Sleep‐wake patterns in newborns are associated with infant rapid weight gain and incident adiposity in toddlerhood

Abstract

Summary Background Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG. Objective Examine associations between newborn sleep‐wake patterns and incident RWG at 6 months of life and OW at 36 months. Methods Low‐income Mexican/Mexican‐American women with OW/obesity and their infants (n = 126) enrolled in a 1‐year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire‐Revised. Outcome measures included RWG (>0.67 positive change in weight‐for‐age Z‐score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months. Results By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1‐month was significantly associated with decreased odds for RWG compared to napping <5x (OR = 0.11, 95%CI:0.02, 0.63). Each 1‐hour increase in nocturnal vs diurnal sleep was associated with greater odds of incident OW at 36 mos (OR = 1.51, 95%CI:1.13, 2.03). Conclusions Early‐life sleep patterns related to infant nap frequency and nocturnal vs diurnal sleep distribution were associated with obesity outcomes and may be important intervention targets to prevent lasting consequences on infant growth.

Protocol of the Snuggle Bug/Acurrucadito Study: a longitudinal study investigating the influences of sleep-wake patterns and gut microbiome development in infancy on rapid weight gain, an early risk factor for obesity

“…Further, obese children are more likely to become obese adults [ 3 ]. Rapid weight gain (RWG) in the first 6 months of infancy, defined as a greater than 0.67 positive change in weight-for-age Z-score (difference between centile lines on standard growth charts) [ 4 ], is associated with greater total weight gain from 0 to 12 months and greater weight-for-length and weight-for-age percentiles at 36 months [ 5 ]. It also increases the odds of obesity across the life course [ 6 – 9 ] and relates to adverse health outcomes later in life, including hypertension, diabetes, and cardiovascular diseases [ 10 ].…”

“…Infants receiving interventions with a sleep component had lower BMI z-scores [ 19 , 20 ] and weight-for-length percentiles [ 21 ], were less likely to be overweight/obese [ 19 ], and had slower weight gain rates [ 19 ] than non-sleep interventions (follow-up from 6 months to 5 years). However, no studies have explored associations between sleep-wake patterns and RWG, with the exception of our single, previous study [ 5 ]. Our results indicated that newborns (1 month) with later bedtimes (≥10:00 PM) were more likely to experience RWG in their first 6 months than newborns who went to bed earlier [ 5 ].…”

“…However, no studies have explored associations between sleep-wake patterns and RWG, with the exception of our single, previous study [ 5 ]. Our results indicated that newborns (1 month) with later bedtimes (≥10:00 PM) were more likely to experience RWG in their first 6 months than newborns who went to bed earlier [ 5 ]. Further, newborns taking more daytime naps were significantly less likely to experience RWG [ 5 ].…”

“…Our results indicated that newborns (1 month) with later bedtimes (≥10:00 PM) were more likely to experience RWG in their first 6 months than newborns who went to bed earlier [ 5 ]. Further, newborns taking more daytime naps were significantly less likely to experience RWG [ 5 ]. Also, previous studies have rarely used actigraphic monitoring (i.e., movement-based recording with a wearable sensor) of infants to provide a comprehensive, prospective assessment of sleep patterns [ 22 ], particularly in association with early infant growth.…”

Increased risk for excessive weight gain in infants who sleep less than 12 hours per 24 hoursCommentary on Yu J, Jin H, Wen L, et al. Insufficient sleep during infancy is correlated with excessive weight gain in childhood: a longitudinal twin cohort study. J Clin Sleep Med . 2021;17(11):2147–2154. doi:10.5664/jcsm.9350

“…1 A potent risk for obesity across the lifespan is rapid weight gain (> 0.67 positive change in weight-for-age z score), especially when it occurs in the first 6 months of life. [2][3][4][5][6][7] A 2020 study of 17,002 children found that rapid weight gain most often occurs between ages 0 and 6 months (17.5%) vs 18-24 months (1.8%) and increases the risk of being overweight/ obese at age 3 years by 2.6-fold. 3 The Generation R study showed that rapid weight gain between ages 0 and 3 months was associated with a higher percentage of body fat, more central adiposity, and reduced insulin sensitivity in early adulthood.…”