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Cited by 368Obesity, Physical Activity, DietPhysical Activity and HealthSleep and related disorders

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

Open access
for the ISCOLE Research Group, Roman-Viñas, Blanca, Chaput, Jean-Philippe, Katzmarzyk, Peter T., Fogelholm, Mikael, Lambert, Estelle V., Maher, Carol, Maia, Jose +6 more·2016·International Journal of Behavioral Nutrition and Physical Activity
DOI 10.1186/s12966-016-0449-8PMC PMC5123420
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Abstract

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: ) 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 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/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 ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).

AI snapshot

Written from the paper’s full text.

TL;DR

In 6,128 children aged 9–11 years from 12 ISCOLE countries, only 7.2% met all three 24-hour movement guidelines (MVPA, screen time, sleep), and meeting all three was associated with lower odds of obesity (OR 0.28, 95% CI 0.18–0.45) and lower BMI z-score. MVPA was the single recommendation most strongly associated with lower obesity odds.

Key findings

  • Overall adherence to all three recommendations was 7.2%; the highest site prevalences were Australia (14.9%) and Canada (14.0%), and the lowest was China (1.5%).
  • Children meeting all three recommendations had lower odds of obesity than those meeting none: total sample OR 0.28 (95% CI 0.18–0.45); boys OR 0.38 (95% CI 0.22–0.64); girls OR 0.11 (95% CI 0.04–0.35). The paper states children meeting the three recommendations were 72% less likely to be obese than those who did not meet them.
  • Meeting any single recommendation was generally associated with lower obesity odds, especially MVPA: total sample OR 0.45 (95% CI 0.38–0.52) for MVPA, OR 0.67 (95% CI 0.58–0.77) for sleep, and OR 0.86 (95% CI 0.75–0.98) for screen time.
  • Meeting all three recommendations was associated with the lowest BMI z-score: total sample 0.01 vs 0.49 for not meeting; boys 0.07 vs 0.58; girls −0.05 vs 0.41.

Methods

  • Cross-sectional analysis of ISCOLE data collected September 2011–December 2013 from 6,128 children aged 9–11 years across 12 countries. From 7,372 ISCOLE participants, exclusions were invalid accelerometry (n = 1,214), missing screen time (n = 25), and missing BMI (n = 5).
  • MVPA and sleep duration were assessed with 24-hour waist-worn Actigraph GT3X+ accelerometry; screen time was self-reported; height and weight were measured, BMI was calculated, and BMI z-scores used WHO age- and sex-specific reference data. Obesity was BMI z-score > +2 SD. Meeting guidelines was defined as 9–11 h/night sleep, ≤2 h/day screen time, and ≥60 min/day MVPA.
  • Associations with obesity were assessed with odds ratios from generalized linear mixed models; differences in BMI z-scores were examined with linear mixed models. Models adjusted for age, sex, highest parental education, and unhealthy diet pattern score; study sites were fixed effects and schools nested within sites were random effects.

Limitations

  • Stated in the paper: the cross-sectional design precludes cause-and-effect associations; possible residual confounding by unmeasured variables; sleep duration was analyzed without a measure of sleep quality; screen time was self-reported; and findings have limited generalizability to the whole population.
  • Evident in the text: participants excluded for missing data had significantly higher BMI z-scores (0.61) than those included (0.46), suggesting possible selection bias; within-site samples were not intended to be nationally representative.
  • Evident in the text: analyses by study site were not possible due to lack of statistical power for certain combinations of movement behaviors.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12966-016-0449-8

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 68 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Overall adherence to the screen time recommendation was 39%.

    “The mean overall adherence to the MVPA, screen time and sleep time recommendations were 44, 39 and 42%, respectively.”
    • Also stated in: § Results · plain
      “| All sites | 19.0 | 44.1 | 39.3 | 41.9 | 16.6 | 18.2 | 16.7 | 7.2 |”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overall adherence to the sleep duration recommendation was 42%.

