Behavioral and social routines and biological rhythms in prevention and treatment of pediatric obesity

Intermittent Fasting in Youth: A Scoping Review

Intermittent fasting (IF) focuses on the timing of eating rather than diet quality or energy intake, with evidence supporting its effects on weight loss and cardiometabolic outcomes in adults. However, there is limited evidence for its efficacy in adolescents and emerging adults. To address this, a scoping review examined IF regimens in individuals aged 10 to 25, focusing on methodology, intervention parameters, outcomes, adherence, feasibility, and efficacy. The review included 39 studies with 731 participants aged 15 to 25. Methodologies varied, with 18 studies on time-restricted eating and others requiring caloric restriction. Primary outcomes included cardiometabolic risk factors (11/29), body composition (9/29), anthropometric measurements (8/29), and feasibility (2/29). Most studies reported significant weight loss. This review underscores IF's potential in treating obesity in this age group but highlights the need for rigorous studies with standardized frameworks for feasibility to ensure comparability and determine IF's practicality in this age group.

Association between Sleep Timing, Being Overweight and Meal and Snack Consumption in Children and Adolescents in Southern Brazil

Sleep timing is one of the dimensions of sleep that refers to the time of day when sleep occurs. It has been included in sleep-related research because of the potential associations between being overweight and the consumption of meals and snacks. This cross-sectional study aimed to investigate associations between sleep timing, meal and snack consumption and weight status in 1333 schoolchildren aged 7-14 years. The midpoint of sleep was used as a sleep timing measure obtained by the midpoint between bedtime and wake-up time, classified as Early, Intermediate, and Late. Schoolchildren in the Early group were less likely to be overweight (OR: 0.83, 95% CI 0.69; 0.99), and had higher odds of mid-morning snack consumption (OR: 1.95, 95% CI 1.56; 2.44) and lower probability to consume an evening snack (OR: 0.75, 95% CI 0.59; 0.94) compared with the Intermediate group. The Late group had lower odds of mid-morning snack consumption (OR: 0.67, 95% CI 0.55, 0.80) than the Intermediate group. The consumption of mid-morning and evening snacks was associated with the Early and Late midpoints of sleep. These results suggest that bedtime and wake-up time are relevant to consuming meals and snacks and may also be related to a greater probability of being overweight in children and adolescents.

The effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding and movement behaviour of children aged 6-20 months in rural China: a cluster randomized controlled trial

Background

Appropriate infant feeding and movement behaviour (i.e. physical activity, sedentary behaviour, sleep) play an important role in children's healthy development during the first two years of life. The popular Chinese social media app 'WeChat' has become a potential data collection and health promotion tool. We aimed to evaluate the effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding practices and movement behaviour of children aged 6-20 months in rural China.

Methods

We conducted a two-armed cluster randomized control trial in Datong County, Qinghai Province, China. There were 106 clusters from 257 villages allocated (1:1) to two groups: the feeding group, which received a complementary feeding recommendations feedback report; the movement behaviour group, which received movement behaviour recommendations feedback report. The feeding group acted as a control for the movement behaviour group and vice versa. Children aged 6-20 months and their primary caregivers were invited to be participants. WeChat was used to collect the data on outcomes and to deliver the interventions. Participants received the interventions by filling out the WeChat self-assessment questionnaire and reading tailored feedback reports at baseline, at the first 1-month follow-up and at the second 2-month follow-up. Outcome measures included changes in the prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD); and the proportion of children who met physical activity time (PAT), outdoor time (OT) and screen time (ST) recommendation between the two groups at the two follow-ups. This study is registered at Chinese Clinical Trial Registry-ChiCTR2200062529.

Findings

Between September 28th and October 12th 2022, we recruited 1610 children in 106 clusters, of which 53 clusters (800 children) were randomized to the feeding group and 53 clusters (810 children) to the movement behaviour group. All caregivers of children completed questionnaires at three time points without loss to follow-up. From baseline to the second follow-up, the prevalence of MDD (OR: 1.62 [95% CI, 1.16-2.28; p = 0.0058]), MMF (OR: 1.45 [95% CI, 1.03-2.04; p = 0.032]) and MAD (OR: 1.51 [95% CI, 1.12-2.05; p = 0.0081]) in the feeding group were significantly higher than that in the movement behaviour group. The proportion of children who met PAT during the last 24 h at the second follow-up (OR: 2.22 [95% CI, 1.26-2.17; p < 0.0001]) and OT at the second follow-up (OR: 1.94 [95% CI, 1.49-2.54; p < 0.0001]) significantly improved in the movement behaviour group compared to the feeding group. Furthermore, ST in the movement behaviour group showed a significant increase only at the first follow-up (OR: 1.36 [95% CI, 1.02-1.82; p = 0.036]).

