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Energy Drinks and Sleep among Adolescents.
Tomanic, M, Paunovic, K, Lackovic, M, Djurdjevic, K, Nestorovic, M, Jakovljevic, A, Markovic, M
Nutrients. 2022;14(18)
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Sleep deprivation is a common problem among adolescents. There has been an increase in the consumption of energy drinks among adolescents in recent years. It is well known that energy drinks contain caffeine, sugar, and amino acids such as taurine, B vitamins, Ginseng, and guarana, which have psychoactive properties and disrupt the circadian rhythm. Insufficient sleep can affect genes involved in circadian rhythm and serotonin pathways, resulting in a higher risk of developing mental health problems. Therefore, researchers accessed the data from a population-based cross-sectional study to evaluate the effect of an energy drink on sufficient sleep in male and female adolescents. This study found that high energy drink consumption negatively affected sufficient sleep in male and female adolescents, with boys consuming energy drinks more frequently. The intake of vegetables and water, as well as regular physical activity, were positively correlated with adequate sleep in male adolescents. Physical activity and sufficient sleep were positively correlated in girls. Girls who used sedatives were less likely to get sufficient sleep. In order to determine how the different ingredients of energy drinks affect the sleep quality and neurodevelopment of adolescents individually and synergistically, further robust studies are required. The results of this study may help healthcare professionals to understand the adverse effects of energy drinks on adolescents.
Abstract
Many adolescents worldwide have the problem of meeting recommended nightly sleep hours. The causes of sleep disturbance are multifactorial, but interest in food's effect on sleep has dramatically increased lately. In this study, we investigated the association between regular energy drink (ED) intake (weekly or more frequent) and sufficient sleep (SS) (≥8 h) in adolescents. Additional objectives were to examine the relationship between health-related behaviors and SS, stratified by gender. A population-based cross-sectional study was conducted during the 2019/2020 school year from 12 schools in Belgrade. There were 1287 students aged 15 to 19 who participated (37.4% male). We used a modified version of the food frequency questionnaire adapted for Serbian adolescents. Logistic regression revealed that regular ED consumption was an independent risk factor negatively related to SS in both sexes. Additionally, daily vegetable and water intake (≥2 L) showed a positive correlation with SS in boys, while in girls, the odds of realizing SS decreased with statements of sedative use. In conclusion, we show that ED intake is negatively associated with SS in both sexes; daily vegetable and water intake (≥2 L) may raise the odds of SS in boys, while sedative use may decrease the chances of SS in girls.
2.
The effect of Melatonin on Improving the benign Prostatic Hyperplasia Urinary Symptoms, a Randomized Clinical Trial.
Fotovat, A, Samadzadeh, B, Ayati, M, Nowroozi, MR, Momeni, SA, Yavari, S, Nasseri, A, Sharifi, L
Urology journal. 2022;19(5):406-411
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Benign prostatic hyperplasia (BPH) is a common issue in men older than 40. BPH is accompanied by irritating and obstructive symptoms that sometimes lead to surgery due to lack of recovery. Tamsulosin is an alpha-receptor blocker that is considered a standard treatment for patients. The aim of this study was to investigate the effect of melatonin [a hormone secreted by the pineal gland at night that regulates the sleep-wake cycle] along with standard treatment on improving the BPH urinary symptoms as well as patients’ quality of life due to their urinary problems. This study is a single centre, parallel group randomised, double-blind clinical trial with balanced randomisation. Patients (n = 108) were randomly allocated to one of the two groups. Results show the combination of melatonin and tamsulosin was significantly effective in treating the symptoms of frequency and nocturia in patients with BPH. Authors conclude that their findings can be used to pave the way to improving the symptoms of patients with BPH.
