Abstract
Objectives
To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level.
Methods
Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5–17.5 years old) from Maringá/Brazil (BRACAH Study; n = 682) and ten European cities (HELENA Study; n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods.
Results
Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents’ university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers’ university degree was associated with the Healthy cluster.
Conclusions
Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- EBRB:
-
Energy balance-related behaviors
- BRACAH Study:
-
Brazilian Cardiovascular Adolescent Health Study
- HELENA Study:
-
Healthy Lifestyle in Europe by Nutrition in Adolescence Study
- IPAQ-A:
-
International Physical Activity Questionnaire
- FFQ:
-
Food frequency questionnaire
- PR:
-
Prevalence ratio
References
ABEP: The Brazilian Research Companies Association (2006). The Brazilian Criteria for Economic Classification (CCEB). http://www.abep.org/codigos-e-guias-da-abep. Accessed 30 June 2011
Adamo KB, Wilson S, Belanger K, Chaput JP (2013) Later bedtime is associated with greater daily energy intake and screen time in obese adolescents independent of sleep duration. J Sleep Disord Ther 2:2167-0277
Beck CC, da Silva Lopes A, Pitanga FJG (2011) Indicadores antropométricos como preditores de pressão arterial elevada em adolescentes. Arq Bras Cardiol 96:126–133
Corella D, Ordovas JM (2015) Biomarkers: background, classification and guidelines for applications in nutritional epidemiology. Nutr Hosp 31(Suppl 3):177–188. https://doi.org/10.3305/nh.2015.31.sup3.8765
Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395. https://doi.org/10.1249/01.mss.0000078924.61453
Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M (2008) Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Soc Sci Med 66(6):1429–1436. https://doi.org/10.1016/j.socscimed.2007.11.024
Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore C, Kelley K, Fairlie L (2015) Providing comprehensive health services for young key populations: needs, barriers and gaps. J Int AIDS Soc 18(Suppl 1):19833
Djordjevic-Nikic M, Dopsaj M (2013) Characteristics of eating habits and physical activity in relation to body mass index among adolescents. J Am Coll Nutr 32:224–233. https://doi.org/10.1080/07315724.2013.791149
Elgar FJ, Pfortner TK, Moor I, De Clercq B, Stevens GW, Currie C (2015) Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. Lancet. https://doi.org/10.1016/s0140-6736(14)61460-4
Fernandez-Alvira JM, De Bourdeaudhuij IS, Amika SV et al (2013) Clustering of energy balance-related behaviors and parental education in European children: the ENERGY-project. Int J Behav Nutr Phys Act 10:5. https://doi.org/10.1186/1479-5868-10-5
Ferrar K, Golley R (2015) Adolescent diet and time use clusters and associations with overweight and obesity and socioeconomic position. Health Educ Behav. https://doi.org/10.1177/1090198114560017
Gakidou E, Cowling K, Lozano R, Murray CJ (2010) Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 376(9745):959–974. https://doi.org/10.1016/s0140-6736(10)61257-3
Hagstromer M, Bergman P, De Bourdeaudhuij I et al (2008) Concurrent validity of a modified version of the International Physical Activity Questionnaire (IPAQ-A) in European adolescents: The HELENA Study. Int J Obes (Lond) 32(Suppl 5):S42–48. https://doi.org/10.1038/ijo.2008.182
Hill AJ (2006) Motivation for eating behaviour in adolescent girls: the body beautiful. Proc Nutr Soc 65:376–384
Hobbs M, Pearson N, Foster PJ, Biddle SJ (2014) Sedentary behaviour and diet across the lifespan: an updated systematic review. Br J Sports Med 1:1. https://doi.org/10.1136/bjsports-2014-093754
Iliescu C, Beghin L, Maes L et al (2008) Socioeconomic questionnaire and clinical assessment in the HELENA Cross-Sectional Study: methodology. Int J Obes (Lond) 32(Suppl 5):S19–S25. https://doi.org/10.1038/ijo.2008.178
Johnson WD, Kroon JJ, Greenway FL, Bouchard C, Ryan D, Katzmarzyk PT (2009) Prevalence of risk factors for metabolic syndrome in adolescents: National Health and Nutrition Examination Survey (NHANES), 2001–2006. Arch Pediatr Adolesc Med 163:371–377. https://doi.org/10.1001/archpediatrics.2009.3
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K (2003) American Herat Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 107:1562–1566
Krolner R, Rasmussen M, Brug J, Klepp KI, Wind M, Due P (2011) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Act 8:112. https://doi.org/10.1186/1479-5868-8-112