Interpretation

WeChat-based self-assessment with tailored feedback was an effective channel to deliver feeding and movement behaviour recommendations in rural China in our study. This approach can be applied to change feeding practices of caregivers of young children alongside routine child health care in rural China.

Funding

Capital Institute of Pediatrics.

Association between maternal and infant screen time with child growth and development: A longitudinal study

BACKGROUND

Sedentary screen time is an early, modifiable risk factor for obesity and poor child development.

OBJECTIVES

To examine the relationship between maternal and infant screen time with child growth and development.

METHODS

Pregnant women were recruited for a cohort study related to maternal and infant development. Screen time was assessed in mothers during pregnancy, and subsequently in children at 3 months, 12 months, and 24 months of age. Child anthropometry was measured, and nuclear magnetic resonance quantified child fat mass. Fat mass index (FMI) was calculated. The Bayley Scales of Infant Development-III were used to assess child development. Linear regression models were used to assess the relationship between screen time and child growth and development, adjusted for covariates and stratified by sex.

RESULTS

Mother/child dyads (n = 89) were mainly white (92.1%), and half were boys (52%). Both sexes increased screen time between 12 months and 24 months (ps <0.05). Child screen time was positively associated with FMI and negatively associated with development scores. In adjusted models, screen time was positively associated with FMI in boys, and meeting the screen time guideline was associated with lower FMI in girls.

CONCLUSION

Greater infant screen time was related to higher adiposity. Though few relationships emerged, a cautionary approach to screen time early in life may benefit child health.

Systematic Review of General Parenting Intervention Impacts on Child Weight as a Secondary Outcome

General parenting interventions have improved parent-child relationships and child behavior, with emerging evidence that they may also reduce prevalence of pediatric overweight/obesity. We conducted a systematic review on interventions that were designed to promote positive parenting and examined child weight post-hoc. We searched for studies published through January 2022 that promoted positive parenting among parents of children ages 0-18 years and reported effects on body weight as an ancillary outcome, with no intervention content focused on energy balance (e.g., feeding, physical activity). This search was carried out within ClinicalTrials.gov, ISRCTN Registry, PubMed, PsycINFO, Web of Science, and Connected Papers. Studies were imported into EndNote X9 and assessed independently by two investigators. In total, 753 clinical trials and 723 publications were assessed, and six publications met inclusion criteria. All cohorts were low-income and interventions targeted expectant mothers up through parents of adolescents. Follow-ups occurred when participants were between 2 and 25 years. Significant improvements in weight-related outcomes were observed across all studies for the intervention arm as a whole or for certain subgroups, and reasons underlying these gains tended to differ by participants' age. The magnitude of effect sizes ranged from medium to large. Interventions focused on general positive parenting are efficacious at lowering risk of overweight/obesity without focusing on physical health. Promoting attachments among infants, restructuring a toddler's home environment, praising preschoolers, and communicating with adolescents may optimize weight outcomes in parenting interventions adapted for obesity prevention.

Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth

PURPOSE OF REVIEW

Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep.

RECENT FINDINGS

Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.

STRATEGIES IN ADDRESSING STATE SCREEN TIME POLICIES IN EARLY CARE AND EDUCATION CENTERS IN LOUISIANA

Background

Multiple state and local governments have legislated screen time policy regulations in early care and education (ECE) centers in the United States, though little is known about how and whether these are enacted within these settings. This study examined the implementation, communication, monitoring, enforcement, and evaluation strategies of recently enacted state-level early childhood education (ECE) center screen time regulations in a southern U.S. state.

Methods

ECE directors (n=12) participated in semi-structured interviews after the regulations were enacted, and interview transcripts were evaluated using thematic analysis.

