Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood

Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents

OBJECTIVES

The objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a cross-sectional study among 4604 children aged 6-17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS.

RESULTS

Among the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (P for trend: <0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: -0.686; 95% confidence interval [CI]: -1.148, -0.223). Individuals who adhered to all recommendations had a lower cMetS (β: -0.693; 95% CI: -1.147, -0.238) than those who met none of the recommendations.

CONCLUSIONS

Our study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.

Mapping the research using 24-h movement guidelines in children and adolescents: A bibliometric analysis

BACKGROUND

There are limited comprehensive bibliometric analyses that have examined research articles using the 24-h movement guidelines, which are necessary to evaluate the impact of the research field, map the scientific structure of the research landscape, and identify knowledge gaps.

OBJECTIVES

The aim of this study was to analyse the published research articles using the 24-h movement guidelines and assess their bibliometric characteristics.

METHODS

The search was conducted across all databases indexed in the Web of Science on March 6, 2024, and the bibliometric characteristics of studies published from 2016 onwards were analysed. Descriptive statistics and visualisations by the VOSviewer were used for the presentation of bibliometric characteristics.

RESULTS

120 studies using the 24-h movement guidelines in children and adolescents were included for analysis in this study. In general, number of the related publications using the 24-h movement guidelines increased from 2016 until now. 16 distinct clusters of author networking were displayed, of which the Canadian team was the strongest cluster with the highest research impacts. Of the included studies, cross-sectional studies accounted for the majority. North America and Europe were the leading two study locations across the included studies. Highly varied adherence rate to the 24-h movement guidelines across the included studies were observed. In terms of correlates and health outcomes of meeting the 24-h movement guidelines, separately, sociodemographic and health functioning characteristics were the most examined aspects.

CONCLUSIONS

This study provides a comprehensive scientific overview for research using the 24-h movement guidelines in children and adolescents, which may help guide potential research directions to improve the low compliance rates in this population.

Mediterranean Diet and Cardiometabolic Biomarkers in Children and Adolescents: A Systematic Review and Meta-Analysis

Importance

No prior systematic review and meta-analysis has specifically verified the association of Mediterranean diet (MedDiet)-based interventions with biomarkers of cardiometabolic health in children and adolescents.

Objective

To review and analyze the randomized clinical trials (RCTs) that assessed the effects of MedDiet-based interventions on biomarkers of cardiometabolic health among children and adolescents.

Data Sources

Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) from database inception to April 25, 2024.

Study Selection

Only RCTs investigating the effect of interventions promoting the MedDiet on cardiometabolic biomarkers (ie, systolic blood pressure [SBP], diastolic blood pressure [DBP], triglycerides [TGs], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], glucose, insulin, and homeostatic model assessment for insulin resistance [HOMA-IR]) among children and adolescents (aged ≤18 years) were included.

Data Extraction and Synthesis

A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted from the studies by 2 independent reviewers. Results across studies were summarized using random-effects meta-analysis.

Main Outcome and Measures

The effect size of each trial was computed by unstandardized mean differences (MDs) of changes in biomarker levels (ie, SBP, DBP, TGs, TC, HDL-C, LDL-C, glucose, insulin, HOMA-IR) between the intervention and the control groups. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach.

Results

Nine RCTs were included (mean study duration, 17 weeks; range, 8-40 weeks). These studies involved 577 participants (mean age, 11 years [range, 3-18 years]; 344 girls [59.6%]). Compared with the control group, the MedDiet-based interventions showed a significant association with reductions in SBP (mean difference, -4.75 mm Hg; 95% CI, -8.97 to -0.52 mm Hg), TGs (mean difference, -16.42 mg/dL; 95% CI, -27.57 to -5.27 mg/dL), TC (mean difference, -9.06 mg/dL; 95% CI, -15.65 to -2.48 mg/dL), and LDL-C (mean difference, -10.48 mg/dL; 95% CI, -17.77 to -3.19 mg/dL) and increases in HDL-C (mean difference, 2.24 mg/dL; 95% CI, 0.34-4.14 mg/dL). No significant associations were observed with the other biomarkers studied (ie, DBP, glucose, insulin, and HOMA-IR).

Conclusions and Relevance

These findings suggest that MedDiet-based interventions may be useful tools to optimize cardiometabolic health among children and adolescents.