Leech RM, McNaughton SA, Timperio A (2014) The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review. Int J Behav Nutr Phys Act 11:4. https://doi.org/10.1186/1479-5868-11-4
Michels N, Vynckier L, Moreno LA et al (2018) Mediation of psychosocial determinants in the relation between socio-economic status and adolescents’ diet quality. Eur J Nutr 57:951–963. https://doi.org/10.1007/s00394-017-1380-8
Moraes AC, Delaporte TR, Molena-Fernandes CA, Falcao MC (2011) Factors associated with medicine use and self medication are different in adolescents. Clinics (Sao Paulo) 66:1149–1155
Moreno LA, De Henauw S, Gonzalez-Gross M et al (2008) Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes (Lond) 32(Suppl 5):S4–11. https://doi.org/10.1038/ijo.2008.177
Murakami H, Kawakami R, Nakae S, Nakata Y, Ishikawa-Takata K, Tanaka S, Miyachi M (2016) Accuracy of wearable devices for estimating total energy expenditure: comparison with metabolic chamber and doubly labeled water method. JAMA Intern Med 176:702–703. https://doi.org/10.1001/jamainternmed.2016.0152
Nascimento-Ferreira MV, Collese TS, de Moraes AC, Rendo-Urteaga T, Moreno LA, Carvalho HB (2015) Validity and reliability of sleep time questionnaires in children and adolescents: a systematic review and meta-analysis. Sleep Med Rev 30:85–96. https://doi.org/10.1016/j.smrv.2015.11.006
Ottevaere C, Huybrechts I, Benser J et al (2011) Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study. BMC Public Health 11:328. https://doi.org/10.1186/1471-2458-11-328
Rey-Lopez JP, Ruiz JR, Ortega FB et al (2012) Reliability and validity of a screen time-based sedentary behaviour questionnaire for adolescents: The HELENA study. Eur J Public Health 22:373–377. https://doi.org/10.1093/eurpub/ckr040
Rey-Lopéz JP, Vicente-Rodríguez G, Bueno G, Moreno LA (2011) Chapter 20: sedentary behaviors and obesity in children and adolescents. In: Moreno L, Pigeot I, Ahrens W (eds) Epidemiology of obesity in children and adolescents, SeraPH, vol 2. Springer, New York, pp 367–376
Rodenburg G, Oenema A, Kremers SPJ, van de Mheen D (2013) Clustering of diet- and activity-related parenting practices: cross-sectional findings of the INPACT study. Int J Behav Nutr Phys Act 10:36
Sabbe D, De Bourdeaudhuij I, Legiest E, Maes L (2008) A cluster-analytical approach towards physical activity and eating habits among 10-year-old children. Health Educ Res 23:753–762. https://doi.org/10.1093/her/cyl135
Santaliestra-Pasias AM, Mouratidou T, Reisch L et al (2015) Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study. Eur J Clin Nutr 69:811–816. https://doi.org/10.1038/ejcn.2015.76
Seabra AF, Mendonca DM, Thomis MA, Anjos LA, Maia JA (2008) Biological and socio-cultural determinants of physical activity in adolescents. Cad Saude Publica 24(4):721–736
Sirard JR, Bruening M, Wall MM, Eisenberg ME, Kim SK, Neumark-Sztainer D (2013) Physical activity and screen time in adolescents and their friends. Am J Prev Med 44:48–55. https://doi.org/10.1016/j.amepre.2012.09.054
Steinberger J, Daniels SR, Hagberg N et al (2016) Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association. Circulation 134:e236–255. https://doi.org/10.1161/cir.0000000000000441
Thivel D, Isacco L, Aucouturier J et al (2015) Bedtime and sleep timing but not sleep duration are associated with eating habits in primary school children. J Dev Behav Pediatr. https://doi.org/10.1097/dbp.0000000000000131
Vereecken CA, Maes L (2003) A Belgian study on the reliability and relative validity of the health behaviour in school-aged children food-frequency questionnaire. Public Health Nutr 6:581–588
Victora CG, Huttly SR, Fuchs SC, Olinto MT (1997) The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 26:224–227
Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C (2012) Adolescence and the social determinants of health. Lancet 379:1641–1652. https://doi.org/10.1016/s0140-6736(12)60149-4
Ward J (1963) Hierarchical grouping to optimize an objective function. J Am Stat Assoc 58:236. https://doi.org/10.2307/2282967
WHO (2015) Core competencies in adolescent health and development for primary care providers: including a tool to assess the adolescent health and development component in pre-service education of health-care providers. World Health Organization, Geneva
Acknowledgements
We gratefully acknowledge all adolescents participating in both studies together with their parents, and all members from BRACAH and HELENA* Study research groups.
