{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T02:49:47Z","timestamp":1762051787862,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T00:00:00Z","timestamp":1652745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"California Tobacco-Related Research Program (TRDRP)","award":["T30IP0998"],"award-info":[{"award-number":["T30IP0998"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Insomnia is prevalent in up to 40% of breast cancer survivors. Few studies have examined pessimism and dietary factors as risk factors for insomnia among breast cancer survivors. We leveraged a cohort of 2944 breast cancer survivors who enrolled in the Women\u2019s Healthy Eating and Living study; these survivors provided dietary, insomnia, mental health, demographic, and lifestyle information at baseline and at 1- and 4-year follow-up assessments. Insomnia symptoms were assessed using the Women\u2019s Health Initiative (WHI)-Insomnia Rating Scale, and pessimism was assessed using the Life Orientation Test Revised (LOT-R). Total calorie intake and acid-producing diets were assessed using 24 h dietary recalls. Multivariable-adjusted generalized estimating equation (GEE) models were used to test the independent and joint effects of psychological and dietary factors on insomnia. In the multivariable model, women in the third tertile of pessimism had greater odds (OR = 1.57 95% CI [1.37\u20131.79]) of insomnia when compared to women in the lowest tertile. Total calorie intake and acid-producing diets were each independently and significantly associated with insomnia symptoms. Further, pessimism and calorie intake\/acid-producing diets were jointly associated with insomnia. For instance, women with pessimism scores in tertile 3 and total calorie intakes &lt; median reported 2 times the odds (OR = 2.09; 95% CI [1.51\u20133.47]) of insomnia compared to women with pessimism score in tertile 1 and calorie intakes &lt; median. Our results highlight the need for patient care regarding mental health, and recommendations of healthy dietary intakes for breast cancer survivors.<\/jats:p>","DOI":"10.3390\/jcm11102828","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T08:34:29Z","timestamp":1652776469000},"page":"2828","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Independent and Joint Associations of Pessimism, Total Calorie Intake and Acid-Producing Diets with Insomnia Symptoms among Breast Cancer Survivors"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-3511","authenticated-orcid":false,"given":"Tianying","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"},{"name":"Moores Cancer Center, University of California, San Diego, CA 92037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5336-4674","authenticated-orcid":false,"given":"Cesar","family":"Arevalo","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang-Chi","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA"},{"name":"Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzi","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA"},{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6562-8577","authenticated-orcid":false,"suffix":"Jr.","given":"Humberto","family":"Parada","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"},{"name":"Moores Cancer Center, University of California, San Diego, CA 92037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingan","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Pierce","sequence":"additional","affiliation":[{"name":"Moores Cancer Center, University of California, San Diego, CA 92037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,17]]},"reference":[{"key":"ref_1","unstructured":"(2021, January 23). World Health Organization Cancer Fact Sheet. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cancer."},{"key":"ref_2","unstructured":"(2022, January 23). Key Statistics for Breast Cancer. Available online: https:\/\/www.cancer.org\/cancer\/breast-cancer\/about\/how-common-is-breast-cancer.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/s41416-018-0154-2","article-title":"Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: Effects on insomnia and circadian rhythm during chemotherapy: A phase II randomised multicentre controlled trial","volume":"119","author":"Palesh","year":"2018","journal-title":"Br. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"434","DOI":"10.3122\/jabfm.2007.05.060225","article-title":"Symptom burden among cancer survivors: Impact of age and comorbidity","volume":"20","author":"Mao","year":"2007","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4401","DOI":"10.1007\/s00520-019-04936-5","article-title":"Prevalence and risk factors of sleep disturbances in breast cancersurvivors: Systematic review and meta-analyses","volume":"27","author":"Leysen","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2147\/NSS.S125807","article-title":"Sleep problems during the menopausal transition: Prevalence, impact, and management challenges","volume":"10","author":"Baker","year":"2018","journal-title":"Nat. Sci. Sleep"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.6118\/jmm.19192","article-title":"Sleep Disorders and Menopause","volume":"25","author":"Lee","year":"2019","journal-title":"J. Menopausal Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/sleep\/24.5.583","article-title":"Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer","volume":"24","author":"Savard","year":"2001","journal-title":"Sleep"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"329","DOI":"10.31887\/DCNS.2008.10.3\/dnutt","article-title":"Sleep disorders as core symptoms of depression","volume":"10","author":"Nutt","year":"2008","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.sleep.2014.11.008","article-title":"Longitudinal changes in insomnia status and incidence of physical, emotional, or mixed impairment in postmenopausal women participating in the Women\u2019s Health Initiative (WHI) study","volume":"16","author":"Zaslavsky","year":"2015","journal-title":"Sleep Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/10705500801929510","article-title":"Association of hostility with sleep duration and sleep disturbances in an employee population","volume":"15","author":"Vahtera","year":"2008","journal-title":"Int J. Behav. