Reciprocal Roles of Sleep and Diet in Cardiovascular Health: a Review of Recent Evidence and a Potential Mechanism

An Overview of the Potential Role of Nutrition in Mental Disorders in the Light of Advances in Nutripsychiatry

PURPOSE OF REVIEW

As research on the potential impact of nutrition on mental disorders, a significant component of global disability continues to grow the concepts of "nutritional psychiatry, psycho-dietetics/nutripsychiatry" have taken their place in the literature. This review is a comprehensive examination of the literature on the the potential mechanisms between common mental disorders and nutrition and evaluates the effectiveness of dietary interventions.

RECENT FINDINGS

Inflammation, oxidative stress, intestinal microbiota, mitochondrial dysfunction, and neural plasticity are shown as potential mechanisms in the relationship between mental disorders and nutrition. As a matter of fact, neurotrophic factors, which make important contributions to repair mechanisms throughout life, and neuronal plasticity, which plays a role in mental disorders, are affected by nutritional factors. In metabolism, the antioxidant defense system works with nutritional cofactors and phytochemicals. A balanced, planned diet that provides these components is more likely to provide nutrients that increase resilience against the pathogenesis of mental disorders. Nutrition can be considered a risk factor for mental disorders. Therefore, developing public health strategies focused on improving diet may help reduce the global burden of mental disorders and other related diseases.

Gut Microbiota Dysbiosis and Sleep Disorders: Culprit in Cardiovascular Diseases

Background: Over the past decade, the gut microbiome (GM) has progressively demonstrated to have a central role in human metabolism, immunity, and cardiometabolic risk. Likewise, sleep disorders showed an impact on individual health and cardiometabolic risk. Recent studies seem to suggest multi-directional relations among GM, diet, sleep, and cardiometabolic risk, though specific interactions are not fully elucidated. We conducted a systematic review to synthesize the currently available evidence on the potential interactions between sleep and GM and their possible implications on cardiometabolic risk. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses, including articles from January 2016 until November 2022. Narrative syntheses were employed to describe the results. Results: A total of 8 studies were selected according to these criteria. Our findings indicated that the sleep disorder and/or the acute circadian rhythm disturbance caused by sleep-wake shifts affected the human GM, mainly throughout microbial functionality. Conclusions: Sleep disorders should be viewed as cardiovascular risk factors and targeted for preventive intervention. More research and well-designed studies are needed to completely assess the role of sleep deprivation in the multi-directional relationship between GM and cardiometabolic risk.

Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study

BACKGROUND

More is to be explored between dietary patterns and sleep quality in the Chinese adult population.

METHODS

A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations.

RESULTS

The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27).

CONCLUSIONS

In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

Evaluation of the relationship between the Mediterranean diet adherence and sleep quality in adults

PURPOSE

To investigate the association between Mediterranean diet adherence (MDA) and sleep quality in adults.

METHODS

This cross-sectional research was conducted among adults aged 19-64 years in Ankara, Türkiye. Data on demographics, education, lifestyle, and physical activity habits were collected. Mediterranean diet adherence was assessed with the Mediterranean Diet Adherence Screener (MEDAS). Healthy eating attitudes were evaluated with the Attitude Scale for Healthy Nutrition (ASHN). Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Data were gathered using an online format.

RESULTS

Among 1031 participants enrolled (74% women), mean age was 28.6 ± 8.3 years. Median age increased with MDA (p = 0.001). As individuals' MDA increased, ASHN total and subgroup scores also increased significantly (p < 0.001). The total sleep duration of the participants with low MDA was significantly lower than the other groups (p = 0.003). Pittsburgh Sleep Quality Index score and MEDAS (β =  - 0.222, p < 0.001), ASHN (β =  - 0.043, p < 0.001) and ASHN subgroups (β = (- 0.086) - (- 0.031)) were found to have a weakly signficant negative relation.

CONCLUSIONS

The findings suggest that healthy eating attitudes and nutritional behavior in accordance with the Mediterranean diet are associated with sleep quality.

Fasting diets: what are the impacts on eating behaviors, sleep, mood, and well-being?

Fasting diets (FDs) have drawn great attention concerning their contribution to health and disease over the last decade. Despite considerable interest in FDs, the effect of fasting diets on eating behaviors, sleep, and mood-essential components of diet satisfaction and mental health- has not been addressed comprehensively. Understanding the critical role that fasting plays in these elements will open up potential treatment avenues that have not yet been explored. The aim of the present paper was to conduct a comprehensive critical review exploring the effects of fasting on eating behaviors, sleep, and mood. There is currently a lack of clarity regarding which fasting option yields the most advantageous effects, and there is also a scarcity of consistent trials that assess the effects of FDs in a comparable manner. Similarly, the effects and/or treatment options for utilizing FDs to modify eating and sleep behaviors and enhance mood are still poorly understood. Further researches aiming at understanding the impacts of various fasting regimes, providing new insights into the gut-brain axis and offering new treatment avenues for those with resistant anxiety and depression, are warranted. Alteration of eating behaviors can have lasting effects on various physiological parameters. The use of fasting cures can underpin ancient knowledge with scientific evidence to form a new approach to the prevention and treatment of problems associated with co-morbidities or challenges pertaining to eating behaviors. Therefore, a thorough examination of the various fasting regimens and how they impact disease patterns is also warranted.

Sleep and cardiometabolic risk. Narrative revision

OBJECTIVES

Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various chronic diseases, including cardiometabolic, neurodegenerative, and autoimmune diseases.

MATERIAL AND METHODS

This is a narrative review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century.

RESULTS

The relationship between sleep disorders and metabolic dysregulation has been clearly established, mainly in the setting of modern epidemic of cardiometabolic disease, a cluster of conditions include obesity, insulin resistance, arterial hypertension, and dyslipidaemia, all of them considered as main risk factor for atherosclerotic cardiovascular disease (ACVD) and its clinical expression such as ischemic ictus, myocardial infarction and type 2 diabetes. Clinically viable tools to measure sleep duration and quality are needed for routine screening and intervention.

