Sleep and obesity in children and adolescents

Exploring parental preferences for childhood obesity prevention program in China: a discrete choice experiment

BACKGROUND

Childhood obesity has emerged as one of the most critical public health challenges in China. Despite its urgency, the existing research on parental preference for tackling childhood obesity remains insufficient. This study aimed to determine the factors that parents prioritise most when commissioning hypothetical programs that target childhood obesity prevention in China.

METHODS

A discrete choice experiment (DCE) was conducted to assess parental preferences for a hypothetical childhood obesity prevention programme attributes. Recruitment occurred between 20th October 2022 and 30th December 2022, using snowball sampling facilitated through social media platforms. Eligibility criteria were limited to parents with at least one child aged between 5 and 17 years old. Relevant attributes of the childhood obesity prevention programme were identified through a literature review and expert consultation. The study encompassed six attributes, and the coefficient of these different attributes was analysed using multinomial logit models (MNL) and latent class models (LCM).

RESULTS

This study, involving 631 participants, demonstrates that in prioritizing attributes of childhood obesity prevention programs, parents place the greatest importance on additional costs (32.36%). This is followed by daily sleep duration (18.42%) and dietary choices (16.49%). A preference for a 9-hour sleep duration is evident (Odds Ratio [OR]: 1.291; 95% Confidence Interval [CI]: 1.186-1.406; p < 0.05, reference: 7 h), as well as a tendency towards high-protein diets over low-fat ones (OR: 1.114; 95% CI: 1.034-1.200; p < 0.05, reference: low-fat diet). School-based exercise is favoured over fitness centres (OR: 0.837; 95% CI: 0.785-0.893; p < 0.001, reference: school-based). A latent class model (LCM) identifies two distinct groups: one preferring school-based exercise, 8-hour sleep, and minimal additional expenses; the other favouring 9-hour sleep and willingness to invest an additional RMB200 for weight control. Both groups prefer high-protein diets and early eating schedules.

CONCLUSIONS

Understanding parental preferences and concerns is vital for crafting effective public health policies aligned with UN SDGs and the SDH framework. Key elements include promoting balanced diets, ensuring safe exercise spaces, and fostering parental engagement. Collaboration among policymakers, educators, and parents is essential to mitigate childhood obesity.

Melatonin secretion across puberty: A systematic review and meta-analysis

BACKGROUND

Melatonin levels decrease with aging and substantially during puberty. Studies have presented distinct melatonin levels in patients with disorders related to their pubertal development compared to healthy controls. The discrepancy suggests that a decrease in melatonin concentrations seen during adolescence might be related to the physical, hormonal, and/or neuronal alterations that occur during the pubertal period. The aim of this review was to analyze the literature reporting melatonin levels in healthy children and adolescents during puberty, and to look for a potential relationship.

METHODS

The Medline and Embase databases were searched on November 28th 2024, including all articles published from 1974 to 2024. Moreover, in the studies eligible for full-text review, a "snowball" search based by backwards referencing was carried out to identify additional studies. This means going through the references of the eligible studies, to find potential other articles relevant for our review and met our inclusion criteria. Lastly, a meta-analysis on serum melatonin concentrations with increasing age and Tanner status was performed.

RESULTS

21 studies were included. 12 studies found a decrease, 5 found no difference and 3 reported an increase in melatonin levels during pubertal advancement. One study could not report secretory alterations but was eligible for inclusion in the meta-analysis. This analysis revealed that Tanner stages were significantly associated with decreasing average as well as peak concentrations of melatonin.

CONCLUSION

The simultaneous occurrence of pubertal progression and chronological aging complicates potential reasons to the decrease observed. However, possible explanations could be related to sex hormones, physical properties of puberty or light exposure. To justify these explanations research in controlled conditions along with biochemical and clinical assessment of pubertal status is needed.

Generation Healthy Kids: Protocol for a cluster-randomized controlled trial of a multi-component and multi-setting intervention to promote healthy weight and wellbeing in 6-11-year-old children in Denmark

BACKGROUND

Childhood obesity can have significant negative consequences for children's wellbeing and long-term health. Prior school-based interventions to prevent child overweight and obesity have shown limited effects, highlighting the necessity for comprehensive approaches addressing complex drivers of childhood obesity. "Generation Healthy Kids" (GHK) is a multi-setting, multi-component intervention to promote healthy weight development, health and wellbeing in Danish children aged 6-11 years. This protocol describes the GHK main trial, which is a cluster-randomized trial evaluating effectiveness and implementation of the GHK intervention.

METHODS

Twenty-four schools from the Capital, Zealand and Southern Denmark Regions are randomly allocated 1:1 to intervention or control. The intervention will run for two school years (18-20 months) from October 2023 to June 2025 and will include children in 1st-3rd grade (approx. n = 1,600). The intervention targets multiple settings, including families, schools, after-school clubs, and local communities. Within four focus areas-diet, physical activity, screen media use, and sleep habits-the intervention incorporates several fixed elements, including a school lunch program and three weekly sessions of physical activity at school. Furthermore, building on whole-systems thinking, the intervention encompasses co-created elements developed in collaboration with local stakeholders, e.g. municipalities, sports clubs and supermarkets. This part of the intervention emphasizes building local capacity and engagement to promote child health. Effectiveness data will be collected from participating children and families at baseline, and at the end of school year one (after 6-8 months) and school year two (after 18-20 months). The primary outcome is the change in fat mass, measured by air-displacement plethysmography, from baseline to end-of-study in the intervention group compared to the control group. This is supplemented with numerous secondary outcomes and other prespecified outcomes related to child health and wellbeing. Furthermore, thorough process evaluation will be performed.

DISCUSSION

GHK combines evidence-based intervention elements targeting multiple settings with a whole-systems approach focusing on capacity building and stakeholder involvement. This novel approach holds promise as an innovative way to promote child health and wellbeing and prevent childhood obesity.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05940675 (registered on 4 July 2023).

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

The Role of Family Physicians in Children's Sleep

Sleep holds significant importance for maintaining health and aiding in illness recovery. Its deprivation impacts all human organ systems, from cognitive function, social interaction, and work capacity to cellular regeneration and immune function. Therefore, sleep plays a crucial role in our body and maintaining health and well-being. Given its importance and close relationship with the neurodevelopment and growth of children and adolescents, this topic is highly significant in pediatric and adolescent health consultations. Family physicians, due to their proximity and understanding of the individual within their family, have the prerogative to contribute to family literacy, empower them, and significantly enhance the quality of life and overall health.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents

OBJECTIVE

This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association.

