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Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study

Abstract

Background:

Adequate sleep is a critical factor for adolescent's health and health-related behaviors.

Objective:

(a) to describe sleep duration in European adolescents from nine countries, (b) to assess the association of short sleep duration with excess adiposity and (c) to elucidate if physical activity (PA), sedentary behaviors and/or inadequate food habits underlie this association.

Design:

A sample of 3311 adolescents (1748 girls) aged 12.5–17.49 years from 10 European cities in Austria, Belgium, France, Germany, Greece, Hungary, Italy, Spain and Sweden was assessed in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study between 2006 and 2008. We measured anthropometric data, sleep duration, PA (accelerometers and questionnaire), television watching and food habits (Food Frequency Questionnaire).

Results:

Average duration of daily sleep was 8 h. Shorter sleepers showed higher values of BMI, body fat, waist and hip circumferences and fat mass index (P<0.05), particularly in females. Adolescents who slept <8 h per day were more sedentary, as assessed by accelerometry, and spent more time watching TV (P<0.05). The proportion of adolescents who eat adequate amounts of fruits, vegetables and fish was lower in shorter sleepers than in adolescents who slept 8 h per day, and so was the probability of having adequate food habits (P<0.05). Correlation analysis indicated that short sleep is associated with higher obesity parameters.

Conclusions:

In European adolescents, short sleep duration is associated with higher adiposity markers, particularly in female adolescents. This association seems to be related to both sides of the energy balance equation due to a combination of increased food intake and more sedentary habits.

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References

  1. Knutson KL, Van Cauter E, Rathouz PJ, DeLeire T, Lauderdale DS . Trends in the prevalence of short sleepers in the USA: 1975–2006. Sleep 2010; 33: 37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Basner M, Fomberstein KM, Razavi FM, Banks S, William JH, Rosa RR et al. American time use survey: sleep time and its relationship to waking activities. Sleep 2007; 30: 1085–1095.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yu Y, Lu BS, Wang B, Wang H, Yang J, Li Z et al. Short sleep duration and adiposity in Chinese adolescents. Sleep 2007; 30: 1688–1697.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Van Cauter E, Knutson KL . Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol 2008; 159: S59–S66. Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Adámková V, Hubácek JA, Lánská V, Vrablík M, Králová Lesná I, Suchánek P et al. Association between duration of the sleep and body weight. Physiol Res 2009; 58: S27–S31.

    PubMed  Google Scholar 

  6. Meisinger C, Heier M, Löwel H, Schneider A, Döring A . Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. Sleep 2007; 30: 1121–1127.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chen MY, Wang EK, Jeng YJ . Adequate sleep among adolescents is positively associated with health status and health-related behaviors. BMC Public Health 2006; 6: 59.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dahl RE, Lewin DS . Pathways to adolescent health: sleep regulation and behavior. J Adolesc Health 2002; 31: 175–184.

    Article  PubMed  Google Scholar 

  9. Redeker NS, Rugiero JS, Hedges C . Sleep is related to physical function and emotional well-being after cardiac surgery. Nurs Res 2004; 53: 154–162.

    Article  PubMed  Google Scholar 

  10. Carskadon MA, Acebo C . Regulation of sleepiness in adolescents: update, insights, and speculation. Sleep 2002; 25: 606–614.

    Article  PubMed  Google Scholar 

  11. Patel SR, Hu FB . Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 2008; 16: 643–653. Review.

    Article  Google Scholar 

  12. Cappuccio FP, Taggart FM, Kandala NB, Currie A, Peile E, Stranges S et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008; 31: 619–626.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Al Mamun A, Lawlor DA, Cramb S, O’Callaghan M, Williams G, Najman J . Do childhood sleeping problems predict obesity in young adulthood? Evidence from a prospective birth cohort study. Am J Epidemiol 2007; 166: 1368–1373.

    Article  PubMed  Google Scholar 

  14. Nedeltcheva AV, Kilkus JM, Imperial J, Kasza K, Schoeller DA, Penev PD . Sleep curtailment is accompanied by increased intake of calories from snacks. Am J Clin Nutr 2009; 89: 126–133.

