Ashley Hardy

Evidence Based Question #2

NUTR 780
May 2, 2017

The Impact of Short Sleep Duration on Childhood Weight Status

During the first decade of life, infants and children are recommended to sleep 12

to 19 hours per night, depending on their age.1 Children receiving less or more sleep than

recommended have been shown to have poorer attention, behavior, and memory

retention than those that meet the recommendations.1 Researchers have also considered

inadequate sleep duration as a potential risk factor for childhood obesity. Sleep plays an

essential role in many physiological functions that also influence weight status including

hormonal regulation, metabolism, and behavior.2 Evidence has shown that shortened

sleep duration is correlated with higher body mass index (BMI) and greater obesity risk in

children during the first decade of life.

Early childhood is a critical time for the development of rhythmic sleep patterns

and may play a role in the development of body composition.3 To study the relationship

between early childhood sleep duration and weight status, Diethelm et al conducted a

prospective cohort study following 481 children. Researchers collected data on sleep

duration from children’s parents at 1.5 and 2 years of age. Subjects were grouped

according to sleep patterns as “consistently short sleep duration” (CS), “inconsistent sleep

duration” (I) or “consistently long sleep duration” (CL). Weight status was determined by

measuring weight and length and was defined according to the World Health

Organization's z-score BMI for sex and age. Anthropometrics were collected at age two

and again at age seven to determine change in BMI over time. Subjects in the CS group

had slightly greater BMI compared to the I and CS groups at age two (p=.07) and at age

seven (p=.06) but the results were not significant. The authors suggested that insignificant

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differences across groups may be due to the lack of differentiation between lean and fat

body mass when calculating BMI. In analysis of interaction where significance was set at

p=0.01, the CS group had significantly greater fat mass (p=.006) and a significantly higher

excess body fat percentage (p=0.01). Data were adjusted for sex, gestational age,

breastfeeding, rapid weight gain and self-reported sleeping problems. This study was

limited by a generally homogenous cohort characterized by high socioeconomic and

maternal education attainment. Further, sleep duration was self-reported and fat mass

was measured using the skinfold test, a tool that is often subject to human error. This

study was the first of its kind to study sleep duration and subsequent weight status later

in childhood and also has strength in collecting repeated measures of sleep duration and

anthropometrics. Overall, this study did not find a significant relationship between

shortened sleep duration and BMI but did find that sleep duration may have an impact on

other heavy weight status indicators such as body fat percentage.

To further assess the relationship between shortened sleep duration and weight

status, Bell et al studied 822 children who were ages 5 years or younger.4 Researchers

determined sleeping patterns based on self-reported time diaries recorded on a randomly

selected weekday and weekend day during the school year. Short sleep duration was

defined as less than the 25th percentile for age-specific sleep recommendations. Five

years later, height and weight were measured and participants were grouped according

to z-score BMI as normal weight, overweight, or obese. Roughly 18% of all participants

were overweight and another 15% were obese. Researchers found short sleep duration

to be associated with an 80% increased odds of overweight and obesity (OR:1.80; 95%

CI, 1.16-2.80). Results were still significant after adjusting for parents' BMI,

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socioeconomic status, and birth weight. This study was limited by self-reported sleep

patterns reflecting only two days, single anthropometric data collection, and a lack of

physical activity and dietary information. While this study did find a statistically significant

relationship between sleep duration and weight status, there are many other variables

that might have contributed to the development of obesity, such as dietary patterns and

environmental factors. The results are not clinically significant enough to base weight-

loss recommendations on sleep duration alone.

Halal et al studied the association between sleep duration and the development

obesity in a Brazilian birth cohort of roughly 4,200 infants and children.5 Researchers

collected data perinatally and at one-, two-, and four-year check-ups. Weight status was

determined using z-score BMI. Parents reported their children’s bedtime and the time

they woke up over the two weeks prior to the check-up's. Short sleep duration was defined

as less than 10 hours of sleep per night. The prevalence of overweight or obesity in the

Brazilian cohort was 13.3%, which is similar to the 12.1% prevalence among children in

the United States during the same year. The study found that children at age four were

32% more likely to be overweight or obese if they reported short sleep duration at any

point between the ages of 1 and 4 (PR=1.32;95% CI: 1.03=1.70). After adjusting for

maternal characteristics, overweight or obese status at age one or two, and short sleep

duration at age one, children who reported less than ten hours of sleep per night at age

two had a 90% greater risk for being overweight or obese at age four (PR=1.90; 95% CI:

1.28-2.84). Study limitations include the lack of dietary data, which could have been used

to explain weight change. The study also did not assess any metabolic indicators, which

would have been helpful in explaining the association between sleep duration and weight

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status at the biochemical level. Lastly, the study did not use an objective scale for

measuring sleep duration. These findings are consistent with the literature that suggest

shortened sleep duration may lead to heavy weight status later in childhood but the results

were not clinically significant. Further studies should assess other variables that may lead

to weight gain in addition to short sleep duration.

The first decade of life is a critical time in the lifecycle for human development.

Lifestyle factors, including sleeping patterns, can influence the trajectory of future health

outcomes and the development of obesity later in childhood.2,3 Researchers have found

that shortened sleep duration may play a role in heavy weight status as indicated by

several factors including BMI and fat mass percentage.3 The current findings suggest

there is a positive correlation between short sleep duration and high BMI but they lack

clinical significance. Further studies that assess dietary information and use objective

sleep scales are needed to explore other causes of weight gain and high BMI among this

population. Given the evidence that suggest short sleep duration may lead to heavy

weight status, parents should enforce clear bedtimes to promote positive wellness habits

and to ensure their children are receiving adequate sleep each night.

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 References

1. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for

pediatric populations: a consensus statement of the American Academy of Sleep

Medicine. J Clin Sleep Med. 2016;12(6):785-786.

2. Li L, Zhang S, Huang Y, Chen K. Sleep duration and obesity in children: a systematic

review and meta-analysis of prospective cohort studies. J Paediatr Child Health.

2017;53(4):378-385. Doi: 10.1111/jpc.13434

3. Diethelm K, Bolzenius K, Cheng G, Remer T, Buyken AE. Longitudinal associations

between reported sleep duration in early childhood and the development of body mass

index, fat mass index and fat free mass index until age 7. Int J Pediatr Obes.

2011;6(22):114-123. Doi:10.3109/17477166.2011.566338.

4. Bell JF and Zimmerman FJ. Shortened nighttime sleep duration in early life and

subsequent childhood obesity. Arch Pediatr Adolesc Med. 2010 Nov;164(11):1070.

5. Halal CS, Matijasevich A, Howe LD, Santos IS, Barros FC, Nunes ML. Short sleep

duration in the first years of life and obesity/overweight at age 4 years: a birth cohort

study. J Pediatr. 2016;168:99-103. Doi: 10.1016/j.jpeds.2015.09.074.