Background: Physical inactivity, sedentary behaviour and an unhealthy diet are factors that may increase weight and general and/or abdominal obesity. Objective: To evaluate the relationship between general and abdominal obesity and lifestyle factors among adolescents in Qatar. Methods: The study data are based on the Arab Teens Lifestyle Study (ATLS). The target population consisted of 1184 adolescents aged between 14 and 18 years old (563 boys and 621 girls), randomly selected through multistage sampling. A validated questionnaire was used to collect data on lifestyle indicators. Anthropometric indicators, which included body weight, height and waist circumference (WC), were measured according to standardised procedures. International Obesity Task Force (IOTF) age- and sex-specific body mass index (BMI) reference values were used to define overweight and obesity. Abdominal obesity was defined by the ‘waist-to-height ratio’ (WHtR > 0.5) and by sex- and age-specific WC cutoff values. Results: Females were more inactive than males (63.7% vs. 36.3%; p < 0.001). The proportion of adolescents who reported screen time of over 2 h per day was 82.5%. Females engaged in more sedentary behaviour than males (53.4% vs. 46.4%, p = 0.009). Being male (OR: 1.3; CI: 1.0–1.7) and skipping breakfast (OR: 1.5; CI: 1.2–2) were significantly associated with overweight/obesity. In contrast, high intake of fast food, fries, sweets and cake were negative predictors of general and abdominal obesity. Conclusions: The findings revealed the prevalence of unhealthy lifestyle habits among adolescents in Qatar and indicated relationships between certain dietary habits and obesity. The findings of this study may help in advocating for the implementation of an intervention that includes lifestyle changes targeting adolescents.

Purpose The purpose of this study is to evaluate the associations between adolescents’ perceptions of their parents’ and peers’ opinions about body weight and their actual weight status. Design/methodology/approach A total of 795 Jordanian adolescents, 15-18 years of age, were recruited in this study. Adolescents completed a questionnaire to evaluate their perceptions: about how their parents’ and peers’ viewed their weight, regarding any criticism of their parents and peers about their weight and if their parents compared their weight against their siblings. Findings The study found that the majority of non-overweight adolescents thought their parents and peers considered them to have a normal weight (94.9 and 94.6 per cent for boys, 76.6 and 85.5 per cent for girls, respectively). For obese girls, 83.4 per cent thought their parents and 91.7 per cent thought their peers perceived them as overweight. The risk of being obese was significantly related to the amount of parental criticism perceived by adolescent girls with OR = 3.9 (95 per cent CI: 1.6-9.4; P = 0.01), while perception of peer criticism showed an increased trend of risk for obesity in boys. Adolescents’ perceptions regarding parental comparisons between their body weights against their siblings’ body weight was found to increase the risk for obesity significantly among girls. Originality/value The current study highlights that most of the obese adolescents perceived that their parents and peers underestimated their actual weight status. While obese boys were more likely to report being criticized about their body shape by their peers, obese girls indicated that they received more criticism about their weight from their parents.

Background: Fast food restaurants have become widespread in both developed and developing countries due to nutritional and economic transitions. The frequency of fast food intake is relatively high among adolescents; however, fast food consumption is positively associated with total energy intake and obesity in adolescents. Objective: This study aimed to examine the perception of Jordanian adolescents towards fast foods relative to gender and obesity. Methods: A cross-sectional survey was conducted on 400 boys and 395 girls, aged 15–18 years. The adolescents completed a validated questionnaire to measure the perception of adolescents towards fast foods during the year 2013–2014. Weight and height were measured. Numbers who were non-overweight, overweight, and obese were calculated for each age and sex using the International Obesity Task Force (IOTF) standard. Results: The majority of participants perceived foods which are eaten as sandwiches as fast foods. A significant difference between boy and girl adolescents was reported regarding perception of French fries ( p < 0.012), fried chicken ( p < 0.001), fattayer ( p < 0.001), foul (boiled broad beans) sandwich ( p < 0.001), falafel sandwich ( p < 0.044) and fried eggs sandwich ( p < 0.001) as fast foods. Girls were significantly more enthusiastic than boys to consider cuscusi plate ( p < 0.001), rice dishes ( p < 0.002), Chinese foods ( p < 0.001), Indian foods ( p < 0.010), Mexican foods ( p < 0.011), and Italian foods ( p < 0.004) as non-fast foods. The difference between obese and non-obese regarding the perception of fast foods was only significant among boy participants. Western or non-Arab foods, food prepared fast and eaten fast in self-service outlets, and food rich in calories were significantly perceived as fast food by Jordanian adolescents ( p < 0.05). Conclusions: The perception of foods as fast foods or non-fast foods was significantly different between both genders as well as in obese and non-obese male Jordanian adolescents.

