Abstract
Poor sleep and psychological stress are obesity determinants that are rarely included in obesity prevention programs. The aim was to report the effects of the Healthy Start randomized intervention on the secondary outcomes psychological stress and sleep duration and onset latency. Data was obtained from the Healthy Start randomized intervention conducted in 2009-2012 among Danish healthy weight children aged 2-6 years, who had either a high birth weight (>4,000 g), high maternal pre-pregnancy body mass index (>28 kg/m2), or low maternal educational level (≤10 years of schooling) and their parents. The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep habits, and reduction of psychological family stress. The average intervention period was 15 months. Children with information on a 7-day sleep record, sleep onset latency, Strengths and Difficulties Questionnaire (SDQ), and a modified version of Parenting Stress Index (PSI) were included. The effects of the intervention on sleep habits, PSI scores, SDQ Total Difficulties (SDQ-TD) and Pro-social Behavior scores, and 95% Confidence Intervals (95% CI) were analyzed using linear regression intention-to-treat (n = 543 (intervention group n = 271, control group n = 272)) analyses. No statistically significant effects on sleep duration, sleep onset latency, PSI score, or SDQ Pro-social Behavior score were observed. Values both before and after the intervention were within the normal range both for children in the intervention and children in the control group. Mean change in SDQ-TD was 0.09 points (95% CI -0.57;0.59) in the intervention group, and -0.69 points (95% CI -1.16; -0.23) in the control group (p = 0.06). In conclusion, there were no intervention effects in relation to sleep duration, sleep onset latency, PSI score, or SDQ Pro-social behavior. There was an indication that children in the intervention group had slightly more behavioral problems than the control group after the intervention, but values were within normal range both before and after the intervention, and the difference is not considered to be clinically meaningful.
Highlights
Information on stress in children may be obtained by measuring reactivity to stressors, for example as behavior problems. This approach is supported by previous research; in a subsample from a larger longitudinal study in the US, Hypothalamic Pituitary Axis (HPA) reactivity was measured at age 7, and internalizing symptoms via teachers reports were measured at age 5 and 11
To test the effect of the intervention, linear regression models with treatment status included as the explanatory variable and changes in sleep duration, sleep onset latency, Strengths and Difficulties Questionnaire (SDQ) scores or Parenting Stress Index (PSI) during follow-up included as the response variables were conducted
The mean change in SDQ Total Difficulties (SDQ-TD) was 0.09 points in the intervention group, and -0.69 points in the control group (p = 0.06) (Table 2)
Summary
Children are not commonly identified as susceptible to stress, chronic exposure to stressful situations in the environment is common [1]. As chronic stress can initiate inflammatory processes in the body, which can be expressed e.g. in adipose tissue, muscle mass and hormones, stress may have adverse implications for children’s health, and may lead to an increased risk of obesity, metabolic syndrome, and cardiovascular disease [2, 3]. Information on stress in children may be obtained by measuring reactivity to stressors, for example as behavior problems. This approach is supported by previous research; in a subsample from a larger longitudinal study in the US, Hypothalamic Pituitary Axis (HPA) reactivity was measured at age 7, and internalizing symptoms via teachers reports were measured at age 5 and 11. The study found that greater HPA reactivity at age 7 was associated with greater increases in internalizing symptoms between age 5 to 11 years [4]. A study embedded in the Dutch “Generation R” cohort found that variations in diurnal cortisol rhythm measured at age 12–20 months were associated with change in internalizing problems between 1.5 and 3 years [5]
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