TYPE Original Research

PUBLISHED 15 December 2023

DOI 10.3389/fnut.2023.1301818

Sleep, activity, and diet in

OPEN ACCESS harmony: unveiling the
EDITED BY
Humaira Jamshed,
Habib University, Pakistan
relationships of chronotype, sleep
REVIEWED BY
Adriana Meireles,
quality, physical activity, and
Universidade Federal de Ouro Preto, Brazil
Müge Arslan,
Üsküdar University, Türkiye
dietary intake
*CORRESPONDENCE
Ahmet Murat Günal Ahmet Murat Günal*
a.muratgunal@gmail.com
Faculty of Health Sciences, Department of Nutrition and Dietetics, İstanbul Okan University, İstanbul,
Türkiye
RECEIVED 26 September 2023
ACCEPTED 20 November 2023
PUBLISHED 15 December 2023

CITATION
Günal AM (2023) Sleep, activity, and diet Introduction: This cross-sectional study aims to explore the intricate
in harmony: unveiling the relationships
of chronotype, sleep quality, physical activity, relationships among chronotype, sleep quality, physical activity, and dietary intake
and dietary intake. in a diverse cohort of 3,072 (50.2% female) participants residing in İstanbul,
Front. Nutr. 10:1301818.
doi: 10.3389/fnut.2023.1301818
Türkiye.

COPYRIGHT Methods: This study utilized established measurement tools, including the
© 2023 Günal. This is an open-access article
Morningness-Eveningness Questionnaire (MEQ) to assess chronotype, the
distributed under the terms of the Creative
Commons Attribution License (CC BY). The Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality, the International
use, distribution or reproduction in other Physical Activity Questionnaire Short Form (IPAQ-SF) to measure physical activity,
forums is permitted, provided the original
author(s) and the copyright owner(s) are and a 24-h dietary recall method to assess dietary intake.
credited and that the original publication in this
journal is cited, in accordance with accepted Results: The findings of this study revealed compelling associations. Firstly, a
academic practice. No use, distribution or robust association was observed between sleep quality and chronotype (OR:
reproduction is permitted which does not
comply with these terms. 2.265; 95% CI: 1.954–2.626; p < 0.001) as well as physical activity (OR: 0.836;
95% CI: 0.750–0.932; p = 0.002). Specifically, evening chronotypes are more
likely to have poor sleep quality, while highly active individuals tend to report
lower sleep quality. Transitioning from inactivity to high activity was associated
with a 16.4% increase in the odds of transitioning from normal to poor sleep,
while a shift from an evening to a morning chronotype was linked to a substantial
126.5-fold increase in the odds of moving from poor to normal sleep. Additionally,
morning chronotypes also display distinctive dietary patterns, characterized by
higher energy, protein, and fat intake, and reduced carbohydrate intake. Poor
sleep quality is associated with increased energy and macronutrient consumption.
Discussion: These findings underscore the intricate relationships of
chrononutrition within the context of sleep quality, physical activity, and dietary
choices. The study underscores the significance of personalized interventions
to effectively address specific health behaviors, highlighting the complexity of
chrononutrition’s role in promoting overall health and wellbeing.

KEYWORDS

chrononutrition, chronotypes, sleep quality, physical activity, dietary intake, nutrition

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1 Introduction between these pivotal domains. In doing so, it aspires to

inform targeted interventions that promote healthful synergies
The intricate interplay between sleep, physical activity, and between these concepts, thereby fostering a holistic framework for
dietary intake has garnered substantial attention in the realm individual wellbeing.
of health sciences, underscored by the recognition of their
collective influence on individual wellbeing. Emerging research
has highlighted the significance of sleep duration and quality in 2 Materials and methods
shaping various aspects of human physiology and metabolism,
while parallel investigations have illuminated the profound impact 2.1 Design
of dietary choices and physical activity levels on overall health
outcomes. Furthermore, the recognition of chronotype has added This study employed a cross-sectional design, in accordance
a nuanced layer to the complex relationship between these factors with the STROBE guidelines (15), conducted between September
(1–4). 2022 and July 2023, following ethical approval. Thirty senior
Chronotype refers to an individual’s inherent preference for students from the Nutrition and Dietetics Department were
either morning or evening activities, stemming from the interplay purposively selected for data collection. The author provided
between biological rhythms and external societal schedules. It comprehensive training to ensure accurate data collection,
signifies when an individual is most alert, productive, and particularly in 24-h dietary recall records. The students volunteered
responsive to environmental cues. Morning chronotypes, often for this study as an extracurricular activity. This approach aimed to
termed “morning people,” experience heightened alertness and maintain data quality and was conducted by established research
cognitive function during the early hours of the day, while evening practices in nutrition and dietetics.
chronotypes, colloquially referred to as “night owls,” are more
active and attentive during later hours. The distinction between
these chronotypes is influenced by the social environment, genetic 2.2 Participants and procedure
predisposition, and hormonal fluctuations that regulate the sleep-
wake cycle (5). Before participation in the study, written informed consent
Sleep quality encapsulates various dimensions of sleep was obtained from all participants. The inclusion criteria included
experiences beyond the duration of sleep. It is defined by the residence in İstanbul/Türkiye and an age range of 18–65 years.
subjective satisfaction and restorative nature of sleep. Sleep quality Additionally, those who use prescription drugs and have been
encompasses factors such as sleep latency (time taken to fall diagnosed with physiological or psychological diseases that may
asleep), sleep efficiency (ratio of time asleep to time spent in bed), affect their sleep patterns were not included in the study. Ethical
sleep disturbances (frequency of awakenings), sleep duration (total approval was granted by the Ethics Committee of İstanbul
time slept), use of sleep medication, daytime dysfunction (impact Okan University (Date: 12.09.2022; Number: 153-7) under the
of sleep problems on daytime functioning), and overall sleep Helsinki Declaration.
satisfaction. Optimal sleep quality is characterized by uninterrupted This study’s sample size was determined to accommodate
and restful sleep, while poor sleep quality is associated with frequent the multifaceted nature of investigating chronotype, sleep quality,
awakenings, discomfort, and daytime impairment (6). physical activity, and dietary intake while aiming to provide
The interplay between chronotype, sleep quality, physical statistically robust findings. Complex interactions among these
activity, and dietary intake underscores the intricate nature of variables necessitated a sizeable cohort to sufficiently capture the
human health and wellbeing. The chronotype influences an diversity of behaviors within the population under investigation.
individual’s sleep-wake patterns, activity preferences, and alertness A total of 3,072 individuals (50.2% female) were participated in
levels throughout the day. Sleep quality, in turn, is influenced by the the study. This allowed for a comprehensive exploration of the
alignment of sleep patterns with individual chronotypes, impacting intricate relationships between chrononutrition variables, ensuring
overall restfulness and vitality (7, 8). Physical activity levels, adequate statistical power to detect meaningful associations while
regardless of chronotype, contribute to sleep quality by promoting maintaining a balance between feasibility and representativeness.
better sleep architecture and reducing sleep disturbances (3, Data collection was conducted through face-to-face interviews,
9). Similarly, dietary intake, influenced by both chronotype ensuring no exclusions due to incomplete forms.
and physical activity, can also impact sleep quality (10, 11). Participants were randomly recruited on a voluntary basis in
Conversely, sleep quality can influence dietary choices and appetite multiple city centers of İstanbul. This approach might limit the
regulation (12–14). The multidirectional interactions among these study’s representation of rural areas or individuals less accessible
factors create a complex web of influences on health outcomes. through city-centered recruitment. But, according to the Turkish
Understanding these relationships has implications for tailored Statistical Institute’s (TurkStat) report released in May 2023, only
interventions that optimize sleep, physical activity, and dietary 0.9% of the population of İstanbul resides in rural areas (16).
behaviors to enhance overall wellbeing. Regarding potential selection bias due to self-selection, it is
The present study aims to unveil the intricate interplay of essential to acknowledge that the voluntary nature of participation
chronotype, sleep quality, physical activity, and dietary intake might introduce a degree of bias. While the sample’s voluntary
within a large participant cohort. By adopting a multifaceted nature could influence the generalizability of findings, the diverse
approach, this investigation aims to contribute substantively to demographics and geographical representation of İstanbul/Türkiye
the evolving body of knowledge elucidating the relationships within the sample enhance the study’s external validity.

