Longitudinal study on association between sugar-sweetened beverages consumption and insomnia among college students in Yunnan Province
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摘要:
目的 探讨云南省大学生含糖饮料消费特征与失眠的关系，为改善大学生睡眠质量提供依据。 方法 采用整群随机抽样法抽取云南省昆明市及大理市2所大学(昆明学院、大理护理职业学院)2 515名在校大学生进行纵向研究，包括基线调查(T1，2021年11月)和3次随访调查(T2：2022年6月，T3：2022年11月，T4：2023年6月)。采用半定量饮食频率调查表收集大学生含糖饮料消费情况，使用失眠严重指数量表(ISI)评估失眠情况。含糖饮料消费情况采用Kruskal-Wallis检验分析，使用Mann-Whiter U检验和Kruskal-Wallis检验比较不同人口学特征大学生失眠检出率，建立广义估计方程模型分析含糖饮料消费与失眠的关联。 结果 T1、T2、T3、T4调查大学生失眠检出率分别为21.2%，23.6%，30.5%，36.0%。大学生平均每周消费含糖饮料为5(1，9)瓶/人，不同失眠状态大学生含糖饮料(碳酸饮料、果汁饮料、茶饮料、功能饮料、乳饮料)消费量差异均有统计学意义(χ2值分别为42.91，23.67，29.98，61.70，30.82，P值均 < 0.01)。广义估计方程模型分析结果显示，大学生碳酸饮料消费(β=0.04，95%CI=0.00~0.08)及乳饮料消费(β=0.04，95%CI=0.00~0.09)与失眠相关(P值均 < 0.05)。分层分析表明，女大学生碳酸饮料消费与失眠相关[β值(95%CI)=0.06(0.01~0.11)]；自评家庭经济情况中等的大学生乳饮料消费与失眠有关[β值(95%CI)=0.05(0.00~0.10)]，自评家庭经济情况好的大学生碳酸饮料及果汁消费与失眠均有关联[β值(95%CI)分别为0.35(0.23~0.46)，0.12(0.00~0.24)](P值均 < 0.05)。 结论 云南大学生失眠情况与含糖饮料尤其是碳酸饮料的消费相关。 Abstract:Objective To study the relationship between sugar-sweetened beverages consumption characteristics and insomnia of college students in Yunnan Province, so as to provide evidence for sleep quality improvement of college students. Methods A cluster random sampling method was used to select 2 515 college students from two universities (Kunming University and Dali Nursing Vocational College) in Kunming and Dali in Yunnan Province for a longitudinal study, including baseline survey (T1, November 2021) and three follow-up surveys (T2: June 2022, T3: November 2022, T4: June 2023). Sugar-sweetened beverages consumption of college students was collected by Semi-quantitative Food Frequency Questionnaire and insomnia was assessed by Insomnia Severity Index Scale. Sugar-sweetened beverages consumption was analyzed by Kruskal-Wallis test. The Mann-Whiter U test and Kruskal-Wallis test were used to compare the detection rate of insomnia in college students with different population characteristics, and the generalized estimating equations model was established to analyze the association between sugar-sweetened beverages consumption and insomnia. Results The reported rate of insomnia among college students from T1 to T4 was 21.2%, 23.6%, 30.5% and 36.0%, respectively. The median of sugar-sweetened beverages consumption per week was 5 (1, 9) bottles per person, and there were significant differences in sugar-sweetened beverages (carbonated beverages, fruit beverages, tea beverages, milk beverages, energy beverages) consumption among college students with different insomnia status (χ2=42.91, 23.67, 29.98, 61.70, 30.82, P < 0.01). The analysis of the generalized estimating equation model revealed that the consumption of carbonated beverages (β=0.04, 95%CI=0.00-0.08) and the consumption of milk beverages among college