Habitual sleep variability, not sleep duration, is associated with caloric intake in adolescents

doi:10.1016/j.sleep.2015.03.004

Sleep Medicine

Volume 16, Issue 7, July 2015, Pages 856-861

https://doi.org/10.1016/j.sleep.2015.03.004 Get rights and content

Highlights

•
The association between sleep pattern and energy intake in adolescents is unclear.
•
Habitual sleep duration is not associated with caloric intake or food consumption.
•
High sleep variability is related to higher energy intake and snack consumption.
•
Maintaining a regular sleep pattern may reduce the risk of obesity in adolescents.

Abstract

Objective

The objective of this study was to investigate the associations between objectively measured habitual sleep duration (HSD), habitual sleep variability (HSV), and energy and snack intake in adolescents.

Methods

We used data from 324 adolescents who participated in the Penn State Child Cohort follow-up examination. Actigraphy was used over seven consecutive nights to estimate nightly sleep duration. The seven-night mean and standard deviation of sleep duration were used to represent HSD and HSV, respectively. The Youth/Adolescent Food Frequency Questionnaire was used to obtain the daily average total energy, protein, fat, and carbohydrate intake, and number of snacks consumed. Linear regression models were used to investigate the associations between habitual sleep patterns and caloric, protein, fat, and carbohydrate intake. Proportional odds models were used to associate habitual sleep patterns with snack consumption.

Results

After adjusting for age, sex, race, body mass index (BMI) percentile, and smoking status, an increased HSV was associated with a higher energy intake, particularly from fat and carbohydrate. For example, with a 1-h increase in HSV, there was a 170 (66)-kcal increase in the daily total energy intake. An increased HSV was also related to increased snack consumption, especially snacks consumed after dinner. For instance, a 1-h increase in HSV was associated with 65% and 94% higher odds of consuming more snacks after dinner during school/workdays and weekends/vacation days, respectively. Neither energy intake nor snack consumption was significantly related to HSD.

Conclusion

High habitual sleep variability, not habitual sleep duration, is related to increased energy and food consumption in adolescents. Maintaining a regular sleep pattern may decrease the risk of obesity in adolescents.

Introduction

Pediatric obesity is becoming a global epidemic [1]. In 2010, 43 million children were estimated to be overweight and obese worldwide. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010, and this is projected to reach 9.1% in 2020 [2]. Not only is childhood obesity prevalent, but it is also a risk factor for increased morbidity and premature mortality in adulthood [3]. Concurrent with the epidemic of childhood obesity is a marked increase in sleep disturbances and deprivation. Therefore, sleep duration has attracted attention as a potential novel risk factor for obesity in children. However, the majority of the previous studies reported the association between subjectively reported sleep duration and obesity [4], [5], [6], [7]. As subjectively measured sleep duration is weakly correlated to objectively measured sleep duration [8], it may not represent the actual sleep duration but it may serve as a surrogate marker of stress and depression [9]. Therefore, the observed association between subjectively measured short sleep duration and obesity may be partially confounded by participants' psychological profiles [10], [11]. On the other hand, previous literature reported an inconsistent relationship between objectively measured sleep duration, a quantitative assessment of the actual sleep duration, and obesity [10], [11], [12], [13], [14], [15].

Meanwhile, excessive food consumption is considered as a primary behavioral contributing factor to the pediatric obesity epidemic. As energy intake is in excess of energy expenditure, a positive energy balance occurs. The cumulative impact of sustained positive energy balance results in weight gain, and this may lead to obesity [16]. In the last decade, several short-term interventional studies have consistently found a significant association between objectively measured sleep duration and energy intake [17], [18], [19]. However, these studies may not be generalized to real life.

With the increasing availability of actigraphy for multiple nights of sleep measurements, objectively measured habitual sleep pattern, including both sleep duration and sleep duration variability, has been used in observational sleep studies [20], [21], [22], [23]. Among these studies, Kjeldsen and coworkers reported that both sleep duration and sleep duration variability were related to the dietary risk factor for obesity in Danish schoolchildren [23]. Therefore, it is plausible that an increased variability in sleep duration may contribute to an unhealthy food consumption behavior. To date, it is the only study that examined the relationship between objectively measured sleep duration variability and food intake.

