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Abdollahi AM, Li X, Merikanto I, Vepsäläinen H, Lehto R, Rahkola J, Nissinen K, Kanerva N, Roos E, Erkkola M. A tendency toward evening chronotype associates with less healthy diet among preschoolers: cross-sectional findings from the DAGIS study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae026. [PMID: 38737796 PMCID: PMC11085840 DOI: 10.1093/sleepadvances/zpae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 04/12/2024] [Indexed: 05/14/2024]
Abstract
Study Objectives Evidence suggests that adolescents and adults with a later chronotype have poorer sleep habits and are more susceptible to unhealthy behaviors, but little is known about these associations in younger children. The objective of the study was to (1) identify and compare individual chronotype tendencies among preschool-aged children and (2) investigate associations of sleep dimensions and chronotype with diet. Methods Participants were 636 3-6 years old (mean ± SD age: 4.74 ± 0.89 years, 49% girls) preschoolers from the cross-sectional Increased Health and Well-Being in Preschoolers (DAGIS) study in Finland. Sleep duration, sleep variability (in duration and midpoint), social jetlag, and midsleep on weekends adjusted for sleep debt (MSWEadj) were measured with 7-day actigraphy. Morning, intermediate, and evening chronotype tendencies were defined based on the lowest and highest 10th percentile cutoffs of MSWEadj. Food, energy, and macronutrient intake were assessed from 3-day records. Associations between sleep dimensions and diet were assessed with regression models. Results MSWEadj was 1:13 ± 14 minutes for morning (n = 64), 2:25 ± 28 minutes for intermediate (n = 560), and 3:38 ± 15 minutes for evening (n = 64) chronotype tendency. Children with an evening chronotype tendency had greater social jetlag and sleep variability. Having an evening chronotype tendency was associated with higher added sugar, higher sugary food consumption, and lower vegetable consumption compared to intermediate tendency types. A later chronotype (MSWEadj) was associated with higher sugary food consumption, as well as lower vegetable and fiber intake. Sleep duration, social jetlag, and sleep variability were not associated with diet. Conclusions Several less healthy sleep and diet behaviors were observed among children with later chronotypes. Future public health interventions aimed towards children would benefit from taking into account chronotype.
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Affiliation(s)
- Anna M Abdollahi
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong SAR, China
| | - Ilona Merikanto
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Orton Orthopaedics Hospital, Helsinki, Finland
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Reetta Lehto
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
| | - Jenna Rahkola
- Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
| | - Kaija Nissinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
- School of Food and Agriculture, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Noora Kanerva
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Eva Roos
- Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Psychiatr Clin North Am 2024; 47:179-197. [PMID: 38302206 DOI: 10.1016/j.psc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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Liang X, He X, Liu Q, Ren Y, Xu S, Chen L, Wang F, Bi Y, Peng Z. The impact of dietary and sleep rhythms on blood pressure in children and adolescents: a cross-sectional study. Hypertens Res 2024; 47:649-662. [PMID: 37919430 DOI: 10.1038/s41440-023-01493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023]
Abstract
Evidence about the relationship between meal and sleep time and CVD in children is scarce. The aims of this study were to describe the association between life rhythm patterns and blood pressure in children. This research was conducted among 5,608 children aged 6 to 15 years old in Chongqing and Sichuan provinces in 2021 and 2022. Dietary and sleep rhythms information was collected. The time of the first meal and last meal, and sleep time, were obtained. The mean age was 10.48 ± 2.24 years old, with 2958 (52.75%) male participants. The mean feeding window on weekdays was 11.69 h, 12.42 h, and 13.23 h for participants aged 6-7 years old, 8-12 years old and 13-15 years old, respectively. Weekday feeding window and last mealtime were positively correlated with blood pressure levels. And the changes in the feeding window between weekdays and weekends were significantly correlated with BP. Sleep duration and change in wake time were significantly correlated with SBP. Based on these results, this study identified the optimal combination of dietary and sleep rhythm interventions for children younger than 12 years of age and aged 12 and older, respectively. Disorder dietary and sleep rhythms disorders may correlate with elevated blood pressure levels, suggesting developing optimal dietary and sleep rhythm patterns could prevent the incidence of CVDs in children. The optimal dietary rhythm was defined by the indexes of breakfast time, dinner time and daily feeding window. As good meal patterns are defined as satisfied the following three items: for children younger than 12 years should have breakfast after 7:30 am; aged 12 years and over should have breakfast after 7 am; having dinner before 6 pm; daily feeding window less than 12.5 h. And less optimal dietary rhythm should satisfy any condition or eat dinner between 6 pm and 8 pm; and poor dietary rhythm should not satisfy any of the three criteria and eat dinner after 8 pm. Children with optimal dietary rhythm (in group A) had lower SBP (P < 0.001), DBP (P = 0.002) and MAP (P < 0.001) than those in group C.
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Affiliation(s)
- Xiaohua Liang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China.
| | - Xiangqian He
- College of Medical Informatics, Medical Data Science Academy, Chongqing Medical University, Chongqing, 400014, China
| | - Qin Liu
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China
| | - Yanling Ren
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China
| | - Sipei Xu
- The First Department of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Lan Chen
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China
| | - Fengming Wang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China
| | - Yang Bi
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400016, China
| | - Zhilian Peng
- Traditional Chinese Medicine Hospital of Jiulongpo District, Chongqing, China
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Gale EL, James Williams A, Cecil JE. The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review. Sleep Med Rev 2024; 73:101875. [PMID: 38029462 DOI: 10.1016/j.smrv.2023.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.
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Affiliation(s)
- Emma Louise Gale
- School of Medicine, Population and Behavioural Sciences, University of St Andrews, St Andrews, KY16 9TF, UK.
| | - Andrew James Williams
- School of Medicine, Population and Behavioural Sciences, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Joanne E Cecil
- School of Medicine, Population and Behavioural Sciences, University of St Andrews, St Andrews, KY16 9TF, UK
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Calcaterra V, Rossi V, Tagi VM, Baldassarre P, Grazi R, Taranto S, Zuccotti G. Food Intake and Sleep Disorders in Children and Adolescents with Obesity. Nutrients 2023; 15:4736. [PMID: 38004130 PMCID: PMC10675320 DOI: 10.3390/nu15224736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Over the last few decades, numerous scientific studies have investigated the possible association between sleep duration and adiposity during childhood, since it has been reported that sleep deprivation causes a related increase in caloric intake. Even though the underlying pathogenetic mechanisms are still under study and not completely known, the effect of dietetic habits and nutrient intake on sleep quality and patterns has been reported. The aim of this study is to explore the intricate interplay between food intake/diet patterns and pediatric sleep disturbances in children and adolescents with obesity, emphasizing the importance of not underestimating this aspect in the prevention and treatment of this complex disease. Recent evidence supports a high correlation between specific diet patterns and foods with sleep disturbances in children at all ages. Diets rich in fiber, fruit, vegetables, and anti-inflammatory nutrients and low in saturated fats seem to promote better sleep quality. Sleep disturbances are, in turn, risk factors for the development of obesity. Therefore, food strategies should be applied to counteract this harmful process. Unraveling the complex links between dietary habits, sleep patterns, and obesity is essential for developing effective strategies to combat this critical public health issue.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Virginia Rossi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Veronica Maria Tagi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Paola Baldassarre
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Roberta Grazi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Silvia Taranto
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (V.R.); (V.M.T.); (P.B.); (R.G.); (S.T.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
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Akhlaghi M, Kohanmoo A. Sleep deprivation in development of obesity, effects on appetite regulation, energy metabolism, and dietary choices. Nutr Res Rev 2023:1-21. [PMID: 37905402 DOI: 10.1017/s0954422423000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Sleep deprivation, which is a decrease in duration and quality of sleep, is a common problem in today's life. Epidemiological and interventional investigations have suggested a link between sleep deprivation and overweight/obesity. Sleep deprivation affects homeostatic and non-homoeostatic regulation of appetite, with the food reward system playing a dominant role. Factors such as sex and weight status affect this regulation; men and individuals with excess weight seem to be more sensitive to reward-driven and hedonistic regulation of food intake. Sleep deprivation may also affect weight through affecting physical activity and energy expenditure. In addition, sleep deprivation influences food selection and eating behaviours, which are mainly managed by the food reward system. Sleep-deprived individuals mostly crave for palatable energy-dense foods and have low desire for fruit and vegetables. Consumption of meals may not change but energy intake from snacks increases. The individuals have more desire for snacks with high sugar and saturated fat content. The relationship between sleep and the diet is mutual, implying that diet and eating behaviours also affect sleep duration and quality. Consuming healthy diets containing fruit and vegetables and food sources of protein and unsaturated fats and low quantities of saturated fat and sugar may be used as a diet strategy to improve sleep. Since the effects of sleep deficiency differ between animals and humans, only evidence from human subject studies has been included, controversies are discussed and the need for future investigations is highlighted.
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Affiliation(s)
- Masoumeh Akhlaghi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kohanmoo
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Arora N, Bhatta L, Skarpsno ES, Dalen H, Åsvold BO, Brumpton BM, Richmond RC, Strand LB. Investigating the causal interplay between sleep traits and risk of acute myocardial infarction: a Mendelian randomization study. BMC Med 2023; 21:385. [PMID: 37798698 PMCID: PMC10557341 DOI: 10.1186/s12916-023-03078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Few studies have investigated the joint effects of sleep traits on the risk of acute myocardial infarction (AMI). No previous study has used factorial Mendelian randomization (MR) which may reduce confounding, reverse causation, and measurement error. Thus, it is prudent to study joint effects using robust methods to propose sleep-targeted interventions which lower the risk of AMI. METHODS The causal interplay between combinations of two sleep traits (including insomnia symptoms, sleep duration, or chronotype) on the risk of AMI was investigated using factorial MR. Genetic risk scores for each sleep trait were dichotomized at their median in UK Biobank (UKBB) and the second survey of the Trøndelag Health Study (HUNT2). A combination of two sleep traits constituting 4 groups were analyzed to estimate the risk of AMI in each group using a 2×2 factorial MR design. RESULTS In UKBB, participants with high genetic risk for both insomnia symptoms and short sleep had the highest risk of AMI (hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.03, 1.18), although there was no evidence of interaction (relative excess risk due to interaction (RERI) 0.03; 95% CI -0.07, 0.12). These estimates were less precise in HUNT2 (HR 1.02; 95% CI 0.93, 1.13), possibly due to weak instruments and/or small sample size. Participants with high genetic risk for both a morning chronotype and insomnia symptoms (HR 1.09; 95% CI 1.03, 1.17) and a morning chronotype and short sleep (HR 1.11; 95% CI 1.04, 1.19) had the highest risk of AMI in UKBB, although there was no evidence of interaction (RERI 0.03; 95% CI -0.06, 0.12; and RERI 0.05; 95% CI -0.05, 0.14, respectively). Chronotype was not available in HUNT2. CONCLUSIONS This study reveals no interaction effects between sleep traits on the risk of AMI, but all combinations of sleep traits increased the risk of AMI except those with long sleep. This indicates that the main effects of sleep traits on AMI are likely to be independent of each other.
