1 Sleep and Obesity – Sleep and Obesity – does the egg come before the does the egg come before the chicken? chicken? Francesco P Cappuccio MD MSc FRCP FFPH FAHA Cephalon Professor of Cardiovascular Medicine & Epidemiology University of Warwick, Warwick Medical School, Coventry, UK
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1 Sleep and Obesity – does the egg come before the chicken? Francesco P Cappuccio MD MSc FRCP FFPH FAHA Cephalon Professor of Cardiovascular Medicine &
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Sleep and Obesity – Sleep and Obesity – does the egg come before the chicken?does the egg come before the chicken?
Francesco P Cappuccio MD MSc FRCP FFPH FAHA
Cephalon Professor of Cardiovascular Medicine & Epidemiology
University of Warwick, Warwick Medical School, Coventry, UK
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Historical backgroundHistorical background
Steady decline in total sleep time during the past
100 years, generally attributed to lifestyle changes (increased shift work, longer working hours in less physically
demanding jobs, increased and extended sedentary leisure time
activities, ...)
Parallel increase in the prevalence of overweight
and obesity, particularly evident in the last 25 years,
also attributable to lifestyle changes (increased physical
inactivity, energy intake, …)
Recent indication of a possible association between
short sleep duration and obesity
3
Is there a link between the growing obesity epidemic and the decline in sleeping time?
7.56.8
9.0
0.01.02.03.04.05.06.07.08.09.0
10.0
1910 1975 2005
Average sleep duration (hours)in US adults in the last century
25.2
26.9
23.0
21.0
22.0
23.0
24.0
25.0
26.0
27.0
28.0
1910 1975 2005
Average Body Mass Index in US adults in the last century
BMI and Sleep Duration in US Adults Over TimeBMI and Sleep Duration in US Adults Over Time
4
Prevalence of overweight and obesity Prevalence of overweight and obesity in children and adults in the USAin children and adults in the USA
0
5
10
15
20
25
30
35
402 to 5
6 to 11
12 to 19
20 to 39
40 to 59
60+
20+
%
Adults
Children
5
Mean sleep duration in healthy Mean sleep duration in healthy young adults around the worldyoung adults around the world
0
1
2
3
4
5
6
7
8
9
hr
Men
Women
Steptoe A et al. Arch Int Med 2006;166:1689-92
6
Sleep duration and self-rated health problemsSleep duration and self-rated health problems
0
10
20
30
40
50
6 6.5 7 7.5 8 8.5
hours
% p
oo
r h
ealt
h
Steptoe A et al. Arch Int Med 2006;166:1689-92
Japan
Taiwan
Korea
Thailand
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Weight Relative RiskFirst author Year Sample size Deaths(%) (95% CI)
Kojima (men) 2000 2,438 147 1.00% 1.93 (1.12 to 3.35)
Kojima (women) 2000 2,884 109 1.00% 0.90 (0.50 to 1.61)
Heslop (men) 2002 6,022 2,303 9.00% 1.00 (0.89 to 1.12)
Heslop (women) 2002 1,006 262 2.00% 0.98 (0.70 to 1.37)
Kripke (men) 2002 480,841 45,200 14.00% 1.11 (1.04 to 1.17)
Kripke (women) 2002 636,095 32,440 14.00% 1.07 (1.01 to 1.14)
Mallon (men) 2002 906 165 0.00% 1.11 (0.32 to 3.80)
Mallon (women) 2002 964 101 1.00% 1.00 (0.58 to 1.73)
Amagai (men) 2004 4,419 289 1.00% 2.41 (1.34 to 4.34)
Amagai (women) 2004 6,906 206 0.00% 0.70 (0.21 to 2.35)
Patel 2004 82,969 5,409 9.00% 1.08 (0.96 to 1.22)
Ferrie 2007 9,871 566 3.00% 1.25 (0.93 to 1.67)
Hublin (men) 2007 9,529 1,850 9.00% 1.26 (1.12 to 1.42)
Hublin (women) 2007 10,265 1,850 8.00% 1.21 (1.05 to 1.39)
Lan (men) 2007 1,748 816 4.00% 0.98 (0.76 to 1.26)
Lan (women) 2007 1,331 522 2.00% 1.14 (0.77 to 1.69)
Gangwisch (32-59) 2008 5,806 273 1.00% 0.67 (0.43 to 1.05)
Gangwisch (60-86) 2008 3,983 1,604 6.00% 1.27 (1.07 to 1.52)
Ikehara (men) 2009 41,489 8,548 4.00% 1.28 (1.01 to 1.62)
Ikehara (women) 2009 57,145 5,992 5.00% 1.28 (1.04 to 1.59)
Stone 2009 8,101 1,922 7.00% 1.02 (0.87 to 1.19)
Combined effect: p<0.0001 100% 1.13 (1.07 to 1.19)
Activation of inflammatory markersSedentary extra time
↑ caloric intake
↓ energy expenditure
Sleep disordered breathingDisrupted and short sleep
Inflammatory cytokines and the brain
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Conclusions
The ‘epidemic’ of obesity is paralleled by a ‘silent epidemic’ of reduced sleep duration.
These trends are detectable in adults as well as in children as young as 5 years.
Short sleep duration is associated with increased risk of obesity both in adults and in children.
Evidence from prospective studies does not always confirm a temporal sequence
A plausible mechanism could be the effect of short sleep on appetite through the ghrelin-leptin system
Bi-directional effects (obesity causes lack of sleep) might also explain the association
More research needed to understand the mechanisms by which short sleep is linked to chronic conditions of affluent societies, such as obesity, diabetes and hypertension.
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SLEEP, HEALTH & SOCIETYSLEEP, HEALTH & SOCIETYUniversity of Warwick, Warwick Medical SchoolUniversity of Warwick, Warwick Medical School