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Bariatric Surgery

Late bedtime is associated with lower weight loss in patients with severe obesity after sleeve gastrectomy

International Journal of Obesity volume 45, pages 1967–1975 (2021)Cite this article

Subjects

Abstract

Background

Previous research has shown that sleep can play a role in obesity and weight loss. However, the association of sleep with weight loss in patients with severe obesity after bariatric surgery remains unexplored. We aimed to evaluate the role of sleep in weight loss evolution in a cohort of patients who underwent sleeve gastrectomy.

Methods

A cohort of 252 patients with severe obesity (75.7% women; age [mean ± SD] 47.7 ± 10.8 years; BMI 44.2 ± 5.9 kg/m2) was followed for 1 year after surgery. Anthropometric, biochemical, physical activity, sleep (bedtime, wakeup time, and sleep duration) and dietary intake variables were collected pre- and post-surgery (1 year). Linear and non-linear regression models were used to examine the associations between sleep variables and weight loss. Participants were grouped into ‘early’ and ‘late’ sleepers according to a bedtime threshold (before or after 24:00 h), and the differences in weight loss, physical activity, meal timing, and dietary intake between groups were studied.

Results

1-h increments in bedtime were linearly associated with less excess weight loss (EWL) [−2.23%; 95%CI: −3.37; −0.70; p = 0.005] 1 year after the sleeve gastrectomy. Late sleepers lost less weight (−5.64% of EWL [95%CI: −10.11; −1.17]; p = 0.014) when compared to early sleepers and showed a higher energy intake after 21:00 h (8.66% of total energy intake [95% CI: 4.87; 12.46]; p < 0.001).

Conclusions

Late bedtime is associated with less success of weight loss 1 year after the sleeve gastrectomy. Late sleepers consumed more of their calories closer to bedtime. Our results highlight the relevance of considering recommendations on bedtime and meal timing for patients after bariatric surgery.

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Fig. 1: Restricted cubic spline model of the association between bedtime and weight loss after 1 year of surgery (expressed as %EWL).
Fig. 2: Evolution of weight loss expressed as percentage of excess of weight loss (%EWL) over 1 year after laparoscopic sleeve gastrectomy in early (before 24:00 h) and late sleepers (after 24:00 h).

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References

  1. Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, et al. Worldwide trends in body mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

    Article  Google Scholar 

  2. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14:160–9.

    Article  PubMed  Google Scholar 

  3. Himpens J, Ramos A, Welbourn R, Dixon H, Kinsman R, Walton P. The 4th IFSO Global Registry Report 2018. Oxfordshire, United Kingdom; 2018.

  4. Robinson A, Adler S, Stevens H, Darcy A, Morton J, Safer D. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? Surg Obes Relat Dis. 2014;10:697–704.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Courcoulas A, Yanovski S, Bonds D, Eggerman T, Horlick M, Staten M. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149:1323–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Holsen LM, Davidson P, Cerit H, Hye T, Moondra P, Haimovici F, et al. Neural predictors of 12-month weight loss outcomes following bariatric surgery. Int J Obes. 2018;42:785–93.

    Article  CAS  Google Scholar 

  7. Wallwork A, Tremblay L, Chi M, Sockalingam S. Exploring partners’ experiences in living with patients who undergo bariatric surgery. Obes Surg. 2017;27:1973–81.

    Article  PubMed  Google Scholar 

  8. Ruíz-Lozano T, Vidal J, de Hollanda A, Scheer F, Garaulet M, Izquierdo-Pulido M. Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery. Clin Nutr. 2016;35:1308–14.

    Article  PubMed  Google Scholar 

  9. Ruíz-Lozano T, Vidal J, de Hollanda A, Canteras M, Garaulet M, Izquierdo-Pulido M. Evening chronotype associates with obesity in severely obese subjects: interaction with CLOCK 3111T/C. Int J Obes. 2016;40:1550–7.

    Article  CAS  Google Scholar 

  10. Zuraikat FM, Thomas E, Roeshot D, Gallagher D, St-Onge MP. Can healthy sleep improve long-term bariatric surgery outcomes? Results of a pilot study and call for further research. Obesity. 2019;27:1769–71.

    Article  PubMed  Google Scholar 

  11. Martín E, Ruiz-Tovar J, Sánchez R. Vía Clínica de Cirugía Bariátrica 2017. Albacete, España; 2017.

  12. Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for. Endocr Pract. 2013;19:337–72.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Figura A, Ahnis A, Stengel A, Hofmann T, Elbelt U, Ordemann J. et al. Determinants of weight loss following laparoscopic sleeve gastrectomy: the role of psychological burden, coping style, and motivation to undergo surgery. J Obes. 2015;2015:626010

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cantós D, Farran-Codina A & Palma-Linares I. Programa de Càlcul Nutricional PCN Pro versió 1 [software]. University of Barcelona; 2013.