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Affiliation(s)
- Nikhil Arora
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Eivind Schjelderup Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Ben Michael Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Rebecca Claire Richmond
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Linn Beate Strand
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Claydon EA, Kahwash JM, Lilly CL, Alamir Y, Zullig KJ. Subjective Sleep Quality, Caffeine, and Dieting Behaviors Among University-Attending Young Adults. Nat Sci Sleep 2023; 15:737-747. [PMID: 37766873 PMCID: PMC10521926 DOI: 10.2147/nss.s420568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background Research has shown that university students engage in behaviors that are associated with poor sleep quality, such as higher caffeine and alcohol intake. Yet studies exploring eating habits and weight loss mechanisms related to sleep quality have generally been inconclusive. This study explored total daily caffeine consumption (along with different sources of caffeine) as well as dieting and exercising to lose weight in the last 30 days as risk factors for poor sleep quality among an undergraduate university population. Methods Full-time undergraduate students (n = 400) participated in an anonymous online survey about various health behaviors at a large, mid-Atlantic university. Multivariable linear regressions were run to consider subjective sleep quality in relation to caffeine consumption and dieting behavior along with other covariates. A sensitivity analysis was run to explore how different types of caffeinated beverages were associated with sleep quality as well. All analyses were conducted using SAS JMP Version 16. Results A stepwise multivariable linear regression controlling for alcohol use, grade point average, biological sex, and stress showed significant increases in sleep quality scores (indicating worsening sleep quality). Total caffeine consumption remained significant through the models until psychosocial factors were added (B = 0.003, p = 0.0035). The sensitivity analysis indicated that total caffeine consumption from soda remained significant across all models, significantly increasing sleep quality scores (B = 0.01; p = 0.0054). Discussion Higher amounts of caffeine from sodas were associated with more significant decreases in sleep quality than other types of caffeine, including energy drinks, coffee, and tea. Dieting or exercising to lose weight was not significantly associated with sleep quality. The results of this study can help to refine intervention efforts designed to improve sleep quality among undergraduate university students. Behavioral interventions specific to reducing caffeine intake, specifically from caffeinated sodas, may prove to be beneficial with this population.
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Affiliation(s)
- Elizabeth A Claydon
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Jenna M Kahwash
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Yahya Alamir
- Department of Health Education & Promotion, Faculty of Public Health & Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Keith J Zullig
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA
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Zapata-Lamana R, Ibarra-Mora J, Carrasco-Marín F, Durán-Agüero S, Cuevas-Aburto J, Parra-Rizo MA, Cigarroa I. Low Sleep Hygiene Is Associated with Less Adherence to the Mediterranean Diet in Chilean Schoolchildren from Rural Public Schools-A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1499. [PMID: 37761460 PMCID: PMC10529217 DOI: 10.3390/children10091499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
The Mediterranean diet stands as a widely acknowledged and health-promoting dietary pattern, renowned for its notable linkage to the mitigation of noncommunicable chronic maladies. Nonetheless, the existing body of evidence concerning the potential interrelation between sleep hygiene and this dietary regimen remains circumscribed. The main objective was to determine the association between sleep hygiene and adherence to the Mediterranean diet in Chilean schoolchildren from rural public schools in southern Chile. A non-experimental study was carried out, with an analytical, cross-sectional design. A total of 265 students (56.6% women, mean age 13.5 ± 1.8) from a rural community in southern Chile were recruited. Sleep habits were evaluated using Section 6 of the Life Habits and Adolescence Questionnaire, Sleep and Rest, and adherence to the Mediterranean diet was assessed with the KIDMED Mediterranean Diet Adherence Questionnaire. The main results indicated that 52.8% of schoolchildren need to improve adherence to the Mediterranean diet and 16.6% have a low-quality Mediterranean diet. A high percentage of schoolchildren have behaviors related to poor sleep hygiene (going to bed late (46%), waking up tired and wanting to continue sleeping (63.8%), and having problems falling asleep (42.6%)). Schoolchildren who got up after 8:30 a.m., those who fell asleep after midnight, upon conducting a comparative analysis of the students based on their sleep patterns, those who woke up tired and those who had trouble falling asleep had a lower level of adherence to the Mediterranean diet compared to schoolchildren who got up earlier than 8:30 a.m., fell asleep before midnight, did not wake up tired, and those who did not find it difficult to fall asleep, respectively. In conclusion, having poor sleep patterns including difficulties in both awakening and falling asleep are associated with less adherence to the Mediterranean diet in schoolchildren from rural public schools in southern Chile. Monitoring these variables and promoting healthy lifestyle habits within the educational community are essential measures.
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Affiliation(s)
| | - Jessica Ibarra-Mora
- Departamento de Educación Física, Deportes y Recreación, Universidad Metropolitana de Ciencias de la Educación, Santiago 8330106, Chile;
| | | | - Samuel Durán-Agüero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago 8330106, Chile;
| | | | - Maria Antonia Parra-Rizo
- Faculty of Health Sciences, Valencian International University (VIU), 46002 Valencia, Spain
- Department of Health Psychology, Faculty of Social and Health Sciences, Campus of Elche, Miguel Hernandez University (UMH), 03202 Elche, Spain
| | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles 4440000, Chile
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Gavela-Pérez T, Parra-Rodríguez A, Vales-Villamarín C, Pérez-Segura P, Mejorado-Molano FJ, Garcés C, Soriano-Guillén L. Relationship between eating habits, sleep patterns and physical activity and the degree of obesity in children and adolescents. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:10-17. [PMID: 37596175 DOI: 10.1016/j.endien.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/15/2022] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Childhood obesity is an extremely prevalent pathology and, in order to be able to address it, it is necessary to understand the factors that influence on its genesis and maintenance. We hypothesise that the timing of meals and sleep, the regularity of these throughout the week and a sedentary lifestyle influence the degree of obesity. MATERIAL AND METHODS We included children and adolescents with obesity who attended a first check-up visit at the Childhood Obesity Unit between January 2018 and February 2020. The data were obtained from a questionnaire on food (36-h intake, frequency of consumption, eating times and habits) and sleep. RESULTS The degree of obesity was influenced to a greater extent by later meal times and the distribution of calories throughout the day (less at breakfast, more at dinner) than by the total number of calories ingested. In addition, a lower consumption of vegetables was related to a higher degree of obesity. The difference between the hours of sleep at weekends and on weekdays correlated positively with a higher degree of obesity. Finally, the anthropometric data correlated negatively with the number of hours of physical activity. Almost half of the children did not exercise after school. CONCLUSION In the approach to childhood obesity, it is necessary to include recommendations on the regularity of meal and sleep times, as well as the distribution of calories throughout the day. Additionally, it is necessary to encourage the practice of physical exercise.
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Affiliation(s)
- Teresa Gavela-Pérez
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Parra-Rodríguez
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudia Vales-Villamarín
- Laboratorio de Lípidos, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Pilar Pérez-Segura
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Francisco Javier Mejorado-Molano
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Garcés
- Laboratorio de Lípidos, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Leandro Soriano-Guillén
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
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Grimaldi M, Bacaro V, Natale V, Tonetti L, Crocetti E. The Longitudinal Interplay between Sleep, Anthropometric Indices, Eating Behaviors, and Nutritional Aspects: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:3179. [PMID: 37513597 PMCID: PMC10385596 DOI: 10.3390/nu15143179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Sleep is fundamental for adolescents' healthy development but undergoes dramatic changes in quantity and quality due to the conflict between biological and social rhythms. Insufficient sleep has been associated with worse physical health status and irregular eating behaviors in adolescents. This review aims to systematically synthesize the longitudinal associations between adolescents' sleep dimensions (i.e., duration, timing, quality, and insomnia symptoms) and physical health indicators (i.e., anthropometric indices, fat percentage, and risk of obesity), eating behaviors, and nutritional aspects (i.e., type of diet related to the intake of specific foods and nutrients, amount and timing of food consumption, energy expenditure). A total of 28 longitudinal studies were included. The meta-analytic results showed that longer sleep duration, better sleep quality, and lower insomnia symptoms were associated with lower BMI and fat percentage and that shorter sleep duration (<7 h) and lower sleep quality were associated with a higher risk of obesity. Conversely, anthropometric indices were not related to sleep over time. Limited literature examined the bidirectional association between adolescents' sleep and their eating behaviors and nutritional aspects. Such knowledge sheds new light on the role of sleep for adolescents' health, highlighting the need to examine further the interplay between these variables.
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Affiliation(s)
- Martina Grimaldi
- Department of Psychology "Renzo Canestrari", University of Bologna, 40126 Bologna, Italy
| | - Valeria Bacaro
- Department of Psychology "Renzo Canestrari", University of Bologna, 40126 Bologna, Italy
| | - Vincenzo Natale
- Department of Psychology "Renzo Canestrari", University of Bologna, 40126 Bologna, Italy
| | - Lorenzo Tonetti
- Department of Psychology "Renzo Canestrari", University of Bologna, 40126 Bologna, Italy
| | - Elisabetta Crocetti
- Department of Psychology "Renzo Canestrari", University of Bologna, 40126 Bologna, Italy
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12
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Magri CJ, Xuereb S, Xuereb RA, Xuereb RG, Fava S, Galea J. Sleep measures and cardiovascular disease in type 2 diabetes mellitus. Clin Med (Lond) 2023; 23:380-386. [PMID: 38614653 PMCID: PMC10541029 DOI: 10.7861/clinmed.2022-0442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE The objective of this study was to assess whether poor sleep is independently associated with cardiovascular disease in people with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was performed in subjects with T2DM aged between 40 and 80 years. Sleep assessment was achieved by actigraphy and Pittsburgh Sleep Quality Index (PSQI) score. RESULTS The study population comprised 108 subjects with T2DM. The mean age was 64.9 years, the median diabetes duration was 6 years and 73.1% were men. No association was shown between sleep parameters as assessed by actigraphy and T2DM-associated micro- and macrovascular complications. However, sleep quality as assessed by PSQI was significantly associated with macrovascular disease in univariate analysis. Multivariate logistic regression analysis showed red blood cell distribution width (RDW) (odds ratio (OR) 1.79, p=0.018) and good sleep quality (OR 0.35, p=0.017) to be independently associated. Binary logistic regression analysis revealed that body mass index (BMI) (OR 1.11, p=0.024), RDW (OR 1.95, p=0.007) and Center for Epidemiologic Studies Depression score (OR 1.06, p=0.012] were independently associated with abnormal carotid intima-media thickness (CIMT). CONCLUSIONS Poor sleep quality and higher RDW levels are associated with macrovascular disease in a T2DM population. Increased BMI as well as depression also appear to have an independent role in subclinical atherosclerosis, as assessed by CIMT.
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Affiliation(s)
| | - Sara Xuereb
- Mater Dei Hospital, Malta; University of Malta, Malta
| | | | | | - Stephen Fava
- Mater Dei Hospital, Malta; University of Malta, Malta.
| | - Joseph Galea
- Mater Dei Hospital, Malta; University of Malta, Malta
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Mohd Saat NZ, Abd Talib R, Alarsan SF, Saadeh N, Shahrour G. Risk Factors of Overweight and Obesity Among School Children Aged 6 to 18 Years: A Scoping Review. NUTRITION AND DIETARY SUPPLEMENTS 2023; Volume 15:63-76. [DOI: 10.2147/nds.s420370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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14
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Felső R, Lányi É, Erhardt É, Laufer Z, Kardos D, Herczeg R, Gyenesei A, Hollódy K, Molnár D. Total sleep deprivation decreases saliva ghrelin levels in adolescents. J Sleep Res 2023; 32:e13746. [PMID: 36217837 DOI: 10.1111/jsr.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
Ghrelin, a regulator of food intake and energy expenditure, has been shown to be associated with insufficient sleep. The goal of the present study was to investigate the effect of a single night of total sleep deprivation on fasting saliva ghrelin and on nocturnal variation of saliva ghrelin concentration. A further aim of the study was to investigate the influence of body mass index on changes in saliva ghrelin levels. Altogether 35 adolescents (18 boys; age: 13.8 ± 1.14 years) were studied on two subsequent days (sleep and total sleep deprivation). Saliva samples were collected during the two experimental nights at 21:00 hours, 01:00 hours and 06:00 hours. Total-ghrelin concentration showed a continuous increase from the evening until 06:00 hours. This increase was blunted significantly (p = 0.003) by total sleep deprivation. Total-ghrelin level was significantly lower (p = 0.02) during total sleep deprivation at 06:00 hours (median 403.6 pg ml-1 ; 95% confidence interval: 343.1-468.9 pg ml-1 ) as compared with values during the sleep condition (median 471.2 pg ml-1 ; 95% confidence interval: 205.4-1578.7 pg ml-1 ). Acyl-ghrelin levels did not present any change at the three time points, and were not affected by total sleep deprivation. Stratifying the study population according to body mass index (normal weight and overweight/obese groups), the blunting effect of total sleep deprivation was more pronounced in the obese/overweight group (sleep: median 428.2 pg ml-1 ; 95% confidence interval: 331.3-606.9 pg ml-1 versus total sleep deprivation: median 333.1 pg ml-1 ; 95% confidence interval: 261.5-412.9 pg ml-1 ; p = 0.0479). Saliva total-ghrelin concentrations gradually increased during the night, and total sleep deprivation significantly blunted this increase. This blunting effect was mainly observed in subjects with overweight/obesity. The physiological and clinical implications of the present observation are to be clarified by further studies.