Results

Most directors reported making environmental changes (e.g., removing screens from the classroom) and limiting children's and staff members' access to devices (e.g., restricting classroom time spent on screens), including regulating staff members' own screen time (i.e., phone usage). ECE center directors reported daily monitoring for adherence to regulations and used a variety of enforcement strategies, and most reported no adverse effects from implementing the policy. A few directors reported receiving resources from agencies or organizations to assist in implementing, monitoring, or enforcing screen time regulations.

Discussion

In this sample, environmental and individual changes helped ECE centers adhere to the regulations, along with frequent monitoring.

Conclusions

Development of technical assistance resources to support environmental and logistical changes, along with continued evaluation of the regulations, are warranted to minimize or eliminate screen time at ECE centers.

Randomized controlled trial to enhance children's sleep, eating, and weight

BACKGROUND

The present study assessed the efficacy of a behavioral intervention to enhance children's sleep and reduce caloric intake and body mass index (BMI) change.

METHODS

Seventy-eight children 8-11 years old who slept 9.5 h/night or less were randomized to the sleep intervention or to no treatment control. The primary outcome was 2-month change in the actigraph-estimated sleep period; changes in reported caloric intake, percent calories from fat, and BMI/BMI z-score (BMIz) were assessed.

RESULTS

Children randomized to intervention enhanced their sleep period by 40 ± 7 min/night relative to control (p < 0.001), and were more likely to increase their sleep period by 30 min/night or more (52% versus 15%, p = 0.003). No differences were observed for reported dietary intake or BMI/BMIz. However, in post-hoc analyses collapsing across groups, those who increased sleep by 30 min/night or more had lower BMI (-0.31 kg/m², p = 0.01) and BMIz (-0.07, p = 0.03) and reported fewer percent calories from fat at 2 months (-2.2%, p = 0.04).

CONCLUSIONS

A brief behavioral intervention can enhance children's sleep, but did not result in changes in caloric intake or weight status. Enhancing sleep by 30 min/night or more may be beneficial for weight regulation.

IMPACT

A brief behavioral intervention improved children's nocturnal sleep relative to no treatment control. Given the many benefits of a good night's sleep across domains of functioning, findings have significant implications for children's health and wellbeing. There were no differences between groups on eating behaviors or BMI. However, across groups, children who increased their sleep period by at least 30 min/night, reported reduced intake from fat and evidenced lower BMI at 2 months. Thus, a brief intervention can improve sleep and may have potential benefits for weight regulation.

A child-centered health dialogue for the prevention of obesity in child health services in Sweden - A randomized controlled trial including an economic evaluation

BACKGROUND

Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost-effective interventions for children aged 2-6 years and their caregivers in Child Health Services are lacking.

OBJECTIVES

To evaluate the effects and cost-effectiveness of a child-centered health dialogue in the Child Health Services in Sweden on 4-year-old children with normal weight and overweight.

METHODS

Thirty-seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI-change.

RESULTS

A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow-up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI-change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI-change for children with overweight was -0.11, with a 95% confidence interval of -0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child-Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost-effectiveness ratio was 183 euros per 0.1 zBMI unit prevented.

CONCLUSIONS

This low-intensive multicomponent child-centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost-effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio-economic factors in universally implemented obesity prevention programs.

Life Interrupted: Family Routines Buffer Stress during the COVID-19 Pandemic

Adoption of certain behavioral and social routines that organize and structure the home environment may help families navigate the challenges presented by the COVID-19 pandemic. The current cross-sectional study aimed to assess family routines prior to and during the COVID-19 pandemic and examine associations with individual and family well-being. Using a national sample, 300 caregivers of children ages 6-18 were surveyed using Amazon Mechanical Turk platform during the first three months of COVID-19 pandemic in the United States. Caregivers reported on family demographics, COVID-19-related stress, engagement in family routines (prior to and during the COVID-19 pandemic), stress mindset, self-efficacy, and family resiliency. Overall, families reported engaging in fewer routines during the COVID-19 pandemic compared to prior to the pandemic. COVID-19-related stress was highest in low-income families, families of healthcare workers, and among caregivers who had experienced the COVID-19 virus. Moreover, COVID-19-related stress was negatively related to self-efficacy, positively related to an enhancing stress mindset, and negatively related to family resilience. Engagement in family routines buffered relations between COVID-19-related stress and family resilience, such that COVID-19-related stress was not associated with lower family resilience among families that engaged in high levels of family routines. Results suggest that family routines were challenging to maintain in the context of the COVID-19 pandemic, but were associated with better individual and family well-being during this period of acute health, economic, and social stress.