Compliance with the 24-h Movement Guidelines for Portuguese children: differences between boys and girls

The 24-h Movement Guidelines for children recommend at least 60 min per day of moderate-to-vigorous intensity physical activity (PA), ≤ 2 h/day of screen time, and 9-11 h/day of sleep for children. Since little information is available on the 24-h Movement Guidelines in Portuguese children, this research attempts to know the proportion of Portuguese children meeting individual and combinations of these 24-h Movement Guidelines. Another aim of this study is to test sex differences in compliance with 24-h Movement Guidelines. A final sample of 1351 Portuguese children (51.4% girls, aged 7.65 ± 1.21) participated in this cross-sectional study. PA, screen time and sleep duration were parent-reported through a questionnaire. Only 3.7% of children met all three 24-h Movement Guidelines, whereas 11.9% met none. Although boys showed greater compliance with PA recommendations and girls with screen time recommendations, no significant sex differences were found in the compliance of all three 24-h Movement Guidelines. Given that 96.3% of Portuguese children did not meet 24-h Movement Guidelines, promoting these three movement behaviours in both boys and girls is crucial to encouraging positive consequences early.

Meeting the 24-h movement recommendations and its relationship with Mediterranean dietary patterns in early childhood: the SENDO project

The aim of this study was twofold: (1) to assess the association between meeting all three 24-h movement recommendations and adherence to the Mediterranean diet (MedDiet) in early childhood and (2) to examine whether participants who meet all three 24-h movement recommendations have greater adherence to the individual MedDiet foods/components than those who do not meet these recommendations. A cross-sectional study was conducted using a sample of 822 participants from the Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project (Pamplona, Spain). Physical activity was assessed through a questionnaire that covered 17 different types of activities. Screen time was assessed by averaging the daily hours spent on activities such as watching TV, using a computer, or playing video games. Sleep duration was determined by taking the average of sleep durations during both weekdays and weekends. Adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Greater odds of having an optimal adherence to the MedDiet were found for participants meeting all three 24-h movement recommendations (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.33-2.87, p = 0.001) in comparison with their counterparts not meeting these recommendations. Specifically, significant differences were found for "fruit or fruit juice every day" (p = 0.012), "second fruit every day" (p = 0.001), and "fresh or cooked vegetables regularly once a day" (p = 0.018) in relation to meeting all three 24-h movement recommendation status.    Conclusions: This study provides further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern. What is Known: • Only a limited number of studies have investigated the joint connection between the 24-h movement recommendations and dietary habits. • Integrating the 24-h movement recommendations with dietary recommendations could potentially yield greater effectiveness compared to promoting these recommendations independently within public health strategies. What is New: • This is the first study in assessing the relationship between 24-h movement recommendations and adherence to the Mediterranean diet in early childhood. • These findings provide further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern.

Is meeting with the 24-h movement recommendations linked with suicidality? Results from a nationwide sample of 44,734 U.S. adolescents

BACKGROUND

To our knowledge, only few studies have analyzed the relationship between meeting the 24-h movement guidelines and suicidality in adolescents. The aim of this study was twofold: first, to examine the association between meeting the 24-h movement recommendations and suicidal ideation, suicide planning, and attempted suicide in a representative sample of adolescents from the U.S.; and second, to test whether age group, sex, or race moderate these associations.

METHOD

This is a cross-sectional study including pooled data from the 2011, 2013, 2015, 2017, 2019, and 2021 high school Youth Risk Behavior Surveys (YRBS). A total sample of 44,734 participants (48.5 % females) was included. The recommendations of the 24-h movement guidelines included physical activity, screen time, and sleep duration. Suicidality was examined considering three suicide-related behaviors: suicidal ideation (yes/no), suicide planning (yes/no), and attempted suicide (at least one time or more during the past 12 months).

RESULTS

Adolescents who met all three recommendations showed a lower likelihood of suicidal ideation (odds ratio [OR] = 0.49, 95 % confidence interval [CI] 0.37 to 0.64, p < 0.001), suicide planning (OR = 0.51, 95 % CI 0.37 to 0.68, p < 0.001), and attempted suicide (OR = 0.66, 95 % CI 0.44 to 0.96, p = 0.038) than those who did not meet all the recommendations. Overall, when younger adolescents, female adolescents, and adolescents of minority races met the 24-h movement recommendations, they had lower odds of suicide-related outcomes than when they did not.

LIMITATIONS

This is a cross-sectional study using self-reported data. It is not possible to establish cause-and-effect relationships, and the results could be influenced by some biases.

CONCLUSION

This study suggests that meeting the 24-h movement recommendations could play a relevant role in the prevention of suicidal ideation, planning suicide, and attempted suicide in a nationwide sample from the U.S. adolescents.

Meeting 24-h movement behavior guidelines is linked to academic engagement, psychological functioning, and cognitive difficulties in youth with internalizing problems

BACKGROUND

This study aimed to investigate associations of meeting 24-h movement behavior (24-HMB: physical activity [PA], screen time [ST] in the school-aged youth, and sleep) guidelines with indicators of academic engagement, psychological functioning, and cognitive function in a national representative sample of U.S. youth.

