Associations of nighttime sleep, midday napping, and physical activity with all-cause mortality in older adults: the Seniors-ENRICA cohorts

We examined associations between nighttime sleep and midday nap duration with all-cause mortality according to adherence to moderate-to-vigorous physical activity (MVPA) recommendations in older adults. We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts, respectively. Nighttime sleep time was classified as short (< 7 h), middle (≥ 7 and < 8 h), and long (≥ 8 h), and midday napping as no nap, short (≤ 30 min), long (> 30 and ≤ 60 min), and very long (> 60 min). Time spent in MVPA was classified as meeting (i.e., ≥ 150 min/week) or not the MVPA recommendations. All-cause mortality was the main outcome. Analyses were performed with Cox regression and adjusted for the main confounders. Overall, compared with middle nighttime sleep, both short (HR 1.20; 95% CI 1.03-1.39) and long (HR 1.30; 95% CI 1.12-1.52) were associated with higher mortality. Among participants who did not meet MVPA recommendations, the association between short (HR 1.22; 95% CI 1.01-1.48) and long (HR 1.46; 95% CI 1.21-1.77) sleeping duration mortality remained. Short napping was associated with lower mortality (HR 0.83; 95% CI 0.71-0.96) and very long with higher mortality (HR 1.29; 95% CI 1.04-1.59), compared to those who did not nap. Among participants not meeting MVPA recommendations, only very long napping was associated with increased mortality (HR 1.32; 95% CI 1.01-1.73). No associations were identified between nighttime sleep or midday napping with mortality among participants meeting MVPA recommendations. Meeting MVPA recommendations can attenuate the risks associated with short or long sleep duration.

Steroid Hormone Biosynthesis and Dietary Related Metabolites Associated with Excessive Daytime Sleepiness

Background

Excessive daytime sleepiness (EDS) is a complex sleep problem that affects approximately 33% of the United States population. Although EDS usually occurs in conjunction with insufficient sleep, and other sleep and circadian disorders, recent studies have shown unique genetic markers and metabolic pathways underlying EDS. Here, we aimed to further elucidate the biological profile of EDS using large scale single- and pathway-level metabolomics analyses.

Methods

Metabolomics data were available for 877 metabolites in 6,071 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and EDS was assessed using the Epworth Sleepiness Scale (ESS) questionnaire. We performed linear regression for each metabolite on continuous ESS, adjusting for demographic, lifestyle, and physiological confounders, and in sex specific groups. Subsequently, gaussian graphical modelling was performed coupled with pathway and enrichment analyses to generate a holistic interactive network of the metabolomic profile of EDS associations.

Findings

We identified seven metabolites belonging to steroids, sphingomyelin, and long chain fatty acids sub-pathways in the primary model associated with EDS, and an additional three metabolites in the male-specific analysis. The identified metabolites particularly played a role in steroid hormone biosynthesis.

Interpretation

Our findings indicate that an EDS metabolomic profile is characterized by endogenous and dietary metabolites within the steroid hormone biosynthesis pathway, with some pathways that differ by sex. Our findings identify potential pathways to target for addressing the causes or consequences of EDS and related sleep disorders.

Funding

Details regarding funding supporting this work and all studies involved are provided in the acknowledgments section.

Research in context

Evidence before this study: There is a growing recognition of the paramount importance of sleep on health and cardiometabolic disease. Excessive daytime sleepiness (EDS), one of the key common sleep treatment targets, has been linked to increased risk of mortality, hypertension, cardiovascular disease, car accidents as well as decrease in life quality, and productivity. Despite its impact on health, much remains unknown about the biological mechanisms of EDS and if those mechanisms are independent from other sleep disorders. Recent genetic evidence that shows that EDS is associated with specific genetic biomarkers supports the need to further study the underlying biology of EDS.Added value of this study: Here, we used measurements of metabolites, the products and by-products of metabolism to identify the metabolomic profile of EDS. Metabolites are produced by the biological reactions within the body via proteins-themselves products of genes-and by the breakdown of external sources such as nutritional intake and breathing air pollutants. Therefore, metabolomics enables study of the effects of nutrition, environmental exposures, and genetics. In this study we aimed to identify the metabolites that were associated with excessive daytime sleepiness. Additionally, we mapped these metabolites into a publicly available online biological network of human metabolism pathways to obtain an understanding of our findings on a larger scale.Implications of all the available evidence: Identifying the metabolites and pathways related to daytime sleepiness provides insights into the biological mechanisms of EDS and suggests future research opportunities to identify targets for prevention, prediction, and treatments for EDS and potentially other sleep disorders coupled with sleepiness. In this study we found 7 such metabolites-some endogenously synthesised and some obtained from dietary sources-associated with EDS. The network analysis implicated the steroid hormone biosynthesis pathway as a shared pathway underlying those metabolites, and identified linkages to key metabolites related to sleep: melatonin and cortisol metabolism.

Association between the Dietary Inflammatory Index and Sleep Quality among Lebanese University Students

Objective  The association between sleep quality and overall health has been extensively examined. However, few studies have investigated the relationship between sleep and the inflammatory potential of the diet. Thus, the purpose of the present study was to explore the association between the scores on the Energy-Adjusted Dietary Inflammatory Index (E-DII) and sleep quality in Lebanese university students. Materials and Methods  We conducted a cross-sectional study with students attending the Tripoli campus of Beirut Arab University. A total of 270 students aged between 17 and 25 years were randomly selected. All students filled out a multicomponent questionnaire that included an assessment of their sleep quality using the Pittsburg Sleep Quality Index, and of their physical activity level using the short version of the International Physical Activity Questionnaire. The scores on the E-DII were calculated based on a validated food frequency questionnaire. Results  Individuals in the highest (most proinflammatory) quartile of the E-DII were at an increased risk of having poor overall sleep quality compared with the lowest quartile (odds ratio [OR] = 2.86; 95% confidence interval [95%CI]: 1.27-6.44). Regarding the individual domains of sleep quality, subjects in quartiles 3 and 4 of the E-DII were at an increased risk of having poor sleep efficiency compared with those in quartile 1 (OR = 2.49; 95%CI: 1.12-5.54; and OR = 2.52, 95%CI: 1.13-5.62 respectively). However, individuals in quartile 3 were at a reduced risk of having daytime dysfunction compared with those in the lowest quartile (OR = 0.44; 95%CI: 0.23-0.83). Conclusion  The inflammatory potential of the diet seems to be related to sleep quality in our sample of Lebanese university students. Future prospective studies are required to further explore this association.

Insomnia in Parkinson's Disease: Causes, Consequences, and Therapeutic Approaches

Sleep disorders represent prevalent non-motor symptoms in Parkinson's disease (PD), affecting over 90% of the PD population. Insomnia, characterized by difficulties in initiating and maintaining sleep, emerges as the most frequently reported sleep disorder in PD, with prevalence rates reported from 27 to 80% across studies. Insomnia not only significantly impacts the quality of life of PD patients but is also associated with cognitive impairment, motor disabilities, and emotional deterioration. This comprehensive review aims to delve into the mechanisms underlying insomnia in PD, including neurodegenerative changes, basal ganglia beta oscillations, and circadian rhythms, to gain insights into the neural pathways involved. Additionally, the review explores the risk factors and comorbidities associated with insomnia in PD, providing valuable insights into its management. Special attention is given to the challenges faced by healthcare providers in delivering care to PD patients and the impact of caregiving roles on patients' quality of life. Overall, this review provides a comprehensive understanding of insomnia in PD and highlights the importance of addressing this common sleep disorder in PD patients.

Associations of dietary patterns with objective and subjective sleep duration and sleep quality in a population-based cohort study

OBJECTIVE

To examine cross-sectional and longitudinal associations of various types of dietary patterns with self-reported sleep quality and with actigraphy-estimated sleep parameters in the prospective, population-based Rotterdam Study.

METHODS

For each participant, scores for five different dietary patterns were derived based on food frequency questionnaires; two pre-defined scores developed to estimate adherence to the Dutch dietary guidelines and to the Mediterranean diet; and three data-driven scores indicating a prudent, unhealthy and typical Dutch diet. In 2589 participants (median age 56.9 years; 58 % female), self-rated sleep quality was assessed with the Pittsburgh Sleep Quality Index. In 533 participants, actigraphs were worn for an average of 6.8 days (SD: 0.7) to estimate total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency. Sleep parameters were measured at baseline and 3-6 years later. Multiple linear regression was used to assess cross-sectional and longitudinal associations.