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2.3 Measurements TABLE 1 Participants’ characteristics.

n %
The data collection tool consists of an information form, the
Sex
Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh
Sleep Quality Index (PSQI), the International Physical Activity Female 1,543 50.2
Questionnaire Short Form (IPAQ-SF), and lastly, a 24-h Dietary Male 1,529 49.8
Recall, respectively. Age groups
18–24 years 1,371 44.6
2.3.1 Information form
The information form comprises a set of inquiries 25 years and above 1,701 55.4

encompassing participants’ anthropometric attributes, including Education status

weight and height, along with sociodemographic details such Primary school 122 4
as age, education, and income level. Body mass index (BMI)
High school 676 22
values were derived from participants’ self-reported weight
and height statements and calculated using the formula: Vocational school 493 16

BMI = weight(kg)/[height(m)]2 . Undergraduate 1,556 50.7

Graduate 225 7.3

2.3.2 Morningness-Eveningness Questionnaire
Marital status
The MEQ, developed by Horne and Ostberg (5), represents
Single 2,033 66.2
a pivotal instrument utilized for discerning individuals’ circadian
preferences. It was subsequently adapted into Turkish by Pündük Married 1,039 33.8
et al. (17) and Agargun et al. (18). These adaptations demonstrated Income status
high reliability in Turkish samples, with Cronbach’s α coefficients
Income < Expense 590 19.2
of 0.812 and 0.81, respectively.
Income = Expense 1,517 49.4
The MEQ consists of 19 items, designed to probe respondents’
time preferences in various daily activities, with a total score Income > Expense 965 31.4
ranging from 16 to 86 points. Higher scores indicate an inclination Smoking status
toward morningness chronotype. Interpretation categorizes scores
No 1,806 58.8
into three types: evening type (16–41), neither/intermediate type
Yes 1,266 41.2
(42–58), and morning type (59–86).
Alcohol consumption
2.3.3 Pittsburgh Sleep Quality Index No 2,431 79.1
The evaluation of sleep quality was carried out using the Yes 641 20.9
Pittsburgh Sleep Quality Index (PSQI) developed by Buysse et al.
Total 3,072 100.0
(6), a self-administered questionnaire designed to evaluate sleep
quality over the past month. Turkish adaptation, assessed by Min Max Mean SD
Ağargün et al. (19), showed high internal consistency with a Age 18.00 65.00 30.16 10.92
Cronbach’s α coefficient of 0.804.
The PSQI encompasses 19 self-rated questions that collectively
yield seven distinct components: subjective sleep quality, sleep of frequency, duration (in minutes), and intensity, quantified
latency, sleep duration, sleep efficiency, sleep disturbance, use of as the metabolic equivalent of task (MET) value. One MET
hypnotic medications, and daytime dysfunction. Each component represents the oxygen consumption of a person at rest (3.5 ml
is scored on a scale ranging from 0 to 3, thereby generating a global O2 /kg/min).
PSQI score spanning from 0 to 21. A higher score indicates a lower The questionnaire comprises four sections: vigorous physical
quality of sleep, with a global PSQI score exceeding 5 categorizes activities, moderate-intensity physical activities, walking, and
individuals as poor sleepers, experiencing severe difficulties in at sitting. In the IPAQ framework, “vigorous physical activities”
least two or moderate difficulties in more than three areas. correspond to an expenditure of 8.0 MET, “moderate-intensity
physical activities” equate to 4.0 MET, and “walking” translates
2.3.4 International physical activity to 3.3 MET. To calculate the total MET score, the MET values
questionnaire–short form for specific activities are multiplied by their respective durations
The IPAQ-SF, collaboratively developed by an international and frequencies (days) and then summed. An individual’s overall
research consortium led by Craig et al. (20), serves as a valuable physical activity level is determined by this score, with a MET
tool for assessing physical activity patterns in large-scale studies. score below 600 indicating inactivity, 600–1,500 signifying minimal
Its concise format and standardized scoring facilitate insights activity, and a score above 1,500 denoting an active lifestyle.
into population-level physical activity. The Turkish adaptation,
executed by Saglam et al. (21), maintains the questionnaire’s 2.3.5 24-h dietary recall
effectiveness. The short form evaluates physical activities of The final pillar of measurement is dietary intake, assessed
at least 10 min duration over the past seven days in terms through 24-h dietary recall. This method offers a comprehensive

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TABLE 2 Participants’ anthropometrics.

Female Male Total p

Min–max Mean ± SD Min–max Mean ± SD Min–max Mean ± SD
Height (cm) 150–185 164.7 ± 6.1 152–206 178.7 ± 7.1 150–206 171.67 ± 9.63 < 0.001*a

Weight (kg) 38–125 62.1 ± 11.4 49–150 81 ± 12.6 38–150 71.50 ± 15.31 < 0.001*a

BMI (kg/m2 ) 15.60–44.3 22.9 ± 4.2 15.40–46.3 25.4 ± 3.6 15.43–46.3 24.12 ± 4.1 < 0.001*a

n % n % n % p
Underweight (< 18.5 163 10.6 20 1.3 183 6.0 < 0.001*b
BMI)

Normal (18.5–24.99 989 64.1 734 48.0 1,723 56.1

BMI)

Overweight 297 19.2 637 41.7 934 30.4

(25.00–29.99 BMI)

Obesity (≥ 30 BMI) 94 6.1 138 9.0 232 7.6

a Independent samples t-test.
b Pearson chi-square.

*p < 0.001.

means to capture detailed information regarding food and beverage TABLE 3 Participants’ scores from scales and distribution into groups.
consumption within a specific day. This structured interview
Mean SD
process involves collecting data on all items consumed in the past
24 h, typically from midnight to midnight on the previous day (22). MEQ scores 50.01 8.25

The energy and macronutrient consumption of the participants PSQI scores 6.38 3.02
were analyzed using the Turkish Nutrition Information System MET scores 1,647.90 1,203.26
(BeBiS) program version 8.0. Although the 24-h dietary recall
n %
method is well-established and widely used in nutrition research,
it is important to note dietary preferences may change from day to Chronotype
day and this approach provides a snapshot of dietary consumption. Evening type (16–41) 434 14.1

