The Effect of High-Protein and Low-Calorie Diets on Sleep Quality in Individuals with Obesity

Document Type : Review Article


1 Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences.

2 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Division of Sleep Medicine, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Obesity, defined as excess body fat, has become a global epidemic, especially in low- and middle-income countries. Sleep problems are among the complications faced by obese individuals, although such problems are not very common. Previous studies indicate that obese individuals have a significantly greater likelihood of developing insomnia and other sleep disorders. Meanwhile, there is growing scientific evidence that diet and sleep may be related, and that weight loss can improve sleep quality and sleep-related indexes. In order to improve sleep quality and alleviate sleep disorders, this study examined the effects of weight loss diets on sleep quality in obese individuals. The literature indicates that sleep quality and sleep-related indexes are improved by weight loss. Compared with a low-fat diet, a very low-carbohydrate diet (VLCD) does not adversely affect cardiovascular risk factors for short-term weight loss. When weight loss is combined with VLCD, obstructive sleep apnea (OSA) can be improved.


Main Subjects

  1. Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, et al. Obesity in South and Southeast Asia—A new consensus on care and management. Obesity Reviews. 2023;24(2):e13520.
  2. Shekar M, Popkin B. Obesity: health and economic consequences of an impending global challenge: World Bank Publications; 2020.
  3. Kim SY. The definition of obesity. Korean journal of family medicine. 2016;37(6):309-.
  4. Lijnen HR. Angiogenesis and obesity. Cardiovascular research. 2008;78(2):286-93.
  5. Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635-43.
  6. Prentice AM. The emerging epidemic of obesity in developing countries. International journal of epidemiology. 2006;35(1):93-9.
  7. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC public health. 2009;9:1-20.
  8. Young IE, Poobalan A, Steinbeck K, O'Connor HT, Parker HM. Distribution of energy intake across the day and weight loss: A systematic review and meta‐analysis. Obesity Reviews. 2022:e13537.
  9. Dixon JB. The effect of obesity on health outcomes. Molecular and cellular endocrinology. 2010;316(2):104-8.
  10. Akbari Z, Mirzaei M, Azizi R. The Quantity and Quality of Sleep and their Relationship to Obesity. Journal of Mazandaran University of Medical Sciences. 2016;26(137):128-36.
  11. Zeighami Mohammadi S, Shahparian M. Evaluation of sleep problems and its associated factors in male patients with systolic heart failure. Qom University of Medical Sciences Journal. 2012;6(4):64-73.
  12. Mai E, Buysse DJ. Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep medicine clinics. 2008;3(2):167-74.
  13. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Archives of internal medicine. 2006;166(16):1775-82.
  14. Ong CW, O’Driscoll DM, Truby H, Naughton MT, Hamilton GS. The reciprocal interaction between obesity and obstructive sleep apnoea. Sleep medicine reviews. 2013;17(2):123-31.
  15. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS medicine. 2004;1(3):e62.
  16. Castellucci B, Barrea L, Laudisio D, Aprano S, Pugliese G, Savastano S, et al. Improving sleep disturbances in obesity by nutritional strategies: review of current evidence and practical guide. International Journal of Food Sciences and Nutrition. 2021;72(5):579-91.
  17. Bes-Rastrollo M, van Dam RM, Martinez-Gonzalez MA, Li TY, Sampson LL, Hu FB. Prospective study of dietary energy density and weight gain in women. The American journal of clinical nutrition. 2008;88(3):769-77.
  18. Savage JS, Marini M, Birch LL. Dietary energy density predicts women's weight change over 6 y. The American journal of clinical nutrition. 2008;88(3):677-84.
  19. Howarth NC, Murphy SP, Wilkens LR, Hankin JH, Kolonel LN. Dietary energy density is associated with overweight status among 5 ethnic groups in the multiethnic cohort study. The Journal of nutrition. 2006;136(8):2243-8.
  20. Ledikwe JH, Blanck HM, Kettel Khan L, Serdula MK, Seymour JD, Tohill BC, et al. Dietary energy density is associated with energy intake and weight status in US adults. The American journal of clinical nutrition. 2006;83(6):1362-8.