RESULTS

No statistically significant associations between dietary patterns and total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency and subjective sleep quality were observed in cross-sectional or longitudinal analyses. To illustrate, the effect estimate for sleep duration was 2.7 min per night (95 % CI -2.1, 7.5) per 5 point increase in Mediterranean diet score in the cross-sectional analyses. Furthermore, in longitudinal analyses, the effect estimate for sleep duration was -1.0 min per night (95 % CI -5.2, 3.1) per SD increase in the prudent diet.

CONCLUSIONS

Our results suggest that dietary patterns are not associated with sleep in this population-based cohort study.

TRIAL REGISTRATION

Netherlands National Trial Register and WHO International Clinical Trials Registry Platform (ICTRP; https://apps.who.int/trialsearch/) shared catalogue number NL6645/NTR6831. Registered November 13th, 2017.

Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS)

Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.

Dietary patterns and insomnia symptoms: A systematic review and meta-analysis

We aimed to systematically review and synthesize the available evidence regarding the link between dietary patterns and insomnia symptoms among the general population using observational studies. We reviewed 16,455 references, of which 37 studies met inclusion criteria with a total sample size of 591,223. There was a significant association of the Mediterranean diet (OR: 0.86; 95 % CI, 0.79, 0.93; P < 0.001; I2 = 32.68 %), a high-quality diet (OR: 0.66; 95 % CI, 0.48, 0.90; P = 0.010; I2 = 84.62 %), and an empirically-derived healthy dietary pattern (OR: 0.91; 95 % CI, 0.85, 0.98; P = 0.010; I2 = 57.14 %) with a decreased risk of insomnia symptoms. Moreover, the dietary glycemic index (OR: 1.16; 95 % CI, 1.08, 1.25; P < 0.001; I2 = 0.0 %), the dietary glycemic load (OR: 1.10; 95 % CI, 1.01, 1.20; P = 0.032; I2 = 74.36 %), and an empirically-derived unhealthy dietary pattern (OR: 1.20; 95 % CI, 1.01, 1.42; P = 0.040; I2 = 68.38 %) were linked with a higher risk of insomnia symptoms. Most individual studies were of good quality (NOS) but provided very low certainty of evidence (GRADE). Consistent data reveals that following healthy diets is associated with decreased insomnia symptoms prevalence, while adherence to an unhealthy pattern is associated with an increased prevalence of insomnia symptoms.

Exercise and Nutrition in the Mental Health of the Older Adult Population: A Randomized Controlled Clinical Trial

(1) Background: Global population aging is changing demographic structures and presents significant challenges for health systems, which must adapt to an increasingly elderly population. (2) Methods: The study employed a randomized controlled trial design with a total of 116 older adults aged 65 or older, randomly assigned to an experimental group (n = 57) undergoing a combined resistance program and Mediterranean diet program and a control group (n = 59) who did not receive any intervention. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), sleep quality through the Pittsburgh Sleep Quality Index (PSQI), and perceived stress using the Perceived Stress Scale (PSS). (3) Results: Statistically significant improvements (p < 0.05) were observed both within and between groups in anxiety (Cohen's d = 0.38 and 0.78, respectively), depression (Cohen's d = 0.56 and 0.18, respectively), perceived stress (Cohen's d = 0.15 and 0.39, respectively), and in the PSQI domains: subjective sleep quality (Cohen's d = 1.01 and 0.53, respectively), sleep duration (Cohen's d = 0.112 and 0.53, respectively), sleep disturbances (Cohen's d = 1.92 and 0.95, respectively), use of medications (Cohen's d = 0.34 and 0.40, respectively), and the PSQI total score (Cohen's d = 0.68 and 0.49, respectively). No significant differences were observed in sleep latency or daytime dysfunction. (4) Conclusions: The results of the present study suggest that resistance intervention may be an effective therapeutic option to improve mental health and sleep quality in older adults aged 65 or older, offering a non-pharmacological approach to improving overall well-being in this demographic.

Association between adherence to the mediterranean diet, physical activity, and sleep apnea-hypopnea syndrome (SAHS) in a middle-aged population with cardiovascular risk: Insights from the ILERVAS cohort

INTRODUCTION

Sleep Apnea-Hypopnea Syndrome (SAHS) is a common sleep disorder influenced by factors like age, gender, and obesity. The Mediterranean Diet (MedDiet) and physical activity have shown health benefits in lung diseases, but their effects on SAHS remain underexplored.

METHODS

In a cross-sectional analysis of 678 middle-aged individuals with low-to-moderate cardiovascular risk from the ILERVAS cohort, we assessed adherence to the MedDiet and physical activity levels using validated tools. Sleep parameters, SAHS severity, and excessive daytime sleepiness were evaluated through non-attended cardiorespiratory polygraphy and the Epworth Sleepiness Scale. Multinomial logistic regression models were employed to assess the relationship between MedDiet adherence, physical activity, and SAHS severity.

RESULTS

The prevalence of severe, moderate, and mild SAHS was 15.5%, 23.2% and 36.1%, respectively. We found no significant associations between adherence to the MedDiet, physical activity levels, and the presence or severity of SAHS. However, we noted a significant interaction between MedDiet and physical activity with minimum SpO2 values (p = 0.049). Notably, consuming more than one serving of red meat per day was independently associated with a higher risk of moderate SAHS [OR = 2.65 (1.29-5.44), p = 0.008].

CONCLUSION

Individually, MedDiet adherence and physical activity did not show independent correlations with SAHS. However, when considered together, a minimal but significant effect on minimum SpO2 was observed. Additionally, red meat consumption was associated with a moderate risk of SAHS. Further research is necessary to comprehend the intricate connections between lifestyle factors and sleep-breathing disorders, with a focus on personalized approaches for high-risk populations.

Mediterranean diet adherence and sleep pattern: a systematic review of observational studies

BACKGROUND AND AIMS

Despite a huge body of evidence on the linkage between dietary intakes and pattern of sleeping, the findings are controversial. The current study aimed to summarize earlier findings on the association between adherence to Mediterranean diet (MD) and pattern of sleeping.

METHODS

This study performed based on PRISMA guideline. Systematically search was applied in PubMed, Scopus and Google Scholar to find out relevant publications appeared up to February 2023. No restrictions on language and time of publication were applied. Duplicate citations were removed. We included observational studies which assessed MD as the main exposure and kind of sleep disorders as the main outcome.

RESULTS

A total of 20 observational studies included. Out of these studies, two were cohort studies and 18 had a cross-sectional design. A total of 21,714 participants included. Usual dietary intakes were assessed using a validated Food Frequency Questionnaire, and a diet history questionnaire. Some studies did not report methods of measuring habitual dietary intakes. Adherence to MD was evaluated by KIDMED questionnaire, PREMED, alternate Mediterranean (aMed) questionnaire, MEDAS questionnaire, MedDietScore, MEDI-LITE score, modified Mediterranean Diet Score (mMDS), Mediterranean food pattern (MFP) and modified Mediterranean diet score (mMED). Pattern of sleeping was examined as sleep quality, sleep duration, sleep latency, sleep efficacy, sleepiness, sleep disturbance, taking a nap and some other sleep disorders.

CONCLUSION

In conclusion, findings of published studies highlighted the importance of consumption of MD for better sleep quality.

Plant-based dietary patterns and risk of insomnia: a prospective study

BACKGROUND

Accumulating evidence suggests that dietary factors may affect sleep, but the associations between dietary patterns and insomnia risk have been poorly explored. The aim of this study was to investigate if plant-based diets are associated with reduced insomnia risks in a cohort study design.

METHODS

Tzu Chi Health Study participants (N = 5821) recruited from 2007 to 2009 without insomnia were followed until 2018. A traditional classification method (vegetarians vs. non-vegetarians) and a healthful plant-based index (hPDI) were used to define adherence to plant-based dietary patterns. Incident cases of insomnia were ascertained by linking with the National Health Insurance Research Database (NHIRD). Associations between plant-based diets and insomnia were estimated using Cox proportional hazard models.

