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Association of meal timing with body composition and cardiometabolic risk factors in young adults.
Dote-Montero, M, Acosta, FM, Sanchez-Delgado, G, Merchan-Ramirez, E, Amaro-Gahete, FJ, Labayen, I, Ruiz, JR
European journal of nutrition. 2023;62(5):2303-2315
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Despite the known consequences of excess body weight, the prevalence of obesity continues to rise. Body weight regulation and obesity are highly influenced by several factors such as genetics, physiology, and socioeconomic factors. The aim of this study was to elucidate the association of meal timing with anthropometry body composition and cardiometabolic risk factors in young adults. This study was a cross-sectional study of 118 young adults (n=82 women). Results showed that meal timing is not related to anthropometry or body composition parameters in young adults. Similarly, caloric midpoint, eating jetlag and the time from last food intake to midsleep point are not associated with cardiometabolic risk factors. However, a longer daily eating window and a shorter time from midsleep point to first food intake (i.e., earlier first food intake in a 24 h cycle) are associated with a healthier cardiometabolic profile in young men. Authors concluded that eating early in alignment with circadian rhythms may improve cardiometabolic health.
Abstract
PURPOSE To investigate the association of meal timing with body composition and cardiometabolic risk factors in young adults. METHODS In this cross-sectional study participated 118 young adults (82 women; 22 ± 2 years old; BMI: 25.1 ± 4.6 kg/m2). Meal timing was determined via three non-consecutive 24-h dietary recalls. Sleep outcomes were objectively assessed using accelerometry. The eating window (time between first and last caloric intake), caloric midpoint (local time at which ≥ 50% of daily calories are consumed), eating jetlag (variability of the eating midpoint between non-working and working days), time from the midsleep point to first food intake, and time from last food intake to midsleep point were calculated. Body composition was determined by DXA. Blood pressure and fasting cardiometabolic risk factors (i.e., triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and insulin resistance) were measured. RESULTS Meal timing was not associated with body composition (p > 0.05). The eating window was negatively related to HOMA-IR and cardiometabolic risk score in men (R2 = 0.348, β = - 0.605; R2 = 0.234, β = - 0.508; all p ≤ 0.003). The time from midsleep point to first food intake was positively related to HOMA-IR and cardiometabolic risk score in men (R2 = 0.212, β = 0.485; R2 = 0.228, β = 0.502; all p = 0.003). These associations remained after adjusting for confounders and multiplicity (all p ≤ 0.011). CONCLUSIONS Meal timing seems unrelated to body composition in young adults. However, a longer daily eating window and a shorter time from midsleep point to first food intake (i.e., earlier first food intake in a 24 h cycle) are associated with better cardiometabolic health in young men. CLINICAL TRIAL REGISTRATION NCT02365129 ( https://www. CLINICALTRIALS gov/ct2/show/NCT02365129?term=ACTIBATE&draw=2&rank=1 ).
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Enhancing Night and Day Circadian Contrast through Sleep Education in Prediabetes and Type 2 Diabetes Mellitus: A Randomized Controlled Trial.
García-Serrano, C, Pujol Salud, J, Aran-Solé, L, Sol, J, Ortiz-Congost, S, Artigues-Barberà, E, Ortega-Bravo, M
Biology. 2022;11(6)
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Diabetes mellitus is a chronic condition that occurs when blood glucose levels increase because the body cannot produce enough insulin or cannot effectively use the insulin it produces. Type 2 diabetes mellitus (T2DM) is the most common type of diabetes. It is a chronic metabolic disease that can be controlled when its pathophysiological factors are neutralised. The aim of this study was to analyse the effect of a sleep hygiene intervention in the management of impaired fasting glucose (IFG) and T2DM. This is an experimental study based on a parallel clinical trial using blocked randomization with equal allocation ratio. A total of 69 participants were included in the analysis (31 and 38 from the control and intervention groups, respectively). Results show a significant improvement in all the measured sleep parameters (sleep quality, time and efficiency). Furthermore, it also demonstrates that sleep health educational intervention, delivered during the regular check-ups of patients with T2DM or IFG, has a positive metabolic effect and is feasible as a complementary therapy in primary care settings. Authors conclude that sleep education improves T2DM metabolic management.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Sleep has a restorative function that benefits glucose metabolism.
- Sleep education should emphasise that maintaining a regular and sufficient sleep schedule and establishing a series of routines and habits in the hours prior to going to sleep would prevent early awakenings.
