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The present study investigated the roles birthplace and acculturation play in sleep estimates among Hispanic/Latino population at the US–Mexico border. Data were collected in 2016, from N = 100 adults of Mexican descent from the city of Nogales, AZ, at the US–Mexico border. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index categorized as none, mild, moderate, and severe, and Multivariable Apnea Prediction Index (MAP) categorized as never, infrequently, and frequently. Acculturation was measured with the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II). The sample consisted of majority Mexican-born (66%, vs. born in the USA 38.2%). Being born in the USA was associated with 55 fewer minutes of nighttime sleep (p =.011), and 1.65 greater PSQI score (p =.031). Compared to no symptoms, being born in the USA was associated with greater likelihood of severe difficulty falling asleep (OR = 8.3, p =.030) and severe difficulty staying asleep (OR = 11.2, p =.050), as well as decreased likelihood of breathing pauses during sleep (OR = 0.18, P =.020). These relationships remained significant after Mexican acculturation was entered in these models. However, greater Anglo acculturation appears to mediate one fewer hour of sleep per night, poorer sleep quality, and reporting of severe difficulty falling asleep and staying asleep. Among individuals of Mexican descent, being born in the USA (vs Mexico) is associated with about 1 hour less sleep per night, worse sleep quality, more insomnia symptoms, and less mild sleep apnea symptoms. These relationships are influenced by acculturation, primarily the degree of Anglo rather than the degree of Mexican acculturation. [ABSTRACT FROM AUTHOR]

STUDY PURPOSE:The integration of methods to assess daytime physical activity (PA) and sedentary behavior (SB) and nighttime sleep would allow the evaluation of 24-hour daily activity using a single device. Accelerometer devices used to assess daytime PA have not been substantially validated to evaluate sleep. The objective of this study was to use polysomnography (PSG) to validate a commonly used PA accelerometer worn on both wrists and the hip. METHODS:Seventeen participants (50-75years) completed a single-night in-home PSG recording while concurrently wearing 3 PA accelerometers. Accelerometer devices were worn on each wrist and the hip. Total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO) were compared for each device against PSG. Correlation coefficients estimated measurement agreement. Paired t tests and Bland-Altman plots assessed measurement differences. RESULTS:Between PSG and devices, mean TST ranged from 361.6 to 403.2minutes. Mean SE estimates ranged from 86.9% to 96.9%. Mean WASO estimates ranged from 12 to 51.2minutes. For TST, SE, and WASO hip estimates differed significantly from PSG estimates (paired t tests, TST: P=.03, SE: P

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

This study aimed to determine which dietary factors were associated with habitual sleep duration in pre/peri- and post-menopausal women. Data from the 2007–2008 National Health and Nutrition Examination Survey were used (N = 1,783). Habitual sleep duration was categorized as very short (<5 h), short (5–6 h), normal (7–8 h), and long (≥9 h). Diet assessment was performed following validated procedures. In pre/peri-menopausal women (n = 1,116), controlling for the confounders, fewer number of foods, less intake of protein, carbohydrates, thiamin (B1), food folate, total choline, phosphorus, sodium, potassium, and selenium were significantly associated with a higher risk for very short sleep. Being on a low-salt diet was related to a lower risk for long sleep. In comparison, in post-menopausal women (n = 667), controlling for the confounders, more sugar intake, less intake of phosphorus and zinc were related to a higher risk for short sleep. There were novel associations between diet and sleep duration, particularly among pre/peri-menopausal women. Future research is needed to confirm those causal relationships. [ABSTRACT FROM AUTHOR]

Introduction: Inadequate sleep (≤6 and ≥9h) is more prevalent in smokers than non-smokers but the extent to which sleep duration in smokers relates to smoking behaviors and cessation outcomes, is not yet clear. To begin to address this knowledge gap, we investigated the extent to which sleep duration predicted smoking behaviors and quitting intention in a population sample.Methods: Data from current smokers who completed the baseline (N=635) and 5-year follow-up (N=477) assessment in the United Kingdom Biobank cohort study were analyzed. Multivariable regression models using smoking behavior outcomes (cigarettes per day, time to first cigarette, difficulty not smoking for a day, quitting intention) and sleep duration (adequate (7-8h) versus inadequate (≤6 and ≥9h) as the predictor were generated. All models adjusted for age, sex, race, and education.Results: Worsening sleep duration (adequate to inadequate) predicted a more than three-fold higher odds in increased cigarettes per day (OR=3.18; 95% CI=1.25-8.06), a more than three-fold increased odds of not smoking for the day remaining difficult (OR=3.90; 95% CI=1.27-12.01), and a >8-fold increased odds of higher nicotine dependence (OR=8.98; 95% CI=2.81-28.66). Improving sleep duration (i.e., inadequate to adequate sleep) did not predict reduced cigarette consumption or nicotine dependence in this population sample.Conclusion: Transitioning from adequate to inadequate sleep duration may be a risk factor for developing a more "hard-core" smoking profile. The extent to which achieving healthy sleep may promote, or optimize smoking cessation treatment response, warrants investigation. [ABSTRACT FROM AUTHOR]

