Applied nutritional investigationSleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran
Introduction
Obesity, a major public health problem worldwide [1], is determined by both genetic and non-genetic factors [2], [3]. It has been considered that an individual's susceptibility to obesity is determined by genetic characteristics, whereas the expressed phenotype of obesity is determined by non-genetic factors such as environmental and behavioral factors [2], [3], [4]. An inverse association between some environmental determinants such as diet quality indices [5], sleep duration [6], [7], [8], and weight gain has been shown. Several cross-sectional and epidemiologic studies have reported that the concurrency of reduced sleep duration could be associated with increased obesity rate over the recent decade [6], [7], [8]. Furthermore, both sleep deprivation and lower diet quality are associated with some chronic diseases [9], [10], [11].
The exact mechanisms by which sleep curtailment may lead to weight gain and obesity have not been well established. Therefore, it needs to be answered whether weight gain resulted from restricted sleep time by itself or was also a result of other relevant risk factors. However, some probable mechanisms have been suggested by previous studies, i.e., having more time to eat [12], irregular food intake and lower vegetable consumption [13], lower physical activity levels [14], modified concentrations of orexigenic and anorexigenic hormones [8], [15], [16], and thermogenic processes [17]; besides, diet quality as a good predictor of weight status [5] is an additional mechanism that should be noted.
So far, no study has assessed the diet quality indices among short and longer sleepers but energy and dietary intakes have been assessed [13], [14], [18], [19]. Total energy intake and carbohydrate consumption after sleep restriction have been mentioned in different studies [14], [15], [16], [18], [19], [20]. Most of these studies have reported more fat [14], [18], [19] and lower vegetable [13] consumption among short sleepers than among longer sleepers. Furthermore, the greater desire for energy-dense foods among short sleepers has also been shown by Spiegel et al. [15].
Although there are many studies assessing sleep duration and energy intake, weight status, obesity, and consumption patterns for some food groups, to our knowledge, there is no study that assessed these relationships among Iranians. Additionally, this is the first study that assessed quality of diet as a possible mechanism of predicting weight status among short sleepers. In the present study, in addition to determining the association of general and abdominal obesity with sleep duration, we aimed to clarify the diet quality indices such as dietary diversity score (DDS) and dietary energy density (DED) and different food groups consumption in short and longer sleepers among Iranian female students.
Section snippets
Subjects
This cross-sectional study was conducted among 410 young female students aged 18-28 y and studying in Isfahan University of Medical Sciences in Iran. To provide a random sampling, after considering all schools and departments of Isfahan University of Medical Sciences, we randomly selected some departments; then using multistage cluster random sampling method, we chose some students. All subjects declared their willingness to participate in the research by providing written informed consent. The
Results
Four hundred ten female students, aged 18-28 y, who were studying in Isfahan University of Medical Sciences in Iran, participated in this study. Table 1 shows the general characteristics and anthropometric measurements of the subjects across the tertiles of sleep duration. No significant differences were observed in socioeconomic status and physical activity levels across the tertiles. Subjects in the lowest tertile of sleep duration (the sleep duration lower than 6 h/d) in comparison with
Discussion
In this cross-sectional study, we found that short sleepers had significantly lower diet quality indices and higher values of BMI and waist circumferences, as well as a higher percentage of obesity and abdominal adiposity compared to longer sleepers, without any significant differences in physical activity levels. Although the inverse association between sleep duration and BMI values has been shown separately, to the best of our knowledge, this is the first study that assessed not only the
Acknowledgments
The authors would like to thank the female students of Isfahan University of Medical Sciences who participated in this study.
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This article was supported by a grant from the School of Health, Isfahan University of Medical Sciences.