  21. Ello-Martin JA, Roe LS, Ledikwe JH, Beach AM, Rolls BJ. Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets. The American journal of clinical nutrition. 2007;85(6):1465-77.
  22. Bolinger RE, LUKERT BP, BROWN RW, GUEVARA L, STEINBERG R. Metabolic balance of obese subjects during fasting. Archives of Internal Medicine. 1966;118(1):3-8.
  23. Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes care. 1991;14(9):802-23.
  24. Saris WH. Very‐low‐calorie diets and sustained weight loss. Obesity research. 2001;9(S11):295S-301S.
  25. Ruban A, Stoenchev K, Ashrafian H, Teare J. Current treatments for obesity. Clinical Medicine. 2019;19(3):205.
  26. Muscogiuri G, Barrea L, Annunziata G, Di Somma C, Laudisio D, Colao A, et al. Obesity and sleep disturbance: the chicken or the egg? Critical reviews in food science and nutrition. 2019;59(13):2158-65.
  27. Godos J, Grosso G, Castellano S, Galvano F, Caraci F, Ferri R. Association between diet and sleep quality: A systematic review. Sleep Medicine Reviews. 2021;57:101430.
  28. López-Padrós C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, et al. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. Journal of Clinical Sleep Medicine. 2020;16(4):503-14.
  29. Carneiro‐Barrera A, Díaz‐Román A, Guillén‐Riquelme A, Buela‐Casal G. Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: systematic review and meta‐analysis. Obesity Reviews. 2019;20(5):750-62.
  30. Al Kibria GM. Prevalence and factors affecting underweight, overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016. Obesity research & clinical practice. 2019;13(2):129-36.
  31. Mbogori T, Kimmel K, Zhang M, Kandiah J, Wang Y. Nutrition transition and double burden of malnutrition in Africa: a case study of four selected countries with different social economic development. AIMS Public Health. 2020;7(3):425.
  32. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. The lancet. 2011;378(9793):804-14.
  33. Organization WH. Obesity: preventing and managing the global epidemic. 2000.
  34. Bray G, Kim K, Wilding J, Federation WO. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obesity reviews. 2017;18(7):715-23.
  35. Saddichha S. Diagnosis and treatment of chronic insomnia. Annals of Indian Academy of Neurology. 2010;13(2):94.
  36. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, et al. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. hypertension. 2006;47(5):833-9.
  37. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes care. 2010;33(2):414-20.
  38. Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB. Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep. 2005;28(10):1289-96.
  39. Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nature and science of sleep. 2013;5:27-.
  40. Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, et al. Risk factors for incident chronic insomnia: a general population prospective study. Sleep medicine. 2012;13(4):346-53.
  41. Vgontzas AN, Lin HM, Papaliaga M, Calhoun S, Vela-Bueno A, Chrousos GP, et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. International journal of obesity. 2008;32(5):801-9.
  42. Dallman MF, Pecoraro N, Akana SF, La Fleur SE, Gomez F, Houshyar H, et al. Chronic stress and obesity: a new view of “comfort food”. Proceedings of the National Academy of Sciences. 2003;100(20):11696-701.
  43. Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metabolic syndrome and related disorders. 2009;7(4):271-7.
  44. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Annals of internal medicine. 2005;142(3):187-97.
  45. Tuomilehto H, Seppä J, Uusitupa M. Obesity and obstructive sleep apnea–clinical significance of weight loss. Sleep medicine reviews. 2013;17(5):321-9.
  46. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. New England Journal of Medicine. 2017;376(3):254-66.
  47. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine. 2009;360(9):859-73.
  48. Singh RK, Kumar P, Mahalingam K. Molecular genetics of human obesity: A comprehensive review. Comptes rendus biologies. 2017;340(2):87-108.
  49. Lin X, Li H. Obesity: Epidemiology, Pathophysiology, and Therapeutics. Frontiers in endocrinology. 2021;12:706978-.
  50. Yoo S. Dynamic energy balance and obesity prevention. Journal of Obesity & Metabolic Syndrome. 2018;27(4):203-.
  51. Duffey KJ, Gordon-Larsen P, Jacobs Jr DR, Williams OD, Popkin BM. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. The American journal of clinical nutrition. 2007;85(1):201-8.
