Use of latent class analysis as a method of assessing the physical activity level, sedentary behavior and nutritional habit in the adolescents' lifestyle: A scoping review

Influence of lifestyle patterns on depression among adults with diabetes: a mediation effect of dietary inflammatory index

BACKGROUND

Lifestyle has become a crucial modulator in the management of diabetes and is intimately linked with the development and exacerbation of comorbid depression. The study aimed to analyze lifestyle patterns and their impact on depression in individuals with diabetes and to explore the role of the Dietary Inflammatory Index (DII) in the relationship between lifestyle patterns and depression.

METHODS

Data was attained from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2020. A latent class analysis (LCA) was performed on 3,009 diabetic adults based on lifestyle behaviors. A generalised linear model (GLM) was employed to analyse the effects of different lifestyle patterns on depression. The mediation effect model was utilised to examine the relationship between lifestyle patterns, DII and Patient Health Questionnaire-9 (PHQ-9) scores.

RESULTS

The cohort was divided through LCA into unhealthy lifestyle (44.53%), unhealthy but non-alcohol use (48.06%) and healthy but smoking (7.41%) groups of lifestyle behaviors, the unhealthy but non-alcohol use group was identified as a risk factor for depression (OR = 1.379, 95%CI = 1.095 ~ 1.735, P = 0.006). The DII partially mediated the relationship between the unhealthy but non-alcohol use group and PHQ-9, and fully mediated the relationship between the healthy but smoking group and PHQ-9, with effect coefficients of - 0.018 (95%CI: -0.044 ~ - 0.001) and - 0.035 (95%CI: -0.083 ~ - 0.001).

CONCLUSIONS

Lifestyle patterns significantly influence the occurrence of depression among diabetes patients. The dietary inflammation plays a varying mediating role between different lifestyle patterns and depression. Restricting pro-inflammatory diets or encouraging anti-inflammatory diets, combined with the promotion of healthy lifestyle practices, may be an effective method for preventing and alleviating symptoms of depression among patients with diabetes.

A systematic scoping review of latent class analysis applied to accelerometry-assessed physical activity and sedentary behavior

BACKGROUND

Latent class analysis (LCA) identifies distinct groups within a heterogeneous population, but its application to accelerometry-assessed physical activity and sedentary behavior has not been systematically explored. We conducted a systematic scoping review to describe the application of LCA to accelerometry.

METHODS

Comprehensive searches in PubMed, Web of Science, CINHAL, SPORTDiscus, and Embase identified studies published through December 31, 2021. Using Covidence, two researchers independently evaluated inclusion criteria and discrepancies were resolved by consensus. Studies with LCA applied to accelerometry or combined accelerometry/self-reported measures were selected. Data extracted included study characteristics and both accelerometry and LCA methods.

RESULTS

Of 2555 papers found, 66 full-text papers were screened, and 12 papers (11 cross-sectional, 1 cohort) from 8 unique studies were included. Study sample sizes ranged from 217-7931 (mean 2249, standard deviation 2780). Across 8 unique studies, latent class variables included measures of physical activity (100%) and sedentary behavior (75%). About two-thirds (63%) of the studies used accelerometry only and 38% combined accelerometry and self-report to derive latent classes. The accelerometer-based variables in the LCA model included measures by day of the week (38%), weekday vs. weekend (13%), weekly average (13%), dichotomized minutes/day (13%), sex specific z-scores (13%), and hour-by-hour (13%). The criteria to guide the selection of the final number of classes and model fit varied across studies, including Bayesian Information Criterion (63%), substantive knowledge (63%), entropy (50%), Akaike information criterion (50%), sample size (50%), Bootstrap likelihood ratio test (38%), and visual inspection (38%). The studies explored up to 5 (25%), 6 (38%), or 7+ (38%) classes, ending with 3 (50%), 4 (13%), or 5 (38%) final classes.

CONCLUSIONS

This review explored the application of LCA to physical activity and sedentary behavior and identified areas of improvement for future studies leveraging LCA. LCA was used to identify unique groupings as a data reduction tool, to combine self-report and accelerometry, and to combine different physical activity intensities and sedentary behavior in one LCA model or separate models.

Association between Socioeconomic Factors, Food Insecurity, and Dietary Patterns of Adolescents: A Latent Class Analysis

Socioeconomic factors and food insecurity play a fundamental role in the food choices of adolescents, and in addition to influencing access to food, they also have significant effects on dietary patterns. The objectives of this study were to identify the dietary patterns of adolescents through the application of latent class analysis and to evaluate their association with socioeconomic variables and food insecurity. This cross-sectional study was conducted with adolescents aged between 11 and 17 years from public schools. Latent class analysis was used to identify the dietary patterns. Associations between socioeconomic factors, food insecurity and dietary patterns were assessed using multinomial logistic regression (odds ratio (OR); 95% confidence interval (CI)). Among the 1215 participants in the study, four dietary patterns were identified: "Mixed", "Low consumption", "Prudent" and "Diverse". A "Diverse" dietary pattern was associated with a lower economic stratum (OR:2.02; CI:1.26-3.24). There was no association between food insecurity and identified dietary patterns. These results highlight the importance of promoting healthy eating in this age group at all socioeconomic levels, especially the lowest level.

