A systematic review of lifestyle patterns and their association with adiposity in children aged 5-12 years

Diet, physical activity, sedentary behaviour and sleep are typically examined independently with childhood adiposity; however, their combined influence remains uncertain. This review aims to systematically summarize evidence on the clustering of these behaviours through lifestyle patterns and evaluate associations with adiposity in children aged 5-12 years. Search strategies were run in six databases. Twenty-eight papers met the inclusion criteria, six of which included all four behaviours. A range of lifestyle patterns were identified (healthy, unhealthy and mixed). Mixed patterns were most frequently reported. Unhealthy patterns comprising low physical activity and high sedentary behaviour were also frequently observed. Mixed patterns comprising healthy diets, low physical activity and high sedentary behaviour were more commonly seen in girls, whereas boys were more physically active, similarly sedentary and had unhealthier diets. Children from lower socio-economic backgrounds tended to more frequently display unhealthy patterns. Unhealthy lifestyle patterns were more often associated with adiposity risk than healthy and mixed patterns. With few studies including all four behaviours, it is difficult to establish a clear picture of their interplay and associations with adiposity. Nonetheless, reliance on lifestyle patterns is likely more beneficial than individual behaviours in targeting adiposity and improving understanding of how these behaviours influence health.