Sleep duration mediates the relationship between health behavior patterns and obesity

Objective: To examine associations between health behavior patterns and childhood obesity, and the mediating effect of sleep duration. Design: Population-based survey. Participants: Secondary analysis of data from the Infant Feeding Practices Study (age 6 years, n = 1073). Measurements: Mothers self-reported their child's health behaviors including physical activity (PA), screen time, sleep duration, and diet. Latent class analysis determined the child's patterns based on health behaviors. Sleep was examined as a mediator between the class membership variable and % BMIp95. Results: A 3-class model fit the data best, with classes labeled as "Poorest eaters" (low fruit/vegetable consumption, high fast food), "Healthy" (low screen time, highest fruit/vegetable consumption) and "Active, super-eaters, highest screen time" (highest PA and screen time, ate the most). "Poorest eaters" had an increased % BMIp95 (beta = 4.11, P =.006) relative to the "Healthy" class. The "Poorest eaters" and "Active, super-eaters, highest screen time" classes had shorter sleep duration (beta = -0.51, P <.001; beta = -0.38, P <.001; respectively) relative to the "Healthy" class. Independent of class membership, each additional hour of sleep was associated with a % BMIp95 that was 2.93 U lower (P <.001). Conclusions: Our results indicate that health behavior patterns mediated by sleep durationmay influence a child's % BMIp95. The bi-directionality of the relationship between health behaviors and sleep remains unclear. Our findings suggest the importance of a constellation of health behaviors on childhood obesity. Interventions should include a multitude of health behaviors and consider the possibility that improving diet and activity behaviors may facilitate improved sleep and lowered obesity risk among children. (c) 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.