Clustering of Health Behaviors and Cardiorespiratory Fitness Among U.S. Adolescents.

Purpose: Decreased cardiorespiratory fitness (CRF) is associated with an increased risk of cardiovascular disease. However, little is known how the interaction of diet, physical activity (PA), and sedentary time (ST) affects CRF among adolescents. By using a nationally representative sample of U.S. adolescents, we used cluster analysis to investigate the interactions of these behaviors with CRF. We hypothesized that distinct clustering patterns exist and that less healthy clusters are associated with lower CRF.

Methods: We used 2003-2004 National Health and Nutrition Examination Survey data for persons aged 12-19 years (N = 1,225). PA and ST were measured objectively by an accelerometer, and the American Heart Association Healthy Diet Score quantified diet quality. Maximal oxygen consumption (V˙O​max) was measured by submaximal treadmill exercise test. We performed cluster analysis to identify sex-specific clustering of diet, PA, and ST. Adjusting for accelerometer wear time, age, body mass index, race/ethnicity, and the poverty-to-income ratio, we performed sex-stratified linear regression analysis to evaluate the association of cluster with V˙O​max.

Results: Three clusters were identified for girls and boys. For girls, there was no difference across clusters for age (p = .1), weight (p = .3), and BMI (p = .5), and no relationship between clusters and V˙O​max. For boys, the youngest cluster (p < .01) had three healthy behaviors, weighed less, and was associated with a higher V˙O​max compared with the two older clusters.

Conclusions: We observed clustering of diet, PA, and ST in U.S. adolescents. Specific patterns were associated with lower V˙O​max for boys, suggesting that our clusters may help identify adolescent boys most in need of interventions.