Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students During the Covid-19
Keywords:
night eating syndrome, sleep quality, body mass index, university students, Covid-19
Abstract
Night eating syndrome (NES) is a disordered eating behaviour characterized by hyperphagia at night and is often accompanied by a sleep disturbance. This study aims to determine the prevalence of NES and its association between sleep quality and body mass index (BMI) among the private university students during the Covid-19. A total of 166 students from a private university participated in this cross-sectional study. Online self-administered questionnaires were used to collect and determine socio-demographic data, BMI, NES, and sleep quality. NES was assessed using Night Eating Diagnostic Questionnaire (NEDQ) while sleep quality was assessed using Pittsburgh Sleep Quality Index Questionnaire (PSQI). The results showed that 38.6% of the participants were engaging with NES, 45.2% were having poor sleep quality and 25.9% were overweight or obese during the Covid-19. There were significant associations between NES with sleep quality and BMI, which students with NES were found to have poorer sleep quality (r=0.306, p<0.001) and higher BMI (r=0.024, p=0.763). In addition, poor sleep quality was found to be positively associated with BMI (r=0.161, p=0.038). Males (AOR=2.198, 95% CI=1.005-4.808) and poor sleepers (AOR=1.176, 95% CI=1.028-1.346) were the risk factors of NES. In conclusion, the prevalence of NES, poor sleep quality, and overweight and obesity were at an alarming rate. NES was found to be related to both poorer sleep quality and higher BMI among the students. Therefore, interventions such as behavioural and cognitive therapy should be implemented to promote healthy eating behaviour among university students.
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References
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Al-Kandari S., Alsalem A., Al-Mutairi S., Al-Lumai D., Dawoud A., Moussa M. (2017). Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students. Sleep Health 3(5):342-347.
Allison K. C., Lundgren J. D., O’Reardon J. P., Martino N. S., Sarwer D. B., Wadden T. A., Crosby R. D., Engel S. G., Stunkard A. J. (2008). The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the Night Eating Syndrome. Eating Behaviours 9(1):62-72.
Allison K.C., Lundgren J.D., O’Reardon J. P., Geliebter A., Gluck M. E., Vinai P., Mitchell J. E., Schenck C. H., Howell M. J., Crow S. J., Engel S., Latzer Y., Tzischinsky O., Mahowald M. W., Stunkard A. J. (2010). Proposed diagnostic criteria for night eating syndrome. International Journal of Eating Disorders 43(3):241–247.
Babar M. G., Hasan S. S., Ooi Y. J., Ahmed S. I., Wong P. S., Ahmad S. F., MNM-Rosdy N. M., Malik N. A. (2015). Perceived sources of stress among Malaysian dental students. International Journal Of Medical Education 6:56-61.
Birketvedt G. S., Florholmen J., Sundsfjord J., Osterud B., Dinges D., Bilker W., Stunkard A. (1999). Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA, 282, pp. 657-663.
Buysse D. J., Reynolds III, C. F., Monk T. H., Berman S. R., Kupfer D. J. (1989). The
Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research 28(2):193-213.
Bruzas M. B., Allison K. C. (2019). A Review of the Relationship between Night Eating Syndrome and Body Mass Index. Psychological Issues 8:145-155.
Cao W., Fang Z., Hou G., Han M., Xu X., Dong J., Zheng J. (2020) The psychological impact of the COVID-19 epidemic on college students in China. J. Psychiatry Res. 287, 112934.
Cheng S-H. & Mohd Kamil, M.K (2020). Stress and food intake among university students – is there a relationship? Sains Malaysiana 49(1):121-128.
Canuto R., Garcez A. S., Olinto M. T. A. (2013). Metabolic syndrome and shift work: a
systematic review. Sleep Med Rev. 17(6):425-431.
Daniel W. W., Cross C. L. (1999). Biostatistics: A Foundation for Analysis in the Health Sciences. 7th edn. New York: John Wiley & Sons.
Dietch J. R., Taylor D. J., Sethi K., Kelly K., Bramoweth A. D., Roane B. M. (2016).
Psychometric Evaluation of the PSQi in U.S. College Students. J Clin Sleep Med 12(8):1121-1129.
Djalalinia, S., Qorbani, M., Peykari N., Kelishadi R. (2015). Health Impacts Of Obesity. Pak J Med Sci 31:239-242.
Dzulkafli N. H., Hamirudin A. H., Sidek S. (2020). Night Eating Syndrome and its Association with Body Mass Index among Female University Students. International Journal of Allied Health Sciences 4(4):1626-1634.
