Association between Sleep Duration and Body Mass Index among South Korean Adolescents

Bokim Lee

doi:10.15384/kjhp.2015.15.1.16

Korean J Health Promot > Volume 15(1); 2015 > Article

Lee: Association between Sleep Duration and Body Mass Index among South Korean Adolescents

Original Article

Korean Journal of Health Promotion 2015;15(1):16-23.

Published online: December 19, 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.1.16

Association between Sleep Duration and Body Mass Index among South Korean Adolescents

Bokim Lee

Department of Nursing, University of Ulsan College of Medicine, Ulsan, Korea

￭ Corresponding author：Bokim Lee, PhD Department of Nursing, University of Ulsan College of Medicine, 93 Daehak-ro, Nam-gu, Ulsan 680-749, Korea
Tel: +82-52-259-1283, Fax: +82-52-259-1236 E-mail: bokimlee@ulsan.ac.kr

Received June 12, 2014 Accepted November 28, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

Recently, there has been a growing interest in sleep duration as a risk factor for obesity. The link between sleep duration and obesity has been well established in adults, but there are limited studies in adolescents. Also, little research had been done involving South Korean adolescents. This study aimed to investigate the relationship between sleep duration and body mass index in South Korea adolescents.

Methods

This was a secondary analysis of the data collected from the 2013 Korean Youth Risk Behavior Web-based Survey. The sample included 59,367 adolescents. The questionnaires used for this study assessed gender, age, mother's education level, academic performance, smoking, alcohol use, eating behaviors, physical activity, duration of internet use, perceived stress level, and perceived health status. Data were analyzed with χ²-test, ANOVA, and logistic regression analysis using SPSS Version 21.

Results

The percentage of obese subjects was the greatest among respondents reporting less than 5 h of sleep (11.0%) and the lowest among those reporting 8 or more hours of sleep (8.4%). In the results of logistic regression analysis, compared with sleep duration of 8h or more, the adjusted odds ratio was 1.11 for 7-8 h, 1.19 for 6-7 h, 1.19 for 5-6 h, and 1.19 for <5 h of sleep, with other factors controlled.

Conclusions

The results of this study showed that a shortsleep duration is significantly associated with obesity among South Korea adolescents. In managing obesity in this population, health professionals should attend to how much sleep they are getting.

Keywords: Adolescent, Body mass index, Sleep

Table 1.

General characteristics of the study sample according to BMI (N [%] or mean ± SD^a)

BMI category	Underweight (n=3,387)	Normal (n=47,370)	Overweight (n=2,719)	Obese (n=5,891)	Total (n=59,367)	χ² (P)^e
Gender						609.59 (<0.001)
Male	1,829 (6.4)	23,082 (78.2)	640 (2.0)	3,937 (13.4)	29,488 (100.0)
Female	1,558 (5.3)	24,288 (81.7)	2,079 (6.8)	1,954 (6.2)	29,879 (100.0)
Mother's education level						67.02 (<0.001)
≤Middle school	121 (6.0)	1,627 (76.5)	104 (4.6)	271 (12.9)	2,123 (100.0)
High school diploma	1,480 (5.9)	20,469 (79.0)	1,223 (4.5)	2,730 (10.6)	25,902 (100.0)
≥Bachelor’s degree	1,229 (5.6)	18,181 (81.2)	941 (4.1)	2,030 (9.2)	22,381 (100.0)
Unknown	557 (6.2)	7,093 (79.5)	451 (4.8)	860 (9.5)	8,961 (100.0)
Age, y	15.41±0.05	14.96±0.03^d	14.12±0.06^d	15.38±0.03^c	14.99±0.03	205.55 (<0.001)
Economic statusb	3.15±0.04^d	3.18±0.03^d	3.15±0.04	3.11±0.02^c	3.17±0.02	10.56 (<0.001)
Academic performanceb	2.95±0.04^d	3.03±0.03^d	2.93±0.04^d	2.85±0.02^c	3.00±0.02	40.11 (<0.001)

Abbreviations: BMI, body mass index; SD, standard deviation.

^aN: non-weighted, %: weighted, mean: weighted, SD: weighted.

^b1(low)-5(high).

^cReference category.

^dSignificantly different group from the reference category.

^eCalculated by chi-square test or analysis of variance.

Table 2.

