Summary
This is the first systematic review of the literature on sleep and its relation to cognition and behaviour in preschool‐aged children. In comparison with the literature focused on school‐aged ...children, knowledge involving preschoolers is rather sparse. A total of 26 studies was included in this review, which revealed a high degree of heterogeneity regarding the type and means of measuring sleep variables and behavioural and cognitive variables, as well as the statistical methods employed. Amongst the 13 articles with the largest sample sizes (top 50% of the included studies, 12 different populations), 12 found that a higher quantity or quality of sleep was associated with better behavioural and/or cognitive outcomes. Results point to an association between sleep, behaviour and cognition as early as preschool years, but the strengths of associations reported in the articles were relatively small. Studies with a smaller sample size were less concordant. It is consistent with our findings that the strengths of association are small, and thus require large sample sizes to ensure statistical detection power. Different aspects of sleep were not associated with all cognitive or behavioural features in the same way, which underscores the need for specific measures rather than general ones such as ‘sleep problems’ or ‘behaviour problems’ to be able to decipher the relationships. There is also a need for large longitudinal studies using objective measures and accounting for confounding factors. The child's genotype has recently been shown to have a moderating role in the association between sleep and behaviour, and should be further explored.
Background and Aims
The association between birth weight (BW) and metabolic outcomes has been described since the 1980s but NAFLD has been rarely studied. This study aimed to investigate the ...association between BW and NAFLD occurrence in adult subjects.
Approach and Results
The study population consisted of participants from the French nationwide Constances cohort from 2012 to 2019. Participants with a history of chronic viral hepatitis or excessive alcohol consumption were excluded. Noninvasive diagnosis of NAFLD and fibrosis was performed using a combination of the Fatty Liver Index (FLI) and the Forns Index. The relationship between BW and NAFLD was analyzed with a sex‐stratified logistic regression model adjusted for sociodemographic parameters, lifestyle, and birth term, whereas liver fibrosis was analyzed with a sex‐stratified linear regression model. In total, 55,034 individuals with reliable BW were included (43% men, mean age: 38 years). NAFLD (FLI ≥ 60) was present in 5530 individuals (10%). Multivariate logistic regression showed a significant U‐shaped relationship between BW and NAFLD, with no significant interaction with sex. A significant and slightly decreasing association was found between BW and Forns Index (β = −0.05; p = 0.04). Premature birth (OR, 1.23; 95% CI, 1.03–1.48 for birth between 33 and 37 weeks versus ≥ 37 weeks) was associated with NAFLD, with a significant direct effect of premature birth, and without an indirect effect of low BW in mediation analysis. Forns Index was not significantly higher in participants with preterm birth compared to full‐term birth.
Conclusions
This large prospective adult‐based cohort confirms the relationship between BW and NAFLD occurrence.
Objective To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related ...injuries.Data sources Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013.Study selection Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures.Data synthesis Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models.Results 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I2=50%, P=0.04).Conclusions Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.
Background
The associations of screen use with children's cognition are not well evidenced and recent, large, longitudinal studies are needed. We aimed to assess the associations between screen use ...and cognitive development in the French nationwide birth cohort.
Methods
Time and context of screen use were reported by parents at ages 2, 3.5 and 5.5. Vocabulary, non‐verbal reasoning and general cognitive development were assessed with the MacArthur‐Bates Communicative Development Inventory (MB) at age 2, the Picture Similarities subtest from the British Ability Scales (PS) at age 3.5 and the Child Development Inventory (CDI) at ages 3.5 and 5.5. Outcome variables were age‐adjusted and standardized (mean = 100, SD = 15). Multiple imputations were performed among children (N = 13,763) with ≥1 screen use information and ≥1 cognitive measures. Cross‐sectional and longitudinal associations between screen use and cognitive development were assessed by linear regression models adjusted for sociodemographic and birth factors related to the family and children, and children's lifestyle factors competing with screen use. Baseline cognitive scores were further considered in longitudinal analysis.
Results
TV‐on during family meals at age 2, not screen time, was associated with lower MB scores at age 2 (β 95% CI = −1.67 −2.21, −1.13) and CDI scores at age 3.5 (−0.82 −1.31, −0.33). In cross‐sectional analysis, screen time was negatively associated with CDI scores at ages 3.5 (−0.67 −0.94, −0.40) and 5.5 (−0.47 −0.77, −0.16), and, in contrast, was positively associated with PS scores (0.39 0.07, 0.71) at age 3.5. Screen time at age 3.5 years was not associated with CDI scores at age 5.5 years.
Conclusions
Our study found weak associations of screen use with cognition after controlling for sociodemographic and children's birth factors and lifestyle confounders, and suggests that the context of screen use matters, not solely screen time, in children's cognitive development.
Abstract
Study Objectives
To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates.
Methods
We collected early family, maternal, and child characteristics, ...including children’s nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors.
Results
We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The “Good sleepers” (31.6%) and “Long sleepers” (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in “Good sleepers” than in “Long sleepers.” The “Good sleepers but few SOD” group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the “Improving NW and SOD” group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the “Persistent NW and SOD” group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups.
Conclusions
We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions.