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Affiliation(s)
- Regina Felső
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary.,National Laboratory on Human Reproduction, University of Pécs, Pécs, Hungary
| | - Éva Lányi
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Éva Erhardt
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Zsófia Laufer
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Kardos
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Róbert Herczeg
- National Laboratory on Human Reproduction, University of Pécs, Pécs, Hungary.,National Laboratory for Human Reproduction, Genomics and Bioinformatics Core Facility Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Attila Gyenesei
- National Laboratory on Human Reproduction, University of Pécs, Pécs, Hungary.,National Laboratory for Human Reproduction, Genomics and Bioinformatics Core Facility Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Katalin Hollódy
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Dénes Molnár
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary.,National Laboratory on Human Reproduction, University of Pécs, Pécs, Hungary
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Morales-Ghinaglia N, Larsen M, He F, Calhoun SL, Vgontzas AN, Liao J, Liao D, Bixler EO, Fernandez-Mendoza J. Circadian Misalignment Impacts the Association of Visceral Adiposity With Elevated Blood Pressure in Adolescents. Hypertension 2023; 80:861-871. [PMID: 36876501 PMCID: PMC10023353 DOI: 10.1161/hypertensionaha.122.20398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/10/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents. METHODS We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break. RESULTS Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034). CONCLUSIONS A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.
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Affiliation(s)
- Natasha Morales-Ghinaglia
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Michael Larsen
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Fan He
- Department of Public Health Sciences, Penn State University, College of Medicine, Hershey PA 17033
| | - Susan L. Calhoun
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Alexandros N. Vgontzas
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Jason Liao
- Department of Public Health Sciences, Penn State University, College of Medicine, Hershey PA 17033
| | - Duanping Liao
- Department of Public Health Sciences, Penn State University, College of Medicine, Hershey PA 17033
| | - Edward O. Bixler
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
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16
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Nakanishi T, Yoshikawa T, Higuchi R, Kanehisa H, Suzuki S. Weekdays' sleeping condition and its influence on occurrence of general malaise in Japanese children aged 10 to 12 years. Sleep Biol Rhythms 2023; 21:193-199. [PMID: 38469280 PMCID: PMC10899972 DOI: 10.1007/s41105-022-00435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
The present study aimed to elucidate weekdays' sleeping condition and its influence on occurrence of general malaise in children. A total of 761 Japanese children aged 10 to 12 years were surveyed regarding their weekdays' waking time and bedtime and general malaise using a self-administered questionnaire. As the result of hierarchical cluster analysis on the sleep condition, the participants were classified into three clusters. Sleep duration was significantly longer in cluster 1 (9.35 ± 0.52 h) than in clusters 2 (7.83 ± 0.77 h) and 3 (9.02 ± 0.30 h) and significantly longer in cluster 3 than in cluster 2. Waking time was significantly later in cluster 3 (7:01 ± 0:12) than in clusters 1 (6:22 ± 0:31) and 2 (6:24 ± 0:33, p < 0.001). Bedtime was significantly later in cluster 2 (22:34 ± 0:47) than in clusters 3 (21:59 ± 0:19) and 1 (21:01 ± 0:22) and significantly later in cluster 3 than in cluster 1. There were significantly more subjects in cluster 2 than in clusters 1 and 3 who responded "nearly every day" or "occasionally" to the five of seven questionnaires related to general malaise. The current results indicate that in Japanese children aged 10 to 12 years, (1) sleeping condition of weekdays are classified into three clusters with different mean values for each of sleep duration, bedtime, and waking time, and (2) the occurrence of general malaise may be enhanced in individuals whose sleep duration is less than 8 h.
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Affiliation(s)
| | - Tatsuya Yoshikawa
- Graduate School of Health & Social Work, Kanagawa University of Human Services, Kanagawa, Japan
| | - Ryoko Higuchi
- Kanagawa University of Human Services, Kanagawa, Japan
| | - Hiroaki Kanehisa
- National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan
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17
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Moreno JP, Hannay KM, Goetz AR, Walch O, Cheng P. Validation of the Entrainment Signal Regularity Index and associations with children's changes in BMI. Obesity (Silver Spring) 2023; 31:642-651. [PMID: 36628610 PMCID: PMC9975028 DOI: 10.1002/oby.23641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Jennette P. Moreno
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kevin M. Hannay
- Department of Mathematics, University of Michigan, Ann Arbor, MI, USA
- Arcascope; Chantilly, VA, USA
| | - Amy R. Goetz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Olivia Walch
- Arcascope; Chantilly, VA, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health, Detroit, MI, USA
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Morales-Ghinaglia N, Fernandez-Mendoza J. Sleep variability and regularity as contributors to obesity and cardiometabolic health in adolescence. Obesity (Silver Spring) 2023; 31:597-614. [PMID: 36754840 PMCID: PMC9975080 DOI: 10.1002/oby.23667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Adolescence is a developmental stage of critical changes in sleep and its circadian timing when the contribution of abnormal sleep variability (amount) and sleep regularity (timing) to obesity and its associated adverse cardiometabolic health outcomes appears to increase. The aim of this study was to summarize findings from studies conducted in adolescents examining both sleep variability and regularity in relation to obesity and cardiometabolic health. Gaps in research and potential causal pathways that future studies should examine are highlighted. RESULTS Nightly deviations in sleep duration and sleep midpoint appear to contribute to the development of obesity and associated adverse cardiometabolic outcomes in youth. Studies show that increased sleep variability and irregularity are associated with obesity, decreased physical activity, dysregulated eating and inadequate diet, metabolic dysfunction, impaired cardiac autonomic balance, and elevated blood pressure in adolescents. CONCLUSIONS A stable circadian timing of sleep is essential to the overall physical well-being of youth. Emerging evidence supports that sleep variability and circadian misalignment, including sleep irregularity, contribute to adverse obesity-related health outcomes early on in adolescence. Future studies should focus on the underlying behavioral and biological mechanisms in the causal pathway between day-to-day deviations in the amount and timing of sleep and obesity.
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Affiliation(s)
- Natasha Morales-Ghinaglia
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey PA 17033
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Winpenny EM, Rowthorn H, Hollidge S, Westgate K, Goodyer IM, Brage S, van Sluijs EMF. Shorter sleep among adolescents is associated with lower fruit and vegetable consumption the following day. Int J Behav Nutr Phys Act 2023; 20:12. [PMID: 36750845 PMCID: PMC9906927 DOI: 10.1186/s12966-023-01420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Insufficient sleep has been associated with weight gain and metabolic dysregulation, with one suggested mechanism being through reduction in diet quality. Experimental evidence supports a causal effect of sleep timings on diet but this may not be applicable to a free-living adolescent population. In this analysis we use daily measures of sleep timings and diet quality, to examine the effect of sleep duration and timing on diet quality the following day among free-living adolescents. METHODS The ROOTS study is a prospective cohort recruited from secondary schools in Cambridgeshire and Suffolk (UK). Participants (n = 815) at mean age 15.0y (SD 0.3y) completed a diet diary and wore a combined heart rate and accelerometer device over 4 consecutive days. Sleep duration and timing (midpoint) were derived from acceleration and heart rate traces, while daily energy density and fruit and vegetable intake were calculated from dietary data. Analyses were performed at day-level (1815 person-days). Multilevel random effects models were used to test associations between sleep each night and subsequent day diet, with daily sleep and diet measures nested within individuals and schools, and adjusted for day-level and individual-level confounding variables. RESULTS Adolescents slept a mean of 7.88 hrs (SD 1.10) per night, reporting a mean energy density of 2.12 kcal/g (SD 0.48) and median energy-adjusted daily fruit and vegetable intake of 137.3 g (IQR 130.4). One hour shorter sleep duration was associated with lower intake of fruit and vegetables (-6.42 g, 95%CI -1.84, -10.99) the following day. An association with higher dietary energy density (0.016 kcal/g, 95%CI 0.034, -0.002) the following day was observed but did not reach statistical significance. Sleep timing was not associated with either fruit and vegetable intake (-2.52 g/d, 95%CI -7.66, 2.62) or dietary energy density (-0.001 kcal/g, 95%CI -0.022, 0.020). CONCLUSIONS Our observational findings from a free-living adolescent population support the experimental evidence for a causal role of sleep on diet, with shorter sleep duration at night leading to a small decrease in diet quality the following day. These findings support experimental evidence to suggest inclusion of sleep duration as one component of interventions designed to improve diet quality and weight status in adolescents.
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Affiliation(s)
- Eleanor M. Winpenny
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Harriet Rowthorn
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stefanie Hollidge
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kate Westgate
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ian M. Goodyer
- grid.5335.00000000121885934Developmental Psychiatry, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Soren Brage
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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The effect of modest changes in sleep on dietary intake and eating behavior in children: secondary outcomes of a randomized crossover trial. Am J Clin Nutr 2023; 117:317-325. [PMID: 36863827 DOI: 10.1016/j.ajcnut.2022.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/01/2022] [Accepted: 10/28/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Insufficient sleep duration increases obesity risk in children, but the mechanisms remain unclear. OBJECTIVES This study seeks to determine how changes in sleep influence energy intake and eating behavior. METHODS Sleep was experimentally manipulated in a randomized, crossover study in 105 children (8-12 y) who met current sleep guidelines (8-11 h/night). Participants went to bed 1 h earlier (sleep extension condition) and 1 h later (sleep restriction condition) than their usual bedtime for 7 consecutive nights, separated by a 1-wk washout. Sleep was measured via waist-worn actigraphy. Dietary intake (2 24-h recalls/wk), eating behaviors (Child Eating Behavior Questionnaire), and the desire to eat different foods (questionnaire) were measured during or at the end of both sleep conditions. The type of food was classified by the level of processing (NOVA) and as core or noncore (typically energy-dense foods) foods. Data were analyzed according to 'intention to treat' and 'per protocol,' an a priori difference in sleep duration between intervention conditions of ≥30 min. RESULTS The intention to treat analysis (n = 100) showed a mean difference (95% CI) in daily energy intake of 233 kJ (-42, 509), with significantly more energy from noncore foods (416 kJ; 6.5, 826) during sleep restriction. Differences were magnified in the per-protocol analysis, with differences in daily energy of 361 kJ (20, 702), noncore foods of 504 kJ (25, 984), and ultraprocessed foods of 523 kJ (93, 952). Differences in eating behaviors were also observed, with greater emotional overeating (0.12; 0.01, 0.24) and undereating (0.15; 0.03, 0.27), but not satiety responsiveness (-0.06; -0.17, 0.04) with sleep restriction. CONCLUSIONS Mild sleep deprivation may play a role in pediatric obesity by increasing caloric intake, particularly from noncore and ultraprocessed foods. Eating in response to emotions rather than perceived hunger may partly explain why children engage in unhealthy dietary behaviors when tired. This trial was registered at Australian New Zealand Clinical Trials Registry; ANZCTR as CTRN12618001671257.
