Edited by: David Gozal, University of Chicago, United States
Reviewed by: Catherine Huggins, Monash University, Australia; Thirumagal Kanagasabai, McGill University, Canada
†These authors have contributed equally to this work.
Specialty section: This article was submitted to Sleep and Chronobiology, a section of the journal Frontiers in Neurology
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This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.
In contrast to other lifestyle risk factors of chronic disease, sleep has not been accorded the same amount of attention in public health or clinical research and practice until recently. There exist complex processes linking sleep duration, quality, and behaviors to both nutrition and risk of chronic disease (Figure
Conceptual framework for the interconnections between dietary factors, sleep, and disease. The complex, bidirectional, relationship between sleep components, dietary composition, behavioral factors, and biological factors are theorized to affect the development of chronic diseases and other health outcomes. Intake of nutrients and foods and dietary behaviors are correlated with components of sleep quality and quantity. Dietary components and eating behaviors are regulated by biological factors, which in turn may impact nutritional status. Similarly, sleep quantity and quality result in biological factors being modulated, and these biological factors control sleep factors in return. Dietary components, sleep components, and biological factors have subsequent independent as well as interactive effects on downstream health outcomes. Notably, this multifaceted interaction is evident early in life and continues throughout the life course.
Dietary composition, with a focus on specific dietary components, has been shown to influence sleep duration, quality, and behaviors (
Example of studies linking dietary components and sleep outcomes.
Study design | Participants | Dietary component | Sleep outcome | Reference |
---|---|---|---|---|
Laboratory-based intervention | Young healthy males | High-carbohydrate/low-fat (vs. low-carbohydrate/high-fat or balanced isocaloric diets) | Less slow-wave sleep | Phillips et al. ( |
Laboratory-based experiment | Young healthy males | High-glycemic index carbohydrate meals (vs. low glycemic index) | Shortening of sleep onset latency | Afaghi et al. ( |
Cross-sectional survey | Adults (general population) | Fat intake | Decreased sleep duration | Shi et al. ( |
Parallel, randomized, controlled, open label trial | Men with obesity and moderate to severe obstructive sleep apnea | Liquid very low energy diet followed by gradual normal food (vs. usual diet) | Improved obstructive sleep apnea | Johansson et al. ( |
Longitudinal cohort | 3-month-old infants followed-up until age 2 | Higher energy intakes at the evening meal | Longer sleep duration | Diethelm et al. ( |
Carbohydrates (especially from high GI or high GL foods) | ||||
Randomized, crossover intervention | Inpatient normal weight adults | Low fiber, high-saturated fat, and sugar intake vs. |
Lighter, less restorative sleep with more arousals | St-Onge et al. ( |
Double-blind, placebo-controlled trial | Healthy young adults | Tryptophan-rich diet (vs. tryptophan-low placebo protein) | Reduced sleepiness and sustained alertness in the following morning | Markus et al. ( |
Double-blind, placebo-controlled clinical trial | Older adults with primary insomnia in a long-term care facility | Food supplement with melatonin, magnesium, and zinc (vs. placebo) | Improved sleep quality (getting to sleep, quality of sleep, alertness upon awakening) and sleep time | Rondanelli et al. ( |
Cross-sectional analysis | Adults (general population) | Deficiency in vitamin B1, folate, iron, zinc, phosphorus, magnesium, and selenium | Shorter sleep duration | Grandner et al. ( |
Cross-sectional analysis | Adults (general population) | Deficiency in alpha-carotene, selenium, calcium, vitamin D, lycopene, and vitamin C | Difficulty falling asleep, sleep maintenance, or non-restorative sleep | Grandner et al. ( |
Double-blind, clinical trial | Adults with sleep disorders | Vitamin D supplement (vs. placebo) | Improved sleep quality, reduced sleep latency, increased sleep duration, and improved subjective sleep quality | Majid et al. ( |
Randomized, double-blinded, placebo-controlled parallel group trial | Healthy adults | Zinc-rich food (vs. zinc-, and astaxanthin-rich food or placebo supplemented with zinc-enriched yeast and astaxanthin oil, or placebo) | Decreased time needed to fall asleep and improved sleep efficiency | Saito et al. ( |
Randomized, double-blind, placebo-controlled, crossover | Healthy elderly | Fermented milk drink (vs. placebo drink) | Improved sleep efficiency and number of wakening episodes | Yamamura et al. ( |
Randomized, double-blind, crossover | Healthy older adults with chronic insomnia | Tart cherry juice beverage (vs. placebo) | Reduction in insomnia severity | Pigeon et al. ( |
Laboratory-based experiment | Middle-aged and elderly healthy adults | Jerte Valley cherry cultivars | Beneficial effects on sleep time, total nocturnal activity, assumed sleep, and immobility | Garrido et al. ( |
Free-living, self-controlled diet | Adults with self-reported sleep disturbance | Kiwi fruit | Improved sleep onset, duration, and efficiency | Lin et al. ( |
Randomized, placebo-controlled | Inpatient male adults | Atlantic salmon (vs. alternative meal, i.e., pork, beef, and chicken) | Better daily functioning | Hansen et al. ( |
Cross-sectional analysis | Middle-aged and older adults | Oily fish consumption | Better sleep quality | Del Brutto et al. ( |
Cross-sectional survey | Middle-school children | “Unhealthy eating habits and environments” and “snacking between meals and after supper” (identified by factor analysis) | Shorter sleep and poor sleep quality | Khan et al. ( |
Cross-sectional analysis | Healthy adult men | Percentage of energy from protein, energy-adjusted intake of sodium, vitamin D, and vitamin B12, intake of bread, pulses, and fish and shellfish | Longer sleep duration | Komada et al. ( |
Micronutrients intake have also been suggested to affect sleep patterns. For example, associations have been reported for deficiencies in vitamin B1, folate, phosphorus, magnesium, iron, zinc, and selenium with shorter sleep duration (
Intake of stimulant-containing foods and beverages similarly affects elements of sleep. Caffeine and theobromine are competitive antagonists to adenosine, a hormone that regulates sleep–wake cycles (