  15. Farran-Codina A, Zamora RCP Tablas de Composición de Alimentos del CESNID [CESNID food-composition tables]. McGraw-Hil. Barcelona, Spain; 2004.

  16. Mota MC, Silva C, Cristina L, Balieiro T, Gonçalves B, Fahmy W, et al. Association between social jetlag food consumption and meal times in patients with obesity-related chronic diseases. PLoS One. 2019;14:1–14.

    Article  CAS  Google Scholar 

  17. Xiao Q, Garaulet M, Scheer FAJL. Meal timing and obesity: interactions with macronutrient intake and chronotype. Int J Obes. 2019;43:1701–11.

    Article  Google Scholar 

  18. Roman-Viñas B, Serra-Majem L, Hagströmer M, Ribas-Barba L, Sjöström M, Segura-Cardona R. International Physical Activity Questionnaire: reliability and validity in a Spanish population. Eur J Sport Sci. 2010;10:297–304.

    Article  Google Scholar 

  19. Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4:97–110.

    CAS  PubMed  Google Scholar 

  20. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67:1–48.

    Article  Google Scholar 

  21. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2019. https://www.r-project.org/.

  22. Kenny DA. Mediation [Internet]. 2018. http://davidakenny.net/cm/mediate.htm#RR. Accessed 8 Apr 2020.

  23. Mascha EJ, Dalton JE, Kurz A, Saager L. Understanding the mechanism: mediation analysis in randomized and nonrandomized studies. Anesth Analg. 2013;117:980–94.

    Article  PubMed  Google Scholar 

  24. Hayes AJ. PROCESS Macro [Internet]. New York; 2018. http://www.processmacro.org.

  25. Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity. 2011;19:1374–81.

    Article  PubMed  Google Scholar 

  26. Lucassen EA, Zhao X, Rother KI, Mattingly MS, Courville AB, Jonge LDE, et al. Evening chronotype is associated with changes in eating behavior, more sleep apnea, and increased stress hormones in short sleeping obese individuals. PLoS One. 2013;8:e56519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Baron KG, Reid KJ, Kim T, Van Horn L, Attarian H, Wolfe L, et al. Circadian timing and alignment in healthy adults: associations with BMI, body fat, caloric intake and physical activity. Int J Obes. 2017;41:203–9.

    Article  CAS  Google Scholar 

  28. Roenneberg T, Allebrandt KV, Merrow M. Social Jetlag and obesity. Curr Biol. 2012;23:737.

    Article  CAS  Google Scholar 

  29. Roenneberg T, Pilz LK, Zerbini G, Winnebeck ECChronotype. and Social Jetlag—a (self-) critical review. Biology. 2019;8:54.

    Article  PubMed Central  Google Scholar 

  30. Parsons MJ, Moffitt TE, Gregory AM, Goldman-Mellor S, Nolan PM, Poulton R, et al. Social jetlag, obesity and metabolic disorder: Investigation in a cohort study. Int J Obes. 2015;39:842–8.

    Article  CAS  Google Scholar 

  31. Wong PM, Hasler BP, Kamarck TW, Muldoon MF, Manuck SB. Social Jetlag, chronotype, and cardiometabolic. Risk. 2015;100:4612–20.

    CAS  Google Scholar 

  32. Mota MC, Silva CM, Balieiro LCT, Fahmy WM, Crispim CA. Social jetlag and metabolic control in non-communicable chronic diseases: a study addressing different obesity statuses. Sci Rep. 2017;7:6358.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity. 2013;21:2504–12.

    Article  CAS  PubMed  Google Scholar 

  34. Lombardo M, Bellia A, Padua E, Annino G, Gublielmi V, D’Adamo M, et al. Morning meal more efficient for fat loss in a 3-month lifestyle intervention. J Am Coll Nutr. 2014;33:198–205.

    Article  PubMed  Google Scholar 

  35. Keim NL, Van Loan MD, Horn WF, Barbieri TF, Mayclin PL. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. J Nutr. 1997;127:75–82.

    Article  CAS  PubMed  Google Scholar 

  36. Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Beneficial effect of high energy intake at lunch rather than dinner on weight loss in healthy obese women in a weight-loss program: a randomized clinical trial. Am J Clin Nutr. 2016;104:982–9.

    Article  CAS  PubMed  Google Scholar 

  37. Wang JB, Patterson RE, Ang A, Emond JA, Shetty N, Arab L. Timing of energy intake during the day is associated with the risk of obesity in adults. J Hum Nutr Diet. 2014;27:255–62.

    Article  PubMed  Google Scholar 

  38. Baron KG, Reid KJ, Van Horn L, Zee PC. Contribution of evening macronutrient intake to total caloric intake and body mass index. Appetite. 2013;60:246–51.

