Sleep and obesity in children at different obesity risks : patterns, associations and early intervention

Background: Childhood obesity is a global health concern with a range of adverse outcomes. Short sleep has been consistently linked to childhood obesity. However, associations between other sleep characteristics and obesity are less studied in children. Some multi-component obesity intervention studies har started included sleep as a target. Nevertheless, whether sleep can be improved and further benefit obesity prevention are still uncertain. Moreover, parental obesity is one of the major risk factors for child obesity, which probably due to both shared genetic factors and obesity-related environment and behaviours within families. Understanding whether and how sleep is involved in the obesity transfer within families has important implications for developing better interventions. Aims: The overall aim of this thesis was to explore the role of sleep in the development of obesity among children at high and low obesity risks, determined by their parental weight, as well as to assess the effect of a long-term, low-intensive, family-based multi-component intervention on both preventing obesity and promoting sleep. Materials: All studies included in this thesis are embedded in the Early Stockholm Obesity Prevention Project (Early STOPP), which was a long-term (5-year), low-intensive, family-based obesity prevention project conducted in Stockholm County. In Early STOPP, 181 children with two overweight or at least one obese parent (defined as at high obesity risk) were recruited and randomly allocated to the intervention (n=66) and control (n=115) groups. Meanwhile, a group of children (n=57) with normal-weight parents were recruited randomly as a reference group (defined as at low obesity risk). The baseline data was collected when the child was 1-year-old and an annual follow-up was conducted until the child was 6-year-old. Methods: Study I is a cross-sectional study of Early STOPP baseline data, where child and parental sleep patterns were compared between high and low obesity risk groups, respectively. In Study II, an explorative study, changes of child sleep patterns from age 1 to 2 years were compared between risk groups. Furthermore, child weekday-weekend sleep variations at age 2 years and associated family factors were explored. Study III is a longitudinal study, where the development of child sleep patterns from age 2 to 6 years were studied and the association between child sleep and obesity was explored. Study IV is a randomised controlled trial (RCT) examining the effect of a long-term, low-intensive, family-based intervention on preventing obesity in children at high obesity risk, as well as effects on secondary behaviour outcomes, including child sleep, physical activity and eating behaviour. Results: In Study I and II, some differences were observed in sleep patterns between children at different obesity risks. Compared to children at low obesity risk, children at high obesity risk had slightly longer sleep onset latency at both age 1 and 2 years, as well as greater weekday-weekend sleep variations in sleep schedules at age 2 years. Moreover, children in the high obesity risk group were more likely to experience unfavourable sleep characteristics than their peers in the low-risk group during the first two years of life, including more transient prolonged sleep onset latency and low sleep efficiency. In Study III, when child sleep was assessed using actigraphy, no difference was observed in either child sleep variables or the prevalence of unfavourable sleep characteristics from age 2 to 6 years. In Study III, from child 2 to 6 years, higher short sleep duration score was associated with a greater increase in BMI z-score (0.12, 95% confidence interval [CI]: 0.01-0.25) across ages. Independent of sleep duration, higher late sleep score was associated with greater increases in both BMI z-score (0.16, 95% CI: 0.05-0.27) and waist circumference (0.60 cm, 95% CI: 0.23-0.98) across ages. Moreover, a significant combined effect was detected between late sleep and family obesity risk on child weight gain, as children at high obesity risk and having habitual late sleep had the greatest increase in both BMI z-score (0.93, 95% CI: 0.40-1.45) and waist circumference (3.45 cm, 95% CI: 1.78-5.12) from age 2 to 6 years. In Study IV, during the follow-up period, no main intervention effect was identified on either primary outcome (BMI z-score) or other weight-related outcomes (weight and BMI) across ages. At age 6 years, there were 36 children with overweight and obesity, with 12 (23%) in the intervention group and 24 (26%) in the control group. The intervention was not significantly effective for reducing the risk of developing overweight and obesity. For the secondary outcomes, no significant intervention effect was detected in child eating behaviour, total sleep duration or average physical activity across ages. Conclusion: Frequent exposures to short sleep and late sleep were independently associated with more increases in weight measures in children from age 2 to 6 years. Although the development of sleep was similar in children at different obesity risks, determined by parental weight, a combined effect between child late sleep and high family obesity risk on more weight gain was observed. Moreover, a five-year, low-intensive, family-based, multicomponent obesity intervention was not more effective than routine health care in either promoting behaviours or preventing obesity among children with overweight and obese parents