CONCLUSIONS

In view of what has been exposed in this review, it is evident that the timing, amount, and quality of sleep are critical to reduce the burden of risk factors for several chronic disease, including ACVD and type 2 diabetes, and most relevant in young people. Future research studies should elucidate the effectiveness of multimodal interventions to counteract the risk of short sleep for optimal patient outcomes across the healthcare continuum, especially in young people.

Mediterranean Diet and Cardiovascular Disease: The Moderating Role of Adequate Sleep-Results from the ATTICA Cohort Study (2002-2022)

The relationship between diet, sleep duration and cardiovascular disease (CVD) has not been well understood. The aim of the present study was to test the potential modifying role of sleep duration in the association between adherence to the Mediterranean-type diet (MD) and CVD risk. The study consisted of n = 313 initially free-of-CVD adults, from the ATTICA cohort study (2002-2022), with available information on sleep habits. Sleep habits were categorized as inadequate and adequate sleep duration (< or ≥7 h/day, respectively). In multi-adjusted analysis, MD adherence was inversely associated with CVD risk [Hazard Ratio-HR per 1/55 in MedDietScore: 0.80, 95% Confidence Interval-CI: 0.65, 0.98]. A significant interaction between sleep duration and MedDietScore was observed (p < 0.001). In subgroup analysis, the protective association between MD adherence and CVD risk was found only in participants who slept adequately, i.e., >7 h/day [HR:0.80, 95%CI: 0.65, 0.98]. Those who had a high adherence to the MD along with adequate sleep habits, had a 70% reduced 20-year CVD risk [HR:0.30, 95%CI: 0.11, 0.80], compared to those who had a low MD adherence and inadequate sleep habits. Sleep duration should be a part of an individual's lifestyle, together with dietary and other habits, to effectively evaluate CVD risk for future events.

Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation

Background

With the establishment of the cardiac-gut axis concept, increasing evidence has suggested the involvement and important regulatory role of the gut microbiota (GM) and short chain fatty acid (SCFA) in cardiovascular diseases. However, the relationship between GM and atrial fibrillation (AF) is still poorly understood.

Objectives

The aim of this study was to investigate whether there were differences in GM and SCFA between AF patients and healthy controls.

Methods

In this study, we enrolled 30 hospitalized patients with AF and 30 matched patients with sinus rhythm (SR). GM species in fecal samples were evaluated through amplicon sequencing targeting the 16Sribosomal RNA gene. The feces SCFAs were describe step by step the quantitative analysis using gas chromatography-mass spectrometry (GC-MS). GM species richness, diversity, differential abundance of individual taxa between AF and SR were analyzed.

Results

AF patients showed decreased species richness and α-diversity compared to SR patients, but there was no statistical difference. The phylogenetic diversity was significant decreased in AF group. The β-diversity indexes revealed significant differences in GM community structure between the AF group and the SR group. After investigated the individual taxa, AF group showed altered relative abundance in several taxa compared to the SR group. linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed, a significant decrease in Bifidobacterium and a greater abundance of Lactobacillus, Fusobacterium, Haemophilus in AF group compared with the SR group. The abundance of haemophilus was negative correlated with isovaleric acid and isobutyric acid.

Conclusions

In AF patients, the GM phylogenetic diversity and β-diversity decreased, the relative abundance altered in several taxa and the bacterial community structure changed as well as the SCFA level. GM and SCFA dysbiosis might play a crucial part in the occurrence and development of AF.

Unveiling the sleep-cardiovascular connection: Novel perspectives and interventions-A narrative review

Introduction

Sleep is an important neurophysiological condition that is intricately linked to general health, laying the basis for both physiological and psychological well-being. A thorough examination of sleep disorders and cardiovascular health demonstrates their deep relationship, emphasizing the numerous diagnostic tools and treatment techniques available.

Aim

This study aims to examine the impact, mechanisms, diagnostic techniques, treatment strategies, implications, and healthcare interventions of the sleep-cardiovascular connection, to better understand the relationship between sleep disorders and cardiovascular health.

Methods

The paper reviews key studies conducted from 2015-till date, investigating the impact of sleep disorders on the cardiovascular system. It looked into data relating to cardiovascular outcomes based on the degree of sleep disorders, considered potential confounding factors, and addressed current research constraints.

Results

The findings highlight a strong link between sleep problems and poor cardiovascular outcomes. Emerging diagnostic tools, such as enhanced sleep-related technology and biomarkers, open up new avenues for determining the impact of sleep disturbances on cardiovascular health. In addition, the research discusses several treatment options, ranging from cognitive behavioral therapy to pharmaceutical therapies, and their potential benefits in addressing sleep-related cardiovascular risks.

Conclusion

The complex association between sleep disturbances and cardiovascular health emphasizes the need to recognize sleep as a critical component of overall well-being. Thus collaboration among medical disciplines, as well as individualized therapies, are critical to improving patient care. Moreover, Understanding and managing the consequences of sleep problems on cardiovascular health can lead to more effective interventions, better outcomes, and improved public health as research advances.

Resilience Effect and Association Analysis between Sleep Duration and Body Mass Index

The Article Abstract is not available.