Intermediate type (42–58) 2,231 72.6

Morning type (59–86) 407 13.2

2.4 Data analysis
Sleep quality
In the analysis of the data, SPSS 22.0 and Microsoft Excel Poor Sleep Quality (> 5) 1,730 56.3
16 software programs were utilized. The criterion for assessing Normal Sleep Quality (≤ 5) 1,342 43.7
normality was based on the skewness and kurtosis values that fall
Physical activity
within the range of ± 1.00. T-tests and Mann–Whitney U tests
Inactive (< 600) 367 11.9
were used for pairwise comparisons in independent samples. One-
way analysis of variance and the Kruskal–Wallis H test were applied Minimally Active 1,422 46.3
for comparisons involving three or more groups. The assumption (600–1,500)

of homoscedasticity was verified using the Levene test. Post-hoc Highly Active (> 1500) 1,283 41.8
analyses were conducted using the Tukey Honestly Significant Total 3,072 100.0
Difference (HSD), Games-Howell, and Dunn tests. Relationships
between categorical variables were assessed using Pearson’s chi-
square test. Logistic regression and multinomial logistic regression reported in 1,806 (58.8%), and 2,431 (79.1%) did not consume
were employed to determine the effects. All evaluations were alcohol. The participants’ ages ranged from 18 to 65 years, with a
carried out with a confidence interval of 95%. mean age of 30.16 and a standard deviation of 10.92 (Table 1).
When comparing females and males, significant differences
were observed in height, weight, and BMI in favor of males (all
3 Results p < 0.001). In terms of BMI classifications, significant differences
were observed as well (p < 0.001). Among females, 10.6% were
The study included a total of 3,072 participants, 1,543 (50.2%) classified as underweight, 64.1% as normal weight, 19.2% as
of whom were female. In terms of age groups, 1,701 (55.4%) were overweight, and 6.1% as with obesity. Among males, 1.3% were
25 years and older, while 1,371 (44.6%) were in the 18–24 age range. underweight, 48% were normal weight, 41.7% were overweight, and
Regarding educational background, 1,556 (50.7%) had a bachelor’s 9.0% were with obesity (Table 2).
degree, and 2,033 (66.2%) were single. Concerning income levels, The participants exhibited a wide range of scores, with an
1,517 (49.4%) reported income equal to expenses. Smoking was average Chronotype score of 50.01 ± 8.25, an average PSQI score

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TABLE 4 Comparison of sociodemographic characteristics of participants according to chronotype, sleep quality, and physical activity.

Chronotype Sleep quality Physical activity

Evening type Intermediate type Morning type p Poor Normal p Inactive Minimally active Highly active p
n % n % n % n % n % n % n % n %
Sex
Female 220 14.3 1,125 72.9 198 12.8 0.787 928 60.1 615 39.9 < 0.001*** 166 10.8 795 51.5 582 37.7 < 0.001***
Male 214 14.0 1,106 72.3 209 13.7 802 52.5 727 47.5 201 13.1 627 41.0 701 45.8
Age groups
18–24 years 253 18.5 1,019 74.3 99 7.2 < 0.001*** 814 59.4 557 40.6 0.002** 158 11.5 620 45.2 593 43.3 0.318
25 years and above 181 10.6 1,212 71.3 308 18.1 916 53.9 785 46.1 209 12.3 802 47.1 690 40.6
Education status
Primary school 5 4.1 81 66.4 36 29.5 < 0.001*** 56 45.9 66 54.1 0.001** 25 20.5 56 45.9 41 33.6 0.009**
High school 70 10.4 490 72.5 116 17.2 348 51.5 328 48.5 101 14.9 294 43.5 281 41.6
Vocational School 69 14.0 384 77.9 40 8.1 276 56.0 217 44.0 56 11.4 229 46.5 208 42.2
Undergraduate 255 16.4 1,127 72.4 174 11.2 910 58.5 646 41.5 164 10.5 733 47.1 659 42.4
Graduate 35 15.6 149 66.2 41 18.2 140 62.2 85 37.8 21 9.3 110 48.9 94 41.8
Marital status
05

Single 338 16.6 1,509 74.2 186 9.1 < 0.001*** 1,185 58.3 848 41.7 0.001** 236 11.6 908 44.7 889 43.7 0.008**
Married 96 9.2 722 69.5 221 21.3 545 52.5 494 47.5 131 12.6 514 49.5 394 37.9
Income status
Income < Expense 103 17.5 419 71.0 68 11.5 0.021* 340 57.6 250 42.4 0.039* 57 9.7 259 43.9 274 46.4 < 0.001***
Income = Expense 205 13.5 1,121 73.9 191 12.6 879 57.9 638 42.1 187 12.3 763 50.3 567 37.4
Income > Expense 126 13.1 691 71.6 148 15.3 511 53.0 454 47.0 123 12.7 400 41.5 442 45.8
Smoking
No 193 10.7 1,344 74.4 269 14.9 < 0.001*** 925 51.2 881 48.8 < 0.001*** 241 13.3 867 48.0 698 38.6 < 0.001***
Yes 241 19.0 887 70.1 138 10.9 805 63.6 461 36.4 126 10.0 555 43.8 585 46.2
Alcohol consumption
No 305 12.5 1,788 73.5 338 13.9 < 0.001*** 1,282 52.7 1,149 47.3 < 0.001*** 284 11.7 1,166 48.0 981 40.4 0.001**
Yes 129 20.1 443 69.1 69 10.8 448 69.9 193 30.1 83 12.9 256 39.9 302 47.1

10.3389/fnut.2023.1301818
BMI groups
Underweight 33 18.0 132 72.1 18 9.8 0.003** 91 49.7 92 50.3 0.130 30 16.4 97 53.0 56 30.6 0.021*
Normal 235 13.6 1,268 73.6 220 12.8 988 57.3 735 42.7 212 12.3 788 45.7 723 42.0
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Overweight 126 13.5 687 73.6 121 13.0 513 54.9 421 45.1 102 10.9 420 45.0 412 44.1
Obesity 40 17.2 144 62.1 48 20.7 138 59.5 94 40.5 23 9.9 117 50.4 92 39.7
Pearson chi-square; *p < 0.05; **p < 0.01; ***p < 0.001.
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TABLE 5 Comparison of participants’ chronotypes, sleep quality, and physical activity levels.

Chronotype
Evening type Intermediate type Morning type p
n % n % n %
PSQI
Poor 319 18.4 1,268 73.3 143 8.3 < 0.001**
Normal 115 8.6 963 71.8 264 19.7
MET
Inactive 51 13.9 257 70.0 59 16.1 0.003*
Minimally active 222 15.6 996 70.0 204 14.3
Highly active 161 12.5 978 76.2 144 11.2
PSQI
Poor 179 10.3 794 45.9 757 43.8 0.002*
Normal 188 14.0 628 46.8 526 39.2
Pearson chi-square; *p < 0.01; **p < 0.001.

TABLE 6 The effect of chronotype on physical activity and the effect of chronotype and physical activity on sleep quality.