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s10865-016-9792-0","article-title":"Dispositional optimism and sleep quality: A test of mediating pathways","volume":"40","author":"Uchino","year":"2017","journal-title":"J. Behav. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2903","DOI":"10.1007\/s00520-018-4610-6","article-title":"Optimism outweighs neuroticism and anxiety sensitivity to predict insomnia symptoms in women after surgery for breast cancer","volume":"27","author":"Ren","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_14","unstructured":"(2022, January 23). American Psychological Association Dictionary of Psychology. Available online: https:\/\/dictionary.apa.org\/pessimism."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5607\/en.2013.22.3.173","article-title":"The neural basis of optimism and pessimism","volume":"22","author":"Hecht","year":"2013","journal-title":"Exp. Neurobiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.5665\/sleep.2810","article-title":"A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression","volume":"36","author":"Alvaro","year":"2013","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1093\/ajcn\/nqz275","article-title":"High glycemic index and glycemic load diets as risk factors for insomnia: Analyses from the Women\u2019s Health Initiative","volume":"111","author":"Gangwisch","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2188\/jea.JE20120101","article-title":"Associations of protein, fat, and carbohydrate intakes with insomnia symptoms among middle-aged Japanese workers","volume":"23","author":"Tanaka","year":"2013","journal-title":"J. Epidemiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"462","DOI":"10.3945\/ajcn.116.131060","article-title":"Probable insomnia is associated with future total energy intake and diet quality in men","volume":"104","author":"Cheng","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wu, T., Hsu, F.-C., and Pierce, J.P. (2020). Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses Among Breast Cancer Survivors: A Prospective Cohort Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061817"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wu, T., Hsu, F.-C., and Pierce, J.P. (2020). Acid-Producing Diet and Depressive Symptoms among Breast Cancer Survivors: A Longitudinal Study. Cancers, 12.","DOI":"10.3390\/cancers12113183"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tessou, K., Lemus, H., Hsu, F.-C., Pierce, J., Hong, S., Brown, L., and Wu, T. (2021). Independent and Joint Impacts of Acid-Producing Diets and Depression on Physical Health among Breast Cancer Survivors. Nutrients, 13.","DOI":"10.3390\/nu13072422"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chronister, B.N.C., Wu, T., Santella, R.M., Neugut, A.I., Wolff, M.S., Chen, J., Teitelbaum, S.L., and Parada, H. (2021). Dietary Acid Load, Serum Polychlorinated Biphenyl Levels, and Mortality Following Breast Cancer in the Long Island Breast Cancer Study Project. Int. J. Env. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010374"},{"key":"ref_24","unstructured":"Shirali, A. (2016). Electrolyte and Acid\u2013Base Disorders in Malignancy, in Onco-Nephrology Curriculum, American Society of Nephrology."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.15537\/smj.2015.2.10205","article-title":"Type-B lactic acidosis associated with progressive multiple myeloma","volume":"36","author":"Abdullah","year":"2015","journal-title":"Saudi. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/S0197-2456(02)00241-6","article-title":"A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: The Women\u2019s Healthy Eating and Living (WHEL) Study","volume":"23","author":"Pierce","year":"2002","journal-title":"Control. Clin. Trials"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1037\/1040-3590.15.2.137","article-title":"Reliability and validity of the Women\u2019s Health Initiative Insomnia Rating Scale","volume":"15","author":"Levine","year":"2003","journal-title":"Psychol Assess."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1037\/1040-3590.15.2.123","article-title":"Factor structure and measurement invariance of the Women\u2019s Health Initiative Insomnia Rating Scale","volume":"15","author":"Levine","year":"2003","journal-title":"Psychol Assess."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/1753-0407.12584","article-title":"Optimism, pessimism, cynical hostility, and biomarkers of metabolic function in the Women\u2019s Health Initiative","volume":"10","author":"Tindle","year":"2018","journal-title":"J. Diabetes"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1177\/0146167203262086","article-title":"Optimism and pessimism in the context of health: Bipolar opposites or separate constructs?","volume":"30","author":"Kubzansky","year":"2004","journal-title":"Pers. Soc. Psychol. Bull."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/ajcn\/68.3.576","article-title":"Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents","volume":"68","author":"Frassetto","year":"1998","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0002-8223(95)00219-7","article-title":"Potential renal acid load of foods and its influence on urine pH","volume":"95","author":"Remer","year":"1995","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1007\/s11136-005-4344-z","article-title":"Multiple predictors of health-related quality of life in early stage breast cancer. Data from a year follow-up study compared with the general population","volume":"14","author":"Schou","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/07347330802359578","article-title":"Relationship of optimism-pessimism and health-related quality of life in breast cancer survivors","volume":"26","author":"Petersen","year":"2008","journal-title":"J. Psychosoc. