Association of Sleep Duration with Weight Gain and General and Central Obesity Risk in Chinese Adults: A Prospective Study

Insomnia, Short Sleep, and Their Treatments: Review of Their Associations with Weight

PURPOSE OF REVIEW

Insomnia and short sleep have been linked with weight gain and obesity. However, these findings have not been consistent across studies. We review recent evidence for the association between insomnia, short sleep, and weight gain, as well as the relationship between behavioral and pharmacological treatments for sleep and weight.

RECENT FINDINGS

The relationship between insomnia and obesity is mixed, with stronger associations between insomnia with short sleep and obesity than other presentations of insomnia. Short sleep is associated with weight gain. Z-drugs and benzodiazapines do not appear to impact weight, but many antidepressants and antipsychotics that are used for insomnia treatment do cause weight gain. The relationships between insomnia and short sleep with weight gain and obesity are inconsistent. More prospective trials are needed to identify mediators and moderators of this relationship to better develop and deliver effective interventions for both sleep and weight problems.

Short sleep duration is associated with higher risk of central obesity in adults: A systematic review and meta-analysis of prospective cohort studies

Background and Objective

The relationship between sleep duration and obesity has been the focus of numerous investigations. This systematic review and meta-analysis of prospective cohort studies aimed to assess the relationship between sleep duration, abdominal obesity, and body composition.

Methods

PubMed, Scopus, and Web of Science were searched until February 2024. Cohort studies that assessed the relationship between sleep duration at night and central obesity measures or body composition indices in adults were included. The quality of studies was assessed using the Newcastle-Ottawa scale. Random-effects meta-analysis was conducted on studies that reported risk ratio (RR) and 95% confidence intervals (CIs).

Results

Eighteen studies were eligible to be included. Eleven out of the 18 studies were not included in the analysis as 10 studies did not report RR, and in one study, the definition of short and normal sleep duration was different from others. The results of the meta-analysis indicated that short sleep duration was significantly associated with abdominal obesity (RR = 1.08; 95% CI: 1.04-1.12; I 2 = 49.1%, n = 7), but long sleep duration was not (RR = 1.02; 95% CI: 0.83-1.24; I 2 = 98.2%, n = 6).

Conclusions

Short sleep duration was associated with a slightly higher risk of central obesity, while long sleep duration was not.

Delayed Sleep Midpoint Across Pregnancy Is Associated with Excessive Gestational Weight Gain

Background: Changes in sleep patterns and body weight occur during pregnancy, yet it is unclear whether sleep patterns are related to gestational weight gain (GWG). This study examined the relationship between maternal sleep across pregnancy and excessive GWG. Methods: Participants from the Michigan Archive for Research on Child Health (MARCH) cohort study, who had singleton births and provided information on fall-asleep and wake-up times during early (first or second) and the third trimesters, were included (n = 372). Changes in sleep duration and sleep midpoints throughout pregnancy were calculated. Prepregnancy weight and the last maternal weight before delivery were used to calculate GWG, which was categorized into groups (inadequate, adequate, and excessive). Poisson regression models were used to examine associations between sleep changes and excessive GWG, adjusted for age, race, gestational age, prepregnancy body mass index, income, fetus gender, physical activity, added sugar, and fruit and vegetable intake. Results: Excessive GWG was observed in 46.5% of women, and was more common among those with prepregnancy obesity (p < 0.001). Women who delayed sleep midpoint by 1 hour (or more) from the early trimester assessment to the third trimester experienced higher risk of excessive GWG (Risk ratio: 1.3; 95% confidence interval: 1.1-1.7). Single time points of sleep duration and sleep midpoint or changes in sleep duration were not related to GWG. Conclusions: Delay in sleep midpoint from early-mid pregnancy to the third trimester was associated with excessive GWG. Health professionals should consider changes in sleep patterns during pregnancy to identify those prone to excessive GWG.

