JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2021, Vol. 41 ›› Issue (4): 519-524.doi: 10.3969/j.issn.1674-8115.2021.04.017

• Public health • Previous Articles     Next Articles

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

Shu-ping LOU1(), Yan HUANG2, Pan-yue LIU3, Hui CHEN3()   

  1. 1.Department of Infection Management, The Fourth Affiliated Hospital, Zhejiang University School of Medical, Yiwu 322000, China
    2.Department of Physical Education, Guangdong Preschool Normal College in Maoming, Maoming 525000, China
    3.Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2020-03-19 Online:2021-04-28 Published:2021-05-14
  • Contact: Hui CHEN;
  • Supported by:
    National Nature Science Foundation of China(81072371)

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.


· 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.


· 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.


· 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

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