Children's and adolescents' lifestyle factors associated with physical activity in five Mediterranean countries: the...

Physical activity in children and adolescents represents one of the most important lifestyle factors to determine current and future health.

The aim of the study is to assess the lifestyle and dietary factors linked to physical activity in younger populations across five countries in the Mediterranean region.

A total of 2,011 parents of children and adolescents (age range 6-17 years) participating to a preliminary survey of the DELICIOUS project were investigated to determine children's adequate physical activity level (identified using the short form of the international physical activity questionnaire) as well as diet quality parameters [measured as Youth-Healthy Eating Index (Y-HEI)] and eating and lifestyle factors (i.e., meal habits, sleep duration, screen time, etc.). Logistic regression analyses were performed to assess the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between variables of interest.

Younger children of younger parents currently working had higher rates and probability to have adequate physical activity. Multivariate analysis showed that children and adolescents who had breakfast (OR = 1.88, 95% CI: 1.38, 2.56) and often ate with their family (OR = 1.80, 95% CI: 0.90, 3.61) were more likely to have an adequate level of physical activity. Children and adolescents who reported a sleep duration (8-10 h) closest to the recommended one were significantly more likely to achieve adequate levels of physical activity (OR = 1.88, 95% CI: 1.38, 2.56). Conversely, those with more than 4 h of daily screen time were less likely to engage in adequate physical activity (OR = 0.77, 95% CI: 0.54, 1.10). Furthermore, children and adolescents in the highest tertile of YEHI scores showed a 60% greater likelihood of engaging in adequate physical activity (OR = 1.60, 95% CI: 1.27, 2.01).

These results emphasize the importance of promoting healthy diet and lifestyle habits, including structured and high quality shared meals, sufficient sleep, and screen time moderation, as key strategies to support active behaviors in younger populations. Future interventions should focus on reinforcing these behaviors through parental guidance and community-based initiatives to foster lifelong healthy habits.