Body mass index and movement behaviors among schoolchildren from 13 countries across a continuum of human development indices: A multinational cross-sectional study

Am J Hum Biol. 2020 Mar;32(2):e23341. doi: 10.1002/ajhb.23341. Epub 2019 Oct 24.


Objective: This study describes the distributions of body mass index (BMI) and movement behaviors among schoolchildren from 13 countries across a continuum of human development.

Methods: Data were from a cross-sectional study of 9-11-year-old children (n = 8055) recruited from 269 urban schools in 13 countries, and an additional 7 rural schools in one of these countries (Mozambique). BMI was derived from objectively measured heights and weights. Moderate- to vigorous-intensity physical activity (MVPA), sedentary time (SED), and sleep duration were assessed by waist-worn Actigraph GT3X+ accelerometers. Linear models were used to describe the distributions of BMI z-scores, MVPA, SED, and sleep among sites across varying Human Development Indices (HDIs).

Results: Mean MVPA, SED, and sleep duration were 63.1 ± 27.3 minutes/day, 508.7 ± 72.4 minutes/day, and 8.8 ± 0.9 hours/night, respectively. Overall, 2.1% of the sample were thin, 19.5% overweight, and 11.7% were obese. Density curves (BMI z-scores and SED) for urban children in Mozambique showed significantly higher mean values compared with rural children. Boys had significantly higher mean MVPA compared with girls. Mean BMI z-scores were positively associated (β = .02; P = .004) with HDI, mean daily MVPA minutes were negatively associated (β = -.38; P = .025) with HDI, and mean SED time was positively associated with HDI (β = 1.18; P = .049). No significant association (β = .01; P = .29) was observed between sleep duration and HDI.

Conclusion: Our findings show distinct differences in BMI and movement behavior profiles between urban and rural children in Mozambique. Mean BMI z-scores, MVPA, and SED differed by country HDI. These findings support the need to include both rural and urban participants in study samples.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accelerometry*
  • Australia
  • Body Mass Index
  • Brazil
  • Canada
  • Child
  • China
  • Colombia
  • Cross-Sectional Studies
  • Exercise*
  • Female
  • Finland
  • Humans
  • India
  • Kenya
  • Male
  • Mozambique
  • Portugal
  • Sedentary Behavior*
  • South Africa
  • Students
  • United Kingdom
  • United States