Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample.

Introduction Children with overweight/obesity are more likely to have shortened sleep, though little is known about the role of weight status in insomnia severity, sleep quality, and sleep hygiene in clinically referred youth. Methods A total of 1133 children (43.7% female) presented to a Pediatric Behavioral Sleep Medicine Clinic for insomnia. At the initial evaluation, caregivers of children ages 2–10.9 years (N = 744) completed the Pediatric Insomnia Severity Scale (PISI) and the Children’s Sleep Habits Questionnaire (CSHQ); adolescents ages 11–18 years (N = 389) completed the PISI, the Adolescent Sleep Hygiene Scale (ASHS), and the Adolescent Sleep Wake Scale (ASWS). The PISI was completed during at least one Pediatric Behavioral Sleep Medicine visit subsequent to evaluation and initiation of treatment. Patient height and weight, objectively measured within 3 months of the initial evaluation, was used to determine sex-adjusted body mass index z-scores (BMIz). Hierarchal linear regression models were used to determine the impact of BMIz on baseline PISI insomnia severity scores, and CSHQ, ASHS, and ASWS total scores, after covarying for income. Repeated-measures general linear modeling was used to determine whether weight status moderated improvement in insomnia severity over time, covarying for income. Results For children (ages 2–10.9), weight was not associated with baseline insomnia severity (p=.62) or predictive of insomnia improvement following behavioral sleep medicine intervention (p=.71), though higher weight predicted poorer parent-reported sleep quality (p=.006). For adolescents (ages 11–18), higher weight was predictive of higher baseline insomnia severity (p=.026), though did not predict insomnia improvement over time (p = .86); higher weight was also predictive of poorer sleep hygiene (p<.001) and worse sleep quality (p=.03). Conclusion Initial insomnia severity and subjective sleep quality may be worse for youth of higher weight, particularly for adolescents; these findings increase our understanding of how and when overweight/obesity negatively impacts sleep. Fortunately, youth with higher weight respond equally well to pediatric behavioral sleep medicine interventions as their lower-weight peers, suggesting that these interventions need not be modified based on patient weight. Support (if any) Cincinnati Children’s Hospital Medical Center Division of Behavioral Medicine and Clinical Psychology’s Research Funds

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.

Childhood eating behaviors and temperament may have important implication for constructing the pathways from maternal feeding practices to childhood overweight and obesity (OW/OB). Examining multiple feeding styles simultaneously to childhood OW/OB is critical through the mediators of early childhood temperament and eating behaviors. This cross-sectional study recruited mothers mainly responsible for child care from two hospitals and two healthcare centers in eastern China. Sociodemographic characteristics, and data from the Infant Feeding Style Questionnaire (IFSQ), the short form of Children Behavior Questionnaire [Revised (IBQ-RSF)], and the Child Eating Behavior Questionnaire for toddler (CEBQ-T) were collected. Weight and recumbent length were measured to calculate the age- and sex-specific body mass index (BMI) z-scores (BMIz). The structural equation modeling (SEM) approach was used to examine direct and indirect pathways from five maternal feeding styles to childhood OW/OB through temperament and eating behaviors. A total of 486 children were recruited, 73 (15.02%) children were OW/OB; the age of the children was 14.55 (SD = 5.14) months, and the age of the mothers was 29.90 (SD = 3.63) years. The responsive feeding exerted significant direct (β = -0.098), indirect (β = -0.136) and total (β = -0.234) effects on childhood OW/OB. Restrictive feeding had significant direct (β = 0.222), indirect (β = 0.102) and total (β = 0.324) effects on childhood OW/OB. Indulgent feeding had significant direct (β = 0.220), indirect (β = 0.063), and total (β = 0.283) effects on childhood OW/OB. Pressuring feeding had significant direct (β = -0.116), indirect (β = -0.096) and total (β = -0.212) effects on childhood OW/OB. There was a direct effect of feeding practices on childhood OW/OB; feeding practices indirectly predicted childhood OW/OB through temperament and eating behaviors in children aged 6-23 months. This study could help governments agencies, policymakers, and healthcare workers to establish optimal intervention programs targeting feeding practices through childhood eating behaviors and temperament to prevent childhood OW/OB.