    “The mean overall adherence to the MVPA, screen time and sleep time recommendations were 44, 39 and 42%, respectively.”
    • Also stated in: § Results · plain
      “| All sites | 19.0 | 44.1 | 39.3 | 41.9 | 16.6 | 18.2 | 16.7 | 7.2 |”
    Quote in the paperNot a substantial claim
  • Findingown data

    Nineteen percent of the overall ISCOLE sample met none of the 24-h movement recommendations.

    “Nineteen percent of the overall sample met none of the recommendations.”
    • Also stated in: § Results · plain
      “| All sites | 19.0 | 44.1 | 39.3 | 41.9 | 16.6 | 18.2 | 16.7 | 7.2 |”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the ISCOLE sample of 6128 children aged 9-11 years from 12 countries, the prevalence of meeting all three 24-h movement recommendations (9-11 h/night sleep, ≤2 h/day screen time, ≥60 min/day MVPA) was 7.2% (reported as 7% in the abstract).

    “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%).”
    • Also stated in: § Results · plain
      “| All sites | 19.0 | 44.1 | 39.3 | 41.9 | 16.6 | 18.2 | 16.7 | 7.2 |”
    • Also stated in: § Conclusions · plain
      “However, only a small percentage of children met all recommendations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Canadian 24-h movement guidelines thresholds (9–11 h/night sleep, ≤2 h/day screen time, ≥60 min/day MVPA) are appropriate for children in all 12 ISCOLE countries.
  • Findingown data

    Overall adherence to the MVPA recommendation was 44%.

    “The mean overall adherence to the MVPA, screen time and sleep time recommendations were 44, 39 and 42%, respectively.”
    • Also stated in: § Results · plain
      “| All sites | 19.0 | 44.1 | 39.3 | 41.9 | 16.6 | 18.2 | 16.7 | 7.2 |”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingown data

    Australia and Canada had the highest adherence to all three 24-h movement recommendations (15% and 14%, respectively), and China had the lowest (2%).

    “with children from Australia and Canada showing the highest adherence (15%)”
    • Also stated in: § Results · plain
      “Regarding the adherence to the 24-h movement guidelines, the countries with the highest prevalence to the overall recommendations were Australia and Canada (15 and 14% of the sample, respectively); the lowest adherence was found in China (2%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Canadian 24-h movement guidelines thresholds (9–11 h/night sleep, ≤2 h/day screen time, ≥60 min/day MVPA) are appropriate for children in all 12 ISCOLE countries.

  • May combine two claims.

    Findingown data

    Brazil, Portugal and the USA had the highest prevalence of meeting none of the recommendations (29% each), and Australia had the lowest (7%).

    “Brazil, Portugal and the USA (29% each) were the countries with the highest prevalence of adherence to none of the recommendations, and Australia showed the lowest percentage of non-adherence (7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Finland had the highest adherence to the MVPA guideline (61%) and China the lowest (15%).

    “The population with highest adherence to the MVPA guideline was found in Finland (61%) and the population with the lowest adherence was found in China (15%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Australia and the UK had the highest adherence to the sleep recommendation (76%), and Portugal the lowest (18%).

    “The highest adherence to the sleep time recommendation was found in Australia and the UK (76%), and the lowest was found in Portugal (18%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Except for the screen time recommendation in boys and girls separately, adherence to a single recommendation was associated with lower odds of obesity, especially for MVPA.

    “Except for the screen time recommendation in boys and girls separately, the adherence to a single recommendation resulted in a lower odds ratio of being obese, especially when adhering to the MVPA recommendation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Canadian 24-h movement guidelines thresholds (9–11 h/night sleep, ≤2 h/day screen time, ≥60 min/day MVPA) are appropriate for children in all 12 ISCOLE countries.
    • Rests on an assumption: Exclusion of participants with missing data did not materially bias the associations between movement behaviors and adiposity.
    • Rests on an assumption: The main analyses had sufficient statistical power to detect the reported associations.

  • May combine two claims.

    Findingown data

    India had the highest adherence to the screen time guideline (62%) and Brazil the lowest (24%).

    “The highest and lowest proportion of the population meeting the screen time guideline was found in India (62%) and Brazil (24%), respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Among the individual recommendations, the MVPA recommendation had the strongest association with obesity (meeting it associated with the lowest odds ratios; not meeting it associated with the highest odds ratios).

