Clusters of 24-hour movement behavior and diet and their relationship with health indicators among youth: a systematic review

Movement-related behaviors (physical activity [PA], sedentary behavior [SB], and sleep) and diet interact with each other and play important roles in health indicators in youth. This systematic review aimed to investigate how PA, SB, sleep, and diet cluster in youth by biological sex; and to examine which cluster are associated with health indicators. This study was registered in PROSPERO (number: CRD42018094826). Five electronic databases were assessed. Eligibility criteria allowed studies that included youth (aged 19 years and younger), and only the four behaviors {PA, SB, sleep, and diet (ultra-processed foods [UPF]; fruits and vegetables [FV])} analyzed by applying data-based cluster procedures. From 12,719 articles screened; 23 were included. Of these, four investigated children, and ten identified clusters by biological sex. Sixty-six mixed cluster were identified including, 34 in mixed-sex samples, 10 in boys and 11 in girls. The most frequent clusters in mixed-sex samples were "High SB UPF Low Sleep", "Low PA High SB Satisfactory Sleep", and "High PA". The main difference in profiles according to sex was that girls' clusters were characterized by high sleep duration, whereas boys' clusters by high PA. There were a few associations found between cluster types and health indicators, highlighting that youth assigned to cluster types with low PA exhibited higher adiposity. In conclusion, the youth presented a range of clusters of behaviors, typically exhibiting at least one unhealthy behavior. Similar patterns were observed in both sexes with the biggest difference in time of sleep for girls and PA for boys. These findings underscore the importance of intervention strategies targeting multiple behaviors simultaneously to enhance health risk profiles and indicators in children and adolescents.

A systematic review of the clustering and correlates of physical activity and sedentary behavior among boys and girls

Identifying the clustering and correlates of physical activity (PA) and sedentary behavior (SB) is very important for developing appropriate lifestyle interventions for children and adolescents. This systematic review (Prospero CRD42018094826) aimed to identify PA and SB cluster patterns and their correlates among boys and girls (0-19 years). The search was carried out in five electronic databases. Cluster characteristics were extracted in accordance with authors' descriptions by two independent reviewers and a third resolved any disagreements. Seventeen studies met the inclusion criteria and the population age ranged from six to 18 years old. Nine, twelve, and ten cluster types were identified for mixed-sex samples, boys, and girls, respectively. While girls were in clusters characterized by "Low PA Low SB" and "Low PA High SB", the majority of boys were in clusters defined by "High PA High SB" and "High PA Low SB". Few associations were found between sociodemographic variables and all cluster types. Boys and girls in "High PA High SB" clusters had higher BMI and obesity in most of the tested associations. In contrast, those in the "High PA Low SB" clusters presented lower BMI, waist circumference, and overweight and obesity. Different cluster patterns of PA and SB were observed in boys and girls. However, in both sexes, a better adiposity profile was found among children and adolescents in "High PA Low SB" clusters. Our results suggest that it is not enough to increase PA to manage the adiposity correlates, it is also necessary to reduce SB in this population.

Family-focused contextual factors associated with lifestyle patterns in young children from two mother-offspring cohorts: GUSTO and EDEN

BACKGROUND

Integrated patterns of energy balance-related behaviours of preschool children in Asia are sparse, with few comparative analyses.

PURPOSE

Using cohorts in Singapore (GUSTO) and France (EDEN), we characterized lifestyle patterns of children and investigated their associations with family-focused contextual factors.

METHODS

Ten behavioural variables related to child's diet, walking, outdoor play and screen time were ascertained by parental questionnaires at age 5-6 years. Using principal component analysis, sex-specific lifestyle patterns were derived independently for 630 GUSTO and 989 EDEN children. Contextual variables were organised into distal (family socio-economics, demographics), intermediate (parental health, lifestyle habits) and proximal (parent-child interaction factors) levels of influence and analysed with hierarchical linear regression.

