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

The Association Between Ultra-Processed Food Consumption and Chronic Insomnia in the NutriNet-Santé Study

BACKGROUND

The consumption of ultra-processed foods (UPF) is on the rise worldwide, and it has been linked to numerous health conditions, such as diabetes, obesity, and cancer. Few studies have focused on the effect of UPF consumption on sleep health and even fewer on chronic insomnia.

OBJECTIVE

This study investigated the association between UPF intake and chronic insomnia in a large population-based sample.

DESIGN

This was a cross-sectional analysis using the NutriNet-Santé study data, an ongoing Web cohort in France.

PARTICIPANTS/SETTING

Thirty-eight thousand five hundred seventy adult males and females who had completed a sleep questionnaire (2014) and at least two 24-hour dietary records were included in the analysis.

MAIN OUTCOMES MEASURES

Chronic insomnia was defined according to established criteria. Categorization of food and beverages as UPF was based on the NOVA-Group 4 classification.

STATISTICAL ANALYSES PERFORMED

The cross-sectional association between UPF intake and chronic insomnia was assessed using multivariable logistic regression.

RESULTS

Among the 38,570 participants (mean age, 50.0 ±14.8 years, 77.0% female) included in the analysis, 19.4% had symptoms of chronic insomnia. On average, UPF represented 16% of the total amount (g/day) of the overall dietary intake. In the fully adjusted model, UPF consumption was associated with higher odds of chronic insomnia (odds ratio [OR] for an absolute 10% greater UPF intake in the diet = 1.06; 95% confidence interval [CI]: 1.02-1.09). Sex-specific OR for chronic insomnia for an absolute 10% greater UPF intake in the diet were 1.09 (1.01-1.18) among males and 1.05 (1.01-1.09) among females.

CONCLUSIONS

This large epidemiological study revealed a statistically significant association between UPF intake and chronic insomnia, independent of sociodemographic, lifestyle, diet quality, and mental health status covariates. The findings provide insights for future longitudinal research as well as nutrition- and sleep-focused intervention and prevention programs.

From Garden to Pillow: Understanding the Relationship between Plant-Based Nutrition and Quality of Sleep

The effect of diet on sleep quality has been addressed in many studies; however, whether/how plant-based diets (PBDs) impact sleep-related parameters has not been explored in detail. This review aims to give an overview of the components of PBDs and the possible mechanisms through which PBDs may improve sleep quality. Studies have indicated that diets such as PBDs, which are typically high in fruits, vegetables, nuts, seeds, whole grains, and fiber, are associated with better sleep outcomes, including less fragmented sleep and improved sleep duration. Several mechanisms may explain how PBDs impact and/or improve sleep outcomes. Firstly, PBDs are characteristically rich in certain nutrients, such as magnesium and vitamin B6, which have been associated with improved sleep patterns. Secondly, PBDs are often lower in saturated fats and higher in fiber, which may contribute to better overall health, including sleep quality. Additionally, plant bioactive compounds like phytochemicals and antioxidants in fruits, vegetables, and herbs may have sleep-promoting effects. According to available data, PBD and Mediterranean diet elements promise to enhance sleep quality; however, it is crucial to note that diets should be customized based on each person's needs.

Bridging the Gap: The Need to Implement Dietary Guidance to Address Cardiovascular Health

Cardiovascular disease (CVD) is the leading cause of death in the U.S. and globally. Research demonstrates that diet is a leading contributor to the development of CVD, its prevention and management, and the overall promotion of cardiovascular health. This article describes the current state of the evidence, including research on the DASH and Mediterranean diets to promote cardiovascular health and prevent CVD. The article suggests approaches to implement evidence-based diets and federal dietary guidance to promote the adoption and integration of these interventions in both community and clinical settings. It highlights the current U.S. federal interest in "Food is Medicine" and its importance in addressing diet-related chronic diseases and promoting cardiovascular health.

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.

Dietary fiber: Still alive

Dietary fiber (DF) was established as a key dietary constituent some decades ago, as were some of its mechanisms of action and health effects. Although there is consolidated evidence on many features regarding DF, at the same time there are still many aspects to be explored in the field, e.g., deeper explorations of the contribution of phenolic compounds linked to cell walls to the biological activities of DF, or of the relevance of the gut-brain axis. At the same time, increasing DF intake should be seen as a major public health problem since worldwide intakes are quite far from recommendations. The awareness of this fact by public bodies should lead, among others, to the assessment of effective strategies for promoting DF intake among general population or specific groups; and to consider potential regulatory modifications in order to clarify several aspects potentially misleading for consumers.

