Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Investigation of the association between sleep problems and food allergies in preschool children with/without siblings: a cross-sectional study in Chongqing, China

  • Received : 2023.05.31
  • Accepted : 2023.09.05
  • Published : 2023.10.31
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Abstract

Purpose: This study investigated the association between sleep problems and food allergies (FAs) in Chinese preschoolers and assessed whether there is a difference in this association among children with/without siblings. Methods: A cluster-stratified sampling approach was employed to select four districts in Chongqing based on demographic considerations. A total of 16 kindergartens (n = 966 parents) participated in this study. Parents completed the Children's Sleep Habits Questionnaire (CSHQ) and a standard FAs questionnaire. Analysis of covariance and multiple logistic regression were used to assess the associations between sleep problems and FAs after adjusting for relevant confounders. Results: The study found that 16.3% of children had FAs, with eggs, shellfish, and fruit being the most common allergenic foods. The prevalence of FAs was significantly higher in single children (20.63%) than in children with siblings (13.36%). A total of 70.39% of children had CSHQ scores above the clinical cut-off for sleep disorder. Factor analysis revealed five underlying dimensions from the CSHQ. Factor scores, except for the 'difficulty morning waking' factor, were not significantly different between the two groups. Remarkably, the factor scores of 'parasomnias' and 'sleep anxiety' were significantly higher when children had both siblings and FAs. For all subjects, the odds ratios (ORs) of FAs significantly increased with the presence of sleep disorder (OR, 2.35; 95% confidence interval [CI],1.50-3.68) and 'difficulty falling asleep' (OR, 1.34; 95% CI, 1.22-1.48). The subgroup analysis showed that the probability of FAs significantly increased with the 'difficulty falling asleep' (OR, 1.32 vs. 1.38) and sleep disorder (OR, 2.48 vs. 2.14) in children with and without siblings, respectively. The 'parasomnias' was positively associated only with children with siblings. Conclusion: This study suggests that children with siblings might be more susceptible to FAs when accompanied by certain sleep problems. Further studies are warranted to address the underlying dimensions and possible mediation effects of having siblings with sleep problems.

Keywords

Acknowledgement

We would like to thank all leaders and teachers of kindergartens who helped us coordinate the survey and all parents. We would like to acknowledge Xin Zhao, Mao Zou, and Jing Gao's support during the field investigation. We would like to thank the support of the Chongqing Collaborative Innovation Center for Child Nutrition and Health Development, Chongqing University of Education.