    “However, the MVPA recommendation was the single recommendation associated with the lowest overall odds ratios for obesity.”
    • Also stated in: § Discussion · plain
      “Our study also showed that children not meeting the MVPA guideline showed the highest odds ratios for obesity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    A low proportion of children from China, India and the USA met the recommendation of being physically active at least 60 min per day, consistent with the 15 to 28% prevalence from the International Children's Accelerometry database.

    “A low proportion of children from China, India and the USA met the recommendation of being physically active at least 60 min per day, data in line with the 15 to 28% prevalence coming from the International Children’s Accelerometry database [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Cooper AR, Goodman A, Page AS, Sherar LB, Esliger DW, van Sluijs EM, et al. Objectively measured physical activity and sedentary time in youth: the International Children’s Accelerometry Database (ICAD). Int J Behav Nutr Phys Act. 2015;12:113. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingown data

    There was a trend showing similar results across all the countries in the study (data not shown).

    “there was a trend showing similar results across all the countries in the study (data not shown)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Adherence to the combined recommendations was very low, especially in China, Portugal, the US and Brazil, which are the sites with the highest prevalence of obesity in ISCOLE.

    “It is concerning to see very low levels of adherence to the combined recommendations, especially in sites such as China, Portugal, the US and Brazil, which are the sites with the highest prevalence of obesity in ISCOLE.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Meeting all three movement behavior recommendations resulted in the lowest odds ratios for obesity, while meeting two guidelines was better than meeting one, and meeting one was better than meeting none.

    “Meeting all three movement behavior recommendations resulted in the lowest odds ratios for obesity, while meeting two guidelines was better than meeting one, and meeting one was better than meeting none.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Most studies on this topic have been conducted in developed countries and only a few have included a multi-country analysis.

    “In addition, most of the studies have been conducted in developed countries and only a few have included a multi-country analysis [16–18].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Fernández-Alvira JM, te Velde SJ, De Bourdeaudhuij I, Bere E, Manios Y, Kovacs E, et al. Parental education associations with children’s body composition: mediation effects of energy balance-related behaviors within the ENERGY-project. Int J Behav Nutr Phys Act. 2013;10:80. source

      Not checked in the free run.

    • cites [17] Wijnhoven TM, van Raaij JM, Yngve A, Sjöberg A, Kunešová M, Duleva V, et al. WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren. Public Health Nutr. 2015;18(17):3108–24. source

      Not checked in the free run.

    • cites [18] Kovács E, Hunsberger M, Reisch L, Gwozdz W, Eiben G, De Bourdeaudhuij I, Russo P, Veidebaum T, Hadjigeorgiou C, Sieri S, Moreno LA, Pigeot I, Ahrens W, Pohlabeln H, Molnár D, IDEFICS consortium. Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study. Obes Rev. 2015;16 Suppl 2:138–50. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    How combinations of movement behaviors are associated with obesity is largely unknown, as few studies have examined specific recommendation combinations and obesity, and only a subset have considered sleep duration as a health-related risk behavior in combined analyses.

    “How combinations of these movements behaviors are associated with obesity is largely unknown as few studies have examined the influence of meeting specific movement behavior recommendation combinations and obesity, and only a subset have considered sleep duration as a health-related risk behavior in combined analyses [11–18].”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [11] Saunders TJ, Gray CE, Poitras VJ, Chaput JP, Janssen I, Katzmarzyk PT, et al. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S283–93. source

      Not checked in the free run.

    • cites [12] Laurson KR, Lee JA, Gentile DA, Walsh DA, Eisenmann JC. Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity. ISRN Obes. 2014;. doi: 10.1155/2014/204540 . eCollection 2014. source

      Not checked in the free run.

    • cites [13] Laurson KR, Lee JA, Eisenmann JC. The cumulative impact of physical activity, sleep duration, and television time on adolescent obesity: 2011 Youth Risk Behavior Survey. J Phys Act Health. 2015;12(3):355–60. source

      Not checked in the free run.

    • cites [14] Carson V, Chaput J-P, Janssen I, Tremblay MS. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Prev Med. (in press).

