BackgroundAlthough insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger.MethodsThe Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8–12 years, with normal reported sleep duration of 8–11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1–2 h per night.DiscussionDetermining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12618001671257. Registered 10 October 2018.

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Anemia has been identified as a severe public health concern among young children in India, however, information on the prevalence of anemia attributed to micronutrient deficiencies is lacking. We aimed to assess multiple micronutrient status (iron, zinc, selenium, vitamin A, vitamin D, folate and vitamin B12) in young Indian children and to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia. One-hundred and twenty children aged 12 to 23 months were included in a cross-sectional nutritional assessment survey, of which 77 children provided a blood sample. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR), total body iron, zinc, selenium, retinol binding protein (RBP), folate, vitamin B12 and 25-hydroxyvitamin D (25(OH)D) were measured, and adjusted for inflammation using C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), where appropriate. Predictors for hemoglobin and anemia were identified in multiple regression models. Most of the children were classified as anemic, of which 86 to 93% was associated with iron deficiency depending on the indicator applied. Deficiencies of folate (37%), and notably vitamin D (74%) were also common; fewer children were classified with deficiencies of vitamin B12 (29%), zinc (25%), and vitamin A (17%) and selenium deficiency was nearly absent. Multiple micronutrient deficiencies were common with over half (57%) deficient in three or more micronutrients, and less than 10% of children were classified with adequate status for all the micronutrients measured. Iron status was found to be the only nutritional factor statistically significantly inversely associated with anemia (P = 0.003) in multivariate analysis after controlling for sex. A coordinated multi-micronutrient program is urgently needed to combat the co-existing micronutrient deficiencies in these young children to improve micronutrient status and reduce the high burden of childhood anemia.

Background While insufficient sleep duration has emerged as a strong, independent risk factor for obesity, the mechanisms remain unclear. One possibility is greater “eating in the absence of hunger” (EAH) or energy intake beyond the point of satiety, when tired. Objective The aim was to determine whether mild sleep loss increases EAH in children. Methods A crossover study was undertaken in 105 healthy children (8–12 y) with normal sleep (∼8–11 h/night). After randomization, children went to bed 1 h earlier (sleep extension) or 1 h later (sleep restriction) than their usual bedtime, over 2 intervention weeks separated by a 1-wk washout. At the end of each intervention week, children underwent an EAH feeding experiment involving a preloading meal until satiation, followed by an ad libitum buffet (of highly palatable snacks) to measure EAH, with each food item weighed before and after consumption. Results Ninety-three children completed the EAH experiment. There was no evidence of a difference in energy intake from EAH between sleep restriction and extension conditions when analyzed as a crossover design. However, a learning effect was found, with children eating significantly less (−239 kJ; 95% CI: −437, −41 kJ; P = 0.018) during the preload phase and significantly more (181 kJ; 95% CI: 38, 322 kJ; P = 0.013) in the ad libitum phase in the second week. No significant differences were seen using an underpowered parallel analysis for energy intake during the ad libitum phase when sleep deprived (106 kJ; 95% CI: −217, 431 kJ; P = 0.514). Conclusions Our findings suggest that measuring a difference in eating behavior in relation to sleep proved unsuitable using the EAH experiment in a crossover design in children, due to a learning effect. This trial was registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true) as ACTRN12618001671257 .

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