Evening chronotype is associated with poor cardiovascular health and adverse health behaviors in a diverse population of women

ABSTRACT

Chronotype reflects time of day preferences for performing daily activities. Previous research within Asian and European cohorts indicates evening chronotype is associated with elevated cardiometabolic risk. However, evidence is limited from population-based US cohorts, particularly among women in whom evening chronotype prevalence may become higher after middle-age, coinciding with life stages associated with higher cardiovascular disease (CVD) risk. This cross-sectional study evaluated associations of chronotype with overall cardiovascular health (CVH), health behaviors, and cardiometabolic risk factors among 506 women (mean age = 37 ± 16y, 62% racial/ethnic minority) in the American Heart Association (AHA)’s Go Red for Women Strategically-Focused Research Network cohort at Columbia University (New York City, NY, USA). Chronotype was assessed using the validated Morningness-Eveningness Questionnaire (MEQ) and categorized as “evening”, “intermediate”, and “morning” chronotypes. Health behaviors (diet, physical activity, and sleep) were assessed using validated questionnaires. Anthropometrics, clinical blood pressure, and blood biomarkers were assessed at the clinic visit. CVH was evaluated using the AHA Life’s Simple 7 (LS7) metrics; LS7 scores of 0–8 and 9–14 were considered indicative of poor and moderate-to-high CVH, respectively. Linear and logistic regression models adjusted for age, race/ethnicity, education, health insurance, and menopausal status were used to examine associations of MEQ scores and chronotype categories with overall CVH, clinical cardiometabolic risk factors, and health behaviors. Overall, 13% of women identified as evening chronotypes, while 55% and 32% reported being intermediate and morning types. In linear models, higher MEQ scores were associated with higher AHA LS7 scores (β(SE) = 0.02(0.01); p = .014), indicative of more favorable CVH, and with health behaviors not included in the LS7. Higher MEQ scores were also associated with lower Pittsburgh Sleep Quality Index, i.e. better sleep quality, (β(SE) = ?0.07(0.02), p < .0001), lower insomnia severity (β(SE) = ?0.14(0.01), p < .0001), shorter time to fall asleep (β(SE) = ?0.28(0.14), p = .044), and less sedentary time (β(SE) = ?0.11(0.03), p = .001). In logistic regression models, evening chronotype, compared to intermediate/morning type, was associated with higher odds of having poor CVH (OR(95%CI):2.41(1.20–4.85)), not meeting AHA diet (OR(95%CI):2.89(1.59–5.23)) and physical activity guidelines (OR(95%CI):1.78(1.03–3.07)), and having short sleep (OR(95%CI):2.15(1.24–3.73)) or insomnia (OR(95%CI):2.69(1.53–4.75)). The evening type compared to morning type was also associated with being a current smoker (OR(95%CI):2.14(1.02–4.52)) and having poor sleep quality (OR(95%CI:2.35(1.27–4.37)) and long sleep onset latency (OR(95%CI:1.89(1.00–3.56)). In our cohort of women, evening chronotype was related to poor CVH, likely driven by its influence on health behaviors. These findings, although warranting confirmation prospectively in other populations, suggest chronotype is an important factor to consider and possibly target when designing lifestyle interventions for CVD prevention.     

Associations of chronotype,Big Five,and emotional competences with perceived stress in university students

ABSTRACT

This study aimed to investigate the associations between individual difference factors (chronotype, Big Five, emotional competences) and perceived stress in French university students. In total, 362 students agreed to take part (M _age = 20.19 ± 1.75 years). Participants completed the Caen Chronotype Questionnaire, Big Five Inventory, the Profile of Emotional Competences, and the Perceived Stress Scale. Results showed that chronotype amplitude (+), eveningness chronotype (+), neuroticism (+), conscientiousness (-), and intrapersonal emotional competences (-) were important for perceived stress. These findings have theoretical and practical implications in terms of identifying students who might benefit most from stress management interventions.     