Exploring the Role of Dairy Products In Sleep Quality: From Population Studies to Mechanistic Evaluations

Poor sleep quality and insufficient sleep affect a large portion of the population. This is concerning given increasing evidence that poor sleep health is a behavioral risk factor for the development of cardiometabolic diseases. A healthy diet is associated with a plethora of favorable health outcomes, and emerging research now highlights diet as a potential determinant of sleep health that could be leveraged to improve sleep quality. Dairy products are notably rich in tryptophan (Trp), a key substrate for serotonin and melatonin production, which are instrumental for initiating and maintaining sleep. Furthermore, dairy products provide a range of micronutrients that serve as cofactors in the synthesis of melatonin from Trp, which could contribute to sleep-promoting effects. In this review, we evaluate population studies and clinical trials to examine a possible link between dairy consumption and sleep. Available epidemiologic studies illustrate positive associations between dairy intake and sleep outcomes. Moreover, some intervention studies support a causal effect of dairy intake on sleep. Given these data, we discuss potential mechanisms, invite additional clinical research on this topic, and provide insights on how limitations of current studies can be addressed in future trials.

Sleep duration, plasma metabolites, and obesity and diabetes: a metabolome-wide association study in US women

Short and long sleep duration are associated with adverse metabolic outcomes, such as obesity and diabetes. We evaluated cross-sectional differences in metabolite levels between women with self-reported habitual short (<7 h), medium (7-8 h), and long (≥9 h) sleep duration to delineate potential underlying biological mechanisms. In total, 210 metabolites were measured via liquid chromatography-mass spectrometry in 9207 women from the Nurses' Health Study (NHS; N = 5027), the NHSII (N = 2368), and the Women's Health Initiative (WHI; N = 2287). Twenty metabolites were consistently (i.e. praw < .05 in ≥2 cohorts) and/or strongly (pFDR < .05 in at least one cohort) associated with short sleep duration after multi-variable adjustment. Specifically, levels of two lysophosphatidylethanolamines, four lysophosphatidylcholines, hydroxyproline and phenylacetylglutamine were higher compared to medium sleep duration, while levels of one diacylglycerol and eleven triacylglycerols (TAGs; all with ≥3 double bonds) were lower. Moreover, enrichment analysis assessing associations of metabolites with short sleep based on biological categories demonstrated significantly increased acylcarnitine levels for short sleep. A metabolite score for short sleep duration based on 12 LASSO-regression selected metabolites was not significantly associated with prevalent and incident obesity and diabetes. Associations of single metabolites with long sleep duration were less robust. However, enrichment analysis demonstrated significant enrichment scores for four lipid classes, all of which (most markedly TAGs) were of opposite sign than the scores for short sleep. Habitual short sleep exhibits a signature on the human plasma metabolome which is different from medium and long sleep. However, we could not detect a direct link of this signature with obesity and diabetes risk.

Total sleep deprivation selectively impairs motor preparation sub-stages in visual search task: Evidence from lateralized readiness potentials

Introduction

Many studies have provided evidence of a damage effect triggered by total sleep deprivation (TSD). However, it remains unclear whether the motor preparation processing is affected by TSD.

Methods

In the current study, 23 volunteers performed a stimulus-response compatibility visual search task before and after TSD while undergoing spontaneous electroencephalography (EEG).

Results

Repeated-measures analysis of variance revealed that: Compared with that at baseline, the visual search task's accuracy decreased after TSD, while the response time variance increased significantly. The peak amplitude of the stimulus-locked lateralized readiness potential (LRP) induced by a compatible stimulus was significantly more negative than that induced by an incompatible stimulus before TSD, whereas this difference was not significant after TSD. However, when taking sleep status into consideration, there were no significant main or interaction effects on response-locked LRPs.

Discussion

Our findings suggest that TSD damages visual search behavior, selectively impairs the earlier sub-stages of motor preparation (sensory integration). These findings will provide a new perspective for understanding the effects of sleep loss.

Nutrition, Sleep, Circadian Rhythms, and Health Implications: "Come Together"

Over the last few years, novel and important aspects of nutrition that are often overlooked in nutritional epidemiology, experimental research, and recommendations for health maintenance and disease prevention concerning the circadian rhythmicity of feeding, as well as the bidirectional interaction of nutrition with central and peripheral endogenous circadian clocks, and with other rhythmic behaviors including the sleep-wake cycle have received increasing attention from the research community [...].

Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes: A prospective cohort study

AIMS

This study aimed to assess the association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes.

METHODS

Our study included 12,770 individuals from the UK Biobank at baseline. Sleep patterns were defined by a combination of five sleep behaviors (chronotype, sleep duration, snoring, insomnia, and excessive daytime sleepiness). The competing risk models were used to estimate the relationship between sleep patterns and CVD (including coronary heart disease [CHD] and stroke) in individuals with diabetes. To examine the association between sleep patterns and all-cause mortality risk, we utilized the flexible parametric Royston-Parmar proportion-hazard models.

RESULTS

We recorded 2627 CVD events, which includes 1999 CHD and 903 S events, and 1576 all-cause mortality events. Compared to those with poor sleep pattern, individuals having healthy sleep pattern have a 24% lower CVD risk (p < 0.001), a 26% lower CHD risk (p = 0.001), a 25% lower stroke risk (p = 0.036), and a 21% lower all-cause mortality risk (p = 0.020).

CONCLUSIONS

Adherence to healthy sleep pattern has been significantly related to cardiovascular disease and all-cause mortality risk reduction among people with diabetes.

Total Sleep Deprivation Triggers Greater Activation in the Parietal Brain in the Visual Working Memory Updating Processes: An Event-Related Potentials Study

Working memory functions are known to be altered after total sleep deprivation (TSD). However, few studies have explored the deficits of working memory updating (WMU) after TSD, or the underlying electrophysiological mechanisms of these alterations. In the current exploratory study, we enrolled 14 young male volunteers who performed two kinds of WMU tasks—spatial and object two-back tasks—with simultaneous electroencephalography recordings under two sleep conditions: a normal sleep baseline condition and after 36 h of TSD. Repeated-measures analysis of variance showed that compared with those at baseline, the rates of correct responses in the WMU tasks decreased significantly after TSD. Analysis of event-related potentials revealed that the average amplitude of P3 components decreased significantly in the frontal and central brain regions and increased significantly in the parietal brain regions. Our findings suggest that TSD damages WMU behavior, impairs cognitive functions in the frontal and central brain regions, and triggers greater activation in the parietal brain regions. This is the first study to report the existence of event-related compensatory neural activity. This event-related compensatory effect may provide a new perspective for understanding the mechanisms underlying the influences triggered by sleep loss.