Farhangi M. A. (2019). Night Eating Syndrome and Its Relationship with Emotional Eating, Sleep Quality and Nutritional Status Among Adolescents’ Boys. Community Mental Health Journal 55:1411-1418.
Gallant A. R., Lundgren J., Drapeau V. (2012). The night-eating syndrome and obesity. Obesity Reviews 13(6):528-536.
Gan W. Y., Chin P. Q., Law L. S. (2019). Determination of Risk Factors for Night Eating Syndrome among Public University Students in Malaysia. Malaysian Journal of Medicine and Health Science 15(SP1):25-32.
Gopalakrishnan S., Ganeshkumar P., Prakash M. V. S., Christopher, Amalraj V. (2012).
Prevalence of overweight/obesity among the medical students, Malaysia. The Medical Journal of Malaysia 67(4):442-444.
Ghazi H. F., Abdalqader M. A., Baobaid M. F., Hasan T. N., Alabed A. A. A., Veerabadran V., Abdalrazak H. A., Gazi T. M., Hassan M. R., (2018). Obesity Knowledge and its Associated Factors among Medical Students in a Private University in Shah Alam, Selangor. Malaysian Journal of Public Health Medicine 18(2):45-51.
Gluck M. E., Geliebter A., Satov T. (2001). Night Eating Syndrome Is Associated with
Depression, Low Self-Esteem, Reduced Daytime Hunger, and Less Weight Loss in Obese Outpatients. Obesity Research 9:264-267.
He J., Huang F., Yan J., Wu W., Cai Z., Fan X. (2018). Prevalence, demographic correlates, and association with psychological distress of night eating syndrome among Chinese college students. Psychology, Health & Medicine 23(5):578-584.
Kabrita C. S., Hajjar-Muca T. A., Duffy J. (2014). Predictors of poor sleep quality among Lebanese university students: association between evening typology, lifestyle behaviors, and sleep habits. Nat Sci Sleep 6:11-18.
Krističević T., Štefan L., Sporiš G. (2014). The Association between Sleep Duration and Sleep Quality with Body-Mass Index in a Large Sample of Young Adults. International Journal of Environmental Research and Public Health 15(4):758.
Lai P.-P., Say Y.-H. (2012). Associated Factors of Sleep Quality and Behaviour among
Students of Two Tertiary Institutions in Northern Malaysia. Med J Malaysia 68(3)195-202.
Lundgren J. D., Allison K. C., Vinai P., Gluck M. E. (2012). Assessment instruments for night eating syndrome. In J. D. Lundgren, K. C. Allison, & A. J. Stunkard, eds, Night eating syndrome: Research, assessment, and treatment (2012). New York: Guilford Press, pp. 197-217.
Meule A., Allison K. C., Platte P. (2014). A German version of the Night Eating Questionnaire (NEQ): psychometric properties and correlates in a student sample. Eat Behav 15(4):523–527.
Najem J., Saber M., Aoun C., Osta N. E., Papazian T., Khabbaz L. R. (2020). Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students. Clinical Nutrition 39(2):533-539.
Nolan L. J., Geliebter A. (2016). “Food addiction” is associated with night eating severity.Appetite 98:89-94.
Nolan, L. J., Geliebter A. (2017). Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its relationship with depression, sleep quality, “food addiction”, and body mass index. Appetite 111:86-95.
Ngu S. T., Masalamany K., Manan N. A., Adam S. K. (2017). Sleep Quality among Pre-Clinical Medical Students in Universiti Putra Malaysia and University Malaya, Malaysia. Education in Medicine Journal 9(3):23-31.
Orzech K. M., Salafsky D. B., Hamilton L. A. (2011). The state of sleep among college students at a large public university. J Am Coll Health 59(7):612-619.
Pike K. M., Dunne P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders 3(33).
Radzi C. W. J. W. M., Jenatabadi H. S., Alanzi A. R. A., Mokhtar M. I., Mamat M. Z., Abdullah N. A., (2019). Analysis of Obesity among Malaysian University Students: A Combination Study with the Application of Bayesian Structural Equation Modelling and Pearson Correlation. International Journal of Environment Research and Public Health 16(3):492.
Riccobono G., Pompili A., Iannitelli A., Pacitti F. (2019). The relationship between Night-Eating Syndrome, depression and chronotype in a non-clinical adolescent population. Riv Psichiatr. 54(3):115-119.
