Complex Association Among Diet Styles, Sleep Patterns, and Obesity in Patients with Diabetes

Figures & data

Figure 1 Hypothesis model.

Figure 2 Flow chart of participants in study.

Table 1 The Characteristics of WC

Variables	Total N(%)	≤p25	P25-p50	p50-p75	≥p75	χ^2 /F value
Age						13.87*
≤43y	194	59(30.4)	40(20.6)	40(20.6)	55(28.4)
44–59y	823	206(25.0)	193(23.5)	230(27.9)	194(23.6)
≥60y	748	178(23.8)	208(27.8)	175(23.4)	187(25.0)
Sex						31.24**
Male	873	179(20.5)	210(24.1)	227(26.0)	257(29.4)
Female	892	264(29.6)	231(25.9)	218(24.4)	179(20.1)
Ethnic						0.44
Han	1745	439(25.2)	436(25.0)	440(25.2)	430(24.6)
Nonhan	20	4(20.0)	5(25.0)	5(25.0)	6(30.0)
Married						0.39
No	30	9(30.0)	7(23.3)	7(23.3)	7(23.3)
Yes	1735	434(25.0)	434(25.0)	438(25.2)	429(24.7)
Education level						6.34
Primary below	800	208(26.0)	199(24.9)	207(25.9)	186(23.3)
Primary	262	64(24.4)	68(26.0)	61(23.3)	69(26.3)
Junior college	472	108(22.9)	113(23.9)	120(25.4)	131(27.8)
Senior high or above	231	63(27.3)	61(26.4)	57(24.7)	50(21.6)
Total annual household income (yuan)						21.91**
≤18,000	354	101(28.5)	70(19.8)	83(23.4)	100(28.2)
18,000–40,000	749	165(22.0)	185(24.7)	206(27.5)	193(25.8)
40,000–70,000	346	84(24.3)	97(28.0)	84(24.3)	81(23.4)
>70,000	316	93(29.4)	89(28.2)	72(22.8)	62(19.6)
Very good
Occupation status						2.54
No	653	161(24.7)	177(27.1)	160(24.5)	155(23.7)
Yes	1112	282(25.4)	264(23.7)	285(25.6)	281(25.3)
Social economic status						7.22
Low	835	219(26.2)	200(24.0)	208(24.9)	208(24.9)
Medium	461	102(22.1)	111(24.1)	123(26.7)	125(27.1)
High	469	122(26.0)	130(27.7)	114(24.3)	103(22.0)

Note: *P<0.05, **P<0.01.

Abbreviation: WC, waist circumference.

Table 2 The General Demographic Characteristics of BMI and Sleep Disorders

Variables	BMI (kg/m^2)				Sleep Disorders
	N (%)	Average	Standard Deviation	t/F value	N (%)	Average	Standard Deviation	t/F value
Gender				0.50*				−6.54**
Male	874	25.97	3.59		873	6.85	1.21
Female	891	26.07	3.72		892	7.25	1.31
Married status				−1.13				−1.09
Unmarried	30	25.27	3.90		30	6.80	1.19
Married	1735	26.04	3.65		1735	7.06	1.28
Ethnic				0.22				0.54
Han	1745	26.02	3.65		1745	7.05	1.28
Non-Han	20	25.84	4.15		20	6.90	1.25
Educational level				3.47*
Under primary	800	26.16	3.61		800	7.33	1.27
Primary	262	25.79	3.55		262	6.99	1.22
Junior high	472	26.23	3.90		472	6.82	1.27
Senior high above	231	25.40	3.34		231	6.65	1.18
Total annual household income (yuan)				1.19				13.78**
≤18,000	354	26.0	4.14		354	7.38	0.066
18,000–40,000	749	26.17	3.48		749	7.06	0.046
40,000–70,000	346	26.02	3.41		346	6.94	0.072
>70,000	316	25.71	3.75		316	6.78	0.067
SES				4.12*				29.67**
Low	835	25.99	3.67		835	7.16	1.24
Medium	461	26.39	3.78		461	7.25	1.33
High	469	25.71	3.48		469	6.67	1.22
Age (years)				5.96*				23.75**
≤43	194	26.540	4.4100		194	6.55	1.25
44–59	823	26.084	3.6472		823	7.0	1.27
≥60	748	25.821	3.4360		748	7.24	1.26

Note: *P<0.05, **P<0.01.

