Associations of Dietary ω-3, ω-6 Fatty Acids Consumption with Sleep Disorders and Sleep Duration among Adults

A low n-6/n-3 PUFA ratio and high level of dietary ɑ-linolenic acid improves sleep behavior in mice with insomnia

Camelina sativa oil (CSO) and Semen Ziziphi Spinosae oil (SZSO) are functional oils that have beneficial effects on brain health. This study evaluated the sedative and hypnotic effects of vegetable oils with various n - 6/n - 3 polyunsaturated fatty acids (PUFA) ratios and ɑ-linolenic acid (ALA) contents to mice. The n - 6/n - 3 PUFA ratios of CSO (CSO:SZSO = 1:0, 1.8 g/kg), SZSO (CSO:SZSO = 0:1, 1.8 g/kg), CSO-SZSO-L (CSO:SZSO = 1:1, 1.8 g/kg), and CSO-SZSO-H (CSO:SZSO = 1:1, 3.6 g/kg) were 0.51, 140, 1.69, and 1.69, respectively. The doses of ALA administered to mice with p-chlorophenylalanine-induced insomnia were approximately 0.64, 50 × 10-4, 0.32, and 0.64 g/kg, respectively. The mice were administered CSO, SZSO, and a low-dose combination of CSO and SZSO for seven days with no obvious hypnotic effects. However, the administration of a high-dose combination of CSO and SZSO significantly prolonged sleep duration in mice with induced insomnia and inhibited the serum levels of corticotropin-releasing hormone, adrenocorticotropic hormone, and cortisol. Interestingly, there were no significant effects on the structure and function of the hippocampal tissue. The results indicated that the anti-insomnia effects of these vegetable oils were positively correlated with a low n - 6/n - 3 PUFA ratio and the absolute amount of ALA.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-024-06004-1.

Sex- and age-dependent associations of EPA and DHA with very short sleep duration in adults: a cross-sectional analysis

OBJECTIVES

This study aimed to compare the efficacy of dietary intake of eicosapentaenoic acid (EPA; 20:5 ω-3) and docosahexaenoic acid (DHA; 22:6 ω-3) on very short sleep duration (<5 h/night) in adults.

METHODS

The bootstrap method was used in the multinomial logistic regression to estimate the ORs and corresponding 95% confidence intervals (CIs) of very short sleep duration. We used rolling window method to analyze the effects of EPA and DHA dietary intakes on very short sleep durations in men and women over age. To illustrate the stability of the results for the selected window width, we built a shiny application.

RESULTS

Compared to the first quartile, the mean ORs of EPA intake on very short sleep duration and the corresponding 95% CIs for the second, third and fourth quartiles of EPA intake among men under 32 years old were 1.50 (0.56, 3.44) mg, 1.55 (0.59, 3.48) mg, and 3.99 (1.15, 10.01) mg, respectively. Among women over 44 years old, the ORs for DHA intake were 1.12 (0.81, 1.52) mg, 0.94 (0.68, 1.29) mg, and 0.62 (0.38, 0.98) mg for the second, third and fourth quartiles, respectively.

CONCLUSIONS

The associations of EPA and DHA with very short sleep duration are sex- and age-dependent. In males under the age of 32, a significant positive correlation exists between dietary EPA intake and very short sleep duration. For women above 44 years of age, an increase in DHA intake can notably ameliorate issues of very short sleep duration.

Does tinnitus amplify the effects of healthy eating patterns and physical activity on the sleep disturbance or sleep insufficiency, based on the case study of NHANES survey in the United States

Objective

Exploring whether the presence of tinnitus amplifies the effects of an individual's dietary patterns and physical activity on sleep disturbance or sleep insufficiency.

Study design

This study extracted data from the five National Health and Nutrition Examination Surveys (NHANES) between 2009 and 2018, including individuals who had undergone complete questionnaires on tinnitus, dietary habits, physical activity, and sleep. Multivariate logistic regression, restricted cubic spline (RCS) and subgroup analyses were conducted to explore the associations of dietary habits, physical activity, and tinnitus with sleep disturbance and sleep insufficiency.

