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Epidemiology and Population Health

Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study

International Journal of Obesity (2023)Cite this article

Subjects

Abstract

Background

The relationship of insufficient sleep with the increased risk of obesity has been reported, but less is known about other sleep dimensions in the sleep-obesity associations.

Objectives

To assess the associations of multiple sleep dimensions with overall and abdominal obesity among Chinese students.

Methods

This was a cross-sectional study involving 10,686 Han students aged 9–18 from Chinese National Survey on Students’ Constitution and Health (CNSSCH). We collected sex, age, regions, parental educational levels, physical activity duration and sleep-related information by questionnaire survey, and also conducted anthropometric measurements including height, weight and waist circumference (WC). Unadjusted and adjusted binary logistic regression models were used to estimate the associations of sleep-related dimensions with obesity-related indicators.

Results

Short sleep duration was associated with higher body mass index (BMI), larger WC and higher waist-to-height ratio (WHtR) in 9–12 and 16–18 age groups, whereas prolonged sleep duration on weekday was associated with higher BMI in 13–15 age group. Non-habitual midday napping and midday napping ≤0.5 h/d (vs 0.5 to 1 h/d) increased the risk of higher BMI in 13–15 age group, and the former was also associated with larger WC in 9–12 age group. Late bedtime was associated with larger WC and higher WHtR in 9–12 age group and with higher BMI and WHtR in 13–15 age group. Students aged 9–12 with social jet lag ≥2 h were found to have greater BMI after adjustment (Odds Ratio: 1.421; 95% confidence interval: 1.066–1.894).

Conclusions

Short or overlong sleep duration, late bedtime and great social jet lag were associated with higher prevalence of overall or abdominal obesity, while moderate midday napping can effectively decrease the risk. Those findings may assist in developing preventive strategies to combat obesity epidemic.

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Fig. 1: Associations of sleep with obesity among students aged 9–12.
Fig. 2: Associations of sleep with obesity among students aged 13–15.
Fig. 3: Associations of sleep with obesity among students aged 16–18.

Data availability

Data generated or analyzed during this study can be applied under the data holder’s permission.

References

  1. Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, et al. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol. 2019;7:231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol. 2021;9:373–92.

    Article  PubMed  Google Scholar 

  3. WHO. Global status report on non-communicable diseases 2014. 2014 Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/.

  4. Poddar M, Chetty Y, Chetty VT. How does obesity affect the endocrine system? A narrative review. Clin Obes. 2017;7:136–44.

    Article  CAS  PubMed  Google Scholar 

  5. Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep. 2016;5:424–34.

    Article  PubMed  Google Scholar 

  6. Berenson GS. Bogalusa Heart Study g. Health consequences of obesity. Pediatr Blood Cancer. 2012;58:117–21.

    Article  PubMed  Google Scholar 

  7. Yang HJ, Kim MJ, Hur HJ, Lee BK, Kim MS, Park S. Association between Korean-style balanced diet and risk of abdominal obesity in Korean adults: an analysis using KNHANES-VI (2013–2016). Front Nutr. 2021;8:772347.

    Article  PubMed  Google Scholar 

  8. Chaput JP, Perusse L, Despres JP, Tremblay A, Bouchard C. Findings from the quebec family study on the etiology of obesity: genetics and environmental highlights. Curr Obes Rep. 2014;3:54–66.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chaput JP, Dutil C. Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors. Int J Behav Nutr Phys Act. 2016;13:103.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Marshall NS, Glozier N, Grunstein RR. Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev. 2008;12:289–98.

    Article  PubMed  Google Scholar 

  11. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008;16:643–53.

    Article  PubMed  Google Scholar 

  12. Knutson KL. Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence. Best Pract Res Clin Endocrinol Metab. 2010;24:731–43.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Asarnow LD, McGlinchey E, Harvey AG. Evidence for a possible link between bedtime and change in body mass index. Sleep. 2015;38:1523–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Malone SK, Zemel B, Compher C, Souders M, Chittams J, Thompson AL, et al. Social jet lag, chronotype and body mass index in 14–17-year-old adolescents. Chronobiol Int. 2016;33:1255–66.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zeron-Rugerio MF, Cambras T, Izquierdo-Pulido M. Social jet lag associates negatively with the adherence to the mediterranean diet and body mass index among young adults. Nutrients. 2019;11:1756.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sa J, Choe S, Cho BY, Chaput JP, Kim G, Park CH, et al. Relationship between sleep and obesity among U.S. and South Korean college students. BMC Public Health. 2020;20:96.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Loredo JS, Weng J, Ramos AR, Sotres-Alvarez D, Simonelli G, Talavera GA, et al. Sleep patterns and obesity: Hispanic community health study/study of Latinos Sueno Ancillar study. Chest. 2019;156:348–56.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ji CY, Cheng TO. Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol. 2008;131:1–8.

