Sleep behavior and depression: Findings from the China Kadoorie Biobank of 0.5 million Chinese adults.

BACKGROUND: Mixed results have shown the association between sleep behavior and depression, but evidence relating the joint effect of sleep duration and sleep disturbances is limited, especially in Chinese population. METHODS: A total of 512,891 adults aged 30-79 years from China Kadoorie Biobank (CKB) were included. Depression was defined by Composite International Diagnostic Inventory-short form (CIDI-SF). Sleep duration and sleep disturbances, including difficulty initiating and maintaining sleep (DIMS), early morning awakening (EMA), daytime dysfunction (DDF) and any sleep disturbances (ASD), were obtained by a self-reported questionnaire. Logistic regression was applied to examine the association between sleep behavior and depression. RESULTS: About 23.1% of participants reported short sleep duration (≤ 6h), and 5.1% reported long sleep duration (> 9h). Compared with normal sleep duration (7-9h), both groups were associated greater likelihood of having depression (short sleep: OR = 2.32, 95%CI: 2.14-2.51; long sleep: OR = 1.56, 96%CI: 1.34-1.81). Participants reported sleep disturbances were significantly associated with depression (odds ratios ranged from 3.31 to 4.17). Moreover, the associations tended to be stronger for those who reported both abnormal sleep duration and sleep disturbances (p for interactions < 0.05), especially for those who slept long. LIMITATIONS: The cross-sectional nature of the study design limits the interpretation of the results. CONCLUSIONS: Abnormal sleep duration and sleep disturbances were associated with depression. The associations were stronger for abnormal sleep duration accompanied with sleep disturbances, especially for a long duration. More attention should be paid on these persons in clinical practice

中国成年人睡眠时长、午睡与失眠症状的分布及关联研究 [Distributions and associations between duration of sleep, daytime naps and insomnia symptoms among Chinese adults]

Objective: To investigate the distribution of sleep duration, daytime naps habits, and insomnia-related symptoms among participants from the China Kadoorie Biobank (CKB) study, and to examine the associations between the sleep-associated factors. Methods: A self-designed computer-based questionnaire was adopted to collect social-demographic information and lifestyle-related factors of the participants. A total of 452 829 Chinese adults aged 30-79 years, without self-reported histories of coronary heart disease, stroke, chronic obstructive pulmonary diseases or cancer, were included in this study. General linear regression and multinomial logistic regression models were used to estimate the distributions on duration of sleep, daytime naps habits, and insomnia-related symptoms in different populations, after adjusted for gender, age, and residential regions. Gender-specific logistic regression model was adopted to examine the associations between the above mentioned sleep-related factors. Results: The average sleep duration of the participants was 7.41 hours per day, with 20.3% of them having daytime naps all year round, but 40.1% only had daytime naps in summer, and 39.6% had no habits of daytime naps. 11.0%, 10.0%, and 2.1% of the participants reported having had symptoms as difficulty in falling asleep, waking up too early or with daytime dysfunction, respectively. There were significant differences on the distributions in sleep-related factors between participants with different gender, age, residential areas, education levels,household income, and marital status (P<0.05). Results from the logistic regression showed that longer sleep duration was associated with lower risks of insomnia-related symptoms trend (P<0.001). Factor as without habits of daytime naps seemed to be associated with higher risks of insomnia-related symptoms (P<0.05). Participants with longer sleep duration were more likely to have the habit of taking daytime naps (P<0.05). Conclusions: The distributions of sleep duration, habits on daytime naps and insomnia-related symptoms varied according to the differences on social-demographic factors. There were associations existed between the sleeping-related factors, which would influence the promotion on optimal sleep duration and better quality of sleep

生命早期饥荒暴露与成年期体质指数的关联分析 [Association between famine exposure during early life and BMI in adulthood]

Objective: To examine the influence of famine exposure during early life on BMI in adulthood. Methods: A total of 94 052 participants recruited in the baseline survey of China Kadoorie Biobank were included in this study. The participants who were born between October 1956 and September 1958, between October 1959 and September 1961 and between October 1962 and September 1964 were classified as group born before famine, group born during famine and group born after famine (control group). The regression coefficients and 95% confidence intervals (CIs) for BMI of famine exposure groups were estimated by linear regression model. And P values for interaction between famine and smoking, alcohol use, physical activity were estimated by likelihood ratio tests. Results: Compared with the group born after famine, in females, the group born during famine had higher BMI (coefficient: 0.12, 95% CI: 0.03-0.22) after adjusting other impact factors. Except physical activity (interaction: P<0.077), both smoking and alcohol use had modification effects on the associations between famine exposure and BMI (interaction: all P<0.001). Conclusion: Famine exposure during early life, especially during fetal period, might increase risks of overweight and obesity in females. Therefore, it is important to ensure the adequacy of nutrition during early life to prevent overweight or obesity in adulthood

[Associations between airflow obstruction and total and cause-specific mortality in adults in China].

