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

The Impact of the Double School Shift System on Lifestyle Behaviors Among Mexican Adolescents

PURPOSE

Early school start times could adversely impact adolescent sleep duration. They could also impact other behaviors like diet and physical activity, either directly or indirectly through effects on sleep. We examined whether the double school shift system was associated with sleep, diet, and physical activity behaviors among Mexican adolescents.

METHODS

The analytic sample included 305 Mexican adolescents from a cohort study (on average 14.53 ± 1.75 years old and 51% male). Sleep and physical activity were measured with wrist actigraphy, while diet and other lifestyle behaviors were assessed with questionnaires. Regression analyses were conducted to compare lifestyle behaviors between the morning and afternoon school shifts, adjusting for potential confounders.

RESULTS

Adolescents attending the morning school shift (44%) had pronounced differences in sleep compared to those attending afternoon shift, including a 1.77-hour shorter sleep duration on weekdays (95% CI -1.55, -2.00), a 0.40-hour longer sleep duration on weekends (95% CI 0.10, 0.70), higher social jetlag (1.07 hours with a 95% CI of 0.87, 1.27), and an earlier chronotype. Morning shift students also had 0.85 hours longer sedentary time (95% CI 0.61, 1.10) and higher consumption of a meat and starchy food dietary pattern. Among boys only, morning shift was associated with a lower likelihood of smoking and higher consumption of a breakfast pattern.

DISCUSSION

Overall, attending a morning school shift was associated with shorter sleep, more social jetlag, greater sedentary time, and higher consumption of a meat and starchy diet. However, among boys, a few healthier behaviors were observed for the morning versus afternoon shift.

Association between watching eating broadcast "Mukbang and Cookbang" and body mass index status in South Korean adolescents stratified by gender

BACKGROUND

It has been suggested that Mukbang and Cookbang, a type of eating broadcast originating from Korea and gaining popularity, may contribute to obesity. However, despite suggestions that Mukbang might contribute to obesity, studies investigating the impact of watching Mukbang on obesity is lacking. The goal of this study is to analyze the relationship between watching Mukbang and Cookbang and body mass index (BMI) status in Korean adolescents. All analyses were stratified by gender.

METHODS

This study utilized data from the 2022 Korea Youth Risk Behavior Web-based Surveys. The anonymous online survey was conducted with 56,213 students, and 51,850 students (92.2%) who participated in the survey were analyzed. Participants reported the frequency of watching Mukbang and Cookbang per week over the previous 12 months. BMI was categorized into four subgroups based on percentiles: underweight (< 5th percentile), normal (5th - 85th percentiles), overweight (85th - 95th percentiles), and obese (> 95th percentile). This study used multinomial logistic regression for analysis.

RESULTS

The likelihood of being obese was significantly higher in Mukbang-watching boys compared to those who never watched Mukbang and Cookbang (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.12-1.32). A dose-dependent association was found between the frequency of Mukbang and Cookbang watching and the likelihood of obesity among boys (p-for-trend < 0.0001). Subgroups that currently smoke, currently drink alcohol, frequently consume fast food, or drink sweetened beverages showed significantly higher odds of being obese in the "Ever" group than those in the "Never" group.

CONCLUSION

This study found a relationship between watching Mukbang and Cookbang and obesity in boys. Appropriate interventions should be considered for boys watching Mukbang and Cookbang.

Associations Among Sleep, Emotional Eating, and Body Dissatisfaction in Adolescents

The literature on adolescent sleep has shown a bidirectional relationship between sleep difficulties and altered eating habits, including emotional eating. However, it is unclear if this relationship is related to preexisting body concerns, or if poor sleep is the prime contributor to emotional eating patterns. This study therefore seeks to examine body dissatisfaction as a moderator of the sleep-emotional eating relationship in an at-risk sample. Adolescents (N = 106) presenting for overnight polysomnography self-reported on time-in-bed, insomnia, body dissatisfaction, and emotional eating. Less time-in-bed was correlated with a greater desire for thinness and greater insomnia severity was related to overall emotional eating and eating in response to anxiety, anger, and frustration and in response to depression. Moderation analyses revealed that the relationships between time-in-bed and eating in response to feeling unsettled (b =  -.002, 95% CI[- .003,  - .001], p < .005) and eating in response to anxiety, anger, and frustration (b =  -.01, 95% CI[- .01,  - .001], p < .05) were exacerbated by worse body dissatisfaction. Optimizing sleep may attenuate the risk for disordered eating, particularly for adolescents with high body dissatisfaction.

Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive sleep apnea

OBJECTIVE

To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.

METHODS

This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form).

RESULTS

A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes.

CONCLUSIONS

Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.

Sleep extension and cardiometabolic health: what it is, possible mechanisms and real-world applications

Short sleep duration is associated with heightened cardiometabolic disease risk and has reached epidemic proportions among children, adolescents and adults. Potential mechanisms underlying this association are complex and multifaceted, including disturbances in circadian timing, food intake and appetitive hormones, brain regions linked to control of hedonic eating, physical activity, an altered microbiome and impaired insulin sensitivity. Sleep extension, or increasing total sleep duration, is an emerging and ecologically relevant intervention with significant potential to advance our understanding of the mechanisms underlying the association between short sleep duration and the risk of cardiometabolic disease. If effective, sleep extension interventions have potential to improve cardiometabolic health across the lifespan. Existing data show that sleep extension is feasible and might have potential cardiometabolic health benefits, although there are limitations that the field must overcome. Notably, most existing studies are short term (2-8 weeks), use different sleep extension strategies, analyse a wide array of cardiometabolic health outcomes in different populations and, frequently, lack adequate statistical power, thus limiting robust scientific conclusions. Overcoming these limitations will require fully powered, randomized studies conducted in people with habitual short sleep duration and existing cardiometabolic risk factors. Additionally, randomized controlled trials comparing different sleep extension strategies are essential to determine the most effective interventions. Ongoing and future research should focus on elucidating the potential cardiometabolic health benefits of sleep extension. Such studies have high potential to generate crucial knowledge with potential to improve health and quality of life for those struggling with short sleep duration.

The impact of experimentally shortened sleep on timing of eating occasions in adolescents: A brief report

Short sleep increases the risk for obesity in adolescents. One potential mechanism relates to when eating occurs in the day. This study investigated the impact of shortened sleep on eating occasion timing in adolescents. Ninety-three healthy 14- to 17-year-olds (62% female) completed a within-subject experimental sleep manipulation, engaging in 5-night spans of Short Sleep (6.5-hr sleep opportunity) or Healthy Sleep (9.5-hr sleep opportunity), with order randomized. During each condition, adolescents completed three 24-hr diet recall interviews. Repeated-measure t-tests assessed the sleep manipulation effect on each adolescent's number of meals, first and last eating occasion (relative to the clock and time since sleep onset/offset), feeding window (timespan from first to last eating), and the midpoint of feeding. The timing of the first eating occasion was similar across conditions, relative to the clock (Short = 08:51, Healthy = 08:52) and to time since waking (Short = 2.0 hr, Healthy = 2.2 hr). The timing of the last eating occasion was later relative to the clock (Short = 20:34, Healthy = 19:39; p < 0.001), resulting in a longer feeding window (Short = 11.7 hr, Healthy = 10.8 hr, p < 0.001) and a later midpoint in the feeding window (Short = 14:41, Healthy = 14:18, p = 0.002). The gap between last eating occasion and sleep onset was larger in Short (4.2 hr) than Healthy Sleep (2.9 hr; p < 0.001), though the last eating occasion was much earlier than when they fell asleep during either condition. Shortened sleep resulted in adolescents eating later and lengthening the daily feeding window. These findings may help explain the link between shortened sleep and increased obesity risk in adolescents.

Multidimensional Sleep and Cardiometabolic Risk Factors for Type 2 Diabetes: Examining Self-Report and Objective Dimensions of Sleep

Purpose:

The purpose of the study was to determine the association between objective and self-report measures of sleep and cardiometabolic risk factors for type 2 diabetes.