    Article  PubMed  Google Scholar 

  19. Ma J, Pei T, Dong F, Dong Y, Yang Z, Chen J, et al. Spatial and demographic disparities in short stature among school children aged 7–18 years: a nation-wide survey in China, 2014. BMJ Open. 2019;9:e026634.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Health requirements of daily learning time for secondary and elementary school students 2012. Available from: https://std.samr.gov.cn/gb/search/gbDetailed?id=71F772D7F4BAD3A7E05397BE0A0AB82A.

  21. Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int. 2006;23:497–509.

    Article  PubMed  Google Scholar 

  22. Hena M, Garmy P. Social jetlag and its association with screen time and nighttime texting among adolescents in Sweden: a cross-sectional study. Front Neurosci. 2020;14:122.

    Article  PubMed  PubMed Central  Google Scholar 

  23. de Zwart BJ, Beulens JWJ, Elders P, Rutters F. Pilot data on the association between social jetlag and obesity-related characteristics in Dutch adolescents over one year. Sleep Med. 2018;47:32–5.

    Article  PubMed  Google Scholar 

  24. Li X, Buxton OM, Kim Y, Haneuse S, Kawachi I. Do procrastinators get worse sleep? Cross-sectional study of US adolescents and young adults. SSM Popul Health. 2020;10:100518.

    Article  PubMed  Google Scholar 

  25. Group of China Obesity Task F. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25:97–102.

    Google Scholar 

  26. Ma GS, Ji CY, Ma J, Mi J, Sung R, Xiong F, et al. Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7–18 years. Zhonghua Liu Xing Bing Xue Za Zhi. 2010;31:609–15.

    CAS  PubMed  Google Scholar 

  27. Dai Y, Fu J, Liang L, Gong C, Xiong F, Liu G.et al. A proposal for the cutoff point of waist-to-height for the diagnosis of metabolic syndrome in children and adolescents in six areas of China. Zhonghua Liu Xing Bing Xue Za Zhi. 2014;35:882–5.

  28. Fan M, Lyu J, He P. Chinese guidelines for data processing and analysis concerning the International Physical Activity Questionnaire. Zhonghua Liu Xing Bing Xue Za Zhi. 2014;35:961–4.

    PubMed  Google Scholar 

  29. Ke Y, Zhang S, Hao Y, Liu Y. Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents. BMC Public Health. 2023;23:401.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Apfelbacher CJ, Loerbroks A, Cairns J, Behrendt H, Ring J, Kramer U. Predictors of overweight and obesity in five to seven-year-old children in Germany: results from cross-sectional studies. BMC Public Health. 2008;8:171.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cardenas-Fuentes G, Homs C, Ramirez-Contreras C, Juton C, Casas-Esteve R, Grau M, et al. Prospective association of maternal educational level with child’s physical activity, screen time, and diet quality. Nutrients. 2021;14:160.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dong X, Ding L, Zhang R, Ding M, Wang B, Yi X. Physical activity, screen-based sedentary behavior and physical fitness in Chinese adolescents: a cross-sectional study. Front Pediatr. 2021;9:722079.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gong QH, Li SX, Li H, Cui J, Xu GZ. Insufficient sleep duration and overweight/obesity among adolescents in a Chinese population. Int J Environ Res Public Health. 2018;15:997.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zhang J, Jin X, Yan C, Jiang F, Shen X, Li S. Short sleep duration as a risk factor for childhood overweight/obesity: a large multicentric epidemiologic study in China. Sleep Health. 2015;1:184–90.

    Article  PubMed  Google Scholar 

  35. Fan J, Ding C, Gong W, Yuan F, Zhang Y, Feng G, et al. Association of sleep duration and overweight/obesity among children in China. Int J Environ Res Public Health. 2020;17:1962.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. Wu J, Wu H, Wang J, Guo L, Deng X, Lu C. Associations between sleep duration and overweight/obesity: results from 66,817 Chinese adolescents. Sci Rep. 2015;5:16686.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Singh M, Drake CL, Roehrs T, Hudgel DW, Roth T. The association between obesity and short sleep duration: a population-based study. J Clin Sleep Med. 2005;1:357–63.

    Article  PubMed  Google Scholar 

  39. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Spiegel K, Leproult R, L’Hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89:5762–71.

    Article  CAS  PubMed  Google Scholar 

  41. St-Onge MP, Wolfe S, Sy M, Shechter A, Hirsch J. Sleep restriction increases the neuronal response to unhealthy food in normal-weight individuals. Int J Obes (Lond). 2014;38:411–6.

