Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors

Epidemiology of sleep patterns and circadian typology in uruguayan children: The contribution of school shifts

Healthy sleep is defined by the combination of adequate duration, good quality, and regular timing. In children, sleep thus depends on the interplay of individual, parental, organizational, community, and social variables, but only a few studies have addressed this issue in a comprehensive way nationwide. Using the Uruguayan nationally representative survey (Nutrition, Child Development, and Health Survey, Encuesta de Nutrición, Desarrollo Infantil y Salud, ENDIS), we present the first epidemiological characterization of chronobiological and sleep parameters in Latin American children. On average, Uruguayan urban children (n = 2437; 5-10-years old) showed quite late chronotypes (MSFsc = 03:53 ± 1:07), moderate misalignment (SJL = 1.0 ± 0.9 h), and adequate sleep duration (SDweek = 9.9 ± 1.0 h). Further, we show the substantial influence of school shift schedules on children's circadian typology and sleep patterns. Our results show that children attending the morning school shift have a higher risk of sleep problems than afternoon-school shift ones. The chronotype and sleep were earlier in morning-school shift children than in children attending the afternoon school shift. However, morning-school shift children had stronger misalignment, shorter sleep on school days, and a higher risk of chronic sleep deficit and non-healthy circadian misalignment (even worse in late chronotypes) than afternoon-shift children. This evidence points to the need of evaluating policies to reorganize school start times to prevent the negative effects that early schooling seems to have on children's sleep health, which has been neglected so far.

Sleep disturbances in hospitalized children: a wake-up call

Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1-12 years, admitted to a tertiary center, and compared this with home 6-8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital. Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.

Ketamine induces insomnia-like symptom of zebrafish at environmentally relevant concentrations by mediating GABAergic synapse

Although the stimulative effects on the normal behaviors of fish posed by ketamine (KET) were well-studied, the adverse effects on the behavioral functions induced by KET at nighttime were unknown. Here, we used zebrafish larvae as a model exposed to KET (10, 50, 100, and 250 ng/L) at environmental levels for 21 days. The behavioral functions at nighttime, morphological changes during exposure stage, and alterations on the associated genes transcriptional levels of fish were determined. The difficultly initiating sleep was found in the fish exposed to KET, while the sleep duration of the animals was at the normal levels in exposure groups. The significant suppressions of the developmentally relevant genes, including bmp2, bmp4, and pth2ra were consistent with the developmental abnormalities of fish found in exposure groups. Moreover, the expression of γ-aminobutyric acid (GABA) receptor increased and melatonin (MTN) receptor decreased while the levels of GABA and MTN remained unchanged after exposure, by gene expression analysis and molecular docking. In addition, the transcriptional expression of apoptotic genes, including tp53, aifm1, and casp6, was significantly upregulated by KET. After a 7-day recovery, the insomnia-like behaviors (shorter sleep duration) were observed in zebrafish from the 250 ng/L-KET group. Accordingly, the adverse outcome pathway framework of KET was constructed by prognostic assessment of zebrafish larvae. This study suggested that the adverse outcomes of KET on the sleep health of organisms at environmentally relevant concentrations should be concerned.

Sleep and insulin sensitivity in adolescents at risk of type 2 diabetes: the Sleep Manipulation in Adolescents at Risk of Type 2 Diabetes randomized crossover study

STUDY OBJECTIVES

To investigate the effect of increasing sleep duration for 1 week, compared to a week of habitual and decreased sleep, on insulin sensitivity (IS) in adolescents at risk for type 2 diabetes (T2D).

METHODS

Adolescents, 13-18 years old, at risk for T2D, with obesity and other risk factors, were recruited for a randomized (1:1), open-label, sex-stratified crossover study, that manipulated time-in-bed to modify sleep duration (measured by actigraphy). Following a week of habitual (HB) sleep, time-in-bed was increased (IN) and decreased (DE) by 1 hour 30 min/night for 1 week, counterbalanced across participants (HBINDE or HBDEIN), and separated by a week of washout sleep. The main outcome measure was IS, obtained via 2-hour oral-glucose-tolerance-test conducted after each sleep week.

RESULTS

Of the 43 participants recruited, 36 (84%) completed all sleep interventions (52.8% female, age = 15.1 years, body mass index = 99.9th percentile, order: HBINDE = 18 and HBDEIN = 18). On average, during the HB week, participants slept 7 hours 31 min/night; sleep duration was 1 hour 02 min/night higher during the IN week and 1 hour 19 min/night lower during the DE week. We found a significant effect of sleep week on IS with a large effect size. Following the IN sleep week, IS was 20% higher compared to after the HB and DE sleep weeks, but there was no significant difference in IS following HB versus DE sleep weeks.

CONCLUSIONS

Whenever possible, clinicians should empower youth at risk of T2D to improve their sleep duration, since even a modest increase in sleep duration of 1 h/night for 1 week can have a positive impact on IS in this population.

CLINICAL TRIALS

Sleep Extension and IS in Adolescents, https://clinicaltrials.gov/study/NCT03754036, November 23rd, 2018.

TRIAL REGISTRATION

ClinicalTrials.gov (ID:NCT03754036).

Late bedtime combined with more screen time before bed increases the risk of obesity and lowers diet quality in Spanish children

This cross-sectional study aimed to investigate whether the combination of bedtime and screen time (ST) before bed were associated with obesity and diet quality in toddlers and school-aged children. Parents reported children's bedtimes and ST before bed (0 min, 1-30 min, >30 min). We then defined bed + screen time behavior using bedtime median cut-offs (early [EB] or late [LB]) and ST responses, resulting in four groups: EB-0'ST, EB ≤ 30'ST/LB-0'ST, EB > 30'ST/LB ≤ 30'ST, and LB > 30'ST. For all participants (n = 1133; 5.4 ± 2.7 years, 49.7% girls, 51.9% school-aged) we evaluated body mass index (BMI), diet quality, sleep-related variables, physical activity, and health-related quality of life (HRQoL). Outcome variables were compared across bed + screen time behavior groups, stratified by age group (toddlers and school-aged children) using general linear models for continuous variables, as well as chi-squared tests or logistic regressions for categorical variables. Additionally, we calculated linear p-trends. Analyses were adjusted for sociodemographic variables, BMI, and physical activity (unless the variable was tested). The results showed that toddlers and school-aged children in the LB ≥ 30'ST group were more likely to have overweight/obesity (OR: 3.42 [95%CI:1.41,8.26] and OR: 2.53 [95%CI:1.10,5.03], respectively) than those in the EB-0'ST group. Additionally, toddlers and school-aged children in the EB > 30'ST/LB ≤ 30'ST and LB > 30'ST groups showed significantly lower adherence to the Mediterranean diet compared to the other groups (p < 0.001). Regarding sleep-related outcomes, we observed that the combination of LB and more ST was associated with poorer sleep quality and shorter sleep duration in toddlers and school-aged children (p < 0.001). These findings emphasize the importance of promoting earlier bedtimes and limiting ST before bed as part of obesity prevention strategies for children. Furthermore, such intervention could benefit the quality of children's diet and overall lifestyle.

