title: Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment.
abstract: OBJECTIVE
  The purpose of this study was to explore the independent associations between multiple lifestyle behaviours (physical activity, sleep, screen time (ST) and diet) and overweight and obesity in UK children. The second objective was to compare body mass index (BMI) z-score between children who meet health guidelines for each lifestyle behaviour and those who do not and to explore the impact of interactions between lifestyle behaviours on BMI z-score.
  
  
  METHODS
  Cross-sectional study on children aged 9-11 years in the UK (n=374).
  
  
  METHODS
  Participants were classified as overweight or obese using the WHO BMI cut-points. Moderate-to-vigorous intensity physical activity (MVPA) and sleep duration were measured using an ActiGraph GT3X+ accelerometer, whereas ST and dietary habits were assessed using questionnaires. Multilevel multiple logistic regression was employed to analyse associations between lifestyle behaviours and overweight/obesity. Participants were then categorised according to whether or not they met specific health criteria for MVPA, ST, sleep and diet. Multilevel multiple linear regression was used to compare these groupings on the outcome of BMI z-score and interactions were explored.
  
  
  RESULTS
  MVPA and longer sleep duration were associated with lower odds of overweight or obesity, whereas ST and a healthy diet score were associated with increased odds of overweight/obesity. No association was found for an unhealthy diet score. Meeting MVPA guidelines was significantly associated with a lower BMI z-score in all models, and significant two-way interactions were observed for physical activity and sleep, ST and sleep, and physical activity and diet.
  
  
  CONCLUSIONS
  MVPA, sleep and ST are important lifestyle behaviours associated with overweight/obesity among children. More research is required to confirm the role of diet on adiposity and such work would benefit from objective assessment. Overall, this work suggests that strategies aimed at improving compliance with health guidelines are needed.
  
  
  BACKGROUND
  NCT01722500.
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Wilkie
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Standage
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Fiona B
authors.initials: FB
authors.lastname: Gillison
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cumming
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
mesh_terms: D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D050177:Overweight / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology; D057185:Sedentary Behavior; D012890:Sleep; D011795:Surveys and Questionnaires; D013690:Television / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D018910:Video Games / Q000706:statistics & numerical data
keywords: Child; Obesity; Overweight; behaviour; lifestyle