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Corresponding Author Yiming Li. Introduction: In the past two decades, urbanization in many Asian countries has led to sedentary lifestyle and overnutrition, which has set the stage for the epidemic of obesity. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Recent data suggest that short sleep duration may contribute to the risk of obesity, opening a new avenue for potential intervention. The aim of Fat women in China who need sex study was to describe the prevalence of sleeping time, body mass index BMIand fat mass in Chinese freshmen and to indicate the relationship among them.
Methods: We conducted a cross-sectional study consisting of 1, freshmen aged from 18 to 24 years, including BMI, sleeping time, and Fat women in China who need sex potential related variables were collected by questionnaire. Conclusion: Longer sleeping time was associated with a lower Fat women in China who need sex in Chinese freshmen, even after adjustment for multiple confounders. The overweight stage is a critical period of weight management intervention by changing sleeping time.
If adolescents have entered the obesity stage, the effect size of lifestyle intervention might be ificantly limited. The prevalence and severity of obesity and overweight in different cohorts has been increasing worldwide and has more than doubled since In Asia, the prevalence of obesity was very low ly and recently is increasing at an alarming rate, especially in China, Japan, and India [ 1 ].
The of Chinese obese people was below 0. Adolescent obesity is an important predictor of obesity in adulthood. Compared to healthy weight youths, the risk of becoming obese in adulthood is approximately five times higher among boys and nine times higher among girls who are obese in youth [ 3 ]. It has long been known that obesity is associated with numerous comorbidities, including cardiovascular diseases, diabetes mellitus [ 4 ], musculoskeletal disorders [ 5 ], and several cancers [ 6 ].
Adults with obesity who also had obesity during adolescence have a higher risk of developing complications of obesity than those who become obese during adulthood but were normal weight during adolescence [ 78 ]. Furthermore, emerging evidence shows that childhood and adolescent obesity is positively related to weight gain in adults.
Without intervention, these comorbidities, as well as obesity itself, usually continue into adulthood, which can result in premature death [ 8 - 11 ]. In addition, adults with obesity are likely to have children with obesity, thus passing all the problems of obesity on to the next generation [ 12 - 15 ]. As a result, obesity and overweight would cause expensive and difficult socioeconomic problems, which need continued effort to identify modifiable risk factors for them.
Because the constellation of cardiometabolic risk factors is considered to be modifiable, the early identification of and intervention for adolescents with metabolic syndrome is an important contention for public health to improve their condition. Although genetic factors play an important role in the pathogenesis of obesity, human behavior and lifestyle, such as physical activity [ 16 ] and dietary habits [ 17 ], are also critical contributors to its clinical manifestation.
In parallel with the growing epidemics of obesity and overweight, sleeping time is decreasing in modern society. In the United States, data from the National Health Interview Survey NHIS has shown that self-reported mean sleeping time decreased by 10—15 min from towhile the percentage of adults reporting less than 6 h of sleep per night increased from Insufficient sleep may lead to negative social, psychological, and public health consequences, including motor vehicle accidents [ 19 ], poor functioning at school or work, and physical diseases [ 20 ].
Evidence from laboratory [ 21 ] and epidemiological studies [ 22 ] is accumulating to suggest the association between sleep deprivation and obesity [ 23 ]. On the other hand, investigators from the United States [ 24 ] have conducted cross-sectional studies together with prospective studies demonstrating an increased risk for overweight status or obesity in children, adolescents, and adults who have shorter sleep.
As in the West, studies in Asian populations are on the rise simultaneously [ 25 ]. However, the relation between decreasing sleeping time and increasing obesity incidence is under debate. Some studies have reported U-shaped association [ 26 ], whereby both short and long sleeping time are associated with higher body mass index BMIwhile some others have found reverse association [ 27 ] in which shorter sleeping time is associated with greater BMI. Irrelevant association [ 28 ] has been documented as well.
Sleeping Fat women in China who need sex is differentially associated with BMI across population subgroups, such as sex or age. Some studies have found stronger associations among males, others have shown stronger effects among women or no sex difference [ 32 ].