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.breast.2019.01.012","article-title":"Effects of pessimism, depression, fatigue, and pain on functional health-related quality of life in patients with resected non-advanced breast cancer","volume":"44","author":"Calderon","year":"2019","journal-title":"Breast"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Li, L., Wu, C., Gan, Y., Qu, X., and Lu, Z. (2016). Insomnia and the risk of depression: A meta-analysis of prospective cohort studies. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-1075-3"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"P\u00e4nk\u00e4l\u00e4inen, M., Kerola, T., Kampman, O., Kauppi, M., and Hintikka, J. (2016). Pessimism and risk of death from coronary heart disease among middle-aged and older Finns: An eleven-year follow-up study. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3764-8"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1161\/STROKEAHA.109.565440","article-title":"Low pessimism protects against stroke: The Health and Social Support (HeSSup) prospective cohort study","volume":"41","author":"Nabi","year":"2010","journal-title":"Stroke"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1017\/S0007114519003179","article-title":"Association of dietary acid load and plant-based diet index with sleep, stress, anxiety and depression in diabetic women","volume":"123","author":"Daneshzad","year":"2020","journal-title":"Br. J. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"957","DOI":"10.3109\/0886022X.2015.1038476","article-title":"Association between serum bicarbonate and pH with depression, cognition and sleep quality in hemodialysis patients","volume":"37","author":"Afsar","year":"2015","journal-title":"Ren. Fail."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s11136-017-1496-6","article-title":"Physical exercise, vegetable and fruit intake and health-related quality of life in Chinese breast cancer survivors: A cross-sectional study","volume":"26","author":"Gong","year":"2017","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kim, N.-H., Song, S., Jung, S.-Y., Lee, E., Kim, Z., Moon, H.-G., Noh, D.-Y., and Lee, J.E. (2018). Dietary pattern and health-related quality of life among breast cancer survivors. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0555-7"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1378\/chest.87.5.619","article-title":"Effect of metabolic acidosis upon sleep apnea","volume":"87","author":"Sharp","year":"1985","journal-title":"Chest"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1152\/advan.90137.2008","article-title":"Using the pathophysiology of obstructive sleep apnea to teach cardiopulmonary integration","volume":"32","author":"Levitzky","year":"2008","journal-title":"Adv. Physiol Educ."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"731","DOI":"10.3109\/07420528.2014.901347","article-title":"Chronotype and sleep duration: The influence of season of assessment","volume":"31","author":"Allebrandt","year":"2014","journal-title":"Chronobiol. Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"938","DOI":"10.3945\/ajcn.114.085191","article-title":"Association of self-reported sleep duration with eating behaviors of American adults: NHANES 2005-2010","volume":"100","author":"Kant","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1001\/jamaoncol.2016.0164","article-title":"Prolonged Nightly Fasting and Breast Cancer Prognosis","volume":"2","author":"Marinac","year":"2016","journal-title":"JAMA Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.cgh.2009.04.026","article-title":"Effect of zolpidem on the sleep arousal response to nocturnal esophageal acid exposure","volume":"7","author":"Gagliardi","year":"2009","journal-title":"Clin. Gastroenterol Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5056\/jnm.2010.16.1.22","article-title":"Gastroesophageal reflux disease and sleep disorders: Evidence for a causal link and therapeutic implications","volume":"16","author":"Jung","year":"2010","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1272\/jnms.80.104","article-title":"Sleep disorders in functional dyspepsia and future therapy","volume":"80","author":"Futagami","year":"2013","journal-title":"J. Nippon. Med. Sch."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"104","DOI":"10.5056\/jnm.2014.20.1.104","article-title":"Impact of sleep disorders, quality of life and gastric emptying in distinct subtypes of functional dyspepsia in Japan","volume":"20","author":"Yamawaki","year":"2014","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1038\/ncomms3259","article-title":"The impact of sleep deprivation on food desire in the human brain","volume":"4","author":"Greer","year":"2013","journal-title":"Nat. Commun."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.physbeh.2013.09.006","article-title":"Sleep patterns, diet quality and energy balance","volume":"134","author":"Chaput","year":"2014","journal-title":"Physiol. Behav."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"559","DOI":"10.3945\/ajcn.114.086579","article-title":"Sex and race differences in caloric intake during sleep restriction in healthy adults","volume":"100","author":"Spaeth","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12937-018-0400-8","article-title":"Pessimism, diet, and the ability to improve dietary habits: A three-year follow-up study among middle-aged and older Finnish men and women","volume":"17","author":"Fogelholm","year":"2018","journal-title":"Nutr. J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12937-020-0522-7","article-title":"Optimism is associated with diet quality, food group consumption and snacking behavior in a general population","volume":"19","author":"Shankland","year":"2020","journal-title":"Nutr. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/10\/2828\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:11:48Z","timestamp":1760137908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/10\/2828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,17]]},"references-count":56,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11102828"],"URL":"https:\/\/doi.org\/10.3390\/jcm11102828","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,5,17]]}}}