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These results may reflect demographic-dependent differences in intrinsic circadian rhythms and may have important implications for understanding racial, ethnic, sex and other disparities in morbidity and mortality risk.

Circadian rhythms have been observed in almost all life forms and play a critical role in human health. Disruption of circadian rhythms has been associated with poor health, including increased risk of neurodegenerative diseases [ 2 , 3 ], metabolic syndrome, diabetes [ 4 , 5 ], cardiovascular disease [ 6 ], and cancer [ 7 ].

Rest-activity rhythm RAR , namely magnitude, timing and regularity of rest-activity patterns, is the most evident manifestation of the circadian rhythm and can be objectively quantified from accelerometry data. In a recent prospective study, accelerometry-derived metrics of RAR including amplitude strength or magnitude of the rhythm , acrophase timing of peak activity and pseudo-F statistic robustness of the rhythm independently predicted increased risk of incident diabetes among older men [ 8 ].

Another longitudinal analysis of older men also reported that, compared with participants in the highest quartile of amplitude, mesor mean activity level and pseudo-F statistic, those who were in the lowest quartiles had nearly three times greater risk of developing Parkinson disease [ 9 ].

Risk of dementia or mild cognitive impairment have also been associated with decreased amplitude or delayed acrophase [ 10 , 11 ]. Metrics of RAR irregularity such as decreased interdaily stability IS, day-to-day stability of RAR and increased intradaily variability IV, fragmentation of RAR have been linked with increased risk of cardiometabolic disorders [ 12 ], neurodegenerative diseases [ 3 , 13 ], and mortality [ 14 , 15 , 16 ], thus underscoring the critical role of RAR for human health.

Most of the population-level evidence from accelerometry is limited to standard physical activity levels [ 17 , 18 , 19 ]. A small study [ 20 ] with adults Therefore, there is need for studies describing RAR composition in the general populations in real-life settings, given that intrinsic circadian rhythms as assessed by core body temperature or melatonin release varied with demographic characteristics in laboratory settings [ 21 , 22 , 23 ].

NHANES provides nationally representative data on nutrition and health of non-institutionalized US civilians obtained from in-person interviews and physical examinations. A stratified, multistage probability sampling method is applied for participant selection [ 25 ]. Acceleration measurements from all three axes were summed for each minute as Monitor-Independent Movement Summary MIMS units, a non-proprietary and device-independent universal summary metric [ 29 ].

We used two common approaches to quantifying RAR, the extended cosinor model [ 8 , 9 , 30 ] and the nonparametric method [ 31 ], excluding the first and last day of accelerometry data due to incomplete h periods from midnight to midnight. The extended cosinor model applies an antilogistic transformation to the cosinor curve and fits the activity data to a squared wave rather than a cosinor curve [ 30 ].

It has been proposed that the extended cosinor model may fit human activity data with higher flexibility since it assumes a shape more similar to a square wave than a cosinor curve [ 9 ]. Nonparametric methods do not make distributional or functional assumptions on patterns of rest-activity data, and therefore, may also describe the RAR better than the cosinor model [ 13 ].

Figure 1 shows pictorial examples of RARs generated by the extended cosinor model using accelerometry data from two participants. Missing activity data from non-wear periods were left as zero activity. Acrophase was categorized into three groups in accordance with previous studies [ 8 , 9 ]: phase advanced 1 SD lower than the mean, i. Illustration of rest-activity rhythms of two participants generated using extended cosinor model.

Details of other sociodemographic factors are provided in Additional file 1 Table S2. To be representative of the US adult population, complex survey design factors including sample weights, clustering, and stratification were taken into account as recommended [ 32 ].

Categorical variables are expressed as numbers and weighted percentages and continuous variables are expressed as weighted means and standard errors SE. RAR metrics are presented as averages for the entire sample as well as according to their quartile distribution and phase categories for acrophase. Multivariate linear regression models with each of the RAR metrics as dependent variable and each of demographic factors, i.

Sociodemographic variables were adjusted for when not tested as exposures. Accelerometry data were processed using R version 4. Statistical analyses were performed using SPSS The mean number of valid days of accelerometry data was 6.

Of the total 54, person-days, 51, Of the remaining 5. Table 1 shows the weighted demographic and RAR characteristics of the study population. Mean age of participants was Non-Hispanic whites constituted Demographic characteristics stratified by phases of acrophase and quartiles of amplitude, mesor, pseudo-F statistic, IS and IV are reported in Additional file 1 Tables S3-S5. Consistently, women were more likely to be in the highest quartile of amplitude Women were also more likely to be in the normal acrophase than men Similarly, older adults were more likely to be in the lowest quartiles of amplitude, mesor and IV Additional file 1 Table S3 and Table S5 than younger and middle-aged adults, but also more likely to be in the highest quartile of pseudo-F statistic and IS Additional file 1 Table S4—5.

Older adults reached their peak activity earlier than younger adults Acrophase, vs ; Table 1 and were more likely to be in advanced phase In multivariable linear analysis, age was inversely associated with amplitude, mesor, acrophase and IV, and was positively associated with pseudo-F statistic and IS Table 2.

Consistently, Hispanics were more likely to be in the highest quartiles of amplitude, mesor, and IS and lowest quartiles of IV, whereas non-Hispanic blacks were more likely to be in the lowest quartile of amplitude, IS and highest quartiles of IV Additional file 1 Table S3 and Table S5.

