Adherence to a healthy lifestyle behavior composite score and cardiometabolic risk factors in Spanish children from the CORALS cohort
Authors: Garcidueñas-Fimbres Tany E. , Gómez-Martínez Carlos , Pascual-Compte Maria , Jurado-Castro Jose Manuel , Leis Rosaura , Moreno Luis A. , Navas-Carretero Santiago , Codoñer-Franch Pilar , Echeverria Ana Moreira , Pastor-Villaescusa Belén , López-Rubio Alicia , García Sara Moroño , De Miguel-Etayo Pilar , Martínez J. Alfredo , Aguayo Inmaculada Velasco , Vázquez-Cobela Rocío , Escribano Joaquín , Miguel-Berges María Luisa , De La Torre-Aguilar María José , Gil-Campos Mercedes , Salas-Salvadó Jordi , Babio Nancy 
Published: January 2024

To assess the associations between the adherence to a composite score comprised of 6 healthy lifestyle behaviors and its individual components with several cardiometabolic risk factors in Spanish preschool children. Cross-sectional analyses were conducted in 938 participants included in the CORALS cohort aged 3–6 years. Six recognized healthy lifestyle behaviors (breastfeeding, sleep duration, physical activity, screentime, adherence to the Mediterranean diet, and eating speed) were assessed in a composite score. Multiple linear and logistic regression models were fitted to assess the associations with cardiometabolic risk factors (weight status, waist circumference, fat mass index, blood pressure, fasting plasma glucose, and lipid profile). In the adjusted multiple linear and logistic regression models, compared with the reference category of adherence to the healthy lifestyle behavior composite score, those participants in the category of the highest adherence showed significant decreased prevalence risk of overweight or obesity [OR (95% CI), 0.4 (0.2, 0.6)] as well as significant lower waist circumference, fat mass index (FMI), systolic blood pressure and fasting plasma glucose concentration [β (95% CI), − 1.4 cm (− 2.5, − 0.4); − 0.3 kg/m2 (− 0.5, − 0.1); and − 3.0 mmHg (− 5.2, − 0.9); − 1.9 mg/dL (− 3.5, − 0.4), respectively]. Slow eating speed was individually associated with most of the cardiometabolic risk factors.

   Conclusions: Higher adherence to the healthy lifestyle behavior composite score was associated with lower waist circumference, FMI, other cardiometabolic risk factors, and risk of overweight or obesity in Spanish preschool children. Further studies are required to confirm these associations.

What is Known:• Lifestyle is a well-recognized etiologic factor of obesity and its comorbidities.• Certain healthy behaviors such as adhering to a healthy diet, increasing physical activity, and decreasing screentime are strategies for prevention and treatment of childhood obesity.

What is New:• Higher adherence to the healthy lifestyle behavior composite score to 6 healthy behaviors (breastfeeding, sleep duration, physical activity, screentime, eating speed, and adherence to the Mediterranean diet) was associated with decreased adiposity, including prevalence risk of overweight or obesity, and cardiometabolic risk in preschool children.• Slow eating and greater adherence to the Mediterranean diet were mainly associated to lower fasting plasma and serum triglycerides concentration, respectively.