Nighttime sleep duration and hedonic eating in childhood

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Abstract

Background: Higher food intake is implicated in the elevated risk of obesity associated with shorter sleep in children, but the mechanisms driving higher intake are uncertain. Research in adults suggests that acute sleep deprivation affects brain reward systems, which increases responsiveness to palatable foods. However, there have been few studies addressing habitual sleep duration, and few in children, among whom the strongest associations with body mass index (BMI) are seen. Objective: The objective of this study is to test the hypothesis that shorter-sleeping children are more food responsive and explore the mediation of the relationship between sleep and weight by food responsiveness (FR). Methods: Participants were families from Gemini, a UK twin birth cohort, who had provided complete information on their children's sleep and appetite at age 5 years (n=1008). One child from each twin pair was randomly selected for analyses. Nighttime sleep duration was calculated from parent-reported bedtime and wake time, and categorised as shorter, adequate or longer according to age-specific reference values. FR was assessed with the Child Eating Behaviour Questionnaire. BMI s.d. scores (BMI-SDS) were calculated from parent-measured heights and weights using the UK 1990 reference data and were available for 494 children. Results: There was a significant linear association between shorter sleep and higher FR at age 5 years (P for linear trend=0.032), which was maintained after adjusting for age, sex, birth weight, maternal education and BMI-SDS. In the subset with BMI data at age 5 years, shorter sleep was associated with higher BMI-SDS (P=0.026) as expected. Testing for mediation by adding FR to the model attenuated the linear relationship to borderline significance (P=0.049), suggesting partial mediation. Conclusions: Shorter sleep in childhood is associated with higher FR, which may partly explain the association between shorter sleep and adiposity in childhood.

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Statistical mediation analysis with a multicategorical independent variable.

Andrew Hayes, Kristopher J Preacher (2014)

Virtually all discussions and applications of statistical mediation analysis have been based on the condition that the independent variable is dichotomous or continuous, even though investigators frequently are interested in testing mediation hypotheses involving a multicategorical independent variable (such as two or more experimental conditions relative to a control group). We provide a tutorial illustrating an approach to estimation of and inference about direct, indirect, and total effects in statistical mediation analysis with a multicategorical independent variable. The approach is mathematically equivalent to analysis of (co)variance and reproduces the observed and adjusted group means while also generating effects having simple interpretations. Supplementary material available online includes extensions to this approach and Mplus, SPSS, and SAS code that implements it. © 2013 The British Psychological Society.

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Meta-analysis of short sleep duration and obesity in children and adults.

Francesco Cappuccio, Frances M. Taggart, Ngianga-Bakwin Kandala … (2008)

Recent epidemiological studies suggest that short sleep duration may be associated with the development of obesity from childhood to adulthood. To assess whether the evidence supports the presence of a relationship between short sleep duration and obesity at different ages, and to obtain an estimate of the risk. We performed a systematic search of publications using MEDLINE (1996-2007 wk 40), EMBASE (from 1988), AMED (from 1985), CINHAL (from 1982) and PsycINFO (from 1985) and manual searches without language restrictions. When necessary, authors were contacted. Criteria for inclusion were: report of duration of sleep as exposure, BMI as continuous outcome and prevalence of obesity as categorical outcome, number of participants, age, and gender. Results were pooled using a random effect model. Sensitivity analysis was performed, heterogeneity and publication bias were also checked. Results are expressed as pooled odds ratios (OR [95% confidence intervals, CIs]) and as pooled regression coefficients (beta; 95% CIs). Of 696 studies identified, 45 met the inclusion criteria (19 in children and 26 in adults) and 30 (12 and 18, respectively) were pooled in the meta-analysis for a total of 36 population samples. They included 634,511 participants (30,002 children and 604,509 adults) from around the world. Age ranged from 2 to 102 years and included boys, girls, men and women. In children the pooled OR for short duration of sleep and obesity was 1.89 (1.46 to 2.43; P < 0.0001). In adults the pooled OR was 1.55 (1.43 to 1.68; P < 0.0001). There was no evidence of publication bias. In adults, the pooled beta for short sleep duration was -0.35 (-0.57 to -0.12) unit change in BMI per hour of sleep change. Cross-sectional studies from around the world show a consistent increased risk of obesity amongst short sleepers in children and adults. Causal inference is difficult due to lack of control for important confounders and inconsistent evidence of temporal sequence in prospective studies.