Methods:

This study examines data on Australian adults, collected as part of the Child Health CheckPoint study. Sleep was examined in terms of actigraphy-derived sleep duration, timing, efficiency and variability; and self-report trouble sleeping. Cardiometabolic risk factors for type 2 diabetes were examined in terms of body mass index and biomarkers of inflammation and dyslipidemia. Generalized estimating equations, adjusted for geographic clustering, were used to determine the association between measures of sleep and cardiometabolic risk factors.

Results:

Complete case analysis was conducted for 1017 parents (87% mothers). Both objective and self-report measures of sleep were significantly but weakly associated with cardiometabolic risk factors.

Conclusion:

Both objective and self-report measures of sleep are significantly associated with cardiometabolic risk factors for type 2 diabetes. Self-report troubled sleep is associated with poorer cardiometabolic health, independent of actigraphy-derived sleep parameters.

Exploring the bidirectional relationships between night eating, loss of control eating, and sleep quality in Chinese adolescents: A four-wave cross-lagged study

OBJECTIVE

This study examined the bidirectional relationships between sleep quality, loss of control (LOC) eating, and night eating in Chinese adolescents using longitudinal data over an 18-month study period.

METHOD

Four-waves of data measurement (Waves 1-4), at 6-month intervals, were conducted with 2566 adolescents aged 11-17 years at baseline. A set of questionnaires were used to assess night eating, LOC eating, and sleep quality at each wave of data collection. Cross-lagged models were applied to analyze the bidirectional relationships between night eating, LOC eating, and sleep quality.

RESULTS

Results indicated that higher night eating scores consistently predicted poorer sleep quality and higher LOC eating scores at Waves 1, 2, and 3. Furthermore, poorer sleep quality predicted higher night eating scores at Wave 1 and Wave 3, and higher LOC eating scores predicted higher night eating scores at Wave 1 and Wave 2.

DISCUSSION

These findings highlight that night eating, LOC eating, and sleep quality were interrelated across time in Chinese adolescents. Improving sleep quality and reducing LOC eating might be promising in the prevention of night eating in adolescents. Similarly, reducing night eating might be promising in improving sleep quality and reducing LOC eating in adolescents.

PUBLIC SIGNIFICANCE

This study explored the bidirectional relationship between night eating, LOC eating, and sleep quality in Chinese adolescents using cross-lagged models. Findings indicate bidirectional relationships between these variables and highlight the potential utility in incorporating sleep, LOC eating, and night eating interventions in eating pathology prevention designs for adolescents.

The Continued Impact of the COVID-19 Pandemic on Pediatric Obesity: A Commentary on the Return to a Healthy New "Normal"

Two years into this pandemic, mental health symptoms are more prevalent in children and adolescents, routine wellness visits have decreased, individuals and families are experiencing increased stress, and food and nutrition insecurity are on the rise. Pediatric overweight and obesity are yet another health condition that has been impacted by the pandemic. The current commentary aims to (a) summarize a variety of factors contributing to worsening obesity and healthy lifestyle choices in youth throughout the pandemic and to (b) provide recommendations for healthcare providers on navigating this challenge. Specific health behaviors, such as increased sedentary behavior, decreased physical activity, a change to families' home-food environments, and an increase in sleep dysregulation have contributed to increased weight gain in children and adolescents. As uncertainty continues with the advent of various COVID-19 variants, it remains important to consider how the pandemic has impacted pediatric overweight and obesity.

Infant sleep patterns and maternal postpartum fatigue: A cross-sectional study

AIM

Unpredictable nature of infant sleep-wake cycles go against that of the adult sleep. Maternal sleep quality is acknowledged as a main factor to postpartum fatigue. This study explored the effects of infant sleep patterns on maternal postpartum fatigue.

METHODS

A total of 319 mothers of infants from two teaching hospitals in the Nantong City were enrolled. Maternal fatigue status and infant sleep patterns were assessed by the Fatigue Scale (FS-14) and the Brief Infant Sleep Questionnaire (BISQ). Generalized estimating equation analyses were perform to explored the effect of infant sleep patterns on maternal fatigue.

RESULTS

Sleep-onset time later than 10 p.m., and nocturnal wakefulness more than 60 min were risk factors of postpartum fatigue. After controlling the confounding variables, infant sleep patterns were still the determinant factors of postpartum fatigue.