      Not checked in the free run.

    • cites [15] Pérez-Rodrigo C, Gil Á, González-Gross M, Ortega RM, Serra-Majem L, Varela-Moreiras G, et al. Clustering of Dietary Patterns, Lifestyles, and Overweight among Spanish Children and Adolescents in the ANIBES Study. Nutrients. 2015; doi: 10.3390/nu8010011 source

      Not checked in the free run.

    • cites [16] Fernández-Alvira JM, te Velde SJ, De Bourdeaudhuij I, Bere E, Manios Y, Kovacs E, et al. Parental education associations with children’s body composition: mediation effects of energy balance-related behaviors within the ENERGY-project. Int J Behav Nutr Phys Act. 2013;10:80. source

      Not checked in the free run.

    • cites [17] Wijnhoven TM, van Raaij JM, Yngve A, Sjöberg A, Kunešová M, Duleva V, et al. WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren. Public Health Nutr. 2015;18(17):3108–24. source

      Not checked in the free run.

    • cites [18] Kovács E, Hunsberger M, Reisch L, Gwozdz W, Eiben G, De Bourdeaudhuij I, Russo P, Veidebaum T, Hadjigeorgiou C, Sieri S, Moreno LA, Pigeot I, Ahrens W, Pohlabeln H, Molnár D, IDEFICS consortium. Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study. Obes Rev. 2015;16 Suppl 2:138–50. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    By design, the within-site samples were not intended to be nationally representative.

    “By design, the within-site samples were not intended to be nationally representative.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The new sleep algorithm produces more precise estimates of sleep duration than previous algorithms.

    “This new algorithm produces more precise estimates of sleep duration than previous algorithms and captures total sleep time from sleep onset to the end of sleep, including all epochs and wakefulness after onset [24, 25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] Barreira TV, Schuna Jr JM, Mire EF, Katzmarzyk PT, Chaput JP, Leduc G, et al. Identifying children’s nocturnal sleep using a 24-h waist accelerometry. Med Sci Sports Exerc. 2015;47:937–43. source

      Not checked in the free run.

    • cites [25] Tudor-Locke C, Barreira TV, Schuna Jr JM, Mire EF, Katzmarzyk PT. Fully automated waist-worn accelerometer algorithm for detecting children’s sleep-period time separate from 24-h physical activity or sedentary behaviors. Appl Physiol Nutr Metab. 2014;39:53–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Biological maturity was not included as a covariate because age and weight are included in the maturity offset calculation.

    “Of note, biological maturity was estimated using the maturity offset method in ISCOLE; however, because age and weight are included in the maturity offset calculation, biological maturity was not included as a covariate in our analyses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Body weight and height were measured according to standardized procedures by trained ISCOLE staff.

    “Body weight and height were measured according to standardized procedures by trained ISCOLE staff [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Katzmarzyk PT, Barreira TV, Broyles ST, Champagne CM, Chaput JP, Fogelholm M, et al. The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods. BMC Public Health. 2013;13:900. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Self-report methods of quantifying screen time have acceptable reliability and validity in children.

    “Furthermore, self-report methods of quantifying screen time have been reported to have acceptable reliability and validity in children [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Lubans DR, Hesketh K, Cliff DP, Barnett LM, Salmon J, Dollman J, et al. A systematic review of the validity and reliability of sedentary behaviour measures used with children and adolescents. Obes Rev. 2011;12:781–99. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The TV viewing time question had adequate reliability (Spearman correlation = 0.55-0.68) and validity (Spearman correlation = 0.47) compared to 7-day TV time use logs, though it was not tested individually in every participating country.

    “Although not tested individually in every participating country, the TV viewing time question was shown to have adequate reliability with a one week test-retest interval (Spearman correlation = 0.55–0.68) and validity as compared to 7-day TV time use logs (Spearman correlation = 0.47) [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Schmitz KH, Harnack L, Fulton JE, Jacobs DR, Gao S, Lytle LA, et al. Reliability and validity of a brief questionnaire to assess television viewing and computer use by middle school children. J Sch Health. 2004;74:370–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The relationship of adherence to the 24-h movement guidelines with obesity had been previously evaluated in a sample of Canadian and US children and adolescents.

