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Randomized Controlled Trial
. 2025 Jul;114(7):1642-1652.
doi: 10.1111/apa.70012. Epub 2025 Feb 24.

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

Dorothea Dumuid  1 , Ashley B Yamanaka  2 , Kar Hau Chong  3 , Anthony D Okely  3 , Lynne R Wilkens  4 , Yurii B Shvetsov  4 , Chloe P Lozano  4 , Rachel Novotny  2
Affiliations
Randomized Controlled Trial

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

Dorothea Dumuid et al. Acta Paediatr. 2025 Jul.

Abstract

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

Methods: 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.

Results: 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).

Conclusion: Various lifestyle patterns support healthy body weight.

Trial registration: ClinicalTrials.gov identifier: NCT01881373.

Keywords: energy balance; macronutrient composition; movement behaviour; physical activity; screen time; sleep.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Cluster view for younger children (2–5 years): Z‐scores relative to the grand mean. Carbs, carbohydrates; E%, % of total energy intake; LPA, light physical activity; MVPA, moderate‐to‐vigorous physical activity.
FIGURE 2
FIGURE 2
Cluster view for older children (6–8 years): Z‐scores relative to the grand mean. Carbs, carbohydrates; E%, % of total energy intake; LPA, light physical activity; MVPA, moderate‐to‐vigorous physical activity.
FIGURE 3
FIGURE 3
Relationship between cluster membership and anthropometric measures. All analyses were adjusted for child's age, indigenous status, parental education level and clustering at jurisdiction and community levels.
See this image and copyright information in PMC

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