METHOD

The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire.

RESULTS

Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss.

CONCLUSIONS

Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effects of the Jump-In Whole-School Intervention on the Weight Development of Children in Amsterdam, the Netherlands

BACKGROUND

This study assessed the effects of the "Jump-in" whole-school intervention in Amsterdam, the Netherlands, on children's weight development by comparing children exposed to the intervention and controls from 3 other large Dutch cities. Jump-in is a comprehensive intervention that aims to stimulate healthy nutrition and physical activity in children at primary schools in Amsterdam. In addition, the relationship between the intervention's implementation degree and its effectiveness was studied.

METHODS

Demographic and anthropometric data, collected by youth health care professionals via routine health checks at T0 (2014) and T1 (2019), were used to analyze possible intervention effects by comparing the weight development of children exposed to the Jump-in intervention versus unexposed controls. Implementation logs from health promotion professionals were used to determine intervention effects per implementation degree. Multilevel regression analyses were used for all analyses.

RESULTS

In total, 4299 children were included mean age ± 5.5 years (T0), 10.6 years (T1), and ≈50% boys/girls at both times. Receiving the fully implemented intervention resulted in a decline in standardized body-mass index (zBMI) compared to the controls (-0.23, confidence interval [CI] -0.33, -0.13). It also led to higher odds to move into a healthier weight category over time (odds ratio [OR] 1.36, CI 1.06, 1.74), yet no statistically significant shift towards a healthy weight was found.

CONCLUSIONS

Relative to the controls, children exposed to the intervention showed positive zBMI developments, with stronger effects when the implementation degree was higher. Despite positive results, creating more impact might require the further integration of school-based programs into whole-systems approaches that include other energy-balance behaviors.

Food Intake and Sleep Disorders in Children and Adolescents with Obesity

Over the last few decades, numerous scientific studies have investigated the possible association between sleep duration and adiposity during childhood, since it has been reported that sleep deprivation causes a related increase in caloric intake. Even though the underlying pathogenetic mechanisms are still under study and not completely known, the effect of dietetic habits and nutrient intake on sleep quality and patterns has been reported. The aim of this study is to explore the intricate interplay between food intake/diet patterns and pediatric sleep disturbances in children and adolescents with obesity, emphasizing the importance of not underestimating this aspect in the prevention and treatment of this complex disease. Recent evidence supports a high correlation between specific diet patterns and foods with sleep disturbances in children at all ages. Diets rich in fiber, fruit, vegetables, and anti-inflammatory nutrients and low in saturated fats seem to promote better sleep quality. Sleep disturbances are, in turn, risk factors for the development of obesity. Therefore, food strategies should be applied to counteract this harmful process. Unraveling the complex links between dietary habits, sleep patterns, and obesity is essential for developing effective strategies to combat this critical public health issue.

Childhood diabetes and sleep

Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.

Prevalence and Factors Associated with Overweight/Obesity in Adolescent School Girls: A Cross-Sectional Study in Kolkata, India

Overweight and obesity in adolescent girls are considered a leading global public health issues in recent times. There is a need to evaluate the potential socioeconomic and behavioural factors behind adolescents’ overweight and obesity in different environmental settings. The present study aims to understand the prevalence of overweight and obesity among urban adolescent school girls and to determine the association between selected socioeconomic and behavioural factors and overweight/obesity. This is a cross-sectional study using a multistage stratified cluster sampling with a sample size of 1041 adolescent girls aged 10 to 18 years from schools of Kolkata, India. Overall prevalence of overweight and obesity were 18.9% and 23.7%, respectively. The prevalence of overweight and obesity was higher among those adolescent girls whose parents had completed higher education (49.5%) and had higher monthly per capita household expenditure (48.4%). Stepwise binary logistic regression analysis confirmed that the probability of being overweight/ obese tended to be in adolescents who slept less than 7 hours per day (p<0.001). Overweight /obesity was also higher among those children whose fathers were fatty (p=0.002), taken medicines three months before the survey (p=0.008), and watched television and mobile phones for more than 1 hour a day (p=0.039). Rapid change in modern lifestyles is seemingly decreasing sleep duration in adolescents with subsequent negative impact on their health.

Examination of Sleep and Obesity in Children and Adolescents in the United States

PURPOSE

This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US.

DESIGN

Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children's Health.

SETTING

US, national.

SUBJECTS

Children ages 10-17 years (n = 34,640).

MEASURES

Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts.

ANALYSIS

Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics.

RESULTS

An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time.

CONCLUSION

Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime.

Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity

BACKGROUND

Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration.

METHODS

Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity.

RESULTS

On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights.

CONCLUSIONS

Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.

[Sleep duration, overweight and consumption of ultra-processed foods among adolescents]

The scope of this article is to analyze the relationship between insufficient sleep duration, overweight/obesity and the consumption of ultra-processed foods among adolescents aged 10 to 14 years. This is a cross-sectional study, with an evaluation of 1,384 adolescents from public schools in João Pessoa-PB, participating in the Longitudinal Study on Sedentary Behavior, Physical Activity, Diet and Adolescent Health (LONCAAFS). Sociodemographic variables, sleep duration, class shift, anthropometric nutritional status, sedentary behavior and food consumption were measured. Linear and logistic regression of the following were performed using Stata 13.0 Software: the prevalence of short sleep duration of 29.5% (<9h/night); a significant association between short sleep duration and excess weight only for adolescents <12 years old. With respect to the relationship between sleep duration and the consumption of ultra-processed foods, the longer the sleep duration, the lower the consumption of snacks by adolescents under 12 years old, with a positive association for ≥12 years old only with adjustment by the physical activity variable. There was no association with the "sugary drinks" and "cookies" groups for any of the age groups analyzed.

NCS Assessments of the Motor, Sensory, and Physical Health Domains

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.

High incidence of acute self-reported sleep disturbances in patients following arthroscopic-assisted knee surgery

OBJECTIVES

To evaluate the self-reported incidence of sleep disturbances, defined as ≤7 hours of sleep per 24-hour period, in patients undergoing arthroscopic-assisted knee surgery.

METHODS

Patients who underwent arthroscopic knee surgery over the course of a 4-month period were prospectively included. Patients were excluded if a history of insomnia or other sleep altering medical history was reported. Self-reported sleep metrics included average number of hours of sleep per night, average number of awakenings during sleep per night, perceived quality of sleep, average pain level during sleep and number of hours of physical activity/therapy per week. Data were collected at weeks 1, 3, and 6 postoperatively. Joint circumference was measured on postoperative day 1 and served as an indicator of a knee effusion. Paired t-tests were used to compare preoperative to postoperative hours of sleep. Simple and multiple linear regression were used to evaluate relationships between surgical variables and postoperative sleep metrics.

