Inequality in physical activity, sedentary behaviour, sleep duration and risk of obesity in children : a 12-country study

ObjectiveStudies examining associations between movement behaviours (i.e. physical activity, sedentary behaviour and sleep duration) and obesity focus on average values of these movement behaviours, despite important within-country and between-country variability. A better understanding of movement behaviour inequalities is important for developing public health policies and behaviour-change interventions. The objective of this ecologic analysis at the country level was to determine if inequality in movement behaviours is a better correlate of obesity than average movement behaviour volume in children from all inhabited continents of the world. MethodsThis multinational, cross-sectional study included 6,128 children 9-11years of age. Moderate-to-vigorous physical activity (MVPA), total sedentary time (SED) and sleep period time were monitored over 7 consecutive days using waist-worn accelerometry. Screen time was self-reported. Inequality in movement behaviours was determined using Gini coefficients (ranging from 0 [complete equality] to 1 [complete inequality]). ResultsThe largest inequality in movement behaviours was observed for screen time (Gini of 0.32; medium inequality), followed by MVPA (Gini of 0.21; low inequality), SED (Gini of 0.07; low inequality) and sleep period time (Gini of 0.05; low inequality). Average MVPA (hd(-1)) was a better correlate of obesity than MVPA inequality (r=-0.77 vs. r=0.00, p=0.03). Average SED (hd(-1)) was also a better correlate of obesity than SED inequality (r=0.52 vs. r=-0.32, p=0.05). Differences in associations for screen time and sleep period time were not statistically significant. MVPA in girls was found to be disproportionally lower in countries with more MVPA inequality. ConclusionsFindings from this study show that average MVPA and SED should continue to be used in population health studies of children as they are better correlates of obesity than inequality in these behaviours. Moreover, the findings suggest that MVPA inequality could be greatly reduced through increases in girls' MVPA alone.Peer reviewe

Sleep characteristics and health-related quality of life in 9- to 11-year-old children from 12 countries

IntroductionPrevious studies have linked short sleep duration, poor sleep quality, and late sleep timing with lower health-related quality of life (HRQoL) in children. However, almost all studies relied solely on self-reported sleep information, and most studies were conducted in high-income countries. To address these gaps, we studied both device-measured and self-reported sleep characteristics in relation to HRQoL in a sample of children from 12 countries that vary widely in terms of economic and human development.MethodsThe study sample included 6,626 children aged 9-11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Waist-worn actigraphy was used to measure total sleep time, bedtime, wake-up time, and sleep efficiency on both weekdays and weekends. Children also reported ratings of sleep quantity and quality. HRQoL was measured by the KIDSCREEN-10 survey. Multilevel regression models were used to determine the relationships between sleep characteristics and HRQoL.ResultsResults showed considerable variation in sleep characteristics, particularly duration and timing, across study sites. Overall, we found no association between device-measured total sleep time, sleep timing or sleep efficiency, and HRQoL. In contrast, self-reported ratings of poor sleep quantity and quality were associated with HRQoL.ConclusionsSelf-reported, rather than device-based, measures of sleep are related to HRQoL in children. The discrepancy related to sleep assessment methods highlights the importance of considering both device-measured and self-reported measures of sleep in understanding its health effects

Outdoor time and dietary patterns in children around the world

Abstract Background Whether outdoor time is linked to dietary patterns of children has yet to be empirically tested. The objective of this study was to examine the association between outdoor time and dietary patterns of children from 12 countries around the world. Methods This multinational, cross-sectional study included 6229 children 9–11 years of age. Children self-reported the time that they spent outside before school, after school and on weekends. A composite score was calculated to reflect overall daily outdoor time. Dietary patterns were assessed using a food frequency questionnaire, and two components were used for analysis: healthy and unhealthy dietary pattern scores. Results On average, children spent 2.5 h outside per day. After adjusting for age, sex, parental education, moderate-to-vigorous physical activity, screen time and body mass index z-score, greater time spent outdoors was associated with healthier dietary pattern scores. No association was found between outdoor time and unhealthy dietary pattern scores. Similar associations between outdoor time and dietary patterns were observed for boys and girls and across study sites. Conclusions Greater time spent outside was associated with a healthier dietary pattern in this international sample of children. Future research should aim to elucidate the mechanisms behind this association. </jats:sec

Aerobic capacity, activity levels and daily energy expenditure in male and female adolescents of the kenyan nandi sub-group

