Associations between sleep duration and insulin resistance in European children and adolescents considering the mediating role of abdominal obesity.

Barbara F Thumann,Claudia Börnhorst,Wolfgang Ahrens,Nathalie Michels,Alfonso Siani,Stefaan De Henauw,Luis A Moreno,Toomas Veidebaum,Monica Hunsberger,On Behalf Of The Idefics And I Family Consortia ,Jaakko Kaprio,Regina Felső,Michael Tornaritis

doi:10.1371/journal.pone.0235049

Abstract

Short sleep duration has been suggested to lead to insulin resistance both directly by altering glucose metabolism and indirectly through obesity. This study aims to investigate associations between nocturnal sleep duration and insulin resistance considering abdominal obesity as a mediator. We analysed data of 3 900 children aged 2-15 years participating in the second (2009/10) and third (2013/14) examination wave of the European IDEFICS/I.Family study (hereafter referred to as baseline and follow-up). Information on nocturnal sleep duration was collected by questionnaires and age-standardised (SLEEP z-score). The homeostasis model assessment (HOMA) was calculated from fasting insulin and fasting glucose obtained from blood samples; waist circumference (WAIST) was measured with an inelastic tape. HOMA and WAIST were used as indicators for insulin resistance and abdominal obesity, respectively, and transformed to age- and sex-specific z-scores. Cross-sectional and longitudinal associations between SLEEP z-score and HOMA z-score were investigated based on a path model considering WAIST z-score as a mediator adjusting for relevant confounders. Cross-sectionally, baseline SLEEP z-score was negatively associated with baseline WAIST z-score (unstandardised effect estimate -0.120, 95% confidence interval [-0.167; -0.073]). We observed no direct effect of baseline SLEEP z-score on baseline HOMA z-score but a negative indirect effect through baseline WAIST z-score (-0.042 [-0.058; -0.025]). Longitudinally, there was no direct effect of baseline SLEEP z-score on HOMA z-score at follow-up but a negative indirect effect through both baseline WAIST z-score and WAIST z-score at follow-up (-0.028 [-0.040; -0.016]). Our results do not support the hypothesis of an association between short sleep duration and insulin resistance independent of abdominal obesity. However, longer sleep duration may exert short and long term beneficial effects on insulin resistance through its beneficial effects on abdominal obesity.

Highlights

Prevalence rates of overweight and obesity in European children are at a high level the rising trend over the last decades has been stopped in some countries [1, 2]
There was no direct effect of baseline SLEEP z-score on homeostasis model assessment (HOMA) z-score at follow-up but a negative indirect effect through both baseline waist circumference (WAIST) z-score and WAIST z-score at follow-up (-0.028 [-0.040; -0.016])
Our results do not support the hypothesis of an association between short sleep duration and insulin resistance independent of abdominal obesity

Summary

Introduction

Prevalence rates of overweight and obesity in European children are at a high level the rising trend over the last decades has been stopped in some countries [1, 2]. Short sleep duration has been suggested as a potential risk factor for both obesity and insulin resistance [5]. One hypothesis is that sleep deprivation leads to a dysregulation of appetite hormones such as leptin and ghrelin resulting in higher energy intake and weight gain [5, 6]. Short sleep duration might influence insulin resistance indirectly through obesity and directly by altering glucose metabolism [5, 6]. Short sleep duration has been suggested to lead to insulin resistance both directly by altering glucose metabolism and indirectly through obesity. This study aims to investigate associations between nocturnal sleep duration and insulin resistance considering abdominal obesity as a mediator

Objectives

Methods

Results

Conclusion