RESULTS

A total of 464 incident cases of insomnia were identified in the 55,562 person-years of follow up. Insomnia risk was lower in vegetarians when compared to non-vegetarians, hazard ratios (HR) 0.47 (95% CI: 0.27, 0.81) and 0.71 (95% CI: 0.55, 0.91) for males and females respectively. Male participants with the highest hPDI were associated with a significant lower risk of insomnia (HR 0.50 [95% CI: 0.30, 0.85]) when compared to those in the lowest quintile. No association between adherence to hPDI and insomnia in female participants was observed.

CONCLUSIONS

Our study showed that vegetarians are associated with a lower risk of insomnia, but there may be sex-specific associations between adherence to hPDI and insomnia risk. These favorable associations are important when considering plant-based diets for their potential additional sleep benefits.

Impact of Medical School on the Relationship between Nutritional Knowledge and Sleep Quality-A Longitudinal Study of Students at Wroclaw Medical University in Poland

The aim of this study was to investigate the impact of the first year of medical school on the relationship between nutritional knowledge and sleep. To achieve this, first-year medical students at Wroclaw Medical University were invited to participate in the study during both the initial and final months of their first academic year. The study included 570 students in the initial period and 705 in the latter. The research questionnaire comprised the KomPAN, assessing nutritional knowledge, and the Pittsburgh Sleep Quality Index (PSQI), evaluating sleep quality. The majority of students demonstrated at least sufficient nutritional knowledge, while approximately two-thirds of students experienced poor sleep in both periods. Notably, sleep quality further deteriorated in the second period (PSQI total score: 6.86 vs. 7.38, p = 0.0157). This change was influenced mainly by a decrease in sleep duration and an increase in the use of sleep medications (both p < 0.0001). The significant difference in overall sleep quality between different nutritional knowledge levels emerged only in the second semester, where students with the highest nutritional knowledge slept the best, while those with the lowest slept the worst (p = 0.0001). Crucially, in both periods, the use of sleep medications was highest among individuals with insufficient nutritional knowledge. Throughout the academic year, the usage increased for all except those with the highest nutritional knowledge, who exhibited the best sleep (p < 0.0001). The escalating use of sleep medications among medical students warrants greater attention, and leveraging the relationship between nutritional knowledge and sleep could prove beneficial, as positive habits in one domain may positively influence the other.

Mediterranean Diet and Sleep Features: A Systematic Review of Current Evidence

The prevalence of sleep disorders, characterized by issues with quality, timing, and sleep duration is increasing globally. Among modifiable risk factors, diet quality has been suggested to influence sleep features. The Mediterranean diet is considered a landmark dietary pattern in terms of quality and effects on human health. However, dietary habits characterized by this cultural heritage should also be considered in the context of overall lifestyle behaviors, including sleep habits. This study aimed to systematically revise the literature relating to adherence to the Mediterranean diet and sleep features in observational studies. The systematic review comprised 23 reports describing the relation between adherence to the Mediterranean diet and different sleep features, including sleep quality, sleep duration, daytime sleepiness, and insomnia symptoms. The majority of the included studies were conducted in the Mediterranean basin and reported a significant association between a higher adherence to the Mediterranean diet and a lower likelihood of having poor sleep quality, inadequate sleep duration, excessive daytime sleepiness or symptoms of insomnia. Interestingly, additional studies conducted outside the Mediterranean basin showed a relationship between the adoption of a Mediterranean-type diet and sleep quality, suggesting that biological mechanisms sustaining such an association may exist. In conclusion, current evidence suggests a relationship between adhering to the Mediterranean diet and overall sleep quality and different sleep parameters. The plausible bidirectional association should be further investigated to understand whether the promotion of a healthy diet could be used as a tool to improve sleep quality.

Diet quality in young adulthood and sleep at midlife: a prospective analysis in the Bogalusa Heart Study

Background

Diet and sleep are both established risk factors for cardiometabolic diseases. Prior evidence suggests a potential link between these behaviors, though evidence for how they associate with each is scarce. This study aimed to determine the association between diet quality in young adulthood and multiple sleep outcomes at midlife in the Bogalusa Heart Study (BHS).

Methods

This prospective study included 593 BHS subjects with dietary assessment at the 2001-2002 visit and sleep questionnaire responses from the 2013-2016 visit, after an average of 12.7 years (baseline mean age: 36 years, 36% male, 70%/30% White and Black persons). A culturally tailored, validated food frequency questionnaire assessed usual diet. Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015, and the alternate Mediterranean (aMed) dietary score. Robust Poisson regression with log-link function estimated risk ratios (RR) for insomnia symptoms, high sleep apnea score, and having a healthy sleep pattern by quintile and per standard deviation (SD) increase in dietary patterns. Models adjusted for potential confounders including multi-level socioeconomic factors, depression, and body mass index. Trends across quintiles and effect modification by sex, race, and education were tested.

Results

Higher diet quality in young adulthood, measured by both AHEI and HEI, was associated with lower risk of having insomnia symptoms at midlife. In the adjusted model, each SD-increase in AHEI (7.8 points; 7% of score range) conferred 15% lower risk of insomnia symptoms at follow-up (RR [95% confidence interval CI]: 0.85 [0.77, 0.93]), those in Q5 of AHEI had 0.54 times the risk as those in Q1 (95% CI: 0.39, 0.75), and there was a significant decreasing risk trend across quintiles (trend p = 0.001). There were no significant associations between young adult diet quality and having a high sleep apnea risk or a healthy sleep pattern at follow-up.

Conclusions

A healthy diet was associated with a lower risk of future insomnia symptoms. If replicated, these findings could have implications for chronic disease prevention strategies incorporating the lifestyle behaviors of sleep and diet.

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.

Sweet dreams are not made of this: no association between diet and sleep quality

STUDY OBJECTIVES

Numerous studies have emphasized the significance of nutrition on the quality of sleep, but few have evaluated the effect of various coexisting dietary markers on middle-aged adults. We assessed the association between sleep quality and a large array of dietary markers among middle-aged, community-dwelling participants.

METHODS

Data from the first, second, and third follow-ups of CoLaus|PsyCoLaus, a population-based study in Lausanne, Switzerland, was used. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Dietary intake was assessed by a validated food frequency questionnaire.

RESULTS

Data from 3857 (53% women, 57.2 ± 10.4 years), 2370 (52% women, 60.7 ± 9.5 years), and 1617 (52% women, 63.5 ± 9.0 years) participants from the first, second, and third follow-ups was used. Bivariate correlations showed fish, vegetables, fruit, and cheese intake to be associated with a better sleep quality (lower Pittsburgh Sleep Quality Index), while rusks, sugar, and meat intake were associated with a poorer sleep quality (higher Pittsburgh Sleep Quality Index). After multivariable adjustment, participants reporting poor sleep quality (Pittsburgh Sleep Quality Index > 5) had a lower Mediterranean diet score and a lower likelihood of complying with the meat and fish recommendations, but the results were inconsistent between surveys. No association was found between sleep quality and macro- or micronutrients in the three surveys.

CONCLUSIONS

No consistent associations were found between a large panel of nutritional markers and sleep quality. Components of the Mediterranean diet such as dairy, fruits, and vegetables might favor good sleep quality, while increased consumption of sugary foods or meat might favor poor sleep quality.

CITATION

Oliveira JL, Marques-Vidal P. Sweet dreams are not made of this: no association between diet and sleep quality. J Clin Sleep Med. 2023;19(12):2005-2014.

Association of Dietary Approaches to Stop Hypertension (DASH) diet with self-reported sleep-disordered breathing (SDB): a cross-sectional study from China

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been associated with sleep quality. However, its relationship with sleep-disordered breathing (SDB) remains unknown. This study aimed to explore the association between the DASH diet and SDB using data from a community-based survey among adults in Suzhou, Eastern China. We conducted a cross-sectional analysis of the Suzhou Food Consumption and Health Survey in 2018-2020. Dietary intake was measured by a validated FFQ. The association between the DASH diet and SDB was estimated by multivariable logistic regression analysis. In addition, subgroup analysis and sensitivity analysis were performed to reinforce our findings. A total of 3939 participants were included in the final analysis. Participants in the upper quintile of the DASH score consumed more fruits, vegetables, nuts and legumes, whole grains, and dairy products, and less Na, red/processed meats, and sweetened beverages. The OR for the highest compared with the lowest quintile of the DASH score was 0·68 (95 % CI 0·52, 0·88; Pfor trend = 0·004) for SDB after multivariable adjustment. Of the eight DASH components, vegetables, nuts and legumes, and dairy products were inversely associated with SDB. The associations were similar in subgroups by age, sex, BMI, smoking, alcohol drinking, hypertension, diabetes and hyperlipidaemia. Adherence to the DASH diet was independently associated with decreased odds of self-reported SDB. Our novel results expand previous findings on diet and sleep and suggest the possibility of improving SDB by enhancing diet quality.