Abstract
PURPOSE to investigate the effect of melatonin along with tamsulosin in improving BPH urinary symptoms. MATERIALS AND METHODS A total of 108 men with BPH symptoms, age of ≥ 50 years, and International Prostate Symptom Score (IPSS) ≥ 8 entered into the parallel group randomized, double-blind clinical trial with balanced randomization. The treatment group received of 3mg melatonin plus 0.4mg tamsulosin and the control group received placebo plus 0.4mg tamsulosin. Patients and physicians were concealed by sealed and opaque envelopes. Symptoms were assessed at baseline and 1 month after treatment. Finally all scores at the initial and end of the study were compared and analyzed using SPSS software. RESULTS This study showed that adding melatonin to the classic treatment of BPH patients with tamsulosin could significantly reduce the likelihood of nocturia by 2.39 times (95% CI: 1.07-5.32, OR = 2.39, p = 0.033) and could also reduce the frequency of urination by 2.59 times (95% CI: 1.15-5.84, OR = 2.59, p = 0.021). There was no statistically significant difference between the two groups in IPSS, intermittency, incomplete emptying, straining, urgency, and weak stream. CONCLUSION Melatonin plus tamsulosin treatment is associated with a significant improvement of nocturia and frequency in patients with benign proststic hyperplasia. However, it is necessary to do more studies.
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The Window Matters: A Systematic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion.
Chawla, S, Beretoulis, S, Deere, A, Radenkovic, D
Nutrients. 2021;13(8)
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Time-Restricted Eating (TRE) is an eating pattern based on the circadian rhythm that gives the body a daily fasting period. This involves limiting daily food intake to 8–12 hours with an intention to prolong the time spent in a fasting state. In fact, chrono-nutrition is an emerging field of nutritional science that aims to understand how timing of food-intake may impact our health by affecting our circadian rhythm. The aim of this study was to examine the effects of two patterns of TRE, traditional TRE (a predetermined window of eating and fasting) and Ramadan fasting, on two markers of circadian rhythm, cortisol and melatonin. This study was a systematic review and meta-analysis of fourteen studies (13 reported results on cortisol, and four on melatonin). Results showed that: - Ramadan practice of TRE resulted in a reduced waking response of cortisol, and in most cases a statistically significant increase relative to non-Ramadan in the evening. - the Ramadan studies also found significant reductions in levels of nocturnal melatonin during Ramadan compared to baseline. - in the non-Ramadan TRE studies, skipping dinner led to a decreased evening cortisol level, and, potentially, an elevated morning level (however not in all cases waking time was accounted for). - skipping breakfast led to a relative increase in midday cortisol. Authors conclude that their findings indicated a potential blunting of the circadian cortisol rhythm during Ramadan and a reduction in melatonin which could lead to poor sleep duration and quality.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Other human and animal studies have highlighted the benefits of restricting the feeding window for longevity and metabolic health.
- Whether one chooses early or late TRE may help to determine the optimal time of alertness and sleep.
- Early TRE, which involves skipping dinner, may allow for greater alertness in the morning as the lower levels of cortisol at night can improve sleep quality and higher morning cortisol raises alertness, optimising wakefulness and productivity.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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X
B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction:
This systematic review aimed to examine the effects of two patterns of Time Restricted Feeding (TRE): (1) traditional TRE, and (2) Ramadan fasting, on two markers of circadian rhythm: (1) cortisol and (2) melatonin.
Methods
- A search was performed on PubMed, and Web of Science (all databases) up to December 2020 using search terms relating to “time-restricted eating”, “intermittent fasting”, “cortisol”, “melatonin”, and “orexin”.
- 14 randomised controlled trials and observational studies that met the criteria were included.
- Quality assessment of all studies was performed
Results
14 studies met the inclusion criteria. 10 of the studies used TRE in the context of Ramadan (total n=242) whilst 4 followed non-Ramadan TRE protocols (total n=124). Of the 14 studies identified in the literature review, 13 reported results on cortisol, and 4 on melatonin.
- All 4 melatonin studies found a statistically significant reduction of melatonin (p < 0.05) during Ramadan.