HELENA Study Group
General Coordinator: LA Moreno.
Core Group members: LA Moreno, F Gottrand, S De Henauw, M González-Gross, C Gilbert.
Steering Committee: A Kafatos (President), LA Moreno, C Libersa, S De Henauw, J Sánchez, F Gottrand, M Kersting, M Sjöstrom, D Molnár, M González-Gross, J Dallongeville, C Gilbert, G Hall, L Maes, L Scalfi.
Project Manager: P Meléndez.
Universidad de Zaragoza (Spain): LA Moreno, J Fleta, JA Casajús, G Rodríguez, C Tomás, MI Mesana, G Vicente-Rodríguez, A Villarroya, CM Gil, I Ara, J Revenga, C Lachen, J Fernández Alvira, G Bueno, A Lázaro, O Bueno, JF León, JMª Garagorri, M Bueno, I Iglesia, P Velasco, S Bel, L Gracia-Marco, T Mouratidou.
Consejo Superior de Investigaciones Científicas (Spain): A Marcos, J Wärnberg, E Nova, S Gómez, E Ligia Díaz, J Romeo, A Veses, M Angeles Puertollano, B Zapatera, T Pozo.
Université de Lille 2 (France): L Beghin, C Libersa, F Gottrand, C Iliescu, J Von Berlepsch.
Research Institute of Child Nutrition Dortmund, Rheinische Friedrich-Wilhelms-Universität Bonn (Germany): M Kersting, W Sichert-Hellert, E Koeppen.
Pécsi Tudományegyetem (University of Pécs) (Hungary): D Molnar, E Erhardt, K Csernus, K Török, S Bokor, Mrs. Angster, E Nagy, O Kovács, J Répasi.
University of Crete School of Medicine (Greece): A Kafatos, C Codrington, M Plada, A Papadaki, K Sarri, A Viskadourou, C Hatzis, M Kiriakakis, G Tsibinos, C Vardavas, M Sbokos, E Protoyeraki, M Fasoulaki.
Institut für Ernährungs- und Lebensmittelwissenschaften – Ernährungphysiologie. Rheinische Friedrich Wilhelms Universität (Germany): P Stehle, K Pietrzik, M González-Gross, C Breidenassel, A Spinneker, J Al-Tahan, M Segoviano, A Berchtold, C Bierschbach, E Blatzheim, A Schuch, P Pickert.
University of Granada (Spain): MJ Castillo, A Gutiérrez, FB Ortega, JR Ruiz, EG Artero, V España, D Jiménez-Pavón, P Chillón, C Sánchez-Muñoz, M Cuenca.
Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (Italy): D Arcella, E Azzini, E Barrison, N Bevilacqua, P Buonocore, G Catasta, L Censi, D Ciarapica, P D’Acapito, M Ferrari, M Galfo, C Le Donne, C Leclercq, G Maiani, B Mauro, L Mistura, A Pasquali, R Piccinelli, A Polito, R Spada, S Sette, M Zaccaria.
University of Napoli “Federico II” Dept of Food Science (Italy): L Scalfi, P Vitaglione, C Montagnese.
Ghent University (Belgium): I De Bourdeaudhuij, S De Henauw, T De Vriendt, L Maes, C Matthys, C Vereecken, M de Maeyer, C Ottevaere, I Huybrechts.