Runfola C. D., Allison K. C., Hardy K. K., Lock J., Peebles R. (2014). Prevalence and clinical significance of night eating syndrome in university students. Journal of Adolescent Health 55(1):41–48.
Saat N.Z.M., Hanawi S. A., Chan K. S., Hanafiah H., The S. C., Aznan S. R., Joan C A. S., Zulkefli Z. H. (2020). Sleep Quality among University Students: Association between Demographic Factors and Physical Activity Level. International Journal of Pharmaceutical Research & Allied Sciences 9(3):57-65.
Sarina S., Poh L. K. (2015). Association between Socio-demographic Status and Body Mass Index with Night Eating Syndrome among University Students in Shah Alam, Selangor, Malaysia. Malaysia Journal of Nutrition 21.
Suh Y., Lee E. k., Chung Y. J. (2012). Comparison of nutritional status by energy level of night snack in Korean adults: using the data from 2005 Korean National Health and Nutrition Examination Survey. The Korean Journal of Nutrition 45(5):479-488.
Shillito, J. A., Lea, J., Tierney S., Cleator J., Tai S., Wilding J. P. H. (2018). Why I eat at night: A qualitative exploration of the development, maintenance and consequences of Night Eating Syndrome. Appetite 125:270-277.
Spiegel K., Tasali E., Penev P., Cauter E. V. (2004). Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite. Annals of internal medicine 141(11):846-850.
Stunkard, A. J., Grace, W.J., Wolff H. G. (1955). The night-eating syndrome. A pattern of food intake among certain obese patients. American Journal of Medicine 19:78-86.
Stunkard A. J. (1992). Obesity. In R. Berkow, A. J. Fletcher, eds. The Merck Manual of
Diagnosis and Therapy. Rahway, NJ: Merck Research Laboratories, pp. 981-986.
Stunkard A. J. (2008). The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the night eating syndrome. Eat Behav 9:62-72.
Thompson, S. (2015). Gender And Racial Differences In Emotional Eating, Food Addiction Symptoms, And Body Weight Satisfaction Among Undergraduates. Journal Of Diabetes And Obesity 2:1-6.
Vander Wal J. S. (2012). Night eating syndrome. Clinical Psychology Review 32(1):49-59.
Vargas P. A., Flores M., Robles E. (2014). Sleep Quality and Body Mass Index in College Students: The Role of Sleep Disturbances. Journal of American College Health 62(8):534-541.
World Health Organization (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet 363:157-163.
Yahia N., El-Ghazale H., Achkar A., Rizk S. (2011). Dieting practices and body image
perception among Lebanese university students. Asia Pacific journal of clinical nutrition 20(1):21-28.
Yahia N., Brown C., Potter S., Szymanski H., Smith K., Pringle L., Herman C., Uribe M., Fu Z., Chung M., Geliebter A. (2017). Night eating syndrome and its association with weight status, physical activity, eating habits, smoking status, and sleep patterns among college students. Eat Weight Disord. 22(3):433.
Al-Kandari S., Alsalem A., Al-Mutairi S., Al-Lumai D., Dawoud A., Moussa M. (2017). Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students. Sleep Health 3(5):342-347.
Allison K. C., Lundgren J. D., O’Reardon J. P., Martino N. S., Sarwer D. B., Wadden T. A., Crosby R. D., Engel S. G., Stunkard A. J. (2008). The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the Night Eating Syndrome. Eating Behaviours 9(1):62-72.
Allison K.C., Lundgren J.D., O’Reardon J. P., Geliebter A., Gluck M. E., Vinai P., Mitchell J. E., Schenck C. H., Howell M. J., Crow S. J., Engel S., Latzer Y., Tzischinsky O., Mahowald M. W., Stunkard A. J. (2010). Proposed diagnostic criteria for night eating syndrome. International Journal of Eating Disorders 43(3):241–247.
Babar M. G., Hasan S. S., Ooi Y. J., Ahmed S. I., Wong P. S., Ahmad S. F., MNM-Rosdy N. M., Malik N. A. (2015). Perceived sources of stress among Malaysian dental students. International Journal Of Medical Education 6:56-61.
Birketvedt G. S., Florholmen J., Sundsfjord J., Osterud B., Dinges D., Bilker W., Stunkard A. (1999). Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA, 282, pp. 657-663.
Buysse D. J., Reynolds III, C. F., Monk T. H., Berman S. R., Kupfer D. J. (1989). The
Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research 28(2):193-213.
