A Western dietary pattern is associated with poor academic performance in Australian adolescents

Food Knowledge for Better Nutrition and Health: A Study among University Students in Portugal

When students enter university, they suffer adaptations, including, usually, greater autonomy and responsibility for the choices they make. Therefore, it is crucial that they are well informed so as to make healthier food choices. The aim of this study was to determine whether sociodemographic characteristics, academic performance and lifestyle (tobacco and alcohol consumption) interfere with food literacy in university students. A quantitative, analytical, descriptive, transversal and correlational study was carried out, using quantitative data obtained through a questionnaire survey applied to a sample of 924 university students in Portugal. Food literacy was assessed through a scale of 27 items, distributed in three dimensions: D1-Literacy about food nutritional value and composition, D2-Literacy about labelling and food choice and D3-Literacy about healthy eating practices. Results showed no differences in food literacy according to sex or age. However, food literacy varied significantly with nationality, either globally (p = 0.006) or in the different dimensions evaluated (p-values of 0.005, 0.027 and 0.012 for D1, D2 and D3, respectively). In terms of academic achievement, the results showed no significant differences according to self-reported academic performance or even to the average classification obtained in the course. Regarding lifestyle variables, it was observed that alcohol consumption or smoking are not associated with food literacy, that is, food literacy does not vary significantly with these two lifestyle variables. In conclusion, food literacy in general and the dimensions evaluated are essentially constant among university students in Portugal, only varying for students from abroad. These results help to better perceive the food literacy levels for the population under study, university students, and that can be a valuable tool to better increase food literacy at these institutions as a way to better prepare for a healthier life and proper food habits that can enhance health in the long term.

Diet structure and academic achievement of children from difficult families: a cross-sectional study of Chinese children

OBJECTIVES

Welfare policy focuses on vulnerable populations, such as children with difficult family backgrounds. Education is a crucial way to reduce poverty. This study explored the relationship between children's diet structure and academic achievement and compared these across different family backgrounds.

DESIGN

A cross-sectional study was conducted to survey the health status of children from difficult families based on a random sampling method in 2018. Survey data were collected from children and their guardians with a questionnaire. A multi-sample latent class model and an ordinal logistic model were applied for data analysis.

SETTING

This study was conducted in 31 provinces nationwide. Two provinces in the Central (Shandong and Jiangxi), Eastern (Hebei and Henan) and Western (Chongqing and Shanxi) regions and one province in the Northeast (Liaoning) were selected considering different stratum of economic development.

PARTICIPANTS

A total of 2099 children with difficult family backgrounds and 666 children from ordinary families were surveyed.

RESULTS

The dietary structure of children from ordinary families was significantly better than that of children with difficult or unstable family backgrounds ([Formula: see text] =9.178, p<0.01). Children from difficult families had an intake of dairy products and fruits below dietary standards. The difference in academic achievement between children in the balanced and deprived groups was statistically significant (OR=0.640, 95% CI 0.429 to 0.955). Other determinants of the academic achievement of children in difficult families were parents' education level (OR=1.331, 95% CI 1.162 to 1.525), family economic status (OR=0.835, 95% CI 0.748 to 0.932) and parents' academic concern (OR=0.373, 95% CI 0.252 to 0.553).

CONCLUSIONS

To address the differences between children from difficult families and ordinary families, policymakers should develop support policies for difficult children, guide the formation of a reasonable dietary structure. Besides, enhancing family closeness and fostering family nurturing behaviours are the keys to promote the good academic development of children from difficult families.

Association Between Eating Habits and Perceived School Performance: A Cross-Sectional Study Among 46,455 Adolescents From 42 Countries

PURPOSE

This study analyzed the association between selected self-reported eating habits and perceived school performance in adolescents by gender.

METHODS

A cross-sectional analysis was conducted with data from a large representative sample of adolescents from 42 different countries. Participants answered questions about their weekly frequency of fruit, vegetable, sweets, and soft drink consumption, as well as the frequency of breakfast consumption and family meals. The adolescents subjectively rated their school performance compared to that of their classmates. Logistic regression models were adjusted for region, age, body mass index (z-score), socioeconomic status, physical activity, recreational screen time, and sleep difficulties.

