Gender-, Age-, and Region-Specific Associations Between Obesity and Nutrition/Health Knowledge, Dietary Diversity,...

Background: Chinese school-age students are at a high risk of developing obesity. However, few studies have reported individualized ways to prevent obesity by age, gender, and living regions. Methods: A total of 11,285 students aged 6-18 years were recruited and participated in this cross-sectional study. Questionnaires were used to assess scores of dietary diversity (DDS), physical activity (PA) duration, and nutritional literacy awareness. According to age and gender-specific BMI thresholds, the participants were categorized into normal and participants with obesity groups. Pearson correlation and logistic regression analysis were used to explore the association between nutritional literacy, DDS, PA, and the risk of BMI or obesity. Results: Scores of nutritional literacy were positively associated with Total DDS, Plant DDS, Animal DDS, and PA, and were negatively associated with BMI. High Total DDS (OR = 0.878, p = 0.030), Plant DDS (OR = 0.885, p = 0.027), and PA (OR = 0.869, p = 0.022) were strongly associated with a low risk of obesity. Furthermore, high Total DDS and Plant DDS decreased the risk of obesity only in the high PA group but not in the low PA group. High PA only decreased the risk of obesity in the high Total DDS and high Plant DDS group. Gender-, age-, and living-region-specific associations were also observed. Conclusions: Diverse dietary intakes and physical activity are essential for reducing the risk of obesity in Chinese school-age students. Notably, gender-, age-, and living-region-specific health and nutritional literacy education are required in school-age children to prevent obesity.