Independent and Joint Prospective Associations of Screen Time and Sleep Disturbance with Body Mass Index and Waist Circumference Among U.S. Adolescents

<b><i>Background:</i></b> We examined the independent and joint prospective associations of screen time, sleep disturbance, and sleep duration with body mass index (BMI) and waist circumference (WC) stratified by sex. <b><i>Methods:</i></b> Data are from 7445 participants (47.3% females) aged 9-10 years at baseline (2016-2018) in the Adolescent Brain Cognitive Development Study. Missing data were imputed, and weighted multivariable linear regression models estimated the independent and joint effects of screen time and sleep disturbance or sleep duration on BMI and WC after 2 years. Joint associations grouped participants by combinations of screen time and sleep, with low screen time and sufficient sleep or no sleep disturbance as the reference groups. <b><i>Results:</i></b> Screen time was significantly associated with higher BMI (B = 0.32; 95% CI: 0.19, 0.45; <i>p</i> < 0.001) and WC (B = 0.40; 95% CI: 0.23, 0.56; <i>p</i> < 0.001). Sleep disturbance was associated with higher BMI (B = 1.23; 95% CI: 0.14, 2.33; <i>p</i> 0.026) in males. Insufficient sleep (<9 hours) (B = 1.30; 95% CI: 0.53, 2.07; <i>p</i> < 0.001) was associated with higher BMI. Medium screen time without sleep disturbance or insufficient sleep, and medium and high screen time with either sleep problem were associated with higher BMI and WC. Low screen time with insufficient sleep and high screen time with sufficient sleep were associated with higher BMI. Associations were generally stronger among males, particularly with high screen time. <b><i>Conclusion:</i></b> Screen time and insufficient sleep were independently and jointly associated with higher BMI and WC 2 years later, especially when both were present.