β SE OR (%95 CI) p
1 Model 1 (R2 : 0.082)
Constant −1.481 0.201 0.227 < 0.001
PSQI ← MET −0.179 0.056 0.836 (0.750–0.932) 0.002*
PSQI ← CHRONO 0.818 0.075 2.265 (1.954–2.626) < 0.001*
2 Model 2 (R2 : 0.006)
2.1 MET ← CHRONO (Inactive)
[ref.: highly active]
Intercept −0.892 0.155 < 0.001
Group 1 0.257 0.223 0.773 (0.499–1.197) 0.248
Group 2 −0.444 0.170 0.641 (0.460–0.894) 0.009*
Group 3 0
2.2 MET ← CHRONO (Minimal active)
[ref.: highly active]
Intercept 0.348 0.109 0.001
Group 1 −0.027 0.150 0.973 (0.725–1.307) 0.857
Group 2 0.330 0.118 0.719 (0.571–0.906) 0.005*
Group 3 0
2.3 MET ← CHRONO (Minimal Active)
[ref.: inactive]
Intercept 1.241 0.148 < 0.001
Group 1 0.230 0.214 1.259 (0.827–2.002) 0.248
Group 2 0.114 0.164 1.121 (1.118–2.175) 0.485
Group 3 0
Coding: MET: inactive (1), minimal active (2), highly active (3); CHRONO: evening type (1), intermediate type (2), morning type (3); PSQI: poor (1), normal (2); Model 1: logistic regression;
Model 2: multinomial logistic regression; OR: odds ratio; CI: confidence interval; *p < 0.05.

of 6.38 ± 3.02, and an average MET score of 1,647.90 ± 1,203.26. demographic and lifestyle factors. In terms of chronotype, there
In terms of chronotype, 14.1% were classified as evening type, were significant differences by age group, with the 18–24 age range
72.6% as intermediate type, and 13.2% as morning type. Regarding being more likely to be of the evening type (18.5%) compared to
sleep quality, 56.3% experienced poor sleep quality, while 43.7% those aged 25 and older (10.6%) (p < 0.001). Those who had a
had normal sleep quality. Considering physical activity, 11.9% were primary education were more likely to be morning types (29.5%)
inactive, 46.3% were minimally active, and 41.8% were highly active compared to those with higher levels of education (p < 0.001).
(Table 3). Furthermore, there were significant differences in chronotype by
There were significant differences in the chronotype, sleep marital status, with single individuals more likely to be evening
quality, and MET groups of the participants in their various types (16.6%) compared to married ones (9.2%) (p < 0.001).

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TABLE 7 Comparison of participants’ chronotypes and dietary intakes.

Chronotype
Mean ± SD Q2 (Q1 -Q3 ) p Post-
hoc
Sex Evening type Intermediate Morning type
type
Energy (kcal) Female 2,558.19 ± 850.15 2,621 ± 779.3 2,641.16 ± 828.38 0.453a

2,573.69 2,635.17 2,635.17

(1,846.6–3,088.97) (2,073.93–3,129.1) (2,028.13–3,230.59)

Male 2,702.49 ± 850.86 2,744.71 ± 874.43 2,935.57 ± 788.38 0.011*a 3 > 1, 2

2,674.26 2,730.06 2,965.56

(2,061.17–3,410.72) (2,091.9–3,376.02) (2,391.37–3,549.38)

Carbohydrate (g) Female 230.2 ± 76.61 241.03 ± 77.06 225.33 ± 79.54 0.006**a 2>3

230.1 (170.51–282.06) 239.37 (189.54–294.44) 232.16 (169.8–274.86)

Male 251.22 ± 85.98 251.52 ± 88.05 255.39 ± 77.12 0.876a

253.19 (197.35–322.25) 250.65 (185.73–315.63) 251 (207.29–306.7)

Carbohydrate (%) Female 0.37 ± 0.09 0.37 ± 0.09 0.34 ± 0.08 0.115a

0.36 (0.31–0.43) 0.36 (0.32–0.43) 0.34 (0.28–0.4)

Male 0.38 ± 0.1 0.37 ± 0.09 0.35 ± 0.07 0.005**k 1, 2 > 3

0.37 (0.31–0.43) 0.36 (0.31–0.42) 0.35 (0.31–0.38)

Protein (g) Female 88.93 ± 33.49 95.93 ± 31.18 100.33 ± 31.13 0.001**a 2, 3 > 1

88.85 (64.09–108.98) 96.02 (73.68–114.96) 100.1 (76.63–122.17)

Male 105.02 ± 32.75 104.75 ± 34.83 111.09 ± 32.32 0.069a

105.27 (82.53–127.91) 101.6 (80.42–127.44) 109.68 (91.38–131.36)

Protein (%) Female 0.14 ± 0.04 0.15 ± 0.04 0.16 ± 0.04 0.001**k 3 > 1, 2
2>1

0.14 (0.12–0.16) 0.15 (0.13–0.17) 0.15 (0.14–0.17)

Male 0.16 ± 0.04 0.16 ± 0.04 0.15 ± 0.03 0.138k

0.15 (0.14–0.18) 0.15 (0.13–0.18) 0.15 (0.13–0.17)

Fat (g) Female 143.04 ± 60.5 142.24 ± 55.71 149.56 ± 57.25 0.307a

143.53 (92.74–192.4) 143.53 (97.26–184.82) 148.19 (104.97–192.94)

Male 142.54 ± 60.49 147.32 ± 58.58 164.11 ± 54.39 < 0.001***a 2, 3 > 1

142.95 (94.63–187.97) 145.35 (101.09–191.46) 163.64 (130.76–207.26)

Fat (%) Female 0.49 ± 0.1 0.48 ± 0.1 0.5 ± 0.09 0.001**a 3>2

0.5 (0.41–0.56) 0.49 (0.4–0.55) 0.51 (0.44–0.57)

Male 0.46 ± 0.11 0.47 ± 0.1 0.49 ± 0.08 0.001**a 2, 3 > 1

0.47 (0.39–0.53) 0.49 (0.4–0.54) 0.49 (0.45–0.54)

SFA (g) Female 39.78 ± 15.85 40.63 ± 14.1 42.54 ± 14.78 0.150a

41.06 (27.93–50.68) 40.66 (30.99–50.13) 41.06 (31.66–54.41)

Male 41.78 ± 15.22 42.53 ± 15.33 46.52 ± 14.79 0.002**a 2, 3 > 1

42.08 (30.91–53.08) 41.76 (31.38–53.67) 46.72 (36.96–59.38)

MUFA (g) Female 66.26 ± 34.39 64.95 ± 32.19 69.57 ± 31.71 0.310k

69.19 (35.01–95.95) 65.29 (37.34–92.05) 73.78 (42.15–95.73)

Male 63.06 ± 33.76 66.54 ± 32.39 74.59 ± 30.19 0.001**k 3 > 1, 2

62.17 (32.08–91.15) 65.29 (38.51–94.53) 76.25 (53.34–99.72)

PUFA (g) Female 28.79 ± 11.66 28.3 ± 11.73 28.63 ± 12.45 0.894a

28.53 (19.55–37.52) 28.24 (19.17–36.76) 27.44 (19.22–38.1)

Male 28.94 ± 13.04 29.38 ± 12.86 33.37 ± 11.8 < 0.001***a 2, 3 > 1

28.31 (19.11–38.57) 28.67 (19.3–39.47) 33.39 (24.22–44.07)

(Continued)

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TABLE 7 (Continued)

Chronotype
Mean ± SD Q2 (Q1 -Q3 ) p Post-
hoc
Sex Evening type Intermediate Morning type
type
Cholesterol (mg) Female 412.48 ± 232.61 460.18 ± 224.15 494.15 ± 201.99 0.001**a 2, 3 > 1

396.88 (258.91–536.26) 424.68 (327.83–603.58) 495.4 (367.91–622.13)

Male 564.66 ± 270.96 560.94 ± 256.67 581.55 ± 232.19 0.635a

588.18 (386.52–751.26) 551.89 (383.03–757.68) 572.99 (412.98–742.33)

Fiber (g) Female 27.66 ± 10.95 29.06 ± 10.91 29.29 ± 11.38 0.172a

27.31 (19.67–34.92) 28.67 (20.82–36.65) 28.82 (21.28–37.15)

Male 28.83 ± 11.75 29.6 ± 12.29 32.89 ± 10.96 0.001**a 3 > 1, 2

28.89 (20.23–36.21) 28.85 (19.58–38.5) 33.76 (24.61–40.43)

a One-way ANOVA. k Kruskal–Wallis test. *p < 0.05; **p < 0.01; ***p < 0.001. SFA, saturated fatty acids; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids.