Health behavior characteristics of the study sample according to BMI (N [%] or mean±SD^a)

BMI category	Underweight	Normal	Overweight	Obese	Total	χ² (P)^b
Smoking						102.07 (<0.001)
Yes	323 (6.1)	4,306 (80.3)	108 (1.9)	628 (11.7)	5,365 (100.0)
No	3,064 (5.8)	43,064 (79.8)	2,611 (4.6)	5,263 (9.8)	54,002 (100.0)
Alcohol use						36.22 (<0.001)
Yes	524 (5.7)	7,573 (79.7)	297 (2.9)	1,094 (11.7)	9,488 (100.0)
No	2,863 (5.9)	39,797 (79.9)	2,422 (4.6)	4,797 (9.6)	49,879 (100.0)
Eat vegetables						73.02 (<0.001)
None	131 (7.0)	1,643 (80.1)	84 (4.1)	185 (8.8)	2,043 (100.0)
1-2 times/wk	623 (6.9)	7,406 (80.5)	394 (4.1)	805 (8.6)	9,228 (100.0)
3-4 times/wk	820 (6.0)	11,276 (79.9)	634 (4.3)	1,368 (9.9)	14,098 (100.0)
5-6 times/wk	486 (5.9)	6,618 (79.7)	382 (4.5)	816 (9.9)	8,302 (100.0)
1 serving/d	374 (5.2)	5,931 (80.3)	336 (4.1)	755 (10.3)	7,396 (100.0)
2 serving/d	437 (5.3)	6,585 (79.3)	405 (4.6)	907 (10.7)	8,334 (100.0)
≥3serving/d	516 (5.3)	7,911 (79.4)	484 (4.6)	1,055 (10.7)	9,966 (100.0)
Eat a snack						146.24 (<0.001)
None	507 (4.9)	8,014 (77.2)	542 (4.8)	1,347 (13.1)	10,410 (100.0)
1-2 times/wk	1,315 (5.2)	20,341 (79.3)	1,297 (4.8)	2,754 (10.7)	25,707 (100.0)
3-4 times/wk	1,037 (6.6)	13,210 (81.3)	646 (3.8)	1,333 (8.3)	16,226 (100.0)
5-6 times/wk	268 (6.9)	3,342 (83.7)	130 (3.0)	269 (6.3)	4,009 (100.0)
1 serving/d	178 (9.5)	1,684 (81.4)	69 (3.2)	117 (6.0)	2,048 (100.0)
2 serving/d	47 (8.3)	506 (82.5)	17 (2.5)	42 (6.7)	612 (100.0)
≥serving/d	35 (9.2)	273 (78.3)	18 (3.6)	29 (8.9)	355 (100.0)
Eat fast food						111.58 (<0.001)
None	963 (5.3)	14,450 (78.7)	955 (5.0)	2,025 (11.0)	18,393 (100.0)
1-2 times/wk	1,941 (5.9)	26,948 (80.3)	1,491 (4.1)	3,183 (9.6)	33,563 (100.0)
3-4 times/wk	363 (6.6)	4,782 (80.6)	217 (3.7)	548 (9.1)	5,910 (100.0)
5-6 times/wk	68 (7.2)	761 (82.0)	34 (3.3)	70 (7.5)	933 (100.0)
1 serving/d	31 (10.2)	264 (74.9)	14 (4.0)	40 (10.9)	349 (100.0)
2 serving/d	14 (12.7)	76 (75.3)	4 (5.1)	8 (7.0)	102 (100.0)
≥serving/d	7 (5.4)	89 (77.6)	4 (2.7)	17 (14.3)	117 (100.0)
Exercise (d/wk)	2.67±0.07^c	2.88±0.06^c	2.79±0.08^c	2.00±0.03^d	1.87±0.03	23.17 (<0.001)
Walking time (min/d)	61.02±2.74	61.80±2.06	60.77±2.95	60.79±1.00^d	61.61±2.11	0.48 (0.684)

Abbreviations: BMI, body mass index; SD, standard deviation.

^aN: non-weighted, %: weighted, mean: weighted, SD: weighted.

^bCalculated by chi-square test or analysis of variance.

^cSignificantly different group from the reference category.

^dReference category.

Table 3.