The Dynamic Interplay of Healthy Lifestyle Behaviors for Cardiovascular Health

PURPOSE OF REVIEW

The recent rise in cardiovascular disease (CVD) deaths in the USA has sparked interest in identifying and implementing effective strategies to reverse this trend. Healthy lifestyle behaviors (i.e., healthy diet, regular physical activity, achieve and maintain a healthy weight, avoid tobacco exposure, good quality sleep, avoiding and managing stress) are the cornerstone for CVD prevention.

RECENT FINDINGS

Achieving all of these behaviors significantly benefits heart health; however, even small changes lower CVD risk. Moreover, there is interplay among healthy lifestyle behaviors where changing one may result in concomitant changes in another behavior. In contrast, the presence of one or more unhealthy lifestyle behaviors may attenuate changing another lifestyle behavior(s) (poor diet, inadequate physical activity, overweight/obesity, poor sleep quality, tobacco exposure, and poor stress management). It is important to assess all of these lifestyle behaviors with patients to plan an intervention program that is best positioned for adherence.

Arab Women Adherence to the Mediterranean Diet and Insomnia

Background and objective: Sleeping difficulties affect the overall health, nutrition, and wellbeing. The Mediterranean diet has proven effective in improving the quality of life and overall health of people of all ages. Therefore, this study aimed to determine whether adherence to the Mediterranean diet (MD) is linked to reduced insomnia in Arabic-speaking female adults in Jordan. Materials and Methods: A self-administered, cross-sectional survey was used to detect the relationship between MD and sleep quality in Arabic-speaking female adults. Data were collected from 917 Arabic-speaking female participants of 14 Arab nationalities in Jordan between March and May 2021 via social media. All participants answered the whole questionnaire, including questions on sociodemographic aspects, Mediterranean diet adherence, sleeping habits measured with the Athens Insomnia Scale (AIS), and lifestyle components such as smoking and dietary patterns. Results: The mean age of the 917 Arabic-speaking female participants was 36 ± 10 years. Most participants were unemployed (85%) single females (64%) with an undergraduate degree (74%). Most of them (86%) were non-smokers. More than half of the participants were Jordanians (57%). The BMI was normal for 52% of the participants, whereas 26% of them were overweight, and 12% were obese. One-way ANCOVA showed a statistically significant difference between MD adherence score categories and AIS, F (2, 914) = 3.36, p = 0.015. Among the MD adherence score categories, we found that between groups, MD scores above or equal to 10 were associated with a statistically significant difference in AIS. Cohen's value was calculated for the three MD score categories and indicated a 'small' effect size association between all adherence scores of the MD categories and AIS. Conclusions: In conclusion, our findings provide preliminary evidence that participants' adherence to the MD was significantly associated with better sleep and reduced insomnia symptoms, highlighting the need for further research.

Indole-3-propionic acid, a tryptophan-derived bacterial metabolite, increases blood pressure via cardiac and vascular mechanisms in rats

Recent evidence suggests that gut bacteria-derived metabolites interact with the cardiovascular system and alter blood pressure (BP) in mammals. Here, we evaluated the effect of indole-3-propionic acid (IPA), a gut bacteria-derived metabolite of tryptophan, on the circulatory system. Arterial BP, electrocardiographic, and echocardiographic (ECHO) parameters were recorded in male, anesthetized, 12-wk-old Wistar-Kyoto rats at baseline and after intravenous administration of either IPA or vehicle. In additional experiments, rats were pretreated with prazosin or pentolinium to evaluate the involvement of the autonomic nervous system in cardiovascular responses to IPA. IPA's concentrations were measured using ultra-high performance liquid chromatography tandem mass spectrometry. The reactivity of endothelium-intact and -denuded mesenteric resistance arteries was tested. Cells' viability and lactate dehydrogenase (LDH) cytotoxicity assays were performed on cultured cardiomyocytes. IPA increased BP with a concomitant bradycardic response but no significant change in QTc interval. The pretreatment with prazosin and pentolinium reduced the hypertensive response. ECHO showed increased contractility of the heart after the administration of IPA. Ex vivo, IPA constricted predilated and endothelium-denuded mesenteric resistance arteries and increased metabolic activity of cardiomyocytes. IPA increases BP via cardiac and vascular mechanisms in rats. Furthermore, IPA increases cardiac contractility and metabolic activity of cardiomyocytes. Our study suggests that IPA may act as a mediator between gut microbiota and the circulatory system.

Diet in Scleroderma: Is There a Need for Intervention?

Systemic sclerosis (SSc) patients exhibit a plethora of risk factors for nutritional decline, including the presence of chronic inflammation and the progressive nature of disease-related multisystem involvement. The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated, its management currently remaining a subject of debate. The main objective of the present study was to perform a detailed assessment of scleroderma patients' diet as well as their eating habits and to describe the relationships with weight loss and malnutrition risk in the absence of professional nutritional counseling.

METHODS

We used a translated and validated version of the EPIC-Norfolk FFQ (European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire) to evaluate the patients' diet and MUST (Malnutrition Universal Screening Tool) to investigate the risk of malnutrition. Disease activity was estimated using the EUSTAR-AI (European Scleroderma Trials and Research group Activity Index).

