Changes in sleep phase and body weight of mobile health App users during COVID-19 mild lockdown in Japan.

OBJECTIVE AND METHOD: The stay-at-home order during the COVID-19 pandemic has restricted individuals' social behaviors, and therefore, effected their lifestyle including sleep, diet, and physical activity. Using the cross-sectional study design with a large sample size (N = 30,275) from the mobile health App users in Japan, we show age-dependent lifestyle changes during a nonpunitive "mild lockdown" (from April to May 2020). RESULTS: Sleep onset and offset were delayed on work-days but not on free-days with increased sleep duration and decreased social jetlag, and the changes were more evident in the younger population. Although average weight change was close to none because of the users' characteristic (95% of App users try to lose weight), we investigated an association between lifestyle change and body-weight change. Participants who reported advanced sleep phase during mild lockdown described a weight decrease. In contrast, the delayed sleep phase reported a weight gain. The results were significant after adjustment of confounding factors including physical activity and meal changes. CONCLUSIONS: Although there is cumulative evidence showing a relationship between late chronotype and obesity, it is still unclear about the potential benefit of the chronotype management to control body weight. Thus, to the best of our knowledge, this is the first study investigating the association between chronotype and weight changes by leveraging a large cohort.

Screen time duration and timing: effects on obesity, physical activity, dry eyes, and learning ability in elementary school children.

BACKGROUND: As internet use becomes more widespread, the screen time (ST) of elementary school students increases yearly. It is known that longer durations of ST can affect obesity, physical activity, dry eye disease, and learning ability. However, the effects of ST just before bedtime have not been clarified. Therefore, we examined ST duration and timing effects on elementary school children. METHODS: We conducted a survey of 7419 elementary school students in Tokyo, Japan using a questionnaire on food education. ST duration and timing (just before bedtime) served as the explanatory variables, and the relationship between obesity, physical activity, dry eyes, and learning ability was analyzed using logistic regression analysis. Gender, school year, height, and weight were considered confounding factors. First, we examined whether ST duration and timing were related to each objective variable, using a univariate model to examine all variables. Thereafter, we performed multivariate logistic regression analyses for all variables showing a significant difference in the univariate models. RESULTS: A significant association was observed between ST duration and obesity, physical activity, and academic performance, indicating that a longer ST duration may lead to obesity, decreased physical activity, and decreased academic performance. ST timing was associated with obesity, dry eyes, and academic performance, and ST immediately before bedtime contributed to obesity, dry eyes, and reduced academic performance. Furthermore, the results of investigating the combined effect of ST duration and timing (immediately before bedtime) on these factors revealed that ST timing has a greater effect on dry eyes, and ST duration has a greater effect on academic performance. CONCLUSION: Our findings indicate that ST in school children is related to obesity, physical activity, dry eyes, and learning ability, and they suggest that not only the duration but also the timing of ST is important.

Association of Eating Pattern, Chronotype, and Social Jetlag: A Cross-Sectional Study Using Data Accumulated in a Japanese Food-Logging Mobile Health Application.

Chronotype (morningness-eveningness) and social jetlag (SJL; discrepancy in the sleep pattern between the weekday and weekend) are related to eating behavior and health. The association between sleep behavior and the daily macro- and micronutrient eating pattern of each meal (breakfast, lunch, and dinner) have not been discussed well and need more evidence. Here, meal pattern datasets of Japanese participants aged 20-59 years were obtained as averages over 1 month from the data stored in the food-logging app "Asken". We allocated three groups for each chronotype and SJL. Multiple regression analyses revealed that morning chronotype and small SJL were associated with higher total daily intake of potassium, fiber, magnesium, phosphorus, and vitamin K. Breakfast energy intake and consumption of nutrients, including protein, lipid, carbohydrate, and minerals, were higher in the morning chronotype or small SJL. Lunch intake of potassium, cholesterol, fiber, magnesium, and vitamin K was also higher in the morning chronotype or small SJL. Dinner energy intake and nutrient intake of proteins, lipids, carbohydrates, sodium, and saturated fatty acids were lower in the morning chronotype or small SJL. The current data would help to establish a detailed reference for dietary intake which considers eating patterns over a day.

Association Between Na, K, and Lipid Intake in Each Meal and Blood Pressure.

Cardiovascular diseases (CVDs) are one of the leading causes of death worldwide, and one of the most significant risk factors for CVDs is high blood pressure. Blood pressure is associated with various nutrients, such as sodium, potassium, and cholesterol. However, research focusing on the timing of intake of these nutrients and blood pressure has not been conducted. In this study, we used dietary data and a questionnaire asking about the sleep, physical activity, and blood pressure, collected from the food-log app "Asken" (total N = 2,402), to investigate the relationship between the dietary data of nutrient intake in the breakfast, lunch, and dinner and blood pressure. Daily total intake of various nutrients such as sodium, sodium-to-potassium ratio, total energy, lipid, carbohydrate, and saturated fat showed a significant association with blood pressure depending on the meal timing. From multiple regression analysis, eliminating the confounding factors, lunch sodium-to-potassium ratio, dinner energy, lipid, cholesterol, saturated fat, and alcohol intake were positively associated with blood pressure, whereas breakfast protein and lunch fiber intake showed a negative association with blood pressure. Our results suggest that nutrient intake timing is also an important factor in the prevention of high blood pressure. Our study provides possibilities to prevent hypertension by changing the timing of nutrient intake, especially sodium, together with potassium and lipids. However, because our research was limited to food-log app users, broader research regarding the general population needs to be conducted.

