Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries

Dorothea Dumuid, Timothy Olds, Lucy K. Lewis, Josep Antoni Martin-Fernández, Peter T. Katzmarzyk, Tiago Barreira, Stephanie T. Broyles, Jean Philippe Chaput, Mikael Fogelholm, Gang Hu, Rebecca Kuriyan, Anura Kurpad, Estelle V. Lambert, José Maia, Victor Matsudo, Vincent O. Onywera, Olga L. Sarmiento, Martyn Standage, Mark S. Tremblay, Catrine Tudor-LockePei Zhao, Fiona Gillison, Carol Maher

Research output: Contribution to journalArticle

38 Scopus citations


Objective: To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions. Study design: This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models. Results: Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk-food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all-rounders). Health-related quality of life was greatest in the all-rounders cluster. Conclusions: Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health-related quality of life, with children from the all-rounders cluster consistently reporting greatest health-related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior). Trial registration: NCT01722500.

Original languageEnglish (US)
JournalJournal of Pediatrics
StateAccepted/In press - Sep 14 2016



  • Compositional analysis
  • Diet
  • Physical activity
  • Screen time
  • Sedentary behavior

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Dumuid, D., Olds, T., Lewis, L. K., Martin-Fernández, J. A., Katzmarzyk, P. T., Barreira, T., Broyles, S. T., Chaput, J. P., Fogelholm, M., Hu, G., Kuriyan, R., Kurpad, A., Lambert, E. V., Maia, J., Matsudo, V., Onywera, V. O., Sarmiento, O. L., Standage, M., Tremblay, M. S., ... Maher, C. (Accepted/In press). Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries. Journal of Pediatrics.