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Patterns and correlates of objectively measured physical activity in 3-year-old children

BACKGROUND: To increase the knowledge about physical activity (PA) patterns and correlates among children under the age of 4, there is a need for study's using objective measurements. The aim of this study was therefore to investigate if objectively measured PA among 3-year-old children differed between day of week and time of day and whether it correlated to child weight status and sex as well as parental weight status and education. METHODS: Totally 61 children (51% girls) aged 3, participating in Early Stockholm Obesity Prevention Project were included. PA was measured with a tri-axial accelerometer (ActiGraph GT3X+) worn on the non-dominant wrist for one week. The main outcome was average PA expressed as counts per minute from the vector magnitude. PA and demographics/family-related factors were collected at baseline and at age 3. To analyze the results simple linear regression, ANOVA and paired t-tests were performed. RESULTS: The mean number of valid days was 6.7 per child. The children were more active on weekdays than weekends (p < 0.01) and the hourly pattern differed over the day with children being most active midmorning and midafternoon (p = 0.0001). Children to parents with low education were more active (p = 0.01) than those with highly educated parents. No differences in PA by child weight status, sex nor parental weight status were found. CONCLUSIONS: PA in 3-year-old children was lower during weekends than weekdays and varied over the day. Boys and girls had similar PA patterns, these patterns were independent of child or parental weight status. Children to parents with low education were more active than their counterparts. The fact that PA differed between weekdays and weekends indicates that PA might be affectable in 3-year-old children

Predictive factors of surgical site infection after hysterectomy for endometrial carcinoma: a retrospective analysis

Abstract Background Surgical site infection (SSI) is a common postoperative complication. We aimed to analyze the potential risk factors of SSI in patients with endometrial carcinoma. Methods Patients with endometrial carcinoma who underwent surgery treatment in our hospital from Sept 1, 2018 to August 31, 2020 were included. We retrospectively compared the characteristics of SSI and no SSI patients, and logistic regression analyses were performed to identify the risk factors of SSI in patients with endometrial carcinoma. Results A total of 318 postoperative patients with endometrial carcinoma were included. The incidence of SSI in patients with endometrial carcinoma was 14.47 %. There were significant differences on the FIGO stage, type of surgery, durations of drainage, postoperative serum albumin and postoperative blood sugar (all p  0.05). FIGO stage IV (HR3.405, 95 %CI 2.132–5.625), open surgery (HR2.692, 95 %CI 1.178–3.454), durations of drainage ≥ 7 d (HR2.414,95 %CI 1.125–2.392), postoperative serum albumin < 30 g/L (HR1.912,95 %CI 1.263–2.903), postoperative blood sugar ≥ 10 mmol/L (HR1.774,95 %CI 1.102–2.534) were the independent risk factors of SSI in patients with endometrial carcinoma (all p <  0.05). Conclusions Measures including reasonable control of serum albumin and blood glucose levels, minimally invasive surgery as much as possible, timely assessment of drainage and early removal of the tube may be beneficial to reduce the postoperative SSI in in patients with endometrial carcinoma