RESULTS

Among the 46,455 (53.5% female, mean age of 13.7 ± 1.6 years) adolescents studied, 20.6% of males and 25.5% of females reported high perceived school performance. In the results of the fully adjusted analyses, the higher the frequency of all healthy eating habits studied, the higher the perceived school performance in both males and females. Specifically, both males and females reporting a higher frequency of fruit and vegetable consumption, a lower frequency of sweets and soft drink consumption, more frequent breakfast consumption, and more frequent family meals (breakfast and dinner) were more likely to perceive their school performance as higher compared to their classmates. In addition, having breakfast regularly on weekends and the frequency of family dinner were associated with better school performance in both males and females.

CONCLUSIONS

In summary, this study provide cross-sectional evidence on the association between healthy eating habits and perceived school performance. Considering that school performance is an indicator of healthy development in adolescence, our findings reinforce and extend the evidence on the importance of healthy eating at this stage of life.

Association between dietary patterns and cognitive ability in Chinese children aged 10-15 years: evidence from the 2010 China Family Panel Studies

Background

Limited information is available concerning the association between dietary patterns and cognitive ability during adolescence, especially in regards to the epidemiological studies in China. Therefore, this study aimed to analyze the association between dietary patterns and cognitive ability in Chinese children aged 10–15 years.

Methods

The dietary information, cognitive ability and sociodemographic data of 2029 children were retrieved from the 2010 China Family Panel Studies. Dietary patterns were assessed by principal component analysis. Ordinal logistic regression models were used to determine the association between dietary patterns and cognitive ability in these children.

Results

Three dietary patterns were identified, namely, ‘High protein’, ‘High fat’ and ‘High salt-oil’. Following adjustment for gender, age, nationality, household registration, school type, parental education level, family learning environment, annual household income and family size, we found that an increase in ‘High protein’ pattern score was significantly associated with higher mathematics test scores (OR = 1.62, CI: 1.23 ~ 2.15; P = 0.001), but not with vocabulary test scores (OR = 1.21, CI: 0.93 ~ 1.58; P = 0.149). On the contrary, an increase in ‘High fat’ pattern score was significantly associated with lower scores of mathematics (OR = 0.76, CI: 0.59 ~ 0.98; P = 0.031) and vocabulary (OR = 0.77, CI: 0.61 ~ 0.97; P = 0.029) tests. However, there was no significant association between ‘High salt-oil’ pattern and the scores of mathematics (OR = 0.99, CI: 0.77 ~ 1.27; P = 0.915) and vocabulary (OR = 0.93, CI: 0.73 ~ 1.18; P = 0.544) tests.

Conclusion

The findings of this study demonstrated that ‘High protein’ pattern was positively associated with cognitive ability in Chinese children, while ‘High fat’ pattern exhibited a negative association.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12209-2.

Social capital and dietary patterns in three ethnic minority groups native to Yunnan Province, Southwest China

BACKGROUND

Few studies have focused on the influencing factors of dietary practices among ethnic minority groups in China, particularly from a social capital perspective.

METHODS

Between May and September 2019, we conducted a cross-sectional survey among adults (n = 1,813) from three ethnic minority communities (A Chang, De Ang and Jing Po) in Yunnan Province, Southwest China. Dietary intakes during the past 12 months were measured with a 100-item Food Frequency Questionnaire (FFQ), and two forms of social capital (bonding and bridging) were measured using the validated Personal Social Capital Scale 16 (PSCS-16). Principal component factor analysis was used to derive dietary patterns from 20 food groups. Multivariate linear regressions were used to examine the associations between social capital and dietary patterns.

RESULTS

Two distinct dietary patterns were identified: the traditional and the modern. The traditional pattern was characterized by high consumptions of tubers, poultry, rice, fruits, vegetables and low consumptions of oil and salt, whereas the modern pattern was highly correlated with egg, nut, beverage, snack and oil consumptions. After adjusted for potential confounders, the modern pattern was positively associated with bonding capital (β = 0.066; 95%CI: 0.058, 0.075) and negatively associated with bridging capital (β = -0.017; 95%CI: -0.024, -0.010).

