title: Sleep duration and growth outcomes across the first two years of life in the GUSTO study.
abstract: OBJECTIVE
  Short sleep duration is thought to be a factor contributing to increased body mass index (BMI) in both school-age children and adults. Our aim was to determine whether sleep duration associates with growth outcomes during the first two years of life.
  
  
  METHODS
  Participants included 899 children enrolled in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study. Anthropometric data (weight and body length) and parental reports of sleep duration were collected at 3, 6, 9, 12, 18, and 24 months of age. A mixed-model analysis was used to evaluate the longitudinal association of BMI and body length with sleep duration. In subgroup analyses, effects of ethnicity (Chinese, Indian, and Malay) and short sleep at three months of age (≤12 h per day) were examined on subsequent growth measures.
  
  
  RESULTS
  In the overall cohort, sleep duration was significantly associated with body length (β = 0.028, 95% confidence interval [CI] 0.002-0.053, p = 0.033), but not BMI, after adjustment for potential confounding factors. Only in Malay children, shorter sleep was associated with a higher BMI (β = -0.042, 95% CI -0.071 to -0.012, p = 0.005) and shorter body length (β = 0.079, 95% CI 0.030-0.128, p = 0.002). In addition, shorter sleep was associated with a higher BMI and shorter body length in children who slept ≤12 h per day at three months of age.
  
  
  CONCLUSIONS
  The association between sleep duration and growth outcomes begins in infancy. The small but significant relationship between sleep and growth anthropometric measures in early life might be amplified in later childhood.
authors.affiliation: Program in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Izzuddin M
authors.initials: IM
authors.lastname: Aris
authors.affiliation: Program in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Sara Shuhui
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Shirong
authors.initials: S
authors.lastname: Cai
authors.affiliation: Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Mya Thway
authors.initials: MT
authors.lastname: Tint
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Gita
authors.initials: G
authors.lastname: Krishnaswamy
authors.affiliation: Department of Psychiatry, Neurology, and Neurosurgery, McGill University, Montréal, Québec, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Meaney
authors.affiliation: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore.
authors.forename: Yap-Seng
authors.initials: YS
authors.lastname: Chong
authors.affiliation: Program in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore; Department of Paediatrics, Paediatric Endocrinology Service, KK Women's and Children's Hospital, Singapore.
authors.forename: Fabian
authors.initials: F
authors.lastname: Yap
authors.affiliation: Department of Paediatrics, Paediatric Endocrinology Service, KK Women's and Children's Hospital, Singapore.
authors.forename: Ngee
authors.initials: N
authors.lastname: Lek
authors.affiliation: Program in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore. Electronic address: joshua.gooley@duke-nus.edu.sg.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Gooley
authors.affiliation: Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore; Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore. Electronic address: paeleeys@nus.edu.sg.
authors.forename: Yung Seng
authors.initials: YS
authors.lastname: Lee
mesh_terms: D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012846:Singapore; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000150:complications / Q000503:physiopathology
keywords: Body length; Body mass index; Children; Cohort study; Growth; Sleep duration