Lifestyle Clusters and Cardiometabolic Risks in Adolescents: A Chinese School-Based Study Using a Latent Class Analysis Approach

Abstract

Background: Unhealthy dietary and lifestyle behaviors are associated with a higher prevalence of non-communicable chronic diseases and higher mortality in adults. However, there remains some uncertainty about the magnitude of the associations between lifestyle behaviors and cardiovascular factors in adolescents.Methods: We conducted a school-based cross-sectional study of 895 Chinese adolescents aged 15–19 years. They participated in a questionnaire survey, physical examination, and blood sample collection. Latent class analysis (LCA) was used to identify heterogeneous subgroups of lifestyle behaviors. A set of 12 latent class indicators, which reflected lifestyle behaviors including dietary habits, physical activity, sleep duration, screen time, and pressure perception, were included in the analysis. Logistic regression analysis was performed to determine whether the derived classes were related to a cardiometabolic risk.Results: In total, 13.7 and 5.6% of the participants were overweight and obese, respectively, and 8.4 and 14.1% reported having pre-hypertension and hypertension, respectively. A two-class model provided the best fit with a healthy lifestyle pattern (65.8%) and a sub-healthy lifestyle pattern (34.2%). There were more female participants with a healthy lifestyle (56.2 vs. 43.8%), whereas there were more males with a sub-healthy lifestyle (45.4 vs. 54.6%), (all P = 0.002). Increased risk of cardiometabolic abnormality (BMI categories, blood pressure and lipids) was not significant across lifestyle patterns, except for waist circumference (70.5 vs 69.1 cm, P = 0.044). There was no significant difference in physical activity and intake of fruit and vegetable between the two patterns.Conclusion: Primary prevention based on lifestyle modification should target patterns of behaviors at high risk in adolescents. Due to the complex effect of lifestyle clusters on cardiometabolic risks, well-designed and prospective studies in adolescents are needed in the future.

Ultra-processed food consumption and children and adolescents’ health

“… Health actions represented by official national health and education bodies must foster health promotion and the prevention of NCDs in adolescents, especially in dealing the different factors that compromise the full development of this population. Zhao et al 11 (2021) Cross-sectional 895 Chinese adolescents aged 15 to 19 years. To identify modifiable lifestyle behaviors and explore the best intervention in Chinese adolescents.…”

“…This review included studies that share the objective of analyzing and discussing the effects of dietary patterns and the relationship with chronic NCDs in children and adolescents. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 …”

“…Zhao et al (2021) 11 sought to identify modifiable lifestyle-defining behaviors and explore the best form of intervention for Chinese adolescents. The sample included 895 adolescents and of these, 8.4 % and 14.1 % reported having pre-hypertension and hypertension, respectively.…”

“…In the same study, significant differences were also found in waist circumference between the two classes (70.5 vs. 69.1 cm; p = 0.044). 11 …”

“…Zhao et al (2021) 11 evaluated modifiable risk factors aiming to promote effective interventions for adolescents. Based on the definition of two patterns – healthy and unhealthy – no significant difference in physical activity was identified between the participants in each of the patterns since an insufficient level of physical activity was identified in the minority (36.4 %) of Chinese adolescents.…”