Association between Beverage Consumption and Sleep Quality in Adolescents

The objective of this study was to verify if the consumption of different beverages (such as water, 100% pure fruit juice, and sugar-sweetened beverages (SSBs)) is associated with adolescents' sleep quality. French-speaking adolescents were recruited in person and online throughout the province of Québec (Canada) from the end of March to early July 2023. Beverage consumption and sleep quality were measured using French versions of validated questionnaires specifically designed for adolescents. A total of 218 adolescents (14-17 years; 55.5% female) completed the online survey. Among caffeinated SSBs, energy drink (rs = -0.16; p = 0.0197) and sugar-sweetened coffee (rs = -0.33; p < 0.0001) intake was correlated with adolescents' sleep quality. Energy drink consumption (β = -0.0048; p = 0.0005) and being male (β = 0.6033; p < 0.0001) were associated with adolescents' sleep quality. There was an interaction between sugar-sweetened coffee intake and biological sex that was associated with adolescents' sleep quality (p = 0.0053). Sugar-sweetened coffee consumption was correlated with adolescent girls' abilities to go to bed (rs = -0.21; p = 0.0203) and fall asleep (rs = -0.28; p = 0.0020), while in boys, it was only significantly correlated with their abilities to go to bed (rs = -0.27; p = 0.0069). Public health interventions aimed at adolescent boys should primarily target lowering energy drink consumption, while those aimed at girls should prioritize sugar-sweetened coffee intake to possibly improve their sleep quality.

The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren

Background: Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. Aim: To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10-12 years old from several schools of Greece. Methods: A cross-sectional study was conducted on 1688 students in Greece, during 2014-2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. Results: Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; p < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit (p = 0.002) and physical activity (p < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = -0.095, p < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. Conclusion: Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.

Effects of a calorie-restricted dietary intervention on weight loss and gut microbiota diversity in obese patients with sleep deprivation

OBJECTIVES

This study aimed to investigate the effects of a calorie-restricted dietary (CRD) intervention on weight and gut microbiota diversity in obese patients with sleep deprivation (SD).

METHODS

Twenty obese patients were divided into a sleep deprivation group (SD group, n = 10) and a nonsleep deprivation group (NSD group, n = 10), both of which underwent a CRD intervention for 12 weeks. Measurement of anthropometric parameters, biochemical examinations and gut microbiota detection were performed at baseline and at the end of week 12. Mi Smart Bands 1 (Standard Option) were used to monitor sleep and exercise.

RESULTS

(1) The CRD intervention improved body weight (BW), waist circumference (WC), blood pressure (BP), basal metabolic rate (BMR), body fat content (BFC), and insulin resistance index (HOMA-IR) in all obese patients. (2) In the NSD group, BW, BFC, VFA (visceral fat area), BMR and total cholesterol (TC) were significantly reduced after the CRD intervention (P < 0.05). (3) The alpha diversity of the gut microbiota remained unchanged after the intervention in the two groups. (4) There was a negative correlation between Mollicutes and BMR in the NSD group.

CONCLUSIONS

The effects of a CRD intervention weaken on weight loss and the metabolism of blood lipids may be weakened by SD. The abundance of Mollicutes bacteria may be related to weight loss after a CRD intervention in obese patients.

LEVEL OF EVIDENCE

III, prospective cohort study.

Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study

BACKGROUND

The relationship of insufficient sleep with the increased risk of obesity has been reported, but less is known about other sleep dimensions in the sleep-obesity associations.

OBJECTIVES

To assess the associations of multiple sleep dimensions with overall and abdominal obesity among Chinese students.

METHODS

This was a cross-sectional study involving 10,686 Han students aged 9-18 from Chinese National Survey on Students' Constitution and Health (CNSSCH). We collected sex, age, regions, parental educational levels, physical activity duration and sleep-related information by questionnaire survey, and also conducted anthropometric measurements including height, weight and waist circumference (WC). Unadjusted and adjusted binary logistic regression models were used to estimate the associations of sleep-related dimensions with obesity-related indicators.

RESULTS

Short sleep duration was associated with higher body mass index (BMI), larger WC and higher waist-to-height ratio (WHtR) in 9-12 and 16-18 age groups, whereas prolonged sleep duration on weekday was associated with higher BMI in 13-15 age group. Non-habitual midday napping and midday napping ≤0.5 h/d (vs 0.5 to 1 h/d) increased the risk of higher BMI in 13-15 age group, and the former was also associated with larger WC in 9-12 age group. Late bedtime was associated with larger WC and higher WHtR in 9-12 age group and with higher BMI and WHtR in 13-15 age group. Students aged 9-12 with social jet lag ≥2 h were found to have greater BMI after adjustment (Odds Ratio: 1.421; 95% confidence interval: 1.066-1.894).

CONCLUSIONS

Short or overlong sleep duration, late bedtime and great social jet lag were associated with higher prevalence of overall or abdominal obesity, while moderate midday napping can effectively decrease the risk. Those findings may assist in developing preventive strategies to combat obesity epidemic.

Prevalence of overweight/obesity and related factors in Keerqin District, Tongliao City: A cross-sectional study

OBJECTIVE

This study aimed to analyze the prevalence of overweight/obesity and the factors influencing these conditions among 9- to 18-year-old adolescents in Keerqin District of Tongliao City. We explored whether overweight/obesity is accompanied by differences in eating habits, lifestyle, and mental health.

METHODS

A cross-sectional survey was administered to 1,736 adolescents in November 2020. A physical examination was performed for each participant, and an online questionnaire was adopted to collect information. The association of several risk factors with overweight/obesity was explored using a logistic regression model.

RESULTS

The prevalence of overweight/obesity in the study population was 43.32%. The risk of overweight/obesity was higher among nonresident students (odds ratio [OR] = 1.564, 95% CI = 1.182-2.069) who had an average of 3-4 (OR = 2.164, 95% CI = 1.087-4.308) or 5 or more (OR = 2.114, 95% CI = 1.376-3.248) PE classes per week. The risk of overweight/obesity was lower among girls (OR = 0.485, 95% CI = 0.396-0.593), students aged 15-16 years (OR = 0.288, 95% CI = 0.135-0.617) and those aged 17-18 years (OR = 0.282, 95% CI = 0.124-0.639), students who ate sweets more than once a week (OR = 0.570, 95% CI = 0.366-0.887), students who spent less than 1 hour per day on the computer each week (OR = 0.776, 95% CI = 0.620-0.971), students with depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score ≥ 16) (Model 2: OR = 0.618, 95% CI = 0.385-0.990; Model 3: OR = 0.623, 95% CI = 0.388-1.000), and students with depressed affect (Model 2: OR = 0.921, 95% CI = 0.877-0.967; Model 3: OR = 0.929, 95% CI = 0.885-0.976).

CONCLUSION

Overweight/obesity was influenced by eating habits and lifestyle factors. In addition, overweight/obesity adolescents had a lower risk of depressed than those with normal weight.

Sleep Duration and Sarcopenia: An Updated Systematic Review and Meta-Analysis

OBJECTIVES

In adults, short and long sleep duration has been associated with sarcopenia risk. Studies have shown that various factors, including biological and psychological factors, could be the underlying cause of the association between aberrant sleep duration and sarcopenia risk. In this study, we have qualitatively and quantitatively summarized previously published studies on sleep duration to assess the relationship between sleep duration and sarcopenia risk in adults. This would aid in enhancing our understanding of recent advancements in this field and the association between sleep duration and sarcopenia risk.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

In this review, we included studies evaluating the association between the duration of sleep and sarcopenia in adults in observational studies.

METHODS

Five electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Web of Science) were searched to April 20, 2023, to identify studies related to sarcopenia and sleep duration. Next, we calculated the odds ratios (ORs) for sarcopenia prevalence based on the adjusted data from individual studies. Statistical analyses were performed using Stata 11.0.

RESULTS

Sarcopenia prevalence was high (18%) in adults with long sleep duration. Our results showed a significant association between short duration of sleep and high sarcopenia prevalence in older adults (OR 1.2, 95% CI 1.02-1.41, I2 = 56.6%). Furthermore, a significant association was observed between all participants with long-duration sleep and high sarcopenia prevalence (OR 1.53, 95% CI 1.34-1.75, I2 = 56.8%). We also observed significant heterogeneity in the adjusted ORs.

