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Cited by 435Sleep and related disordersObesity, Physical Activity, DietSleep and Wakefulness Research

Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies

Open access
Miller, Michelle A, Kruisbrink, Marlot, Wallace, Joanne, Ji, Chen, Cappuccio, Francesco P·2018·Sleep
DOI 10.1093/sleep/zsy018
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Abstract

Study Objectives: To assess the prospective relationship between sleep and obesity in a paediatric population. Methods: We performed a systematic search using PubMed, Embase, Web of Science, and Cochrane (up to September 25, 2017). Included studies were prospective, had follow-up of ≥1 year, had duration of sleep at baseline, and measures of incidence of overweight or obesity and/or changes in body mass index (BMI) z-score and BMI during follow-up. We extracted relative risks or changes in BMI z-score or BMI and 95% confidence intervals (CI) and pooled them using a random effect model. Results: Forty-two studies were included but, as there was significant heterogeneity, results are presented by age strata. Short sleep was associated with a greater risk of developing overweight or obesity in infancy (seven studies, 14738 participants, risk ratio [RR]: 1.40; 95% CI 1.19 to 1.65; p < .001), early childhood (eight studies, 31104 participants, RR: 1.57; 1.40 to 1.76; p < .001), middle childhood (three studies, 3005 participants, RR: 2.23; 2.18 to 2.27; p < .001), and adolescence (three studies, 26652 participants, RR: 1.30; 1.11 to 1.53; p < .002). Sleep duration was also associated with a significant change in BMI z-score (14 studies, 18 cohorts, 31665 participants; mean difference -0.03; -0.04 to -0.01 per hour sleep; p = .001) and in BMI (16 studies, 24 cohorts, 24894 participants; mean difference -0.03 kg/m2; -0.04 to -0.01 for every hour of increase in sleep; p = .001). Conclusions: Short sleep duration is a risk factor or marker of the development of obesity in infants, children, and adolescents.

Integrity signals

Registry

Crossref · 10.1093/sleep/zsy018

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 18 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was significant heterogeneity between studies for the association between short sleep and overweight or obesity (I2=92%, p<0.001).

    “There was significant heterogeneity between studies (I 2 = 92%, p<0.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    In the pooled analysis, short sleep was associated with an increased risk of overweight or obesity in the combined group (RR 1.58, 95% CI 1.35 to 1.85; P<0.001).

    “In the pooled analysis, short sleep was associated with an increased risk of overweight or obesity in the combined group (RR: 1.58 [95% CI 1.35, 1.85]; P<0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    The trim and fill method revised the pooled estimate for short sleep and overweight or obesity to 1.42 (95% CI 1.12 to 1.81).

    “The addition of seven point estimates identified by the 'trim and fill' method resulted in a revised pooled estimate of 1.42 [1.12, 1.81]”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was evidence of publication bias for the association between short sleep and overweight or obesity (Egger's test p=0.005).

    “with evidence of publication bias (Supp Figure S1a) (Egger's test p=0.005).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Follow-up time was not significantly associated with heterogeneity for BMI (p=0.836 by meta-regression).

    “Follow-up time was not significantly associated with heterogeneity (p=0.836 by meta-regression).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 12
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Sub-group analysis by continent yields risk ratios ranging from 1.26 to 2.19 across three sub-groups, each with statistically significant results.

    “Sub-group analysis by continent yields risk ratios ranging from 1.26 to 2.19 across the three sub-groups; each with statistically significant results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Heterogeneity estimates by continent ranged from 0% to 92%, with no evidence of heterogeneity in the Australia and Oceania sub-group.

    “Heterogeneity estimates ranged from 0% to 92%, with no evidence of heterogeneity in the Australia and Oceania sub-group (Supp Table S2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For BMI z-score, Egger's test for publication bias gave p=0.054.

    “Eggers test p=0.054”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When correcting for publication bias by trim and fill, the pooled estimate for short sleep and overweight or obesity was only marginally reduced and maintained statistical significance.

    “Furthermore, when we attempted to correct for publication bias by using the 'trim and fill' method, the pooled estimate was only marginally reduced and maintained statistical significance.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Follow-up time was not significantly associated with heterogeneity for short sleep and overweight or obesity (p=0.878 by meta-regression).

    “Follow-up time was not significantly associated with heterogeneity (p=0.878 by meta-regression).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In sub-group analysis by age groups for BMI, there was some heterogeneity of effect (p=0.03) with the effect being greater in children aged 3 to <9 years.