There is evidence that particular whole foods affect sleep. For example, milk, fatty fish, cherries, and kiwis have been associated with beneficial effects on sleep outcomes (
Growing evidence suggests that sleep patterns, such as short (<7 h) and long (>9 h) sleep duration, can impact risk of chronic disease (
Biologically, sleep influences the circulating levels of the hunger signaling hormones ghrelin and leptin. Ghrelin indicates hunger and leptin signals satiety; sleep deprivation causes high levels of ghrelin and low levels of leptin. Therefore, the hormonal imbalance of ghrelin and leptin may induce overeating behaviors (
Another pathway by which sleep deprivation and disorders contribute to metabolic dysregulation is through activation of the hypothalamic–pituitary–adrenal (HPA) axis, which deregulates neuroendocrine parameters such as cortisol, leading to downstream increases in glucose and insulin and decreases in adiponectin levels (
Circadian disturbances are another possible mechanism linking short sleep behaviors (such as shift work and sleep deprivation) and dietary behaviors and intake (meals irregularity and infrequency) to weight-related outcomes (
As for behavioral mechanisms, both short sleep duration and poor sleep quality are correlated with increased energy intake, poor diet quality, and dysregulated dietary patterns, which can lead to weight gain (
Sleep deficiency may thus promote excess energy intake by affecting both eating behaviors and dietary composition (
While the association between sleep and weight gain has been well studied and appears robust (
Finally, there is emerging evidence regarding the association between long sleep duration, usually defined as more than 9 h of sleep, and chronic disease (
The complex relationship between diet, sleep, and risk factors for chronic disease becomes evident early in life and continues throughout the life course. The impact of dietary composition on sleep patterns has been observed in early childhood. In a cohort of 1- and 2-year-old children, higher energy intake during the evening meal was associated with longer sleep duration (
Similar to the pattern observed in young children, adolescents that report short sleep duration have elevated ghrelin and relatively low leptin levels (
Much of the research regarding the relationship between diet and sleep has been conducted in healthy, young or middle-aged adult populations. There is less evidence regarding the relationship between sleep and nutrition in the elderly, or in subgroups with preexisting conditions. The limited research conducted with the elderly echoes that found in younger populations. Among the elderly, poor sleep quality has been associated with obesity, hypertension, metabolic syndrome, and type 2 diabetes (
According to the National Sleep Foundation, both diet quality and sleep duration are poor and have been declining steadily in the U.S. population (
Nevertheless, there are few official sleep recommendations available to guide health practitioners and the general population. In the U.S., the National Sleep Foundation has published age-specific, evidence-based recommendations for sleep duration to lower the risk of chronic disease (
In addition, there should be efforts to incorporate sleep-related content into existing interdisciplinary programs that target nutrition and other relevant aspects of health. Initial work in this area has been promising. For example, in a community-based intervention focused on wellness, participants experienced improvements in dietary quality, sleep duration, and indicators of obesity (
Additional strategies could help improve the approach to sleep and nutrition in the clinical setting. We recommend the following actions: (1) train and educate health-care professionals on the relationship between diet and sleep, particularly those caring for at-risk groups; (2) develop and apply rapid, validated screeners to assess diet composition, eating behaviors, and sleep patterns, to help identify and counsel at-risk patients; and (3) develop new and integrative therapies that account for the critical associations between diet and sleep.
Despite the evidence and public health recommendations presented here, there is still a gap in understanding the complex relationship between sleep, diet, and nutrition, and risk for chronic disease. Much of the evidence to date has been done in cross-sectional studies or small trials, making it difficult to define causal pathways between various dietary components and sleep or to generalize results. More research is needed to understand the mechanisms by which specific nutrients, foods, and eating behaviors impact quality and quantity of sleep. This could be achieved through laboratory studies, larger randomized clinical trials, and longitudinal analyses of diet and sleep outcomes. Similarly, these studies can help identify potential mechanisms that mediate the relationship between sleep, diet, and risk for chronic disease. Future research should seek to strengthen the evidence linking short and long sleep duration and risk of chronic disease. Such research would inform clinical and public health recommendations regarding the specific dietary and sleep behaviors associated with the lowest risk of developing chronic conditions.
At the population level, emerging research has explored the social determinants of sleep in the U.S. A recent study found that poor sleep quality was directly related to indicators of socioeconomic status and race/ethnicity, with African-American and Hispanic/Latino populations reporting the poorest sleep quality (
SF, KG, LL-A, and MY conceptualized the topic, researched and analyzed the background literature, and wrote the manuscript, including interpretations and conclusions. JM analyzed the content to prepare the table and portions of the figure and manuscript. MT and JM provided substantial scholarly guidance on the conception of the topic, manuscript draft and interpretation, and revised the manuscript critically for intellectual content. All the authors approved the final version of the manuscript, ensured the accuracy and integrity of the work, and agreed to be accountable for all aspects of the work.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors appreciate the comments from our colleagues from the 2016 Principles of Nutrition course at Harvard TH Chan School of Public Health. The authors recognize Brett O. Otis, Amina Gueye, and Xiaolu Amelia Zhang Gross for creating the graphic design of the figure.