Independent and combined influence of healthy lifestyle factors on academic performance in adolescents: DADOS Study

BACKGROUND: Few studies have analyzed the combined effect of lifestyle factors on academic performance (AP) in adolescents. The aim of this study was to analyze the independent and combined effects of weight status, screen time, sleep quality, daily meal frequency, cardiorespiratory fitness, and physical activity (PA) on AP in adolescents. METHODS: A total of 262 adolescents (13.9 +/- 0.3 years) from the DADOS study were included in the analysis. Weight status was assessed through body mass index (kg/m(2)). Participants completed questionnaires to evaluate screen time, sleep quality, and daily meal frequency. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. PA was evaluated by a wrist-worn GENEActiv accelerometer. AP was assessed through the final academic grades and a validated questionnaire. RESULTS: Non-overweight status, low screen time, good sleep quality, and proper meal frequency showed independent, positive influence on AP. Moreover, adolescents achieving at least three healthy lifestyles were more likely to be in the high-performance group for academic grades than those achieving <= 1 (math OR: 3.02-9.51, language OR: 3.51-6.76, and grade point average OR: 4.22-936). CONCLUSIONS: Although individual healthy lifestyles are independently and positively associated with AP, the cumulative effect of multiple healthy lifestyles have a stronger impact.