Background: Sleep duration and morningness/eveningness (circadian preference) have separately been associated with cardiovascular risk factors (i.e. tobacco use, physical inactivity). Interactive effects are plausible, resulting from combinations of sleep homeostatic and circadian influences. These have not been examined in a population sample. Methods: Multivariable regression models were used to test the associations between combinations of sleep duration (short [-6 h], adequate [7-8 h], long [≥9 h]) and morning/evening preference (morning, somewhat morning, somewhat evening, evening) with the cardiovascular risk factors of tobacco use, physical inactivity, high sedentary behaviour, obesity/overweight and eating fewer than 5 daily servings of fruit and vegetables, in a cross- sectional sample of 439 933 adults enrolled in the United Kingdom Biobank project. Results: Participants were 56% female, 95% white and mean age was 56.5 (SD= 8.1) years. Compared with adequate sleep with morning preference (referent group), long sleep with evening preference had a relative odds of 3.23 for tobacco use, a 2.02-fold relative odds of not meeting physical activity recommendations, a 2.19-fold relative odds of high screen-based sedentary behaviour, a 1.47-fold relative odds of being obese/overweight and a 1.62-fold relative odds of <5 fruit and vegetable daily servings. Adequate sleep with either morning or somewhat morning preference was associated with a lower prevalence and odds for all cardiovascular risk behaviours except fruit and vegetable intake. Conclusions: Long sleepers with evening preference may be a sleep phenotype at high cardiovascular risk. Further work is needed to examine these relationships longitudinally and to assess the effects of chronotherapeutic interventions on cardiovascular risk behaviours. [ABSTRACT FROM AUTHOR]

Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the social and behavioral predictors of insufficient sleep. Objective: To assess the social and behavioral predictors of insufficient sleep in the U.S. Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design. Results: The mean age for the sample was 56 ± 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (<7 hours) was 37%. Multivariate-adjusted logistic regression revealed associations of four important factors with insufficient sleep, which were: working more than 40 hours per week [OR = 1.65, p < 0.001, 95% CI = 1.65-1.66], black race/ethnicity [OR = 1.37, p < 0.001, 95% CI = 1.37-1.38], history of heart disease [OR = 1.26, p < 0.001, 95% CI = 1.25-1.28], care-giving to family/friends [OR = 1.50, p < 0.001, 95% CI = 1.49-1.51], and lack of social and emotional support [OR = 1.24, p < 0.001, 95% CI = 1. 23-1.25]. Conclusion: Social and behavioral predictors of health uniquely contribute to the report of insufficient sleep and should be considered when developing programs to increase awareness of the adverse effects of insufficient sleep. [ABSTRACT FROM AUTHOR]

Insufficient sleep is associated with cardiometabolic disease and poor health. However, few studies have assessed its determinants in a nationally representative sample. Data from the 2009 behavioral risk factor surveillance system were used (N = 323,047 adults). Insufficient sleep was assessed as insufficient rest/sleep over 30 days. This was evaluated relative to sociodemographics (age, sex, race/ethnicity, marital status, region), socioeconomics (education, income, employment, insurance), health behaviors (diet, exercise, smoking, alcohol), and health/functioning (emotional support, BMI, mental/physical health). Overall, insufficient sleep was associated with being female, White or Black/African-American, unemployed, without health insurance, and not married; decreased age, income, education, physical activity; worse diet and overall health; and increased household size, alcohol, and smoking. These factors should be considered as risk factors for insufficient sleep. [ABSTRACT FROM AUTHOR]