Later sleep timing predicts accelerated summer weight gain among elementary school children: a prospective observational study

OBJECTIVES AND BACKGROUND

Social demands of the school-year and summer environment may affect children's sleep patterns and circadian rhythms during these periods. The current study examined differences in children's sleep and circadian-related behaviors during the school-year and summer and explored the association between sleep and circadian parameters and change in body mass index (BMI) during these time periods.

METHODS

This was a prospective observational study with 119 children ages 5 to 8 years with three sequential BMI assessments: early school-year (fall), late school-year (spring), and beginning of the following school-year in Houston, Texas, USA. Sleep midpoint, sleep duration, variability of sleep midpoint, physical activity, and light exposure were estimated using wrist-worn accelerometry during the school-year (fall) and summer. To examine the effect of sleep parameters, physical activity level, and light exposure on change in BMI, growth curve modeling was conducted controlling for age, race, sex, and chronotype.

RESULTS

Children's sleep midpoint shifted later by an average of 1.5 h during summer compared to the school-year. After controlling for covariates, later sleep midpoints predicted larger increases in BMI during summer, (γ = .0004, p = .03), but not during the school-year. Sleep duration, sleep midpoint variability, physical activity levels, and sedentary behavior were not associated with change in BMI during the school-year or summer. Females tended to increase their BMI at a faster rate during summer compared to males, γ = .06, p = .049. Greater amounts of outdoor light exposure (γ = -.01, p = .02) predicted smaller increases in school-year BMI.

CONCLUSIONS

Obesity prevention interventions may need to target different behaviors depending on whether children are in or out of school. Promotion of outdoor time during the school-year and earlier sleep times during the summer may be effective obesity prevention strategies during these respective times.

Household chaos, family routines, and young child movement behaviors in the U.S. during the COVID-19 outbreak: a cross-sectional study

BACKGROUND

The home environment is an important facilitator of young child movement behaviors, including physical activity (PA), sleep, and screen-time. Household chaos, characterized by crowding, noise, and disorder in the home, may hinder efforts to obtain adequate amounts of movement behaviors. The COVID-19 outbreak impacted many families, and social distancing during this time may create conditions for more household chaos. Family routines can help establish order in the home and encourage an appropriate balance of movement behaviors, such as less screen-time and more sleep. The purpose of this study was to evaluate the association between household chaos and young child movement behaviors during the COVID-19 outbreak in the United States, and the role of family routines in this relationship.

METHODS

A national online survey including 1836 mothers of preschoolers (3.0-5.9 years) was conducted during May 2020. Mothers reported demographic characteristics, household chaos, family routines, and the preschooler's movement behaviors during the outbreak. Mothers completed a household chaos questionnaire and were grouped into chaos categories (low, moderate/low, moderate/high, and high) for analysis. Linear regression was used to assess the association between chaos category, family routines, and movement behaviors with adjustment for covariates.

RESULTS

Mothers were 35.9 ± 4.1 years of age, middle income (47.8%), and preschoolers were 3.8 ± 0.8 years of age. Most mothers reported their preschooler was less physically active (38.9%), slept the same amount of time (52.1%), and increased their screen-time (74.0%) after the COVID-19 outbreak. Preschoolers in the high chaos households performed less total PA (β = - 0.36 days/week, 95% CI:-0.62 to - 0.09, p = 0.008), slept less (β = - 0.42 h, 95% CI:-0.59 to - 0.25, p = 0.001) and had more screen-time (β = 0.69 h, 95% CI:0.45 to 0.92, p = 0.001) compared to those in low chaos households. In most chaos categories, having a bed-time ritual was related to more child sleep, and mothers who viewed routines as "less/not important" reported more preschooler screen-time compared to mothers who viewed routines as "very important".

CONCLUSION

Promoting bed-time rituals and prioritizing routines, even somewhat, may be related to an improved balance of child movement behaviors. Innovative measures are needed to support families during periods of disruption such as that experienced in the COVID-19 pandemic.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study

INTRODUCTION

Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children.

METHODS

Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity.

RESULTS

American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m² higher (obese model) and 0.27 kg/m² higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children.

CONCLUSIONS

Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

Association between Home Environment in Infancy and Child Movement Behaviors

Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.