RESULTS

Three broadly similar lifestyle patterns were identified in both cohorts: "discretionary consumption and high screen time", "fruit, vegetables, and low screen time" and "high outdoor playtime and walking". The latter two patterns showed small differences between cohorts and sexes. The "discretionary consumption and high screen time" pattern was consistently similar in both cohorts; distal associated factors were lower maternal education (EDEN boys), no younger siblings (GUSTO boys) and Malay/Indian ethnicity (GUSTO), while intermediate and proximal associated factors in both cohorts and sexes were poor maternal diets during pregnancy, parents allowing high child control over food intake, snacking between meals and having television on while eating.

CONCLUSIONS

Three similar lifestyle patterns were observed among preschool children in Singapore and France. There were more common associated proximal factors than distal ones. Cohort specific family-focused contextual factors likely reflect differences in social and cultural settings. Findings will aid development of strategies to improve child health.

Associations between Child and Family Level Correlates and Behavioural Patterns in School-Aged Children

Identifying correlates of behavioural patterns are important to target population sub-groups at increased health risk. The aim was to investigate correlates of behavioural patterns comprising four behavioural domains in children. Data were from the HAPPY study when children were 6–8 years (n = 335) and 9–11 years (n = 339). Parents reported correlate and behavioural data (dietary intake, physical activity, sedentary behaviour, and sleep). Behavioural data were additionally captured using accelerometers. Latent profile analysis was used to derive patterns. Patterns were identified as healthy, unhealthy, and mixed at both time points. Multinomial logistic regression tested for associations. Girls were more likely to display healthy patterns at 6–8 years and display unhealthy and mixed patterns at 9–11 years than boys, compared to other patterns at the corresponding ages. Increased risk of displaying the unhealthy pattern with higher age was observed at both timepoints. At 9–11 years, higher parental working hours were associated with lower risk of displaying mixed patterns compared to the healthy pattern. Associations observed revealed girls and older children to be at risk for unhealthy patterns, warranting customisation of health efforts to these groups. The number of behaviours included when deriving patterns and the individual behaviours that dominate each pattern appear to be drivers of the associations for child level, but not for family level, correlates.

An Update on Physical Activity Research among Children in Hong Kong: A Scoping Review

Similar to their Western counterparts, children in Hong Kong generally fail to reach the recommended levels of physical activity (PA). As an ultra-dense metropolis, Hong Kong is different from most Western cities. It is therefore important to update and appraise previous PA research in order to inform future PA promotion for Hong Kong children. Using a scoping review, the current study aimed to evaluate PA research among preschool and school-aged children in Hong Kong aged 3-12 years old who are at a critical development stage. Literature was searched from four English databases: Medline via EBSCOhost, SPORTDiscus, ERIC and PsycINFO via ProQuest; and three Chinese databases: CNKI, CQVIP and WAN-FANG. PA research among Hong Kong children published from 1 January 1997 to the searching date, 31 March 2020 was included. A total of 63 studies were identified, with the majority of studies focused on school-aged children as compared to preschoolers, adopted a cross-sectional design, using self-reported PA measures, and with small to medium sample sizes. We classified eligible studies into five main categories: (a) Health benefits of PA (k = 12). Consistent evidence on the health benefits of skeletal and cardiovascular capacity, quality of life, cognitive function, and sleep quality was revealed. However, inconsistent evidence was found on the benefits of weight-related indicators and academic performance. (b) Patterns of PA (k = 12). There is a general pattern of low levels of PA among Hong Kong children, in particular girls and children with special educational needs. (c) Measures of PA and related constructs (k = 11). The Chinese versions of self-reported measures of PA, PA-related social environment, and PA-related psychological constructs showed acceptable reliabilities and validities. (d) Correlates of PA (k = 18). The correlates of PA include physical environment, social environment, physical factors, psychological factors, and multiple correlates, which is in line with the social-ecological model. (e) Interventions for promoting PA (k = 10). PA interventions among Hong Kong children were conducted for healthy children, children with special educational needs, and children with cancer. Overall, there is a growing volume of PA research among children in Hong Kong in the recent decade. Yet, there is a lack of high-quality research for measuring, understanding, and promoting PA among Hong Kong children. It is highly recommended that future PA research among children should pay more attention on the preschoolers, adopting robust research design (e.g., randomized controlled trials), recruiting large and representative sample, and collecting device-assessed data.

