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

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. 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. 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 h/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, I = 62.1%).) and OR = 1.26 (95% CI = 1.19-1.34; I = 54.3%), respectively. Spending > 8 h/day of SB compared to