Development of sleep patterns in children with obese and normal-weight parents

Aim To study the sleep development and sleep characteristics in children at different obesity risks, based on parental weight, and also to explore their weekday–weekend sleep variations and associated family factors. Methods A total of 145 children participating in a longitudinal obesity prevention project were included, of which 37 had normal‐weight parents (low obesity risk), and 108 had overweight/obese parents (high obesity risk). Sleep diaries at ages 1 and 2 years were used to study sleep development in children at different obesity risks. Objectively assessed sleep using an accelerometer at 2 years of age was used to analyse weekday–weekend sleep variations. Results There was no difference in sleep development from age 1 to age 2 among children at different obesity risks, but more children in the high‐risk group had prolonged sleep onset latency and low sleep efficiency. At 2 years of age, children in the high‐risk group had more weekday–weekend variation in sleep offset (mean difference 18 min, 95% confidence interval (CI) 4–33 min), midpoint of sleep (mean difference 14 min, 95% CI 3–25 min) and nap onset (mean difference 42 min, 95% CI 10–74 min) than children in the low‐risk group, after adjusting for other family factors. However, no difference could be detected between groups in weekday–weekend variation in sleep duration. Conclusions Unfavourable sleep characteristics, as well as more variation in sleep schedules, have been observed in children at high obesity risk. While the differences were relatively small, they may reflect the unfavourable sleep hygiene in families at high obesity risk

On the performance of laser-induced breakdown spectroscopy for direct determination of trace metals in lubricating oils

Laser-induced breakdown spectroscopy (LIBS) provides a technique to directly determine metals in viscous liquids and especially in lubricating oils. A specific laser ablation configuration of a thin layer of oil applied on the surface of a pure aluminum target was used to evaluate the analytical figures of merit of LIES for elemental analysis of lubricating oils. Among the analyzed oils, there were a certified 75cSt blank mineral oil, 8 virgin lubricating oils (synthetic, semi-synthetic, or mineral and of 2 different manufacturers), 5 used oils (corresponding to 5 among the 8 virgin oils), and a cooking oil. The certified blank oil and 4 virgin lubricating oils were spiked with metallo-organic standards to obtain laboratory reference samples with different oil matrix. We first established calibration curves for 3 elements, Fe, Cr, Ni, with the 5 sets of laboratory reference samples in order to evaluate the matrix effect by the comparison among the different oils. Our results show that generalized calibration curves can be built for the 3 analyzed elements by merging the measured line intensities of the 5 sets of spiked oil samples. Such merged calibration curves with good correlation of the merged data are only possible if no significant matrix effect affects the measurements of the different oils. In the second step, we spiked the remaining 4 virgin oils and the cooking oils with Fe, Cr and Ni. The accuracy and the precision of the concentration determination in these prepared oils were then evaluated using the generalized calibration curves. The concentrations of metallic elements in the 5 used lubricating oils were finally determined

β-Elemene-Attenuated Tumor Angiogenesis by Targeting Notch-1 in Gastric Cancer Stem-Like Cells

Emerging evidence suggests that cancer stem cells are involved in tumor angiogenesis. The Notch signaling pathway is one of the most important regulators of these processes. β-Elemene, a naturally occurring compound extracted from Curcumae Radix, has been used as an antitumor drug for various cancers in China. However, its underlying mechanism in the treatment of gastric cancer remains largely unknown. Here, we report that CD44+ gastric cancer stem-like cells (GCSCs) showed enhanced proliferation capacity compared to their CD44− counterparts, and this proliferation was accompanied by the high expression of Notch-1 (in vitro). These cells were also more superior in spheroid colony formation (in vitro) and tumorigenicity (in vivo) and positively associated with microvessel density (in vivo). β-Elemene was demonstrated to effectively inhibit the viability of GCSCs in a dose-dependent manner, most likely by suppressing Notch-1 (in vitro). β-Elemene also contributed to growth suppression and attenuated the angiogenesis capacity of these cells (in vivo) most likely by interfering with the expression of Notch-1 but not with Dll4. Our findings indicated that GCSCs play an important role in tumor angiogenesis, and Notch-1 is one of the most likely mediators involved in these processes. β-Elemene was effective at attenuating angiogenesis by targeting the GCSCs, which could be regarded as a potential mechanism for its efficacy in gastric cancer management in the future