Children's and adolescents' lifestyle factors associated with physical activity in five Mediterranean countries: the DELICIOUS project

Alice Rosi¹Francesca Scazzina¹Maria Antonieta Touriz Bonifaz^2,3Francesca Giampieri^4,5,6,7Achraf Ammar^8,9Khaled Trabelsi^10,11Osama Abdelkarim¹²Mohamed Aly¹²Evelyn Frias-Toral^13,14Juancho Pons¹⁵Laura Vázquez-Araújo^16,17Josep Alemany-Iturriaga^18,19,5Lorenzo Monasta²⁰Nunzia Decembrino²¹Ana Mata²²Adrián Chacón²²Pablo Busó²²Giuseppe Grosso^23,24*

• ¹Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy, Parma, Italy
• ²Facultad de Ciencias de la Salud, Universidad Católica de Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador, Guayaquil, Ecuador
• ³Facultad de Ciencias Médicas, Universidad de Guayaquil, Avenida 10 NO, Guayaquil 090613, Ecuador, Guayaquil, Ecuador
• ⁴Department of Clinical Sciences, Università Politecnica delle Marche, 60131 Ancona, Italy, Ancona, Italy
• ⁵Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain, Santander, Spain
• ⁶Joint Laboratory on Food Science, Nutrition, and Intelligent Processing of Foods Universidad Europea del Atlántico Spain, Jiangsu University, China at Polytechnic University of Marche, Ancona, Italy, Ancona, Italy
• ⁷International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China, Zhenjiang, China
• ⁸Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany, Mainz, Germany
• ⁹Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, 3029 Sfax, Tunisia, Sfax, Tunisia
• ¹⁰Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia, Sfax, Tunisia
• ¹¹Department of Movement Sciences and Sports Training, School of Sport Science, The University of Jordan, Amman, Jordan, Amman, Jordan
• ¹²Faculty of Physical Education, Assiut University, 71515 Assiut, Egypt, Assiut, Egypt
• ¹³Escuela de Medicina, Universidad Espíritu Santo, Samborondón, 0901952, Ecuador, Samborondón, Ecuador
• ¹⁴Division of Research, Texas State University, 601 University Dr, San Marcos, TX 78666, United States, San Marcos, United States
• ¹⁵Editorial Luis Vives (EDELVIVES), Carretera de Madrid, 50012 Zaragoza, Spain, Zaragoza, Spain
• ¹⁶BCC Innovation, Technology Center in Gastronomy, Basque Culinary Center, 20009 Donostia-San Sebastián, Spain, Donostia-San Sebastián, Spain
• ¹⁷Basque Culinary Center, Faculty of Gastronomic Sciences, Mondragon Unibertsitatea, 20009 Donostia-San Sebastián, Spain, Donostia-San Sebastián, Spain
• ¹⁸Department of Health, Nutrition and Sport, Universidad Internacional Iberoamericana, Campeche 24560, México, Campeche, Mexico
• ¹⁹Universidade Internacional do Cuanza, Cuito, Bié, Angola, Cuito, Angola
• ²⁰Institute for Maternal and Child Health – IRCCS Burlo Garofolo, 34137 Trieste, Italy, Trieste, Italy
• ²¹Neonatal Intensive Care Unit, University Hospital "Policlinico-San Marco" Catania, Integrated Department for Maternal and Child's Health Protection, 95100 Catania, Italy, Catania, Italy
• ²²Technological Institute for children's products & leisure AIJU, 03440 Alicante, Spain, Alicante, Spain
• ²³Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy, Catania, Italy
• ²⁴Center for Human Nutrition and Mediterranean Foods (NUTREA), University of Catania, 95123 Catania, Italy, Catania, Italy

Background: Physical activity in children and adolescents represents one of the most important lifestyle factors to determine current and future health. Aim: The aim of the study is to assess the lifestyle and dietary factors linked to physical activity in younger populations across 5 countries in the Mediterranean region. Design: A total of 2,011 parents of children and adolescents (age range 6-17 y) participating to a preliminary survey of the DELICIOUS project were investigated to determine children's adequate physical activity level (identified using the short form of the international physical activity questionnaire) as well as diet quality parameters [measured as Youth-Healthy Eating Index (Y-HEI)] and eating and lifestyle factors (i.e., meal habits, sleep duration, screen time, etc.). Logistic regression analyses were performed to assess the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between variables of interest. Results: Younger children of younger parents currently working had higher rates and probability to have adequate physical activity. Multivariate analysis showed that children and adolescents who had breakfast (OR = 1.88, 95% CI: 1.38, 2.56) and often ate with their family (OR = 1.80, 95% CI: 0.90, 3.61) were more likely to have an adequate level of physical activity. Children and adolescents who reported a sleep duration (8-10 hours) closest to the recommended one were significantly more likely to achieve adequate levels of physical activity (OR = 1.88, 95% CI: 1.38, 2.56). Conversely, those with more than 4 hours of daily screen time were less likely to engage in adequate physical activity (OR = 0.77, 95% CI: 0.54, 1.10). Furthermore, children and adolescents in the highest tertile of YEHI scores showed a 60% greater likelihood of engaging in adequate physical activity (OR = 1.60, 95% CI: 1.27, 2.01). Conclusion: These results emphasize the importance of promoting healthy diet and lifestyle habits, including structured and high quality shared meals, sufficient sleep, and screen time moderation, as key strategies to support active behaviors in younger populations. Future interventions should focus on reinforcing these behaviors through parental guidance and community-based initiatives to foster lifelong healthy habits.