# Diet, Activity and Sleep Clusters Associated With Obesity Markers of Children in the US‐Affiliated Pacific

## TL;DR

This study identifies lifestyle patterns in children in the US-Affiliated Pacific and finds that certain diet, activity, and sleep behaviors are linked to lower obesity markers.

## Contribution

The study introduces distinct lifestyle clusters and their associations with obesity markers in children from a specific region.

## Key findings

- Among 2–5-year-old boys, clusters with high physical activity and sleep had lower BMI z-scores.
- For 6–8-year-old girls, clusters with low sedentary time and high physical activity were linked to lower BMI z-scores.
- Longer sleep duration was consistently associated with healthier weight outcomes in both age groups.

## Abstract

Among children in the US‐Affiliated Pacific, we aimed to identify lifestyle clusters and associations with obesity.

Movement behaviours, diet and anthropometrics were from the Children's Healthy Living Program (n = 1780; 2012–2015). Partitioning‐around‐medoids identified clusters; regression examined differences in anthropometrics.

Among 2–5‐year‐olds, boys' clusters were: (1) high %energy from (E%) fat and sedentary behaviour; (2) high screen time and energy intake and (3) long sleep. Body mass index z‐score (zBMI) was lower in Cluster 3 versus 1 (−0.28 [−0.50; −0.07], p = 0.01). Girls' clusters were: (1) high energy intake; (2) low E% fat and (3) high physical activity and sleep. zBMI was lower in Cluster 3 versus 1 (−0.34 [−0.55; −0.13], p = 0.002). Among 6–8‐year‐olds, boys' clusters were: (1) high screen time; (2) high energy intake; (3) high E% protein; (4) long sleep and (5) high sedentary time and low E% saturated fat. Compared with Cluster 1, zBMI was lower in Clusters 3 (−0.43 [−0.84; −0.02], p = 0.04), 4 (−0.64 [−1.08; −0.20], p = 0.004) and 5 (−0.93 [−1.35; −0.51], p < 0.001). Girls' clusters were: (1) high E% fat and protein; (2) high screen time and energy intake; (3) short sleep and high physical activity (4) long sleep and (5) low sedentary time. Compared with Cluster 1, zBMI was lower in Clusters 2 (−0.57 [−0.98; −0.17], p = 0.006), 3 (−0.48 [−0.81; −0.14], p = 0.005) and 5 (−0.50 [−0.83; −0.18], p = 0.003).

Various lifestyle patterns support healthy body weight.

ClinicalTrials.gov identifier: NCT01881373