Insulin therapy is lifesaving treatment for individuals with type 1 diabetes (T1D). Its initiation maybe associated with significant weight gain because of change from a catabolic to an anabolic state. Excessive weight-gain increases the risk of obesity and is associated with chronic disease. To examine if change in body mass index (BMI) among children in the 6 months after diagnosis with type 1 diabetes mellitus is associated with long-term obesity. This was a population-based retrospective study of 377 children (aged 2-18 yr) with type 1 diabetes. Measured heights and weights were used to calculate BMI z-scores based on Centers for Disease Control and Prevention (CDC) cut-points. Generalized Linear Models using BMI group, and age group at diagnosis; postdiagnosis weight change; and sex were applied to assess associations between postdiagnosis weight change and BMI z-score at transition to adult care. Mean BMI z-score increased from 0.28 at diagnosis, to 0.53 at 6 months and 0.66 at transition to adult care. Change in BMI z-scores differed by initial BMI group and magnitude of postdiagnosis weight change. Younger children (<11 yr) had higher (p = 0.004) BMI z-scores at diagnosis but not at last visit (p = 0.1) than older (≥11 yr) children at diagnosis. BMI z-score at diagnosis, postdiagnosis weight change, female sex, and longer duration with TID were associated with higher BMI z-score at time of transition. BMI z-score at diagnosis was the strongest predictor of BMI z-score at time of transition to adult care, however; its effect was mediated by magnitude of weight change 6 months after diagnosis, sex, and age group at diagnosis.

The growth trajectory of Chinese preschoolers still remains unclear. Our objective was to determine whether there was an association between adverse pregnancy outcomes and overweight offspring. We analyzed population-based retrospective cohort data from the Medical Birth Registry of Xiamen, which comprised 33,157 children examined from 1 to 6 years of age. Longitudinal analyses were used to evaluate the growth trajectories of offspring body mass index (BMI). Multivariate logistic regression was used to assess the effects of two adverse pregnancy outcomes, gestational diabetes mellitus (GDM) and being large-for-gestational age (LGA), on childhood overweight. Offspring of mothers with GDM and LGA has a higher annual BMI z-score from 1 to 6 years of age (all P < 0.05). But, a higher annual BMI z-score was only observed in children aged 1–5 years in models 1–3. Overall BMI z-score of offspring aged 1–6 who were born to mothers with GDM and LGA were also higher in models 1–3 (all P < 0.05). Additionally, offspring of mothers with GDM and LGA had a higher risk for overweight in model 1, from 1 to 6 years of age (odds ratio (OR), 1.814; 95% confidence interval (CI), 1.657–1.985; P < 0.0001). However, this association was attenuated after adjusting for maternal pre-pregnancy BMI (OR, 1.270; 95% CI, 0.961–1.679; P = 0.0930). Offspring of mothers with GDM and LGA had a higher BMI z-score and increased risk for overweight. Indeed, intrauterine exposure to maternal GDM and LGA could bias offspring to overweight, whereas maternal pre-pregnancy BMI may play a key role in offspring overweight for children born to mothers with GDM and LGA.

Prenatal exposure to airborne polycyclic aromatic hydrocarbons and childhood growth trajectories from age 5–14 years

To determine if there is a relationship between maternal perception of neighborhood safety in 3(rd) grade and weight status in 5(th) grade children, to test if gender moderates this relationship, and to identify potential mediators. Data from 868 children and their mothers involved in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD-SECCYD) were used to examine the relationship between maternal perception of neighborhood safety in the 3(rd) grade and child body mass index (BMI) z-score in the 5(th) grade. Multiple regression models tested this relationship, the effect of gender, and potential mediating variables (time outdoors in neighborhood, television viewing, child behavior problems and puberty status). Neighborhood safety ratings in the least safe tertile, compared with the safest tertile, were associated with an increased risk of obesity independent of gender, race and income-to-needs ratio (OR=1.59; 95% confidence interval [CI]: 1.03, 2.46), and higher child BMI z-scores among girls, but not boys, compared with the safest tertile (beta=0.33; 95% CI: 0.09, 0.57). Neither amount of time spent outdoors in the neighborhood, television viewing, child behavior problems (internalizing or externalizing), nor puberty status altered the relationship. Maternal perception of the neighborhood as unsafe in 3(rd) grade independently predicted a higher risk of obesity, and a higher BMI z-score among girls, but not boys, in the 5(th) grade. The relationship was not explained by several potential mediators. Further investigation is needed to explore these gender differences and potential mediators.