    “In a sub-group analysis by age groups, there was some heterogeneity of effect (p=0.03) with the effect being greater in children aged 3 to <9 years (Supp Figure S2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In children 3 to <9 years at baseline, short sleep duration is associated with a pooled relative risk of 1.57 (95% CI 1.40-1.76) for incident overweight/obesity, with no statistical evidence of heterogeneity (I2=23%, p=0.25).

    “Eight cohorts included children 3 to <9 years at baseline.The pooled relative risk was 1.57 [1.40, 1.76], P<0.001, with no statistical evidence of heterogeneity (I 2 = 23%; p=0.25).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In children 9 to <12 years at baseline, short sleep duration is associated with a pooled relative risk of 2.23 (95% CI 2.18-2.27) for incident overweight/obesity, with no evidence of heterogeneity (I2=0%, p=0.41).

    “Three cohorts included children 9 to <12 years at baseline.The pooled relative risk was 2.23 [2.18, 2.27], P<0.001 with no evidence of heterogeneity (I 2 = 0%; p=0.41).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In infants 0 to <3 years at baseline, short sleep duration is associated with a pooled relative risk of 1.40 (95% CI 1.19-1.65) for incident overweight/obesity, with no statistical evidence of heterogeneity (I2=40%, p=0.13).

    “In a sub-group analysis by age group seven cohorts included infants 0 to <3 years at baseline.The pooled relative risk was 1.40 [1.19, 1.65], P<0.001, with no statistical evidence of heterogeneity (I 2 = 40%; p=0.13).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Differences about inclusion of studies were resolved by arbitration with the co-authors.

    “Differences about inclusion of studies were resolved by arbitration with the co-authors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Short sleep duration is a risk factor or marker of the development of obesity in infants, children and adolescents.

    “Short sleep duration is a risk factor or marker of the development of obesity in infants, children and adolescents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Three reviewers independently extracted the data.

    “Three reviewers (MAM, MK & FPC) independently extracted the data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The systematic review and meta-analysis were carried out in line with the PRISMA guidelines for nonrandomised studies, with appropriate exclusion of non-relevant items.

    “The systematic review and the meta-analysis were carried out in line with the PRISMA guidelines for nonrandomised studies, with the appropriate exclusion of non-relevant items.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings suggest that sleep may be an important and potentially modifiable risk factor or marker of future obesity and ensuing type 2 diabetes in early life.

    “The findings from this study suggests that sleep may be an important and potentially modifiable risk factor (or marker) of future obesity and ensuing type 2 diabetes in early life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The quality of the studies included in the meta-analysis was evaluated by the Downs & Black Quality Index score system using a validated checklist.

    “The quality of the studies included in the meta-analysis was evaluated by the Downs & Black Quality Index score system using a validated checklist for assessing the quality of the studies.13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Downs, 1998, The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions, J Epidemiol Community Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A meta-analysis of observational studies cannot directly control for confounding and therefore may be open to biased estimates.

    “A meta-analysis of observational studies is open to important fallacies in that it cannot directly control for confounding and therefore may be open to biased estimates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Some papers adjusted for age and sex in BMI z-score models; this adjustment was unnecessary as both variables were used for BMI standardization.

    “Some papers adjusted for age and sex in BMI z-score models.The adjustment was unnecessary as both variables were used for BMI standardization (although continuous age might slightly improve the estimation).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Only one included study used polysomnography and three used accelerometry to assess sleep.

    “Only one used the gold-standard polysomnography 36 and three used accelerometry.29,45,56”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [36] Silva, 2011, Longitudinal association between short sleep, body weight, and emotional and learning problems in Hispanic and Caucasian children, Sleep source

      Not checked in the free run.

    • cites [29] Carter, 2011, Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study, BMJ source

      Not checked in the free run.

    • cites [45] Martinez, 2014, Is it time for bed? Short sleep duration increases risk of obesity in Mexican American children, Sleep Med source

      Not checked in the free run.

    • cites [56] Butte, 2016, Role of physical activity and sleep duration in growth and body composition of preschool-aged children, Obesity (Silver Spring) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Insufficient sleep is associated with alterations in mood, attention, impulse control, motivation, and judgment, all of which could potentially influence eating behaviours, energy intake, and ultimately BMI in children.

    “Finally, insufficient sleep is associated with alterations in mood, attention, impulse control, motivation, and judgment, all of these factors could potentially influence eating behaviours, energy intake, and ultimately BMI in children.77”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Taveras, 2017, Prospective study of insufficient sleep and neurobehavioral functioning among school-age children, Acad Pediatr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Short-term, acute, laboratory, and cross-sectional observational studies indicate that adverse changes in sleep are associated with adverse changes in insulin and glucose response but can be reversed when sleep quantity and quality are restored.

