Health-related quality of life and lifestyle behavior clusters in school-aged children from 12 countries

Dorothea Dumuid, Timothy Olds, Lucy K Lewis, Josep Antoni Martin-Fernández, Peter T Katzmarzyk, Tiago Barreira, Stephanie T Broyles, Jean-Philippe Chaput, Mikael Fogelholm, Gang Hu, Rebecca Kuriyan, Anura Kurpad, Estelle V Lambert, José Maia, Victor Matsudo, Vincent O Onywera, Olga L Sarmiento, Martyn Standage, Mark S Tremblay, Catrine Tudor-LockePei Zhao, Fiona Gillison, Carol Maher, International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) research group

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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).


Original languageEnglish
Pages (from-to)178-183.e2
Number of pages6
JournalJournal of Pediatrics
Early online date10 Jan 2017
Publication statusPublished - 1 Apr 2017


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