Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005-2016

Sleep and health improvement programme (SHIP) for patients with prostate cancer and caregivers

Objective

The objective of this study is to determine whether a sleep and health improvement programme (SHIP) to promote healthy sleep, eating and physical activity would be feasible, acceptable and have a positive impact on lifestyle behaviours for prostate cancer survivors and caregivers.

Methods

We recruited 50 participants for a single group 3-month pre-post pilot study. The SHIP intervention included (1) website about sleep, nutrition and physical activity (≥1 view/week), (2) two email newsletters with goal-setting exercises and resources and (3) midpoint health coach call. The primary outcome was changes in validated sleep scales; secondary outcomes included changes in diet, physical activity and concentration from baseline to 3 months.

Results

Of 50 participants enrolled, median age was 65, 30% were Black and 8% were Hispanic. Thirty-four patients and 7 family caregivers completed the pilot study (82%). Following the intervention, we observed a statistically significant improvement in the Sleep Hygiene Index (pre: 15, post: 13, p < 0.01), and a trend toward lower Insomnia Severity Index (pre: 12, post: 9, p = 0.07). There were no statistically significant improvements in sleep quality or physical activity, but there were improvements in healthy eating (e.g., increase in cruciferous vegetables and reduction in dairy) and in fatigue-related problems and concentration. Exit interview feedback was positive.

Conclusions

A web-based sleep and healthy lifestyle programme for patients with prostate cancer and their caregivers is feasible and acceptable. A randomized controlled trial is planned to test whether a refined SHIP improves sleep and lifestyle in patients with prostate cancer and caregivers.

Effects of an Acute Dose of Zinc Monomethionine Asparate and Magnesium Asparate (ZMA) on Subsequent Sleep and Next-Day Morning Performance (Countermovement Jumps, Repeated Sprints and Stroop Test)

The goal of the present study was to determine whether an acute dose of a zinc-containing nutritional supplement (ZMA) has any effects on sleep and morning performance in recreationally trained males. Nineteen males participated in a repeated-measures within-subjects study to assess objective and subjective measures of sleep, completed counter-movement jumps (CMJ) and repeated sprint morning performance (RSP). Three days of baseline food intake showed no major deficiencies of zinc, magnesium or vitamin B6 for all participants (11.9 ± 3.4, 395 ± 103 and 2.7 ± 0.9 mg.day-1, respectively). Sleep (22:30-06:30 h) was assessed via actimetry, and either a control (no tablets, NoPill), dextrose placebo (PLAC) or ZMA was ingested 30-60 min before retiring to bed for two nights. The participants undertook the three conditions (NoPill, PLAC or ZMA) administered in a counterbalanced order. The data were analyzed using general linear models with repeated measures. In healthy active males who consume diets of adequate micronutrients, sleep normally and maintain good sleep hygiene (time to bed and wake times), ZMA supplementation had no beneficial effect on RSP or performance in the Stroop test (p > 0.05) but did improve CMJ height (p < 0.001) compared to that of PLAC but not NoPill (p > 0.05). Supplementation of ZMA for two nights had no effect on sleep, RSP or cognitive function. The NoPill condition elucidated the effects of the intervention under investigation.

In Males with Adequate Dietary Needs Who Present No Sleep Disturbances, Is an Acute Intake of Zinc Magnesium Aspartate, Following Either Two Consecutive Nights of 8 or 4 h of Sleep Deprivation, Beneficial for Sleep and Morning Stroop Interference Performance?

PURPOSE

Purpose: We examined whether supplementation of zinc magnesium aspartate (ZMA) in two groups of males, either partially sleep-restricted (4 h) or with habitual sleep (8 h) for 2 nights, was beneficial for sleep and subsequent morning Stroop performance.

METHODS

Participants were randomly allocated to two independent groups who either had 4 h (33 males) or 8 h (36 males) sleep for two nights. Using a double-blinded, randomised counterbalanced design, they then completed five sessions, (i) two familiarisation sessions including 7 days of sleep and dietary intake, (ii) three conditions with 4 h or 8 h sleep and either NoPill control (NoPill), placebo (PLAC) or ZMA (ZMA). Sleep was assessed by actimetry and sleep questionnaires, and cognitive performance was assessed by the Stroop test. The data were analysed using a general linear model with repeated measures.

RESULTS

A main effect for "sleep" (4 or 8 h) was found, where more opportunity to sleep resulted in better "sleep" metrics (both objective and subjective) as well as better Stroop scores (lower colour-interference and word-interference scores and lower error in words). No main effect for "Pill" was found other than the mood state depression, where subjective ratings for the PLAC group were lower than the other two conditions. Interactions were found in anger, ease to sleep and waking time.

CONCLUSION

Having 8 h opportunity to sleep resulted in better "sleep" metrics as well as better Stroop scores compared to 4 h. Supplementation of ZMA for 4 or 8 h for 2 nights had no effect on subsequent morning cognitive performance but reduced sleep or total sleep time by ~0.46 h compared to the other conditions. An interaction was found where sleep time was reduced by ~0.94 h in the ZMA group in the 8 h condition compared to NoPill or PLAC.

Nonlinear associations between the ratio of family income to poverty and all-cause mortality among adults in NHANES study

Socioeconomic status (SES) has been linked to mortality rates, with family income being a quantifiable marker of SES. However, the precise association between the family income-to-poverty ratio (PIR) and all-cause mortality in adults aged 40 and older remains unclear. A cross-sectional study was conducted using data from NHANES III, including 20,497 individuals. The PIR was used to assess financial status, and various demographic, lifestyle, and clinical factors were considered. Mortality data were collected from the NHANES III linked mortality file. The study revealed a non-linear association between PIR and all-cause mortality. The piecewise Cox proportional hazards regression model showed an inflection point at PIR 3.5. Below this threshold, the hazard ratio (HR) for all-cause mortality was 0.85 (95% CI 0.79-0.91), while above 3.5, the HR decreased to 0.66 (95% CI 0.57-0.76). Participants with lower income had a higher probability of all-cause mortality, with middle-income and high-income groups showing lower multivariate-adjusted HRs compared to the low-income group. This study provides evidence of a non-linear association between PIR and all-cause mortality in adults aged 40 and older, with an inflection point at PIR 3.5. These findings emphasize the importance of considering the non-linear relationship between family income and mortality when addressing socioeconomic health disparities.