Shift Work and Metabolic Syndrome Updates: A Systematic Review

Shift work can cause circadian cycles disturbances and misaligns the endogenous rhythms. The physiological variables are driven by the circadian system and, its misalignment, can impair the metabolic functions. Thus, the main objective of this study was to evaluate the metabolic alterations as a result of shift work and night work reported in articles published in the last 5 years, using the eligibility criteria both gender and indexed articles in English language. In order to execute this work, we perform a systematic review according to PRISMA guidelines and searched about Chronobiology Disorders and Night Work, both related to metabolism, in Medline, Lilacs, ScienceDirect and Cochrane. Cross-sectional, cohort and experimental studies with low risk of bias were included. We found a total of 132 articles, and, after the selection process, 16 articles remained to be analyzed. It was observed that shift work can cause circadian misalignment and, consequently, some metabolic parameters alterations such as an impaired glycemic control and insulin functioning, cortisol phase release, cholesterol fractions imbalance, changes in morphological indexes and melatonin secretion. There are some limitations, such as heterogenicity in used databases and the 5 years restriction period, because the effects of sleep disturbance may have been reported earlier. In conclusion, we suggest that shift work interferes with the sleep-wake cycle and eating patterns, which cause crucial physiological alterations that, together, can lead to metabolic syndrome.

Temporal relationship between sleep duration and obesity among Chinese Han people and ethnic minorities

BACKGROUND

No studies have assessed the association between sleep duration and obesity in Chinese ethnic minorities. Whether the relationship between sleep duration and obesity is different between Chinese Han people and Chinese ethnic minorities remains unclear. The study aimed to explore the relationship between sleep duration and obesity among Chinese Han people and Chinese ethnic minorities.

METHODS

We applied data from the Guizhou Population Health Cohort Study (GPHCS), which 9,280 participants were recruited in the baseline survey from 2010 to 2012, and 8,163 completed the follow-up survey from 2016 to 2020. A total of 5,096 participants (3,188 Han Chinese and 1,908 ethnic minorities) were included in the ultimate analysis. Information on sleep duration (total 24-hour sleep time), body mass index (BMI), and waist circumference (WC) was collected at the baseline and follow-up survey, respectively. Cross-lagged panel analyses were conducted to explore the temporal relationship between sleep duration and obesity for Han people and ethnic minorities.

RESULTS

For Han people, the results from cross-lagged panel analyses indicated that baseline sleep duration was significantly associated with follow-up BMI (β_BMI = -0.041, 95% CI_BMI: -0.072 ~ -0.009) and follow-up WC (β_WC = -0.070, 95%CI_WC: -0.103 ~ -0.038), but baseline BMI (β_BMI = -0.016, 95% CI_BMI: -0.050 ~ 0.018) and baseline WC (β_WC = -0.019, 95% CI_WC: -0.053 ~ 0.016) were not associated with follow-up sleep duration. In addition, the relationship between baseline sleep duration and follow-up BMI was gender-specific and significant only in the Han people female (β_BMI = -0.047, 95% CI_BMI: -0.090 ~ -0.003) but not in the Han people male (β_BMI = -0.029, 95% CI_BMI: -0.075 ~ 0.016). For ethnic minorities, the results indicated that there was no relationship between sleep duration and obesity at all, either from sleep duration to obesity (β_BMI = 0.028, 95%CI_BMI: -0.012 ~ 0.068; β_WC = 0.020, 95%CI_WC: -0.022 ~ 0.062), or from obesity to sleep duration (β_BMI = -0.022, 95%CI_BMI: -0.067 ~ 0.022; β_WC = -0.042, 95%CI_WC: -0.087 ~ 0.003).

CONCLUSION

The relationship pattern between sleep duration and obesity across Han people and ethnic minorities is different. Future sleep-aimed overweight and obesity intervention should be conducted according to population characteristics.

Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants

BACKGROUND

This study examined the joint associations of sleep patterns and physical activity (PA) with all-cause, cardiovascular disease (CVD), and cancer mortality.

METHODS

A total of 341,248 adults (mean age = 39.7 years; men: 48.3%) were included in the study, with a 15-year follow-up. Participants reported sleep duration and disturbances (difficulty falling asleep, easily awakened, or use of sleeping medication). PA was classified into 4 levels: <7.5, 7.5-14.9, 15.0-29.9, and ≥30.0 metabolic equivalent hours per week (MET-h/week). To understand the joint associations of sleep patterns and PA with mortality, Cox proportional hazard models were conducted, with exposure variables combining sleep duration/disturbances and PA.

