Sleep, nutritional status and eating behavior in children: a review study

Hermes, Fernanda Nascimento; Nunes, Eryclis Eduardo Miguel; Melo, Camila Maria de

doi:10.1590/1984-0462/2022/40/2020479IN

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Revista Paulista de Pediatria

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REVIEW ARTICLE • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020479IN copy

Sleep, nutritional status and eating behavior in children: a review study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To review the current literature on the relationship between sleep, nutritional status and eating behavior, as well as mechanisms associated with these elements in children.

Data source:

The literature research was conducted in the PubMed, LILACS and Scopus databases, using the following terms: “Child”; “Nutritional status”; “Sleep”; “Physical activity OR Physical activities OR Exercise”. The articles included were those that met the research objective. Review articles, letters to authors, or guidelines were excluded.

Data synthesis:

402 articles were initially found in the literature search. After careful analyses of the title and abstract, and application of inclusion criteria, only 24 studies were included in the present review. Most studies (n=13) suggest that short sleep duration (<9-10 hours/night) is associated with overweight/obesity in children. Only three studies did not show associations between overweight/obesity and sleep variables. Short sleep duration is also associated with poor food quality, higher intake of soft drinks and stimulant beverages before bedtime, as well as micronutrient deficiency.

Conclusions:

Sleep duration is related to overweight and obesity development in infants. Changes in dietary pattern are also related to sleep debt, being one of the mechanisms that contribute to excessive weight gain. It is necessary that health professionals understand the importance of sleep quality in the nutritional status maintenance in children.

Keywords:
Sleep; Nutritional status; Physical activity; Child

Author (year)	Goals and Sample	Main results
King (2017)⁷7. King C. Soft drinks consumption and child behaviour problems: the role of food insecurity and sleep patterns. Public Health Nutr. 2017;20:266-73. https://doi.org/10.1017/s1368980016002093 https://doi.org/https://doi.org/10.1017/...	To analyze the association between soft drink consumption and child behavior, according to food safety status and sleep patterns; 2,829 children; ±5 years old.	Sleep problems were associated with soft drink intake in food-insecure children.
Carrillo-Larco et al. (2014)¹⁶16. Carrillo-Larco RM, Bernabé-Ortiz A, Miranda JJ. Short sleep duration and childhood obesity: cross-sectional analysis in Peru and patterns in four developing countries. PLoS One. 2014;9:e112433. https://doi.org/10.1371/journal.pone.0112433 https://doi.org/https://doi.org/10.1371/...	To describe nutritional status and sleep duration in children from four countries; >8,000 children; ±8 years old.	Sleep duration <10h was associated with 15% increased incidence of obesity. Maternal education and family income attenuated this relationship.
Na et al. (2019)³²32. Na M, Eagleton SG, Jomaa L, Lawton K, Savage JS. Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income head start children of pre-school age. Public Health Nutr. 2019;23:701-10. https://doi.org/10.1017/s136898001900332x https://doi.org/https://doi.org/10.1017/...	To examine the association between food insecurity and child sleep outcomes; 362 preschoolers; 7-8 years old.	Child food insecurity was associated with a 2.25 times increase in poor child sleep quality in the adjusted model.
Ruotolo et al. (2016)³³33. Ruotolo F, Prado LB, Ferreira VR, Prado GF, Carvalho LB. Intake of stimulant foods is associated with development of parasomnias in children. Arq Neuropsiquiatr. 2016;74:62-6. https://doi.org/10.1590/0004-282x20150193 https://doi.org/https://doi.org/10.1590/...	To verify whether nocturnal eating habits can influence sleep and parasomnia in children; 226 children; 7-8 years old.	45% of children who presented parasomnia during the night consumed stimulant caffeine-rich food before bedtime. Late dinner was associated with late bedtime.
Kordas et al. (2007)³⁴34. Kordas K, Casavantes KM, Mendoza C, Lopez P, Ronquillo D, Rosado JL, et al. The association between lead and micronutrient status, and children’s sleep, classroom behavior, and activity. Arch Environ Occup Health. 2007;62:105-12. https://doi.org/10.3200/aeoh.62.2.105-112 https://doi.org/https://doi.org/10.3200/...	To investigate the relationship between lead exposure, micronutrient status, sleep, classroom behavior and physical activity in Mexican children; 602 children; 6-8 years old.	Blood lead≥10μg/dL was associated with later waking time and shorter duration of sleep. Anemia was linked to earlier bedtime, and shorter sleep onset.
Kordas et al. (2008)³⁵35. Kordas K, Siegel EH, Olney DK, Katz J, Tielsch JM, Chwaya HM, et al. Maternal reports of sleep in 6-18-month-old infants from Nepal and Zanzibar: association with iron deficiency anemia and stunting. Early Hum Dev. 2008;84:389-98. https://doi.org/10.1016/j.earlhumdev.2007.10.007 https://doi.org/https://doi.org/10.1016/...	To investigate the relationship between iron deficiency anemia (ADI), swimming and maternal sleep reports; 1,270 children; 6-18 months of age.	Iron deficiency, low length and stunting were associated short sleep duration and higher frequency of night wakening; stunting was related to shorter nap duration.
Durán et.al. (2012)³⁷37. Sleep Foundation [homepage on the Internet]. Stages of sleep [cited 2020 Apr 7]. Available from: Available from: https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep https://www.sleepfoundation.org/how-slee...	To determine the association of sleep duration and obesity; 155 schoolchildren; 5-7 years old.	Sleeping >10 hours/night, exercising, and not eating chocolate at night are associated factors for obesity.