Short sleep duration is increasingly recognized as a risk factor for obesity. Sleep is now considered 1 of the 3 lifestyle behaviors, along with diet and exercise, which are closely associated with health. If sleep duration is a causal factor in the etiology of obesity, it must affect energy intake and/or energy expenditure to create a positive energy balance. The preponderance of evidence to date points to an effect of sleep restriction on energy intake that exceeds the added energy costs of maintaining longer wakefulness. Observational studies describe greater intakes of energy, fat, and possibly carbohydrates in short sleepers and this is corroborated by clinical interventions. These intervention studies further provide mechanistic explanations, via alterations in hormonal and neuronal controls of food intake, for an association between short sleep and obesity. [ABSTRACT FROM PUBLISHER]

The majority of sleep research has focused on deleterious health outcomes, with little attention to positive sequels. A systematic review of the literature regarding sleep duration and/or sleep quality in relation to mental toughness and resilience amongst non-clinical, healthy populations was completed. Eight databases and selected sources for grey literature were searched from their inception to April 2021. A total of 1925 unique records (1898 from the database search and 27 from grey sources) were identified and screened against the pre-set inclusion and exclusion criteria. Of these, 68 studies were eligible and 63 were included in the meta-analysis. Pooled results indicated a weak, positive correlation between sleep duration and resilience (r = 0.11, p < 0.001), and sleep quality (r = 0.27, p < 0.001). The pooled correlation was slightly attenuated for prospective studies pertaining to sleep quality and resilience (r = 0.18, p < 0.001). We found evidence of high publication bias for studies that explored the relationship between sleep quality and resilience. Sleep and resilience are positively correlated but additional research is needed to verify the direct relationship through carefully designed, prospective studies that capture both subjective and objective sleep estimates. For a more comprehensive understanding, complementary reviews that explore the sleep-resilience association are needed for clinical populations, and those who have suffered extreme hardship. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this investigation was to assess the relationships between suicidal ideation and insomnia symptoms in Veterans misusing alcohol. Method: Data were extracted in this retrospective chart review of Veterans referred from primary care for a behavioral health evaluation (N=161) based on evidence of heavy drinking, drug use or another behavioral problem. Suicidal ideation (SI) was assessed using the Paykel questionnaire. Insomnia symptoms were assessed with standard diary questions in an interview format and pertained to sleep latency (SL), wake after sleep onset time (WASO), sleep quality (SQ), and habitual sleep duration (HSD). The relations between suicidal ideation and insomnia symptoms were assessed using ordinal regression analyses adjusted for socio-demographic, psychiatric and addiction-related variables. Results: Suicidal ideation was reported in 62 (39%) of the Veterans interviewed. In a multivariable model, only inadequate SQ was associated with suicidal ideation. Short sleepers were more likely to endorse suicidal ideation and have attempted suicide in the past year. In addition, older age, inadequate financial status, and the presence of a psychiatric disorder were also significantly associated with suicidal ideation in most of the adjusted models. Conclusion: Given their association with suicidal ideation, insomnia symptoms in Veterans misusing alcohol should prompt an assessment of underlying psychiatric and social factors. [Copyright &y& Elsevier]

Highlights: [•] Our study examines sleep duration relative to self-reported and objective cardiometabolic risk factors. [•] Very short sleep (<5h) was associated with self-reported hypertension, hyperlipidemia and diabetes mellitus (DM). [•] Very short sleep (<5h) was associated with objectively determined hyperlipidemia and obesity. [•] Short sleep (5–6h) was associated with self-reported hypertension and obesity, and objective obesity. [•] Race/ethnicity interactions are significant for self-reported and objective hypertension, hyperlipidemia, DM, and obesity. [Copyright &y& Elsevier]

Highlights: [•] Overall, more drowsy driving in short sleepers and less in long sleepers. [•] With 7 nights/wk insufficient sleep, more drowsy driving in both short and long sleepers. [•] With 0 nights/wk insufficient sleep, more drowsy driving in short sleepers. [•] Short sleepers at greater risk of drowsy driving, irrespective of sufficient sleep. [ABSTRACT FROM AUTHOR]

