title: The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada.
abstract: Few studies have investigated the independent associations of lifestyle behaviors (diet, physical activity, sleep, and screen time) and body weight status with academic achievement. Even fewer have investigated the combined effect of these behaviors on academic achievement. We hypothesize that the combined effect of these behaviors will have a higher impact on academic achievement than any behavior alone, or that of body weight status.
  
  
  
  In 2011, 4253 grade 5 (10-11 years old) students and their parents were surveyed about the child's diet, physical activity, screen time and sleep. Students' heights and weights were measured by research assistants. Academic achievement was measured using provincial standardized exams in mathematics, reading and writing, and was expressed as 'meeting' or 'not meeting' expectations as per standardized criterion. Exams were written 1 year following the measurement of lifestyle behaviors. Lifestyle behaviors were measured with self- and parental proxy reports and expressed as meeting recommendations (yes/no) for each behavior. Mixed effects logistic regression models adjusting for demographic confounders and caloric intake were used to determine the independent and combined associations.
  
  
  
  Meeting dietary recommendations was associated with increased likelihood of meeting academic expectations for each of math, reading and writing. Meeting recommendations for screen time and sleep was associated with meeting expectations for writing. For all three subjects, meeting additional lifestyle behavior recommendations was associated with higher likelihood of meeting expectations. Children who met 7-9 lifestyle behavior recommendations had greater than three-times the odds of meeting expectations for reading compared to those who met 0-3 recommendations (OR: 3.07, 95% CI: 2.09, 4.51), and 1.47 and 2.77 times the odds of meeting expectations in mathematics and writing, respectively. Body weight status was not associated with academic achievement.
  
  
  
  We found that lifestyle behaviors, not body weight status, are strongly associated with student academic performance. Promoting compliance with established healthy lifestyle recommendations could improve both the health and educational outcomes of school-aged children. School-based health promotion initiatives that target multiple lifestyle behaviors may have a greater effect on academic achievement than those that focus on a single behavior.
authors.affiliation: Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 street, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Faught
authors.affiliation: Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 street, Edmonton, AB, T6G 2T4, Canada.
authors.forename: John P
authors.initials: JP
authors.lastname: Ekwaru
authors.affiliation: Department of Elementary Education, University of Alberta, 436 Education South Tower, 11210 - 87 ave, Edmonton, AB, T6G 2G5, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gleddie
authors.affiliation: Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 street, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Storey
authors.affiliation: Department of Community Health and Epidemiology, Department of Emergency Medicine, Dalhousie University, Centre for Clinical Research, 4th Floor, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Asbridge
authors.affiliation: Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 street, Edmonton, AB, T6G 2T4, Canada. paul.veugelers@ualberta.ca.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Veugelers
mesh_terms: D000124:Achievement; D001835:Body Weight; D002648:Child; D004032:Diet / Q000379:methods*; D004522:Educational Status; D015444:Exercise; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D009674:Nova Scotia; D010290:Parents; D011446:Prospective Studies; D012890:Sleep; D013334:Students / Q000706:statistics & numerical data*; D013690:Television / Q000706:statistics & numerical data*
keywords: Childhood obesity; Children; Diet; Epidemiology; Physical activity; School health; Sedentary behavior; Sleep