CONCLUSIONS AND IMPLICATIONS

There was a correlation between sarcopenia and short or long sleep duration, especially in older adults. In adults with a long duration of sleep, sarcopenia prevalence was relatively high.

Life Satisfaction and Emerging Health Behaviors in Underserved Adolescents: A Narrative Review

Objectives: Obesity rates continue to rise in underserved adolescents. Obesity is linked to poor mental health outcomes. The purpose of this narrative review is to examine existing literature on life satisfaction and obesity-related emerging health behaviors (sugar-sweetened beverage consumption, sleeping patterns, and screen time) in underserved adolescents. Methods: We conducted a review of articles published in English between January 1995 and November 2021 to develop a narrative summary. Results: In general, few studies have been conducted investigating life satisfaction and the emerging behaviors of sugar-sweetened beverage consumption, sleeping patterns, and screen time use with adolescents, especially underserved adolescents. In the studies reviewed, we noted links between lower life satisfaction and more than once-a-day sugar consumption, including sugar-sweetened beverages, lower life satisfaction and lower sleep duration, and life satisfaction and screen-time, with both positive and negative relationships shown. Conclusions: Given the limitations in the number of studies, recommendations are provided for future research.

Interventions to increase sleep duration in young people: A systematic review

This systematic review explored the outcomes of current interventions to increase sleep duration in healthy young people (14-25 years). Nine databases were systematically searched, and 26 studies were included in this review. Quality assessment of the included studies was evaluated using two tools: the Newcastle-Ottawa scale, and Cochrane Risk of Bias. The interventions incorporated a range of strategies including behavioral (46.2%), educational (26.9%), a combination of behavioral and educational (15.4%), and other strategies such as physical therapy (11.5%). The findings indicate that behavioral and combination interventions were consistently effective in increasing sleep duration in healthy young people. Educational interventions alone were less effective at increasing young people's sleep duration. Of all the included studies, only one randomized control trial but none of the non-randomized trials were rated as good quality. Our findings suggest a combination of strategies with an emphasis on personalization of intervention could possibly maximize the chances of success at improving sleep duration in healthy young people. More high-quality studies with long-term assessments (≥ 6 months) should be conducted to test the efficacy and durability of interventions to increase sleep duration in young people, as well as the clinical implications to mental and physical health.

Bidirectional associations of sleep and discretionary screen time in adults: Longitudinal analysis of the UK biobank

The direction of the association between discretionary screen time (DST) and sleep in the adult population is largely unknown. We examined the bidirectional associations of DST and sleep patterns in a longitudinal sample of adults in the general population. A total of 31,361 UK Biobank study participants (52% female, 56.1 ± 7.5 years) had two repeated measurements of discretionary screen time (TV viewing and leisure-time computer use) and self-reported sleep patterns (five sleep health characteristics) between 2012 and 2018 (follow-up period of 6.9 ± 2.2 years). We categorised daily DST into three groups (low, <3 h/day; medium, 3-4 h/day; and high, >4 h/day), and calculated a sleep pattern composite score comprising morning chronotype, adequate sleep duration (7-8 h/day), never or rare insomnia, never or rare snoring, and infrequent daytime sleepiness. The overall sleep pattern was categorised into three groups (healthy: ≥ 4; intermediate: 2-3; and poor: ≤ 1 healthy sleep characteristic). Multiple logistic regression analyses were applied to assess associations between DST and sleep with adjustments for potential confounders. Participants with either an intermediate (OR: 1.40; 95% CI: 1.15, 1.71) or a poor (OR: 1.16; 95% CI: 1.10, 1.24) sleep pattern at baseline showed higher odds for high DST at follow-up, compared with those with a healthy baseline sleep pattern. Participants with medium (OR: 1.40; 95% CI: 1.14, 1.71) or high DST (OR: 1.62; 95% CI: 1.30, 2.00) at baseline showed higher odds for poor sleep at follow-up, compared with participants with a low DST. In conclusion, our findings provide consistent evidence that a high DST at baseline is associated with poor sleep over a nearly 7 year follow-up period, and vice versa.

Adequacy of energy and macronutrients intake in differently active slovenian adolescents

OBJECTIVE

Evaluate the adequacy of energy/macronutrient intake in adolescents according to the Slovenian national recommendations adopted from the recommendations of the German Nutrition Society and to identify differences in energy/macronutrient intake between differently active adolescents.

METHODS

Data on energy and macronutrient intake (24-hour dietary recall), physical activity (SHAPES questionnaire), and anthropometric characteristics (body mass and height) of adolescents were obtained on a representative sample of first-year secondary school students (average (SD) age: 15.3 (0.5) years; N = 341), who were included in the national survey The Analysis of Children's Development in Slovenia (ACDSi) in 2013/14.

RESULTS

75% of adolescents met the national recommendations for carbohydrates and proteins and 44% for fats, whereas only 10% of adolescents met the recommendations for energy intake. Energy/macronutrient intakes were significantly higher in vigorously physically active (VPA) boys compared to moderately (MPA) and less (LPA) physically active boys. No such differences were observed between girls of different physical activity levels.

CONCLUSION

Adolescents need to be encouraged to meet their energy needs according to gender and physical activity (especially VPA girls) and to reach for higher quality foods in adequate macronutrient proportions.

Physical Activity Levels and Sleep in Schoolchildren (6-17) with and without School Sport

There is strong evidence to support the association between daily physical activity and sleep parameters in children and adolescents. Physical activity and outdoor play are favourably associated with most sleep outcomes in school children. The aim is to find out the levels of physical activity and the quality of sleep in Basque schoolchildren aged between six and seventeen and to analyse the possible differences between those who carry out some kind of physical sports activity and those who do not. The sample consisted of 1082 schoolchildren (50.1% male and 49.9% female). Differences between groups were compared using the Mann-Whitney U test (2 samples) and Kruskal-Wallis one-factor ANOVA (k samples). A total of 723 (66.94%) of the participants said they practiced some physical sports activity. The accelerometers obtained significant differences in all levels of physical activity, as well as in sleep efficiency, with higher levels of physical activity (sedentary p = 0.001; light p = 0.017; moderate p = 0.009; vigorous p = 0.001 and moderate-to-vigorous physical activity p = 0.002) and better sleep efficiency (p = 0.002) in those schoolchildren who perform some type of physical sports activity. A significant difference in time spent in sedentary activities was also observed between primary and secondary school pupils of both sexes and regardless of the degree of physical sports activity completion.

Did the increase in sitting time due to COVID-19 lead to obesity in adolescents?

INTRODUCTION

Since adolescent with obesity is closely linked with the incidence of cardiovascular disease, it is important to identify the factors that increase the prevalence of adolescent with obesity and prevent it early. This study aimed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents with obesity during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We used the Korean Youth Risk Behavior Web-based Survey (KYRBWS) data. The primary outcome was the relationship between sitting hours and obesity during and after the COVID-19 pandemic. Multiple logistic regression analysis was performed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents' obesity status.

RESULTS

The prevalence of obesity was significantly higher during the COVID-19 than before the COVID-19 (OR, 1.268, CI:1.232-1.305). There was a significant increase in the OR for sitting hours per week for purposes other than study (OR, 1.021, 95% CI, 1.019-1.024). Compared to low household income, the OR decreased for middle (OR = 0.798, 95% CI:0.77, 0.826) and high-income household students (OR, 0.833, 95% CI: 0.803-0.865).

DISCUSSION/CONCLUSION

The results of this study confirmed the relationship between sit-ting hours and obesity in adolescents during the pandemic. To prevent adolescent with obesity, further studies are needed to focus on the importance of promoting health policy in adolescents to avoid the continuous rising of its prevalence and needed to understand whether the increase in obesity rates during the pandemic is a temporary trend.