Abstract: Short sleep duration is associated with weight gain and obesity, diabetes, cardiovascular disease, psychiatric illness, and performance deficits. Likewise, long sleep duration is also associated with poor physical and mental health. The role of a healthy diet in habitual sleep duration represents a largely unexplored pathway linking sleep and health. This study evaluated associations between habitual sleep parameters and dietary/nutritional variables obtained via the National Health and Nutrition Examination Survey (NHANES), 2007–2008. We hypothesized that habitual very short (<5h) short (5–6h) and long (9+h) sleep durations are associated with intake of a number of dietary nutrient variables. Overall, energy intake varied across very short (2036kcal), short (2201kcal), and long (1926kcal) sleep duration, relative to normal (2151kcal) sleep duration (p =0.001). Normal sleep duration was associated with the greatest food variety (17.8), compared to very short (14.0), short (16.5) and long (16.3) sleep duration (p <0.001). Associations between sleep duration were found across nutrient categories, with significant associations between habitual sleep duration and proteins, carbohydrates, vitamins and minerals. In stepwise analyses, significant contributors of unique variance included theobromine (long sleep RR=0.910, p <0.05), vitamin C (short sleep RR=0.890, p <0.05), tap water (short sleep RR=0.952, p <0.001; very short (<5h) sleep RR=0.941, p <0.05), lutein+zeaxanthin (short sleep RR=1.123, p <0.05), dodecanoic acid (long sleep RR=0.812, p <0.05), choline (long sleep RR=0.450, p =0.001), lycopene (very short (<5h) sleep RR=0.950, p <0.05), total carbohydrate (very short (<5h) sleep RR=0.494, p <0.05; long sleep RR=0.509, p <0.05), selenium (short sleep RR=0.670, p <0.01) and alcohol (long sleep RR=1.172, p <0.01). Overall, many nutrient variables were associated with short and/or long sleep duration, which may be explained by differences in food variety. Future studies should assess whether these associations are due to appetite dysregulation, due to short/long sleep and/or whether these nutrients have physiologic effects on sleep regulation. In addition, these data may help us better understand the complex relationship between diet and sleep and the potential role of diet in the relationship between sleep and obesity and other cardiometabolic risks. [Copyright &y& Elsevier]

Summary: This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social–ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research. [Copyright &y& Elsevier]

Abstract: Objective: To describe which dietary nutrient variables are related to subjective and objective habitual sleep and subjective and objective napping. Methods: Participants were 459 post-menopausal women enrolled in the Women’s Health Initiative. Objective sleep was estimated using one week of actigraphy. Subjective sleep was prospectively estimated with a daily sleep diary. Dietary nutrients were calculated from food frequency questionnaires. Results: The most significant correlations were with subjective napping, including (from strongest to weakest): total fat, calories, saturated fat, monounsaturated fat, trans fat, water, proline, serine, tyrosine, phenylalanine, valine, cholesterol, leucine, glutamic acid, ash, isoleucine, histidine, sodium, tryptophan, protein, threonine, cystine, methionine, phosphorous, polyunsaturated fat, animal protein, aspartic acid, arginine, lysine, alanine, caffeine, riboflavin, gamma-tocopherol, glycine, retinol, delta-tocopherol, Vitamin D, and selenium. Actigraphic nocturnal sleep duration was negatively associated with total fat, monounsaturated fat, trans fat, saturated fat, polyunsaturated fat, calories, gamma-tocopherol, cholesterol, and alpha-tocopherol-eq. Conclusions: Actigraphic total sleep time was negatively associated with intake of fats. Subjective napping, which may be a proxy for subjective sleepiness, was significantly related to fat intake as well as intake of meat. [Copyright &y& Elsevier]

Summary: While much is known about the negative health implications of insufficient sleep, relatively little is known about risks associated with excessive sleep. However, epidemiological studies have repeatedly found a mortality risk associated with reported habitual long sleep. This paper will summarize and describe the numerous studies demonstrating increased mortality risk associated with long sleep. Although these studies establish a mortality link, they do not sufficiently explain why such a relationship might occur. Possible mechanisms for this relationship will be proposed and described, including (1) sleep fragmentation, (2) fatigue, (3) immune function, (4) photoperiodic abnormalities, (5) lack of challenge, (6) depression, or (7) underlying disease process such as (a) sleep apnea, (b) heart disease, or (c) failing health. Following this, we will take a step back and carefully consider all of the historical and current literature regarding long sleep, to determine whether the scientific evidence supports these proposed mechanisms and ascertain what future research directions may clarify or test these hypotheses regarding the relationship between long sleep and mortality. [Copyright &y& Elsevier]