- Education is an important part of clinical practice.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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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
The aim of this study was to analyse the effect of a sleep hygiene intervention in the management of impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM).
Methods
This experimental parallel open-label clinical trial included 69 adults with IFG or T2DM.
The intervention was individual informative education which aimed to develop skills to improve sleep, which consisted of:
1. Information: Reading of the educational sheet (9 tips for a healthy sleep) with subsequent discussion.
2. Verification: checking participants understood the advice.
3. Participant information: One telephone call after 1 month was made as educational reinforcement of the intervention.
The controlled group received no educational intervention. The main outcome variable measured was levels of HbA1c (%) 3 and 6 months post intervention. Secondary outcomes were fasting glucose (mg/dL) 3 and 6 months post intervention, Pittsburgh Sleep Quality Index (PSQI), declared sleep hours and sleeping efficiency 3 months post intervention.
Results
- . 84.2% participants from the intervention group and 14.0% in the control group reported a change in sleep habits.
- 3 months after the intervention, the control group did not report any change, while the intervention group reported a statistically significant improvement in all three: PSQI (−2.97 ± 2.93), hours of sleep (1.00 [0.00; 2.00] hours) and sleep efficiency (6.74 ± 12.9%).
- The intervention group achieved a significant reduction in 3 months post intervention fasting glucose levels (−14.69; CI 95%: −28.15, −1.22) and HbA1c levels (−0.39; 95% CI: −0.73, −0.05), as well as a reduction in 6 months post intervention HbA1c levels (−0.66; 95% CI: −0.96, −0.36).
Conclusion
- The results show a significant improvement in all the measured sleep parameters (sleep quality, time and efficiency).
- The PSQI score improvement in the intervention group was 3.6 points higher than the control group.
- The median sleep time in the intervention group was increased by 1.5 h, doubling the number of participants who reported sleeping more than 6 h.
Clinical practice applications:
- An educational intervention in sleep hygiene and circadian contrast may help to increase sleep quality, time and efficiency.
- The educational intervention helped lower HbA1c levels in patients with IFG and T2DM.
- Sleep education helps to improve T2DM metabolic management.
- The 9 tips for a healthy sleep, were developed from the latest guidelines from the American Academy of Sleep Medicine, the National Health Service, and the Health Department of Catalonia.
Considerations for future research:
- The open-labelled intervention and the use of subjective variables related to sleep quality could lead to biassed self-reports in the intervention group so further studies are required.
- Future studies should gather baseline parameters closer to the start of the intervention rather than wait 3 months to assess the immediate outcomes of the intervention.
- Future research could take the same approach with diet and exercise education.
Abstract
BACKGROUND Evidence supports a causal relationship between circadian disturbance and impaired glucose homeostasis. METHODS To determine the effect of an educational intervention delivered by primary care nurses to improve sleep hygiene, a parallel, open-label clinical trial in subjects aged 18 and older with impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM) was performed. Study variables were sex, age, fasting glucose, glycated haemoglobin A1c (HbA1c), Pittsburgh Sleep Quality Index (PSQI), sleep duration and efficiency, body mass index, antidiabetic treatment, diet and physical exercise. An individual informative educational intervention was carried out following a bidirectional feedback method. The intervention aimed to develop skills to improve sleep through nine simple tips. An analysis of covariance was performed on all the mean centred outcome variables controlling for the respective baseline scores. RESULTS In the intervention group, PSQI dropped, the duration and quality of sleep increased, and a decrease in fasting glucose and in HbA1c levels was observed. CONCLUSION The proposed intervention is effective for improving sleep quality, length and efficiency, and for decreasing fasting glucose and HbA1c levels in only 3 months. These findings support the importance of sleep and circadian rhythm education focused on improving IFG and T2DM.
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Development and Effects of College-Based Lifestyle Modification Program for Menstrual Health of Young Adult Women with Irregular Menses: A Randomized Controlled Trial.
