Associations of sleep duration with obesity and serum lipid profile in children and adolescents
Abstract
Introduction The association between sleep duration, obesity, and serum lipid profile in the youth population is under-explored.Objective To evaluate the association between sleep duration, obesity and serum lipid profile in the youth population.Methods We conducted a cross-sectional population-based study with students recruited from primary and secondary schools in Hong Kong. Anthropometric measurements, fasting lipid profiles and validated questionnaires on sleep duration were performed. A subgroup (n=138) was randomly selected for both questionnaires and actigraphy to assess the agreement between subjective and objective measurements of sleep duration.Results We studied 2053 healthy children and adolescents aged 6-20 years. Their mean ages were 13.0±3.3 (boys) and 13.6±3.3 (girls) years. The average sleep duration during schooldays, weekends, and long holidays was 8.0±1.1, 9.6±1.2, and 9.8±1.2h in boys and 7.7±1.1, 9.9±1.2, and 10.1±1.2h in girls, respectively. Using logistic regression, age, and pubertal stage were associated with obesity in secondary school students, whereas male gender and short sleep duration were associated with obesity in primary school children. In secondary school children, those with long sleep duration, as compared to those with short sleep duration, were significantly associated with reduced risk to have high TC and LDL-C levels after adjustment for age, gender, BMI, and pubertal stage. There was no significant association between sleep duration and lipid levels in primary school children.Conclusion Reduced sleep duration was associated with obesity and atherogenic dyslipidemia in young school children in Hong Kong.
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Self-reported short and long sleep duration have been associated with elevated risk of obesity in both children and adults.
“Both self-reported short and long sleep duration have been associated with elevated risk of obesity in both children and adults[1-7]”
From Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors (2014) · cites this paper as [7]
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“Finally scarce studies also are available regarding the possible influence of sleep on cardiorespiratory fitness [18] or blood lipid levels [19].”
BackgroundAcute and Chronic Effects of Sleep Duration on Blood Pressure
Au, C. T., Ho, C. K. W., Wing, Y. K., Lam, H. S., & Li, A. M. (2013) · PEDIATRICS · doi:10.1542/peds.2013-1379 · Cited by 55 · see citing works
Sleep disturbances and their impact in pediatric cystic fibrosis
Shakkottai, A., O'Brien, L. M., Nasr, S. Z., & Chervin, R. D. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.07.002 · Cited by 55 · see citing works
“Reduced sleep duration also is associated with an increased risk for hyperlipidemia and insulin resistance among healthy children (12, 14, 15).”
BackgroundInteractions between the lipidome and genetic and environmental factors in autism
Yap, C. X., Henders, A. K., Alvares, G. A., Giles, C., Huynh, K., Nguyen, A., Wallace, L. M., McLaren, T., Yang, Y., Hernandez, L. M., et al. (2023) · Nature Medicine · doi:10.1038/s41591-023-02271-1 · Cited by 53 · see citing works
Academic performance in adolescents with delayed sleep phase
Sivertsen, B., Glozier, N., Harvey, A. G., & Hysing, M. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.04.011 · Cited by 55 · see citing works
Impact of a modest delay in school start time in Hong Kong school adolescents
Chan, N. Y., Zhang, J., Yu, M. W. M., Lam, S. P., Li, S. X., Kong, A. P. S., Li, A. M., & Wing, Y. K. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.09.018 · Cited by 55 · see citing works
Cao, M., Zhu, Y., He, B., Yang, W., Chen, Y., Ma, J., & Jin, J. (2015) · BMC Public Health · doi:10.1186/s12889-015-2359-0 · Cited by 52 · see citing works
“Several cross-sectional studies have reported that short sleep duration is associated with childhood obesity [6, 10–13].”
BackgroundChronic insufficient sleep and diet quality: Contributors to childhood obesity
Feliciano, E. M. C., Hu, F. B., Redline, S. S., ROSNER, B. A., Gillman, M. W., Rifas‐Shiman, S. L., & Taveras, E. M. (2015) · Obesity · doi:10.1002/oby.21196 · Cited by 51 · see citing works
Liu, X., Liu, Z., Liu, B.-P., Sun, S., & Jia, C.-X. (2019) · SLEEP · doi:10.1093/sleep/zsz294 · Cited by 50 · see citing works
Lai, Y., Lin, C., Lin, M., Lee, S.-T., Sung, F.-C., Chang, Y.-J., & Kao, C. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.03.024 · Cited by 50 · see citing works
“Previous studies have reported that insomnia with objective short sleep duration was associated with the increased risks for hypertension, obesity, dyslipidemia, stroke and CVD events, and all-cause mortality [22–29].”
