Cumulative Effect of Obesogenic Behaviours on Adiposity in Spanish Children and Adolescents

Abstract

Objective: Little is known about the cumulative effect of obesogenic behaviours on childhood obesity risk. We determined the cumulative effect on BMI z-score, waist-to-height ratio (WHtR), overweight and abdominal obesity of four lifestyle behaviours that have been linked to obesity. Methods: In this cross-sectional analysis, data were obtained from the EnKid sudy, a representative sample of Spanish youth. The study included 1,614 boys and girls aged 5-18 years. Weight, height and waist circumference were measured. Physical activity (PA), screen time, breakfast consumption and meal frequency were self-reported on structured questionnaires. Obesogenic behaviours were defined as <1 h PA/day, ≥2 h/day screen time, skipping breakfast and <3 meals/day. BMI z-score was computed using age- and sex-specific reference values from the World Health Organization (WHO). Overweight including obesity was defined as a BMI > 1 SD from the mean of the WHO reference population. Abdominal obesity was defined as a WHtR ≥ 0.5. Results: High screen time was the most prominent obesogenic behaviour (49.7%), followed by low physical activity (22.4%), low meal frequency (14.4%), and skipping breakfast (12.5%). Although 33% of participants were free of all 4 obesogenic behaviours, 1, 2, and 3 or 4 behaviours were reported by 44.5%, 19.3%, and 5.0%, respectively. BMI z-score and WHtR were positively associated (p < 0.001) with increasing numbers of concurrent obesogenic behaviours. The odds of presenting with obesogenic behaviours were significantly higher in children who were overweight (OR 2.68; 95% CI 1.50; 4.80) or had abdominal obesity (OR 2.12; 95% CI 1.28; 3.52); they reported more than 2 obesogenic behaviours. High maternal and parental education was inversely associated (p = 0.004 and p < 0.001, respectively) with increasing presence of obesogenic behaviours. Surrogate markers of adiposity increased with numbers of concurrent presence of obesogenic behaviours. The opposite was true for high maternal and paternal education.

Impact of lifestyle behaviors in early childhood on obesity and cardiometabolic risk in children: Results from the Spanish INMA birth cohort study

“…Our finding is also consistent with result of a study from 12 countries including children aged 9–11 years, where TV time was positively associated with obesity . In studies based on Spanish children, associations between TV time and obesity and abdominal obesity were inconsistent . TV watching reduce the time children spend being physically active .…”

“…16 Similar findings was observed by a study among US adolescents of 9th through 12th grade students from Youth Risk Behavior Surveillance System (YRBSS). 6 The Spanish enKid and AVENA (Alimentación y Valoracióndel Estado Nutricional de los Adolescentes) study analyzed the cumulative effect of low physically activity, high television time and low meal frequency, low sleep duration only in the AVENA study, and skipping breakfast only in the enKid study on the risk of overweight and obesity in children 17 and adolescent. 17,18 They found that increased number of these obesity promoting behaviors increased the odds of overweight, 17,18 abdominal obesity.…”

“…17,18 They found that increased number of these obesity promoting behaviors increased the odds of overweight, 17,18 abdominal obesity. 17 In our population, TV time was a significant predictor for obesity and abdominal obesity. The national health survey of Spain revealed that half of children age 5 to 15 years exceeded the recommended number of 2 hours screen time per day.…”

“…The evidence for an association between the co‐occurrence of unhealthy lifestyle behaviors and overweight/obesity comes mainly from studies conducted in adults, but little is known about the relationship between these behaviors and cardiometabolic risk factors in children using a longitudinal study design …”

“…The evidence for an association between the co-occurrence of unhealthy lifestyle behaviors and overweight/obesity comes mainly from studies conducted in adults, 6,[16][17][18] but little is known about the relationship between these behaviors and cardiometabolic risk factors in children using a longitudinal study design. 19,20 Therefore, in the present study our main objective was to assess the association of five lifestyle behaviors in children aged 4 years (physical activity, sleep duration, television watching, ultra-processed food, and plant based food consumption) independently and combined using a predefined score, the child healthy lifestyle score (CHLS), with overweight, obesity, blood pressure, and lipid profile at 4 years old (cross-sectional assessment) and with overweight, obesity and blood pressure at 7 years old (longitudinal assessment).…”