Food consumption according to the level of processing and sleep quality during the COVID-19 pandemic.

Abstract

Background and aims: Consumption of ultra-processed foods is negatively associated with health out- comes, however, the contribution to sleep quality is limited. Therefore, the objective of this study was to

evaluate the association between food intake by frequency and degree of processing and sleep quality in adults during the covid-19 pandemic. Methods: Population-based survey of adults from October to December 2020 in the Iron Quadrangle

region, Brazil. The exposure variable was a food intake score that considered the frequency of con- sumption and food processing degree. The total score ranged from 0 (best) to 48 points (worst food

quality), categorized into quartiles. Furthermore, we also evaluated whether individuals replaced their lunch and/or dinner based mostly on fresh/minimally processed foods for ultra-processed foods, for five or more days in the week. The outcome variable was sleep quality assessed with the Pittsburgh Sleep Quality Index. We constructed a contrasting directed acyclic graph (DAG) model to estimate the adjusted odds ratio of the association between score eating and sleep, by logistic regression. Results: Most of the 1762 individuals evaluated had poor sleep quality (52.5%). The minimum and maximum food scores were 0 and 30 points (mean 9.16; 95% CI 8.50, 9.81). The higher values of the score corresponded to lower consumption of fresh and minimally processed foods and higher consumption of ultraprocessed foods. In multivariate analysis, individuals in the third food consumption score had 71% greater odds of poor sleep quality (OR 1⁄4 1.71; 95% CI: 1.03, 2.85) and in the fourth quartile 144% greater odds (OR 1⁄4 2.44; 95% CI: 1.32, 2.44). Besides, replacing the dinner meal with ultra-processed foods five days or more in the week was also associated with poor sleep quality (OR 1⁄4 2.01; 95%CI: 1.14, 3.57). Conclusion: Higher consumption of ultra-processed foods concomitant with lower consumption of fresh and minimally processed foods is associated with a higher chance of poor sleep quality.