Author (year)	Goals and sample	Main results
Marques et al. (2018)⁶6. Marques G, Matos M, Afonso C, Conceição AP, Martins T, Pinto S, et al. Childhood obesity and reduction of hours of sleep: results from cross-sectional study. Mundo Saúde. 2018;42:811-22. https://doi.org/10.15343/0104-7809.20184204811822 https://doi.org/https://doi.org/10.15343...	To analyze the association between sleep duration and nutritional status of school-age children studying in Portugal; 829 students; ±9 years old.	There was a weak but significant correlation between sleep duration and body mass index z-score (r=0.15; p<0.01).
Agüero et al. (2017)¹⁹19. Agüero DS, Giraldo GS, Guerra JB. Relationship between nutritional status and sleep duration in Chilean school-age children. ALAN. 2017;67:1-5.	To establish a relationship between sleep duration, nutritional status and consumption patterns of caffeinated beverages; 805 school-age children; 6-10 years old.	Normal weight (NW) subjects slept significantly more hours than obese participants (9.8±0.9 vs. 9.6±0.9). Sleep duration during the week was inversely associated to obesity (OR 3.5, 95%CI 1.3-9.2).
Chamorro et al. (2014)¹⁵15. Chamorro R, Ferri R, Algarín C, Garrido M, Lozoff B, Peirano P. Sleep cyclic alternating pattern in otherwise healthy overweight school-age children. Sleep. 2014;37:557-60. https://doi.org/10.5665/sleep.3496 https://doi.org/https://doi.org/10.5665/...	To compare the characteristics of sleep microstructure (CAP) in overweight (OW) and normal weight children; 58 children; 10 years old.	CAP time and CAP rate showed significant associations with body mass index z-score. Obese subjects might have less stable slow wave sleep episodes.
Corso et al. (2012)²⁴24. Corso AC, Caldeira GV, Fiates GM, Schmitz BA, Ricardo GD, Vasconcelos FA. Behavioral factors associated with overweight and with obesity in students in the State of Santa Catarina. Rev Bras Estud Popul. 2012;29:117-31. https://doi.org/10.1590/s0102-30982012000100008 https://doi.org/https://doi.org/10.1590/...	To analyze the association between OW/obesity (OB) and hours spent with TV/computer, hours of sleep and physical activity; 4,964 schoolchildren; 6-10 years old.	OW and OB were associated with weekly sports practice and sleep hours per night.