  52. Obri A, Claret M. The role of epigenetics in hypothalamic energy balance control: Implications for obesity. Cell stress. 2019;3(7):208-.
  53. Fitzgerald MP, Hennigan K, O'Gorman CS, McCarron L. Obesity, diet and lifestyle in 9-year-old children with parentally reported chronic diseases: Findings from the growing up in Ireland longitudinal child cohort study. Irish Journal of Medical Science (1971-). 2019;188(1):29-34.
  54. Romero-Ibarguengoitia ME, Vadillo-Ortega F, Caballero AE, Ibarra-González I, Herrera-Rosas A, Serratos-Canales MF, et al. Family history and obesity in youth, their effect on acylcarnitine/aminoacids metabolomics and non-alcoholic fatty liver disease (NAFLD). Structural equation modeling approach. PloS one. 2018;13(2):e0193138-e.
  55. Corica D, Aversa T, Valenzise M, Messina MF, Alibrandi A, De Luca F, et al. Does family history of obesity, cardiovascular, and metabolic diseases influence onset and severity of childhood obesity? Frontiers in Endocrinology. 2018;9:187-.
  56. Wu Y, Duan H, Tian X, Xu C, Wang W, Jiang W, et al. Genetics of obesity traits: a bivariate genome-wide association analysis. Frontiers in genetics. 2018;9:179-.
  57. Kasuga M. Genetic factor for diabetes and obesity. Nihon rinsho Japanese Journal of Clinical Medicine. 2010;68:359-63.
  58. Srinivasan S, Chen L, Todd J, Divers J, Gidding S, Chernausek S, et al. The first genome-wide association study for type 2 diabetes in youth: The Progress in Diabetes Genetics in Youth (ProDiGY) Consortium. Diabetes. 2021;70(4):996-1005.
  59. Chen J, Sun M, Adeyemo A, Pirie F, Carstensen T, Pomilla C, et al. Genome-wide association study of type 2 diabetes in Africa. Diabetologia. 2019;62(7):1204-11.
  60. Bogardus C. Missing heritability and GWAS utility. Obesity (Silver Spring, Md). 2009;17(2):209-.
  61. Thaker VV. Genetic and epigenetic causes of obesity. Adolescent medicine: state of the art reviews. 2017;28(2):379-.
  62. Huvenne H, Dubern B, Clément K, Poitou C. Rare genetic forms of obesity: clinical approach and current treatments in 2016. Obesity facts. 2016;9(3):158-73.
  63. Czajkowski P, Adamska-Patruno E, Bauer W, Fiedorczuk J, Krasowska U, Moroz M, et al. The impact of FTO genetic variants on obesity and its metabolic consequences is dependent on daily macronutrient intake. Nutrients. 2020;12(11):3255-.
  64. Koochakpour G, Esfandiar Z, Hosseini-Esfahani F, Mirmiran P, Daneshpour MS, Sedaghati-Khayat B, et al. Evaluating the interaction of common FTO genetic variants, added sugar, and trans-fatty acid intakes in altering obesity phenotypes. Nutrition, Metabolism and Cardiovascular Diseases. 2019;29(5):474-80.
  65. Rosen ED, Kaestner KH, Natarajan R, Patti M-E, Sallari R, Sander M, et al. Epigenetics and epigenomics: implications for diabetes and obesity. Diabetes. 2018;67(10):1923-31.
  66. Jaenisch R, Bird A. Epigenetic regulation of gene expression: how the genome integrates intrinsic and environmental signals. Nature genetics. 2003;33(3):245-54.
  67. of Cardiology AC, Guidelines AHATFoP. Guidelines (2013) for managing overweight and obesity in adults. Preface to the Expert Panel Report. Obesity (Silver Spring, Md). 2014;22(Suppl 2):S40-S.
  68. Lee EY, Yoon K-H. Epidemic obesity in children and adolescents: risk factors and prevention. Frontiers of medicine. 2018;12(6):658-66.