The Association Between Essential Metal Element Mixture and Sleep Quality in Chinese Community-Dwelling Older Adults

Previous studies have related single essential metal elements (EMEs) to sleep quality among older adults, however, the association of the EME mixture with sleep quality remained poorly understood. This study aimed to investigate the relationships between single EMEs and the EME mixture and sleep quality in older adults living in Chinese communities. This study consisted of 3957 older adults aged 60 years or over. Urinary concentrations of cobalt (Co), vanadium (V), selenium (Se), molybdenum (Mo), strontium (Sr), calcium (Ca), and magnesium (Mg) were detected using inductively coupled plasma mass spectrometry. Sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). The associations of single EMEs and EME mixture with sleep quality were assessed using logistic regression and Bayesian kernel machine regression (BKMR) models, respectively. Adjusted single-element logistic regression models showed that Mo (OR = 0.927, 95%CI:0.867-0.990), Sr (OR = 0.927, 95%CI:0.864-0.994), and Mg (OR = 0.934, 95%CI:0.873-0.997) were negatively related to poor sleep quality. BKMR models exhibited similar results. Also, higher levels of the EME mixture in urine were inversely related to the odds of poor sleep quality after adjustment for covariates, and Mo had the largest conditional posterior inclusion probability (condPIP) value in the mixture. Mo, Sr, and Mg were negatively related to poor sleep quality, separately and as the mixture. The EME mixture in urine was associated with decreased odds of poor sleep quality in older adults, and Mo was the greatest contributor within the mixture. Additional cohort research is warranted to clarify the relationship of multiple EMEs with sleep quality.

Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BACKGROUND

Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.

METHODS

Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.

RESULTS

In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.

CONCLUSIONS

Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

Assessing the journey of calcium supplementation: A mendelian randomization study on the causal link between calcium levels and sleep disorders

BACKGROUND & AIM

Sleep disorder is a growing concern, and calcium supplementation is often recommended as a potential intervention for sleep disorders. However, the causal relationship between calcium levels and the incidence of sleep disorders remains unclear. Mendelian randomization techniques utilizing genetic variants that affect calcium levels, can provide valuable insights into causality. This study aims to examine the association between calcium levels and sleep disorders in a diverse population that includes both adolescents and adults, and investigate the effects of calcium levels on sleep disorders.

METHODS

Mendelian randomization analysis was conducted using data from UK Biobank and FinnGen datasets. The inverse-variance weighting (IVW) was selected as the primary method. In addition, traditional mediation analysis was performed on a subset of the NHANES data spanning from 2007 to 2018.

RESULTS

Our findings provide evidence supporting a causal relationship between calcium intake and reduced risk of sleep disorders (beta = -0.079, SE = 0.0395, P = 0.0457). While not reaching statistical significance, other MR methods such as weighted median and Mr-Egger exhibited similar directional trends. Analysis of the NHANES cohort revealed a negative association between calcium levels and the prevalence of sleep disorders in male, black, and physically active populations. However, this association was not observed in other demographic groups.

CONCLUSION

Our results suggested that there is no significant correlation between calcium levels and sleep disorder in non-exercise populations. This raises concerns about the long-term high-dose calcium supplementation in clinical practice, which requires further investigation.

Effects of Supplementing Zinc Magnesium Aspartate on Sleep Quality and Submaximal Weightlifting Performance, following Two Consecutive Nights of Partial Sleep Deprivation

Purpose: We examined whether supplementation of zinc magnesium aspartate (ZMA), while partially sleep deprived, was beneficial to sleep quality and subsequent morning (07:00 h) submaximal weightlifting. Methods: Using a double-blinded, randomized counterbalanced design, sixteen trained males were recruited and completed six sessions: (i) one repetition max (1 RM) for bench press and back squat; (ii) two familiarisation sessions; (iii) three conditions with 4 h sleep and either: ZMA, placebo (PLA), or NoPill control (NoPill). Submaximal exercise session consisted of three repetitions at 40, 60 and 80% of 1 RM for bench press and back squat. Average power (AP), average velocity (AV), peak velocity (PV), displacement (D) and time-to-peak velocity (tPV) were recorded using MuscleLab linear encoders. Data were analysed using a general linear model with repeated measures and linear correlation. Results: No significant main effect for condition was found for performance values or subjective ratings of fatigue. Main effect for "load" on the bar was found, where AP and tPV values increased with load (p < 0.05). No significant relationship between dose of zinc or magnesium ingested and change in performance for 80% 1 RM power-outputs was found. Conclusion: Supplementation of ZMA for two nights of partial sleep deprivation had no effect on sleep or subsequent morning performance.

Association between dietary calcium, potassium, and magnesium consumption and glaucoma

BACKGROUND

Calcium (Ca), potassium (K) and magnesium (Mg) may be involved in the occurrence and development of glaucoma by influencing the retinal oxidative stress and regulate blood pressure. However, epidemiological opinions on dietary intake of macroelement related to glaucoma are inconsistent. Herein, this study aims to explore the association between dietary Ca, K, and Mg consumption and glaucoma.

METHODS

Data of 7,042 adults aged ≥40 years old who received the glaucoma examinations were extracted from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2008 in this cross-sectional study. Univariate and multivariate logistic regression were used to explore the association between dietary Ca, K, and Mg intake and glaucoma with the odd ratios (ORs) and 95% confidence intervals (CIs). We also investigated this relationship in individuals of different age, with/without hypertension and visual field defect (VFD).

RESULTS

There were 502 (8.11%) participants had glaucoma. After adjusted for covariables, we found that enough dietary Ca consumption was related to a decreased risk of glaucoma [OR = 0.59, 95%CI: (0.42-0.81)], whether in persons with/without hypertension (all P<0.05). In particular, dietary K intake may be a potential protect factor for glaucoma in non-hypertension populations [OR = 0.47, 95%CI: (0.22-0.99), P = 0.049]. Additionally, hypertension/non-hypertension persons who aged <65 years old or with/without VFD should all pay attention to the enough dietary supplement of Ca, K, and Mg according to their own circumstances.

CONCLUSION

Enough dietary Ca, K, and Mg consumption may be potential protect factors of glaucoma that could provide some dietary reference for developing targeted glaucoma prevention and control measures.

Association of dietary oxidative balance score and sleep duration with the risk of mortality: prospective study in a representative US population

OBJECTIVE

We investigated the association between dietary oxidative balance score (DOBS) and mortality and whether this association can be modified by sleep duration.