Effects of Sleep on Adolescents' Appetite, Dietary Intake, and Weight

Introduction

Several factors have been associated with excess weight gain in adolescents, including loss of sleep.

Objective

The purpose of this study is to examine the effects of sleep factors on appetite, dietary intake, and the body weights of adolescent youth.

Methods

A prospective correlational study design was used. Male and female adolescents (N = 76) ages 12-18 years completed a 5-night study. Sleep was assessed using Fitbits (88.5% accuracy) and the Pittsburgh Sleep Quality Index (PSQI) (test-retest reliability = .81); appetite was assessed by a Visual Analog Scale (α = 0.84); dietary intake was assessed by the Block Kids Food Screener (reliability up to .88); sleep hygiene was assessed using the Adolescent Sleep Hygiene Practice Scale (α = .67).

Results

Poor sleep quality was reported by 39.5% of participants, and 75% of participants had inadequate sleep time (7.33 h). Participants' age significantly correlated with PSQI scores (r = .28, p < .05) and BMI (r = .37, p < .01). Participants' PSQI scores significantly correlated with sleep hygiene (r = .45, p = .05) and appetite (r = .3 3, p < .01). Sleep latency significantly correlated with sleep hygiene (r = .32, p < .05). Several sleep hygiene factors correlated significantly with the participants' sleep quality, quantity and latency scores and dietary intakes.

Conclusion

These findings suggest that changes in sleep hygiene practices may improve adolescent sleep quality and quantity as well as appetite and dietary intake.

Methodological aspects and characteristics of participants in the study on the prevalence of obesity in children and adolescents in Florianópolis, Southern Brazil, 2018-2019: EPOCA study

PURPOSE

To describe the methodological aspects and characteristics of the participants of the EPOCA survey.

METHODS

The study was conducted with schoolchildren aged between seven to 14 years old from 30 schools in Florianópolis, Southern Brazil. Body mass, height, girths, and skinfold thicknesses were measured. Food consumption and physical activity from the previous day were self-reported using the validated Web-CAAFE questionnaire. Adolescents completed a specific questionnaire about physical activity, meal consumption, and weight control behaviors. Parents/guardians responded to a sociodemographic and habits questionnaire.

RESULTS

A total of 1671 schoolchildren participated in the study (response rate: 27.2%). About 63% of schoolchildren were enrolled in public schools. Most studied in the morning shift (54.2%), were female (53.1%) and aged between seven and 10 years (58.1%). The prevalence of overweight was 33.7% and obesity was 11.3%.

CONCLUSIONS

The data obtained will allow us to assess the trend in the prevalence of overweight and obesity and associated factors when compared to other surveys performed. Descriptions of the logistics and protocols can help in the development and improvement of similar studies. It is hoped that the results of EPOCA 2018/2019 may help in the design of obesity prevention policies and programs for this population.

Sleep, circadian biology and skeletal muscle interactions: Implications for metabolic health

There currently exists a modern epidemic of sleep loss, triggered by the changing demands of our 21st century lifestyle that embrace 'round-the-clock' remote working hours, access to energy-dense food, prolonged periods of inactivity, and on-line social activities. Disturbances to sleep patterns impart widespread and adverse effects on numerous cells, tissues, and organs. Insufficient sleep causes circadian misalignment in humans, including perturbed peripheral clocks, leading to disrupted skeletal muscle and liver metabolism, and whole-body energy homeostasis. Fragmented or insufficient sleep also perturbs the hormonal milieu, shifting it towards a catabolic state, resulting in reduced rates of skeletal muscle protein synthesis. The interaction between disrupted sleep and skeletal muscle metabolic health is complex, with the mechanisms underpinning sleep-related disturbances on this tissue often multifaceted. Strategies to promote sufficient sleep duration combined with the appropriate timing of meals and physical activity to maintain circadian rhythmicity are important to mitigate the adverse effects of inadequate sleep on whole-body and skeletal muscle metabolic health. This review summarises the complex relationship between sleep, circadian biology, and skeletal muscle, and discusses the effectiveness of several strategies to mitigate the negative effects of disturbed sleep or circadian rhythms on skeletal muscle health.

Maternal Sleep Problems in the Periconceptional Period and the Impact on Health of Mother and Offspring: A Systematic Review

Knowledge of the impact of sleep problems in the periconceptional period is scarce. Since this period is the most sensitive time window for embryonic and placental development, we aim to study the impact of maternal sleep problems in the periconceptional period on both mother and offspring. We systematically searched various databases up until September 2021 for studies reporting on maternal sleep in the periconceptional period and any outcome in mother and offspring. We included observational studies describing maternal sleep problems in the periconceptional period and associations with either maternal and/or offspring outcomes. The search produced 8596 articles, of which we selected 27 studies. Some associations were found between sleep problems and lower fertility, more hypertensive disorders, more mood disorders in mothers, higher risk of preterm birth and low birth weight, and more sleep and behavior problems in offspring, with associations with maternal mood disorders being most consistent. This systematic review shows that maternal sleep problems in the periconceptional period are associated with a higher risk of various adverse outcomes in both mother and offspring, although not consistently. It shows that good sleep during pregnancy is crucial, starting as early as before conception, especially for maternal mood. Therefore, it is important for clinicians to pay attention to sleep problems in the periconceptional period and provide adequate treatment for potential sleep problems, even before pregnancy.

Sleep in hospitalized pediatric and adult patients – A systematic review and meta-analysis

Background

Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing.

Objective

The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors.

Methods

A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep’ and 'hospitalization’. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines.

Results

Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6–1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep.

Conclusion

Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7–3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3–3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.

•

An overview of the magnitude of sleep deprivation in hospitalized patients.

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A meta-analysis of studies reporting on some of the main sleep outcomes.

•

An overview of internal and external factors affecting sleep in hospitalized patients.

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Guidance for potential interventions to improve sleep during clinical admission.

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Uncovers a knowledge gap regarding the sleep quality of hospitalized children and daytime sleep of hospitalized adults.

Sleep habits of high school student-athletes and nonathletes during a semester

STUDY OBJECTIVES

Lack of sleep has been shown to be harmful to athletic and academic performance as well as health and well-being. The primary purpose of this study was to analyze the sleep and physical activity differences between US high school student-athletes and nonathletes during a semester of school and competition.

METHODS

Participants included 34 student-athletes (18 males and 16 females), age 15.8 ± 0.8 years, and 38 nonathletes (10 males and 28 females), age 16.3 ± 0.7 years. Objective sleep and physical activity outcomes were collected using Fitbit wrist-worn activity trackers for 8-14 consecutive days and nights, measuring total sleep time, sleep efficiency, bedtimes, wake times, and steps counted.

RESULTS

Student-athletes and nonathletes did not differ in total sleep time (440.4 ± 46.4 vs 438.1 ± 41.7 min, P = .82) and sleep efficiency (93.6 ± 2.3 vs 92.9 ± 2.3%, P = .20). Fitbit data revealed that 79% of student-athletes and 87% of nonathletes failed to get greater than the minimally recommended 8 hours of total sleep time per night. Student-athletes had significantly more steps per day (10,163 ± 2,035 vs 8,418 ± 2,489, P < .01). Student-athletes had earlier bedtimes and wake times. Earlier bedtimes were significantly correlated with increased total sleep time (P < .01). Earlier wake times were significantly correlated to increased steps per day (P < .01).

CONCLUSIONS

Participation in high school sports may not have a detrimental effect on a student's sleep habits. High school students are not meeting the recommended 8-10 hours of sleep per night. Going to bed and waking up early were linked to healthier outcomes. Consistent and earlier sleep/wake schedules may optimize students sleep and health.

