Enhancing Sleep Duration: Effects of Children's Eating and Activity Behaviors

项目总结/摘要 34%的学龄儿童超重或肥胖，有明显的肥胖和心血管疾病（CV）， 种族群体之间的健康差异。有人呼吁评估新的方法， 预防肥胖和心血管风险，特别是非洲裔美国人（AA）/黑人儿童。鉴于其增长 睡眠不足、肥胖和心血管障碍的风险，这是一种可能对儿童有希望的方法， AA/Black可以延长睡眠时间。对儿童的观察性研究表明， 增加肥胖和其他CV风险因素的风险。对成年人的实验研究证明， 睡眠可能主要通过饮食途径影响肥胖风险。我们自己的随机对照试验， 8 - 11岁的儿童提供了一个强有力的信号，即增加睡眠时间会导致以下方面的减少： 对于食物，报告的食物摄入量和电视观看;以及身体活动的增加-净结果是积极的 体重状况的变化和葡萄糖调节的潜在变化，特别是对于那些 睡眠最多。然而，初步研究受到研究时间短（2周至2周）的限制。 月），主要招募非西班牙裔白色儿童，主要目标集中在饮食行为 而不是肥胖或其他CV风险。在这一竞争性更新中，我们建议通过以下方式解决这些限制： 招募AA/黑人儿童，评估12个月期间的干预效果，并将重点放在 主要目标是zBMI的变化。具体来说，我们建议对两种积极的预防性药物进行严格的评价。 干预措施：a）单独增强睡眠（优化睡眠[OS]），和B）增强睡眠沿着进食， 活动行为已被证明对预防肥胖有效，并与自我调节有关。 与睡眠相关的通路（即，能量密集的零食和饮料，看电视和体育活动） （OS-Plus）。本研究拟招募204名8 - 11岁AA/黑人儿童，主要来自 低社会经济背景，以及在12个月的研究中每晚睡眠<9.5小时的人。孩子将被 随机分配到OS或OS-Plus。在6个月的治疗阶段，所有儿童将参加8- 会话治疗（4个人和4个电话随访），他们将学习有效的行为策略， 改善睡眠持续时间（OS）或改善睡眠和有针对性的饮食和活动行为（OS-Plus）; 在维护期间（6 - 12个月），每月电话联系。基线时，治疗结束时（6 月）和12个月，将测量以下内容：睡眠时间（活动记录）、饮食行为（24小时 饮食回忆，饮食自我调节），身体活动（加速度计），人体测量（身高，体重，腰围 围）和其他心脏代谢风险因素（肥胖、血脂和血糖调节）。初级 目的是确定OS-Plus相对于OS对结束时体重指数z评分（BMIz）变化的疗效 治疗。次要目的将评估OS-Plus相对于OS在额外心脏代谢风险方面的疗效 因素、饮食和活动行为。探索性目的将评估12个月时的效果维持情况。

PROJECT SUMMARY/ABSTRACT Thirty four percent of school-age children are overweight or obese with clear obesity- and cardiovascular (CV)- related health disparities among racial groups. There have been calls to assess novel approaches for prevention of obesity and CV risk, particularly for African-American (AA)/black children. Given their increased risk of short sleep, obesity and CV disturbance, one approach that may be promising for children who are AA/Black is enhancing sleep duration. Observational studies with children demonstrate that short sleep increases risk of obesity and other CV risk factors. Experimental studies with adults document that changes in sleep may influence obesity risk primarily through eating pathways. Our own randomized controlled trials with children 8-11 years old provide a robust signal that enhancing sleep duration leads to decreases in: motivation for food, reported food intake and TV viewing; and increases in physical activity-with a net result of positive changes in weight status and potential changes in glucose regulation, particularly for children who enhance their sleep the most. However, preliminary studies are limited by short study timeframes (2-weeks to 2- months), primary enrollment of non-Hispanic White children, and primary aims focused on eating behaviors rather than obesity or other CV risk. In this competing renewal we propose addressing these limitations by enrolling children who are AA/black, assessing effects of intervention over a 12-month period, and focusing the primary aim on change in zBMI. Specifically, we propose rigorous evaluation of two active preventive interventions: a) enhancing sleep alone (Optimize Sleep [OS]), and b) enhancing sleep along with eating and activity behaviors that have demonstrated efficacy for obesity prevention and are implicated in self-regulatory pathways related to sleep (i.e., energy dense snack foods and beverages, TV viewing, and physical activity) (OS-Plus). The present study proposes to enroll 204 children 8-11 years old who are AA/black, primarily from low socioeconomic backgrounds, and who sleep < 9.5 hours/night into a 12-month study. Children will be randomly assigned to either OS or OS-Plus. Over the 6-month treatment phase, all children will attend an 8- session treatment (4 in-person & 4 phone follow-up) in which they will learn effective behavioral strategies to improve sleep duration (OS) or improve sleep and targeted eating and activity behaviors (OS-Plus); there will be monthly phone contact during the maintenance period (6-12 months). At baseline, end of treatment (6 months), and 12 months, the following will be measured: sleep duration (actigraphy), eating behaviors (24-hour dietary recalls, eating self regulation), physical activity (accelerometry), anthropometrics (height, weight, waist circumference), and additional cardiometabolic risk factors (adiposity, lipids, and glucose regulation). Primary aim is to determine the efficacy of OS-Plus relative to OS on change in body mass index z-score (BMIz) at end of treatment. Secondary aims will assess efficacy of OS-Plus relative to OS on additional cardiometabolic risk factors, eating and activity behaviors. Exploratory aims will assess maintenance of effects at 12 months.