students (β=0.04, 95%CI=0.00-0.09) were correlated with insomnia (P < 0.05). The stratified analysis indicated that consumption of carbonated beverages by female college students was associated with insomnia [β(95%CI)=0.06(0.01-0.11)]; consumption of milk beverages among college students from middle-income family was associated with insomnia [β(95%CI)=0.05(0.00-0.10)], and consumption of carbonated beverages and fruit beverages from college students with high household economic status were both associated with insomnia [β(95%CI)=0.35(0.23-0.46), 0.12(0.00-0.24)] (P < 0.05). Conclusion Sugar-sweetened beverages, especially carbonated beverages, are associated with insomnia among college students in Yunnan Province. -
Key words:
- Beverages /
- Sleep disorders /
- Mental health /
- Longitudinal studies /
- Students
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表 1 不同组别大学生失眠状态分布比较
Table 1. Comparison of insomnia status distribution of college students with different groups
组别 选项 人次 无失眠 亚失眠 临床失眠 严重失眠 Z/χ2值 年龄/岁 17~18 2 788 2 054(73.7) 636(22.8) 77(2.8) 21(0.8) 11.86 19~20 6 680 4 807(72.0) 1 576(23.6) 243(3.6) 54(0.8) 21~22 592 398(67.2) 158(26.7) 29(4.9) 7(1.2) 学历 本科 7 576 5 574(73.6) 1 697(22.4) 252(3.3) 53(0.7) -5.56 专科 2 484 1 685(67.8) 673(27.1) 97(3.9) 29(1.2) 专业 工学 1 064 811(76.2) 205(19.3) 33(3.1) 15(1.4) 29.88 管理学 1 364 965(70.7) 339(24.9) 52(3.8) 8(0.6) 教育学 516 395(76.6) 101(19.6) 14(2.7) 6(1.2) 理学 1 596 1 178(73.8) 360(22.6) 52(3.3) 6(0.4) 农学 1 056 763(72.3) 246(23.3) 41(3.9) 6(0.6) 文学 812 614(75.6) 173(21.3) 23(2.8) 2(0.2) 医学 3 392 2 370(69.9) 866(25.5) 119(3.5) 37(1.1) 其他 260 163(62.7) 80(30.8) 15(5.8) 2(0.8) 家庭居住地 农村 8 348 5 971(71.5) 2 013(24.1) 294(3.5) 70(0.8) -3.07 城市 1 712 1 288(75.2) 357(20.9) 55(3.2) 12(0.7) 家庭类型 双亲家庭 8 748 6 357(72.7) 2 023(23.1) 294(3.4) 74(0.8) 8.96 单亲家庭 684 467(68.3) 187(27.3) 26(3.8) 4(0.6) 组合家庭 484 339(70.0) 117(24.2) 24(5.0) 4(0.8) 其他 144 96(66.7) 43(29.9) 5(3.5) 0 自评家庭经济状况 差 3 192 2 164(67.8) 852(26.7) 141(4.4) 35(1.1) 58.32 中等 6 448 4 753(73.7) 1 451(22.5) 201(3.1) 43(0.7) 好 420 342(81.4) 67(16.0) 7(1.7) 4(1.0) 朋友数量/个 0 112 67(59.8) 37(33.0) 6(5.4) 2(1.8) 28.31 1~2 1 268 868(68.5) 341(26.9) 47(3.7) 12(0.9) 3~4 1 896 1 326(69.9) 491(25.9) 68(3.6) 11(0.6) >5 6 784 4 998(73.7) 1 501(22.1) 228(3.4) 57(0.8) 父亲文化程度 小学以下 1 932 1 345(69.6) 471(24.4) 94(4.9) 22(1.1) 12.78 小学毕业 2 488 1 806(72.6) 574(23.1) 87(3.5) 21(0.8) 初中 3 704 2 675(72.2) 901(24.3) 107(2.9) 21(0.6) 高中或中专 1 284 941(73.3) 286(22.3) 43(3.2) 14(1.1) 大专及以上 652 492(75.5) 138(21.2) 18(2.8) 4(0.6) 母亲文化程度 小学以下 3 360 2 330(69.3) 847(25.2) 144(4.3) 39(1.2) 28.43 小学毕业 2 388 1 718(71.9) 578(24.2) 75(3.1) 17(0.7) 初中 2 900 2 171(74.9) 629(21.7) 91(3.1) 9(0.3) 高中或中专 968 709(73.2) 217(22.4) 629(3.2) 11(1.1) 大专及以上 444 331(74.5) 99(22.3) 8(1.8) 6(1.4) 自评学习负担 很重 468 265(56.6) 151(32.3) 41(8.8) 11(2.4) 161.79 