Sleep Restriction and the Adolescent Diet: Impact and Mechanisms

摘要 预防肥胖已经成为国家健康的当务之急， 尤其是在青春期。青少年在饮食选择中形成持久的生活方式 和活动水平，可以为终身肥胖奠定基础，因此该领域必须确定新的 影响青少年生活方式的可变因素。这项研究测试了一个有希望的新目标， 预防工作。我们的小组收集了试点数据，这些数据建立在儿童和青少年的先前相关发现的基础上， 在成年人中的实验结果表明，睡眠限制（SR）会导致青少年摄入更多的卡路里， 而不增加他们的体力活动。如果这些初步发现在一项更大、更明确的研究中得到证实， 肥胖预防工作可以通过减轻SR的策略来加强，众所周知，SR是非常严重的。 在青少年中很常见此外，我们对青少年的试点研究结果将先前的成人研究扩展到 表明这种效应的机制是甜/甜点食物的奖励价值的特别增加， 使它们被吃得更多，被更积极地感知，并引起更多的激活， 奖励相关的大脑区域在功能磁共振成像在SR。确认这些试点发现将告知复杂的 肥胖的生物行为基础，并确定次要干预点的场合时， 青少年的睡眠不足是由于不寻常的情况下或一个顽固的睡眠障碍。然而，在这方面， 在实现这些好处之前，实地必须克服我们知识基础中的重大差距。我们的飞行员 研究得出了有趣的发现，但由于规模太小，方法上也有局限性，因此无法确定。其他 儿科的发现几乎完全来自相关性研究，极大地限制了因果关系的推断。 成人SR研究结果也很难适用于青少年，因为多种方法和 发展因素。我们建议通过一项有力的机制研究来克服这些限制， 在青春期的高风险时期，平衡实验的严谨性和现实世界的相关性。健康，非- 14-17岁的肥胖儿童将接受一项随机交叉试验， 5-夜间时段（模拟上学周），比较夜间睡眠（a）~9小时， 健康睡眠vs.（B）~6.3小时，这是许多青少年在上学之夜（SR）经历。实验室评估青少年的 对特定食物的感知和大脑反应将与现实世界的饮食和 活动模式，以明确测试（a）SR对健康青少年热量摄入和活动的影响， (b)SR对高热量食物的奖励质量的影响，以及（c）热量变化之间的联系 摄入量和食物的有益质量。分析将进一步探讨肥胖的风险因素是否能识别 青少年特别容易受到SR对热量摄入的影响。调查结果将直接 对改善肥胖预防和发现肥胖的复杂生物行为的影响 机制等

Abstract Obesity prevention has become a national health imperative, and may be exceptionally important yet particularly difficult during adolescence. Adolescents develop enduring lifestyle patterns in their dietary choices and activity levels that can set the stage for life-long obesity, so it is essential that the field identify novel modifiable factors that impact the lifestyle patterns of adolescents. This study tests a promising new target for prevention efforts. Our group has collected pilot data that builds upon prior correlational findings in children and experimental findings in adults to suggest that sleep restriction (SR) causes adolescents to eat more calories without increasing their physical activity. If these pilot findings are confirmed in a larger, more definitive study, obesity prevention efforts could be augmented by strategies to alleviate SR, which is known to be extremely common among adolescents. Further, our pilot findings with adolescents extend prior adult research to suggest that the mechanism for this effect is a particular increase in the reward value of sweet/ dessert foods, causing them to be eaten in greater amounts, to be perceived more positively, and to elicit more activation of reward-related brain regions on fMRI during SR. Confirmation of these pilot findings will inform the complex biobehavioral foundations of obesity, and identify secondary points of intervention for occasions when an adolescent's sleep is inadequate due to unusual circumstances or to an intractable sleep disorder. However, before such benefits can be realized, the field must overcome significant gaps in our knowledge base. Our pilot studies yielded intriguing findings, but were too small and methodologically limited to be definitive. Other pediatric findings have come almost exclusively from correlational studies, greatly limiting causal inferences. Adult SR findings also are difficult to apply to adolescents because of multiple methodological and developmental factors. We propose to overcome these limitations with a well-powered mechanistic study that balances experimental rigor with real-world relevance during the high-risk period of adolescence. Healthy, non- obese 14-17 year-olds will undergo a randomized cross-over trial of an experimental sleep manipulation across 5-night periods (simulating a school week), comparing nightly sleep of (a) ~9 hr, the recommendation for healthy sleep vs. (b) ~6.3 hr, which many teens experience on school nights (SR). Lab assessments of teens' perception of, and brain responses to, specific foods will be paired with measures of real-world dietary and activity patterns to definitively test (a) the effect of SR on the caloric intake and activity of healthy adolescents, (b) the effect of SR on the rewarding quality of calorie-dense foods, and (c) the link between changes in caloric intake and the rewarding quality of food. Analyses will further explore whether risk factors for obesity identify which adolescents are especially vulnerable to the effect of SR on caloric intake. Findings will have direct implications for improving obesity prevention and for discoveries into obesity's complex biobehavioral mechanisms.