Chronotype, Social Jet Lag, and Cardiometabolic Risk Factors in Early Adolescence
Chronotype, Social Jet Lag, and Cardiometabolic Risk Factors in Early Adolescence
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DOI：
10.1001/jamapediatrics.2019.3089
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发表时间：
2019-11-01
期刊：
影响因子：
26.1
通讯作者：
Taveras, Elsie M.
中科院分区：
文献类型：
--
作者：
Cespedes Feliciano, Elizabeth M.;Rifas-Shiman, Sheryl L.;Taveras, Elsie M.
睡眠时间和质量不足会增加肥胖的风险。睡眠时间虽然研究较少，但对青少年来说很重要，因为越来越多的晚上偏好（时间类型）、早上学时间和不规律的睡眠时间表可能会导致昼夜节律失调。目的探讨青少年睡眠类型和社会时差与肥胖和心脏代谢风险的关系。设计、环境和参与者从1999年开始，Viva项目从马萨诸塞州东部招募孕妇。在整个儿童时期都有母子面对面的访问。从2012年1月23日至2016年10月16日，804名12至17岁的青少年完成了5天或更长时间的手腕活动记录仪、问卷调查和人体测量。利用这些数据对2018年4月31日至2019年5月1日进行了横断面分析。睡眠类型，通过连续量表测量，得分越高，表明更喜欢晚上；社交时差，通过周末与工作日从午夜开始的活动睡眠中点的持续差异来测量，数值越高，表明周末的睡眠时间越晚。主要结果和测量方法：通过人体测量和双能x线吸收测量法测量肥胖。对于479名有血液样本的青少年，心脏代谢风险评分被计算为腰围、收缩压、负比例高密度脂蛋白胆固醇、对数转化甘油三酯和胰岛素抵抗稳态模型的5个性别和队列特定z评分的平均值。结果804例青少年中，女孩418例，男孩386例，平均（SD）年龄13.2（0.9）岁。在调整了年龄、青春期、季节和社会人口统计学的多变量模型中，生物钟和社会时差与肥胖的关系因性别而异。对于女孩来说，更大的晚上偏好与0.58厘米（95% CI, 0.12-1.03厘米；交互作用P= 0.04）较高的腰围和0.16 kg/m(95% CI, 0.01-0.31 kg/m(2)；双能x线吸收仪测量的脂肪质量指数较高；每小时的社交时差与1.19厘米（95% CI, 0.04-2.35厘米；交互作用P= 0.21）的腰围升高和0.45 kg/m（95% CI, 0.09-0.82 kg/m(2)）相关；双能x线吸收仪测量的脂肪质量指数较高。在调整了睡眠时间和其他生活方式行为后，社会时差和夜间睡眠类型的关联仍然存在于许多肥胖测量中。相比之下，在男孩中没有观察到任何关联。这与两性的心脏代谢风险评分没有关联，尽管这一结果的统计效力很低。结论和相关性：夜间睡眠类型和社交时差与青春期女孩的肥胖程度相关，而与青春期男孩无关。旨在改善睡眠时间表的干预措施可能有助于预防肥胖，尤其是对女孩。
IMPORTANCE Inadequate sleep duration and quality increase the risk of obesity. Sleep timing, while less studied, is important in adolescents because increasing evening preferences (chronotypes), early school start times, and irregular sleep schedules may cause circadian misalignment.OBJECTIVE To investigate associations of chronotype and social jet lag with adiposity and cardiometabolic risk in young adolescents.DESIGN, SETTING, AND PARTICIPANTS Starting in 1999, Project Viva recruited pregnant women from eastern Massachusetts. Mother-child in-person visits occurred throughout childhood. From January 23, 2012, to October 16, 2016, 804 adolescents aged 12 to 17 years completed 5 days or more of wrist actigraphy, questionnaires, and anthropometric measurements. A cross-sectional analysis using these data was conducted from April 31, 2018, to May 1, 2019.EXPOSURES Chronotype, measured via a continuous scale with higher scores indicating greater evening preferences, and social jet lag, measured as the continuous difference in actigraphy sleep midpoint in hours from midnight on weekends vs weekdays, with higher values representing more delayed sleep timing on weekends.MAIN OUTCOMES AND MEASURES Adiposity, measured via anthropometry and dual-energy x-ray absorptiometry. For a subset of 479 adolescents with blood samples, cardiometabolic risk scores were computed as the mean of 5 sex- and cohort-specific z scores for waist circumference, systolic blood pressure, inversely scaled high-density lipoprotein cholesterol, and log-transformed triglycerides and homeostatic model of insulin resistance.RESULTS Among the 804 adolescents in the study, 418 were girls and 386 were boys, with a mean (SD) age of 13.2 (0.9) years. In multivariable models adjusted for age, puberty, season, and sociodemographics, associations of chronotype and social jet lag with adiposity varied by sex. For girls, greater evening preference was associated with a 0.58-cm (95% CI, 0.12-1.03 cm; P=.04 for interaction) higher waist circumference and 0.16 kg/m(2) (95% CI, 0.01-0.31 kg/m(2); P=.03 for interaction) higher fat mass index as measured by dual-energy x-ray absorptiometry; each hour of social jet lag was associated with a 1.19-cm (95% CI, 0.04-2.35 cm; P=.21 for interaction) higher waist circumference and 0.45 kg/m(2) (95% CI, 0.09-0.82 kg/m(2); P=.01 for interaction) higher fat mass index as measured by dual-energy x-ray absorptiometry. Associations of social jet lag and evening chronotypes persisted for many measures of adiposity after adjustment for sleep duration and other lifestyle behaviors. By contrast, no associations were observed in boys. There were no associations with the cardiometabolic risk score for either sex, although statistical power was low for this outcome.CONCLUSIONS AND RELEVANCE Evening chronotypes and social jet lag were associated with greater adiposity in adolescent girls but not adolescent boys. Interventions aimed at improving sleep schedules may be useful for obesity prevention, especially in girls.