Abstract
BackgroundInadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10–15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes.MethodsCross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex.ResultsThe combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54–1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78–2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes.ConclusionsThe results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.
Highlights
The immediate and long-term health benefits of adequate physical activity (PA) levels, low recreational screen time (ST), and optimum sleep quality in adolescents are well documented [1,2,3,4]
Despite these established guidelines, the PA levels are on a steady decline [7, 12], time spent in sedentary behaviors (SB) has increased [2, 13], sleep disturbances remain high [8, 11, 14, 15] and the prevalence of obesity continues to be on a progressive rise in adolescents across developed and developing countries [16, 17]
A higher prevalence of increased body mass index (BMI) and waist circumference (WC) was observed in adolescents with insufficient sleep [18,19,20], yet few studies reported that these associations were not statistically significant when adjusted for confounding variables [18, 21, 22]
Summary
The immediate and long-term health benefits of adequate physical activity (PA) levels, low recreational screen time (ST), and optimum sleep quality in adolescents are well documented [1,2,3,4]. Previous studies have shown significant associations of meeting the recommended moderate to vigorous physical activity (MVPA > 60 min/d) [5, 6], ST (≤ 2 h/d) [7,8,9], and sleep duration (9-11 h/d) [10, 11]) guidelines with a lower risk of obesity and its associated metabolic comorbidities during adolescence Despite these established guidelines, the PA levels are on a steady decline [7, 12], time spent in sedentary behaviors (SB) has increased [2, 13], sleep disturbances remain high [8, 11, 14, 15] and the prevalence of obesity continues to be on a progressive rise in adolescents across developed and developing countries [16, 17]. A secondary aim was to explore if these influences vary between sexes
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