    Article  CAS  PubMed  Google Scholar 

  15. Spiegel K, Tasali E, Penev P, Van Cauter E . Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141: 846–850.

    Article  PubMed  Google Scholar 

  16. Taheri S, Lin L, Austin D, Young T, Mignot E . Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1: e62.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chaput JP, Després JP, Bouchard C, Tremblay A . Short sleep duration is associated with reduced leptin levels and increased adiposity: results from the Quebec family study. Obesity (Silver Spring) 2007; 15: 253–261.

    Article  CAS  Google Scholar 

  18. De Henauw S, Gottrand F, De Bourdeaudhuij I, Gonzalez-Gross M, Leclercq C, Kafatos A et al. Nutritional status and lifestyles of adolescents from a public health perspective. The HELENA Project-Healthy Lifestyle in Europe by Nutrition in Adolescence. J Public Health 2007; 15: 187–197.

    Article  Google Scholar 

  19. Moreno LA, De Henauw S, González-Gross M, Kersting M, Molnár D, Gottrand F et al. Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes 2008; 32: S4–S11.

    Article  Google Scholar 

  20. Béghin L, Castera M, Manios Y, Gilbert CC, Kersting M, De Henauw S et al. Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA cross-sectional study. Int J Obes (Lond) 2008; 32: S12–S18.

    Article  Google Scholar 

  21. Nagy E, Vicente-Rodriguez G, Manios Y, Béghin L, Iliescu C, Censi L et al. Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes (Lond) 2008; 32: S58–S65.

    Article  Google Scholar 

  22. Sun SS, Chumlea WC, Heymsfield SB, Lukaski HC, Schoeller D, Friedl K et al. Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys. Am J Clin Nutr 2003; 77: 331–340.

    Article  CAS  PubMed  Google Scholar 

  23. Tanner JM, Whitehouse RH . Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976; 51: 170–179.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lund HG, Reider BD, Whiting AB, Prichard JR . Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health 2010; 46: 124–132.

    Article  PubMed  Google Scholar 

  25. Vereecken CA, Maes L . A Belgian study on the reliability and relative validity of the health behaviour in school-aged children food-frequency questionnaire. Public Health Nutr 2003; 6: 581–588.

    Article  PubMed  Google Scholar 

  26. Puyau MR, Adolph AL, Vohra FA, Butte NF . Validation and calibration of physical activity monitors in children. Obesity Res 2002; 10: 150–157.

    Article  Google Scholar 

  27. Ekelund U, Anderssen SA, Froberg K, Sardinha LB, Andersen LB, Brage S . Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study. Diabetologia 2007; 50: 1832–1840.

    Article  CAS  PubMed  Google Scholar 

  28. Sardinha LB, Baptista T, Ekelund U . Objectively measured physical activity and bone strength in 9-year-old boys and girls. Pediatrics 2008; 122: E728–E736.

    Article  PubMed  Google Scholar 

  29. De Cocker K, Ottevaere C, Sjostrom M, Moreno LA, Wärnberg J, Valtueña J et al. Self-reported physical activity in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr 2010; 18: 1–9.

    Google Scholar 

  30. Barnett J, Nigg CR, De Bourdeaudhuij I, Maglione C, Maddock J . The effect of item order on physical activity estimates using the IPAQ. Californion J Health Promotion 2007; 5: 23–29.

    Google Scholar 

  31. Haerens L, Deforche B, Maes L, Cardon G, De Bourdeaudhuij I . Physical activity and endurance in normal weight versus overweight boys and girls. J Sports Med Phys Fitness 2007; 47: 344–350.

    CAS  PubMed  Google Scholar 

  32. Landis JR, Koch GG . The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

    Article  CAS  PubMed  Google Scholar 

  33. Ortega FB, Ruiz JR, Castillo R, Chillón P, Labayen I, Martínez-Gómez D et al. Sleep duration and cognitive performance in adolescence. The AVENA study. Acta Paediatr 2010; 99: 454–456.

    Article  CAS  PubMed  Google Scholar 

  34. Spruyt K, O’Brien LM, Cluydts R, Verleye GB, Ferri R . Odds, prevalence and predictors of sleep problems in school-age normal children. J Sleep Res 2005; 14: 163–176.

