Effect of energy intake expenditure balance on sleep duration: a cross-sectional study concerning the 2019, 2020, and 2022 Korea National Health and Nutrition Examination Surveys.

Abstract

Background: Diet and physical activity influence sleep duration; however, the association between energy intake expenditure balance (EIEB) and sleep duration has not been fully investigated. This study examined the relationship between EIEB and sleep duration among Korean adults.

Methods: This cross-sectional study included 13,164 adults aged ≥19 years (5,707 males and 7,457 females) from the 2019, 2020, and 2022 Korea National Health and Nutrition Examination Surveys. EIEB was defined as the difference between daily energy intake and energy expenditure. Energy intake was assessed using a 24-hour dietary recall, and energy expenditure was calculated by summing basal metabolic rate and physical activity. Participants were categorized into sex-specific EIEB quartiles (Q1-Q4). Logistic regression analyses were performed to evaluate the association between EIEB quartiles and short sleep duration (≤6 hours), adjusting for socioeconomic status, body mass index, lifestyle factors, and comorbidities.

Results: Among women, those in the Q2 EIEB group (-260.45 to 90.81 kcal) had a significantly lower risk of short sleep (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.60-0.84). Reduced odds were also observed in Q3 (OR, 0.75; 95% CI, 0.63-0.91) and Q4 (OR, 0.76; 95% CI, 0.62-0.94), with a significant trend across quartiles (P for trend=0.03). No significant associations were observed among men.

Conclusion: A balanced EIEB was inversely associated with short sleep duration in women but not in men, suggesting that sex-specific strategies for energy balance may be needed to support adequate sleep.