Relative to non-Hispanic whites, Hispanics had significantly higher amplitude, mesor, and IS and significantly lower IV independent of covariates Table 2. Conversely, non-Hispanic blacks had significantly lower amplitude and IS than non-Hispanic whites. There were no significant interactions between sex and age on other RAR metrics. Rest-activity rhythm metrics in men and women across age groups. Graphs were plotted using spline regression adjusting for race, education, marital status, employment status and poverty income ratio.

Graphs were plotted using spline regression adjusting for sex, education, marital status, employment status and poverty income ratio. NH, non-Hispanic. In this large, nationally representative US sample we found that women had higher RAR amplitude and mesor and also had a more stable and less fragmented rest-activity circadian rhythm than men.

To our knowledge, this is the first study to systematically describe demographic factors associated with RAR patterns in a real-life setting using a large and, importantly, representative sample of US adults. In line with findings from the UK Biobank and the FinHealth Survey [ 18 , 19 ], accelerometry data showed slightly higher amplitude and mesor in women relative to men, indicating higher physical activity as estimated from the fitted curve.

However, other reported men having higher or similar accelerometer-measured total physical activity levels compared with women [ 35 , 36 ], with men being more likely to be sedentary and engaged in moderate-to-vigorous activities and women in light activities. Such discrepancy may be owed to the approach used to determine activity.

Because amplitude and mesor are circadian rhythm-adjusted estimates of physical activity based on the fitted curve derived from the extended cosinor model, they may not align with conventionally measured physical activity levels, and especially may not reflect short bursts of vigorous activity. A prior small study showed that women had more stable RAR but showed similar fragmentation levels compared with men, possibly due to the small proportion of male participants Supporting this hypothesis and in line with our results, men were found to have a more fragmented RAR in a study with more balanced sex distribution [ 13 ].

The more stable RAR pattern in women could potentially result from the more frequent involvement of regular household activities [ 37 ]. When we explored interactions between sex and age, we found that the age-related RAR phase advance was attenuated in women compared to men.

Although underlying mechanisms are unclear, this observation may reflect potential effects of estrogens on the intrinsic circadian rhythm. The slightly shorter circadian period exhibited by women in comparison to men, which results in earlier intrinsic circadian phase [ 23 , 39 , 40 ], has been attributed to their higher level of estrogens.

As estrogen levels decrease with aging, their shortening effects on the circadian period may be blunted, therefore leading to less striking phase advance in women than men. Sociocultural factors could also contribute to the observed sex differences in acrophase changes with aging. The association between aging and changes in circadian rhythm has been well established. Briefly, the phase of endogenous circadian rhythms advances and the amplitude dampens with aging [ 21 ].

Our findings that mesor and amplitude of RAR decreased while phase advanced in older adults are consistent with these data. Moreover, environmental factors such as reduced work-related physical activity [ 41 ] and diminished social interaction [ 42 ] may also contribute to decreased amplitude and mesor in older adults. On the other hand, we also unexpectedly found that older adults had more stable and less fragmented RAR than younger adults.

However, the association between circadian rhythms and neurodegenerative disease has been reported to be bidirectional, with neurodegenerative disease also affecting circadian rhythms [ 1 , 3 ].

Moreover, the present study aimed to assess the association of RAR with age in the general population, which may account for the discrepancy. Accordingly, many studies showed decreased variability in activity in older adults [ 20 , 43 , 44 , 45 ]. It is plausible that the higher interdaily stability and lower intradaily variability of RAR in older adults may reflect their more rigid day-to-day routine.

Similar to our findings, a previous study with adults showed that African-Americans and Asians had less stable and weaker accelerometry-derived rest-activity patterns compared to Whites [ 20 ]. Similarly, a recent study also reported no significant difference between whites and blacks on circadian rhythms phase measured by dim light melatonin onset in free-living environment [ 51 ]. Potential explanation could be that entrainment of environmental factors may offset the minor circadian rhythms phase difference between the white and black populations.

Studies have reported that Asians or Asian immigrants are usually sedentary during their leisure time and longer duration of residence in US has been linked to more leisure time physical activity [ 52 , 53 ], potentially reflecting the process of settling down into new environment and culture.

Our findings provide important and novel insights into characteristics of RAR and their potential role on health and disease. First, we report that RAR at least partially reflected the age and sex variation of endogenous circadian rhythms.

Supporting our findings, significant correlations between fragmentation of RAR and decreased amplitude of melatonin secretion [ 54 ] and between RAR acrophase and cortisol acrophase [ 55 ] have been observed. Hence, RAR metrics derived from accelerometry data may serve as complementary marker for assessing endogenous circadian rhythms patterning in epidemiological studies and our data provided a compelling hypothesis-generating foundation for future studies of endogenous circadian variations and their health implications among different populations.

Last, as disruption of RAR has been associated with increased risk of neurodegenerative diseases [ 3 , 13 ], cardiometabolic diseases [ 12 ] and cancer [ 7 ], findings from the present study support targeting RAR in preventive and therapeutic strategies to enhance public health.

Strengths of the current study include high device-wearing compliance with By using both an extended cosinor model and non-parametric methods we performed a comprehensive assessment of RAR patterns, describing strength, timing and regularity, which are generalizable to the US population. Our study also has several limitations. First, we acknowledge that accelerometry-derived RAR metrics may be influenced by several environmental and sociodemographic factors in addition to endogenous circadian rhythms.

Although we have adjusted for common sociodemographic factors, unmeasured environmental factors could have affected our findings.

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