title: Clustering of multiple lifestyle behaviors and health-related fitness in European adolescents.
abstract: OBJECTIVE
  To explore the clustering of different lifestyle behaviors and whether this clustering differs by gender, age, and health-related fitness.
  
  
  METHODS
  Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study.
  
  
  METHODS
  Ten European cities.
  
  
  METHODS
  A total of 2,084 adolescents (12.5-17.5 years).
  
  
  METHODS
  Four lifestyle behaviors were assessed by self-administered questionnaires: moderate to vigorous physical activity, homework time, screen time, and diet. Health-related fitness components (aerobic capacity, strength, speed-agility, and body composition) were assessed.
  
  
  METHODS
  Hierarchical method and κ-means cluster analysis. Analysis of variance tests.
  
  
  RESULTS
  Five clusters were identified: Healthy diet and Active, Healthy diet and Academic, Healthy diet and Inactive, Unhealthy diet and Screen user, and Unhealthy diet and Active. Younger adolescents were more active and followed a healthier diet than older adolescents. Older boys devoted more time to screen use, whereas older girls devoted more time to homework. Boys in the Healthy diet and Active cluster presented higher aerobic capacity and speed-agility, whereas girls presented higher aerobic capacity, strength, and speed-agility.
  
  
  CONCLUSIONS
  Clustering of different lifestyle behaviors is observed. Different healthy lifestyles do not always come together and clusters are associated with gender, age, and health-related fitness, but not with body composition. These differences need to be considered when developing intervention strategies for the prevention of unhealthy habits.
authors.affiliation: Department of Medical Physiology, School of Medicine, Granada University, Granada, Spain; Department of Public Health, Ghent University, Ghent, Belgium. Electronic address: mmcuenca@ugr.es.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cuenca-García
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.forename: Jonatan R
authors.initials: JR
authors.lastname: Ruiz
authors.forename: Francisco B
authors.initials: FB
authors.lastname: Ortega
authors.forename: Charlene
authors.initials: C
authors.lastname: Ottevaere
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Gross
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
authors.forename: Germán
authors.initials: G
authors.lastname: Vicente-Rodríguez
authors.forename: Denés
authors.initials: D
authors.lastname: Molnár
authors.forename: Angela
authors.initials: A
authors.lastname: Polito
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.forename: Maria
authors.initials: M
authors.lastname: Plada
authors.forename: Jeremy
authors.initials: J
authors.lastname: Vanhelst
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.forename: Mathilde
authors.initials: M
authors.lastname: Kersting
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Castillo
mesh_terms: D000203:Activities of Daily Living / Q000145:classification*; D000293:Adolescent; D000704:Analysis of Variance; D016000:Cluster Analysis; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D057185:Sedentary Behavior; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: HELENA study; adolescents; healthy diet; homework; physical activity; screen time