Daily Physical Activity Patterns of Children with Delayed Eating Behaviors Annette R. Gallant,*,† Marie-Eve Mathieu,‡ Jennifer D. Lundgren,§ Kelly Allison,|| Angelo Tremblay,†,¶ Jennifer O’Loughlin,# and Vicky Drapeau*,†,1 *Department of Physical Education, Laval University, Québec, QC, Canada, †The Quebec Heart and Lung Research Institute, Laval Hospital, Québec, QC, Canada, ‡Department of Kinesiology, University of Montréal, Montréal, QC, Canada, §Department of Psychology, University of Missouri–Kansas City, Kansas City, MO, USA, ||Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, ¶Department of Kinesiology, Laval University, Québec, QC, Canada, and # Department of Social and Preventative Medicine, University of Montréal, Montréal, QC, Canada Abstract Night eating syndrome (NES) is a delayed pattern of energy intake. It is unknown if symptoms associated with this syndrome are accompanied by a delayed pattern of physical activity. This study examines the relationship between physical activity patterns and delayed eating behaviors in children. Children from the QUALITY cohort (n = 269, 45% female, aged 8-11 y) completed the Night Eating Questionnaire (NEQ), which measures NES symptoms on a continuous scale and identifies single NES symptoms. Daily accelerometer data were transformed into mean counts per wear-time minute for each hour of the day. Children with high NEQ scores had higher levels of daily (p < 0.001) and evening physical activity (p = 0.05) and reached 75% of their total daily physical activity 20 minutes later than children with low NEQ scores (p < 0.05). Excessive evening snacking and a strong urge to eat in the evening or at night were the symptoms most related to these physical activity patterns. Children with delayed eating behaviors had higher levels of physical activity in the late morning and evening and a delayed physical activity pattern compared to children with no or fewer symptoms. Future research is needed to determine if physical activity plays a role in the onset or maintenance of night eating. Keywords night eating syndrome, children, physical activity, accelerometry, circadian
Childhood obesity is a major health concern, and there is a current need to recognize novel factors implicated in weight gain. The circadian aspect of behavior is emerging as a potential obesity risk factor (Garaulet et al., 2010). Accordingly, night eating syndrome (NES) (Stunkard et al., 1955), a syndrome of misaligned eating and sleeping patterns, is associated with obesity (Gallant et al., 2012b).
Compared to controls, individuals with NES report a delayed eating pattern of approximately 1.5 hours (Goel et al., 2009), such that they start eating later in the day, overeat in the evening (>25% of total energy intake), and/or wake up at night to eat. Aside from the core symptoms of excessive evening snacking and night eating, other important clinical symptoms of NES were recently specified: morning anorexia, onset
1. To whom all correspondence should be addressed: Vicky Drapeau, Department of Physical Education (bur. 2214), Laval University, 2300 rue de la Terrasse, PEPS, Québec, Québec G1V 0A6, Canada; e-mail: [email protected]. JOURNAL OF BIOLOGICAL RHYTHMS, Vol. 28 No. 5, October 2013 332-338 DOI: 10.1177/0748730413499857 © 2013 The Author(s)
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and maintenance of insomnia, depressed mood, a strong urge to eat in the evening and into the night, and the belief that one must eat in order to fall asleep or resume sleep (Allison et al., 2010). Recently and for the first time, night eating was examined in a population-based cohort of children (aged 8-10 y) (Lundgren et al., 2012) using the Night Eating Questionnaire (NEQ) (Allison et al., 2008). Although no children in this cohort reported the presence of all NES symptoms (Lundgren et al., 2012), the NEQ total scores, a measure of symptom severity, were variable and were associated with a relatively delayed pattern of energy intake; that is, relatively less energy intake was consumed for breakfast and more after the evening meal (Gallant et al., 2012a). The causes of late night eating in NES are currently unknown, although biological and behavioral models have been hypothesized (Stunkard et al., 2009) including involvement of the circadian system (O’Reardon et al., 2004; Goel et al., 2009). Physical activity could be implicated, as exercise can entrain the circadian rhythm by producing either a phase advance or a phase delay depending on timing (Mistlberger and Skene, 2005; Atkinson et al., 2007). Only 1 study has reported the daily physical activity profile associated with NES, and this was in adults in a 24-hour in-patient study with findings of greater spontaneous physical activity in night eaters (Gluck et al., 2011). It remains to be tested if physical activity patterns are different in individuals with a delayed pattern of energy intake or with specific delayed eating behaviors. The aim of this study was to investigate the relationship between circadian physical activity patterns and delayed eating behaviors in children at risk of obesity.
MATERIALS AND METHODS QUALITY Study Data were drawn from cycle 1 of the QUALITY (Québec Adipose and Lifestyle InvesTigation in Youth) study, which is a prospective cohort of 630 families that investigated obesity risk factors in children (Lambert et al., 2012). Families were recruited through schools, and eligibility symptoms consisted of a white child aged 8 to 10 years with at least 1 obese biological parent based on body mass index (BMI) (≥30 kg/m2) or waist circumference (>102 cm for men, >88 cm for women). Body weight and height were measured during a clinical testing day.