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Lin X, Liu H. A study on the effects of health behavior and sports participation on female college students' body mass index and healthy promoting lifestyle. Front Public Health 2023; 10:1069219. [PMID: 36684986 PMCID: PMC9846220 DOI: 10.3389/fpubh.2022.1069219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
Objective Life form and body composition may affect the health of college students. This study will explore the relationship between the demographic variables of female college students and their body composition and health promoting lifestyle, so as to provide useful reference for the future design and planning of college students' physical and mental health courses and improving their physical activity level. Methods Using the method of questionnaire and bioelectrical resistance measurement, a questionnaire on healthy lifestyle of college students was constructed on the basis of consulting a large number of relevant research literature. Relevant survey samples were obtained through random sampling, and their body composition was measured; use SPSS21.0 statistical analysis software to conduct statistical analysis on relevant indicators. Results and conclusions (1) at present, female college students generally lack leisure activities and sleep, the proportion of regular fitness habits is low, and the number of snacks and average daily online time are generally too high; The overweight rate and body fat rate of female college students are generally too high, while the standard rate of muscle weight is generally too low. (2) Female college students' health promoting lifestyle has the highest score of self-realization, followed by interpersonal support and the worst behavior of sports participation; The older the college students, the worse their sports participation and overall health promotion behavior; The better the Conscious health status, the better the self-realization, exercise participation and nutritional behavior; The more exercise time per day, the higher their participation in sports and the stronger their health responsibility; The more time spent on the Internet every day, the worse the health responsibility and sports participation. (3) The more time female college students spend on the Internet every day, the higher the probability of overweight. Those with regular exercise habits have a lower proportion of overweight and high body fat rate, while the better their sleep and night snack behavior, the lower their body fat rate. The older college students are, the larger their visceral fat area is, the better their exercise habits and sleep behavior are, the smaller their visceral fat area is, and the lower their visceral fat level is.
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Affiliation(s)
- Xiangyun Lin
- Department of Physical Education, North Sichuan Medical College, Nanchong, China
| | - Hao Liu
- College of Physical Education, Southwest Medical University, Luzhou, China
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22
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Mata JDS, Freitas JV, Crispim SP, Interlenghi GS, Magno MB, Ferreira DMTP, Araujo MC. Technological tools for assessing children's food intake: a scoping review. J Nutr Sci 2023; 12:e43. [PMID: 37123397 PMCID: PMC10131056 DOI: 10.1017/jns.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/02/2023] Open
Abstract
Technological innovations can standardise and minimise reporting errors in dietary assessment. This scoping review aimed to summarise the characteristics of technological tools used to assess children's food intake. The review followed the Joanna Briggs Institute's manual. The main inclusion criterion was studied that assessed the dietary intake of children 0-9 years of age using technology. We also considered articles on validation and calibration of technologies. We retrieved 15 119 studies and 279 articles were read in full, after which we selected 93 works that met the eligibility criteria. Forty-six technologies were identified, 37 % of which had been developed in Europe and 32⋅6 % in North America; 65⋅2 % were self-administered; 27 % were used exclusively at home; 37 % involved web-based software and more than 80 % were in children over 6 years of age. 24HR was the most widely used traditional method in the technologies (56⋅5 %), and 47⋅8 % of the tools were validated. The review summarised helpful information for studies on using existing tools or that intend to develop or validate tools with various innovations. It focused on places with a shortage of such technologies.
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Affiliation(s)
- Jonas de Souza Mata
- Emília de Jesus Ferreiro School of Nutrition, Federal Fluminense University, Niterói, RJ, Brazil
| | - Jade Veloso Freitas
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, 7° andar, bloco E, sala 6004, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil
- Corresponding author: Jade Veloso Freitas, Email
| | | | | | - Marcela Baraúna Magno
- Associate Professor of Graduate Studies in Dentistry, Veiga de Almeida University, Rio de Janeiro, RJ, Brazil
| | | | - Marina Campos Araujo
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, RJ, Brazil
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23
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Nicholson L, Bohnert AM, Crowley SJ. A developmental perspective on sleep consistency: Preschool age through emerging adulthood. Behav Sleep Med 2023; 21:97-116. [PMID: 35014925 DOI: 10.1080/15402002.2021.2024192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE/BACKGROUND Beyond sleep duration, the regularity of sleep patterns (e.g., sleep consistency), including variability in sleep timing (e.g., bedtime, wake time) and duration, is a critical marker of sleep health. Sleep consistency is captured using a variety of methods within the literature (e.g., sleep intraindividual variability, social jetlag), but most of the research focuses on adolescents. METHODS Drawing on a developmental perspective, this narrative review highlights how normative changes at the individual (e.g., biological, cognitive, and social) and contextual (e.g., home, school, sociocultural) levels may contribute to inconsistent sleep patterns across development. RESULTS AND CONCLUSIONS This review emphasizes how inconsistent sleep may increase across pivotal transitions throughout development (e.g., elimination of naps, puberty, summertime, entering college). Finally, recommendations for measuring sleep consistency and areas to address in future research are discussed.
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Affiliation(s)
- Laura Nicholson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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24
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Hamermesh DS, Pfann GA. The variability and volatility of sleep: An ARCHetypal behavior. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101175. [PMID: 36054947 DOI: 10.1016/j.ehb.2022.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Using 1975-2005 Dutch time-diary data covering over 10,000 respondents for 7 consecutive days each, we show that sleep time exhibits non-constant variability, or volatility, characterized by stationary autoregressive conditional heteroscedasticity: The absolute values of deviations from a person's average sleep on one day are positively correlated with those on adjacent days. Sleep is more variable on weekends and among younger people, those without young children, or with less education. Volatility is greater among parents with young children, slightly greater among men, but independent of other demographics. Economic incentives to minimize the dispersion of sleep imply higher-wage workers will exhibit less dispersion, which we observe. Sleep volatility spills over onto volatility in other personal activities, with no reverse causation onto sleep. The results illustrate a novel dimension of inequality among people and could be applied to a wide variety of human behavior and biological processes.
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Affiliation(s)
- Daniel S Hamermesh
- University of Texas at Austin, Research Fellow, IZA, and Associate, NBER, United States; Sue Killam Professor Emeritus, University of Texas at Austin, United States; Royal Holloway University of London, United Kingdom.
| | - Gerard A Pfann
- Maastricht University, Research Fellow, IZA and CEPR, the Netherlands.
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25
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Zhang KP, Buxton M, Rodríguez-Carmona Y, Peterson KE, Liu Y, Burgess HJ, Cantoral A, Tellez-Rojo MM, Torres-Olascoaga LA, Arboleda-Merino L, Jansen EC. Duration, timing, and consistency of sleep in relation to inflammatory cytokines in Mexican adolescents. Sleep Med 2022; 100:103-111. [PMID: 36041378 PMCID: PMC9997045 DOI: 10.1016/j.sleep.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate whether sleep duration, timing, and variability were associated with inflammatory cytokines in a cohort of Mexico City adolescents. METHODS The analytic sample comprised >500 adolescents who were part of an ongoing longitudinal study in Mexico City. At two time points during mid-to-late puberty (average age 14, n = 391) and late-to-post puberty (average age 16, n = 345), adolescents completed a follow-up visit that included 7-day wrist actigraphy and clinical assessment of plasma inflammatory cytokines (high-sensitivity C-reactive protein, Interleukin 1β, Interleukin 6, and Tumor Necrosis Factor ɑ). Sleep characteristics included weekday and weekend sleep duration and midpoint (median of bed and wake time), as well as sleep variability (SD of sleep duration across 7 days) and social jetlag (midpoint difference from weekdays to weekends). At each time point, multivariable linear regression models were run with log inflammatory levels as the outcome and categories of sleep characteristics as predictors, while adjusting for potential confounders (specific to each model). Analyses were run unstratified and sex-stratified. RESULTS In the mid-to-late pubertal visit, weekday sleep duration was inversely associated with natural log hs-CRP after adjustment (Q4 vs Q1: β = -0.41, 95% Confidence Interval (CI) -0.81 to -0.01) and later sleep midpoint was positively associated with log hs-CRP (Q4 vs Q1: β = 0.55, 95% CI 0.13 to 0.97). Sleep duration variability was associated with higher IL-1β among boys, while in girls social jetlag was associated with higher IL-1β and weekend sleep duration was inversely associated with IL-6. At the late-to-post pubertal visit, there were few associations except for a positive association between weekday sleep duration and hs-CRP among boys (β = 0.60, 95% CI 0.04 to 1.16) and a non-linear positive association between social jetlag and hs-CRP among girls (β = 0.80, 95% CI 0.22 to 1.37 comparing 2 to 3 h of social jetlag vs <1 h). CONCLUSION Later timing, shorter duration, and inconsistency of sleep were related to higher levels of inflammatory biomarkers, but associations were more evident at the mid-to-late pubertal visit than the late-to-post pubertal visit.
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Affiliation(s)
- Kelvin Pengyuan Zhang
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Miatta Buxton
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Yanelli Rodríguez-Carmona
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Yun Liu
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Martha María Tellez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Libni A Torres-Olascoaga
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Laura Arboleda-Merino
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA; Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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26
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González-Treviño IM, Arrona-Palacios A, Núñez-Rocha GM, Jansen EC. Association between self-reported sleep duration and dietary quality in Mexican school-aged children. Appetite 2022; 178:106177. [PMID: 35853522 PMCID: PMC10103144 DOI: 10.1016/j.appet.2022.106177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
Short sleep duration has been associated with poor diet quality in school-aged children in multiple populations. However, investigations of sleep and dietary quality in Mexican school-aged children are scarce. The main objective of this work was to assess the association between sleep duration and dietary quality in Mexican school-aged children stratified by sex. The data were collected from 373 (138 girls and 235 boys) elementary school children aged 6-12 years in Monterrey, Nuevo Leon, Mexico. Surveys collected information on general demographic characteristics and self-reported sleep duration. Diet was assessed with 24-h recalls, and dietary quality was calculated by the Healthy Eating Index (HEI-2015). Results indicated that overall mean sleep duration was 8.23 ± 1.06 h. From the total sample, 6.7% slept ≤6 h (not recommended), 55.8% 7-8 h (may be appropriate), and 37.5% ≥ 9 h (recommended). Average total HEI-2015 score was 64.6 (out of possible 100), with boys having lower HEI-2015 scores than girls (57.7 vs 69.4). Moreover, girls and boys with shorter sleep duration (≤6 h compared to ≥ 9 h) had lower HEI-2015 scores (-1.03 [95% CI -2.74, -0.47; p < .01] and -1.78 [95% CI -3.15, -0.86; p < .001], respectively). Regarding the individual components of dietary quality, those with ≤6 h of sleep had lower scores particularly in vegetables, protein sources, added sugars and saturated fats for girls and boys compared to those with ≥9 h. These findings suggest sleep may be an important determinant of dietary practices within the Mexican children.
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Affiliation(s)
| | - Arturo Arrona-Palacios
- Writing Lab, Institute for the Future of Education, Tecnologico de Monterrey, Monterrey, NL, Mexico; Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Erica C Jansen
- Department of Nutritional Science, University of Michigan School of Public Health, Ann Arbor, MI, USA; Division of Sleep Medicine, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA.