重 3 488 2 344(67.2) 971(27.8) 141(4.0) 32(0.9) 一般 5 956 4 526(76.0) 1 227(20.6) 164(2.8) 39(0.7) 轻 112 92(82.1) 17(15.2) 3(2.7) 0 很轻 36 32(88.9) 4(11.1) 0 0 父亲职业 公职人员 544 401(73.7) 116(21.3) 20(3.7) 7(1.3) 30.76 工人 264 202(76.5) 53(20.1) 8(3.0) 1(0.4) 公司职员 440 341(77.5) 86(19.5) 9(2.0) 4(0.9) 商人 6 228 4 408(70.8) 1 547(24.8) 219(3.5) 54(0.9) 农民 1 336 945(70.7) 330(24.7) 51(3.8) 10(0.7) 其他 1 248 962(77.1) 238(19.1) 42(3.4) 6(0.5) 母亲职业 公职人员 324 250(77.2) 61(18.8) 6(1.9) 7(2.2) 21.47 工人 268 207(77.2) 54(20.1) 6(2.2) 1(0.4) 公司职员 444 339(76.4) 89(20.0) 14(3.2) 2(0.5) 商人 6 664 4 719(70.8) 1 646(20.7) 243(3.6) 56(0.8) 农民 816 593(72.7) 190(23.3) 29(3.6) 4(0.5) 其他 1 544 1 151(74.5) 330(21.4) 51(3.3) 12(0.8) 注： ()内数字为构成比/%；P值均 < 0.05。 
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表 2 不同失眠状态大学生含糖饮料消费量比较[瓶，M(P25, P75)]
Table 2. Comparison of consumption of sugar-sweetened beverages among college students with different insomnia status[bottle, M(P25, P75)]
失眠状态 人次 碳酸饮料 果汁饮料 茶饮料 功能饮料 乳饮料 无失眠 7 259 1(0，2) 1(0，2) 1(0，2) 0(0，1) 1(0，2) 亚失眠 2 370 1(0，2) 1(0，2) 1(0，2) 0(0，1) 1(0，2) 临床失眠 349 1(0，2) 1(0，3) 1(0，2) 0(0，1) 1(0，2) 严重失眠 82 1(1，3) 1(1，3) 1(0，2) 1(0，2) 1(0，2) χ2值 42.91 23.67 29.98 61.75 30.82 注： P值均 < 0.01。
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表 3 不同性别大学生含糖饮料消费与失眠的关联[β值(95%CI)]
Table 3. Association between sugar-sweetened beverages consumption and insomnia in college students of different genders[β(95%CI)]
性别 自变量 模型1 模型2 男(n=697) 碳酸饮料 0.03(-0.04~0.10) 0.02(-0.05~0.09) 果汁饮料 -0.04(-0.11~0.05) -0.02(-0.09~0.06) 茶饮料 0.00(-0.08~0.09) 0.00(-0.09~0.08) 功能饮料 0.02(-0.08~0.12) 0.01(-0.09~0.10) 乳饮料 0.06(-0.03~0.14) 0.06(-0.03~0.14) 女(n=1 818) 碳酸饮料 0.06(0.01~0.11)* 0.06(0.01~0.11)* 果汁饮料 -0.01(-0.06~0.04) -0.01(-0.06~0.04) 茶饮料 -0.02(-0.08~0.03) -0.02(-0.08~0.03) 功能饮料 -0.01(-0.07~0.05) -0.01(-0.07~0.05) 乳饮料 0.03(-0.02~0.08) 0.03(-0.02~0.08) 注：*P < 0.05。
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表 4 不同家庭经济状况大学生含糖饮料消费与失眠的关联[β值(95%CI)]
Table 4. Association between sugar-sweetened beverages consumption and insomnia among college student with different economic status[β(95%CI)]
自评家庭经济状况 自变量 模型1 模型2 差(n=798) 碳酸饮料 0.06(-0.02~0.14) 0.06(-0.02~0.14) 果汁饮料 -0.03(-0.11~0.05) -0.05(-0.14~0.03) 茶饮料 -0.02(-0.10~0.07) -0.03(-0.11~0.06) 功能饮料 -0.01(-0.10~0.09) -0.04(-0.13~0.06) 乳饮料 0.05(-0.03~0.13) 0.03(-0.05~0.11) 中(n=1 612) 碳酸饮料 0.03(-0.02~0.08) 0.03(-0.02~0.08) 果汁饮料 -0.02(-0.07~0.04) -0.01(-0.06~0.04) 茶饮料 -0.02(-0.07~0.04) -0.02(-0.08~0.03) 功能饮料 0.01(-0.05~0.07) 0.01(-0.05~0.07) 乳饮料 0.05(0.00~0.10)* 0.05(0.00~0.11)* 好(n=105) 碳酸饮料 0.25(0.04~0.47)* 0.35(0.23~0.46)** 果汁饮料 -0.02(-0.21~0.16) 0.12(0.00~0.24)* 茶饮料 -0.03(-0.22~0.17) 0.02(-0.09~0.13) 功能饮料 -0.01(-0.27~0.24) 0.04(-0.11~0.19) 乳饮料 -0.05(-0.27~0.17) -0.05(-0.16~0.07) 注：*P < 0.05，**P < 0.01。
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