DESIGN

We calculated DOBS to estimate the overall oxidative effects of the diet, with higher DOBS reflecting more antioxidant intake and less pro-oxidant intake. Cox proportional hazards models were employed to examine the associations between DOBS and all-cause, CVD and cancer mortality in the general population and people with different sleep durations.

SETTING

Prospective analysis was conducted using data from the US National Health and Nutrition Examination Survey (NHANES, 2005-2015).

PARTICIPANTS

A total of 15 991 US adults with complete information on dietary intake, sleep duration and mortality were included.

RESULTS

During a median follow-up of 7·4 years, 1675 deaths were observed. Participants in the highest quartile of DOBS were significantly associated with the lower risk of all-cause mortality (hazard ratio (HR) = 0·75; 95 % CI 0·61, 0·93) compared with those in the lowest. Furthermore, we found statistically significant interactions between DOBS and sleep duration on all-cause mortality (P interaction = 0·021). The inverse association between DOBS and all-cause mortality was significant in short sleepers (HR = 0·66, 95 % CI 0·48, 0·92), but not in normal and long sleepers.

CONCLUSIONS

Our study observed that higher DOBS was associated with lower all-cause mortality, and this association appeared to be stronger among short sleepers. This study provides nutritional guidelines for improving health outcomes in adults, especially for short sleepers.

The association between nutritional status and sleep quality of Chinese community-dwelling older adults

BACKGROUND

Sleep disorders are a common syndrome and could affect the life quality of the older adults.

AIMS

This study aimed to investigate the association between nutritional status and sleep quality in the Chinese community-dwelling older adults.

METHODS

A total of 2,878 participants ≥ 65 years old from the Yiwu Elderly Cohort were included in the study. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Participants were categorized as subjects with malnutrition, at risk of malnutrition or well-nourished based on their MNA-SF score. Pittsburgh Sleep Quality Index (PSQI) was used to identify sleep disorders. PSQI score ≥ 6 was categorized as poor sleep quality.

RESULTS

Among the 2,878 participants (mean age 72.71 ± 5.79 years, 50.3% men), 31.5% (n = 906) were classified as having sleep disorders, and 25.5% were identified as malnutrition or at risk of malnutrition. We found a significantly relationship between nutritional status and sleep quality in older adults, and the results showed well-nourished decreased the risk of sleep disorders (OR = 0.32, 95% CI = 0.13, 0.75). And well-nourished status was significantly associated with less daytime dysfunction, adequate sleep duration, and good subjective sleep quality (all P < 0.05).

CONCLUSION

There was a close association of nutritional status and sleep quality in older adults. We should pay more attention to the nutritional status of older people with sleep problems, as well as the sleep quality of older adults with malnutrition.

The association between vitamin D status and sleep duration in school-aged children; the CASPIAN-V study

Background

Considering the high prevalence of both vitamin D deficiency (VDD) and sleep impairment in children and adolescents, this study was conducted to determine the association between VDD and sleep duration in the Iranian pediatric population.

Methods

This multicentric national study was conducted in 2019 on 2564 frozen sera obtained from 7 to 18- year students who were studied in the fifth survey of a national school-based surveillance program conducted in 30 provinces of Iran. Sleep duration was assessed using a questionnaire based on the World Health Organization-Global School-based Student Health Survey protocol. Short sleep duration was defined as sleep duration less than 8 h/day VDD Vitamin D < 20 ng/dL, and vitamin D insufficiency as 20-30 ng/dL.An adjusted logistic regression model was applied to evaluate the associations of vitamin D status with sleep duration.

Results

The Mean (SD) of students' age was 12.1(3.0) years; overall 10.6%of participants had VDD and 23% of participants had short sleep duration. in the adjusted logistic model, students with a low level of vitamin D (insufficient and deficient) had a higher odds of short sleep duration in comparison to those with normal vitamin D level (OR: 1.29, 95%CI: 1.02-1.62).

Conclusion

The current study showed that low Vitamin D levels (insufficient and deficient)were significantly associated with short sleep duration in school-aged children. Further studies are recommended to determine the efficacy of vitamin D replacement in improving sleep duration and quality.

The association between recreational physical activity and depression in the short sleep population: a cross-sectional study

Background

Short sleep is more common in the modern society. Recreational physical activity (RPA) like exercise brings both mental and physiological benefits to depression; paradoxically, lack of sleep is harmful. Evidence on the association between RPA and depression in the short sleep population is limited.

Methods

Participants with short sleep condition from the National health and Nutrition Examination Surveys (NHANES 2007-2018) were included in the present study. Short sleep condition was defined as ≤ 7 h per night. Sleep duration and RPA status were self-reported in NHANES by the Physical Activity Questionnaire using a 7-day recall method. Multivariable logistic regression was applied to evaluate the association between RPA and depression. Additionally, the non-linear relationship between RPA and depression was evaluated using the threshold effect analysis and restricted cubic spline.

Results

This cross-sectional study comprised 6,846 adults' data, and the weighted participants were 52,501,159. The weighted prevalence of depression was higher in females, which took up 65.85% of all depression patients. In fully adjusted models, sufficient volume of RPA was associated with lower depression risks, with OR (95% CI) =0.678 (0.520, 0.883). Further analysis revealed a U-shaped association between RPA and incident depression, and the inflection point was 640 MET-minutes/week. When RPA <640 MET-minutes/week, increased RPA was associated with lower risk of incident depression, with OR (95% CI) = 0.891 (0.834, 0.953). When RPA ≥ 640 MET-minutes/week, the benefits of RPA seemed to be not significant, with OR (95% CI) = 0.999 (0.990, 1.009).

Conclusion

Our findings observed associations between RPA condition and incident depression in the short sleep population. Moderate RPA was beneficial to maintain mental health and associated with lower incidence of depression for short sleepers, but excessive RPA might increase the risk of depression. For general short sleepers, keeping the RPA volume approximately 640 MET-minutes/week was beneficial to lower risks of depression. Gender difference should be considered as an important factor for further studies to examine these relationships and explore mechanisms.

Vitamin D and chronotype: is there any relationship in individuals with obesity?

PURPOSE

Chronotype is the attitude to perform most of the daily activities in the morning ("morning chronotype", MC) or in the evening ("evening chronotype", EC). The latter, as well as vitamin D deficiency, has been associated with an increased risk of obesity-related complications, likely through the promotion of insulin resistance. Therefore, we aimed to investigate whether there is any relationship between vitamin D (25-OH-D) and chronotype in individuals with obesity.

