Open Access Research article

Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study

Charlene Ottevaere1*, Inge Huybrechts1, Jasmin Benser2, Ilse De Bourdeaudhuij3, Magdalena Cuenca-Garcia4, Jean Dallongeville5, Maria Zaccaria6, Frederic Gottrand7, Mathilde Kersting8, Juan P Rey-López9, Yannis Manios10, Dénes Molnár11, Luis A Moreno9, Emmanouel Smpokos12, Kurt Widhalm13, Stefaan De Henauw1 and the HELENA Study Group

Author Affiliations

1 Department of Public Health, Ghent University, Ghent, Belgium

2 Institut für Ernährungs- und Lebensmittelwissenschaften - Ernährungphysiologie, Rheinische Friedrich Wilhelms Universität, Bonn, Germany

3 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium

4 Department of Physiology, School of Medicine, University of Granada, Granada, Spain

5 Institut Pasteur de Lille, Lille, France

6 National Research Institute on Food and Nutrition, Rome, Italy

7 Inserm U995, IFR114, Faculty of medicine, Université de Lille2, Lille, France

8 Research Institute of Child Nutrition Dortmund, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany

9 Growth, Exercise, Nutrition and Development (GENUD) research Group, E.U., Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain

10 Harokopio University, Athens, Greece

11 Pécsi Tudemányegyetem, Pecs, Hungary

12 University of Crete School of medicine, Crete, Greece

13 Medical University of Vienna, Vienna, Austria

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BMC Public Health 2011, 11:328  doi:10.1186/1471-2458-11-328

Published: 17 May 2011



Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. A better insight in the clustering of those behaviors, could help to identify groups who are at risk in developing chronic diseases. This study examines the prevalence and clustering of physical activity, sedentary and dietary patterns among European adolescents and investigates if the identified clusters could be characterized by socio-demographic factors.


The study comprised a total of 2084 adolescents (45.6% male), from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity and sedentary behavior were measured using self-reported questionnaires and diet quality was assessed based on dietary recall. Based on the results of those three indices, cluster analyses were performed. To identify gender differences and associations with socio-demographic variables, chi-square tests were executed.


Five stable and meaningful clusters were found. Only 18% of the adolescents showed healthy and 21% unhealthy scores on all three included indices. Males were highly presented in the cluster with high levels of moderate to vigorous physical activity (MVPA) and low quality diets. The clusters with low levels of MVPA and high quality diets comprised more female adolescents. Adolescents with low educated parents had diets of lower quality and spent more time in sedentary activities. In addition, the clusters with high levels of MVPA comprised more adolescents of the younger age category.


In order to develop effective primary prevention strategies, it would be important to consider multiple health indices when identifying high risk groups.