    Article  PubMed  Google Scholar 

  35. Loessl B, Valerius G, Kopasz M, Hornyak M, Riemann D, Voderholzer U . Are adolescents chronically sleep-deprived? An investigation of sleep habits of adolescents in the Southwest of Germany. Child Care Health Dev 2008; 34: 549–556.

    Article  CAS  PubMed  Google Scholar 

  36. Liu X, Zhao Z, Jia C, Buysse DJ . Sleep patterns and problems among Chinese adolescents. Pediatrics 2008; 121: 1165–1173.

    Article  PubMed  Google Scholar 

  37. Gupta R, Bhatia MS, Chhabra V, Sharma S, Dahiya D, Semalti K et al. Sleep patterns of urban school-going adolescents. Indian Pediatr 2008; 45: 183–189.

    PubMed  Google Scholar 

  38. Reid A, Maldonado CC, Baker FC . Sleep behavior of South African adolescents. Sleep 2002; 25: 423–427.

    Article  PubMed  Google Scholar 

  39. Taheri S . The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 2006; 91: 881–884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Sun Y, Sekine M, Kagamimori S . Lifestyle and overweight among Japanese adolescents: the Toyama Birth Cohort Study. J Epidemiol 2009; 19: 303–310.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Shaikh WA, Patel M, Singh S . Sleep deprivation predisposes gujarati Indian adolescents to obesity. Indian J Community Med 2009; 34: 192–194.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Westerterp KR . Assessment of physical activity: a critical appraisal. Eur J Appl Physiol 2009; 105: 823–828. Review.

    Article  PubMed  Google Scholar 

  43. Reilly JJ, Penpraze V, Hislop J, Davies G, Grant S, Paton JY . Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child 2008; 93: 614–619. Review.

    Article  CAS  PubMed  Google Scholar 

  44. Knutson KL . The association between pubertal status and sleep duration and quality among a nationally representative sample of U.S. adolescents. Am J Hum Biol 2005; 17: 418–424.

    Article  PubMed  Google Scholar 

  45. Von kries R, Toschke AM, Wurmser H, Sauerwald T, Koletzko B . Reduced risk for overweight and obesity in 5-and 6-y-old children by duration of sleep-cross sectional study. Int J Obes Relat metab Disord 2002; 26: 710–716.

    Article  CAS  PubMed  Google Scholar 

  46. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB . Association between reduced sleep and weight gain in women. Am J Epidemiol 2006; 164: 947–954.

    Article  PubMed  Google Scholar 

  47. Kuriyan R, Bhat S, Thomas T, Vaz M, Kurpad AV . Television viewing and sleep are associated with overweight among urban and semi-urban South Indian children. Nutr J 2007; 6: 25.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ofcom. Child obesity—food advertising in context. 2004. http://www.ofcom.org.uk/research/tv/reports/food_ads/ (accessed 10 August 2006).

  49. Owens J, Maxim R, McGuinn M, Nobile C, Msall M, Alario A . Television viewing habits and sleep disturbance in school children. Pediatrics 1999; 104: e27.

    Article  CAS  PubMed  Google Scholar 

  50. Garaulet M, Corbalán MD, Madrid JA, Morales E, Baraza JC, Lee YC et al. CLOCK gene is implicated in weight reduction in obese patients participating in a dietary programme based on the Mediterranean diet. Int J Obes (Lond) 2010; 34: 516–523.

    Article  CAS  Google Scholar 

  51. Garaulet M, Lee YC, Shen J, Parnell LD, Arnett DK, Tsai MY et al. Genetic variants in human CLOCK associate with total energy intake and cytokine sleep factors in overweight subjects (GOLDN population). Eur J Hum Genet 2010; 18: 364–369.

    Article  CAS  PubMed  Google Scholar 

  52. Garaulet M, Lee YC, Shen J, Parnell LD, Arnett DK, Tsai MY et al. CLOCK genetic variation and metabolic syndrome risk: modulation by monounsaturated fatty acids. Am J Clin Nutr 2009; 90: 1466–1475.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Garaulet M, Sánchez-Moreno C, Smith CE, Lee YC, Nicolás F, Ordovás JM . Ghrelin, sleep reduction and evening preference: relationships to CLOCK 3111 T/C SNP and weight loss. PLoS One 2011; 6: e17435.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Garaulet M, Ordovás JM, Madrid JA . The chronobiology, etiology and pathophysiology of obesity. Int J Obes (Lond) 2010; 34: 1667–1683.

