Article
Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children’s BMI: Findings from the IDEFICS Study in Eight European Countries Monica Hunsberger 1, *, Kirsten Mehlig 1 , Claudia Börnhorst 2 , Antje Hebestreit 2 , Luis Moreno 3 , Toomas Veidebaum 4 , Yiannis Kourides 5 , Alfonso Siani 6 , Dénes Molnar 7 , Isabelle Sioen 8,9 and Lauren Lissner 1 Received: 7 August 2015; Accepted: 1 December 2015; Published: 8 December 2015 1 2 3 4 5 6 7 8 9
*
Section for Epidemiology and Social Medicine, University of Gothenburg, P.O. Box 453, 40530 Gothenburg, Sweden; [email protected] (K.M.); [email protected] (L.L.) Leibniz Institute for Prevention Research and Epidemiology-BIPS GmbH, Achterstrasse 30, D-28359 Bremen, Germany; [email protected] (C.B.); [email protected] (A.H.) Growth, Exercise, Nutrition, and Development (GENUD) research group, University of Zaragoza, Domingo Miral, 50009 Zaragoza, Spain; [email protected] National Institute for Health Development, P.O. Box 3012, 10504 Tallinn, Estonia; [email protected] Research and Education Institute of Child Health, 138 Limassol Ave, #205, 2015, Strovolos 510903, Cyprus; [email protected] Institute for Food Sciences, Unit of Epidemiology and Population Genetics, National Research Council, Via Roma 64, 83100 Avellino, Italy; [email protected] Department of Paediatrics, Medical Faculty, University of Pécs, Jozsef A.u., 7 H-1062 Budapest, Hungary; [email protected] Department of Public Health, Ghent University, 4K3, De Pintelaan 185, 9000 Ghent, Belgium; [email protected] Research Foundation—Flanders, Egmonstraat 5, B-1000 Brussels, Belgium Correspondence: [email protected]; Tel./Fax: +46-0-7033-82411
Abstract: Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future. Keywords: proportion carbohydrate intake at main meals; starch; sugar; childhood overweight; nocturnal sleep duration; breakfast consumption
Nutrients 2015, 7, 10223–10236; doi:10.3390/nu7125529
www.mdpi.com/journal/nutrients
Nutrients 2015, 7, 10223–10236
1. Introduction Childhood obesity is a serious threat to public health due to long-term consequences, including chronic disease in early adulthood [1]. Overweight and obesity are believed to be preventable conditions, although the issue of effective interventions for primary prevention is not well understood [2] and increased knowledge of modifiable risk factors is needed [3]. Previous investigations have shown that reduced sleep duration is associated with overweight in children and adolescents [4–6]. Nielsen et al. (2011) report on eight prospective cohort studies of children, all of which confirmed a significant inverse association between hours spent sleeping and future weight gain or development of obesity [4]. Findings from a Belgian longitudinal study confirmed that short sleep duration is associated with central adiposity [7]. Additionally, findings from our own cohort, the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study, indicated that sleep duration and overweight were associated cross-sectionally, but this association was no longer observed after adjustment for other behavioral factors and for parental education [8]. Carbohydrate, i.e., digestible starch and sugar, is likely to play a significant role in energy balance since it is the major macronutrient impacting blood sugar levels. Low carbohydrate intake is generally defined as
Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children’s BMI: Findings from the IDEFICS Study in Eight European Countries Monica Hunsberger 1, *, Kirsten Mehlig 1 , Claudia Börnhorst 2 , Antje Hebestreit 2 , Luis Moreno 3 , Toomas Veidebaum 4 , Yiannis Kourides 5 , Alfonso Siani 6 , Dénes Molnar 7 , Isabelle Sioen 8,9 and Lauren Lissner 1 Received: 7 August 2015; Accepted: 1 December 2015; Published: 8 December 2015 1 2 3 4 5 6 7 8 9
*
Section for Epidemiology and Social Medicine, University of Gothenburg, P.O. Box 453, 40530 Gothenburg, Sweden; [email protected] (K.M.); [email protected] (L.L.) Leibniz Institute for Prevention Research and Epidemiology-BIPS GmbH, Achterstrasse 30, D-28359 Bremen, Germany; [email protected] (C.B.); [email protected] (A.H.) Growth, Exercise, Nutrition, and Development (GENUD) research group, University of Zaragoza, Domingo Miral, 50009 Zaragoza, Spain; [email protected] National Institute for Health Development, P.O. Box 3012, 10504 Tallinn, Estonia; [email protected] Research and Education Institute of Child Health, 138 Limassol Ave, #205, 2015, Strovolos 510903, Cyprus; [email protected] Institute for Food Sciences, Unit of Epidemiology and Population Genetics, National Research Council, Via Roma 64, 83100 Avellino, Italy; [email protected] Department of Paediatrics, Medical Faculty, University of Pécs, Jozsef A.u., 7 H-1062 Budapest, Hungary; [email protected] Department of Public Health, Ghent University, 4K3, De Pintelaan 185, 9000 Ghent, Belgium; [email protected] Research Foundation—Flanders, Egmonstraat 5, B-1000 Brussels, Belgium Correspondence: [email protected]; Tel./Fax: +46-0-7033-82411
Abstract: Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future. Keywords: proportion carbohydrate intake at main meals; starch; sugar; childhood overweight; nocturnal sleep duration; breakfast consumption
Nutrients 2015, 7, 10223–10236; doi:10.3390/nu7125529
www.mdpi.com/journal/nutrients
Nutrients 2015, 7, 10223–10236
1. Introduction Childhood obesity is a serious threat to public health due to long-term consequences, including chronic disease in early adulthood [1]. Overweight and obesity are believed to be preventable conditions, although the issue of effective interventions for primary prevention is not well understood [2] and increased knowledge of modifiable risk factors is needed [3]. Previous investigations have shown that reduced sleep duration is associated with overweight in children and adolescents [4–6]. Nielsen et al. (2011) report on eight prospective cohort studies of children, all of which confirmed a significant inverse association between hours spent sleeping and future weight gain or development of obesity [4]. Findings from a Belgian longitudinal study confirmed that short sleep duration is associated with central adiposity [7]. Additionally, findings from our own cohort, the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study, indicated that sleep duration and overweight were associated cross-sectionally, but this association was no longer observed after adjustment for other behavioral factors and for parental education [8]. Carbohydrate, i.e., digestible starch and sugar, is likely to play a significant role in energy balance since it is the major macronutrient impacting blood sugar levels. Low carbohydrate intake is generally defined as