Psychosocial characteristics of the study sample according to BMI (N [%] or mean ± SD^a)

BMI category	Underweight	Normal	Overweight	Obese	Total	F (P)^b
Using internet (min/d)	102.98±4.56^c	95.15±3.65^c	89.95±4.59^c	126.31±1.89^d	98.48±3.74	111.53 (<0.001)
Stresse	3.31±0.05	3.32±0.03	3.45±0.04^c	3.33±0.01^d	3.32±0.03	16.36 (<0.001)
Health statusf	3.69±0.03^c	3.89±0.03^c	3.78±0.03	3.74±0.01^d	3.86±0.03	39.78 (<0.001)

Abbreviations: BMI, body mass index; SD, standard deviation.

^aN: non-weighted, %: weighted, mean: weighted, SD: weighted.

^bCalculated by analysis of variance.

^cSignificantly different group from the reference category.

^dReference category.

^e1(never)-5(very frequently).

^f1(very unhealthy)-5(very healthy).

Table 4.

Sleep duration on school nights according to BMI (N [%]^a)

Sleep duration	Underweight	Normal	Overweight	Obese	Total	χ² (P)^b
<5 h	454 (5.8)	6,268 (79.4)	312 (3.8)	869 (11.0)	7,903 (100.0)	98.48 (<0.001)
5h≤, <6 h	705 (5.7)	10,023 (79.8)	488 (3.7)	1,314 (10.8)	12,530 (100.0)
6h≤, <7 h	812 (5.8)	11,741 (79.6)	659 (4.2)	1,534 (10.4)	14,746 (100.0)
7h≥, <8 h	799 (5.8)	11,338 (80.1)	718 (5.0)	1,303 (9.1)	14,158 (100.0)
≥8 h	617 (6.2)	8,000 (80.4)	542 (5.0)	871 (8.4)	10,030 (100.0)

Abbreviation: BMI, body mass index.

^aN: non-weighted, %: weighted.

^bCalculated by chi-square test.

Table 5.

Association between sleep duration and BMI^a

Sleep duration	Underweight			Normal			Overweight			Obese
Sleep duration	OR	95% CI	P	OR	95% CI	P	OR	95% CI	P	OR	95% CI	P
<5 h	0.58	0.50-0.67	<0.001	1.03	0.94-1.13	0.485	1.20	1.02-1.42	0.032	1.19	1.05-1.34	0.005
5h≤, <6 h	0.60	0.53-0.69	<0.001	1.03	0.96-1.11	0.432	1.11	0.95-1.29	0.186	1.19	1.07-1.32	0.001
6h≤, <7 h	0.69	0.61-0.78	<0.001	0.99	0.92-1.06	0.771	1.05	0.92-1.19	0.483	1.19	1.08-1.31	<0.001
7h≤, <8 h	0.85	0.75-0.96	0.011	0.98	0.91-1.05	0.507	1.01	0.89-1.14	0.928	1.11	1.01-1.22	0.037
≥8 h	1.00			1.00			1.00			1.00

Abbreviations: BMI, body mass index; OR, odds ratio; CI, confidence interval.

^aCalculated by logistic regression analysis, adjusted for gender, age, mother's education level, economic status, academic performance, smoking, alcohol use, diet habits, exercises habits, using internet, stress, and health status.

REFERENCES

1.. Jee SH, Pastor-Barriuso R, Appel LJ, Suh I, Miller III ER, Guallar E. Body mass index and incident ischemic heart disease in South Korean men and women. Am J Epidemiol 2005;162(1):42-8.

2.. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Heatlh Statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANES V-3). Seojong: Ministry of Health and Welfare; 2013. p.52..

3.. Korea Ministry of Education, Korean Ministry of Health and Welfare, & Korea Centers for Disease Control and Prevention. 2013 Korean Youth Risk Behavior Web-Based Survey statistics. Seoul: KCDC; 2014. p. 174-5.

4.. Kiess W, Galler A, Reich A, Müller G, Kapellen T, Deutscher J, et al. Clinical aspects of obesity in childhood and adolescence. Obes Rev 2001;2(1):29-36.

5.. Brooks-Gunn J, Fink C, Paxson C. Obesity. In: Gullotta TP & Adams GR (Eds.), Handbook of adolescent behavioral problems: Evidence-based approaches to prevention and treatment. NY: Springer; 2005. p. 387-412.

6.. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004;141(11):846-50.

7.. Chen MY, Wang EK, Jeng YJ. Adequate sleep among adolescents is positively associated with health status and health-related behaviors. BMC Public Health 2006;6:59.

