Many different roads lead to Rome: equivalence of time-use for activity, sedentary and sleep behaviours and dietary intake profiles among adolescents

Abstract

Background: How we spend our time and what we eat have important implications for our health. Evidence suggests that health-equivalent behaviour change options which result in the same benefit are available within both time use (physical activities, sedentary behaviours and sleep) and diet (e.g., fruit and vegetables, snack foods). However, it is not yet known if health-equivalent choices exist across both time-use and diet behaviours. This study aimed to explore if a variety of different time-use and dietary profiles were associated with equivalent physical functioning score among adolescents.

Methods: This study used cross-sectional data from 2123 adolescent participants from the Longitudinal Study of Australian Children (LSAC) (mean age = 14.4 ± 0.5 years), including time-use diaries (min/day of sleep, self-care, screen time, quiet time, physical activity, school-related and domestic/social), diet questionnaires (serves/day of fruit and vegetables, discretionary (snack) foods and sugar-sweetened beverages) and a measure of physical functioning (PedsQL™ 4.0 physical functioning scale for teens). Multiple linear regression models were used to find the association of 24-h time-use composition (expressed as isometric log ratios) and dietary variables with physical functioning score. The models were used to estimate which time-use and diet profiles (within a feasible range from the sample average) were associated with equivalent physical functioning scores. Finally, an interactive app was developed to make the results accessible to end users.

Results: Within 30 min and 1.5 servings of the average adolescent's time-use and dietary behaviours, 45 equivalent options were associated with a ~ 0.2 SD improvement in physical functioning scale. All options associated with this improvement in physical function involved increasing physical activity and increasing fruit and vegetable intake, whilst also reducing discretionary food intake and sugar-sweetened beverages. Most behavioural options also increased sleep and reduced time spent in self-care, screen time and quiet time activities.

Conclusions: There are a range of time-use and diet profiles that may result in equivalent benefits in physical functioning among adolescents. Communicating these options using decision tools such as interactive apps may allow for tailored interventions across both time use and diet which are based on an individual's needs, preferences and constraints.

Keywords: Adolescent; Diet; Health; Non-communicable diseases; Time use.

Fig. 1

Simulated equivalent behaviour-change options for physical functioning across time use and dietary intake. For each time-use behaviour (displayed in top five cells) and dietary choice (displayed in bottom five cells), the percentage of options associated with increases in physical functioning of + 0.5, + 1, + 1.5, + 2 or + 2.5 points is shown. For example, the top-most right cell displays what percent of options for changes in each time-use behaviour are associated with + 2.5 improvement in physical functioning, showing that there are no options to reduce physical activity, but that the majority of options require reductions in quiet time, screen time and self-care (brown/green colours). In terms of diet, the only options available for a + 2.5 improvement in physical functioning are increases in fruit and vegetables, and decreases in SSBs and discretionary foods. Models were adjusted for age, sex and household socioeconomic position. Reference durations (zero difference) for time-use behaviours are: sleep = 740; self care = 130; screen time = 160; quiet time = 170; physical activity = 50; school-related = 130; domestic/social = 60. Reference serves for dietary intake are: fruit and vegetables = 4; discretionary foods = 2, SSB = 1. The largest simulated decrease for SSB was − 1 serve to avoid negative values. SSB sugar sweetened beverages

Fig. 2

Mock-up of ShinyApp interface to allow users to explore equivalent behaviour-change options