RESULTS

Compared with the reference group (sleeping 6-8 h/day), individuals who slept >8 h/day had higher risk for all-cause mortality (hazard ratio (HR) = 1.307, 95% confidence interval (95%CI): 1.248-1.369), CVD mortality (HR = 1.298, 95%CI: 1.165-1.445), and cancer mortality (HR = 1.128, 95%CI: 1.042-1.220). Short sleep duration was not associated with mortality risk. Increased risk of all-cause and CVD mortality was found in participants who had difficulty falling asleep (HR = 1.120, 95%CI: 1.068-1.175; HR = 1.163, 95%CI: 1.038-1.304, respectively), and used sleeping medication (HR = 1.261, 95%CI: 1.159-1.372; HR = 1.335, 95%CI: 1.102-1.618, respectively) compared with those who slept well. Long sleep duration and sleep disturbances were not associated with risk of all-cause and CVD mortality among individuals achieving a PA level of ≥15 MET-h/week, and in particular among those achieving ≥30 MET-h/week.

CONCLUSION

Long sleep duration, difficulty falling asleep, and use of sleeping medication were related to a higher risk of death. Being physically active at a moderate intensity for 25-65 min/day eliminated these detrimental associations.

The Association Between Lifestyle and Abdominal Obesity Among Postmenopausal Women: A Cross-Sectional Study

Background: This study examined the association between sedentary behavior, sleep duration, breakfast skipping, and abdominal obesity among postmenopausal women in South Korea. Materials and Methods: A total of 7,270 postmenopausal women were included in this cross-sectional, secondary analysis study, using a nationally representative dataset from the Korea National Health and Nutrition Examination Survey. Results: Sleep duration of fewer than 5 hours/day was associated with an increased risk of abdominal obesity (odds ratio [OR] = 1.29; 95% confidence interval [CI], [1.02-1.63]), compared to sleep duration of 6-8 hours/day after controlling for covariates. Additionally, breakfast skipping was associated with an increased risk of abdominal obesity (OR = 1.45; 95% CI [1.02-2.06]), compared to breakfast eating after covariate adjustment. There was no significant association between sedentary behavior and abdominal obesity. Conclusions: The findings of this study demonstrate that special consideration should be given to behavior modification strategies to improve sleep duration and decrease breakfast skipping to decrease the risk of abdominal obesity in postmenopausal women.

Age and Sex Differences in the Association of Sleep Duration and Overweight/Obesity among Chinese Participants Age above 45 Years: A Cohort Study

OBJECTIVES

We aimed to evaluate the association between sleep duration and obesity and estimate the attributable risk of sleep in the China Health and Retirement Longitudinal Study surveys (CHARLS).

METHODS

A total of 9061 adults aged 45 years above from CHARLS (2011-2015) were included. The main outcome of this study was incident overweight/obesity specific to general and abdominal obesity. Overweight/obesity was defined as BMI ≥ 23.0 (kg/m2) and BMI≥27.5 (kg/m2), respectively. Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. Self-reported sleep durations were obtained using a structured questionnaire. We assessed hazard ratios (HRs) and 95% confidence intervals (CIs) as well as the population attributable fraction (PAF) for associations between sleep duration and obesity.

