Clustering of multiple energy balance-related behaviors in school children and its association with overweight and obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017)

Bel-Serrat, Silvia and Ojeda-Rodríguez, Ana and Heinen, Mirjam and Buoncristiano, Marta and Abdrakhmanova, Shynar and Duleva, Vesselka and Sant’Angelo, Victoria and Fijałkowska, Anna and Hejgaard, Tatjana and Huidumac, Constanta and Hyska, Jolanda and Kujundzic, Enisa and Musić Milanović, Sanja and Ovezmyradova, Guljemal and Pérez-Farinós, Napoleón and Petrauskiene, Ausra and Rito, Ana and Shengelia, Lela and Braunerová, Radka and Rutter, Harry and Murrin, Celine and Kelleher, Cecily and Breda, João (2019) Clustering of multiple energy balance-related behaviors in school children and its association with overweight and obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017). Nutrients, 11 (3). ISSN 2072-6643

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It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster ‘Physically active and healthy diet’. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.

Item Type: Article
Additional Information: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
MeSH: Child ; Cluster Analysis ; Energy Metabolism / physiology ; Europe ; Exercise ; Female ; Health Behavior ; Humans ; Male ; Obesity / epidemiology ; World Health Organization
Departments: Katedra za medicinsku statistiku, epidemiologiju i medicinsku informatiku
Depositing User: Kristina Berketa
Status: Published
Bel-Serrat, SilviaUNSPECIFIED
Ojeda-Rodríguez, AnaUNSPECIFIED
Buoncristiano, MartaUNSPECIFIED
Abdrakhmanova, ShynarUNSPECIFIED
Duleva, VesselkaUNSPECIFIED
Sant’Angelo, VictoriaUNSPECIFIED
Fijałkowska, AnnaUNSPECIFIED
Hejgaard, TatjanaUNSPECIFIED
Huidumac, ConstantaUNSPECIFIED
Kujundzic, EnisaUNSPECIFIED
Musić Milanović, SanjaUNSPECIFIED
Ovezmyradova, GuljemalUNSPECIFIED
Pérez-Farinós, NapoleónUNSPECIFIED
Petrauskiene, AusraUNSPECIFIED
Shengelia, LelaUNSPECIFIED
Braunerová, RadkaUNSPECIFIED
Kelleher, CecilyUNSPECIFIED
Date: 27 February 2019
Date Deposited: 25 Nov 2019 09:37
Last Modified: 25 Nov 2019 09:37
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