Effect of Peanut Butter Intake on Sleep Health in Firefighters: A Randomized Controlled Trial

Sleep is often impaired in firefighters due to the psychologically and physiologically intense nature of their work and working shift schedules. Peanut butter is affordable and a substantial source of monounsaturated fatty acids, which may aid sleep health. Thus, this study sought to determine if a daily serving of peanut butter consumed before bedtime for seven weeks altered sleep quality and quantity among full-time firefighters. Forty firefighters (peanut butter group = 20; control group = 20) participated in this eight-week randomized controlled trial. All participants completed a subjective questionnaire on mood, focus, and alertness twice daily and wore an Actigraph wristwatch to measure sleep variables, including latency, efficiency, time in bed, time asleep, wake after sleep onset, number of awakenings, and time spent awake. After a baseline week, the peanut butter group consumed two tablespoons of peanut butter two hours prior to bedtime for seven weeks. Compared to the control group, the peanut butter group did not demonstrate significant changes (p > 0.05) in sleep measures or subjective feelings of mood, focus, or alertness after consuming peanut butter for seven weeks. Therefore, peanut butter as a source of peanuts did not alter sleep quality or quantity in this group of firefighters.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

The impact of plant-rich diets on sleep: a mini-review

Plant-rich diets (PRDs), also referred to as plant based diets, have been shown to have beneficial effects on various chronic diseases and all-cause mortality. However, limited data are available on the effect of such diets on sleep and sleep disorders. In this review article, we explore existing evidence and potential mechanisms by which PRDs may impact sleep and sleepiness. High-fat diets are associated with drowsiness, while fiber-rich diets improve sleep quality. Anti-inflammatory diets may benefit patients with sleep disturbances, and diets rich in tryptophan and serotonin precursors may improve sleep quality. Isoflavones and polyphenols present in PRDs may also have a positive impact on sleep. Furthermore, diets rich in plants may reduce the risk of obstructive sleep apnea and associated daytime sleepiness. Overall, the current knowledge about PRDs in sleep and sleep disorders is limited, and further research is needed to explore the potential advantages of this dietary approach in sleep disorders.

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.

A Systematic Review of the Bidirectional Association Between Consumption of Ultra-processed Food and Sleep Parameters Among Adults

PURPOSE OF REVIEW

We summarized research on the bidirectional association between intake of ultra-processed food (UPF) and sleep.

RECENT FINDINGS

Sleep contributes to cardiometabolic health in part via food intake patterns. Restricting sleep increases intakes of high-carbohydrate/high-fat foods, a profile representative of UPF. This systematic review covers the association of UPF intake, as an exposure or an outcome, and sleep. UPF was defined as NOVA Group 4. MEDLINE and EMBASE were searched through April 2023 for epidemiological studies with general-population adult samples. Fifteen studies met the inclusion criteria; all were cross-sectional, published between 2016 and 2023, with samples from Brazil (n = 8), Spain (n = 2), Italy (n = 1), the UK (n = 1), Paraguay (n = 1), Iran (n = 1) and China (n = 1). Thirteen studies examined UPF intake as the exposure whereas two tested UPF intake as the outcome. UPF intakes were determined using food frequency questionnaires (73%) or 24-h recalls (27%). Two studies assessed sleep via accelerometry; the remaining studies relied on self-reports of sleep quality, duration, anxiety-induced insomnia, and napping, with 60% using a single question. The average methodological quality across the studies was deemed "fair". Six of the 13 studies that examined UPF consumption as the exposure revealed inverse associations with sleep outcomes in adjusted (n = 5) or bivariate (n = 1) analyses. Both studies addressing UPF consumption as the outcome and sleep as the exposure showed significant inverse associations. Evidence for UPF-sleep associations is accumulating, although sleep assessment limitations are apparent. This review can provide impetus for research using comprehensive and validated sleep measures and nudge policymakers towards refining dietary guidelines worldwide.

Association between dietary pattern and insomnia symptoms among independent older adults: A cross-sectional study based on JAGES

BACKGROUND

Poor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults.

METHODS

This cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders.

RESULTS

Among 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05).

CONCLUSION

Our results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

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.

