Sleep Health and Obesity-Related Eating Behaviors in Low-Income Toddlers

• In Event: 1-149 - Sleep in High-Risk Young Children: Disparities, Behavioral Correlates, and Intervention Results

Integrative Statement

Background
Poor sleep health has been associated with obesity risk in children, but the mechanisms are not well understood, particularly early in development. Eating behavior, or the manner in which a child eats, may be one possible mechanism. For example, insufficient sleep may drive unhealthy eating behavioral patterns or habits such as eating in the absence of hunger or eating in response to emotional stress, which may over time promote risk for obesity. The present study examined whether different sleep health parameters (duration, timing, and quality) were associated with eating behaviors including emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness, and eating in the absence of hunger (EAH), during toddlerhood. As low-income children are at increased risk for obesity from an early age, we examined these associations in a sample of low-income children.

Method
Participants were 134 low-income 33-month-olds and their families who were recruited from Early Head Start, Women Infant and Children’s (WIC) programs, and community settings (see Table 1 for sample characteristics and descriptive statistics).

Parents reported the child’s usual bedtime and wake time on weekdays and weekends, from which weeknight sleep duration and weekday-to-weekend bedtime delay were calculated. Parents also reported on child sleep quality using the Children’s Sleep Wake Scale (CSWS; LeBourgeois & Harsh, 2016; Cronbach’s α=.82).

Child eating behaviors were assessed using both observed and parent-report measures. Parents completed the Child Eating Behavior Questionnaire-Toddler (CEBQ-T; Herle et al. 2016) to assess the child’s: Emotional Overeating (tendency to overeat when upset; α=.83); Food Responsiveness (tendency to eat in response to external stimuli other than hunger; α=.84); Enjoyment of Food (general desire to eat; α=.83); and Satiety Responsiveness (capacity to stop eating in response to internal satiety cues; α=.65).

Observed child EAH was evaluated by measuring kilocalories (kcal) of palatable foods consumed following a meal at home. EAH was assessed using a standard protocol (Asta et al., 2016) wherein the child was presented with standardized sweet and salty foods using standard prompts, and given 10 minutes of free access before the foods were removed and weighed. Kcal consumed was calculated based on calories per unit weight for each food.

Analysis and Results
Multivariable linear regression was used to examine the associations between sleep parameters (duration, timing, and quality) and eating behaviors (see Table 2). Poorer sleep quality was associated with greater Emotional Overeating (standardized β=-0.20 (SE 0.09), p<.05) and greater Food Responsiveness (β=-0.18 (SE 0.09), p<.05). Shorter nighttime sleep duration was associated with greater EAH kcal consumed (standardized β=-0.22 (SE 0.09), p<.05). Sleep timing was not associated with any of the eating behaviors, and no sleep variables were associated with either Enjoyment of Food or Satiety Responsiveness.

Conclusion
Shorter nocturnal sleep duration and poorer sleep quality during toddlerhood are associated with obesity-related eating behaviors. Poor sleep health may promote childhood obesity risk through eating behavior pathways. As children growing up in poverty may experience poor sleep health, sleep duration and sleep quality may be important targets for intervention among low-income families with young children.

Authors

• Alison L. Miller, University of Michigan School of Public Health
  Presenting Author

• Sara E Miller, University of Michigan
  Non-Presenting Author

• Monique K. LeBourgeois, University of Colorado
  Non-Presenting Author

• Julie Sturza, University of Michigan
  Non-Presenting Author

• Katherine L Rosenblum, University of Michigan
  Non-Presenting Author

• Julie Lumeng, University of Michigan
  Non-Presenting Author