Ultra-processed foods (UPF) are frequently consumed by children, possibly contributing to childhood obesity. It is unknown if UPF consumption among Australian children differentiates by sociodemographic factors. To describe schoolchildren's intake of UPF across sexes, age, geographic location and socioeconomic status (SES). To analyse associations between UPF intake and indicators of obesity. UPF consumption of children aged 8-12 years in Victoria (Australia) was examined using 24-h dietary-recall data classified by the NOVA system. UPF intake was compared across sociodemographic groups. Regression analysis explored the association between UPF intake and BMI z-score, overweight/obesity and abdominal obesity. UPF comprised 47.2% of total energy intake (range 23.7%-72.2%), with no significant differences across sex, age group (8-9 vs. 10-12 years), geographic location or SES. Including all children, there were no associations between UPF intake and obesity indicators. In age-stratified models, among children aged 10-12 years, a 10% increment in the proportion of UPF in the diet (% g/day) was significantly associated with a 0.07 (95% CI 0.01, 0.12) higher body mass index (BMI) z-score and a 19% (odds ratio 1.19, 95% CI 1.07, 1.33) increase in the odds of central obesity. No associations between UPF intake and indicators of obesity were found in the younger 8- to 9-year-old group. UPF contributed greatly to the dietary intake of primary schoolchildren. Among older children, higher intake of UPF was associated with higher BMI z-score and central adiposity. Further longitudinal research in Australian pediatric samples to understand UPF impact upon adiposity outcomes across different stages of childhood is needed.

Urinary concentrations of phthalate/DINCH metabolites and body mass index among European children and adolescents in the HBM4EU Aligned Studies: A cross-sectional multi-country study

To explore whether maternal feeding styles at 12 months predict child Body Mass Index (BMI) z-scores at 72 months and evaluate whether BMI z-scores at 18 months mediates the association. Data from 239 mother-child pairs participating in a parenting intervention were analyzed. Feeding information was ascertained at 12 months by questionnaire with feeding styles identified using factor analysis. Children's weight and length/height were measured at 18 and 72 months and BMI z-scores computed. Maternal sociodemographic data, depressive symptoms and language skills were obtained by questionnaire. Multilevel linear regression analysis was used to examine whether feeding styles predicted 72 month BMI z-scores. Complete case analysis was conducted and multiple imputation used to treat missing values of explanatory and outcome variables at 18 and 72 months. Mediational analysis was performed to assess the indirect effects of feeding styles on 72 month BMI z-scores via 18 month BMI z-scores. Restrictive feeding at age 12 months predicted higher 72 month BMI z-scores in both complete case analysis [β (95%CI): 0.19 (0.02, 0.37)] and multiple imputation [β (95%CI): 0.20 (0.02, 0.39)]. Uninvolved, forceful, indulgent and responsive feeding styles were not significant predictors of 72 month BMI z-scores. A significant indirect effect was observed between restrictive feeding and child BMI z-scores at 72 months via 18 month BMI z-scores [β (95% CI) 0.12 (0.03, 0.22)]. Restrictive feeding at 12 months was associated with higher BMI z-scores at 72 months and appeared to be mediated by BMI z-scores at 18 months.

Sleep problems are highly comorbid with pediatric pain, yet there is a dearth of research on how pain and somatic complaints impact adolescent insomnia presentation and response to cognitive-behavioral therapy for insomnia (CBT-I). This study aims to (1) determine the prevalence of parent-reported somatic/pain complaints in adolescents with insomnia presenting to a behavioral sleep clinic, (2) assess the impact of somatic/pain complaints on initial sleep presentation, and (3) assess the impact of baseline somatic/pain complaints on response to CBT-I. Participants included adolescents (n = 375) presenting to a behavioral sleep medicine center with a primary diagnosis of insomnia. As a part of clinical care, pre-evaluation measures were completed including the Pediatric Insomnia Severity Index, Adolescent Sleep Hygiene Scale, Adolescent Sleep Wake Scale, and Child Behavior Checklist. The Somatic Syndrome Scale of the Child Behavior Checklist measured somatic complaints and teens were categorized as endorsing pain if reported to experience aches/pains, headaches, or stomachaches. Adolescents completed the Pediatric Insomnia Severity Index at end of treatment. Most adolescents had parent-reported somatic (61.1%) and/or pain complaints: headaches (66.6%), stomachaches (48.5%), and aches/pains (45.1%). Greater somatic and pain complaints predicted a worse sleep presentation at intake (all P < .05). After controlling for insomnia severity at intake, neither end-of-treatment insomnia severity nor treatment status were predicted by somatic and pain complaints at intake. Results suggest that parent-reported somatic/pain complaints are prevalent in > 50% of adolescents seeking behavioral insomnia treatment. Although complaints are associated with more severe insomnia at intake, they do not appear to interfere with treatment response. Van Dyk TR, Krietsch KN, King CD, Byars KC. Prevalence of somatic and pain complaints and associations with sleep disturbance in adolescents with insomnia presenting to a behavioral sleep medicine clinic. J Clin Sleep Med. 2022;18(1):151-160.

