Despite the widespread use of actigraphy in pediatric sleep studies, there are currently no age-related normative data.
To systematically review the literature, calculate pooled mean estimates of ...actigraphy-derived pediatric nighttime sleep variables and to examine the magnitude of change with age.
A systematic search was performed across eight databases of studies that included at least one actigraphy sleep variable from healthy children aged 0-18 years. Data suitable for meta-analysis were confined to ages 3-18 years with seven actigraphy variables analyzed using random effects meta-analysis and meta-regression performed using age as a covariate.
In total, 1334 articles did not meet inclusion criteria; 87 had data suitable for review and 79 were suitable for meta-analysis. Pooled mean estimates for overnight sleep duration declined from 9.68 hours (3-5 years age band) to 8.98, 8.85, 8.05, and 7.4 for age bands 6-8, 9-11, 12-14, and 15-18 years, respectively. For continuous data, the best-fit (R2 = 0.74) equation for hours over the 0-18 years age range was 9.02 - 1.04 × (age/10)^2 - 0.83. There was a significant curvilinear association between both sleep onset and offset with age (p < .001). Sleep latency was stable at 19.4 min per night. There were significant differences among the older age groups between weekday and weekend/nonschool days (18 studies). Total sleep time in 15-18 years old was 56 min longer, and sleep onset and offset almost 1 and 2 hours later, respectively, on weekend or nonschool days.
These normative values have potential application to assist the interpretation of actigraphy measures from nighttime recordings across the pediatric age range, and aid future research.
Aims
To compare the effects of 4 hours of laboratory‐based regular activity breaks (RABs) and prolonged sitting (SIT) on subsequent 48‐h free‐living interstitial glucose levels in a group of healthy ...adults.
Materials and Methods
In this randomized crossover trial, participants completed two 4‐h laboratory‐based interventions commencing at ~5:00 pm: (1) SIT and (2) SIT interrupted with 3 min of body weight resistance exercise activity breaks every 30 min (RABs). Continuous glucose monitoring was performed during the intervention and for 48‐h after, during which time participants returned to a free‐living setting.
Results
Twenty‐eight adults (female n = 20, mean ± SD age 25.5 ± 5.6 years, body mass index 29.2 ± 6.9 kg/m2) provided data for this analysis. During the intervention period, RABs lowered mean interstitial glucose by 8.3% (−0.47 mmol/L/4 h, 95% confidence interval CI −0.74 to −0.20; p = 0.001) and area under the curve (AUC) by 8.9% (−2.01 mmol/L/4 h, 95% CI −3.05 to −0.97; p < 0.001) compared to SIT. Measures of glycaemic variability were not significantly different during the intervention. There were no significant differences in mean glucose and AUC between conditions during the first nocturnal period and 24‐h post intervention. When compared to SIT, RABs increased continuous overall net action of glucose at 1 h and SD glucose by 22% (0.18 mmol/L, 95% CI 0.03 to 0.29; p = 0.018) and 26% (95% CI 4.9 to 42.7; p = 0.019) in the first nocturnal period and by 10% (0.09 mmol/L, 95% CI 0.01, 0.17; p = 0.025) and 15% (95% CI 6.6 to 22.4; p = 0.001) in the 24‐h post intervention period, respectively.
Conclusion
Performing activity breaks in the evening results in acute reductions in interstitial glucose concentrations; however, the magnitude of these changes is not maintained overnight or into the following 48 hours.
Objective
This study aimed to describe how mild sleep deprivation in children changes time spent physically active and sedentary.
Methods
In 2018 through 2020, children (n = 105) with normal sleep ...were randomized to go to bed 1 hour earlier (extension) or 1 hour later (restriction) than their usual bedtime for 1 week, each separated by a 1‐week washout. Twenty‐four‐hour movement behaviors were measured with waist‐worn actigraphy and expressed in minutes and proportions (percentages). Mixed‐effects regression models determined mean differences in time use (95% CI) between conditions. Time gained from sleep lost that was reallocated to other movement behaviors in the 24‐hour day was modeled using regression.