RESULTS

We included 69 patients with SSc, of which 42 underwent a detailed dietary assessment. Dietary factors were connected to body composition and digestive symptoms. We found high sodium intake and frequent suboptimal energy consumption in our study group, including patients with cardiopulmonary involvement. Liver transaminases were inversely correlated with the consumption of nuts and seeds. Malnutrition and weight loss were significantly associated with pulmonary hypertension, heart failure, albumin levels, and the extent of skin fibrosis, but not advanced age. Although the patients with EUSTAR-AI ≥ 2.5 were more frequently included in the moderate and high malnutrition risk categories, these results did not reach statistical significance.

CONCLUSIONS

Currently, there is an unmet need for longitudinal and interventional research focusing on the long-term significance, ramifications, and management of nutritional impairment in SSc patients with various clinical manifestations. Our results indicate that scleroderma patients could benefit from personalized nutritional counseling in an interdisciplinary setting.

Key Causes and Contributors of Obesity: A Perspective

Obesity is a disease with several potential causes and contributors. This article provides a focused overview of key known causes of obesity and factors that contribute to obesity. Obesity ultimately results from impaired energy storage mechanisms, such as dysregulation of hunger, satiety, digestion, fat storage, and metabolic rate. In addition, myriad contributors promote its expression, including dietary factors, sleep quality and duration, psychological health and well-being, and tobacco cessation, among others. This article concludes with a discussion of the clinical relevance of causes and contributors in obesity prevention and treatment, which is paramount to providing effective, individualized clinical management.

Sleep and Diet: Mounting Evidence of a Cyclical Relationship

Two factors intrinsic to health are diet and sleep. These two behaviors may well influence one another. Indeed, that insufficient sleep adversely impacts dietary intakes is well documented. On the other hand, diet may influence sleep via melatonin and its biosynthesis from tryptophan. Experimental data exist indicating that provision of specific foods rich in tryptophan or melatonin can improve sleep quality. Whole diets rich in fruits, vegetables, legumes, and other sources of dietary tryptophan and melatonin have been shown to predict favorable sleep outcomes. Although clinical trials are needed to confirm a causal impact of dietary patterns on sleep and elucidate underlying mechanisms, available data illustrate a cyclical relation between these lifestyle factors. We recommend adopting a healthful diet to improve sleep, which may further promote sustained favorable dietary practices.

Altered Functional Connectivity in the Resting State Neostriatum After Complete Sleep Deprivation: Impairment of Motor Control and Regulatory Network

Sleep loss not only compromises individual physiological functions but also induces a psychocognitive decline and even impairs the motor control and regulatory network. In this study, we analyzed whole-brain functional connectivity changes in the putamen and caudate nucleus as seed points in the neostriatum after 36 h of complete sleep deprivation in 30 healthy adult men by resting state functional magnetic resonance imaging to investigate the physiological mechanisms involved in impaired motor control and regulatory network in individuals in the sleep-deprived state. The functional connectivity between the putamen and the bilateral precentral, postcentral, superior temporal, and middle temporal gyrus, and the left caudate nucleus and the postcentral and inferior temporal gyrus were significantly reduced after 36 h of total sleep deprivation. This may contribute to impaired motor perception, fine motor control, and speech motor control in individuals. It may also provide some evidence for neurophysiological changes in the brain in the sleep-deprived state and shed new light on the study of the neostriatum in the basal ganglia.

Association of plant-based diet index with inflammatory markers and sleep quality in overweight and obese female adults: A cross-sectional study

BACKGROUND

Inflammation and sleep disturbances increase the risk of multiple diseases, including cardiovascular disease, type 2 diabetes and dementia. Since diet plays a significant role in inflammatory responses and sleep quality, this study aimed to investigate the association of a plant-based diet index (PDI) with sleep quality and inflammatory markers in overweight and obese women.

METHODS

390 overweight and obese women aged 18-48 years participated in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to create an overall PDI, healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Higher scores on the PSQI were indicative of poor sleep. Anthropometric measurements and serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta (IL-1β) and transforming growth factor-beta (TGF-β) were evaluated. Linear regression models were used to determine the association between exposure and outcomes.

RESULTS

After taking potential confounders into account, we found a significant inverse association between adherence to hPDI and hs-CRP (β = -0.14, 95% confidence interval [CI]: -0.22,0.06, P = .001) and a significant positive association between uPDI and hs-CRP (β = 0.13, 95% CI: 0.05,0.21, P = .001). Overall, PDI was significantly associated with TGF-β (β = 2.04, 95% CI: 0.54,3.55, P = .008). No association was detected between PDI indices and IL-1β. Higher adherence to uPDI was significantly associated with higher PSQI score (lower sleep quality) (β= 0.20, 95% CI:0.007,0.40, P = .04). A significant positive association was found between TGF-β (β = 0.05, 95% CI:0.005,0.10, P = .03) and hs-CRP (β = 0.32, 95% CI:0.02,0.62, P = .03) with PSQI.

CONCLUSION

Our findings indicated a significant association between adherence to a plant-based diet with inflammation and sleep quality in obese and overweight females. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Sleep is an essential part of life, and sleep quality has a significant impact on individual well-being and performance. There is a bidirectional relationship between disturbed sleep and elevated levels of inflammatory markers. Diet plays a major part in sleep quality and its related health consequences. Plant-based diets are associated with lower risk of chronic diseases such as coronary artery disease (CAD), type 2 diabetes, obesity and reduced level of inflammation. WHAT DOES THIS ARTICLE ADD?: Adherence to a healthful plant-based diet is associated with lower level of hs-CRP, while adherence to an unhealthful plant-based diet is associated with higher concentrations of hs-CRP. Adherence to an unhealthful plant-based diet is associated with lower sleep quality.

Associations Among Sleep and Cancer Risk Behaviors: a Scoping Review of Experimental Studies in Healthy Adult Populations

BACKGROUND

Links among poor sleep and cancer risk behaviors have been largely overlooked in the context of cancer prevention and behavioral medicine. The goal of this scoping review was to determine the extent and nature of experimental studies conducted with healthy adult populations that tested the associations among poor sleep and cancer risk behaviors.