BackgroundShort sleep duration is related to emerging cardiovascular risk factors in obese children
Navarro‐Solera, M., Carrasco‐Luna, J., Pin‐Arboledas, G., González‐Carrascosa, R., Soriano, J. M., & Codoñer‐Franch, P. (2015) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000000868 · Cited by 46 · see citing works
“937 Saturated fatty acids, g 33 (25) 27 (11) 0.”
BackgroundInfluentialLau, E. Y. Y., Choi, E. W. M., Lai, S., Lau, K. N. T., Au, C. T., Yung, W., & Li, A. M. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.04.025 · Cited by 44 · see citing works
Zhan, Y., Zhang, F., Lu, L., Wang, J., Sun, Y., Ding, R., Hu, D., & Yu, J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-1050 · Cited by 43 · see citing works
“Likewise, reduced sleep duration was found to be related to dyslipidemia in other studies [26,27].”
BackgroundZhu, Y., Li, A. M., Au, C. T., Kong, A. P. S., Zhang, J., Wong, C. K., Chan, J. C. N., & Wing, Y. K. (2015) · Journal of Diabetes · doi:10.1111/1753-0407.12138 · Cited by 42 · see citing works
“The subjects for the present study were healthy Chinese children and adolescents who participated in a territorywide survey that aimed to explore the association between sleep, obesity and metabolic conditions.(11) Briefly, a full list of all primary and secondary schools in Hong Kong was obtained from the Education D…”
BackgroundLee, S.-H., Kim, H.-B., & Lee, K.-W. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.05.071 · Cited by 41 · see citing works
Medical comorbidity of sleep disorders in children and adolescents
Lazaratou, H., Soldatou, A., & Dikeos, D. G. (2012) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3283556c7a · Cited by 41 · see citing works
“The association of obesity with reduced sleep appears to be more significant for male children [9].”
BackgroundMoving into poverty during childhood is associated with later sleep problems.
Sivertsen, B., Bøe, T., Skogen, J., Petrie, K., & Hysing, M. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.06.005 · Cited by 35 · see citing works
Kong, A. P. S., Choi, K. C., Ho, C. S., Chan, M. H. M., Ozaki, R., Chan, C. W., & Chan, J. C. N. (2012) · Pediatric Obesity · doi:10.1111/j.2047-6310.2012.00115.x · Cited by 40 · see citing works
“Details of the subjects and methodology have been previously described (16).”
Getting a Good Night's Sleep in Adolescence: Do Strategies for Coping With Stress Matter?
Matthews, K. A., Hall, M. H., Cousins, J. C., & Lee, L. (2015) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1007994 · Cited by 38 · see citing works
“A few papers suggest short sleep duration may also be associated with insulin resistance, and elevated lipids, nighttime blood pressure, and inflammation in adolescence (Kong et al., 2011; Larkin et al., 2005; Matthews, Dahl, Owens, Lee, & Hall, 2012; Mezick, Hall, & Matthews, 2012).”
BackgroundIntegrative Model of the Relationship Between Sleep Problems and Risk for Youth Substance Use
Edwards, S. M., Reeves, G. M., & Fishbein, D. H. (2015) · Current Addiction Reports · doi:10.1007/s40429-015-0052-0 · Cited by 35 · see citing works
Sleep disorders in pediatric chronic kidney disease patients
Stabouli, S., Papadimitriou, E., Printza, N. G., Dotis, J., & Papachristou, F. (2015) · Pediatric Nephrology · doi:10.1007/s00467-015-3237-9 · Cited by 35 · see citing works
Sleep and Lipid Profile During Transition from Childhood to Adolescence
Kuula, L., Pesonen, A., Kajantie, E., Lahti, J. M. T., ANDERSSON, S. M., Strandberg, T. E., & Räikkönen, K. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.06.026 · Cited by 35 · see citing works
Could emotional eating act as a mediator between sleep quality and food intake in female students?
