Sleep, but not other daily routines, mediates the association between maternal employment and BMI for preschool children

Maternal Risk of Cardiovascular Disease Is Associated With Higher BMI Among Preschool-Aged Children: A Cross-Sectional Study

Childhood obesity is an ongoing concern in the United States. Higher weight status in early childhood is associated with higher weight status at older ages. The Maternal Obesity Matters (MOMs) Study investigated associations between maternal risk of cardiovascular disease (CVD) and child BMI z-scores (BMIz) among preschool-aged children. This cross-sectional exploratory study included mothers and their 3- to 5-year-old children in Colorado, United States. Maternal nonfasting blood samples, blood pressure, and maternal and child anthropometrics were collected. Maternal CVD risk was assessed on a scale of 0-5 using five health measures. Multivariate regression tested associations between maternal CVD risk and child BMIz. Each 1-point increase in maternal CVD risk was associated with a 0.18 increase in child BMIz, controlling for maternal employment. Intervening upon maternal health may be an important strategy for addressing childhood obesity.

Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers

OBJECTIVE

To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.

METHODS

We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).

RESULTS

An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.

CONCLUSIONS

More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

STUDY OBJECTIVES

This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship.

METHODS

Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions.

RESULTS

Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship.

CONCLUSIONS

Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes.

CITATION

Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Maternal employment and child weight-related health

Several studies have documented a link between maternal employment and childhood obesity, but the mechanisms are not clear. This study investigated the association of maternal employment with children's weight status and detailed weight-related behaviors using data from Phase I of Family Matters, a cross-sectional, observational study of 150 children aged 5-8 from six racial/ethnic groups (White, Black, Latinx, Native American, Hmong, and Somali) and their families from the Minneapolis/St. Paul, MN metropolitan area recruited in 2015-2016. Weight status (objectively measured), child dietary intake (three 24-h dietary recalls), physical activity (eight days of hip-mounted accelerometer data on children), and sleep (eight daily parent reports on children's sleep hours) were examined across four categories of maternal employment status: stay-at-home caregivers, working part-time, working full-time, and unemployed/unable to work. This study found that children's weight status and physical activity levels were similar across all categories of maternal employment. However, there were significant differences in aspects of children's diets by maternal employment status and, compared to children with stay-at-home mothers, children's sleep was significantly lower if their mother worked full-time. These findings highlight that dietary and sleep interventions tailored to the mother's employment status may be fruitful.

Measuring Sleep Health Disparities with Polysomnography: A Systematic Review of Preliminary Findings

Socioeconomic status (SES) has an unrecognized influence on behavioral risk factors as well as public health strategies related to sleep health disparities. In addition to that, objectively measuring SES’ influence on sleep health is challenging. A systematic review of polysomnography (PSG) studies investigating the relation between SES and sleep health disparities is worthy of interest and holds potential for future studies and recommendations. A literature search in databases was conducted following Prisma guidelines. Search strategy identified seven studies fitting within the inclusion criteria. They were all cross-sectional studies with only adults. Except for one study conducted in India, all of these studies took place in western countries. Overall emerging trends are: (1) low SES with its indicators (income, education, occupation and employment) are negatively associated with PSG parameters and (2) environmental factors (outside noise, room temperature and health worries); sex/gender and BMI were the main moderators of the relation between socioeconomic indicators and the variation of sleep recording with PSG. Socioeconomic inequalities in sleep health can be measured objectively. It will be worthy to examine the SES of participants and patients before they undergo PSG investigation. PSG studies should always collect socioeconomic data to discover important connections between SES and PSG. It will be interesting to compare PSG data of people from different SES in longitudinal studies and analyze the intensity of variations through time.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Association Between Sleep Duration and Intelligence Quotient in 6-Year-Old Children

BACKGROUND

Sufficient sleep during childhood is important for cognitive functions such as learning and successful school performance. This study aimed to investigate the effects of sleep duration on the intelligence quotient (IQ) of 6-year-old children and aimed to analyze whether these effects differed by sex.