Medical University of Vienna (Austria): K Widhalm, K Phillipp, S Dietrich, B Kubelka, M Boriss-Riedl.
Harokopio University (Greece): Y Manios, E Grammatikaki, Z Bouloubasi, T Louisa Cook, S Eleutheriou, O Consta, G Moschonis, I Katsaroli, G Kraniou, S Papoutsou, D Keke, I Petraki, E Bellou, S Tanagra, K Kallianoti, D Argyropoulou, K Kondaki, S Tsikrika, C Karaiskos.
Institut Pasteur de Lille (France): J Dallongeville, A Meirhaeghe.
Karolinska Institutet (Sweden): M Sjöström, J Ruiz, FB Ortega, M Hagströmer, L Hallström, E Patterson, L Kwak, J Wärnberg, N Rizzo, A Hurtig Wennlöf.
Asociación de Investigación de la Industria Agroalimentaria (Spain): J Sánchez-Molero, E Picó, M Navarro, B Viadel, JE Carreres, G Merino, R Sanjuán, M Lorente, MJ Sánchez, S Castelló.
Campden BRI (United Kingdom): C Gilbert, S Thomas, E Allchurch, P Burguess.
SIK - Institutet foer Livsmedel och Bioteknik (Sweden): G Hall, A Astrom, A Sverkén, A Broberg.
Meurice Recherche & Development asbl (Belgium): A Masson, C Lehoux, P Brabant, P Pate, L Fontaine.
Campden & Chorleywood Food Development Institute (Hungary): A Sebok, T Kuti, A Hegyi.
Productos Aditivos SA (Spain): C Maldonado, A Llorente.
Cárnicas Serrano SL (Spain): E García.
Cederroth International AB (Sweden): H von Fircks, M Lilja Hallberg, M Messerer.
Lantmännen Food R&D (Sweden): M Larsson, H Fredriksson, V Adamsson, I Börjesson.
European Food Information Council (Belgium): L Fernández, L Smillie, J Wills.
Universidad Politécnica de Madrid (Spain): Marcela González-Gross, Jara Valtueña, David Jiménez-Pavón, Ulrike Albers, Raquel Pedrero, Gonzalo Palacios, Agustín Meléndez, Pedro J. Benito, Juan José Gómez Lorente, David Cañada, Alejandro Urzanqui, Juan Carlos Ortiz, Francisco Fuentes, Rosa María Torres, Paloma Navarro.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
The content of this paper reflects only the authors’ views and the rest of HELENA Study members, and the European Community is not liable for any use that may be made of the information contained therein. The authors declare that they have no competing interests.
Ethical approval
Data from the Brazilian Cardiovascular Adolescent Health (BRACAH) Study were approved by the Ethics Committee on Research Involving Human Participants of the University Center of Maringá and authorized by the Ethics Committee on Research Projects of the University of São Paulo, in accordance with Brazilian law. The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study was approved by the Human Research Review Committees of all the European centers involved. Both studies were conducted according to the guidelines laid down in the Declaration of Helsinki, and a formal request to conduct the survey was submitted and accepted by the boards of all participant schools.
Funding
The HELENA study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education (EX-2007-1124, and EX-2008-0641), and the Spanish Ministry of Health, Maternal, Child Health and Development Network (RD08/0072). LAM was given a visiting professor scholarship from São Paulo Research Foundation—FAPESP (proc. 2015/11406-3). TSC was given a PhD scholarship from São Paulo Research Foundation—FAPESP (proc. 2016/13922-1). ACFM was given a Post-Doctoral scholarship from São Paulo Research Foundation—FAPESP (proc. 2014/13367-2). The GENUD Research Group is co-financed by the European Regional Development Fund (MICINN-FEDER). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) - Finance Code 001.
Informed consent
Written informed consent was obtained from all adolescents as well as from their parents/guardians.
Additional information
This article is part of the special issue “Adolescent transitions.”
Rights and permissions
About this article
Cite this article
Collese, T.S., De Moraes, A.C.F., Fernández-Alvira, J.M. et al. How do energy balance-related behaviors cluster in adolescents?. Int J Public Health 64, 195–208 (2019). https://doi.org/10.1007/s00038-018-1178-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-018-1178-3