METHODS

In this cross-sectional study, 1794 participants aged 6 to 17 years old were included for multivariable logistic regression to determine the above-mentioned associations, while adjusting for sociodemographic and health covariates.

RESULTS

The proportion of participants who met 24-HMB guideline(s) varied greatly (PA+ ST+ sleep = 34 [weighted 1.17 %], PA + ST = 23 [weighted 1.72 %], PA + sleep = 52 [weighted 2.15 %], PA = 34 [weighted 2.88 %], ST = 142 [weighted 7.5 %], ST+ sleep = 209 [weighted 11.86 %], sleep = 725 [weighted 35.5 %], none = 575 [weighted 37.22 %]). Participants who met ST guideline alone and integrated (ST + Sleep and ST + sleep + PA) guidelines demonstrated the consistently beneficial associations with learning interest/curiosity, caring for school performance, completing required homework, resilience, cognitive difficulties, self-regulation (ps < 0.05).

CONCLUSION

Meeting 24-HMB guidelines in an isolated or integrative manner was associated with improved academic engagement, psychological functioning, and reduced cognitive difficulties. These findings highlight the importance of the promotion of 24-HMB guidelines in youth with internalizing problems. Future longitudinal studies are needed to investigate whether changes or modifications of meeting specific 24-HMB guidelines (especially ST) is beneficial for youth with internalizing problems.

Gamified family-based health exercise intervention to improve adherence to 24-h movement behaviors recommendations in children: "3, 2, 1 Move on Study"

BACKGROUND

Evidence suggests that movement patterns, including physical activity, sedentary behavior, and sleep duration, throughout a 24-h period, have a significant impact on biological processes and health outcomes for both young and adult populations. However, 80% of adolescents worldwide are not sufficiently active, and many children do not meet international physical activity recommendations for their age. Thus, the aim of this study is to evaluate the impact of a 12-week gamified family-based health and exercise intervention on physical fitness, basic motor competencies, mental and behavioral health, and adherence to 24-h movement guidelines in children aged 4 to 5 years old. The study will evaluate changes in sedentary levels, physical fitness, basic motor competencies, mental and behavioral disorders, adherence to the exercise program, and compliance with physical activity recommendations. In addition, the aim of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures.

METHODS/DESIGN

A total of 80 children, aged 4 to 5 years old, will be randomly assigned in a 1:1 ratio to one of two groups: the exercise group and the routine care group. The exercise group will undergo a 12-week exercise intervention, followed by a 12-week follow-up period. On the other hand, the routine care group will undergo a 12-week period of routine care, followed by a 12-week follow-up control period. The exercise program will be implemented in a family setting and facilitated through a gamified web platform with online supervision, with the hypothesis that it will have a positive impact on physical fitness, anthropometric measures, basic motor competencies, and adherence to 24-h movement guidelines.

DISCUSSION

The results of this study will provide valuable insights into the impact of a gamified, family-oriented health and exercise program on various aspects of health, including physical fitness, basic motor competencies, mental and behavioral well-being, and adherence to 24-h movement guidelines. The findings will contribute to closing the gap in current knowledge on the effectiveness of these types of interventions for children and their parents. These findings will also contribute to  the development of future guidelines for promoting physical activity in children who do not meet the World Health Organization's recommended levels. An online "3, 2, 1 Move on Study" is believed to increase accessibility, promoting health equity, and reducing economic barriers for all children and their families across diverse social groups.

TRIAL REGISTRATION

Trial registration: NCT05741879 . Registered February 14, 2023, Version 1.

Environmental tobacco smoke exposure and 24-h movement guidelines in Spanish young people

Background

No prior research has investigated how exposure to environmental tobacco smoke is related to the combination of 24-h movement behaviors among young populations thus far. The aim of this study was to examine the associations between exposure to secondhand smoke and the 24-h movement guidelines.

Methods

This is a cross-sectional study using data from the last available wave of the Spanish National Health Survey [2017], a nationally representative survey of the Spanish children and adult population. The final sample included 4,378 (49.0% girls) Spanish young people aged 2-14 years.

Results

A lower likelikood of meeting screen time (ST) and all three 24-h movement guidelines were found in those exposed to environmental tobacco smoke in unadjusted models. After adjusting for several covariates, meeting screen time [odds ratio (OR) =0.76; 95% confidence interval (CI), 0.59-0.97], sleep duration (OR =0.75; 95% CI, 0.58-0.96), and all three 24-h movement guidelines (OR =0.63; 95% CI, 0.44-0.91) reached significance after adjusting for potential confounders.

Conclusions

Given the inverse associations found, environmental tobacco smoke exposure should be a relevant factor to consider when promoting 24-h behaviors in the young population. Avoiding exposure to tobacco smoke in the environment is essential, as it can potentially influence the 24-h movement behaviors of young people, and consequently, the health benefits associated with such behaviors.

