Abstract
Objective: To investigate the association of sleep duration with adiposity and to determine if caloric intake and physical activity mediate this relationship.
Methods: The Quebec Adiposity and Lifestyle Investigation in Youth (QUALITY) study is an ongoing longitudinal investigation of Caucasian children with at least one obese biological parent. Children (n=550) with an average age of 9.6 years (SD=0.9) who provided complete data at baseline were included in the cross-sectional analyses. Objective measures of adiposity (BMI Z-score, waist circumference, percent body fat measured by dual-energy X-ray absorptiometry), sleep duration and physical activity (accelerometer over 7 days), and diet (24-hour food recalls) were collected. Children were categorized into 4 groups according to sleep duration: <10 hours, 10–10.9 hours, 11–11.9 hours, and ≥12 hours of sleep per night.
Results: We observed a U-shaped relationship between sleep duration and all adiposity indices. None of energy intake, snacking, screen time or physical activity intensity differed significantly between sleep categories. After adjusting for age, sex, Tanner stage, highest educational level of the parents, total annual family income, and parental BMI, only short-duration sleepers (<10 hours) had an increased odds of overweight/obesity (OR 2.08, 95% CI 1.16–3.67). Addition of total energy intake and physical activity to the model did not change the association substantially (OR 2.05, 95% CI 1.15–3.63).
Conclusion: The present study provides evidence that short sleep duration is a risk factor for overweight and obesity in children, independent of potential covariates. These results further emphasize the need to add sleep duration to the determinants of obesity.
Keywords: Adiposity, body mass index, body weight, children, energy balance, sleep loss, sleep deprivation
Résumé
Objectif: Cette étude avait pour but d’investiguer la relation entre la durée du sommeil et les indices d’adiposité et de déterminer si l’apport calorique et la pratique d’activité physique sont des médiateurs de cette relation.
Méthodologie: L’étude QUALITY (Quebec Adiposity and Lifestyle Investigation in Youth) est une étude longitudinale chez des enfants caucasiens qui ont au moins un parent biologique obèse. Les enfants (n=550) avec une moyenne d’âge de 9,6 ans (déviation standard: 0.9 ans) et chez qui des données complètes ont été obtenues ont été inclus dans les analyses transversales. Des mesures objectives d’adiposité (score Z d’indice de masse corporelle, circonférence de la taille et pourcentage de gras mesuré par absorption bi-photonique à rayons X), du temps de sommeil et d’activité physique (accéléromètre sur une période de 7 jours) et de la diète (rappels alimentaires de 24 heures) ont été collectées. Les enfants ont été catégorisés dans 4 groupes selon leur durée de sommeil: <10 heures, 10–10.9 heures, 11–11.9 heures et ≥12 heures de sommeil par nuit.
Résultats: Nous avons observé une relation en forme de U entre la durée du sommeil et tous les indices d’adiposité. L’apport énergétique, le nombre de collations, le temps devant l’écran et l’intensité de l’activité physique ne différaient pas de façon significative entre les catégories de sommeil. Après ajustement pour l’âge, le sexe, les stages de Tanner, le niveau d’éducation des parents, le revenu annuel total des parents et l’indice de masse corporelle des parents, seulement les petits dormeurs (<10 heures) avaient un risque accru d’être en surpoids ou obèse (rapport des cotes (RC) 2.08, intervalle de confiance à 95% 1,16–3,67). L’addition de l’apport énergétique total et de la pratique d’activité physique au modèle statistique n’a pas changé l’association de façon importante (RC 2,05, IC 95% 1,15–3,63).
Conclusion: La présente étude montre qu’une courte durée de sommeil est un facteur de risque de surpoids et d’obésité chez les enfants, indépendamment des variables confondantes potentielles. Ces résultats renforcent le besoin d’ajouter la durée du sommeil dans la liste des déterminants de l’obésité.
Motsclés: adiposité, indice de masse corporelle, poids corporel, enfants, balance énergétique, manque de sommeil, restriction du sommeil
Footnotes
Acknowledgements: The research team is grateful to all the children and their families who took part in this study as well as the technicians, research assistants and coordinators involved in the QUALITY cohort project.