For sleep quality, there were significant differences by sex, with Based on these findings, the logistic regression model and the
60.1% of females being poor sleepers compared to 52.5% of males equations representing the probabilities of experiencing normal or
(p < 0.001). By age group, those aged between 18–24 were less poor sleep can be expressed as follows:
likely to have normal sleep quality (40.6%) compared to those aged

P PSQI = Normal
25 and older (46.1%) (p = 0.002). Furthermore, those having a ln (
P (PSQI = Poor)
higher education level were more likely to report poor sleep quality
(p = 0.001). There were significant differences in MET groups by = − 1.481 − 0.179 ∗ (MET) + 0.818 ∗ (CHRONO)
sex, with 37.7% of females being highly active compared to 45.8%
of males (p < 0.001). There were also significant differences in MET


P PSQI = Normal =
groups by smoking status and alcohol consumption, with smokers
e−1.481−0.179 ∗ (MET) + 0.818 ∗ (CHRONO)
and drinkers being more likely to be highly active (p < 0.001;
p = 0.001, respectively). Other correlations can be seen in Table 4. 1 + e−1.481−0.179 ∗ (MET) + 0.818 ∗ (CHRONO)
When comparing the chronotypes, sleep quality, and physical
activity levels of participants, it is observed that individuals P (PSQI = Poor) = 1 − P(PSQI = Normal)
with an evening chronotype constitute 18.4% of those with poor In Model 2, the influence of chronotype on physical activity was
sleep quality, while those with a morning chronotype have a examined using multinomial logistic regression. The overall model
higher percentage (19.7%) of normal sleep quality (p < 0.001). (Model 2) was found to explain only 0.6% of the total variance.
Additionally, individuals with an intermediate chronotype exhibit a Within Model 2.1 and Model 2.2, the reference category was set
higher level of physical activity (76.2%), and as inactivity increases, as “highly active” compared to the MET group, while in Model
morning chronotype prevalence also rises (p = 0.003). Furthermore, 2.3, it was defined as “inactive.” Within the CHRONO group, the
individuals with normal sleep quality show a higher level of reference category was “morning chronotype.”
inactivity (14%) compared to those with poor sleep quality (10.3%), In Model 2.1, an evaluation was conducted within the inactive
and conversely, individuals with high physical activity also exhibit group in reference to the highly active group. It was observed that,
a higher prevalence of poor sleep quality (p = 0.002) (Table 5). compared to a highly active individual, an inactive individual had
Table 6 provides insight into the relationships between a significant effect on being of intermediate chronotype, reducing
chronotype, physical activity (MET levels), and their combined the probability by 35.9%. However, the probability of being an
effects on sleep quality (PSQI scores). The table is divided into two evening chronotype compared to a morning chronotype for an
models. inactive individual as opposed to a highly active individual was
In Model 1, a logistic regression model was employed to not significant.
investigate the influence of chronotype and physical activity In Model 2.2, an evaluation was performed within the
on sleep quality. This model yielded significant effects on the minimally active group in reference to the highly active group. It
dependent variable, PSQI, for both independent variables, MET was found that, compared to a highly active individual, a minimally
and CHRONO, explaining 8.2% of the variance. In particular, active individual had a significant effect on being of intermediate
as MET levels transitioned from inactive to highly active, it chronotype, reducing the probability by 28.1%. However, the
was observed to increase the odds of moving from normal to probability of being an evening chronotype compared to a morning
poor PSQI categories by 16.4%. Conversely, shifting from an chronotype for a minimally active individual as opposed to a highly
evening chronotype to a morning chronotype was associated with a active individual was not significant.
substantial 126.5-fold increase in the odds of moving from poor to In Model 2.3, an evaluation was conducted within the
normal PSQI categories within the CHRONO variable. minimally active group in reference to the inactive group. It was

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TABLE 8 Comparison of participants’ sleep quality and dietary intakes.

Sleep quality
Mean ± SD Q2 (Q1 -Q3 ) p
Sex Poor Normal
Energy (kcal) Female 2,667.28 ± 817.51 2,535.54 ± 756.79 0.001**t

2,636.76 (2,070.29–3,237.67) 2,538.05 (2,021.91–2,996.85)

Male 2,863.26 ± 890.21 2,656.36 ± 817.62 < 0.001***t

2,869.31 (2,238.01–3,544.84) 2,635.17 (2,059.18–3,251.36)

Carbohydrate (g) Female 244 ± 80.59 227.65 ± 71.61 < 0.001***t

239.37 (187.42–300.01) 230.2 (180.46–273.15)

Male 263.84 ± 90.56 238.96 ± 79.45 < 0.001***t

263.57 (199.28–334.57) 239.37 (183.65–295.22)

Carbohydrate (%) Female 0.37 ± 0.09 0.37 ± 0.09 0.234t

0.36 (0.31–0.43) 0.36 (0.31–0.42)

Male 0.37 ± 0.08 0.37 ± 0.09 0.006**u

0.36 (0.32–0.43) 0.36 (0.31–0.41)

Protein (g) Female 97.53 ± 32.99 92.47 ± 29.26 0.002**t

98.08 (74.32–118.08) 93.19 (72.07–111.27)

Male 111.33 ± 35.07 99.4 ± 32.26 < 0.001***t

109.86 (86.54–136.4) 98.08 (78.8–120.07)

Protein (%) Female 0.15 ± 0.04 0.15 ± 0.03 0.445u

0.15 (0.13–0.17) 0.15 (0.13–0.17)

Male 0.16 ± 0.04 0.15 ± 0.04 < 0.001***u

0.15 (0.14–0.18) 0.15 (0.13–0.17)

Fat (g) Female 145.23 ± 57.58 140.37 ± 55.12 0.098t

143.53 (99.28–189.26) 143.53 (95.42–182.04)

Male 151.98 ± 59.56 145.6 ± 57.41 0.033*t

148.19 (106.07–201.16) 148.49 (99.2–187.25)

Fat (%) Female 0.48 ± 0.1 0.48 ± 0.1 0.220t

0.49 (0.41–0.55) 0.49 (0.41–0.56)

Male 0.47 ± 0.09 0.48 ± 0.1 0.014*t

0.48 (0.4–0.53) 0.49 (0.42–0.55)

SFA (g) Female 41.42 ± 14.59 39.75 ± 14.22 0.026*t

41.06 (31.02–52.03) 39.67 (30.33–49.49)

Male 44.13 ± 15.53 41.69 ± 14.96 0.002**t

43.65 (32.49–55.98) 41.06 (31.1–52.92)

MUFA (g) Female 66.03 ± 33 65.28 ± 31.7 0.301u

65.29 (37.81–94.64) 66.89 (37.31–91.54)

Male 67.31 ± 32.5 66.97 ± 32.4 0.421u

65.29 (40.53–95.54) 67.39 (37.32–94.62)

PUFA (g) Female 29.28 ± 11.99 27.1 ± 11.43 < 0.001***t

28.67 (19.88–37.86) 25.53 (18.18–35.34)

Male 31.37 ± 13.04 28.2 ± 12.38 < 0.001***t

31.5 (21.59–42.61) 27.39 (18.49–38.05)

Cholesterol (mg) Female 470.14 ± 232.67 439.26 ± 208.06 0.007**t

442.29 (326.52–620.32) 414.29 (326.59–562.45)