Bruzas M. B., Allison K. C. (2019). A Review of the Relationship between Night Eating Syndrome and Body Mass Index. Psychological Issues 8:145-155.
Cao W., Fang Z., Hou G., Han M., Xu X., Dong J., Zheng J. (2020) The psychological impact of the COVID-19 epidemic on college students in China. J. Psychiatry Res. 287, 112934.
Cheng S-H. & Mohd Kamil, M.K (2020). Stress and food intake among university students – is there a relationship? Sains Malaysiana 49(1):121-128.
Canuto R., Garcez A. S., Olinto M. T. A. (2013). Metabolic syndrome and shift work: a
systematic review. Sleep Med Rev. 17(6):425-431.
Daniel W. W., Cross C. L. (1999). Biostatistics: A Foundation for Analysis in the Health Sciences. 7th edn. New York: John Wiley & Sons.
Dietch J. R., Taylor D. J., Sethi K., Kelly K., Bramoweth A. D., Roane B. M. (2016).
Psychometric Evaluation of the PSQi in U.S. College Students. J Clin Sleep Med 12(8):1121-1129.
Djalalinia, S., Qorbani, M., Peykari N., Kelishadi R. (2015). Health Impacts Of Obesity. Pak J Med Sci 31:239-242.
Dzulkafli N. H., Hamirudin A. H., Sidek S. (2020). Night Eating Syndrome and its Association with Body Mass Index among Female University Students. International Journal of Allied Health Sciences 4(4):1626-1634.
Farhangi M. A. (2019). Night Eating Syndrome and Its Relationship with Emotional Eating, Sleep Quality and Nutritional Status Among Adolescents’ Boys. Community Mental Health Journal 55:1411-1418.
Gallant A. R., Lundgren J., Drapeau V. (2012). The night-eating syndrome and obesity. Obesity Reviews 13(6):528-536.
Gan W. Y., Chin P. Q., Law L. S. (2019). Determination of Risk Factors for Night Eating Syndrome among Public University Students in Malaysia. Malaysian Journal of Medicine and Health Science 15(SP1):25-32.
Gopalakrishnan S., Ganeshkumar P., Prakash M. V. S., Christopher, Amalraj V. (2012).
Prevalence of overweight/obesity among the medical students, Malaysia. The Medical Journal of Malaysia 67(4):442-444.
Ghazi H. F., Abdalqader M. A., Baobaid M. F., Hasan T. N., Alabed A. A. A., Veerabadran V., Abdalrazak H. A., Gazi T. M., Hassan M. R., (2018). Obesity Knowledge and its Associated Factors among Medical Students in a Private University in Shah Alam, Selangor. Malaysian Journal of Public Health Medicine 18(2):45-51.
Gluck M. E., Geliebter A., Satov T. (2001). Night Eating Syndrome Is Associated with
Depression, Low Self-Esteem, Reduced Daytime Hunger, and Less Weight Loss in Obese Outpatients. Obesity Research 9:264-267.
He J., Huang F., Yan J., Wu W., Cai Z., Fan X. (2018). Prevalence, demographic correlates, and association with psychological distress of night eating syndrome among Chinese college students. Psychology, Health & Medicine 23(5):578-584.
Kabrita C. S., Hajjar-Muca T. A., Duffy J. (2014). Predictors of poor sleep quality among Lebanese university students: association between evening typology, lifestyle behaviors, and sleep habits. Nat Sci Sleep 6:11-18.
Krističević T., Štefan L., Sporiš G. (2014). The Association between Sleep Duration and Sleep Quality with Body-Mass Index in a Large Sample of Young Adults. International Journal of Environmental Research and Public Health 15(4):758.
Lai P.-P., Say Y.-H. (2012). Associated Factors of Sleep Quality and Behaviour among
Students of Two Tertiary Institutions in Northern Malaysia. Med J Malaysia 68(3)195-202.
Lundgren J. D., Allison K. C., Vinai P., Gluck M. E. (2012). Assessment instruments for night eating syndrome. In J. D. Lundgren, K. C. Allison, & A. J. Stunkard, eds, Night eating syndrome: Research, assessment, and treatment (2012). New York: Guilford Press, pp. 197-217.
Meule A., Allison K. C., Platte P. (2014). A German version of the Night Eating Questionnaire (NEQ): psychometric properties and correlates in a student sample. Eat Behav 15(4):523–527.
