Sleep dimensions are associated with obesity, poor diet quality and eating behaviors in school-aged children

Abstract

Objectives: The aim of this cross-sectional study was to investigate the association between sleep dimensions (duration, patterns, and disturbances) with body mass index (BMI), diet quality, and eating behaviors in school-aged children. Additionally, we aimed to investigate whether obesogenic eating behaviors (higher food responsiveness, lower satiety responsiveness, and less slowness in eating) and poor diet quality could mediate the potential association between sleep and obesity in school-aged children.

Materials and methods: For all participants (n = 588 children, age 5-12 years; 51% girls) we evaluated: sleep dimensions, BMI, diet quality, eating behaviors (food responsiveness, satiety responsiveness and slowness in eating). Linear regression models were used to test associations between exposure and outcome variables. Additionally, path analysis was conducted to test whether eating behaviors mediated the relationship between sleep and obesity.

Results: Shorter sleep duration (β = -0.722, p = 0.009) and greater sleep disturbances (β = 0.031, p = 0.012) were significantly associated with BMI. Additionally, we observed that diet quality was significantly associated with sleep duration (β = 0.430, p = 0.004), the midpoint of sleep (β = -0.927, p < 0.001), and sleep disturbances (β = -0.029, p < 0.001). Among other findings, greater sleep disturbances were associated with food responsiveness (β = 0.017, p < 0.001), satiety responsiveness (β = 0.015, p < 0.001), and slowness in eating (β = 0.012, p < 0.001). Importantly, food responsiveness was found as significant mediator of the relationship between sleep and BMI (R = 0.427, R ² = 0.182, p < 0.001).

Conclusions: Late sleep patterns, short sleep duration, and greater sleep disturbances are significantly related with what and how school-aged children eat. Importantly, poor diet quality was significantly related to all three sleep dimensions, while eating behaviors had a significant relationship with greater sleep disturbances. These findings may be relevant to the development of behavioral targets to prevent childhood obesity, including sleep hygiene guidelines as a strategy to improve children's eating habits, as well as their BMI.

Keywords: body mass index; children; diet quality; eating behaviors; sleep disturbances; sleep duration; sleep pattern.

Figure 1

Associations between sleep dimensions and the 16 items of the Mediterranean Diet Quality Index. General linear models adjusted for age, gender, and physical activity were conducted to test these associations. The figure shows the unstandardized coefficient (β), 95% CI, and adjusted p-values associated with each predictor variable. P-values were corrected using the Benjamini–Hochberg method, assuming a False Discovery Rate (FDR) of 5%. *p < 0.05, ***p < 0.001.

Figure 2

Mediation model highlighting the effect of sleep disturbances on BMI via food responsiveness, satiety responsiveness and slowness in eating. Figure (A) shows the direct effect of sleep disturbances on BMI, while the remaining figures show the effect of sleep disturbances on BMI via food responsiveness (B), satiety responsiveness (C) and slowness in eating (D). All models were adjusted for age, gender, and physical activity. Results are shown as unstandardized β coefficient represents with their 95% CI. Solid lines indicate statistically significant paths, while dotted lines indicate non-significant paths; ***p < 0.001; **p < 0.01, *p < 0.05.