Investigating and promoting health behaviors reactivity among Hong Kong older adults in the post-COVID-19 Era: An exploratory network analysis

BACKGROUND

Physical distance has increased the risk of developing a variety of health problems, especially among older people. During the COVID-19 lockdown period, physical activity decreased, screen time increased, food consumption increased, as well as exposure to unhealthy behaviour, leading to poorer sleep quality and more negative emotions, which ultimately led to poorer physical health, mental health, and subjective vitality among older adults. Although there were numerous research studies on changes in health behaviours during COVID-19, only a few were targeted at older adults, and none were conducted in Asian countries.

METHOD

The current study is aiming to identify the changes in health behaviours, as well as their associations with older adults' mental health as a result of the COVID-19 pandemic among Hong Kong older adults, using exploratory network analysis. In this study, a random tele-survey was conducted among older adults.

RESULTS

A total of 664 participants have been involved in the telephone survey, with 213 males and 451 females, of which mean age was 74.37. The explored network showed strong centrality and edge stability, thus enabling to reveal an overview of the associations between health behaviours and mental well-being of older adults. The lavaan model has also demonstrated the casual paths within the explored network, which indicated the significant impact of sleeping quality, eating habits and social networking on resilience.

CONCLUSION

The outcomes of the study were able to identify the lifestyle changes of Hong Kong older adults due to COVID-19. Although the present study is not regarded as novel internationally, it may be representative of the Hong Kong community. In order to facilitate active aging during the pandemic, a user-friendly electronic platform for healthy living should include older adults in the future.

Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults

Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.

Association between patterns of nutrient intake and circulating vitamin D with sleep status among Iranian adults

Nutrient pattern analysis is an easy way to compare nutrient intakes across different nations due to the universality of nutrients nature. The purpose of this study was to examine the relationship between dietary nutrient patterns (NPs) and circulating 25(OH)D concentrations with sleep duration and sleep quality among Iranian adults. We used a multistage cluster random sampling method to enroll 535 adults in this cross-sectional investigation. A validated food frequency questionnaire was applied to evaluate typical dietary intakes. Fasting blood samples were obtained to determine levels of circulating 25(OH)D. Sleep characteristics were assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants had a mean age of 42.57 years and 51.2% of them had insufficient or deficient levels of serum vitamin D. Three NPs were identified: "high animal protein", "high vegetable" and "high carbohydrate". After adjustments for potential confounders, no significant associations were observed between "high animal protein" pattern and short sleeping or sleep quality. Greater adherence to "high vegetable" NP was associated with lower odds of short sleeping (OR 0.24; 95% CI 0.10, 0.54) and poor sleep quality (OR 0.45; 95% CI 0.20, 1.05). Stratified analysis revealed that these associations were stronger in normal-weight participants. Greater adherence to "high carbohydrate" NP, on the other hand, was connected to higher odds of short sleeping (OR 2.83; 95% CI 1.20, 6.72). Low adherence to "high vegetable" pattern and vitamin D insufficiency/deficiency were jointly associated with increased odds of short sleeping (OR 3.42, 95% CI 1.42, 6.64). High adherence to pattern comprising mainly of vegetable nutrients was associated with a reduced likelihood of being short sleepers and having poor sleep quality in Iranian adults, especially among those with a normal weight. Lower adherence to vegetable NP and insufficient/deficient vitamin D levels were synergistically associated with greater likelihood of being short sleepers. Greater adherence to carbohydrate NP was associated with an increased likelihood of short sleeping.

Association between Mediterranean dietary pattern with sleep duration, sleep quality and brain derived neurotrophic factor (BDNF) in Iranian adults

Data on the association between Mediterranean diet, sleep and brain-derived neurotrophic factor (BDNF) were limited in Middle Eastern populations. We examined the association between Mediterranean dietary pattern with sleep quality/quantity, and serum BDNF in Iranian adults. This cross-sectional study was performed among 535 middle-aged adults (54% men), selected by multistage cluster random sampling method. The Pittsburgh sleep quality index and a validated food frequency questionnaire were used to assess sleep quality, sleep quantity, and Mediterranean diet score (MDS). Twelve-hour fasting blood samples were taken to evaluate serum BDNF values. Participants in the highest tertile of MDS, in comparison to those in the lowest tertile, had lower odds of having short sleep (OR = 0.44, 95%CI: 0.21-0.91) and poor sleep quality (OR = 0.48, 95%CI: 0.22-0.96), after adjustment for potential confounders. Among specific domains of sleep quality, lower odds of subjective sleep quality, sleep latency, and daytime dysfunction were associated with increased MDS. Higher adherence to MDS among individuals with overweight or obesity reduced the odds of having short sleep; this relation was not seen among individuals with normal weight. In contrast, the association between sleep quality and the MDS was significant in individuals with normal weight, but not those with overweight or obesity. Participants with higher adherence to MDS had lower odds for low BDNF values; however, this relation was not statistically significant. Overall, Iranian adults with a higher adherence to MDS had considerably lower odds of having short sleep and poor sleep quality. BDNF would not be an intermediate molecule for this connection.

Weight Loss and Sleep, Current Evidence in Animal Models and Humans

Sleep is a vital process essential for survival. The trend of reduction in the time dedicated to sleep has increased in industrialized countries, together with the dramatic increase in the prevalence of obesity and diabetes. Short sleep may increase the risk of obesity, diabetes and cardiovascular disease, and on the other hand, obesity is associated with sleep disorders, such as obstructive apnea disease, insomnia and excessive daytime sleepiness. Sleep and metabolic disorders are linked; therefore, identifying the physiological and molecular pathways involved in sleep regulation and metabolic homeostasis can play a major role in ameliorating the metabolic health of the individual. Approaches aimed at reducing body weight could provide benefits for both cardiometabolic risk and sleep quality, which indirectly, in turn, may determine an amelioration of the cardiometabolic phenotype of individuals. We revised the literature on weight loss and sleep, focusing on the mechanisms and the molecules that may subtend this relationship in humans as in animal models.

Dietary and Sleep Quality Association in Hemodialysis Patients

Background

Poor sleep quality is a common issue among patients with end-stage renal disease (ESRD) who undergo dialysis. Nutritional habits are associated with sleep hygiene in patients undergoing dialysis. The objective of this study was to examine the potential correlation between nutritional status and sleep quality in individuals receiving hemodialysis treatment.

Materials and Methods

This cross-sectional study included 160 hemodialysis patients. A food frequency questionnaire (FFQ) was used to measure food intake in participants. The Persian-validated version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Patients were classified as poor or good sleepers with a PSQI score of <5 and >5, respectively.

Results

Eighty-four percent of hemodialysis patients had bad sleep hygiene. There was a significant association between sleep quality and educational status and age (P < 0.001). Poor sleepers were older (61.65 years versus 51.12) and less educated (31.1% versus 4%). However, there was no significant difference in the intake of micro- and macronutrients between poor and good sleepers (P > 0.05).

Conclusion

The results of this study suggest that sleep quality has no significant relationship with nutrient intake in hemodialysis patients. Demographic factors, such as age and educational status, have played a more effective role than nutritional factors in patients' sleep quality.

