Johanneke E. Oosterman

Objective: Chronic stress is linked to cardiometabolic diseases through increased glucocorticoid exposure, but the impact of daily life stress on glucocorticoid regulation and cardiometabolic health remains underexplored. This study investigated these associations. Design: This is a cross-sectional analysis of participants from the Netherlands Study of Depression and Anxiety (NESDA) without psychiatric diagnosis in the prior 6 months. Methods: We included 870 participants (64.7% female, median age 47.0 years). Daily life stress was assessed using the Daily Hassles Questionnaire (DHQ). Salivary cortisol was analyzed for 1-h awakening cortisol (4 time points), evening cortisol, and slope. Also an overnight 0.5 mg dexamethasone suppression test was performed. Associations between DHQ, glucocorticoid measures, and cardiometabolic health were studied using logistic and linear regressions. Results: After multivariable adjustment, each standard deviation (SD) increase in DHQ score was associated with 1.38 times (95% confidence interval [CI] 1.07; 1.77) higher odds of cardiovascular disease (CVD), but not diabetes, metabolic syndrome, or obesity. Higher DHQ scores were also associated with higher evening cortisol levels. In addition, each SD increase in cortisol suppression ratio was associated with 1.36 times (95% CI 1.08; 1.72) higher odds of CVD, but not diabetes, metabolic syndrome, or obesity. No interactions between DHQ and glucocorticoid measures on CVD were observed. Conclusion: A higher cortisol suppression ratio, indicative of increased glucocorticoid sensitivity, and increased daily hassles were both independently associated with having CVD. The absence of interaction suggests they influence CVD through separate pathways, highlighting the need for further research to better understand stress mechanisms and identify “stress profiles” most closely linked to cardiometabolic diseases.

Digital biomarkers are quantifiable and objective indicators of a person's physiological function, behavioral state or treatment response, that can be captured using connected sensor technologies such as wearable devices and mobile apps. We envision that continuous and 24-h monitoring of the underlying physiological and behavioral processes through digital biomarkers can enhance early diagnostics, disease management, and self-care of cardiometabolic diseases. Cardiometabolic diseases, which include a combination of cardiovascular and metabolic disorders, represent an emerging global health threat. The prevention potential of cardiometabolic diseases is around 80%, indicating a promising role for interventions in the lifestyle and/or the environmental context. Disruption of sleep and circadian rhythms are increasingly recognized as risk factors for cardiometabolic disease. Digital biomarkers can be used to measure around the clock, that is, day and night, to quantify not only sleep patterns but also diurnal fluctuations of certain biomarkers and processes. In this way, digital biomarkers can support the delivery of optimal timed medical care. Night-time cardiometabolic patterns, such as blood pressure dipping, are predictive of cardiometabolic health outcomes. In addition, the sleep period provides an opportunity for digital cardiometabolic health monitoring with relatively low influence of artifacts, such as physical activity and eating. Digital biomarkers that utilize sleep as a window of health can be used during daily life to enable early diagnosis of cardiometabolic diseases, facilitate remote patient monitoring, and support self-management in people with cardiometabolic diseases. This review describes the influence of sleep and circadian rhythms on cardiometabolic disease and highlights the state-of-the-art sleep and circadian digital biomarkers which could be of benefit in the prevention of cardiometabolic disease.

Objective Eating out of phase with the endogenous biological clock alters clock and metabolic gene expression in rodents and can induce obesity and type 2 diabetes mellitus. Diet composition can also affect clock gene expression. Here, we assessed the combined effect of diet composition and feeding time on (1) body composition, (2) energy balance, and (3) circadian expression of hepatic clock and metabolic genes. Methods Male Wistar rats were fed a chow or a free‐choice high‐fat, high‐sugar (fcHFHS) diet, either ad libitum or with food access restricted to either the light or dark period. Body weight, adiposity, and hepatic fat accumulation as well as hepatic clock and metabolic mRNA expression were measured after 5 weeks of diet. Energy expenditure was measured using calorimetric cages. Results Animals with access to the fcHFHS diet only during the light period showed more hepatic fat accumulation than fcHFHS dark‐fed animals despite less calories consumed. In contrast, within the chow‐fed groups, light‐fed animals showed the lowest hepatic fat content, but they also showed the lowest caloric intake. Locomotor activity and heat production followed feeding times, except in the fcHFHS light‐fed group. Hepatic clock and metabolic gene expression rhythms also followed timing of food intake. Yet, in the fcHFHS light‐fed animals, clock gene expression appeared 3 hours advanced compared with chow light‐fed animals, an effect not observed in the fcHFHS dark‐fed animals. Conclusions A fcHFHS diet consumed in the light period promotes hepatic fat accumulation and advances clock gene expression in male Wistar rats, likely because of a mismatch between energy intake and expenditure.