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Clusters of 24-hour movement behavior and diet and their relationship with health indicators among youth: a systematic review

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posted on 2024-05-06, 08:02 authored by GT de Mello, G Minatto, RM Costa, RM Leech, Yingting CaoYingting Cao, RE Lee, KS Silva
Movement-related behaviors (physical activity [PA], sedentary behavior [SB], and sleep) and diet interact with each other and play important roles in health indicators in youth. This systematic review aimed to investigate how PA, SB, sleep, and diet cluster in youth by biological sex; and to examine which cluster are associated with health indicators. This study was registered in PROSPERO (number: CRD42018094826). Five electronic databases were assessed. Eligibility criteria allowed studies that included youth (aged 19 years and younger), and only the four behaviors {PA, SB, sleep, and diet (ultra-processed foods [UPF]; fruits and vegetables [FV])} analyzed by applying data-based cluster procedures. From 12,719 articles screened; 23 were included. Of these, four investigated children, and ten identified clusters by biological sex. Sixty-six mixed cluster were identified including, 34 in mixed-sex samples, 10 in boys and 11 in girls. The most frequent clusters in mixed-sex samples were “High SB UPF Low Sleep”, “Low PA High SB Satisfactory Sleep”, and “High PA”. The main difference in profiles according to sex was that girls’ clusters were characterized by high sleep duration, whereas boys’ clusters by high PA. There were a few associations found between cluster types and health indicators, highlighting that youth assigned to cluster types with low PA exhibited higher adiposity. In conclusion, the youth presented a range of clusters of behaviors, typically exhibiting at least one unhealthy behavior. Similar patterns were observed in both sexes with the biggest difference in time of sleep for girls and PA for boys. These findings underscore the importance of intervention strategies targeting multiple behaviors simultaneously to enhance health risk profiles and indicators in children and adolescents.


GTM is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior —Brasil (CAPES) — Finance Code 001 with a scholarship. RMC is supported by Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) with a scholarship. KSS receives Productivity Grant from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq process number: 305803/2020–4). RML is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (APP1175250). REL is supported by NHMRC Emerging Leadership Fellowship and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health Other Transaction Award OT2HD108101-01. The views of the funding agency had no influence on the content or conduct of the review.


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BMC Public Health





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© The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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