Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity Nicole Glaser, MD, Dennis Styne, MD
A substantial body of epidemiologic data has demonstrated associations between obesity and shorter sleep duration.1– 6 These associations have been found in both adults and children and in diverse populations. These findings are particularly relevant because insufficient sleep is a widespread problem in the United States.7,8 Depending on the cutoff used to define inadequate sleep duration, anywhere from 30% to 90% of American children sleep fewer than the recommended number of hours per night.7,8 Adolescents meet recommended targets for sleep duration less frequently than younger children.7– 9 The pressure of homework or extracurricular activities, the distraction of electronics, the mismatch between adolescents’ biological clocks and school schedules, and the noisy environments of many inner cities may be contributing factors for the relative sleeplessness of these children and adolescents. To date, most pediatric studies investigating relationships between sleep and obesity have been strictly observational and therefore do not provide information to make inferences about causation. Decreased sleep duration of children aged 16 months to 17 years is associated with a risk ratio between 1.86 and 2.06 for obesity, as well as increased calorie and sugar intake in many10– 13 but not all studies.14,15 Although a causal relationship between inadequate sleep and obesity is possible, numerous noncausal relationships might also be
hypothesized. For example, less active children might require less sleep, or children who are allowed more screen time might tend to stay awake later. Lack of adequate sleep might even reflect lower levels of parental vigilance about all aspects of health (such as diet and exercise).
In the current issue of the journal, Rudnicka et al16 provide information that brings us a step closer to understanding the relationship between sleep, obesity, and the metabolic syndrome. These investigators conducted comprehensive metabolic evaluations of a large, diverse sample of 9- to 10-year-old children and correlated these with sleep duration. They document inverse associations between sleep duration and risk markers for type 2 diabetes and demonstrate that these associations persist after accounting for differences in adiposity. These findings also were unchanged after adjusting for differences in physical activity. These data are important because they confirm that the relationship between sleep, obesity, and the metabolic syndrome is unlikely to simply reflect lifestyle variables (such as activity level, screen time, or parental vigilance) and instead reflect more complex relationships that must be explored. The Rudnicka study reveals a correlation in which 1 hour increased mean weekday sleep duration is associated with ∼0.2 lower BMI and 3% reduction in insulin resistance.
Downloaded from by guest on August 20, 2017
PEDIATRICS Volume 140, number 3, September 2017:e20172015
Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, California
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees. DOI: https://doi.org/10.1542/peds.2017-2015 Accepted for publication Jun 19, 2017 Address correspondence to Nicole Glaser, MD, Department of Pediatrics, Section of Endocrinology, University of California Davis, School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817. E-mail: [email protected] PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2017 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/ 10.1542/peds.2017-0338. To cite: Glaser N and Styne D. Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity. Pediatrics. 2017;140(3):e20172015
Commentary
The recent Endocrine Society Clinical Practice Guideline on assessment, treatment, and prevention of pediatric obesity states that every 1 U reduction of BMI in kg/m2 is associated with a decrease in systolic BP of 1.25 mm Hg and a decrease in serum triglyceride concentration of 1.55 mg/day, which is a proxy measure of insulin resistance.17 Although all of these associations indicate small effects, the development of obesity and type 2 diabetes is due to multiple factors. Each influence may exert a small effect, but multiple influences combined may lead to a more robust drive to these conditions.
The data from Rudnicka et al16 reinforce those from epidemiologic studies of adults that similarly demonstrate associations between shorter sleep duration and insulin resistance, type 2 diabetes, and the metabolic syndrome.18,19 Given the substantial evidence linking inadequate sleep and aspects of the metabolic syndrome, it is necessary to consider how these factors might be related. A causal relationship remains to be confirmed, and it is possible that short sleep duration and risk factors for type 2 diabetes might reflect separate but related alterations in hypothalamic functions controlling sleep and those modulating neuroendocrine regulators of appetite and insulin sensitivity. To disprove this hypothesis and support a causal relationship, it is necessary to demonstrate that reductions in sleep duration increase risk factors for type 2 diabetes and that increasing sleep duration has the reverse effect. Of course, such an intervention would have to extend over a considerable time period and presents ethical challenges.