RESULTS

986 and 606 participants were identified as overweight and general obesity respectively, 1253 experienced abdominal obesity events. In multivariable-adjusted models, participants with daytime sleep of 0-30 minutes and more than 30 minutes associated with 30% (HR: 0.70, 95% CI: 0.56-0.87) and 35% (HR: 0.65, 95% CI: 0.55-0.78) decreased incident overweight risk respectively compared to those having no daytime sleep, this association also found among females and middle-aged, not males or elderly. Similarly, 0-30 minutes (HR: 0.68, 95% CI: 0.48-0.96) and more than 30 minutes of daytime sleep (HR: 0.73, 95% CI: 0.59-0.91) were associated with a reduced risk of abdominal obesity, similar results also found among females and middle-aged. Compared with 7-9 hours of nocturnal sleep, people who slept 5-7 hours had a reduced risk of overweight (HR: 0.59, 95% CI=0.47-0.74),but not found in subgroups. The hazard role of long nocturnal sleep for abdominal obesity was only found among elderly (HR: 2.33, 95% CI=1.35-4.04) and males (HR: 2.24, 95% CI=1.17-4.29). Compared with moderate total sleepers (7-9hours/day), participants with short total sleep duration exhibited an elevated risk of overweight (HR: 1.13, 95% CI=1.00-1.28), this also found among middle-aged. The PAF for inadequate total sleep duration (<7 hours/day) was 10.77% for overweight individuals.

CONCLUSIONS

Insufficient sleep duration was associated with an elevated risk of overweight only detected among middle-aged not elderly and other subgroups specific by age. The risks for abdominal obesity were increased for males and middle-aged with long nocturnal sleep. Daytime sleep may significantly reduce the risk of overweight and abdominal obesity in female and middle-aged individuals. The link between sleep duration and obesity requires further study.

Gender differences in the association between sleep duration and body mass index, percentage of body fat and visceral fat area among chinese adults: a cross-sectional study

BACKGROUND

The relationship between sleep duration and anthropometric indices are still unclear. This study aimed to explore the association between sleep duration and body mass index (BMI), percentage of body fat (PBF) and visceral fat area (VFA) among Chinese adults, further to explore gender difference in it.

METHODS

We analyzed part of the baseline data of a cohort study among adult attendees at two health-screening centers in China. Sleep duration was self-reported and categorized into short (< 7 h/day), optimal (7-9 h/day) and long sleep (≥ 9 h/day). BMI, PBF and VFA were assessed by bioelectric impedance analysis. Demographic characteristics, chronic diseases and medication history, physical activity, smoking and alcohol drinking behaviors were measured by an investigator-administrated questionnaire.

RESULTS

A total of 9059 adult participants (63.08% were females) were included in the analysis. The participants aged from 19 to 91 years with the mean age of 45.0 ± 14.6 years. Short sleep was independently associated with elevated odds of general obesity (defined using BMI) and visceral obesity (defined using VFA) among the total study population, and gender differences were observed in these associations. Among women, short sleep was associated with 62% increased odds of general obesity (OR = 1.62, 95% CI: 1.24-2.12) and 22% increased odds of visceral obesity (OR = 1.22, 95% CI: 1.02-1.45). Among men, long sleep duration was associated with 21% decreased odds of visceral obesity (OR = 0.79, 95% CI: 0.64-0.99). No association was observed between sleep duration and PBF in both sexes.

CONCLUSIONS

Sleep duration was associated with increased odds of general and visceral obesity, and this association differed between men and women. No association was observed between sleep duration and PBF among either males or females.

Epidemiology and determinants of obesity in China

Obesity has become a major public health issue in China. Overweight and obesity have increased rapidly in the past four decades, and the latest national prevalence estimates for 2015-19, based on Chinese criteria, were 6·8% for overweight and 3·6% for obesity in children younger than 6 years, 11·1% for overweight and 7·9% for obesity in children and adolescents aged 6-17 years, and 34·3% for overweight and 16·4% for obesity in adults (≥18 years). Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations. Strong evidence from prospective cohort studies has linked overweight and obesity to increased risks of major non-communicable diseases and premature mortality in Chinese populations. The growing burden of overweight and obesity could be driven by economic developments, sociocultural norms, and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments. Substantial changes in dietary patterns have occurred in China, with increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours. The effects of dietary factors and physical inactivity intersect with other individual-level risk factors such as genetic susceptibility, psychosocial factors, obesogens, and in-utero and early-life exposures. In view of the scarcity of research around the individual and collective roles of these upstream and downstream factors, multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.