Socioeconomic status was determined by reported family income. All parents signed informed consent forms for their child, and this study was approved by the ethics committees of Laval University and the Centre Hospitalier Universitaire de Sainte-Justine. Physical Activity Children’s physical activity was measured using 7-day accelerometry (Actigraph LS 7164 activity monitor, Actigraph LLC, Pensacola, FL) during the week following the baseline clinical testing day. The Actigraph monitor is a waist-mounted, uniaxial accelerometer that detects vertical accelerations (magnitude and frequency) and was set at 1-minute movement epochs for the current study. A valid day was defined as ≥10 hours of recorded activity time per day (Troiano et al., 2008). Children were excluded from the analysis if they had 0 but ≤100 counts/min (Troiano et al., 2008). Nonwear time was subtracted from wear time. Hourly counts (i.e., 1200-1259 h) were divided by hourly wear time (after nonwear time was removed) to give hourly counts per minute for each hour of the day for all 7 days. Mean counts per minute for each hour were calculated from available valid days (“0900” represents activity from 0900-0959 h). Total daily physical activity levels were estimated with the equations developed by Evenson and colleagues (2008), as recommended for the Actigraph monitor (Trost et al., 2011), where sedentary activity was 100 but
Childhood obesity is a major health concern, and there is a current need to recognize novel factors implicated in weight gain. The circadian aspect of behavior is emerging as a potential obesity risk factor (Garaulet et al., 2010). Accordingly, night eating syndrome (NES) (Stunkard et al., 1955), a syndrome of misaligned eating and sleeping patterns, is associated with obesity (Gallant et al., 2012b).
Compared to controls, individuals with NES report a delayed eating pattern of approximately 1.5 hours (Goel et al., 2009), such that they start eating later in the day, overeat in the evening (>25% of total energy intake), and/or wake up at night to eat. Aside from the core symptoms of excessive evening snacking and night eating, other important clinical symptoms of NES were recently specified: morning anorexia, onset
1. To whom all correspondence should be addressed: Vicky Drapeau, Department of Physical Education (bur. 2214), Laval University, 2300 rue de la Terrasse, PEPS, Québec, Québec G1V 0A6, Canada; e-mail: [email protected]. JOURNAL OF BIOLOGICAL RHYTHMS, Vol. 28 No. 5, October 2013 332-338 DOI: 10.1177/0748730413499857 © 2013 The Author(s)
332
Gallant et al. / PHYSICAL ACTIVITY PATTERNS AND NIGHT EATING IN CHILDREN 333
and maintenance of insomnia, depressed mood, a strong urge to eat in the evening and into the night, and the belief that one must eat in order to fall asleep or resume sleep (Allison et al., 2010). Recently and for the first time, night eating was examined in a population-based cohort of children (aged 8-10 y) (Lundgren et al., 2012) using the Night Eating Questionnaire (NEQ) (Allison et al., 2008). Although no children in this cohort reported the presence of all NES symptoms (Lundgren et al., 2012), the NEQ total scores, a measure of symptom severity, were variable and were associated with a relatively delayed pattern of energy intake; that is, relatively less energy intake was consumed for breakfast and more after the evening meal (Gallant et al., 2012a). The causes of late night eating in NES are currently unknown, although biological and behavioral models have been hypothesized (Stunkard et al., 2009) including involvement of the circadian system (O’Reardon et al., 2004; Goel et al., 2009). Physical activity could be implicated, as exercise can entrain the circadian rhythm by producing either a phase advance or a phase delay depending on timing (Mistlberger and Skene, 2005; Atkinson et al., 2007). Only 1 study has reported the daily physical activity profile associated with NES, and this was in adults in a 24-hour in-patient study with findings of greater spontaneous physical activity in night eaters (Gluck et al., 2011). It remains to be tested if physical activity patterns are different in individuals with a delayed pattern of energy intake or with specific delayed eating behaviors. The aim of this study was to investigate the relationship between circadian physical activity patterns and delayed eating behaviors in children at risk of obesity.
MATERIALS AND METHODS QUALITY Study Data were drawn from cycle 1 of the QUALITY (Québec Adipose and Lifestyle InvesTigation in Youth) study, which is a prospective cohort of 630 families that investigated obesity risk factors in children (Lambert et al., 2012). Families were recruited through schools, and eligibility symptoms consisted of a white child aged 8 to 10 years with at least 1 obese biological parent based on body mass index (BMI) (≥30 kg/m2) or waist circumference (>102 cm for men, >88 cm for women). Body weight and height were measured during a clinical testing day.
Socioeconomic status was determined by reported family income. All parents signed informed consent forms for their child, and this study was approved by the ethics committees of Laval University and the Centre Hospitalier Universitaire de Sainte-Justine. Physical Activity Children’s physical activity was measured using 7-day accelerometry (Actigraph LS 7164 activity monitor, Actigraph LLC, Pensacola, FL) during the week following the baseline clinical testing day. The Actigraph monitor is a waist-mounted, uniaxial accelerometer that detects vertical accelerations (magnitude and frequency) and was set at 1-minute movement epochs for the current study. A valid day was defined as ≥10 hours of recorded activity time per day (Troiano et al., 2008). Children were excluded from the analysis if they had 0 but ≤100 counts/min (Troiano et al., 2008). Nonwear time was subtracted from wear time. Hourly counts (i.e., 1200-1259 h) were divided by hourly wear time (after nonwear time was removed) to give hourly counts per minute for each hour of the day for all 7 days. Mean counts per minute for each hour were calculated from available valid days (“0900” represents activity from 0900-0959 h). Total daily physical activity levels were estimated with the equations developed by Evenson and colleagues (2008), as recommended for the Actigraph monitor (Trost et al., 2011), where sedentary activity was 100 but
