Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents

(2023) 23:562 Matias et al. BMC Public Health https://doi.org/10.1186/s12889-023-15444-x BMC Public Health Open Access RESEARCH Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents Thiago Sousa Matias1*, Julianne Fic Alves1, Gislaine Terezinha Amaral Nienov1, MarcusVinicius Veber Lopes1 and Diego Itibere Cunha Vasconcellos2 Abstract Backgound Although obesogenic behaviors have been found to be related to social isolation, evidence-based person-centered approaches are lacking. This study investigated the association between clusters of obesogenic behavior – derived from a data-driven process – and social isolation among Brazilian adolescents. Methods Data from the National Adolescent School-based Health Survey (PeNSE) 2015 were analyzed. A total of 100,794 9th-grade students (51.3% females; 14.3 ± 0.1 years old) enrolled in 3,040 public and private high schools participated in the study. Social isolation was assessed by two outcomes (i.e., perceived loneliness and lack of close friends). A two-step cluster analysis was conducted to identify patterns of obesogenic behaviors with the input of leisure-time physical activity (PA), sitting time as a proxy of sedentary behavior (SB), and the weekly consumption of healthy and unhealthy food. Crude and adjusted binary logistic regression models were applied to evaluate the associations between the clusters of obesogenic behaviors and social isolation variables in adolescents. Results Three clusters were identified. Adolescents in the “Health-promoting SB and diet” (32.6%; OR = 0.69; 95% CI = 0.62–0.76) and “Health-promoting PA and diet” (44.9%; OR = 0.73; 95% CI = 0.67–0.79) clusters had lower odds of loneliness compared to those in the “Health-risk” cluster (22.5%). Those belonging to the “Health-promoting PA and diet” cluster were more likely to report having close friends (OR = 1.19; 95% CI = 1.00–1.41) than those in the “Healthrisk” cluster. Conclusion Adolescents in clusters where positive behaviors outweighed negative ones were less likely to perceive themselves as lonely and without close connections. Keywords Healthy Lifestyle, Loneliness, Mental Health, Health Surveys, Motor Activity *Correspondence: Thiago Sousa Matias 1 Department of Physical Education, Federal University of Santa Catarina, Florianópolis 88040‑900, Brazil 2 Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia Introduction Regular practice of physical activity (PA) and reduced time in sedentary behaviors (SB) have been positively associated with mental health in adolescence [1, 2]. This benefit includes favoring socialization and avoiding social isolation [3, 4]. Thus, recent evidence has shown that both high PA and low SB are associated with lower loneliness [5]. Active adolescents can be more socially integrated [4], while having friends help them to overcome barriers associated with a less active lifestyle [6]. © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Matias et al. BMC Public Health (2023) 23:562 It is important to consider that PA and SB do not occur in isolation in adolescents’ lives. These behaviors carry synergies with other behaviors such as diet, for example, which can (synergically speaking) influence socialization [6]. This influence might depend on the extension of adolescents’ lifestyle have more favorable than unfavorable behaviors coexisting [7, 8]. These behaviors can be more or less obesogenic depending on the different profiles observed [3]. The problem that arises is that: (a) being in an obesogenic cluster can make socialization difficult, increasing social isolation [9, 10]; and (b) clusters that combine positive and negative behaviors can still favor better socialization and psychological disposition in adolescents when compared to clusters that mostly combine risk behaviors [2, 11]. The pioneering study by Iannotti and Wang (2013) [11], which investigated clusters of obesogenic behaviors and their impact on physical and mental health in adolescents in the United States, found that the group with the highest sedentary behavior and the highest proportion of non-healthy diet, but who still moderately met physical activity criteria or consumed fruits and vegetables daily, had lower levels of body dissatisfaction. Similarly, Matias and colleagues reported that adolescents in healthier clusters were more likely to be satisfied with their body image [2]. More recently, a large survey of Brazilian adolescents found that obesogenic clusters with more positive behaviors than negative ones were associated with prosocial attitudes and reduced adolescent bullying [12]. Despite some evidence from cross-sectional studies, few investigations have explored the association between clusters of obesogenic behaviors and psychosocial factors, such as social isolation. It is important to note that adolescents do not possess isolated virtues in their lifestyle, and there is an interplay between essentially positive or negative behaviors that can have an impact on mental health in numerous ways. Therefore, countries with low- to middle-income, like Brazil, have undergone demographic and epidemiologic transitions characterized by economic and sociocultural disparities, significant increases in inequality [13], and a corresponding rise in diseases associated with changes in lifestyle. Thus, the aim of the present study was to investigate the association between clusters of obesogenic behaviors and social isolation in a population-based study of Brazilian adolescents. Methods Study design and participants A cross-sectional study using data from the National Adolescent School-based Health Survey (PeNSE – sample 1) was conducted in 2015 by the Brazilian Institute of Geographic and Statistics and the Ministry of Health Page 2 of 6 of Brazil. PeNSE relates to World Health Organization recommendations for (...truncated)