Mediation effects of energy balance-related behaviors on associations between sleep and the risk of obesity among elementary and junior high school students

doi:10.3969/j.issn.1674-8115.2021.04.017

Abstract

Abstract: Objective

· To investigate the possible mediation effects of energy balance-related behaviors on the association of sleep with obesity among elementary and junior high school students.

Methods

· Data of 5 179 primary and middle school students were assessed via a self-reported questionnaire and anthropometric measurement, including sleep variables, physical activities, screen behaviors, dietary patterns, height and weight status in Maoming City, Guangdong Province from September to November 2016. The enrolled students were divided into obese group and non-obese group according to body mass index threshold of Screening of Overweight and Obesity in School-age Children and Adolescents in China. Linear regression and Logistic regression analyses were used to estimate the associations between sleep, the aforementioned energy balance-related behaviors and obesity. The MacKinnon's product-of-coefficients method was used to assess the mediation effects of energy balance-related behaviors.

Results

· Compared with the non-obese group, most obese students were characterized by being male, young, parental obesity, high monthly house income, long screen time, high frequency of high calorie food and fruit-milk diet. Significant associations were observed between sleep duration, bedtime and wake-up time of elementary and junior high school students with the risk of obesity (all P=0.000). The intermediary pathways of obesity (sleep→screen behavior→obesity, and sleep→physical activity→obesity) were statistically significant (P<0.05). No evidence for the mediating role of high calorie or fruit-milk dietary habits was found in this study.

Conclusion

· Physical activity and screen behavior were identified as possible mediators of the association between sleep and obesity.

Key words: obesity, sleep, energy balance-related behavior, mediation effect

CLC Number:

R723.14

Shu-ping LOU, Yan HUANG, Pan-yue LIU, Hui CHEN. Mediation effects of energy balance-related behaviors on associations between sleep and the risk of obesity among elementary and junior high school students[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(4): 519-524.

Figures/Tables 6

TrendMD

References 33

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Variable	Total (n=5 179)	Obese group (n=725)	Non-obese group (n=4 454)	P value
Age/year	10.66 (8.78, 12.32)	8.95 (7.81, 10.64)	10.92 (9.09, 12.60)	0.000
Physical activity/h	1.00 (0.50, 1.20)	1.00 (0.50, 1.24)	1.00 (0.50, 1.20)	0.349
Screen behavior/h	1.50 (0.50, 2.50)	2.00 (1.50, 2.67)	1.50 (0.50, 2.50)	0.000
Monthly fruit and milk/time	4.00 (3.00, 10.50)	5.00 (3.00, 14.00)	4.00 (3.00, 10.50)	0.038
Monthly high calorie diet/time	18.00 (6.50, 30.50)	20.00 (6.25, 30.50)	18.00 (6.50, 30.50)	0.963
Sleep duration/h	9.00 (8.50, 10.00)	8.67 (7.85, 9.50)	9.50 (8.50, 10.00)	0.000
Wake-up time	6∶40 (6∶00, 7∶00)	6∶30 (6∶00, 6∶57)	6∶50 (6∶10, 7∶00)	0.000
Bedtime	22∶00 (22∶00, 23∶00)	23∶00 (22∶00, 23∶15)	22∶00 (22∶00, 23∶00)	0.000
Gender (male)/n (%)	2 899 (56.0)	478 (65.9)	2 421 (54.4)	0.000
Breastfeeding for 6 months/n (%)	2 293 (44.3)	336 (46.9)	1 957 (43.8)	0.051
Parental obesity/n (%)				0.000
None	4 776 (92.2)	617 (85.1)	4 159 (93.4)
Either	372 (7.2)	97 (13.4)	275 (6.2)
Both	31 (0.6)	11 (1.5)	20 (0.4)
Monthly house income/n (%)				0.006
<1 000 yuan	459 (8.9)	49 (6.8)	410 (9.2)
1 000?4 999 yuan	3 203 (61.8)	440 (60.8)	2 763 (62.0)
5 000?10 000 yuan	1 138 (22.0)	164 (22.5)	974 (21.9)
>10 000 yuan	379 (7.3)	72 (9.9)	307 (6.9)

Variable	Total (n=5 179)	Obese group (n=725)	Non-obese group (n=4 454)	P value
Age/year	10.66 (8.78, 12.32)	8.95 (7.81, 10.64)	10.92 (9.09, 12.60)	0.000
Physical activity/h	1.00 (0.50, 1.20)	1.00 (0.50, 1.24)	1.00 (0.50, 1.20)	0.349
Screen behavior/h	1.50 (0.50, 2.50)	2.00 (1.50, 2.67)	1.50 (0.50, 2.50)	0.000
Monthly fruit and milk/time	4.00 (3.00, 10.50)	5.00 (3.00, 14.00)	4.00 (3.00, 10.50)	0.038
Monthly high calorie diet/time	18.00 (6.50, 30.50)	20.00 (6.25, 30.50)	18.00 (6.50, 30.50)	0.963
Sleep duration/h	9.00 (8.50, 10.00)	8.67 (7.85, 9.50)	9.50 (8.50, 10.00)	0.000
Wake-up time	6∶40 (6∶00, 7∶00)	6∶30 (6∶00, 6∶57)	6∶50 (6∶10, 7∶00)	0.000
Bedtime	22∶00 (22∶00, 23∶00)	23∶00 (22∶00, 23∶15)	22∶00 (22∶00, 23∶00)	0.000
Gender (male)/n (%)	2 899 (56.0)	478 (65.9)	2 421 (54.4)	0.000
Breastfeeding for 6 months/n (%)	2 293 (44.3)	336 (46.9)	1 957 (43.8)	0.051
Parental obesity/n (%)				0.000
None	4 776 (92.2)	617 (85.1)	4 159 (93.4)
Either	372 (7.2)	97 (13.4)	275 (6.2)
Both	31 (0.6)	11 (1.5)	20 (0.4)
Monthly house income/n (%)				0.006
<1 000 yuan	459 (8.9)	49 (6.8)	410 (9.2)
1 000?4 999 yuan	3 203 (61.8)	440 (60.8)	2 763 (62.0)
5 000?10 000 yuan	1 138 (22.0)	164 (22.5)	974 (21.9)
>10 000 yuan	379 (7.3)	72 (9.9)	307 (6.9)

Sleep variable	β value	SE	OR (95%CI)
Sleep duration	-0.559	0.037	0.572 (0.532?0.614)
Bedtime	0.741	0.053	2.097 (1.890?2.327)
Wake-up time	-1.064	0.087	0.345 (0.291?0.409)

Sleep variable	β value	SE	OR (95%CI)
Sleep duration	-0.559	0.037	0.572 (0.532?0.614)
Bedtime	0.741	0.053	2.097 (1.890?2.327)
Wake-up time	-1.064	0.087	0.345 (0.291?0.409)

Sleep variable	Fruit and milk		High calorie diet		Physical activity		Screen behavior
Sleep variable	β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value
Sleep duration	0.049 (-0.310?0.408)	0.790	-0.936 (-1.366?-0.505)	0.000	0.081 (0.059?0.103)	0.000	0.051 (0.015?0.088)	0.005
Bedtime	1.769 (1.139?2.398)	0.000	0.531 (0.005?1.057)	0.048	-0.100 (-0.132?-0.068)	0.000	-0.040 (-0.093?0.013)	0.136
Wake-up time	-0.277 (-1.248?0.693)	0.576	0.960 (0.153?1.767)	0.020	0.068 (0.019?0.117)	0.007	0.190 (0.109?0.272)	0.000