METHOD

Electronic databases and major sleep journals were searched to identify experimental studies in healthy adult samples published through January 2018. Studies examined associations among eight pairings of manipulated behaviors and outcomes ("independent variable (IV)-outcome pairs"): the impact of sleep manipulations on physical activity (PA), diet, alcohol consumption, and tobacco use outcomes; and the impact of PA, diet, alcohol consumption, and tobacco use manipulations on sleep outcomes. Studies were characterized in terms of sample characteristics; study design; IV type, dose, and duration; and outcome measurement and duration.

RESULTS

Abstracts of 5697 papers and 345 full texts were screened. Eighty-eight studies describing 125 comparisons met inclusion criteria. Only two studies tested the association between tobacco use and sleep; none tested whether sleep influenced alcohol consumption. Sample sizes were typically small, most studies used crossover designs, and studies tended to include younger and more male participants. Within each IV-outcome pair, there was substantial heterogeneity in how behaviors were manipulated, outcome measurement, and type of control group. Few studies assessed mechanisms.

CONCLUSION

There is a need for larger experimental studies with more representative samples. Overall, heterogeneity and limitations in study designs make it difficult to synthesize evidence across studies.

Decreased P2 Waveform Reflects Impaired Brain Executive Function Induced by 12 h of Low Homeostatic Sleep Pressure: Evidence From an Event-Related Potential Study

Homeostatic sleep pressure can cause cognitive impairment, in which executive function is the most affected. Previous studies have mainly focused on high homeostatic sleep pressure (long-term sleep deprivation); thus, there is still little related neuro-psycho-physiological evidence based on low homeostatic sleep pressure (12 h of continuous wakefulness) that affects executive function. This study aimed to investigate the impact of lower homeostatic sleep pressure on executive function. Our study included 14 healthy young male participants tested using the Go/NoGo task in normal resting wakefulness (10:00 am) and after low homeostatic sleep pressure (10:00 pm). Behavioral data (response time and accuracy) were collected, and electroencephalogram (EEG) data were recorded simultaneously, using repeated measures analysis of variance for data analysis. Compared with resting wakefulness, the participants' response time to the Go stimulus was shortened after low homeostatic sleep pressure, and the correct response rate was reduced. Furthermore, the peak amplitude of Go-P2 decreased significantly, and the peak latency did not change significantly. For NoGo stimulation, the peak amplitude of NoGo-P2 decreased significantly (p < 0.05), and the peak latency was significantly extended (p < 0.05). Thus, the P2 wave is likely related to the attention and visual processing and reflects the early judgment of the perceptual process. Therefore, the peak amplitude of Go-P2 and NoGo-P2 decreased, whereas the peak latency of NoGo-P2 increased, indicating that executive function is impaired after low homeostatic sleep pressure. This study has shown that the P2 wave is a sensitive indicator that reflects the effects of low homeostatic sleep pressure on executive function, and that it is also an important window to observe the effect of homeostatic sleep pressure and circadian rhythm on cognitive function.

Insight into the potential application of polyphenol-rich dietary intervention in degenerative disease management

In recent times, a great number of plants have been studied in order to identify new components with nutraceutical properties, among which are polyphenols. Dietary polyphenols represent a large group of bioactive molecules widely found in the food of plant origin and they have been found able to prevent the onset and progression of degenerative diseases, and to reduce and control their symptoms. These health protective effects have been mainly related to their antioxidant and anti-inflammatory properties. However, it must be considered that the application of isolated polyphenols as nutraceuticals is quite limited due to their poor systemic distribution and relative bioavailability. The present review highlights the potential effect of dietary intervention with polyphenol-rich food and plant extracts in patients with cancer, diabetes and neurodegenerative, autoimmune, cardiovascular and ophthalmic diseases, as well as the possible molecular mechanisms of action suggested in numerous studies with animal models.

The chronotype conjecture in the association between dietary carbohydrate intake and high-sensitivity C-reactive protein (hs-CRP): a cross-sectional study from NHANES 2015 data

Substantial evidence suggests that the timing of macronutrient intake affects cardiovascular health. The present study aims to assess the association between the dietary carbohydrate intake (DCI) and the high-sensitivity C-reactive protein (hs-CRP) combined with the implication of the chronotype. Thus, we explored the most recently released National Health and Nutrition Examination Survey (NHANES) data. We analysed data from 5,616 participants of the NHANES in 2015. We selected participants with available data for the DCI, sleep and wake-up time, and the hs-CRP. Chronotypes were categorized according to the sleep times. Binary logistic regression analysis was performed to predict participants with low or high levels of hs-CRP based on the DCI and chronotypes. Moderation analysis was used to investigate the effect of the chronotypes on the DCI-hs-CRP's association. A higher DCI was significantly associated with the higher hs-CRP levels (odds ratio (OR) = 1.36, 95% confidence interval (CI) = [0.9-1.8]). Moderate evening (ME) chronotypes had higher risk for high hs-CRP level (OR = 1.15, 95% CI = [1.22-1.23]) compared to the intermediate and the morning chronotypes. The chronotype significantly moderated the hs-CRP given the DCI (moderation coefficient, α2=0.05, 95% CI = [0.01-0.08]). The chronotype diminished the hs-CRP predicted by the DCI. The findings of the study underscore the significance of assessing the protective effect of individuals' chronotype concerning cardiovascular health.