    “The relationship of adherence to the 24-h movement guidelines with obesity had been previously evaluated in a sample of Canadian and US children and adolescents [12–14].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [12] Laurson KR, Lee JA, Gentile DA, Walsh DA, Eisenmann JC. Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity. ISRN Obes. 2014;. doi: 10.1155/2014/204540 . eCollection 2014. source

      Not checked in the free run.

    • cites [13] Laurson KR, Lee JA, Eisenmann JC. The cumulative impact of physical activity, sleep duration, and television time on adolescent obesity: 2011 Youth Risk Behavior Survey. J Phys Act Health. 2015;12(3):355–60. source

      Not checked in the free run.

    • cites [14] Carson V, Chaput J-P, Janssen I, Tremblay MS. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Prev Med. (in press).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Analyses by study site were not possible due to a lack of statistical power for certain combinations of movement behaviors.

    “Models were presented for the total sample and by sex only; analyses by study site were not possible due to a lack of statistical power for certain combinations of movement behaviors.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    A standard protocol was used across all sites, and all study personnel underwent rigorous training and certification to ensure data quality.

    “A standard protocol was used to collect data across all sites, and all study personnel underwent rigorous training and certification before and during the data collection to ensure the quality of data collected [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Katzmarzyk PT, Barreira TV, Broyles ST, Champagne CM, Chaput JP, Fogelholm M, et al. The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods. BMC Public Health. 2013;13:900. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Wijnhoven et al. found that children with an unhealthier physical activity-risk behavior score were more likely to be obese than children with a better score.

    “They found that children with an unhealthier physical activity-risk behavior score (defined as the combination of the use of inactive transportation going to and from school, going to a sports or dancing club less than 2 days/week, playing outside less than 1 h/day, engaging in screen time 2 or more hours/day, and a sleep duration lower than 9 h/day) were more likely to be obese than children with”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Wijnhoven TM, van Raaij JM, Yngve A, Sjöberg A, Kunešová M, Duleva V, et al. WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren. Public Health Nutr. 2015;18(17):3108–24. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An unhealthier combination of low physical activity and poor diet was more prevalent in girls, older children and those from lower socio-economic backgrounds.

    “An unhealthier combination of low physical activity and poor diet was also more prevalent in girls, older children and those from lower socio-economic backgrounds [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Pérez-Rodrigo C, Gil Á, González-Gross M, Ortega RM, Serra-Majem L, Varela-Moreiras G, et al. Clustering of Dietary Patterns, Lifestyles, and Overweight among Spanish Children and Adolescents in the ANIBES Study. Nutrients. 2015; doi: 10.3390/nu8010011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some studies indicate that most children spend a large proportion of their awake time being active at low levels of intensity, especially girls.

    “some studies indicate that most children spend a large proportion of their awake time being active at low levels of intensity [39–41], especially girls [40].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [39] Collings PJ, Wijndaele K, Corder K, Westgate K, Ridgway CL, Dunn V, Goodyer I, Ekelund U, Brage S. Levels and patterns of objectively-measured physical activity volume and intensity distribution in UK adolescents: the ROOTS study. Int J Behav Nutr Phys Act. 2014;11:23. source

      Not checked in the free run.

    • cites [40] Ishii K, Shibata A, Adachi M, Nonoue K, Oka K. Gender and grade differences in objectively measured physical activity and sedentary behavior patterns among Japanese children and adolescents: a cross-sectional study. BMC Public Health. 2015;15:1254. source

      Not checked in the free run.

    • cites [41] Verloigne M, Van Lippevelde W, Maes L, Yıldırım M, Chinapaw M, Manios Y, Androutsos O, Kovács E, Bringolf-Isler B, Brug J, De Bourdeaudhuij I. Levels of physical activity and sedentary time among 10- to 12-year-old boys and girls across 5 European countries using accelerometers: an observational study within the ENERGY-project. Int J Behav Nutr Phys Act. 2012;9:34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Behaviors of not meeting physical activity and high screen time are most frequently related to negative health outcomes.