METHODS

The IQ of 538 6-year-old Korean participants from the cohort study, "The Environment and Development of Children," was measured during follow-up using the Korean Educational Developmental Institute's Wechsler Intelligence Scale for Children. The total, verbal, and performance IQ scores were evaluated. The relationship between sleep duration and IQ scores after adjusting for maternal age, maternal educational level, maternal occupation, maternal IQ, exposure to secondhand smoking, gestational age, and monthly age and birth season was also assessed.

RESULTS

Longer sleep duration was significantly associated with improved verbal IQ measures (β 0.55; p value 0.030). After stratifying participants by sex, a significant association was observed between sleep duration and total, verbal, and performance IQ scores in boys (total IQ 2.49, p value 0.012; verbal IQ 0.75, p value: 0.037; performance IQ 0.73, p value 0.048), but not in girls.

CONCLUSIONS

The results indicated that only boys show a significant association between IQ scores and sleep duration. These findings support the hypothesis that sleep duration is associated with IQ, in a sex dependent manner. Future studies are needed for a thorough evaluation of the connection between sleep duration and health outcome in young children.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Traditional Societal Practices Can Avert Poor Dietary Habits and Reduce Obesity Risk in Preschool Children of Mothers with Low Socioeconomic Status and Unemployment

Healthy nutritional habits are of vital importance for good health and quality of life for all individuals in all life stages. Nutritional habits shaped in early childhood set the foundation for future dietary practices applied through lifespan, hence informing risk towards chronic diseases. A key contributor to child health is maternal impact. A healthy childhood status translates into increased lifespan, health, and life-quality, as well as better family and social interactions and improved academic performance. These conditions can contribute to a healthier and more vibrant workforce, and thus extend positive impact on the economic and overall development of a country. Evidence related to maternal impact on childhood dietary habits is limited in Turkey, an emerging economy with notable disparities and a significant segment (approximately one third) of its 83 million population under the age of 30. Hence, the aim of this study was to investigate the relationship between the socioeconomic status (SES) of mothers on the dietary habits of their preschool children. A pilot cross-sectional observational study was conducted involving the mothers of 109 preschool children aged 4-6 years. Data on the nutritional status of children were collected through a food frequency questionnaire and a 24-h recall interview, while sociodemographic information was also collected, and statistical analyses conducted. An unexpected finding regarding the lack of association between the socioeconomic and employment status of mothers and the nutritional intakes of their children was observed. Interestingly, it appears that more traditional societal and nutritional practices typically undertaken in the case of lower SES, especially in more traditional settings like the case of Turkey, appear to extend a protective effect as per the nutritional habits and ensuing obesity risk in the case of children of women with lower SES. Another way to interpret our finding is that the difference in education and SES is not adequate to produce a significant effect in terms of children dietary intake. This is an interesting finding that warrants further study. Additionally, such studies serve to increase awareness about the importance of healthy nutritional practices in preschool children and the critical role of the mother on their nutritional status, particularly in the Turkish idiosyncratic setting.

Systematic review and meta-analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children

The aim of this study is to determine (a) whether short sleep is associated with the incidence of obesity and (b) whether interventions beneficial for sleep reduce weight gain in preschool children. We systematically searched PubMed, Embase, Web of Science and Cochrane up to 12/09/2019. (a) Studies that were included were prospective, had follow-up ≥1 year, with sleep duration at baseline and required outcome measures. (b) Intervention trials with sleep intervention and measures of overweight or obesity were included. Data were extracted according to PRISMA guidelines. (a) The risk of developing overweight/obesity was greater in short sleeping children (13 studies, 42 878 participants, RR: 1.54; 95% CI, 1.33 to 1.77; p < 0.001). Sleep duration was associated with a significant change in BMI z-score (10 studies, 11 cohorts and 29 553 participants) (mean difference: -0.02 unit per hour sleep; -0.03 to -0.01; p < 0.001). (b) Four of the five intervention studies reported improved outcomes: for BMI (-0.27 kg/m2 ; -0.50 to -0.03; p = 0.03); for BMI z-score (-0.07 unit; -0.12 to -0.02; p = 0.006). Short sleep duration is a risk factor or marker of the development of obesity in preschool children. Intervention studies suggest that improved sleep may be beneficially associated with a reduced weight gain in these children.

Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research

To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Long work hours of mothers and fathers are linked to increased risk for overweight and obesity among preschool children: longitudinal evidence from Germany

BACKGROUND

Most existing studies on maternal employment and childhood overweight/obesity are from the USA. They are predominantly cross-sectional and show a consistent linear association between the two. Less is known about the joint impact of fathers' and mothers' work hours on childhood overweight and obesity.

OBJECTIVES

To examine the impact of maternal and paternal work hours on overweight/obesity among children aged 1-6 years in Germany using longitudinal data.

METHODS

Child body weight and height and their parents' work hours were collected for 2413 children at ages 0-1, ages 2-3 and ages 5-6. Overweight and obesity was defined using the body mass index percentiles based on the Cole LMS-Method. Random effects model was conducted, adjusting for demographic, socioeconomic and health characteristics of parents and children.

RESULTS

Compared with non-employment, when mothers worked 35 or more hours per week, the risk for child overweight and obesity increased among preschool children. When fathers worked 55 or more hours per week, this effect was strengthened and maternal part-time hours (24-34 per week) also became a risk for child overweight and obesity. The effect was mainly found in high-income families.

CONCLUSIONS

Both mothers' and fathers' long work hours matter to young children's overweight status. Employment protection and work time regulation for both working parents during the first 6 years of the child's life should be considered in future policy.

Night sleep duration trajectories and associated factors among preschool children from the EDEN cohort

OBJECTIVE

Sleep duration may vary both interindividually and intraindividually over time. We aimed to identify night-sleep duration (NSD) trajectories among preschoolers and to study associated factors.

METHODS

NSD was collected within the French birth-cohort study EDEN at ages 2, 3, and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics, as well as child health, lifestyle, and sleep characteristics at birth and/or at age two years were investigated in association with NSD using multinomial logistic regressions.

RESULTS

Five distinct NSD trajectories were identified: short (SS, <10 h, 4.9%), medium-low (MLS, <11 h, 47.8%), medium-high (MHS, ≈11.5 h, 37.2%), long (LS, ≥11.5 h, 4.5%) and changing (CS, ie, ≥11.5 h then <11 h, 5.6%) NSD trajectories. Multivariable analyses showed in particular that compared to the MHS trajectory factors associated with increased risk for the SS trajectory were male gender, first child, maternal age and working status, night-waking, parental presence when falling asleep, television-viewing duration, as well as both "Processed and fast foods" and the "Baby food" dietary patterns at age two years. Factors positively associated with the CS trajectory were maternal smoking, feeding at night, and the Processed and fast foods dietary pattern at age two years, whereas child's activity and emotionality scores at age one year were negatively associated.

CONCLUSION

We identified distinct NSD trajectories among preschoolers and associated early life factors. Some of them may reflect less healthy lifestyles, providing cues for early multi-behavioral prevention interventions.

Demographics and Psychological Factors Associated with Adiposity in Nurses

Adiposity-based chronic disease (ABCD), overweight-Ow- or obesity-Ob-) in health personnel is as frequent as in the general population, even though they understand well the importance of maintaining a healthy weight. Thus, it is highly likely that certain demographic and psychological conditions, independently of knowledge, are contributing to develop ABCD. The aim of this study was to examine the association between these factors and ABCD in nurses. Data were collected from a cross-sectional study conducted in a tertiary level institute in Mexico City from 2012 to 2013. All the nurses of the institute of any age, shift, service area and seniority were invited to participate and 55% (265) accepted. We found that ABCD was present in 79.6%, and low self-esteem and emotional distress in 26% and 10%, respectively. Working in the night shift (p = 0.031), labor seniority ≥15 years (p = 0.006), having 1 or more children (p = 0.021) and sessions of physical activity <30 min (p = 0.03) were associated with ABCD. Low self-esteem (OR = 2, 95% CI 1.150–3.07, p = 0.023) and emotional distress (OR = 4, 95% CI 1.472–13.078, p = 0.012) were associated with unhealthy lifestyle (less of 3 days per week and/or less of 30 min per session of physical activity and poor dietary habits). Therefore, strategies to prevent and treat ABCD must consider each context among nurses and psychological disorders need be identified to avoid an unhealthy lifestyle.