CONCLUSION

Infant sleep pattern is a factor of maternal postpartum fatigue. It is recommended to promote infant sleep so as to improve maternal sleep quality and finally alleviate postpartum fatigue.

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.

Latent Class Analysis of Obesogenic Behaviors among Korean Adolescents: Associations with Weight-Related Outcomes

This study aimed to explore sex-specific latent class models of adolescent obesogenic behaviors (OBs), predictors of latent class membership (LCM), and associations between LCM and weight-related outcomes (i.e., weight status and unhealthy weight control behaviors). We analyzed nationally representative data from the 2019 Korea Youth Risk Behavior Survey. To identify latent classes for boys (n = 29,841) and girls (n = 27,462), we conducted a multiple-group latent class analysis using eight OBs (e.g., breakfast skipping, physical activity, and tobacco product use). Moreover, we performed a multinomial logistic regression analysis and a three-step method to examine associations of LCM with predictors and weight-related outcomes. Among both sexes, the 3-class models best fit the data: (a) mostly healthy behavior class, (b) poor dietary habits and high Internet use class, and (c) poor dietary habits and substance use class. School year, residential area, academic performance, and psychological status predicted the LCM for both sexes. In addition, perceived economic status predicted the LCM for girls. The distribution of weight-related outcomes differed across sex-specific classes. Our findings highlight the importance of developing obesity prevention and treatment interventions tailored to each homogeneous pattern of adolescent OBs, considering differences in their associations with predictors and weight-related outcomes.

Independent associations of sleep timing, duration and quality with adiposity and weight status in a national sample of adolescents: The UK Millennium Cohort Study

Short sleep appears to elevate obesity risk in youth; however, sleep is a multidimensional construct, and few studies have investigated parameters beyond duration. The objective of this study was to investigate if sleep onset time, duration, latency and night waking frequency are independently associated with adiposity and weight status in UK adolescents. This was a cross-sectional observational study of 10,619, 13-15 years olds. Adjusted linear and logistic regressions were used to investigate associations of self-reported sleep characteristics with adiposity markers (body mass index z-score and percent body fat) and weight status. Compared with a sleep onset before 10pm, later sleep timing was associated with higher adiposity and higher likelihood of overweight and obesity in boys (after midnight, odds ratio [95% confidence interval]: 1.76 [1.19-2.60]) and girls (between 11pm and 11:59pm: 1.36 [1.17-1.65]). Sleeping ≤ 8 hr, compared with > 9-10 hr, was associated with higher odds of overweight and obesity in both sexes (boys: 1.80 [1.38-2.35]; girls: 1.38 [1.06-1.79]), and so too was sleeping > 10 hr in girls (1.31 [1.06-1.62]), indicating evidence for a U-shaped association. Also in girls, compared to a sleep latency of 16-30 min, sleep latencies ≥ 46 min were associated with higher adiposity (46-60 min, beta coefficient [95% confidence interval], percent body fat: 1.47 [0.57-2.36]) and higher likelihood of overweight and obesity (46-60 min: 1.39 [1.05-1.83]), and often as opposed to never waking in the night was associated with higher adiposity (body mass index z-score: 0.24 [0.08-0.41]; percent body fat: 1.44 [0.44-2.44]). Sleep duration and timing in both sexes, and sleep quality in girls, appear to be independently associated with adiposity and weight status in adolescence, and may be important targets for obesity prevention.

How do associations between sleep duration and metabolic health differ with age in the UK general population?

BACKGROUND

Despite a growing body of evidence suggesting that short sleep duration may be linked to adverse metabolic outcomes, how these associations differ between age groups remains unclear. We use eight years of data from the UK National Diet and Nutritional Survey (NDNS) (2008-2016) to analyse cross-sectional relationships between sleep duration and metabolic risk in participants aged 11-70 years.

METHODS

Participants (n = 2008) who provided both metabolic risk and sleep duration data were included. Self-reported sleep duration was standardised by age, to account for differences in age-related sleep requirements. A standardised metabolic risk score was constructed, comprising: waist circumference, blood pressure, serum triglycerides, serum high-density lipoprotein cholesterol, and fasting plasma glucose. Regression models were constructed across four age groups from adolescents to older adults.

