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Short sleep duration has been linked to adverse behavioral and cognitive outcomes in schoolchildren, but few studies examined this relation in preschoolers. We aimed to investigate the association between parent-reported sleep duration at 3.5 years and behavioral and cognitive outcomes at 5 years in European children. We used harmonized data from five cohorts of the European Union Child Cohort Network: ALSPAC, SWS (UK); EDEN, ELFE (France); INMA (Spain). Associations were estimated through DataSHIELD using adjusted generalized linear regression models fitted separately for each cohort and pooled with random-effects meta-analysis. Behavior was measured with the Strengths and Difficulties Questionnaire. Language and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or the McCarthy Scales of Children's Abilities. Behavioral and cognitive analyses included 11,920 and 2981 children, respectively (34.0%/13.4% of the original sample). In meta-analysis, longer mean sleep duration per day at 3.5 years was associated with lower mean internalizing and externalizing behavior percentile scores at 5 years (adjusted mean difference: − 1.27, 95% CI [− 2.22, − 0.32] / − 2.39, 95% CI [− 3.04, − 1.75]). Sleep duration and language or non-verbal intelligence showed trends of inverse associations, however, with imprecise estimates (adjusted mean difference: − 0.28, 95% CI [− 0.83, 0.27] / − 0.42, 95% CI [− 0.99, 0.15]). This individual participant data meta-analysis suggests that longer sleep duration in preschool age may be important for children's later behavior and highlight the need for larger samples for robust analyses of cognitive outcomes. Findings could be influenced by confounding or reverse causality and require replication. [ABSTRACT FROM AUTHOR]

Summary: Background: Energy balance‐related behaviours (EBRBs), that is, dietary intake, screen, outdoor play and sleep, tend to combine into 'lifestyle patterns', with potential synergistic influences on health. To date, studies addressing this theme mainly focused on school children and rarely accounted for sleep, with a cross‐country perspective. Objectives: We aimed at comparing lifestyle patterns among preschool‐aged children across Europe, their associations with socio‐demographic factors and their links with body mass index (BMI). Methods: Harmonized data on 2–5‐year‐olds participating in nine European birth cohorts from the EU Child Cohort Network were used (EBRBs, socio‐demographics and anthropometrics). Principal component analysis and multivariable linear and logistic regressions were performed. Results: The most consistent pattern identified across cohorts was defined by at least three of the following EBRBs: discretionary consumption, high screen time, low outdoor play time and low sleep duration. Consistently, children from low‐income households and born to mothers with low education level had higher scores on this pattern compared to their socioeconomically advantaged counterparts. Furthermore, it was associated with higher BMI z‐scores in the Spanish and Italian cohorts (β = 0.06, 95% CI = [0.02; 0.10], both studies). Conclusion: These findings may be valuable in informing early multi‐behavioural interventions aimed at reducing social inequalities in health at a European scale. [ABSTRACT FROM AUTHOR]