Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children

[Relationship between diet, nutritional aspects and sleep quality in a pediatric population]

Introduction

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the "unhealthy fast food" or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. "Unhealthy" dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.

Physical activity and sleep changes among children during the COVID-19 pandemic

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann-Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data were collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1655 steps. Sleep onset and wake time were delayed by about an hour and 45 min, respectively, while sleep duration decreased by over 12 min as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. Trial Registration: Clinical trial registration: NCT03339440.

The effect of childhood depression trajectories on sugar-sweetened beverage habit trajectories in adolescence: Exploring sleep problems as a mediator

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04-1.77), high-stable (aOR = 2.01; CI: 1.28-3.15), or increasing (aOR = 1.97; CI: 1.26-3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review

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.

Physical activity and sleep changes among children with obesity during a period of school closures related to the COVID-19 pandemic

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data was collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1,655 steps. Sleep onset and wake time were delayed by about an hour and 45 minutes, respectively, while sleep duration decreased by over 12 minutes as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. We demonstrate the utility of wearable sensors in objectively measuring longitudinal physical activity and sleep behavior patterns in children with obesity and in quantifying changes in their health behaviors due to disruption of structured, daily routines following in-person school closures during the COVID-19 pandemic.

Trial Registration

Clinical trial registration: NCT03339440.

Low Sleep Hygiene Is Associated with Less Adherence to the Mediterranean Diet in Chilean Schoolchildren from Rural Public Schools-A Cross-Sectional Study

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.

Association between visual impairment and sleep duration in college students: A study conducted in UAE and Lebanon

Objective: To examine whether self-reported sleep duration and visual impairment were associated among College students. Participants: Students (n = 1002, age 17-35 years) from Lebanon and the United Arab Emirates. Methods: Students were asked to complete a validated questionnaire between October 2018 and May 2019. The questions were related to sociodemographics, lifestyle characteristics, visual impairment status, sleeping pattern, mobile-phone use and chronic conditions. Results: 18.3% of the respondents reported to suffer from visual impairment. Among them, 72.7% were females (p < .001), 65% admitted to frequently use mobile phones before sleeping (p < .001), 54.6% reported to sleep less than 7 h (p = .008) and 71.6% reported to suffer from sleep disturbances (p = .05). Visual impairment was associated with poor sleep quality (p < .001), mobile phone use before sleeping (p < .01) and daily stress (p < .05). Conclusion: Visual impairment in college students is associated with short sleep duration, mobile phone use before sleeping and stress level.

Unprecedented times and uncertain connections: A systematic review examining sleep problems and screentime during the COVID-19 pandemic

Objective

Sleep has been impacted by the COVID-19 pandemic around the world. Furthermore, screen time has been reported to influence sleep and has increased during pandemic quarantines. This systematic review searched databases to determine if screen time affected sleep during the COVID-19 pandemic.

Methods

PubMed, Nursing and Allied Health Proquest, and Science Direct Health and Lifescience college edition were searched for articles that fit the inclusion criteria. There were 2750 articles initially screened. Then, 119 articles were further assessed to determine eligibility, creating a final sample of 18 articles that explored whether screen time affected sleep.

Results

After reviewing the included articles (n = 18), the main theme revealed that screen time negatively affected sleep during the COVID-19 pandemic, specifically aspects such as sleep duration, sleep quality, sleep onset latency, and wake time. However, several articles countered this implication. Therefore, it is important to consider other factors that may influence the relationship between screen time and sleep.

Conclusions

Although the number of articles included is limited, the overall synthesis suggests that COVID-19-related lifestyle changes, such as increased screen time, may negatively affect sleep health. However, other unidentified factors may have contributed to these findings and warrant further research. Nonetheless, community leaders must consider the long-term consequences of the pandemic and implement initiatives to address sleep challenges due to the intricate connection between sleep and well-being.

Adiposity in preadolescent children: Associations with cardiorespiratory fitness

Lifestyle factors contribute to childhood obesity risk, however it is unclear which lifestyle factors are most strongly associated with childhood obesity. The purpose of this cross-sectional study was to simultaneously investigate the associations among dietary patterns, activity behaviors, and physical fitness with adiposity (body fat %, fat mass, body mass index [BMI], and waist to hip ratio) in preadolescent children. Preadolescent children (N = 392, 50% female, age: 9.5 ± 1.1year, BMI: 17.9 ± 3.3 kg/m2) were recruited. Body fat (%) and fat mass (kg) were measured with bioelectrical impedance analysis. Cardiorespiratory fitness (VO2 max), muscular strength (hand-grip strength), activity, sleep, and dietary pattern was assessed. Multivariable analysis revealed that cardiorespiratory fitness associated most strongly with all four indicators of adiposity (body fat (%) (β = -0.2; p < .001), fat mass (β = -0.2; p < .001), BMI (β = -0.1; p < .001) and waist to hip ratio (β = -0.2; p < .001). Additionally, fruit and vegetable consumption patterns were associated with body fat percentage, but the association was negligible (β = 0.1; p = 0.015). Therefore, future interventions should aim to promote the use of cardiorespiratory fitness as a means of reducing the obesity epidemic in children.