CONCLUSION

In conclusion, an unhealthy dietary pattern was identified among the ethnic minority groups in Southwest China. The influences of people's social connections on dietary behaviors should be considered in designing and implementing nutrition intervention programs for the population.

Increased Adherence to the Mediterranean Diet and Higher Efficacy Beliefs Are Associated with Better Academic Achievement: A Longitudinal Study of High School Adolescents in Lebanon

This longitudinal study aims to examine how changes in health behaviors and socio-cognitive factors influence the academic achievement of Lebanese adolescents over a period of 12 months. Adolescents (n = 563) from private and public schools in Mount Lebanon and the Beirut area, aged between 15 and 18, participated in a three-wave longitudinal study and completed a self-administered questionnaire assessing socio-demographics, health behaviors, socio-cognitive factors, parenting styles, and academic achievement. A linear mixed model was carried out to examine if changes in health behaviors and cognitive factors affect changes in academic achievement after 6 and 12 months from the baseline, adjusting for demographic variables and parenting style. Results show that improved adherence to the Mediterranean diet and an increase in self-efficacy were associated with an increase in academic achievement. An increase in adherence to the Mediterranean diet had the same effect on academic achievement 6 and 12 months from the baseline, whereas an increase in efficacy beliefs was only significantly associated with achievement at 12 months from the baseline. This study supports the longitudinal link between diet quality and efficacy beliefs with the academic achievement of adolescents. This relationship is independent of sex, age, religion, parents’ education, and raising styles.

Adherence to the Mediterranean diet and academic performance in adolescents: Does BMI status moderate this association?

BACKGROUND

Adolescence is a critical period for neurodevelopment, it is characterised by the establishment of behavioural patterns that can affect children's physical, mental and cognitive health, both immediately and later in life.

OBJECTIVE

The aim of the present research was to examine the association between adherence to the Mediterranean diet (MeD) and academic performance, as well as to analyze the moderating role of body mass index (BMI) status in this relationship.

METHODS

This cross-sectional study had a total 1290 adolescents (13.07 ± 0.82 years old, 714 boys and 576 girls) aged 12-14 years were included in this study. Adherence to the MeD was assessed using the Mediterranean Diet Quality Index. Academic performance was assessed through school records using four subjects: language, mathematics, English and grade point average (GPA).

RESULTS

Results showed a positive association between adherence to the MeD and all academic indicators after adjusting for potential confounders (β ranging from 0.165 to 0.213, all p < 0.001). The group of good adherence to the MeD had significantly higher scores in all the academic indicators compared with the poor/average group (p < 0.01). No interaction was found between BMI status and adherence to MeD in relation to academic indicators (all p > 0.340). These differences remained significant for both normal weight and overweight/obesity groups (p < 0.01).

CONCLUSIONS

Our results suggest that adherence to the MeD may be positively associated academic performance on adolescents regardless, of BMI status.

The role of body-esteem in academic functioning problems associated with eating disturbances

To explore the role of body-esteem and self-esteem in the occurrence of academic functioning problems associated with eating disturbances. Participants: 330 university students (aged 16-53 years) in Finland in 2016. Method: Interference with academic functioning measured with the Eating and Body Image Academic Interference Scale. Multivariable logistic regression analyses were performed to describe the relationship of body-esteem, global self-esteem, and age with academic functioning problems associated with eating disturbances. Results: The level of academic functioning problems was low. High appearance-esteem (OR = 0.26; 95% CI [0.14-0.48]) and a five-year increase in age (OR = 0.68; 95% CI [0.52-0.89]) provided protection against academic functioning problems, whereas high evaluations attributed to others about one's body and appearance increased the odds of such problems (OR = 2.25; 95% CI [1.41-3.59]). Conclusion: Problems in academic functioning may relate to problems in eating behavior, body image, and feelings about appearance.

