A Study On The Relationship Of Sleep And Lifestyle With Metabolic Syndrome

Background and Objective:People’s lifestyles and life structures have significantly changed with improved living standards.Metabolic syndrome(Met S),of which prevalence has increased year by year worldwide,has become one of the critical public health problems.Different from the influence of genes on chronic diseases,lifestyle and other external factors are controllable,which is the easiest and cost-effective way for people to become healthy and reduce diseases.The impact of diet,and activity habits on MetS has always been the focus of research.With the gradual increase of people’s social mental pressure caused by the fast pace of modern life,sleep problems have attracted researchers’more attention.However,the evidence for a correlation between sleep and Met S and its form is unclear.Moreover,few studies focus on cumulative effect of lifestyle.The demonstration strength of the association between lifestyle and Met S was affected by the description of lifestyle of most studies based on participants’feelings subjectively and the lack of recognized objective serological indicators reflecting lifestyle.This study firstly conducted a comprehensive and systematic meta-analysis to evaluate the association between sleep and the risk of Met S quantitatively,providing evidence-based medical evidence for lifestyle intervention strategies.Secondly,we preliminarily explore the prevalence of Met S and the relationship between different lifestyles and the risk of Met S for parts of Jiangsu Province based on the baseline survey data of the Diabetes Project of the Major Chronic Noncommunicable Diseases Research and Development Program of the Ministry of Science and Technology in2017.Finally,a nested case-control study was conducted to explore the association between lifestyle and the risk of Met S.By creating lifestyle score and measuring the levels of inflammatory factors and oxidative stress factors in people,objective serological indicators that can reflect the cumulative effect of lifestyles were preliminarily explored to further clarify the association between lifestyle and Met S and its mechanism in the process of disease occurrence and development,providing basis for early prevention and comprehensive treatment of Met S in public health services.Methods:1.Meta-analysis:We systematically searched electronic databases of Pub Med,Embase,Ovid,and Web of Science from the date of inception up to 17 February 2022.For evaluating articles quality,cross-sectional studies were assessed by the Quality Assessment Scale recommended by Agency for Healthcare Research and Quality(AHRQ)and cohort studies were assessed by the Newcastle-Ottawa Quality Assessment Scale(NOS),respectively.Stata 15.0 was applied to statistical analysis.Heterogeneity between studies was assessed using Q test and I~2,and subgroup analyses were performed based on possible sources of heterogeneity.Sensitivity analysis was used to assess the stability of the results,and funnel plots and Begg’s tests were used to test publication bias.The restricted cubic spline random-effects meta-analysis was performed to examine a dose-response relationship between sleep duration and Met S.2.Cross-sectional survey at baseline:We conducted a cross-sectional study using a multi-stage stratified random sampling method in Jurong City of Zhenjiang City and Yandu District of Yancheng City of Jiangsu Province from April to July in 2017.Subjects over 18 years old were selected to complete the survey with informed consent,in which information of investigation and physical examination were collected.According to the Joint Interim Statement(JIS)proposed by multiple organizations in 2009 to determine MetS and Kappa consistency test was used to compare the consistency between different standards.Logistic regression analysis was used to evaluate the relationship between different lifestyles and the risk of Met S.3.Nested case-control study:A follow-up survey was conducted on the baseline population that met the investigation objectives from July to August in 2020.A nested case-control study was conducted using newly Met S patients with complete baseline information and participating in the 2020 follow-up as the case group,and healthy controls were randomly selected by the method of random number from the follow-up population without Met S as the control group.The levels of interleukin-6,malondialdehyde,and superoxide dismutase in serum were measured by Enzyme linked immunosorbent assay(ELISA).The association between lifestyle and the risk of Met S was assessed by logistic regression analysis.Lifestyle score was created based on the questionnaire to analysis the correlation