References

  1. Carter KA, Hathaway NE, Lettieri CF. Common sleep disorders in children. Am Fam Physician 2014;89(5):368-377. 
  2. Ma Y, Tang J, Wen Y, Hu Y, Liang J, Jiang L, et al. Associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers. Sci Rep 2022; 12(1): 8102.
  3. Gomez-Gonzalez B, Dominguez-Salazar E, Hurtado-Alvarado G, Esqueda-Leon E, Santana-Miranda R, Rojas-Zamorano JA, et al. Role of sleep in the regulation of the immune system and the pituitary hormones. Ann N Y Acad Sci 2012; 1261(1): 97-106. https://doi.org/10.1111/j.1749-6632.2012.06616.x
  4. Urrutia-Pereira M, Sole D, Chong Neto HJ, Acosta V, Cepeda AM, Alvarez-Castello M, et al. Sleep disorders in Latin-American children with asthma and/or allergic rhinitis and normal controls. Allergol Immunopathol (Madr) 2017; 45(2): 145-151. https://doi.org/10.1016/j.aller.2016.05.005
  5. Renz H, Allen KJ, Sicherer SH, Sampson HA, Lack G, Beyer K, et al. Food allergy. Nat Rev Dis Primers 2018; 4(1): 17098.
  6. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010; 65(8): 933-945. https://doi.org/10.1111/j.1398-9995.2010.02342.x
  7. Prescott S, Allen KJ. Food allergy: riding the second wave of the allergy epidemic. Pediatr Allergy Immunol 2011; 22(2): 155-160. https://doi.org/10.1111/j.1399-3038.2011.01145.x
  8. Wei Z, Jing Z, Huilian C, Jianguo H, Li H, Hong L, et al. Evidence-based clinical practice guideline: food allergy in children. Zhonghua Shiyong Erke Linchuang Zazhi 2022; 37(08): 572-83. 
  9. Du Toit G, Foong RX, Lack G. Prevention of food allergy - early dietary interventions. Allergol Int 2016; 65(4): 370-377. https://doi.org/10.1016/j.alit.2016.08.001
  10. Halken S, Muraro A, de Silva D, Khaleva E, Angier E, Arasi S, et al. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol 2021; 32(5): 843-858. https://doi.org/10.1111/pai.13496
  11. China National Center for Food Safety Risk Assessment. The explanation of the top ten-hot debate issue of food safety and health in 2020 [Internet] Beijing: China National Center for Food Safety Risk Assessment; 2021 [cited 2023 Jul 31]. Available from: https://cfsa.net.cn/article/News.aspx?id=A15A9B67DE0E39EB778CBAC0CD562C035B8584CC5640A1E1. 
  12. Benede S, Blazquez AB, Chiang D, Tordesillas L, Berin MC. The rise of food allergy: environmental factors and emerging treatments. EBioMedicine 2016; 7: 27-34. https://doi.org/10.1016/j.ebiom.2016.04.012
  13. Dominguez-Ortega G, Borrelli O, Meyer R, Dziubak R, De Koker C, Godwin H, et al. Extraintestinal manifestations in children with gastrointestinal food allergy. J Pediatr Gastroenterol Nutr 2014; 59(2): 210-214. https://doi.org/10.1097/MPG.0000000000000391
  14. Wasilewska J, Kaczmarski M, Protas PT, Kowalczuk-Kryston M, Mazan B, Topczewska M. Sleep disorders in childhood and adolescence, with special reference to allergic diseases. Pol Merkuriusz Lek 2009; 26(153): 188-193.
  15. Filiz S, Keles S, Akbulut UE, Isik IA, Kara MZ. Sleep disturbances and affecting factors in young children with food allergy and their mothers. Allergol Immunopathol (Madr) 2020; 48(2): 158-164. https://doi.org/10.1016/j.aller.2019.06.014
  16. Wang X, Gao X, Yang Q, Wang X, Li S, Jiang F, et al. Sleep disorders and allergic diseases in Chinese toddlers. Sleep Med 2017; 37: 174-179. https://doi.org/10.1016/j.sleep.2017.02.011
  17. Tatum M. China's three-child policy. Lancet 2021; 397(10291): 2238.
  18. Chongqing Municipal Bureau of Statistics. Data of the seventh National Population Census of Chongqing Municipality Chongqing [Internet]. Chongqing: Chongqing Municipal Bureau of Statistics; 2021 [cited 2023 Jul 17]. Available from: http://tjj.cq.gov.cn/zwgk_233/fdzdgknr/tjxx/sjjd_55469/202105/t20210513_9277447.html. 
  19. Laursen MF, Zachariassen G, Bahl MI, Bergstrom A, Host A, Michaelsen KF, et al. Having older siblings is associated with gut microbiota development during early childhood. BMC Microbiol 2015; 15(1): 154.
  20. Breitenstein RS, Doane LD, Clifford S, Lemery-Chalfant K. Children's sleep and daytime functioning: Increasing heritability and environmental associations with sibling conflict. Soc Dev 2018; 27(4): 967-983. https://doi.org/10.1111/sode.12302
  21. Georgountzou A, Papadopoulos NG. Postnatal innate immune development: from birth to adulthood. Front Immunol 2017; 8: 957.
  22. Chen X, Ke ZL, Chen Y, Lin X. The prevalence of sleep problems among children in mainland China: a meta-analysis and systemic-analysis. Sleep Med 2021; 83: 248-255. https://doi.org/10.1016/j.sleep.2021.04.014
  23. Ma Z, Chen L, Xian R, Fang H, Wang J, Hu Y. Time trends of childhood food allergy in China: three cross-sectional surveys in 1999, 2009, and 2019. Pediatr Allergy Immunol 2021; 32(5): 1073-1079. https://doi.org/10.1111/pai.13490
  24. World Health Organization. Measuring change in nutritional status: guidelines for assessing the nutritional impact of supplementary feeding programmes for vulnerable groups. Geneva: World Health Organization; 1983. 