8.. Seicean A, Redline S, Seicean S, Kirchner HL, Gao Y, Sekine M, et al. Storfer-Isser, Association between short sleeping hours and overweight in adolescents: results from a US suburban high school survey. Sleep Breath 2007;11(4):285-93.

9.. Choi SM, Seo WS, Sung HM, Koo BH, Kim KK, Kim SY, et al. Sleep duration and body mass index in Korean children. J Korean Acad Child Adolesc Psychiatry 2009;20(3):146-51.

10.. Park S. Association between short sleep duration and obesity among South Korean adolescents. West J Nurs Res 2011;33(2):207-23.

11.. Kageyama T, Kobayashi T, Abe-Cotoh A. Correlates to sleepiness on night shift among male workers engaged in three-shift work in a chemical plant: its association with sleep practice and job stress. Ind Health 2011;49(5):634-41.

12.. Duncan AE, Grant JD, Bucholz KK, Madden PA, Heath AC. Relationship between body mass index, alcohol use, and alcohol misuse in a young adult female twin sample. J Stud Alcohol Drugs 2009;70(3):458-66.

13.. Leatherdale ST, Wong SL, Manske SR, Colditz GA. Susceptibility to smoking and its association with physical activity, BMI, and weight concerns among youth. Nicotine Tob Res 2008;10(3):499-505.

14.. Koval JJ, Pederson LL, Zhang X, Mowery P, McKenna M. Can young adult smoking status be predicted from concern about body weight and self-reported BMI among adolescents? Results from a ten-year cohort study. Nicotine Tob Res 2008;10(9):1449-55.

15.. Van den Bulck J. Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep 2004;27(1):101-4.

16.. Sekine M, Chandola T, Martikainen P, Marmot M, Kagamimori S. Work and family characteristics as determinants of socioeconomic and sex inequalities in sleep: The Japanese Civil Servants Study. Sleep 2006;29(2):206-16.

17.. Unalan D, Ozturk A, Ismailogullari S, Akgul N, Aksu M. The effect of sleep duration and quality on academical success of the elementary school children in Kayseri Turkey. J Pak Med Assoc 2013;63(5):576-80.

18.. Glozier N, Martiniuk A, Patton G, Ivers R, Li Q, Hickie I, et al. Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. Sleep 2010;33(9):1139-45.

19.. Bae J, Joung H, Kim JY, Kwon KN, Kim YT, Park SW. Test-retest reliability of a questionnaire for the Korea youth risk behavior web-based survey. J Prev Med Public Health 2010;43(5):403-10.

20.. Leung SO, Xu ML. Single-item measures for subjective academic performance, self-esteem, and socioeconomic status. J Soc Serv Res 2014;39(4):511-20.

21.. Soh HK, Lee EJ, Choi BS. The development of nutrition education program for improvement of body perception of middle school girls (I); The analysis of problems according to the body perception of middle school girls. Korean J Food Culture 2008;23(3):403-9.

22.. Nixon GM, Thompson JM, Han DY, Becroft DM, Clark PM, Robinson E, et al. Short sleep duration in middle childhood: risk factors and consequences. Sleep 2008;31(1):71-8.

23.. Roche A, Sun S. Human growth: Assessment and interpretation. Cambridge: Cambridge University Press; 2003. p. 172-87.

24.. Morgenstern M, Sargent JD, Hanewinkel R. Relation between socioeconomic status and body mass index: evidence of an indirect path via television use. Arch Pediatr Adolesc Med 2009;163(8):731-8.

25.. Rashmi. Jaswal S. Obesity and Academic performance in adolescents. Int J Edu Sci 2012;4(3):275-8.

26.. Rouhani MH, Mirseifinezhad M, Omrani N, Esmaillzadeh A, Azadbakht L. Fast food consumption, quality of diet, and obesity among Isfahanian adolescent girls. J Obes 2012;2012:597924.

27.. Moon SS, Lee YS. Comparison of dietary habits, exercise, recognized body shapes and weight control between obesity and underweight of adolescents. Korean J Hum Ecol 2009;18(6):1337-48.

28.. Matusitz J, McCormick J. Sedentarism: the effects of Internet use on human obesity in the United States. Soc Work Public Health 2012;27(3):250-69.

29.. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition 2007;23(11-12):887-94.

30.. Trakas K, Oh PI, Singh S, Risebrough N, Shear NH. The health status of obese individuals in Canada. Int J Obes Relat Metab Disord 2001;25(5):662-8.