A pilot study to determine the short-term effects of milk with differing glycaemic properties on sleep among toddlers: a randomised controlled trial

Snigdha Misra, Geok L Khor, Peter Mitchell, Samsul Haque, David Benton, Snigdha Misra, Geok L Khor, Peter Mitchell, Samsul Haque, David Benton

Abstract

Background: Sleep is important for children as it directly impacts their mental and physical development. Sleep is not only influenced by the timing but also the macronutrient (carbohydrate and protein) content of meals. Glycaemic index (GI) and glycaemic load (GL) describe the quality of carbohydrates in a food and the burden of these foods on the body's blood glucose response. Diets with a high GI/GL may increase the risk of developing obesity and type 2 diabetes mellitus in adulthood. The present study is piloted to evaluate the short-term impact of milk products with differing glycaemic properties on the sleep patterns of toddlers.

Methods: Toddlers were recruited from various day care centres. Informed consent was obtained from both the mothers and the centres. A double-blind randomised controlled trial with a between-subjects design was adopted. The toddlers were randomised to either one of two types of milk with a differing GI ("Low" = 23 and "High = 65") for a period of 3.5 days. There were no other dietary restrictions imposed except that the enrolled child did not consume any other milk during the study period. The sleep patterns were recorded using a Phillips Actiwatch-2, which was worn on the wrist for 24 h over 4 days. The parameters used to measure the sleep pattern were sleep-onset latency (SOL), total sleep time (TST), wake after sleep onset (WASO) and sleep efficiency (SE).

Results: A total of 56 toddlers completed the study. The toddlers had a mean age of 19.9 ± 4.3 months. There were no significant differences (p > 0.05) between the two GI groups for SOL, TST, WASO and SE at the end of the feeding period.

Conclusions: Sleep patterns of toddlers on low-GI milk did not differ from those with high-GI milk consumed over a short period. Future studies should consider the glycaemic effects of other foods, along with milk with differing GI, consumed for a longer feeding duration.

Trial registration: ClinicalTrial.gov NCT01589003.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) diagram for the flow of enrolment of the toddlers. LGI and HGI respectively represent the groups administered a low or high glycaemic index milk product