Time restricted feeding and mental health: a review of possible mechanisms on affective and cognitive disorders

In the last decades, a high increase in life expectancy not adequately balanced by an improvement in the quality of life has been observed, leading possibly to an increase in the prevalence of affective and cognitive disorders related to aging, such as depression, cognitive impairment, dementia and Alzheimer's disease. As mental illnesses have multifactorial aetiologies, many modifiable factors including lifestyle and nutrition play an essential role. Among nutritional factors, intermittent fasting has emerged as an innovative strategy to prevent and treat mental health disorders, sleep disturbances and cognitive impairment. Among all types of intermittent fasting regimens, the time restricted feeding appears to be the most promising protocol as it allows to induce benefits of a total fasting without reducing global calories and nutrients intake. This review summarises the evidence on the effect of time restricted feeding towards brain health, emphasising its role on brain signalling, neurogenesis and synaptic plasticity.

Influence of Dietary Habits and Mediterranean Diet Adherence on Sleep Quality during Pregnancy. The GESTAFIT Project

We examined the association of the dietary habits and the Mediterranean diet (MD) adherence with sleep quality during pregnancy. A food frequency questionnaire and the Mediterranean Food Pattern were employed to assess dietary habits and MD adherence, respectively. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) global score (n = 150; mean age 32.9 ± 4.6 years). A higher consumption of fruits was associated with better sleep quality at the 16th gestational week (g.w.; p < 0.05). A greater olive oil consumption and a higher MD adherence were associated with better sleep quality at the 16th and 34th g.w. (all, p < 0.05). Contrarily, a higher red meat and subproducts consumption was associated with worse sleep quality at the 34th g.w. (p < 0.05). The group with the highest adherence to the MD (Tertile 3) showed better sleep quality than the group with the lowest adherence (Tertile 1) at the 16th and 34th g.w. (both, p < 0.05). A higher adherence to the MD, a greater intake of fruits and olive oil and a lower intake of red meat and subproducts were associated with better sleep quality along the pregnancy course, especially among sedentary women.

A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network

Consumption of a Mediterranean diet has been linked to better sleep health in older, European populations. However, whether this dietary pattern is predictive of sleep quality in US women, a group prone to poor sleep, is unknown. This prospective cohort study of 432 US women (20–76 y; 60% racial/ethnic minority) evaluated whether compliance with a Mediterranean diet at baseline predicted sleep quality at 1-y follow-up. Alternate Mediterranean (aMed) diet scores and habitual sleep quality were computed from the validated Block Brief Food Frequency Questionnaire and Pittsburgh Sleep Quality Index (PSQI), respectively. Linear regression models evaluated prospective associations of the aMed diet pattern and its components with measures of sleep quality, after adjustment for age, BMI, race/ethnicity, education, and health insurance status. Higher baseline aMed scores were associated with lower PSQI scores (β = −0.30 ± 0.10, p < 0.01), indicative of better sleep quality, higher sleep efficiency (β = 1.20 ± 0.35, p < 0.001), and fewer sleep disturbances (β = −0.30 ± 0.12, p = 0.01) at 1-y. Fruit and vegetable consumption also predicted lower PSQI scores, higher sleep efficiency and fewer sleep disturbances (all p < 0.05). Higher legume intake predicted better sleep efficiency (β = 1.36 ± 0.55, p = 0.01). These findings suggest that adherence to a Mediterranean diet pattern should be evaluated as a strategy to promote sleep quality in US women.

Effects of endometriosis on sleep quality of women: does life style factor make a difference?

BACKGROUND

This study aimed to compare the lifestyle factors and SQ between women with and without endometriosis. Also in this essay, the influence of food intake, socio-demographic and clinical characteristics on sleep quality of women with endometriosis was determined.

METHODS

Of the 156 infertile women approached for the study, 78 women had endometriosis and 78 were included in the control group. At first, each participant completed a checklist including questions about demographics, physical activity, reproductive and menstrual status. SQ was assessed by the Pittsburgh Sleep Quality Index (PSQI). Dietary data were collected using a validated 147-item semi-quantitative FFQ.

RESULTS

Irregular menstrual status, menorrhagia, dysmenorrhea, pelvic pain, history of abortion, family history of endometriosis were associated with endometriosis risk (P < 0.05). In women with physical activity more than 3 h per week, high consumption of the dairy product, and fruit endometriosis is less common (P < 0.05). The total PSQI score, and the scores for subjective sleep quality, sleep latency, sleep disturbance domains were significantly different between the two groups (P < 0.05). In women with endometriosis, poor SQ was associated with dysmenorrhea, pelvic pain, dyspareunia, physical activity, and low consumption of the dairy product, fruit, and nut (p < 0.05).

CONCLUSION

In endometriosis women, SQ was lower than healthy individuals. Lifestyle factors can effect on SQ of these patients.

Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women's Health Initiative

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds.

METHODS

A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women's Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity.

RESULTS

High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15-1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7-9) (1.36 (1.28-1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1-7 days per week) (1.28 (1.20-1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03).

CONCLUSION

Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.

Associations among Sleep Quality, Changes in Eating Habits, and Overweight or Obesity after Studying Abroad among International Students in South Korea

International students are experiencing health problems due to many lifestyle changes, such as those in dietary and sleep patterns. We conducted this study to identify the associations among sleep patterns, changes in eating habits after studying abroad, and overweight or obesity in international students. In this cross-sectional study, we analyzed data on health-related variables, changes in eating habits after studying abroad, and sleep patterns that were collected from 225 international students in South Korea. Approximately half of the participants experienced poor sleep (47.6%). After adjusting for covariates such as age, gender, nationality, and acculturative stress, the subjects who had poor sleep quality were 2.020-fold (adjusted odds ratio, 95% confidence interval = 1.045–3.906) more likely to be overweight and obese than those who had good sleep quality. There were significant differences in changes of eating habits after studying abroad according to sleep quality (p < 0.001). When subjects were stratified into groups according to changes in eating habits after studying abroad, the risk of overweight and obesity increased in those with poor sleep quality but not in those with good sleep quality among subjects who had changes in bad eating habits. However, the risk of overweight and obesity did not differ among subjects with changes in good eating habits regardless of their sleep quality.

