Evaluation of the Predominant Dietary Pattern and Sleep Disorders in Obese Diabetic Patients and Non-diabetic Obese Individuals
Keywords:
Dietary Pattern; Diabetes Mellitus; Sleep Quality; ObesityAbstract
Background: Objective: Diabetes mellitus is a chronic metabolic disorder and a major public health concern worldwide, particularly in developing countries. Dietary habits and sleep quality are important factors influencing metabolic health and diabetes outcomes. This study aimed to compare dietary patterns and sleep disorders among obese patients with diabetes and obese individuals without diabetes. Materials and Methods: This quasi-experimental study was conducted in 2023 on 140 obese adults, including 70 patients with diabetes and 70 non-diabetic individuals, who attended the endocrinology subspecialty clinic of Imam Khomeini Hospital in Ahvaz, Iran. Dietary intake was assessed using a 147-item Food Frequency Questionnaire (FFQ), while sleep quality and daytime sleepiness were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Healthy, traditional, and Western dietary patterns were identified and compared between the groups. Results: No significant difference was observed in mean age between the two groups. However, diabetic participants had significantly higher body weight than non-diabetic subjects (P=0.02). Sleep quality was poor in both groups, but diabetic patients had significantly worse PSQI scores than non-diabetic individuals (13.35±1.26 vs. 9.41±0.98, P=0.001). Consumption of fruits, vegetables, and low-fat dairy products did not differ significantly between groups, whereas intake of high-fat dairy products was significantly higher among diabetic patients (P=0.03). Adherence to the traditional and Western dietary patterns was associated with a 4.42-fold and 3.63-fold increased risk of type 2 diabetes, respectively, while no significant association was found for the healthy dietary pattern. Conclusion: Obese patients with diabetes exhibit poorer sleep quality and less favorable dietary habits than obese non-diabetic individuals. These findings highlight the importance of promoting healthy dietary patterns and improving nutritional awareness to support diabetes prevention and management.
References
Hossain MJ, AlMamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health science reports. 2024;7(3):e2004.
https://doi.org/10.1002/hsr2.2004
PMid:38524769 PMCid:PMC10958528
Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The Diabetes MellitusAtherosclerosis Connection: The Role of Lipid and Glucose Metabolism and Chronic Inflammation. International journal of molecular sciences. 2020;21(5): 1835.
https://doi.org/10.3390/ijms21051835
PMid:32155866 PMCid:PMC7084712
Minari TP, Tácito LHB, Yugar LBT, FerreiraMelo SE, Manzano CF, Pires AC et al. Nutritional Strategies for the Management of Type 2 Diabetes Mellitus: A Narrative Review. Nutrients. 2023;15(24): 5734.
https://doi.org/10.3390/nu15245096
PMid:38140355 PMCid:PMC10746081
Palacios OM, Kramer M, Maki KC. Diet and prevention of type 2 diabetes mellitus: beyond weight loss and exercise. Expert review of endocrinology & metabolism. 2019;14(1):112.
https://doi.org/10.1080/17446651.2019.1554430
PMid:30521416
Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci (Qassim). 2017;11(2):6571.
Salvia MG, Quatromoni PA. Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review. American Journal of Medicine Open. 2023;9:100034.
https://doi.org/10.1016/j.ajmo.2023.100034
PMid:39035058 PMCid:PMC11256231
American Diabetes Association. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S167-S180.
https://doi.org/10.2337/dc25-S008
PMid:39651976 PMCid:PMC11635032
TheorellHaglöw J, Lemming EW, Michaëlsson K, Elmståhl S, Lind L, Lindberg E. Sleep duration is associated with healthy diet scores and meal patterns: results from the populationbased EpiHealth study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2020;16(1):918.
https://doi.org/10.5664/jcsm.8112
PMid:31957658 PMCid:PMC7052994
Chaput JP, Dutil C. Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors. International Journal of Behavioral Nutrition and Physical Activity. 2016;13(1):103.