METHODS

In this cross-sectional study, we enrolled 59 individuals (43.1 ± 13 years; 17M/42F) with obesity. Anthropometric parameters, lifestyle habits, personal medical history, chronotype, insulin resistance, and 25-OH-D were assessed.

RESULTS

Individuals with EC presented significantly higher BMI than MC (p < 0.001), greater waist (p = 0.012), and hip circumferences (p = 0.001). Individuals with EC showed significantly lower insulin sensitivity (p = 0.017) and 25-OH-D than MC. In addition, the prevalence of vitamin D deficiency and impaired fasting glucose was significantly higher in EC than in MC. 25-OH-D directly correlated with chronotype score (r = 0.351; p = 0.019) whereas inversely with BMI (r = - 0.363; p = 0.016). The regression analysis showed that BMI was most tightly associated with 25-OH-D concentrations (β = - 0.323, p = 0.032), followed by chronotype score (β = 0.340, p = 0.042). Using chronotype score as the dependent variable, BMI significantly predicted a lower chronotype score (β = - 0.586, p < 0.001).

CONCLUSION

The present study showed that 25-OH-D, as well as chronotype, correlate independently with obesity.

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.

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

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

Effect of Vitamin E Supplementation on Chronic Insomnia Disorder in Postmenopausal Women: A Prospective, Double-Blinded Randomized Controlled Trial

Chronic insomnia disorder is one of the most common problems in postmenopausal women, exacerbated by underdiagnosis and improper treatment. This double-blinded, randomized, placebo-controlled trial was conducted to evaluate the potential of vitamin E to treat chronic insomnia as an alternative to sedative drugs and hormonal therapy. The study enrolled 160 postmenopausal women with chronic insomnia disorder, divided randomly into two groups. The vitamin E group received 400 units of mixed tocopherol daily, while the placebo group received an identical oral capsule. The primary outcome of this study was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), a self-evaluated and standardized questionnaire. The secondary outcome was the percentage of participants using sedative drugs. There were no significant differences in baseline characteristics between the study groups. However, the median PSQI score at baseline was slightly higher in the vitamin E group compared with the placebo (13 (6, 20) vs. 11 (6, 20); p-value 0.019). After one month of intervention, the PSQI score was significantly lower (indicating better sleep quality) in the vitamin E group compared with the placebo (6 (1, 18) vs. 9 (1, 19); p-value 0.012). Moreover, the improvement score was significantly higher in the vitamin E group compared with the placebo (5 (-6, 14) vs. 1 (-5,13); p-value < 0.001). In addition, there was a significant reduction in the percentage of patients using sedative drugs in the vitamin E group (15%; p-value 0.009), while this reduction was not statistically significant in the placebo group (7.5%; p-value 0.077). This study demonstrates vitamin E's potential as an excellent alternative treatment for chronic insomnia disorder that improves sleep quality and reduces sedative drug use.

Time in Bed, Sleeping Difficulties, and Nutrition in Pregnant New Zealand Women

We consider the relationship between time in bed (TIB) and sleeping difficulties with demographic variables and nutrient intakes in the second (T2) and third (T3) trimester of pregnancy. Data were acquired from a volunteer sample of New Zealand pregnant women. In T2 and T3, questionnaires were administered, diets were obtained from one 24 h recall and three weighed food records, and physical activity was measured with the use of three 24 h diaries. In total, 370 women had complete information in T2 and 310 in T3. In both trimesters, TIB was associated with welfare or disability status, marital status and age. In T2, TIB was associated with work, childcare, education and pre-pregnancy alcohol consumption. There were fewer significant lifestyle covariates in T3. In both trimesters, TIB declined with increasing dietary intake, especially water, protein, biotin, potassium, magnesium, calcium, phosphorus and manganese. Adjusted for weight of dietary intake and welfare/disability, TIB declined with increasing nutrient density of B vitamins, saturated fats, potassium, fructose and lactose; and TIB increased with carbohydrate, sucrose and vitamin E. Subjective sleeping difficulties increased with the week of gestation, morning sickness severity, anxiety, dairy and saturated fat intake, and they decreased with fruit, vegetable and monounsaturated fat intake. The study highlights the changing influence of covariates throughout the pregnancy and corroborates several published findings on the relationship of diet and sleep.

Association of sleep problems with urinary concentrations of personal care and consumer product chemicals: a nationally representative, population-based study

Sleep problems are common in modern society and may be related to environmental chemicals. The objective of this study is to investigate the association between exposure to personal care and consumer product chemicals (PCCPCs) and sleep-related disorders. Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) were used in this study (N=2415). Sleep-related variables, including sleep duration, snoring, and self-reported sleep problems, were included as outcome variables to assess sleep quality. Urinary PCCPC concentrations were used to assess the association of PCCPCs with sleep problems and adjusted for variables similar to those used in related studies. PCCPC levels were analysed as quartiles. Multivariate logistic regression and weighted quantile sum (WQS) regression were used to analyse the association of urinary PCCPCs with sleep problems. Nine of the 12 kinds of PCCPCs with a detection rate greater than 50% were included in our study. Specifically, the concentrations of bisphenol A (BPA), bisphenol F (BPF), methyl paraben (MP) and triclosan (TCS) were significantly related to insufficient sleep. Based on the WQS model, combined exposure to PCCPCs was also significantly related to insufficient sleep; TCS, BPA, and MP were the compounds with the greatest impact regarding combined exposure. A variety of PCCPCs were associated with insufficient sleep in participants but were not significantly associated with the other sleep problems reported in the NHANES. As poor quality sleep is associated with multiple adverse health outcomes, our study provides insight into the health risks of PCCPC exposure.

Effect of Tomato (Solanum lycopersicum) Extract in Patients with Primary Insomnia: A Double-blind Randomized Study

OBJECTIVE

Insomnia is a condition that causes sleep problems, and many people suffer from it. Patients with this disorder have difficulty with beginning or continuation of sleep, so they are exhausted all day long, and their performance reduces. This study was designed to assess the efficacy of capsules that contain tomato extract in patients with primary insomnia.

METHODS

In this study, 70 patients with primary insomnia were assigned to 2 groups randomly: intervention and control. The intervention group used to take tomato capsules every night for 2 weeks, and the placebo one used to take placebo capsules every night for 2 weeks. All patients used to fill out Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires before and after the intervention. ISI and PSQI results were analyzed separately on SPSS software.