- 2 of 3 studies assessing 24-h serum cortisol changes during Ramadan noted an “abolishing” of the circadian rhythm of cortisol (p < 0.05), meaning there was a flattening of cortisol levels during the fasting month compared with the non-fasting month.
- All 13 cortisol studies recorded a cortisol shift in response to time restricted eating, albeit over different time frames and different cortisol recording methods.
- 1 randomised 4-day crossover study (n=11) found skipping dinner resulted in significantly reduced evening cortisol (p=0.03) and non-significantly raised morning cortisol. Skipping breakfast resulted in significantly reduced morning cortisol (p=0.10) .
- 1 observational study of females aged 18-45 (n-65) found that skipping breakfast demonstrated decreased morning (waking) cortisol, elevated midday cortisol, and no significant evening cortisol differences compared to the control group.
Conclusion
The potential blunting of the circadian cortisol rhythm during Ramadan may impact the HPA axis and is associated with poor cardio-metabolic outcomes. A reduction in melatonin could lead to poor sleep duration and quality.
Clinical practice applications:
- The mechanisms behind these findings are not well understood, but are likely to include: the complex endocrine interplay with insulin response and glucocorticoid secretion.
- Caution must be taken in terms of generalisability due to the small sample size of the included studies
Early or late TRE can determine the optimal time of alertness and sleep:
- Early TRE (eating 8am-2pm / skipping dinner), may allow for greater alertness in the morning as the lower levels of cortisol at night can improve sleep quality and higher morning cortisol raises alertness, optimising wakefulness and productivity.
- Late TRE (skipping breakfast) may provide greater alertness mid-day, due to an intensified cortisol response mid-day.
Considerations for future research:
In order to better understand the effects of meal timing on health outcomes, further larger studies should be conducted. They should:
- Examine TRE during the inactive and active phases of the circadian rhythm under controlled conditions.
- Exclude studies relating to pregnancy, pathology, and athletic status.
- Ensure sufficient control for confounding factors that can affect serum parameters, including sleep duration and timing, total energy expenditure, and light exposure
Abstract
Time-Restricted Eating is an eating pattern based on the circadian rhythm which limits daily food intake (usually to ≤12 h/day), unique in that no overt restriction is imposed on the quality, nor quantity, of food intake. This paper aimed to examine the effects of two patterns of TRE, traditional TRE, and Ramadan fasting, on two markers of circadian rhythm, cortisol and melatonin. PubMed and Web of Science were searched up to December 2020 for studies examining the effects of time restricted eating on cortisol and melatonin. Fourteen studies met our inclusion criteria. All Ramadan papers found statistically significant decrease in melatonin (p < 0.05) during Ramadan. Two out of the three Ramadan papers noted an abolishing of the circadian rhythm of cortisol (p < 0.05). The non-Ramadan TRE papers did not examine melatonin, and cortisol changes were mixed. In studies comparing TRE to control diets, Stratton et al. found increased cortisol levels in the non-TRE fasting group (p = 0.0018) and McAllister et al. noted no difference. Dinner-skipping resulted in significantly reduced evening cortisol and non-significantly raised morning cortisol. Conversely, breakfast skipping resulted in significantly reduced morning cortisol. This blunting indicates a dysfunctional HPA axis, and may be associated with poor cardio-metabolic outcomes. There is a paucity of research examining the effects of TRE on cortisol and melatonin. The contrasting effect of dinner and breakfast-skipping should be further examined to ascertain whether timing the feeding window indeed has an impact on circadian rhythmicity.
4.
Endocrine and metabolic aspects of the COVID-19 pandemic.
