睡眠时相、不健康的生活方式与中年美国女性的糖尿病风险：一项前瞻性队列研究。
Chronotype, Unhealthy Lifestyle, and Diabetes Risk in Middle-Aged U.S. Women : A Prospective Cohort Study.
机构信息
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.K., Y.L.).
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (M.G.).
出版信息
Ann Intern Med. 2023 Oct;176(10):1330-1339. doi: 10.7326/M23-0728. Epub 2023 Sep 12.
BACKGROUND
Evening chronotype may promote adherence to an unhealthy lifestyle and increase type 2 diabetes risk.
OBJECTIVE
To evaluate the role of modifiable lifestyle behaviors in the association between chronotype and diabetes risk.
DESIGN
Prospective cohort study.
SETTING
Nurses' Health Study II.
PARTICIPANTS
63 676 nurses aged 45 to 62 years with no history of cancer, cardiovascular disease, or diabetes in 2009 were prospectively followed until 2017.
MEASUREMENTS
Self-reported chronotype using a validated question from the Morningness-Eveningness Questionnaire. The lifestyle behaviors that were measured were diet quality, physical activity, alcohol intake, body mass index (BMI), smoking, and sleep duration. Incident diabetes cases were self-reported and confirmed using a supplementary questionnaire.
RESULTS
Participants reporting a "definite evening" chronotype were 54% (95% CI, 49% to 59%) more likely to have an unhealthy lifestyle than participants reporting a "definite morning" chronotype. A total of 1925 diabetes cases were documented over 469 120 person-years of follow-up. Compared with the "definite morning" chronotype, the adjusted hazard ratio (HR) for diabetes was 1.21 (CI, 1.09 to 1.35) for the "intermediate" chronotype and 1.72 (CI, 1.50 to 1.98) for the "definite evening" chronotype after adjustment for sociodemographic factors, shift work, and family history of diabetes. Further adjustment for BMI, physical activity, and diet quality attenuated the association comparing the "definite evening" and "definite morning" chronotypes to 1.31 (CI, 1.13 to 1.50), 1.54 (CI, 1.34 to 1.77), and 1.59 (CI, 1.38 to 1.83), respectively. Accounting for all measured lifestyle and sociodemographic factors resulted in a reduced but still positive association (HR comparing "definite evening" vs. "definite morning" chronotype, 1.19 [CI, 1.03 to 1.37]).
LIMITATIONS
Chronotype assessment using a single question, self-reported data, and homogeneity of the study population.
CONCLUSION
Middle-aged nurses with an evening chronotype were more likely to report unhealthy lifestyle behaviors and had increased diabetes risk compared with those with a morning chronotype. Accounting for BMI, physical activity, diet, and other modifiable lifestyle factors attenuated much but not all of the increased diabetes risk.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
夜间型可能会促进不健康的生活方式，并增加 2 型糖尿病的风险。
目的
评估可改变的生活方式行为在睡眠类型与糖尿病风险之间的关联中的作用。
设计
前瞻性队列研究。
地点
护士健康研究 II。
参与者
2009 年，63676 名年龄在 45 至 62 岁之间、无癌症、心血管疾病或糖尿病史的护士进行了前瞻性随访，直到 2017 年。
测量
使用 Morningness-Eveningness Questionnaire 中的经过验证的问题来自我报告睡眠类型。测量的生活方式行为包括饮食质量、身体活动、饮酒量、体重指数（BMI）、吸烟和睡眠时间。通过补充问卷自行报告和确认新发糖尿病病例。
结果
与报告“明确的早晨”睡眠类型的参与者相比，报告“明确的晚上”睡眠类型的参与者更有可能拥有不健康的生活方式，占 54%（95%CI，49%至 59%）。在 469120 人年的随访中，共记录了 1925 例糖尿病病例。调整社会人口因素、轮班工作和糖尿病家族史后，与“明确的早晨”睡眠类型相比，“中间”睡眠类型的调整后 HR 为 1.21（CI，1.09 至 1.35），“明确的晚上”睡眠类型为 1.72（CI，1.50 至 1.98）。进一步调整 BMI、身体活动和饮食质量后，与“明确的晚上”和“明确的早晨”睡眠类型相比，分别将关联减弱至 1.31（CI，1.13 至 1.50）、1.54（CI，1.34 至 1.77）和 1.59（CI，1.38 至 1.83）。考虑到所有测量的生活方式和社会人口因素，关联仍然为正，但有所减弱（与“明确的晚上”相比，“明确的早晨”的 HR 为 1.19 [CI，1.03 至 1.37]）。
局限性
使用单一问题评估睡眠类型、自我报告数据和研究人群的同质性。
结论
与早晨型睡眠类型的中年护士相比，夜间型睡眠类型的护士更有可能报告不健康的生活方式行为，并且糖尿病风险增加。考虑到 BMI、身体活动、饮食和其他可改变的生活方式因素，虽然大大降低了，但仍增加了糖尿病的风险。
主要资金来源
美国国立卫生研究院。
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