Najem J., Saber M., Aoun C., Osta N. E., Papazian T., Khabbaz L. R. (2020). Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students. Clinical Nutrition 39(2):533-539.
Nolan L. J., Geliebter A. (2016). “Food addiction” is associated with night eating severity.Appetite 98:89-94.
Nolan, L. J., Geliebter A. (2017). Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its relationship with depression, sleep quality, “food addiction”, and body mass index. Appetite 111:86-95.
Ngu S. T., Masalamany K., Manan N. A., Adam S. K. (2017). Sleep Quality among Pre-Clinical Medical Students in Universiti Putra Malaysia and University Malaya, Malaysia. Education in Medicine Journal 9(3):23-31.
Orzech K. M., Salafsky D. B., Hamilton L. A. (2011). The state of sleep among college students at a large public university. J Am Coll Health 59(7):612-619.
Pike K. M., Dunne P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders 3(33).
Radzi C. W. J. W. M., Jenatabadi H. S., Alanzi A. R. A., Mokhtar M. I., Mamat M. Z., Abdullah N. A., (2019). Analysis of Obesity among Malaysian University Students: A Combination Study with the Application of Bayesian Structural Equation Modelling and Pearson Correlation. International Journal of Environment Research and Public Health 16(3):492.
Riccobono G., Pompili A., Iannitelli A., Pacitti F. (2019). The relationship between Night-Eating Syndrome, depression and chronotype in a non-clinical adolescent population. Riv Psichiatr. 54(3):115-119.
Runfola C. D., Allison K. C., Hardy K. K., Lock J., Peebles R. (2014). Prevalence and clinical significance of night eating syndrome in university students. Journal of Adolescent Health 55(1):41–48.
Saat N.Z.M., Hanawi S. A., Chan K. S., Hanafiah H., The S. C., Aznan S. R., Joan C A. S., Zulkefli Z. H. (2020). Sleep Quality among University Students: Association between Demographic Factors and Physical Activity Level. International Journal of Pharmaceutical Research & Allied Sciences 9(3):57-65.
Sarina S., Poh L. K. (2015). Association between Socio-demographic Status and Body Mass Index with Night Eating Syndrome among University Students in Shah Alam, Selangor, Malaysia. Malaysia Journal of Nutrition 21.
Suh Y., Lee E. k., Chung Y. J. (2012). Comparison of nutritional status by energy level of night snack in Korean adults: using the data from 2005 Korean National Health and Nutrition Examination Survey. The Korean Journal of Nutrition 45(5):479-488.
Shillito, J. A., Lea, J., Tierney S., Cleator J., Tai S., Wilding J. P. H. (2018). Why I eat at night: A qualitative exploration of the development, maintenance and consequences of Night Eating Syndrome. Appetite 125:270-277.
Spiegel K., Tasali E., Penev P., Cauter E. V. (2004). Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite. Annals of internal medicine 141(11):846-850.
Stunkard, A. J., Grace, W.J., Wolff H. G. (1955). The night-eating syndrome. A pattern of food intake among certain obese patients. American Journal of Medicine 19:78-86.
Stunkard A. J. (1992). Obesity. In R. Berkow, A. J. Fletcher, eds. The Merck Manual of
Diagnosis and Therapy. Rahway, NJ: Merck Research Laboratories, pp. 981-986.
Stunkard A. J. (2008). The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the night eating syndrome. Eat Behav 9:62-72.
Thompson, S. (2015). Gender And Racial Differences In Emotional Eating, Food Addiction Symptoms, And Body Weight Satisfaction Among Undergraduates. Journal Of Diabetes And Obesity 2:1-6.
Vander Wal J. S. (2012). Night eating syndrome. Clinical Psychology Review 32(1):49-59.
Vargas P. A., Flores M., Robles E. (2014). Sleep Quality and Body Mass Index in College Students: The Role of Sleep Disturbances. Journal of American College Health 62(8):534-541.
World Health Organization (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet 363:157-163.
Yahia N., El-Ghazale H., Achkar A., Rizk S. (2011). Dieting practices and body image
perception among Lebanese university students. Asia Pacific journal of clinical nutrition 20(1):21-28.
Yahia N., Brown C., Potter S., Szymanski H., Smith K., Pringle L., Herman C., Uribe M., Fu Z., Chung M., Geliebter A. (2017). Night eating syndrome and its association with weight status, physical activity, eating habits, smoking status, and sleep patterns among college students. Eat Weight Disord. 22(3):433.
