Association Between Sleep Quality and Depression in Women with Abdominal Obesity and Dietary Energy Density Sleep Quality and Depression in Women with Abdominal Obesity and Dietary Energy Density

Main Article Content

Hülya Yılmaz Önal
Aysun Yüksel
Kezban Esen Karaca Çelik


Sleep quality;, obesity;, dietary energy density;, abdominal obesity;, depression


Obesity has a multifactorial effect caused by genetic, metabolic, environmental, behavioral, and socio-cultural factors. Depression and a high-energy diet are observed in sleep deprivation. This study was planned to determine the relationship between sleep quality and depression in obese women and dietary energy density (DED) and abdominal obesity. Demographic information, anthropometric measurements, eating habits, and sleep and depression status of 106 obese female participants with a BMI ≥30 kg/m2 (Pittsburgh Sleep Quality Index-PSQI and Beck Depression Inventory (BDI) were evaluated. In this study, it was determined that 22.6% of the women had short sleep duration and 44.3% had poor sleep quality. No significant relationship was found between sleep quality and BDI results and the average amount of carbohydrates, proteins, fats, and the energy contribution percentages of three-day food intake (p>0.05). There was no significant relationship between Dietary Energy Density (DED) and waist circumference, BMI, sleep duration, and BDI score. However, there was a relationship between PSQI and BDI score results (r=0.373, p<0.01). As sleep quality decreased, the prevalence of depression increased. The prevalence of obesity increasing in recent years in parallel with decreased sleep quality, high intake of energy-dense foods, and increased prevalence of depression, is at significant levels. More comprehensive studies are needed to examine the relationship between DED, sleep quality, depression, and obesity.

