Conference Coverage

Sleep may mediate healthy behavior in children


Key clinical point: Sleep may mediate how diet and activity influence weight in children.

Major finding: Healthy children had 9.97 hours of sleep per night versus 9.46 hours for poorest eaters.

Study details: A 6-year follow-up of 1,542 children in the Infant Feeding Practices Study II whose health behaviors were self-reported by mothers.

Disclosures: Dr. Kaar reported having no financial relationships. The study was funded through an American Heart Association Scientist Development Award.



BALTIMORE – Children who get up to 10 hours of sleep nightly may be more inclined to develop healthy behaviors that reduce their chances of being overweight or obese, a 6-year follow-up of children in the Infant Feeding Practices Study II determined.


However, improving health in these children is more than a matter of simply seeing that they get more sleep, said lead investigator Jill Landsbaugh Kaar, PhD, of Children’s Hospital Colorado, Aurora, in presenting the results at the annual meeting of the Associated Professional Sleep Societies. “Perhaps there’s a potential pathway linking healthy eaters and obesity in children that may be mediated through sleep duration.”

The relationship between sleep, diet, and activity level may be more cyclical, rather than linear, Dr. Kaar said. “Poor sleep is typically linked to a poor diet or low levels of physical activity, and then linked to some outcome or disease,” she said. But her research indicates that those three factors – sleep, diet and activity – are more interrelated than one being causative of the others.

Noting that one in three adults and one in six children in the United States are either overweight or obese (JAMA. 2014 Feb 26;311[8]:806-14), Dr. Kaar said, “Childhood obesity prevention has really not been effective in reducing weight or preventing or limiting weight gain.” Such programs typically focus on one health behavior when each child has a unique pattern of health behaviors that influence weight.

Dr. Kaar’s research used data collected by the Centers for Disease Control and Prevention as part of a 6-year follow-up study of women from the Infant Feeding Practices Study II. Some 1,542 women completed mailed questionnaires about their 6-year-olds’ diet, activity, screen time, sleep duration, height, and weight. The statistical analysis grouped the children into health behavior patterns of diet, activity, and screen time and used a three-step mediation regression model to examine their hypothesis.

The analysis characterized children into three health behavior pattern groups: poorest eaters (22%), healthy children (37%), and active supereaters with the highest screen time (41%). The poorest eaters were more likely to be female (58%) and obese (18%) than the other groups, but even 10% of the healthy children group were obese.

Dr. Jill Landsbaugh Kaar of Children's Hospital Colorado

Dr. Jill Landsbaugh Kaar

In the first model, the poorest eaters had the highest risk of obesity. In the second model, both the poorest eaters and active supereaters had shorter sleep duration than healthy children – 9.46 and 9.59 hours a night, respectively, versus 9.97 hours for healthy children – “thus telling me that sleep was really driving that relationship,” Dr. Kaar said.

“Future interventions should consider that improving health behavior patterns by targeting someone’s diet or physical activity, that you’re also targeting them to improve sleep, and then through increasing sleep you will be influencing obesity,” she said. “Interventions and research studies in general really need to measure all of those health behaviors because they’re all related; it’s not just one of them leading to obesity risk.”

The next step for her research is to branch out beyond a one-center study, Dr. Kaar said.

Dr. Kaar reported having no financial relationships. An American Heart Association Scientist Development Award provided funding for the study.

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