title: Relationships between active school transport and adiposity indicators in school-age children from low-, middle- and high-income countries.
abstract: OBJECTIVE
  Within the global context of the nutrition and physical activity transition it is important to determine the relationship between adiposity and active school transport (AST) across different environmental and socio-cultural settings. The present study assessed the association between adiposity (that is, body mass index z-score (BMIz), obesity, percentage body fat (PBF), waist circumference) and AST in 12 country sites, in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).
  
  
  METHODS
  The analytical sample included 6797 children aged 9-11 years. Adiposity indicators included, BMIz calculated using reference data from the World Health Organization, obesity (BMIz ⩾+2 s.d.), PBF measured using bioelectrical impedance and waist circumference. School travel mode was assessed by questionnaire and categorized as active travel versus motorized travel. Multilevel linear and non-linear models were used to estimate the magnitude of the associations between adiposity indicators and AST by country site and sex.
  
  
  RESULTS
  After adjusting for age, sex, parental education and motorized vehicle availability, children who reported AST were less likely to be obese (odds ratio=0.72, 95% confidence interval (0.60-0.87), P<0.001) and had a lower BMIz (-0.09, s.e.m.=0.04, P=0.013), PBF (least square means (LSM) 20.57 versus 21.23% difference -0.66, s.e.m.=0.22, P=0.002) and waist circumference (LSM 63.73 cm versus 64.63 cm difference -0.90, s.e.m.=0.26, P=0.001) compared with those who reported motorized travel. Overall, associations between obesity and AST did not differ by country (P=0.279) or by sex (P=0.571).
  
  
  CONCLUSIONS
  AST was associated with lower measures of adiposity in this multinational sample of children. Such findings could inform global efforts to prevent obesity among school-age children.
authors.affiliation: Department of Public Health, School of Medicine, Universidad de los Andes , Bogotá, Colombia.
authors.forename: O L
authors.initials: OL
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authors.affiliation: Department of Public Health, School of Medicine, Universidad de los Andes, Bogotá, Colombia; Department of Industrial Engineering, Faculty of Engineering, CeiBA Complex Systems Research Center, Universidad de los Andes, Bogotá, Colombia.
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authors.affiliation: Department of Public Health, School of Medicine, Universidad de los Andes , Bogotá, Colombia.
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authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.affiliation: Department of Human Biology, Faculty of Health Sciences, Division of Exercise Science and Sports Medicine, University of Cape Town , Cape Town, South Africa.
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authors.affiliation: Alliance for Research In Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
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authors.affiliation: Alliance for Research In Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
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