Clinical Review
Longitudinal associations between sleep duration and subsequent weight gain: A systematic review

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Summary

Objective

To systematically examine the relationship between sleep duration and subsequent weight gain in observational longitudinal human studies.

Methods

Systematic review of twenty longitudinal studies published from 2004–October 31, 2010.

Results

While adult studies (n = 13) reported inconsistent results on the relationship between sleep duration and subsequent weight gain, studies with children (n = 7) more consistently reported a positive relationship between short sleep duration and weight gain.

Conclusion

While shorter sleep duration consistently predicts subsequent weight gain in children, the relationship is not clear in adults. We discuss possible limitations of the current studies: 1) the diminishing association between short sleep duration on weight gain over time after transition to short sleep, 2) lack of inclusion of appropriate confounding, mediating, and moderating variables (i.e., sleep complaints and sedentary behavior), and 3) measurement issues.

Introduction

According to the Centers for Disease Control and Prevention (CDC) more than one-third of adults and 17% of children in the United States (U.S.) are obese; in the past three decades, obesity rates for adults doubled while rates for children tripled.1 To stem this epidemic, the CDC recommends regular physical activity and healthy nutritional practices. A growing body of evidence points to another important risk factor for both weight gain and obesity: getting too little sleep.*2, 3

Previous literature reviews and meta-analyses have reported significant associations between sleep duration and obesity.*2, 3, *4, 5, 6, 7, 8, 9 These reviews indicate that there is evidence that sleep duration is associated with being overweight and/or experiencing weight gain over time. The majority of review conclusions support Nielsen et al.7 who state that “short sleep duration is consistently associated with development of obesity in children and young adults, but not consistently so in older adults”.

There are multiple mechanisms through which sleep deprivation is hypothesized to have a causal link with weight gain. First, there is experimental evidence at the physiologic level. Evidence indicates short sleep may result in hormonal and metabolic changes contributing to weight gain and obesity.10, 11, 12, 13 For example, studies of young healthy men found sleep curtailment was associated with increased ghrelin levels and decreased leptin levels, corresponding to increased hunger and appetite.11, 14 Suppressed leptin levels10, 12, 14 and elevated ghrelin levels10, 14 related to short sleep duration have been confirmed by other studies. Also, an association between sleep deprivation and thermoregulation decreases the available energy expenditure and is related to increased food intake.15 In addition, short sleep duration has been associated with fatigue and reduced physical activity, a source of reduced caloric expenditure.16 And finally, being awake longer gives one more opportunity to eat, coupled with the fact that sleep deprivation may affect choices about food quality. While there is evidence that meal intake remains stable among sleep durations, sleep restriction is associated with an increased consumption of calories from snacks prior to bedtime17 and an average daily increase in calories consumed from fat.18

Media use (e.g., television, video games, computers) has grown dramatically in the U.S., which has also been associated with short sleep and obesity. With 24-h media availability, the amount of time spent with entertainment media has risen, especially among youth.19, 20 In 2009 U.S. children aged 8-18 spent 7 h and 38 min per day using entertainment media.21 Of those aged 8–18, 71% have a television in their bedroom, 50% have a game console in their bedroom,20 33% have internet access in their bedroom, which makes parental monitoring difficult and may have direct effects on nighttime sleep schedules.20, 21

Short sleep duration is a known risk factor for overweight22 and obesity,23 and media use is associated with both short sleep and obesity in infants, children, and adolescents around the world.*22, 23, 24, 25, 26, 27, 28 Taveras et al.22 report that a combination of short sleep duration and high levels of television in infants predict a 17% probability of overweight in 3 years, more than twice the predicted probability of having either short sleep duration or high levels of television alone. Infant television and video viewing is associated with shorter sleep duration at age 1 and 2 years.25 Ortega et al.26 found that insufficient sleep and ≥3 h/day television watching were significantly associated among adolescents in Spain. Vioque et al.23 found that people aged 15 years and older in Spain who watched television ≥4 h a day were significantly more likely to be obese compared to those who watched ≤1 h per day. Gortmaker et al.27 observed a strong dose-response relationship between the prevalence of overweight and the hours of television viewed. A randomized controlled trial found that relative to controls, an intervention group receiving instruction on reducing television, videotape and video game use had statistically significant decreases in children’s reported television viewing and statistically significant relative decreases in BMI, concluding that reducing media use may be a promising approach towards preventing childhood obesity.28

As with the relationship between sleep duration and all-cause mortality,29, 30 some studies of adults have found that both short and long sleeping are associated with weight gain. Regarding the u-shaped curves, the proposed mechanisms behind an association between long sleep duration and weight gain are at least partially distinct from those of short sleep.9For example, weight gain among the longer sleepers may be related to less physical activity among the long sleepers or other third factors such as co-morbidities.

Section snippets

Challenges in interpreting the results from previous studies on sleep duration and weight gain

There are numerous challenges in comparing the various associations between short sleep and weight gain across studies.2 First, the definition of short sleep measured in hours across studies is far from standard, with “short sleep” measurement varying from “two to 4 h” per night in adults31 to “less than 11 h” per night in five-year old children.32 In addition, the inclusion of confounding variables varies widely among studies.*2, *4, 5, 6 Finally, the majority of studies to date have been

Methods

We performed a systematic literature search in PubMed for relevant original publications meeting the following criteria from 1990 through June 21, 2010 to identify original publications: (“sleep”[MeSH Terms] OR “sleep”[All Fields]) AND ((“obesity"[MeSH Terms] OR “obesity”[All Fields]) OR “weight gain”[All Fields] OR “BMI”[All Fields] OR “overweight”[MeSH Terms] OR “overweight” [All Fields]) NOT (“sleep apnea” OR “apnea” OR “narcolepsy” OR “sleep disorder” OR “sleep disorders” OR “sleep

Results

In total, we reviewed 20 longitudinal studies. While adult studies (n = 13) reported inconsistent results on the association between sleep duration and subsequent weight gain, studies with children (n = 7) consistently reported a negative association between sleep duration and subsequent weight gain.

Table 1 summarizes the identified 13 adult studies. Four found an association between short sleep and weight gain but no association between long sleep and weight gain.16, 40, 41, *42 Four found an

Discussion

This study provides for the first time a systematic review of longitudinal-only studies examining the association between sleep duration and subsequent weight gain.

Children studies in this review consistently reported a relationship between short sleep duration and weight gain with the exception of the older children (8.0–12.9 years at baseline and followed for 5 years) in one study.56 The results of the adult studies were more varied, with four studies finding an association between only short

Acknowledgment

This research is funded in part by grants R21HD060208 and R01AG036868.

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