Abstract 358 | PDF Downloads 255


1. WHO (2016), Obesity and overweight. Accessed on 28.10.2020.
2. Özyildirim B, Açkurt F, Ince N, Yıldırım Ç, Özay r, Yılmaz H, editors. Determination of overweight and obesity assessment of associated factors and nutritional status in women aged 31-50 in four residential centers of Istanbul 2014;5(1).
3. Singh B, Arora S, Goswami B, Mallika V. Metabolic syndrome: A review of emerging markers and management. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2009;3(4):240-54.
4. Alberti K, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640-5.
5. Crispim CA, Zimberg IZ, dos Reis BG, Diniz RM, Tufik S, de Mello MT. Relationship between food intake and sleep pattern in healthy individuals. Journal of Clinical Sleep Medicine. 2011;7(06):659-64.
6. Dixon JB, Dixon ME, Anderson ML, Schachter L, O'brien PE. Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity. 2007;15(10):2504-11.
7. Beccuti G, Pannain S. Sleep and obesity. Current opinion in clinical nutrition and metabolic care. 2011;14(4):402.
8. Cappuccio FP, Taggart FM, Kandala N-B, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-26.
9. Stranges S, Cappuccio FP, Kandala N-B, Miller MA, Taggart FM, Kumari M, et al. Cross-sectional versus prospective associations of sleep duration with changes in relative weight and body fat distribution: the Whitehall II Study. American journal of epidemiology. 2007;167(3):321-9.
10. Rontoyanni VG, Baic S, Cooper AR. Association between nocturnal sleep duration, body fatness, and dietary intake in Greek women. Nutrition. 2007;23(11-12):773-7.
11. Apolzan JW, Bray GA, Hamilton MT, Zderic TW, Han H, Champagne CM, et al. Short‐term overeating results in incomplete energy intake compensation regardless of energy density or macronutrient composition. Obesity. 2014;22(1):119-30.
12. Grandner MA, Kripke DF, Naidoo N, Langer RD. Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep medicine. 2010;11(2):180-4.
13. Weiss A, Xu F, Storfer-Isser A, Thomas A, Ievers-Landis CE, Redline S. The association of sleep duration with adolescents' fat and carbohydrate consumption. Sleep. 2010;33(9):1201-9.
14. Bechthold A. Food energy density and body weight. Ernahrungs Umschau. 2014;6:2-11.
15. Rouhani MH, Haghighatdoost F, Surkan PJ, Azadbakht L. Associations between dietary energy density and obesity: A systematic review and meta-analysis of observational studies. Nutrition. 2016;32(10):1037-47.
16. Pérez-Escamilla R, Obbagy JE, Altman JM, Essery EV, McGrane MM, Wong YP, et al. Dietary energy density and body weight in adults and children: a systematic review. Journal of the Academy of Nutrition and Dietetics. 2012;112(5):671-84.
17. Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, et al. Low-energy-density diets are associated with high diet quality in adults in the United States. Journal of the American Dietetic Association. 2006;106(8):1172-80.
18. Marti-Henneberg C, Capdevila F, Arija V, Perez S, Cuco G, Vizmanos B, et al. Energy density of the diet, food volume and energy intake by age and sex in a healthy population. European Journal of Clinical Nutrition. 1999;53(6):421-8.
19. Cedillo YE, Garr-Barry V, Maciel B, Fernández JR. Dietary energy–density and adiposity markers among a cohort of multi-ethnic children. Maternal and child health journal. 2019;23(11):1536-46.
20. Vernarelli J, DiSarro R. Eat better, run longer? Dietary energy density is associated with cardiovascular fitness level in a nationally representative sample of adolescents (P16-030-19). Current developments in nutrition. 2019;3(Supplement_1):nzz050. P16-30-19.
21. Grossniklaus DA, Dunbar SB, Gary R, Tohill BC, Frediani JK, Higgins MK. Dietary energy density: a mediator of depressive symptoms and abdominal obesity or independent predictor of abdominal obesity? European Journal of Cardiovascular Nursing. 2012;11(4):423-31.
22. Benton D. Carbohydrate ingestion, blood glucose and mood. Neuroscience & Biobehavioral Reviews. 2002;26(3):293-308.
23. Jeffery RW, Linde JA, Simon GE, Ludman EJ, Rohde P, Ichikawa LE, et al. Reported food choices in older women in relation to body mass index and depressive symptoms. Appetite. 2009;52(1):238-40.
24. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of general psychiatry. 2010;67(3):220-9.
25. Rosmond R, Björntorp P. Occupational status, cortisol secretory pattern, and visceral obesity in middle‐aged men. Obesity research. 2000;8(6):445-50.
26. Thakore JH, Richards PJ, Reznek RH, Martin A, Dinan TG. Increased intra-abdominal fat deposition in patients with major depressive illness as measured by computed tomography. Biological Psychiatry. 1997;41(11):1140-2.
27. Agargun M. The Validity and Reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry. 1996;7:107-15.
28. Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol. 1989;7:3-13.
29. Dehne LI, Klemm C, Henseler G, Hermann-Kunz E. The German food code and nutrient data base (BLS II. 2). European journal of epidemiology. 1999;15(4):355-8.
30. Öztürk ME, Yabancı Ayhan N. Associations between poor sleep quality, obesity, and the anthropometric measurements of women in Turkey. Ecology of Food and Nutrition. 2018;57(1):3-12.
31. Jennings JR, Muldoon MF, Hall M, Buysse DJ, Manuck SB. Self-reported sleep quality is associated with the metabolic syndrome. Sleep. 2007;30(2):219-23.
32. Rahe C, Czira ME, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep medicine. 2015;16(10):1225-8.
33. Doi Y, Minowa M, Uchiyama M, Okawa M. Subjective sleep quality and sleep problems in the general Japanese adult population. Psychiatry and Clinical Neurosciences. 2001;55(3):213-5.
34. Cooper CB, Neufeld EV, Dolezal BA, Martin JL. Sleep deprivation and obesity in adults: a brief narrative review. BMJ open sport & exercise medicine. 2018;4(1).
35. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62.
36. Grandner MA, Jackson N, Gerstner JR, Knutson KL. Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample. Appetite. 2013;64:71-80.
37. Chaput JP, Tremblay A. Does short sleep duration favor abdominal adiposity in children? International Journal of Pediatric Obesity. 2007;2(3):188-91.
38. Maddahi NS, Yarizadeh H, Setayesh L, Nasir Y, Alizadeh S, Mirzaei K. Association between dietary energy density with mental health and sleep quality in women with overweight/obesity. BMC Research Notes. 2020;13:1-6.
39. Vermeulen E, Stronks K, Snijder MB, Schene AH, Lok A, De Vries JH, et al. A combined high-sugar and high-saturated-fat dietary pattern is associated with more depressive symptoms in a multi-ethnic population: the HELIUS (Healthy Life in an Urban Setting) study. Public health nutrition. 2017;20(13):2374-82.
40. Grossniklaus DA, Dunbar SB, Tohill BC, Gary R, Higgins MK, Frediani J. Psychological factors are important correlates of dietary pattern in overweight adults. The Journal of cardiovascular nursing. 2010;25(6):450.
41. Atlantis E, Lange K, Goldney RD, Martin S, Haren MT, Taylor A, et al. Specific medical conditions associated with clinically significant depressive symptoms in men. Social psychiatry and psychiatric epidemiology. 2011;46(12):1303-12.
42. Vahip S. From researches to clinical practice in the treatment of bipolar depression. Bull Clin Psychopharmacol. 1999;9(4):213-21.
43. Sarıarslan HA, Gulhan YB, Unalan D, Basturk M, Delibas S. The relationship of sleep problems to life quality and depression. Neurosciences. 2015;20(3):236.
44. Aslan S, Gulcat Z, Selda Albayrak F, Maral I, Yetkin S, Sutcigil L, et al. Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey. International journal of psychiatry in clinical practice. 2006;10(1):52-8.

Most read articles by the same author(s)