Male 600.98 ± 261.03 523.78 ± 243.19 < 0.001***t

614.51 (407.8–826.03) 498.69 (364.51–675.65)

(Continued)

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TABLE 8 (Continued)

Sleep quality
Mean ± SD Q2 (Q1 -Q3 ) p
Sex Poor Normal
Fiber (g) Female 29.75 ± 11.24 27.6 ± 10.46 < 0.001***t

28.82 (21.99–37.14) 26.46 (19.83–35.16)

Male 31.74 ± 12.55 27.95 ± 11.25 < 0.001***t

32.48 (22.19–42.02) 27.5 (19.01–36.57)

t Tukey’s HSD test. u Mann–Whitney U test. *p < 0.05; **p < 0.01; ***p < 0.001. SFA, saturated fatty acids; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids.

found that the probability of being an evening chronotype or an the percentage of protein intake, females with an evening
intermediate chronotype compared to a morning chronotype for chronotype consume significantly less compared to morning and
a minimally active individual as opposed to an inactive individual intermediate types (p = 0.001). Males with intermediate and
was not significant. morning chronotypes have significantly higher total fat intake (g
Based on these findings, the significant models of multinomial and %) compared to those with an evening chronotype (p < 0.001).
regression can be expressed as follows. For specific fatty acids (SFA, MUFA, and PUFA), a similar
trend is observed. Female participants classified as intermediate
P (MET = Inactive)
ln (
= and morning types have significantly higher cholesterol intake
P MET = Highly Active
than those with an evening chronotype (p = 0.001). Lastly,
−0.892 − 0.444 ∗ Intermediate Type + 0.257 ∗ (Evening Type)


males with a morning chronotype consume significantly more
dietary fiber compared to intermediate and evening types

(p = 0.001).
P MET = Minimal active
ln (
= The analysis of dietary habits concerning sleep quality reveals
P MET = Highly Active
noteworthy differences (Table 8). Male participants with normal
0.348 − 0.027 ∗ Evening Type + 0.330 ∗ (Intermediate Type)


sleep quality display significantly lower energy intake (kcal)
compared to those with poor sleep quality (p < 0.001), a trend
For the probabilities of being inactive, minimally active, and similarly observed in females (p = 0.001). Additionally, both
highly active within the significant models of regression, the male and female individuals with normal sleep quality consume
equations are as follows: significantly fewer carbohydrates (g) than those with poor sleep
quality (p < 0.001). While there are no significant differences
P (MET = Inactive) =
in carbohydrate percentage between sleep quality groups, there
e−0.892 + 0.257 ∗ (Evening Type)−0.444 ∗ (Intermediate Type) are significant disparities in protein intake (g). Females with
1 + e−0.892 + 0.257 ∗ (Evening Type)−0.444 ∗ (Intermediate Type) + poor sleep quality consume more protein than those with normal
e0.348−0.027 ∗ (Evening Type) + 0.330 ∗ (Intermediate Type) sleep quality (p = 0.002), and a similar trend is observed in
males (p < 0.001). In terms of dietary fat intake (g), males with
normal sleep quality have lower consumption levels compared


P MET = Minimal Active = to those with poor sleep quality (p = 0.033), whereas there
are no significant differences among females. However, the
e−0.892 + 0.257 ∗ (Evening Type)−0.444 ∗ (Intermediate Type) percentage of dietary fat varies, with males displaying lower fat
1 + e−0.892 + 0.257 ∗ (Evening Type)−0.444 ∗ (Intermediate Type) + percentages with normal sleep quality (p = 0.014). Furthermore,
e0.348−0.027 ∗ (Evening Type) + 0.330 ∗ (Intermediate Type) participants with poor sleep quality consume significantly higher
levels of SFA (females: p = 0.026; males: p = 0.002) and

PUFA (p < 0.001, both) in comparison to those with normal
P MET = Highly Active = sleep quality. Cholesterol intake is also significantly higher in
1 − [P (MET = Inactive) + P MET = Minimal Active ]

participants with poor sleep quality (females: p = 0.007; males:
p < 0.001). Lastly, dietary fiber intake is notably lower in
Table 7 reveals significant differences in dietary intake based both male and female individuals with normal sleep quality
on participants’ chronotypes. Male individuals with a morning (p < 0.001).
chronotype have a significantly higher energy intake (kcal) Table 9 provides the relationship between physical activity
compared to those with intermediate and evening chronotypes levels and dietary parameters, categorized by sex. The results
(p = 0.011). Among females, those with an intermediate chronotype reveal significant variations in dietary parameters across different
consume significantly more carbohydrates (g) than morning levels of physical activity and between sexes. In the context
types (p = 0.006). For protein intake (g), both intermediate of energy intake (kcal), females exhibited statistically significant
and morning chronotypes in females have significantly higher differences (p = 0.012) among groups. Post-hoc analysis indicated
consumption levels than the evening types (p = 0.001), with a that the inactive group consumed significantly less energy than
similar but non-significant trend in males (p = 0.069). Regarding more active groups. In males, the difference in energy intake was

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TABLE 9 Comparison of participants’ physical activity and dietary intakes.

Physical activity
Mean ± SD Q2 (Q1 -Q3 ) p Post-hoc
Sex Inactive Minimal active Highly active
Energy (kcal) Female 2,449.58 ± 816.88 2,633.9 ± 786.39 2,636.11 ± 798.62 0.012*a 2, 3 > 1

2,586.79 2,635.17 2,635.17

(1,809.43–3,013.51) (2,094.52–3,168.29) (2,040.14–3,228.26)

Male 2,566.19 ± 962.52 2,731.93 ± 871.67 2,851.34 ± 811.31 < 0.001***a 3 > 1, 2
2>1

2,531.05 2,703.38 2,851.59

(1,856.27–3,295.17) (2,121.45–3,368.55) (2,271.16–3,431.34)

Carbohydrate Female 214.78 ± 74.42 234.97 ± 74.1 247.43 ± 81.28 < 0.001***a 3 > 1, 2
(g) 2>1

222.6 (161.78–262.11) 237.07 (180.76–290.39) 239.37 (194.57–298.8)

Male 226.24 ± 96.18 246.31 ± 86.28 264.49 ± 81.12 < 0.001***a 3 > 1, 2
2>1

235.55 (140.57–299.27) 245.5 (180.77–308.01) 261.59 (207.94–323.17)

Carbohydrate Female 0.36 ± 0.1 0.36 ± 0.08 0.38 ± 0.09 0.004**a 3>2
(%)

0.36 (0.3–0.41) 0.36 (0.31–0.41) 0.37 (0.32–0.44)

Male 0.35 ± 0.1 0.37 ± 0.09 0.38 ± 0.09 0.002**k 3 > 1, 2

0.35 (0.3–0.4) 0.36 (0.31–0.41) 0.36 (0.32–0.43)

Protein (g) Female 90.34 ± 34.57 94.67 ± 30.21 98.14 ± 32.44 0.009**a 3>1

97.59 (66.76–112.06) 96.01 (73.04–114.11) 95.74 (74.58–120.2)

Male 96.58 ± 36.93 103.79 ± 34.27 109.93 ± 32.8 < 0.001***a 3 > 1, 2
2>1

98.08 (74.87–120.1) 103.13 (77.78–126.84) 105.88 (87.65–131.83)

Protein (%) Female 0.15 ± 0.04 0.15 ± 0.04 0.15 ± 0.04 0.018*k 3>2

0.15 (0.12–0.17) 0.15 (0.12–0.17) 0.15 (0.13–0.17)