Graphical Abstract
The objective of the study was to describe the prevalences of obesity in French adults over a 9‐year period. Mailed questionnaire surveys, in 1997, 2000, 2003, and 2006, sampled 20,000 representative ...French households by the method of quotas. Weight, height, and waist circumference were reported by all members of the selected households ≥18‐years. Obesity was defined according to the WHO criteria, BMI >30 kg/m2. The prevalence of adult obesity increased progressively from 8.6% (95% confidence interval: 8.2–8.8) in 1997 to 13.1% (12.7–13.5) in 2006. The increase affected all ages, socioeconomic strata, and regions. Although the prevalence of obesity increased in parallel in men and women from 1997 to 2003, the rate of increase was lower in men between 2003 and 2006. These surveys showed a sharp increase in the prevalence of obesity in France in recent years contrasting with a stable prevalence in the 1980s. The results of the first Obepi surveys prompted the French government to implement a Nutrition and Health National Plan in 2001. Regular monitoring of obesity prevalence in France and neighboring countries is needed to compare future trends.
Abstract
Studies in children have reported associations of screen time and background TV on language skills as measured by their parents. However, few large, longitudinal studies have examined ...language skills assessed by trained psychologists, which is less prone to social desirability. We assessed screen time and exposure to TV during family meals at ages 2, 3 and 5–6 years in 1562 children from the French EDEN cohort. Language skills were evaluated by parents at 2 years (Communicative Development Inventory, CDI) and by trained psychologists at 3 (NEPSY and ELOLA batteries) and 5–6 years (verbal IQ). Cross-sectional and longitudinal associations were assessed by linear regression adjusted for important confounders. Overall, daily screen time was not associated with language scores, except in cross-sectional at age 2 years, where higher CDI scores were observed for intermediate screen time. Exposure to TV during family meals was consistently associated with lower language scores: TV always on (vs never) at age 2 years was associated with lower verbal IQ (− 3.2 95% IC: − 6.0, − 0.3 points), independent of daily screen time and baseline language score. In conclusion, public health policies should better account for the context of screen watching, not only its amount.
This study aimed to characterize paternal diet during the peri-conception period and its associated characteristics. These cross-sectional analyses were based on 998 fathers from the French ...nationwide ELFE birth cohort recruited in 2011. Fathers’ diet before mothers’ pregnancies was assessed by a 46-item food frequency questionnaire. Six exploratory dietary patterns were identified by principal component analysis: “Diverse diet”, “Balanced”, “Alcohol”, “Snacking”, “Bread and cheese”, and “Processed products”. Older age was related to higher scores for the “Balanced”, “Alcohol”, and “Snacking” patterns, and high education level with high scores on the “Balanced” pattern and low scores on the “Processed products” pattern. Unemployment and having a first child were related to high scores on the “Alcohol” pattern. Smoking was positively related to “Alcohol” and “Processed products” patterns. A restrictive diet was associated with high scores on the “Balanced” and “Processed products” patterns and low scores on “Alcohol”, “Snacking”, and “Bread and cheese” patterns. Maternal dietary patterns, identified in a previous analysis, were moderately and positively related to the similar patterns among fathers. These findings are important for screening fathers at risk of a suboptimal diet and for accounting for this factor in future studies to examine the specific influence of paternal diet on a child’s health and development.
Background
The new European regulations require the enrichment of formulas with docosahexaenoic acid (DHA) because of the positive effects of long‐chain polyunsaturated fatty acids (LCPUFAs) on ...neurodevelopment and visual acuity. In this observational study, we aimed to evaluate whether the consumption of LCPUFA‐enriched formula was associated with the risk of infection and allergy in early childhood.
Methods
Analyses involved data from 8389 formula‐fed infants from the ELFE birth cohort. Formula enrichment was identified from the list of ingredients of the formula consumed at 2 months. Infections (gastrointestinal, lower respiratory tract LRTI, upper respiratory tract) and allergies (wheezing, itchy rash, asthma medication, food allergy) from age 2 months to 5.5 years were reported by parents during follow‐up surveys. Multivariable logistic regression models were used to assess associations between the consumption of LCPUFA‐enriched formula and the risk of infection and allergy.
Results
Among formula‐fed infants at 2 months, 36% consumed formula enriched with DHA and arachidonic acid (ARA), and 11% consumed formula additionally enriched with eicosapentaenoic acid (EPA). Enriched formula consumption was not associated with infection or allergy, except for an association between consumption of DHA/ARA/EPA‐enriched formula and lower use of asthma medications. Furthermore, as compared with non‐DHA/ARA/EPA‐enriched formula, consumption of formula with high EPA content (≥3.2 mg/100 kcal) was related to lower risk of LRTI and lower use of asthma medications.
Conclusion
This study suggests that consumption of DHA/ARA/EPA‐enriched formula (especially those with high EPA content) is associated with a lower risk of LRTI and lower use of asthma medications.
Among formula‐fed infants at 2 months, 36% consumed DHA/ARA‐enriched formula, and 11% consumed formula additionally enriched with EPA. DHA/ARA/EPA‐enriched formula consumption (especially with high EPA content) was associated with a lower risk of LRTI and lower use of asthma medications up to 5.5 years. DHA/ARA/EPA‐enriched formula consumption was not associated with gastrointestinal infection, wheezing, itchy rash, and food allergy.Abbreviations: ARA, arachidonic acid; DHA, docosahexaenoic acid; ELFE, birth cohort (Étude longitudinale française depuis l’enfance); EPA, eicosapentaenoic acid; LCPUFA, long‐chain polyunsaturated fatty acids; LRTI, lower respiratory tract infection; OR, odds ratio.
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