https://doi.org/10.1186/s12966-016-0428-0
PMid:27669980 PMCid:PMC5037605
StOnge MP, Shechter A. Sleep disturbances, body fat distribution, food intake and/or energy expenditure: pathophysiological aspects. Hormone molecular biology and clinical investigation. 2014;17(1):2937.
https://doi.org/10.1515/hmbci-2013-0066
PMid:25372728 PMCid:PMC4410731
Shamshirgaran SM, Ataei J, Malek A, IranparvarAlamdari M, Aminisani N. Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran. World journal of diabetes. 2017;8(7):35864.
https://doi.org/10.4239/wjd.v8.i7.358
PMid:28751959 PMCid:PMC5507833
StOnge MP, Mikic A, Pietrolungo CE. Effects of Diet on Sleep Quality. Adv Nutr. 2016;7(5):93849.
https://doi.org/10.3945/an.116.012336
PMid:27633109 PMCid:PMC5015038
Chaput JP, Tremblay A. Sleeping habits predict the magnitude of fat loss in adults exposed to moderate caloric restriction. Obesity facts. 2012;5(4):5616.
https://doi.org/10.1159/000342054
PMid:22854682
Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM et al. Management of hyperglycaemia in type 2 diabetes, 2022 A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022;65(12):192566.
https://doi.org/10.1007/s00125-022-05787-2
PMid:36151309 PMCid:PMC9510507
Sadeghniiat Haghighi K, Montazeri A, Khajeh Mehrizi A, Aminian O, Rahimi Golkhandan A, Saraei M et al. The Epworth Sleepiness Scale: translation and validation study of the Iranian version. Sleep Breath. 2013;17(1):41926.
https://doi.org/10.1007/s11325-012-0646-x
PMid:22327509
Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014;1311:15173.
https://doi.org/10.1111/nyas.12355
PMid:24628249
Saaty AH, Aljadani HM. Comparison of food intake pattern of diabetic patients and healthy individuals in a sample of Saudi population: a casecontrol study. BMC public health. 2024;24(1):1590.
https://doi.org/10.1186/s12889-024-19064-x
PMid:38872144 PMCid:PMC11177409
Ueno S, Aung MN, Yuasa M, Ishtiaq A, Khin ET, Latt TS et al. Association between Dietary Habits and Type 2 Diabetes Mellitus in Yangon, Myanmar: A CaseControl Study. Int J Environ Res Public Health. 2021;18(21): 11267.
https://doi.org/10.3390/ijerph182111056
PMid:34769575 PMCid:PMC8582904
Fatima MT, Bhat AA, Nisar S, Fakhro KA, AlShabeeb Akil AS. The role of dietary antioxidants in type 2 diabetes and neurodegenerative disorders: An assessment of the benefit profile. Heliyon. 2023;9(1):e12698.
https://doi.org/10.1016/j.heliyon.2022.e12698
PMid:36632095 PMCid:PMC9826852
Wang PY, Fang JC, Gao ZH, Zhang C, Xie SY. Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: A metaanalysis. Journal of diabetes investigation. 2016;7(1):5669.
https://doi.org/10.1111/jdi.12376
PMid:26816602 PMCid:PMC4718092
Halvorsen RE, Elvestad M, Molin M, Aune D. Fruit and vegetable consumption and the risk of type 2 diabetes: a systematic review and doseresponse metaanalysis of prospective studies. BMJ Nutr Prev Health. 2021;4(2):51931.
https://doi.org/10.1136/bmjnph-2020-000218
PMid:35028521 PMCid:PMC8718861
Stanaway JD, Afshin A, Ashbaugh C, Bisignano C, Brauer M, Ferrara G et al. Health effects associated with vegetable consumption: a Burden of Proof study. Nat Med. 2022;28(10):206674.
https://doi.org/10.1038/s41591-022-01970-5
PMid:36216936 PMCid:PMC9556321
Yamamoto J, Ishihara J, Kotemori A, Yoshizaki T, Goto A, Mizoue T et al. Association Between Okinawan Vegetables Consumption and Risk of Type 2 Diabetes in Japanese Communities: The JPHC Study. Journal of epidemiology. 2020;30(5):22735.
