat.⁴⁵ Plant-based diets containing meat alternatives have been shown to be related to better sleep quality.⁴⁶ More specifically, those with higher quality sleep in the current study ate about one serving of white meat and about 0.6 servings of meat alternatives per day on average over the month.

This is somewhat similar to the results found in the European study.¹³ Adolescents are at a significant stage of growth in their lives and their bodies are much different to those aged 30 to 80 years.⁵ The Canadian Food Guide suggests female and male teens to consume two and three servings per day respectively of meat and meat alternatives, such a white meat and legumes. This food guide does not discuss⁵³ red meat and meat alternatives. This is to ensure a reduced risk of obesity, Type II diabetes, heart disease, cancer and osteoporosis as well as boost health and vitality.²⁸

While there are not many studies done on adolescent sleep quality, there are a good deal of studies conducted on older adults collected through cross-sectional assessments. A study in Australia done on men aged 30 to 80 found that eating less red meat and a more plant-based diet had a positive correlation with falling asleep quicker.¹⁴ Another survey was led by the Nurses’ Health Study which included both men and women. The results found that a plant-based diet is associated with greater sleep quality compared to red meat.³² While these studies give critical insight on red meat intake and its positive effects on sleep quality on adults, it is important to consider the difference between adult and adolescent bodies.

It is important to consider other key factors affecting sleep quality in addition to red meat consumption. The questionnaire included an open ended question asking, “Why do you think your sleep quality is the way it is?” The main influences reported for participants with good sleep quality were 1) stress with high amounts of processed meat, 2) do not care about sleep with high amounts of red and processed meat, and 3) caffeine use with high amounts of processed meat. This contradicts what was expected by the authors, as these factors have been related to poor sleep in previous research. These results suggest that sleep quality may be impacted by a variety of factors interacting with each other, such as biological factors and perceptions of sleep not assessed in the current study.

When looking at poor quality sleepers in the thematic analysis, those with reported mental health issues had the worst average sleep quality, and also seemed to eat more processed and red meat. Poor mental health often causes symptoms of needing more sleep than usual. Depression can cause fragmented sleep leading to increased fatigue.⁵² Further, excessive school work and screen time before bed were commonly reported factors for those with poor quality sleep. Participants in these groups had slightly higher levels of red and processed consumption. This aligns with previous research findings.

Limitations

This study has several limitations. The sample size was small and heavily female. This was due to the sample being collected via convenience sampling. This type of sampling may create bias and likely not be representative of all adolescents in Canada. The distribution of red and processed meat consumption was non-normal, with about half of the participants not consuming these foods at all. These characteristics of the small and non-normal sample limited what statistical tests could be performed, as well as looking at the impact of covariates such as caffeine use and BMI, due to reduced power (i.e., the ability of a false negative to occur). Additionally, the study was geographically limited, focusing only on the Greater Toronto Area (GTA), reducing the ability to generalize these results to other areas of Canada. It also may be hard to assess diet over the past month as opposed to a daily diary, however, this assessment was still relatively accurate.⁵⁰

Future Research

Future research should explore red and processed meat consumption with a larger and more diverse sample to capture greater variation. Further investigation into white meat is also needed, possibly considering changes in how chickens are raised compared to the past. Chickens today are genetically selected and improved nutrition allows farmers to produce larger birds compared to 50 years ago.⁵³ Due to the lack of research in this area, more investigation overall is needed to investigate the impact of various aspects of diet, beyond meat consumption, and how diet interacts with aspects of lifestyle, such as physical activity, mental health, genetics, and comorbidities, as well as perceptions of sleep.

Conclusion

Moderation seems to be important as this led to better sleep quality for those who ate white meat and meat alternatives. Overall, a considerable amount of evidence has shown that meat alternatives are positively correlated with sleep quality, and how eating too much white meat can be detrimental.54 Further, the current sample did not eat much processed meat and red meat, likely resulting in no relationship to sleep quality. Yet, previous research shows that red meat contains sources of essential amino acids, proteins, minerals (iron, zinc, manganese, etc.), and B-complex vitamins (particularly vitamin B12) vital for the body. However, red meat also contains saturated and trans fatty acids which can negatively impact human health.7 Processed meat should also be eaten in moderation to help prevent negative health impacts. Previous findings suggest that it is important to eat the appropriate amount of red meat to maximize sleep quality.⁵⁵

These results suggest that adolescents should follow the Canadian Food Guide and eat two to three servings per day of meat and meat alternatives. This can be accomplished through diets such as the DASH and Mediterranean diets both promote eating less red meat and emphasize obtaining nutrients from plant-based foods. Additionally, more research is needed to investigate the impact of other lifestyle factors in relation to diet and sleep quality. The results suggest that poor mental health may be an important factor, and improving mental health, as well as diet will likely help to improve sleep quality. It is essential to find the diet that is right for your body, age, and additional factors.

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This research paper was completed within the framework of BeMo Academic Consulting’s Pre-Med Research Program. BeMo's contribution played a crucial role in enhancing the quality of this work and I extend my gratitude for their invaluable guidance and support.

Special thank you to Dr. Narusis, Academic Consultant at BeMo.