Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries

Dorothea Dumuid, Timothy Olds, Lucy Lewis, Josep Martin-Fernandez, Peter Katzmarzyk, Tiago Barreira, Stephanie Broyles, Jean-Philippe Chaput, Mikael Fogelholm, Gang Hu, Rebecca Kuriyan, Anura Kurpad, Estelle Lambert, Jose Maia, Victor Matsudo, Vincent Onywera, Olga Sarmiento, Martyn Standage, Mark Tremblay, Catrine Tudor-LockePei Zhao, Fiona Gillison, Carol Maher

    Research output: Contribution to journalArticlepeer-review

    91 Citations (Scopus)


    Objective 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. Study design 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. Results 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. Conclusions 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). Trial registration NCT01722500.

    Original languageEnglish
    Pages (from-to)178-183.e2
    Number of pages6
    JournalJournal of Pediatrics
    Publication statusPublished - 1 Apr 2017


    • compositional analysis
    • diet
    • physical activity
    • screen time
    • sedentary behavior


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