    “behaviors most frequently related to negative health outcomes [8, 9].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput JP, Janssen I, Katzmarzyk PT, Pate RR, Connor Gorber S, Kho ME, Sampson M, Tremblay MS. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S197–239. source

      Not checked in the free run.

    • cites [9] Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput JP, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S240–65. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ENERGY study identified a short sleeper inactive cluster that was most prevalent in Greece and contained the highest proportion of overweight and obese boys and girls.

    “They identified a short sleeper inactive cluster that was most prevalent in Greece and contained the highest proportion of overweight and obese boys and girls.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Fernández-Alvira JM, te Velde SJ, De Bourdeaudhuij I, Bere E, Manios Y, Kovacs E, et al. Parental education associations with children’s body composition: mediation effects of energy balance-related behaviors within the ENERGY-project. Int J Behav Nutr Phys Act. 2013;10:80. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The trend of similar results across countries stresses the importance of the 24-h movement recommendations to prevent obesity in all countries.

    “stressing the importance of the 24-h movement recommendations to prevent obesity in all countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pérez-Rodrigo et al. identified a combination of high physical activity level, low sedentary time and longer sleep time to be associated with a lower prevalence of obesity in a representative sample of Spanish children.

    “Pérez-Rodrigo et al. [15] identified a combination of high physical activity level, low sedentary time and longer sleep time to be associated with a lower prevalence of obesity in a representative sample of Spanish children.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Pérez-Rodrigo C, Gil Á, González-Gross M, Ortega RM, Serra-Majem L, Varela-Moreiras G, et al. Clustering of Dietary Patterns, Lifestyles, and Overweight among Spanish Children and Adolescents in the ANIBES Study. Nutrients. 2015; doi: 10.3390/nu8010011 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The results are similar to those found in the WHO analysis where only 8% of children achieved the best classification in the physical activity-risk behavior score and the Canadian and US studies, with a range of compliance between 5 and 17% of the population.

    “The results are similar to those found in the WHO analysis [17] where only 8% of children achieved the best classification in the physical activity-risk behavior score and the Canadian and US studies, with a range of compliance between 5 and 17% of the population [12–14].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [17] Wijnhoven TM, van Raaij JM, Yngve A, Sjöberg A, Kunešová M, Duleva V, et al. WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren. Public Health Nutr. 2015;18(17):3108–24. source

      Not checked in the free run.

    • cites [12] Laurson KR, Lee JA, Gentile DA, Walsh DA, Eisenmann JC. Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity. ISRN Obes. 2014;. doi: 10.1155/2014/204540 . eCollection 2014. source

      Not checked in the free run.

    • cites [13] Laurson KR, Lee JA, Eisenmann JC. The cumulative impact of physical activity, sleep duration, and television time on adolescent obesity: 2011 Youth Risk Behavior Survey. J Phys Act Health. 2015;12(3):355–60. source

      Not checked in the free run.

    • cites [14] Carson V, Chaput J-P, Janssen I, Tremblay MS. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Prev Med. (in press).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The studies by Duncan et al. and Danielzik et al. were the first to examine the cumulative effects of multiple risk factors on adiposity in children.

    “The studies by Duncan et al. [34] and Danielzik et al. [35] were the first ones that examined the cumulative effects of multiple risk factors on adiposity in children.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] Duncan JS, Schofield G, Duncan EK, Rush EC. Risk factors for excess body fatness in New Zealand children. Asia Pac J Clin Nutr. 2008;17(1):138–47.

      Not checked in the free run.

    • cites [35] Danielzik S, Czerwinski-Mast M, Langnäse K, Dilba B, Müller MJ. Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5–7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS). Int J Obes Relat Metab Disord. 2004;28(11):1494–502. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    MVPA only accounts for a small proportion (<5%) of the 24-h period, with the remaining 95% dedicated to sleep, sedentary behavior and light-intensity activities.

    “MVPA only accounts for a small proportion (<5%) of the 24-h period, with the remaining 95% dedicated to sleep, sedentary behavior and light-intensity activities [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Chaput JP, Carson V, Gray CE, Tremblay MS. Importance of all movement behaviors in a 24 hour period for overall health. Int J Environ Res Public Health. 2014;11(12):12575–81. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is no clear consensus about how to define light-intensity activities by accelerometry.