Table 3 The Multilevel Linear Regression Between Dependent Health Risk Factors and WC and BMI

Variables	WC(cm)			BMI(kg/m^2)
	R^2	P	β (95% CI)	R^2	P	β (95% CI)
Physical activity (moderate)	0.02	>0.05	−0.29(−0.99, 0.71)	0.01	>0.05	0.21(−0.29, 0.71)
Sedentary behavior	0.02	<0.05*	0.15(−0.03, 0.33)	0.01	<0.05*	0.42(0.06, 0.78)
Walking	0.02	<0.05*	−0.12(−0.24, −0.01)	0.01	<0.05*	−0.004(−0.01, −0.001)
Sleep (dichotomy)	0.02	>0.05	−0.55(−0.12, 1.76)	0.01	>0.05	0.14(−0.21, 0.49)
Alcohol drinking	0.02	>0.05	0.97(−0.12, 2.07)	0.01	>0.05	−0.32(−0.68, 0.04)
Smoking	0.02	>0.05	0.24(−1.01, 1.49)	0.01	>0.05	−0.19(−1.10, 0.72)
SSBs	0.03	<0.01**	2.97(1.09, 4.84)	0.02	<0.01**	1.29(0.59, 1.99)
Sleep disorders	0.03	<0.01**	0.87(0.50, 1.24)	0.02	<0.01**	0.33(0.19, 0.47)
Sleep duration	0.02	>0.05	−0.14(−0.40, 0.13)	0.01	>0.05	−0.01(−0.11, 0.09)
HbA1c	0.03	<0.05*	0.28(0.01, 0.54)	0.01	>0.05	−0.03(−0.12, 0.07)
FBG	0.02	>0.05	0.02(−0.13, 0.16)	0.01	<0.05*	−0.06(−0.11, −0.002)
TG	0.04	<0.01**	0.55(0.38, 0.72)	0.03	<0.01**	0.21(0.15, 0.28)
TC	0.02	>0.05	0.11(−0.27, 0.50)	0.01	>0.05	−0.03(−0.18, 0.11)

Note: Controlled for educational level, total annual household income, marital status, ethnic, gender and age. *P<0.05, **P<0.01.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 4 The Moderation Analysis Between Diet (Unhealthy), Sleep Disorders, SES and BMI

Variables	BMI
	Coeff	se	t	P	LLCI	ULCI
Diet (unhealthy)	3.72	3.88	0.96	>0.05	−3.90	11.33
Sleep disorders	2.24	2.75	0.81	>0.05	−3.16	7.64
SES	1.79	2.33	0.77	>0.05	−2.78	6.36
Int_1	−0.42	0.53	−0.80	>0.05	−1.47	0.62
Int_2	−0.40	0.45	−0.88	>0.05	−1.29	0.49
Int_3	−0.19	0.32	0.58	>0.05	−0.82	0.45
Int_4	0.04	0.06	0.68	>0.05	−0.08	0.17

Note: Int 1: diet × sleep disorders; Int 2: diet × HbA1c; Int 3: HbA1c × sleep disorders; Int 4: diet × sleep disorders × HbA1c.

Abbreviations: BMI, body mass index; WC, waist circumferenc.

