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)
Palabras clave : 
Materias Investigacion::Ciencias de la Salud::Nutrición y dietética
Children
Cluster analysis
Dietary intake
Energy balance-related behaviors
Obesity
Overweight
Physical activity
Screen time
Sedentary behavior
Fecha de publicación : 
2019
Editorial : 
MDPI AG
ISSN : 
2072-6643
Nota: 
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Cita: 
Bel-Serrat, S. (Silvia); Ojeda-Rodríguez, A. (Ana); Heinen, M.M. (Mirjam M.); et al. "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. 11 (511), 2019, 1 - 20
Resumen
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.

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