    Article  CAS  Google Scholar 

  55. Adan A, Natale V . Gender differences in morningness-eveningness preference. Chronobiol Int 2002; 19: 709–720.

    Article  PubMed  Google Scholar 

  56. Lockley SW, Skene DJ, Arendt J . Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999; 8: 175–183.

    Article  CAS  PubMed  Google Scholar 

  57. Hauri PJ, Wisbey J . Wrist actigraphy in insomnia. Sleep 1992; 15: 293–301.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOODCT-2005-007034). This work was also partially supported by grants from the Spanish Ministry of Education (EX-2008-0641), the Spanish Ministry of Science and Innovation (RYC-2010-05957) and the Swedish Heart-Lung Foundation (20090635). The writing group takes sole responsibility for the content of this article. The content of this paper reflects only the authors’ views, and the European Community is not liable for any use that may be made of the information contained therein.

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Correspondence to M Garaulet.

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The authors declare no conflict of interest.

Additional information

For HELENA study group see Appendix.

Appendix

Appendix

HELENA Study Group:

Coordinator: Luis A Moreno.

Core Group Members: Luis A Moreno, Fréderic Gottrand, Stefaan De Henauw, Marcela González-Gross, Chantal Gilbert.

Steering Committee: Anthony Kafatos (President), Luis A Moreno, Christian Libersa, Stefaan De Henauw, Jackie Sánchez, Fréderic Gottrand, Mathilde Kersting, Michael Sjöstrom, Dénes Molnár, Marcela González-Gross, Jean Dallongeville, Chantal Gilbert, Gunnar Hall, Lea Maes, Luca Scalfi.

Project Manager: Pilar Meléndez.

 1. Universidad de Zaragoza (Spain)

Luis A Moreno, Jesús Fleta, José A Casajús, Gerardo Rodríguez, Concepción Tomás, María I Mesana, Germán Vicente-Rodríguez, Adoración Villarroya, Carlos M Gil, Ignacio Ara, Juan Revenga, Carmen Lachen, Juan Fernández Alvira, Gloria Bueno, Aurora Lázaro, Olga Bueno, Juan F León, Jesús Ma Garagorri, Manuel Bueno, Juan Pablo Rey López, Iris Iglesia, Paula Velasco, Silvia Bel.

 2. Consejo Superior de Investigaciones Científicas (Spain)

Ascensión Marcos, Julia Wärnberg, Esther Nova, Sonia Gómez, Esperanza Ligia Díaz, Javier Romeo, Ana Veses, Mari Angeles Puertollano, Belén Zapatera, Tamara Pozo.

 3. Université de Lille 2 (France)

Laurent Beghin, Christian Libersa, Frédéric Gottrand, Catalina Iliescu, Juliana Von Berlepsch.

 4. Research Institute of Child Nutrition Dortmund, Rheinische Friedrich-Wilhelms-Universität Bonn (Germany)

Mathilde Kersting, Wolfgang Sichert-Hellert, Ellen Koeppen.

 5. Pécsi Tudományegyetem (University of Pécs) (Hungary)

Dénes Molnar, Eva Erhardt, Katalin Csernus, Katalin Török, Szilvia Bokor, Mrs Angster, Enikö Nagy, Orsolya Kovács, Judit Repásy.

 6. University of Crete School of Medicine (Greece)

Anthony Kafatos, Caroline Codrington, María Plada, Angeliki Papadaki, Katerina Sarri, Anna Viskadourou, Christos Hatzis, Michael Kiriakakis, George Tsibinos, Constantine Vardavas, Manolis Sbokos, Eva Protoyeraki, Maria Fasoulaki.

 7. Institut für Ernährungs- und Lebensmittelwissenschaften—Ernährungphysiologie. Rheinische Friedrich Wilhelms Universität (Germany)

Peter Stehle, Klaus Pietrzik, Marcela González-Gross, Christina Breidenassel, Andre Spinneker, Jasmin Al-Tahan, Miriam Segoviano, Anke Berchtold, Christine Bierschbach, Erika Blatzheim, Adelheid Schuch, Petra Pickert.