Results

A total of 7,440 participants were enrolled in this study, of whom 1,795 participants were evaluated as sleep disturbance (24.13%), and 2,281 were sleep insufficiency (30.66%). With adjusting confounding factors of demographic and socioeconomic variables, among overall population, participants with tinnitus showed a significantly increased risk of sleep disturbance [adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.83-2.36), and sleep insufficiency (aOR = 1.31, 95% CI: 1.15-1.49). Poor dietary habits also increased the risk of sleep disturbance (aOR = 1.08, 95% CI: 1.04-1.12), as does lack of physical activity (aOR = 1.14, 95% CI: 1.03-1.27); but neither exposure factors significantly increased the risk of sleep insufficiency. The non-linear trend analyses of RCS found that the influence of exposure factors on sleep disturbance experiencing a steady or small decline trend after rising. In addition, the results of the subgroup analysis showed that in tinnitus patients, poor dietary habits and lack of physical activity both significantly increased the risk of sleep disturbance, and poor dietary habits also increased the risk of sleep insufficiency remarkable, but lack of physical activity did not. In healthy participants, poor dietary habits were only significantly associated the sleep disturbance, while lack of physical inactivity even had a protective effect against sleep insufficiency.

Conclusion

Compared to the general population, tinnitus significantly amplified the effects of poor dietary patterns and physical inactivity on sleep disturbance and sleep insufficiency. For tinnitus patients, adjusting a healthy diet and increasing exercise could more effectively promote their sleep health.

Association between diet, mental health and sleep quality in university students during the COVID-19 pandemic: a systematic review

OBJECTIVES

To evaluate recently published scientific evidence and synthesize the results of observational studies that examine the association between diet, mental health, and sleep quality in university students during the COVID-19 pandemic.

CONTENT

An electronic search of scientific literature published in 2021 and up to 2 years ago was performed using keyword search, with focus on observational studies published in PubMed, MEDLINE and Web of Science. It included: active university students of both sexes during the COVID-19 pandemic.

SUMMARY AND OUTLOOK

The 5 studies included in this review showed that there have been significant changes in both mental health and eating habits during the COVID-19 pandemic. The conclusion, there is an association between mental health and sleep quality in university students, resulting in an alteration of sleep hours and poor sleep. Furthermore, an association between mental health and diet quality is also observed, producing an increase in caloric intake or in the number of meals during the day.

Dietary fatty acids improve perceived sleep quality, stress, and health in migraine: a secondary analysis of a randomized controlled trial

Background

Migraine is a prevalent disabling condition often associated with comorbid physical and psychological symptoms that contribute to impaired quality of life and disability. Studies suggest that increasing dietary omega-3 fatty acid is associated with headache reduction, but less is known about the effects on quality of life in migraine.

Methods

After a 4-week run-in, 182 adults with 5-20 migraine days per month were randomized to one of the 3 arms for sixteen weeks. Dietary arms included: H3L6 (a high omega-3, low omega-6 diet), H3 (a high omega-3, an average omega-6 diet), or a control diet (average intakes of omega-3 and omega-6 fatty acids). Prespecified secondary endpoints included daily diary measures (stress perception, sleep quality, and perceived health), Patient-Reported Outcome Measurement Information System Version 1.0 ([PROMIS©) measures and the Migraine Disability Assessment (MIDAS). Analyses used linear mixed effects models to control for repeated measures.

Results

The H3L6 diet was associated with significant improvements in stress perception [adjusted mean difference (aMD): -1.5 (95% confidence interval: -1.7 to -1.2)], sleep quality [aMD: 0.2 (95% CI:0.1-0.2)], and perceived health [aMD: 0.2 (0.2-0.3)] compared to the control. Similarly, the H3 diet was associated with significant improvements in stress perception [aMD: -0.8 (-1.1 to -0.5)], sleep quality [aMD: 0.2 (0.1, 0.3)], and perceived health [aMD: 0.3 (0.2, 0.3)] compared to the control. MIDAS scores improved substantially in the intervention groups compared with the control (H3L6 aMD: -11.8 [-25.1, 1.5] and H3 aMD: -10.7 [-24.0, 2.7]). Among the PROMIS-29 assessments, the biggest impact was on pain interference [H3L6 MD: -1.8 (-4.4, 0.7) and H3 aMD: -3.2 (-5.9, -0.5)] and pain intensity [H3L6 MD: -0.6 (-1.3, 0.1) and H3 aMD: -0.6 (-1.4, 0.1)].

