The Longitudinal Interplay between Sleep, Anthropometric Indices, Eating Behaviors, and Nutritional Aspects: A Systematic Review and Meta-Analysis

Assessing the longitudinal association between sleep, diet quality and BMI z-score among Black adolescent girls

BACKGROUND

Cross-sectional research has suggested associations between diet, sleep and obesity, with sparse longitudinal research.

OBJECTIVES

To identify longitudinal mechanistic associations between sleep, diet and obesity.

METHODS

We used longitudinal data from a sample of Black adolescent girls. At T1 (enrolment), 6 months (T2) and 18 months (T3), we estimated sleep duration and quality (7-day accelerometry), diet quality (Healthy Eating Index [HEI-2020]) and body mass z-scores (zBMI) from measured height and weight. Longitudinal mediation using structural equation models examined the mechanistic roles of sleep, diet quality and zBMI.

RESULTS

At enrolment, girls (n = 441) were mean age 12.2 years (±0.71), 48.3% had overweight/obesity, and mean HEI 55.8 (±7.49). The association between sleep and diet quality did not vary over time. Sleep duration at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant. Sleep quality at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant.

CONCLUSIONS

Diet was not a mediator between sleep and obesity. Study strengths are the longitudinal design and direct measures of sleep and zBMI among a homogeneous sample.

The Association of Sodium or Potassium Intake Timing with Athens Insomnia Scale Scores: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Insomnia is a significant public health problem affecting a large population. Although previous research has explored the relationship between specific nutrients and insomnia, comprehensive analyses of daily eating patterns of macro- and micronutrients remain limited. Since nocturnal hypertension is related to sodium/potassium intake and sleep disturbances, the present cross-sectional study hypothesized that daily eating patterns of potassium and sodium would be associated with Athens Insomnia Scale (AIS) scores.

METHODS

Dietary data (breakfast, lunch, dinner, and snack intake) and additional online questionnaire responses were obtained from users (N = 4568; age: 43.5 ± 11.2 years) of Asken, a Japanese food-logging mobile health application. AIS scores were divided into three groups according to symptom classification.

RESULTS

Multiple regression analyses revealed that individuals with higher AIS scores had higher daily potassium intake; potassium at dinner was especially crucial.

CONCLUSIONS

These results underscore the potential importance of potassium intake in relation to sleep and highlight a novel association between sleep disturbances and the timing of sodium and potassium consumption.

Examining the factor structure of the Pittsburgh Sleep Quality Index and its determinants among GI cancer patients

BACKGROUND

Poor sleep quality is one of the prevalent manifestations experienced by cancer patients. There is a lack of research focusing specifically on sleep quality and affecting factors in Gastrointestinal (GI) cancer patients. This study aimed to assess the potential interaction between dietary, comorbid conditions, demographic, and socioeconomic determinants of sleep quality in GI cancer patients.

METHODS

In a cross-sectional study, the Pittsburg Sleep Quality Index (PSQI) was completed for 875 adult patients suffering from GI cancer in a referral hospital. We conducted structural equation modeling analyses to evaluate the potential interaction between dietary and socioeconomic determinants of sleep quality in GI cancer patients.

RESULTS

This study demonstrated that the PSQI encompasses two factors (perceived sleep quality and sleep disturbances) in GI cancer patients in Iran. Based on the standardized coefficients for the structural paths, the wealth index (WI) partially mediated the effect of food insecurity (FI) on the sleep quality index. There was a direct predictive effect of the WI on the PSQI (β = 0.10, P = 0.01). In addition, WI indirectly through FI (effect of WI on FI: β = -0.21, P = 0.01 & effect of FI on PSQI: β = 0.07, P = 0.03) had a negative effect on PSQI. Our finding suggested the full mediation effect of age on PSQI through the number of comorbidities (effect of age on number of comorbidities: β = 0.25, P < 0.001 & the effect of number of comorbidities on PSQI: β = 0.13, P < 0.001). Structural path outputs for gender-model indicated the full mediation effect of age on PSQI through the number of comorbidities among males and through the FI among females.

CONCLUSION

These findings highlight the importance of considering the bi-dimensional construct of the PSQI for assessing sleep quality among GI cancer patients. The current study demonstrated that food insecurity and comorbidity prevalence mediated the relationship between socio-demographic determinants of sleep quality in patients with GI cancer.