Immunity is influenced by sleep and the circadian rhythm. Healthcare workers are predisposed to both insufficient sleep and circadian disruption. This study aimed to evaluate the relationship between sleep and work characteristics and the antibody response to the mRNA SARS-CoV-2 vaccine BNT162b2. The authors' prospective cohort study ("COVI3") evaluated the effect of a third (booster) dose of the BNT162b2 vaccine. A subset of participants provided information on anthropometric measures, sleep, stress and work characteristics including shift work and number of work hours per week. Blood samples for anti -S1-RBD IgG antibody levels were obtained 21 weeks following receipt of the third dose of the vaccine. In total, 201 healthcare workers (73% women) were included. After adjustment for age, body mass index (BMI), shift work, smoking status, and perceived stress, short sleep duration (<7 h per night) was associated with lower anti -S1-RBD IgG levels (Odds ratio 2.36 [95% confidence interval 1.08–5.13]). Participants who performed shift work had higher odds of lower anti -S1-RBD IgG levels compared to those who did not work in shifts [odds ratio = 2.99 (95% confidence interval 1.40, 6.39)] after accounting for age, short sleep duration, BMI, smoking status and perceived stress. Shift work and self-reported short sleep duration were associated with a lower antibody response following a booster dose of the SARS-CoV-2 vaccine. These findings suggest that the efficacy of vaccination, particularly among healthcare workers, may be augmented by addressing both sleep and circadian alignment. [Display omitted] • Vaccination is a primary strategy to combat viral pandemics. • Healthcare workers are predisposed to both insufficient sleep and circadian disruption. • Shift work and short sleep duration were associated with a lower antibody response to the SARS-CoV-2 vaccine. • These findings highlight the importance of sleep as part of vaccination efforts. • Adequate sleep and circadian alignment around vaccination may enhance vaccine efficacy. [ABSTRACT FROM AUTHOR]

Cognitive behavioural therapy for insomnia (CBT-I) substantially reduces total wake time (TWT) by the end of treatment. In contrast, total sleep time (TST) does not increase above baseline levels for most patients following 4–8 sessions of treatment. In the 6–12 months following CBT-I, without any further intervention, up to 64% of participants substantially increase their TST (by ≥ 30 min). The current study investigated which baseline characteristics are associated with increases in TST after CBT-I. Data were analysed from a randomised controlled trial assessing acute and maintenance CBT-I (N = 80). Linear mixed models were conducted to assess the effect of baseline characteristics on changes in TST up to 24 months after CBT-I. Baseline characteristics included age, sex, marital status, sleep continuity (derived from sleep diaries and polysomnography studies), and mental health and quality of life questionnaires. At baseline, self-reported sleep latency, wake after sleep onset, early morning awakenings, TWT, TST, and sleep efficiency were associated with the greatest changes in TST (p <.03 for interactions), such that patients who reported more wake/less sleep at baseline also reported the largest increases in TST. No other baseline variables were associated with changes in TST after CBT-I, including age, sex, and polysomnography-derived sleep continuity (p >.07 for interactions). Patients with more severe self-reported sleep difficulties and lower sleep duration at baseline showed greater improvements in TST after CBT-I. Whether more patients could increase their TST, within the context of acute treatment or following treatment, warrants investigation. • The study assessed which factors are associated with sleep duration changes after treatment. • Worse sleep at baseline is associated with the greatest gains in sleep duration. • Other factors were not associated, including demographics and objectively derived sleep. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. Methods: A total of N =30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI⩾30kgm−2) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency. Results: Results indicated that, when examined alone, sleep duration <5h (versus 7h) was related to BMI (B =2.716, p <0.01), obesity (B =2.080, p <0.000001), diabetes (B =3.162, p <0.000001), hypertension (B =2.703, p <0.000001), hypercholesterolaemia (B =1.922, p <0.00001), heart attack (B =4.704, p <0.000001) and stroke (B =4.558, p< 0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B =0.181, p <0.01), obesity (B =1.061, p <0.000001) and hypercholesterolaemia (B =1.025, p <0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B =1.039, p <0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5h (versus 7h) and BMI (B =1.266, p <0.05), obesity (B =1.389, p <0.05), hypertension (B =1.555, p <0.01), heart attack (B =2.513, p <0.01) and stroke (B =1.807, p <0.05). It should be noted that relationships between sleep duration >9h (versus 7h) were seen for heart attack (B =1.863, p <0.001) and stroke (B =1.816, p <0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B =1.031, p <0.01) and hypertension (B =1.027, p <0.05). Conclusions: These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects. [Copyright &y& Elsevier]