The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis

Background

Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters.

Methods

We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents.

Results

Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households.

Conclusion

Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.

Clustering of Activity-Related Behaviors in Relation to Self-Reported Causes of Stress among Pre-Adolescents: Results from a National Epidemiological Study

An epidemiological study was conducted among 1728 10–12-year-old students (55.1% girls) and their parents during 2014–2016 in Greece. This study aimed to identify the dominant clusters of physical activity/sedentariness among preadolescents and investigate their association with self-reported sources of stress. Children’s physical activity levels and sources of stress were evaluated using validated questionnaires that assessed daily hours of activities, both on weekdays and on weekends, including physical activity, screen-based sedentary time, and non-screen-based sedentary time. The k-means algorithm of cluster analysis was applied. Three clusters of children’s physical activity/sedentariness were revealed. Cluster 1 was characterized as “Inactive-Non sedentary”, cluster 2 as “Active –Non-screen sedentary”, and cluster 3 as “Inactive-Sedentary”. Parental needs/expectations were associated with physical activity patterns (p = 0.009), i.e., children assigned to the third and second clusters had 36% and 51% lower odds to be stressed due to parental requirements [(OR for cluster 3 = 0.64, 95% CI = 0.41–0.99), (OR for cluster 2 = 0.49, 95% CI = 0.32–0.76)], compared with their first-cluster counterparts. Considering the need to promote physical activity in early life stages, the identification of these complex activity-related patterns along with their significant interaction with parental expectations as a cause of stress could enhance the effectiveness of targeted behavior change interventions among those parent–child dyads most in need.

Patterns of improvement in functional ability and predictors of responders to dual-task exercise: A latent class analysis

Background

Exercise is the pillar for healthy aging. "Non-responders" may be due to a mismatch in exercise prescription. A latent cluster analysis (LCA) profile can be useful to uncover subpopulations sharing similar profiles or outcomes. We aim to use the LCA to develop a response prediction model for older adults who would benefit from The Healthy Aging Promotion Program for You, a community-embedded dual-task exercise program.

Methods

A total of 197 participants completed the 3-month follow-up, and the complete data were available for 136 community-dwelling older adults. Inclusion criteria were age ≥60 years, pre-frail or frail and ambulant, mild cognitive impairment, and ability to provide consent. Data collected include demographics, education, falls, physical function (Katz ADL scale and Lawton's IADL scale), physical activity (rapid assessment of physical activity), cognition (Montreal Cognitive Assessment; MoCA), frailty (FRAIL scale), and perceived health, pain, anxiety/depression, fear of falling, and social isolation (Lubben Social Network Scale). The body mass index (BMI), handgrip strength, and short physical performance battery (SPPB) were measured. Those who improved in frailty, anxiety/depression, pain, Lubben, MoCA, SPPB, fear-of-falling, physical activity, falls, and HGS were classified as responders.

Results

The mean age was 74.7 years, BMI 23.5 kg/m², 23.5% were male, 96.3% were of Chinese ethnicity, 61% were pre-frail, education level of 4.3 years, and the MoCA score of 23.3 ± 4.8. Two clusters were identified: non-responders (61.8%) and responders (38.2%). Responders had significant improvement in cognition (44.2% vs. 0, p < 0.001) and SPPB (gait:28.8% vs. 0, p < 0.001; balance:42.3% vs. 15.5%, p = 0.001; chair-stand:65.4% vs. 4.8%, p < 0.001). Responders were significantly older (76.9 vs. 73.3 years, p = 0.005), had higher BMI (24.8 vs. 22.8 kg/m², p = 0.007), lower education (3.4 vs. 4.9 years, p = 0.021), lower MoCA scores (21.8 vs. 24.3, p = 0.002), and lower SPPB scores (8.7 vs. 10.6, p < 0.001). The predictive variables for the responder cluster were age ≥75 years, BMI ≥23 kg/m², robust, no anxiety, pain, fear of falling, MoCA ≤22, Lubben ≤12, SPPB score: chair-stand ≤2, balance ≤2, gait >2, handgrip strength <20 kg, no falls and RAPA >3. With an optimal cut-off of ≥12, this prediction model had sensitivity of 76.9%, specificity of 70.2%, positive predictive value 61.5%, and negative predictive value of 83.1%.