    “Although there is no clear consensus about how to define light-intensity activities by accelerometry [37, 38]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [37] Vanhelst J, Béghin L, Salleron J, Ruiz JR, Ortega FB, Ottevaere C, Molnar D, Kafatos A, Manios Y, Widhalm K, Casajus JA, Mauro B, Sjöström M, Gottrand F. Impact of the choice of threshold on physical activity patterns in free living conditions among adolescents measured using a uniaxial accelerometer: the HELENA study. J Sports Sci. 2014;32(2):110–5. source

      Not checked in the free run.

    • cites [38] Lee IM, Shiroma EJ. Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges. Br J Sports Med. 2014;48(3):197–201. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Except for Duncan et al. (New Zealand), all studies examining cumulative effects were conducted in European countries, analyzing selected, national, or multi-country data.

    “Except for the study by Duncan et al. that was conducted in New Zealand [34], all of them were conducted in European countries, either analyzing selected samples [35], national samples [15] or multi-country data [16, 17].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Duncan JS, Schofield G, Duncan EK, Rush EC. Risk factors for excess body fatness in New Zealand children. Asia Pac J Clin Nutr. 2008;17(1):138–47.

      Not checked in the free run.

    • cites [35] Danielzik S, Czerwinski-Mast M, Langnäse K, Dilba B, Müller MJ. Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5–7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS). Int J Obes Relat Metab Disord. 2004;28(11):1494–502. source

      Not checked in the free run.

    • cites [15] Pérez-Rodrigo C, Gil Á, González-Gross M, Ortega RM, Serra-Majem L, Varela-Moreiras G, et al. Clustering of Dietary Patterns, Lifestyles, and Overweight among Spanish Children and Adolescents in the ANIBES Study. Nutrients. 2015; doi: 10.3390/nu8010011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The relationship between light-intensity physical activity and health outcomes is largely unknown, partly due to the difficulty of its quantification as many methods to measure physical activity are not precise enough to capture such activities.

    “The relationship between light-intensity physical activity and health outcomes is largely unknown, partly due to the difficulty of its quantification as many methods to measure physical activity are not precise enough to capture such activities [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Lee IM, Shiroma EJ. Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges. Br J Sports Med. 2014;48(3):197–201. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sleep duration was analyzed without a measure of sleep quality.

    “the analysis of sleep duration without a measure of sleep quality”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Residual confounding by unmeasured variables is possible.

    “the possibility of residual confounding by unmeasured variables”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The generalizability of our data to the whole population is limited.

    “the limited generalizability of our data to the whole population”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Screen time was assessed by a self-reported questionnaire.

    “the use of a self-reported questionnaire to assess screen time”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Current recommendations and previous research show that MVPA, screen time and sleep duration are the components of the 24-h day that are more strongly associated with obesity and other health outcomes.

    “This is in line with current recommendations and previous research showing that MVPA, screen time and sleep duration are the components of the 24-h day that are more strongly associated with obesity and other health outcomes [2, 4, 11, 14].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2] Chaput JP, Carson V, Gray CE, Tremblay MS. Importance of all movement behaviors in a 24 hour period for overall health. Int J Environ Res Public Health. 2014;11(12):12575–81. source

      Not checked in the free run.

    • cites [4] Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S311–27. source

      Not checked in the free run.

    • cites [11] Saunders TJ, Gray CE, Poitras VJ, Chaput JP, Janssen I, Katzmarzyk PT, et al. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S283–93. source

      Not checked in the free run.

    • cites [14] Carson V, Chaput J-P, Janssen I, Tremblay MS. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Prev Med. (in press).

      Not checked in the free run.

40 of 40

  • The paper relies on this without support.

    The Canadian 24-h movement guidelines thresholds (9–11 h/night sleep, ≤2 h/day screen time, ≥60 min/day MVPA) are appropriate for children in all 12 ISCOLE countries.