Sedentary behavior is more related with cardiovascular parameters in normal weight than overweight adolescents

This study analyzed the relationship between sedentary behavior and cardiovascular parameters in normal weight and overweight adolescents. The sample included 449 boys and 555 girls with mean age of 13 years from public schools, which were divided into five geographical regions, with data collections performed in one selected school from each region. Sedentary behavior was assessed by screen time on TV, computer, videogame and cell phone/tablet, with good reliability in adolescents. Physical activity was assessed by Baecke's questionnaire, validated for adolescents. Measures of body weight, height and waist circumference were collected. Adolescents were classified as overweight or normal weight by cut-off points of body mass index for age and sex. Cardiovascular parameters were evaluated by oscillometric device and heart rate by specific monitor. Computer use was positively related to systolic blood pressure (SBP) (β = 0.35; 95%CI = 0.07-0.62) and diastolic blood pressure (DBP) (β = 0.25; 95%CI = 0.05-0.44) in normal weight but not in overweight adolescents. Similar results were observed for cell phone/tablet in SBP (β = 0.46; 95%CI = 0.20-0.72) and DBP (β = 0.36; 95%CI = 0.18-0.54), only for normal weight. The cluster of screen time was related to SBP in normal weight (β = 0.44; 95%CI = 0.03-0.84) and overweight (β = 0.60; 95%CI = 0.01-1.19). Screen time in computer and cell phone/tablet was more related to cardiovascular parameters in normal weight than overweight adolescents.

A systematic review of lifestyle patterns and their association with adiposity in children aged 5-12 years

Diet, physical activity, sedentary behaviour and sleep are typically examined independently with childhood adiposity; however, their combined influence remains uncertain. This review aims to systematically summarize evidence on the clustering of these behaviours through lifestyle patterns and evaluate associations with adiposity in children aged 5-12 years. Search strategies were run in six databases. Twenty-eight papers met the inclusion criteria, six of which included all four behaviours. A range of lifestyle patterns were identified (healthy, unhealthy and mixed). Mixed patterns were most frequently reported. Unhealthy patterns comprising low physical activity and high sedentary behaviour were also frequently observed. Mixed patterns comprising healthy diets, low physical activity and high sedentary behaviour were more commonly seen in girls, whereas boys were more physically active, similarly sedentary and had unhealthier diets. Children from lower socio-economic backgrounds tended to more frequently display unhealthy patterns. Unhealthy lifestyle patterns were more often associated with adiposity risk than healthy and mixed patterns. With few studies including all four behaviours, it is difficult to establish a clear picture of their interplay and associations with adiposity. Nonetheless, reliance on lifestyle patterns is likely more beneficial than individual behaviours in targeting adiposity and improving understanding of how these behaviours influence health.

Comparability of ActivPAL-Based Estimates of Meeting Physical Activity Guidelines for Preschool Children

The activPAL (PAL Technologies, Glasgow, UK) has been increasingly used on children to assess sedentary time and physical activity (PA). However, there is no consensus on how it can estimate PA at different intensities. This study compared three commonly used, activPAL-based classifications of moderate-to-vigorous physical activity (MVPA) (daily steps, acceleration counts, and step rate) in determining compliance with the World Health Organization (WHO)’s PA guidelines for preschool children on a daily basis. One hundred and fourteen preschool children aged 3–6 years wore an activPAL^TM for 24 h over 7 consecutive days and provided valid data for a total of 548 days. MVPA was calculated based on published cut-points of counts (MVPA-counts) and step rate (MVPA-step rate). Compliance with standard PA guidelines (≥180 min/day of PA including ≥60 min/day of MVPA) was determined based on three criteria: ≥11,500 steps/day, a threshold of 1418 acceleration counts/15 s, and 25 steps/15 s for MVPA. Applying cut-points of daily steps and acceleration counts provided the same estimates of compliance with the WHO PA guidelines (20%), while the estimated compliance based on the step rate was lower (7.7%). There was a moderate agreement between the daily steps- (or counts-) derived and step rate-derived compliances (κ = 0.41; 95% confidence interval (CI): 0.31, 0.51). The amount of MVPA derived from counts (1.95 ± 0.72 h/day) was significantly higher than that from step rates (0.47 ± 0.31 h/day). The activPAL may be useful for surveillance studies to estimate total PA in preschool children. Further development of the activPAL algorithms based on either counts or step rate is warranted before it can be used to accurately estimate MVPA in this age group.