Results
Children (n = 96) gained ~49 minutes of awake time when sleep was restricted compared with extended. This time was mostly reallocated to sedentary behavior (28 minutes; 95% CI: 19‐37), followed by physical activity (22 minutes; 95% CI: 14‐30). When time was expressed as a percentage, the overall composition of movement behavior remained similar across both sleep conditions.
Conclusions
Children were not less physically active when mildly sleep deprived. Time gained from sleeping less was proportionally, rather than preferentially, reallocated to sedentary time and physical activity. These findings suggest that decreased physical activity seems unlikely to explain the association between short sleep and obesity in children.
Stunting and underweight among under-five children in Indonesia are common, raising public health concerns. Whether inappropriate complementary feeding (CF) practices compromise optimal growth during ...late infancy in Indonesia is uncertain. Therefore we characterized and evaluated CF practices in Indonesian infants and investigated their relationship with subsequent growth. We enrolled breastfed infants at 6 months of age (n = 230); and followed them at 9 (n = 202) and 12 months of age (n = 190). We collected socio-demographic and anthropometric data and two-day in-home weighed food records. Relations between WHO CF indicators, sentinel foods, and energy and micronutrient intakes at 9 months and growth at 12 months were explored using multiple linear regression. Stunting and underweight increased from 15.8% and 4.4% at 6 months to 22.6% and 10.5% at 12 months, respectively. Median intakes of calcium, iron, zinc, and riboflavin were below WHO recommendations. Infants consuming fortified infant foods (FIFs) at 9 months had diets with a lower dietary diversity (DD) score (2.3 vs.3.0), energy density, median energy (250 vs. 310 kcal/d) and protein (6.5 vs. 9.1 g/d) intake than non-consumers (p<0.01), despite higher intakes of calcium, iron, and vitamins A and C (p<0.001). Positive relations existed for 9-month consumption of iron-rich/iron fortified infant foods with length-for-age Z-score (LAZ) at 12 months (β = 0.22; 95% CI: 0.01, 0.44; P = 0.04), and for fortified infant foods alone with both LAZ (β = 0.29; 95% CI: 0.09, 0.48; P = 0.04) and weight-for-age Z-score (β = 0.14; 95% CI: 0.02, 0.26; P = 0.02) at 12 months. The positive association of FIFs with subsequent growth may be attributed to their content of both powdered cow's milk and multi-micronutrient fortificants. Nonetheless, mothers should not be encouraged to over-rely on FIFs as they reduce DD.
To estimate via questionnaire within a population sample of New Zealand (NZ) children aged 6-to-10 years, the prevalence of sleep disordered breathing (SDB) and those struggling academically, and to ...identify individual and shared risk factors (health and demographic) for parent-reported SDB symptoms and academic difficulties.
In this cross-sectional study, parents/caregivers of children were recruited through schools and social media to complete an online questionnaire covering health and demographic factors, their children's SDB symptoms (Pediatric Sleep Questionnaire; PSQ) and parental ratings of academic performance based on teacher feedback relative to expected progress in the national curriculum (well below/below/at/above) in reading, writing, and math.
A total of 1205 children (53% male) aged (mean) eight years two months were included, comprising 79.4% NZ European/other and 15.0% Māori. The survey-weighted prevalence of SDB (based on the PSQ) was 17.5%. This was higher amongst those with academic difficulties rated ‘below/well below’ expected progress for reading, writing and math (estimated at 24.0%, 31.0% and 27.5% respectively), with increased odds (adjusted odds ratios) for poor progress of 1.9 (95% CI: 1.2, 3.0), 1.8 (95% CI: 1.2, 2.7) and 2.4 (95% CI: 1.6, 3.7) respectively. There were no shared risk factors common to both SDB and academic difficulties identified from multivariate analyses.
The findings suggest that children with parent-reported SDB symptoms may be at high risk for poor progress in reading, writing, and math. Future research could examine whether treatment of SDB reduces barriers to learning and offsets educational risk.
