Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families

Associations between objectively measured nighttime sleep duration, sleep timing, and sleep quality and body composition in toddlers in the Guelph Family Health Study

The prevalence of child obesity is a worldwide public health concern. Good sleep quality is associated with reduced adiposity in older children and adults. More research is needed in younger children to help mitigate risk of obesity. In addition, we aimed to address limitations found in previous studies such as relying on subjective measures, or only including one parameter of sleep, using only one body composition parameter, and/or not adjusting for relevant covariates. This cross-sectional study examined baseline data from 48 toddlers aged 1 to <3 years enrolled in the Guelph Family Health Study. Nighttime sleep duration (total sleep time; TST), sleep timing (sleep onset and offset time), and sleep quality (wake after sleep onset; WASO) were measured using 24 h accelerometry for 7 consecutive days. Height, body weight, and waist circumference were measured, and BMI z-scores and waist-to-height ratios were calculated. Percent fat mass and fat mass index were calculated using bioelectrical impedance analysis. Linear regression models were used to estimate associations between sleep parameters and body composition outcomes, with adjustments for relevant covariates (age, sex, household income, screen time, energy intake, physical activity, household stress). Nighttime sleep onset time was positively associated with waist-to-height ratio (β ̂ = 0.004, p = 0.04). Sleep offset time was negatively associated with BMI z-score (β ̂ = -0.48, p = 0.02). TST and WASO were not associated with any body composition outcome. Building healthy sleep habits may prevent childhood obesity; longitudinal research in a larger sample is warranted. This study was registered on ClinicalTrials.gov (NCT02939261).

Impact of household income on the risk of overweight and obesity over time among preschool-aged children: a population-based cohort study

BACKGROUND

The temporality of household income level with overweight/obesity in children has not been extensively studied. Little research has been conducted to determine the impact of household income on the risk of childhood overweight/obesity over time. This population-based cohort study aimed to investigate the impact of household income on the risk of overweight/obesity over time among preschool-aged children in Taiwan.

METHODS

From 2009 to 2018, we recruited 1,482 preschool-aged children ( ≦ 7 y of age) from low-income households and selected age- and sex-matched controls from non-low-income households for comparison; All participants were selected from those who consistently participated in the Taipei Child Development Screening Program and were monitored for overweight/obesity using body mass index (BMI) until December 31, 2018. Low-income households were defined as those with an average monthly disposable income < 60% of the minimum standard of living expense in Taiwan. The primary outcome was childhood overweight or obesity in study participants, defined as BMI (kg/m2) ≥ 85th percentile or ≥ 95th percentile, respectively. The generalized estimating equations (GEE) model was used to determine the impact of low-income households on the risk of overweight/obesity in study participants.

RESULTS

Over 21,450 person-years of follow-up, 1,782 participants developed overweight /obesity, including 452 (30.5%) and 1,330 (22.4%) children from low- and non-low-income households, respectively. The GEE model showed that the first group had a significantly higher risk of becoming overweight/obese than the other during the follow-up period (adjusted odds ratio [aOR] = 1.44, 95% CI: 1.29-1.60). Moreover, children of foreign mothers had a higher risk of becoming overweight/obese than those of Taiwanese mothers during the follow-up period (aOR = 1.51, 95% CI: 1.24-1.8). The subgroup analysis revealed a significant association between low-income households and an increased risk of overweight/obesity in children aged 2-7 years (P =.01). However, this association was not observed in children aged 0-1 years (P >.999).

CONCLUSIONS

During the follow-up period, there was a notable correlation between low-income households and an increased risk of preschool-aged children developing overweight or obesity. Implementing health promotion initiatives aimed at reducing overweight and obesity in this demographic is crucial.

Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.

Qualitative study of the association between psychosocial health and physical activity/sleep quality in toddlers

Physical activity and sleep are important factors of mental and physical health in children, with some reports indicating that their effects can persist into adulthood. However, there is limited research on the qualitative aspects of physical activity and sleep in preschool children, particularly in those aged < 3 years. Therefore, to elucidate the association between psychosocial health and physical activity/sleep in early childhood in terms of qualitative aspects, we conducted a retrospective cohort study in 2985 3-year-old children (37.2 ± 0.75 months) in Shanghai, China. An analysis using structural equation modeling indicated that current physical activity had a direct and moderate impact on current psychosocial health evaluated using the Strength and Difficulties Questionnaire. In particular, past physical activity had an indirect and mild effect on current psychosocial health via current physical activity in girls. However, regardless of sex, past sleep quality had slight impact on current psychosocial health, not only indirectly via current sleep quality, but also directly. These findings highlight the importance of considering the qualitative aspects of physical activity and sleep quality as significant factors influencing the current and future psychosocial health of children, even at a very early age (< 3 years).

