Compliance with the 24-Hour Movement Behavior Guidelines and Associations with Adiposity in European Preschoolers: Results from the ToyBox-Study.

Marga Decraene,Vera Verbestel,Marieke De Craemer,Yannis Manios,Odysseas Androutsos,Violeta Iotova,Luis A Moreno,María L Miguel-Berges,Beata Gurzkowska,Berthold Koletzko,Greet Cardon

doi:10.3390/ijerph18147499

Abstract

In 2019, the World Health Organization (WHO) published 24 h movement behavior guidelines for preschoolers with recommendations for physical activity (PA), screen time (ST), and sleep. The present study investigated the proportion of preschoolers complying with these guidelines (on a total week, weekdays and weekend days), and the associations with adiposity. This cross-sectional study included 2468 preschoolers (mean age: 4.75 years; 41.9% boys) from six European countries. The associations were investigated in the total sample and in girls and boys separately. PA was objectively assessed by step counts/day. Parent-reported questionnaires provided ST and sleep duration data. Generalized estimating equations were used to analyze the association between guideline compliance and adiposity indicators, i.e., body mass index (BMI) z-score and waist to height ratio (WHR). Only 10.1% of the preschoolers complied with the 24 h movement behavior guidelines, 69.2% with the sleep duration guideline, 39.8% with the ST guideline and 32.7% with the PA guideline. No association was found between guideline compliance with all three movement behaviors and adiposity. However, associations were found for isolated weekday screen time (BMI z-scores and WHR: p = 0.04) and weekend day sleep duration (BMI z-scores and WHR: p = 0.03) guideline compliance with both lower adiposity indicators. The latter association for sleep duration was also found in girls separately (BMI z-scores: p = 0.02; WHR: p = 0.03), but not in boys. Longitudinal studies, including intervention studies, are needed to increase preschoolers’ guideline compliance and to gain more insight into the manifestation of adiposity in children and its association with 24 h movement behaviors from a young age onwards.

Highlights

Overweight (OW) and obesity (OB) among preschoolers (3–5 years of age) are major public health concerns
Attrition analyses showed that preschoolers with a parent/caregiver with a lower educational level were more likely to have incomplete data compared to preschoolers with a parent/caregiver with a higher educational level (OR = 1.52; 95% confidence interval (CI) = 1.38–1.68); no differences were found for sex (OR = 0.95; 95% CI = 0.86–1.05); and for age (OR =0.93; 95% CI = 0.84–1.02)
When investigating the countries separately, the current study found guideline compliance ranging from 0% (Bulgaria) and 27.9% (Germany)

Summary

Introduction

Overweight (OW) and obesity (OB) among preschoolers (3–5 years of age) are major public health concerns. In 2019, the World Health Organization (WHO) estimated that 38 million children under five years of age had OW or OB [1] This is problematic as these young children are at risk for being obese in later childhood and even adulthood [2,3]. A sufficient amount of physical activity (PA), low levels of sedentary behavior (SB) and a sufficient amount of sleep are known to counteract OW and OB [6,7,8,9,10,11,12] These behaviors can more be shaped in children under five years of age, as they are most susceptible for changes in behavioral habits [13]. Taking this together with the knowledge that habits track throughout life [14,15], the prevention of OW and OB from a young age is highly required

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