    Article  PubMed  Google Scholar 

  42. Knutson KL, Van, Cauter E. Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci. 2008;1129:287–304.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.

    Article  PubMed  Google Scholar 

  44. Xin C, Zhang B, Fang S, Zhou J. Daytime napping and successful aging among older adults in China: a cross-sectional study. BMC Geriatr. 2020;20:2.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wang N, Zou J, Fang S, Zhou J. Association between daytime napping and obesity in Chinese middle-aged and older adults. J Glob Health. 2020;10:020804.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Zhao X, Cheng L, Zhu C, Cen S, Lin W, Zheng W, et al. A double-edged sword: the association of daytime napping duration and metabolism related diseases in a Chinese population. Eur J Clin Nutr. 2021;75:291–8.

    Article  PubMed  Google Scholar 

  47. Ji X, Li J, Liu J. The relationship between midday napping and neurocognitive function in early adolescents. Behav Sleep Med. 2019;17:537–51.

    Article  PubMed  Google Scholar 

  48. Olds TS, Maher CA, Matricciani L. Sleep duration or bedtime? Exploring the relationship between sleep habits and weight status and activity patterns. Sleep. 2011;34:1299–307.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Busto-Zapico R, Amigo-Vazquez I, Pena-Suarez E, Fernandez-Rodriguez C. Relationships between sleeping habits, sedentary leisure activities and childhood overweight and obesity. Psychol Health Med. 2014;19:667–72.

    Article  PubMed  Google Scholar 

  50. Thivel D, Isacco L, Aucouturier J, Pereira B, Lazaar N, Ratel S, et al. Bedtime and sleep timing but not sleep duration are associated with eating habits in primary school children. J Dev Behav Pediatr. 2015;36:158–65.

    Article  PubMed  Google Scholar 

  51. Skene DJ, Arendt J. Human circadian rhythms: physiological and therapeutic relevance of light and melatonin. Ann Clin Biochem. 2006;435:344–53.

    Article  Google Scholar 

  52. Sun M, Feng W, Wang F, Li P, Li Z, Li M, et al. Meta-analysis on shift work and risks of specific obesity types. Obes Rev. 2018;19:28–40.

    Article  CAS  PubMed  Google Scholar 

  53. Van Cauter E, Leproult R, Plat L. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA. 2000;284:861–8.

    Article  PubMed  Google Scholar 

  54. Mathew GM, Hale L, Chang AM. Social jetlag, eating behaviours and BMI among adolescents in the USA. Br J Nutr. 2020;124:979–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Bray MS, Young ME. Circadian rhythms in the development of obesity: potential role for the circadian clock within the adipocyte. Obes Rev. 2007;8:169–81.

    Article  CAS  PubMed  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. Qian J, Dalla Man C, Morris CJ, Cobelli C, Scheer F. Differential effects of the circadian system and circadian misalignment on insulin sensitivity and insulin secretion in humans. Diabetes Obes Metab. 2018;20:2481–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Marcinkevage JA, Alverson CJ, Narayan KM, Kahn HS, Ruben J, Correa A. Race/ethnicity disparities in dysglycemia among U.S. women of childbearing age found mainly in the nonoverweight/nonobese. Diabetes Care. 2013;36:3033–9.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Vgontzas AN, Fernandez-Mendoza J, Miksiewicz T, Kritikou I, Shaffer ML, Liao D, et al. Unveiling the longitudinal association between short sleep duration and the incidence of obesity: the Penn State Cohort. Int J Obes (Lond). 2014;38:825–32.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (Grant No.82003478).

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Author notes

  1. These authors contributed equally: Liu Yang, Shuo Han.

Authors and Affiliations

  1. College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan, P. R. China

    Liu Yang, Shuo Han, Chengyuan Miao, Xiaomin Lou, Changfu Hao & Xian Wang

  2. Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, P. R. China

    Hao Lou

  3. The Education Department of Henan Province, Zhengzhou, 450018, Henan, P. R. China

    Genli Gao

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Contributions

XW designed the study, edited the writing and revised the manuscript; LY and SH independently carried out the literature search and screening of articles, analyzed the data and wrote the manuscript; CM participated in data analysis; XL designed the study, conducted field research and provided data; HL, GG, and CH conducted field research and provided data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xian Wang.

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The authors declare no competing interests.

Ethics approval

The research protocol was approved by the Zhengzhou University Life Science Ethics Committee (ZZUIRB2021–56). Informed consent of parents and their children were obtained.

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Yang, L., Han, S., Miao, C. et al. Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study. Int J Obes (2023). https://doi.org/10.1038/s41366-023-01324-2

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  • DOI: https://doi.org/10.1038/s41366-023-01324-2

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