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Plant-based dietary patterns and risk of insomnia: a prospective study

European Journal of Clinical Nutrition volume 78, pages 228–235 (2024)Cite this article

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Abstract

Background

Accumulating evidence suggests that dietary factors may affect sleep, but the associations between dietary patterns and insomnia risk have been poorly explored. The aim of this study was to investigate if plant-based diets are associated with reduced insomnia risks in a cohort study design.

Methods

Tzu Chi Health Study participants (N = 5821) recruited from 2007 to 2009 without insomnia were followed until 2018. A traditional classification method (vegetarians vs. non-vegetarians) and a healthful plant-based index (hPDI) were used to define adherence to plant-based dietary patterns. Incident cases of insomnia were ascertained by linking with the National Health Insurance Research Database (NHIRD). Associations between plant-based diets and insomnia were estimated using Cox proportional hazard models.

Results

A total of 464 incident cases of insomnia were identified in the 55,562 person-years of follow up. Insomnia risk was lower in vegetarians when compared to non-vegetarians, hazard ratios (HR) 0.47 (95% CI: 0.27, 0.81) and 0.71 (95% CI: 0.55, 0.91) for males and females respectively. Male participants with the highest hPDI were associated with a significant lower risk of insomnia (HR 0.50 [95% CI: 0.30, 0.85]) when compared to those in the lowest quintile. No association between adherence to hPDI and insomnia in female participants was observed.

Conclusions

Our study showed that vegetarians are associated with a lower risk of insomnia, but there may be sex-specific associations between adherence to hPDI and insomnia risk. These favorable associations are important when considering plant-based diets for their potential additional sleep benefits.

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Data availability

The current study’s datasets are in the Health and Welfare Data Science Center (HWDC). As per local law and regulation, National Health Insurance Research Database (NHIRD) data can only be accessed and analyzed within the facility of the HWDC. To access these data, one must apply to the HWDC of the Ministry of Health in Taiwan.

References

  1. American Psychiatric Association, DSMTF, et al. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013.

  2. Kao C-C, Huang C-J, Wang M-Y, Tsai P-S. Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Qual Life Res. 2008;17:1073–80.

    Article  PubMed  Google Scholar 

  3. Tobaldini E, Costantino G, Solbiati M, Cogliati C, Kara T, Nobili L, et al. Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases. Neurosci Biobehav Rev. 2017;74:321–9.

    Article  PubMed  Google Scholar 

  4. Sivertsen B, Pallesen S, Glozier N, Bjorvatn B, Salo P, Tell GS, et al. Midlife insomnia and subsequent mortality: the Hordaland health study. BMC Public Health. 2014;14:720.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Javaheri S, Redline S. Insomnia and risk of cardiovascular disease. Chest. 2017;152:435–44.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K, Johann A, et al. Insomnia as a predictor of mental disorders: a systematic review and meta-analysis. Sleep Med Rev. 2019;43:96–105.

    Article  PubMed  Google Scholar 

  7. Kyle SD, Morgan K, Espie CA. Insomnia and health-related quality of life. Sleep Med Rev. 2010;14:69–82.

    Article  PubMed  Google Scholar 

  8. Banks S. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3:519–28.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Matthews EE, Arnedt JT, McCarthy MS, Cuddihy LJ, Aloia MS. Adherence to cognitive behavioral therapy for insomnia: a systematic review. Sleep Med Rev. 2013;17:453–64.

    Article  PubMed  Google Scholar 

  10. Schifano F, Chiappini S, Corkery JM, Guirguis A. An insight into Z-drug abuse and dependence: an examination of reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. Int J Neuropsychopharmacol. 2019;22:270–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wang L-J, Chen Y-C, Chen C-K, Chou W-J, Chou M-C. Trends in anxiolytic-hypnotic use and polypharmacy in Taiwan, 2002-2009: a nationwide, population-based survey. Psychiatr Serv. 2014;65:208–14.

    Article  PubMed  Google Scholar 

  12. St-Onge MP, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Adv Nutr. 2016;7:938–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zuraikat FM, Wood RA, Barragán R, St-Onge M-P. Sleep and diet: mounting evidence of a cyclical relationship. Annu Rev Nutr. 2021;41:309–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Binks H, Vincent GE, Gupta C, Irwin C, Khalesi S. Effects of diet on sleep: a narrative review. Nutrients. 2020;12:936.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.