Gut microbiota: Candidates for a novel strategy for ameliorating sleep disorders

The aim of this review was to evaluate the feasibility of treating sleep disorders using novel gut microbiota intervention strategies. Multiple factors can cause sleep disorders, including an imbalance in the gut microbiota. Studies of the microbiome-gut-brain axis have revealed bidirectional communication between the central nervous system and gut microbes, providing a more comprehensive understanding of mood and behavioral regulatory patterns. Changes in the gut microbiota and its metabolites can stimulate the endocrine, nervous, and immune systems, which regulate the release of neurotransmitters and alter the activity of the central nervous system, ultimately leading to sleep disorders. Here, we review the main factors affecting sleep, discuss possible pathways and molecular mechanisms of the interaction between sleep and the gut microbiota, and compare common gut microbiota intervention strategies aimed at improving sleep physiology.

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.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19

Background

Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors.

Methods

This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters.

Results

In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters.

Conclusion

Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

Mediterranean diet and structural neuroimaging biomarkers of Alzheimer's and cerebrovascular disease: A systematic review

Previous studies have demonstrated an association between adherence to the Mediterranean diet (MedDiet) and better cognitive performance, lower incidence of dementia and lower Alzheimer's disease biomarker burden. The aim of this systematic review was to evaluate the evidence base for MedDiet associations with hippocampal volume and white matter hyperintensity volume (WMHV). We searched systematically for studies reporting on MedDiet and hippocampal volume or WMHV in MedLine, EMBASE, CINAHL and PsycInfo. Searches were initially carried out on 21st July 2021 with final searches run on 23rd November 2022. Risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of an initial 112 papers identified, seven papers were eligible for inclusion in the review reporting on 21,933 participants. Four studies reported on hippocampal volume, with inconclusive or no associations seen with MedDiet adherence. Two studies found a significant association between higher MedDiet adherence and lower WMHV, while two other studies found no significant associations. Overall these results highlight a gap in our knowledge about the associations between the MedDiet and AD and cerebrovascular related structural neuroimaging findings.

Associations between the Dietary Inflammatory Index and Sleep Metrics in the Energy Balance Study (EBS)

(1) Background: Sleep, a physiological necessity, has strong inflammatory underpinnings. Diet is a strong moderator of systemic inflammation. This study explored the associations between the Dietary Inflammatory Index (DII®) and sleep duration, timing, and quality from the Energy Balance Study (EBS). (2) Methods: The EBS (n = 427) prospectively explored energy intake, expenditure, and body composition. Sleep was measured using BodyMedia’s SenseWear® armband. DII scores were calculated from three unannounced dietary recalls (baseline, 1-, 2-, and 3-years). The DII was analyzed continuously and categorically (very anti-, moderately anti-, neutral, and pro-inflammatory). Linear mixed-effects models estimated the DII score impact on sleep parameters. (3) Results: Compared with the very anti-inflammatory category, the pro-inflammatory category was more likely to be female (58% vs. 39%, p = 0.02) and African American (27% vs. 3%, p < 0.01). For every one-unit increase in the change in DII score (i.e., diets became more pro-inflammatory), wake-after-sleep-onset (WASO) increased (βChange = 1.00, p = 0.01), sleep efficiency decreased (βChange = −0.16, p < 0.05), and bedtime (βChange = 1.86, p = 0.04) and waketime became later (βChange = 1.90, p < 0.05). Associations between bedtime and the DII were stronger among African Americans (βChange = 6.05, p < 0.01) than European Americans (βChange = 0.52, p = 0.64). (4) Conclusions: Future studies should address worsening sleep quality from inflammatory diets, leading to negative health outcomes, and explore potential demographic differences.

Nutritional Elements in Sleep

Sleep comprises one-third of our day and plays an integral role in human health and well-being. Many factors influence sleep, with nutrition being a key element that impacts various sleep parameters. Meal-timing through strategies like chrono-nutrition leads to positive sleep outcomes. In addition, consuming a high-protein diet with essential amino acids, low-glycemic-index foods, and certain fruits rich in antioxidants can all contribute to better sleep quality. Other facets of nutrition that can affect sleep outcomes include weight loss and limiting certain nutritional elements such as caffeine, nicotine, and alcohol. In this article, we will shed some light on how some of these factors can play a vital role in sleep quality.

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.