Is Academic Achievement Related to Mediterranean Diet, Substance Use and Social-Cognitive Factors: Findings from Lebanese Adolescents

There is substantial evidence that good academic performance significantly enhances the prospects of success for adolescents in terms of employment, social status, quality of life and health. Identifying which factors are correlated to good academic achievement and which factors may need to be addressed by policies is crucial. Despite its importance, there is insufficient data concerning factors associated with academic achievement in the Middle East, particularly Lebanon. This study assessed the association of lifestyle, socio-demographics and motivational factors with academic achievement of Lebanese adolescents. Grade 10 and 11 Lebanese adolescents aged 15 to 18 years (n = 600), from private and public schools in Beirut and the Mount Lebanon area, completed a multi-component questionnaire assessing health behaviors, socio-demographic characteristics and motivational factors. Height and weight were physically measured and, subsequently, Body Mass Index was calculated. Academic achievement was assessed using self-reported grades and was categorized into high and low. Associations between all factors and academic achievement were tested using logistic regression models. Adherence to the Mediterranean diet, high self-efficacy and intention were positively associated with academic achievement, whereas smoking was associated with poor achievement. Our findings support the need for targeting adolescents with an unhealthier lifestyle and focusing on socio-cognitive determinants interventions aimed at enhancing academic achievement.

Sports Participation Correlates With Academic Achievement: Results From a Large Adolescent Sample Within the 2017 U.S. National Youth Risk Behavior Survey

This study sought to examine associations between (a) sports team participation; (b) lifestyle behaviors (e.g., sleeping, alcohol, and tobacco use); and (c) dietary behaviors with self-reported academic achievement using data derived from the 2017 U.S. National Youth Risk Behavior Survey. A multistage cluster sampling procedure was employed to obtain a representative sample of U.S. adolescents from among whom the number with usable data was 14,765. We used weighted logistic regression models to examine the associations between sports participation, lifestyle behaviors, and diet with reported academic achievement (mostly A’s and B’s), adjusting for age, sex, body mass index, and race/ethnicity. After controlling for lifestyle behaviors, diet, and other potentially confounding variables, we found that adolescents participating in one or more sport teams throughout the past year also reported higher academic achievement (A’s and B’s) compared with adolescents participating in zero sports teams (odds ratio [ OR] = 1.39 to 2.40, p <  .001). This relationship was dose-dependent, as participating in multiple sports teams (i.e., > 3) showed a stronger association with academic achievement than participating on only one sports team ( p <  .001). Other independent behavioral correlates with similarly high grades included daily breakfast consumption ( OR = 1.40, p <  .001), sleeping at least eight hours per night ( OR = 1.21, p <  .001), and regular consumption of vegetables ( OR = 1.56, p <  .001) and salads ( OR = 1.30, p <  .001). We discuss the meaning and implication of these findings.

An evidence-based nutrition education programme for orphans and vulnerable children: protocol on the development of nutrition education intervention for orphans in Soweto, South Africa using mixed methods research

BACKGROUND

Focus on interventions for orphans and vulnerable children (OVC) in South Africa on education, quality of life (QoL) and nutrition-related matters have been reported diminutive. The risk of dropping out of school for an OVC with poor QoL and without varied food intake is very high. The problem with poor; QoL, nutritional care and academic performance (AP) of the OVC is that it sets the foundation for their adults' life. The purpose of this longitudinal study is to develop, implement and to test the efficacy of an evidence-based nutrition education programme (NEP) for OVC that will integrate their families/caregivers, schools and communities.

METHODS

A longitudinal study, and a mixed-methods approach steered by action research will be used. This study will be in three phases. Phase 1 will be the needs assessment; Phase 2 will be the development of nutritional education materials, and Phase 3 is the intervention. QoL, dietary intakes, body composition, and anthropometric status, physical activities, and AP of 520 OVC in Soweto will be assessed using standard techniques. Nutrition knowledge, attitude and practices (KAP) of the caregivers will be assessed using previously validated questionnaires. Focus group discussion (FGD) will be conducted to gain an in-depth understanding of what OVC eat and factors affecting their food intakes. Data will be collected at baseline, week 12 and week 24. Generalised Least Squares (GLS) regression model will be used to test the study hypotheses. Atlas-ti and Thematic Framework Analysis (TFA) will be used for qualitative data analysis.