    “Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA.”
    “The 24-h movement guidelines recently developed in Canada represent a paradigm shift in thinking about movement behaviors [4] from a focus on a single specific movement behavior type (e.g., MVPA) to an integrated movement behavior model.”

  • The paper relies on this without support.

    Exclusion of participants with missing data did not materially bias the associations between movement behaviors and adiposity.

    “Participants excluded due to missing data had significantly higher BMI z-scores (0.61) compared to those included in the present analytical sample (0.46).”

  • The paper relies on this without support.

    The main analyses had sufficient statistical power to detect the reported associations.

    “Models were presented for the total sample and by sex only; analyses by study site were not possible due to a lack of statistical power for certain combinations of movement behaviors.”

  • The paper relies on this without support.

    Self-reported screen time is a valid measure of screen time in all 12 participating countries.

    “Although not tested individually in every participating country, the TV viewing time question was shown to have adequate reliability with a one week test-retest interval (Spearman correlation = 0.55–0.68) and validity as compared to 7-day TV time use logs (Spearman correlation = 0.47) [28].”

  • The paper relies on this without support.

    How children distribute their time during the day may affect their total energy expenditure.

    “How children distribute their time during the day may affect their total energy expenditure.”

  • The paper relies on this without support.

    There are currently no specific recommendations for light-intensity activities or non-screen sedentary behaviors.

    “Consequently, there are currently no specific recommendations for light-intensity activities or non-screen sedentary behaviors.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Brazil exceeds the stated maximum screen time

    Minor

    The results say screen time ranged up to 3.4 h/day in the USA, but Table 1 reports 3.9 h/day in Brazil.

  • Canada's adherence is reported as 15% instead of 14%

    Minor

    The abstract gives both Australia and Canada 15% adherence, whereas Table 2 reports 14.9% for Australia and 14.0% for Canada.

2 of 2

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Authors
for the ISCOLE Research Group, Roman-Viñas, B., Chaput, J.-P., Katzmarzyk, P. T., Fogelholm, M., Lambert, E. V., Maher, C., Maia, J., Olds, T., Onywera, V., Sarmiento, O. L., Standage, M., Tudor-Locke, C., & Tremblay, M. S.
Affiliations
  • Children's Hospital of Eastern Ontario (CA)
  • Pennington Biomedical Research Center (US)
  • University of Helsinki (FI)
  • University of Cape Town (ZA)
  • University of South Australia (AU)
  • Kenyatta University (KE)
  • Universidad de Los Andes (CO)
  • University of Bath (GB)
Corresponding author
Tremblay, Mark S.
ORCID
Venue
International Journal of Behavioral Nutrition and Physical Activity
Publisher
Springer Science and Business Media LLC
Published
2016-11-25
Volume
13
Issue
1
Pages
123-123
ISSN
1479-5868 (ISSN-L)
DOI
10.1186/s12966-016-0449-8
PMC
PMC5123420
OpenAlex
W2555900862
Semantic Scholar
70f8d2a02fbd42b79118fcc959f4ea6d25c9ff0f
Cited by
368
References
44
Citations by year
2026: 14 · 2025: 31 · 2024: 43 · 2023: 51 · 2022: 60 · 2021: 65 · 2020: 56 · 2019: 24 · 2018: 18 · 2017: 6
FWCI
15.87
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
  • The University of Bath Online Publications Store (The University of Bath) (submittedVersion, cc-by)
  • uO Research (University of Ottawa) (submittedVersion, public-domain)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
  • Open University of Cape Town (University of Cape Town) (submittedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, cc-by)
  • Pure (University of Bath) (submittedVersion, cc-by)
  • UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
Funders
Coca-Cola (not applicable)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
24-hour movement guidelines, childhood obesity, BMI z-score, sleep duration, screen time, moderate-to-vigorous physical activity, guideline adherence, children and young people, cross-national comparison
MeSH terms
Australia, Body Weight, Canada, Child, Cross-Sectional Studies, Diet, Feeding Behavior, Female, Humans, Male, Sleep, Exercise, Body Mass Index, Prevalence, Odds Ratio, Guidelines as Topic, Adiposity, Sedentary Behavior, Self Report, Accelerometry, Pediatric Obesity

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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