RESULTS

There were 123 patients who underwent arthroscopic knee surgery during the prospective enrolment period; 83 patients were included in the final analysis. The overall incidence of preoperative sleep disturbances was 20% (n=17). The overall incidence of self-reported postoperative sleep disturbances was 99%, 96% and 90% at weeks 1, 3 and 6, respectively. The average number of hours slept was significantly reduced at 1, 3 and 6 weeks postoperatively compared with the preinjury state (p<0.001). Knee joint circumference had a significantly negative correlation with average number of hours of sleep in the first 6 weeks postoperatively (R=-0.704; p=0.001). Surgical variables including severity of surgery, weekly postoperative pain level and weekly hours of postoperative physical therapy were not significant independent predictors of acute postoperative sleep disturbances (p>0.05).

CONCLUSION

Sleep disturbances were commonly reported in patients following arthroscopic knee surgery without correction of sleep metrics by 6 weeks postoperatively. The majority of sleep disturbances in this cohort correlated with an increased knee effusion. A multidisciplinary team approach is recommended to counsel patients regarding the potential for and problems with acute sleep disturbances following arthroscopic knee surgery.Level of evidence: 3.

Assessing Changes in Adolescents' Sleep Characteristics and Dietary Quality in the START Study, a Natural Experiment on Delayed School Start Time Policies

BACKGROUND

Sleep duration, quality, and timing may influence dietary quality. In adults, poor dietary quality is a risk factor for numerous chronic diseases. It is unclear how these various sleep domains influence adolescents' diets because prior population-based studies have not effectively manipulated sleep, did not include objective sleep measures, and had short follow-up times.

OBJECTIVES

The objectives of this study were to examine 1) how adolescent sleep characteristics relate to dietary quality; and 2) how delay in high school start times (which lengthened sleep duration) affects dietary quality over 2 y.

METHODS

In the START study, adolescents (grades 9-11, n = 423) attending 5 high schools in the Minneapolis, Minnesota metropolitan area were annually assessed in 3 waves (2016-2018). At Baseline, all schools started "early" (07:30 or 07:45). From Follow-up 1 through Follow-up 2, 2 "policy change schools" shifted to later start times (to 08:20 and 08:50). Three "comparison schools" maintained their early start throughout. Sleep characteristics were measured with actigraphy. Mixed-effect regression models were used to examine cross-sectional and longitudinal associations of sleep characteristics with dietary quality, and school start time policy change with dietary quality change.

RESULTS

Cross-sectionally, later sleep midpoint and onset were associated with dietary quality scores 1.6-1.7 lower (both P < 0.05). However, no prospective associations were observed between sleep characteristics and dietary quality in longitudinal models. Shifting to later school start time tended to be associated with a 2.4-point increase in dietary quality score (P = 0.09) at Follow-up 1, but was not associated with change in dietary quality scores at Follow-up 2 (P = 0.35).

CONCLUSIONS

High school students attending delayed-start schools maintained better dietary quality than students in comparison schools; however, differences were not statistically significant. Overall study findings highlight the complexity of the relation between sleep behavior and diet in adolescence.

Lifestyle Behaviors Associated With Body Fat Percent in 9- to 11-Year-Old Children

PURPOSE

To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9-11 years and (2) the consistency of these associations over a 10-year period.

METHODS

In this repeat, cross-sectional study, 15,977 children aged 9-11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates.

RESULTS

Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school ( β = -0.99 [0.19], P < .001), full-fat milk (-0.07 [0.15], P < .001), and sweetened beverage consumption (-0.40 [0.15], P = .007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM ( β = 1.60 [0.26], P < .001); 9:00 to 10:00 PM ( β = 1.04 [0.24], P < .001); ≥10:00 PM ( β = 1.18 [0.30], P < .001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys ( β = 0.95 [0.25], P < .001) and girls ( β = -0.85 [0.37], P = .021). There was no significant change in these associations over a 10-year period.

CONCLUSIONS

In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF.

Sleep, Food Insecurity, and Weight Status: Findings from the Family Life, Activity, Sun, Health, and Eating Study

Background: Shorter sleep duration and lower sleep quality have been previously associated with greater obesity risk among adult samples. Food insecurity has also been found to impact sleep patterns and obesity. Yet few studies have explored associations between sleep, food insecurity, and obesity in adolescent populations, who may have more irregular sleep patterns. Thus, the objectives of this study were to determine associations between measures of sleep, food insecurity, and weight status. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, an online cross-sectional study of parent and adolescent (12-17-year old) dyads. Participants were drawn from a Consumer Opinion Panel representative of the general population of the United States with respect to sex, education, income, age, household size, and region. First, multinomial logistic regression analyses were conducted to determine associations between sleep measures (adolescent-reported average nighttime sleep duration, having a regular bedtime, and having difficulty staying asleep), food insecurity (a validated two-item parent-reported measure), and weight status (being underweight, of healthy weight, overweight, and obese). Weight status was based upon adolescent BMI z-scores using Centers for Disease Control and Prevention growth charts using information from parent report of adolescent height and weight and adolescent-reported age and sex among adolescents (N = 1544). Conditional process models were also fitted to the data to determine whether food insecurity moderates the associations between sleep measures and weight status, and to determine whether the association between food insecurity and weight status is mediated by average sleep duration. Results: Compared to those with food security, a greater percentage of those with food insecurity reported having difficulties staying asleep and a longer average sleep duration. Multinomial logistic regression models demonstrated that having a regular bedtime was associated with lower odds of having obesity, having difficulties staying asleep was associated with greater odds of being underweight, and having food insecurity was associated with greater odds of being overweight. Conditional process models demonstrated that food insecurity did not moderate associations between sleep measures and weight status and that average nighttime sleep duration did not mediate the association between food insecurity and weight status. Conclusions: This is one of the first studies to examine associations between sleep, food insecurity, and weight status among adolescents. Results provide additional support for the need to uncover mechanisms for how sleep and food insecurity affect pediatric obesity using longitudinal data.

Weekday time in bed and obesity risk in adolescence

INTRODUCTION

Sleep curtailment is associated with obesity in children, but few studies have investigated this relationship in a longitudinal sample of adolescents. The aim of the present study was to examine the longitudinal association between weekday time in bed (TIB) at age 10-13 and overweight at age 16-19.

