Behavioral Clusters of Diet, Physical Activity, and Sedentary Behavior Among Moroccan School-Age Adolescents: A...

Adolescence is a critical period when unhealthy diet (UD), insufficient physical activity (PA), and sedentary behavior (SB) co-occur and persist into adulthood, fueling noncommunicable diseases. This is the first national latent class analysis (LCA) of UD, PA, and SB among Moroccan adolescents. The objective of this study was to identify latent behavioral classes and to examine their sociodemographic and mental health correlates.

We analyzed cross-sectional data from the 2016 Global School-based Student Health Survey (GSHS) in Morocco. Unweighted LCA was applied to binary indicators of UD, insufficient PA, and SB. Models with two to five classes were estimated, and we retained the most parsimonious and substantively interpretable solution. Correlates of class membership were estimated with multinomial logistic regression.

Complete data were available for 6,745 school-attending adolescents (median age 15 years; 46.9% female; 48.8% urban; response rate 91%). A three-class solution provided the best fit: "low fruit/vegetable intake and inactive" (58.1%), "carbonated soft drink and fast-food intake and inactive" (18.8%), and "multi-risk diet and inactive" (23.1%). Compared with the "low fruit/vegetable intake and inactive" class, higher odds of membership in the two higher risk profiles were observed for urban residence, male sex (for the multi-risk diet and inactive class), high-school level, anxiety, suicidality, and smoking; underweight status was associated with lower odds for the multi-risk profile.

To our knowledge, this is the first national LCA of UD, insufficient PA, and SB among Moroccan adolescents, identifying three recurrent profiles all underpinned by insufficient PA and differentiated by diet. Findings inform policy and practice, supporting school-based, multi-behavior programs pairing PA promotion with dietary improvements and brief mental health support, with priority for boys, urban schools, and smokers. Estimates are sample-specific; future work should use survey-weighted/three-step LCA and longitudinal, multilevel designs incorporating sleep and objective PA.