Abstract Objective: The aim of this study was to investigate the dietary patterns and sedentary behaviors among university students in Bahrain. Materials and methods: A cross-sectional study was carried out with students of the College of Health Sciences in Bahrain using a self-reported questionnaire. All the students enrolled in this college were included in this study (642 students; 90 males and 552 females). The mean age of the sample was 20.1±2.0 years. A pre-tested questionnaire was used to collect information on the students’ breakfast intake, snacking, food frequency intake, and sedentary habits. Results: More than 50% of the students did not consume breakfast on a daily basis. A statistically significant difference (p<0.003) was found between males (19%) and females (35%) in relation to the intake of an afternoon snack. There were no significant gender differences regarding frequency of food intake, except for carbonated beverages (p<0.001) and nuts (p<0.047) consumption. Females were more likely than males to spend time watching television, use the Internet, use a mobile phone and sleep; however, the only significant difference found was for Internet use (p<0.003). Being physically active on a daily basis was more prevalent among males (41.6%) than females (16%) (p<0.001). Females (42.9%) were more prone to sleep for less time (<7 h) than males (34.4%)(p<0.08). Conclusion: The findings indicated that a high percentage of health science students in Bahrain had unhealthy dietary habits and sedentary behaviors. Thus, an intervention program to promote healthy dietary patterns and lifestyle habits among university students is highly recommended.

Background: The prevalence of overweight and obesity among adolescents has increased dramatically during the past decades, in most developing and developed countries. This study aimed to evaluate the beverage intake among Jordanian adolescents and to investigate the possible associations between beverage consumption and weight status. Methods: A cross-sectional survey was conducted at government and private schools in Amman city, the capital of Jordan. Seven hundred and ninety five adolescent students (400 boys and 395 girls) aged 15-18 years were recruited using a multistage stratified sampling method. Students were asked to complete a validated questionnaire to assess their beverage consumption during school year 2013- 2014. Students' body weight was categorized as non-obese and obese according to the International Obesity Task Force standard. Results: The average beverage consumption was found to be significantly higher in Jordanian adolescent boys than in girls. However, both boys and girls had similar beverage consumption frequencies except for whole milk and sweetened coffee with or without milk or non-dairy coffee creamer. The boys consumed 1-2 cups of whole milk and sweetened coffee with or without milk or non-dairy coffee creamer/day (58.5% and 55.5% respectively), while the girls consumed less than one cup/ day of whole milk and sweetened coffee with or without milk or non-dairy coffee creamer/day (57.7% and 49.9% respectively). No significant associations were established between the investigated beverage consumptions and the weight status for Jordanian adolescents. Conclusion: Although beverage consumption was significantly higher in Jordanian adolescent boys than girls, it was not associated with the obesity among Jordanian adolescents.

OBJECTIVE:Although emotional eating is positively associated with serious health problems such as obesity and eating disorders, it is rarely investigated. The aim of this study was to investigate the prevalence of emotional eating among urban adolescents in Sudan, one of the poorest countries in the world.METHODS:A multistage stratified sampling method was used to select adolescents aged 14-18 years from governmental schools in Khartoum State, the capital of Sudan. The total sample selected was 945 (507 males, 438 females). A self-reported validated questionnaire was used to collect the data.RESULTS:Of the males, 57% eat mostly or sometimes while watching television, compared with 62% of females (p<0.036). Females were more likely to eat when angered than males (9.6% and 5.7%, eat mostly when angered, respectively, p<0.02). There were no statistically significant differences between males and females regarding eating late at night, eating when bored and eating when anxious.CONCLUSION:The findings revealed that emotional eating is a growing problem among urban adolescents in Sudan. This creates the need to incorporate emotional eating in any prevention plan to promote healthy eating among these adolescents.

Background: This study aimed to highlight the proportion of disordered eating attitudes among university students in Kuwait by gender and obesity.Methods: A sample of 530 Kuwaiti university students was selected from four universities in Kuwait (203 men and 327 women). The eating attitudes test-26 was used to determine disordered eating attitudes.Results: The prevalence of disordered eating attitudes was 31.8% and 33.6% among men and women respectively. Obese students of both genders had doubled the risk of disordered eating attitudes compared to nonobese students (odds ratio 1.99 and 1.98, respectively).Conclusions: About one third of university students in Kuwait had disordered eating attitudes. There is an urgent need to prevent and treat disordered eating attitudes in university students in Kuwait.