Adherence and Sociodemographic Determinants of Adherence to the Mediterranean Diet among Slovenian Adults and the Elderly

The Mediterranean diet (MD) is considered a model for good health, and is promoted worldwide as one of the healthiest dietary patterns. Despite the MD's health benefits, the literature suggests that adherence to the MD tends to be in decline in most populations worldwide, including those in the Mediterranean region. The aim of this study was to investigate adherence to the MD, and its main sociodemographic and lifestyle factors, in the Slovenian population. Using a nationwide cross-sectional food consumption survey (SI.Menu), data were collected from a general questionnaire, from the 14-item MD adherence screener (14-MEDAS score), and from a questionnaire on the dietary habits of 850 adults and elderly people. The mean MEDAS score for the total study sample was 5.6 (SD 2.1), indicating a low adherence to the MD among the Slovenian population. The adherence to the MD was higher among women (OR = 1.534; 95% Cl 1.156-2.034), those with a university degree (OR = 1.527; 1.098-2.125; compared to those with no university degree), those who lived in a suburb or city (OR = 1.511; 1.016-2.249; OR = 1.568; 1.122-2.191; compared with those who lived in a village), non-smokers (OR = 1.561; 1.380-1.830; compared with smokers), and those who lived in the western part of Slovenia (OR = 1.558; 1.170-2.074; compared with those who lived in eastern Slovenia). Adherence to the MD in the Slovenian population is low, and is strongly related to educational level, gender, geographic region, place of residence, and smoking status. The frequency of the consumption of different food groups is also closely related.

The interrelationship between sleep, diet, and glucose metabolism

Obesity and type 2 diabetes (T2D) are increasingly common worldwide. While these disorders have increased in prevalence over the past several decades, there has been a concomitant reduction in sleep duration. Short sleep duration has been associated with higher rates of obesity and T2D, and the causality of these associations and their directionality, continue to necessitate evaluation. In this review we consider the evidence that sleep is an intrinsic factor in the development of obesity and chronic metabolic disorders, such as insulin resistance and T2D, while evaluating a potential bi-directional association. We consider the evidence that diet and meal composition, which are known to impact glycemic control, may have both chronic and acute impact upon sleep. Moreover, we consider that postprandial nocturnal metabolism and peripheral glycemia may affect sleep quality. We propose putative mechanisms whereby acute effects of nighttime glucose excursions may lead to increased sleep fragmentation. We conclude that dietary manipulations, particularly with respect to carbohydrate quality, may confer sleep benefits. Future research may seek to evaluate the effectiveness of synergistic nutrient strategies to promote sleep quality, with particular attention to carbohydrate quality, quantity, and availability as well as carbohydrate to protein ratio.

Diet Quality and Sleep Characteristics in Midlife: The Bogalusa Heart Study

BACKGROUND

Sleep and diet contribute to cardiometabolic disease, but evidence is sparse for the association between these behaviors. This study analyzed the cross-sectional relationship between diet quality and multiple sleep outcomes in the Bogalusa Heart Study (BHS).

METHODS

Diet and sleep characteristics, including insomnia and sleep apnea symptoms, were measured with validated questionnaires. Poisson regression using generalized estimating equations with a log link estimated prevalence rate ratios (PRR) of sleep outcomes by dietary pattern scores (quintile (Q) and per SD). Models were adjusted for body mass index (BMI), multi-level socioeconomic factors, physical activity, depressive symptoms, and other potential confounders.

RESULTS

In 824 participants, higher diet quality, measured by the Alternate Healthy Eating Index-2010, was associated with lower sleep apnea risk score after adjustment (PRR [95% confidence interval (CI)] Q5 vs. Q1: 0.59 [0.44, 0.79], per SD increase: 0.88 [0.81, 0.95], p-trend < 0.0001). There were no statistically significant associations with the Healthy Eating Index 2015 or the Alternate Mediterranean dietary patterns, or for insomnia symptoms or a healthy sleep score.

CONCLUSIONS

Higher diet quality, after adjustment for BMI, was associated with a lower sleep apnea risk score in a cohort with substantial minority representation from a semi-rural, lower-income community.

Mediterranean Diet Adherence Is Associated with Favorable Health-Related Quality of Life, Physical Activity, and Sleep Quality in a Community-Dwelling Greek Older Population

BACKGROUND

The Mediterranean diet (MD) is a beneficial dietary pattern with strong antioxidant and anti-inflammatory properties that can promote mental and physical human health. This study aims to assess the impact of MD adherence on health-related quality of life, physical activity levels, and sleep quality in a representative Greek elderly population.

METHODS

This is a cross-sectional study. A total of 3254 persons ≥65 years from 14 different Greek regions, urban, rural and islands participated in this study, of which 48.4% were female and 51.6% were male. Health-Related Quality of Life (HRQOL) was evaluated utilizing a short form healthy survey, physical activity was determined by the International Physical Activity Questionnaire (IPAQ), sleep quality was assessed utilizing the Pittsburgh Sleep Quality Index (PSQI) and MD adherence was assessed via the Mediterranean Diet Score (MedDietScore).

RESULTS

Moderate adherence to the MD and an increased prevalence of poor quality of life, low physical activity levels and inadequate sleep quality among the elderly population were recorded. High MD adherence was independently associated with better quality of life (OR: 2.31, 95% CI: 2.06-2.68, p = 0.0008), higher physical activity (OR: 1.89, 95% CI: 1.47-2.35, p = 0.0141) and adequate sleep quality (OR: 2.11, 95%: 1.79-2.44, p = 0.0018), female sex (OR: 1.36, 95% CI: 1.02-1.68, p = 0.0032) and living with others (OR: 1.24, 95% CI: 0.81-1.76, p = 0.0375), after adjustment for potential confounding factors. In unadjusted analysis, participants' age (p < 0.0001), anthropometric characteristics (p < 0.005), educational (p = 0.0026) and financial status (p = 0.0005) and smoking habits (p = 0.0031) were also identified as indicators of MD adherence; however, their impact on MD adherence was considerably attenuated after adjusting for confounding factors (p > 0.05).

CONCLUSION

High MD adherence was correlated with favorable quality of life, higher levels of physical activity, and a more adequate sleep quality score. Strategies and public health policies that facilitate MD adherence and physical activity in older adults may improve sleep and quality of life, impacting overall wellbeing in this age group.

Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review

Background

Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots.

Methods

Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies.

Results

The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots.

Conclusion

This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.

Protein intake and its effect on sleep outcomes: a systematic review and meta-analysis of randomized controlled trials

CONTEXT

Poor sleep is increasingly seen as an issue of public health concern. In recent years, there has been growing interest in protein as a route to improve sleep outcomes; however, the evidence is limited and inconclusive.

OBJECTIVE

To examine, using a systematic review and meta-analysis, the effect of increased protein intake (≥1 g/kg//d, ≥25% of total energy intake, or protein supplementation of ≥10 g/d/) on sleep outcomes in adults.

METHODS

On November 30, 2021, 5 electronic databases were searched to identify relevant randomized controlled trials (PubMed, Cochrane, Embase, Web of Science, and CINAHL Plus). Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2.0.

DATA EXTRACTION

Five sleep outcomes were included in this systematic review (sleep quality [SQ], sleep latency [SL], sleep efficiency [SEff], sleep time [ST], wake episodes, and other sleep outcomes) and 4 in the meta-analysis (SQ, SL, SEff, and ST). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

DATA ANALYSIS

Twelve intervention studies reported on in 10 articles were included. The qualitative analyses showed that increased protein consumption has little influence on sleep outcomes. Only subjective SQ was positively associated with protein consumption in a few studies. Meta-analyses also showed no significant effect of increased protein intake on sleep outcomes (number of studies for SQ, ST, SL, and SEff: 8, 8, 7, and 6, respectively), with very low certainty of evidence. However, results from sensitivity analyses, excluding high-risk studies, suggest a small effect on SQ in favor of high protein intake (mean difference, -4.28; 95%CI, -7.77, -0.79; on a scale from 0 to 100).

CONCLUSION

This systematic review and meta-analysis indicate there is no clear relationship between increased protein intake and sleep. However, the strength of the evidence is low and more randomized controlled trials that focus on this specific research question are warranted. Systematic Review Registration: PROSPERO registration no. CRD42020196021.

Diet Quality is Associated with Prodromal Parkinson's Disease Features in Chinese Adults

BACKGROUND

The prodromal phase of Parkinson's disease (PD) is a critical window for prevention by modifying lifestyle factors. However, there is limited knowledge on how diet quality is associated with prodromal PD symptoms in Asian populations.

OBJECTIVE

To examine the association between overall diet quality and prodromal PD features.