    Article  CAS  PubMed  Google Scholar 

  16. Kurotani K, Kochi T, Nanri A, Eguchi M, Kuwahara K, Tsuruoka H, et al. Dietary patterns and sleep symptoms in Japanese workers: the Furukawa Nutrition and Health Study. Sleep Med. 2015;16:298–304.

    Article  PubMed  Google Scholar 

  17. Cao Y, Taylor AW, Wittert G, Adams R, Shi Z. Dietary patterns and sleep parameters in a cohort of community dwelling Australian men. Asia Pac J Clin Nutr. 2017;26:1158.

    PubMed  Google Scholar 

  18. Campanini MZ, Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E. Mediterranean diet and changes in sleep duration and indicators of sleep quality in older adults. Sleep. 2017;40.3:zsw083.

  19. Castro-Diehl C, Wood AC, Redline S, Reid M, Johnson DA, Maras JE, et al. Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2018;41:zsy158.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Singh RK, Chang HW, Yan D, Lee KM, Ucmak D, Wong K, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15:73.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sen P, Molinero-Perez A, O’Riordan KJ, McCafferty CP, O’Halloran KD, Cryan JF. Microbiota and sleep: awakening the gut feeling. Trends Mol Med. 2021;27:935–45.

    Article  CAS  PubMed  Google Scholar 

  22. Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol. 2019;19:702–15.

    Article  CAS  PubMed  Google Scholar 

  23. Friedman M. Analysis, nutrition, and health benefits of tryptophan. Int J Tryptophan Res. 2018;11:1178646918802282.

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  24. Hoefelmann LP, da Silva Lopes A, da Silva KS, da Silva SG, Cabral LGA, Nahas MV. Lifestyle, self-reported morbidities, and poor sleep quality among Brazilian workers. Sleep Med. 2012;13:1198–201.

    Article  PubMed  Google Scholar 

  25. Katagiri R, Asakura K, Kobayashi S, Suga H, Sasaki S. Low intake of vegetables, high intake of confectionary, and unhealthy eating habits are associated with poor sleep quality among middle-aged female Japanese workers. J Occup Health. 2014;56:359–68.

  26. Gangwisch JE, Hale L, St-Onge MP, Choi L, LeBlanc ES, Malaspina D, et al. High glycemic index and glycemic load diets as risk factors for insomnia: analyses from the Women’s Health Initiative. Am J Clin Nutr. 2020;111:429–39.

  27. Lana A, Struijk EA, Arias-Fernandez L, Graciani A, Mesas AE, Rodriguez-Artalejo F, et al. Habitual meat consumption and changes in sleep duration and quality in older adults. Aging Dis. 2019;10:267.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chiu TH, Chang HR, Wang LY, Chang CC, Lin MN, Lin CL. Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan. Neurology. 2020;94:e1112–e1121.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tsai JH, Huang CF, Lin MN, Chang CE, Chang CC, Lin CL. Taiwanese vegetarians are associated with lower dementia risk: a prospective cohort study. Nutrients. 2022;14:588.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bian G, Gloor GB, Gong A, Jia C, Zhang W, Hu J, et al. The gut microbiota of healthy aged Chinese is similar to that of the healthy young. Msphere. 2017;2:e00327–17.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bhupathiraju SN, Sawicki CM, Goon S, Gujral UP, Hu FB, Kandula NR, et al. A healthy plant–based diet is favorably associated with cardiometabolic risk factors among participants of South Asian ancestry. Am J Clin Nutr. 2022;116:1078–90.

  32. Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JE, Willett W, et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults. J Am Coll Cardiol. 2017;70:411–22.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Satija A, Bhupathiraju SN, Rimm EB, Spiegelman D, Chiuve SE, Borgi L, et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med. 2016;13:e1002039.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Li H, Zeng X, Wang Y, Zhang Z, Zhu Y, Li X, et al. A prospective study of healthful and unhealthful plant-based diet and risk of overall and cause-specific mortality. Eur J Nutr. 2022;61:387–98.

    Article  CAS  PubMed  Google Scholar 

  35. Kim H, Caulfield LE, Rebholz CM. Healthy plant-based diets are associated with lower risk of all-cause mortality in US adults. J Nutr. 2018;148:624–31.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chiu TH, Huang HY, Chen KJ, Wu YR, Chiu JP, Li YH, et al. Relative validity and reproducibility of a quantitative FFQ for assessing nutrient intakes of vegetarians in Taiwan. Public health Nutr. 2014;17:1459–66.

