Open Access
Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity?
(Springer, 2022) Torres-López, Lucía V.; Cadenas-Sánchez, Cristina; Migueles, Jairo H.; Esteban Cornejo, Irene; Molina García, Pablo; Hillman, Charles H.; Catena, Andrés; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Approximately 4–11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8–12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05). Conclusion: our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone.What is Known:• Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children.• Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. What is New:• To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children.• SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.
Open Access
Associations of sleep-related outcomes with behavioral and emotional functioning in children with overweight/obesity
(Elsevier, 2022) Torres-López, Lucía V.; Cadenas-Sánchez, Cristina; Migueles, Jairo H.; Henriksson, Pontus; Löf, Marie; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Objective To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and deviceassessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/ obesity. Study design A total of 109 children with overweight/obesity (mean age, 10.0 (±) 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). Results SDB was positively associated with all clinical scale variables (all b > 0.197, P ≤ .041) and with lower adaptability and leadership (all b < 0.226, P < .021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all b > 0.196, P ≤ .045) and lower adaptability (b = 0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all b > |0.192|, P ≤ .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. Conclusions Our study suggests that SDB symptoms, but not deviceassessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability. (J Pediatr 2022;246:170-8).
Open Access
Association of breakfast quality and energy density with cardiometabolic risk factors in overweight/obese children: role of physical activity
(MDPI, 2018) Arenaza Etxeberría, Lide; Muñoz-Hernández, Victoria; Medrano Echeverría, María; Osés Recalde, Maddi; Amasene, María; Merchán Ramírez, Elisa; Cadenas-Sánchez, Cristina; Ortega, Francisco B.; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8-12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders (= -0.172, p = 0.028), but the relationship was attenuated after further controlling for total PA (p < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all p < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all p < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.

Cadenas-Sánchez, Cristina

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