title: Associations among late chronotype, body mass index and dietary behaviors in young adolescents.
abstract: OBJECTIVE
  Levels of pediatric obesity continue to rise. Previous evidence has linked short sleep duration and/or poor sleep quality to obesity development, although objective data are limited. As adolescents transition through puberty, circadian shifts occur, resulting in sleep loss. However, little is known whether chronotype is associated with body mass index (BMI) or dietary behaviors in adolescents. We hypothesized late chronotype would be positively associated with BMI and poorer dietary behaviors.
  
  
  METHODS
  A total of 511 UK young adolescents (11-13 years) from eight secondary schools across the Midlands region (UK) participated in the Midlands Adolescent Schools Sleep Education Study (MASSES), a cross-sectional study to assess potential relationships between chronotype and BMI z-score as well as dietary habits. Height (cm) and weight (kg) were objectively measured for BMI calculation and participants completed a questionnaire to assess dietary habits. A subsample of 236 adolescents wore wrist actigraphy for 7 days to estimate average sleep duration (weekday, weekend and combined) and sleep efficiency.
  
  
  RESULTS
  Definitely evening chronotype was positively associated with BMI z-score compared to definitely morning chronotypes β = 0.51, P < 0.01, after adjustment. Higher frequency of consuming unhealthy snacks, night-time caffeine consumption and inadequate daily intake of fruit/vegetables were also associated with later chronotype (all P ⩽ 0.01). Actigraphy estimated sleep duration was an independent predictor of BMI z-score β = -0.36, P < 0.001. Sleep efficiency did not predict BMI z-score after adjustment, β = -0.03, P = 0.07.
  
  
  CONCLUSIONS
  Later chronotype young adolescents are at risk of increased BMI and poorer dietary behaviors. Although short sleep duration, but not sleep efficiency, was also an independent risk factor for increased BMI, different mechanisms may be driving the late chronotype and shorter sleep duration associations with BMI in this age group. Sleep hygiene education may help adolescents to better understand the impact of sleeping habits on physical health.
authors.affiliation: Weill Cornell Medical College in Qatar, Qatar Foundation, Education City, Doha, Qatar.
authors.forename: T
authors.initials: T
authors.lastname: Arora
authors.affiliation: Weill Cornell Medical College in Qatar, Qatar Foundation, Education City, Doha, Qatar.
authors.forename: S
authors.initials: S
authors.lastname: Taheri
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D012574:Schools / Q000706:statistics & numerical data*; D057566:Self Report; D012890:Sleep; D012892:Sleep Deprivation / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015430:Weight Gain