Dietary patterns and sleep duration in middle childhood

doi:10.21203/rs.3.rs-4702112/v1

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Dietary patterns and sleep duration in middle childhood

https://doi.org/10.21203/rs.3.rs-4702112/v1

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High consumption of ultra-processed foods (UPF) has been related to short sleep duration, a risk factor for chronic disease. However, the temporality of the association remains unclear, especially among children. We assessed associations of adherence to dietary patterns and sleep duration in middle childhood longitudinally, among 729 participants in the Bogotá School Children Cohort. Four dietary patterns (UPF, traditional, animal protein, and cheaper protein) were identified through principal component analysis of a food frequency questionnaire. Sleep duration was assessed through parental report after a median 2 years of follow-up. Compared with children in the lowest quartile of UPF pattern adherence, those in the highest quartile slept an adjusted 0.39 hours less (95% CI: 0.10, 0.68; P trend = 0.004). Adherence to cheaper protein was non-linearly related to sleep duration. We conclude that adherence to a UPF dietary pattern is prospectively related to shorter sleep duration in children.

Health sciences/Risk factors

Biological sciences/Neuroscience/Circadian rhythms and sleep/Sleep

Sleep is a vital restorative mechanism for the body. In middle childhood, insufficient sleep has been associated with cognitive dysfunction, behavior problems, and metabolic disorders [1, 2]. Despite its importance, 14% of children have insufficient sleep duration by age 12 years [3]. Importantly, sleep disturbances that start in childhood often track into adulthood and can contribute to chronic disease burden by increasing risk of heart disease and diabetes [4].

Greater consumption of ultra-processed foods (UPF) may explain in part the increasing trends in sleep disturbances in many areas. Previous studies have generally found a positive association between UPF intake and short sleep duration in children and adults [5]. However, these studies have been cross-sectional in nature, making the temporality of the association undiscernible.

The objective of this study was to assess the associations between adherence to dietary patterns and sleep duration in middle childhood longitudinally, in the Bogotá School Children Cohort (BoSCCo).

BoSCCo was a longitudinal study of 3,202 low- and middle-income children from primary public schools in Bogotá, Colombia recruited in February 2006. At enrollment, we administered a parental questionnaire on child behaviors and habits and sociodemographic background, measured children’s heights and weights and administered a 38-item food frequency questionnaire (FFQ) to a random sample of 1,027 mothers to assess the children’s usual food intake during the previous year. Details of the FFQ are provided elsewhere [6]. All participants provided informed consent prior to enrollment. The study was approved by the Ethics Committee at the National University of Colombia Medical School; the University of Michigan Institutional Review Board approved the use of data from the study.

Between 2007 and 2009, parents of 2,308 participants completed a follow-up self-administered survey that included questions on the nightly number of hours and minutes from falling asleep to awakening, separately for weekdays and weekends of a typical week.

The analytic sample comprised children with both FFQ and sleep assessments, who were 6–12 years of age at the time of sleep assessment (n = 729). We used principal component analysis to identify dietary patterns using the responses to the items in the FFQ as input [6]. The patterns identified were UPF (e.g., candy, ice cream, packed fried snacks, soda, fruit punch), traditional/starch (e.g., rice, potato, plantain), animal protein (e.g., milk, yogurt, beef/pork/veal/lamb, cheese, chicken), and cheaper protein (e.g., cow tripe/liver, spleen, chicken giblets). We estimated nighttime sleep duration as the weighted average of the weekday (weight, 5/7) and weekend day (weight, 2/7) reported sleep hours.

We compared the distribution of nighttime sleep duration across quartiles of adherence to each dietary pattern using means ± standard deviations (SD) and estimated mean differences with 95% confidence intervals (CI) using linear regression. Multivariable models were adjusted for known independent predictors of sleep duration [1], that have also been related to adherence to dietary patterns [7] but are not its consequence; these included child’s age, sex, time playing outdoors, height- and body mass index-for-age z-scores per the World Health Organization Growth Reference, maternal parity and education, and home ownership, socioeconomic status per the local government classification, and food insecurity per a validated Spanish version of the USDA Household Food Security Survey module. Analyses were performed with Statistical Analysis Software version 9.4 (SAS Institute, Cary, NC).

Mean ± SD ages at baseline and sleep assessment were 8.6 ± 1.7 years and 10.6 ± 1.9 years, respectively; 50% of children were female. Mean ± SD nighttime sleep duration was 9.2 ± 1.3 hours. Adherence to the UPF pattern was inversely associated with sleep duration in a dose-response manner. Mean sleep duration was an adjusted 0.39 hours shorter (95% CI: 0.10, 0.68; P trend = 0.004) among children in the highest versus lowest quartiles of adherence (Table 1). Adherence to the cheaper protein pattern was related to sleep duration in a non-linear manner; children with intermediate adherence had longer sleep duration than those at the extremes (Table 1).