Saleh‐Ghadimi, S., Dehghan, P., Farhangi, M. A., Jafarabadi, M. A., & Vayghan, H. J. (2019) · BioPsychoSocial Medicine · doi:10.1186/s13030-019-0154-3 · Cited by 35 · see citing works
Mustafa, N., Majid, H. A., Toumpakari, Z., Carroll, H. A., Jalaludin, M. Y., Al-Sadat, N., & Johnson, L. (2019) · Nutrients · doi:10.3390/nu11050973 · Cited by 31 · see citing works
“[56]), with observational research suggesting similar health outcomes in adolescents [57].”
BackgroundLin, C., Tsai, Y., & Yeh, M. C. (2016) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2016.01.013 · Cited by 31 · see citing works
“Objective sleep measurement is certainly more accurate, although a recent study suggested that there was a strong agreement between reported sleep duration and objective actigraphy measurements.(34) Secondly, the original questionnaires were limited by the lack of questions addressing obstructive sleep apnea for the c…”
BackgroundSleep duration and risk of obesity among a sample of Victorian school children
Morrissey, B., Malakellis, M., Whelan, J., Millar, L., Swinburn, B. A., Allender, S. E., & Strugnell, C. (2016) · BMC Public Health · doi:10.1186/s12889-016-2913-4 · Cited by 31 · see citing works
Ethnic variation in the association between sleep and body mass among US adolescents
Reither, E. N., Krueger, P. M., Hale, L. E., Reiter, E. M., & Peppard, P. E. (2014) · International Journal of Obesity · doi:10.1038/ijo.2014.18 · Cited by 31 · see citing works
Kleszczewska, D. W., Małkowska‐Szkutnik, A., Siedlecka, J., & Mazur, J. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16060915 · Cited by 32 · see citing works
“After analysing data on 53,769 teenagers, it was demonstrated that these three health determinants should be considered in parallel, because the underlying mechanisms for each of these factors are different [25].”
MethodDerks, I. P. M., Kocevska, D., Jaddoe, V. W. V., Franco, O. H., Wake, M. A., Tiemeier, H. W., & Jansen, P. W. (2017) · Childhood Obesity · doi:10.1089/chi.2016.0341 · Cited by 29 · see citing works
“In addition, children who slept less had increased cholesterol concentrations,(18,19) but again, results were inconsistent and associations with triglycerides were not found.(17,20) Moreover, most studies had a crosssectional design, making it difficult to infer a temporal relationship.”
Kong, A. P. S., Choi, K. C., Chan, R., Lok, K. Y. W., Ozaki, R., Li, A. M., Ho, C. S., Chan, M. H. M., Sea, M. M.-M., Henry, C. J., et al. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-180 · Cited by 27 · see citing works
“Obese adolescents were identified from territory-wide, population-recruited surveys [2,4,15].”
BackgroundHam, O. K., Kim, J., Lee, B. G., & Choi, E. (2017) · Research in Nursing & Health · doi:10.1002/nur.21792 · Cited by 26 · see citing works
Hemati, Z., Mozafarian, N., Heshmat, R., Ahadi, Z., Motlagh, M. E., Ziaodini, H., Taheri, M., Aminaee, T., Qorbani, M., & Kelishadi, R. (2018) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-018-0381-y · Cited by 26 · see citing works
Song, Q., Liu, X., Zhou, W., Wu, S., & Wang, X. (2020) · Lipids in Health and Disease · doi:10.1186/s12944-020-01363-y · Cited by 23 · see citing works
A Systematic Review on Sleep Duration and Dyslipidemia in Adolescents: Understanding Inconsistencies
Abreu, G. D. A., Barufaldi, L. A., Bloch, K. V., & Szklo, M. (2015) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20150121 · Cited by 23 · see citing works
Sleeping Time, BMI, and Body Fat in Chinese Freshmen and Their Interrelation
Yang, Y., Miao, Q., Zhu, X., Qin, L., Gong, W., Zhang, S., Zhang, Q., Lü, B., Ye, H., & Li, Y. (2020) · Obesity Facts · doi:10.1159/000506078 · Cited by 22 · see citing works
Familial Aggregation and Heritability of Obstructive Sleep Apnea Using Children Probands
Au, C. T., Zhang, J., Cheung, J. Y. F., Chan, K. C. C., Wing, Y. K., & Li, A. M. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8012 · Cited by 22 · see citing works
“Those without habitual snoring were recruited from a cohort established by a previous epidemiologic study, which assessed the relationship between sleep disturbance and neurohormonal dysregulation in a random sample of primary and secondary school students, 17 to serve as suspected control probands.”