Diet and Mental Health: Review of the Recent Updates on Molecular Mechanisms

Over the last decades, there has been a substantial increase in the prevalence of mental health disorders, including an increased prevalence of depression, anxiety, cognitive, and sleep disorders. Diet and its bioactive components have been recognized among the modifiable risk factors, possibly influencing their pathogenesis. This review aimed to summarize molecular mechanisms underlying the putative beneficial effects toward brain health of different dietary factors, such as micro- and macronutrient intake and habits, such as feeding time and circadian rhythm. The role of hormonal homeostasis in the context of glucose metabolism and adiponectin regulation and its impact on systemic and neuro-inflammation has also been considered and deepened. In addition, the effect of individual bioactive molecules exerting antioxidant activities and acting as anti-inflammatory agents, such as omega-3 fatty acids and polyphenols, considered beneficial for the central nervous system via modulation of adult neurogenesis, synaptic and neuronal plasticity, and microglia activation has been summarized. An overview of the regulation of the gut–brain axis and its effect on the modulation of systemic inflammation and oxidative stress has been provided. Finally, the impact of bioactive molecules on inflammation and oxidative stress and its association with brain health has been summarized.

Measures of Poor Sleep Quality Are Associated With Higher Energy Intake and Poor Diet Quality in a Diverse Sample of Women From the Go Red for Women Strategically Focused Research Network

Background

Poor sleep increases cardiovascular disease risk, and diet likely contributes to this relationship. However, there are limited epidemiological data on the relationship between measures of sleep quality and habitual dietary patterns. This study examined these associations in a diverse sample of women.

Methods and Results

Baseline data from 495 participants in the AHA Go Red for Women prospective cohort study (age: 20–76 years; 61% racial/ethnic minority) were examined. Sleep quality and sleep‐onset latency were measured using the Pittsburgh Sleep Quality Index (PSQI) and insomnia using the Insomnia Severity Index. The validated Block Brief Food Frequency Questionnaire was used to assess diet quantity and quality. Linear regression models adjusted for confounding variables tested relationships between sleep and diet variables. Results showed that higher PSQI scores, indicative of poorer sleep quality, were associated with lower unsaturated fat intake (β=−0.14, P<0.05) and higher food weight (β=14.9, P=0.02) and added sugars consumed (β=0.44, P=0.04). Women with sleep‐onset latency >60 minutes had higher intakes of food by weight (β=235.2, P<0.01) and energy (β=426, P<0.01), and lower intakes of whole grains (β=−0.37, P=0.01) than women with sleep‐onset latency ≤15 minutes. Greater insomnia severity was associated with higher food weight (β=9.4, P=0.02) and energy (β=17, P=0.01) consumed and lower total (β=−0.15, P=0.01) and unsaturated fat intakes (β=−0.11, P<0.01).

Conclusions

Poor sleep quality was associated with greater food intake and lower‐quality diet, which can increase cardiovascular disease risk. Future studies should test whether promoting sleep quality could augment efforts to improve cardiometabolic health in women.

Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice

Neuropsychiatric disorders stem from gene-environment interaction and their development can be, at least in some cases, prevented by the adoption of healthy and protective lifestyles. Once full blown, neuropsychiatric disorders are prevalent conditions that patients live with a great burden of disability. Indeed, the determinants that increase the affliction of neuropsychiatric disorders are various, with unhealthy lifestyles providing a significant contribution in the interplay between genetic, epigenetic, and environmental factors that ultimately represent the pathophysiological basis of these impairing conditions. On one hand, the adoption of Healthy Eating education, Physical Activity programs, and Sleep hygiene promotion (HEPAS) has the potential to become one of the most suitable interventions to reduce the risk to develop neuropsychiatric disorders, while, on the other hand, its integration with pharmacological and psychological therapies seems to be essential in the overall management of neuropsychiatric disorders in order to reduce the disability and improve the quality of life of affected patients. We present an overview of the current evidence in relation to HEPAS components in the prevention and management of neuropsychiatric disorders and provide suggestions for clinical practice.

Association of Depressive Symptoms With Incident Cardiovascular Diseases in Middle-Aged and Older Chinese Adults

IMPORTANCE

The prevalence of depressive symptoms among older adults has become an increasingly important public health priority. Elevated depressive symptoms are well documented among elderly people with cardiovascular disease (CVD), but studies conducted among Chinese adults are scarce.

OBJECTIVE

To estimate the association between depressive symptoms and incident CVD among middle-aged and older Chinese adults.

DESIGN, SETTING, AND PARTICIPANTS

The China Health and Retirement Longitudinal Study is an ongoing nationally representative prospective cohort study that was initiated in 2011. This cohort study included 12 417 middle-aged and older Chinese adults without heart disease and stroke at baseline. Statistical analysis was conducted from April 25, 2018, to December 13, 2018.

EXPOSURE

Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale.

MAIN OUTCOMES AND MEASURES

Incident CVD (ie, self-reported physician-diagnosed heart disease and stroke combined) was followed-up from June 1, 2011, to June 31, 2015. The Center for Epidemiologic Studies Depression Scale total score ranges from 0 to 30, with a score of 12 or more indicating elevated depressive symptoms.

RESULTS

Of the 12 417 participants (mean [SD] age at baseline, 58.40 [9.51] years), 6113 (49.2%) were men. During the 4 years of follow-up, 1088 incident CVD cases were identified. Elevated depressive symptoms were independently associated with an increased CVD risk (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.58) after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.39) and loneliness (adjusted hazard ratio, 1.21; 95% CI, 1.02-1.44), were significantly associated with incident CVD.

CONCLUSIONS AND RELEVANCE

Elevated depressive symptoms overall and 2 individual symptoms (restless sleep and loneliness) were significantly associated with incident CVD among middle-aged and older Chinese adults.