Dietary habits and physical activity patterns in relation to nutritional status among school-aged children in Pakistan: A cross-sectional study

Background Childhood malnutrition remains a significant public health problem impacting the physical and mental growth if school aged children, particularly in limited-resource countries. Objective The study objective was to assess levels of physical activity, patterns of screen time (S.T.), the relationship between physical activity and screen time patterns, and how these factors affect growth status (adjusting for socioeconomic status). Methodology A cross-sectional study included 3,834 children between 6–14 years attending pre-selected schools. Teachers, students, and parents were invited to fill out a standardized questionnaire, and Body Mass Index (BMI) was calculated using Center for disease control (CDC) centile charts. A Chi-square was performed to see the possible association between any height and weight abnormalities and all possible risk factors. Multivariate logistic regression was applied to see the effect of variables significantly associated with univariate analysis. Results Approximately 2,447 (63.8%) children were between 11–14 years old and 1,387 (36.2%) were between 4–10 years old. The mean height was 143.71 ± 16.51 centimetres, the mean weight was 36.5 ± 12.9 kilogram, and the mean BMI was 17.16 ± 3.52. Multivariate logistic regression status and junk food combined affected stunting socioeconomic status was significantly associated with being underweight p = 0.001. Conclusion Childhood obesity and stunting remain significant problems in Pakistani school-going children. These are significantly associated with poverty, a lack of physical activity opportunities, and available food quality.

To evaluate the factor associated with obesity and stunting in Pakistani school children (4-14 years) and to assess the effect of socioeconomic status, dietary habits, and exercise patterns on the outcome by evaluating anthropometric data.

Study design 4
Present key elements of study design early in the paper

4-6 This was a cross-sectional observational study
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Setting 5
Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection 4-5 A cross-sectional descriptive study was conducted in 22 preselected schools in the Punjab Province of Pakistan. The chosen schools provided written informed permission, and the head teacher received information about the study's context. The study covered public and private schools from urban and rural locations Participants 6 (a) Give the eligibility criteria, and the sources and methods of selection of participants 4-6 include those who were of age 4 to 14 years regardless of gender, either male or female, the children able to communicate correctly, do not have any metabolic syndrome associated, the student must be regular students at the particular school, and their parents were present at the last 2 parent teachers' meetings. The data was collected from the children in their routine school activities. With the assistance of their class teachers, the students and parents completed a validated structured questionnaire to evaluate their socioeconomic position, dietary preferences, amount of physical activity, and screen time. Bias 9 Describe any efforts to address potential sources of bias 6 To address the potential bias, the data collection process was completely done by the third individual not involved in the study. However, to keep data integrity, the investigator team was aligned with the group to check for data validity. Overall stunting based on height for age was present in 192, i.e., 5% of the total cohort. Of these, 106 (55.2%) were male, and 86 (44.8%) were female. Most stunted children, 189 (98.4 %), were 4-10 years old, and 3(1.6%) were in the 10-14year group. A total of 165(4.3%) Children were overweight; most of these 163(6.7%) were in the 11-14 years group. The number of underweight children was 8 (0.2%). Z score for height was -0.83 ± 0.77 (Mean ± S.D.) and -0.97 ± 0.91 in males and females, respectively, in the 4-10 years age group, and was 0.52 ± 0.74 and 0.44 ± 0.61 in males and females respectively in the 11-14 years group Main results 16 (a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included 7-10 To handle the issue of zero counts in some cells for categorical variables, we used a statistical method that accounted for this issue. Specifically, we used exact logistic regression, which calculates the exact probability of observing the observed data or data more extreme, given the null hypothesis of no association between the predictor and the outcome variable.

12-14
The study found a high prevalence of unhealthy lifestyle habits, such as regular junk food intake and low physical activity, among school children. The prevalence of stunting was 5%, with a strong association with low socioeconomic status and junk food intake. Overweight cases were observed in 4.3% of children, with higher rates in the 11-14 age group. Urgent interventions are needed to address these issues. (1) *Give information separately for exposed and unexposed groups. Information on the STROBE Initiative is available at www.strobe-statement.org.