Links between the organization of the family home environment and child obesity: a systematic review

Due to increasingly high rates of child overweight and obesity, it is important to identify risk and protective factors that may inform more effective prevention and intervention. The degree of organization in the family home environment is a studied, but not well-specified, factor that may impact child weight. Prior research on household organization has examined an array of constructs, including family routines, limit setting, household chaos, crowding and the broad home environment. This study systematically reviews literature on organization within the family home environment and weight among children ages 2-12. Six hundred thirty-seven studies were reviewed by four coders for eligibility, and 32 studies were included in the final synthesis. Overall, 84% of studies provided evidence for relations between at least one indicator of organization within the family home environment and child weight. Studies provided compelling evidence across several constructs, suggesting that the relevance of household organization to child weight extends beyond a single indicator. Directions for future work include (i) examining the mediating role of health behaviours, (ii) examining the moderating role of socioeconomic factors, (iii) broadening this evidence base across cultures and nationalities and (iv) integrating constructs to develop a comprehensive model of organization within the home environment.

Sleeping Habits among School Children and their Effects on Sleep Pattern

Introduction: Sleep problems can occur at any age. Inadequate sleep affects the physiological as well as psychological well-being of an individual. Thus, the objective of the present study is, to determine the pre sleep habits, duration and pattern of sleep among school children and to determine association between their sleep schedules and sleep habits.

Methods: This cross-sectional study comprised of 1050 children attending the government school. Based on inclusion and exclusion criteria children were from three age groups: 4-5 years, 6-10 years and 11-15 years of age. A questionnaire about demographical data, sleep problems and habits, was duly filled by the parents. The parents of children were questioned for bed time, wakeup time, sleep time and sleep duration during both weekdays and weekends.

Results: Total sleep time during weekdays was 8.9 (1.2) hours and 10.7 (1.1) hours during weekends. The wakeup time was significantly delayed during weekends in all age groups. Moreover, total sleep time increased significantly during weekends in all age groups. Children using media after 8 pm and sleeping alone are also in significant sleep debt. Screen activities such as TV, internet and cellular phones in a child’s bedroom had a negative effect on children’s sleep/wake patterns and duration of sleep. Children in higher grades are sleep debt compared to younger ones. Practices such as co sleeping and sharing bed with parents significantly improve the duration and quality of sleep.

Conclusion: The sleep durations reported in the present study were lower than recommended sleep duration for children.

Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years)

Background

The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years.

Methods

Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed.

Results

A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from “very low” to “high” across study designs and health indicators.

Conclusions

Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4850-2) contains supplementary material, which is available to authorized users.

Association Between Sleep Duration and Body Mass Index Among US Low-Income Preschoolers

OBJECTIVE

To verify whether sleep duration was related to body mass index z scores (zBMI) and whether bedtimes or ethnicity was a moderator of the sleep duration-zBMI association among preschoolers from low-income families.

METHODS

Two hundred twenty-eight African American and Hispanic parents and their preschoolers were recruited from Head Start Centers. Parents reported their preschoolers' sleep duration and bedtimes (using the Children's Sleep Habits Questionnaire) and their television watching. Food intake was measured using multiple days of digital photography to estimate energy intake at dinner. The Parenting Stress Index and the Center for Epidemiologic Studies Depression Scale were used to measure stress and depression. Parents' and preschoolers' height and weight were measured by trained staff.

RESULTS

Longer sleep duration was significantly associated with lower zBMI when controlling for demographics, bedtimes, energy intake at dinner, and television watching, but not when also controlling for parents' demographics, BMI, stress, and depression. Preschoolers' sleep duration-zBMI association was not moderated by bedtimes or ethnicity.

CONCLUSIONS

Longer sleep duration was associated with lower zBMI among low-income preschoolers when controlling for preschoolers' characteristics, but this was no longer the case when also controlling for parents' characteristics. Additional studies are needed on the moderators of the sleep duration-zBMI association among low-income preschoolers.