References

    1. Carskadon MA, Dement WC. Normal Human Sleep: An Overview. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 4. Philadelphia: Elsevier Saunders; 2005. pp. 13–23.
    1. Thoman EB. Sleeping and waking states in infants: a functional perspective. Neurosci Biobehav Rev. 1990;14:93–107. doi: 10.1016/S0149-7634(05)80165-4.
    1. Grigg-Damberger M, Gozal D, Marcus CL, Quan SF, Rosen CL, Chervin RD, Wise M, Picchietti DL, Sheldon SH, Iber C. The visual scoring of sleep and arousal in infants and children. J Clin Sleep Med. 2007;3:201–240.
    1. Parmelee AH, Stern E. Development of States in Infants. In: Clemente CD, Purpura DP, Mayer FE, editors. Sleep and the Maturing Nervous System. New York: Academic; 1972. pp. 199–228.
    1. Coons S, Guilleminault C. Development of sleep-wake patterns and non-rapid eye movement sleep stages during the first six months of life in normal infants. Pediatrics. 1982;69:793–798.
    1. Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
    1. Dollander M. Etiology of adult insomnia. Encephale. 2002;28:493–502.
    1. Tae Won K, Jong-Hyun J, Seung-Chul H. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015. doi:10.1155/2015/591729.
    1. Pietrowsky R, Meyrer R, Kern W, Born J, Fehm HL. Effects of diurnal sleep on secretion of cortisol, luteinizing hormone, and growth hormone in man. Journal of Clinical Endocrinology and Metabolism. 1994;78(3):683–687.
    1. Weibel L, Follenius M, Spiegel K, Gronfier C, Brandenberger G. Growth hormone secretion in night workers. Chronobiology International. 1997;14(1):49–60. doi: 10.3109/07420529709040541.
    1. Van Cauter E, Kerkhofs M, Caufriez A, Van Onderbergen A, Thorner MO, Copinschi G. A quantitative estimation of growth hormone secretion in normal man: reproducibility and relation to sleep and time of day. Journal of Clinical Endocrinology and Metabolism. 1992;74(6):1441–1450.
    1. Roky R, Chapotot F, Hakkout F, Benchekroun MT, Buguet A. Sleep during Ramadan intermittent fasting. J Sleep Res. 2001;10:319–27. doi: 10.1046/j.1365-2869.2001.00269.x.
    1. Porter JM, Horn JA. Bed-time food supplement and sleep: effect of different carbohydrate levels. Electromyogr Clin Neurophysiol. 1981;51:426–33. doi: 10.1016/0013-4694(81)90106-1.
    1. Wells AS, Read NW, Uvnas-Moberg K, Alster P. Influences of fat and carbohydrate on postprandial sleepiness, mood, and hormones. Physiol Behav. 1997;61:679–86. doi: 10.1016/S0031-9384(96)00519-7.
    1. Hartmann E, Spinweber CL. Sleep induced by L-tryptophan: effect of dosages within the normal dietary intake. J Nerv Ment Dis. 1979;167:497–9. doi: 10.1097/00005053-197908000-00008.
    1. Hartmann E. Effect of L-Tryptophan on sleepiness and on sleep. J Psychiatr Res. 1982/83;17:107–13.
    1. Fernstron JD, Wurtman RJ. Brain serotonin content: physiological regulation by plasma neutral amino acids. Science. 1972;178:414–6. doi: 10.1126/science.178.4059.414.
    1. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunešová M, Pihlsgård M, Stender S, Holst C, Saris WH, Astrup A. Diets with high or low protein content and glycaemic index for weight-loss maintenance. N Engl J Med. 2010;363(22):2102–13. doi: 10.1056/NEJMoa1007137.
    1. Barclay A, Petocz P, McMillan-Price J, Flood V, Prvan T, Brand-Miller J. Glycaemic index, glycaemic load and chronic disease risk: a meta-analysis. American Journal of Clinical Nutrition. 2008;87:627–37.
    1. Fernstrom JD. Tryptophan Availability and Serotonin Synthesis in Brain. In: Huether G, editor. NATO ASI Series, Vol H 20, Amino acid Availability and Brain Function in Health and Disease. Berlin: Springer-Verleg; 1988.
    1. Wurtman RJ, Wurtman JJ, Regan MM, McDermott JM, Tasay RH, Breu JJ. Effect of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. Am J Clin Nutr. 2003;77:128–32.
    1. De Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among pre-school children. Am J Clin Nutr. 2010;92(5):1257–64. doi: 10.3945/ajcn.2010.29786.
    1. National Coordinating Committee on Food and Nutrition. Ministry of Health Malaysia . Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya, Malaysia: MOH; 2013.
    1. Khor GL, Shariff ZM, Sariman S, Huang SLM, Mohamad M, et al. Milk drinking patterns among Malaysian Urban children of different household income status. J Nutr Health Sci. 2014;1(4):403.
    1. Brand-Miller J, Atkinson F, Rowan A. Effect of added carbohydrates on glycaemic and insulin responses to children’s milk products. Nurients. 2013;5:23–31. doi: 10.3390/nu5010023.
    1. Willett W, Manson J, Liu S. Glycaemic index, glycaemic load, and risk of type 2 diabetes. Am J Clin Nutr. 2002;76 Suppl:274S–80S.
