Eating in the absence of hunger in children with mild sleep loss: a randomized crossover trial with learning effects.

BACKGROUND: While insufficient sleep duration has emerged as a strong, independent risk factor for obesity, the mechanisms remain unclear. One possibility is greater "eating in the absence of hunger" (EAH) or energy intake beyond the point of satiety, when tired. OBJECTIVE: The aim was to determine whether mild sleep loss increases EAH in children. METHODS: A crossover study was undertaken in 105 healthy children (8-12 y) with normal sleep (∼8-11 h/night). After randomization, children went to bed 1 h earlier (sleep extension) or 1 h later (sleep restriction) than their usual bedtime, over 2 intervention weeks separated by a 1-wk washout. At the end of each intervention week, children underwent an EAH feeding experiment involving a preloading meal until satiation, followed by an ad libitum buffet (of highly palatable snacks) to measure EAH, with each food item weighed before and after consumption. RESULTS: Ninety-three children completed the EAH experiment. There was no evidence of a difference in energy intake from EAH between sleep restriction and extension conditions when analyzed as a crossover design. However, a learning effect was found, with children eating significantly less (-239 kJ; 95% CI: -437, -41 kJ; P = 0.018) during the preload phase and significantly more (181 kJ; 95% CI: 38, 322 kJ; P = 0.013) in the ad libitum phase in the second week. No significant differences were seen using an underpowered parallel analysis for energy intake during the ad libitum phase when sleep deprived (106 kJ; 95% CI: -217, 431 kJ; P = 0.514). CONCLUSIONS: Our findings suggest that measuring a difference in eating behavior in relation to sleep proved unsuitable using the EAH experiment in a crossover design in children, due to a learning effect. This trial was registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true) as ACTRN12618001671257 .

Do sleep interventions change sleep duration in children aged 0-5 years? A systematic review and meta-analysis of randomised controlled trials.

This review investigated whether randomised controlled trials attempting to improve sleep or prevent sleep problems in 0-5 year olds influenced nocturnal sleep duration, day-time naps, or 24-h sleep. Medline (Ovid), EMBASE, and CINAHL were searched from inception until 9 July 2020 and supplemented with hand searching. Search results were screened, eligible data were extracted, and risk of bias was assessed by at least two reviewers. Of 8571 publications considered, 32 trials which used a variety of subjective and objective sleep measurements were included in generic inverse variance random effects meta-analysis of nocturnal (n = 24), day-time (n = 14), and 24-h (n = 13) sleep duration. Overall, sleep interventions increased nocturnal sleep duration by a mean of 9 min (95% CI 4.1 to 13.8, I228%) per night when compared with no sleep intervention. Increases were predominantly seen in sleep-only, rather than multi-component interventions. Total 24-h sleep duration tended to increase by a similar amount (8.6 min (95% CI -2.7 to 19.8, I2 = 59%)), but this was mainly only seen in studies that assessed sleep using diaries. There was no evidence that interventions changed day-time sleep duration. Future studies should involve sleep-only rather than multi-component interventions, and use objective sleep measures (reviewregistry857).

Suboptimal feeding and caring practices among young Indian children ages 12 to 24 mo living in the slums of New Delhi.

OBJECTIVES: Inappropriate infant and young child feeding and caring practices affect nutritional status, increases the risk for growth faltering, and ultimately, affect child survival. The aim of this study was to characterize the feeding and caring practices of disadvantaged urban Indian children 12 to 24 mo of age in relation to the World Health Organization (WHO) and Pan American Health Organization (PAHO) recommendations. METHODS: This cross-sectional study was conducted in self-selected households in a South Delhi slum. A household survey was administered to the mother/primary caregiver of 120 eligible children. We collected child anthropometry, 2-d weighed food records (n = 69), and compliance to WHO and PAHO recommended feeding, caring, food safety, and hygiene practices. RESULTS: Of the children, 39% were stunted, 31% underweight, and 10% wasted; none were overweight. Despite 88% achieving minimum meal frequency (more than three to four meals daily), only 50% consumed at least four food groups (minimum dietary diversity), and 44% a minimum acceptable diet (composite score of minimum meal frequency and minimum dietary diversity). Consumption of iron-rich or iron-fortified foods, vitamin A-rich fruits and vegetables, and eggs was low (<25%) and flesh foods were negligible (1.4%), whereas consumption of both sugary and snack foods was >60%. Reported compliance to responsive feeding indicators was generally ∼50%, but there was a wide range (13-98%) for food safety and hygiene practices, which were not always consistent with home observations. CONCLUSIONS: Complementary feeding and caregiving practices were suboptimal among these disadvantaged young Indian children and education interventions focused on infant and young child feeding, responsive feeding, food safety, and hygiene practices are urgently needed.

The effect of mild sleep deprivation on diet and eating behaviour in children: protocol for the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial.

BACKGROUND: Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger. METHODS: The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8-12 years, with normal reported sleep duration of 8-11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1-2 h per night. DISCUSSION: Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001671257 . Registered 10 October 2018.