title: Sleep patterns and television viewing in relation to obesity and blood pressure: evidence from an adolescent Brazilian birth cohort.
abstract: BACKGROUND
  Disruption of circadian rhythms has been associated with obesity in children and adolescents, and with hypertension in adults, in industrialized populations.
  
  
  OBJECTIVE
  We examined cross-sectional associations between sleep duration or television viewing and obesity and blood pressure in Brazilian adolescents.
  
  
  METHODS
  The sample consisted of 4452 adolescents aged 10-12 years participating in a prospective birth cohort study in Pelotas, Brazil. Sleep duration and television viewing were determined through questionnaires. Obesity was assessed using international cut-offs for body mass index (BMI), and body fatness by skinfold thicknesses. Blood pressure was measured using a validated monitor.
  
  
  RESULTS
  Short sleep duration was associated with increased BMI, skinfolds, systolic blood pressure, activity levels and television viewing. Each hour of sleep reduced BMI by 0.16 kg/m(2) (s.e. 0.04), and was associated with odds ratio for obesity of 0.86 (s.e. 0.04), both P<0.001. Television viewing was associated with increased BMI and skinfolds, and increased blood pressure. The effects of sleep duration and television viewing on obesity were independent of one another. Their associations with blood pressure were mediated by body fatness.
  
  
  CONCLUSIONS
  Both short sleep duration and increased television viewing were associated with greater body fatness, obesity and higher blood pressure, independently of physical activity level. These associations were independent of maternal BMI, identified in other studies as the strongest predictor of childhood obesity. Our study shows that behavioural factors associated with metabolic risk in industrialized populations exert similar deleterious effects in a population undergoing nutritional transition and suggest options for public health interventions.
authors.affiliation: Childhood Nutrition Research Centre, Institute of Child Health, London, UK. j.wells@ich.ucl.ac.uk
authors.forename: J C K
authors.initials: JC
authors.lastname: Wells
authors.forename: P C
authors.initials: PC
authors.lastname: Hallal
authors.forename: F F
authors.initials: FF
authors.lastname: Reichert
authors.forename: A M B
authors.initials: AM
authors.lastname: Menezes
authors.forename: C L P
authors.initials: CL
authors.lastname: Araújo
authors.forename: C G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D001938:Brazil; D002648:Child; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000209:etiology*; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D012885:Skinfold Thickness; D012892:Sleep Deprivation; D013690:Television