RESULTS

A total of 70 patients (35 in the intervention group and 35 in the control group), including 50 females and 20 males, were studied. Female to male ratio and the rate of unemployment were significantly higher in the intervention group (in both cases P < 0.001), but there was no significant difference between the intervention and control groups in other characteristics (Age, marital status, weight, height, education; in all cases P > 0.05). At the end of the study, the amount of actual sleep had increased, and the delay in falling asleep decreased in both groups; the two groups at the end of the study were not significantly different in terms of these two variables (P > 0.05). The ISI score in both groups decreased significantly at the end of the study, and the PSQI score in both groups decreased significantly at the end of the study (In both cases, P < 0.05). The absolute value of ISI score change in the intervention group was significantly higher than the control group (P < 0.001); But the absolute value of PSQI score change was not significantly different between the two groups (P = 0.102). Most importantly, the improvement of both ISI and PSQI scores in the intervention group was significantly better than the control group (P > 0.05).

CONCLUSION

This study showed that tomato capsules have sleep-inducing effects, although there was no significant difference in the amount of actual sleep, and the delay in falling sleep in the intervention group compared to the control group.

Association of Food Intake with Sleep Durations in Adolescents from a Capital City in Northeastern Brazil

(1) Background: During adolescence, there are significant changes in food consumption, such as reducing the consumption of in natura or minimally processed foods and increasing the consumption of ultra-processed foods. Thus, eating habits can influence sleep duration and, consequently, affect the quality of life of young people. This study thus aims to estimate the association of consumption of in natura or minimally processed, processed, and ultra-processed foods with sleep durations in adolescents. (2) Methods: This is a cross-sectional study including 964 adolescents (18 to 19 years old) from the 1997 to 1998 birth cohort in São Luís, Maranhão. Food consumption was assessed using the food frequency questionnaire (FFQ) and stratified based on the NOVA classification. Sleep duration was verified using accelerometry in hours. The analysis of the association between the consumption of in natura or minimally processed, processedand ultra-processed foods with sleep durations in adolescents used crude and adjusted linear regression (by gender, age, skin color, education, economic class, work, consumption of alcohol, smoking, screen time, physical activity, use of illicit drugs, anxiety, depressive symptoms, and lean and fat mass). A directed acyclic graph (DAG) was used to determine the minimum set of adjustment factors. (3) Results: Of the 964 individuals evaluated, 52.0% were female. The mean sleep duration was 6 h (± 0.95). In the crude and adjusted analyses, no association was observed between food consumption according to the degree of processing and adolescent sleep durations. (4) Conclusion: There was no association between the consumption of in natura or minimally processed, processed, and ultra-processed foods with sleep durations.

Reported dietary habits and lifestyle behaviors of students before and during COVID-19 lockdown: A cross-sectional survey among university students from Ghana

Background:

COVID-19 lockdowns involved precautions and social rules that resulted in drastic changes to daily life activities in every setting. University students were not left out as their education was affected and they had to resort to online learning from their homes. The lockdowns did not only affect their education but also potentially affected their dietary habits and lifestyle behaviors. We evaluated the reported dietary habits and lifestyle behaviors of students from a Ghanaian University before and during the COVID-19 lockdown.

Materials and Methods:

Following a cross-sectional design, 220 students were recruited from the University for Development Studies in Ghana. Data was collected by means of an online questionnaire. Chi-square test (χ²) analysis was used to examine associations among variables.

Results:

About 59% of the students skipped meals before COVID-19 whereas 47.8% skipped meals during the COVID-19 lockdown. While 64.1% consumed homemade meals before the COVID-19, 82.3% consumed homemade meals during the COVID-19 lockdown. In addition, there was a significant increase in the consumption of homemade food (p < 0.001), level of healthy foods choices (p = 0.029), and a reduced skipping of meals (0.014) during the COVID-19 lockdown. Again, 56.4% of the students engaged in exercise before the lockdown while 45% participated in exercise during the lockdown.

Conclusions:

The lockdown had an impact on some of the dietary and lifestyle habits of the students. University students should be supported with appropriate nutrition education and counseling programs to help them adopt healthy dietary and lifestyle habits.

Is Melatonin the "Next Vitamin D"?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements

Melatonin has become a popular dietary supplement, most known as a chronobiotic, and for establishing healthy sleep. Research over the last decade into cancer, Alzheimer's disease, multiple sclerosis, fertility, PCOS, and many other conditions, combined with the COVID-19 pandemic, has led to greater awareness of melatonin because of its ability to act as a potent antioxidant, immune-active agent, and mitochondrial regulator. There are distinct similarities between melatonin and vitamin D in the depth and breadth of their impact on health. Both act as hormones, affect multiple systems through their immune-modulating, anti-inflammatory functions, are found in the skin, and are responsive to sunlight and darkness. In fact, there may be similarities between the widespread concern about vitamin D deficiency as a "sunlight deficiency" and reduced melatonin secretion as a result of "darkness deficiency" from overexposure to artificial blue light. The trend toward greater use of melatonin supplements has resulted in concern about its safety, especially higher doses, long-term use, and application in certain populations (e.g., children). This review aims to evaluate the recent data on melatonin's mechanisms, its clinical uses beyond sleep, safety concerns, and a thorough summary of therapeutic considerations concerning dietary supplementation, including the different formats available (animal, synthetic, and phytomelatonin), dosing, timing, contraindications, and nutrient combinations.

Association of sleep duration with chronic constipation among adult men and women: Findings from the National Health and Nutrition Examination Survey (2005-2010)

Background

Previous studies suggested that unhealthy sleep patterns were closely associated with gastrointestinal diseases, but the impact of unhealthy sleep duration on chronic constipation has not been well studied until now. In this study, we aim to explore the association between sleep duration and constipation among males and females.

Methods

We utilized the US National Health and Nutrition Examination Surveys data from 2005 to 2010, and adults (≥20 years old) who completed the sleep and bowel health questionnaires were enrolled in this observational study. Sleep duration was categorized into four groups: very short sleep (<5 h/night), short sleep (5-6 h/night), normal sleep (7-8 h/night), and long sleep (≥9 h/night). Chronic constipation was defined as Bristol Stool Scale Type 1(separate hard lumps, like nuts) or Type 2(sausage-like but lumpy). Controlling demographic, lifestyle, and dietary factors, the logistic regression model in Generalized Linear Model (GLM) function was used to estimate the correlation of sleep duration with constipation among men and women.

