Elsevier

The Journal of Pediatrics

Volume 183, April 2017, Pages 178-183.e2
The Journal of Pediatrics

Original Articles
Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries

https://doi.org/10.1016/j.jpeds.2016.12.048Get rights and content

Objective

To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions.

Study design

This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models.

Results

Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk-food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all-rounders). Health-related quality of life was greatest in the all-rounders cluster.

Conclusions

Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health-related quality of life, with children from the all-rounders cluster consistently reporting greatest health-related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior).

Trial registration

ClinicalTrials.gov: NCT01722500.

Section snippets

Methods

Data from the cross-sectional International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) were used (ClinicalTrials.gov: NCT01722500). A detailed description of the ISCOLE protocol can be found in the work of Katzmarzyk et al.18

Participants were recruited from schools in study sites spread across 12 countries (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, England, and the US). From these schools, children aged 9-11 years were

Results

Participants were enrolled from September 2011 to December 2013, and their characteristics are presented in Table I. Children's self-reported HRQoL differed between sites (Table II). Children from higher-income countries tended to report greater HRQoL than children from low-to-middle income countries (correlation between HRQoL and world bank classification: r = 0.74, P = .01, and between HRQoL and human development index: r = 0.62, P = .03).

Three similar clusters were identified across most of

Discussion

Remarkable commonality was observed in lifestyle behavior patterns throughout the world, with each country having a cluster characterized by (1) high sedentary behavior, (2) high PA, and (3) a combination of high screen time and unhealthy eating pattern. A fourth cluster, characterized by low screen/healthy eating and moderate PA (all-rounders), was absent in Kenya, South Africa, and Brazil, suggesting that this lifestyle behavior pattern may be more common in higher-income nations.

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    This study used data from the International Study of Childhood Obesity, Lifestyle and Environment (ISCOLE), which was funded by The Coca-Cola Company. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of this manuscript. The authors declare no conflicts of interest.

    *

    List of members of the ISCOLE research group is available at www.jpeds.com (Appendix).

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