Sources of Funding: This study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada and Fonds de la Recherche en Santé du Québec. JPC holds a Junior Research Chair in Healthy Active Living and Obesity Research. JOL holds a Canada Research Chair in the Early Determinants of Adult Chronic Disease. AT holds a Canada Research Chair in Environment and Energy Balance.
Conflict of Interest: None to declare.
References
- 1.Nielsen LS, Danielsen KV, Sørensen TI. Short sleep duration as a possible cause of obesity: Critical analysis of the epidemiological evidence. Obes Rev. 2011;12:78–92. doi: 10.1111/j.1467-789X.2010.00724.x. [DOI] [PubMed] [Google Scholar]
- 2.Patel SR. Reduced sleep as an obesity risk factor. Obes Rev. 2009;10(Suppl2):61–68. doi: 10.1111/j.1467-789X.2009.00664.x. [DOI] [PubMed] [Google Scholar]
- 3.Brondel L, Romer MA, Nougues PM, Touyarou P, Davenne D. Acute partial sleep deprivation increases food intake in healthy men. Am J Clin Nutr. 2010;91:1550–59. doi: 10.3945/ajcn.2009.28523. [DOI] [PubMed] [Google Scholar]
- 4.Spiegel K, Tasali E, Leproult R, Van Cauter E. Effects of poor and short sleep on glucose metabolism and obesity risk. Nat Rev Endocrinol. 2009;5:253–61. doi: 10.1038/nrendo.2009.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846–50. doi: 10.7326/0003-4819-141-11-200412070-00008. [DOI] [PubMed] [Google Scholar]
- 6.Chaput JP. Short sleep duration promoting overconsumption of food: A reward-driven eating behavior? Sleep. 2010;33:1135–36. doi: 10.1093/sleep/33.9.1135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Chaput JP, Klingenberg L, Astrup A, Sjödin AM. Obes Rev. 2011. Modern sedentary activities promote overconsumption of food in our current obesogenic environment. [DOI] [PubMed] [Google Scholar]
- 8.Nishiura C, Noguchi J, Hashimoto H. Dietary patterns only partially explain the effect of short sleep duration on the incidence of obesity. Sleep. 2010;33:753–57. doi: 10.1093/sleep/33.6.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Patel SR, Malhotra A, White DR, Gottlieb DJ, Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164:947–54. doi: 10.1093/aje/kwj280. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Chaput JP, Després JP, Bouchard C, Tremblay A. The association between sleep duration and weight gain in adults: A 6-year prospective study from the Quebec Family Study. Sleep. 2008;31:517–23. doi: 10.1093/sleep/31.4.517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.The Airlie (VA) Consensus Conference. In: Lohman TG, Roche AF, Martorell R (Eds.), Standardization of Anthropometric Measurements. Champaign, IL: Human Kinetics Publishers, 1988;39–80.
- 12.Centers for Disease Control. Growth chart training. 2000. [Google Scholar]
- 13.Sadeh A. The role and validity of actigraphy in sleep medicine: An update. Sleep Med Rev. 2011;15:259–67. doi: 10.1016/j.smrv.2010.10.001. [DOI] [PubMed] [Google Scholar]
- 14.National Sleep Foundation. How much sleep do we really need? Available at: http://www.sleepfoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-need (Accessed May 2011).
