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Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017)

1
National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D4 Dublin, Ireland
2
Department of Nutrition, Food Science and Physiology, University of Navarra, 31008 Pamplona, Spain
3
Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO European Office for Prevention and Control of Noncommunicable Diseases, 125009 Moscow, Russia
4
National Center of Public Health, Ministry of Health of the Republic of Kazakhstan, 010000 Astana, Kazakhstan
5
National Center of Public Health and Analyses, 1431 Sofia, Bulgaria
6
Primary Health Care, 1940 Floriana, Malta
7
Department of Cardiology, Institute of Mother and Child, 01-211 Warsaw, Poland
8
Danish Health Authority,2300 København, Denmark
9
National Institute of Public Health, 050463 Bucharest, Romania
10
Institute of Public Health, 1001 Tirana, Albania
11
Institute of Public Health of Montenegro, 8100 Podgorica, Montenegro
12
Croatian Institute of Public Health, 10000 Zagreb, Croatia
13
School of Medicine, School of Public Health Andrija Štampar, University of Zagreb, 10000 Zagreb, Croatia
14
WHO Country Office in Turkmenistan, 744000 Ashgabat, Turkmenistan
15
Spanish Agency for Food Safety and Nutrition (AESAN), 28071 Madrid, Spain
16
Department of Preventive Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
17
National Institute of Health Doutor Ricardo Jorge, I.P., 1649-016 Lisbon, Portugal
18
National Center for Disease Control and Public Health of Georgia, 0186 Tbilisi, Georgia
19
Obesity Management Centre, Institute of Endocrinology, 113 94 Prague, Czech Republic
20
Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath BA2 7AY, UK
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(3), 511; https://doi.org/10.3390/nu11030511
Received: 15 January 2019 / Revised: 19 February 2019 / Accepted: 21 February 2019 / Published: 27 February 2019
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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Abstract

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster ‘Physically active and healthy diet’. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries. View Full-Text
Keywords: cluster analysis; energy balance-related behaviors; physical activity; sedentary behavior; screen time; dietary intake; overweight; obesity; children cluster analysis; energy balance-related behaviors; physical activity; sedentary behavior; screen time; dietary intake; overweight; obesity; children
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Bel-Serrat, S.; Ojeda-Rodríguez, A.; Heinen, M.M.; Buoncristiano, M.; Abdrakhmanova, S.; Duleva, V.; Farrugia Sant’Angelo, V.; Fijałkowska, A.; Hejgaard, T.; Huidumac, C.; Hyska, J.; Kujundzic, E.; Musić Milanović, S.; Ovezmyradova, G.; Pérez-Farinós, N.; Petrauskiene, A.; Rito, A.I.; Shengelia, L.; Taxová Braunerová, R.; Rutter, H.; Murrin, C.M.; Kelleher, C.C.; Breda, J. Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017). Nutrients 2019, 11, 511.

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