Polysomnographic indicators of restorative sleep and body mass trajectories in the Wisconsin Sleep Cohort Study

STUDY OBJECTIVES

Previous research suggests that reductions in restorative, slow-wave (N3), and rapid eye movement (REM) sleep are associated with weight gain and obesity in mid-to-late life. We extend prior work by examining how within-person (WP) changes and between-person (BP) differences in restorative sleep over several years are associated with body mass trajectories among participants in the Wisconsin Sleep Cohort Study (WSCS).

METHODS

We used data from 4,862 polysomnographic (PSG) sleep studies and physical exams collected from 1,187 WSCS participants over an average duration of 14.9 years. Primary measures of interest included body mass index (BMI = kg/m2) and the percentages of time spent in N3 and REM sleep. We estimated a series of linear mixed regression models to examine how WP changes and BP differences in N3 and REM sleep affected BMI trajectories, controlling for other sleep measures, demographic characteristics, and health behaviors as potential confounders.

RESULTS

Women in the WSCS experienced more rapid BMI gain than men. With some variation by sex, we found that (1) below-average N3 and REM sleep is associated with above-average BMI, and (2) within-person decreases in N3 and REM sleep over time are associated with gains in BMI. These findings persisted after adjustment for sleep duration and other potential confounders.

CONCLUSIONS

Our findings highlight the importance of PSG indices of restorative sleep in mid-to-late life, suggesting that future clinical treatments and public health policies will benefit from heightened attention to sleep quality.

The association between poor sleep quality and anxiety and depression symptoms in Chinese patients with coronary heart disease

Poor sleep quality might be a potentially modifiable predictor of prognosis in patients with coronary heart disease (CHD). Anxiety and depression symptoms are highly prevalent in these patients. Whether anxiety and depression symptoms are risk factors for poor sleep quality in Chinese patients with CHD is unclear. This study is intended to examine the prevalence of poor sleep quality in Chinese patients with CHD and its associations with anxiety and depression symptoms, and to explore whether sex, obesity and CHD type modify these associations. Three hundred and forty-eight participants were included. The Pittsburgh Sleep Quality Index (PSQI, >7 was defined as poor sleep quality) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and psychological symptoms. 47.1% of the participants had poor sleep quality. Logistic regression analysis showed that poor sleep quality was independently associated with anxiety and depression symptoms adjusting for demographic and clinical factors. However, adjusted for anxiety symptoms, poor sleep quality was no longer associated with depression symptoms. Subgroup and interaction analysis showed that poor sleep quality was associated with markedly higher HADS anxiety and depression scores among patients with stable angina than those with acute coronary syndrome (ACS). These findings suggest that poor sleep quality was associated with both anxiety and depression symptoms in Chinese patients with CHD. However, in the case of concurrent anxiety and depression, anxiety was the main related factor of a high prevalence of poor sleep quality. The association between poor sleep quality and psychological symptoms was influenced by CHD type.

Ten Years of the Cohort Biobank: Bibliometric Outcomes

Background: Cohort studies with biobanks that use strict quality standards are essential requirements, not only for the development of new diagnostic and prognostic markers, but also for improving the understanding of pathophysiology of disease development, which have drawn an increasing amount of attention over the past decades. However, a bibliometric analysis of the global research on cohort biobanks is rare. The objective of this study was to evaluate the origin, current trend, and research hotspots of cohort biobanks. Materials and Methods: We searched the Web of Science Core Collection (WoSCC) with "biobank" and "cohort" as the topic words to retrieve English language articles published from 2009 to 2018. The CiteSpace 5.5.R2 was used to perform the cooperation network analysis, key words co-occurrence and burst detection analysis, and reference co-citation analysis. Results: The number of publications on cohort biobanks has increased over the past decade. Tai Hing Lam from the Department of Community Medicine, University of Hong Kong, was found to be the most productive researcher in this field. The percentage of publications in England (38.30%) was the highest all over the world. Risk, biobank, meta-analysis, cohort, disease, and so on were the most frequent keywords. Metabolic syndrome was the strongest burst keyword in this field, followed by Hong Kong, Guangzhou biobank cohort and personalized medicine. Moreover, of all the references for 932 articles included in the study, the article titled "UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age" published in PLoS Med by Sudlow et al., was the most frequently co-cited reference in this field. The largest cluster was labeled as Guangzhou biobank cohort study. Conclusions: This study provides an insight into cohort biobanks and the valuable information for biobankers to identify new perspectives on potential collaborators and cooperative countries/territories.