- 15.Obarzanek E, Kimm SY, Barton BA, Van Horn LL, Kwiterovich PO, Jr, Simons-Morton DG, et al. Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: Seven-year results of the Dietary Intervention Study in Children (DISC) Pediatrics. 2001;107:256–64. doi: 10.1542/peds.107.2.256. [DOI] [PubMed] [Google Scholar]
- 16.The Canadian Nutrient File. Health and Welfare Canada. 2007. [Google Scholar]
- 17.Colley R, Gorber SC, Tremblay MS. Quality control and data reduction procedures for accelerometry-derived measures of physical activity. Health Rep. 2010;21:63–69. [PubMed] [Google Scholar]
- 18.Puyau MR, Adolph AL, Vohra FA, Butte NF. Validation and calibration of physical activity monitors in children. Obes Res. 2002;10:150–57. doi: 10.1038/oby.2002.24. [DOI] [PubMed] [Google Scholar]
- 19.Esliger DW, Tremblay MS. Technical reliability assessment of three accelerom-eter models in a mechanical setup. Med Sci Sports Exerc. 2006;38:2173–81. doi: 10.1249/01.mss.0000239394.55461.08. [DOI] [PubMed] [Google Scholar]
- 20.Allison PD. Logistic regression using SAS–Theory and application. SAS Institute and Wiley. 2001. [Google Scholar]
- 21.Chaput JP, Klingenberg L, Sjödin AM. Do all sedentary activities lead to weight gain: Sleep does not. Curr Opin Clin Nutr Metab Care. 2010;13:601–7. doi: 10.1097/MCO.0b013e32833ef30e. [DOI] [PubMed] [Google Scholar]
- 22.Chaput JP, Brunet M, Tremblay A. Relationship between short sleeping hours and childhood overweight/obesity: Results from the “Québec en Forme” Project. Int J Obes. 2006;30:1080–85. doi: 10.1038/sj.ijo.0803291. [DOI] [PubMed] [Google Scholar]
- 23.Chaput JP, Leblanc C, Pérusse L, Després JP, Bouchard C, Tremblay A. Risk factors for adult overweight and obesity in the Quebec Family Study: Have we been barking up the wrong tree? Obesity. 2009;17:1964–70. doi: 10.1038/oby.2009.116. [DOI] [PubMed] [Google Scholar]
- 24.Danielsen YS, Pallesen S, Stormark KM, Nordhus IH, Bjorvatn B. The relationship between school day sleep duration and body mass index in Norwegian children (aged 10–12) Int J Pediatr Obes. 2010;5:214–20. doi: 10.3109/17477160903473739. [DOI] [PubMed] [Google Scholar]
- 25.Chaput JP, Després JP, Bouchard C, Astrup A, Tremblay A. Sleep duration as a risk factor for the development of type 2 diabetes or impaired glucose tolerance: Analyses of the Quebec Family Study. Sleep Med. 2009;10:919–24. doi: 10.1016/j.sleep.2008.09.016. [DOI] [PubMed] [Google Scholar]
- 26.King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS. Short sleep duration and incident coronary artery calcification. JAMA. 2008;300:2859–66. doi: 10.1001/jama.2008.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Knutson KL, Van Cauter E, Rathouz P, Yan LL, Hulley SB, Liu K, et al. Association between sleep and blood pressure in midlife: The CARDIA Sleep Study. Arch Intern Med. 2009;169:1055–61. doi: 10.1001/archinternmed.2009.119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Gallicchio L, Kalesan B. Sleep duration and mortality: A systematic review and meta-analysis. J Sleep Res. 2009;18:148–58. doi: 10.1111/j.1365-2869.2008.00732.x. [DOI] [PubMed] [Google Scholar]
- 29.Nedeltcheva AV, Kilkus JM, Imperial J, Kasza K, Schoeller DA, Penev PD. Sleep curtailment is accompanied by increased intake of calories from snacks. Am J Clin Nutr. 2009;89:126–33. doi: 10.3945/ajcn.2008.26574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Weiss A, Xu F, Storfer-Isser A, Thomas A, Ievers-Landis CE, Redline S. The association of sleep duration with adolescents’ fat and carbohydrate consumption. Sleep. 2010;33:1201–9. doi: 10.1093/sleep/33.9.1201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Schmid SM, Hallschmid M, Jauch-Chara K, Wilms B, Benedict C, Lehnert H, et al. Short-term sleep loss decreases physical activity under free-living conditions but does not increase food intake under time-deprived laboratory conditions in healthy men. Am J Clin Nutr. 2009;90:1476–82. doi: 10.3945/ajcn.2009.27984. [DOI] [PubMed] [Google Scholar]