Chan, N. P. T., Choi, K. C., Nelson, E. A. S., Chan, J. C. N., & Kong, A. P. S. (2015) · BMC Pediatrics · doi:10.1186/s12887-015-0446-0 · Cited by 20 · see citing works
“This study was a sub-study of a large, school-based, crosssectional study funded by the Hong Kong Research Grants Council (CUHK4465/06 M) and was conducted between 2007 and 2008 [14].”
A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean?
Walton, T. F., Ree, M. J., Fueggle, S. N., & Bucks, R. S. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.11.016 · Cited by 19 · see citing works
Lehmann, S., Askeland, K. G., & Hysing, M. (2020) · Child & Family Social Work · doi:10.1111/cfs.12794 · Cited by 19 · see citing works
Effects of sleep deprivation on coronary heart disease
Wei, R., Duan, X., & Guo, L. (2022) · Korean Journal of Physiology and Pharmacology · doi:10.4196/kjpp.2022.26.5.297 · Cited by 18 · see citing works
“[73] published a cross-sectional study of a sample from Hong Kong, China.”
BackgroundThe Effect of Sleep Deprivation on Coronary Heart Disease
Yuan, R., Wang, J., & Guo, L. (2016) · Chinese Medical Sciences Journal · doi:10.1016/s1001-9294(17)30008-1 · Cited by 19 · see citing works
Longer Sleep – Slimmer Kids: The ENERGY-Project
Altenburg, T. M., Chinapaw, M. J. M., van der Knaap, E. T. W., Brug, J., Μanios, Y., & Singh, A. S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0059522 · Cited by 19 · see citing works
Byrne, E. M., Gehrman, P., Trzaskowski, M., Tiemeier, H. W., & Pack, A. I. (2016) · SLEEP · doi:10.5665/sleep.6168 · Cited by 19 · see citing works
Sleep in adolescence: Considering family structure and family complexity
Nilsen, S. A., Bergström, M., Sivertsen, B., Stormark, K. M., & Hysing, M. (2022) · Journal of Marriage and the Family · doi:10.1111/jomf.12844 · Cited by 18 · see citing works
Gender Differences in the Relationship Between Sleep Problems and Suicide Attempt in Adolescents
Wan, Y., Xu, H., Wang, S., Boyda, D., McFeeters, D., Sun, Y., Zhang, S., Chen, R., & Tao, F. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00133 · Cited by 18 · see citing works
“Although it was impractical to assess sleep via experimental methods in large-scale populationbased studies, self-reported sleep behavior has been shown to have good concordance with objectively-measured sleep (38, 39).”
MethodSleep‐disordered breathing in cystic fibrosis
Jagpal, S. K., Jobanputra, A. M., Ahmed, O., Santiago, T. V., & Ramagopal, M. (2020) · Pediatric Pulmonology · doi:10.1002/ppul.25028 · Cited by 17 · see citing works
Du, J., Chen, Y., Zhou, N., Song, Y., Wang, W., & Hong, X. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.04.004 · Cited by 16 · see citing works
Sleep patterns and cardiometabolic risk in schoolchildren from Cuenca, Spain
la Cruz, L. L., Espinosa, N. M. M., Cavero‐Redondo, I., González‐García, A., Díez‐Fernández, A., Martínez‐Vizcaíno, V., & Notario‐Pacheco, B. (2018) · PLoS ONE · doi:10.1371/journal.pone.0191637 · Cited by 17 · see citing works
dos Santos, E. D. S. G., & de Souza, O. F. (2020) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/2021/39/2019225 · Cited by 18 · see citing works
Lin, C., Tsai, Y., & Yeh, M. C. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12844 · Cited by 16 · see citing works
Sleep-disordered breathing in cystic fibrosis
Shakkottai, A., Nasr, S. Z., Hassan, F., Irani, S., O'Brien, L. M., & Chervin, R. D. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.05.031 · Cited by 16 · see citing works
Monzon, A. D., Patton, S. R., & Koren, D. (2021) · Pediatric Pulmonology · doi:10.1002/ppul.25651 · Cited by 16 · see citing works
Evanger, L. N., Bjorvatn, B., Pallesen, S., Hysing, M., Sivertsen, B., & Saxvig, I. W. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13840 · Cited by 16 · see citing works
“Also, a previous study found sound agreement between adolescents' actigraph-assessed and subjectively assessed sleep duration (Kong et al., 2011).”