A practical approach to obesity prevention: Healthy home habits

ABSTRACT

Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as "obesity," "overweight," "healthy habits," "physical activity," "obesogenic behaviors," "family meals," "screen time," "depression," "sugary beverages," and "portion sizes." The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.

Beyond sleep duration: Sleep timing as a risk factor for childhood obesity

BACKGROUND

Ample evidence attests to the relationship between short sleep duration, sleep problems and childhood obesity. However, few studies have examined the association between sleep timing and obesity in children.

OBJECTIVES

To investigate how sleep duration, problems and timing relate to obesity and obesogenic behaviours in children.

METHODS

Eighty-five children (58.8% girls) with severe obesity and mean (SD) age of 12.1 (2.9) years, were matched by age and sex with peers with normal weight (n = 85,12.0 [2.8] years). Sleep and moderate-to-vigorous physical activity (MVPA) were measured via accelerometer for seven consecutive days. Children self-reported emotional eating on the Dutch eating behavior questionnaire. Parents reported children's screen time and sleep problems.

RESULTS

Children with severe obesity had significantly later mean mid-sleep time, overall (36 minutes later, P < .001), on school nights (36 minutes later, P < .001) and weekend nights (39 minutes later, P = .002) compared to children with normal weight. Children with obesity had more sleep problems (P = .030), but no differences emerged in sleep duration or social jetlag. After adjusting for demographic factors, mid-sleep time was positively related to screen time (P = .030). Mid-sleep time and sleep duration were inversely related to time in MVPA (Ps ≤ .041). There were no other significant associations between the sleep variables and the obesogenic behaviours.

CONCLUSIONS

Later sleep timing was related to obesogenic behaviours in children and may represent an obesity risk factor.

Severe paediatric obesity and sleep: A mutual interactive relationship!

Childhood severe obesity is a serious, urgent and complex global health problem with long-term co-morbidities. Obstructive sleep-disordered breathing is more common in obese children and adolescents. Increased body mass index is associated with an increase in apnea-hypopnea index. Obstructive sleep apnea leads to a decrease in rapid eye movement sleep, and obese children have been noted to have a decrease in rapid eye movement sleep, leading to weight gain. Short sleep duration and poor sleep quality are associated with childhood obesity and cardiometabolic risks. Public health strategies for obesity prevention should focus more on sleep. Targeting childhood obesity is important in the prevention and management of obstructive sleep-disordered breathing.

Relationship between the 24-Hour Movement Guidelines and fundamental motor skills in preschoolers

OBJECTIVES

To examine the association among 24-Hour Movement Guidelines and fundamental motor skills (FMS) in preschoolers.

DESIGN

Prospective cohort study with one-year follow-up.

METHODS

Parents of 3-4-year-old children reported child age, sex, race, and time spent viewing screens (hours/day). Accelerometers measured preschooler physical activity (PA) and sleep. The 24-Hour Movement Guidelines were examined (≥3 h/day total PA including ≥1 h/day of moderate-to-vigorous [MVPA], 10-13 h/day of sleep, and ≤1 h/day of screen-time). Trained researchers administered the Test of Gross Motor Development-Third Edition (TGMD-3) to assess FMS. Linear regression was used to assess guidelines met and raw locomotor, ball skills, and total TGMD-3 scores with adjustment for covariates.

RESULTS

One hundred and seven preschoolers provided complete cross-sectional data, and 53 preschoolers provided complete longitudinal data. Of the 107 preschoolers, they were 3.4 ± 0.6 years of age, 44% were male, 50% were White, and the mean age-and-sex adjusted TGMD-3 total score percentile was below average (41 ± 22). Many preschoolers met the PA guideline (91%) and sleep guideline (83%), but few preschoolers met the screen-time guideline (8%) or all three guidelines (6%). MVPA was positively associated with locomotor and total TGMD-3 scores in cross-sectional analysis (p < 0.05 for all). Baseline PA, sleep, and screen-time were associated with total TGMD-3 score at follow-up (p < 0.05 for all). Meeting the screen-time guideline and all three guidelines at baseline were each positively associated with total TGMD-3 score at follow-up (p < 0.05 for all).

CONCLUSIONS

Each movement behavior contributed to later FMS. Promotion of adequate movement behaviors is warranted for child health.