Non-linear relationship between maternal work hours and child body weight: Evidence from the Western Australian Pregnancy Cohort (Raine) Study

Using longitudinal data from the Western Australia Pregnancy Cohort (Raine) Study and both random-effects and fixed-effects models, this study examined the connection between maternal work hours and child overweight or obesity. Following children in two-parent families from early childhood to early adolescence, multivariate analyses revealed a non-linear and developmentally dynamic relationship. Among preschool children (ages 2 to 5), we found lower likelihood of child overweight and obesity when mothers worked 24 h or less per week, compared to when mothers worked 35 or more hours. This effect was stronger in low-to-medium income families. For older children (ages 8 to 14), compared to working 35-40 h a week, working shorter hours (1-24, 25-34) or longer hours (41 or more) was both associated with increases in child overweight and obesity. These non-linear effects were more pronounced in low-to-medium income families, particularly when fathers also worked long hours.

Sleep duration and obesity in children: A systematic review and meta-analysis of prospective cohort studies

AIM

Childhood obesity is a major public problem worldwide, and sleep duration may be associated with childhood obesity. We conducted a systematic review and meta-analysis of prospective cohort studies to estimate the associations between sleep duration and obesity/body mass index (BMI) in children.

METHODS

PubMed, Embase and the Cochrane Library were searched. For the meta-analysis, the pooled relative risk (RR) and 95% confidence intervals (CI) were estimated to reveal the association between short sleep duration and obesity. For the review, the outcomes focused on BMI change or subsequent BMI status.

RESULTS

A total of 12 studies (15 populations) met the criteria for inclusion in the meta-analysis. Short sleep duration was significantly associated with obesity (RR: 1.45; 95% CI: 1.14-1.85). After excluding two cohorts that substantially affected the heterogeneity, the pooled results remained significant (RR: 1.30; 95% CI: 1.20-1.42), and the association was not substantially altered in the subgroup analysis. In addition, we summarised 24 studies that met the criteria for our review of the relationship between sleeping and BMI.

CONCLUSION

The present meta-analysis indicated that short sleep duration increased the risk of childhood obesity. Public health efforts that encourage children to have sufficient sleep time may be important in combating obesity.

Association between maternal lifestyle and preschool nutrition

Introduction:

Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition.

Objective:

To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children.

Method:

From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers ("schools" and "children"). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression.

Results:

Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting "sedentary behavior" and the habit of eating "ultra-processed foods" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the "consumerist" cluster.

Conclusion:

Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Clustering patterns of obesity-related multiple lifestyle behaviours and their associations with overweight and family environments: a cross-sectional study in Japanese preschool children

OBJECTIVES

The purpose of this study is (1) to identify obesity-related lifestyle behaviour patterns of diet, physical activity, sedentary and sleep behaviours in preschool children, (2) to examine the association between identified behaviour clusters and overweight/obesity and (3) to investigate differences in children's family environments according to clusters.

DESIGN SETTING AND PARTICIPANTS

A cross-sectional study on 2114 preschool children aged 3-6 years who attended childcare facilities (24 nursery schools and 10 kindergartens) in Tsuruoka city, Japan in April 2003 was conducted.

MAIN OUTCOME MEASURES

Children's principal caregivers completed a questionnaire on children's lifestyle behaviours (dinner timing, outside playtime, screen time and night-time sleep duration), family environment (family members, maternal employment, mealtime regularity and parents' habitual exercise and screen time) and measurements of weight and height. Cluster analysis was performed using children's 4 lifestyle behaviours based on those non-missing values (n=1545). The χ² tests and analysis of variance (ANOVA) estimated cluster differences in overweight/obesity and family environments.

RESULTS

6 clusters were identified. Children's overweight/obesity varied across clusters (p=0.007). The cluster with the most screen time, shorter night-time sleep duration, average dinner timing and outside playtime had the highest overweight/obesity prevalence (15.1%), while the cluster with the least screen time, the longest sleep duration, the earliest dinner timing and average outside playtime had the lowest prevalence (4.0%). Family environments regarding mealtime regularity and both parents' screen time also significantly varied across clusters. The cluster having the highest overweight/obesity prevalence had the highest proportion of irregular mealtimes and the most screen time for both parents.

CONCLUSIONS

This study suggests that public health approaches to prevent children's overweight/obesity should focus on decreasing screen time and increasing night-time sleep duration. To shape those behaviours, regular mealtimes and decreasing parents' screen time within family environments need to be targeted among family members.

Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study

The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.