    Article  PubMed  Google Scholar 

  37. Rizzo G, Baroni L. Soy, soy foods and their role in vegetarian diets. Nutrients. 2018;10:43.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21:5–17.

    Article  PubMed  Google Scholar 

  39. Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, de Deus Mendonça R, de la Fuente-Arrillaga C, Gómez-Donoso C, et al. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019;365:l1949.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019;365:l1451.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Thorpy M. International classification of sleep disorders. Sleep disorders medicine: Basic Science, Technical Considerations and Clinical Aspects, 2017, p 475–84.

  42. Wu M-P, Lin H-J, Weng S-F, Ho C-H, Wang J-J, Hsu Y-W. Insomnia subtypes and the subsequent risks of stroke: report from a nationally representative cohort. Stroke. 2014;45:1349–54.

    Article  PubMed  Google Scholar 

  43. Chen PJ, Huang CLC, Weng SF, Wu MP, Ho CH, Wang JJ, et al. Relapse insomnia increases greater risk of anxiety and depression: evidence from a population-based 4-year cohort study. Sleep Med. 2017;38:122–9.

    Article  PubMed  Google Scholar 

  44. Ibsen DB, Laursen ASD, Würtz AML, Dahm CC, Rimm EB, Parner ET, et al. Food substitution models for nutritional epidemiology. Am J Clin Nutr. 2021;113:294–303.

    Article  CAS  PubMed  Google Scholar 

  45. Pan WH, Wu SY, Yeh NH, Hung SY. Healthy Taiwanese Eating Approach (TEA) toward Total Wellbeing and Healthy Longevity. Nutrients. 2022;14:2774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Afaghi A, O’Connor H, Chow CM. High-glycemic-index carbohydrate meals shorten sleep onset. Am J Clin Nutr. 2007;85:426–30.

    Article  CAS  PubMed  Google Scholar 

  47. Palego L, Betti L, Rossi A, Giannaccini G. Tryptophan biochemistry: structural, nutritional, metabolic, and medical aspects in humans. J Amino acids. 2016;2016:8952520.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Yoneyama S, Sakurai M, Nakamura K, Morikawa Y, Miura K, Nakashima M, et al. Associations between rice, noodle, and bread intake and sleep quality in Japanese men and women. PloS One. 2014;9:e105198.

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  49. Peuhkuri K, Sihvola N, Korpela R. Diet promotes sleep duration and quality. Nutr Res. 2012;32:309–19.

    Article  CAS  PubMed  Google Scholar 

  50. Chiu TH, Pan WH, Lin MN, Lin CL. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes. 2018;8:12.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding

The establishment of the cohorts was supported by a grant from the Department of Health in Taiwan (DOH94-TD-F-113-044) and a grant from Buddhist Dalin Tzu Chi General Hospital (TCRD: I9605-02). The follow-up was supported by grants from the Buddhist Tzu Chi Medical Foundation (TCMMPSP104-08-02, TCMMP105-13-05, and TCMMP106- 04-01) and a grant from the Ministry of Science and Technology in Taiwan (108-2320-B-030-007). The funders played no role in study design, data collection, analysis, interpretation, or report writing.

Author information

Author notes

  1. These authors contributed equally: Ming-Nan Lin, Po-Hsiu Kuo.

Authors and Affiliations

  1. Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan

    Zuo Hua Gan & Po-Hsiu Kuo

  2. Lianan Wellness Center, Taipei, Taiwan

    Zuo Hua Gan

  3. Department of Nutritional Science, Fu Jen Catholic University, New Taipei City, Taiwan

    Tina H. T. Chiu

  4. Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan

    Chin-Lon Lin

  5. Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan

    Chin-Lon Lin

  6. Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan

    Ming-Nan Lin

  7. Department of Family Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan

    Ming-Nan Lin

  8. Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan

    Po-Hsiu Kuo

  9. Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Po-Hsiu Kuo

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  1. Zuo Hua Gan
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Contributions

All authors contributed to the study’s conception and design. MNL, THTC, and CLL acquired the funding, collected the data, and were involved in the project administration. ZHG and PHK analyzed and interpreted the data. ZHG wrote the manuscript’s first draft, and all authors commented on previous versions. All authors read and approved the final manuscript.

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Correspondence to Po-Hsiu Kuo.

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Gan, Z.H., Chiu, T.H.T., Lin, CL. et al. Plant-based dietary patterns and risk of insomnia: a prospective study. Eur J Clin Nutr 78, 228–235 (2024). https://doi.org/10.1038/s41430-023-01380-x

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