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Shahdadian F, Boozari B, Saneei P. Association between short sleep duration and intake of sugar and sugar-sweetened beverages: A systematic review and meta-analysis of observational studies. Sleep Health 2022; 9:159-176. [PMID: 36424247 DOI: 10.1016/j.sleh.2022.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Findings of previous investigations that evaluated the relationship between sleep duration and sugar or sugar-sweetened beverages (SSBs) intake have been inconsistent. We aimed to summarize extant research that assessed the relation between short sleep duration and sugar and SSB intake. METHODS A comprehensive search of PubMed, ISI Web of Sciences, Scopus, Science Direct, Embase, and Google Scholar was conducted. All observational studies that reported sleep duration as the exposure and intake of sugar or sugary drinks as the outcome were included. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. The body of evidence was assessed using the GRADE approach. Random and fixed effects models were used to estimate pooled OR and 95% confidence intervals. RESULTS Twenty-two studies in children and twelve in adults were included in the systematic review. Only 10 studies in children and 3 investigations in adults provided odds ratios (95% confidence intervals) for this association and could be included in the meta-analysis. All studies had a cross-sectional design and found a negative association between sleep duration and sugar in children, but not in adults. SSB intake was lower in those with sufficient sleep in all populations. Compared with those with sufficient sleep, children with short sleep duration had 16% (significant) higher odds of consuming sugar (OR: 1.16; 95% CI: 1.10, 1.21), 21% higher odds of soda intake (OR: 1.21; 95% CI: 1.16, 1.26), and 92% higher odds of consuming energy drink intake (OR: 1.92; 95% CI: 1.66, 2.22). However, sleep duration was not significantly associated with soft drink intake in children (OR: 1.17; 95% CI: 0.93, 1.48). In adults, the odds of drinking soda in those with short sleep duration was 1.2 times more than in those with sufficient sleep (OR: 1.20; 95% CI: 1.12, 1.28). Also, low vs. optimal sleep duration in adults was associated with a 58% increased intake of energy drinks (OR: 1.58; 95% CI: 1.31, 1.90). Of note, these findings in the adult population resulted from only 2 included investigations, due to the limited number of studies. CONCLUSION The evidence reviewed supports a significant association between shorter sleep duration and higher SSBs intake in both children and adults, while such association with higher total sugar intake was significant in children but not in adults. Further research with more accurate measurements, sex-specific, and prospective designs should be carried out to clarify the causality and underlying mechanisms.
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Affiliation(s)
- Farnaz Shahdadian
- Students' Scientific Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Clinical Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behnoosh Boozari
- Students' Scientific Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Clinical Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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28
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Voltas N, Jardí C, Hernández-Martínez C, Arija V, Canals J. Association between free sugars intake and early psychopathological problems. J Child Health Care 2022:13674935221135106. [PMID: 36282888 DOI: 10.1177/13674935221135106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental health problems are highly prevalent in childhood and adolescence and may be associated with nutritional intake. It has recently been shown that a high percentage of infants and children consume large amounts of free sugars. In this paper, we analyse the relationship between free sugar consumption at 12 and 30 months and the risk of developing psychological problems at 30 months in a community sample of 86 children evaluated longitudinally. Socio-family and anthropometric data, and the amount of free sugars consumed were collected at both ages. At 30 months, the Child Behavior Checklist 1.5-5 was administered to parents and an interview was conducted to identify psychological disorders in accordance with DC: 0-3's classification. We report a relationship between high free sugar consumption at 30 months and the concurrent presence of sleeping problems, ADHD and anxiety symptoms. However, no significant association was observed between free sugar consumption at 12 months and the subsequent development of psychological problems. Early detection of emotional and behavioural manifestations and high sugar consumption in children may help to prevent the persistence of psychological problems.
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Affiliation(s)
- Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, 16777Universitat Rovira i Virgili, Tarragona, Spain
- Nutrition and Mental Health Research Group (NUTRISAM), 16777Universitat Rovira i Virgili, Tarragona, Spain
- Serra Húnter fellow; , Department of Psychology, 16777Universitat Rovira i Virgili, Tarragona, Spain
| | - Cristina Jardí
- Nutrition and Mental Health Research Group (NUTRISAM), 16777Universitat Rovira i Virgili, Tarragona, Spain
- Nutrition and Public Health Unit, 73047Universitat Rovira i Virgili, Reus, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, 16777Universitat Rovira i Virgili, Tarragona, Spain
- Nutrition and Mental Health Research Group (NUTRISAM), 16777Universitat Rovira i Virgili, Tarragona, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), 16777Universitat Rovira i Virgili, Tarragona, Spain
- Nutrition and Public Health Unit, 73047Universitat Rovira i Virgili, Reus, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, 16777Universitat Rovira i Virgili, Tarragona, Spain
- Nutrition and Mental Health Research Group (NUTRISAM), 16777Universitat Rovira i Virgili, Tarragona, Spain
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Jibril AT, Mirzababaei A, Shiraseb F, Barekzai AM, Jalilpiran Y, Mirzaei K. Association of healthy beverage index with circadian rhythm and quality of sleep among overweight and obese women: a cross-sectional study. Eat Weight Disord 2022; 27:2541-2550. [PMID: 35389150 DOI: 10.1007/s40519-022-01391-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Circadian rhythm is a behavioral, physiological, and molecular change with a cycle length of approximately 24 h. Changes to the circadian rhythm can result in sleep difficulty. The healthy beverage index (HBI) is a holistic concept for evaluating the quality of overall beverage intake and its association with health-related outcomes in nutritional epidemiological studies. This study aimed to assess the relationship of HBI with circadian rhythm and sleep quality among overweight/obese women. METHODS The current study was conducted among 208 overweight and obese women between 18-48 years in Tehran, Iran. We evaluated potential HBI with a valid food frequency questionnaire. Following standard procedures, trained personnel assessed anthropometric measures, blood samples, and other baseline characteristics. The Pittsburgh Sleep Quality Index and the morning-eveningness questionnaire were applied to evaluate sleep quality and circadian rhythm respectively. RESULTS The mean (SD) BMI for this study was 30.8 (4.2) kg/m2. We observed that subjects in the least tertile had significantly high levels of triglyceride (p = 0.04) and low-density lipoprotein (p = 0.009). High-density lipoprotein was significantly different across the tertiles (p = 0.003). After adjusting for potential covariates, subjects in the second tertile of HBI had 5.07 odds of having the worst quality of sleep as compared to those in the third tertile, p < 0.05. We also observed a significant inverse association between the HBI and the "moderately evening type" participants (OR 0.86; 95% CI 0.68-0.99; p: 0.02) after adjusting for potential confounders. CONCLUSION Healthy beverage consumption may have the potential of improving sleep quality among overweight and obese subjects. LEVEL OF EVIDENCE Level IV, evidence obtained from a descriptive study.
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Affiliation(s)
- Aliyu Tijani Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box: 14155-6117, Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box: 14155-6117, Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box: 14155-6117, Tehran, Iran
| | - Ahmad Mujtaba Barekzai
- Department of Community Nutrition, Ministry of Public Health, Ghazanfar Institute of Health Science, Kabul, Afghanistan
| | - Yahya Jalilpiran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box: 14155-6117, Tehran, Iran.
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30
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Relación de los hábitos alimentarios, los patrones de sueño y el grado de actividad física con el grado de obesidad en niños y adolescentes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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He J, Hong C, Zhang L, Li C, Wang Y, Fan Y, Guo P, Zhang B, Qi X, Chen S, Niu YJ, Liu F, Zhang R, Li Q, Ma S, Zhang M, Zhang M. Associations between night-time sleep duration and fasting glucose and ratio of triglyceride to high-density lipoprotein cholesterol among adults free of type 2 diabetes or without diagnosed type 2 diabetes: a multicentre, cross-sectional study in China. BMJ Open 2022; 12:e062239. [PMID: 35906046 PMCID: PMC9345048 DOI: 10.1136/bmjopen-2022-062239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We aimed to assess the associations between night-time sleep duration and fasting glucose (FG), triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and body mass index (BMI) among adults free of type 2 diabetes (T2D) or without diagnosed T2D. DESIGN Cross-sectional study. SETTING Medical examination centres at six hospitals in Beijing-Tianjin-Hebei region, China. PARTICIPANTS Participants were recruited via multistage, stratified cluster sampling. We included adults free of T2D or without diagnosed T2D who attended for physical examination and completed the validated questionnaire. 32 497 participants were included in the study, of whom 52.50% were men. PRIMARY AND SECONDARY OUTCOME MEASURES FG, TG, HDL-C, height and weight were measured. RESULTS Overall, 12.80% and 9.67% reported night sleep duration <7 hours and ≥9 hours, respectively; 6.91% had elevated FG and 3.57% had undiagnosed T2D. Sleep duration had an independent, U-shaped associated with FG (β1 (linear term)=-0.111, p=0.047; β2 (quadratic term)=0.008, p=0.026) with 6.9 hours of sleep associated with the lowest FG and a negative association with BMI (β=-0.154, p<0.001). BMI mediated a U-shaped association of sleep duration with TG/HDL-C (β1=-0.040, p=0.017; β2=0.003, p=0.023). CONCLUSIONS Both short and long night-time sleep was associated with elevated FG, and short sleep duration was associated with increased BMI. BMI mediated a U-shaped association between sleep duration and TG/HDL-C.
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Affiliation(s)
- Jiangshan He
- School of Medicine, Nankai University, Tianjin, China
| | - Chenglin Hong
- Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Li Zhang
- Tianjin First Central Hospital, Tianjin, China
| | - Chunjun Li
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Yuxue Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Yaqi Fan
- School of Medicine, Nankai University, Tianjin, China
| | - Pei Guo
- School of Medicine, Nankai University, Tianjin, China
| | - Binbin Zhang
- School of Medicine, Nankai University, Tianjin, China
| | - Xin Qi
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China
| | - Yu-Jie Niu
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Feng Liu
- Beijing Physical Examination Center, Beijing, China
| | - Rong Zhang
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Qiang Li
- Beijing Physical Examination Center, Beijing, China
| | - Shitao Ma
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Mianzhi Zhang
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Minying Zhang
- School of Medicine, Nankai University, Tianjin, China
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Magriplis E, Kanellopoulou A, Notara V, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Lagiou A, Zampelas A, Panagiotakos DB. The Association of Sugar-Sweetened Beverages to Children's Weights Status Is Moderated by Frequency of Adding Sugars and Sleep Hours. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071088. [PMID: 35884072 PMCID: PMC9317324 DOI: 10.3390/children9071088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
Adding extra sugars in milk and the moderating effect of sleep has yet to be investigated, setting the aim of this study. A total of 1361 school-aged children were included, aged 10−12 years old, by randomly sampling schools. Data were interview-obtained by trained personnel using a validated 17-item food frequency questionnaire, with specifics on type of milk and extra sugar additions. Analyses were stratified by average recommended hours of sleep. Predictive probability margins were obtained following necessary adjustments. Mean BMI was significantly lower, the level of SSB intake was higher, and the prevalence of adding sugars to milk four or more times per week was higher in children that slept ≥10 h. Most children (64%) consumed full fat milk, 21% had low fat, and 19.7% chocolate milk, with a significantly larger proportion of overweight or obese children consuming full fat or chocolate milk, also adding extra sugars four or more times per week (4.1% compared to 9.6%, and 12.2% compared to 39.5%, respectively). The predictive probability of being overweight or obese exponentially increased for children consuming >0.5 SSB/day while also adding sugars to their milk frequently, although this effect remained significant only for children sleeping <10 h/day. In conclusion, to accurately address the effect of SSBs on children’s body weight, frequency of any type of sugar addition in milk should be accounted for, as well as average sleep hours that may further moderate the effect.
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Affiliation(s)
- Emmanuella Magriplis
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece;
- Correspondence:
| | - Aikaterini Kanellopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (A.K.); (G.A.); (D.B.P.)
| | - Venetia Notara
- Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, 12243 Athens, Greece; (V.N.); (A.L.)