Park, YJ, Shin, H, Jeon, S, Cho, I, Park, HJ
International journal of environmental research and public health. 2020;18(1)
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Irregular menstruation is characterized by abnormal uterine bleeding, unpredictable menstrual volume, and irregularity of menstruation. A regular menstrual cycle demonstrates a normal sex hormone profile and functioning of reproductive organs, whereas irregularity may suggest a dysfunctional sex hormone profile or disorder of reproductive organs. This study is a randomised controlled trial intended to develop a College-based Lifestyle Modification Programme (LMP) to improve the menstrual health of young adult women who experienced irregular menstruation less than ten times a year, and its effects on their health. The study has two arms: intervention and control group. Female participants (n=46) were randomly assigned 1:1 to one of the two groups. Results show that the College-based LMP had positive effects on the alleviation of depression and anxiety, and improvement of sleep duration. Whereas there were no significant differences for certain variables (menstrual cycle index, sex hormone binding globulin, testosterone, free androgen index), overall premenstrual syndrome, menstrual volume, body composition parameters, and nutrient intake. Authors conclude that their findings demonstrated the importance of lifestyle modifications, which could provide ordinary young adult women with healthy menstruation. However, further studies with the use of supplements are required to address the limitations of the current study.
Abstract
Purpose: This study was conducted to develop the 'College-based Lifestyle Modification Program' (College-based LMP) for young adult women with irregular menstruation and examine its effects after intervention. Methods: The College-based LMP consisted of small group education, individual physical exercise counseling/training, individual diet counseling, and feedback and support. Participants were comprised of 38 females who reported less than 10 irregular menstruations in a year and were randomly assigned to the experimental and control groups. The primary outcome variables consisted of menstrual cycle index (MCI), sex hormone binding globulin (SHBG), and androgenic profile (testosterone-T, free androgen index-FAI), while the outcome variables included premenstrual symptoms (PMS), menstrual volume, body composition parameters, glycemic parameters (fasting blood sugar-FBS, insulin, HOMA-IR), sleep duration, perceived stress, and nutrient intake.. Results: There were no significant differences in primary outcome variables (MCI, SHBG, T, and FAI). In the variables, there were no significant differences except for the partial domain of PMS (symptoms of depression and anxiety) and sleep duration. Conclusions: The study was significant in that it demonstrated the importance of lifestyle, which could provide ordinary young adult women with healthy menstruation. The College-based LMP needs to be elaborated with further studies.
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Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention.
Robertson, MC, Lyons, EJ, Song, J, Cox-Martin, M, Li, Y, Green, CE, Pinto, BM, Carmack, CL, Harrison, C, Baum, G, et al
Health and quality of life outcomes. 2019;17(1):91
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Endometrial cancer survivors suffer from high rates of obesity and physical activity-related co-morbidities that are related to cancer-specific and overall mortality. The aim of this study was to investigate how change in physical activity over time related to change in multiple, specific measures of quality of life for endometrial cancer survivors receiving a physical activity intervention. This study was a one-group, pre-post design which recruited 100 women diagnosed with stage I, II, or IIIa endometrial cancer. Each participant received a customized exercise prescription that was based on the results of baseline fitness tests. Results indicate change in physical activity was positively associated with change in SF-36 (Short Form Health Survey) subscale scores for role limitations due to physical health and general health. Furthermore, change in physical activity was negatively associated with change in pain and somatic distress. Authors conclude that increasing physical activity was positively associated with improvements in role limitation due to physical health, general health, pain, and somatic distress.
Abstract
BACKGROUND Endometrial cancer survivors are at an increased risk of poor quality of life outcomes. Physical activity is positively associated with general quality of life in this population, however, little is known about how changes in physical activity may be associated with changes in specific aspects of quality of life. The aim of this secondary data analysis was to explore the relationships between change in physical activity and change in physical, mental, social, and other aspects of quality of life in endometrial cancer survivors receiving a physical activity intervention. METHODS Endometrial cancer survivors (N = 100) participated in a telephone-based physical activity intervention for six months. At baseline and post-intervention we measured physical activity via accelerometry and ecological momentary assessment, and quality of life via the Short Form Health Survey (SF-36), the Quality of Life of Adult Cancer Survivors instrument, the Brief Symptom Inventory, the Pittsburgh Sleep Quality Index, and the Perceived Stress Scale. We conducted structural equation modeling path analyses to investigate how physical activity post-intervention was associated with the quality of life measures' subscales post-intervention, adjusting for baseline levels and potentially confounding covariates. RESULTS Increasing physical activity was positively associated with improvements in general health (p = .044), role limitation due to physical health (p = .005), pain (p = .041), and somatic distress (p = .023). There was no evidence to indicate that change in physical activity was associated with change in other aspects of quality of life. CONCLUSIONS Endometrial cancer survivors are at higher risk for suffering from challenges to physical quality of life, and findings from this study suggest that increasing physical activity may alleviate some of these problems. Further research is needed to determine whether other aspects of quality of life are linked to change in physical activity. TRIAL REGISTRATION Trial registration number: NCT00501761 Name of registry: clinicaltrials.gov Date of registration: July 16, 2007. Date of enrollment: June 16, 2005.