Conclusion

Response to dual-task exercise was influenced by age, SPPB, BMI, and cognition. Prospective longitudinal studies are needed to validate this LCA model and guide the development of public health strategies.

Breakfast habits, sedentary behavior, and suicide among Korean adolescents: A cross-sectional national study

This study aims to identify the relationships between breakfast habits, leisure-time sedentary behavior, and suicidal behaviors among Korean adolescents, including the mediating effect of leisure-time sedentary behavior on the relationship between breakfast habits and suicidal behaviors. We conducted a cross-sectional national study using secondary data from the 2017-2019 (13-15th) Korea Youth Risk Behavior Web-Based Surveys, analyzing data from a final sample of 153,992 Korean adolescents using multivariate logistic regression. No breakfast habits were statistically significantly related to suicidal ideation (crude OR [COR], 95% CI = 1.218, 1.172-1.265), suicidal plans (COR, 95% CI = 1.305, 1.228-1.385), and suicide attempts (COR, 95% CI = 1.533, 1.432-1.642). The effects of breakfast habits (independent variable) on suicidal behaviors (outcome variables) were mediated by leisure-time sedentary behavior (mediating variable). Leisure-time sedentary behavior had a statistically significant indirect effect on breakfast habits and suicidal behaviors (p < 0.05). The mediating effect size of breakfast habits mediated by leisure-time sedentary behavior was 3.46% for suicidal ideation, 2.48% for suicidal plans, and 1.06% for suicide attempts. Adolescents who did not consume breakfast demonstrated a significantly higher possibility of suicidal ideation, suicidal plans, and suicide attempts. Parents and teachers should be aware of and monitor adolescents' leisure-time sedentary behavior and breakfast habits to prevent suicidal behavior among this age group.

Latent profile analysis approach to the relationship between daily ambulatory activity patterns and metabolic syndrome in middle-aged and elderly Japanese individuals: The Toon Health Study

BACKGROUND

This cross-sectional study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the Japanese middle-aged and elderly individuals and examine the relationship of these derivative patterns with metabolic syndrome (MetS).

METHODS

A total of 1850 participants (66.1% women, mean age: 57.7 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA), and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify groups of participants based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with MetS after adjusting for age, sex, alcohol intake, and cigarette smoking.

RESULTS

Four distinct groups were identified: Group A had few steps and low levels of LIAA and MVAA; group B had a certain number of steps and recommended level of MVAA but low level of LIAA; group C had a certain number or more of steps, high level of LIAA, and recommended level of MVAA; group D had an extremely high number of steps and high levels of both LIAA and MVAA. The multivariate-adjusted odds ratio (95% CI) for MetS in groups B, C, and D relative to group A were 0.857 (0.611-1.201), 0.679 (0.500-0.922), and 0.434 (0.259-0.730), respectively. Groups C and D had significantly lower odds ratio of MetS compared to group A.

CONCLUSION

AA pattern involving a certain number or greater of steps accumulated through not only MVAA but also LIAA may help reduce the risk of MetS compared to inactive AA pattern.

Association Between Physical Activity and Prevalence/Mortality of Non-Alcoholic Fatty Liver Disease in Different Socioeconomic Settings

Objectives: We aimed to investigate the effect of physical activity (PA) on non-alcoholic fatty liver disease (NAFLD) prevalence and long-term survival, particularly in some specific population such as those with different socioeconomic status (SES). Methods: Multivariate regression and interaction analyses were conducted to deal with confounders and interacting factors. Results: Active PA was associated with lower prevalence of NAFLD in both cohorts. Individuals with active-PA had better long-term survival compared to those with inactive-PA in both cohorts, and the results were only statistically significant in NAFLD defined by US fatty liver index (USFLI). We found clear evidence that the beneficial role of PA was more obvious in individuals with better SES, and the statistical significances were presented in both two hepatic steatosis index (HSI)-NAFLD cohorts from the NHANES III and NHANES 1999-2014. Results were consistent in all sensitivity analyses. Conclusion: We demonstrated the importance of PA in decrease the prevalence and mortality of NAFLD, and highlights the need for improving SES simultaneously to increase the protective effect of PA.

The importance of eating patterns for health-related quality of life among children aged 10-11 years in Alberta of Canada

Children with unhealthy eating behaviours are more likely to experience poor physical and mental health. Few studies have investigated the importance of eating patterns for health-related quality of life (HRQoL) among children. This study aimed to identify common eating patterns, and their associations with HRQoL among Canadian children. Data were collected from 9150 grade five students (aged 10-11 years) in repeat cross-sectional population-based surveys in Alberta, Canada. Students' eating behaviours were analyzed using latent class analysis to identify the eating patterns. We applied multilevel multivariable logistic regression to examine the association of the eating patterns with HRQoL. We identified three groups of children with distinct eating patterns: eating healthy (52%), less healthy (31%) and unhealthy (17%). The first group had a higher proportion of students engaged in healthy eating behaviours. The unhealthy pattern group (third group) included a higher proportion of students with poor eating behaviours. Students' eating behaviours in the second group were healthier than the third group but less healthy than the first group. Children with unhealthy and less healthy patterns were more likely to experience lower HRQoL than children with the healthy pattern. Health promotion programs effective in improving healthy eating patterns may not only reduce the risk for chronic diseases in the long term, but also improve the HRQoL in the short term.