Timing of sedentary behaviour and access to sedentary activities in the bedroom and their association with sleep quality and duration in children and youth: a systematic review

BACKGROUND

The purpose of this study was to systematically review the relationship between the timing of sedentary behaviours and access to sedentary activities in the bedroom with sleep duration and quality in children and youth. A secondary purpose was to examine whether these relationships differ when comparing screen-based and non-screen-based sedentary activities.

METHODS

We searched four databases for peer-reviewed studies published between 1 January 2010 and 19 January 2021. Risk of bias assessment for each study and certainty of evidence were assessed using the GRADE framework.

RESULTS

We identified 44 eligible papers reporting data from 42 separate datasets and including 239 267 participants. Evening participation in screen-based sedentary behaviours and access to screen-based devices in the bedroom were associated with reduced sleep duration and quality. Daytime screen use was also associated with reduced sleep duration, although this was examined in relatively few studies. Whether performed during the day or night, non-screen-based sedentary behaviours were not consistently associated with sleep duration or quality. The quality of evidence was rated as low to very low for all outcomes.

CONCLUSION

In order to maximize sleep duration and quality, children and youth should be encouraged to minimize screen time in the evening and remove screens from bedrooms. (PROSPERO registration no.: CRD42020189082).

Association between Free Sugars Intake and Excessive Daytime Sleepiness among Chinese Adolescents

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.

Is the physical activity environment surrounding primary schools associated with students' weight status, physical activity or active transport, in regional areas of Victoria, Australia? A cross-sectional study

OBJECTIVES

To explore whether the physical activity (PA) environment (walkability, greenspace and recreational facilities) surrounding regional primary schools is associated with children's PA levels, active transport and weight status. Limited research on this topic has been conducted outside of major cities.

DESIGN

Cross-sectional ecological study using baseline data from two large-scale obesity prevention interventions.

SETTING

Eighty (n=80) primary schools across two regional areas in Victoria, Australia.

PARTICIPANTS

Students aged 8-13 years (n=2144) attending participating primary schools.

OUTCOME MEASURES

Measured weight status (body mass index z-score, proportion overweight/obese) and self-reported PA behaviours (meeting PA recommendations and active travel behaviour).

RESULTS

When adjusted for student and school demographics, students had significantly increased odds of using active transport to or from school when the school neighbourhood was more walkable (OR 1.21 (95% CI 1.09 to 1.35), had a greater number of greenspaces (OR 1.35 (95% CI 1.20 to 1.53)) and a greater number of recreational facilities (OR 1.18 (95% CI 1.07 to 1.31)). A higher cumulative PA environment score was also associated with a higher proportion of children using active transport (OR 1.33 (95% CI 1.28 to 1.51)). There were no significant associations between the PA environment measures and either weight status or meeting the PA recommendations in adjusted models.

CONCLUSIONS

This study is the first of its kind exploring school neighbourhood environments and child weight status and PA in regional areas of Australia. It highlights the potential of the environment surrounding primary schools in contributing to students' active travel to and from school. Further research with the use of objective PA measurement is warranted in regional areas that have been under-researched.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437; Results.

Association between diet and sleep quality: A systematic review

Dietary habits are considered a leading behavioral risk factor for human health. There is growing scientific evidence suggesting that diet and sleep may be related. The aim of this study was to review the evidence of association between diet and sleep quality. A systematic search in electronic databases PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials was conducted from their inception to November 2019. Studies investigating parameters of diet quality (including dietary patterns or individual healthy/unhealthy foods) and sleep quality (assessed through self-reported or objective methods) were included. The NIH Quality Assessment Tools were used to evaluate the study quality. Twenty-nine studies were reviewed: in summary, consumption of healthy foods was associated with better sleep quality, while higher intake of processed and free-sugar rich foods was associated with worse sleep features. Despite a certain consistency between studies have been observed, the overall poor-to-fair quality of study design (mostly represented by cross-sectional investigations) does not allow to conclude a causal relation. However, diet-related variables are associated with sleep quality, but further studies are needed to corroborate this finding.

Prevalence and Predictors of Overweight and Obesity among Young Children in the Children's Healthy Living Study on Guam

This study is part of the Children's Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2-8 years) were recruited via community-based sampling from select communities in Guam. Children's demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves 'integrated' into the culture were 2.05 (CI 0.81-5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2-8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam.