Associations between lifestyle patterns and body mass index in a sample of Greek children and adolescents.

BACKGROUND: Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored.

OBJECTIVE: To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population

DESIGN: Cross-sectional study. Data were collected from May through July 2007.

SUBJECTS: The sample consisted of 1,305 children and adolescents (ages 3 to 18 years).

MAIN OUTCOME MEASURES: Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters.

STATISTICAL ANALYSIS: Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders.

RESULTS: Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized beta=-.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis.

CONCLUSIONS: Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.