Objective To examine the prospective associations between airflow obstruction (AFO) and total and cause-specific mortality. Methods The study is based on China Kadoorie Biobank, in which 199 099 men and 287 895 women aged 30 to 79 years at baseline were included after excluding participants with heart disease, stroke, and cancer at baseline. The Global Initiative on Obstructive Lung Disease (GOLD) guideline was used to classify AFO. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Results During 3 494 079 person-years of follow-up between 2004 and 2013 (median 7.2 years), a total of 21 649 people died. Absolute mortality rates were 5.5, 9.9, 13.1, 32.4 and 63.3 deaths per 1000 person-years for participants who have normal AFO, GOLD-1 to GOLD-4, respectively. After adjusting potential confounders, compared with participants with normal lung function, the HRs (95% CIs) for death were 0.98 (0.88～1.09), 1.03 (0.97～1.09), 1.62 (1.53～1.73), and 2.83 (2.59～3.10) for those whose AFO were classified as GOLD-1 to GOLD-4, respectively. The airflow obstruction was also associated with increased risk for deaths due to ischemic heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease. Conclusion The airflow obstruction was associated with total and certain cause-specific mortality, independent of other risk factors of death.</p

生命早期饥荒暴露与成年期体质指数的关联分析 [Association between famine exposure during early life and BMI in adulthood]

Objective: To examine the influence of famine exposure during early life on BMI in adulthood. Methods: A total of 94 052 participants recruited in the baseline survey of China Kadoorie Biobank were included in this study. The participants who were born between October 1956 and September 1958, between October 1959 and September 1961 and between October 1962 and September 1964 were classified as group born before famine, group born during famine and group born after famine (control group). The regression coefficients and 95% confidence intervals (CIs) for BMI of famine exposure groups were estimated by linear regression model. And P values for interaction between famine and smoking, alcohol use, physical activity were estimated by likelihood ratio tests. Results: Compared with the group born after famine, in females, the group born during famine had higher BMI (coefficient: 0.12, 95% CI: 0.03-0.22) after adjusting other impact factors. Except physical activity (interaction: P&lt;0.077), both smoking and alcohol use had modification effects on the associations between famine exposure and BMI (interaction: all P&lt;0.001). Conclusion: Famine exposure during early life, especially during fetal period, might increase risks of overweight and obesity in females. Therefore, it is important to ensure the adequacy of nutrition during early life to prevent overweight or obesity in adulthood

[Associations between airflow obstruction and total and cause-specific mortality in adults in China].

Objective To examine the prospective associations between airflow obstruction (AFO) and total and cause-specific mortality. Methods The study is based on China Kadoorie Biobank, in which 199 099 men and 287 895 women aged 30 to 79 years at baseline were included after excluding participants with heart disease, stroke, and cancer at baseline. The Global Initiative on Obstructive Lung Disease (GOLD) guideline was used to classify AFO. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Results During 3 494 079 person-years of follow-up between 2004 and 2013 (median 7.2 years), a total of 21 649 people died. Absolute mortality rates were 5.5, 9.9, 13.1, 32.4 and 63.3 deaths per 1000 person-years for participants who have normal AFO, GOLD-1 to GOLD-4, respectively. After adjusting potential confounders, compared with participants with normal lung function, the HRs (95% CIs) for death were 0.98 (0.88～1.09), 1.03 (0.97～1.09), 1.62 (1.53～1.73), and 2.83 (2.59～3.10) for those whose AFO were classified as GOLD-1 to GOLD-4, respectively. The airflow obstruction was also associated with increased risk for deaths due to ischemic heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease. Conclusion The airflow obstruction was associated with total and certain cause-specific mortality, independent of other risk factors of death.</p

Alcohol drinking and risks of total and site-specific cancers in China: a 10-year prospective study of 0.5 million adults

