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

J Pediatr. 2017 Apr;183:178-183.e2. doi: 10.1016/j.jpeds.2016.12.048. Epub 2017 Jan 10.


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.

Keywords: compositional analysis; diet; physical activity; screen time; sedentary behavior.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • Child
  • Child Behavior*
  • Cluster Analysis
  • Cross-Sectional Studies
  • Environment*
  • Female
  • Health Behavior
  • Humans
  • Incidence
  • Internationality
  • Life Style
  • Linear Models
  • Male
  • Pediatric Obesity / diagnosis
  • Pediatric Obesity / epidemiology*
  • Pediatric Obesity / psychology*
  • Quality of Life*
  • Risk Assessment
  • Severity of Illness Index

Associated data