•The survey-weighted prevalence of ‘high risk’ for SDB was 17.5%.•These children were also at increased risk for performing ‘below’/‘well below’ that of their peers in reading, writing, and math.•There were common demographic correlates of SDB risk and academic difficulties.•No shared risk factors for SDB risk and academic difficulties were identified.
Although excess visceral fat (VAT) is associated with numerous cardio-metabolic risk factors, measurement of this fat depot has historically been difficult. Recent dual X-ray absorptiometry ...approaches have provided an accessible estimate of VAT that has shown acceptable validity against gold standard methods. The aims of this study were to (i) evaluate DXA measured VAT as a predictor of elevated blood lipids and blood pressure and (ii) calculate thresholds associated with these cardio-metabolic risk factors.
The sample comprised 1482 adults (56.4% women) aged 18-66 years. Total body scans were performed using a GE Lunar Prodigy, and VAT analyses were enabled through Corescan software (v 16.0). Blood pressure and blood lipids were measured by standard procedures. Regression models assessed how VAT mass was associated with each cardio-metabolic risk factor compared to other body composition measures. Measures of sensitivity and specificity were used to determine age- and sex-specific cut points for VAT mass associated with high cardio-metabolic risk.
Similar to waist circumference, VAT mass was a strong predictor of cardio-metabolic risk especially in men over age 40. Four cut-offs for VAT mass were proposed, above which the cardio-metabolic risk increased: 700 g in women <40 yrs; 800 g in women 40+ yrs; 1000g in men <40 yrs; and 1200 g in men 40+ yrs. In general, these cut-offs discriminated well between those with high and low cardio-metabolic risk.
In both sexes, DXA measured VAT was associated with traditional cardio-metabolic risk factors, particularly high blood pressure in those 40+ yrs and low HDL < 40 yrs. These reference values provide a simple, accessible method to assess cardio-metabolic risk in adults.
This study aimed to describe meat consumption rationalisation and relationships with meat consumption patterns and food choice motivations in New Zealand adolescents.
This was a cross-sectional study ...of adolescents from high schools across New Zealand. Demographics, dietary habits, and motivations and attitudes towards food were assessed by online questionnaire and anthropometric measurements taken by researchers. The 4Ns questionnaire assessed meat consumption rationalisation with four subscales: 'Nice', 'Normal', 'Necessary' and 'Natural'.
Nineteen secondary schools from eight regions in New Zealand, with some purposive sampling of adolescent vegetarians in Otago, New Zealand.
Questionnaires were completed by 385 non-vegetarian and vegetarian (self-identified) adolescents.
A majority of non-vegetarian adolescents agreed that consuming meat was 'nice' (65 %), but fewer agreed that meat consumption was 'necessary' (51 %). Males agreed more strongly than females with all 4N subscales. High meat consumers were more likely to agree than to disagree that meat consumption was nice, normal, necessary and natural, and vegetarians tended to disagree with all rationalisations. Adolescent non-vegetarians whose food choice was motivated more by convenience, sensory appeal, price and familiarity tended to agree more with all 4N subscales, whereas adolescents motivated by animal welfare and environmental concerns were less likely to agree.
To promote a reduction in meat consumption in adolescents, approaches will need to overcome beliefs that meat consumption is nice, normal, necessary and natural.