Results

Of the 11,785 individuals (51.2% males and 48.8% females), 4.3% of men and 10.2% of women had constipation, respectively. More than half of patients with constipation did not adopt the recommended sleep duration. Compared with normal individuals, male participants with constipation had a higher proportion of shorter sleep duration (41.0 vs. 32.3% in the short sleep group and 6.3 vs. 4.7% in the very short sleep group), and female individuals with constipation had a higher proportion of long sleep duration (12.7 vs. 8.2%). After covariates adjustment, men with short sleep duration (5-6 h/night) correlated with increased odds for constipation (OR:1.54, 95%CI:1.05-2.25), and women with long sleep duration (≥9 h/night) linked to the higher constipation risk (OR:1.58, 95%CI:1.10-2.29). Excessive sleep duration in males or insufficient sleep duration in females was neither linked to increased nor decreased constipation risk.

Conclusions

In this observational study of a nationally representative sample of adults, we demonstrate a differential impact of unhealthy sleep duration on constipation among men and women. Short sleep duration poses a higher risk of constipation in men, and excessive sleep duration correlates with higher constipation risk in women.

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.

Food consumption according to the level of processing and sleep quality during the COVID-19 pandemic

BACKGROUND AND AIMS

Consumption of ultra-processed foods is negatively associated with health outcomes, however, the contribution to sleep quality is limited. Therefore, the objective of this study was to evaluate the association between food intake by frequency and degree of processing and sleep quality in adults during the covid-19 pandemic.

METHODS

Population-based survey of adults from October to December 2020 in the Iron Quadrangle region, Brazil. The exposure variable was a food intake score that considered the frequency of consumption and food processing degree. The total score ranged from 0 (best) to 48 points (worst food quality), categorized into quartiles. Furthermore, we also evaluated whether individuals replaced their lunch and/or dinner based mostly on fresh/minimally processed foods for ultra-processed foods, for five or more days in the week. The outcome variable was sleep quality assessed with the Pittsburgh Sleep Quality Index. We constructed a contrasting directed acyclic graph (DAG) model to estimate the adjusted odds ratio of the association between score eating and sleep, by logistic regression.

RESULTS

Most of the 1762 individuals evaluated had poor sleep quality (52.5%). The minimum and maximum food scores were 0 and 30 points (mean 9.16; 95% CI 8.50, 9.81). The higher values of the score corresponded to lower consumption of fresh and minimally processed foods and higher consumption of ultraprocessed foods. In multivariate analysis, individuals in the third food consumption score had 71% greater odds of poor sleep quality (OR = 1.71; 95% CI: 1.03, 2.85) and in the fourth quartile 144% greater odds (OR = 2.44; 95% CI: 1.32, 2.44). Besides, replacing the dinner meal with ultra-processed foods five days or more in the week was also associated with poor sleep quality (OR = 2.01; 95%CI: 1.14, 3.57).

CONCLUSION

Higher consumption of ultra-processed foods concomitant with lower consumption of fresh and minimally processed foods is associated with a higher chance of poor sleep quality.

The association between modified Nordic diet with sleep quality and circadian rhythm in overweight and obese woman: a cross-sectional study

OBJECTIVE

Previous studies have shown an association between diet quality and sleep quality. The objective of this study was to investigate the association between modified Nordic diet with sleep quality and circadian rhythm in overweight and obese woman.

METHODS

We enrolled 399 overweight and obese women (body mass index (BMI): 25-40 kg/m²), aged 18-48 years, in this cross-sectional study. For each participant, anthropometric measurements, biochemical tests, and food intake were evaluated. Sleep quality and circadian rhythm was measured by Pittsburgh Sleep Quality Index (PSQI) and morning-evening questionnaire (MEQ) questionnaire. Modified Nordic diet score was measured using a validated 147-item food frequency questionnaire (FFQ).

RESULTS

Overall, 51.7% of the subjects were good sleepers (the Pittsburgh Sleep Quality Index (PSQI) < 5) while 48.3% were poor sleepers (PSQI ≥ 5). Moreover, participants were divided into five groups of MEQ, namely, completely morning 8 (2.4%), rarely morning 82 (24.8%), normal 196 (59.2%), rarely evening 43 (13%), and completely evening 2 (0.6%). After controlling for confounders, there was a significant association between poor sleep quality and the modified Nordic diet (OR = 0.80, %95 CI = 0.66-0.98, P = 0.01). Moreover, a significant positive association was observed between the completely morning and modified Nordic diet (OR = 1.80, %95 CI = 0.54-6.00, P = 0.03), in addition to a significant inverse association between the completely evening type and modified Nordic diet (OR = 0.16, %95 CI = 0.002-5.41, P = 0.02).

CONCLUSIONS

The present study indicated that higher adherence to a modified Nordic diet reduces poor sleep quality. Also, the completely morning type was associated with higher adherence to a modified Nordic diet, and completely evening type was associated with lower adherence to a modified Nordic diet.

LEVELS OF EVIDENCE

Level IV, evidence obtained from multiple time series analysis.

Validation of the National Health And Nutritional Survey (NHANES) single-item self-reported sleep duration against wrist-worn accelerometer

PURPOSE AND METHODS

This study aimed to validate the single-item sleep duration question used in the National Health And Nutritional Survey (NHANES), "How much sleep do you usually get at night on weekdays or workdays (hours)?", against a wrist-worn accelerometer (ActiGraph GT3X +) in waves 2011-2012 and 2013-2014 among an adult population aged 20 or above (n = 8,438, mean age 49.7, 48% male).

RESULTS

The accelerometer-measured and self-reported sleep duration were 6.01 (SD 1.48) and 6.88 (SD 1.40) h/day, respectively, representing a 0.87 h/day of over-reporting (SD 1.90, p < 0.001). Such an over-reporting was observed in all subgroups, where the over-reporting ranged from 0.72 (those aged 41-50) to 1.13 h/day (those aged 71 or above). The correlation between accelerometer-measured and self-reported sleep duration was low (ρ = 0.14, p < 0.001).

CONCLUSIONS

The associations between sleep duration and other health outcomes identified using NHANES data should be further tested using more accurate and valid measures of sleep duration.