METHODS

Adolescents and their parents (N = 3025 families), participating in a longitudinal population-based study, completed questionnaires assessing habitual bedtime and wake time on weekdays, weight and height, socioeconomic status (SES), internalizing mental health problems and disturbed eating. Two surveys were administered with a 6-year interval (T1 and T2). A one-way analysis of covariance (ANCOVA) was performed examining the association between TIB and weight category 6 years later, with SES, internalizing problems and disturbed eating at baseline entered as covariates. Hierarchical and logistic regression analyses were used to assess TIB at age 10-13 years to as a predictor of body mass index (BMI) standardized deviation scores (SDS) and overweight status at age 16-19 adjusting for the same confounders and baseline BMI.

RESULTS

A linear inverse relationship between TIB at age 10-13 and BMI category at age 16-19 was demonstrated by the ANCOVA, p < 0.001. Shorter TIB was related to higher weight, but the effect size was small (partial eta squared = 0.01). When adjusting for the included baseline confounders in the hierarchical regression model TIB significantly predicted later BMI SDS (β = -0.039, p = 0.02). The adjusted logistic regression model showed that for each hour reduction of TIB at T1 the odds of being overweight/obese at T2 increased with a factor of 1.6.

CONCLUSION

Shorter TIB was found to be a significant, yet modest, independent predictor of later weight gain in adolescence. The findings implicate that establishing healthy sleep habits should be addressed in prevention and treatment strategies for adolescent obesity.

Association between objectively measured body composition, sleep parameters and physical activity in preschool children: a cross-sectional study

OBJECTIVE

Associations between self-reported sleep duration and obesity indices in children are well recognised; however, there are no studies on associations between objectively measured other sleep parameters and physical activity with body composition in preschoolers. Therefore, the aim of this study was to determine the associations between sleep parameters and moderate-to-vigorous physical activity (MVPA) with body composition indices in preschoolers using objective measures.

DESIGN

A cross-sectional study.

PARTICIPANTS

The study group consisted of 676 children aged 5-6 years, who were enrolled in kindergartens in the 2017/2018 school year.

OUTCOME MEASURES

Sleep parameters and MVPA were measured using accelerometers for 7 days. Bioelectrical impedance analysis was used to estimate body composition.

RESULTS

Sleep duration and sleep efficiency were inversely associated with body fat percentage (BFP) (β=-0.013 and β from -0.311 to -0.359, respectively) and body mass index (BMI) (β from -0.005 to -0.006 and from -0.105 to -0.121, respectively), and directly associated with fat-free mass (FFM) (β from 0.010 to 0.011 and from 0.245 to 0.271, respectively) and muscle mass (β from 0.012 to 0.012 and from 0.277 to 0.307, respectively) in unadjusted and adjusted models. BFP was inversely associated with MVPA and positively associated with number of awakenings and sleep periods. Number of sleep periods was inversely associated with FFM, and positively with BMI and muscle mass. Correlation matrix indicated significant correlation between BFP, FFM and muscle mass with sleep duration, sleep efficiency, number of sleep periods and MVPA.

CONCLUSIONS

Periodic assessment of sleep parameters and MVPA in relation to body composition in preschool children may be considered, especially in those who are at risk for obesity.

The importance of specialized sleep investigations in children with a suprasellar tumor

PURPOSE

Disruption of sleep has great impact on quality of life. In children with a suprasellar tumor and hypothalamic-pituitary dysfunction, the circadian rhythm may be disturbed causing sleep problems. However, also other factors may influence sleep. Awareness of these different etiologies and careful history taking with appropriate additional diagnostics will aid in restoring sleep quality.

METHODS

We present the workup of 4 cases with a suprasellar tumor and disturbances of sleep initiation, sleep maintenance, and daytime sleepiness. In parallel, we developed a flowchart, to aid clinicians in the diagnostics of sleep problems in children after treatment for a (supra) sellar brain tumor.

RESULTS

All four patients, known with hypopituitarism, presented with sleep complaints and increased daytime sleepiness. In all four, the cause of sleep problems showed to be different. In the first case, sleep evaluation revealed a severe obstructive sleep apnea, whereupon nocturnal ventilation was started. The second case revealed poor sleep hygiene in combination with an obsessive compulsive disorder. Sleep hygiene was addressed and psychiatric consultation was offered. Dexamphetamine treatment was started to reduce her obsessive compulsive complaints. The third case showed a delayed sleep phase syndrome, which improved by educational support. The fourth case revealed a secondary organic hypersomnia for which modafinil treatment was started.

CONCLUSION

Sleep disturbances in children with hypopituitarism due to a (supra) sellar tumor can have different entities which require specific therapy. Awareness of these different entities is important to enable appropriate counseling. Referral to an expertise sleep center may be advised, if standard educational support is insufficient.

ADHERENCE TO THE MEDITERRANEAN DIET IN ELEMENTARY SCHOOL CHILDREN (1ST CYCLE)

Objective:

To characterize the adherence to the Mediterranean diet (MD) in students from elementary schools in Porto and Maia and analyze its association with sleep hygiene, physical activity, cardiometabolic risk, and school performance.

Methods:

This is a cross-sectional study with 891 Portuguese students: 455 boys (51%) and 436 girls (49%), aged between 9 and 11 years old (mean [M]=9.2, standard deviation [SD]=0.4), with an average weight of 35.9 kg (SD=8.1), average height of 1.4 m (SD=0.1), average body mass index (standardized BMI Z score for the pediatric age group) of 0.76 (SD=1.21); 59.5% of them had normal weight and 15.9% were obese. The students filled a questionnaire on the adherence to the Mediterranean Diet (Mediterranean Diet Quality Index in Children and Adolescents [KIDMED]), participated in a socio-demographic interview, and had their anthropometric data collected after their parents signed the informed consent form.

Results:

The results suggest high levels of adherence to the MD (77.6%) both in males and females. Using Pearson’s correlation coefficient, we found that the Z score was positively associated to cardiometabolic risk and the starting age of an extracurricular physical activity, and negatively associated to the average hours of sleep on a typical day both in males and females. We also identified a negative relation between KIDMED and the starting age of physical activity.

Conclusions:

This study has contributed to the knowledge of adherence to the MD among Portuguese elementary students and correlations with variables associated to a healthier lifestyle (MD, hours of sleep, and physical activity). Future studies should focus their attention on other countries and more heterogeneous samples.