Discussion

The diary measures, with their increased power, supported our hypothesis that symptoms associated with migraine attacks could be responsive to specific dietary fatty acid manipulations. Changes in the PROMIS© measures reflected improvements in non-headache pain as well as physical and psychological function, largely in the expected directions. These findings suggest that increasing omega-3 with or without decreasing omega-6 in the diet may represent a reasonable adjunctive approach to reducing symptoms associated with migraine attacks. Trial Registration: ClinicalTrials.gov NCT02012790.

Higher intakes of nutrients and regular drinking are associated with habitual sleep duration in pre- and postmenopausal women with comorbidities

OBJECTIVES

We aimed to assess the association between nutrient intake, health-related behaviors, and habitual sleep duration in pre- and postmenopausal women.

DESIGN

A cross-sectional study.

PARTICIPANTS

2084 pre- and postmenopausal women aged 18-80 years old.

MEASUREMENTS

Nutrient intake and sleep duration were measured by a 24-hour recall approach and self-reports, respectively. We examined the association and interaction between comorbidities, nutrient intake, and sleep duration groups among 2084 women using data from KNHASES (2016-2018) and multinomial logistic regression.

RESULTS

In premenopausal women, we observed negative associations between very short (<5 hours)/short (5-6 hours)/long (≥9 hours) sleep duration and 12 nutrients (vitamin B1, B3, vitamin C, PUFA, n-6 fatty acid, iron, potassium, phosphorus, calcium, fiber, carbohydrate) and a positive association between retinol and short sleep duration (prevalence ratio (PR), 1.08; 95% CI, 1.01-1.15). In premenopausal women, interactions were found between comorbidities and PUFA (PR, 3.83; 95% CI, 1.56-9.41), n-3 fatty acid (PR, 2.43; 95% CI, 1.17-5.05), n-6 fatty acid (PR, 3.45; 95% CI, 1.46-8.13), fat (PR, 2.77; 95% CI, 1.15-6.64), and retinol (PR, 1.28; 95% CI, 1.06-1.53) for very short and short sleep duration, respectively. Interactions between comorbidities, vitamin C (PR, 0.41; 95% CI, 0.24-0.72), and carbohydrates (PR, 1.67; 95% CI, 1.05-2.70) for very short and short sleep duration in postmenopausal women, respectively. Regular drinking was positively associated with a risk of short sleep duration in postmenopausal women (PR, 2.74, 95% CI: 1.11-6.74).

CONCLUSIONS

Dietary intake and alcohol use were found to be involved in sleep duration, so healthcare staff should encourage women to maintain a healthy diet and reduce alcohol use to improve sleep duration.

Recent evidence and progress for developing precision nursing in symptomatology: A scoping review

AIM

To summarize the omics results of symptomatic research that can help nurses identify intervention targets and design precision interventions for pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life, so as to provide a comprehensive summary of help and inspire to precision nursing.

METHODS

CINAHL, PubMed, Web of Science, and ScienceDirect databases were searched. Retrieval time was from January 2012 to December 2021. Symptomatology research applying omics that can be used to guide nurses in designing targeted interventions was included.

RESULTS

Forty-six studies were included in the final review. Symptomatology research that can be integrated with nursing science to develop precision nursing focused on pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life. Most studies were related to cognitive impairment (n = 10; 21.74%), pain (n = 9; 19.57%), and mental health (n = 8; 17.39%). Moreover, the included studies involved various omics technologies, such as whole genome, epigenome, transcriptome, proteome, and metabolome.

CONCLUSION

The rapid development of various omic technologies promotes symptomatology research, which can help nurses fully understand the information of patients. Phenotypic characteristics and biomarkers shown in symptomatology research help nurses identify intervention targets and develop individualization interventions, so as to prevent and reduce symptoms and improve the quality of life.

IMPLICATION FOR NURSING AND HEALTH POLICY

This scoping review is the first synthesis of all peer-reviewed literature to summarize and provide important information and references from the omic results of symptomatology studies to develop precision nursing, highlighting the status and development of precision nursing. Nursing education policies should introduce the development and importance of precision nursing. Further research could consider investing more attention in precision nursing. Nursing researchers can carry out some studies applying omics technology to explore more biomarkers, helping guide the formulation of clinical intervention for symptoms.