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (A.K.); (G.A.); (D.B.P.)
| | - Andrea Paola Rojas-Gil
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, 22100 Tripoli, Greece;
| | - Ekaterina N Kornilaki
- Department of Preschool Education, School of Education, University of Crete, 74100 Rethimno, Greece;
| | - Areti Lagiou
- Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, 12243 Athens, Greece; (V.N.); (A.L.)
| | - Antonis Zampelas
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece;
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (A.K.); (G.A.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
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Goetz AR, Jindal I, Moreno JP, Puyau MR, Adolph AL, Musaad S, Butte NF, Bacha F. The Role of Sleep and Eating Patterns in Adiposity Gain among Preschool-Aged Children. Am J Clin Nutr 2022; 116:1334-1342. [PMID: 35833269 PMCID: PMC9630867 DOI: 10.1093/ajcn/nqac197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/05/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Short sleep duration is related to risk for obesity in preschool children. However, the underlying mechanism(s) are not clear. OBJECTIVE We evaluated the relationship between sleep characteristics with body composition, energetics and weight-regulating behaviors in preschool-aged children; and the longitudinal associations between children's sleep and eating patterns with body composition at 1-year follow-up. METHODS Data were drawn from a longitudinal study of 118 children aged 3-5 years. Sleep (duration, midpoint, regularity) and physical activity (PA) were measured by accelerometry over 6 consecutive days; total energy expenditure (TEE) using the doubly-labeled water method; body composition (fat mass, fat-free mass, and %body fat) by dual energy x-ray absorptiometry; and dietary intake (energy intake, timing) using two 24-h recalls. Multivariable regression was used to estimate interindividual associations of sleep parameters with body composition, PA, TEE and dietary outcomes; and to examine the relationship between sleep and dietary behaviors with body composition one year later. RESULTS Cross-sectionally, later sleep midpoint was associated with greater fat mass (0.33; 95% CI: 0.05, 0.60) and %body fat (0.92; 95% CI: 0.15, 1.70). Later sleep midpoint was associated with delayed morning (0.51; 95% CI: 0.28, 0.74) and evening meal times (0.41; 95% CI: 0.29, 0.53), higher nighttime (45.6; 95% CI: 19.7, 71.4), and lower morning (-44.8; 95% CI: -72.0, -17.6) energy intake. Longitudinally, shorter sleep duration (-0.02; 95% CI: -0.03, -0.00) and later meal timing (0.83; 95% CI: 0.24, 1.42) were associated with higher %body fat 1 year later. CONCLUSIONS Shorter sleep duration and later meal timing are associated with adiposity gain in preschoolers.
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Affiliation(s)
- Amy R Goetz
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ishita Jindal
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA,Division of Pediatric Endocrinology and Diabetes, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jennette P Moreno
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Maurice R Puyau
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Anne L Adolph
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Salma Musaad
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Nancy F Butte
- Department of Pediatrics, USDA and Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Fida Bacha
- Address correspondence to Fida Bacha (e-mail: )
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Hart CN, Spaeth AM, Egleston BL, Carskadon MA, Raynor HA, Jelalian E, Owens JA, Considine RV, Wing RR. Effect of changes in children's bedtime and sleep period on targeted eating behaviors and timing of caloric intake. Eat Behav 2022; 45:101629. [PMID: 35390756 PMCID: PMC9730292 DOI: 10.1016/j.eatbeh.2022.101629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Abstract
Short sleep is associated with obesity risk. Experimental studies with adults and observational studies with children demonstrate that changes in eating, including increased caloric intake from energy-dense foods and sugar-sweetened beverages as well as increased caloric intake in the evening, may partially account for this increased risk. We therefore examined whether experimental changes in children's sleep period lead to changes in reported caloric intake from energy-dense snack foods and sugar-sweetened beverages, and in the evening. Thirty-seven children, 8-11 years old, completed a three-week study that used a within-subject randomized cross-over design. Children slept their typical amount for one week and were subsequently randomized to either increase or decrease their typical amount by 1.5 h/night for one week; the alternate schedule was completed during the third week of the study, creating a 3-h time in bed difference between the increase and decrease conditions. Sleep was monitored with actigraphy, and dietary intake was assessed with 24-hour dietary recalls. Participants reported consuming 35 kcal per day more from sugar-sweetened beverages during the decrease sleep than the increase sleep condition, p = .033. There were no reported differences between conditions from energy-dense snack foods. Although no differences in reported intake were observed earlier in the day, from 2000 h (8:00 PM) and later, children reported consuming 132 kcal more during the decrease sleep condition than the increase condition, p < 0.001. Shortened sleep achieved by delaying bedtimes led to increased caloric intake in the evening and from sugar-sweetened beverages. Clinical Trials Registration: clinicaltrials.gov Identifier: NCT01030107.
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Affiliation(s)
- Chantelle N. Hart
- Center for Obesity Research and Education and Department of Social and Behavioral Sciences, College of Public Health, Temple University
| | | | | | - Mary A. Carskadon
- E.P. Bradley Hospital Sleep Research Laboratory;,Psychiatry & Human Behavior, Alpert Medical School of Brown University
| | | | - Elissa Jelalian
- Psychiatry & Human Behavior, Alpert Medical School of Brown University;,Weight Control & Diabetes Research Center, The Miriam Hospital
| | - Judith A. Owens
- Department of Neurology at Boston Children’s Hospital and Harvard Medical School
| | | | - Rena R. Wing
- Psychiatry & Human Behavior, Alpert Medical School of Brown University;,Weight Control & Diabetes Research Center, The Miriam Hospital
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Moreno JP, Dadabhoy H, Musaad S, Baranowski T, Thompson D, Alfano CA, Crowley SJ. Evaluation of Circadian Rhythm and Sleep Focused mHealth Intervention for the Prevention of Accelerated Summer Weight Gain among Elementary School-Age Children: Protocol for a Randomized Controlled Feasibility Study (Preprint). JMIR Res Protoc 2022; 11:e37002. [PMID: 35576573 PMCID: PMC9152728 DOI: 10.2196/37002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The i♥rhythm project is a mobile health adaptation of interpersonal and social rhythm therapy designed to promote healthy sleep and behavioral rhythms among 5-8-year olds during summer for the prevention of accelerated summer weight gain. Objective This pilot study will examine the feasibility, acceptability, and preliminary efficacy of the i♥rhythm intervention. This will ensure that the research protocol and procedures work as desired and are acceptable to families in preparation for the fully powered randomized controlled trial. The proposed study will examine the willingness of participants to participate in the intervention and determine whether modifications to the intervention, procedures, and measures are needed before conducting a fully powered study. We will assess our ability to (1) recruit, consent, and retain participants; (2) deliver the intervention; (3) implement the study and assessment procedures; (4) assess the reliability of the proposed measures; and (5) assess the acceptability of the intervention and assessment protocol. Methods This study will employ a single-blinded 2-group randomized control design (treatment and no-treatment control) with randomization occurring after baseline (Time 0) and 3 additional evaluation periods (postintervention [Time 1], and 9 months [Time 2] and 12 months after intervention [Time 3]). A sample of 40 parent-child dyads will be recruited. Results This study was approved by the institutional review board of Baylor College of Medicine (H-47369). Recruitment began in March 2021. As of March 2022, data collection and recruitment are ongoing. Conclusions This study will address the role of sleep and circadian rhythms in the prevention of accelerated summer weight gain and assess the intervention’s effects on the long-term prevention of child obesity. Trial Registration ClinicalTrials.gov NCT04445740; https://clinicaltrials.gov/ct2/show/NCT04445740. International Registered Report Identifier (IRRID) DERR1-10.2196/37002
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Affiliation(s)
- Jennette P Moreno
- Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Hafza Dadabhoy
- Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Salma Musaad
- Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Candice A Alfano
- Sleep and Anxiety Center of Houston, Department of Psychology, University of Houston, Houston, TX, United States
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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36
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Shih YH, Wu HC, Pan WH, Chang HY. The Association Between Frequent Sugar-Sweetened Beverage Intake and Sleep Duration in School Children: A Cross-Sectional Study. Front Nutr 2022; 9:847704. [PMID: 35369050 PMCID: PMC8965345 DOI: 10.3389/fnut.2022.847704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Higher consumption of sugar-sweetened beverages (SSBs) maybe association with children's sleep pattern. However, few studies have considered this association in Asia, especially in school children. This study investigated the relationship between children's consumption frequency of such beverages and their sleep duration. Methods Participants aged 6–12 years were analyzed from two survey data in 2012 and 2013–2016 Nutrition and Health Surveys in Taiwan. A total of 2,628 participants were included in the analysis (2012, N = 1,267; 2013–2016, N = 1,361). Beverages weekly consumption were divided into low and high intake groups by medians cut-off points. The sleep variables were the sleep duration at night (including school days and weekends) and sleep debt. After controlling the confounders, the correlation between sugar-sweetened beverage consumption and sleep duration was examined using multinomial logistic regression analysis. Results The students slept for an average of 8.8 h on school days and 9.7 h on weekends. Relative to the low SSB intake group, the high intake group exhibited shorter sleep durations on school days (P < 0.001), greater sleep debt (P = 0.049). In logistic regression, high intake group were more likely to sleep for <8.5 h on school days (OR = 1.67, P = 0.002) and exhibit >2 h of sleep debt than low intake group (OR = 1.41, P = 0.022). Conclusions Children who had consumed sugar-sweetened beverages frequently slept for shorter durations at night on school days and exhibited greater sleep debt. The causal relationship was not clear. Nonetheless, these two factors are important in promoting children health.
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Affiliation(s)
- Ya-Hui Shih
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsin-Chuan Wu
- Department of Food Nutrition, College of Human Science and Technology, Chung Hwa University of Medical Technology, Tainan City, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Hsing-Yi Chang
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37
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Egan KA, Waring ME, Wang ML. Pilot Intervention Targeting Sugary Drink Intake Associated With Improvements in Adolescent Sleep Duration. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:276-281. [PMID: 34920968 DOI: 10.1016/j.jneb.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To examine temporal associations between participation in a community-based intervention targeting sugary drink intake and sleep outcomes among children. METHODS Data are from an ethnically diverse sample of 100 children aged 9-12 years from 2 Massachusetts Boys and Girls Club (BGC) sites who participated in a pilot-site randomized trial (usual BGC programming plus H2GO! intervention vs usual BGC programming). Secondary outcomes of the trial (sleep duration and adequate sleep duration [≥ 9 h/night] were assessed via a self-report survey at baseline, 2 months, and 6 months. Generalized linear and logistic regression models estimated intervention effects associated with outcomes. RESULTS The intervention was associated with increased sleep duration (β = 0.74; 95% confidence interval, 0.03-1.45) and higher odds of adequate sleep (odds ratio, 2.47; 95% confidence interval, 1.06-5.74) at 2 months. Sleep did not differ by treatment condition at 6 months. CONCLUSIONS AND IMPLICATIONS This community-based sugary drink intake intervention may be a potential avenue to improve child sleep outcomes in the short term.
