Energy balance-related behavioural patterns in 5-year-old children and the longitudinal association with weight status development in early childhood.

Objective: The current study examined clustering of dietary intake and activity behaviours (i.e. physical activity (PA) and sedentary behaviour) in 5-year-old children, as well as the longitudinal association with BMI and overweight development.

Design: Principal component analysis (PCA) was used to identify behavioural patterns. Backward regression analyses were used to examine the association of behavioural patterns with parent and child background characteristics, as well as the association of the patterns with BMI Z-score and overweight development up to ages 7 and 8 years.

Setting: The Netherlands.

Subjects: Data originated from the KOALA Birth Cohort Study (n 2074 at age 5 years).

Results: Four patterns emerged: a 'sedentary-snacking' pattern (including television viewing and snack consumption), a 'healthy intake' pattern (including healthy items such as fruit, vegetables and fish), a 'sandwich' pattern (including bread and sandwich fillings) and a 'sporty-traditional meal' pattern (including sports, meat and potatoes). The patterns were related to child gender, general appetite and various parental characteristics. The sedentary-snacking pattern was positively associated with longitudinal BMI development.

Conclusions: Cross-behavioural energy balance-related behavioural patterns exist at age 5 years. Different activity types (e.g. sports, television viewing) clustered differently with the behavioural patterns, indicating the need to incorporate these different types instead of one general PA measure in energy balance-related pattern analyses. The clustering and potential synergy between activity behaviours and dietary intake, as well as the associations with weight status development, stress the importance of an integrated approach to PA and healthy nutrition promotion in preventing childhood overweight.