    Article  CAS  PubMed  Google Scholar 

  39. Kutsuma A, Nakajima K, Suwa K. Potential association between breakfast skipping and concomitant late-night-dinner eating with metabolic syndrome and proteinuria in the Japanese population. Sci. 2014;2014:253581.

    Google Scholar 

  40. Fong M, Caterson ID, Madigan CD. Are large dinners associated with excess weight, and does eating a smaller dinner achieve greater weight loss? A systematic review and meta-analysis. Br J Nutr. 2017;118:616–28.

    Article  CAS  PubMed  Google Scholar 

  41. Beccuti G, Monagheddu C, Evangelista A, Ciccone G, Broglio F, Soldati L, et al. Timing of food intake: sounding the alarm about metabolic impairments? A systematic review. Pharmacol Res. 2017;125:132–41.

    Article  PubMed  Google Scholar 

  42. McCrory MA, Shaw AC, Lee JA. Energy and nutrient timing for weight control. Does timing of ingestion matter? Endocrinol Metab Clin. 2016;45:689–718.

    Article  Google Scholar 

  43. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135:e96–121.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Mchill AW, Phillips AJK, Czeisler CA, Keating L, Yee K, Barger LK, et al. Later circadian timing of food intake is associated with increased body fat. Am J Clin Nutr. 2017;106:1213–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Morris CJ, Garcia JI, Myers S, Yang JN, Trienekens N, Scheer FA. The human circadian system has a dominating role in causing the morning/evening difference in diet-induced thermogenesis. Obesity. 2015;23:2053–8.

    Article  PubMed  Google Scholar 

  46. Lopez-Minguez J, Saxena R, Bandín C, Scheer FA, Garaulet M. Late dinner impairs glucose tolerance in MTNR1B risk allele carriers: a randomized, cross-over study. Clin Nutr. 2018;37:1133–40.

    Article  CAS  PubMed  Google Scholar 

  47. Chaix A, Manoogian ENC, Melkani GC, Panda S. Time-restricted eating to prevent and manage chronic metabolic diseases. Annu Rev Nutr. 2019;39:1–25.

    Article  CAS  Google Scholar 

  48. Gill S, Panda S. A smartphone app reveals erratic diurnal eating patterns in humans that can be modulated for health benefits. Cell Metab. 2015;22:789–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Ross KM, Thomas JG, Wing RR. Successful weight loss maintenance associated with morning chronotype and better sleep quality. J Behav Med. 2016;39:465–71.

    Article  PubMed  Google Scholar 

  50. Giacchetti-Vega M, Baquerizo-VonBerswordts P, Carbone-Moane C, Bernabé-Ortiz A. Abandono de la terapia nutricional y pérdida de peso en pacientes bariátricos: cohorte retrospectiva en Lima. Perú. Rev Esp Nutr Humana Diet. 2017;21:18–28.

    Article  Google Scholar 

  51. Michelini I, Falchi AG, Muggia C, Grecchi I, Montagna E, De Silvestri A, et al. Early dropout predictive factors in obesity treatment. Nutr Res Pract. 2014;8:94–102.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

MFZR was supported by a scholarship from the ‘Consejo Nacional de Ciencia y Tecnologia’ CONACYT from Mexico. AH was supported by a Sara Borrell post-doctoral contract (CD17/00122) granted by the Instituto de Salud Carlos III (Spain).

Author information

Author notes

  1. These authors contributed equally: Cristina Barnadas-Solé, María Fernanda Zerón-Rugerio

Authors and Affiliations

  1. Clínica Sagrada Familia, Barcelona, Spain

    Cristina Barnadas-Solé & Javier Foncillas-Corvinos

  2. Hospital Universitari del Sagrat Cor de Barcelona, Barcelona, Spain

    Cristina Barnadas-Solé & Javier Foncillas-Corvinos

  3. Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain

    María Fernanda Zerón-Rugerio & Maria Izquierdo-Pulido

  4. INSA-UB, Nutrition and Food Safety Research Institute, Barcelona, Spain

    María Fernanda Zerón-Rugerio & Maria Izquierdo-Pulido

  5. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain

    Álvaro Hernáez

  6. Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Álvaro Hernáez

  7. Department of Biochemistry and Physiology, School of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain

    Trinitat Cambras

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Contributions

CB and MIP designed the study; CB and JFC acquired the data; CB, MFZR, AH and MIP analysed the data; CB, MFZR and MIP wrote the first draft; MFZR, AH, TC and MIP revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Maria Izquierdo-Pulido.

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Barnadas-Solé, C., Zerón-Rugerio, M.F., Hernáez, Á. et al. Late bedtime is associated with lower weight loss in patients with severe obesity after sleeve gastrectomy. Int J Obes 45, 1967–1975 (2021). https://doi.org/10.1038/s41366-021-00859-6

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