RESULTS

Overall, decreased sleep duration (hrs) was associated with an increased metabolic risk (standard deviations) with significant quadratic (B:0.028 [95%CI: 0.007, 0.050]) and linear (B:-0.061 [95%CI: -0.111, -0.011]) sleep duration coefficients. When separated by age group, stronger associations were seen among mid-aged adults (36-50y) (quadratic coefficient: 0.038 [95%CI: 0.002, 0.074]) compared to other age groups (e.g. adolescents (11-18y), quadratic coefficient: -0.009 [95%CI: -0.042, 0.025]). An increased difference between weekend and weekday sleep was only associated with increased metabolic risk in adults aged 51-70 years (B:0.18 [95%CI: 0.005, 0.348]).

CONCLUSIONS

Our results indicate that sleep duration is linked to adverse metabolic risk and suggest heterogeneity between age groups. Longitudinal studies with larger sample sizes are required to explore long-term effects of abnormal sleep and potential remedial benefits.

Associations between the Neighborhood Social Environment and Obesity Among Adolescents: Do Physical Activity, Screen Time, and Sleep Play a Role?

This study examines: (1) the association between the neighborhood social environment and obesity among adolescents, (2) whether physical activity, screen time, and short sleep mediates this association, and (3) examine sex differences. Participants (n=12,692; age 11-19 years old) came from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health. Neighborhood social disorganization and socioeconomic status (NSES) measures were associated with obesity adjusting for sex, race, age, parental education, and urbanicity. Screen time mediated NSES and obesity. Very short sleep duration (<6 hours) mediated social disorganization and obesity among females only. Findings suggest improving neighborhood social conditions may reduce the risk for obesity.

The challenges of adolescent sleep

Sleep is vital for our physical, emotional and cognitive health. However, adolescents face many challenges where their sleep is concerned. This is reflected in their sleep patterns including the timing of their sleep and how much sleep they achieve on a regular basis: their sleep is characteristically delayed and short. Notably, insufficient sleep is associated with impairments in adolescent functioning. Endogenous and exogenous factors are known to affect sleep at this age. Alterations in the bioregulation of sleep, comprising the circadian timing system and the sleep/wake homeostatic system, represent the intrinsic mechanisms at work. Compounding this, environmental, psychosocial and lifestyle factors may contribute to shortened sleep. This review discusses the amount of sleep gained by adolescents and its implications, the challenges to adolescent sleep and the interventions introduced in an effort to prioritize sleep health in this important developmental period.

The impact of short sleep on food reward processes in adolescents

Short sleep has been linked to adolescent risk of obesity, but questions remain regarding the dietary mechanisms by which this occurs. We tested whether mildly shortening sleep influences how rewarding and appealing healthy adolescents find several kinds of foods. Eighty-eight healthy adolescents completed a within-subjects crossover sleep experiment comparing 5 days of Short Sleep (6.5 hr sleep opportunity) with 5 days of Healthy Sleep (9.5 hr sleep opportunity). Following each condition, adolescents completed measures of food appeal and reinforcing value of food across five food types: sweets/desserts, fruits/vegetables, lean meats/eggs, fast food and processed snacks. Adolescents averaged 2.2 hr/night longer sleep periods in Healthy Sleep versus Short Sleep. We observed a significant interaction of experimental order with sleep condition on three of four primary outcomes related to the appeal and reinforcing value of foods (p's < .005). When Short Sleep preceded Healthy Sleep, adolescents endorsed significantly greater appeal (p < .04) and rewarding value of food (p's ranging from <.01 to .048) during Short Sleep (compared to Healthy Sleep). However, when Healthy Sleep preceded Short Sleep, we did not observe a main effect of sleep condition on the same outcomes (p's > .05). This study provides evidence that restricting adolescents' sleep opportunity to 6.5 hr (compared to sleeping a healthy amount) increases the appeal and reinforcing value of a variety of foods, but this may occur only under protracted short sleep. Increased food reward may be one mechanism linking chronically shortened sleep with risk of obesity in adolescence.