The relative importance of genetic and socio-cultural influences contributing to the success of east Africans in endurance athletics remains unknown in part because the pre-training phenotype of this population remains incompletely assessed. Here cardiopulmonary fitness, physical activity levels, distance travelled to school and daily energy expenditure in 15 habitually active male (13.9±1.6 years) and 15 habitually active female (13.9±1.2) adolescents from a rural Nandi primary school are assessed. Aerobic capacity ([Formula: see text]) was evaluated during two maximal discontinuous incremental exercise tests; physical activity using accelerometry combined with a global positioning system; and energy expenditure using the doubly labelled water method. The [Formula: see text] of the male and female adolescents were 73.9±5.7 ml(.) kg(-1.) min(-1) and 61.5±6.3 ml(.) kg(-1.) min(-1), respectively. Total time spent in sedentary, light, moderate and vigorous physical activities per day was 406±63 min (50% of total monitored time), 244±56 min (30%), 75±18 min (9%) and 82±30 min (10%). Average total daily distance travelled to and from school was 7.5±3.0 km (0.8-13.4 km). Mean daily energy expenditure, activity-induced energy expenditure and physical activity level was 12.2±3.4 MJ(.) day(-1), 5.4±3.0 MJ(.) day(-1) and 2.2±0.6. 70.6% of the variation in [Formula: see text] was explained by sex (partial R(2) = 54.7%) and body mass index (partial R(2) = 15.9%). Energy expenditure and physical activity variables did not predict variation in [Formula: see text] once sex had been accounted for. The highly active and energy-demanding lifestyle of rural Kenyan adolescents may account for their exceptional aerobic fitness and collectively prime them for later training and athletic success

Correlates of compliance with recommended levels of physical activity in children

The purpose of this study was to describe children's daily compliance with moderate-to-vigorous physical activity (MVPA) recommendations across a week in different parts of the world, and to identify individual-and school-level correlates that may explain differences in daily MVPA compliance. The sample included 6553 children aged 9-11 years from 12 countries, and multilevel statistical analyses were used, including both child-and school-level variables. Most children did not comply with the MVPA guidelines on a daily basis: Chinese children complied the least, whereas Finnish, Australian, Colombian, UK, and Kenyan children complied the most. Boys (rate ratio [RR] = 1.47) and children with higher unhealthy diet scores (RR = 1.08) complied more, but overweight/obese children (RR = 0.81), earlier maturing children (RR = 0.93), and those who spent more time in screen activities (RR = 0.98) and sleeping (RR = 0.96) had the lowest compliance. At the school level, children with access to playground or sport equipment (RR = 0.88, for both) tended to comply less, whereas those with access to a gymnasium outside the school hours complied more with the MVPA guidelines (RR = 1.14). Significant between-country differences in children's daily MVPA compliance were observed, reflecting not only site characteristics, but also the importance of individual traits and local school contexts.Peer reviewe

Relationship between soft drink consumption and obesity in 9-11 years old children in a multi-national study

The purpose of this study was to determine the association between regular (sugar containing) and diet (artificially sweetened) soft drink consumption and obesity in children from 12 countries ranging in levels of economic and human development. The sample included 6162 children aged 9-11 years. Information on soft drink consumption was obtained using a food frequency questionnaire. Percentage body fat (%BF) was estimated by bio-electrical impedance analysis, body mass index (BMI) z-scores were computed using World Health Organization reference data, and obesity was defined as a BMI &gt; +2 standard deviations (SD). Multi-level models were used to investigate trends in BMI z-scores, %BF and obesity across categories of soft drink consumption. Age, sex, study site, parental education and physical activity were included as covariates. There was a significant linear trend in BMI z-scores across categories of consumption of regular soft drinks in boys (p = 0.049), but not in girls; there were no significant trends in %BF or obesity observed in either boys or girls. There was no significant linear trend across categories of diet soft drink consumption in boys, but there was a graded, positive association in girls for BMI z-score (p = 0.0002) and %BF (p = 0.0001). Further research is required to explore these associations using longitudinal research designs.</p

Socioeconomic status and dietary patterns in children from around the world : different associations by levels of country human development?