Association of possible sleep bruxism in children with different chronotype profiles and sleep characteristics

Sleep bruxism (SB) in children has been associated with several sleep characteristics, which may alter their sleep pattern. This change affects the internal biological clock and consequently the chronotype profile. The aim of this study was to evaluate the existence of an association between possible SB in children with specific chronotype profiles and sleep characteristics. The study included 207 parents/guardians of children aged between 3 and 12 years who were waiting for their children’s dental treatment at the Pediatric Dentistry Clinic of the Federal University of Rio de Janeiro, Brazil. A questionnaire on the socio-demographic characteristics of parents and children as well as on the features of the children’s sleep was applied. In addition, the CIRENS scale (Circadian Energy Scale) was completed by the parents to identify the children’s chronotype. A chi-squared test was used to determine the association between possible SB, the chronotype, and sleep characteristics. A multiple logistic regression model was implemented to observe the influence of chronotype, age, and other independent variables on the possible SB. The logistic regression model demonstrated that nocturnal agitation (p = 0.009; OR = 3.42) and nightmares (p = 0.045; OR = 3.24) were associated with possible SB in children. Although no significant association (p = 0 .089) between the chronotype profile and possible SB was observed in the 3 to 5 years age group, a proportional difference was observed between the chronotype categories in this age group—12.5% of children with SB had a morning type, while 26.4% had an intermediate type and 47.8% an evening type compared to those without possible SB. Nocturnal agitation and nightmares were associated with possible SB. In addition, young children with an evening chronotype had a tendency toward possible SB.     

Characterization of bimodal chronotype and its association with sleep: A population-based study

The circadian system coordinates internal events in a daily schedule to make sure that the body systems are synchronized to environmental time and internal cues. One important behavioral aspect of the circadian system is the chronotype. It is usually assessed through subjective questionnaires, being the Horne-Ostberg Morningness–Eveningness Questionnaire (MEQ) one of the most used. It classifies individuals into three major categories: morning, evening, and intermediate types. Recently, it has been hypothesized the existence of a fourth chronotype, the bimodal type, through an algorithm derived from the MEQ responses. Bimodals answer as morning-types in some questions, and as evening-types in others, resulting in an intermediate total score. To better characterize this phenotype, the present study aimed to detect and characterize the frequency of the bimodal chronotype in the EPISONO, a large population-based cohort, as well as to verify the association between bimodality and sleep parameters and genetic variation in the PER3 gene. Of the 1,042 individuals who participated of the EPISONO, 857 had MEQ filled correctly. We found that 16% of our sample were bimodal types. We observed that bimodal individuals were significantly younger and had lower body mass index. The association between PER3 VNTR genotype and gender with bimodal chronotype was not significant. However, we found an association between bimodality and Epworth Sleepiness Scale (EES) and apnea-hypopnea index (AHI). We did not find a statistically significant difference between bimodals and intermediate non-bimodals for the studied variables. Lastly, it was observed that the most significant predictors for bimodal chronotype were female gender, AHI, and EES. In conclusion, the present work provides more evidence that the bimodal type might have to be considered when classifying chronotype and its association with young age and sleepiness may be due to the influence of social and environmental factors.     

Sleep quality,chronotype and social jetlag differentially associate with symptoms of attention deficit hyperactivity disorder in adults

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioural disorder which has been associated with sleep and circadian rhythm disturbances. Numerous studies have linked evening circadian typology with traits and behaviours associated with the disorder, although a precise reason for this relationship has not been clarified. The current study examines ADHD symptoms, impulsivity, cognitive failures, sleep quality and chronotype in a cohort of healthy young adults (N = 396). Results show significant, small magnitude associations between mid-point of sleep on free days, social jetlag (SJL) and ADHD symptoms and impulsivity, although not with cognitive failures. Similarly, sleep quality is also associated with ADHD symptoms and impulsivity. Group-wise approaches show that higher SJL is associated with significantly more ADHD symptoms and impulsivity, and later mid-sleep on free days is also associated with more ADHD symptoms. Stepwise multiple linear regression reveals that, when controlling for age and sex, SJL but not mid-sleep on free days is a significant predictor of ADHD symptoms and impulsivity. These results indicate that SJL may be an important factor to consider when exploring circadian rhythm associations with ADHD symptoms.     

