WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies.
BACKGROUND
Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children.


METHODS
The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation.


RESULTS
One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]).


CONCLUSIONS
The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.
Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstrasse 30, 28359, Bremen, Germany. boern@bips.uni-bremen.de.
Claudia
C
Börnhorst
Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark. twi@euro.who.int.
Trudy M A
TM
Wijnhoven
Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694, Prague 1, Czech Republic. mkunesova@endo.cz.
Marie
M
Kunešová
School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, SE, 712 02, Grythyttan, Sweden. Agneta.Yngve@oru.se.
Agneta
A
Yngve
National Health Institute Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal. ana.i.rito@gmail.com.
Ana I
AI
Rito
Section for Epidemiology and Social medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 454, SE, 405 30, Gothenburg, Sweden. lauren.lissner@gu.se.
Lauren
L
Lissner
Department of Food and Nutrition, National Center of Public Health and Analyses, 15 Akad. Ivan Evstatiev Geshov Blvd, 1431, Sofia, Bulgaria. v.duleva@ncpha.government.bg.
Vesselka
V
Duleva
Department of Preventive Medicine, Lithuanian University of Health Sciences, Eiveniu str. 4, 50009, Kaunas, Lithuania. ausrapet@vector.kmu.lt.
Ausra
A
Petrauskiene
Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark. jbr@euro.who.int.
João
J
Breda
D002648:Child; D003201:Computers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004032:Diet; D005060:Europe; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D005638:Fruit; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010290:Parents; D063766:Pediatric Obesity / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*; D012890:Sleep; D013690:Television / Q000706:statistics & numerical data*; D013997:Time Factors; D014675:Vegetables; D014944:World Health Organization