Table 5 The Moderation Analysis Between Diet (Unhealthy), Sleep Disorders, SES and BMI

Variables	WC
	Coeff	se	t	P	LLCI	ULCI
Diet (unhealthy)	4.46	10.53	0.43	>0.05	−16.19	25.11
Sleep disorders	1.71	7.46	0.23	>0.05	−12.92	16.34
SES	1.40	6.32	0.22	>0.05	−11.0	13.79
Int_1	−0.35	1.44	−0.24	>0.05	−3.17	2.48
Int_2	−0.39	1.23	−0.32	>0.05	−2.80	2.01
Int_3	−0.02	0.88	−0.02	>0.05	−1.74	1.71
Int_4	0.02	0.17	0.14	>0.05	−0.31	0.36

Notes: Int 1: diet × sleep disorders; Int 2: diet × HbA1c; Int 3: HbA1c × sleep disorders; Int 4: diet × sleep disorders × HbA1c.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 6 The Moderation Analysis Between Diet (Healthy), Sleep Disorders, SES and BMI

Variables	WC
	Coeff	se	t	P	LLCI	ULCI
Diet (healthy)	8.52	5.30	1.61	>0.05	−1.88	18.92
Sleep disorders	14.39	7.69	1.87	<0.05	−0.70	29.48
SES	12.43	6.69	1.86	>0.05	−0.70	25.56
Int_1	−1.40	0.73	−1.93	>0.05	−2.82	0.03
Int_2	−1.28	0.64	−1.99	<0.05	−2.55	−0.02
Int_3	−1.98	0.94	−2.12	0.05	−3.82	−0.15
Int_4	0.20	0.09	2.26	<0.05	0.03	0.38

Notes: Int 1: diet × sleep disorders; Int 2: diet × SES; Int 3: SES × sleep disorders; Int 4: diet × sleep disorders × SES.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 7 The Moderation Analysis Between Diet (Healthy), Sleep Disorders, SES and BMI

Variables	BMI
	Coeff	se	t	P	LLCI	ULCI
Diet (healthy)	2.48	1.96	1.27	>0.05	−1.36	6.32
Sleep disorders	4.44	2.84	1.56	>0.05	−1.13	10.01
SES	3.55	2.47	1.44	>0.05	−1.29	8.40
Int_1	−0.42	0.27	−1.57	>0.05	−0.95	0.10
Int_2	−0.37	0.24	−1.57	>0.05	−0.84	0.09
Int_3	−0.59	0.35	−1.70	>0.05	−1.27	0.09
Int_4	0.06	0.03	1.82	0.069	−0.005	0.13

Notes: Int 1: diet × sleep disorders; Int 2: diet × HbA1c; Int 3: HbA1c × sleep disorders; Int 4: diet × sleep disorders × HbA1c.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 8 The Moderation Analysis Between Diet, Sleep Disorders, HbA1c and WC

Variables	WC
	Coeff	se	t	P	LLCI	ULCI
Diet (unhealthy)	−0.72	0.70	−1.03	>0.05	−7.64	0.50
Sleep disorders	−3.57	2.07	−1.72	>0.05	−0.95	0.50
HbA1c	−0.63	0.44	−1.42	>0.05	−1.50	0.64
Int_1	0.68	0.41	1.69	>0.05	−0.11	1.48
Int_2	0.12	0.09	1.41	>0.05	−0.05	0.29
Int_3	0.56	0.26	2.15	<0.05	0.048	1.07
Int_4	−0.10	0.05	−2.05	<0.05	−0.20	−0.005

Notes: Int 1: diet × sleep disorders; Int 2: diet × HbA1c; Int 3: HbA1c × sleep disorders; Int 4: diet × sleep disorders × HbA1c.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 9 The Moderation Analysis Between SSBs, Sleep Disorders, HbA1c and WC

Variables	BMI
	Coeff	se	t	P	LLCI	ULCI
Diet (unhealthy)	0.89	0.74	1.19	>0.05	−0.57	2.34
Sleep disorders	3.68	2.21	1.67	>0.05	−0.65	8.02
HbA1c	0.62	0.47	1.32	>0.05	−0.30	1.55
Int_1	−0.77	0.43	−1.79	>0.05	−1.62	0.07
Int_2	−0.12	0.09	−1.35	>0.05	−0.30	0.06
Int_3	−2.54	0.28	−1.94	>0.05	−1.08	0.01
Int_4	0.11	0.054	1.97	<0.05	0.0004	0.21