Objectives 1) Compare the sleep hygiene of our clinical sample to the community-based validation sample and established clinical thresholds and 2) clarify the relationship between sleep hygiene and sleep problems in adolescents referred for Behavioral Sleep Medicine (BSM) treatment. Methods Clinical participants included BSM patients aged 11–18 years (n = 354) with insomnia. Adolescents completed the Adolescent Sleep Hygiene Scale (ASHS) and the Pediatric Insomnia Severity Index. Caregivers completed the Sleep Disorders Inventory for Students. Independent samples t-tests compared sleep hygiene between our clinical sample and the community-based ASHS validation sample (572 American adolescents). We report which sleep hygiene subscales fell below thresholds indicating clinically significant problems. Multiple linear regressions determined whether demographics and sleep hygiene subscales predicted sleep problems. Results Adolescents referred to our BSM clinic had better overall sleep hygiene than the community-based validation sample, p < .001. They had inadequate sleep hygiene practices related to sleep stability, behavioral arousal, and cognitive/emotional arousal. Demographics and sleep hygiene factors significantly predicted both adolescent-reported insomnia severity and caregiver-reported sleep disturbance, ps < 0.001. Conclusion Poor sleep hygiene may result from maladaptive coping and can compound existing sleep problems. It is important to have consistent definitions of sleep hygiene that limit overlap with other key intervention targets.

Disclosure: Y. Lee: None. K. Lee: None. J. Kim: None. Y. Lim: None. J.I. Kim: None. B. Kim: None. Y. Hong: None. J. Song: None. C. Shin: None. Y. Lee: None. Background: 11-oxygenated androgens (11-oxyandrogens) have been recognized for their important role in adrenarche or androgen excess conditions. However, the trajectory during childhood remains understudied. Herein, we examined the longitudinal changes in 11-oxyandrogens among healthy prepubertal children. Methods: In an ongoing prospective cohort study, 172 prepubertal children with available blood samples at the ages of 4, 6, and 8 years were included. Serum concentrations of 14 adrenal androgens and precursors, including dehydroepiandrosterone (DHEA), DHEA-sulfate (DHEAS), androstenedione (A4), testosterone (T), 11β-hydroxyandrostenedione (11OHA4), 11-ketoandrostenedione (11KA4), 11β-hydroxytestosterone (11OHT), and 11-ketotestosterone (11KT) were assessed using liquid chromatography-tandem mass spectrometry. Repeated measures ANOVA was used to analyze the changes in adrenal androgens across age groups. Linear mixed model analysis was used to evaluate factors associated with adrenal hormone levels during 4 to 8 years of age. Results: Among 172 prepubertal children (107 boys, 65 girls), 11OHA4 was the predominant 11-oxyandrogen, exceeding concentrations of DHEA or A4. Serum 11KT level was higher than testosterone level from 6 years of age. Across age 4, 6, and 8 years, 11-oxyandrogens showed an increasing trend. Trajectories of 11OHA4, 11KA4, and 11KT significantly differed by sex (p for interaction &amp;lt; 0.05). Serum levels of 11OHA4 and 11KT consistently increased from 4, 6, to 8 years in both sexes, while 11OHT increased during 6-8 years (p &amp;lt; 0.05 for all). Serum 11KA4 levels increased during 4-6 years in boys and 6-8 years in girls (p &amp;lt; 0.05 for all). Girls showed higher levels of 11OHA4, 11KA4 at 4 years, 11OHT at 6 years, and 11KT at 4 and 6 years. Regarding classic adrenal androgens, DHEA, DHEAS, and A4 also exhibited increases in different patterns between sexes (p for interaction &amp;lt; 0.05) during 4-8 years. Girls had higher serum DHEA and A4 levels at 4 and 6 years, and DHEAS levels at 4 years (p &amp;lt; 0.05 for all). In boys, lower gestational age, lower birth weight z-score, and higher body mass index (BMI) z-score were correlated with elevated levels of DHEA and DHEA-S. Additionally, a higher BMI z-score was associated with increased levels of A4, 11OHT, and 11KT (p &amp;lt; 0.05 for all, multivariable models). In girls, a higher BMI z-score was linked to elevated DHEA levels, while a higher birth weight z-score was associated with increased A4 levels (p &amp;lt; 0.05 for all, multivariable models). Conclusion: In prepubertal children, 11-oxyandrogens showed increasing patterns similar to classic androgens, with sex-differences. Some 11-oxyandrogens were more predominant than classic androgens. This study suggests the importance of 11-oxyandrogens as biomarkers for zona reticularis development and adrenarche in prepubertal children. Presentation: 6/3/2024

Prenatal exposure to organochlorine pesticides and infant growth: A longitudinal study