Twenty-four-hour movement guidelines during adolescence and its association with obesity at adulthood: results from a nationally representative study

To determine the association between adherence to the 24-h movement guidelines during adolescence with obesity at adulthood 14 years later in a nationally representative cohort. We analyzed data from 6984 individuals who participated in Waves I (1994-1995) and IV (2008-2009) of the National Longitudinal Study of Adolescent Health (Add Health) in the USA. Obesity was defined by the International Obesity Task Force cut-off points at Wave I and adult cut-points at Wave IV (body mass index [BMI]≥30 kg/m2 and waist circumference [WC]≥102 cm in male and 88 cm in female). Physical activity, screen time and sleep duration were self-reported. Adolescents who met screen time recommendation alone (β = -1.62 cm, 95%CI -2.68 cm to -0.56), jointly with physical activity (β = -2.25 cm, 95%CI -3.75 cm to -0.75 cm), and those who met all three recommendations (β = -1.92 cm, 95%CI -3.81 cm to -0.02 cm) obtained lower WC at Wave IV than those who did not meet any of these recommendations. Our results also show that meeting with screen time recommendations (IRR [incidence rate ratio] = 0.84, 95%CI 0.76 to 0.92) separately and jointly with physical activity recommendations (IRR = 0.86, 95%CI 0.67 to 0.97) during adolescence is associated with lower risk of abdominal obesity at adulthood. In addition, adolescents who met all 24-h movement recommendations had lower risk of abdominal obesity later in life (IRR = 0.76, 95%CI 0.60 to 0.97).

CONCLUSION

Promoting the adherence to the 24-h movement guidelines from adolescence, especially physical activity and screen time, seems to be related with lower risk of abdominal obesity later in life, but not for BMI.

WHAT IS KNOWN

• Some studies have shown a relationship between adherence to 24-h movement guidelines and adiposity or obesity markers in youth. However, most of these studies have a cross-sectional design or a short follow-up.

WHAT IS NEW

• This is the first study which determined the association between adherence to the 24-h movement guidelines during adolescence with obesity at adulthood 14 years later in a nationally representative US cohort. • Meeting the 24-h movement guidelines from adolescence seems to be related with lower risk of abdominal obesity later in life, but not for body mass index.

Trajectories of 24-h movement guidelines from middle adolescence to adulthood on depression and suicidal ideation: a 22-year follow-up study

Background:

The 24-h movement guidelines for youth and adults recommend the specific duration of physical activity, sedentary time, and sleep duration to ensure optimal health, but little is known about its relationship to mental health indicators. The aim of the study was to explore the association between 24-h movement guidelines in adolescence and its trajectories from middle adolescence (12–17 years old) to adulthood (33–39 years old) with depression and suicidal ideation in adulthood.

Methods:

This prospective cohort study included individuals who participated in Waves I (1994–1995) and V (2016–2018) of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. Physical activity, screen time and sleep duration were measured using questionnaires. Adults were categorized as having depression if they had a self-reported history of depression and/or prescription medication-use for depression in the previous four weeks. Suicidal ideation was assessed by a self-reported single question in both waves. Poisson regression analyses were used to estimate the incidence rate ratio (IRR) of depression and suicidal ideation at adulthood, according to meeting specific and combinations of 24-h movement guidelines at Wave I and its trajectories from adolescence to adulthood.

Results:

The study included 7,069 individuals (56.8% women). Adolescents who met physical activity guidelines and all three guidelines at middle adolescence had lower risk of depression (IRR = 0.84, 95%CI 0.72 to 0.98) and suicidal ideation (IRR = 0.74, 95%CI 0.55 to 0.99) at adulthood than those who did not meet any of these guidelines, respectively. Individuals who met the guidelines for screen time and all three guidelines in both adolescence and adulthood had lower risk of depression (screen time, IRR = 0.87, 95% CI 0.72 to 0.98; all three, IRR = 0.37, 95% CI 0.15 to 0.92) and suicidal ideation (screen time, IRR = 0.74, 95% CI 0.51 to 0.97; all three, IRR = 0.12, 95% CI 0.06 to 0.33) than those who never met the guidelines. Additionally, individuals who did not meet all three guidelines in adolescence but met the guidelines in adulthood had lower risk of suicidal ideation than those who never met the guidelines (IRR = 0.81, 95%CI 0.45 to 0.89).

Conclusion:

Our findings highlight the importance of promoting and maintaining adherence to the 24-h movement guidelines from middle adolescence to adulthood to prevent mental health problems. However, our findings must be interpreted carefully due to declared limitations, e.g., the self-reported assessments which are subject to sources of error and bias or that the dataset used to gauge meeting a guidelines (1994–1996) was made later (2016).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01367-0.