Table 1

Adherence to dietary patterns and sleep duration in children ages 6–12 years in the Bogotá School Children Cohort.
Sleep duration, hours	Quartiles of adherence to dietary pattern				P, trend¹
Sleep duration, hours	Q1	Q2	Q3	Q4	P, trend¹
Ultra-processed foods
n	182	182	183	182
Mean (SD)	9.50 (1.52)	9.28 (1.14)	9.20 (1.17)	9.16 (1.30)
Unadjusted difference (95% CI)²	Reference	-0.22 (-0.49, 0.04)	-0.30 (-0.56, -0.03)	-0.34 (-0.60, -0.07)	0.01
Adjusted difference (95% CI)³	Reference	-0.20 (-0.49, 0.08)	-0.40 (-0.69, -0.11)	-0.39 (-0.68, -0.10)	0.004
Traditional/Starch
n	182	182	183	182
Mean (SD)	9.11 (1.10)	9.33 (1.21)	9.40 (1.46)	9.29 (1.36)
Unadjusted difference (95% CI)	Reference	0.22 (-0.04, 0.49)	0.30 (0.03, 0.56)	0.18 (-0.08, 0.45)	0.15
Adjusted difference (95% CI)	Reference	0.14 (-0.15, 0.43)	0.28 (-0.01 0.57)	0.08 (-0.21, 0.37)	0.43
Animal protein
n	182	183	182	182
Mean (SD)	9.41 (1.61)	9.19 (1.15)	9.18 (1.15)	9.35 (1.20)
Unadjusted difference (95% CI)	Reference	-0.22 (-0.48, 0.05)	-0.23 (-0.49, 0.04)	-0.06 (-0.32, 0.21)	0.69
Adjusted difference (95% CI)	Reference	-0.22 (-0.51, 0.07)	-0.25 (-0.54, 0.04)	-0.07 (-0.36, 0.21)	0.63
Cheaper protein
n	182	182	183	182
Mean (SD)	9.10 (1.17)	9.40 (1.38)	9.47 (1.35)	9.16 (1.24)
Unadjusted difference (95% CI)	Reference	0.30 (0.03, 0.56)	0.37 (0.11, 0.63)	0.05 (-0.21, 0.32)	0.58
Adjusted difference (95% CI)	Reference	0.32 (0.04 ,0.61)	0.37 (0.08, 0.66)	0.04 (-0.24, 0.33)	0.77
Abbreviations; SD: Standard Deviation; CI: Confidence Interval
¹ Test for linear trend where a variable representing quartiles of adherence to the dietary pattern was introduced into a linear regression model as a continuous covariate.
² Mean differences estimated from linear regression models (n = 729).
³ Adjusted for child’s age, sex, time playing outdoors, height- and body mass index-for-age z-scores, maternal parity and education, and home ownership, socioeconomic status, and food insecurity. Complete case analysis (n = 632).

In this longitudinal analysis of Colombian school children, adherence to a UPF dietary pattern was associated with shorter sleep duration in a dose-response manner. These findings are consistent with previous cross-sectional studies that generally found inverse associations between UPF consumption and sleep duration [5]. However, our study is novel because of its longitudinal design, which allows to clarify the temporality of the association. In addition, assessing predictors of sleep duration in middle childhood may be especially relevant since sleep duration becomes relatively stable by age 10 years [3].

Different mechanisms could explain an association between UPF intake and shortened sleep. Simple sugars and saturated fats, which are common in UPF, have been linked to hyperarousal during sleep time in adults, resulting in greater sleep latency and arousals during sleep [8]. Alternatively, high adherence to the UPF pattern may shorten sleep duration by replacing intake of foodstuffs that are vital for production of sleep-promoting compounds like serotonin and melatonin, [9]. Similarly, high adherence to the UPF pattern may result in magnesium, zinc, or iron deficiencies which have been previously associated with shorter sleep duration [10].

Our study has several notable strengths. First, prospective collection of exposure and outcome reduces likelihood of reverse causation and differential recall bias. Second, the FFQ allows for the assessment of long-term diet. Last, we were able to adjust for many important potential confounders of the diet-sleep association. There are also limitations worth noting. Sleep duration was measured through parental report which may be prone to measurement error. Nevertheless, this measurement error would likely be non-differential with respect to dietary patterns which could result in an attenuation of the observed association. UPF could not be classified according to the prevailing NOVA system due to the limited number of items in the FFQ. We lacked data on sleep quality and other sleep outcomes. Also, as in any observational study, residual confounding cannot be ruled out. Last, results may not be generalizable to populations with different dietary patterns and sleep habits.

In conclusion, this study provides evidence that high adherence to an UPF pattern may contribute to shorter sleep duration in middle childhood.

DATA AVAILABILITY STATEMENT

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTEREST

None of the authors have any conflicts of interest to disclose.

AUTHOR CONTRIBUTIONS

M.Q.Z. and E.V. designed the research, M.M.P. conducted the research and provided critical revisions to the manuscript, M.Q.Z. performed the statistical analysis, M.Q.Z. and E.V. wrote the paper and had primary responsibility for the final content. All authors have read and approved the final version of the manuscript.

FUNDING

This work was supported by the ASISA Foundation.

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Dietary patterns and sleep duration in middle childhood

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