Alcohol drinking is associated with increased risks of several site-specific cancers, but its role in many other cancers remains inconclusive. Evidence is more limited from China, where cancer rates, drinking patterns and alcohol tolerability differ importantly from Western populations. The prospective China Kadoorie Biobank recruited &gt;512,000 adults aged 30-79&#x2009;years from ten diverse areas during 2004-2008, recording alcohol consumption patterns by a standardised questionnaire. Self-reported alcohol consumption was estimated as grams of pure alcohol per week based on beverage type, amount consumed per occasion, and drinking frequency. After ten years of follow-up, 26,961 individuals developed cancer. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) relating alcohol consumption to incidence of site-specific cancers. Overall, 33% (n=69,734) of men drank alcohol regularly (i.e. &#x2265;weekly) at baseline. Among male current regular drinkers, alcohol intake showed positive dose-response associations with risks of cancers in the oesophagus (655 events; HR=1.98 [95%CI 1.79-2.18], per 280g/week), mouth and throat (236; 1.74 [1.48-2.05]), liver (573; 1.52 [1.31-1.76]), colon-rectum (575; 1.19 [1.00-1.43]), gallbladder (107; 1.60 [1.16-2.22]), and lung (1017; 1.25 [1.10-1.42]), similarly among never- and ever-regular smokers. After adjustment for total alcohol intake, there were greater risks of oesophageal cancer in daily than non-daily drinkers, and of liver cancer when drinking without meals. The risks of oesophageal cancer and lung cancer were greater in men reporting flushing after drinking than not. In this male population, alcohol drinking accounted for 7% of cancer cases. Among women, only 2% drank regularly, with no clear associations between alcohol consumption and cancer risk. Among Chinese men, alcohol drinking is associated with increased risks of cancer at multiple sites, with certain drinking patterns (e.g. daily, drinking without meals) and low alcohol tolerance further exacerbating the risks

Association of sleep duration with weight gain and general and central obesity risk in Chinese adults: a prospective study

Objective Evidence on the association between sleep duration and obesity among adults is inconsistent. Prospective studies investigating the association in Chinese adults have been limited. This study aims to prospectively evaluate sleep duration in relation to subsequent weight gain and general and central obesity risk among Chinese adults. Methods A total of 21,958 participants aged 30 to 79 years reported their daily sleep duration. Obesity indicators were objectively measured; then significant weight gain (≥ 5 kg) and general and central obesity were modeled as the outcome. Logistic regression models were used to estimate odds ratios and 95% CIs. Results Average sleep duration was 7.5 hours at baseline. During 8.0 ± 0.8 years of follow‐up, participants who reported sleeping ≤ 6 hours had higher risk for significant weight gain than those who slept 7 hours (multivariable‐adjusted odds ratio: 1.13; 95% CI: 1.02‐1.29). The association was stronger among those who were physically inactive at baseline (P = 0.04 for interaction). Short sleep duration was also associated with subsequent incident central obesity, with odds ratio of 1.13 (95% CI: 1.00‐1.28), but not with incident general obesity (P = 0.31). Conclusions Compared with those who slept 7 hours per day, short sleepers had an increased risk of significant weight gain and central obesity

Association of sleep duration with weight gain and general and central obesity risk in Chinese adults: a prospective study

Objective Evidence on the association between sleep duration and obesity among adults is inconsistent. Prospective studies investigating the association in Chinese adults have been limited. This study aims to prospectively evaluate sleep duration in relation to subsequent weight gain and general and central obesity risk among Chinese adults. Methods A total of 21,958 participants aged 30 to 79 years reported their daily sleep duration. Obesity indicators were objectively measured; then significant weight gain (≥ 5 kg) and general and central obesity were modeled as the outcome. Logistic regression models were used to estimate odds ratios and 95% CIs. Results Average sleep duration was 7.5 hours at baseline. During 8.0 ± 0.8 years of follow‐up, participants who reported sleeping ≤ 6 hours had higher risk for significant weight gain than those who slept 7 hours (multivariable‐adjusted odds ratio: 1.13; 95% CI: 1.02‐1.29). The association was stronger among those who were physically inactive at baseline (P = 0.04 for interaction). Short sleep duration was also associated with subsequent incident central obesity, with odds ratio of 1.13 (95% CI: 1.00‐1.28), but not with incident general obesity (P = 0.31). Conclusions Compared with those who slept 7 hours per day, short sleepers had an increased risk of significant weight gain and central obesity