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Assessment of sleep and obesity in adults and children: Observational study.
Bonanno, L, Metro, D, Papa, M, Finzi, G, Maviglia, A, Sottile, F, Corallo, F, Manasseri, L
Medicine. 2019;98(46):e17642
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Sleep is essential to support the functions and health of the entire body. The aim of this study was to investigate the association between sleep duration and quality, and overweight risk and obesity in children and adults. The study was conducted on secondary school children. It involved 199 subjects of which 71 were adults (29 males and 42 females) with age between 29 and 65 years, and 128 children (73 males and 55 females) with age between 10 and 13 years. Results indicate that the duration and quality of sleep can represent a risk factor of overweight and obesity in examined subjects (both adults and children irrespective of their gender). Authors conclude that sufficient sleep is required to maintain a normal weight.
Abstract
The sleep allows many psychological processes, such as immune system activity, body metabolism and hormonal balance, emotional and mental health, learning, mnemonic processes. The lack of sleep could undermine mental and physical purposes, causing an alteration in cognitive functions or metabolic disorders. In our study, we have examined the irregular sleep effects with the overweight and obesity risk in children and adults.The sample was composed of 199 subjects, of which 71 adults, (29 males and 42 females), and 128 children (73 males and 55 females). We have measured the weight and height with standard techniques; we also have measured the body mass index dividing the weight in kg with the height square expressed in meters (kg/m). Subjects were divided into underweight, normal weight, overweight, and obese. Were administered some questionnaires to measure the quantity and quality of sleep, and eating habits and individual consumption of food.Analysis of demographic variables not showed significant differences between male and female groups but highlighted a significant trend differences in normal-weight score. The clinical condition has a substantial impact on body mass index score and sleep hours were significant predictor on this.Quantity and quality sleep can also represent a risk factor of overweight and obesity, so sufficient sleep is a factor that influence a normal weight. Adults and children that sleep less, have an increase in obesity and overweight risk with dysfunctional eating behaviors, decreased physical activity, and metabolic changes.
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Association between sleep duration and musculoskeletal pain: The Korea National Health and Nutrition Examination Survey 2010-2015.
Chun, MY, Cho, BJ, Yoo, SH, Oh, B, Kang, JS, Yeon, C
Medicine. 2018;97(50):e13656
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Musculoskeletal pain is highly prevalent in old age and can be disabling to sufferers, resulting in significant economic burden and a detrimental impact on quality of life. The aim of the study was to investigate the association between self-reported sleep duration and musculoskeletal pain in Korean adult population. The study showed that extreme sleep duration is prevalent in musculoskeletal pain subjects and it is more prevalent in subjects with multi-site joint pain. Thus, both longer and shorter sleep durations were linked with a higher prevalence of musculoskeletal pain. Authors conclude that specific assessment and treatment of sleep disturbance should be included as an important part of pain management in patients with musculoskeletal pain.
Abstract
Both extremely long and short sleep durations have been associated with increased risk of numerous health problems. This study examined the association between self-reported sleep duration and reporting of musculoskeletal pain in the adult Korean population.This study included data from 17,108 adults aged ≥50 years, obtained from the Korea National Health and Nutrition Examination Survey 2010-2012 and 2013-2015. Self-reported daily hours slept and the presence of musculoskeletal pain in knee joint, hip joint, or low back were examined. Patients were stratified into 5 groups by their sleep duration: ≤5, 6, 7, 8, or ≥9 h. Multivariate logistic regression analysis was performed, adjusting for covariates including age, sex, marital status, smoking, alcohol use, family income level, education, physical exercise, body mass index (BMI), and stress level.A U-shaped relationship was observed between the length of sleep duration and the presence of musculoskeletal pain. After adjusting for covariates, sleep duration of ≤5 h or ≥9 h was significantly associated with musculoskeletal pain experienced for more than 30 days over a 3-month period. We also found that the presence of multi-site musculoskeletal pain was significantly higher among those who slept for ≤5 h or ≥9 h than in those who slept for 7 h.These findings suggest that either short or long sleep duration is associated with musculoskeletal pain among Korean adults.