Associations of fruit and vegetable intake with sleep quality and stress among Hong Kong female nurses with different working status : a cross-sectional study

Abstract

Background: The relationships of fruit and vegetable (FV) intake with sleep quality and stress among nurses with different working status are largely unknown. This study aimed to assess the FV intake among Hong Kong female nurses with varying working status and evaluate its associations with sleep quality and stress levels. Methods: A cross-sectional survey named “Hong Kong Women’s Health Study” was conducted between 2019 and 2020. Systematic sampling was adopted to recruit eligible nurses from a local Nurses Association. Email invitations followed by mailed questionnaires were used for data collection. FV servings consumed every day with detailed descriptions. The Chinese version of the Pittsburgh Sleep Quality Index and Perceived Stress Scale-14 items were employed to evaluate sleep quality and stress level, respectively. Nurses’ work status was classified as employed/retired and day work/shift work. Multivariate linear regression was applied. Results: A total of 1,270 female nurses were included in the data analysis. The average FV intake was 2.91 servings/day, 88.7% of the participants consumed less than 5 servings/day. Nurses who were aged 45 and above, obese (BMI ≥ 25 kg/m2), post-menopause, with a higher monthly family income, day work schedule, or retired, were more likely to have higher VF intake (all P < .05). The mean PSQI score was 6.14 (SD = 3.41), 53.7% nurses reported poor sleep quality. The mean PSS score was 24.8 (SD = 7.62), with 79.5% of nurses having moderate to high levels of stress. The multiple linear regression analysis revealed that 1-serving increase in FV intake was associated with 0.150 (95% CI: -0.279, -0.021) units and 0.656 (95% CI: -0.932, -0.380) units decrease in sleep and stress scores (both P < .05), respectively. Among retired nurses and routine day-working nurses, consuming more FV servings predicted higher decline in stress levels than those employed and shift-working nurses. Conclusion: Increased FV intake was associated with better sleep quality and lower stress levels among Hong Kong female nurses. The FV intake-stress relationship was strengthened in employed nurses and those working routine day shifts.