Sleep duration and quality are associated with nutrient intake in elite female athletes

OBJECTIVES

Sleep is important for athlete health and performance; however, the relationship between diet and sleep in elite female athletes is not well understood. This study examined associations between energy, macronutrient and micronutrient intakes, and sleep in elite female Australian footballers.

DESIGN

Prospective cohort study.

METHODS

Thirty-two players had their diet and sleep monitored for 10 consecutive days during pre-season. Sleep was monitored using activity monitors and sleep diaries. Sleep outcomes included sleep duration, sleep onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE). Dietary intake was monitored using the smartphone applications Easy Diet Diary and FoodWorks. Relationships between nutrient intake and sleep were assessed using Generalised Estimating Equations.

RESULTS

For each 1-g·kg^-1 increase in carbohydrate intake, WASO increased by 3.6 min (p = 0.007) and SE decreased by 0.6% (p = 0.007). For each 1-g increase in daily saturated fat intake, SOL decreased by 0.27 min (p = 0.030). For each 1-mg increase in iron intake, sleep duration increased by 0.55 min (p < 0.001). For each 1-mg increase in zinc intake, SE increased by 0.23% (p = 0.006). For each 1-μg increase in vitamin B12 intake, WASO decreased by 1.72 min (p < 0.02) and SE increased by 0.40% (p = 0.033).

CONCLUSIONS

Nutrient intake in elite female athletes is associated with sleep and may contribute to sleep problems. Research should explore causal relationships between nutrient intake and sleep, and the efficacy of dietary interventions for improving sleep in female athletes with nutrient deficiencies.

Nutraceuticals as Potential Targets for the Development of a Functional Beverage for Improving Sleep Quality

Functional beverages can be a valuable component of the human diet with the ability to not only provide essential hydration but to deliver important bioactive compounds that can contribute to chronic disease treatment and prevention. One area of the functional beverage market that has seen an increase in demand in recent years are beverages that promote relaxation and sleep. Sleep is an essential biological process, with optimal sleep being defined as one of adequate duration, quality and timing. It is regulated by a number of neurotransmitters which are, in turn, regulated by dietary intake of essential bioactive compounds. This narrative review aimed to evaluate the latest evidence of the sleep promoting properties of a selection of bioactive compounds (such as L-theanine and L-tryptophan) for the development of a functional beverage to improve sleep quality; and the effectiveness of traditional sleep promoting beverages (such as milk and chamomile). Overall, the bioactive compounds identified in this review, play essential roles in the synthesis and regulation of important neurotransmitters involved in the sleep-wake cycle. There is also significant potential for their inclusion in a number of functional beverages as the main ingredient on their own or in combination. Future studies should consider dosage; interactions with the beverage matrix, medications and other nutraceuticals; bioavailability during storage and following ingestion; as well as the sensory profile of the developed beverages, among others, when determining their effectiveness in a functional beverage to improve sleep quality.

Sleep Quality Is Associated with Vitamin B12 Status in Female Arab Students

Studies have explored how vitamin B12 status affects sleep among elders and children, but this remains to be investigated among young adults. We used the Pittsburgh Sleep Quality Index (PSQI) to assess the association between serum vitamin B12 and sleep among female college students in Saudi Arabia. In this cross-sectional study, we enrolled 355 participants (age (years), 20.7 ± 1.5; body mass index, 23.6 kg/m² ± 5.2) at King Saud University, Riyadh, Saudi Arabia. Fasting blood samples were analyzed regarding the serum vitamin B12 and blood lipids. Anthropometric, socio-demographic, clinical history, stress, physical activity, and dietary data were collected. We assessed the sleep statuses of the participants using the PSQI. Around 72% of the participants were “poor” sleepers (PSQI > 5). Subgroup analysis within the tertiles showed that participants with higher vitamin B12 in the second and third tertiles reported better scores for sleep quality (B ± SE = −12.7 ± 5.6, p = 0.03; B ± SE = −32.7 ± 16.4, p = 0.05, respectively) and also reported a lower use of sleep medication (B ± SE = −21.2 ± 9.9, p = 0.03, in the second tertile only), after adjusting for the waist–hip ratio and stress. However, sleep was not found to be directly associated with either serum vitamin B12 or dietary vitamin B12. In conclusion, the serum vitamin B12 results show that the participants with higher vitamin B12 in the second and third tertiles reported better scores on the sleep quality scale and a lower use of sleep medication. However, no such associations were observed with the overall PSQI. More studies with larger sample sizes are needed to establish a direct relationship between sleep and vitamin B12.

Effects of macronutrient intake on sleep duration and quality: A systematic review

AIM

The aim of this systematic review was to characterise and synthesise the literature that explores the effects of macronutrient manipulation on sleep outcomes in order to provide dietary recommendations for sleep improvement.

METHODS

Intervention studies that evaluated the effects of macronutrient manipulations on sleep were identified using four databases. A study was included if it: (a) delivered a macronutrient-based dietary intervention, regardless of length; (b) included healthy human participants aged 18 and older; and (c) measured some aspect of sleep, for example, duration or quality, in some manner.

RESULTS

A total of 17 papers and 19 studies met the inclusion criteria. Included studies were organised into acute studies lasting less than 24 hours (n = 4), longer-term (≥24 hours) studies (n = 10), and energy restriction studies (n = 5). The greatest amount of support was observed for longer-term administration of higher carbohydrate diets. These interventions positively influenced rapid eye movement sleep; however, non-rapid eye movement sleep was negatively affected. The overall health outcomes of these changes are difficult to assess. Limited evidence suggests higher protein diets under conditions of energy restriction can improve sleep quality, but these effects might be restricted to individuals with overweight or obesity. Current evidence does not support the effects of acute macronutrient manipulation, defined as less than 24 hours, on sleep outcomes.

CONCLUSIONS

Manipulating carbohydrate intake for at least 24 hours appears to alter sleep outcomes among healthy individuals. Interventions were highly varied and methodological shortcomings were identified. More work is required to fully understand how macronutrient intake affects sleep outcomes.

Poor sleep quality among young adults: The role of anxiety, depression, musculoskeletal pain, and low dietary calcium intake

PURPOSE

This study examined the relationships between sleep quality, anxiety, depression, musculoskeletal pain (MSP), and calcium intake.

DESIGN AND METHODS

In this cross-sectional study (N = 1422), sleep was assessed using the Pittsburgh Sleep Quality Index, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and calcium intake and MSP were assessed by self-reporting.