Sleep Quality as a Mediator of the Relationship Between Cyber Victimization and Depression

PURPOSE

Cyber victimization is a national mental health concern, especially among adolescents who are digital natives. The current study examined sleep quality as a mediator of the association between cyber victimization and depressive symptoms among adolescents.

DESIGN AND METHOD

A prospective study design was utilized with a community sample of adolescents (N = 801; 57% female; mean age = 14.45, SD = .85) from the eastern United States. Participants completed (a) the Pittsburgh Sleep Quality Index; (b) the Cyber Victimization Scale; and (c) the Center for Epidemiologic Studies Depression Scale Revised via online surveys at baseline and 6-month follow-up. The inter-relationship between variables was analyzed by Hayes' mediation approach.

FINDINGS

Cyber victimization was not directly associated with having depressive symptoms 6 months later when controlling for adolescents' poor sleep quality, sex, and age (direct effect [c'] = .012, t(676) = 1.12, p < .05, confidence interval [CI] -.008, .036). The mediation analysis indicated a significant indirect effect of poor sleep quality on the relationship between cyber victimization and depressive symptoms (ab = .005, bootstrapped standard error [SE] = .003, bootstrapped CI .001, .011; a is the effect of cyber victimization on poor sleep quality; b is the effect of poor sleep quality on depressive symptoms). Specifically, adolescents' cyber victimization led to poor sleep quality (a = .039, SE = .041, p < .05), which also led to increased depressive symptoms (b = .116, SE = .019, p < .001), after controlling for depressive symptoms at baseline, sex, and age. The indirect effect of cyber victimization on depressive symptoms was estimated through poor sleep quality (a*b = .039(.116) = .0045).

CONCLUSIONS

The findings suggest that poor sleep quality may be a mechanism through which cyber bullying is related prospectively to depressive symptoms. Interventions for cyber-victimized adolescents should include assessment of sleep quality and incorporate sleep hygiene education.

CLINICAL RELEVANCE

Adolescents should be screened for cyber victimization and sleep quality. Moreover, promotion of sleep hygiene among cyber-victimized adolescents may help to reduce depression.

Sleep and obesity among children: A systematic review of multiple sleep dimensions

The objectives were to systematically investigate the multiple dimensions of sleep and their association with overweight or obesity among primary school-aged children. CINHAL, PsycINFO, SPORTDiscus, Medline, Cochrane, Embase, and PubMed databases were searched for papers reporting on an association between children's sleep and weight status. Studies on clinical populations, published in languages other than English, without objectively measured weight status, or where weight status was reported outside the outlined age bracket (5-13 years) were excluded. A total of 34  248 citations were extracted from our systematic search protocol, of which 112 were included for detailed review. Compared with sleep duration, of which 86/103 articles found a significant inverse association between sleep duration and measured weight status, few studies examined other dimensions of sleep, such as quality, efficiency and bed/wake times, and relationship with weight status. Where studies existed, variation in defining and measurement of these dimensions restricted comparison and potentially influenced discrepancies across results. Overall, the findings of this review warrant the need for further research of the outlined dimensions of sleep. Future research would benefit from clarity on definitions across the different dimensions, along with the use of valid and reliable tools.

Poor sleep and adolescent obesity risk: a narrative review of potential mechanisms

Poor sleep is related to increased obesity risk in adolescents, though the mechanisms of this relationship are unclear. This paper presents a conceptual framework of the various pathways that have been proposed to drive this relationship. In this framework, increased food reward, emotional reactivity, decreased inhibitory control, metabolic disturbances, poorer dietary quality, and disrupted meal timings may increase the likelihood of increasing overall energy intake. This paper further notes how poor sleep increases sedentary behavior and screen time, which likely limits overall energy expenditure. The model posits that these mechanisms result in an imbalance of energy intake and expenditure following poor sleep, intensifying the overall risk for obesity. Increases in food reward processes, decreases in insulin sensitivity, disrupted meal timing, and increases in sedentary behavior seem to be the most compelling mechanisms linking poor sleep with increased obesity risk in adolescents. Future directions and clinical implications of this framework are discussed.

Cognitive, emotional, and behavioral contributors to early childhood weight status

Pediatric obesity is a serious public health concern affecting almost 16% of two- to five-year-olds. Prior research has not sufficiently addressed how various factors combine to contribute to the heterogeneous condition of obesity. The goal of this study was to assess multiple individual factors to determine how they collectively contribute to weight status in young children, as this information could lead to tailored interventions. This was a cross-sectional, population-based study of three- to five-year-olds. Child height and weight were measured. Parents completed a demographic survey and validated questionnaires regarding these child characteristics: internalizing and externalizing behaviors, sleep problems, executive functions, and food approach and food avoid behaviors. Data for 154 participants (mean age: 4.4 ± 0.8 years; mean body mass index-z: .28 ± 1.0; 50% male) were analyzed using linear and logistic regression and a stepwise regression procedure. In the stepwise selection procedure for the binary outcome of obese/overweight versus normal weight, food avoid (p = .151), food approach (p = .017), and the White demographic variable (p = .117) were identified as important predictors. In conclusion, when considering various cognitive, emotional, and behavioral factors, only food approach and food avoid eating behaviors predicted weight status in young children, suggesting prevention and intervention efforts should specifically address these aspects in young children.

Development of sleep patterns in children with obese and normal-weight parents

AIM

To study the sleep development and sleep characteristics in children at different obesity risks, based on parental weight, and also to explore their weekday-weekend sleep variations and associated family factors.

METHODS

A total of 145 children participating in a longitudinal obesity prevention project were included, of which 37 had normal-weight parents (low obesity risk), and 108 had overweight/obese parents (high obesity risk). Sleep diaries at ages 1 and 2 years were used to study sleep development in children at different obesity risks. Objectively assessed sleep using an accelerometer at 2 years of age was used to analyse weekday-weekend sleep variations.

RESULTS

There was no difference in sleep development from age 1 to age 2 among children at different obesity risks, but more children in the high-risk group had prolonged sleep onset latency and low sleep efficiency. At 2 years of age, children in the high-risk group had more weekday-weekend variation in sleep offset (mean difference 18 min, 95% confidence interval (CI) 4-33 min), midpoint of sleep (mean difference 14 min, 95% CI 3-25 min) and nap onset (mean difference 42 min, 95% CI 10-74 min) than children in the low-risk group, after adjusting for other family factors. However, no difference could be detected between groups in weekday-weekend variation in sleep duration.