Background: Although 'unhealthy' diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development. Methods: This was a multinational cross-sectional study among 9-11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children's dietary patterns. Principal Components Analysis was employed to create two component scores representing 'unhealthy' and 'healthy' dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES. Results: The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative 'unhealthy' diet-SES gradients in 7 countries and positive 'healthy' diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33-5.42), Canada (4.09; 95% CI: 2.02-8.27), Finland (2.82; 95% CI: 1.27-6.22), USA (4.31; 95% CI: 2.20-8.45), Portugal (2.09; 95% CI: 1.06-4.11), South Africa (2.77; 95% CI: 1.22-6.28), India (1.88; 95% CI: 1.12-3.15) and Kenya (3.35; 95% CI: 1.91-5.87). Conclusions: This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.Peer reviewe

Improving wear time compliance with a 24-hour waist-worn accelerometer protocol in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)

Background: We compared 24-hour waist-worn accelerometer wear time characteristics of 9-11 year old children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) to similarly aged U.S. children providing waking-hours waist-worn accelerometer data in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). Methods: Valid cases were defined as having >= 4 days with >= 10 hours of waking wear time in a 24-hour period, including one weekend day. Previously published algorithms for extracting total sleep episode time from 24-hour accelerometer data and for identifying wear time (in both the 24-hour and waking-hours protocols) were applied. The number of valid days obtained and a ratio (percent) of valid cases to the number of participants originally wearing an accelerometer were computed for both ISCOLE and NHANES. Given the two surveys' discrepant sampling designs, wear time (minutes/day, hours/day) from U.S. ISCOLE was compared to NHANES using a meta-analytic approach. Wear time for the 11 additional countries participating in ISCOLE were graphically compared with NHANES. Results: 491 U.S. ISCOLE children (9.92 +/- 0.03 years of age [M +/- SE]) and 586 NHANES children (10.43 +/- 0.04 years of age) were deemed valid cases. The ratio of valid cases to the number of participants originally wearing an accelerometer was 76.7% in U.S. ISCOLE and 62.6% in NHANES. Wear time averaged 1357.0 +/- 4.2 minutes per 24-hour day in ISCOLE. Waking wear time was 884.4 +/- 2.2 minutes/day for U.S. ISCOLE children and 822.6 +/- 4.3 minutes/day in NHANES children (difference = 61.8 minutes/day, p <0.001). Wear time characteristics were consistently higher in all ISCOLE study sites compared to the NHANES protocol. Conclusions: A 24-hour waist-worn accelerometry protocol implemented in U.S. children produced 22.6 out of 24 hours of possible wear time, and 61.8 more minutes/day of waking wear time than a similarly implemented and processed waking wear time waist-worn accelerometry protocol. Consistent results were obtained internationally. The 24-hour protocol may produce an important increase in wear time compliance that also provides an opportunity to study the total sleep episode time separate and distinct from physical activity and sedentary time detected during waking-hours.Peer reviewe

Sources of variability in childhood obesity indicators and related behaviors

The purpose of this study was to describe sources of variability in obesity-related variables in 6022 children aged 9-11 years from 12 countries. The study design involved recruitment of students, nested within schools, which were nested within study sites. Height, weight and waist circumference (WC) were measured and body mass index (BMI) was calculated; sleep duration and total and in-school moderate-to-vigorous physical activity (MVPA) and sedentary time were measured by accelerometry; and diet scores were obtained by questionnaire. Variance in most variables was largely explained at the student level: BMI (91.9%), WC (93.5%), sleep (75.3%), MVPA (72.5%), sedentary time (76.9%), healthy diet score (88.3%), unhealthy diet score (66.2%), with the exception of in-school MVPA (53.8%) and in-school sedentary time (25.1%). Variance explained at the school level ranged from 3.3% for BMI to 29.8% for in-school MVPA, and variance explained at the site level ranged from 3.2% for WC to 54.2% for in-school sedentary time. In general, more variance was explained at the school and site levels for behaviors than for anthropometric traits. Given the variance in obesity-related behaviors in primary school children explained at school and site levels, interventions that target policy and environmental changes may enhance obesity intervention efforts.Peer reviewe

Are Children Like Werewolves? : Full Moon and Its Association with Sleep and Activity Behaviors in an International Sample of Children

In order to verify if the full moon is associated with sleep and activity behaviors, we used a 12-country study providing 33,710 24-h accelerometer recordings of sleep and activity. The present observational, cross-sectional study included 5812 children ages 9-11 years from study sites that represented all inhabited continents and wide ranges of human development (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, United Kingdom, and United States). Three moon phases were used in this analysis: full moon (4 days; reference), half moon (5-9 days), and new moon (+10-14 days) from nearest full moon. Nocturnal sleep duration, moderate -to vigorous physical activity (MVPA), light-intensity physical activity (LPA), and total sedentary time (SED) were monitored over seven consecutive days using a waist -worn accelerometer worn 24 h a day. Only sleep duration was found to significantly differ between moon phases (-5 min/night shorter during full moon compared to new moon). Differences in MVPA, LPA, and SED between moon phases were negligible and non-significant (Peer reviewe