Correlation between lifestyle patterns and overweight and obesity among Chinese adolescents

Lifestyles such as physical exercise, sedentary behavior, eating habits, and sleep duration are all associated with adolescent overweight and obesity. The purpose of this study was to investigate how Chinese adolescents' lifestyles clustered into different lifestyle patterns, and to analyze the correlation between these patterns and adolescent overweight and obesity. The investigated respondents included 13,670 adolescents aged 13-18 from various administrative regions in China. Latent class analysis was employed to cluster the lifestyles of adolescents, χ2 test and Logistic regression were used to explore the relationship between lifestyle patterns and overweight and obesity in adolescents. The results identified 6 types of Chinese adolescents' lifestyle patterns, as well as the significant differences in gender and age. The adolescents with high exercise-high calorie diet had the lowest risk of overweight and obesity, and the adolescents with low consciousness-low physical activity and low consciousness-unhealthy had the highest risk of overweight and obesity, which were 1.432 times and 1.346 times higher than those with high exercise-high calorie diet, respectively. The studied demonstrated that there was a coexistence of healthy behaviors and health-risk behaviors in the lifestyle clustering of Chinese adolescents. Low physical exercise and high intake of snacks and carbonated beverages were the most common. Physical exercise and health consciousness were the protective factors of overweight and obesity in adolescents.

Ecological correlates related to adolescent movement behaviors: A latent class analysis

The ecological model has been widely used to help researchers understand the multiple influences in the physical activity (PA) and in the sedentary behaviors in isolated forms. To date, few correlates concerning the behavioral groupings of PA and sedentary behaviors have been studied. In this context, this study aimed to identify movement behaviors’ latent classes related to the different adolescents’ PA and sedentary time expressions, as well as their associations with individual, sociodemographic, family, and environmental correlates. This is a cross-sectional study with 309 students aged between 14 and 16. Latent Class Analysis was used to identify movement behavior classes based on light PA, moderate to vigorous PA, number of steps, sedentary time, and screen time (ST). An accelerometer was used to evaluate movement behaviors. The individual, sociodemographic, family, and environmental correlates were assessed by questionnaires. Three classes were identified: Class 1, "Active and Non-Sedentary" (8.10% of the sample), Class 2, "Active and Sedentary" (28.5%), and Class 3, "Inactive and Sedentary" (63.4%). Those with low fruit intake, low aerobic fitness, stressed and whose head of the family obtained an ‘elementary school’ level education were, respectively, 7.17, 3.59, 3.56, and 4.40 times more likely to belong to class 3 than class 1. Those with medium and high socioeconomic status were 82% and 83% less likely to belong to class 1 than classes 2 and 3, respectively. Adolescents who perceived the neighborhoods with the best access to diversified land use, street connectivity, walking/pedaling ease, and traffic safety attributes, were 84%, 85%, 82%, and 82%, respectively less likely to belong to class 1 than class 2. It is concluded that distinct correlates can be associated with the movement behaviors classes.

The Mediating Effect of Inflammation between the Dietary and Health-Related Behaviors and Metabolic Syndrome in Adolescence

Chronic diseases develop via complex pathways, depending on the degree of exposure to risk factors from early in life and childhood onward. Metabolic syndrome has multiple risk factors, including genetic factors, inappropriate diet, and insufficient physical activity. This study classified health-related behavior classes in childhood and adolescents and analyzed the direct and indirect effects of each class on the metabolic risk in inflammation-mediated pathways. We identified the health-related lifestyle classes based on health-related behavior indicators in subjects aged 3–15 years who participated in the Ewha Birth and Growth Cohort Study by using a latent class analysis. A mediation analysis was performed to access the direct and indirect effects of each class on the continuous metabolic syndrome score (cMetS), with the inflammatory index used as a mediating factor. Subjects were classified into inactive and positive lifestyle classes according to their characteristics. In the inactive lifestyle class, interleukin (IL)-6 and cMetS had a significant association. The study confirmed that IL-6 exerts a significant indirect effect between inactive lifestyle and cMetS. This result supports previous studies. Since the health behaviors of children and adolescents can affect the likelihood of subsequent metabolic syndrome, appropriate health behavior interventions for this period are needed.