Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study

Roman-Viñas, Blanca and Chaput, Jean Philippe and Katzmarzyk, Peter T. and Fogelholm, Mikael and Lambert, Estelle V. and Maher, Carol and Maia, Jose and Olds, Timothy and Onywera, Vincent and Sarmiento, Olga L. and Standage, Martyn and Tudor-Locke, Catrine and Tremblay, Mark S. and Church, Timothy S. and Lambert, Denise G. and Barreira, Tiago and Broyles, Stephanie and Butitta, Ben and Champagne, Catherine and Cocreham, Shannon and Denstel, Kara D. and Drazba, Katy and Harrington, Deirdre and Johnson, William and Milauskas, Dione and Mire, Emily and Tohme, Allison and Rodarte, Ruben and Amoroso, Bobby and Luopa, John and Neiberg, Rebecca and Rushing, Scott and Lewis, Lucy and Ferrar, Katia and Georgiadis, Effie and Stanley, Rebecca and Matsudo, Victor Keihan Rodrigues and Matsudo, Sandra and Araujo, Timoteo and de Oliveira, Luis Carlos and Fabiano, Luis and Bezerra, Diogo and Ferrari, Gerson and Bélanger, Priscilla and Borghese, Mike and Boyer, Charles and LeBlanc, Allana and Francis, Claire and Leduc, Geneviève and Wang, Yue, for the ISCOLE Research Group (2016) Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study. International Journal of Behavioral Nutrition and Physical Activity, 13 (1). 123. ISSN 1479-5868 (

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Background: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Methods: Cross-sectional results were based on 6128 children aged 9-11years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kgm2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score>+2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11h/night of sleep, ≤2h/day of screen time, and at least 60min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations. Results: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR=0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower. Conclusions: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children. Trial registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at (Identifier NCT01722500) (October 29, 2012).


Roman-Viñas, Blanca, Chaput, Jean Philippe, Katzmarzyk, Peter T., Fogelholm, Mikael, Lambert, Estelle V., Maher, Carol, Maia, Jose, Olds, Timothy, Onywera, Vincent, Sarmiento, Olga L., Standage, Martyn, Tudor-Locke, Catrine, Tremblay, Mark S., Church, Timothy S., Lambert, Denise G., Barreira, Tiago, Broyles, Stephanie, Butitta, Ben, Champagne, Catherine, Cocreham, Shannon, Denstel, Kara D., Drazba, Katy, Harrington, Deirdre ORCID logoORCID:, Johnson, William, Milauskas, Dione, Mire, Emily, Tohme, Allison, Rodarte, Ruben, Amoroso, Bobby, Luopa, John, Neiberg, Rebecca, Rushing, Scott, Lewis, Lucy, Ferrar, Katia, Georgiadis, Effie, Stanley, Rebecca, Matsudo, Victor Keihan Rodrigues, Matsudo, Sandra, Araujo, Timoteo, de Oliveira, Luis Carlos, Fabiano, Luis, Bezerra, Diogo, Ferrari, Gerson, Bélanger, Priscilla, Borghese, Mike, Boyer, Charles, LeBlanc, Allana, Francis, Claire, Leduc, Geneviève and Wang, Yue;