Levels of pediatric obesity continue to rise. Previous evidence has linked short sleep duration and/or poor sleep quality to obesity development, although objective data are limited. As adolescents transition through puberty, circadian shifts occur, resulting in sleep loss. However, little is known whether chronotype is associated with body mass index (BMI) or dietary behaviors in adolescents. We hypothesized late chronotype would be positively associated with BMI and poorer dietary behaviors.
A total of 511 UK young adolescents (11–13 years) from eight secondary schools across the Midlands region (UK) participated in the Midlands Adolescent Schools Sleep Education Study (MASSES), a cross-sectional study to assess potential relationships between chronotype and BMI z-score as well as dietary habits. Height (cm) and weight (kg) were objectively measured for BMI calculation and participants completed a questionnaire to assess dietary habits. A subsample of 236 adolescents wore wrist actigraphy for 7 days to estimate average sleep duration (weekday, weekend and combined) and sleep efficiency.
Definitely evening chronotype was positively associated with BMI z-score compared to definitely morning chronotypes β=0.51, P<0.01, after adjustment. Higher frequency of consuming unhealthy snacks, night-time caffeine consumption and inadequate daily intake of fruit/vegetables were also associated with later chronotype (all P0.01). Actigraphy estimated sleep duration was an independent predictor of BMI z-score β=−0.36, P<0.001. Sleep efficiency did not predict BMI z-score after adjustment, β=−0.03, P=0.07.
Later chronotype young adolescents are at risk of increased BMI and poorer dietary behaviors. Although short sleep duration, but not sleep efficiency, was also an independent risk factor for increased BMI, different mechanisms may be driving the late chronotype and shorter sleep duration associations with BMI in this age group. Sleep hygiene education may help adolescents to better understand the impact of sleeping habits on physical health.
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We are grateful to all participating adolescents. We thank Mona Campbell at the Heart of England Foundation Trust for excellent management support. Participating schools were Abbot Beyne School, Bordesley Green Girls School, Bablake School, Droitwich Spa High School, Foremarke Hall School, Hamstead Hall Community Learning Centre, Repton School, Solihull School and Sutton Coldfield Grammar School for Girls. We thank all teaching staff for their support, in particular Denise Gould, Sue Hughes, Louise Yates, Chris Seeley, Ami Hands, Richard Merriman, Ian Clarkson, Denyse Price, Jess Sheridan and Claire Horne. We thank all parents who agreed for their children to participate and students who assisted with the project. Financial support for the study was provided by the children’s charity, Action Medical Research.
About this article
Circadian timing and alignment in healthy adults: associations with BMI, body fat, caloric intake and physical activity
International Journal of Obesity (2017)