Association of leisure-time sedentary behavior with fast food and carbonated soft drink consumption among 133,555 adolescents aged 12-15 years in 44 low- and middle-income countries

Background: Rates of sedentary behavior (SB), fast food and carbonated soft drink consumption are increasing worldwide, with steeper increases being observed in low- and middle-income countries (LMICs) in recent years. Given that these behaviors have been linked to adverse health outcomes among adolescents, this presents a new but rapidly growing challenge to human health in these under-resourced nations. However, very little is known about the associations between SB and fast food or soft drink consumption among adolescents in LMICs. Methods: Thus, data from the Global school-based Student Health Survey (GSHS) were cross-sectionally analyzed in 133,555 adolescents aged 12-15 years from 44 LMICs [mean (SD) age 13.8 (1.0) years; 49% females]. The data were collected in the form of self-report questionnaires. Associations were assessed with multivariable logistic regression analysis and meta-analysis. Results: The overall prevalence of fast food consumption (at least once in previous 7 days) and carbonated soft drink consumption (at least once per day during past 30 days) were 49.3% and 43.8%, respectively. The overall pooled estimates based on a meta-analysis with random effects for the association of ≥3 hours/day of SB with fast food consumption and soft drink consumption using country-wise estimates were OR=1.35 (95%CI=1.27-1.43, I2=62.1%).) and OR=1.26 (95%CI=1.19-1.34; I2=54.3%), respectively. Spending >8 hours/day of SB compared to <1 hour/day in females was associated with significantly higher odds for fast food (OR=1.61, 95% CI= 1.38-1.88) and soft drink consumption (OR=1.91, 95% CI= 1.60-2.28). Conclusions: Future interventions to address unhealthy behaviors in adolescents should take into account the interrelated nature of SB and unhealthy dietary habits, and seek to further understand the mechanisms linking these behaviors in the LMIC context.