CITATION

Ungaro CT, De Chavez PJD. Sleep habits of high school student-athletes and nonathletes during a semester. J Clin Sleep Med. 2022;18(9):2189-2196.

Relationships between food-related behaviors, obesity, and medication use in individuals with Smith-Magenis syndrome

BACKGROUND

Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder that includes obesity and food-seeking/satiety-related behaviors.

AIMS

This study examined associations between food-related/hyperphagic behaviors, weight, and medication use in individuals with SMS.

METHODS/PROCEDURES

Caregivers of individuals with SMS in the Parents and Researchers Interested in SMS (PRISMS) Patient Registry completed a demographic/medication questionnaire, the Hyperphagia Questionnaire for Clinical Trials, and the Food Related Problems Questionnaire.

OUTCOMES/RESULTS

Among 49 participants (M_age = 16.41 ± 12.73 years, range = 4-69 years, 55% girls/women), individuals with SMS with overweight/obesity (n = 22) had worse overall food-related problems including greater impaired satiety (p < 0.05), maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.01), and hyperphagia (p < 0.01) compared to individuals of normal/underweight (n = 27). Those taking anti-depressants/anxiolytics (n = 16) had greater maladaptive eating behaviors (p < 0.05), hyperphagic behaviors (p < 0.05), and hyperphagic severity (p < 0.05) than those not taking anti-depressants/anxiolytics (n = 33). Boys/men with SMS had greater maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.05), and hyperphagic drive (p < 0.01) than girls/women with SMS.

CONCLUSIONS/IMPLICATIONS

Maladaptive food-related behaviors were higher in individuals with SMS with overweight/obesity, taking anti-depressants/anxiolytics, or who were male. Medications in this population should be chosen with weight-related side effects in mind.

Factors associated with sleep problems and sleeping pill use in Brazilians

OBJECTIVE

To estimate the prevalence of sleep problems and sleeping pill use and associated factors in the Brazilian population.

METHODS

This study was conducted with data from the 2019 Brazilian National Health Survey. Our sample consisted of 94,114 participants and the outcomes analyzed were sleep problems and sleeping pill use. Sociodemographic, lifestyle, and health characteristics were explored in a descriptive and multivariate analysis with Poisson regression, robust variance, and 5% significance.

RESULTS

We found a 35.1% (95%CI: 34.5–35.7) and 8.5% (95%CI: 8.2–8.9) prevalence of sleep problems and sleeping pill use, respectively. Sleep problems were associated with women (PR = 1.41; 95%CI: 1.36–1.46), individuals who self-assess their health as regular/poor/very poor (PR = 1.56; 95%CI: 1.51–1.62), those with chronic diseases (PR = 1.70; 95%CI: 1.64–1.78), those who use alcohol excessively (PR = 1.14; 95%CI: 1.09–1.20), and smokers (PR = 1.16; 95%CI: 1.10–1.22). Sleeping pill use was associated with women (PR = 1.57; 95%CI: 1.43–1.73), divorcees (PR = 1.46; 95%CI: 1.30–1.65), urban denizens (PR = 1.32; 95%CI: 1.21–1.45) those who self-assess their health as regular/poor/very poor (PR = 1.79; 95%CI: 1.64–1.95), those with chronic diseases (PR = 4.07; 95%CI: 3.48–4.77), and smokers (PR = 1.49; IC95%: 1.33–1.67).

CONCLUSION

This study found that the prevalence of sleep problems and sleeping pill use in Brazilians indicates the need for attention and sleep care for this population, especially in women and those with lifestyle and health conditions associated with the analyzed outcomes.

Prevalence and Factors Associated with Overweight/Obesity in Adolescent School Girls: A Cross-Sectional Study in Kolkata, India

Overweight and obesity in adolescent girls are considered a leading global public health issues in recent times. There is a need to evaluate the potential socioeconomic and behavioural factors behind adolescents’ overweight and obesity in different environmental settings. The present study aims to understand the prevalence of overweight and obesity among urban adolescent school girls and to determine the association between selected socioeconomic and behavioural factors and overweight/obesity. This is a cross-sectional study using a multistage stratified cluster sampling with a sample size of 1041 adolescent girls aged 10 to 18 years from schools of Kolkata, India. Overall prevalence of overweight and obesity were 18.9% and 23.7%, respectively. The prevalence of overweight and obesity was higher among those adolescent girls whose parents had completed higher education (49.5%) and had higher monthly per capita household expenditure (48.4%). Stepwise binary logistic regression analysis confirmed that the probability of being overweight/ obese tended to be in adolescents who slept less than 7 hours per day (p<0.001). Overweight /obesity was also higher among those children whose fathers were fatty (p=0.002), taken medicines three months before the survey (p=0.008), and watched television and mobile phones for more than 1 hour a day (p=0.039). Rapid change in modern lifestyles is seemingly decreasing sleep duration in adolescents with subsequent negative impact on their health.

Association between Recreational Screen Time and Sleep Quality among Adolescents during the Third Wave of the COVID-19 Pandemic in Canada

The study objective was to verify whether recreational screen time was associated with sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada. Data collection took place in four high schools in the region of Chaudière-Appalaches (Quebec, Canada) from the end of April to mid-May 2021. Recreational screen time and sleep quality were measured using the French versions of validated questionnaires specifically designed for adolescents. A total of 258 adolescents (14−18 years; 66.3% girls) answered the online survey. Adolescent boys had a higher total mean recreational screen time (454.3 ± 197.5 vs. 300.5 ± 129.3 min/day, p < 0.0001) and a higher total mean sleep quality score (4.2 ± 0.9 vs. 3.9 ± 0.8, p = 0.0364) compared to girls. Recreational screen time (β = −0.0012, p = 0.0005) and frequency of concurrent screen use (sometimes: β = −0.3141, p = 0.0269; often: β = −0.4147, p = 0.0048; almost always or always: β = −0.6155, p = 0.0002) were negatively associated with sleep quality while being a boy (β = 0.4276, p = 0.0004) was positively associated with sleep quality and age (p = 0.6321) was not. This model explained 16% of the variance in adolescents’ sleep quality. Public health interventions during and after the COVID-19 pandemic should target recreational screen time, concurrent screen use and especially girls to possibly improve sleep quality and promote adolescents’ physical and mental health.

Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health: An Update

Sleep health is an important consideration for athletic performance. Athletes are at high risk of insufficient sleep duration, poor sleep quality, daytime sleepiness and fatigue, suboptimal sleep schedules, irregular sleep schedules, and sleep and circadian disorders. These issues likely have an impact on athletic performance via several domains. Sleep loss and/or poor sleep quality can impair muscular strength, speed, and other aspects of physical performance. Sleep issues can also increase risk of concussions and other injuries and impair recovery after injury. Cognitive performance is also impacted in several domains, including vigilance, learning and memory, decision making, and creativity.

Associations between sleep duration, sleep quality, and weight status in Chinese children and adolescents

Background and objective

The high prevalence of obesity is a serious problem, and sleep is considered to be a factor for obesity. This study aimed to examine the relationship between sleep duration, sleep quality, and weight status among children and adolescents in China and to explore whether the relationship between sleep duration and weight status is independent of sleep quality. Sex and age differences were also explored.

Methods

A cross-sectional research was conducted among 2019 children and adolescents (1029 boys and 990 girls) aged 8–16 years in Shanghai. An open-question was used to obtain data on sleep duration, which was categorized into the following four groups based on the age-specific National Sleep Foundation Sleep Duration Recommendations: 1) very short, 2) short, 3) recommended, and 4) long. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Weight and height were measured for all participants. The variable weight status was estimated with the Chinese children and adolescent age- and sex-specific body mass index (BMI) and was categorized into overweight/obesity and normal weight.