https://doi.org/10.2188/jea.JE20180262
PMid:31080191 PMCid:PMC7153960
Sanders LM, Wilcox ML, Maki KC. Red meat consumption and risk factors for type 2 diabetes: a systematic review and metaanalysis of randomized controlled trials. European journal of clinical nutrition. 2023;77(2):15665.
https://doi.org/10.1038/s41430-022-01150-1
PMid:35513448 PMCid:PMC9908545
ZelberSagi S, IvancovskyWajcman D, Fliss Isakov N, Webb M, Orenstein D, Shibolet O et al. High red and processed meat consumption is associated with nonalcoholic fatty liver disease and insulin resistance. J Hepatol. 2018;68(6):123946.
https://doi.org/10.1016/j.jhep.2018.01.015
PMid:29571924 PMCid:PMC11018916
Malin SK, Kullman EL, Scelsi AR, Haus JM, Filion J, Pagadala MR et al. A wholegrain diet reduces peripheral insulin resistance and improves glucose kinetics in obese adults: A randomizedcontrolled trial. Metabolism: clinical and experimental. 2018;82:1117.
https://doi.org/10.1016/j.metabol.2017.12.011
PMid:29305946 PMCid:PMC5930046
Tester JM, Stiers KB, Garber A, Leung CW. Whole Grain Intake and Impaired Fasting Glucose in Adolescents, National Health and Nutrition Examination Survey, 20052014. Preventing chronic disease. 2020;17:E130.
https://doi.org/10.5888/pcd17.190439
PMid:33092687 PMCid:PMC7587298
Wang M, Yu M, Fang L, Hu RY. Association between sugarsweetened beverages and type 2 diabetes: A metaanalysis. Journal of diabetes investigation. 2015;6(3):3606.
https://doi.org/10.1111/jdi.12309
PMid:25969723 PMCid:PMC4420570
Li B, Yan N, Jiang H, Cui M, Wu M, Wang L et al. Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A metaanalysis. Front Nutr. 2023;10:1019534.
https://doi.org/10.3389/fnut.2023.1019534
PMid:37006931 PMCid:PMC10050372
Surani S, Brito V, Surani A, Ghamande S. Effect of diabetes mellitus on sleep quality. World journal of diabetes. 2015;6(6):86873.
https://doi.org/10.4239/wjd.v6.i6.868
PMid:26131327 PMCid:PMC4478581
Sapkota S, Poudyal J, Shah R, Thapa K. Health Related Quality of life of Diabetic and NonDiabetic Elderly in a Municipality of Central Nepal. Journal of College of Medical SciencesNepal. 2021;17:1709.
https://doi.org/10.3126/jcmsn.v17i2.30499
Joukar F, Khoshgoftar SS, Ghanbari A, Maroufizadeh S, Faraji N, Zeinali T et al. Sleep quality and associated factors among individuals with and without diabetes: PERSIAN Guilan Cohort Study (PGCS). Journal of Public Health. 2024;32(11):208390.
https://doi.org/10.1007/s10389-023-01958-6
Lee SWH, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and metaanalysis. Sleep medicine reviews. 2017;31:91101.
https://doi.org/10.1016/j.smrv.2016.02.001
PMid:26944909
Zeighami Mohammadi S, Shahparian M. Evaluation of Sleep Problems and Its Associated Factors in Male Patients with Systolic Heart Failure. Qom University of Medical Sciences Journal. 2012;6(4):6473.
https://doi.org/10.29252/jnkums.4.2.209
Ghorbani A, Esmailzadehha N, Mohammadpoorasl A, Ziaee A. Association of Sleep Quality and Waking Time with Prediabetes: The Qazvin Metabolic Diseases Study, Iran. Sleep disorders. 2015;2015:480742.
https://doi.org/10.1155/2015/480742
PMid:26351585 PMCid:PMC4553331
Rogers EM, Banks NF, Jenkins NDM. The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review. Diabetes/Metabolism Research and Reviews. 2024;40(2):e3667.
https://doi.org/10.1002/dmrr.3667
PMid:37269143
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Galen Medical Journal

This work is licensed under a Creative Commons Attribution 4.0 International License.