Associations of chronotype with social jetlag and behavioral problems in preschool children

The timing, duration, and intensity of sleep are determined by the interaction between a sleep-wake-dependent homeostatic process and a sleep-wake-independent, intrinsic, clock-like circadian process. Chronotype represents individual differences in diurnal preferences, which are not only genetically determined but also influenced by social and environmental factors. Thus, the discrepancy between biological and social clocks, so-called “social jetlag”, occurs. Chronotype, social jetlag, and the links between chronotype and behavioral problems are well documented in adults and adolescents. However, such studies on young children are limited. We conducted a survey of sleep and health for preschool children attending kindergarten or childcare centers in Wako, Okayama and Kurashiki cities, Japan, between May and July 2012. A total of 654 children aged 4–6 years (342 boys and 312 girls, with an average age of 4.7 years) were assessed using the Children’s ChronoType Questionnaire and the Strength and Difficulties Questionnaire. Morning (M)-type, neither (N)-type and evening (E)-type accounted for 36.2%, 54.0% and 9.8% of the participants, respectively. The weekday-to-weekend differences in midsleep time – originally proposed as the concept of social jetlag – were 11, 25 and 35?min for M-, N- and E-types, respectively. There was a negative correlation between chronotype and sleep period during weekdays (p?<?0.001) and a positive correlation on weekends (p?<?0.001). The weekday-to-weekend difference in sleep period was 0.5?h for E-types, whereas there was no difference for M-types. Binomial logistic regression analyses were used to examine the links between chronotype and behavioral problems, adjusted for participants’ sex, age, childcare programs and locations. Chronotype was significantly associated with hyperactivity/inattention: N-type (adjusted OR?=?1.74, 95% CI?=?1.03–2.95, p?<?0.05) and E-type (adjusted OR?=?2.47, 95% CI?=?1.18–5.20, p?<?0.05). E-type was significantly associated with conduct problems (adjusted OR?=?2.11, 95% CI?=?1.03–4.31, p?<?0.05) and peer problems (adjusted OR?=?2.75, 95% CI?=?1.18–6.44, p?<?0.05). The results suggest that E-type children are vulnerable to higher social jetlag and more behavioral problems. The immature adjustment function of their endogenous circadian pacemakers may not be able to correct a small but significant social jetlag to synchronize with their social clocks. Furthermore, guidance based on chronobiological evidence is required for parents, teachers and health professionals to help children achieve optimal sleep and reduce behavioral problems.     

Tobacco-related disease burden and preventive initiatives in China. Global health and the chronic diseases: perspective, policy and practice

The burden of chronic diseases in global health is a surging area of research. The Global Health Initiative at the National Heart, Lung, and Blood Institute brings together investigators from developing countries with those from the developed world to study these diseases. In China, approximately 83 percent of all deaths in 2000 were attributed to chronic illnesses, which are the research focuses of the Chinese center of the Global Health Initiative. Tobacco use as well as passive smoking are modifiable risk factors in a large number of such chronic conditions. The prevalence of smoking in China is extensive and has inseparable ties to the economy, with tobacco taxes making up a large portion of government revenue in poorer provinces. Methods of smoking prevention have been piloted in some Chinese schools, which have mitigated the increase in smoking rate but have not resulted in a primary preventive effect. Efforts by the Yale Global Health Initiative and the Yale-China Association are bringing researchers together to address chronic disease in China as Yale School of Medicine enters its 200th year.     

从医联体到康联体防控慢性病策略的变化——以上海市闵行区为例

本文介绍了复旦大学附属上海市第五人民医院在不断巩固区域医疗联合体的基础上,试图建立一种以预防疾病,控制慢性疾病如慢性呼吸道感染、慢性肝病、糖尿病等,加强健康教育为目的的社区健康联合体(简称康联体)。这是一项卫生服务可持续发展的模式,其建立是基于复旦大学和闵行区的长期合作,以智慧医疗技术为依托,以"防大病、管慢病、促健康"为核心服务内容,以期及早预防社区居民严重疾病的发生,对社区慢性病患者进行方便、有效的监控,并向社区介绍先进的人口健康理念,实现全方位、全生命周期保障社区居民健康,为闵行区康联体的扩大与完善提供参考依据。希望这些方法能促进优质医疗服务的合理布局,使社区居民终身健康关怀得到发展,并在防控慢性疾病及慢性感染中发挥有效作用,在今后也能应用于其他区域。     