Results

Short sleep duration (7–8 and 6–7 h for 6–13 and 14–16 years old, respectively) significantly increased odds of overweight/obesity (OR = 1.32, 95% CI: 1.06–1.64) compared with that of the recommended sleep duration (9–11 and 8–10 h for 6–13 and 14–16 years old, respectively). The relationship between the two variables existed independent of sleep quality. No significant relationship was found between sleep quality and overweight/obesity of children and adolescents. Sleep quality (OR = 1.07, 95% CI: 1.01–1.14) and short sleep duration (OR = 1.51, 95% CI: 1.06–2.13) increased the risk for overweight/obesity among girls, whereas no significant relationships between sleep duration, sleep quality, and overweight/obesity were found among boys. Short sleep duration increased the risk of overweight/obesity in children aged 8–13 years (OR = 1.34, 95% CI: 1.05–1.71), independent of sleep quality, but no significant relationships between these two variables existed for adolescents aged 14–16 years.

Conclusions

Overall, short sleep duration increased the risks of overweight/obesity in children and adolescents in China, independent of sleep quality. This relationship is significant for girls and children aged 8–13 years instead of boys and adolescents aged 14–16 years. Interventions to extend the sleep duration of children and adolescents, especially girls and children aged 8–13 years in China, are necessary to improve their weight status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13534-w.

A review on pathophysiological aspects of Sleep Deprivation

Sleep deprivation (SD) (also referred as insomnia) is a condition in which peoples fails to get enough sleep due to excessive yawning, facing difficulty to learn new concepts, forgetfulness as well as depressed mood. This could be occurs due to several possible reasons including medications, stress (caused by shift work). Despite the fact that sleep is important for the normal physiology, it currently affects millions of people around the world US (70 million) and Europe (45 million). Due to increase work demand nowadays lots of peoples experiencing sleep deprivation hence, this could be the reason for several car accident followed by death and morbidity. This review highlighted the impact of SD on neurotransmitter release and functions, theories (Flip-flop theory, oxidative stress theory, neuroinflammation theory, neurotransmitter theory, and hormonal theory) associated with SD pathogenesis apart from this it also demonstrate the molecular pathways underlying SD (PI3K and Akt , NF-κB, Nrf2, and adenosine pathway. However, this study also elaborates the SD induced changes in the level of neurotransmitters, hormonal, and mitochondrial functions. Along with this, it also covers several molecular aspects associated with SD as well. Through this study a link is made between SD and associated causes, which will further help to develop potential therapeutic strategy against SD.

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents

INTRODUCTION

Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health.

METHODS

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.

RESULTS

Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results.

CONCLUSION

This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.

Adolescent Technology-use Rules and Sleep in a Large Representative Sample

PURPOSE

This study investigated the prevalence of technology-use rules, typical sleep habits, and associations between rules and sleep using the representative 2017-2018 California Health Interview Survey adolescent sample.

METHODS

Adolescents aged 12-17 years completed the California Health Interview Survey, including queries of (1) rules at home regarding times to turn off or put away electronics and (2) school-night bedtime and rise time. Rates of rules and associations between rules and sleep were investigated using descriptive statistics and bivariate and multivariable analyses.

RESULTS

Seventy-two percent reported technology-use rules. Rates were comparable across subgroups. Rules and sleep were not significantly associated after adjusting for covariates. Reported time in bed fell below National Sleep Foundation guidelines for 38% of participants.

CONCLUSIONS

Most adolescents reported technology-use rules at home. Associations between rules and bedtime were mixed, suggesting that further exploration of contextual and developmental factors is needed. Many reported inadequate sleep duration, supporting sleep as a key topic in adolescent health.

Weekday sleep duration and morning tiredness are independent covariates of breakfast skipping in adolescents

BACKGROUND/OBJECTIVES

Although regular breakfast consumption is associated with various health benefits, many adolescents skip this meal, particularly those with shorter sleep durations. In order to better understand the association between sleep duration and breakfast consumption among youth, we analyzed the association between weekday morning tiredness and daily breakfast consumption in adolescents, and explored the mediating role of morning tiredness in the association between sleep duration and daily breakfast consumption on weekdays.

SUBJECTS/METHODS

The "Health Behaviour in School-aged Children" survey conducted in 2018 in French-speaking Belgian schools provided data (n = 8444 11-20-year-old adolescents) on bed- and wake-up times, and on the frequency of breakfast consumption and morning tiredness on weekdays. Multivariable logistic regressions and mediation analyses assessed the association, on weekdays, of morning tiredness (≥4 school mornings a week vs. less) and sleep duration (hours), with daily breakfast consumption, and the mediating role of morning tiredness.

RESULTS

Feeling tired ≥4 school mornings a week was associated with lower odds of daily breakfast consumption on weekdays (aOR = 0.77 (95% CI 0.69-0.86)). In turn, on weekdays, sleep duration was positively associated with daily breakfast consumption (aOR = 1.29 (95% CI 1.23-1.36)), even after adjustment for morning tiredness (aOR = 1.28 (95% CI 1.21-1.35)). Morning tiredness only explained 4.9% of the association between sleep duration and daily breakfast consumption.

CONCLUSION

Our findings suggest that in adolescents, sleep duration and morning tiredness are independent correlates of daily breakfast consumption on weekdays.

Losing sleep by staying up late leads adolescents to consume more carbohydrates and a higher glycemic load

This study examined how short sleep impacts dietary consumption in adolescents by testing whether experimentally shortening sleep influences the amount, macronutrient content, food types, and timing of food consumed. Ninety-three adolescents completed a within-subjects crossover paradigm comparing five nights of short sleep (6.5-hour sleep opportunity) to five nights of Healthy Sleep (9.5-hour sleep opportunity). Within each condition, adolescents completed three multiple-pass dietary recalls that recorded the types, amount, and timing of food intake. The following outcomes were averaged across days of dietary recall within condition: kilocalories, grams of carbohydrates, fat, protein, and added sugars, glycemic load of foods, and servings of specific types of foods (low-calorie drinks, sweetened drinks, fruits/vegetables, meats/proteins, processed snacks, "fast food" entrees, grains, and sweets/desserts). Timing of consumption of kilocalorie and macronutrient outcomes were also examined across four noncumulative time bins: 06:00-10:59, 11:00-15:59, 16:00-20:59, and 21:00-01:00. Adolescents slept 2 h and 20 min longer in Healthy Sleep than in Short Sleep (p < .0001). While in Short Sleep, adolescents ate more grams of carbohydrates (p = .031) and added sugars (p = .047), foods higher in glycemic load (p = .013), and servings of sweet drinks (p = .023) and ate fewer servings of fruits/vegetables (p = .006) compared to Healthy Sleep. Differences in consumption of kilocalories, fat, and carbohydrates emerged after 9:00 pm (ps = .012, .043, .006, respectively). These experimental findings suggest that adolescents who have insufficient sleep exhibit dietary patterns that may increase the risk for negative weight and cardiometabolic outcomes. Future health promotion efforts should include promoting optimal sleep to increase healthy dietary habits.

A longer time spent at childcare is associated with lower diet quality among children aged 5-6 years, but not those aged 1.5-2 and 3-4 years: Dietary Observation and Nutrient intake for Good health Research in Japanese young children (DONGuRI) study

OBJECTIVE

To examine the association between the amount of time spent at childcare and diet quality in 668 Japanese children aged 1·5-6 years.

DESIGN

A cross-sectional design was used. Dietary information was collected using dietary records (1 d for children aged 1·5-2 years and 2 d for children aged 3-6 years). Diet quality was assessed by counting the number of nutrients not meeting the Japanese Dietary Reference Intakes (DRI). Each child's guardian reported the average amount of time spent at childcare per d for the previous 1 month.

SETTING

In total, 315 childcare centres located in twenty-four areas in Japan.