between serological indicators and lifestyle,and further explore the association between relevant serological indicators and the risk of Met S.Results:1.53 articles(62 independent studies:54 cross-sectional studies and 8 cohort studies)were involved in the meta-analysis,of which 13 articles(15 independent studies:14 cross-sectional studies and one cohort study)reported an association between sleep quality and Met S.Compared to normal sleep duration,short(OR=1.14,95%CI:1.10-1.19)and long sleep duration(OR=1.15,95%CI:1.09-1.23)were associated with increased risk of Met S.A non-linear relationship between sleep duration and the risk of MetS was detected by the restricted cubic spline analysis(P<0.001).The pooled results found that poor sleep quality(OR=1.46,95%CI:1.03-2.06)and sleep complaints(including difficulty falling asleep,use of sleep medications,difficulty maintaining sleep,and sleep-related breathing disorders)were associated with increased risk of Met S.2.Results of the cross-sectional survey at baseline showed an overall prevalence of 48.43%in Met S,with 48.20%in men and 48.58%in women.Men with a higher BMI was associated with a greater risk of Met S compared to those with a normal BMI(overweight:OR=4.78,95%CI:3.74-6.13;Obesity:OR=16.39,95%CI:11.94-22.49).Compared with non-smoking men,smokers were less likely to develop Met S(OR=0.77,95%CI:0.63-0.95).Men with moderate meat intake were less likely to occur MetS than those with low meat intake(OR=0.77,95%CI:0.61-0.97).In women,the risk of Met S increased with age compared to those<45 years(45-59years:OR=2.65,95%CI:2.07-3.38;≥60 years old:OR=3.96,95%CI:2.94-5.33).The higher the BMI,the greater the risk of Met S in women compared to people with a normal BMI(emaciation:OR=0.18,95%CI:0.04-0.77;overweight:OR=3.14,95%CI:2.63-3.77;obesity:OR=8.52,95%CI:6.71-10.82).Women who drank tea daily had a decrease risk of Met S compared with those who rarely or never drank tea(OR=0.81,95%CI:0.66-0.99),and women who snore frequently were more likely to develop Met S than non-snoring women(OR=1.62,95%CI:1.36-1.93).Met S were more common in women who slept longer than 8 hours compared to 7-8h(OR=1.45,95%CI:1.11-1.90).3.The results from the nested case-control study showed that people with moderate fruit intake were less likely to develop Met S(OR=0.61,95%CI:0.41-0.92)compared with those with low fruit intake.People with moderate meat intake were less likely to develop Met S than those with low meat intake(OR=0.61,95%CI:0.40-0.93).Compare with non-snorers,snorers were more likely to develop Met S(OR=1.65,95%CI:1.06-2.57).People with higher lifestyle scores were more likely to develop MetS(OR=1.66,95%CI:1.24-2.23),and those with medium and high lifestyle scores were 1.63 times(95%CI:1.05-2.53)and 2.79 times(95%CI:1.53-5.09)higher than those with low lifestyle scores,respectively.4.Studies on the correlation between serological indicators and lifestyle score showed that people with higher lifestyle scores were more likely to have low levels of SOD(OR=0.67,95%CI:0.52-0.87),and the possibility of high SOD level in the high lifestyle scores group was0.40 times than that in the low group(95%CI:0.24-0.69).No statistical association of IL6 and MDA with lifestyle scores was observed.The results showed that,in the general population,people with higher serum SOD level had a lower risk of MetS compared with those in the first group(T2:OR=0.56,95%CI:0.35-0.89;T3:OR=0.40,95%CI:0.25-0.66),and this result was more obvious in women and younger than 45 years old and 45-59 years old.Conclusion:1.Meta-analyses showed that short or long sleep duration was significantly associated with an increased risk of Met S.Poor overall sleep quality and sleep complaints were positively associated with Met S.However,the results were not entirely consistent across study designs.2.The total prevalence of Met S among general residents was 48.43%in some areas of Jiangsu Province.Higher BMI was associated with greater Met S risk.Eating appropriate meat were less likely to develop Met S in men.Advanced age,snoring,and sleep longer than 8 hours were more likely to develop Met S,and drinking tea daily were less likely to develop Met S in women.3.The results of nested case-control study showed that moderate intake of fruit and meat was less likely to develop Met S,and snoring increased the risk of Met S.The poorer the lifestyle,the higher the risk of Met S and the lower the SOD level.People with higher serum SOD levels are less susceptible to Met S,and this association was more obvious in women and people younger than 60 years old.It suggests that SOD may be introduced as an objective indicator to reflect the cumulative impact of various lifestyles on the body.