FINDINGS

Poor sleep quality was reported by 62.66% of the participants. The participants with poor sleep quality reported lower calcium intake, higher anxiety and depression levels, more severe MSP, and multisite pain. Anxiety, depression, low calcium intake, and multisite pain were significant predictors of poor sleep quality. Anxiety was predicted by poor sleep quality, depression, multisite pain, and sex (ie, female). Depression was predicted by anxiety, poor sleep quality, and low calcium intake.

PRACTICAL IMPLICATIONS

The findings underscore the role of low calcium intake in the development of sleep problems, anxiety, depression, and MSP. Individuals with these conditions should be advised to increase their calcium intake.

The Role of Vitamin C in Two Distinct Physiological States: Physical Activity and Sleep

This paper is a literature overview of the complex relationship between vitamin C and two opposing physiological states, physical activity and sleep. The evidence suggests a clinically important bidirectional association between these two phenomena mediated by different physiological mechanisms. With this in mind, and knowing that both states share a connection with oxidative stress, we discuss the existing body of evidence to answer the question of whether vitamin C supplementation can be beneficial in the context of sleep health and key aspects of physical activity, such as performance, metabolic changes, and antioxidant function. We analyze the effect of ascorbic acid on the main sleep components, sleep duration and quality, focusing on the most common disorders: insomnia, obstructive sleep apnea, and restless legs syndrome. Deeper understanding of those interactions has implications for both public health and clinical practice.

Magnesium Status and Stress: The Vicious Circle Concept Revisited

Magnesium deficiency and stress are both common conditions among the general population, which, over time, can increase the risk of health consequences. Numerous studies, both in pre-clinical and clinical settings, have investigated the interaction of magnesium with key mediators of the physiological stress response, and demonstrated that magnesium plays an inhibitory key role in the regulation and neurotransmission of the normal stress response. Furthermore, low magnesium status has been reported in several studies assessing nutritional aspects in subjects suffering from psychological stress or associated symptoms. This overlap in the results suggests that stress could increase magnesium loss, causing a deficiency; and in turn, magnesium deficiency could enhance the body’s susceptibility to stress, resulting in a magnesium and stress vicious circle. This review revisits the magnesium and stress vicious circle concept, first introduced in the early 1990s, in light of recent available data.

Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES 2009-2010

OBJECTIVES

To determine the prevalence of sleep disorders in the United States and the association between sleep disorders and all-cause mortality.

METHODS

A cross-sectional analysis of the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index (NDI) was performed. The 2009 to 2010 NHANES national household survey for adults ≥ 18 years was examined for the prevalence of sleep disorders as well as standard demographics and the presence of comorbidities (coronary artery disease [CAD], stroke, and emphysema). This dataset was linked to the 2015 NDI to associate the presence of sleep disorders with 5-year all-cause mortality.

RESULTS

The study sample had a mean age of 46.1 years old, was 48.3% male, and had an average body mass index (BMI) of 28.7 (28.4-28.9). 7.1% (6.5%-7.7%) of adults reported being diagnosed with a sleep disorder, which represents an estimated 15.9 million (13.2-18.6) patients. The estimated mortality rate for those having a sleep disorder was 9.3% (7.2%-11.9%) compared to 5.2% (4.5%-5.9%) without a sleep disorder (odds ratio 1.89, P = <.001). After adjusting for age, sex, BMI, CAD, stroke, and emphysema, having a sleep disorder remained a significant predictor of increased mortality (hazard ratio, 1.5 [1.02-2.18], P = .042).

CONCLUSION

This study reports a high prevalence of self-reported but physician-diagnosed sleep disorders; however, this likely represents an underestimate. Given the association with all-cause mortality, there is a need for increased recognition of undiagnosed sleep disorders within the United States.

LEVEL OF EVIDENCE

2b Laryngoscope, 131:686-689, 2021.

Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES

A well-functioning immune system is essential for human health and well-being. Micronutrients such as vitamins A, C, D, E, and zinc have several functions throughout the immune system, yet inadequate nutrient intakes are pervasive in the US population. A large body of research shows that nutrient inadequacies can impair immune function and weaken the immune response. Here, we present a new analysis of micronutrient usual intake estimates based on nationally representative data in 26,282 adults (>19 years) from the 2005-2016 National Health and Nutrition Examination Surveys (NHANES). Overall, the prevalence of inadequacy (% of population below estimated average requirement [EAR]) in four out of five key immune nutrients is substantial. Specifically, 45% of the U.S. population had a prevalence of inadequacy for vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc. Dietary supplements can help address nutrient inadequacy for these immune-support nutrients, demonstrated by a lower prevalence of individuals below the EAR. Given the long-term presence and widening of nutrient gaps in the U.S.-specifically in critical nutrients that support immune health-public health measures should adopt guidelines to ensure an adequate intake of these micronutrients. Future research is needed to better understand the interactions and complexities of multiple nutrient shortfalls on immune health and assess and identify optimal levels of intake in at-risk populations.

Dietary Approaches to Stop Hypertension (DASH) Score and Its Association with Sleep Quality in a National Survey of Middle-Aged and Older Men and Women

Complex processes appear to link sleep duration and quality with dietary patterns. Numerous studies show healthful benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, but few have examined its association with sleep duration or quality. The current study tested cross-sectional associations of DASH diet quality score with sleep quality among adults. Analyses of participants were from the 2005–2008 wave of the National Health and Nutrition Examination Surveys (n = 3941 adults ≥30 years of age, complete data). We performed sex- and age group-stratified multiple OLS regression analyses with DASH total score and components as main predictors and sleep quality as main outcomes, adjusting sequentially for socio-demographic, behavioral and health-related factors. Sex and age differences in associations of DASH with sleep quality, adjusting for covariates, were also examined by incorporating two-way interaction terms between sex/age and the DASH score in each unstratified model. We found that the DASH diet score was inversely related to poor sleep-related daytime dysfunction adjusted by age, sex, demographic and socio-economic factors. Some sex-specific associations were detected between DASH diet component scores and sleep quality. Notably, the potassium DASH component was inversely associated with Factor 1 (“sleepiness and sleep disturbance”) among women. The fiber DASH component was associated with better sleep quality and inversely related to Factor 2 (“sleep-related daytime dysfunction”) in younger subjects. This study indicates health benefits of the DASH diet for sleep duration and quality. Future longitudinal studies and randomized placebo-controlled trials are required to ascertain protective effects.