Male 0.15 ± 0.05 0.16 ± 0.04 0.16 ± 0.03 0.391k

0.15 (0.13–0.18) 0.15 (0.13–0.18) 0.15 (0.13–0.18)

Fat (g) Female 137.24 ± 56.67 146.97 ± 56.56 140.03 ± 56.46 0.023*a 2>1

142.4 (96.59–176.13) 147.99 (103.6–188.99) 141.45 (92.91–183.19)

Male 142.3 ± 61.46 148.66 ± 58.04 151.1 ± 58.18 0.142a

143.53 (93.09–191.16) 151.4 (106.27–191.89) 147.95 (103.67–197.31)

Fat (%) Female 0.49 ± 0.11 0.49 ± 0.1 0.47 ± 0.1 0.004**a 2>3

0.49 (0.43–0.56) 0.5 (0.42–0.56) 0.47 (0.39–0.54)

Male 0.49 ± 0.11 0.48 ± 0.09 0.46 ± 0.1 0.027*a 1>3

0.49 (0.42–0.56) 0.49 (0.42–0.54) 0.48 (0.39–0.54)

SFA (g) Female 39.16 ± 15.24 41.48 ± 14.48 40.22 ± 14.17 0.072a

41.06 (28.92–48.56) 41.06 (31.3–51.58) 39.59 (30.4–49.82)

Male 40.2 ± 16.87 42.88 ± 15.36 43.84 ± 14.69 0.009**a 3>1

41.06 (26.1–53.24) 42.69 (31.67–54.21) 42.75 (32.81–54.84)

MUFA (g) Female 62.83 ± 31.42 68.31 ± 32.54 63.05 ± 32.44 0.008**k 2 > 1, 3

65.29 (37.49–87.48) 71.75 (40.67–93.94) 60.9 (34.66–91.65)

Male 64.61 ± 32.85 67.1 ± 31.6 67.93 ± 33.04 0.038k

65.36 (34.54–91.71) 69.94 (39.35–94.06) 64.99 (39.75–97.04)

PUFA (g) Female 27.15 ± 11.82 28.64 ± 11.73 28.46 ± 11.92 0.276a

28.38 (18.36–34.37) 28.39 (19.56–37.63) 27.78 (18.97–37.26)

(Continued)

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TABLE 9 (Continued)

Physical activity
Mean ± SD Q2 (Q1 -Q3 ) p Post-hoc
Sex Inactive Minimal active Highly active
Male 29.08 ± 13.35 29.77 ± 13.08 30.17 ± 12.43 0.503a
28.67 (18.45–41.21) 29.26 (19.05–39.95) 28.94 (20.47–40.05)

Cholesterol (mg) Female 446.83 ± 221.31 438.36 ± 210.79 487.49 ± 237.8 < 0.001***a 3>2
446.78 (315.19–595.31) 410.64 (325.33–565.56) 455.91 (333.74–652.3)
Male 518.58 ± 260.78 549 ± 244.15 591.03 ± 261.14 < 0.001***a 3 > 1, 2
2>1
541.2 (321.2–691.1) 547.48 (383.41–715.94) 577.4 (395.88–815.7)

Fiber (g) Female 26.55 ± 11.01 28.82 ± 10.87 29.66 ± 11.04 0.004**a 2, 3 > 1
27.79 (17.46–32.72) 28.34 (20.5–36.78) 28.72 (21.97–36.9)
Male 27.63 ± 12.95 29.2 ± 12.31 31.27 ± 11.48 < 0.001***a 3 > 1, 2
28.21 (16.54–37.17) 28.75 (19.68–38.18) 30.8 (22.69–40.02)
a One-way ANOVA k Kruskal–Wallis test; *p < 0.05; **p < 0.01; ***p < 0.001. SFA: saturated fatty acids; MUFA: monounsaturated fatty acids; PUFA: polyunsaturated fatty acids.

even more pronounced (p < 0.001), with the highly active group more closely with conventional schedules, promoting better sleep
consuming significantly more energy than both the minimally quality. A cross-sectional study conducted with the participation
active and inactive groups. Similar patterns of significance were of 5,497 medical students found being an evening type was
observed in carbohydrate, protein, and fat intake (g and %) the strongest predictor of poor sleep quality, underscoring the
for both sexes, highlighting the influence of physical activity disharmony between real-life demands of studying medicine and
on dietary choices. Contrary to other macronutrient intakes fat evening chronotype and suggesting a shift toward a morning
percentages were higher in minimally active females than highly chronotype for better sleep (8). This association underscores
active ones (p = 0.004) and inactive males than highly active ones the importance of considering an individual’s chronotype when
(p = 0.027). Additionally, highly active males had significantly evaluating sleep quality and designing interventions to address
higher cholesterol intake than other groups, while highly active sleep-related issues.
females had significantly higher cholesterol intake compared to
minimally active females (p < 0.001, both). Furthermore, fiber
intake showed significant differences, with the highly active group 4.2 Physical activity and sleep quality
consuming more fiber than the other two groups in both sexes
(females: p = 0.004; males: p < 0.001). The relationship between physical activity and sleep quality in
our study underscores the potential benefits of mild to moderate
exercise in promoting restful sleep. Highly active individuals were
4 Discussion more likely to experience poor sleep quality. This finding may be
attributed to the stimulating effects of vigorous physical activity
The present study delves into the intricate interplay of close to bedtime, which can disrupt the natural transition into sleep.
chronotype, sleep quality, physical activity, and dietary intake, Dubinina et al. (26) suggest high physical activity load at work
aiming to contribute substantively to our understanding of the or frequent vigorous physical activity is associated with difficulties
relationships between these pivotal domains within a diverse initiating sleep and may be a risk factor for insomnia. Another
participant cohort. study presents the relationship between increased physical activity
and decreased sleep time in adolescents (27). On the other hand, a
meta-analysis showed moderate to high-intensity physical activity
4.1 Chronotype and sleep quality was associated with better sleep quality, even though the majority
of the included studies did not find any association (9). Although
The analysis revealed significant associations between there is no consensus on the intense part, many studies revealed
chronotype and sleep quality. Individuals with an evening the beneficial effects of physical activity for better sleep (3, 28).
chronotype were more likely to experience poor sleep quality. This
finding aligns with existing literature, where evening chronotypes
are often associated with delayed sleep onset, shorter sleep 4.3 Chronotype and physical activity
duration, and higher rates of sleep disturbances (7, 23–25). The
propensity for evening chronotypes to encounter poor sleep quality The findings of this study revealed significant associations
may stem from societal schedules that demand early wake times, between chronotype and physical activity level. It was observed
creating a misalignment between their natural sleep-wake patterns that individuals with an evening chronotype were more likely to
and external demands. In contrast, morning chronotypes align be minimally active. Furthermore, as physical inactivity increased,