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Affiliation(s)
- Kelsey A Egan
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA; Office of Narrative, Boston University Center for Antiracist Research, Boston, MA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
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38
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Child maltreatment severity and sleep variability predict mother–infant RSA coregulation. Dev Psychopathol 2021; 33:1747-1758. [DOI: 10.1017/s0954579421000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractRegulatory processes underlie mother-infant interactions and may be disrupted in adverse caregiving environments. Child maltreatment and sleep variability may reflect high-risk caregiving, but it is unknown whether they confer vulnerability for poorer mother–infant parasympathetic coordination. The aim of this study was to examine mother–infant coregulation of respiratory sinus arrhythmia (RSA) in relation to child maltreatment severity and night-to-night sleep variability in 47 low-income mother–infant dyads. Maternal and infant sleep was assessed with actigraphy and daily diaries for 7 nights followed by a mother–infant still-face procedure during which RSA was measured. Higher maltreatment severity was associated with weakened concordance in RSA coregulation related to the coupling of higher mother RSA with lower infant RSA, suggesting greater infant distress and lower maternal support. In addition, higher infant sleep variability was associated with infants’ lower mean RSA and concordance in lagged RSA coregulation such that lower maternal RSA predicted lower infant RSA across the still-face procedure, suggesting interrelated distress. The findings indicate that adverse caregiving environments differentially impact regulatory patterns in mother–infant dyads, which may inform modifiable health-risk behaviors as targets for future intervention.
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Xi Y, Lin Q, Yang Q, Li F, Liu H, Luo J, Ouyang Y, Sun M, Yong C, Xiang C, Zheng W. Association between Free Sugars Intake and Excessive Daytime Sleepiness among Chinese Adolescents. Nutrients 2021; 13:nu13113959. [PMID: 34836214 PMCID: PMC8618473 DOI: 10.3390/nu13113959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022] Open
Abstract
This study aimed to investigate the prevalence of excessive daytime sleepiness (EDS) and explore the association between free sugars intake and EDS. In this cross-sectional study, a total of 1517 middle school students (808 boys and 707 girls) aged 12~14 years were recruited. The study was conducted in Changsha city, China. Adolescents completed an online questionnaire, including the Epworth Sleepiness Scale (ESS), sleep characteristics, a 12-item Food Frequency Questionnaire (FFQ), and other self-reported information. The ESS score ≥ ten was defined as EDS. The anthropometric indices, including height, weight, and waist circumference, were measured and recorded by uniformly trained assistants. Statistical analyses included the Chi-square test and binary logistic regression model. The mean ESS score and free sugars consumption were 6.8 ± 3.9 points and 53.1 ± 44.7 g/d, respectively. The prevalence of EDS among adolescents was 22.5%, and more girls than boys had EDS (26.1% vs. 19.4%, p < 0.05). An exceeded free sugars intake was positively associated with EDS, with the adjusted Odds Ratio (OR) with its 95% Confident Interval (95% CI) of 1.366 (1.060~1.761, p < 0.05). EDS and excessive consumption of free sugars are commonly found among Chinese adolescents. Further studies are needed to confirm whether free sugars restriction can be meaningful to improve daytime drowsiness in those with EDS.
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Affiliation(s)
- Yue Xi
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Qiping Yang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China;
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - Hanmei Liu
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Jing Luo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Yufeng Ouyang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Minghui Sun
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
| | - Wenya Zheng
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (Y.X.); (Q.L.); (Q.Y.); (H.L.); (J.L.); (Y.O.); (M.S.); (C.Y.); (C.X.)
- Correspondence: ; Tel.: +86-199-7985-1193
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Covington LB, Trude AC, Armstrong B, Black MM. Regular Bedtime: Implications for Obesity Prevention During the Pandemic and Beyond. Child Obes 2021; 17:493-495. [PMID: 34061677 PMCID: PMC8568776 DOI: 10.1089/chi.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lauren B. Covington
- School of Nursing, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Address correspondence to: Lauren B. Covington, PhD, RN, School of Nursing, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, 5th Floor, Newark, DE 19713, USA.
| | - Angela C.B. Trude
- Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA.,RTI International, Research Triangle Park, North Carolina, USA
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de Souza AA, Mota JAPS, da Silva GMG, Tassitano RM, Clark CCT, Duncan MJ, Martins CMDL. Associations between Movement Behaviours and Obesity Markers among Preschoolers Compliant and Non-Compliant with Sleep Duration: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9492. [PMID: 34574417 PMCID: PMC8472778 DOI: 10.3390/ijerph18189492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/20/2022]
Abstract
This study identifies physical activity (PA) and sedentary behaviour (SB) clusters in preschoolers compliant (C) or non-compliant (NC) with sleep recommendations; and associates these clusters with obesity markers. PA and SB were objectively assessed (Actigraph WGT3-X) in 272 preschoolers (4.4 ± 0.7 years old). Sleep duration was parent-reported, and preschoolers were classified as C (3-4 years old: 600-780 min/day; 5 years old: 540-660 min/day) or NC with sleep recommendations. Body mass index (BMI) and waist circumference (WC) were assessed according to international protocols. Moderate to vigorous physical activity (MVPA) and light physical activity (LPA) were categorized as low/high (<60 min/>60 min/day or <180 min/180 min/day, respectively). SB was defined according to mean values between clusters. Latent profile analysis was performed. Associations between the observed clusters and obesity markers were determined using linear regression (RStudio; 1.3.1073). Four cluster solutions for C and NC preschoolers were identified. A negative association between C/Low MVPA cluster and BMI, and a positive association between NC/Low MVPA and BMI (β = -0.8, 95%CI = -1.6;-0.1, and β = 0.9, 95%CI = 0.1;1.7, respectively) were observed. No association was seen for SB clusters. Adequate sleep duration may have a protective role for preschoolers' BMI, even if the children do not comply with MVPA recommendations.
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Affiliation(s)
- Alesandra A. de Souza
- Department of Physical Education, Federal University of Tocantins, Tocantinopolis 77900-000, Brazil
| | - Jorge A. P. S. Mota
- Research Centre of Physical Activity, Health and Leisure, Faculty of Sport Sciences, University of Porto, 4050-313 Porto, Portugal; (J.A.P.S.M.); (C.M.d.L.M.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
| | - Gustavo M. G. da Silva
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia (ISMAI), 4475-690 Maia, Portugal;
| | - Rafael M. Tassitano
- Department of Physical Education, Federal Rural University of Pernambuco, Recife 50010-000, Brazil;
| | - Cain C. T. Clark
- Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK;
| | - Michael J. Duncan
- Centre for Applied Biological and Exercise Sciences, Coventry University, Coventry CV1 5FB, UK;
| | - Clarice M. de L. Martins
- Research Centre of Physical Activity, Health and Leisure, Faculty of Sport Sciences, University of Porto, 4050-313 Porto, Portugal; (J.A.P.S.M.); (C.M.d.L.M.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
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42
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Holmes JF, St. Laurent CW, Spencer RMC. Unhealthy Diet Is Associated With Poor Sleep in Preschool-Aged Children. J Genet Psychol 2021; 182:289-303. [PMID: 33876710 PMCID: PMC8764816 DOI: 10.1080/00221325.2021.1905598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy dietary choices are associated with poor sleep in children through adults. Yet, how diet and sleep are related in early childhood, when diet is reliant on parent choices around food availability, is unknown. The authors aimed to explore how frequency of fruit, vegetable, fast food, and soda consumption are associated with preschool children's sleep quality. They also considered how parenting factors may impact the relationship between children's sleep and diet. Actigraphy data were collected from 383 children 33-70 months old. Caregivers reported on child food and beverage frequency, demographics, and health items. Parenting strategies were assessed using the Parenting Scale. Multiple linear regression was used to examine associations between sleep and dietary measures with socioeconomic status, race-ethnicity, physical activity, and body mass index as covariates. Shorter nap duration was associated with more frequent consumption of fruits and vegetables (B = -3.6, p = .03). Shorter nighttime and 24-hr sleep durations were associated with more frequent consumption of fast food (B = -6.5, p = .01; B = -5.8, p = .01). Shorter nighttime sleep and later sleep onset were associated with more frequent soda consumption (B = -9.2, p = .01; B = 0.23, p = .001). Use of ineffective parenting strategies was negatively associated with fruit and vegetable consumption (r = -.29, p = .01) and positively associated with soda consumption (r = .25, p = .02) but was unrelated to sleep measures. Thus, ineffective parenting strategies may underlie child access to unhealthy foods, which, in turn, contributes to poor sleep. Encouraging healthier dietary habits and educating caregivers on how to reinforce such practices may lead to better sleep outcomes in early childhood.
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Affiliation(s)
- Jennifer F. Holmes
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst
| | | | - Rebecca M. C. Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst
- Neuroscience & Behavior Program, University of Massachusetts, Amherst
- Institute for Applied Life Sciences, University of Massachusetts, Amherst
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43
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Jansen EC, Corcoran K, Perng W, Dunietz GL, Cantoral A, Zhou L, Téllez-Rojo MM, Peterson KE. Relationships of beverage consumption and actigraphy-assessed sleep parameters among urban-dwelling youth from Mexico. Public Health Nutr 2021; 25:1-10. [PMID: 34325765 PMCID: PMC8800947 DOI: 10.1017/s136898002100313x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/12/2021] [Accepted: 07/27/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether usual beverage intake was associated with sleep timing, duration and fragmentation among adolescents. DESIGN Usual beverage intake was assessed with a FFQ. Outcomes included sleep duration, midpoint (median of bed and wake times) and fragmentation, assessed with 7-d actigraphy. Sex-stratified linear regression was conducted with sleep characteristics as separate outcomes and quantiles of energy-adjusted beverage intake as exposures, accounting for age, maternal education, physical activity and smoking. SETTING Mexico City. PARTICIPANTS 528 adolescents residing in Mexico City enrolled in a longitudinal cohort. RESULTS The mean age (sd) was 14·4 (2·1) years; 48 % were male. Among males, milk and water consumption were associated with longer weekday sleep duration (25 (95 % CI 1, 48) and 26 (95 % CI 4, 47) more minutes, in the 4th compared to the 1st quartile); and higher 100 % fruit juice consumption was related to earlier weekday sleep timing (-22 (95 % CI -28, 1) minutes in the 1st compared to the last quantile; P = 0·03). Among females, soda was associated with higher sleep fragmentation (1·6 (95 % CI 0·4, 2·8) % in the 4th compared to the 1st), and coffee/tea consumption was related to shorter weekend sleep duration (-23 (95 % CI -44, 2) minutes in the 4th compared to the 1st). CONCLUSIONS Among females, adverse associations with sleep were observed for caffeinated drinks, while males with higher consumption of healthier beverage options (water, milk and 100 % juice) had evidence of longer and earlier-timed sleep. Potential mechanisms involving melatonin and tryptophan should be further investigated.
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Affiliation(s)
- Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, 3863 SPH I, Washington Heights, Ann Arbor, MI48103, USA
- Department of Neurology, Division of Sleep Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Kathleen Corcoran
- Department of Nutritional Sciences, University of Michigan School of Public Health, 3863 SPH I, Washington Heights, Ann Arbor, MI48103, USA
| | - Wei Perng
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Galit L Dunietz
- Department of Neurology, Division of Sleep Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Ling Zhou
- Center of Statistical Research and School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Martha M Téllez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, 3863 SPH I, Washington Heights, Ann Arbor, MI48103, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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44
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van Kooten JAMC, Jacobse STW, Heymans MW, de Vries R, Kaspers GJL, van Litsenburg RRL. A meta-analysis of accelerometer sleep outcomes in healthy children based on the Sadeh algorithm: the influence of child and device characteristics. Sleep 2021; 44:5960427. [PMID: 33161428 DOI: 10.1093/sleep/zsaa231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/22/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Children often experience sleep problems, with a negative impact on mood, behavior, cognitive function, and other aspects of mental and physical health. Accelerometers are widely used to assess sleep, but general reference values for healthy children do not yet exist. The aim of this meta-analysis was to determine mean values for wake after sleep onset (WASO), sleep efficiency (SE), total sleep time (TST) and sleep onset latency (SOL), and to determine the effect of child and accelerometer-characteristics. METHODS A search included studies with healthy children, 0-18 years, reporting WASO, SE, TST, and/or SOL, calculated with the Sadeh algorithm. Meta-analyses with random effects produced pooled estimate means per outcome. Meta-regression analyses determined the effect of age, sex, placement site and accelerometer type. RESULTS Eighty-three studies (9,068 participants) were included. Pooled means were 63 min (95% CI 57 to 69) for WASO, 88% (95% CI 87 to 89) for SE, 477 min (95% CI 464 to 491) for TST and 19 min (95% CI 17 to 22) for SOL. Heterogeneity was high (95%-99%). TST decreased with age and there was an age-effect on SOL. SE differed between wrist and ankle (used in age 0-24 months) placement, and between piezoelectric and MEMS-type accelerometers. No differences were found between boys and girls, although this number of studies was small. CONCLUSIONS We found differences in almost all investigated outcomes and heterogeneity was high. Therefore, we advise to use a study-specific control sample until more robust reference values are available. Future research should narrow the methodological heterogeneity and produce larger datasets, needed to establish these reference values.
