Sleep duration has been linked to obesity and there is also an emerging literature in animals demonstrating a relationship between the timing of feeding and weight regulation. However, there is a paucity of research evaluating timing of sleep and feeding on weight regulation in humans. The goal of this study was to evaluate the role of sleep timing in dietary patterns and BMI. Participants included 52 (25 females) volunteers who completed 7 days of wrist actigraphy and food logs. Fifty‐six percent were “normal sleepers” (midpoint of <5:30 am) and 44% were “late sleepers” (midpoint of sleep ≥5:30 am). Late sleepers had shorter sleep duration, later sleep onset and sleep offset and meal times. Late sleepers consumed more calories at dinner and after 8:00 pm, had higher fast food, full‐calorie soda and lower fruit and vegetable consumption. Higher BMI was associated with shorter sleep duration, later sleep timing, caloric consumption after 8:00 pm, and fast food meals. In multivariate models, sleep timing was independently associated with calories consumed after 8:00 pm and fruit and vegetable consumption but did not predict BMI after controlling for sleep duration. Calories consumed after 8:00 pm predicted BMI after controlling for sleep timing and duration. These findings indicate that caloric intake after 8:00 pm may increase the risk of obesity, independent of sleep timing and duration. Future studies should investigate the biological and social mechanisms linking timing of sleep and feeding in order to develop novel time‐based interventions for weight management.

OBJECTIVE: Despite guidelines recommending an annual oral glucose tolerance test (OGTT) for all patients with cystic fibrosis (CF) aged $10 years, screening rates for cystic fibrosis-related diabetes (CFRD) remained low at our center. The aim of this project was to implement an outpatient system to provide effective, evidence-based screening for CFRD at a pediatric CF program.METHODS: Development of a system to improve outpatient screening for CFRD included structured education, communication with families, and processes for scheduling laboratory appointments. The primary outcome measure was the proportion of eligible patients seen at the clinic who received an OGTT by the subsequent clinic appointment. The proportion of patients without CFRD in our program who received an OGTT within the previous 12 months was also tracked longitudinally. RESULTS:The outpatient screening rate for CFRD increased from 2% of eligible patients seen at the clinic during the 18 weeks before the start of our initiative to 78% during the 18 weeks after the start of our initiative (P , .001). The screening rate was also increased from the corresponding date range the previous year, when only 35% of eligible patients received an OGTT (P , .001). The overall percentage of patients without CFRD in our program who received an OGTT in the previous 12 months increased from 47% to 71% after implementation of our initiative (P = .003). CONCLUSIONS:A systematic, quality improvement approach effectively increased the rate of outpatient screening for CFRD at a pediatric CF program. Pediatrics 2013;132:e512-e518 AUTHORS:

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