ResultImpact of commuting distance and school timing on sleep of school students
Pradhan, R. K., & Sinha, N. (2017) · Sleep and Biological Rhythms · doi:10.1007/s41105-017-0091-0 · Cited by 16 · see citing works
The potential impact of sleep duration on lipid biomarkers of cardiovascular disease
Araghi, M., Thomas, G. N., & Taheri, S. (2012) · Clinical Lipidology · doi:10.2217/clp.12.43 · Cited by 13 · see citing works
Zhou, W., Wang, T., Zhu, L., Wen, M., Hu, L., Huang, X. B., You, C., Li, J., Wu, Y., Wu, Q., et al. (2019) · International Journal of Hypertension · doi:10.1155/2019/9473182 · Cited by 15 · see citing works
“Moreover, our findings revealed that females with later AAM had a larger BMI, WC, BFP, and VAI during adulthood, with the similar conclusion reported in a large population-based investigation [22].”
MethodResultSleep and Obesity in Children and Adolescents
Hanlon, E. C., Dumin, M., & Pannain, S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-812840-4.00013-x · Cited by 15 · see citing works
Lim, H. H. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.10.015 · Cited by 13 · see citing works
Réduction du temps de sommeil chez les adolescents : conséquences et prise en charge ?
Bat‐Pitault, F., & Fonséca, D. D. (2012) · Archives de Pédiatrie · doi:10.1016/j.arcped.2012.07.004 · Cited by 12 · see citing works
Chan, N. Y., Lam, S. P., Zhang, J., Yu, M. W. M., Li, S. X., Li, A. M., & Wing, Y. K. (2015) · Sleep and Biological Rhythms · doi:10.1007/s41105-015-0008-8 · Cited by 13 · see citing works
“4 h) among secondary school students, accompanied by a notable variability of weekday and weekend sleep-wake pattern [2].”
BackgroundThe social gradient of sleep in adolescence: results from the youth@hordaland survey
Hysing, M., Petrie, K. J., Bøe, T., Lallukka, T. M., & Sivertsen, B. (2016) · European Journal of Public Health · doi:10.1093/eurpub/ckw200 · Cited by 13 · see citing works
Lo, K. K.-H., Keung, V. M. W., Cheung, C. K. M., Tam, W., & Lee, A. (2019) · Childhood Obesity · doi:10.1089/chi.2018.0319 · Cited by 13 · see citing works
Intermediate phenotypes of childhood obstructive sleep apnea
Au, C. T., Chan, K. C. C., Zhang, J., Liu, K. H., Chu, C. W., Wing, Y. K., & Li, A. M. (2020) · Journal of Sleep Research · doi:10.1111/jsr.13191 · Cited by 13 · see citing works
“Non-snoring controls were recruited from participants of an epidemiological study that tested the association between sleep disturbance and neurohormonal dysregulation in a random sample of local school students (Kong et al., 2011).”
MethodBhattacharjee, R., Hakim, F., & Gozal, D. (2012) · Clinical Lipidology · doi:10.2217/clp.12.11 · Cited by 12 · see citing works
- Authors
- Kong, A. P., Wing, Y.-K., Choi, K. C., Li, A. M., Ko, G. T. C., Ma, R. C., Tong, P. C., Ho, C.-S., Chan, M. H., Ng, M. H., Lau, J., & Chan, J. C.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Ko, Gary T.C.
- ORCID
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 12
- Issue
- 7
- Pages
- 659-665
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W2151004981
- Cited by
- 152
- References
- 47
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 7 · 2022: 7 · 2021: 8 · 2020: 14 · 2019: 17 · 2018: 13 · 2017: 6 · 2016: 12 · 2015: 21 · 2014: 15 · 2013: 11 · 2012: 11
- FWCI
- 15.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Hong Kong
- Chinese University of Hong Kong
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- sleep duration, childhood obesity, adolescent obesity, lipid profile, atherogenic dyslipidemia, total cholesterol, LDL cholesterol, elementary school students, pubertal stage, sex differences
- MeSH terms
- Adolescent, Child, Female, Hong Kong, Humans, Lipids, Male, Obesity, Surveys and Questionnaires, Random Allocation, Sleep, Sleep Wake Disorders, Prevalence, Asian People, Dyslipidemias, Young Adult, Actigraphy
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