BACKGROUND: Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. METHODS: The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. RESULTS: One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]). CONCLUSION: The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.

Department of Biometry and Data Management Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH Achterstrasse 30 28359 Bremen Germany

Department of Food and Nutrition National Center of Public Health and Analyses 15 Akad Ivan Evstatiev Geshov Blvd 1431 Sofia Bulgaria

Department of Preventive Medicine Lithuanian University of Health Sciences Eiveniu str 4 50009 Kaunas Lithuania

Division of Noncommunicable Diseases and Promoting Health through the Life Course WHO Regional Office for Europe UN City Marmorvej 51 DK 2100 Copenhagen Ø Denmark

National Health Institute Doutor Ricardo Jorge Av Padre Cruz 1649 016 Lisbon Portugal

Obesity Management Centre Institute of Endocrinology Narodni 8 11694 Prague 1 Czech Republic

School of Hospitality Culinary Arts and Meal Science Örebro University Campus Grythyttan P O Box 1 SE 712 02 Grythyttan Sweden

Section for Epidemiology and Social medicine Department of Public Health and Community Medicine University of Gothenburg P O Box 454 SE 405 30 Gothenburg Sweden

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