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Lifestyle Update (Part 2)
We are becoming increasingly aware if the importance of sleep in every aspect of our lives. Two recent papers add to the growing body of evidence of the need for regular adequate sleep.

The first study looked at whether distinct sleep status trajectories are associated with differential glycaemic dynamics in the general (non-diabetic) population. This cohort study1 analysed data collected in the Guangzhou Nutrition and Health Study, a prospective cohort in China, among participants aged 46 to 83.

Participants who had repeated sleep assessments at several study visits and were equipped with continuous glucose monitoring (CGM) devices at the last visit were included.

Dr Ray O’Connor

The study group consisted of 1,156 participants (mean age, 63.0 years, 816 [70.6 per cent] women). The authors identified four distinct sleep duration trajectory groups: severe inadequate, moderate inadequate, mild inadequate, and adequate. The findings were that the trajectories of long-term insufficient sleep duration and persistent late sleep onset, whether alone or in combination, were associated with greater fluctuations in blood glucose levels as monitored by continuous glucose monitoring.

The authors concluded that their findings provide important evidence supporting the health benefit of sufficient sleep duration and early sleep onset for optimizing glycaemic control in adults.

Hypertension onset has been linked to sleep, but the precise sleep duration affecting it is unclear. The goal of this systematic review and meta analysis2 was to assess the level of sleep duration that is associated with hypertension incidence to help focus advice on prevention and management.

The authors search focused on cohort studies examining the association between nighttime sleep duration and hypertension risk in adults aged 18 and above. They found that out of the 173,734 participants included in the meta-analysis, 41,528 eventually developed hypertension. The analysis revealed a correlation between short sleep duration and increased risk of hypertension: 1.07 for those sleeping ≤ 7 h and 1.17 for < 6 h.

The figures were slightly worse for women and those aged under 60. There was no association between night-time sleep duration more than 8 h and the development of hypertension, suggesting that lack of sleep rather than excessive sleep is related to the onset of hypertension. The authors’ conclusion is that hypertension is significantly correlated with sleep duration under 7 h, highlighting the importance of sleep management in hypertension prevention and treatment strategies.

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases, and ultimately, mortality, as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes.

Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. This consensus paper3 provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults.

Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided.

The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts.

Midlife is the period of life between early adulthood and old age, typically between the ages of 40 and 65. This period is characterized by a variety of physical, psychological, and social changes, particularly in women as it coincides with the menopause transition. Concerns about weight are common among women during midlife, with reports of weight gain and increased abdominal adiposity, occurring in isolation or together.

The purpose of this narrative review⁴ was to summarize the evidence and clinical implications of weight and body composition changes during midlife in women, and provide an overview of weight gain prevention and management in this population.

The findings were that aging-related changes such as decreased energy expenditure and physical activity, are important culprits for weight gain in midlife women. The hormonal changes of menopause also influence body adiposity distribution and increase central adiposity. These body changes can have health consequences including the development of cardiometabolic diseases, osteoarthritis, cancer, worsening in cognition, mental health, and menopause symptoms.

The authors conclude that clinical practice should focus on early counselling and anticipatory guidance.

Effective countermeasures against the adverse cardiovascular effects of circadian misalignment, such as effects experienced due to night work or jet lag, remain to be established in humans. The aim of this secondary analysis was to test whether eating only during daytime can mitigate such adverse effects vs. eating during the night and day (typical for night shift workers) under simulated night work.

The study5 was a single-blind, parallel-arm trial which randomized 20 healthy participants (non-shift workers) to simulated night work with meals consumed during night and day or only during daytime.

The findings indicated that daytime eating, despite mistimed sleep, may mitigate changes in cardiovascular risk factors and offer translational evidence for developing a behavioural strategy to help minimize the adverse changes in cardiovascular risk factors in individuals exposed to circadian misalignment, such as shift workers.

More evidence of socioeconomic inequalities in disability-free life expectancy (DFLE) is needed to help develop approaches to narrow the gap between the most and least socioeconomically deprived people. Activities of daily living (ADL) disability represents the most severe and expensive disablement stage.

Using combined longitudinal data, the authors aimed to quantify area-level socioeconomic inequalities in ADL-DFLE and the total person-years lived with ADL disability, in older men and women in England.

In this modelling study,6 the authors harmonised data on ADL disability, area deprivation, age, and self-reported gender for individuals aged 50 years or older from three longitudinal studies in England. The findings are stark. Those living in the least deprived areas had a reduced risk of ADL disability compared with those in the most deprived areas (hazard ratio [HR] 0⋅61 p<0⋅0001), as did those in the middle area-level socioeconomic group (HR 0⋅76 p<0⋅0001).

Increasing area-level socioeconomic disadvantage was associated with reduced life expectancy and more time spent with ADL disability, particularly for women. Living in the most disadvantaged areas was associated with people having ADL disability 11⋅0 years earlier for men and 12⋅0 years earlier for women, compared with living in the least deprived areas. The authors conclude that focused policies to address underlying socioeconomic inequalities in health are likely to be the long-term definitive solution. The differences almost certainly have a large lifestyle component which should be targeted.

References:

1. Shen L et al. Trajectories of Sleep Duration, Sleep Onset Timing, and Continuous Glucose Monitoring in Adults. JAMA Network Open. 2025;8(3):e250114. http://doi.org/10.1001/jamanetworkopen.2025.0114
2. Qi J et al. The Association Between Sleep Duration and the Risk of Hypertension: A Systematic Review and Meta‑analysis of Cohort Studies. J Gen Intern Med 2025 Feb 4. http://doi.org/10.1007/s11606-025-09398-6 . Online ahead of print.
3. Izquierdo M et al. Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR). The Journal of Nutrition, Health and Aging 29 (2025) 100401. http://doi.org/1016/j.jnha.2024.100401
4. Hurtado M et al. Weight Gain in Midlife Women. Curr Obes Rep. 2024 June ; 13(2): 352–363. http://doi.org/10.1007/s13679-024-00555-2 .
5. Chellapa S et al. Daytime eating during simulated night work mitigates changes in cardiovascular risk factors: secondary analyses of a randomized controlled trial. Nature Communications (2025) 16:3186. https://doi.org/10.1038/s41467-025-57846-y
6. Davies L et al. Area-level socioeconomic inequalities in activities of daily living disability-free life expectancy in England: a modelling study. Lancet Healthy Longev 2025;6: 100700 Published Online March 19, 2025. https://doi.org/10.1016/j.lanhl.2025.100700