Validation of the Entrainment Signal Regularity Index and associations with children's changes in BMI

OBJECTIVE

This study examined the validity of a novel metric of circadian health, the Entrainment Signal Regularity Index (ESRI), and its relationship to changes in BMI during the school year and summer.

METHODS

In a longitudinal observational data set, this study examined the relationship between ESRI score and children's (n = 119, 5- to 8-year-olds) sleep and physical activity levels during the school year and summer, differences in ESRI score during the school year and summer, and the association of ESRI score during the school year and summer with changes in BMI across those time periods.

RESULTS

The ESRI score was higher during the school year (0.70 ± 0.10) compared with summer (0.63 ± 0.11); t(111) = 5.484, p < 0.001. Whereas the ESRI score at the beginning of the school year did not significantly predict BMI change during the school year (β = 0.05 ± 0.09 SE, p = 0.57), having a higher ESRI score during summer predicted smaller increases in BMI during summer (β = -0.22 ± 0.10 SE, p = 0.03).

CONCLUSIONS

Overall, children demonstrated higher entrainment regularity during the school year compared with the summer. During summer, having a higher entrainment signal was associated with smaller changes in summertime BMI. This effect was independent of the effects of children's sleep midpoint, sleep regularity, and physical activity on children's BMI.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Childhood obesity prevention: what can be achieved?

PURPOSE OF REVIEW

Childhood obesity is a pandemic generating an enormous individual and socioeconomic burden worldwide. This narrative review summarizes recent evidence on successful and recommended prevention strategies according to age groups and different levels of interventions.

RECENT FINDINGS

Effective prevention of childhood obesity is feasible and most successful early in life up to preschool age, and it should include a multicomponent approach, integrating individuals, family and society. Trials that improve nutrition and/or enhance physical activity are the cornerstones of childhood obesity prevention on an individual level. However, their efficacy is determined by the combination of interventions for the target age group. Further, improving family support and sleep, as well as reducing screen time, lead to favourable results. Many research gaps remain, including a lack of effective interventions for high-risk groups.

SUMMARY

As a multifactorial condition, childhood obesity requires a multicomponent approach. Interventions should be developmental stage-specific and adjusted to the setting. Current research gaps need to be targeted by future trials, with a special focus on the benefit of the most vulnerable groups. From a systems response perspective, a paradigm shift from interventions focusing on the individual to approaches that target society as a whole is warranted.

Associations of diarised sleep onset time, period and duration with total and central adiposity in a biethnic sample of young children: the Born in Bradford observational cohort study

OBJECTIVES

To investigate associations of parent-reported sleep characteristics with adiposity levels in a biethnic sample of young children.

DESIGN

A cross-sectional observational study.

SETTING

The Born in Bradford 1000 study, UK.

PARTICIPANTS

Children aged approximately 18 months (n=209; 40.2% South Asian; 59.8% white) and 36 months (n=162; 40.7% South Asian; 59.3% white).

PRIMARY AND SECONDARY OUTCOME MEASURES

Children's body mass index (BMI) z-score, sum of two-skinfolds (triceps and subscapular) and waist circumference. Adjusted regression was used to quantify associations of sleep parameters with adiposity stratified by ethnicity and age group. The results are beta coefficients (95% CIs) and unless otherwise stated represent the difference in outcomes for every 1-hour difference in sleep parameters.

RESULTS

The average sleep onset time was markedly later in South Asian (21:26±68 min) than white children (19:41±48 min). Later sleep onset was associated with lower BMI z-score (-0.3 (-0.5 to -0.0)) and sum of two-skinfolds (-1.5 mm (-2.8 mm to -0.2 mm)) in white children aged 18 months and higher BMI z-score in South Asian children aged 36 months (0.3 (0.0-0.5)). Longer sleep duration on weekends than weekdays was associated with higher BMI z-score (0.4 (0.1-0.8)) and waist circumference (1.2 cm (0.3-2.2 cm)) in South Asian children aged 18 months, and later sleep onset on weekends than weekdays was associated with larger sum of two-skinfolds (1.7 mm (0.3-3.1 mm)) and waist circumference (1.8 cm (0.6-2.9 cm)). Going to sleep ≥20 min later on weekends than weekdays was associated with lower waist circumference in white children aged 18 months (-1.7 cm (-3.2 cm to -0.1 cm)).

CONCLUSIONS

Sleep timing is associated with total and central adiposity in young children but associations differ by age group and ethnicity. Sleep onset times and regular sleep schedules may be important for obesity prevention.