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  • Population Study Article
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Lifestyle behaviors clusters in a nationwide sample of Spanish children and adolescents: PASOS study

Pediatric Research volume 94, pages 2077–2084 (2023)Cite this article

Abstract

Background

Youth is a vulnerable period. To classify lifestyle behaviors and its relationship with health-related outcomes of Spanish children and adolescents.

Methods

Cross-sectional study including 3261 children aged 7.5–17.5 y (52.8% females). Physical activity (PA), screen-time, sleep time, adherence to Mediterranean diet (MD), weight status (WS) by validated methods. Cluster analysis was run considering chronological age.

Results

Six clusters were identified: C1: high screen time, low adherence to MD and sleep time (n = 431,13.20%); C2: high WS, medium adherence to MD,high sleep time, and low screen time (n = 466,14.30%); C3: young group with low screen time and high PA, adherence to MD and sleep (n = 537,16.40%); C4: worst profile regarding adherence to MD, PA, WS and sleep time (n = 609,18.70%); C5: low screen time and PA, high sleep time (n = 804,24.70%); C6: high PA and screen time, low WS (n = 414,12.70%). Mean absolute values were statistically different among PA levels, screen and sleep time, adherence to MD, age, and WS (all p < 0.001).

Conclusions

The most prevalent pattern was low levels of PA, MD, and screen time, and high sleep time. The second most prevalent was characterized by very low levels of PA, sleep time, and adherence to MD, and high screen time, and WS in adolescents.

Impact statement

  • The main identified lifestyle behavior was poor physical activity, low adherence to Mediterranean Diet and high screen and sleep time.

  • Children should increase physical activity levels, adherence to Mediterranean diet, decrease screen and sleep the appropriate hours per day.

  • Families, schools, and medical communities must work together to gloss over present and future diseases.

  • Sleep time had not been previously included in cluster analysis with physical activity, sedentary behaviors, obesity, and nutritional status, thus the present data open a new perspective in Spanish population.

  • Health policies should focus on promoting physical activity, Mediterranean diet, adequate sleep and reducing screen time.

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Fig. 1: Variable distributions for each cluster.

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Data availability

Data available under request.

References

  1. Leis, R. et al. Cluster analysis of physical activity patterns, and relationship with sedentary behavior and healthy lifestyles in prepubertal children: genobox cohort. Nutrients 12, 1288 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Miller, M. A., Kruisbrink, M., Wallace, J., Ji, C. & Cappuccio, F. P. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep 41, https://doi.org/10.1093/sleep/zsy018 (2018).

  3. Hynynen, S. T. et al. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents. Int Rev. Sport Exerc Psychol. 9, 22–44 (2016).

    Article  PubMed  Google Scholar 

  4. Khan, A., Uddin, R. & Islam, S. M. S. Clustering patterns of behavioural risk factors for cardiovascular diseases in bangladeshi adolescents: a population-based study. Health Policy Technol. 8, 386–392 (2019).

    Article  Google Scholar 

  5. Bull, F. C. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br. J. Sports Med. 54, 1451–1462 (2020).

    Article  PubMed  Google Scholar 

  6. Neira, M. & de Onis, M. The Spanish strategy for nutrition, physical activity and the prevention of obesity. Br. J. Nutr. 96(Suppl 1), S8–S11 (2006).

    Article  CAS  PubMed  Google Scholar 

  7. García-Soidán, J. L., Leirós-Rodríguez, R., Romo-Pérez, V. & Arufe-Giráldez, V. Evolution of the habits of physical activity and television viewing in Spanish children and pre-adolescents between 1997 and 2017. Int J. Environ. Res. Public Health 17, 6836 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Roman-Viñas, B., Zazo, F., Martínez-Martínez, J., Aznar-Laín, S. & Serra-Majem, L. Results from Spain’s 2018 report card on physical activity for children and youth. J. Phys. Act. Health 15, S411–S412 (2018).

    Article  PubMed  Google Scholar 

  9. Leech, R. M., McNaughton, S. A. & Timperio, A. The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review. Int J. Behav. Nutr. Phys. Act. 11, 4 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wärnberg, J. et al. Screen time and parents’ education level are associated with poor adherence to the Mediterranean Diet in Spanish children and adolescents: The Pasos study. J. Clin. Med 10, 795 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sánchez-Oliva, D. et al. Lifestyle clusters in school-aged youth and longitudinal associations with fatness: The up&Down study. J. Pediatr. 203, 317–324.e311 (2018).

    Article  PubMed  Google Scholar 

  12. Santaliestra-Pasías, A. M. et al. Clustering of lifestyle behaviours and relation to body composition in European children. The Idefics study. Eur. J. Clin. Nutr. 69, 811–816 (2015).