CONCLUSIONS

Unfavourable sleep characteristics, as well as more variation in sleep schedules, have been observed in children at high obesity risk. While the differences were relatively small, they may reflect the unfavourable sleep hygiene in families at high obesity risk.

Associations of sleep patterns with metabolic syndrome indices, body composition, and energy intake in children and adolescents

BACKGROUND

Self-reported short sleep duration is associated with greater risk for metabolic syndrome (MetS), obesity, and higher energy intake (EI). However, studies of these associations in children using objective methods are sparse.

OBJECTIVES

The study aims to determine the associations for sleep patterns with MetS indices, body composition, and EI using objective measures in children.

METHODS

Free-living sleep and physical activity were measured in 125 children (aged 8-17 years, BMI z = 0.57 ± 1.0, 55% female) using wrist-worn actigraphs for 14 nights. Blood pressure, fasting blood levels of lipids, insulin, glucose, waist circumference, and body composition (dual-energy X-ray absorptiometry [DXA]) were obtained during outpatient visits. EI was assessed during an ad libitum buffet meal.

RESULTS

Later weekday and weekend bedtimes were associated with higher systolic blood pressure (Ps < 0.05). Sleep duration and bedtime were not significantly associated with other components of MetS, body composition, or EI. Short sleepers (duration less than 7 hours) consumed a greater percentage of carbohydrates than those with adequate (greater than or equal to 7 hours) sleep (P < 0.05).

CONCLUSION

Indicators of sleep duration were variably associated with children's eating patterns and risk for chronic disease. Prospective data are needed to determine whether these indicators of sleep quality represent unique or shared risk factors for poor health outcomes.

Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children

Background: Behavioral factors such as physical activity, sedentary behavior and diet have previously been found to be key modifiable determinants of childhood overweight and obesity, yet require further investigation to provide an understanding of their potential influence on sleep outcomes along with the sleep-obesity nexus. Methods: The study included 2253 students (ages 8.8-13.5) from two monitoring studies across regional Victoria. Students completed a self-report electronic questionnaire on demographic characteristics, health behaviors (including sleep, physical activity, screen time and diet) and well-being, and were invited to have anthropometric measurements (height and weight) taken. Regression models were used to assess the associations between sleep, behavioral factors and BMI z-scores. Results: Screen time (particularly in bed) and sugar-sweetened beverage (SSB) consumption were shown to increase the likelihood of having more than three sleep problems, while physical activity and other dietary factors were not. After controlling for these behaviors, significance remained for having two or more than three sleep problems and an increased odds of overweight/obesity. Conclusions: This study highlights how the usage of screen devices and SSB consumption behaviors might influence children's weight status via the sleep-obesity nexus.

Emergence of racial/ethnic differences in infant sleep duration in the first six months of life

Objective

Examine the emergence of differences in sleep duration between infants from different racial/ethnic backgrounds and extent to which differences are explained by socioeconomic status (SES) and sleep continuity.

Methods

Sleep duration and continuity (number of night wakings and longest nighttime stretch of sleep) were assessed for 394 infants in the Rise & Sleep Health in Infancy & Early Childhood (SHINE) birth cohort at one- and six-months using the Brief Infant Sleep Questionnaire (BISQ). Multivariable regression was used to estimate associations of race/ethnicity with sleep duration adjusting for individual-level covariates, SES, and sleep continuity.

Results

The sample was 40% non-Hispanic white, 33% Hispanic, 11% Black, and 15% Asian. Mean (SD) durations for daytime, nighttime, and total sleep at one-month were 6.3 (2.0), 8.9 (1.5), and 15.2 (2.7) hours, respectively. Corresponding durations at six-months were 3.0 (1.4), 9.9 (1.3), and 13.0 (1.9) hours. At one-month, Hispanic infants had shorter nighttime sleep than white infants [β: −0.44 h (95% CI: −0.80, −0.08)]. At six-months, Hispanic [β: −0.96 h (−1.28, −0.63)] and Black [β: −0.60 h (−1.07, −0.12)] infants had shorter nighttime sleep than white infants. The near 1-h differential in night sleep among Hispanics resulted in shorter total sleep [β: −0.66 h (−1.16, −0.15)]. Associations across all racial/ethnic groups were attenuated after adjustment for SES at one- and six months. Sleep continuity attenuated associations with nighttime and total sleep duration by 20–60% for Hispanic infants at six-months.

Conclusions

Differences in sleep duration emerge early in life among racial/ethnic groups and are in part explained by SES and sleep continuity.

•

At one-month, Hispanic infants slept significantly less at night than white infants.

•

At six-months, Hispanic and Black infants slept less at night than white infants.

•

The near 1-h differential among Hispanics resulted in shorter total sleep.

•

Adjusting for SES attenuated associations across all racial/ethnic groups.

•

Sleep continuity attenuated associations for Hispanic infants at six-months.

Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana

Background

There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods

Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results

The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.

Conclusions

A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

A Longitudinal Study of Road Traffic Noise and Body Mass Index Trajectories from Birth to 8 Years

Background:

Being overweight constitutes a health risk, and the proportion of overweight and obese children is increasing. It has been argued that road traffic noise could be linked to adiposity through its influence on sleep and stress. Few studies, to our knowledge, have investigated whether noise and adiposity are associated. Most of them were on adults, and we are not aware of any longitudinal study using repeated measures.

Objectives:

The present longitudinal study investigated whether road traffic noise exposures in pregnancy (N = 6,963; obs = 22,975) or childhood (N = 6,403; obs = 14,585) were associated with body mass index (BMI) trajectories in children.

Methods:

We obtained information on BMI and covariates from questionnaires used in the Norwegian Mother and Child Cohort Study, Statistics Norway, and Medical Birth Registry of Norway. We modeled road traffic noise for the most exposed façade of children’s present and historical addresses at 6 time points from pregnancy to age 8. We investigated effects on BMI trajectories using repeated measures and linear mixed models.

Results:

The results indicated that BMI curves depended on road traffic noise exposure during pregnancy, but not on exposure during childhood. Children in the highest decile of traffic noise exposure had increased BMI, with 0.35 kg/m² more than children in the lowest decile, from birth to age 8 years.

Conclusions:

The results indicate that exposure to road traffic noise during pregnancy may be associated with children’s BMI trajectories. Future studies should investigate this further, using anthropometric measures such as waist-hip ratio and skinfold thickness, in addition to BMI.

