title: Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study.
abstract: BACKGROUND
  The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).
  
  
  METHODS
  Cross-sectional results were based on 6128 children aged 9-11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg · m-2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations.
  
  
  RESULTS
  The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower.
  
  
  CONCLUSIONS
  For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children.
  
  
  BACKGROUND
  The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).
authors.affiliation: Department of Physical Activity and Sport Sciences, Psychology, Education and Sport Sciences, FPCEE Blanquerna, Universitat Ramon Llull, 34 Cister, 08022, Barcelona, Spain.|Nutrition Research Foundation, 242 Rocafort, 08029, Barcelona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Roman-Viñas
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chaput
authors.affiliation: Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: Department of Food and Environmental Sciences, University of Helsinki, 00014, Helsinki, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Fogelholm
authors.affiliation: Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, PO Box 115, Newlands, Cape Town, South Africa.
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
authors.affiliation: Alliance for Research in Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Maher
authors.affiliation: CIFI2D, Faculdade de Desporto, University of Porto, Porto, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Maia
authors.affiliation: Alliance for Research in Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Olds
authors.affiliation: Department of Recreation Management and Exercise Science, Kenyatta University, Nairobi, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Onywera
authors.affiliation: School of Medicine Universidad de los Andes, Carrera 1ª N° 18A 12, Bogotá, Colombia.
authors.forename: Olga L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Standage
authors.affiliation: Department of Kinesiology, University of Massachusetts, 111 Totman, 30 Eastman Lane, Amherst, MA, 01002, USA.
authors.forename: Catrine
authors.initials: C
authors.lastname: Tudor-Locke
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. mtremblay@cheo.on.ca.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Tremblay
mesh_terms: D061725:Accelerometry / Q000379:methods; D050154:Adiposity; D001315:Australia; D015992:Body Mass Index; D001835:Body Weight; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D016017:Odds Ratio; D063766:Pediatric Obesity / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D057185:Sedentary Behavior; D057566:Self Report; D012890:Sleep
keywords: Children; Obesity; Physical activity; Prevalence; Recommendations; Screen time; Sleep