Objective This study aimed to highlight nutritional status, dietary habits and sedentary patterns among university students in Khartoum state, Sudan.Methods A cross-sectional survey was carried out among 400 university students (183 males and 217 females) from University of Khartoum, Sudan. A pre-validated self-reported questionnaire was used to collect the data. Weight and height were measured and body mass index was used to determine obesity status.Results Of the students, 20.5, 14.7, and 1.7 % were underweight, overweight and obese, respectively. The majority of students (85.5 %) consumed breakfast daily. About 45 and 21.8 % of students consumed vegetables and fruit, respectively, on more than 3 days a week. Fast food was consumed significantly more (p < 0.01) for more than 3 days per week by females (44.2 %) than males (27.3 %). Females (42.9 %) were more likely to watch television for 3 h and more per day than males (30.6 %) (p < 0.039). Males (33.9 %) were more prone to sleep for fewer than 7 h per day than females (23 %) (p < 0.016).Conclusion The health authority in Sudan should not only focus on prevention of malnutrition among children but also should organize programs to promote healthy eating and lifestyle among children and youths to prevent and control alarming risk factors for chronic diseases.

Background: This study aimed to highlight the proportion of disordered eating attitudes among university students in Kuwait by gender and obesity. Methods: A sample of 530 Kuwaiti university students was selected from four universities in Kuwait (203 men and 327 women). The eating attitudes test‐26 was used to determine disordered eating attitudes. Results: The prevalence of disordered eating attitudes was 31.8% and 33.6% among men and women respectively. Obese students of both genders had doubled the risk of disordered eating attitudes compared to nonobese students (odds ratio 1.99 and 1.98, respectively). Conclusions: About one third of university students in Kuwait had disordered eating attitudes. There is an urgent need to prevent and treat disordered eating attitudes in university students in Kuwait.

Background The number of children being diagnosed with type 1 diabetes mellitus (T1DM) is on the rise and has more than doubled in the past 10 years in Bahrain. Some studies have linked low vitamin D levels with an increased risk of diabetes. There are concerns regarding the variations in circulating 25(OH)D levels measured by different laboratories and by using different analytical techniques. Objective The aim of this study was to evaluate the vitamin D levels of newly diagnosed children with T1DM using the “gold standard method” with high-pressure liquid chromatography–tandem mass spectrometry methods compared to the chemiluminescence micro-particle immunoassay (CMIA) used in a hospital laboratory. Subjects Eighteen children, aged 6–12 years, who received a confirmed diagnosis of T1DM in 2014 were chosen as subjects. Methods Serum vitamin D levels were assessed in a hospital, while an extra aliquot of blood collected during routine blood collection after acquiring informed written consents from the subjects, and sent to Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders to be analyzed by ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS). Results The mean age of the study group was 9±2 years. The mean total of 25(OH)D levels (D3 and D2) assessed by UPLC-MS/MS was 49.7±18.8, whereas the mean total of 25(OH)D levels obtained from the CMIA assay was 44.60±13.20. The difference in classification between the two methods was found to be statistically significant (P=0.004). A Bland–Altman plot showed a poor level of agreement between the two assay methods. The CMIA overestimated insufficient values and underestimated deficiency, when compared to UPLC-MS/MS. Conclusion There was a statistically significant difference between the two assay methods with CMIA overestimating vitamin D insufficiency. Clinicians should be prudent in their assessment of a single vitamin D reading, when the gold standard method is not available or feasible.

