The global obesity epidemic is well established, with increases in obesity prevalence in most countries since the 1980s. Obesity is understood to contribute directly to incident cardiovascular risk factors, including dyslipidaemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease (CVD) and CVD mortality independently of other cardiovascular risk factors.
The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy.
The role of improved sleep and better micronutrient intake are two areas that nutritional therapists and clinicians can approach with greater confidence in mechanism and outcomes, as a result of the following published reviews and papers.
Bayesian analysis supports supplements for CVD risks in overweight people.
An analysis of 65 randomised controlled trials covering 4,241 patients presented in the journal Nutrition and Metabolism, lists probiotics, omega 3 and alpha lipoic acid as beneficially influencing key risk markers in CVD patients who are overweight and or obese. Or another way of viewing this is that metabolically unfit people are typically micronutrient deficient.
The analysis of the adult intake of micronutrients covered below suggests that most UK adults are nutrient deficient, those with metabolic function even more so. The simple, safe and effective inclusion of supplementary biofortification is likely to improve outcomes at a minimal cost.
Good sleep adds years to your life
A large-scale study presented at the 2023 American College of Cardiology conference, and yet to be published, focused on looking at sleep patterns and the risk of early death and identified 5 key factors that make a great difference to outcomes. These factors included:
1) ideal sleep duration of seven to eight hours a night;
2) difficulty falling asleep no more than two times a week;
3) trouble staying asleep no more than two times a week;
4) not using any sleep medication; and
5) feeling well rested after waking up at least five days a week.
The preliminary results indicate that compared to individuals who had scored zero to one favourable sleep factors, those who had all five were 30% less likely to die for any reason, 21% less likely to die from cardiovascular disease, 19% less likely to die from cancer, and 40% less likely to die of causes other than heart disease or cancer.
Among men and women who reported having all five quality sleep measures (a score of five), life expectancy was 4.7 years greater for men and 2.4 years greater for women compared with those who had none or only one of the five favourable elements of low-risk sleep.
Poor sleep increases the risk of heart disease
Another large-scale observational study published in BMC Medicine identified that inadequate sleep may increase the risk of heart disease and premature death by as much as two to seven years. 
Researchers at the University of Sydney in collaboration with Southern Denmark University analysed over 300,000 middle-aged adults from the UK Biobank and discovered that different sleep disruptions were linked to different durations of compromised cardiovascular health when compared to people with healthy sleep patterns.
The study, which examined the severe impact of clinical sleep-related breathing disorders on cardiovascular health, found that men experienced a loss of almost seven years of life free from heart disease and women lost over seven years.
Importantly, the study underscores the need to address general poor sleep patterns, like insufficient sleep, insomnia, snoring, late bedtimes, and daytime sleepiness, which were all linked to a reduction of about two years of normal heart health in both men and women. Confirming that sleep quality is as important as nutrient quality – and both are modifiable risk factors that should receive equivalent attention in clinical workups.
Overview of sleep achievement
But knowing what to focus on for sleep improvement is harder than suggesting a micronutrient supplement. A comprehensive overview published in PLOS ONE in 2022 on relevant sleep determinants provides a practical and scientifically based starting point to identify relevant intervention approaches to secure or improve individual sleep quality.
The authors have covered many potential interventions but explain that differences in aggregation levels of the determinants and in measurement methods are the major limitations of this umbrella review. However, they do agree that extending existing generic sleep hygiene rules with an overview of all types of potential determinants will enhance the awareness of the complexity and can be used to improve the effect of sleep interventions in health promotion and clinical outcomes.
Micronutrient deficiency is common in the UK adult population
Micronutrient insufficiencies it seems are not a thing of the past. In the twenty-first century, these continue to exist with around two billion people worldwide having micronutrient inadequacies. This includes those living in the developed world in regions such as the United Kingdom, United States and Germany where nutrient-poor food is abundant and consumed on a regular basis, ultimately impacting healthcare costs.
Given that current gaps exist between micronutrient intakes and requirements the importance of a healthy and balanced nutrient-dense diet needs further reiteration. This particularly applies in relation to the elimination or substitution of key food groups by people adopting different nutrition approaches. Alongside this, the value of multivitamin and mineral supplements and food fortification strategies should not be overlooked in the context of today’s modern lifestyles.
In addition, other work has found that nutrients such as iron, zinc, and magnesium are positively associated with sleep duration with potential mechanisms appearing to involve the effects that micronutrients have on neurotransmitters and the expression of circadian genes.
The role of optimal nutrition appears to be an essential component of sleep and related cardiovascular problems. Yet whilst this short article covers these two common problems, the role of micronutrient deficiency in almost all disease and functional disorders is well plotted, if less well understood. Contemporary diets in the western world favour highly processed calorific foods with low micronutrient status, as opposed to less-developed nations where micronutrient challenges are related to many other factors.
The simple addition of a suitable multi-nutrient to all adults and especially those with metabolic disturbances present a cheap and safe method of biofortification and may well lead to reduced human suffering.
 Y. Zengli, Z Dangyang, L Xinxin. Nutritional Supplements Improve Cardiovascular Risk Factors in Overweight and Obese Patients: A Bayesian Network Meta-Analysis. Front. Nutr. Sec. Nutrition and Metabolism Volume 10 – 9th March 2023
 American College of Cardiology. “Getting good sleep could add years to your life: Having five low-risk sleep habits may have long-term benefits.” ScienceDaily. ScienceDaily, 24 February 2023.
 Huang, BH., del Pozo Cruz, B., Teixeira-Pinto, A. et al. Influence of poor sleep on cardiovascular disease-free life expectancy: a multi-resource-based population cohort study. BMC Med 21, 75 (2023
 Philippens N, Janssen E, Kremers S, Crutzen R. Determinants of natural adult sleep: An umbrella review. PLoS One. 2022 Nov 7;17(11)
 Derbyshire E. Micronutrient Intakes of British Adults Across Mid-Life: A Secondary Analysis of the UK National Diet and Nutrition Survey. Front Nutr. 2018 Jul 19;5:55.
 Ji X, Grandner MA, Liu J. The relationship between micronutrient status and sleep patterns: a systematic review. Public Health Nutr. 2017 Mar;20(4):687-701.