    Article  PubMed  Google Scholar 

  13. Teh, C. H. et al. Clustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income Country: A cross-sectional study. BMC Public Health 19, 1177 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pérez-Rodrigo, C. et al. Clustering of dietary patterns, lifestyles, and overweight among spanish children and adolescents in the anibes study. Nutrients 8, 11 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  15. D’Souza, N. J. et al. A systematic review of lifestyle patterns and their association with adiposity in children aged 5-12 years. Obes. Rev. 21, e13029 (2020).

    Article  PubMed  Google Scholar 

  16. Mayne, S. L., Virudachalam, S. & Fiks, A. G. Clustering of unhealthy behaviors in a nationally representative sample of U.S. children and adolescents. Prev. Med. 130, 105892 (2020).

    Article  PubMed  Google Scholar 

  17. Patton, G. C. et al. Health of the world’s adolescents: a synthesis of internationally comparable data. Lancet 379, 1665–1675 (2012).

    Article  PubMed  Google Scholar 

  18. Uddin, R., Lee, E. Y., Khan, S. R., Tremblay, M. S. & Khan, A. Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: a global perspective. Prev. Med. 131, 105955 (2020).

    Article  PubMed  Google Scholar 

  19. Gómez, S. F. et al. Study protocol of a population-based cohort investigating physical activity, sedentarism, lifestyles and obesity in Spanish youth: The Pasos study. BMJ Open 10, e036210 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Steel, D. Multistage Sampling. In: International Encyclopedia of Statistical Sciences (ed. Lovric, M.) (2011).

  21. Sedgwick, P. Multistage sampling. BMJ : Br. Med. J. 351, h4155 (2015).

    Article  Google Scholar 

  22. Instituto Nacional de Estadística (INE). Youth Population, http://www.ine.es/jaxi/Tabla.htm?path=/t20/e245/p08/l0/&file=02002.px (2018).

  23. Zamora Saiz, A., Quesada González, C., Hurtado Gil, L. S. & Mondéjar Ruiz, D. An Introduction to Data Analysis in R: Hands-on Coding, Data Mining, Visualization and Statistics from Scratch. (2020).

  24. Schröder, H. et al. Validity, reliability, and calibration of the physical activity unit 7 item screener (Pau-7s) at population scale. Int. J. Behav. Nutr. Phys. Act. 18, 98 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rey-López, J. P. et al. Reliability and validity of a screen time-based sedentary behaviour questionnaire for adolescents: The Helena Study. Eur. J. Public Health 22, 373–377 (2012).

    Article  PubMed  Google Scholar 

  26. Wolfson, A. R. et al. Evidence for the validity of a sleep habits survey for adolescents. Sleep 26, 213–216 (2003).

    Article  PubMed  Google Scholar 

  27. Hirshkowitz, M. et al. National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep. Health 1, 40–43 (2015).

    Article  PubMed  Google Scholar 

  28. García Cabrera, S. et al. Kidmed test; prevalence of low adherence to the Mediterranean diet in children and young; a systematic review. Nutr. Hosp. 32, 2390–2399 (2015).

    PubMed  Google Scholar 

  29. Mariscal-Arcas, M. et al. Evaluation of the mediterranean diet quality index (Kidmed) in children and adolescents in Southern Spain. Public Health Nutr. 12, 1408–1412 (2009).

    Article  PubMed  Google Scholar 

  30. de Onis, M. et al. Development of a who growth reference for school-aged children and adolescents. Bull. World Health Organ 85, 660–667 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  31. World Health Organization (WHO). Bmi for Age (5–19 Years), https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age (2007).

  32. Nawarycz, T. et al. Waist-to-height ratio as a measure of abdominal obesity in Southern Chinese and European children and adolescents. Int. J. Obes. 40, 1109–1118 (2016).

    Article  CAS  Google Scholar 

  33. World Health Organization (WHO). Weighing and Measuring a Child. In: Training Course and Other Tools. (WHO, Geneva, 2008).

  34. Prevention, C. f. D. C. a. Child Development, https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence.html (2021).

  35. Huang, Z. Extensions to the K-means algorithm for clustering large data sets with categorical values. Data Min. Knowl. Discov. 2, 283–304 (1998).

    Article  Google Scholar 

  36. He, Z., Xu, X. & Deng, S. Squeezer: an efficient algorithm for clustering categorical data. J. Comput. Sci. Technol. 17, 611–624 (2002).

    Article  Google Scholar 

  37. Rousseeuw, L. K. P. J. Findings Groups in Data: An Introduction to Cluster Nalaysis (1990).

  38. Cross, G. R. & Jain, A. K. Measurement of clustering tendency*. IFAC Proc. Volumes 15, 315–320 (1982).

    Article  Google Scholar 

  39. Gómez, S., Robles, C. & Homs. C. Resultados Principales Del Estudio Pasos 2019 Sobre La Actividad Física, Los Estilos De Vida Y La Obesidad De La Población Española De 8 a 16 años. (Gasol Foundation, 2019).