Fatima Ahmed Al-Haddad,1 Mansoor H Rajab,2 S Mahmood Al-Qallaf,3 Abdulrahman O Musaiger,4 Kathryn H Hart5 1Dietetic Unit for Hospitals, 2Pediatric Endocrine and Diabetes Team, Pediatric Department, Salmaniya Medical Complex, 3Pharmacy Program, College of Health Sciences, University of Bahrain, Manama, 4Nutrition and Health Studies Unit Deanship of Scientific Research, University of Bahrain, Sakheer, Kingdom of Bahrain; 5School of Biosciences and Medicine, Department of Nutritional Sciences, University of Surrey, Guildford, UK Background: The number of children being diagnosed with type 1 diabetes mellitus (T1DM) is on the rise and has more than doubled in the past 10 years in Bahrain. Some studies have linked low vitamin D levels with an increased risk of diabetes. There are concerns regarding the variations in circulating 25(OH)D levels measured by different laboratories and by using different analytical techniques. Objective: The aim of this study was to evaluate the vitamin D levels of newly diagnosed children with T1DM using the “gold standard method” with high-pressure liquid chromatography–tandem mass spectrometry methods compared to the chemiluminescence micro-particle immunoassay (CMIA) used in a hospital laboratory. Subjects: Eighteen children, aged 6–12 years, who received a confirmed diagnosis of T1DM in 2014 were chosen as subjects. Methods: Serum vitamin D levels were assessed in a hospital, while an extra aliquot of blood collected during routine blood collection after acquiring informed written consents from the subjects, and sent to Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders to be analyzed by ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS). Results: The mean age of the study group was 9±2 years. The mean total of 25(OH)D levels (D3 and D2) assessed by UPLC-MS/MS was 49.7±18.8, whereas the mean total of 25(OH)D levels obtained from the CMIA assay was 44.60±13.20. The difference in classification between the two methods was found to be statistically significant (P=0.004). A Bland–Altman plot showed a poor level of agreement between the two assay methods. The CMIA overestimated insufficient values and underestimated deficiency, when compared to UPLC-MS/MS. Conclusion: There was a statistically significant difference between the two assay methods with CMIA overestimating vitamin D insufficiency. Clinicians should be prudent in their assessment of a single vitamin D reading, when the gold standard method is not available or feasible. Keywords: type 1 diabetes, children, vitamin D, Middle East

OBJECTIVE:The aim of this study was to highlight the prevalence of overweight and obesity among adolescents in eight Arab countries.METHODS:A school-based cross-sectional study was conducted in eight Arab countries: Iraq, Jordan, Kuwait, Libya, Palestine, Saudi Arabia, Sudan and Tunisia. The total sample included was 6,447 adolescents aged 15-18 years (3,111 males, 3,336 females). The International Obesity Task Force (IOTF) and World Health Organization (WHO) reference standards were used to determine obesity levels.RESULTS:The WHO standard provided lower prevalence of overweight but higher prevalence of obesity than the IOTF standard. According to the IOTF standard, overweight among males was highest in Kuwaiti adolescents (24.8%), followed by Saudi Arabian (23.2%). Among females, the highest prevalence was reported in Kuwaiti adolescents (22.1%), followed by Jordanian (20.0%). Regarding obesity, Kuwaiti adolescents showed the highest prevalence of obesity for both males (28.6%) and females (21.1%).CONCLUSION:Findings revealed no progress in reducing prevalence of obesity.

Body image in the mass media promotes an unrealistic picture of body shape that leads to body dissatisfaction among adolescentsQuery. Therefore, the study presented in this paper aimed to assess the association between mass media and adolescents' weight concerns and perceptions of body weight and shape.A cross-sectional survey was conducted on school adolescents aged between 15 and 18 years during the academic year 2013-2014. Multistage stratified sampling method was used. The number of participants in the study was 795 students: 400 boys and 395 girls.All participants have a common behavior in rarely reading magazines, but they spend more than 2 h in watching television or less than 3 h using the internet. However, most of obese/non-obese adolescents, boys or girls, have shown high influence (p < 0.05) of reading magazines on the subject of dieting to lose weight.While obese students read more magazines on dieting to lose weight, other mass media did not show the same results on weight concerns and body shape among Jordanian adolescents.

Objective: The aim of this study was to investigate the prevalence of obesity, dietary habits, and sedentary patterns among Sudanese adolescents.Methods: A multistage stratified sampling method was used to select 945 adolescents (507 males and 438 females) aged 14 to 18 years, from Khartoum State, Sudan. A self-reported pretested questionnaire was used to collect the data. Overweight and obesity were determined using the International Obesity Task Force standard, which is based on body mass index for sex and age.Results: Overweight and obesity were growing problems among urban Sudanese adolescents (10.7%). Breakfast was commonly consumed on a daily basis by the majority of adolescents (74.2%), followed by lunch (63.9%) and supper (33.5%). Snacking was not a common practice among these individuals. Vegetables (63.9%) were more frequently consumed (more than 3 days per week) than fruit (30.1%). There were significant differences between genders regarding intake of vegetables (P <.048), chicken (P <.013), dairy products, sweets, nuts, chocolate, and legumes (P <.001 for all). Sedentary behaviors (long duration of television viewing and Internet use) were highly prevalent, and physical activity was rarely practiced (6.8%).Conclusion: The findings indicated that risk factors for diet-related chronic diseases such as unhealthy dietary habits and sedentary behaviors are starting to rise among urban adolescents in Sudan. This creates the need for immediate action to prevent and control these risk factors before these diseases become major public health problems.