DISCUSSION

This study will provide detailed information on the QoL, food intakes concerning academic performance and general well-being of OVC in an Africa setting. The participatory mixed methods nature of the study will provide valuable insights into the drivers and challenges to QoL, AP, and nutritional status of this group. This approach will assist the policymakers' and other stakeholders in decision making regarding the general well-being of the OVC.

TRIAL REGISTRATION

ISRCTN12835783 . Date registered 14.01.2019.

Adherence to the Mediterranean Diet Is Related to Healthy Habits, Learning Processes, and Academic Achievement in Adolescents: A Cross-Sectional Study

Background: Several studies have shown that following a healthy diet and practicing regular physical activity (PA) are related with multiple health benefits. However, the cognitive and academic implications of these behaviors within adolescents requires further study. Material and Methods: A cross-sectional study was conducted with a simple of 1059 adolescents from Spain. The main instruments employed were the Adherence to Mediterranean Diet Test (KIDMED), the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Motivation and Learning Strategies Short Form (MSLQ-SF). Results: Practicing PA for more than three hours per week was related to better dietary habits (p < 0.001) such as increased consumption of vegetables (0.75 ± 0.43 vs. 0.62 ± 0.48), fish (0.67 ± 0.47 vs. 0.58 ± 0.49), cereals (0.85 ± 0.35 vs. 0.77 ± 0.41) and nuts (0.44 ± 0.49 vs. 0.35 ± 0.47). High adherence to a Mediterranean diet (MD) was positively related to elaboration strategies (r = 0.116), organizational strategies (r = 0.109), critical thinking (r = 0.116), self-regulation (r = 0.159), time and study habits (r = 0.160), self-regulation of effort (r = 0.118), and intrinsically orientated goals (r = 0.090) (p < 0.01 for all variables). Practicing PA every week was also related to improvements in several of the measured variables and in addition was related to lower levels of anxiety within the academic environment (r = −0.070; p < 0.05). Conclusions: Given the benefits of eating habits and the practice of PA in the cognitive processes involved in adolescent learning, intervention programs within the educational context are recommended to improve healthy habits.

Dietary quality linkage to overall competence at school and emotional disturbance in representative Taiwanese young adolescents: dependence on gender, parental characteristics and personal behaviors

BACKGROUND

Child school performance during puberty may be at increased risk through emotional disturbance. It is hypothesized that this may be mitigated by dietary quality.

METHODS

In a nationally representative sample (Nutrition and Health Survey in Taiwan, NAHSIT), 1371 Taiwanese aged 11-16 years, overall competence at school, (OCS) and emotional status have been assessed by teachers with the SAED (Scale for Assessing Emotional Disturbance). Parents provided family socio-demographics and students completed a behavioral and dietary questionnaire (Youth Healthy Eating Index - Taiwan, YHEI-TW). Associations between emotional disturbance (ED), OCS and dietary quality (YHEI-TW) were assessed in multiple linear regression models with adjustments for covariates including parental characteristics, personal behaviors, body fatness and puberty.

RESULTS

Boys or girls with ED had a less favorable OCS (p < 0.001), minimally dependent on YHEI-TW. On multivariable analysis there was a more positive association between OCS and YHEI-TW among boys (β = 0.05, p < 0.01) and girls (β = 0.07, p < 0.001). Poor dietary quality was associated with ED, especially in girls (β =  - 0.06, p < 0.001). Additionally, parental characteristics, body fatness, and personal behaviors are associated with OCS. Puberty is associated with ED and may be indirectly linked to OCS.

CONCLUSIONS

Unsatisfactory food intake is associated with the link between emotional disturbance and impaired school performance, as assessed by OCS, especially among girls. For both genders, socio-economic and behavioral factors including parenteral income, reading, screen viewing and smoking are modulators of this association. Puberty was a modifying factor in girls. Dietary quality is a relevant factor for health (ED) as well as education (OCS) during early adolescence.