The interplay between macronutrients and sleep: focus on circadian and homeostatic processes

Sleep disturbances are an emerging risk factor for metabolic diseases, for which the burden is particularly worrying worldwide. The importance of sleep for metabolic health is being increasingly recognized, and not only the amount of sleep plays an important role, but also its quality. In this review, we studied the evidence in the literature on macronutrients and their influence on sleep, focusing on the mechanisms that may lay behind this interaction. In particular, we focused on the effects of macronutrients on circadian and homeostatic processes of sleep in preclinical models, and reviewed the evidence of clinical studies in humans. Given the importance of sleep for health, and the role of circadian biology in healthy sleep, it is important to understand how macronutrients regulate circadian clocks and sleep homeostasis.

Non-esterified erythrocyte linoleic acid, arachidonic acid, and subjective sleep outcomes

OBJECTIVE

This study investigated whether non-esterified erythrocyte omega-6 PUFAs were associated with subjective assessment of sleep quality and duration, and risk for obstructive sleep apnea.

METHODS

In this secondary analysis of the cross-sectional OPPERA-II study, 538 adults completed the Pittsburgh Sleep Quality Index (PSQI), reported their usual hours of sleep, and answered STOP screening questions for obstructive sleep apnea. Circulating non-esterified erythrocyte concentrations of omega-6 PUFA linoleic acid and arachidonic acid were quantified by liquid chromatography tandem mass spectroscopy. Sleep outcomes were dichotomized as poor (PSQI ≤5) vs good (PSQI ≥6) sleep quality, insufficient or excessive (≤6 or >9 h) vs good (7-9 h) sleep duration, and high (≥2 affirmative responses) vs low (<2 affirmative responses) risk for obstructive sleep apnea. Non-esterified omega-6 PUFAs and the continuous covariates of body mass index, Short Form (SF) 12 Health Survey Physical and Mental Component scores and resting measures of systolic and diastolic blood pressure were standardized for multivariable analysis. Categorical covariates were study site, age, sex, and race/ethnicity. Multivariable-adjusted logistic regression first estimated odds ratios (OR) and 95% confidence limits (CL) for sleep outcomes using linoleic acid as the main exposure. Analysis was then repeated using arachidonic acid as the main exposure.

RESULTS

In the multivariable-adjusted model, each standard deviation increase in non-esterified erythrocyte linoleic acid was associated with higher odds of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), insufficient or excessive sleep (OR= 1.3, 95% CL: 1.1, 1.6) and high-risk for obstructive sleep apnea (OR=1.3, 95% CL: 1.1, 1.6). Likewise, for each standard deviation increase in non-esterified erythrocyte arachidonic acid, odds increased of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), and insufficient or excessive sleep (OR=1.2, 95% CL: 1.1, 1.5). Odds of being high risk for obstructive sleep apnea increased with greater circulating arachidonic acid, but the association did not reach statistical significance (OR=1.1, 95% CL: 0.9, 1.4).

CONCLUSION

Non-esterified erythrocyte linoleic acid and arachidonic acid were associated with poor sleep quality and insufficient or excessive sleep duration. Linoleic acid, but not arachidonic acid, was also associated with high risk for obstructive sleep apnea.

Associations between Serum Folate Concentrations and Functional Disability in Older Adults

Folate may have beneficial effects on physical function through its antioxidant effect. Thus, we investigated the associations between serum folate and functional disability in older adults. Data from the National Health and Nutrition Examination Survey 2011–2018 were used. Serum folate included 5-methyltetrahydrofolate and total folate. Five domains of functional disability, including lower extremity mobility (LEM), instrumental activities of daily living (IADL), activities of daily living (ADL), leisure and social activities (LSA), and general physical activities (GPA), were self-reported. Multivariable-adjusted logistic regression models and restricted cubic splines were employed. 5-Methyltetrahydrofolate was inversely associated with IADL and GPA disability, and the multivariate-adjusted ORs (95% CIs) in the highest versus lowest quartiles were 0.65 (0.46–0.91) and 0.70 (0.50–0.96), respectively. The total folate was also inversely associated with IADL (OR quartile 4vs1 = 0.65, 95% CI: 0.46–0.90) and GPA (OR quartile 3vs1 = 0.66, 95% CI: 0.44–0.99) disability. The dose–response relationships showed a gradual decrease in the risk of IADL and GPA disability as serum folate increased. In the sex, age, BMI, and alcohol consumption subgroup analyses, we saw that the associations were primarily found in females, under 80 years old, normal weight, and non-drinkers. Sensitivity analyses further confirmed the robustness of our results. Our results indicated that serum folate concentrations were negatively associated with IADL and GPA disability, especially in females. In other subgroup analyses, we discovered that these negative associations were primarily prevalent in participants under 80 years old, normal weight, and non-drinkers.