Moreover, Hasler et al. More work is needed to establish whether the short sleep-obesity association is causal. China has experienced rapid socioeconomic growth over the past several decades, which has led to a transformation of lifestyle. The efficacy of lifestyle interventions to treat obesity has been proven for adolescents in randomized controlled trials and clinical studies, and lifestyle interventions are the recommended therapy for adolescents with obesity [ 34 ].
Few studies [ 35 ] have examined the association in a sample of youths, to our knowledge. College students are a special group, which is an important component of the overall health level of the society. This age group merits attention, as the transition to adulthood is associated with important changes in personal circumstances and behaviors that may impact both sleep and BMI.
Therefore, it is important to study their sleep quality, as well as the relationship between sleep quality and body type. In addition, the government and school-related departments concerned should place great importance on the mental and physical health of college students [ 3637 ]. Given the myriad factors that have been implicated in obesity in studies, adjustment for multiple confounders has not always been undertaken. While most studies have used BMI as primary outcome, there have been few studies assessing the change in body composition such as body fat percentage. Consequently, our group focused on the prevalence of sleeping time, BMI, and body fat percentage in Shanghai freshmen, tried to illustrate the relation among them, and tried to open some new avenues for potential intervention.
This study was a cross-sectional survey of to year-olds in a multidisciplinary university, named Shanghai University of Finance and Economics, where students were recruited nationwide. All freshmen in this university were recruited during the first fall semester Trained investigators administered the questionnaire survey to students and measured relevant indicators. Sixty-two participants were excluded because of missing information or having abnormal medical examination including heart, liver, and kidney dysfunction and thyroid-stimulating hormone abnormalities, and 1, students males and 1, females participated in this baseline survey.
Students recruited in this study came from Fat women in China who need sex provinces, 4 municipalities of China including Han and minority.
The study was approved by the institutional review board of Huashan Hospital, Fudan University. All participants agreed to provide their personal information regarding the purpose and the procedures of our study, and written informed consent was obtained. Information on sociodemographic features, weight perception, dieting practices, disease history, family disease history, residential information, and a 2-year diet habit recall were collected through questionnaires.
Medical examination was performed by experienced doctors from Huashan Hospital. In brief, height was assessed to the nearest 0. The waist circumference was determined at the midline from the lower rib margin to the iliac crest to the nearest 0. To fully grasp the scope of the obesity problem in Asia, one should understand that there are notable differences between the Asian and Western populations in terms of lifestyle, genetics, and body composition. In particular, Asians are more likely to have central fat deposition despite having a lower BMI [ 40 ]. This has led some to recommend different BMI cut-off points for the Asian population.
Generally, obesity is conceptualized as maintaining a BMI higher than 30, whereas in China according to Zhou, it is proposed that the cutoff points for overweight and obesity were 24 and 28, respectively. A segmental bioelectrical impedance analysis scale Tanita, type BC, Japan was used to measure body fat percentage, fat mass, and fat-free mass. All students were divided into three groups according to the tertiles of the body fat percentage.
Appropriate and healthy sleep durations vary with age. Sleep duration tends to decrease with age during childhood and adolescence. The differences of general characteristics at baseline according to BMI classification were assessed by t test or chi-square test. An unadjusted model and a multivariate model were used for the estimation of association between sleeping time and Fat women in China who need sex. The factors with ificant differences in univariate analysis were included in multivariate analysis. The multivariate model used in this study was adjusted for sex, diet control, maternal obesity, and sleeping time.
Since the variance inflation factor is less than 10, there is no multicollinearity among variables, which could be included in multivariate analysis. Statistical analysis was carried out using the SPSS version There was no ificant difference in the distribution of ethnicity between different sexes. The mean BMI of the total sample was The mean body fat percentage was Table 1 shows demographic characteristics, anthropometric measures, and sleeping time across sexes. Demographic characteristics of participants according to sex classification.
As depicted in Figure 1there was an inverse association between BMI, body fat percentage, and sleeping time. Participants sleeping 6—8 h were in between Likewise, body fat percentage showed a similar trend along with sleeping time.
Figures are means SE in sleeping time groups. Table 2 and 3 present the association between BMI and related factors for both univariate and multivariate models. After adjustment for the known covariates in multivariate model, there were substantial changes of p values and ORs in the estimate of sex, diet control, maternal obesity, and sleeping time. Unadjusted odds ratios and multivariate adjusted odds ratios for body fat percentage tertile 3 versus tertiles 1 and 2.