  69. Telles S, Gangadhar BN, Chandwani KD. Lifestyle modification in the prevention and management of obesity. Journal of obesity: Hindawi; 2016.
  70. Aminian A, Zelisko A, Kirwan JP, Brethauer SA, Schauer PR. Exploring the impact of bariatric surgery on high density lipoprotein. Surgery for Obesity and Related Diseases. 2015;11(1):238-47.
  71. Asghari G, Mirmiran P, Yuzbashian E, Azizi F. A systematic review of diet quality indices in relation to obesity. British Journal of Nutrition. 2017;117(8):1055-65.
  72. Weigle DS. Pharmacological therapy of obesity: past, present, and future. The Journal of Clinical Endocrinology & Metabolism. 2003;88(6):2462-9.
  73. ebrahim F, elham K, farzad E. The comparison of effects of high protein-low fat diet, and standard diet on weight loss TT Yafteh. 2009;11(3):31-9.
  74. Mahan LK, Escott-Stump S. Krause's food, nutrition, & diet therapy: Saunders Philadelphia; 2004.
  75. Pesta DH, Samuel VT. A high-protein diet for reducing body fat: mechanisms and possible caveats. Nutrition & metabolism. 2014;11(1):1-8.
  76. Hoffer LJ, Bistrian BR, Young VR, Blackburn GL, Matthews DE. Metabolic effects of very low calorie weight reduction diets. The Journal of clinical investigation. 1984;73(3):750-8.
  77. Blackburn GL, Sd P, Ll M. Mechanisms of nitrogen sparing with severe calorie restricted diets. 1981.
  78. Bistrian BR. Clinical use of a protein-sparing modified fast. Jama. 1978;240(21):2299-302.
  79. Barrows K, Snook JT. Effect of a high-protein, very-low-calorie diet on body composition and anthropometric parameters of obese middle-aged women. The American Journal of Clinical Nutrition. 1987;45(2):381-90.
  80. Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. The Journal of Clinical Endocrinology & Metabolism. 2003;88(4):1617-23.
  81. Liao F-H, Shieh M-J, Yang S-C, Lin S-H, Chien Y-W. Effectiveness of a soy-based compared with a traditional low-calorie diet on weight loss and lipid levels in overweight adults. Nutrition. 2007;23(7):551-6.
  82. Suratt PM, McTier RF, Findley LJ, Pohl SL, Wilhoit SC. Effect of very-low-calorie diets with weight loss on obstructive sleep apnea. The American Journal of Clinical Nutrition. 1992;56(1):182S–4S-S–4S.
  83. Kansanen M, Vanninen E, Tuunainen A, Pesonen P, Tuononen V, Hartikainen J, et al. The effect of a very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome. Clinical Physiology. 1998;18(4):377-85.
  84. Martin CK, Bhapkar M, Pittas AG, Pieper CF, Das SK, Williamson DA, et al. Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults: The CALERIE 2 Randomized Clinical Trial. JAMA internal medicine. 2016;176(6):743-52.
  85. Zhou J, Kim JE, Armstrong CL, Chen N, Campbell WW. Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese adults: results from 2 randomized controlled trials. The American journal of clinical nutrition. 2016;103(3):766-74.
  86. Dobrosielski DA, Patil S, Schwartz AR, Bandeen-Roche K, Stewart KJ. Effects of exercise and weight loss in older adults with obstructive sleep apnea. Medicine and science in sports and exercise. 2015;47(1):20-6.
  87. Hudson JL, Zhou J, Campbell WW. Adults Who Are Overweight or Obese and Consuming an Energy-Restricted Healthy US-Style Eating Pattern at Either the Recommended or a Higher Protein Quantity Perceive a Shift from "Poor" to "Good" Sleep: A Randomized Controlled Trial. The Journal of nutrition. 2020;150(12):3216-23.

Articles in Press, Accepted Manuscript
Available Online from 27 December 2023
  • Receive Date: 12 December 2023
  • Revise Date: 27 December 2023
  • Accept Date: 27 December 2023