Data from studies in adults, and limited data in adolescents, suggest that experimental sleep deprivation may indeed cause insulin resistance and (in some studies) increased calorie intake and more rapid 2
weight gain.20– 25 Adults subjected to severe sleep restriction (4 hours/night) have increased daily cortisol and catecholamine production,21,22 suggesting that elevated stress hormone levels may cause or contribute to insulin resistance in this setting. These data support the possibility of a causal relationship between shorter sleep duration and insulin resistance and/or type 2 diabetes risk; however, experimentallyimposed sleep deprivation may not equate with voluntary short sleep duration. Severe, experimental sleep deprivation induces a physiologic stress state, and similar physiologic alterations may or may not occur in individuals with habitual, apparently asymptomatic, short sleep duration. Interventional studies involving an increase in sleep duration are unfortunately few, and pediatric studies have typically involved interventions that combined sleep promotion with other lifestyle modifications, making it unclear which factors were most associated with the outcomes.26– 28 The study by Rudnicka et al16 suggests that the influence of sleep duration on insulin resistance is relatively modest, particularly in relation to other, nonmodifiable factors such as ethnicity. Therefore, a future interventional study would need to be large, with sufficient statistical power to detect clinically-relevant changes in type 2 diabetes risk factors. The data from Rudnicka et al16 provide ideal information on which to base a future clinical trial, which will be essential to resolve the question of whether relationships between sleep, obesity, and the metabolic syndrome are causal or associated via related but independent pathways. References 1. St-Onge MP, Grandner MA, Brown D, et al; American Heart Association Obesity,
Downloaded from by guest on August 20, 2017
Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Stroke Council. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134(18):e367–e386 2. St-Onge MP. Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes Rev. 2017;18(suppl 1):34–39 3. Bell JF, Zimmerman FJ. Shortened nighttime sleep duration in early life and subsequent childhood obesity. Arch Pediatr Adolesc Med. 2010;164(9):840–845 4. Chaput JP, Gray CE, Poitras VJ, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 suppl 3):S266–S282 5. Wu Y, Gong Q, Zou Z, Li H, Zhang X. Short sleep duration and obesity among children: a systematic review and meta-analysis of prospective studies. Obes Res Clin Pract. 2017;11(2):140–150 6. Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics. 2010;125(3):420–428 7. Emsellem HA, Knutson KL, Hillygus DS, et al; National Sleep Foundation. 2014 sleep in America poll. Sleep in the modern family. Sleep Health. 2014;1(2):e13 8. Buxton OM, Chang AM, Spilsbury JC, Bos T, Emsellem H, Knutson KL. Sleep in the modern family: protective family routines for child and adolescent sleep. Sleep Health. 2015;1(1):15–27 9. Matthews KA, Hall M, Dahl RE. Sleep in healthy black and white adolescents. Pediatrics. 2014;133(5). Available at: www.pediatrics.org/cgi/content/full/ 133/5/e1189 10. Fatima Y, Doi SAR, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and
Glaser and Styne
adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2015;16(2):137–149 11. Chaput JP, Lambert M, Gray-Donald K, et al. Short sleep duration is independently associated with overweight and obesity in Quebec children. Can J Public Health. 2011;102(5):369–374 12. Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–626 13. Kjeldsen JS, Hjorth MF, Andersen R, et al. Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children. Int J Obes. 2014;38(1):32–39 14. Hoppe C, Rothausen BW, Biltoft-Jensen A, et al. Relationship between sleep duration and dietary intake in 4- to 14-year-old Danish children. J Nutr Sci. 2013;2:e38 15. Klingenberg L, Christensen LB, Hjorth MF, et al. No relation between sleep duration and adiposity indicators in 9-36 months old children: the SKOT cohort. Pediatr Obes. 2013;8(1):e14–e18 16. Rudnicka AR, Nightingale CM, Donin AS, et al. Sleep Duration and Risk of Type 2 Diabetes. Pediatrics. 2017;140(3):e20170338
PEDIATRICS Volume 140, number 3, September 2017
17. Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(3):709–757 18. Rutters F, Besson H, Walker M, et al. The association between sleep duration, insulin sensitivity, and β-cell function: the EGIR-RISC study. J Clin Endocrinol Metab. 2016;101(9):3272–3280 19. Grandner MA, Seixas A, Shetty S, Shenoy S. Sleep duration and diabetes risk: population trends and potential mechanisms. Curr Diab Rep. 2016;16(11):106
23. Klingenberg L, Chaput JP, Holmbäck U, et al. Acute sleep restriction reduces insulin sensitivity in adolescent boys. Sleep. 2013;36(7):1085–1090 24. Simon SL, Field J, Miller LE, DiFrancesco M, Beebe DW. Sweet/ dessert foods are more appealing to adolescents after sleep restriction. PLoS One. 2015;10(2):e0115434 25. Killick R, Hoyos CM, Melehan KL, Dungan GC II, Poh J, Liu PY. Metabolic and hormonal effects of ‘catch-up’ sleep in men with chronic, repetitive, lifestyle-driven sleep restriction. Clin Endocrinol (Oxf). 2015;83(4): 498–507
20. Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012;157(8):549–557
26. De Bourdeaudhuij I, Verbestel V, De Henauw S, et al; IDEFICS consortium. Implementation of the IDEFICS intervention across European countries: perceptions of parents and relationship with BMI. Obes Rev. 2015;16(suppl 2):78–88
21. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–1439
27. Taylor BJ, Gray AR, Galland BC, et al. Targeting sleep, food, and activity in infants for obesity prevention: an RCT. Pediatrics. 2017;139(3):e20162037
22. Rao MN, Neylan TC, Grunfeld C, Mulligan K, Schambelan M, Schwarz JM. Subchronic sleep restriction causes tissue-specific insulin resistance. J Clin Endocrinol Metab. 2015;100(4):1664–1671
28. Haines J, McDonald J, O’Brien A, et al. Healthy habits, happy homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr. 2013;167(11):1072–1079
Downloaded from by guest on August 20, 2017
3
Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity Nicole Glaser and Dennis Styne Pediatrics; originally published online August 15, 2017; DOI: 10.1542/peds.2017-2015 Updated Information & Services
including high resolution figures, can be found at: /content/early/2017/08/11/peds.2017-2015.full.html
References
This article cites 28 articles, 4 of which can be accessed free at: /content/early/2017/08/11/peds.2017-2015.full.html#ref-list-1
Subspecialty Collections
This article, along with others on similar topics, appears in the following collection(s): Endocrinology /cgi/collection/endocrinology_sub Diabetes Mellitus /cgi/collection/diabetes_mellitus_sub Obesity /cgi/collection/obesity_new_sub
Permissions & Licensing
Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml
Reprints
Information about ordering reprints can be found online: /site/misc/reprints.xhtml
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2017 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on August 20, 2017
Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity Nicole Glaser and Dennis Styne Pediatrics; originally published online August 15, 2017; DOI: 10.1542/peds.2017-2015
The online version of this article, along with updated information and services, is located on the World Wide Web at: /content/early/2017/08/11/peds.2017-2015.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2017 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on August 20, 2017
A substantial body of epidemiologic data has demonstrated associations between obesity and shorter sleep duration.1– 6 These associations have been found in both adults and children and in diverse populations. These findings are particularly relevant because insufficient sleep is a widespread problem in the United States.7,8 Depending on the cutoff used to define inadequate sleep duration, anywhere from 30% to 90% of American children sleep fewer than the recommended number of hours per night.7,8 Adolescents meet recommended targets for sleep duration less frequently than younger children.7– 9 The pressure of homework or extracurricular activities, the distraction of electronics, the mismatch between adolescents’ biological clocks and school schedules, and the noisy environments of many inner cities may be contributing factors for the relative sleeplessness of these children and adolescents. To date, most pediatric studies investigating relationships between sleep and obesity have been strictly observational and therefore do not provide information to make inferences about causation. Decreased sleep duration of children aged 16 months to 17 years is associated with a risk ratio between 1.86 and 2.06 for obesity, as well as increased calorie and sugar intake in many10– 13 but not all studies.14,15 Although a causal relationship between inadequate sleep and obesity is possible, numerous noncausal relationships might also be
hypothesized. For example, less active children might require less sleep, or children who are allowed more screen time might tend to stay awake later. Lack of adequate sleep might even reflect lower levels of parental vigilance about all aspects of health (such as diet and exercise).
In the current issue of the journal, Rudnicka et al16 provide information that brings us a step closer to understanding the relationship between sleep, obesity, and the metabolic syndrome. These investigators conducted comprehensive metabolic evaluations of a large, diverse sample of 9- to 10-year-old children and correlated these with sleep duration. They document inverse associations between sleep duration and risk markers for type 2 diabetes and demonstrate that these associations persist after accounting for differences in adiposity. These findings also were unchanged after adjusting for differences in physical activity. These data are important because they confirm that the relationship between sleep, obesity, and the metabolic syndrome is unlikely to simply reflect lifestyle variables (such as activity level, screen time, or parental vigilance) and instead reflect more complex relationships that must be explored. The Rudnicka study reveals a correlation in which 1 hour increased mean weekday sleep duration is associated with ∼0.2 lower BMI and 3% reduction in insulin resistance.
