behaviour Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed - - PowerPoint PPT Presentation

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behaviour Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed - - PowerPoint PPT Presentation

Sep 01, 2022 472 likes •884 views

The association between sleep and feeding behaviour Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed University Abu Dhabi Email: Teresa.Arora@zu.ac.ae Global prevalence of obesity Consequences & causes of obesity Introduction to

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Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed University Abu Dhabi Email: Teresa.Arora@zu.ac.ae

The association between sleep and feeding behaviour

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Overview

Global prevalence of obesity Consequences & causes of obesity Introduction to sleep Scientific evidence linking sleep and obesity Mechanisms Scientific evidence surrounding sleep and feeding Summary

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https://ourworldindata.org/obesity

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Consequences of obesity

  • Individual & family
  • Psychological
  • Physiological
  • Societal
  • Employers
  • Healthcare systems
  • What are the causes?
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Energy Balance Equation

Energy Intake

“It’s Easy”

Medications and Surgery - consequences Energy Expenditure Causes

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Energy Balance Equation

Energy Intake

“It’s Easy”

Medications and Surgery

WHERE DOES SLEEP FIT IN TO THIS?

Energy Expenditure

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Energy Balance Equation

Energy Intake

“It’s Easy”

Medications and Surgery

WHERE DOES SLEEP FIT IN TO THIS?

Energy Expenditure

SLEEP

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Is sleep really important?

➢One third (adulthood); half (childhood) ➢Behaviour - all species/organisms ➢Cannot resist urge to sleep ➢Complex physiological process ➢Why do we need it?

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The 90-minute Sleep Cycle

1: wake-sleep, rolling eyes (alpha waves) 2: light sleep, easily woken 3: deep sleep (SWS), muscles relax, breathing slows, confused if woken (delta waves) REM: brain activity, dreaming, paralysis, faster breathing, higher BP

Stage1

(5-10 mins)

Stage 2

(15 mins)

Stage 3

(45 mins)

REM

(20-25 mins)

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1995

Obesity Trends Among U.S. Adults

2005 1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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Is Is it ju just a coincidence?

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Consequences of sleep deprivation

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Where’s the evidence?

  • 1992 first study to link sleep-obesity
  • More than 500 published articles in 2011
  • Currently >800 published studies
  • Cross-sectional evidence
  • Longitudinal evidence
  • Experimental evidence
  • Systematic reviews and meta-analyses
  • Objective and subjective measures
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Early longitudinal evidence (children)

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 <10.5 10.5-10.9 11-11.9 >12 Odds ratio Sleep duration (hours)

p<0.01

*

re ref

*

Reilly JJ, Armstrong J, Dorosty AR et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005;330:1357.

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Sleep-obesity

  • Midlands Adolescent Schools Sleep Education Study (MASSES)
  • Aged 11-18 years, n=624
  • Weekday sleep duration (hours) was negatively associated with

body mass index

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Sleep, BMI and mortality

Kripke et al (2002)

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Meta-analysis of sleep-obesity (adults)

Cappuccio et al. (2008)

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Meta-analysis of sleep-obesity (children)

Cappuccio et al. (2008)

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Sle leep duratio ion is is a predic ictor of f in incid ident dia iabetes

  • Meta analysis – Shan et al (2015)
  • Prospective studies only
  • Pubmed & EMBASE
  • 10 articles included
  • 482,502 participants
  • 18,443 incident cases (3.8%)
  • Follow up period 2.5 – 16 years (median 7.5y)
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The relationship between sleep duration and risk of type 2 diabetes

Zhilei Shan et al. Diabetes Care 2015;38:529-537

Pooled RR= 1.09 (1.04-1.15) for each 1-h <7h Pooled RR=1.14 (1.03-1.26) for each 1h >7h If you sleep too much or not enough then you increase your risk of developing diabetes

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What are the mechanisms?

  • Evidence for sleep-obesity link
  • Prospective studies show consistent sleep impairment causes weight

gain

  • How does this happen?
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Ghrelin Ghrelin Ghrelin

Food Intake & Energy Metabolism

Stomach Adipose Tissue Leptin Hypothalamus Pituitary

Leptin is positively correlated with adipose tissue and signals satiety Obese patients are leptin resistant - eat more Ghrelin indicates hunger

Appetite regulating hormones

To maintain energy balance, leptin should be high and ghrelin should be low

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All employees (aged 30-60 years)

  • f four state agencies in south central

Wisconsin sent mailed survey Overnight sleep study protocol (n= 1,488, 51% response rate) Morning fasted blood sample added to protocol in 1995 (n= 1,024) Sleep diary added to protocol in 1995 (n=721)

Polysomnography:

  • 1. Total sleep time (TST)
  • 2. Sleep efficiency
  • 3. Wake after sleep onset

(WASO) Questionnaire: Usual sleep Serum: Hormones and metabolites Sleep Diary:

  • 1. Average nightly sleep
  • 2. Average nightly sleep

plus naps Stratified random sample (n= 2,917)

Sample Data Collected

Taheri S, Lin L, Austin D, Young T, Mignot E. Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoS Med. 2004;1(3):e62.

