Clustering of Physical Activity, Diet and Sedentary Behavior among Youth from Low-, Middle-, and High-Income Countries: A Scoping Review

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.

Lifestyle patterns in European preschoolers: Associations with socio-demographic factors and body mass index

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.

Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review

BACKGROUND

Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.

METHODS

Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5-24 years, (ii) examined the 'patterning', 'clustering', or 'co-existence' of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).

RESULTS

Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.

CONCLUSIONS

PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.

Obesogenic behavior clusters associated with weight status among Brazilian students: a latent class analysis

This study aimed to examine the association between clusters of physical activity (PA), diet, and television viewing (TV) with weight status among a representative sample of Brazilian students. Data from the National Health School-based Survey (PeNSE) 2015 were analyzed (n = 16,521; mean age 14.8, standard deviation 0.03 year). PA (minutes/week spent in leisure-time, and commuting to/from school), TV (hours/day), and weekly consumption of deep-fried empanadas, candies, sodas, ultra-processed foods, fast foods, green salads or vegetables, and fruits were self-reported on the validated PeNSE questionnaire. Latent class analysis defined behavior classes, and binary logistic regression assessed the association between clustering and weight status. Six classes' types with positive and negative behaviors were identified. Adolescents belonging to the "low TV time and high healthy diet" class had higher chances of being overweight (including obesity) compared to their peers in the "moderate PA and mixed diet" class. No associations were found in the other clusters. Mixed classes with healthy and unhealthy behaviors characterized adolescents' lifestyles and these profiles were related to weight status.

Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents

BACKGOUND

Although obesogenic behaviors have been found to be related to social isolation, evidence-based person-centered approaches are lacking. This study investigated the association between clusters of obesogenic behavior - derived from a data-driven process - and social isolation among Brazilian adolescents.

METHODS

Data from the National Adolescent School-based Health Survey (PeNSE) 2015 were analyzed. A total of 100,794 9^th-grade students (51.3% females; 14.3 ± 0.1 years old) enrolled in 3,040 public and private high schools participated in the study. Social isolation was assessed by two outcomes (i.e., perceived loneliness and lack of close friends). A two-step cluster analysis was conducted to identify patterns of obesogenic behaviors with the input of leisure-time physical activity (PA), sitting time as a proxy of sedentary behavior (SB), and the weekly consumption of healthy and unhealthy food. Crude and adjusted binary logistic regression models were applied to evaluate the associations between the clusters of obesogenic behaviors and social isolation variables in adolescents.

RESULTS

Three clusters were identified. Adolescents in the "Health-promoting SB and diet" (32.6%; OR = 0.69; 95% CI = 0.62-0.76) and "Health-promoting PA and diet" (44.9%; OR = 0.73; 95% CI = 0.67-0.79) clusters had lower odds of loneliness compared to those in the "Health-risk" cluster (22.5%). Those belonging to the "Health-promoting PA and diet" cluster were more likely to report having close friends (OR = 1.19; 95% CI = 1.00-1.41) than those in the "Health-risk" cluster.

CONCLUSION

Adolescents in clusters where positive behaviors outweighed negative ones were less likely to perceive themselves as lonely and without close connections.

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.

Inequalities in energy drink consumption among UK adolescents: a mixed-methods study

OBJECTIVE

To examine energy drink consumption among adolescents in the United Kingdom (UK) and associations with deprivation and dietary inequalities.

DESIGN

Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis.

SETTING

UK.

PARTICIPANTS

Quantitative data: nationally representative sample of 2587 adolescents aged 11-18 years. Qualitative data: 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK.

RESULTS

NDNS data showed adolescents' consumption of energy drinks was associated with poorer dietary quality (OR 0.46 per SD; 95% CI 0.37, 0.58; p<0.001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don't know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work.

CONCLUSIONS

This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents' energy drink intake.

Clusters of obesogenic behaviors and metabolic risk according to somatic maturity status among adolescents

OBJECTIVE

This study aimed to identify the clusters of obesogenic behaviors, and verify the association with metabolic risk according to the categories of somatic maturity status of adolescents.