Marazuela, M, Giustina, A, Puig-Domingo, M
Reviews in endocrine & metabolic disorders. 2020;21(4):495-507
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Endocrine and metabolic related diseases such as diabetes and obesity may increase the risk of developing severe Covid-19 and as a result these diseases could be severely affected by Covid-19 infection. This very large review paper looked at over 100 studies and outlined the interrelationship between Covid-19 infection and several endocrine diseases. Diabetes, obesity, pituitary-hypothalamic function, thyroid function, Cushing's syndrome and adrenal function were all reviewed. No aim was stated. Data on individuals with obesity and diabetes indicated an increased risk for severe Covid-19 infection, hospitalisation and mortality. Data surrounding pituitary-hypothalamic function, thyroid function, Cushing's syndrome and adrenal function was less abundant, however neurological issues in Covid-19 patients suggested an involvement of the pituitary and hypothalamus. In lieu of sufficient data the author commented on the possible similarities between severe acute respiratory syndrome coronavirus with the Covid-19 virus. A number of management strategies were discussed such as the use of vitamin D, oxytocin and melatonin, however the authors commented on the lack of data regarding oxytocin and melatonin in Covid-19 patients, but mechanistic data suggested they might be of use. No overall conclusions were drawn on the findings. Clinicians could use this paper to understand how patients with pre-existing endocrine and metabolic conditions may be at a higher risk of more severe Covid-19 and if contracted could exacerbate their pre-existing condition. These patients could require constant monitoring and additional measures to avoid contracting Covid-19. Supplements such as vitamin D, oxytocin or melatonin could be therapeutic, however more data needs to be reviewed.
Abstract
COVID-19 infection has tremendously impacted our daily clinical practice as well as our social living organization. Virtually all organs and biological systems suffer from this new coronavirus infection, either because the virus targets directly specific tissues or because of indirect effects. Endocrine diseases are not an exception and some of endocrine organs are at risk of direct or indirect lesion by COVID-19. Although there is still no evidence of higher predisposition to contract the infection in patients with diabetes and/or obesity, the coexistence of these conditions contributes to a worse prognosis because both conditions confer an impaired immunologic system. Cytokines storm can be amplified by these two latter conditions thereby leading to multisystemic failure and death. Glycaemic control has been demonstrated to be crucial to avoiding long hospital stays, ICU requirement and also prevention of excessive mortality. Endocrine treatment modifications as a consequence of COVID-19 infection are required in a proactive manner, in order to avoid decompensation and eventual hospital admission. This is the case of diabetes and adrenal insufficiency in which prompt increase of insulin dosage and substitutive adrenal steroids through adoption of the sick day's rules should be warranted, as well as easy contact with the health care provider through telematic different modalities. New possible endocrinological targets of COVID-19 have been recently described and warrant a full study in the next future.
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Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work.
Noorwali, E, Hardie, L, Cade, J
Nutrients. 2019;11(6)
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Both sleep disruption and a low intake of fruit and vegetables (FV) are associated with higher rates of premature death and chronic disease. This review looked at previous studies in order to determine whether there is a link between sleep and FV consumption. A recent meta-analysis found that shorter sleep duration is consistently associated with low fruit and vegetable intake in children, but in adults the association is less clear. Studies looking at the effect of sleep on FV intake had variable results. Tart cherries and kiwi fruits were the most commonly studied fruits for their effect on sleep measures. Observational studies tended to find that both short- and long-sleepers tend to eat less FV than those that sleep for 7-8 hours. A lot of evidence shows that people who go to sleep later (‘owls’) tend to consume unhealthier diets with lower intakes of FV than people who go to bed earlier (‘larks’). The researchers also looked at potential mechanisms for the association between sleep and FV intake. Polyphenols in FV may influence sleep by increasing neurotransmitters via the gut-brain axis, improving energy metabolism and through alterations in circadian rhythms and the CLOCK genes. Ways in which disrupted sleep may affect FV consumption included changes in hunger hormones, emotional stress and impaired decision making. With further research, interactions between sleep measures and FV consumption may be clarified and potentially reduce the burden of chronic diseases and premature deaths.
Abstract
A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7-9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.