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Affiliation(s)
- Jojanneke A M C van Kooten
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Sofie T W Jacobse
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ralph de Vries
- University Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Raphaële R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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45
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Nimitphong H, Sungkanuparph S, Areevut C, Saetung S, Jerawatana R, Hathaidechadusadee A, Somwang S, Tongchom W, Saibuathong N, Sakmanarit J, Pichitchaipitak O, Phuphuakrat A, Reutrakul S. Effects of an intensive lifestyle intervention and the role of sleep in people living with HIV and prediabetes: a pilot and feasibility study. BMC Res Notes 2021; 14:145. [PMID: 33865450 PMCID: PMC8052817 DOI: 10.1186/s13104-021-05558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/08/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives Prediabetes is prevalent in people living with HIV (PLWH). Insufficient and irregular sleep are linked to abnormal glucose metabolism. This study aimed to investigate the differences in sleep characteristics between PLWH with and without prediabetes, determine the acceptability/feasibility and effects of a pilot six-month intensive lifestyle intervention (ILI) program on glucose metabolism in those with prediabetes, and determine how sleep modulates these effects. Results Thirty-nine PLWH (20 normoglycemia and 19 prediabetes) participated. There were no differences in sleep characteristics between individuals with normoglycemia and prediabetes. Next, thirteen individuals with prediabetes completed a six-month ILI program. The ILI program resulted in significant body weight reduction at 6 months (63.5 ± 13.9 to 61.9 ± 14.0 kg, p = 0.012), which was maintained at 12 months (p < 0.001). Waist circumferences were significantly decreased at 12 months (85.4 ± 11.7 to 82.9 ± 12.7 cm, p = 0.014). An increase in sleep variability was significantly associated with an increase in 2-h plasma glucose, independent of changes in BMI (b = 0.603), and physical activity (b = 0.774). This pilot study suggested that ILI in PLWH with prediabetes is feasible and effective in improving metabolic control, with its effects possibly modulated by sleep variability. These findings should be confirmed in a larger study to reduce diabetes risk in this population. Trail registration: ClinicalTrial.gov, NCT03545217 (date of registration: May 22, 2018)
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Affiliation(s)
- Hataikarn Nimitphong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. .,Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Samut Prakan, Thailand
| | - Chatvara Areevut
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sunee Saetung
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ratanaporn Jerawatana
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Amornrat Hathaidechadusadee
- Division of Nutrition and Dietetics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Somwang
- Division of Nutrition and Dietetics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wanabhorn Tongchom
- Nutrition Science Group, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nampeth Saibuathong
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jandanee Sakmanarit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Pichitchaipitak
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Angsana Phuphuakrat
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, University of Illinois At Chicago, Chicago, IL, USA
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46
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Nicholson LM, Egbert AH, Moreno JP, Bohnert AM. Variability of Sleep and Relations to Body Weight Among First-Year College Students. Int J Behav Med 2021; 28:227-237. [PMID: 32385844 DOI: 10.1007/s12529-020-09888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Existing research suggests that greater sleep variability may increase risk for weight gain. College often marks a transition to a less consistent daily schedule, which may adversely impact sleep routines and further increase risk for weight gain. The current study is among the first to explore relations between nighttime sleep variability and daytime sleep (napping) and body weight among first-year college students. METHODS Using daily diary methods, first-year college students (N = 307; 84.7% female) self-reported their sleep for seven days. Several indices were created to capture sleep variability for reported bedtime, wake time, and sleep duration, including weekday versus weekend differences (WvW), day to day differences (D2D), and overall standard deviation (SD). Napping was also assessed. Based on body mass index (BMI), individuals were categorized as underweight, healthy weight, overweight, and obese. RESULTS Across indices, students' sleep varied over an hour on average across the week. Hierarchical regressions revealed that greater differences in wake time D2D, wake time SD, and sleep duration WvW were all associated with higher BMI, after accounting for gender, depressive symptoms, and sleep duration. Longer napping was also associated with higher BMI, using the same covariates. Finally, greater sleep variability was reported by overweight and obese than healthy weight individuals. CONCLUSION These findings suggest that sleep variability, particularly wake times and napping may be important modifiable sleep behaviors to investigate in future studies. More longitudinal research is needed to explore relations between multiple facets of sleep variability and weight gain, including possible mechanisms.
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Affiliation(s)
| | | | - Jennette P Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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47
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Olsen NJ, Ängquist L, Frederiksen P, Lykke Mortensen E, Heitmann BL. Primary prevention of fat and weight gain among obesity susceptible healthy weight preschool children. Main results from the "Healthy Start" randomized controlled intervention. Pediatr Obes 2021; 16:e12736. [PMID: 33021348 DOI: 10.1111/ijpo.12736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND A vital public health challenge lies in understanding the primary drivers behind excessive weight gain among healthy weight individuals. OBJECTIVES To examine if excessive weight and fat gain can be prevented among healthy weight, obesity susceptible children aged 2 to 6 years. METHODS Eligible children were identified based on information on either a high birth weight, maternal pre-pregnancy obesity or maternal low educational level from national registries, and randomized into an intervention group, a control group and a shadow control group. All children with overweight at baseline were excluded from subsequent analysis (n = 196), while healthy weight children were included (n = 926). The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep quantity and quality, and reduction of family stress. The average intervention period was 1.3 years. RESULTS Intention-to-treat analyses indicated a lower gain in percentage fat mass and a higher gain in fat-free mass in the intervention group compared with the control group. However, the results should be interpreted with caution, as they were clinically small and borderline significant, only. CONCLUSION This primary prevention intervention among young healthy weight children with susceptibility to future obesity had clinically small effects on growth and body composition. More interventions, conducting primary obesity prevention, are urgently needed.
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Affiliation(s)
- Nanna Julie Olsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Lars Ängquist
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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48
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Waking Activities and Sleep: Analysis of United Kingdom Adolescents' Daily Time-Use Diaries. J Adolesc Health 2021; 68:385-393. [PMID: 32669234 DOI: 10.1016/j.jadohealth.2020.05.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate waking activities associated with risks of short and long sleep in a representative cohort of UK adolescents. METHODS Data from 14-year-olds participating in the UK Millennium Cohort Study were used. Daily time-use diaries were completed by adolescents on two randomly selected days (one weekday and one weekend) to capture their activities within a 24-hour period from 4 a.m. of each selected day. Short and long sleep duration categories were defined as beyond the extreme lower and upper thresholds of acceptable age-specific sleep durations recommended by the National Sleep Foundation, respectively. RESULTS Approximately 8% and 6% were short sleepers on weekdays and weekends, respectively. On average, adolescents spent 33% of their time awake per weekend day on recreational digital media activities. Compared with those who had optimal sleep on weekdays, short sleepers spent more time on personal care (mean difference = +56 minutes; 95% confidence interval [CI]: 21; 92) and less time on exercise activities (mean difference = -15 minutes; 95% CI: -27; -3). Ten-minute increase in daily digital media activity was associated with 2% (95% CI: 1.01; 1.03) higher relative risk of adolescents being short sleepers on weekdays. Relative risk of short sleeping was 1.03 (95% CI: 1.01; 1.04) times higher for every10-minute daily increase in travel time on weekdays. CONCLUSIONS Adolescents spend up to one-third of their time awake per day on digital media. However, more time spent on personal care and travel on weekdays and weekends is associated with increased risk of short sleep. These findings permit a reflection on appropriate interventions needed to improve sleep duration in sleep-deprived teens.
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49
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Ward AL, Jospe M, Morrison S, Reynolds AN, Kuroko S, Fangupo LJ, Smith C, Galland BC, Taylor RW. Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6-12 years old: a systematic review with evidence mapping. Nutr Rev 2021; 79:1079-1099. [PMID: 33440009 DOI: 10.1093/nutrit/nuaa125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Although dietary advice has long been a cornerstone of a healthy lifestyle, how sleep quality and quantity may interact with dietary intake or eating behaviors remains unclear. OBJECTIVE To consider a bidirectional relationship between sleep and diet in children aged 6-12 years via a systematic review following PRISMA guidelines. DATA SOURCES Relevant trials and observational studies were identified by searching the PubMed, Medline, Embase, and CENTRAL databases up to June 1, 2019, without language or date restrictions and supplemented with hand searching. Recognized procedures and reporting standards were applied. DATA EXTRACTION Data on participant characteristics, study parameters, diet measures, sleep measures, and findings of study quality assessment criteria were collected. DATA ANALYSIS Forty-five articles involving 308 332 participants on a diverse range of topics were included. Meta-analyses were planned but were impossible to perform due to high study heterogeneity. Most studies (82%) were cross-sectional, which prevented examining directionality of the observed associations. Risk of bias was assessed for trial, cohort studies, and cross-sectional studies, using the Cochrane Risk of Bias Tool or Newcastle Ottawa Scale. RESULTS Of 16 studies in which the effect of sleep on dietary intake was investigated, 81% (n = 13) reported a significant association. All studies (n = 8) of sugar-sweetened or caffeinated beverages reported a negative association with sleep, and in 6 of 7 studies in which eating behaviors were investigated, associations with sleep were reported. The use of objective measures of sleep and diet were scarce, with most trials and studies relying on subjective measures of sleep (68%) or diet (93%). CONCLUSION Because most studies investigating the relationship between sleep and diet in this age group are cross-sectional, temporality could not be determined. Additional randomized controlled trials and long-term cohort studies in middle childhood, particularly those using objective rather than questionnaire measures of sleep, are required to better understand interactions between diet and sleep. SYSTEMATIC REVIEW REGISTRATION Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).
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Affiliation(s)
- Aimee L Ward
- Department of Medicine, University of Otago, Dunedin, New Zealand and Department of Geography, Kent State University, Kent, Ohio, USA
| | - Michelle Jospe
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Silke Morrison
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Sarahmarie Kuroko
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Louise J Fangupo
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Claire Smith
- Department of Women's & Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's & Children's Health, University of Otago, Dunedin, New Zealand
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
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50
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Krietsch KN, Beebe DW, King C, Homan KJ, Williams SE. Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment. CHILDREN-BASEL 2021; 8:children8010042. [PMID: 33445734 PMCID: PMC7828171 DOI: 10.3390/children8010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program-"FIRST Program"), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.-8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1-2 months later), FIRST Patients' sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.
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Affiliation(s)
- Kendra N. Krietsch
- Department of Psychology, 1 Children’s Place Suite 3N14, St. Louis Children’s Hospital, St. Louis, MO 63110, USA
- Department of Clinical Pediatrics, Washington University, St. Louis, MO 63130, USA
- Correspondence:
| | - Dean W. Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.W.B.); (C.K.); (K.J.H.); (S.E.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Christopher King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.W.B.); (C.K.); (K.J.H.); (S.E.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kendra J. Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.W.B.); (C.K.); (K.J.H.); (S.E.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Sara E. Williams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.W.B.); (C.K.); (K.J.H.); (S.E.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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