Impact of associated factors and adherence to Mediterranean diet on insomnia among Arab men living in Jordan

The detrimental health and economic burdens associated with insomnia have led to investigations examining its prevalence and potential predictors to utilize this information in insomnia prevention/treatment. Ethnicity, gender, and lifestyle habits are among the important predictors associated with insomnia. The aim of this study was to examine the prevalence of insomnia and potential predictors of insomnia among Arab men living in Jordan, including Mediterranean diet (MD) adherence. The inclusion criteria of this cross-sectional, correlational study were: (1) being a male; (2) aged 18 and older; and (3) able to read, write, and speak the Arabic language. Online questionnaires were used to assess participants' sociodemographic information, adherence to the MD, physical activity, and insomnia. Results demonstrated that there was a high prevalence of insomnia (53.9%) among the study's participants (N = 529). Moreover, in the unadjusted model, the study revealed that being unemployed (OR = 1.90, p = 0.018), categorized as dehydrated (OR = 1.20, p = 0.020), overweight (OR = 1.30, p = 0.035), sleeping less than 6 hours/day (OR = 2.10, p < 0.001), and having high adherence to the MD (OR = 1.60, p = 0.010) were predictors of insomnia. Meanwhile, the adjusted multivariate logistic regression model indicated that being married (OR = 1.20, p = 0.020) played a significant protective role against developing insomnia among Arab men. While high adherence to MD (OR = 1.642, p = 0.028) and sleeping less than 6 hours/day (OR = 2.760, p < 0.001) were relative risk factors for experiencing insomnia. The high prevalence of insomnia in this population and the identification of possible predictors associated with insomnia, and the unexpected relationship between adherence to the MD and insomnia warrant further in-depth investigations that may help promote the understanding of the factors associated with insomnia and facilitate the development of interventions to target it.

Weight-neutral approach and later sleep midpoint in adolescents with "emerging polycystic ovary syndrome phenotype" as vehicles for sustainable weight loss

Objective

Incorporate sleep into a novel lifestyle intervention strategy in adolescents with Emerging symptoms of polycystic ovary syndrome (E-PCOS).

Design

A single-center cohort study.

Setting

University hospital-based clinic for adolescents with PCOS.

Patients

Forty-three girls at an age between 10 and 18 years presenting with E-PCOS between March 2015 and September 2017 with clinical signs of androgen excess and/or accelerated weight gain, acanthosis nigricans, irregular periods, or delayed menarche and followed every 6 months for a minimum of 4 visits, to October 2020.

Interventions

All patients received nutritional counseling, with a goal of "zero weight gain," daily moderate physical activity goals of 45 minutes per day, and education regarding age-appropriate sleep duration. Three treatment strategies for E-PCOS symptoms were applied depending on the chief clinical complaint: anti-insulin approach with metformin; antiandrogen approach with oral contraceptive and spironolactone; and surveillance.

Main Outcome Measures

Body mass index (BMI) Z-score over time. Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver.

Results

Average number of return visits was 4 with 58% having >4 return visits. Testosterone levels were correlated with ALT (r = 0.68). Weeknight sleep duration was less than age-appropriate recommendations for 63% of participants. Sleep midpoint correlated with ALT levels (r = 0.48). Despite the weight-neutral approach, regression models all demonstrated significant weight loss regardless of menarche status, metformin use, number of visits, and high vs. low ALT groups. Those with the latest sleep midpoint at baseline benefited the most, with BMI Z-score dropping significantly (interaction of time and baseline sleep midpoint from the first visit on school night).

Conclusion

A novel approach for adolescent girls with E-PCOS that focuses on metabolic endpoints and includes sleep duration and timing as specific targets, led to significant weight loss irrespective of treatment group.

Poor sleep quality, dementia status and their association with all-cause mortality among older US adults

BACKGROUND

Evidence points to associations between sleep quality, dementia, and mortality. We examined whether poor sleep quality mediated or moderated the association between dementia and mortality risk among older US adults and vice versa, and whether these associations differed by sex and by race.

METHODS

The study investigated bi-directional associations between sleep quality, dementia and mortality in older US adults using data from the Health and Retirement Study (N = 6,991, mean age = 78.1y, follow-up: 2006-2020, number of deaths = 4,938). It tested interactions and mediating effects, using Cox proportional hazards models and four-way decomposition models.

RESULTS

Poor sleep quality was associated with increased mortality risk, particularly among male and White older adults. However, the association was reversed in the fully adjusted model, with a 7% decrease in risk per tertile. Probable dementia was associated with a two-fold increase in mortality risk, with a stronger association found among White adults. The association was markedly attenuated in the fully adjusted models. Sleep quality-stratified models showed a stronger positive association between dementia and mortality among individuals with better sleep quality. Both mediation and interaction were involved in explaining the total effects under study, though statistically significant total effects were mainly composed of controlled direct effects.

