title: Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries.
abstract: To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions.
  
  
  
  This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models.
  
  
  
  Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk-food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all-rounders). Health-related quality of life was greatest in the all-rounders cluster.
  
  
  
  Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health-related quality of life, with children from the all-rounders cluster consistently reporting greatest health-related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior).
  
  
  
  ClinicalTrials.gov: NCT01722500.
authors.affiliation: School of Health Sciences, University of South Australia. Electronic address: Dorothea.dumuid@mymail.unisa.edu.au.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Dumuid
authors.affiliation: School of Health Sciences, University of South Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Olds
authors.affiliation: School of Health Sciences, University of South Australia; School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Lewis
authors.affiliation: Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain.
authors.forename: Josep Antoni
authors.initials: JA
authors.lastname: Martin-Fernández
authors.affiliation: Population Science, Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: Population Science, Pennington Biomedical Research Center, Baton Rouge, LA; School of Education, Syracuse University, Syracuse, NY.
authors.forename: Tiago
authors.initials: T
authors.lastname: Barreira
authors.affiliation: Population Science, Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Broyles
authors.affiliation: Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chaput
authors.affiliation: Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Fogelholm
authors.affiliation: Population Science, Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
authors.affiliation: Department of Nutrition, St John's Research Institute, Karnataka, India.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kuriyan
authors.affiliation: Department of Nutrition, St John's Research Institute, Karnataka, India.
authors.forename: Anura
authors.initials: A
authors.lastname: Kurpad
authors.affiliation: Department of Human Biology, University of Cape Town, Cape Town, South Africa.
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
authors.affiliation: Faculty of Sport, University of Porto, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Maia
authors.affiliation: Center for the Study of Physical Fitness Laboratory of São Caetano do Sul (CELAFISCS), São Caetano do Sul, Brazil.
authors.forename: Victor
authors.initials: V
authors.lastname: Matsudo
authors.affiliation: Department of Recreation Management and Exercise Science, Kenyatta University, Nairobi City, Kenya.
authors.forename: Vincent O
authors.initials: VO
authors.lastname: Onywera
authors.affiliation: School of Medicine, University of the Andes, Bogotá, Colombia.
authors.forename: Olga L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Standage
authors.affiliation: Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Tremblay
authors.affiliation: Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA.
authors.forename: Catrine
authors.initials: C
authors.lastname: Tudor-Locke
authors.affiliation: Tianjin Women's and Children's Health Center, Tianjin, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gillison
authors.affiliation: School of Health Sciences, University of South Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Maher
mesh_terms: D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004777:Environment; D005260:Female; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D038622:Internationality; D008019:Life Style; D016014:Linear Models; D008297:Male; D063766:Pediatric Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: compositional analysis; diet; physical activity; screen time; sedentary behavior