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Annals of Internal Medicine Oct 2023Evening chronotype may promote adherence to an unhealthy lifestyle and increase type 2 diabetes risk.
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.
Topics: Middle Aged; Humans; Female; Circadian Rhythm; Chronotype; Diabetes Mellitus, Type 2; Prospective Studies; Life Style; Surveys and Questionnaires
PubMed: 37696036
DOI: 10.7326/M23-0728 -
JAMA Neurology Aug 2023Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV). (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
OBJECTIVE
To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.
DESIGN, SETTING, AND PARTICIPANTS
This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Two hundred fifty-three patients were assessed for eligibility. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. The analysis was prespecified and per-protocol.
INTERVENTIONS
After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.
MAIN OUTCOME AND MEASURES
Patients had to document whether they could provoke positional vertigo every morning. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. The secondary end point was the effect of the single maneuver performed by the physician.
RESULTS
Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 [range, 1-8] day; 95% CI, 1.64-2.28 days); in the EM group, 3.3 (3.6) days (median, 2 [range, 1-20] days; 95% CI, 2.62-4.06 days) (P = .01; α = .05, 2-tailed Mann-Whitney test). For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 [68.4%] vs 61 of 97 [62.9%]; P = .42; α = .05). No serious adverse event was detected with both maneuvers. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.
CONCLUSIONS AND RELEVANCE
The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05853328.
Topics: Humans; Female; Middle Aged; Male; Benign Paroxysmal Positional Vertigo; Prospective Studies; Physical Therapy Modalities; Treatment Outcome; Ambulatory Care
PubMed: 37358870
DOI: 10.1001/jamaneurol.2023.1408 -
The American Journal of Medicine Aug 2023
PubMed: 36906168
DOI: 10.1016/j.amjmed.2023.02.023 -
Communications Biology Oct 2023Observational studies suggest certain sleep traits are associated with telomere length, but the causal nature of these associations is unclear. The study aimed to...
Observational studies suggest certain sleep traits are associated with telomere length, but the causal nature of these associations is unclear. The study aimed to determine the causal associations between 11 sleep-related traits and leukocyte telomere length (LTL) through two-sample Mendelian randomization and colocalization analyses using the summary statistics from large-scale genome-wide association studies. Univariable Mendelian randomization indicates that genetically determined short sleep is associated with decreased LTL, while morning chronotype is associated with increased LTL. Multivariable Mendelian randomization further supports the findings and colocalization analysis identifies shared common genetic variants for these two associations. No genetic evidence is observed for associations between other sleep-related traits and LTL. Sensitivity MR methods, reverse MR and re-running MR after removing potential pleiotropic genetic variants enhance the robustness of the results. These findings indicate that prioritizing morning chronotype and avoiding short sleep is beneficial for attenuating telomere attrition. Consequently, addressing sleep duration and chronotype could serve as practical intervention strategies.
Topics: Sleep Duration; Chronotype; Genome-Wide Association Study; Mendelian Randomization Analysis; Sleep; Leukocytes; Telomere
PubMed: 37803147
DOI: 10.1038/s42003-023-05397-7 -
American Journal of Hematology Sep 2023Guidelines generally recommend taking iron supplements in the morning away from meals and with ascorbic acid (AA) to increase iron absorption. However, there is little...
Guidelines generally recommend taking iron supplements in the morning away from meals and with ascorbic acid (AA) to increase iron absorption. However, there is little direct evidence on the effects of dietary factors and time of day on absorption from iron supplements. In iron-depleted women (n = 34; median serum ferritin 19.4 μg/L), we administered 100 mg iron doses labeled with Fe, Fe, or Fe in each of six different conditions with: (1) water (reference) in the morning; (2) 80 mg AA; (3) 500 mg AA; (4) coffee; (5) breakfast including coffee and orange juice (containing ~90 mg AA); and (6) water in the afternoon. Fractional iron absorption (FIA) from these n = 204 doses was calculated based on erythrocyte incorporation of multiple isotopic labels. Compared to the reference: 80 mg AA increased FIA by 30% (p < .001) but 500 mg AA did not further increase FIA (p = .226); coffee decreased FIA by 54% (p = .004); coffee with breakfast decreased FIA by 66% (p < .001) despite the presence of ~90 mg of AA. Serum hepcidin was higher (p < .001) and FIA was 37% lower (p = .059) in the afternoon compared to the morning. Our data suggest that to maximize efficacy, ferrous iron supplements should be consumed in the morning, away from meals or coffee, and with an AA-rich food or beverage. Compared to consuming a 100 mg iron dose in the morning with coffee or breakfast, consuming it with orange juice alone results in a ~ 4-fold increase in iron absorption, and provides ~20 more mg of absorbed iron per dose. The trial was registered at Clinicaltrials.gov(NCT04074707).
Topics: Humans; Female; Iron; Coffee; Dietary Supplements; Anemia, Iron-Deficiency; Erythrocytes; Ascorbic Acid; Iron, Dietary
PubMed: 37357807
DOI: 10.1002/ajh.26987 -
Hypertension (Dallas, Tex. : 1979) Jul 2023The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening.
METHODS
A PubMed, EMBASE, and clinicaltrials.gov databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure (BP) parameters (day-time, night-time, and 24/48-hour systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and cardiovascular outcomes.
RESULTS
Of 72 randomized controlled trials included, evening dosing significantly reduced ambulatory BP parameters: 24/48-hour SBP (mean difference [MD]=1.41 mm Hg; [95% CI, 0.48-2.34]), DBP (MD=0.60 mm Hg [95% CI, 0.12-1.08]), night-time SBP (MD=4.09 mm Hg [95% CI, 3.01-5.16]), DBP (MD, 2.57 mm Hg [95% CI, 1.92-3.22]), with a smaller reduction in day-time SBP (MD=0.94 mm Hg [95% CI, 0.01-1.87]), and DBP (MD=0.87 mm Hg [95% CI, 0.10-1.63]), and numerically lower cardiovascular events compared with morning dosing. However, when controversial data by Hermida (23 trials, 25 734 patients) were omitted (<0.05 for most outcomes), the above effect of evening dosing attenuated with no significant effect on 24/48-hour ambulatory blood pressure, day-time BP, and major adverse cardiac event and smaller reduction in night-time ambulatory SBP and DBP.
CONCLUSIONS
Evening dosing of antihypertensive drugs significantly reduced ambulatory BP parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time BP, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects.
Topics: Humans; Antihypertensive Agents; Hypertension; Blood Pressure Monitoring, Ambulatory; Randomized Controlled Trials as Topic; Blood Pressure; Hypotension
PubMed: 37212152
DOI: 10.1161/HYPERTENSIONAHA.122.20862