Notes: Int 1: diet × sleep disorders; Int 2: diet × HbA1c; Int 3: HbA1c × sleep disorders; Int 4: diet × sleep disorders × HbA1c.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 10 Model Characteristics for the Conditional Process Analysis (Diet [Unhealthy], FBG, Sleep Disorders and BMI)

Variables	Sleep Disorders			BMI
	B	t value	P value	B	t value	P value
Diet (unhealthy)	−0.06	−0.40	>0.05	0.12	0.28	>0.05
FBG	−0.08	−0.97	>0.05	−0.30	−1.18	<0.01
Diet*FBG	0.01	0.72	>0.05	−0.02	−0.54	>0.05
Sleep disorders				−0.20	−0.97	>0.05
Sleep disorders*FBG				0.06	−2.65	>0.05
R^2	0.003			0.02
F	1.92			6.48

Notes: Mediate variables: sleep disorders, moderated variables: HbA1c, independent variables: diet, dependent variables: WC. The model was uncontrolled covariates.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 11 Bootstrapped Conditional Direct and Indirect Effects (Diet [Unhealthy], FBG, Sleep Disorders and BMI

			BMI
Direct effect			Effect	SE	(LL,UL)
	Predictor	BMI
	Moderator (FBG)	Low	6.17	−0.02	−0.43, 0.40
		Medium	9.43	−0.09	−0.38, 0.20
		High	12.69	−0.17	−0.56, 0.22
Indirect effect			Effect	SE	(LL,UL)
	Predictor	BMI
	Mediator (sleep disorders)	Low	6.17	0.0006	−0.02.0.03
		Medium	9.43	0.01	−0.02, 0.05
		High	12.69	0.04	−0.03, 0.11

Table 12 Model Characteristics for the Conditional Process Analysis (Diet [Unhealthy], FBG, Sleep Disorders and WC

Variables	Sleep Disorders			WC
	B	t value	P value	B	t value	P value
Diet (unhealthy)	−0.06	−0.40	>0.05	0.68	0.57	>0.05
FBG	−0.08	−0.97	>0.05	−0.63	−0.90	>0.05
Diet*Sleep disorders	0.01	0.72	>0.05	−0.07	−0.60	>0.05
Sleep disorders				−0.70	−1.24	>0.05
FBG *Sleep disorders				0.15	2.66	<0.05
R^2	0.003			0.01
F	1.92			4.64

Notes: Mediate variables: sleep disorders, moderated variables: HbA1c, independent variables: diet, dependent variables: WC. The model was uncontrolled covariates.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 13 Bootstrapped Conditional Direct and Indirect Effects (Diet [Unhealthy], FBG, Sleep Disorders and WC

			WC
Direct effect			Effect	SE	(LL,UL)
	Predictor	WC
	Moderator (FBG)	Low	6.17	0.57	−0.87, 1.37
		Medium	9.43	0.40	−0.77, 0.81
		High	12.69	0.54	−1.26, 0.84
Indirect effect			Effect	SE	(LL,UL)
	Predictor	WC
	Mediator (sleep disorders)	Low	6.17	0.001	−0.05, 0.08
		Medium	9.43	0.03	−0.04, 0.11
		High	12.69	0.09	−0.060.28

Table 14 Model Characteristics for the Conditional Process Analysis (Diet [Healthy], FBG, Sleep Disorders and BMI)

Variables	Sleep Duration			WC
	B	t value	P value	B	t value	P value
Diet (healthy)	−0.08	−0.52	>0.05	−1.16	−1.38	>0.05
HbA1c	−0.19	−0.95	>0.05	0.69	0.59	>0.05
Diet*Sleep duration	0.02	0.02	>0.05	0.13	1.21	>0.05
Sleep duration				1.77	3.02	<0.01
HbA1c *Sleep duration				−0.25	−3.32	<0.01
R^2	0.01			0.01
F	5.40			3.96

Notes: Mediate variables: sleep duration, moderated variables: HbA1c, independent variables: diet, dependent variables: WC. The model was uncontrolled covariates.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 15 Model Characteristics for the Conditional Process Analysis (Diet [Healthy], FBG, Sleep Disorders and BMI)