Interaction effects of sex on the sleep loss and social jetlag-related negative mood in Japanese children and adolescents: a cross-sectional study.

Study Objectives: Sleep problems, such as accumulated sleep loss and social jetlag (SJL), which is characterized by a discrepancy in a person's sleep pattern between the weekday and the weekend, are associated with physical and mental health problems, and academic performance in young ages. However, sex differences in these associations are not fully understood. The purpose of this study was to investigate the effect of sex on sleep-related factors, mental health (negative mood), and academic performance in Japanese children and adolescents. Methods: A cross-sectional online survey was conducted with 9270 students (boys: N = 4635, girls: N = 4635) ranging from the fourth grade of elementary school to the third grade of high school, which typically includes ages 9-18 years in Japan. Participants completed the Munich ChronoType Questionnaire, the Athens Insomnia Scale, self-reported academic performance, and negative mood-related questions. Results: School grade-related changes in sleep behavior (e.g. delayed bedtime, shortened sleep duration, and increased SJL) were detected. Girls had greater sleep loss on weekdays and SJL on weekends than boys. Multiple regression analysis revealed that sleep loss and SJL were more associated with negative mood and higher insomnia scores in girls than in boys, but not with academic performance. Conclusions: Sleep loss and SJL in Japanese girls had a higher correlation to their negative mood and tendency to insomnia than in boys. These results suggest the importance of sex-dependent sleep maintenance for children and adolescents.

Correction: Relationship Between Protein Intake in Each Traditional Meal and Physical Activity: Cross-sectional Study.

[This corrects the article DOI: 10.2196/35898.].

Relationship Between Protein Intake in Each Traditional Meal and Physical Activity: Cross-sectional Study.

BACKGROUND: Protein intake plays an important role in the synthesis and maintenance of skeletal muscles for the prevention of health risks. It is also widely known that physical activity influences muscle function. However, no large-scale studies have examined the relationship between daily dietary habits, especially the timing of protein intake, and daily physical activity. OBJECTIVE: The purpose of this cross-sectional study was to investigate how protein intake and composition (involving the 3 major nutrients protein, fat, and carbohydrate) in the 3 traditional meals (breakfast, lunch, and dinner) are associated with physical activity. METHODS: Using daily dietary data accumulated in the smartphone food log app "Asken" and a web-based cross-sectional survey involving Asken users (N=8458), we analyzed nutrient intake and composition, as well as daily activity levels. As very few individuals skipped breakfast (1102/19,319 responses, 5.7%), we analyzed data for 3 meals per day. RESULTS: Spearman rank correlation analysis revealed that breakfast and lunch protein intakes had higher positive correlations with daily physical activity among the 3 major macronutrients (P<.001). These findings were confirmed by multivariate logistic regression analysis with confounding factors. Moreover, participants with higher protein intake and composition at breakfast or lunch tended to exhibit significantly greater physical activity than those with higher protein intake at dinner (P<.001). CONCLUSIONS: Among the 3 macronutrients, protein intake during breakfast and lunch was closely associated with daily physical activity.

Attending a Sports Club Can Help Prevent Visual Impairment Caused by Cram School in Elementary School Children in Japan.

Longer durations for near-work activities, such as studying, worsen eyesight. In contrast, outdoor exercise is effective in reducing the risk of developing myopia. Despite these findings, however, the interaction between studying and exercise in eyesight has not been quantitatively evaluated. Moreover, since there is a culture of attending lessons in Japan, it is important to investigate the relationship between elementary school activities, such as cram schools or sports clubs, and vision. Therefore, in this study, we examined whether attending cram schools and/or sports clubs is associated with the use of glasses among elementary school students. We conducted a survey among 7419 elementary school students in Tokyo, Japan using a food education questionnaire. A logistic regression analysis was used to evaluate the relationship between wearing glasses, an objective variable, and attending sports clubs and cram schools. Sex and school year were considered confounding factors. The results of this study showed that students who attended only sports clubs were more likely to be categorized into the "not wearing glasses" group (p = 0.03, OR = 1.45), whereas those who attended only cram schools were more likely to be categorized into the "wearing glasses" group (p = 0.008, OR = 0.67). In addition, students who attended both cram schools and sports clubs were more likely to be categorized into the "not wearing glasses" group than those who only attended cram schools (p = 0.28, OR = 0.85). Our findings indicate that attending not only cram schools but also sports clubs may prevent deterioration of eyesight. Parents and health care providers need to take these findings into account in order to prevent visual impairment in children.