Sleep duration and quality are associated with eating behavior in low-income toddlers

OBJECTIVE

The present study examined whether different sleep health parameters (duration, timing, and quality) are associated with obesity-related eating behaviors including emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness, and eating in the absence of hunger (EAH), during toddlerhood.

DESIGN

Among 134 low-income 33-month-old children, parents reported on child sleep parameters, including sleep quality (Children's Sleep Wake Scale; CSWS) and usual bedtimes and wake times on weekdays and weekends (weeknight sleep duration, weekday-to-weekend bedtime delay). Child eating behaviors were assessed using both observed and parent-report measures. Child Emotional Overeating, Food Responsiveness, Enjoyment of Food, and Satiety Responsiveness were measured by parent report using the Child Eating Behavior Questionnaire-Toddler. Observed child EAH was evaluated by measuring kilocalories of palatable foods consumed following a meal. Multivariable linear regression was used to examine the associations between sleep parameters and eating behaviors.

RESULTS

Poorer child sleep quality was associated with greater Emotional Overeating (standardized β = -0.20 (SE 0.09), p < .05) and greater Food Responsiveness (β = -0.18 (SE 0.09), p < .05). Shorter child nighttime sleep duration was associated with greater EAH kcal consumed (standardized β = -0.22 (SE 0.09), p < .05). Child bedtime delay was not associated with any of the eating behaviors, and no child sleep variables were associated with either Enjoyment of Food or Satiety Responsiveness.

CONCLUSIONS

Shorter nocturnal sleep duration and poorer sleep quality during toddlerhood were associated with some, but not all, of the obesity-related eating behaviors. Poor sleep health may promote childhood obesity risk through different eating behavior pathways. As children growing up in poverty may experience greater sleep decrements, sleep duration and sleep quality may be important targets for intervention among low-income families with young children.

Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity

Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.

Mediators in the Relationship between Internet Addiction and Body Mass Index: A Path Model Approach Using Partial Least Square

BACKGROUND

Adolescence obesity has now become an epidemic. In recent years, Internet addiction has been identified as a risk factor for obesity. We aimed to evaluate the role of some mediators such as sleep quality, physical activity and fast food consumption in the relation between internet addiction and Body Mass Index (BMI) among adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

Overall, 928 students, aged between 13 and 17 yr, were randomly selected in Behbahan, southwestern Iran from Oct 2017 to Dec 2017. Data were collected using a demographic survey, Young's internet addiction, Pittsburgh sleep quality, and food frequency, questionnaires. Data analysis was performed using Partial Least Squares (PLS) path analysis.

RESULTS

PLS path analysis revealed that the direct effect of Internet addiction on BMI was (Path Coefficient = 0.16, [95% CI: 0.12- 0.21]). Moreover, the indirect effect of internet addiction on BMI through sleep quality was (f2 = 0.12 (P<0.001)), physical activity (f2 =0.04 (P<0.001)), and fast food consumption ( f2 = 0.05 (P<0.001)).

CONCLUSIONS

Results of this study regarding the relationship between internet addiction and BMI and the effect of this phenomenon on sleep quality, physical activity and dietary habits suggest planning prevention and treatment programs to reduce the prevalence of this phenomenon in schools.

Changes in the amount of sleep and daytime sleepiness: A follow-up study of schoolchildren from ages 10 to 15 years

AIM

This study examines the amount of sleep and daytime sleepiness, and how these change in a follow-up cohort study of school-aged children.

METHODS

A total of 1351 schoolchildren (aged 10) and their parents were invited to participate in the study and were studied again at ages 12 and 15 years. A survey put forth by the Health Behaviour of Schoolchildren research network was used.

RESULTS

The amount of sleep during weekdays dropped significantly from age 10 to 15. At weekends, the amount of sleep increased significantly. During weekdays, the proportion of children reporting having slept enough dropped from 71% at age 10 to 19% at age 15. Frequent daytime sleepiness occurred in 13% of children at age 10 and increased to 24% at the age of 15.

CONCLUSIONS

It is essential to promote adequate amount of sleep and prevent daytime sleepiness in children growing from age 10 to 15 years. Nurses and other health care professionals should systematically assess and promote healthy sleeping habits while caring for children between these ages.

Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y

Background

Our Prevention of Overweight in Infancy (POI) study suggested that a brief sleep intervention in infancy reduced the risk of obesity at age 2 y. In contrast, we observed no benefit from the nutrition and activity intervention.

Objective

The objective of the study was to determine how these interventions influenced growth at ages 3.5 and 5 y compared with usual care (Control).

Design

A follow-up of a parallel, 4-arm, single-blind, 2-y, randomized controlled trial in 802 women (86% European, 48% primiparous) recruited in pregnancy (58% response rate) was undertaken. All groups received standard Well-Child care with additional support for 3 intervention groups: FAB (promotion of breastfeeding, healthy eating, physical activity: 8 contacts, antenatal, 18 mo); Sleep (prevention of sleep problems: antenatal, 3 wk); Combination (both interventions). Follow-up measures were collected by staff blinded to group allocation. The primary outcome was child body mass index (BMI) z score, and secondary outcomes were prevalence of obesity (BMI ≥95th percentile), self-regulation (psychological measures), sleep, physical activity (accelerometry, questionnaires), and dietary intake (food-frequency questionnaire). Analyses were conducted through the use of multiple imputation.

Results

Retention was 77% at age 3.5 y and 69% at age 5 y. Children in the FAB group had significantly higher BMI z scores than did Controls at age 5 y (adjusted difference: 0.25; 95% CI: 0.04, 0.47) but not at age 3.5 y (0.15; 95% CI: -0.04, 0.34). Children who received the Sleep intervention (Sleep and Combination groups) had significantly lower BMI z scores at age 3.5 y (-0.24; 95% CI: -0.38, -0.10) and at age 5 y (-0.23; 95% CI: -0.38, -0.07) than children who did not (Control and FAB groups).

Conclusions

A conventional intervention had unexpected adverse long-term weight outcomes, whereas positive outcomes from a less conventional sleep intervention remained promising at age 5 y. More intensive or extended sleep intervention might have larger or longer-lasting effects and should be investigated. This trial was registered at clinicaltrials.gov as NCT00892983.

School Start Time and the Healthy Weight of Adolescents

PURPOSE

Studies have found that an early school start time is detrimental to the sleep, health, and well-being of youth, but its association with body weight remains unclear. We examined this association in Canadian adolescents.