Author (year)	Goals and Sample	Main results
Agüero and Rivera (2016)¹⁷17. Agüero SD, Rivera PH. Association between the amount of sleep and obesity in Chilean schoolchildren. Arch Argent Pediatr. 2016;114:114-9. https://doi.org/10.5546/aap.2016.eng.114 https://doi.org/https://doi.org/10.5546/...	To investigate sleep and eating habits, physical activity and nutritional status; 1,810 children; 6-11 years old.	Positive associations between sleep and risk of being obese, even when adjusted for confounders.
Bazán et al. (2018)¹⁸18. Bazán AM, Sellán MC, Vázquez AS, Díaz ML, Domínguez FS. Factors associated with overweight and childhood obesity in Spain according to the latest national health survey (2011). Esc Anna Nery Rev Enferm. 2018;22:e20170321. https://doi.org/10.1590/2177-9465-ean-2017-0321 https://doi.org/https://doi.org/10.1590/...	To describe factors associated with overweight (OW)/obesity (OB); 3,752 children; 2-15 years old.	OB was higher in children who sleep less than the recommended hours of sleep.
Cicek et al. (2009)²⁰20. Cicek B, Ozturk A, Mazicioglu MM, Elmali F, Turp N, Kurtoglu S. The risk analysis of arm fat area in Turkish children and adolescents. Ann Hum Biol. 2009;36:28-37. https://doi.org/10.1080/03014460802537690 https://doi.org/https://doi.org/10.1080/...	To examine the risk factors associated with arm fat area (AFA) in Turkish children and adolescents; 5,358 schoolchildren; 6-17 years old.	Sleeping 8-9 h and ≤8 h significantly predicted OW for boys; while sleeping 9-10 h, 8-9 h and ≤8 h significantly predicted OW for girls.
Katsa et al. (2018)²²22. Katsa ME, Ioannidis A, Zyga S, Tsironi M, Koutsovitis P, Chatzipanagiotou S, et al. The effect of nutrition and sleep habits on predisposition for metabolic syndrome in Greek children. J Pediatr Nurs. 2018;40:e2-8. https://doi.org/10.1016/j.pedn.2018.01.012 https://doi.org/https://doi.org/10.1016/...	To investigate the effect of life habits on Child Metabolic Syndrome; 480 children; 5-12 years old.	Late bedtime was associated with increased weight, waist circumference, lower height and blood glucose.
Guo et al. (2012)²³23. Guo X, Zheng L, Li Y, Yu S, Sun G, Yang H, et al. Differences in lifestyle behaviors, dietary habits, and familial factors among normal-weight, overweight, and obese Chinese children and adolescents. Int J Behav Nutr Phys Act. 2012;9:120. https://doi.org/10.1186/1479-5868-9-120 https://doi.org/https://doi.org/10.1186/...	To compare health-related factors among Chinese children and adolescents with normal weight (NW), OW and OB; 4,262 children and adolescents; 5-18 years old.	NW children had a higher change of having a longer sleep duration than OB. OB children were less likely to sleep longer (≥7.5 h) than the NW.
Jong et al. (2012)²⁶26. Jong E, Stocks T, Visscher TL, HiraSing RA, Seidell JC, Renders CM. Association between sleep duration and overweight: the importance of parenting. Int J Obes (Lond). 2012;36:1278-84. https://doi.org/10.1038/ijo.2012.119 https://doi.org/https://doi.org/10.1038/...	To establish an association between sleep duration and OW in childhood; 4,072 children; 4-13 years old.	Short sleep duration was associated with watching TV during meals and eating sugar-rich foods.
Aravena et al. (2017)²⁸28. Aravena P, Mansilla A, Pangue A, Needham V, Muñoz C. Nutritional status and hours of sleep among elementary school students in the city of Punta arenas in 2016. Rev Chil Nutr. 2017;44:270-5. https://doi.org/10.4067/s0717-75182017000300270 https://doi.org/https://doi.org/10.4067/...	To study nutritional status and sleep duration in Chilean children; 481 schoolchildren; 6-15 years old.	The numbers for OB children were not different from those for NW children who sleep the recommended hours.
Giovaninni et al. (2014)²⁹29. Giovaninni NP, Fuly JT, Moraes LI, Coutinho TN, Trarbach EB, Jorge AA, et al. Study of the association between 3111T/C polymorphism of the CLOCK gene and the presence of overweight in schoolchildren. Pediatria. 2014;90:500-5. https://doi.org/10.1016/j.jped.2014.01.011 https://doi.org/https://doi.org/10.1016/...	To analyze clock gene polymorphism and presence of OB and sleep duration; 370 children; 6-13 years old.	Trend toward higher prevalence of OW in children <9h/night of sleep vs >10h/night.
Golley et al. (2013)³⁰30. Golley RK, Maher CA, Matricciani L, Olds TS. Sleep duration or bedtime? Exploring the association between sleep timing behaviour, diet and BMI in children and adolescents. Int J Obes (Lond). 2013;37:546-51. https://doi.org/10.1038/ijo.2012.212 https://doi.org/https://doi.org/10.1038/...	To investigate if sleep time is associated with diet; 2,200 children and adolescents; 9-16 years old.	Late bedtime group had higher body mass index (BMI); there were significant associations between BMI, sleep duration and energy intake.
Jiang et al. (2014)²¹21. Jiang YR, Spruyt K, Chen WJ, Shen XM, Jiang F. Somatic growth of lean children: the potential role of sleep. World J Pediatr. 2014;10:245-50. https://doi.org/10.1007/s12519-014-0500-2 https://doi.org/https://doi.org/10.1007/...	To investigate the association between sleep duration and somatic growth; 143 children; 10-11 years old.	Children that slept >10h/night had higher weight, height and BMI.
Christoph et al. (2017)²⁷27. Christoph MJ, Grigsby-Toussaint DS, Baingana R, Ntambi JM. Physical activity, sleep, and BMI percentile in rural and urban Ugandan youth. Ann Glob Health. 2017;83:311-9. https://doi.org/10.1016/j.aogh.2017.04.005 https://doi.org/https://doi.org/10.1016/...	To investigate weight-related factors in rural and urban schoolchildren; 148 schoolchildren; 11-16 years old.	BMI was positively related to being female, rural, more active and having higher subjective sleep quality.
Hitze et al. (2009)³¹31. Hitze B, Bosy-Westphal A, Bielfeldt F, Settler U, Plachta-Danielzik S, Pfeuffer M, et al. Determinants and impact of sleep duration in children and adolescents: data of the Kiel Obesity Prevention Study. Eur J Clin Nutr. 2009;63:739-46. https://doi.org/10.1038/ejcn.2008.41 https://doi.org/https://doi.org/10.1038/...	To investigate the determinants of sleep duration in children; 414 adolescents; 13 years old.	Short vs long sleep was associated with 5.5-/2.3-fold higher risks for OB in girls.

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[1] *Corresponding author. E-mail: camila.melo@ufla.br (C. M. de Melo).