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Am J Hum Biol. 2019 Oct 24:e23341. doi: 10.1002/ajhb.23341. [Epub ahead of print]

Body mass index and movement behaviors among schoolchildren from 13 countries across a continuum of human development indices: A multinational cross-sectional study.

Author information

Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Research Group for Physical Activity and Health (CIDAF-FEFD), Universidade Pedagógica, Maputo, Mozambique.



This study describes the distributions of body mass index (BMI) and movement behaviors among schoolchildren from 13 countries across a continuum of human development.


Data were from a cross-sectional study of 9-11-year-old children (n = 8055) recruited from 269 urban schools in 13 countries, and an additional 7 rural schools in one of these countries (Mozambique). BMI was derived from objectively measured heights and weights. Moderate- to vigorous-intensity physical activity (MVPA), sedentary time (SED), and sleep duration were assessed by waist-worn Actigraph GT3X+ accelerometers. Linear models were used to describe the distributions of BMI z-scores, MVPA, SED, and sleep among sites across varying Human Development Indices (HDIs).


Mean MVPA, SED, and sleep duration were 63.1 ± 27.3 minutes/day, 508.7 ± 72.4 minutes/day, and 8.8 ± 0.9 hours/night, respectively. Overall, 2.1% of the sample were thin, 19.5% overweight, and 11.7% were obese. Density curves (BMI z-scores and SED) for urban children in Mozambique showed significantly higher mean values compared with rural children. Boys had significantly higher mean MVPA compared with girls. Mean BMI z-scores were positively associated (β = .02; P = .004) with HDI, mean daily MVPA minutes were negatively associated (β = -.38; P = .025) with HDI, and mean SED time was positively associated with HDI (β = 1.18; P = .049). No significant association (β = .01; P = .29) was observed between sleep duration and HDI.


Our findings show distinct differences in BMI and movement behavior profiles between urban and rural children in Mozambique. Mean BMI z-scores, MVPA, and SED differed by country HDI. These findings support the need to include both rural and urban participants in study samples.


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