    1. Laposky AD, Bass J, Kohsaka A, Turek FW. Sleep and circadian rhythms: key components in the regulation of energy metabolism. FEBS Lett. 2008;582:142–51. doi: 10.1016/j.febslet.2007.06.079.
    1. Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9(Suppl 1):S23–8. doi: 10.1016/S1389-9457(08)70013-3.
    1. Crisp AH. Sleep, activity, nutrition and mood. Br J Psychiatry. 1980;137:1–7. doi: 10.1192/bjp.137.1.1.
    1. Waterhouse J, Minors D, Atkinson G, Benton D. Chronobiology and meal times: internal and external factors. Br J Nutr. 1997;77(Suppl 1):S29–38. doi: 10.1079/BJN19970102.
    1. Yehuda S, Rabinovitz S, Mostofsky DI. Essential fatty acids and sleep: mini-review and hypothesis. Med Hypotheses. 1998;50:139–45. doi: 10.1016/S0306-9877(98)90200-6.
    1. García-García F, Drucker-Colín R. Nutritional impact on sleep-wake cycle. Nestle Nutr Workshop Ser Clin Perform Programme. 2001;5:189–97. doi: 10.1159/000061851.
    1. Roenneberg T, Kuehnle T, Juda M, Kantermann T, Allebrandt K, Gordijn M, et al. Epidemiology of the human circadian clock. Sleep Med Rev. 2007;11:429–38. doi: 10.1016/j.smrv.2007.07.005.
    1. Peuhkuri K, Sihvola N, Korpela R. Diet promotes sleep duration and quality. Nutrition Research. 2012;32:309–319. doi: 10.1016/j.nutres.2012.03.009.
    1. Diethelm K, Remer T, Jilani H, Kunz C, Buyken AE. Associations between the macronutrient composition of the evening meal and average daily sleep duration in early childhood. Clin Nutr. 2011;30:640–646. doi: 10.1016/j.clnu.2011.05.004.
    1. UNICEF and WHO . United Nations Children’s Fund and World Health Organization, Low Birth weight: Country, regional and global estimates. New York: UNICEF; 2004.
    1. Nancy MD, Rebecca FG, Andrea M, Juhani M, Noel CB. Comparison of the New World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 Nutrition Program in Niger. Arch Pediatr Adolesc Med. 2009;163(2):126–130. doi: 10.1001/archpediatrics.2008.540.
    1. Jennifer LM, Alex DH. Wrist Actigraphy. Chest. 2011;139(6):1514–1527. doi: 10.1378/chest.10-1872.
    1. Afaghi A, O’Connor H, Chow CM. High-glycaemic-index carbohydrate meals shorten sleep onset. Am J Clin Nutr. 2007;85:426e30.
    1. Jalilolghadr S, Afaghi A, O’Connor H, Chow CM. Effect of low and high glycaemic index drink on sleep pattern in Children. J Pak Med Assoc. 2011;61(6):533–6.
    1. Laurent J, Catanzaro SJ, et al. A measure of positive and negative affect for children: scale development and preliminary validation. Psychological Assessment. 1999;11(3):326–338. doi: 10.1037/1040-3590.11.3.326.
    1. Kwan RM, Thomas S, Mir MA. Effects of a low carbohydrate isoenergetic diet on sleep behavior and pulmonary functions in healthy female adult humans. J Nutr. 1986;116:2393–402.
    1. National Coordinating Committee on Food and Nutrition, Malaysia (NCCFN) Recommended Nutrient Intakes. Malaysia: Institute of Medical Research, Ministry of Health; 2005.
    1. Kranzler JH. Assessment of children and youth from culturally and linguistically diverse backgrounds with mental chronometric techniques. Percept Mot Skills. 1998;86:321–2. doi: 10.2466/pms.1998.86.1.321.
    1. Kranzler JH. Educational policy issues related to the use and interpretation of intelligence tests in the schools. School Psyc Rev. 1997;26:150–163.
    1. Canivez GL, Watkins MW. Long-term stability of the Wechsler intelligence scale for children. Third Edition. Psycholl Assess. 1998;10:285–291. doi: 10.1037/1040-3590.10.3.285.
    1. Berry EM, Growdon JH, Wurtman JJ, Caballero B, Wurtman RJ. A balanced carbohydrate: protein diet in the management of Parkinson’s disease. Neurology. 1991;41:1295–7. doi: 10.1212/WNL.41.8.1295.
    1. Silber BY, Schmitt JA. Effects of tryptophan loading on human cognition, mood, and sleep. Neurosci Biobehav Rev. 2010;34:387e407. doi: 10.1016/j.neubiorev.2009.08.005.
    1. Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY. Cross-cultural differences in infant and toddler sleep. Sleep Med. 2010;11(3):274–80. doi: 10.1016/j.sleep.2009.04.012.
    1. Pierre JM, Igor Allaman. Brain Energy Metabolism. Neuroscience in the 21st Century. Springer Science and Business media; 2013.p 1591–1620.
    1. Micha R, Rogers PJ, Nelson M. Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomised controlled trial. Br J Nutr. 2011;106(10):1552–61. doi: 10.1017/S0007114511002303.
    1. Afaghi A, O’Connor H, Chow CM. Acute effects of the very low carbohydrate diet on sleep indices. Nutr Neurosci. 2008;11:146e54. doi: 10.1179/147683008X301540.
    1. Malaysia Classification of Occupations (MASCO) 3rd Edition. Ministry of Human Resources, Putrajaya, Malaysia; 2008.

Source: PubMed

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