Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Sarah Yi Xuan Tan; Natarajan Padmapriya; Jonathan Y Bernard; Jia Ying Toh; Hwee-Lin Wee; Kok Hian Tan; Fabian Kok Peng Yap; Yung Seng Lee; Yap-Seng Chong; Keith Godfrey; Johan Gunnar Eriksson; Lynette Pei-Chi Shek; Chuen Seng Tan; Mary Foong-Fong Chong; Falk Müller-Riemenschneider

doi:10.1016/j.lanwpc.2023.100918

Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Lancet Reg Health West Pac. 2023 Oct 6:41:100918. doi: 10.1016/j.lanwpc.2023.100918. eCollection 2023 Dec.

Authors

Sarah Yi Xuan Tan¹, Natarajan Padmapriya^{1

2}, Jonathan Y Bernard^{3

4}, Jia Ying Toh³, Hwee-Lin Wee^{1

5}, Kok Hian Tan^{6

7}, Fabian Kok Peng Yap^{6

7

8}, Yung Seng Lee^{3

9

10}, Yap-Seng Chong^{2

3}, Keith Godfrey^{11

12}, Johan Gunnar Eriksson^{2

3

13}, Lynette Pei-Chi Shek^{3

9

10}, Chuen Seng Tan¹, Mary Foong-Fong Chong^{1

3}, Falk Müller-Riemenschneider^{1

14}

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
² Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
³ Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore.
⁴ Université Paris Cité and Université Sorbonne Paris Nord, Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, Inrae, F-75004, Paris, France.
⁵ Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
⁶ Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.
⁷ Duke-National University of Singapore Medical School, Singapore, Singapore.
⁸ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁹ Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
¹⁰ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹¹ Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
¹² NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
¹³ Department of General Practice and Primary Health Care, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland.
¹⁴ Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Background: Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear.

Methods: We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques.

Findings: Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β = 15.94 [2.71, 29.18]) and relationship with friends (β = 10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β = -10.00 [-19.13, -0.87]), relationship with friends (β = -16.41 [-31.60, -1.23]) and school functioning (β = -15.30 [-29.16, -1.44]) scores, while sleep showed a positive trend with overall HRQoL (β = 10.76 [-1.09, 22.61]) and school functioning (β = 17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL.

Interpretation: Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research.

Funding: Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.

Keywords: Adolescent; Children; Cross-sectional; Health-related quality of life; Inactivity; Movement behaviour; Physical activity; Prospective; Sleep; Time-use.