    “Short-term, acute, laboratory, and cross-sectional observational studies indicate that adverse changes in sleep are associated with adverse changes in insulin and glucose response but can be reversed when sleep quantity and quality are restored.78”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Spiegel, 2005, Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes, J Appl Physiol (1985) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Sleeping less gives more time to eat and to engage in sedentary activities, as exemplified by children and adolescents who stay up late to use computers, watch TV, interact with social networks, and snack.

    “Sleeping less would give more time to eat and to engage in other A c c e p t e d M a n u s c r i p t sedentary activities, as exemplified by children and adolescents who like to stay up late to play on their computer or watch TV or to interact with social networks whilst snacking.69”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Taheri, 2006, The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity, Arch Dis Child source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The diagnostic classification of overweight and obesity varied across studies.

    “As described in the methods section, the diagnostic classification of overweight and obesity varied across studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Any overadjustment for age and sex in BMI z-score models would result in an underestimation of the true effect, indicating that the relationship described might be conservative and even stronger had overadjustment been avoided.

    “Whilst this is an inextricable problem, any overadjustment would result in an underestimation of the true effect, hence indicating that the relationship we describe might be conservative and even stronger, had overadjustment been avoided.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The detrimental effects of sustained and prolonged chronic sleep may not be reversible, leading to long-term adverse health and safety consequences.

    “The detrimental effects of sustained and prolonged chronic sleep however, may not be reversible leading to long term adverse health and safety consequences.79”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Cohen, 2010, Uncovering residual effects of chronic sleep loss on human performance, Sci Translat Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies in adults have shown that insufficient sleep can impair one's ability to lose fat mass-associated weight.

    “studies in adults have shown that insufficient sleep can impair one's ability to lose fat mass-associated weight.82”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Nedeltcheva, 2010, Insufficient sleep undermines dietary efforts to reduce adiposity, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors did not use language restrictions in their search.

    “We did not use language restrictions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors searched PubMed, Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials from 1966 to 25 September 2017.

    “We searched the electronic databases PubMed, Medline, Embase Web of Science and Cochrane Central Register of Controlled Trials (from 1966 to 25 th Sept 2017).”
    Quote in the paperNot a substantial claim
27 of 27

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • BMI change estimate is labeled a risk ratio

    Minor

    The results label a negative change-in-BMI estimate as an RR, whereas the methods specify regression coefficients for BMI changes as a continuous outcome. A risk ratio cannot be negative.

  • BMI z-score mean difference is labeled a risk ratio

    Minor

    The results label the negative BMI z-score estimate as an RR, while the paper's Figure 3 caption identifies the same type of result as a mean difference. A risk ratio also cannot be negative.

  • Reported baseline-age range excludes an included study

    Minor

    The results say baseline ages ranged from 0 to 12 years, but Table 1 includes the Berkey study with participants aged 14-21 years at baseline.

  • One-year studies conflict with the stated follow-up criterion

    Minor

    The stated inclusion criterion requires follow-up longer than one year, but Table 1 lists an included study with exactly one year of follow-up.

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Authors
Miller, M. A., Kruisbrink, M., Wallace, J., Ji, C., & Cappuccio, F. P.
Affiliations
  • University of Warwick (GB)
  • University Hospitals Coventry and Warwickshire NHS Trust (GB)
Corresponding author
Miller, Michelle A
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2018-02-01
Volume
41
Issue
4
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/zsy018
OpenAlex
W2785146914
Semantic Scholar
d0747a68047bf87594961dc45a74ebfa9ce88c93
Cited by
435
References
85
Citations by year
2026: 30 · 2025: 54 · 2024: 51 · 2023: 75 · 2022: 47 · 2021: 55 · 2020: 55 · 2019: 44 · 2018: 24
FWCI
7.09
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/about_us/legal/notices (vor)
Locations
  • SLEEP (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Warwick Research Archive Portal (University of Warwick) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
  • Dutch Heart Foundation
  • University of Warwick Undergraduate Research Scholarship Scheme
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
sleep duration, childhood obesity, overweight, body mass index, infants, children, adolescents, short sleep duration, obesity risk factors, BMI z-score
MeSH terms
Adolescent, Child, Humans, Infant, Obesity, Prospective Studies, Risk Factors, Sleep, Body Mass Index, Incidence, Odds Ratio, Overweight

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