{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T11:55:58Z","timestamp":1776513358852,"version":"3.51.2"},"reference-count":68,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,10,5]],"date-time":"2019-10-05T00:00:00Z","timestamp":1570233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged \u2265 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score \u2265 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00\u20132.45) and carbohydrate (OR = 1.23; 95% CI: 0.92\u20131.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93\u20131.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51\u20131.06), protein (OR = 0.63; 95% CI: 0.41\u20130.99) or carbohydrate (OR = 0.79; 95% CI: 0.57\u20131.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS.<\/jats:p>","DOI":"10.3390\/nu11102374","type":"journal-article","created":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T03:34:01Z","timestamp":1570419241000},"page":"2374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3051-7313","authenticated-orcid":false,"given":"Yohannes Adama","family":"Melaku","sequence":"first","affiliation":[{"name":"Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9534-8699","authenticated-orcid":false,"given":"Amy C.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"The Appleton Institute, CQ University Australia, Adelaide 5034, SA, Australia"},{"name":"School of Health, Medical and Applied Sciences, CQ University Australia Adelaide Campus, Adelaide 5034, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2822-2436","authenticated-orcid":false,"given":"Tiffany K.","family":"Gill","sequence":"additional","affiliation":[{"name":"Adelaide Medical School, University of Adelaide, Adelaide 5005, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7292-9714","authenticated-orcid":false,"given":"Sarah","family":"Appleton","sequence":"additional","affiliation":[{"name":"Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia"},{"name":"The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, SA 5011, Australia"},{"name":"Freemason\u2019s Centre for Men\u2019s Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Adams","sequence":"additional","affiliation":[{"name":"Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia"},{"name":"The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, SA 5011, Australia"},{"name":"Freemason\u2019s Centre for Men\u2019s Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1590\/S1516-44462005000500004","article-title":"Excessive daytime sleepiness","volume":"27","author":"Bittencourt","year":"2005","journal-title":"Braz. 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