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the prevalence of morning chronotype also rose. These findings cholesterol, and fiber. Another large-scale cross-sectional
are incongruent with existing literature, which usually established study conducted in Türkiye with 2,446 participants found
a correlation between being a morning type and being highly similar energy and macronutrient intakes across poor and
active and vice-versa, an evening type with inactive (1, 29, 30). normal sleep quality categories, except for fiber intakes were
However, a systematic review of chronotype, physical activity, higher in those who had normal sleep quality. However,
and sports performance suggests evening types are less active they also stated individuals with shorter sleep periods had
and perform less in the morning than intermediate and morning higher SFA intakes (13). Agostini et al. (36) found that
types. They conclude that the chronotype effect on physical poor sleep quality is associated with poor dietary habits.
activity is not consistent (31). These findings suggest a complex They stated individuals with poor sleep quality tend to be
relationship between chronotype and physical activity, wherein missing breakfast and having energy-dense junk foods may
further investigations that delve into the causality are imperative
contribute to higher energy and macronutrient consumption
to elucidate the intricate mechanisms at play and enhance our
(36). Also, a meta-analysis that included intervention studies,
comprehensive understanding of this multifaceted topic.
concluded poor sleep quality, and sleeping less than 5.5 h
increase energy and macronutrient intake (4). Another review
supports these results stating poor sleep quality is associated
4.4 Chronotype and dietary intake with increased caloric consumption, poor dietary habits, and
obesity (14). These findings indicate that sleep quality may
The study suggested intriguing associations between dietary
exert a substantial influence on dietary choices. Individuals
intake and chronotype. Male individuals with a morning
with poor sleep quality may exhibit alterations in appetite-
chronotype exhibited significantly higher energy intake, while
regulating hormones, leading to increased food intake, particularly
females with an intermediate chronotype consumed more
high-protein and high-fat foods, as observed in this study.
carbohydrates. Furthermore, both male and female participants
Moreover, the association between poor sleep quality and higher
with an evening chronotype reported lower protein intake
percentages. These findings align with the previous studies. A study total fat and SFA consumption may have implications for
conducted with 112 young Japanese women suggests evening cardiovascular health, as elevated SFA intake is linked to adverse
chronotype individuals’ energy, protein, and cholesterol intakes outcomes. Therefore, addressing sleep quality may be a key
were lower (32). Toktas et al. (33) compared 12 morning-type component of interventions aimed at improving dietary habits
and 11 evening-type male university students’ dietary intakes and overall health.
and found those with an evening chronotype tendency consume
more energy, carbohydrates, and total fat and lower protein.
Also, several systematic reviews pointed out that the evening
chronotype is associated with poorer dietary habits (1, 2, 34).
Nevertheless, there are studies with minor distinctions. Arslan
4.6 Physical activity and dietary intake
et al. (35) investigated the chronotype and nutritional status of
204 healthcare professionals and found carbohydrate intakes The study demonstrated significant variations in dietary
were higher in evening types. Similarly, Bodur et al. (23) found parameters based on physical activity levels. Highly active
carbohydrate and energy intakes were higher, with no other individuals consumed more energy, carbohydrates, protein, and
significant differences in terms of chronotype and nutrients. These dietary fiber, reflecting increased energy expenditure and nutrient
findings suggest that chronotype may influence dietary choices, requirements associated with physical activity. In contrast, inactive
potentially due to variations in meal timing and food preferences individuals, particularly males, exhibited lower energy intake.
associated with different chronotypes. Morning chronotypes These findings are expected and align with the literature
may have more substantial breakfast consumption, contributing (37, 38). However, the percentage of dietary fat was higher
to higher energy intake, while evening chronotypes may prefer in minimally active females and inactive males compared to
late-night snacking or delayed meal patterns, affecting their their highly active counterparts. A study found similar results;
macronutrient distribution. These associations underscore the sedentary activities are positively associated with dietary fat
importance of considering chronotype when assessing dietary percentages (39). The reason for this result may be that people
habits and developing personalized nutritional recommendations. with high physical activity may consciously stay away from
high-fat foods. This variation in fat consumption may have
implications for body composition and metabolic health and needs
4.5 Sleep quality and dietary intake further investigation.

The analysis also revealed significant relationships between

sleep quality and dietary intake. Participants with normal
sleep quality reported lower energy intake and consumed
fewer carbohydrates in both sexes. Additionally, individuals 4.7 Implications for tailored interventions
with normal sleep quality had lower total fat intake in males.
Poor sleep quality was associated with higher protein intake The multidirectional interactions among chronotype, sleep
in both sexes, as well as increased intake of SFA, PUFA, quality, physical activity, and dietary intake underscore the

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complexity of health behaviors and their interplay. Understanding provide invaluable insights into tailoring interventions effectively.
these relationships has significant implications for tailored Acknowledging and addressing these limitations can guide future
interventions aimed at optimizing sleep, physical activity, and research to achieve a more comprehensive understanding of the
dietary behaviors to enhance overall wellbeing. Personalized complexities involved in health behaviors.
strategies that consider an individual’s chronotype, physical activity
level, and sleep quality can lead to more effective interventions that
address specific needs and challenges. For example, interventions Data availability statement
for evening chronotypes may focus on improving sleep hygiene
and facilitating physical activity during preferred times, while The raw data supporting the conclusions of this article will be
morning chronotypes may benefit from dietary recommendations made available by the author, without undue reservation.
that align with their early eating patterns. Moreover, addressing
the interrelationships between these factors can provide a holistic
framework for promoting individual wellbeing.
Ethics statement
The studies involving humans were approved by the Ethics
5 Conclusion Committee of İstanbul Okan University. The studies were
conducted in accordance with the local legislation and institutional
This study contributes to the evolving body of knowledge
requirements. The participants provided their written informed
elucidating the intricate interplay of chronotype, sleep quality,
consent to participate in this study.
physical activity, and dietary intake. The findings underscore the
need for personalized and multidimensional approaches to health
promotion and intervention. Tailoring strategies to individual
characteristics and considering the complex interactions between Author contributions
these factors can facilitate the development of holistic frameworks
for enhancing wellbeing and optimizing health behaviors. Further AG: Writing – original draft, Writing – review & editing.
research is warranted to deepen our understanding of these
relationships and their implications for public health and
clinical practice. Funding
The author declares that no financial support was received for
5.1 Limitations and future directions the research, authorship, and/or publication of this article.

While this study has provided valuable insights, it is essential

to acknowledge its inherent limitations. The cross-sectional design Acknowledgments
employed in this research precludes the establishment of causal
relationships between variables. As such, while associations were I would like to thank all the participants for volunteering. I
observed, definitive causation cannot be inferred. Longitudinal acknowledge Dr. Salim Yılmaz and Mr. Kürşat Aydın for their
studies or intervention-based research would offer a more advisory on statistical evaluations and 30 senior nutrition and
robust platform for establishing causal pathways between dietetics students for their help in data collection.
chronotype, sleep quality, physical activity, and dietary intake.
Moreover, the reliance on self-reported data for dietary intake
and physical activity introduces potential biases. Recall bias and
social desirability bias are inherent risks associated with self-
Conflict of interest
reported measures. Participants may tend to overestimate or
underestimate their actual behaviors, affecting the accuracy of The author declares that the research was conducted in the
the collected data. Employing complementary methods, such absence of any commercial or financial relationships that could be
as objective measures (e.g., accelerometers for physical activity, construed as a potential conflict of interest.
dietary logs, or biomarkers for dietary intake), could strengthen
future investigations and provide a more comprehensive
understanding of these health behaviors. Additionally, future Publisher’s note
research endeavors might benefit from delving deeper into
the role of psychological factors. Exploring motivational All claims expressed in this article are solely those of the
aspects, self-regulation mechanisms, and individual differences authors and do not necessarily represent those of their affiliated
in behavior change strategies could elucidate the underlying organizations, or those of the publisher, the editors and the
mechanisms influencing health behaviors. Understanding how reviewers. Any product that may be evaluated in this article, or
these psychological factors mediate the relationships between claim that may be made by its manufacturer, is not guaranteed or
chronotype, sleep quality, physical activity, and dietary intake could endorsed by the publisher.

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