Clustering of energy balance-related behaviours and parental education in European preschool children: the ToyBox study.

María L Miguel-Berges,Yannis Manios,Marieke De Craemer,Odysseas Androutsos,Greet Cardon,Luis A Moreno,Theodora Mouratidou,Alba M Santaliestra-Pasias,Berthold Koletzko,Zbigniew Kulaga,Violeta Iotova,Konstantina Zachari,Sonya Galcheva

doi:10.1017/s0007114517003129

Abstract

Energy balance-related behaviours (EBRB) are established in childhood and seem to persist through to adulthood. A lower parental educational level was associated with unhealthy behavioural patterns. The aim of the study is to identify clusters of EBRB and examine their association with preschool children's BMI and maternal, paternal and parental education. A subsample of the ToyBox study (n 5387) conducted in six European countries was used. Six behavioural clusters ('healthy diet and low activity', 'active', 'healthy lifestyle', 'high water and screen time; low fruits and vegetables (F&V) and physical activity (PA)', 'unhealthy lifestyle' and 'high F&V consumers') emerged. The healthiest group characterised by high water and F&V consumption and high PA z scores ('healthy lifestyle') was more prevalent among preschool children with at least one medium- or higher-educated parent and showed markedly healthier trends for all the included EBRB. In the opposite, the 'unhealthy lifestyle' cluster (characterised by high soft drinks and screen time z scores, and low water, F&V and PA z scores) was more prevalent among children with lower parental, paternal and maternal education levels. OR identified that children with lower maternal, paternal and parental education levels were less likely to be allocated in the 'healthy lifestyle' cluster and more likely to be allocated in the 'unhealthy lifestyle' cluster. The 'unhealthy lifestyle' cluster was more prevalent among children with parents in lower parental educational levels and children who were obese. Therefore, parental educational level is one of the key factors that should be considered when developing childhood obesity prevention interventions.

Highlights

Childhood obesity is an important public health issue, as it affects health, educational attainment and long-term quality of life[1]
The healthiest group characterised by high water and fruits and vegetables (F&V) consumption and high physical activity (PA) z scores (‘healthy lifestyle’) was more prevalent among preschool children with at least one medium- or higher-educated parent and showed markedly healthier trends for all the included Energy balance-related behaviours (EBRB)
Weight gain has been associated with various lifestyle behaviours related to diet, physical activity (PA) and sedentary behaviours, referred to collectively as energy balance-related behaviours (EBRB)(6)

Summary

Introduction

Childhood obesity is an important public health issue, as it affects health, educational attainment and long-term quality of life[1]. Weight gain has been associated with various lifestyle behaviours related to diet, physical activity (PA) and sedentary behaviours, referred to collectively as energy balance-related behaviours (EBRB)(6). Such behaviours are established in early childhood and persist into adulthood[7,8,9]. Dietary clusters were reported in 2- to 3-year-old children from low-income US families[21] and in 4-year-old children of southwest England[22], reflecting behavioural combinations that contribute either positively or negatively to the energy balance

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