Diet quality and attention capacity in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5-17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β=0·16, P=0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P>0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted.

Associations between selected dietary behaviours and academic achievement: A study of Australian school aged children

BACKGROUND

Research investigating the effects of dietary behaviours on children's academic achievement has predominately focused on breakfast consumption. The aim of this study was to conduct secondary analysis to examine associations between a range of dietary behaviours and children's academic achievement.

METHODOLOGY

Data on five dietary variables (fruit intake; vegetable intake; consumption of takeaway; sugar sweetened beverages; and breakfast) and scores in the five domains of a standardised academic achievement test known as NAPLAN (reading, writing, grammar/punctuation, spelling and numeracy) were obtained for Australian children aged 8-15 years in school grades three (n = 1185), five (n = 1147), seven (n = 1053) and nine (n = 860). Mixed linear models adjusted for socioeconomic status and gender were used to examine associations between dietary behaviours and academic scores.

RESULTS

Greater consumption of vegetables with the evening meal (7 nights/week) was associated with higher test scores in the domains of spelling and writing (p=<0.01), with the greatest effect observed for spelling with a mean score difference of 86 ± 26.5 NAPLAN points between the highest and lowest levels of consumption (95% CI: 34.0-138.1; p=<0.01). Increased consumption of sugar sweetened beverages was associated with significantly lower test scores in reading, writing, grammar/punctuation and numeracy (<0.01).

PRINCIPLE CONCLUSIONS

The findings of this study demonstrate dietary behaviours are associated with higher academic achievement. Future research should further explore relationships between a wide range of dietary behaviours and children's academic achievement.

Associations between physical activity patterns and dietary patterns in a representative sample of Polish girls aged 13-21 years: a cross-sectional study (GEBaHealth Project)

BACKGROUND

Similar to other countries, trends of decreasing levels of physical activity (PA) and an increasing prevalence of unhealthy dietary patterns are observed among girls in Poland. Better understanding of potentially inter-related behaviours within this population can help to design tailored interventions. The purpose of this study was to determine associations between PA patterns and dietary patterns in a representative sample of Polish girls.

METHODS

Girls aged 13-21 years (n = 1107) were randomly selected for the study. PA was assessed using International Physical Activity Questionnaire - Long (IPAQ-L). Dietary data were collected with food frequency questionnaires. PA patterns and dietary patterns were drawn separately by Principal Component Analysis (PCA). Logistic regression was used to find the associations between PA patterns and dietary patterns.

RESULTS

Four major PA patterns ('School/work activity', 'Active recreation', 'Yard activity' and 'Walking and domestic activity') and four dietary patterns ('Traditional Polish', 'Fruit & vegetables', 'Fast food & sweets' and 'Dairy & fats') were identified. Level of PA was the highest in the upper tertile of 'School/work activity' pattern (mean 1372.2 MET-minutes/week, 95 % Confidence Intervals [CI]: 1285.9-1458.5). Girls in upper tertiles of 'Yard activity', 'Active recreation' and 'School/work activity' patterns had significantly higher chances of being in the upper tertile of the 'Fruit and vegetables' dietary pattern (odds ratio [OR] 2.17, 95 % CI: 1.50-3.14, p < 0.0001; OR 2.02, 95 % CI: 1.41-2.91; p < 0.001 and OR 1.76, 95 % CI: 1.24-2.51, p < 0.01 respectively; all adjusted for confounders) in comparison to bottom tertiles. Weak, but significant inverse associations were found between upper tertiles of 'Active recreation' and 'Yard activity' patterns and unhealthy dietary patterns.

CONCLUSIONS

We found associations between PA patterns and dietary patterns in the population of Polish girls. Girls with the highest adherence to the 'School/work activity' pattern had the highest levels of PA and presented pro-healthy dietary behaviours. School should be recognised as potentially efficient and important setting to maximise girls' PA potential. The after-school time is the area that should also be targeted to increase daily PA or to at least sustain the level of PA after completing education.