Adolescent sleep misalignment: a chronic jet lag and a matter of public health

Sleep is a key element, both physiologically and psychologically, in adolescent development. The prevalence of sleep disorders in western countries is important, as with age the sleep–wake cycle of adolescents becomes irregular and delayed in relation with later sleep onset and waking time resulting in rhythm desynchronization. A large number of adolescents sleep for 7–8 h instead of 9–10 h per night, which can lead to a cumulative sleep debt with fatigue, behavioral problems and poor academic achievement. The effect of electronic media use (such as television, mobile phone, computer, and electronic gaming) on sleep has been the object of several international studies, though pubertal changes may also impact adolescent sleep. Adolescents and their parents should be educated by professionals, including physicians and nurses, on the key role of sleep in adolescent well being and quality of life. A number of basic rules are proposed to improve sleep in adolescents. The permanent social jet lag experienced by a number of adolescents should be considered as a matter of public health.     

Oral health and reduction in respiratory capacity in a cohort of community-dwelling elderly people: a population-based 5-year follow-up study

Objectives: Several anaerobic bacteria originating in periodontal pockets have been isolated from infected lungs and pharyngeal microflora. Increased bacterial load in lungs is known to be a risk factor for decline in forced expiratory volume during the first second. The aim was to evaluate both cross‐sectionally and longitudinally the association between oral health status and forced expiratory volume during the first second (FEV₁) in older residents of the city of Jyväskylä, Finland. Design: Cross‐sectional and prospective cohort study over a 5‐year follow‐up. Setting: Research laboratory of the University of Jyväskylä. Participants: In 1990 dental status and FEV₁ were examined in 203 80‐year‐old people, of whom 88 survivors were retested 5 years later. Main outcome measures: Primary: dental status and FEV₁. Secondary: existence of pulmonary diseases, height, handgrip strength, smoking, and length of education. Results: Participants were regrouped into three categories according to their baseline oral health status. At baseline, men with complete prostheses had the lowest FEV₁. Five years later the greatest reduction in FEV₁ was seen in subjects with poor periodontal status or complete prostheses (?9.4%) while those with healthy periodontal status showed no reduction in FEV₁ values (+1.0%, p = 0.006). Conclusions: Periodontal infections and complete prostheses may be reservoirs for pathogens which may be harmful and partly explain the observed reduction in FEV₁ during ageing.     

Medicinal halophytes: potent source of health promoting biomolecules with medical,nutraceutical and food applications

Salt-tolerant plants grow in a wide variety of saline habitats, from coastal regions, salt marshes and mudflats to inland deserts, salt flats and steppes. Halophytes living in these extreme environments have to deal with frequent changes in salinity level. This can be done by developing adaptive responses including the synthesis of several bioactive molecules. Consequently, several salt marsh plants have traditionally been used for medical, nutritional, and even artisanal purposes. Currently, an increasing interest is granted to these species because of their high content in bioactive compounds (primary and secondary metabolites) such as polyunsaturated fatty acids, carotenoids, vitamins, sterols, essential oils (terpenes), polysaccharides, glycosides, and phenolic compounds. These bioactive substances display potent antioxidant, antimicrobial, anti-inflammatory, and anti-tumoral activities, and therefore represent key-compounds in preventing various diseases (e.g. cancer, chronic inflammation, atherosclerosis and cardiovascular disorder) and ageing processes. The ongoing research will lead to the utilisation of halophytes as a new source of healthy products as functional foods, nutraceuticals or active principles in several industries. This contribution focuses on the ethnopharmacological uses of halophytes in traditional medicine and reviews recent investigations on their biological activities and nutraceuticals. The work is distributed according to the different families of nutraceuticals (lipids, vitamins, proteins, glycosides, phenolic compounds, etc.) discussing the analytical techniques employed for their determination. Information about the claimed health promoting effects of the different families of nutraceuticals is also provided together with data on their application.     

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly

doi: 10.1111/j.1741‐2358.2010.00446.x
Analysis of socio‐demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly Objective: To investigate the association of socio‐demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. Material and methods: A cross‐sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi‐square test and Fisher’s exact test. An estimation of prevalence for the covariates was performed using Poisson’s regression models. Results: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower‐income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60–64 years old and those who are employed had a significant association with periodontal disease. Conclusion: Socio‐demographic factors were associated with some notable oral diseases in the elderly.     