  40. Laguna, M., Ruiz, J. R., Lara, M. T. & Aznar, S. Recommended levels of physical activity to avoid adiposity in Spanish children. Pediatr. Obes. 8, 62–69 (2013).

    Article  CAS  PubMed  Google Scholar 

  41. Miguel-Berges, M. L., Reilly, J. J., Moreno Aznar, L. A. & Jiménez-Pavón, D. Associations between pedometer-determined physical activity and adiposity in children and adolescents: systematic review. Clin. J. Sport Med 28, 64–75 (2018).

    Article  PubMed  Google Scholar 

  42. Moliner-Urdiales, D. et al. Association of objectively assessed physical activity with total and central body fat in Spanish adolescents; the Helena study. Int J. Obes. (Lond.) 33, 1126–1135 (2009).

    Article  CAS  PubMed  Google Scholar 

  43. Poitras, V. J. et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol. Nutr. Metab. 41, S197–S239 (2016).

    Article  PubMed  Google Scholar 

  44. World Health Organization (WHO). Physical Activity and Young People. Recommended Levels of Physical Activity for Children Aged 5–17 Years. In: Global Strategy on Diet, Physical Activity and Health, https://www.who.int/dietphysicalactivity/factsheet_young_people/en/ (2020).

  45. Mohammadi, S. et al. Dietary and physical activity patterns related to cardio-metabolic health among malaysian adolescents: a systematic review. BMC Public Health 19, 251 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  46. Busch, V., Van Stel, H. F., Schrijvers, A. J. P. & de Leeuw, J. R. J. Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study. BMC Public Health 13, 1118 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mielgo-Ayuso, J. et al. Physical activity patterns of the spanish population are mostly determined by sex and age: findings in the anibes study. PLoS One 11, e0149969 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Landsberg, B. et al. Clustering of lifestyle factors and association with overweight in adolescents of the kiel obesity prevention study. Public Health Nutr. 13, 1708–1715 (2010).

    Article  PubMed  Google Scholar 

  49. Bai, Y. et al. The associations of youth physical activity and screen time with fatness and fitness: The 2012 Nhanes national youth fitness survey. PLoS One 11, e0148038 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Banfield, E. C., Liu, Y., Davis, J. S., Chang, S. & Frazier-Wood, A. C. Poor adherence to US Dietary Guidelines for Children and Adolescents in the National Health and Nutrition Examination Survey Population. J. Acad. Nutr. Diet. 116, 21–27 (2016).

    Article  PubMed  Google Scholar 

  51. Yang, L. et al. Trends in Sedentary Behavior among the Us Population, 2001–2016. JAMA 321, 1587–1597 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bel-Serrat, S. et al. Clustering of multiple lifestyle behaviours and its association to cardiovascular risk factors in children: The Idefics study. Eur. J. Clin. Nutr. 67, 848–854 (2013).

    Article  CAS  PubMed  Google Scholar 

  53. González-Gross, M., Gómez-Lorente, J. J., Valtueña, J., Ortiz, J. C. & Meléndez, A. The "Healthy Lifestyle Guide Pyramid" for children and adolescents. Nutrición Hospitalaria 23, 159–168 (2008).

    PubMed  Google Scholar 

  54. Bibiloni, M. D. M. et al. Determinants of adherence to the mediterranean diet in spanish children and adolescents: The Pasos study. Nutrients 14, 738 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Pedersen, S., Grønhøj, A. & Thøgersen, J. Following family or friends. social norms in adolescent healthy eating. Appetite 86, 54–60 (2015).

    Article  PubMed  Google Scholar 

  56. Helsel, B. C., Liang, J., Williams, J. E., Griffin, S. F. & Spitler, H. Family and friend influences on fruit and vegetable intake in elementary aged children. J. Commun. Health 44, 932–940 (2019).

    Article  Google Scholar 

  57. López-Gil, J. F., Reis Gaya, A., Duarte Junior, M. A. D. S. & Yuste Lucas, J. L. Meeting international screen-time guidelines is associated with healthy dietary patterns in Spanish schoolchildren. Nutrición Hospitalaria 37, 1123–1129 (2020).

    PubMed  Google Scholar 

  58. Bayon, V., Leger, D., Gomez-Merino, D., Vecchierini, M. F. & Chennaoui, M. Sleep debt and obesity. Ann. Med. 46, 264–272 (2014).

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the staff, pupils, parents, schools and municipalities for their participation, enthusiasm, and support.

