Sleep

Sleep quality and weight-adjusted waist index in US adults: a cross-sectional study from NHANES 2015-2020.

TL;DR

Higher sleep quality was independently associated with lower weight-adjusted waist index in a nationally representative U.S. sample, suggesting that improving sleep quality may serve as a modifiable strategy to reduce central adiposity and related cardiometabolic risk.

Key Findings

Higher sleep quality was significantly associated with lower weight-adjusted waist index in unadjusted analysis.

  • Each unit increase in sleep quality score corresponded to a lower weight-adjusted waist index (β = -0.21, p < 0.001) in the unadjusted model.
  • The sample included 8,718 adults aged ≥20 years from NHANES 2015–2020.
  • Sleep quality was assessed via self-reported questionnaire and treated as both a continuous and categorical variable (low, medium, high).
  • The weight-adjusted waist index was calculated as waist circumference (cm) divided by the square root of body weight (kg).

The inverse association between sleep quality and weight-adjusted waist index persisted after full adjustment for demographics, socioeconomic status, lifestyle behaviors, and chronic conditions.

  • In the fully adjusted model, each unit increase in sleep quality score corresponded to β = -0.05 lower weight-adjusted waist index (p = 0.001).
  • Four progressive adjustment models were used: demographics (age, sex, race/ethnicity), health insurance and socioeconomic status, lifestyle behaviors, and chronic conditions.
  • The association was independent of these covariates, indicating sleep quality has an effect beyond confounding factors.

High sleep quality (categorical) remained significantly protective against higher weight-adjusted waist index after full adjustment, while medium sleep quality was not significant.

  • High sleep quality was associated with lower weight-adjusted waist index (β = -0.11, p = 0.001) in the fully adjusted model.
  • Medium sleep quality did not show a statistically significant association after full adjustment.
  • This suggests a threshold or dose-response pattern where only high sleep quality confers a meaningful benefit.

Subgroup analyses revealed stronger associations between sleep quality and weight-adjusted waist index among younger adults, women, and non-Hispanic Whites.

  • Associations were stronger among younger adults compared to older adults.
  • Women showed stronger associations than other sex groups.
  • Non-Hispanic Whites showed stronger associations compared to minority groups.
  • Older adults and minority groups showed weaker associations.

No significant interaction effects were observed for marital status, sedentary behavior, smoking, alcohol use, or chronic conditions.

  • Subgroup analyses tested interactions across multiple behavioral and health-related variables.
  • None of the tested interaction terms—marital status, sedentary behavior, smoking, alcohol use, or chronic conditions—reached statistical significance.
  • This suggests the sleep quality–weight-adjusted waist index association is relatively consistent across these subgroups.

This study is reported as the first to demonstrate an independent inverse association between sleep quality and weight-adjusted waist index in a nationally representative U.S. sample.

  • Prior studies relied on BMI and waist circumference, which the authors argue inadequately capture abdominal fat.
  • The weight-adjusted waist index is described as a more sensitive, size-adjusted measure of central adiposity.
  • The study used secondary cross-sectional data from NHANES 2015–2020, a nationally representative survey.
  • The authors note prior findings on sleep quality and central obesity were inconsistent, likely due to measurement limitations.

What This Means

This research suggests that people who report better sleep quality tend to have lower levels of central (abdominal) fat, as measured by a relatively new metric called the weight-adjusted waist index (WWI). This index—calculated by dividing waist circumference by the square root of body weight—is considered a more precise way to measure belly fat compared to traditional measures like BMI or waist circumference alone. The study analyzed data from over 8,700 U.S. adults surveyed between 2015 and 2020, and the connection between better sleep and lower abdominal fat held up even after accounting for factors like age, sex, race, income, lifestyle habits, and chronic diseases. The findings also showed that only 'high' sleep quality (not 'medium') was linked to meaningfully lower abdominal fat, and the relationship was especially pronounced among younger adults, women, and non-Hispanic White individuals. Factors like smoking, drinking, sedentary behavior, and chronic conditions did not change the overall pattern, suggesting sleep quality has a broadly consistent relationship with abdominal fat across different lifestyle groups. This research suggests that sleep quality—separate from how long someone sleeps—may be an important and changeable factor in reducing abdominal fat accumulation, which is associated with heart disease, diabetes, and other metabolic conditions. Because sleep quality can potentially be improved through behavioral and clinical interventions, these findings point to it as a possible target for reducing health risks related to excess belly fat, though the cross-sectional design of the study means it cannot prove that poor sleep directly causes increased abdominal fat.

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Citation

Xiao G, Zhang Y, Li L, Li H, Tian B, Yao H. (2026). Sleep quality and weight-adjusted waist index in US adults: a cross-sectional study from NHANES 2015-2020.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2637291