Downloaded from by guest on August 20, 2017
PEDIATRICS Volume 140, number 3, September 2017:e20172015
Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, California
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees. DOI: https://doi.org/10.1542/peds.2017-2015 Accepted for publication Jun 19, 2017 Address correspondence to Nicole Glaser, MD, Department of Pediatrics, Section of Endocrinology, University of California Davis, School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817. E-mail: [email protected] PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2017 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/ 10.1542/peds.2017-0338. To cite: Glaser N and Styne D. Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity. Pediatrics. 2017;140(3):e20172015
Commentary
The recent Endocrine Society Clinical Practice Guideline on assessment, treatment, and prevention of pediatric obesity states that every 1 U reduction of BMI in kg/m2 is associated with a decrease in systolic BP of 1.25 mm Hg and a decrease in serum triglyceride concentration of 1.55 mg/day, which is a proxy measure of insulin resistance.17 Although all of these associations indicate small effects, the development of obesity and type 2 diabetes is due to multiple factors. Each influence may exert a small effect, but multiple influences combined may lead to a more robust drive to these conditions.
The data from Rudnicka et al16 reinforce those from epidemiologic studies of adults that similarly demonstrate associations between shorter sleep duration and insulin resistance, type 2 diabetes, and the metabolic syndrome.18,19 Given the substantial evidence linking inadequate sleep and aspects of the metabolic syndrome, it is necessary to consider how these factors might be related. A causal relationship remains to be confirmed, and it is possible that short sleep duration and risk factors for type 2 diabetes might reflect separate but related alterations in hypothalamic functions controlling sleep and those modulating neuroendocrine regulators of appetite and insulin sensitivity. To disprove this hypothesis and support a causal relationship, it is necessary to demonstrate that reductions in sleep duration increase risk factors for type 2 diabetes and that increasing sleep duration has the reverse effect. Of course, such an intervention would have to extend over a considerable time period and presents ethical challenges.
Data from studies in adults, and limited data in adolescents, suggest that experimental sleep deprivation may indeed cause insulin resistance and (in some studies) increased calorie intake and more rapid 2
weight gain.20– 25 Adults subjected to severe sleep restriction (4 hours/night) have increased daily cortisol and catecholamine production,21,22 suggesting that elevated stress hormone levels may cause or contribute to insulin resistance in this setting. These data support the possibility of a causal relationship between shorter sleep duration and insulin resistance and/or type 2 diabetes risk; however, experimentallyimposed sleep deprivation may not equate with voluntary short sleep duration. Severe, experimental sleep deprivation induces a physiologic stress state, and similar physiologic alterations may or may not occur in individuals with habitual, apparently asymptomatic, short sleep duration. Interventional studies involving an increase in sleep duration are unfortunately few, and pediatric studies have typically involved interventions that combined sleep promotion with other lifestyle modifications, making it unclear which factors were most associated with the outcomes.26– 28 The study by Rudnicka et al16 suggests that the influence of sleep duration on insulin resistance is relatively modest, particularly in relation to other, nonmodifiable factors such as ethnicity. Therefore, a future interventional study would need to be large, with sufficient statistical power to detect clinically-relevant changes in type 2 diabetes risk factors. The data from Rudnicka et al16 provide ideal information on which to base a future clinical trial, which will be essential to resolve the question of whether relationships between sleep, obesity, and the metabolic syndrome are causal or associated via related but independent pathways. References 1. St-Onge MP, Grandner MA, Brown D, et al; American Heart Association Obesity,
Downloaded from by guest on August 20, 2017
Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Stroke Council. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134(18):e367–e386 2. St-Onge MP. Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes Rev. 2017;18(suppl 1):34–39 3. Bell JF, Zimmerman FJ. Shortened nighttime sleep duration in early life and subsequent childhood obesity. Arch Pediatr Adolesc Med. 2010;164(9):840–845 4. Chaput JP, Gray CE, Poitras VJ, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 suppl 3):S266–S282 5. Wu Y, Gong Q, Zou Z, Li H, Zhang X. Short sleep duration and obesity among children: a systematic review and meta-analysis of prospective studies. Obes Res Clin Pract. 2017;11(2):140–150 6. Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics. 2010;125(3):420–428 7. Emsellem HA, Knutson KL, Hillygus DS, et al; National Sleep Foundation. 2014 sleep in America poll. Sleep in the modern family. Sleep Health. 2014;1(2):e13 8. Buxton OM, Chang AM, Spilsbury JC, Bos T, Emsellem H, Knutson KL. Sleep in the modern family: protective family routines for child and adolescent sleep. Sleep Health. 2015;1(1):15–27 9. Matthews KA, Hall M, Dahl RE. Sleep in healthy black and white adolescents. Pediatrics. 2014;133(5). Available at: www.pediatrics.org/cgi/content/full/ 133/5/e1189 10. Fatima Y, Doi SAR, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and
Glaser and Styne
adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2015;16(2):137–149 11. Chaput JP, Lambert M, Gray-Donald K, et al. Short sleep duration is independently associated with overweight and obesity in Quebec children. Can J Public Health. 2011;102(5):369–374 12. Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–626 13. Kjeldsen JS, Hjorth MF, Andersen R, et al. Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children. Int J Obes. 2014;38(1):32–39 14. Hoppe C, Rothausen BW, Biltoft-Jensen A, et al. Relationship between sleep duration and dietary intake in 4- to 14-year-old Danish children. J Nutr Sci. 2013;2:e38 15. Klingenberg L, Christensen LB, Hjorth MF, et al. No relation between sleep duration and adiposity indicators in 9-36 months old children: the SKOT cohort. Pediatr Obes. 2013;8(1):e14–e18 16. Rudnicka AR, Nightingale CM, Donin AS, et al. Sleep Duration and Risk of Type 2 Diabetes. Pediatrics. 2017;140(3):e20170338
PEDIATRICS Volume 140, number 3, September 2017
17. Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(3):709–757 18. Rutters F, Besson H, Walker M, et al. The association between sleep duration, insulin sensitivity, and β-cell function: the EGIR-RISC study. J Clin Endocrinol Metab. 2016;101(9):3272–3280 19. Grandner MA, Seixas A, Shetty S, Shenoy S. Sleep duration and diabetes risk: population trends and potential mechanisms. Curr Diab Rep. 2016;16(11):106
23. Klingenberg L, Chaput JP, Holmbäck U, et al. Acute sleep restriction reduces insulin sensitivity in adolescent boys. Sleep. 2013;36(7):1085–1090 24. Simon SL, Field J, Miller LE, DiFrancesco M, Beebe DW. Sweet/ dessert foods are more appealing to adolescents after sleep restriction. PLoS One. 2015;10(2):e0115434 25. Killick R, Hoyos CM, Melehan KL, Dungan GC II, Poh J, Liu PY. Metabolic and hormonal effects of ‘catch-up’ sleep in men with chronic, repetitive, lifestyle-driven sleep restriction. Clin Endocrinol (Oxf). 2015;83(4): 498–507
20. Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012;157(8):549–557
26. De Bourdeaudhuij I, Verbestel V, De Henauw S, et al; IDEFICS consortium. Implementation of the IDEFICS intervention across European countries: perceptions of parents and relationship with BMI. Obes Rev. 2015;16(suppl 2):78–88
21. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–1439
27. Taylor BJ, Gray AR, Galland BC, et al. Targeting sleep, food, and activity in infants for obesity prevention: an RCT. Pediatrics. 2017;139(3):e20162037
22. Rao MN, Neylan TC, Grunfeld C, Mulligan K, Schambelan M, Schwarz JM. Subchronic sleep restriction causes tissue-specific insulin resistance. J Clin Endocrinol Metab. 2015;100(4):1664–1671
28. Haines J, McDonald J, O’Brien A, et al. Healthy habits, happy homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr. 2013;167(11):1072–1079
Downloaded from by guest on August 20, 2017
3
Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity Nicole Glaser and Dennis Styne Pediatrics; originally published online August 15, 2017; DOI: 10.1542/peds.2017-2015 Updated Information & Services
including high resolution figures, can be found at: /content/early/2017/08/11/peds.2017-2015.full.html
References
This article cites 28 articles, 4 of which can be accessed free at: /content/early/2017/08/11/peds.2017-2015.full.html#ref-list-1
Subspecialty Collections
This article, along with others on similar topics, appears in the following collection(s): Endocrinology /cgi/collection/endocrinology_sub Diabetes Mellitus /cgi/collection/diabetes_mellitus_sub Obesity /cgi/collection/obesity_new_sub
Permissions & Licensing
Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml
Reprints
Information about ordering reprints can be found online: /site/misc/reprints.xhtml
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2017 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on August 20, 2017
Weighing the Causal Evidence That Associates Short Sleep Duration With Obesity Nicole Glaser and Dennis Styne Pediatrics; originally published online August 15, 2017; DOI: 10.1542/peds.2017-2015
The online version of this article, along with updated information and services, is located on the World Wide Web at: /content/early/2017/08/11/peds.2017-2015.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2017 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on August 20, 2017