Adiposity-related risks among the middle-aged and elderly Chinese: the role of siesta and nocturnal sleep duration

Introduction

Background: increasingly, research suggests that lack of sleep is linked to adiposity worldwide, but few studies have been conducted in middle-aged and elderly Chinese subjects. The purpose of the present study was to analyze the association of siesta and nocturnal sleep duration with the prevalence of adiposity in middle-aged and elderly Chinese individuals. Methods: a total of 7,891 community dwelling Chinese subjects who had participated in the 2015 China Health and Retirement Longitudinal Study were included. A four-stage random sampling method was used to select participants. Siesta and nocturnal sleep duration was self-reported. Adiposity, including general obesity and abdominal obesity, was assessed. Multiple logistic analyses were conducted to explore the association between siesta, nocturnal sleep duration, and adiposity. Results: people with long siesta durations (≥ 1 hour/day) were significantly associated with an increased risk for abdominal obesity, independently and in all subgroup analyses, when compared to those without regular siesta. ORs after adjustment of confounding factors included: all subjects, OR = 1.45, 95 % CI, 1.23 to 1.70; middle-aged subjects, OR = 1.46, 95 % CI, 1.15 to 1.86; elderly, OR = 1.43, 95 % CI, 1.14 to 1.78. Conclusions: our data show that siesta duration plays a role in the prevalence of age-specific abdominal obesity. Individuals with long siesta durations are more likely to have abdominal obesity among the middle-aged and elderly population when compared to those without regular siesta. The results of this study need to be confirmed by further studies.

[Napping, nocturnal sleep and adiposity]

Introduction

Beneficial effects of weekend catch-up sleep on metabolic syndrome in chronic short sleepers

OBJECTIVES

Short sleep duration has been known to be related to metabolic syndrome (MetS) . The aim of this study was to investigate the beneficial effects of weekend catch-up sleep (WCUS) on MetS in the Korean middle-aged population.

METHODS

For this cross-sectional study, 1,812 participants aged 35-60 years were selected from the 2016-2018 Korean National Health and Nutrition Examination Survey (mean age 46.94 years, 49% male). Short sleep duration was defined as <6hrs on weekdays, and participants were divided into two groups: WCUS group and no weekend catch-up sleep group. Multiple logistic regression was performed to determine the association between WCUS and MetS prevalence. The covariates included age, sex, education, income, occupation, smoking, alcohol consumption, and physical activity.

RESULTS

WCUS was significantly associated with lower MetS prevalence in the unadjusted model and in the model adjusted for socioeconomic and health behavior factors.

CONCLUSION

These results support the beneficial effects of WCUS on lowering the risk of MetS among middle-aged chronic short sleepers.

Association between sleep duration and weight gain and incident overweight/obesity: longitudinal analyses from the China Health and Nutrition Survey

OBJECTIVE

To evaluate the association between sleep duration and weight gain and incident overweight/obesity in the population of China.

METHODS

Data were derived from the China Health and Nutrition Survey. Adult participants with baseline data of sleep duration and body mass index (BMI) and who received at least one follow-up evaluation were selected to analyze the association of sleep duration with weight gain (n = 12,871) and incident overweight/obesity (n = 7,752). Daily sleep duration was categorized into five groups: ≤ 6, 7, 8 (as reference), 9, and ≥ 10 h. The study outcomes were weight gain ≥ 5 kg and incident overweight/obesity (BMI ≥ 24 kg/m²).

RESULTS

Adjusted Cox proportional hazards models showed that only short sleep duration (≤ 6 h) significantly increased the risk of weight gain ≥ 5 kg (HR: 1.160, 95% CI: 1.005-1.339, p < 0.001) and incident overweight/obesity (HR: 1.403, 95% CI: 1.185-1.660, p < 0.001), whereas sleep duration 9 h was significantly associated with a lower risk of incident overweight/obesity (HR: 0.817, 95% CI: 0.700-0.953, p = 0.010). No significant correlation was found between long sleep duration (> 10 h) and the risk of weight gain ≥ 5 kg and incident overweight/obesity.