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Results from Wisconsin Sleep Cohort Study

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Spiegel, K. et. al. Ann Intern Med 2004;141:846-850

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Pil ilot data on chronic sle leep reduction/extension

  • Randomised to 30/60 minute condition (n=5)
  • 4 weeks baseline
  • 4 weeks sleep restriction
  • 4 weeks ‘wash out’
  • 4 weeks sleep extension
  • Food intake measured
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Cake consumption

20 40 60 80 100 120 140 1001 1004 1006 1002 1005 Grams Volunteer

Difference in cake consumption across 3 time-points

Visit 3 Visit 4 Visit 6

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Experimental evidence – sle leep and feeding

  • Randomised study
  • Habitual sleep duration (8 nights) vs 2/3 habitual sleep duration (8 nights)
  • SR group consumed +566 kcal/day (p=0.011)
  • Sleep restriction not compensated with increased energy expenditure,

p=0.62

  • How much weight could be gained with +566 kcal/day accountable for

sleeping less?

Calvin et al Effects of Experimental Sleep Restriction on Caloric Intake and Activity Energy Expenditure. Chest (2013)

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100 kcals is:

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100 kcals is: 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

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100 kcals more than your body requires each day will result in:

100 kcals is: 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

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100 kcals more than your body requires each day will result in: 5kg (11.5lbs) weight gain per year 25kg (4 stone) weight gain over 5 years

100kcals is: 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

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Tiredness Reduced Activity Sleep Loss Low Leptin High Ghrelin Opportunity to Eat

  • Hunger
  • Food

Selection

  • Energy

Expenditure OBESITY Increased Energy Dense Food Intake Other Hormones

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Epworth Sleepiness Scale

  • Use the following scale to choose the most appropriate number for

each situation:

  • 0 = no chance of dozing; 1 = slight chance of dozing; 2 = moderate

chance of dozing; 3 = high chance of dozing

  • SITUATION - CHANCE OF DOZING
  • 1. Sitting and reading
  • 2. Watching TV
  • 3. Sitting inactive in a public place (e.g. a theatre, or a meeting)
  • 4. As a passenger in a car for an hour without a break
  • 5. Lying down to rest in the afternoon when circumstances permit
  • 6. Sitting and talking to someone
  • 7. Sitting quietly after a lunch
  • 8. In a car, while stopped for a few minutes in traffic
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Sleep hygiene education

  • Avoid eating large or spicy meals late at night
  • Avoid intense exercise 2-3 h before bed
  • Avoid caffeine after midday
  • Bath vs shower
  • Limit bed for sleeping only
  • Bedroom temperature
  • No electronics in bedroom
  • Consistent bedtime routine
  • Consistent sleep-wake timings
  • Lighting in bedroom (dark room)
  • Lavender scent
  • Avoid conflict, alcohol & smoking before bedtime
  • Keep notepad next to bed
  • Keep a sleep diary
  • Daytime light exposure
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Summary ry

  • Global obesity is becoming more prevalent
  • Old view focuses on energy balance equation
  • Sleep is a third factor which needs to be assessed and addressed
  • Sleep is unequivocally linked to obesity and type 2 diabetes
  • Sleep impacts feeding behaviour resulting in excessive energy intake
  • Sleep also alters appetite regulating hormones
  • Patients should be asked about their sleep
  • Telling someone to sleep more is easier for them vs dieting and exercise
  • Sleep hygiene education can be given as a minimum to help
  • Sleep is your super power
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References

  • Arora, T., Hosseini-Araghi, M., Bishop, J., Yao, G. L., Thomas, G. N., & Taheri, S. (2013). The

complexity of obesity in UK adolescents: relationships with quantity and type of technology, sleep duration and quality, academic performance and aspiration. Pediatric Obesity, 8 (5), 358-366.

  • Calvin et al. (2013). Effects of Experimental Sleep Restriction on Caloric Intake and Activity

Energy Expenditure. Chest, 144 (1), 79-86.

  • Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A.

(2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31 (5), 619- 626.

  • Chen, G. C., Liu, M. M., Chen, L. H., Xu, J. Y., Hidayat, K., Li, F. R., & Qin, L. Q. (2018).

Daytime napping and risk of type 2 diabetes: a meta-analysis of prospective studies. Sleep Breath, 22(3), 815-824.

  • Kripke, D. F., Garfinkel, L., Wingard, D. L., Klauber, M. R., & Marler, M. R. (2002). Mortality

associated with sleep duration and insomnia. Arch Gen Psychiatry, 59 (2), 131-136.

  • Reilly JJ, Armstrong J, Dorosty AR et al. (2005). Early life risk factors for obesity in childhood:

cohort study. BMJ; 330:1357.

  • Shan, Z., Ma, H., Xie, M., Yan, P., Guo, Y., Bao, W., … Liu, L. (2015). Sleep duration and risk of

type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care, 38(3), 529-537.

  • Taheri S, Lin L, Austin D, Young T, Mignot E. Short Sleep Duration Is Associated with Reduced

Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoS Med. 2004;1(3):e62