title: Effects of clustering of multiple lifestyle-related behaviors on blood pressure in adolescents from two observational studies.
abstract: BACKGROUND
  Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents.
  
  
  METHODS
  Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pécs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringá/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed.
  
  
  RESULTS
  The Healthy Eating cluster was negatively associated with DBP in European girls, β=-2.46 (-4.62; -0.30), and with SBP in Brazilian boys, β=-2.79 (-3.10; -0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, β=4.54 (1.29; 7.79), and in Brazilian boys, β=4.10 (0.80; 7.40).
  
  
  CONCLUSIONS
  The Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.
authors.affiliation: School of Medicine of the University of São Paulo, YCARE (Youth/Child and cArdiovascular Risk and Environmental) Research Group, São Paulo, SP, Brazil; Facultad de Ciencias de la Salud de la Universidad de Zaragoza, GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. Electronic address: augustocesar.demoraes@usp.br.
authors.forename: Augusto César Ferreira
authors.initials: AC
authors.lastname: de Moraes
authors.affiliation: Facultad de Ciencias de la Salud de la Universidad de Zaragoza, GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Fernández-Alvira
authors.affiliation: School of Medicine of the University of São Paulo, YCARE (Youth/Child and cArdiovascular Risk and Environmental) Research Group, São Paulo, SP, Brazil; Facultad de Ciencias de la Salud de la Universidad de Zaragoza, GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.
authors.forename: Tara
authors.initials: T
authors.lastname: Rendo-Urteaga
authors.affiliation: Facultad de Ciencias de la Salud de la Universidad de Zaragoza, GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Julián-Almárcegui
authors.affiliation: Univ. Lille, Inserm, CHU Lille, U995 LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France; Centre d'Investigation Clinique, CIC-1403-Inserm-CH&U, Lille, F-59037 France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beghin
authors.affiliation: Preventive Medicine & Nutrition Unit, University of Crete School of Medicine, Heraklion, Crete, Greece.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
authors.forename: Dénes
authors.initials: D
authors.lastname: Molnar
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: De Henauw
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.affiliation: Department of Pediatrics, Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
authors.affiliation: Polytechnic University of Madrid, Health and Human Performance, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Pedrero-Chamizo
authors.affiliation: Agricultural Research Council, Food and Nutrition Research Centre (CRA-NUT), Rome, Italy.
authors.forename: Myriam
authors.initials: M
authors.lastname: Galfo
authors.affiliation: Univ. Lille, Inserm, CHU Lille, U995 LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France; Centre d'Investigation Clinique, CIC-1403-Inserm-CH&U, Lille, F-59037 France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Gottrand
authors.affiliation: School of Medicine of the University of São Paulo, YCARE (Youth/Child and cArdiovascular Risk and Environmental) Research Group, São Paulo, SP, Brazil.
authors.forename: Heráclito Barbosa
authors.initials: HB
authors.lastname: Carvalho
authors.affiliation: Facultad de Ciencias de la Salud de la Universidad de Zaragoza, GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; School of Medicine of the University of São Paulo, Department of Preventive Medicine, São Paulo, SP, Brazil.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001794:Blood Pressure / Q000502:physiology*; D001938:Brazil; D002648:Child; D003430:Cross-Sectional Studies; D005060:Europe; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: Adolescents; Blood pressure; Cross-sectional studies; Lifestyle-related behaviors