Interacting epidemics? Sleep curtailment, insulin resistance, and obesity

Immunogenetics Section, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Annals of the New York Academy of Sciences (Impact Factor: 4.38). 07/2012; 1264(1):110-34. DOI: 10.1111/j.1749-6632.2012.06655.x
Source: PubMed


In the last 50 years, the average self-reported sleep duration in the United States has decreased by 1.5-2 hours in parallel with an increasing prevalence of obesity and diabetes. Epidemiological studies and meta-analyses report a strong relationship between short or disturbed sleep, obesity, and abnormalities in glucose metabolism. This relationship is likely to be bidirectional and causal in nature, but many aspects remain to be elucidated. Sleep and the internal circadian clock influence a host of endocrine parameters. Sleep curtailment in humans alters multiple metabolic pathways, leading to more insulin resistance, possibly decreased energy expenditure, increased appetite, and immunological changes. On the other hand, psychological, endocrine, and anatomical abnormalities in individuals with obesity and/or diabetes can interfere with sleep duration and quality, thus creating a vicious cycle. In this review, we address mechanisms linking sleep with metabolism, highlight the need for studies conducted in real-life settings, and explore therapeutic interventions to improve sleep, with a potential beneficial effect on obesity and its comorbidities.

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Available from: Eliane A Lucassen
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    • "Four found an association between both short and long sleep duration and weight gain, supporting a U-shaped association (Chaput et al., 2008; Hairston et al., 2010; Lopez- Garcia et al., 2008; Watanabe et al., 2010); four found an association between short sleep duration (but not long sleep) and later weight gain (Gunderson et al., 2008; Hasler et al., 2004; Nishiura & Hashimoto , 2010; Patel et al., 2006); fi ve found no signifi cant associations between sleep duration and subsequent weight gain (Gangwisch et al., 2005; Lauderdale et al., 2009; Littman et al., 2007; Marshall et al., 2010; Stranges et al., 2008). Another review similarly concluded that most, but not all, longitudinal studies fi nd short sleepers to experience greater increases in weight over time; however, average reported weight gains tend to be modest, and there is substantial variability among studies (Lucassen et al., 2012). For example, in the largest longitudinal study to date examining sleep duration in relation to later weight gain (N ϭ 68,183), the Nurses ' Health Study, women free of co-morbid disease who slept 6 h and those sleeping Յ 5 h were 12% and 32% more likely to have a 15 kg weight gain over 16 years compared to those sleeping 7 h, respectively (Patel et al., 2006). "
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    ABSTRACT: Rates of obesity and sleep disturbances are substantial in adults. A number of cross-sectional, longitudinal, and experimental studies have found that insufficient sleep and possibly longer sleep are associated with obesity and related eating patterns. Methodological discrepancies and limitations in the literature create ambiguity about the nature and potential mechanisms underlying these relationships. Insomnia and circadian patterns in eating and sleeping have also been examined in relation to weight. Although these studies are not as extensive as those examining sleep duration, the extant literature suggests possible associations between obesity and both insomnia (particularly when combined with short sleep duration) and circadian eating behaviours. However, research has only just begun to examine the benefits of combining sleep interventions with obesity treatment. The goal of the current review is to summarize research examining behavioural sleep patterns and disorders in relation to obesity, to discuss methodological considerations, and to provide an overview of studies examining whether addressing sleep disturbances can augment weight loss treatment effects. We conclude that future studies are needed that take into account sleep duration, sleep disorder co-morbidity, and chronobiology to explore the impact of sleep interventions on weight loss.
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    • "Interestingly, investigators observed that TRB1 gene variants were independently associated with sleep length and lipid metabolism, and there was a significant increase in TRB1 mRNA expression in the peripheral blood mononuclear cells of people restricted to 4 hrs of sleep compared to those with normal sleep duration [186]. Epidemiological studies demonstrate a strong relationship among shortened sleep duration, obesity, and abnormal glucose metabolism [187]. Further work should elucidate whether alterations in TRB isoform expression provide a mechanistic link between sleep duration and metabolic homeostasis. "
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    ABSTRACT: In 2000, investigators discovered Tribbles, a Drosophila protein that coordinates morphogenesis by inhibiting mitosis. Further work has delineated Xenopus (Xtrb2), Nematode (Nipi-3), and mammalian homologs of Drosophila tribbles, which include TRB1, TRB2, and TRB3. The sequences of tribbles homologs are highly conserved, and despite their protein kinase structure, to date they have not been shown to have kinase activity. TRB family members play a role in the differentiation of macrophages, lymphocytes, muscle cells, adipocytes, and osteoblasts. TRB isoforms also coordinate a number of critical cellular processes including glucose and lipid metabolism, inflammation, cellular stress, survival, apoptosis, and tumorigenesis. TRB family members modulate multiple complex signaling networks including mitogen activated protein kinase cascades, protein kinase B/AKT signaling, mammalian target of rapamycin, and inflammatory pathways. The following review will discuss metazoan homologs of Drosophila tribbles, their structure, expression patterns, and functions. In particular, we will focus on TRB3 function in the kidney in podocytes. This review will also discuss the key signaling pathways with which tribbles proteins interact and provide a rationale for developing novel therapeutics that exploit these interactions to provide better treatment options for both acute and chronic kidney disease.
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    • "Specific to the issue of weight gain, a lack of sleep increases insulin resistance, downregulates the satiety hormone leptin, upregulates the appetite-stimulating hormone ghrelin, and increases hunger and food intake.66-69 Thus, identifying and properly managing sleep disorders should be incorporated into an effective weight management program. "
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    ABSTRACT: Objective The purpose of this commentary is to discuss modern lifestyle factors that promote weight gain and to suggest methods for clinicians to more effectively educate patients about weight management. Discussion Most adults in the United States are overweight or obese. Multiple factors related to the modern lifestyle appear to play causal roles. In general, the population maintains sedentary lives and overconsumes calorie-dense foods. In particular, refined carbohydrates negatively impact metabolism and stimulate neural addiction mechanisms, which facilitate weight gain. As adipose tissue mass accumulates, satiation centers in the hypothalamus become resistant to insulin and leptin, which leads to increased caloric consumption. Several behavior issues further augment weight gain, such as eating too quickly, a lack of sleep, high stress levels, and a lack of exercise. Finally, adipose tissue accumulation alters the body weight set point, which leads to metabolic changes that function to resist weight loss efforts. Each of these factors may work together to augment weight gain and promote obesity. Health care providers, such as chiropractic physicians, who educate patients on wellness, prevention, and lifestyle changes are well positioned to address these issues. Conclusion People need to be educated about the modern lifestyle factors that prevent effective weight management. Without this knowledge and the associated practical application of lifestyle choices that prevent weight gain, becoming overweight or obese appears to be an unavoidable consequence of living a modern lifestyle.
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