Frontiers in nutrition · 2026
Meal timing disruption in maintenance dialysis patients: associations with sleep quality and fatigue.
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Chen Hong, Xu Lu, Ai Shiqi, Li Ming, Luo Nana, Wei Mingming, Li Xinjian, Wang Weisong
Аннотация
BACKGROUND: Maintenance dialysis patients frequently experience sleep disturbance and fatigue, which may contribute to disrupted eating timing, yet dialysis-specific evidence on meal timing disruption remains limited.
METHODS: We conducted a single-center cross-sectional study among 383 adults receiving maintenance hemodialysis or peritoneal dialysis at Jining Medical University Affiliated Hospital. Sleep quality, fatigue, and depressive symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI), FACIT-Fatigue (FACIT-F), and PHQ-2. Nocturnal eating was defined as caloric intake at or after 22:00; frequent nocturnal eating (primary outcome) was ≥3 of the past 7 days. We used multivariable logistic regression with progressively adjusted tiered models, indirect association decomposition with bootstrap confidence intervals, and E-value sensitivity analysis. Model 4 (fully adjusted) served as the primary model; all variance inflation factors were below 1.14.
RESULTS: Mean age was 52.9 ± 12.1 years; 55.1% were male and 76.5% received hemodialysis. Mean PSQI was 8.1 ± 3.1 and 85.1% had poor sleep (PSQI >5). Any and frequent nocturnal eating occurred in 54.3% and 15.7%, respectively. In Model 4, higher PSQI was associated with higher odds of frequent nocturnal eating (adjusted OR 1.19 per point, 95% CI 1.07-1.32), while higher FACIT-F (less fatigue) was associated with lower odds (adjusted OR 0.96, 95% CI 0.93-1.00). PHQ-2 positivity was also associated with frequent nocturnal eating (adjusted OR 2.40, 95% CI 1.29-4.47). E-values were 1.66 for PSQI and 4.23 for PHQ-2 positivity, indicating robustness to moderate unmeasured confounding. A descriptive cross-sectional statistical decomposition yielded a fatigue-attributable component of 0.019 log-odds (95% CI -0.000 to 0.045), a modest and non-robust contribution. Sensitivity analyses with alternative outcome cutoffs yielded consistent PSQI and PHQ-2 associations.
CONCLUSION: Meal timing disruption is common in dialysis and is associated with poorer sleep quality, greater fatigue, and depressive symptoms. Incorporating symptom screening into nutrition assessment may support targeted counseling for meal timing behavior in this population.
METHODS: We conducted a single-center cross-sectional study among 383 adults receiving maintenance hemodialysis or peritoneal dialysis at Jining Medical University Affiliated Hospital. Sleep quality, fatigue, and depressive symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI), FACIT-Fatigue (FACIT-F), and PHQ-2. Nocturnal eating was defined as caloric intake at or after 22:00; frequent nocturnal eating (primary outcome) was ≥3 of the past 7 days. We used multivariable logistic regression with progressively adjusted tiered models, indirect association decomposition with bootstrap confidence intervals, and E-value sensitivity analysis. Model 4 (fully adjusted) served as the primary model; all variance inflation factors were below 1.14.
RESULTS: Mean age was 52.9 ± 12.1 years; 55.1% were male and 76.5% received hemodialysis. Mean PSQI was 8.1 ± 3.1 and 85.1% had poor sleep (PSQI >5). Any and frequent nocturnal eating occurred in 54.3% and 15.7%, respectively. In Model 4, higher PSQI was associated with higher odds of frequent nocturnal eating (adjusted OR 1.19 per point, 95% CI 1.07-1.32), while higher FACIT-F (less fatigue) was associated with lower odds (adjusted OR 0.96, 95% CI 0.93-1.00). PHQ-2 positivity was also associated with frequent nocturnal eating (adjusted OR 2.40, 95% CI 1.29-4.47). E-values were 1.66 for PSQI and 4.23 for PHQ-2 positivity, indicating robustness to moderate unmeasured confounding. A descriptive cross-sectional statistical decomposition yielded a fatigue-attributable component of 0.019 log-odds (95% CI -0.000 to 0.045), a modest and non-robust contribution. Sensitivity analyses with alternative outcome cutoffs yielded consistent PSQI and PHQ-2 associations.
CONCLUSION: Meal timing disruption is common in dialysis and is associated with poorer sleep quality, greater fatigue, and depressive symptoms. Incorporating symptom screening into nutrition assessment may support targeted counseling for meal timing behavior in this population.