PARTICIPANTS

In total, 753 children aged 1·5-6 years who attend childcare facilities.

RESULTS

After adjustment for potential confounders, OR for the low diet quality (≥ 5 of twenty nutrients not meeting DRI) in long (≥10 h/d) v. medium (8-10 h/d) childcare hours was 4·81 (95 % CI 1·96, 11·8) among children aged 5-6 years. There was no significant association in children aged 1·5-2 and 3-4 years.

CONCLUSION

This study showed that long time spent at childcare was strongly associated with low diet quality among children aged 5-6 years, but not those aged 1·5-2 and 3-4 years. More research is needed to clarify different associations in each age group.

Life before and after COVID-19: The 'New Normal' Benefits the Regularity of Daily Sleep and Eating Routines among College Students

After the COVID-19 lockdown, a 'new normal' was established, involving a hybrid lifestyle that combined face-to-face with virtual activity. We investigated, in a case-control study, the impact of the 'new normal' on daily sleep and eating routines, compared with pre-pandemic conditions. To do this, we propose using social and eating jet lag as markers of the regularity in daily routines. Additionally, we studied whether the 'new normal' had an impact on the body mass index (BMI), diet quality, and other health-related variables. This study included 71 subjects in the pre-pandemic group, and 68 in the 'new normal' group (20-30 years). For all participants, we evaluated social and eating jet lag, BMI, diet and sleep quality, eating behaviors, physical activity, and well-being. General linear models were used to compare outcome variables between pre-pandemic and 'new normal' groups. The results revealed that the 'new normal' was associated with greater regularity in daily sleep and eating routines (-0.7 h of social jet lag (95% CI: -1.0, -0.4), and -0.3 h of eating jet lag (95% CI: -0.5, -0.1)), longer sleep duration on weekdays (1.8 h (95% CI: 1.5, 2.2)), and lower sleep debt (-1.3 h (95% CI: -1.7, -0.9)). Regarding BMI and other health-related variables, we observed that these variables were similar between 'new normal' and pre-pandemic groups. These findings indicate that the 'new normal' had a positive impact on daily sleep and eating routines. Additionally, our results indicated that the 'new normal' offered college students a more sustainable lifestyle, which was associated with more hours of sleep during the week and lower sleep debt. This, in the long run, could have a positive impact on BMI and overall health.

Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China

INTRODUCTION

Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China.

METHODS

Cross-sectional results were based on 28,048 children aged 6-17 years from the China National Nutrition and Health Surveillance in 2010-2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined.

RESULTS

The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001).

CONCLUSIONS

PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.

Emotional eating and cognitive restraint mediate the association between sleep quality and BMI in young adults

This cross-sectional study was designed to investigate whether diet quality and eating behaviors could mediate the association between sleep quality and body mass index (BMI) in young adults. For all participants (n = 925; aged 21.4 ± 2.5 years; 77.8% women) we evaluated: BMI, sleep quality, diet quality, and eating behavior dimensions (emotional eating, cognitive restraint, and uncontrolled eating). Linear regression models were used to test associations between exposure and outcome variables. Path analysis was conducted with all potential mediators and covariates entered at the same time. Results showed that emotional eating (β = 0.04 [95% CI: 0.03; 0.06]), cognitive restraint (β = 0.03 [95% CI: 0.01; 0.04]), uncontrolled eating (β = 0.02 [95% CI: 0.01; 0.04]) and diet quality (β = -0.14 [95% CI: 0.19;-0.08]) were significantly associated with sleep quality. Additionally, BMI was significantly associated with PSQI score (β = 0.09 [95% CI: 0.01; 0.17]), emotional eating (β = 0.89 [95% CI: 0.60; 1.18]), and cognitive restraint (β = 1.37 [95% CI: 1.02; 1.71]). After testing for mediation, results revealed that emotional eating and cognitive restraint evidenced a significant mediating effect on the association between sleep quality and BMI. Additionally, diet quality was significantly associated with emotional eating (β = -0.35 [95% CI: 0.56;-0.13]), cognitive restraint (β = 0.53 [95% CI: 0.27; 0.79]), and uncontrolled eating (β = -0.49 [95% CI: 0.74;-0.25]). In conclusion, young adults with poor sleep quality are more likely to deal with negative emotions with food, which, in turn, could be associated with higher cognitive restraint, becoming a vicious cycle that has a negative impact on body weight. Our results also emphasize the role of eating behaviors as determinants of diet quality, highlighting the importance of considering sleep quality and eating behaviors when designing obesity prevention strategies in this population.

Changes in Eating Habits and Lifestyles in a Peruvian Population during Social Isolation for the COVID-19 Pandemic

BACKGROUND

Peru has one of the highest infection and death rates in the world for the COVID-19 pandemic. The government implemented house confinement measures with probable consequences on lifestyle, particularly affecting eating habits, physical activity, sleep quality, and mental health.

OBJECTIVES

The aim of this study was to assess the lifestyles, physical activity, and sleep characteristics, as well as changes in eating habits in a Peruvian population during the first wave of the COVID-19 pandemic.

METHODS

A cross-sectional descriptive study was performed. We analyzed Peruvian adults based on an online self-administered questionnaire divided into sociodemographic, anthropometrics, COVID-19 diagnosis reported, lifestyle habits, and frequency of consumption of foods.

RESULTS

During confinement for COVID-19, 1176 participants were studied. Of these, most reported weight gain (1 to 3 kg) and 35.7% were overweight. The lifestyles habits showed that 54.8% reported doing physical activity and 37.2% sleep less. The Peruvian sample presented a main meal pattern of breakfast (95.7%), lunch (97.5%), and dinner (89.1%). Likewise, eating habits before and during COVID-19 pandemic showed that vegetables (OR:1.56, CI95% 1.21-200), fruit (OR: 1.42, CI95% 1.10-1.81), legumes (OR:1.67, CI95% 1.23-2.28), and eggs (OR: 2.00, CI95% 1.52-2.65) presented significant consumption increase during social isolation, while bakery products (OR: 0.74, CI95% 0.56-0.97), meat, snack, refreshment, and fast food decreased in consumption. Other foods showed no significant differences.

CONCLUSION

This study showed an important frequency of overweight and sleep changes. There was a slight increase in physical activity despite the social isolation measures and an increase in healthy eating habits; nevertheless, the majority reported gaining weight.

Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents

BACKGROUND

Inadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10-15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes.

METHODS

Cross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex.

RESULTS

The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54-1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78-2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes.

CONCLUSIONS

The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.

Comparative Study of Risk Profiles for Non-Communicable Diseases in Urban and Suburb Adolescents in Padang City (Indonesia)

Adolescence is when we still like to experiment and often develop bad habits which may lead to non-communicable diseases (NCDs) in the future. This study aimed to understand the lifestyle at risk of non-communicable diseases in adolescents that live in the urban and rural areas of Padang city. This research method is comparative descriptive with a descriptive-analytical approach, with a total sample of 788 people. The study was conducted from March 2019 to November 2019. Results: A total of 57.77% of respondents in urban areas and 69.54% of respondents in rural areas like to eat junk food. 45.35% urban respondents and 60.21% rural respondents like to consume high-sweetened beverages. 73.4% of urban respondents and 7.6% of rural respondents like to smoke. 80.6% of urban respondents and 87.8% of rural respondents lack physical activity. 59.9% of urban respondents and 49.05% of rural respondents do not like to exercise. 67% of urban respondents and 80.2% of rural respondents sleep late at night. Conclusion: The risk behavior of non-communicable diseases in rural adolescents is higher than in urban adolescents. It is recommended that parents, teachers, and health workers work together to carry out intervention activities for healthy lifestyles for all adolescents.

