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

In the paper

“In addition, most of the studies have been conducted in developed countries and only a few have included a multi-country analysis [16–18].”

What the sources say

• Partly supported

  The Methods (Study population and design; page unavailable) describe this study as an analysis of children in seven European countries, and the Discussion calls its sample multinational. That supports citing it as an example of a multi-country study in developed countries. Our copy does not establish that most studies were conducted in developed countries or that only a few were multi-country. (LLM, conf=0.78)

  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. sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (page unavailable in our copy) identifies six European-wide studies and contrasts them with country-specific studies, offering some support for the claim that relatively few studies use multi-country data. It does not say that most studies on the topic were conducted in developed countries, or establish a worldwide count of multi-country analyses. (LLM, conf=0.76)

  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. sourceExperimental — accuracy not yet measured
• Partly supported

  The Study subjects section describes a study of children in eight European countries, so this paper provides an example of a multi-country analysis in developed countries. It does not establish that most studies on the topic were conducted in developed countries or that only a few included multi-country analyses; the Introduction’s reference to developed countries concerns reports of obesity plateauing, not the distribution of studies on this topic. (LLM, conf=0.77)

  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. sourceExperimental — accuracy not yet measured

In the paper

“Although there is no clear consensus about how to define light-intensity activities by accelerometry [37, 38]”

What the sources say

• Not checked yetcites [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
• Supported

  In “Challenges related to data analyses” (page not specified), the paper says accelerometer cutpoints are used to classify activity by intensity and that there is no consensus on the correct cutpoints. That supports the claim about the lack of a clear accelerometric definition for light-intensity activity. (LLM, conf=0.88)

  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

In the paper

“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].”

What the sources say

• Partly supported

  The Introduction links MVPA, screen-based sedentary behavior and sleep duration to health outcomes, including obesity. But it does not say these three are more strongly associated with outcomes than other parts of the 24-hour day; the Conclusions instead emphasize health benefits across all components, including light physical activity. Page numbers are not available in our copy. (LLM, conf=0.86)

  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. sourceExperimental — accuracy not yet measured
• Not checked yetcites [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
• Partly supported

  The Adiposity section reports lower adiposity with combinations of higher physical activity, lower sedentary behaviour and longer sleep, and greater obesity odds when fewer steps/day, screen-time and sleep guidelines were met. The Discussion says benefits were most consistently associated with physical activity, especially MVPA. It does not establish that screen time and sleep duration, alongside MVPA, are each more strongly associated with obesity and other health outcomes than other components of the 24-hour day. (LLM, conf=0.85)

  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. sourceExperimental — accuracy not yet measured
• Not checked yetcites [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).

In the paper

“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%).”

In the paper

“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%).”

In the paper

“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%).”

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

In the paper

“Body weight and height were measured according to standardized procedures by trained ISCOLE staff [22].”

What the sources say

• Not checked yetcites [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

In the paper

“Furthermore, self-report methods of quantifying screen time have been reported to have acceptable reliability and validity in children [29].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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).

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“behaviors most frequently related to negative health outcomes [8, 9].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“stressing the importance of the 24-h movement recommendations to prevent obesity in all countries.”

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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).

In the paper

“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.”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“the analysis of sleep duration without a measure of sleep quality”

In the paper

“the possibility of residual confounding by unmeasured variables”

In the paper

“the limited generalizability of our data to the whole population”

In the paper

“the use of a self-reported questionnaire to assess screen time”