title: Chronic insufficient sleep and diet quality: Contributors to childhood obesity.
abstract: OBJECTIVE
  To examine associations of chronic insufficient sleep with diet and whether diet explains the sleep-adiposity relationship.
  
  
  METHODS
  In Project Viva, 1,046 parents reported children's sleep duration at 6 m and annually until midchildhood (7 y). The main exposure was a sleep curtailment score (6 m-7 y) ranging from 0 (maximal curtailment) to 13 (adequate sleep). In mid-childhood, parents reported children's diet; researchers measured height/weight. Multivariable linear regression assessed associations of sleep with diet (Youth Healthy Eating Index [YHEI]); sleep with BMI z-score adjusting for YHEI; and, secondarily, joint associations of sleep and YHEI with BMI.
  
  
  RESULTS
  Mean (SD) sleep and YHEI scores were 10.21 (2.71) and 58.76 (10.37). Longer sleep duration was associated with higher YHEI in mid-childhood (0.59 points/unit sleep score; 95% CI: 0.32, 0.86). Although higher YHEI was associated with lower BMI z-score (-0.07 units/10-point increase; 95% CI: -0.13, -0.01), adjustment for YHEI did not attenuate sleep-BMI associations. Children with sleep and YHEI scores below the median (<11 and <60) had BMI z-scores 0.34 units higher (95% CI: 0.16, 0.51) than children with sleep and YHEI scores above the median.
  
  
  CONCLUSIONS
  While parent-reported diet did not explain inverse associations of sleep with adiposity, both sufficient sleep and high-quality diets are important to obesity prevention.
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cespedes
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Channing Division of Network Medicine, Harvard Medical School, Boston, Massachusetts, USA.|Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rosner
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Division of General Academic Pediatrics, Boston, Massachusetts, USA.|Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA.
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D063766:Pediatric Obesity / Q000209:etiology*; D012307:Risk Factors; D012892:Sleep Deprivation / Q000150:complications*; D013223:Statistics as Topic