Prospective Associations between Weekend Catch-Up Sleep, Physical Activity, and Childhood Obesity

BACKGROUND

Catch-up sleep and low physical activity on weekends have been commonly documented. Preliminary evidence on Chinese children, however, has shown a variety of weekly physical activity patterns. This study examined the prospective associations between weekend catch-up patterns of sleep and physical activity and obesity over a 2-year period in Chinese children.

METHODS

Prospective data from 599 children in the Understand Children's Activity and Nutrition (UCAN) cohort study were analyzed. Weekly patterns of obesogenic behaviors (physical activity and sleep duration) were assessed annually over a 2-year period. Moderate-to-vigorous physical activity (MVPA) and sedentary time were determined by ActiGraph accelerometry. Data on sleep durations and sociodemographic factors were obtained from parental-reported questionnaires. Weekend catch-up sleep and MVPA patterns were calculated and examined in relation to childhood obesity after controlling for sociodemographic variables and sedentary time.

RESULTS

Every additional hour of average weekly sleep duration was associated with a 16% decrease in the odds of obesity (OR: 0.841, 95%CI: 0.709 - 0.999). After adjustment of average sleep duration, weekend sleep catch-up categories showed no association with obesity risk. Over a 2-year period, half of the children demonstrated weekend catch-up MVPA. Weekend catch-up MVPA for less than 20 minutes (OR: 0.473, 95%CI: 0.258 - 0.867) or more than 20 minutes (OR: 0.505, 95%CI: 0.257 - 0.993) were both related to lower risk of obesity.

CONCLUSIONS

Weekend catch-up sleep did not ameliorate the risk of childhood obesity, whereas weekend catch-up MVPA did reduce that risk. More research is needed to explore the factors contributing to these obesogenic behavior patterns.

Longitudinal changes in objectively measured physical activity differ for weekdays and weekends among Chinese children in Hong Kong

Background

Cross-sectional investigation showed that Chinese children in Hong Kong were more physically active on weekends than weekdays, which is contrary to previous findings. However, little is known as to whether these time-segment-specific differences persist with age. This study aimed to compare the 2-year changes in accelerometer-assessed physical activity (PA) and sedentary time (ST) between weekdays and weekends among Chinese children in Hong Kong.

Methods

Children aged 6–8 years were recruited from primary schools in Hong Kong. Time spent in ST (<100 counts per minute [cpm]), moderate-to-vigorous PA (MVPA), and light-intensity PA (LPA) were measured by accelerometer at baseline and then at 1-year and 2-year follow-ups. Mean annual changes were determined using mixed-effects linear models for children who provided 3-day valid data (including 1 weekend day) for at least two time points (n = 412). Magnitude of changes between weekdays and weekends was compared using age × time-segment interactions.

Results

At each assessment wave, the percentage of time spent in MVPA (% MVPA) and LPA (% LPA) was consistently high, whereas the percentage of time spent in ST (% ST) was lower on weekends than weekdays. A decrease in % MVPA was found for both weekdays (mean annual change: boys, −0.7, 95 % CI = −0.9 to −0.1; girls, −0.8, 95 % CI = −1.0 to −0.6) and weekends (boys, −1.2, 95 % CI = −1.5 to −0.9; girls, −1.4, 95 % CI = −1.6 to −1.1). An increase was found in % ST for both weekdays (boys, 1.3, 95 % CI = 0.7 to 1.9; girls, 2.4, 95 % CI = 1.9 to 3.3) and weekends (boys, 1.8, 95 % CI = 1.1 to 2.5; girls, 2.6, 95 % CI = 1.9 to 3.3). Mean annual change in MVPA time (min) was greater on weekends than weekdays (difference: boys, 3.0, 95 % CI = 0.3 to 5.7; girls, 3.5, 95 % CI = 1.1 to 5.8).

Conclusions

Age-related decline in MVPA was more marked on weekends than weekdays. Interventions to hinder age-related changes in PA and ST should target both time segments, but weekends warrant particular attention for interventions targeting PA maintenance due to the greater declines.