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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
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
1
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
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
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
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,
2
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-
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
3
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
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.
4
References
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
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