METHODS

A total of 71,640 Chinese participants who were free of PD were included in this cross-sectional study. Diet quality was assessed using the modified Alternative Healthy Eating Index (mAHEI) and alternate Mediterranean Diet (aMED). Five prodromal features including probable rapid eye movement sleep behavior disorder (pRBD), hyposmia, excessive daytime sleepiness, constipation, and depressive symptom were measured using validated questionnaires. Logistic regression was used to calculate the odds ratio (OR) for having a combination of prodromal PD symptoms (1 and 2+ symptoms vs. 0 symptoms), adjusting for age, sex, lifestyle factors, total energy intake, and other potential confounders.

RESULTS

In the multivariable-adjusted model, the OR for having 2+ versus 0 prodromal PD features was 0.64 (95% confidence interval [CI]: 0.49, 0.85) comparing the highest versus the lowest mAHEI diet quality quartiles with a significant inverse trend (P-trend = 0.003). For individual prodromal PD features, better diet quality, as assessed by the mAHEI, was associated with lower odds of having excessive daytime sleepiness and constipation (P-trend < 0.05 for both). We observed a marginally significant association between aMED and prodromal PD features (adjusted OR comparing the extreme quartiles = 0.74; 95% CI: 0.55, 0.98; P-trend = 0.09).

CONCLUSION

Better diet quality, as assessed by the mAHEI and the aMED, was associated with lower probability of having prodromal PD features in Chinese adults. © 2022 International Parkinson and Movement Disorder Society.

Do Sleep Disorders and Western Diet Influence Psoriasis? A Scoping Review

Western diet may trigger sleep disorders and vice versa, but their single and mutual effects on systemic inflammatory diseases (i.e., psoriasis) are far from being fully elucidated. At the same time, psoriatic patients display a great burden of sleep disorders and dysmetabolisms related to an unhealthy lifestyle (i.e., diet). These patients are also affected by a chronic disorder deeply modulated by environmental factors (i.e., sleep and diet) capable to influence drug-response and disease progression. Thus, we aimed to summarize the evidence in the literature that may highlight a potential link among psoriasis–diet–sleep in order to further promote a multidisciplinary approach to psoriatic patients in the scientific community.

Sleep Quality and Dietary Patterns in an Occupational Cohort of Police Officers

We examined the association between self-reported sleep quality, sleep duration, and dietary patterns among police officers in the Buffalo Cardio-Metabolic Occupational Stress (BCOPS) study.422 police officers aged 21-74 (2004-2009).We used a cross-sectional study design and obtained sleep quality and duration from responses to the 19-item Pittsburgh Sleep Quality Index. Using 46 energy-adjusted food groups derived from a 125-item food frequency questionnaire, we identified dietary patterns using exploratory factor analysis. Multiple linear regression analysis was used to examine the associations of sleep quality and duration with the derived dietary patterns.We identified major dietary patterns: fruits and vegetables (FV), dairy products, starches and fried foods, and meat and eggs. Individuals with poor sleep quality had a lower average FV score than those with optimal sleep (β [SE] = -0.32 [0.13]; p = .01). Significant interactions were observed between sex and the FV and dairy products dietary patterns, where women with poor sleep quality had a lower mean FV score compared to women with optimal sleep quality (β [SE] = -0.81 [0.29]; p = .01). Women with < 6 hours sleep duration had a lower mean dairy score compared to women with ≥ 7 hours sleep duration (β [SE] = -0.69 [0.29]; p = .02). We did not observe these associations among men.Among women, good sleep quality and long sleep duration were associated with a dietary pattern high in consumption of both fruits and vegetables and dairy products.Abbreviations: BCOPS: Buffalo Cardio-Metabolic Occupational Stress study; BMI: body mass index; FFQ: food frequency questionnaire; FV: fruits and vegetables; KMO: Kaiser-Meyer-Olkin test; MET: metabolic equivalent of task score; PSQI: Pittsburgh Sleep Quality Index questionnaire.

The Effects of a Mediterranean Diet Intervention on Cancer-Related Fatigue for Patients Undergoing Chemotherapy: A Pilot Randomized Controlled Trial

Cancer-related fatigue is a common, burdensome symptom of cancer and a side-effect of chemotherapy. While a Mediterranean Diet (MedDiet) promotes energy metabolism and overall health, its effects on cancer-related fatigue remain unknown. In a randomized controlled trial, we evaluated a rigorous MedDiet intervention for feasibility and safety as well as preliminary effects on cancer-related fatigue and metabolism compared to usual care. Participants had stage I−III cancer and at least six weeks of chemotherapy scheduled. After baseline assessments, randomization occurred 2:1, MedDiet:usual care. Measures were collected at baseline, week 4, and week 8 including MedDiet adherence (score 0−14), dietary intake, and blood-based metabolic measures. Mitochondrial respiration from freshly isolated T cells was measured at baseline and four weeks. Participants (n = 33) were 51.0 ± 14.6 years old, 94% were female, and 91% were being treated for breast cancer. The study was feasible, with 100% completing the study and >70% increasing their MedDiet adherence at four and eight weeks compared to baseline. Overall, the MedDiet intervention vs. usual care had a small-moderate effect on change in fatigue at weeks 4 and 8 (ES = 0.31, 0.25, respectively). For those with a baseline MedDiet score <5 (n = 21), the MedDiet intervention had a moderate-large effect of 0.67 and 0.48 at weeks 4 and 8, respectively. The MedDiet did not affect blood-based lipids, though it had a beneficial effect on fructosamine (ES = −0.55). Fatigue was associated with mitochondrial dysfunction including lower basal respiration, maximal respiration, and spare capacity (p < 0.05 for FACIT-F fatigue subscale and BFI, usual fatigue). In conclusion, the MedDiet was feasible and attenuated cancer-related fatigue among patients undergoing chemotherapy, especially those with lower MedDiet scores at baseline.

Mediterranean Diet on Sleep: A Health Alliance

The Mediterranean diet is a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of noncommunicable diseases and total mortality, so that it is considered one of the healthiest dietary patterns. Clinical trials and mechanistic studies have demonstrated that the Mediterranean diet and its peculiar foods and nutrients exert beneficial effects against inflammation, oxidative stress, dysmetabolism, vascular dysfunction, adiposity, senescence, cognitive decline, neurodegeneration, and tumorigenesis, thus preventing age-associated chronic diseases and improving wellbeing and health. Nocturnal sleep is an essential physiological function, whose alteration is associated with health outcomes and chronic diseases. Scientific evidence suggests that diet and sleep are related in a bidirectional relationship, and the understanding of this association is important given their role in disease prevention. In this review, we surveyed the literature concerning the current state of evidence from epidemiological studies on the impact of the Mediterranean diet on nighttime sleep quantity and quality. The available studies indicate that greater adherence to the Mediterranean diet is associated with adequate sleep duration and with several indicators of better sleep quality. Potential mechanisms mediating the effect of the Mediterranean diet and its foods and nutrients on sleep are described, and gap-in-knowledge and new research agenda to corroborate findings are discussed.

Nutritional Biomarkers and Factors Correlated with Poor Sleep Status among Young Females: A Case-Control Study

Poor sleep status is associated with several health problems. Nutritional biomarkers and factors related to poor sleep are understudied. This study aimed to identify nutrition biomarkers and factors related to sleep status in healthy young Saudi females. The study included 92 normal-weight and obese Saudi females aged 19−25. Fasting blood glucose, insulin, and lipid profiles were measured. Insulin resistance was calculated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR) method. Anthropometric, stress, physical activity, and dietary data were collected. Data on the polyphenol content in foods were retrieved from the Phenol-Explorer database. The sleep status was assessed using the Pittsburgh sleep quality index (PSQI). Associations between variables were assessed using the multiple logistic regression model. Around 76% of the participants had poor sleep status (PSQI > 5). Multiple logistic regression reported high polyphenol intake as a protective factor against poor sleep (OR 0.24; 95% CI 0.07−0.83; p = 0.03) and HOMA-IR as an independent risk for poor sleep (OR 4.97; 95% CI 1.11−22.31; p = 0.04). Other nutritional biomarkers and factors, such as BMI, lipid profile, and vitamins, revealed a trend but were not significant. In conclusion, poor sleep status is associated with insulin resistance and low polyphenol intake among women of reproductive age.