The prevalence of overweight and obesity has reached epidemic proportions in Western nations and has been increasing in developing nations as well. The growing rates of obesity have important health consequences, including increasing the risk of a host of diseases including degenerative t disease, type 2 diabetes, cardiovascular disease, and obesity-associated malignancies. Obesity in children and adolescent appears to be predominantly a problem of the rich in low- and middle-income countries.
Body weight is influenced by an interaction of factors including dietary behaviors, physical activity, sedentary behaviors, and genetic predisposition, among others. These determinants are themselves affected by complex multilevel interacting Fat women in China who need sex at the individual, interpersonal, and societal levels [ 43 ]. As economic transition advances, it is predicted that the current mean BMI trends depicted in developing nations will surpass even the maximum mean BMI values reported in developed countries.
Such an increase in overweight can be attributed to ificant alterations in eating habits and physical activity level caused by socioeconomic influences [ 44 ]. The literature documents socioeconomic gradients in dietary behaviors [ Fat women in China who need sex46 ] and sedentary behaviors [ 4748 ], with youths from a low socioeconomic background generally displaying more unfavorable behaviors.
Besides this, recent data suggests that poor sleep habits may contribute to the risk of obesity, opening a new avenue for potential intervention [ 49 ]. In this paper, we describe the characteristics of sleeping time, BMI, and fat mass in Chinese freshmen and indicate the relationship among them. Freshmen recruited in the current survey comprise a variety of multiethnic and socioeconomically diverse samples.
As in our study, it seems that Chinese freshmen have a thinner body shape with mean BMI Females seem more likely to be obese than males. Similarly, females tend to contain higher body fat percentage. There is no ificant difference in sleeping time across sexes.
The present are generally consistent with inverse association between sleeping time and BMI, body fat percentage across different regarding populations of youths [ 27 ], which does not corroborate a U-shaped association as shown in several studies [ 26 ]. The ificant differences of confounders including sex, diet control, and maternal obesity in BMI and body fat percentage persist despite of the adjustment used. It should be noted that the association between BMI, body fat percentage, and sleeping time.
This suggests that the overweight stage is a critical period of weight management intervention by changing sleeping time. If adolescents have entered the obesity stage, the effect size of lifestyle intervention might be ificantly reduced. The mechanisms underlying the relationship between sleeping and obesity or BMI remain incompletely understood. Proposed mechanisms explaining the shortened sleep associated with higher BMI and body fat percentage include i added time awake provides more opportunity to eat; ii increased hunger from hormones aling appetite and reduced satiety from hormones promoting satiation; iii altered thermoregulation; and iv increased fatigue, implying lower physical activity level [ 50 - 53 ].
Experiments have suggested that sleep curtailment seems to increase sympathetic nervous system activity. Meanwhile, various changes of hormones have resulted from insufficient sleep, such as increased evening cortisol, growth hormone and ghrelin level, reduced thyroid-stimulating hormone and leptin [ 54 ]. Not only physical changes may increase appetite especially for energy-rich food like snacks [ 56 ], but also sleep deprivation itself may offer more opportunities to eat [ 57 ]. Another plausible explanation is that individuals who get insufficient sleep are more likely to experience fatigue, which could make them prefer Fat women in China who need sex engage in sedentary behaviors rather than physical activity [ 57 ].
The strengths of our study include a large sample size, the use of well-trained interviewers, and the valuable data pool. This study is a cluster sampling study from the real-world evidence. We collected data of all freshmen in this multidisciplinary university and described the characteristics of BMI, body fat percentage, and sleeping time.
Although the present study was conducted in Shanghai alone, it incorporated 23 provinces, 4 municipalities of China including Han and minority, which could be crudely representative of the national data. Moreover, the body composition was considered in the present survey, which made up for the limitation of BMI as the only assessment of body weight state. Adjustment for multiple confounders mitigates the potential effects on statistics of variables.
Our support the conclusion that sleeping time is associated with BMI and body composition in Asian young adults. However, there are several limitations in our study as well.Fat women in China who need sex
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Visceral fat area is the measure of obesity best associated with mobility disability in community dwelling oldest-old Chinese adults