Therefore, we carried out this study to investigate the association between objectively measured habitual sleep duration (HSD), habitual sleep variability (HSV), and energy intake and snack consumption in a population-based sample of healthy adolescents.

Section snippets

Population

We used the available data from 421 adolescents who completed the follow-up examination of the Penn State Child Cohort (PSCC) study. Recruitment methods and examination procedures for the PSCC baseline study have been published elsewhere [24]. A total of 700 children aged 6–12 years participated in the baseline examination conducted in 2002–2006. Among the 700 subjects, 421 returned and completed the follow-up examination during 2010–2013, yielding a response rate of 60%. The loss to follow-up

Demographic characteristics of the sample

Demographic information of the study population is summarized in Table 1. The mean (SD) age of this sample of adolescents was 16.7 (2.3) years. Of the subjects, 53% were male and 79% were whites. Of the adolescents in our sample, 8.7% use tobacco products. The average HSD was 7.0 (0.8) h, with an intra-subject variability of 1.2 h. On average, the participants slept 0.3 h longer during weekend/vacation days than during school/workdays. Such a difference in sleep duration between workdays and

Discussion

Although it has been documented in previous studies that self-reported sleep deprivation is related to obesity in both adults and children [4], [5], [6], [7], [10], [28], [29], inconsistent evidence was found between objectively measured sleep duration and obesity [10], [11], [12], [13], [14], [15]. Two studies found significant associations [14], [15], but the majority of the studies reported a lack of association between objectively measured sleep duration and obesity [10], [11], [12], [13].

Conclusions

In summary, we found that an increased HSV, but not HSD, was significantly associated with increased energy intake, particularly from fats and carbohydrates, in this population-based sample of adolescents. Adolescents with a high HSV were likely to consume more snacks, especially at nighttime. These relationships indicated that an irregular habitual sleep pattern, consisting of shorter and longer night sleep, is associated with an unhealthy behavior in energy and food intake, especially after

Funding sources

This work is supported by the National Institutes of Health (NIH) grant: 1 R01 HL 097165, R01 HL63772, R21 HL087858; and by the Penn State Clinical and Translational Science Institute (CTSI) grant: UL Tr000127. The content is solely the responsibility of the authors, and it does not necessarily represent the official views of the NIH.

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.03.004.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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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.
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Short-term individual-level and intermediate-term residential-level PM_2.5 exposures are adversely and synergistically associated with increased sleep variability, an indicator of instability of sleep quantity, in adolescents. Through such an association with sleep pattern, PM_2.5 air pollution may increase long-term cardiometabolic risks.
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In this literature review, we discuss the importance of adequate sleep and the various effects of suboptimal sleep on weight maintenance and metabolic health specifically for adolescents. Two major contributors to adolescents experiencing decreased sleep duration and quality, and thus increasing the risk for developing metabolic syndrome in adolescence as well as later in adulthood, are increased electronic screen time particularly at night and early school start times. The less time adolescents spend sleeping, the less quality sleep they obtain, and the greater the disruption of endocrine hormone function. As another consequence, adolescents are more prone to making poor food choices, from choosing relatively nutrient-poor foods to consuming excess calories without necessarily increasing their energy expenditure. These choices put adolescents at greater risk for becoming obese throughout their lifespan.
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Original ArticleHabitual sleep variability, not sleep duration, is associated with caloric intake in adolescents

Highlights

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Population

Demographic characteristics of the sample

Discussion

Conclusions

Funding sources

Conflict of interest

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Psychoneuroendocrinology

Sleep Med

J Am Diet Assoc

Prev Med

Nutrition

Brain Res Bull

Am J Clin Nutr

J Am Acad Child Adolesc Psychiatry

Worldwide trends in childhood overweight and obesity

Int J Pediatr Obes

Risks and consequences of childhood and adolescent obesity

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Original Article
Habitual sleep variability, not sleep duration, is associated with caloric intake in adolescents