Association between Sleep Duration and Grip Strength in U.S. Older Adults: An NHANES Analysis (2011-2014)

Handgrip strength has been shown an indispensable biomarker for older adults. Furthermore, the association between sleep duration and grip strength in special populations (e.g., type 2 diabetics) has been previously documented. However, the association between sleep duration and grip strength has been less studied in older adults and the dose-response relationship is unclear. Therefore, we drew 1881 participants aged 60 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 to explore their association and the dose-response relationship. Sleep duration was obtained through self-report. Grip strength data were obtained through a grip test using a handgrip dynamometer and divided into two categories: low grip strength and normal grip strength. Thus, dichotomized grip strength was used as a dependent variable. Poisson regression and restricted cubic spline were used for the main part of the analysis. We found that long sleep duration (≥9 h) was associated with a higher prevalence of low grip strength than the normal sleep duration (7-<9 h) group (IRR: 1.38, 95% CI: 1.12-1.69). Moreover, the gender-stratified analysis did not change the original results. This association was particularly pronounced and further strengthened among participants with normal weight (BMI < 25) (IRR: 2.30, 95% CI: 1.64-3.22) and participants aged 60-70 (IRR: 1.76, 95% CI: 1.40-2.22). In addition, with the increase in sleep duration, the multivariate-adjusted IRRs of low grip strength had a general downward trend at first, followed by a brief period of stability, and then presented an upward trend (p-value for non-linearity = 0.001). According to this study, we found that older adults who had long sleep duration had a higher risk of low grip strength. Muscle insulin utilization and muscle glucose metabolism are closely related to grip strength, so our research emphasizes the importance of maintaining normal sleep duration in older adults and suggests that older adults who sleep for a long period should pay more attention to their muscle health.

Associations between organophosphate esters metabolites and sleep disorder and trouble sleeping in adults: a machine-learning approach

Organophosphate esters (OPEs) are used widely as flame retardants and plasticizers. However, the associations between OPEs metabolites and sleep outcomes (sleep disorder and trouble sleeping) remain unknown. Data utilized in this cross-sectional study was from the National Health and Nutrition Examination Survey 2013-2014, including 1393 adults aged ≥ 20 years. We conducted weighted logistic regression and Bayesian kernel machine regression (BKMR) models to analyze the associations between OPEs metabolites and sleep outcomes. We included data from 2011 to 2012 cycle in our sensitivity analysis to explore the association further. Logistic regression model presented a significant positive association between diphenyl phosphate (DPHP) and sleep disorder in all participants (odds ratio (95% confidence interval) for the second quartile was 2.46 (1.85, 3.28)). We observed positive associations between OPEs metabolites and sleep outcomes in males. Among females, no significant association was observed in the logistic model. BKMR presented that dibutyl phosphate (DBUP) was the relatively important exposure. There was a positive association between OPEs metabolites mixture and trouble sleeping. Univariable exposure-response functions demonstrated U-shaped associations between DBUP and sleep outcomes, while bis(2-chloroethyl) phosphate (BCEP) was associated with sleep disorder negatively in females. No substantial changes appeared in the results after including the data from 2011 to 2012 cycle. This current study indicated that OPEs metabolites might be associated with sleep disorder and trouble sleeping, and the associations seemed to be sex-dependent.