CONCLUSION

Short sleep duration is a risk factor for the development of weight gain ≥ 5 kg and incident overweight/obesity in Chinese adults, whereas long sleep duration had no effect on future obesity.

Prevalence of Suboptimal Health Status and the Relationships between Suboptimal Health Status and Lifestyle Factors among Chinese Adults Using a Multi-Level Generalized Estimating Equation Model

This study examined the prevalence of suboptimal health among Chinese adults based on a large-scale national survey and clarified the relationship between suboptimal health and lifestyle factors. We used multi-level generalized estimating equation models to examine the relationships between suboptimal health and lifestyle factors. Of the 48,978 respondents, 34,021 reported one or more suboptimal health symptoms, giving a suboptimal health status prevalence of 69.46%. After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, factors associated with suboptimal health were: current smoking (odds ratio (OR) = 1.083, 95% confidence interval (CI): 1.055-1.111), drinking alcohol (OR = 1.075, 95% CI: 1.025-1.127), family history of disease (OR = 1.203, 95% CI: 1.055-1.111), sleeping <6 h per day (OR = 1.235, 95% CI: 1.152-1.256), poor sleep quality (OR = 1.594, 95% CI: 1.515-1.676), stress (OR = 1.588, 95% CI: 1.496-1.686), negative life events (OR = 1.114, 95% CI: 1.045-1.187), unhealthy diet choices (OR = 1.093, 95% CI: 1.033-1.156), and not regularly having meals at fixed hours (OR = 1.231, 95% CI: 1.105-1.372). Respondents who exercised regularly had lower odds of having suboptimal health status (OR = 0.913, 95% CI: 0.849-0.983). Suboptimal health has become a serious public health challenge in China. The health status of the population could be effectively improved by improving lifestyle behaviors.

Long Sleep Duration is Associated with Increased High-Sensitivity C-Reactive Protein: A Nationwide Study on Chinese Population

PURPOSE

High-sensitivity C-reactive protein (hs-CRP) has been shown as an important predictor of cardiovascular risk, and sleep duration is an important factor influencing health outcomes. However, the association between hs-CRP and sleep duration among Chinese adults remained unknown and controversial. We aimed to explore the associations between sleep duration and hs-CRP levels among Chinese adults, and the differences in sex and geographical regions.

METHODS

This cross-sectional study was based on nationally representative Chinese samples from the 2009 China Health and Nutrition Survey, which employed multistage, random cluster designs. Habitual sleep duration was self-reported with short and long sleep duration defined as ≤6h and ≥9h per day, respectively. Participants were divided into 4 groups based on the categories of self-reported sleep duration (≤6h, 7h, 8h, ≥9h per day), excluding hs-CRP levels ≥10 mg/L. Subset samples were stratified by sex and geographical regions.

RESULTS

A total of 8170 Chinese adults with a mean age of 50.0±14.9 years and 4369 (53.5%) men were included. Participants sleeping eight hours had the lowest hs-CRP levels. Long sleep duration (≥9h) was significantly associated with elevated hs-CRP levels after adjusting for multiple covariates in full samples (β=0.0356; 95% CI: 0.0050-0.0663; P=0.0228), but the associations of short sleep duration (≤ 6h) were limited to the unadjusted model. Long sleep duration was associated with elevated hs-CRP levels in women (β= 0.0512; 95% CI: 0.0097-0.0927; P=0.0155) and in the northern region of China (β=0.0699; 95% CI: 0.0210-0.1187; P=0.0051), but not in men or the southern region.

CONCLUSION

Long but not short sleep duration was positively associated with elevated hs-CRP levels, independent from traditional risk factors among Chinese adults, and sex and geographical differences were observed. Our findings imply that modifications of long sleep duration might be added to behavioral therapy to reduce cardiovascular risk in Chinese adults.