 8. University of Granada (Spain)

Manuel J Castillo, Ángel Gutiérrez, Francisco B Ortega, Jonatan R Ruiz, Enrique G Artero, Vanesa España-Romero, David Jiménez-Pavón, Palma Chillón.

 9. Istituto Nazionalen di Ricerca per gli Alimenti e la Nutrizione (Italy)

Davide Arcella, Giovina Catasta, Laura Censi, Donatella Ciarapica, Marika Ferrari, Cinzia Le Donne, Catherine Leclerq, Luciana Magrì, Giuseppe Maiani, Rafaela Piccinelli, Angela Polito, Raffaela Spada, Elisabetta Toti.

 10. University of Napoli ‘Federico II’ Department of Food Science (Italy)

Luca Scalfi, Paola Vitaglione, Concetta Montagnese.

 11. Ghent University (Belgium)

Ilse De Bourdeaudhuij, Stefaan De Henauw, Tineke De Vriendt, Lea Maes, Christophe Matthys, Carine Vereecken, Mieke de Maeyer, Charlene Ottevaere.

 12. Medical University of Vienna (Austria)

Kurt Widhalm, Katharina Phillipp, Sabine Dietrich, Birgit Kubelka, Marion Boriss-Riedl.

 13. Harokopio University (Greece)

Yannis Manios, Eva Grammatikaki, Zoi Bouloubasi, Tina Louisa Cook, Sofia Eleutheriou, Orsalia Consta, George Moschonis, Ioanna Katsaroli, George Kraniou, Stalo Papoutsou, Despoina Keke, Ioanna Petraki, Elena Bellou, Sofia Tanagra, Kostalenia Kallianoti, Dionysia Argyropoulou, Katerina Kondaki, Stamatoula Tsikrika, Christos Karaiskos.

 14. Institut Pasteur de Lille (France)

Jean Dallongeville, Aline Meirhaeghe.

 15. Karolinska Institutet (Sweden)

Michael Sjöstrom, Patrick Bergman, María Hagströmer, Lena Hallström, Mårten Hallberg, Eric Poortvliet, Julia Wärnberg, Nico Rizzo, Linda Beckman, Anita Hurtig Wennlöf, Emma Patterson, Lydia Kwak, Lars Cernerud, Per Tillgren, Stefaan Sörensen.

 16. Asociación de Investigación de la Industria Agroalimentaria (Spain)

Jackie Sánchez-Molero, Elena Picó, Maite Navarro, Blanca Viadel, José Enrique Carreres, Gema Merino, Rosa Sanjuán, María Lorente, María José Sánchez, Sara Castelló.

 17. Campden & Chorleywood Food Research Association (United Kingdom)

Chantal Gilbert, Sarah Thomas, Elaine Allchurch, Peter Burguess.

 18. SIK—Institutet foer Livsmedel och Bioteknik (Sweden)

Gunnar Hall, Annika Astrom, Anna Sverkén, Agneta Broberg.

 19. Meurice Recherche & Development asbl (Belgium)

Annick Masson, Claire Lehoux, Pascal Brabant, Philippe Pate, Laurence Fontaine.

 20. Campden & Chorleywood Food Development Institute (Hungary)

Andras Sebok, Tunde Kuti, Adrienn Hegyi.

 21. Productos Aditivos SA (Spain)

Cristina Maldonado, Ana Llorente.

 22. Cárnicas Serrano SL (Spain)

Emilio García.

 23. Cederroth International AB (Sweden)

Holger von Fircks, Marianne Lilja Hallberg, Maria Messerer.

 24. Lantmännen Food R&D (Sweden)

Mats Larsson, Helena Fredriksson, Viola Adamsson, Ingmar Börjesson.

 25. European Food Information Council (Belgium)

Laura Fernández, Laura Smillie, Josephine Wills.

 26. Universidad Politécnica de Madrid (Spain)

Marcela González-Gross, Agustín Meléndez, Pedro J Benito, Javier Calderón, David Jiménez-Pavón, Jara Valtueña, Paloma Navarro, Alejandro Urzanqui, Ulrike Albers, Raquel Pedrero, Juan José Gómez Lorente.

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Garaulet, M., Ortega, F., Ruiz, J. et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes 35, 1308–1317 (2011). https://doi.org/10.1038/ijo.2011.149

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