METHODS

We collected information on start times from 362 schools that participated in the 2013/2014 Canadian Health Behaviour in School-aged Children Study (n = 29,635 students; ages 10-18). We estimated body mass indices (BMIs) and BMI z-scores, and identified overweight and obesity using international growth references. Multilevel regression models tested the associations between school start times and our outcomes, adjusted for grade, family affluence, school rurality, latitude, and province.

RESULTS

The average BMI was 21.2 (standard deviation 4.9) and BMI z-score was .48 (standard deviation 1.23). Every 10-minute delay in school start time corresponded with a .02 (95% confidence interval .00, .04) smaller BMI z-score. This association translated to BMIs in the 70th and 64th percentiles when comparing students from schools that started at 8:00 a.m. and 9:30 a.m., respectively. School start time was not significantly related to overweight or obesity.

CONCLUSIONS

Later school start time was linked to lower BMI in Canadian adolescents. Delaying school start time may be an additional strategy to support the healthy weight of adolescents. Future intervention and impact studies are recommended to confirm these findings.

Associations Between Daytime Sleepiness, Psychological Symptoms, Headache, and Abdominal Pain in Schoolchildren

Daytime sleepiness and different symptoms are common problems affecting health and well-being of schoolchildren. This population-based cohort study included 568 children who were followed from ages 10 to 15 years. Daytime sleepiness, headache, abdominal pain, and psychological symptoms (depression, irritability or bad temper, nervousness, anxiety, and dejection) were assessed by self-administered questionnaires. The prevalence of frequent daytime sleepiness was 13% at the ages of 10 and 12 years and increased significantly up to 24% at the age of 15 (p < .0001). Daytime sleepiness as well as psychological symptoms were positively associated with headache and abdominal pain from ages 10 to 15 years. Headache in girls at the ages of 10 predicted the occurrence of headache at the age of 15. School nurses and other professionals need to understand the importance of a holistic evaluation of sleep and different symptoms in children. There is also a need for interventions targeting several co-occurring symptoms.

Interventions that stimulate healthy sleep in school-aged children: a systematic literature review

Background

Healthy sleep among children has social, physical and mental health benefits. As most of today’s children do not meet the healthy sleep recommendations, effective interventions are urgently needed. This systematic review summarizes the characteristics and effectiveness of interventions aiming to stimulate healthy sleeping in a general population of school-aged children.

Methods

The search engines PubMed, Embase, Web of Science, PsycInfo and the Cochrane Database Library were systematically searched up to March 2016. We included all studies evaluating interventions targeting healthy sleep duration and/or bedtime routines of children aged 4–12 years. All steps in this systematic review, i.e. search, study selection, quality assessment and data extraction, were performed following CRD Guidelines and reported according to the PRISMA Statement.

Results

Eleven studies were included, of which only two were of strong quality. The interventions varied in terms of targeted determinants and intervention setting. Overall, no evidence was found favoring a particular intervention strategy. One intervention that delayed school start time and two multi-behavioral interventions that targeted both the school and home setting showed promising effects in terms of increasing sleep duration.

Conclusion

Due to few high quality studies, evidence for the effectiveness of any particular intervention strategy to stimulate healthy sleep in children is still inconclusive. However, the more effective interventions in stimulating healthy sleep duration and adherence to regular bedtimes were mostly multi-behavioral interventions that included creating daily healthy routines and combined intervention settings (e.g. home and school). In conclusion, high-quality studies evaluating systematically developed interventions are needed to move this field forward.

Sleep Patterns and Quality Are Associated with Severity of Obesity and Weight-Related Behaviors in Adolescents with Overweight and Obesity

BACKGROUND

Inadequate sleep duration, sleep patterns, and sleep quality have been associated with metabolic, circadian, and behavioral changes that promote obesity. Adolescence is a period during which sleep habits change to include less sleep, later bedtimes, and greater bedtime shift (e.g., difference between weekend and weekday bedtime). Thus, sleep may play a role in adolescent obesity and weight-related behaviors. This study assesses sleep duration, quality, and schedules and their relationships to relative weight and body fat percentage as well as diet, physical activity, and screen time in adolescents with overweight/obesity.

METHODS

Adolescents between 12 and 17 years old (n = 186) were weighed and measured, reported typical sleep and wake times on weekdays and weekends, and responded to questionnaires assessing diet, physical activity, and screen time habits.

RESULTS

Controlling for sleep duration, later weekend bedtime and greater bedtime shift were associated with greater severity of overweight (β = 0.20; β = 0.16) and greater screen time use (β = 0.22; β = 0.2). Later bedtimes on the weekdays and weekends were associated with fewer healthy diet practices (β = -0.26; β = -0.27). In addition, poorer sleep quality was associated with fewer healthy diet habits (β = -0.21), greater unhealthy diet habits (β = 0.15), and less physical activity (β = -0.22). Sleep duration was not associated with any weight or weight-related behavior.

CONCLUSIONS

Sleep patterns and quality are associated with severity of overweight/obesity and various weight-related behaviors. Promoting a consistent sleep schedule throughout the week may be a worthwhile treatment target to optimize behavioral and weight outcomes in adolescent obesity treatment.

Effect of experimental change in children's sleep duration on television viewing and physical activity

BACKGROUND

Paediatric observational studies demonstrate associations between sleep, television viewing and potential changes in daytime activity levels.

OBJECTIVE(S)

To determine whether experimental changes in sleep lead to changes in children's sedentary and physical activities.

METHODS

Using a within-subject counterbalanced design, 37 children 8-11 years old completed a 3-week study. Children slept their typical amount during a baseline week and were then randomized to increase or decrease mean time in bed by 1.5 h/night for 1 week; the alternate schedule was completed the final week. Children wore actigraphs on their non-dominant wrist and completed 3-d physical activity recalls each week.

RESULTS

Children reported watching more television (p < 0.001) and demonstrated lower daytime actigraph-measured activity counts per epoch (p = 0.03) when sleep was decreased (compared with increased). However, total actigraph-measured activity counts accrued throughout the entire waking period were higher when sleep was decreased (and children were awake for longer) than when it was increased (p < 0.001).

CONCLUSION(S)

Short sleep during childhood may lead to increased television viewing and decreased mean activity levels. Although additional time awake may help to counteract negative effects of short sleep, increases in reported sedentary activities could contribute to weight gain over time.

Past, present, and future: trends in sleep duration and implications for public health

Sleep is important for the physical, social and mental well-being of both children and adults. Over the years, there has been a general presumption that sleep will inevitably decline with the increase in technology and a busy 24-hour modern lifestyle. This narrative review discusses the empirical evidence for secular trends in sleep duration and the implications of these trends.