Associations between self-assessed masticatory ability and some general health factors in a Swedish population

Objectives : The aims of this study were 1) to describe changes in self-assessed masticatory ability over a 14 year period (1975–89); and 2) to describe associations between self-assessed masticatory ability and age, dental state and some other background factors in a sample of the Swedish population in 1988/89. Design: The Swedish National Central Bureau of Statistics investigates annually the living conditions of the Swedish population by means of interviews by trained persons. The data were analysed by means of stepwise logistic regression and calculation of adjusted relative risks. Subjects: In the investigation in 1988/89, 12901 people above 16 years of age participated and the response rate was 80%. Results: In comparison between the investigations, the prevalence of reported impairment was lower in 1988/89 than in 1975 and 1980/81. Prevalence of reported impairment of chewing ability increased with ageing from 2% in young adults (16–34 years old) to 44% in older elderly (>85 years old). In most age groups, edentulous people reported the highest prevalence, and dentate people the lowest. Relative risks for impaired masticatory ability, independent of age, gender and dental state, were higher for people in rural areas, with low income and living single, as well as for those with skeletal, gastrointestinal, psychiatric and tumour diseases. In the elderly, results from the logistic regression showed that some disability and psychosocial factors were also associated with masticatory ability. Conclusions : The results indicated that there was a group of elderly people who reported several functional and health problems including impaired masticatory ability.     

我国人口与健康状况简析

随着经济全球化格局的逐步形成,环境、生态、资源等与人类社会自身发展密切相关的因素已成为超越国界的共性课题。进入新世纪后,我国医药卫生事业面临着人口结构和疾病谱系迅速改变、公共卫生和医疗保健需求剧增、环境污染和食品安全保障等巨大挑战。在计划生育及生殖健康领域,在公共卫生与医疗网络领域,在医学研究与健康促进领域,以及在高新技术与健康产业领域,坚持科学的发展观,以最先进的科学技术研究成果为主导,推动关键技术的相互渗透及综合集成,提倡合理的生活方式已成为我国经济发展和社会进步的重要历史任务。     

Associations of genetic polymorphisms in CTLA-4 and IL-18 with chronic liver diseases: Evidence from a meta-analysis

BackgroundThe aim of this meta-analysis was to explore associations between polymorphisms in CTLA-4/IL-18 and chronic liver diseases by combing the results of all relevant studies.MethodsEligible studies were searched from Pubmed, Embase, Web of Science and Cochrane library. We used Review Manager to combine the results of eligible studies.ResultsSixty-seven studies were included in this meta-analysis. Combined results revealed that CTLA-4 rs231775 (dominant, recessive and allele comparisons), IL-18 rs1946518 (dominant, recessive and allele comparisons) and IL-18 rs187238 (dominant, over-dominant and allele comparisons) polymorphisms were all significantly associated with chronic liver diseases in the overall population. We also obtained similar positive results for rs231775, rs5742909, rs3087243, rs1946518 and rs187238 polymorphisms in subgroup analyses by ethnicity and type of disease.ConclusionsThis meta-analysis demonstrated that CTLA-4 rs231775, CTLA-4 rs5742909, CTLA-4 rs3087243, IL-18 rs1946518 and IL-18 rs187238 polymorphisms may confer susceptibility to certain types of chronic liver diseases.     

Oral health and treatment needs in a non-institutionalized elderly population: Experience of a dental school associated geriatric clinic

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.     

A review and evaluation of study design considerations for site-specifically assessing the health of fish populations

Since there are not any well developed procedures for site-specifically evaluating the health of fish populations, most field surveillance programs have been restricted to collecting information on chemistry, toxicity, bioaccumulation, biochemical alterations orin situ benthic community structure. Identification of the mechanism and significance of contaminant effects on fish populations depends on the ability to identify changes and to distinguish changes in survival, food availability or food conversion efficiency, from coincidental changes associated with alterations in habitat or natural variability. Preliminary identification of the characteristics of adult fish can be used to cost-effectively focus financial resources on the alterations which are of relevance to interpretation of impacts and identification of causal factors. Proper interpretation requires that appropriate attention be given to monitoring level and strategy, selection of species and timing of sampling, sample size requirements and choice of reference site.