Funding

PASOS has the institutional support of Spain’s Ministry of Education and Vocational Training, the Ministry of Health, Consumption and Social Welfare through AESAN (Spanish Agency for Food Safety and Nutrition), the High Commission against Child Poverty, the High Sports Council, the General College of Professional Associations of Physical Education and Sports, and the Departments of Education and/or Health and/or Sports of Spain’s 17 autonomous regions. The CIBERESP, CIBEROBN, CIBERESP and CIBERFES are initiatives of the Institute of Health Carlos III (ICSIII), Madrid, Spain. The PASOS study has been funded mainly by the Gasol Foundation and Fundación PROBITAS. Barça Foundation, Banco Santander, Viena, Grupo IFA and Fundación Deporte Joven also contributed with funds. MGG, JAT and CB are funded by the official funding agency for biomedical research of the Spanish government, Institute of Health Carlos III (ISCIII), which is co-funded by the European Regional Development Fund (CIBEROBN CB12/03/30038). CB is funded by the Directorate General of R + D of the Balearic Islands Government (Margalida Comas Grant). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain

    Augusto G. Zapico, Raquel Aparicio-Ugarriza, Carlos Quesada-González, Eva Gesteiro & Marcela González-Gross

  2. Department of Language, Arts and Physical Education, Universidad Complutense de Madrid, Madrid, Spain

    Augusto G. Zapico

  3. Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain

    Raquel Aparicio-Ugarriza, Julia Wärnberg, Lluís Serra-Majem, Josep A. Tur, Montserrat Fíto, Cristina Bouzas & Marcela González-Gross

  4. Departamento de Matemática Aplicada a las Tecnologías de la Información y la Comunicación, Universidad Politécnica de Madrid, 28031, Madrid, Spain

    Carlos Quesada-González

  5. Gasol Foundation, Sant Boi de Llobregat, Spain

    Santiago Felipe Gómez & Clara Homs

  6. Biomedical Research Networking Center on Epidemiology and Public Health studies (CIBERESP), Institute of Health Carlos III, Madrid, Spain

    Santiago Felipe Gómez & Helmut Schröder

  7. Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    Santiago Felipe Gómez, Montserrat Fíto & Helmut Schröder

  8. Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain

    Santiago Felipe Gómez

  9. EpiPHAAN Research Group. Faculty of Health Sciences, University of Málaga-Institute of Biomedical Research of Malaga (IBIMA), Málaga, Spain

    Julia Wärnberg & Juan Carlos Benavente-Marín

  10. ELIKOS group, Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD). CIBEROBN, ISCIII Navarra, Public University of Navarra, Navarra, Spain

    María Medrano

  11. Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, Universidad de Extremadura, Cáceres, Spain

    Narcís Gusi & Jesús Sánchez-Gómez

  12. PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Toledo, Spain

    Susana Aznar & Fabio Jiménez-Zazo

  13. Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES). Institute of Health Carlos III, Madrid, Spain

    Susana Aznar

  14. Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain

    Elena Marín-Cascales & Pedro E. Alcaraz

  15. Faculty of Sport Sciences, UCAM, Catholic University of Murcia, Murcia, Spain

    Elena Marín-Cascales, Pedro E. Alcaraz & Marta Sevilla-Sánchez

  16. Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain

    Miguel A. González-Valeiro

  17. Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Lluís Serra-Majem & Estefanía Herrera-Ramos

  18. Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain

    Lluís Serra-Majem

  19. Regional Unit of Sports Medicine, Municipal Sports Foundation of Avilés, Asturias, Spain

    Susana Pulgar

  20. Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), Palma de Mallorca, Spain

    Josep A. Tur & Cristina Bouzas

  21. Fundació FC Barcelona, Barcelona, Spain

    Marta Segu & Clara Sistac

  22. GRoW, Global Research on Wellbeing, Blanquerna School of Life Sciences, University Ramon Llull, Barcelona, Spain

    Clara Homs

Authors
  1. Augusto G. Zapico
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  2. Raquel Aparicio-Ugarriza
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Contributions

A.G.Z. and M.G.G. conceptualized and designed the study, R.A.U. and C.Q.G. run statistical analyses, A.G.Z., R.A.U. and M.G.G. drafted the initial manuscript and incorporated the suggestions of all the consortium authors, A.G.Z., R.A.U., C.Q.G., E.G., and M.G.G. wrote the manuscript. S.G. and H.S. are the coordinators of the PASOS study. All authors contributed to the methodology and data acquisition and reviewed the final version of the manuscript.

Corresponding author

Correspondence to Augusto G. Zapico.

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Zapico, A.G., Aparicio-Ugarriza, R., Quesada-González, C. et al. Lifestyle behaviors clusters in a nationwide sample of Spanish children and adolescents: PASOS study. Pediatr Res 94, 2077–2084 (2023). https://doi.org/10.1038/s41390-023-02710-2

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