Homocysteine and Belly Fat Linked to Poor Sleep in Stroke-Risk Adults

Adults living in the community who carry a high risk of stroke report poor sleep at strikingly high rates, and two measurable markers in the body appear to track closely with that sleep trouble. A cross-sectional study drawing on two community screening rounds, one conducted in 2015 and another in 2025, found that more than half of participants screened positive for poor sleep quality, and that higher blood levels of homocysteine and a larger waist-to-height ratio were each consistently associated with greater odds of sleeping badly. The research, published in BMC Public Health, enrolled 402 community-dwelling individuals at high risk of stroke in the 2015 screening round and 430 in the 2025 round.

Sleep quality was measured with the Pittsburgh Sleep Quality Index, with a score above five defining poor sleep quality. By this standard, 52.7 percent of the 2015 cohort and 57.4 percent of the 2025 cohort were classified as poor sleepers, underscoring how common sleep problems are in this population. To strengthen the analysis, the researchers constructed a pooled sample of 689 participants after removing individuals who appeared in both screening rounds.

This allowed them to examine not only whether homocysteine and waist-to-height ratio were associated with poor sleep in each cohort separately, but also whether the pattern held across a larger combined group and whether the associations showed a dose-response trend. Homocysteine is related to vascular health, while waist-to-height ratio reflects central adiposity, and their associations with poor sleep quality in this high-risk population had remained insufficiently understood. In separate multivariable logistic regression analyses of the two screening cohorts, both homocysteine and waist-to-height ratio were consistently associated with poor sleep quality, with statistical significance at P less than 0.05 in each round.

This consistency across two samples collected a decade apart was a central finding of the study, suggesting that the associations are not an artifact of a single screening period. The pooled analysis quantified the associations more precisely. Each 1 micromole per liter increase in homocysteine was associated with 15.3 percent higher odds of poor sleep quality, corresponding to an odds ratio of 1.153 with a 95 percent confidence interval of 1.102 to 1.207 and P less than 0.001.

Each 0.1-unit increase in waist-to-height ratio was associated with 151.6 percent higher odds, an odds ratio of 2.516 with a 95 percent confidence interval of 1.800 to 3.518, also significant at P less than 0.001. Beyond the continuous analyses, the researchers grouped participants into tertiles of homocysteine and of waist-to-height ratio. Significant positive trends emerged across both sets of tertiles in the pooled cohort, with a P for trend of 0.002 for homocysteine and 0.001 for waist-to-height ratio.

In other words, the likelihood of poor sleep rose steadily as each marker moved into higher categories, a pattern that strengthens the observed associations beyond simple binary comparisons. The study’s design imposes important limits on interpretation. As a cross-sectional analysis, it captures measurements at single points in time and cannot establish whether elevated homocysteine or central adiposity cause poor sleep, whether disturbed sleep contributes to metabolic and vascular changes, or whether shared underlying mechanisms drive both.

The population studied consisted of community-dwelling individuals already identified as being at high risk of stroke, so the findings may not generalize to the broader population. Nevertheless, the authors argue that the results address a gap in the literature, since the prevalence of sleep problems and their metabolic-related factors among community-dwelling people at high stroke risk had remained under-researched.

Poor sleep quality has increasingly been recognized as a potentially modifiable factor relevant to cerebrovascular health, and identifying markers such as homocysteine and waist-to-height ratio that are associated with it may help characterize which individuals in this high-risk group report the worst sleep. For now, the takeaway from the two screening rounds is descriptive and associative rather than prescriptive: in this high-risk community population, poor sleep is the majority experience, and the odds of poor sleep climb in step with homocysteine levels and waist-to-height ratio. Whether interventions targeting these markers would improve sleep, or whether better sleep would in turn influence vascular risk, remains a question for future longitudinal and interventional research.

Subject of Research: Associations of homocysteine and waist-to-height ratio with poor sleep quality in community-dwelling adults at high risk of stroke

Article Title: Association of homocysteine and waist-to-height ratio with poor sleep quality in community-dwelling individuals at high risk of stroke: a cross-sectional study based on two community screening rounds in 2015 and 2025

Article References: Liu, A., Tian, X., Xue, J., Yan, Y., & Li, X. (2026). Association of homocysteine and waist-to-height ratio with poor sleep quality in community-dwelling individuals at high risk of stroke: a cross-sectional study based on two community screening rounds in 2015 and 2025. BMC Public Health. https://doi.org/10.1186/s12889-026-30075-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30075-8

Keywords: homocysteine, waist-to-height ratio, sleep quality, stroke risk, PSQI, cross-sectional study, central adiposity, community screening, cerebrovascular health, BMC Public Health, Association, waist-to-height