Study Emphasizes the Independent Role of Sleep in Metabolic Health

Erica Jansen, PhD, MPH

According to a recent investigation, certain lifestyle factors, including sleep quality and duration, are critical components of adolescent health and are linked with insulin resistance (IR). The investigators collected information on participants' sleep characteristics, physical activity, sedentary behavior, smoking, and insulin resistance.¹

The analysis showed that 51% of the participants were considered insulin resistant, and at follow-up 2 years later, this increased to 57%.

At baseline, sleep assessments were measured using a 7-day wrist actigraphy. The study found that shorter sleep duration and later sleep timing were associated with insulin resistance in late adolescence, providing further evidence of the importance of adequate sleep for maintaining good health and preventing chronic diseases such as type 2 diabetes.

Disease Burden of T2D

Type 2 diabetes is a leading cause of death and morbidity worldwide and is prevalent in the Mexican adult population. However, unhealthy dietary patterns and higher body size in early life have been related to later T2D. Investigators speculated the late pubertal and emerging adulthood stage may be another sensitive period for the development of T2D later in life.

Insulin resistance may continue to remain high or even rise for some adolescents, and persistent postpubertal insulin resistance has been related to weight status. Poor sleep is known as an important risk factor for IR during adolescence. According to previous literature, in Mexican adolescents, both delayed and short sleep duration were associated cross-sectionally with higher IR, an association that was stronger in girls.

Data for the analysis were obtained from a longitudinal birth cohort ELEMENT and included adolescents aged 9-18 years. Insulin resistance of the participants was examined using serum glucose and insulin at 2 study visits during peri-puberty, which occurred approximately 2 years apart.

Sleep Health and Insulin Resistance

The investigators, led by Erica Jansen, PhD, MPH, from the Department of Nutritional Sciences at the University of Michigan School of Public Health, analyzed participants according to 4 groups: no insulin resistance over the follow-up period, transition from normal to insulin resistance, transition from insulin resistance to normal, and insulin resistance at both time points.

Multinomial logistic regression models were used to evaluate associations between sleep duration and timing with homeostatic model assessment of insulin resistance categories, adjusting for age, sex, and baseline pubertal status.

The results demonstrated that younger adolescents were more likely to meet the recommended sleep duration and have less social jetlag than older adolescents. While physical activity was not associated with insulin resistance, smoking and increases in adiposity were.

Those who were younger at baseline were more likely to transition from insulin resistant to normal over the follow-up period. Additionally, investigators observed that females were more likely to transition into and out of insulin resistance, whereas males were more likely to have normal insulin resistance at both time points.

Changes in adiposity did not mediate the relationship between sleep and insulin resistance, which emphasized the independent role of sleep in metabolic health, according to the team. Overall, these results underscore the critical role of adequate sleep in maintaining good health and preventing chronic diseases like type 2 diabetes in late adolescence.

References:

1. Jansen, EC, Burgess, HJ, Chervin, RD, et al. Sleep duration and timing are prospectively linked with insulin resistance during late adolescence. Obesity (Silver Spring). 2023; 1- 11. doi:10.1002/oby.23680