Associations between Lifestyle Patterns and Body Mass Index in a Sample of Greek Children and Adolescents
Accepted 5 September 2009.
Abstract
Background
Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored.
Objective
To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population
Design
Cross-sectional study. Data were collected from May through July 2007.
Subjects
The sample consisted of 1,305 children and adolescents (ages 3 to 18 years).
Main outcome measures
Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters.
Statistical analysis
Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders.
Results
Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized β=−.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis.
Conclusions
Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.
Address correspondence to: Mary Yannakoulia, PhD, Department of Nutrition and Dietetics, Harokopio University, El Venizelou 70, Athens 17671, Greece
ABSTRACT