Parental feeding practices are associated with children's eating behaviours and weight, yet current use of such practices lacks detailed description. This limits our understanding of which behaviours ...to target to promote healthy growth. We explored the frequency with which a range of parental feeding practices occurs in mothers of toddler and preschool children. Combined data from four Australasian trials of healthy feeding and growth were utilized, each using the Comprehensive Feeding Practices Questionnaire (CFPQ). Data were included from mothers of toddlers (1.3–2 years; n = 1344) and preschool children (4–6 years; n = 795). Means and standard deviations for each CFPQ dimension were calculated for the two age groups. Scores were categorised by frequency, and percentages in each category calculated. Linear regression analysis determined associations between socio-demographics and feeding practices. In both age groups, mothers reported extensive use of some CFPQ dimensions including modelling, encouraging balance and variety, and healthy food environment (between 84% and 100% reported using these practices ‘usually’ to ‘often’). Greater variation existed for other practices including pressure to eat and restriction for health. Food as a reward and pressure to eat were used more with preschool children (M = 2.5, SD = 1.0 and M = 3.1 SD = 0.9) than with toddlers (M = 1.7, SD = 0.8 and M = 2.5 SD = 0.9). For both age groups, mothers' age, education, SEP and BMI category, or the child's BMI, sex, or age predicted use of some feeding practices. Feeding practices such as modelling and providing a healthy food environment are important, but interventions are unlikely to detect effects as most parents report following best practice. In contrast, given greater variability in reported use of other feeding practices like pressure to eat and restriction for health these constructs may be more likely to detect change.
Summary
Background
Data on body mass index (BMI) in infants and toddlers worldwide are lacking, relative to older age groups.
Objectives
To describe the growth (weight, length/height, head ...circumference, and BMI z‐score) of New Zealand children under the age of 3 years, and examine differences by sociodemographic characteristics (sex, ethnicity, and deprivation).
Methods
Electronic health data were collected by Whānau Āwhina Plunket, who provide free ‘Well Child’ services for approximately 85% of newborn babies in New Zealand. Data from children under the age of 3, who had their weight and length/height measured between 2017 and 2019, were included. The prevalence of BMI (WHO child growth standards) ≤2nd, ≥85th, and ≥95th percentiles were determined.
Results
Between 12 weeks and 27 months of age, the percentage of infants ≥85th BMI percentile increased from 10.8% (95% CI, 10.4%–11.2%) to 35.0% (34.2%–35.9%). The percentage of infants with high BMI (≥95th percentile) also increased, particularly between 6 months (6.4%; 95% CI, 6.0%–6.7%) and 27 months (16.4%; 15.8%–17.1%). By contrast, the percentage of infants with low BMI (≤2nd percentile) appeared steady between 6 weeks and 6 months, and declined at older ages. The prevalence of infants with a high BMI appears to increase substantially from 6 months across sociodemographic characteristics, with a widening prevalence gap by ethnicity occurring from 6 months, mirroring that of infants with a low BMI.
Conclusions
The number of children with high BMI increases rapidly between 6 months and 27 months of age, suggesting this is an important timeframe for monitoring and preventive action. Future work should investigate the longitudinal growth trajectories of these children to determine if any particular patterns predict later obesity and what strategies could effectively change them.
The aim of this study was to compare food fussiness, weight, serious choking, and early feeding characteristics in babies following Baby-Led Weaning (BLW) and babies following traditional ...spoon-feeding (TSF) at 6–7 months of age. The First Foods New Zealand Internet Survey recruited 876 New Zealand caregivers of children aged 6–36 months through social media. Information was collected on food fussiness, infant weight, choking, infant feeding practices, and demographics. Based on infant feeding at 6–7 months of age, participants were described as: TSF (mostly or all adult spoonfed), partial BLW (half adult spoonfed, half self-fed), or full BLW (mostly or all self-fed). A total of 628 (72%), 93 (11%), and 155 (18%) infants followed TSF, partial BLW, and full BLW respectively. Compared to infants following TSF, infants following full BLW had significantly lower food fussiness scores at 6–36 months (difference, 95% CI: −0.37,-0.51 to −0.24). Infants following BLW had been exclusively breastfed for longer (P = 0.019), and at 6–7 months had 1.96 times the odds of consuming red meat, but 0.10 times the odds of consuming iron-fortified infant cereal. Only 21% of BLW participants had received advice from a health professional. In conclusion, many New Zealand parents are following BLW. Benefits associated with BLW included less food fussiness. Although BLW infants were more likely to eat red meat, they were less likely to eat iron-fortified infant cereal. These results suggest the need for studies with biochemical measurement of nutritional status, standardized measurement of weight, and rigorous assessment of diet in infants following BLW.