CONCLUSIONS

Poor sleep quality is directly related to mortality risk before lifestyle and health-related factors are adjusted. Dementia is linked to mortality risk, especially in individuals with better sleep quality, males, and White older adults. Future research should explore the underlying mechanisms.

The association between the dietary behavior, diet quality, and lifestyle scores with anthropometric indices and happiness levels among university students

BACKGROUND

Limited information exists linking food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. Our aim was to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels in the Iranian population.

METHODS

This cross-sectional study included 200 students randomly selected from a university in Iran. Dietary intakes, physical activity (PA), and happiness levels of study participants were assessed using validated questionnaires. The anthropometric indices examined in this study included the body shape index (ABSI), body roundness index (BRI), and abdominal volume index (AVI). Multiple logistic regression models were used to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels.

RESULTS

The mean age and body mass index (BMI) of study participants were 23.5 years ± 4.52 and 23.8 kg/m2 ± 3.17, respectively. In the study population, no significant association was seen between ABSI, BRI, AVI and happiness with food habits, diet quality, and lifestyle scores respectively. After adjusting for potential confounders (age, energy intake, marital status, education, smoking, physical activity, gender, and BMI), the association remained not significant for ABSI and food habits, diet quality, and lifestyle scores respectively (OR: 0.56, 95% CI (0.25-1.34), P = 0.193; OR: 0.59, 95% CI (0.22-1.57), P = 0.413; OR:1.19, 95%CI (0.54-2.63), P = 0.652), BRI and food habits, diet quality, and lifestyle scores respectively (OR:1.98, 95% CI (0.41-9.49), P = 0.381; OR: 0.57, 95%CI (0.12-2.74), P = 0.512; OR: 1.19, 95% CI (0.3-4.71), P = 0.811), AVI and food habits, diet quality, and lifestyle scores (OR:1.15, 95% CI (0.53-2.48), P = 0.743, OR:1.01, 95% CI (0.47-2.18), P = 0.965; OR: 1.3, 95% CI (0.64-2.65), P = 0.465) and happiness and food habits, diet quality, and lifestyle scores respectively (OR:0.3, 95%CI (0.07-1.25), P = 0.972; OR: 0.77, 95%CI (0.18-3.19), P = 0.724, OR: 0.3, 95% CI (0.07-1.25), P = 0.083).

CONCLUSIONS

No significant association was detected between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. However, longitudinal studies are required to confirm these findings.

Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents

Importance

Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity.

Objective

To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later.

Design, Setting, and Participants

American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022.

Exposures

Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment).

Main Outcomes and Measures

Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures.

Results

The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (β = -1.21 [95% CI, -2.19 to -0.24]), anxiety (β = -0.89 [95% CI, -1.76 to -0.03]), DBP (β = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (β = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (β = 0.06 [95% CI, 0.01-0.11]) at follow-up.

Conclusions and Relevance

This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.

Peer effects in weight-related behaviours of young people: A systematic literature review

Individual preferences and beliefs are perpetually shaped by environmental influences, with peers playing a key role in this dynamic process. Compelling evidence from qualitative and quantitative studies has highlighted the significant impact of peer influence on health-related decisions. This systematic literature review critically synthesises findings from 45 studies published between 2011 and 2022, providing a comprehensive understanding of the nature of peer effects on dietary, physical activity and sleep behaviours during youth. The majority of studies indicated that social norms drive directional changes in eating and physical activity. Yet, our analysis revealed a notable gap in exploring alternative mechanisms, including social comparison and social identity, despite their potential relevance. Studies, generally classified as moderate to high quality, predominantly relied on self-reported data, potentially affecting the validity and reliability of measures. Meta-regression analyses suggest a small, but significant association of sample size with the magnitude, sign and significance of the reported peer effects. Moreover, studies focusing on physical activity are more likely to report significant outcomes, whereas findings on peer influence on sleep-related studies tend to reveal less pronounced effects, compared to studies on dietary behaviours. Experimental designs do not appear to increase the likelihood of finding significant effects when compared to other study designs. In conclusion, this synthesis emphasises the need for further research into the underlying mechanisms on peer effects to better inform policy-makers in designing effective policies for improving weight-related behaviours in young people.

Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations

Purpose

Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder.

Patients and Methods

From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia.

Results

The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients.

Conclusion

In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.