24-hour movement behaviour profiles and their transition in children aged 5.5 and 8 years - findings from a prospective cohort study

BACKGROUND

Time spent in movement behaviours, including physical activity (PA), sedentary behaviour (SB) and sleep, across the 24-h day may have distinct health consequences. We aimed to describe 24-h movement behaviour (24 h-MB) profiles in children and how profile membership changed from age 5.5 to 8 years.

METHODS

Children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort were asked to wear an accelerometer (ActiGraph-GT3X+) on their wrist for seven consecutive days at ages 5.5 and 8 years to measure 24 h-MB patterns. Time spent in night sleep, inactivity (proxy for SB), light PA, moderate PA (MPA), and vigorous PA (VPA) per day were calculated using the R-package GGIR 2.0. Using latent profile analyses (n = 442) we identified 24 h-MB profiles, which were given animal names to convey key characteristics. Latent transition analyses were used to describe the profile membership transition from ages 5.5 to 8 years. Associations with sex and ethnicity were examined.

RESULTS

We identified four profiles, "Rabbits" (very high-MPA/VPA, low-inactivity and average-night-sleep), "Chimpanzees" (high-MPA, low-inactivity and average-night-sleep), "Pandas" (low-PA, high-inactivity and high-night-sleep) and "Owls" (low-PA, high-inactivity and low-night-sleep), among children at both time points. At ages 5.5 and 8 years, the majority of children were classified into profiles of "Chimpanzees" (51 and 39%, respectively) and "Pandas" (24 and 37%). Half of the sample (49%), particularly "Rabbits", remained in the same profile at ages 5.5 and 8 years: among children who changed profile the predominant transitions occurred from "Chimpanzees" (27%) and "Owls" (56%) profiles to "Pandas". Sex, but not ethnicity, was associated with profile membership: compared to girls, boys were more likely to be in the "Rabbits" profile (adjusted OR [95% CI]: 3.6 [1.4, 9.7] and 4.5 [1.8, 10.9] at ages 5.5 and 8 years, respectively) and less likely to be in the "Pandas" profile (0.5 [0.3, 0.9] and 0.4 [0.2, 0.6]) at both ages.

CONCLUSIONS

With increasing age about half the children stayed in the same of four 24 h-MB profiles, while the predominant transition for the remaining children was towards lower PA, higher inactivity and longer sleep duration. These findings can aid development and implementation of public health strategies to promote better health.

STUDY REGISTRATION

This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875 .

Investigating the within-person relationships between activity levels and sleep duration using Fitbit data

The advancement of wearable technologies provides opportunities to continuously track individuals' daily activity levels and sleep patterns over extended periods of time. These data are useful in examining the reciprocal relationships between physical activity and sleep at the intrapersonal level. The purpose of this study is to test the bidirectional relationships between daily activity levels and sleep duration. The current study analyzed activity and sleep data collected from a Fitbit device as part of a 6 month employer-sponsored weight loss program. A total of 105 overweight/obese adults were included (92% female, 70% obese, and 44% Hispanic). Multilevel models were used to examine (a) whether daily active and sedentary minutes predicted that night's sleep duration and (b) whether sleep duration predicted active and sedentary minutes the following day. Potential extended effects were explored by using a 2 day average of the activity minutes/sleep duration as the predictor. No significant relationships between active minutes and sleep duration were found on a daily basis. However, having less sleep over two nights than one's usual level was associated with an increased likelihood of engaging in some physical activity the following day. There was a significant bidirectional negative association between sedentary minutes and sleep duration for both the daily and 2 day models. Data from wearable trackers, such as Fitbit, can be used to investigate the daily within-person relationship between activity levels and sleep duration. Future studies should investigate other sleep metrics that may be obtained from wearable trackers, as well as potential moderators and mediators of daily activity levels and sleep.

Prediction model for abnormal eating behaviour among hospital nurses: A structural equation modelling approach

BACKGROUND

Nurses are at a high risk of developing abnormal eating behaviour. However, few studies have attempted to identify the factors that influence such behaviour.

AIM

This study identifies factors that can predict abnormal eating behaviour in hospital nurses.

DESIGN

This study adopted a cross-sectional, descriptive correlational research design.

METHODS

A literature review was used to establish a hypothetical model, comprising the eight factors of shift work, job stress, depression, sleep quality, fatigue, coping strategy (active coping and passive coping) and abnormal eating behaviour. A convenience sample of 298 nurses aged less than 45 was recruited from two university hospitals, and structured questionnaire was administered between March and April 2017. The hypothesized model was tested using structural equation modelling.

RESULTS

Sleep quality and passive coping directly affect abnormal eating behaviour, which implies that poor sleep quality and increased passive coping worsens the behaviour. Shift work and depression indirectly affect abnormal eating behaviours.

CONCLUSION

Nursing managers and health policy makers should adopt strategies such as improving the shift-work pattern, providing adequate rest time after a night shift and enabling coping strategies by providing educational programs for hospital nurses.

Association between Short Hours of Sleep and Overweight/Obesity in Mexican Adolescent Population: A School-Based Cross-Sectional Study

Background/Aim: Obesity in adolescents is increasing; as such, the aim of this study was to determine the prevalence of obesity in Mexican adolescents and examine its possible association with hours of sleep. Methods: A school-based cross-sectional study was carried out. This study included 863 adolescents aged between 11 and 16 years. The prevalence of obesity was estimated using the body mass index (BMI). The duration of sleep (and other information) was assessed by a self-reported questionnaire. The Cochran–Mantel–Hansel test for categorical variables and a general linear model for continuous variables were used to evaluate the interaction effect of BMI and sex with respect to sleeping and assessed activity conditions. Results: It was found that 47.6% of the adolescents were overweight/obese. Men were more frequently overweight/obese than women (52.6% vs. 41.8%, p = 0.002). Moreover, overweight/obese adolescents were younger and spent fewer daily hours watching television (p < 0.05). Men practiced sports more hours per week than women (p = 0.04). However, women spent more daily time on the internet (p = 0.05), and overweight/obese adolescent women slept fewer hours than overweight/obese men and adolescents with normal weight (p = 0.008). Conclusions: The development of strategies for the prevention of overweight/obesity and the improvement of sleep duration should include a gender perspective to improve health habits in Mexican adolescents.

Relationships of physical activity and sedentary behaviour with the previous and subsequent nights' sleep in children and youth: A systematic review and meta-analysis

The interrelationships between sleep and daytime movement behaviours have been examined at interindividual level. Studies of within-person, temporal relationships of daytime physical activity (PA) and sedentary behaviour with the previous and subsequent nights' sleep are increasing. The present systematic review and meta-analysis synthesised the results of studies in school-aged children and youth. Eight databases (MEDLINE, PsycINFO, EMBASE, Global Health, PubMed, Web of Science, SPORTDiscus, and CINAHL) were searched for peer-reviewed articles that examined the association between daytime movement behaviours (including PA, sedentary time, or sedentary recreational screen time) and night-time sleep on the same day, or the association between night-time sleep and daytime movement behaviours the next day, in children and youth. A total of 11 studies comprising 9,622 children and youth aged 5-15 years met the inclusion criteria. Sedentary time was negatively associated with the subsequent night's sleep duration (r = -0.12, 95% confidence interval -0.23 to -0.00; I²  = 93%; p = .04). Positive relationships between PA and the previous or subsequent night's sleep duration were observed only for studies that adjusted for accelerometer wear time. There was some evidence suggesting that a longer sleep duration was associated with less sedentary time and a higher proportion of the daytime spent being physically active and vice versa, although the association was weak and based on a limited number of studies. From a clinical perspective, promotion of either sleep hygiene or daytime PA should be planned with considerations of the virtuous or vicious circle between these behaviours and monitor concurrent effects on the others.