			WC
Direct effect			Effect	SE	(LL,UL)
	Predictor	WC
	Moderator (HbA1c)	Low	5.83	−0.40	−0.93, 0.13
		Medium	7.58	−0.17	−0.55, 0.21
		High	9.33	0.27	−0.47, 0.58
Indirect effect			Effect	SE	(LL,UL)
	Predictor	WC
	Mediator (sleep duration)	Low	5.83	0.02	−0.005, 0.09
		Medium	7.58	−0.01	−0.05, 0.02
		High	9.33	0.05	−0.19, −0.02

Table 16 Model Characteristics for the Conditional Process Analysis (Diet [Healthy], FBG, Sleep Disorders and WC

Variables	Sleep Duration			WC
	B	t value	P value	B	t value	P value
Diet (unhealthy)	0.49	0.30	>0.05	2.14	1.25	>0.05
HbA1c	0.23	0.20	>0.05	3.31	2.78	>0.05
Diet*Sleep duration	−0.03	0.04	>0.05	−0.27	−1.25	>0.05
Sleep duration				1.62	2.78	<0.01
HbA1c *Sleep duration				−0.23	−3.10	<0.01
R^2	0.01			0.01
F	5.51			3.83

Notes: Mediate variables: sleep duration, moderated variables: HbA1c, independent variables: diet, dependent variables: WC. The model was uncontrolled covariates.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 17 Model Characteristics for the Conditional Process Analysis (Diet [Healthy], FBG, Sleep Disorders and WC)

			WC
Direct effect			Effect	SE	(LL,UL)
	Predictor	WC
	Moderator (HbA1c)	Low	5.83	0.57	−0.55, 1.67
		Medium	7.58	0.40	−0.71, 0.88
		High	9.33	−0.39	−1.45, 0.67
Indirect effect			Effect	SE	(LL,UL)
	Predictor	WC
	Mediator (sleep duration)	Low	5.83	0.08	−0.01, 0.26
		Medium	7.58	−0.03	−0.12, 0.03
		High	9.33	−0.09	−0.26, 0.002

Table 18 The Moderation Analysis Between Diet Styles, Sleep Disorders, FBG and WC

Variables	WC
	Coeff	se	t	P	LLCI	ULCI
Diet (healthy)	−9.02	0.74	−1.73	>0.05	−19.21	1.18
Sleep disorders	−3.09	1.45	−2.13	<0.05	−5.92	−0.25
FBG	−3.05	1.02	−3.01	<0.01	−5.05	−1.07
Int_1	1.37	0.74	1.85	>0.05	−0.08	2.82
Int_2	1.17	0.52	2.27	<0.05	0.16	2.19
Int_3	0.45	0.14	3.12	<0.01	0.17	0.73
Int_4	−0.17	0.07	−2.30	<0.05	−0.32	−0.03

Notes: Int 1: diet × sleep disorders; Int 2: diet × FBG; Int 3: FBG× sleep disorders; Int 4: diet × sleep disorders × FBG.

Abbreviations: BMI, body mass index; WC, waist circumference.

Table 19 The Moderation Analysis Between Diet Styles, Sleep Disorders, FBG and BMI

Variables	BMI
	Coeff	se	t	P	LLCI	ULCI
Diet (healthy)	−3.46	1.92	−1.80	>0.05	−7.22	0.31
Sleep disorders	−1.11	0.53	−2.08	<0.05	−2.16	−0.06
FBG	−1.13	0.37	−3.02	<0.01	−1.87	−0.40
Int_1	0.52	0.27	1.90	>0.05	−0.02	1.05
Int_2	0.40	0.19	2.10	<0.05	0.03	0.77
Int_3	0.16	0.05	2.98	<0.01	0.05	0.26
Int_4	−0.06	0.03	−2.14	<0.05	−0.11	−0.01

Notes: Int 1: diet × sleep disorders; Int 2: diet × FBG; Int 3: FBG× sleep disorders; Int 4: diet × sleep disorders × FBG.

Abbreviations: BMI, body mass index; WC, waist circumference.