METHODS

This is a cross-sectional study conducted with 1159 (55.1% girls) Brazilian adolescents aged between 10 and 16 years (mean age: 12.9 years). Measurements of waist circumference, blood pressure, blood glucose, HDL-C, and triglycerides were combined to calculate a metabolic risk score. Somatic maturity was assessed by estimating the peak of height velocity. The obesogenic behaviors analyzed were physical activity (Baecke questionnaire), sedentary behavior (screen-based behaviors) and dietary habits (consumption of healthy and unhealthy food). The Two Step clustering algorithm using the log-likelihood measure was employed to cluster formation and regression models were adopted to the main analysis.

RESULTS

We observed a complex co-existence of obesogenic behaviors. Differences regarding the metabolic risk between clusters was only observed among the early-maturing adolescents, where the cluster with higher number of healthy behaviors but lower physical activity presented higher metabolic risk score.

CONCLUSIONS

We conclude that physical activity has an important role on the association of clusters of obesogenic behaviors and metabolic risk in early-maturing adolescents.

Status of Sedentary Time and Physical Activity of Rural Residents: A Cross-Sectional Population-Based Study in Eastern China

Background

The urbanization process may affect the lifestyle of rural residents in China. Limited information exists on the extent of sedentarism and physical activity (PA) level of rural residents in middle-income countries. This is the first survey on sedentary time (ST) and PA among rural residents in eastern China.

Methods

This cross-sectional observational study randomly samples rural adults from Zhejiang Province in eastern China (n = 1,320). Participants' ST and PA levels were determined from the International Physical Activity Questionnaire Short Form through face-to-face interviews, and the influencing factors of PA levels were assessed through multi-class logistic regression analysis.

Results

The findings showed that the daily ST of the participants ranged from 30 to 660 min, with a median of 240 min (P25, P75:120, 240 min), and 54.6% of participants were sedentary for 240 min or above. The daily ST in men, people aged 18 to 44 years, people with bachelors' degree and above, people working for government agencies or institutions, people with unmarried status, and people with an average income of &lt; 2,000 Yuan was longer than that of other respective groups (p &lt; 0.01). In contrast, the daily ST of people with hypertension or with patients with osteoporosis or osteopenia was less than that of normal people (p &lt; 0.01). Additionally, 69.4% of participants generally had a low level of PA (LPA). Compared with those living in northern Zhejiang, people living in southern Zhejiang who were aged 18–44 years, had bachelor's degree or above, were farmers, and had household incomes below 10,000 Yuan per month were more likely to engage in LPA compared to people &gt; 60 years, with high school or technical education levels or with junior college degrees, working in government agencies and institutions, and with household income above 10,000 Yuan per month (p &lt; 0.05). Furthermore, there was no correlation between ST and PA levels.

Conclusion

Most rural residents in the Zhejiang Province of eastern China had longer daily ST and a LPA. This was predominant in men, young people, highly educated people, unmarried people, and middle to high-income people. Health education programs should be targeted toward specific population groups to decrease the ST and increase PA.

Obesogenic clusters: excess body weight-related lifestyle behaviors in schoolchildren

abstract The objective of the study was to identify the existence of clusters in multiple lifestyle behaviors, including fruits/vegetables intake, sweetened products/soft drinks intake, sleep duration, physical activity and sedentary behavior. In sequence, the association between identified clusters and excess body weight in schoolchildren was examined. This was a cross-sectional school-based epidemiological study with approximately 17 thousand schoolchildren aged 4-20 years who participated in the Parana Health Project. Questionnaire was applied with structured questions to collect lifestyle behaviors. Excess body weight was identified through body mass index. Cluster analysis was performed to identify sex-specific clusters of multiple lifestyle behaviors. Analysis of covariance and logistic regression were used to analyze associations between clusters and excess body weight. Five clusters were identified in both sexes. Schoolchildren in the cluster characterized by lower fruits/vegetables intake and greater time spent in sedentary behavior showed close to twice the chance of having excess body weight compared to their peers in the reference cluster (girls: OR=1.98 [1.41-2.93]; boys: OR=1.94 [1.39-3.01]). In the case of schoolchildren in the cluster characterized by high sweetened products/soft drinks intake and shorter sleep duration, the chances of having excess body weight were 69% in girls (OR=1.69 [1.23-2.67]) and 73% in boys (OR=1.73 [1.25-2.91]). In conclusion, high fruits/vegetables intake, low sweetened products/soft drinks intake, longer sleep duration and less sedentary behavior was considered the most effective combination for maintaining a healthy body weight in the sample of schoolchildren.