The association between low-carbohydrate diet score and sleep duration among Iranian adults

Sleep disorders are linked to obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The evidence suggests that dietary carbohydrate content may be related to sleep duration. We designed a study to investigate the association between a low-carbohydrate diet (LCD) with long sleep duration (> 8 h) and short sleep duration (< 5 h). This cross-sectional analysis was conducted on data obtained from the recruitment phase of Yazd Health Study (YaHS) and the Taghzieh Mardom-e-YaZd (TAMYZ). The dietary intake was assessed using a validated food frequency questionnaire. The LCD score was calculated for each subject based on summing up assigned scores to deciles of percentages of energy from macronutrients. Sleep duration was assessed using a nocturnal sleep questionnaire. The association between LCD and sleep duration was evaluated using logistic regressions in crude and adjusted models. A total of 5929 subjects were entered into the analysis. Most of the participants were aged 20-29 years (24.8%), male (52.2%) and never smokers (87.7%). After adjusting for level of physical activity, age, sex, total energy, smoking status and body mass index in model III, a significant direct association was observed between LCD score with long sleep duration (OR 1.15; 95% CI1-1.32, P = 0.049) and short sleep duration (OR 1.29; 95% CI 1.02-1.62, P = 0.028). Higher LCD score is associated with higher chance of long sleep duration and short sleep duration. Regarding the nature of our study, cohort and clinical trial studies in future are required to reach a causal association and a definitive conclusion.

Prospective assessing metabolic abnormalities, lifestyle and dietary pattern in a Chinese population with heart failure: the MALD-HF study protocol

INTRODUCTION

The evidence on predictive value of lifestyle behaviours and dietary pattern on the prognosis of heart failure (HF) is limited. Our aim is to identify these factors in the setting of secondary prevention of HF.

METHODS AND ANALYSIS

The Metabolic Abnormalities, Lifestyle and Dietary Pattern in Heart Failure study is an ongoing, prospective cohort, single-centre study that aims to recruit 1500 patients with HF from June 2016 to June 2021. At baseline, each participant completes a questionnaire on demographic characteristics, medical history, lifestyle behaviours, sleep duration and quality, bowel movements and regular diet. Biochemical measurements, blood pressure, carotid ultrasound, echocardiography, electrocardiography and cardiac magnetic resonance are obtained and analysed. Muscle strength is assessed using the handgrip dynamometer and the MicroFet2 hand-held dynamometer. Each patient is followed for 5 years or until the occurrence of death. The primary outcome is a composite of cardiovascular mortality or hospitalisation due to worsening heart failure. The secondary end points are cardiovascular deaths and the hospitalisations due to worsening HF. The incidence of mortality and cardiovascular events is documented biennially.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Ethics Committee of the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and follows the norms of the World's Association Declaration of Helsinki. The results of this study will be disseminated in peer-reviewed journals and academic conferences.

TRIAL REGISTRATION NUMBER

NCT03951311.

The Combined Influences of Exercise, Diet and Sleep on Neuroplasticity

Neuroplasticity refers to the brain's ability to undergo structural and functional adaptations in response to experience, and this process is associated with learning, memory and improvements in cognitive function. The brain's propensity for neuroplasticity is influenced by lifestyle factors including exercise, diet and sleep. This review gathers evidence from molecular, systems and behavioral neuroscience to explain how these three key lifestyle factors influence neuroplasticity alone and in combination with one another. This review collected results from human studies as well as animal models. This information will have implications for research, educational, fitness and neurorehabilitation settings.

Associations between sleep duration and Mediterranean diet score in Costa Rican adults

Both insufficient and excessive sleep duration have been associated with lower-quality diets in adult populations. However, investigations in Latin America, where different sleep norms may exist (e.g., daily napping), are scarce. Therefore, we examined whether weekday sleep duration and inconsistencies between weekday and weekend sleep duration were related to adherence to the Mediterranean diet among Costa Rican adults. The study population included 2169 controls (74% men) from a population-based case-control study. Usual sleep duration (weekday versus weekend) was self-reported and defined as short, recommended, and long (<7 h, 7-9 h, >9 h, respectively). Inconsistent weekday-weekend sleep duration was defined as >1-h difference. Diet was assessed with a food frequency questionnaire, and adherence to the Mediterranean diet was calculated with the Alternative Mediterranean Diet Score (AMED). Sex-stratified linear regression models were conducted with AMED score as a continuous outcome and sleep variables as categorical or dichotomous exposures (in separate models). Models were adjusted for age, area of residence, education, napping, caffeine intake, smoking status, type 2 diabetes mellitus, hypertension, and physical activity. Average (SD) hours of sleep per night reported were 7.0 (1.4) on weekdays and 7.3 (1.6) on weekends for men, and 7.0 (1.5) on weekdays and 7.2 (1.6) on weekends for women. Among women, sleep duration <7-h per night was associated with a lower AMED score compared to those with recommended sleep duration (β: -0.35, CI: -0.63 to -0.07). Unstratified models showed a suggestive association between inconsistent weekday-weekend sleep and lower AMED scores that did not vary by sex (β: -0.08, CI: -0.16, 0.006; P, interaction with sex = 0.93). Lastly, the napping frequency was not associated with AMED scores in any model. In conclusion, short and inconsistent sleep duration may affect the dietary patterns of Costa Ricans.

Adherence to the Mediterranean diet among adults in Mediterranean countries: a systematic literature review

BACKGROUND AND AIM

While the Mediterranean diet (MD) is promoted in non-Mediterranean countries, inhabitants of Mediterranean countries seem to be shifting away from this healthy diet. The aim of this study is to provide an overview of MD adherence in the general adult population of Mediterranean countries.

METHODS

A systematic review was conducted following the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO databases for studies published from 2010 up to and including 2021. The following inclusion criteria were used: age 18 years and older, sample size > 1000 participants, and using a validated MD adherence score. Studies that only included participants with nutrition-related or other severe chronic disorders, as well as studies that only included specific subpopulations (e.g., pregnant women), were excluded in order to focus on the general adult population. A quality analysis of the included studies was done using the NCCMT scale.

RESULTS

A total of 50 studies were included. The number of participants in the included studies ranged between 1013 and 94,113. Most of the included studies pertained to the European Mediterranean countries, with fewer studies from the Middle Eastern and North African Mediterranean countries. The vast majority of the included studies reported low or moderate MD adherence, both based on the mean adherence as well as the low or moderate adherence category often being the most prevalent. There were no clear differences noted between sex and age groups. The quality assessment generally showed weak or moderate scores.

CONCLUSIONS

Mediterranean populations have been showing moderate adherence to MD in the past 10 years, indicating room for improving adherence to the MD in countries of its origin.

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.

Associations of Dietary Pattern and Sleep Duration with Cognitive Decline in Community-Dwelling Older Adults: A Seven-Year Follow-Up Cohort Study

BACKGROUND

A few studies have linked dietary patterns and sleep to cognitive decline.

OBJECTIVE

To examine the independent and joint associations of dietary patterns and sleep with cognitive decline.

METHODS

Our analysis included 2,307 participants aged 55- 89 years at baseline from the China Health and Nutrition Survey. Dietary intake was assessed using weighing methods in combination with 24 h dietary recalls for three consecutive days. Exploratory factor analysis was applied to identify major dietary factors. Cognition was assessed in 1997, 2000, 2004, 2006, and 2015.

RESULTS

Five dietary patterns were identified: dairy-fruits-fast foods, grains-vegetables-pork, plant-based food, beans-mushroom, and beverages-nuts patterns. Beans-mushroom pattern and sleep duration of 8 h/day were defined as healthy habits. There was a positive association between the beans-mushroom pattern and change in the global cognitive Z-score over seven years (β (95% CI) for quintile 5 versus quintile 1:0.17 (0.05, 0.30)). Compared to individuals with sleep duration of 8 h/day, those with sleep duration of≤5 h/day (β (95% CI): - 0.23 (- 0.45, - 0.00)) or > 10 h/day (- 0.52 (- 0.73, - 0.32)) had a greater decrease in global cognitive Z-score. Compared to individuals with no healthy patterns, those with a healthy dietary pattern only (β (95% CI): 0.18 (0.08, 0.28)), healthy sleep pattern only (0.13 (0.04, 0.23), and both healthy dietary and sleep patterns (0.19 (0.08, 0.31)) had a relative increase in global cognitive Z-score.

CONCLUSION

Our findings highlight the importance of involving both diet and sleep as intervention priorities for the potential prevention of cognitive decline.