  25. Chuang Y, Ling Y, Zhenxing L, Xiang G, Hang L, Hong L. Assess food allergy risk from allergen hazards. Zhongguo Shipin Weisheng Zazhi 2021; 33(3): 383-391. 
  26. Zeng GQ, Luo JY, Huang HM, Zheng PY, Luo WT, Wei NL, et al. Food allergy and related risk factors in 2540 preschool children: an epidemiological survey in Guangdong Province, southern China. World J Pediatr 2015; 11(3): 219-225. https://doi.org/10.1007/s12519-015-0030-6
  27. Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 2000; 23(8): 1043-1051. https://doi.org/10.1093/sleep/23.8.1d
  28. Liu Z, Wang G, Tang H, Wen F, Li N. Reliability and validity of the Children's Sleep Habits Questionnaire in preschool-aged Chinese children. Sleep Biol Rhythms 2014; 12(3): 187-193. https://doi.org/10.1111/sbr.12061
  29. Tan TX, Wang Y, Cheah CS, Wang GH. Reliability and construct validity of the Children's Sleep Habits Questionnaire in Chinese kindergartners. Sleep Health 2018; 4(1): 104-109. https://doi.org/10.1016/j.sleh.2017.10.008
  30. Dai H, Wang F, Wang L, Wan J, Xiang Q, Zhang H, et al. An epidemiological investigation of food allergy among children aged 3 to 6 in an urban area of Wenzhou, China. BMC Pediatr 2020; 20(1): 220.
  31. Sha L, Shao M, Liu C, Wu Y, Chen Y. A cross-sectional study of the prevalence of food allergies among children younger than ages 14 years in a Beijing urban region. Allergy Asthma Proc 2019; 40(1): e1-e7. https://doi.org/10.2500/aap.2019.40.4193
  32. Xie HL, Shao MJ, Liu CH, Sun ZH, Sha L, Chen YZ. Epidemiology of food allergy in children from 31 cities in China. Int J Pediatr 2017; 044(009): 637-641.
  33. Rangkakulnuwat P, Lao-Araya M. The prevalence and temporal trends of food allergy among preschool children in Northern Thailand between 2010 and 2019. World Allergy Organ J 2021; 14(10): 100593.
  34. Ziyab AH. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: a cross-sectional study. World Allergy Organ J 2019; 12(4): 100024.
  35. Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011; 127(3): 668-676.e1. https://doi.org/10.1016/j.jaci.2011.01.039
  36. Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, et al. The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immunol 2017; 140(1): 145-153.e8. https://doi.org/10.1016/j.jaci.2017.02.019
  37. Leung TF, Yung E, Wong YS, Lam CW, Wong GW. Parent-reported adverse food reactions in Hong Kong Chinese pre-schoolers: epidemiology, clinical spectrum and risk factors. Pediatr Allergy Immunol 2009; 20(4): 339-346. https://doi.org/10.1111/j.1399-3038.2008.00801.x
  38. Zotova V, Clarke AE, Chan ES, Asai Y, Chin R, Van Lambalgen C, et al. Low resolution rates of seafood allergy. J Allergy Clin Immunol Pract 2019; 7(2): 690-692. https://doi.org/10.1016/j.jaip.2018.09.011
  39. Sneddon P, Peacock GG, Crowley SL. Assessment of sleep problems in preschool aged children: an adaptation of the children's sleep habits questionnaire. Behav Sleep Med 2013; 11(4): 283-296. https://doi.org/10.1080/15402002.2012.707158
  40. World Health Organization. WHO coronavirus (COVID-19) dashboard 2023 [Internet]. Geneva: World Health Organization; 2023 [cited 2023 Apr 24]. Available from: https://covid19.who.int/. 
  41. Morin CM, Carrier J. The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Med 2021; 77: 346-347. https://doi.org/10.1016/j.sleep.2020.06.005
  42. Hu Z, Song X, Hu K. The effect of short sleep duration on the development of asthma. Int J Clin Pract 2022; 2022: 3378821.
  43. Chua RX, Tay MJ, Ooi DS, Siah KT, Tham EH, Shek LP, et al. Understanding the link between allergy and neurodevelopmental disorders: a current review of factors and mechanisms. Front Neurol 2021; 11: 603571. 
  44. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006; 166(16): 1756-1762. https://doi.org/10.1001/archinte.166.16.1756
  45. Hu Z, Song X, Hu K, Ruan Y, Zeng F. Association between sleep duration and asthma in different weight statuses (CHNS 2009-2015). Sleep Breath 2021; 25(1): 493-502. https://doi.org/10.1007/s11325-020-02081-6
  46. Strachan DP. Hay fever, hygiene, and household size. BMJ 1989; 299(6710): 1259-1260. https://doi.org/10.1136/bmj.299.6710.1259
  47. Berin MC, Sampson HA. Mucosal immunology of food allergy. Curr Biol 2013; 23(9): R389-R400. https://doi.org/10.1016/j.cub.2013.02.043
  48. Peng X, Yuan G, Ma N. Cosleeping and sleep problems in children: a systematic review and meta-analysis. Sleep Biol Rhythms 2019; 17(4): 367-378. https://doi.org/10.1007/s41105-019-00226-z
  49. Gultekin T, Bayik-Temel A. Sleep problems and effective factors in preschool children. Florence Nightingale J Nurs 2020; 28(2): 164-173. https://doi.org/10.5152/FNJN.2020.18063
  50. Wu R, Wang GH, Zhu H, Jiang F, Jiang CL. Sleep patterns in Chinese preschool children: a population-based study. J Clin Sleep Med 2018; 14(4): 533-540. https://doi.org/10.5664/jcsm.7038