Association of Pyridoxal 5′-Phosphate with Sleep-Related Problems in a General Population

The evidence on the relationship of pyridoxal 5′-phosphate (PLP) with sleep-related problems is limited and controversial. Notably, there is a lack of studies on the general population and studies of the dose–response relationship. Therefore, we conducted a cross-sectional study to examine the associations between serum PLP concentration and sleep-related problems (sleep quality and sleep duration) in adults, using the data of the National Health and Nutrition Examination Survey 2005–2010. High-performance liquid chromatography (HPLC) was used to test PLP in blood samples. Sleep quality and sleep duration were based on self-reported data, with sleep quality categorized as sleep disorder, trouble falling asleep, waking up during the night, and daytime sleepiness. The primary analyses utilized logistic regression models and restricted cubic spline. Compared with the first quartile (Q1), the odds ratios (ORs) and 95% confidence intervals (CIs) of daytime sleepiness for the Q2 and Q3 of serum PLP concentrations were 0.76 (0.59–0.99) and 0.78 (0.62–0.98), respectively. The relationship was only significant for males. Furthermore, a non-linear dose–response relationship was observed between serum PLP concentration and the risk of daytime sleepiness. Compared with the normal sleep duration group, serum PLP concentrations were negatively associated with the risks of very short, short, and long sleep duration, with relative risk ratios (RRRs) of 0.58 (0.43–0.81) (Q4), 0.71 (0.61–0.83) (Q4) and 0.62 (0.34–0.94) (Q3), respectively. The average serum PLP concentrations were higher in people with normal sleep duration, suggesting a non-linear dose–response relationship. Our study indicated that serum PLP concentrations were negatively associated with daytime sleepiness, and this association may only exist in males. Moreover, it was also inversely related to abnormal sleep duration (very short, short, long) compared to normal sleep duration.

Associations of α-linolenic acid dietary intake with very short sleep duration in adults

Objectives

This study aimed to investigate the association of α-linolenic acid (ALA; 18:3 ω-3) dietary intake with very short sleep duration (<5 h) in adults based on the CDC's National Health and Nutrition Examination Survey data.

Methods

Multinomial logistic regression was used to explore the association of ALA intake with very short sleep. To make the estimation more robust, bootstrap methods of 1,000 replications were performed. Rolling window method was used to investigate the trend of the odds ratios of very short sleep with age. A Kruskal-Wallis test was applied to estimate the differences in the ORs of very short sleep between genders and different age groups.

Results

Compared with the first tertile, the ORs of very short sleep and the corresponding 95% CIs for the second and the third tertile of dietary ALA intake in males were 0.618 (0.612, 0.624) and 0.544 (0.538, 0.551), respectively, and in females were 0.575 (0.612, 0.624) and 0.432 (0.427, 0.437). In most cases, the differences between different ages were more significant than those between different sexes. Men's very short sleep odds ratios for the second tertile of ALA intake increased linearly with age before 60.

Conclusions

The risk of a very short sleep duration was negatively related to the dietary intake of ALA. The effect of ALA on very short sleep is significantly different among groups of different genders and ages.

Relationships between urinary antimony concentrations and depressive symptoms in adults

BACKGROUND

Antimony is widely used in industrial production. The general population may be exposed to long-term low-dose antimony, and there are no studies on antimony and depression symptoms. This study aims to explore the relationships between urinary antimony concentrations and depressive symptoms in adults.

METHODS

We conducted a cross-sectional study using data from U.S. National Health and Nutrition Examination Survey (NHANES) 2007-2016 for urinary antimony (N = 8538). Depressive symptoms were assessed through Patient's Health Questionnaire (PHQ-9). In order to determine the relationships between urinary antimony concentrations and depressive symptoms, binary logistic regression model and restricted cubic spline were used. Dominance analysis was used to explore the relative importance between variables associated with depressive symptoms.

RESULTS

There was a significant positive relationship between urinary antimony concentrations and depressive symptoms in the general population, and OR with 95% CI was 1.72 (1.15, 2.60). This relationship also occurred in participants without disease status, and OR with 95% CI was 2.05 (1.10, 3.82). After stratified gender, the urinary antimony concentrations were positively correlated with depressive symptoms in the highest tertiles of female participants, and OR with 95% CI was 1.74 (1.06, 2.86). After adjusted urinary lead, arsenic, cadmium, and mercury as covariates, the result was still statistically significant, and OR with 95% CI was 1.83 (1.23, 2.72). Restricted cubic spline showed a nonlinear positive relationship between urinary antimony and depressive symptoms. Based on the result of dominance analysis, the relative importance of urinary antimony concentration accounted for 3.58%.

CONCLUSION

This study indicated that urinary antimony was positively related to depressive symptoms, especially in female.