The Relationship Between Dietary Intake and Sleep Quality in Endurance Athletes

Many endurance athletes have poor sleep quality which may affect performance and health. It is unclear how dietary intake affects sleep quality among athletes. We examined if sleep quality in endurance athletes is associated with consumption of fruit, vegetables, whole grains, dairy milk, and caffeinated beverages. Two hundred thirty-four endurance athletes (39.5 ± 14.1 year) participated in a survey. Participants provided information on demographics, anthropometry, sleep behavior and quality, and dietary intake via questionnaires. Sleep quality was assessed using the Athlete Sleep Screening Questionnaire (ASSQ) with a global score (ASSQ-global) and subscales including sleep difficulty (ASSQ-SD), chronotype (ASSQ-C), and disordered breathing while sleeping (ASSQ-SDB). A general linear model (GLM), adjusted for age, body mass index, sleep discomfort, sleep behavior, gender, race, and ethnicity, showed that higher caffeinated beverage intake was related to poorer global sleep quality (p = 0.01) and increased risk for disordered breathing while sleeping (p = 0.03). Higher whole grain intake was associated with a morning chronotype and lower risk for sleep issues (p = 0.01). The GLM did not reveal a relationship between sleep quality and dairy milk, fruit, and vegetable intake. In conclusion, caffeinated beverages and whole grain intake may influence sleep quality. This relationship needs to be confirmed by further research.

Adherence to the Mediterranean Diet and Its Association With Sleep Quality and Chronotype Among Youth: A Cross-Sectional Study

Background

Evidence indicates that many university students have poor adherence to a healthy diet accompanied by unhealthy lifestyle behaviors. Chrono-nutrition is an emerging field of research that examines the pattern of optimum daily activity in relation to the human's dietary patterns, and their reflections of variable health indicators such as sleep quality. However, there is a scarcity of research that examines the relationship between adherence to the healthy eating pattern, like the Mediterranean diet (MD), with sleep quality and chronotype among university students.

Methods

A cross-sectional study was conducted, and convenience sampling was used. Participants were assessed for adherence to the MD using the Mediterranean Diet Quality Index (KIDMED), for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and for chronotype using the Morningness-Eveningness questionnaire (MEQ).

Results

The study included 503 university students, most of them (81.5%) were females. Only 15.1 and 16.9% reported morningness chronotype and good sleep quality, respectively. About half of the students showed medium and high adherence to the KIMED. In-depth analysis revealed that students with good adherence to the MD were more likely to have a good sleep quality (OR = 0.35; 95%CI: 0.21–0.59; P < 0.001) even after adjustment for age and sex (OR = 0.36; 95%CI: 0.21–0.62; P < 0.001). The regression analysis also showed that those with good adherence to the MD had a significant association with better subjective sleep quality, less sleep latency, sleep disturbance, and daytime dysfunction even after adjustment for age and sex. Those with morningness chronotype had about a six-fold higher chance to have good adherence to the MD (OR = 5.67; 95%CI: 2.86–11.26; P < 0.001, respectively).

Conclusions

Good adherence to the healthy diet presented in the MD among university students is associated with morningness chronotype and with improved overall sleep quality and sleep components. Long-term, controlled intervention research works are warranted for more elaboration on the impact of chronotype and dietary habits on sleep quality and other important aspects such as mental health and academic achievement.

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.

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.

Dietary Factors and Sleep Quality Among Hemodialysis Patients in Malaysia

OBJECTIVES

Poor sleep quality is a commonly seen problem in hemodialysis patients. This study investigated the associations between dietary factors and sleep quality among hemodialysis patients.

DESIGN AND METHODS

This is a cross-sectional study conducted among 184 eligible hemodialysis patients at four dialysis units in Malaysia. Three days dietary recall were used in the analysis of dietary intake and behavior. Sleep quality was assessed through Pittsburgh Sleep Quality Index.

RESULTS

More than half of the patients were poor sleepers. Among the sleep components, sleep latency affected patients the most, with the use of sleep medications was relatively low. A majority of the patients had inadequate dietary intake of energy (88%) and protein (75%). Dietary protein, potassium adjusted for body weight, and sodium intake were significantly increased in poor sleepers. Lower percentage of energy from carbohydrates; higher percentage of energy from fats; higher intakes of dietary protein, fat, phosphorus, and sodium were correlated with poorer sleep quality and its components. Skipping dinner on non-dialysis days and having supper on dialysis days were associated with poor sleep quality.

CONCLUSION

Poor sleep is prevalent among hemodialysis patients. Sleep quality of hemodialysis patients was highly associated with certain dietary factors. Periodical assessment of sleep quality and dietary intake is necessary to identify poor sleepers with inappropriate dietary intake to allow effective clinical and nutritional interventions to improve the sleep quality and nutritional status of these patients.