Quality of Sleep in the Cypriot Population and Its Association With Multimorbidity: A Cross-Sectional Study

Poor sleep is a relatively common condition with possibly serious adverse health consequences. Lack of sleep affects the endocrine, immune, and nervous systems. In Cyprus, there is no information about the quality of sleep in the population. The goal of this study was to assess the quality of sleep in the Cypriot population and evaluate its association with multimorbidity. A representative sample of the adult population of Cyprus was selected in 2018-2019 among the five government-controlled municipalities of the Republic of Cyprus using stratified sampling. Data on sleep quality as well as on the presence of chronic, clinical, and mental health conditions were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). A total of 1,140 Cypriot men and women over 18-years of age (range: 18-94) participated in the study. The median Pittsburgh sleep quality index score of the participants was 5 (first quartile = 3, third quartile = 7) with the maximum score being 17, which suggests that the Cypriot population has a relatively good quality of sleep overall, although, almost one-third of the study population had a poor quality of sleep. Women, residents of Paphos, and married people had a poorer quality of sleep (p < 0.05). Having a poor quality of sleep was associated with higher odds of multimorbidity (OR = 2.21, 95% CI: 1.55, 3.16), even after adjusting for demographics, socioeconomic, and lifestyle factors. Adopting good sleep habits could be beneficial and would potentially help reduce the risk of multimorbidity. Public health guidelines regarding the importance of sleep and its association with multimorbidity should be considered.

Health, Lifestyle, and Psycho-Social Determinants of Poor Sleep Quality During the Early Phase of the COVID-19 Pandemic: A Focus on UK Older Adults Deemed Clinically Extremely Vulnerable

Background: Several studies have assessed the impact of COVID-19-related lockdowns on sleep quality across global populations. However, no study to date has specifically assessed at-risk populations, particularly those at highest risk of complications from coronavirus infection deemed "clinically-extremely-vulnerable-(COVID-19CEV)" (as defined by Public Health England). Methods: In this cross-sectional study, we surveyed 5,558 adults aged ≥50 years (of whom 523 met criteria for COVID-19CEV) during the first pandemic wave that resulted in a nationwide-lockdown (April-June 2020) with assessments of sleep quality (an adapted sleep scale that captured multiple sleep indices before and during the lockdown), health/medical, lifestyle, psychosocial and socio-demographic factors. We examined associations between these variables and sleep quality; and explored interactions of COVID-19CEV status with significant predictors of poor sleep, to identify potential moderating factors. Results: Thirty-seven percent of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included health/medical factors: COVID-19CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders; and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. Moderators of the negative relationship between COVID-19CEV status and good sleep quality were marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep. Conclusions: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct modifiable factors. An important contribution of our study is the assessment of a "clinically-extremely-vulnerable" population and the sex differences identified within this group. Male and female older adults deemed COVID-19CEV may benefit from targeted mental health and dietary interventions, respectively. This work extends the available evidence on the notable impact of lack of social interactions during the COVID-19 pandemic on sleep, and provides recommendations toward areas for future work, including research into vulnerability factors impacting sleep disruption and COVID-19-related complications. Study results may inform tailored interventions targeted at modifiable risk factors to promote optimal sleep; additionally, providing empirical data to support health policy development in this area.

Is there a relationship between the ketogenic diet and sleep disorders?

Sleep disorders are very often underestimated and, consequently, not treated with due priority. Common sleep disorders include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. The ketogenic diet (KD) is rich in fat, low in carbohydrates (CHO), and adequate in protein. The KD has shown several applications in treating medical conditions, such as epilepsy, neurodegenerative disorders, obesity with its comorbidities, and sleep disorders, with encouraging results. Therefore, the purpose of this review is to address the primary sleep disorders and their respective standard therapeutic approaches, analyse the effect of ketone bodies (KBs) on sleep homeostasis, and the effects of KD on sleep disorders and in particular on obstructive sleep apnoea (OSA) syndrome. The goal is to summarise the evidence existing up to now on the subject, to provide a starting point for further investigations.

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.

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.

Sleep duration, vegetable consumption and all-cause mortality among older adults in China: a 6-year prospective study

BACKGROUND

Sleep duration and vegetable consumption are associated with mortality at old age (termed as sleep-mortality linkage and vegetable-mortality linkage, respectively). Yet, little is known about the interplay of sleep duration and vegetable consumption on mortality.

METHODS

A dataset of nationwide longitudinal survey with 13,441 participants aged 65 years or older recruited in 2008 and followed up till 2014 was used. Sleep duration was classified into five groups (≤5, 6, 7-8, 9, and ≥ 10 h/day). Vegetable consumption was classified as either high frequency (eating vegetables almost daily) or low frequency. We used parametric Weibull hazard regression models to estimate associations of sleep duration and frequency of vegetable consumption with mortality, adjusting for demographics, socioeconomic factors, family/social support, health practice, and health conditions.

RESULTS

Over the six-year study period, when only demographics were present, participants sleeping ≤5, 6, 9, and ≥ 10 h/day had relative hazard (RH) of mortality 1.18 (p < 0.001), 1.14(p < 0.01), 1.06 (p > 0.1), and 1.30 (p < 0.001), respectively, compared to those sleeping 7-8 h/day. The HRs were attenuated to 1.08 (p < 0.05), 1.08 (p < 0.05), 1.09 (p < 0.1), 1.18(p < 0.001), respectively, when all other covariates were additionally adjusted for. High frequency of eating vegetables was associated with 22% lower risk of mortality (RH= 0.78, p < 0.001) compared to low frequency in the demographic model, and with 9% lower risk (RH = 0.91, p < 0.05) in the full model. Subpopulation and interaction analyses show that the sleeping-mortality linkage was stronger in female, urban, oldest-old (aged ≥80), and illiterate participants compared to their respective male, rural, young-old, and literate counterparts. High frequency of vegetable intakes could offset the higher mortality risk in participants with short-sleeping duration, but low frequency of eating vegetables could exacerbate mortality risk for participants with either short or long sleep duration; and except for few cases, these findings held in subpopulations.

CONCLUSIONS

Too short and too long sleep durations were associated with higher mortality risk, and infrequent vegetable consumption could exacerbate the risk, although frequent vegetable intake could offset the risk for short sleep duration. The relationship between these two lifestyles and mortality was complex and varied among subpopulations.

The Relationship Between Diet and Sleep in Older Adults: a Narrative Review

PURPOSE OF REVIEW

Older adults more frequently experience reduced sleep quality and quantity compared to younger adults. Diet is one modifiable lifestyle factor that may influence sleep outcomes in older adults. The purpose of this review is to synthesise the current literature investigating the impact of diet, including foods and nutrients, on the sleep quality and quantity of older adults.

RECENT FINDINGS

Overall, the observational and intervention studies suggest that following a Mediterranean diet, and the consumption of certain food items (e.g. milk), and nutrients (e.g. vitamin D and vitamin E) may influence (improve or reduce) sleep quality and quantity. This review describes the potential efficacy for dietary factors to improve sleep outcomes in older adults. However, given the heterogeneity of included studies in this review (i.e. aims, methodologies, and outcomes assessed), it is difficult to consolidate the available evidence to make specific recommendations. More targeted research exploring the relationship between diet and sleep in older adults is needed to strengthen the current evidence base.

Influence of the COVID-19 Pandemic on the Lifestyles of Health Sciences University Students in Spain: A Longitudinal Study

The COVID-19 pandemic has significantly impacted daily activities worldwide. University students may have experienced substantial changes in daily living as a result of restrictions on university attendance. The return to normalcy may take a long time, and understanding the influence that shifts in daily routines have had on the lifestyles of university students may inform approaches to support overall well-being. We analyzed changes in the lifestyles of students enrolled at a health sciences university during the COVID-19 pandemic. This longitudinal study took place at the Faculty of Medicine and Nursing in the University of the Basque Country in Spain, and the final sample consisted of 113 nursing students, 109 medical students, and 45 physiotherapy students. Our results demonstrate changes in lifestyles of university students during the pandemic. MedDiet adherence scores and the percentage of students with high adherence increased during the pandemic. This increase was due to the increased consumption of vegetables and nuts. In terms of physical activity, the practice of moderate and intense physical activity was maintained. These results provide important information for both public health authorities and educational institutions to guide strategies to maintain the well-being of students and enhance opportunities for young adults to lead a healthy lifestyle.