OBJECTIVES:The aim of the study was to examine the gender differences and predictors of leisure versus non-leisure time physical activities among Saudi adolescents aged 14-19 years.MATERIALS AND METHOD:The multistage stratified cluster random sampling technique was used. A sample of 1,388 males and 1,500 females enrolled in secondary schools in three major cities in Saudi Arabia was included. Anthropometric measurements were performed and Body Mass Index was calculated. Physical activity, sedentary behaviours and dietary habits were measured using a self-reported validated questionnaire.RESULTS:The total time spent in leisure and non-leisure physical activity per week was 90 and 77 minutes, respectively. The males spent more time per week in leisure-time physical activities than females. Females in private schools spent more time during the week in leisure-time physical activities, compared to females in Stateschools. There was a significant difference between genders by obesity status interaction in leisure-time physical activity. Gender, and other factors, predicted total duration spent in leisure-time and non-leisure-time physical activity.CONCLUSIONS:The study showed that female adolescents are much less active than males, especially in leisure-time physical activities. Programmes to promote physical activity among adolescents are urgently needed, with consideration of gender differences.

© 2015, Bahrain Medical Bulletin. All Rights Reserved.Background: The prevalence of diabetes in the Middle East is amongst the highest worldwide; Bahrain ranks amongst the top 10 countries. In particular, increasing number of children are being diagnosed with type 1 diabetes mellitus (T1DM) posing a significant public health concern. Objective: To evaluate the magnitude of type 1 diabetes in Bahrain. Design: A Case-Control Retrospective Study. Setting: Pediatric Diabetes and Endocrine Clinic and Local Health Centers (LHC). Method: Fifty-nine cases and 53 controls were included in the study. Data from the Diabetes Registry were recorded for subjects meeting the inclusion criteria and questionnaire was administered to healthy controls. Chi Square or Student’s t-test was used as appropriate. Logistic regression analysis was used to evaluate independent predictors of T1DM. Result: Fifty-nine children aged 6-12 years diagnosed with T1DM in the years 2009 and 2010 were compared to 53 healthy controls. Children with T1DM were more likely to have suffered from a pre-diabetes illness such as tonsillitis 32 (54.2%) compared to controls 3 (5.7%), and have undergone a surgery prior to diagnosis 14 (23.7%), and to have mothers with T2DM or family history of GDM. No significant difference in infant-feeding practices was observed between children with type 1 diabetes and the healthy controls. Conclusion: Children with T1DM were more likely to have suffered from other infectious illnesses before the diagnosis was established. Whilst unable to fully investigate any potential genetic differences between cases and controls, this study provides support for the theoretical role of infections as a trigger for T1DM.

OBJECTIVE/DESIGN:We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. SETTING/POPULATION:Adult population in the Middle East by age, sex, country and time. RESULTS:Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. CONCLUSIONS:Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

OBJECTIVE:This study aimed to explore the socio-demographic and dietary factors that may be associated with obesity among female university students in Jordan.METHODS:A cross-sectional survey was carried out among 406 female students recruited from two universities in Jordan. Data were collected through self-reporting, using a previously validated questionnaire. Weight and height were measured and body mass index was calculated to determine the weight status of the participants.RESULTS:High educational level of mothers [odds ratio (OR)=1.25] and monthly pocket money of more than 200 Jordanian Dinars (OR=1.67) were found to be risk factors for obesity, whereas a sibling ranking of more than six was a protective factor (OR=0.31). Those who were eating from the university cafeteria had double the risk for obesity (OR=2.41) than those who did not. Regular eating of meals and snacking between meals were found to be protective factors (OR ranged from 0.42 to 0.79). Regular consumption of milk products, fruit, canned fruit juices, bakery products and legumes were found to be protective factors. In contrast, the regular consumption of potato chips (OR=1.35), chicken (OR=1.51), and fish (OR=1.45) were found to be risk factors for obesity. Using a chi-square test, none of the factors studied showed significant association with obesity.CONCLUSION:A program to promote healthy eating among university students in Jordan should consider the local socio-demographic and food behavior factors that could be related to obesity to ensure the effectiveness of such a program.

Objectives To compare the anthropometric and lifestyle characteristics of active and inactive adolescents in Saudi Arabia and Britain. Methods A school‐based cross‐sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al‐Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14‐ to 18‐year‐olds) were randomly selected using a multistage stratified cluster sampling. Measurements included anthropometric [BMI, Waist circumference (WC), Waist to height ratio], screen time, validated physical activity questionnaire and dietary habits. Results British males were lighter ( P = 0.04, 64.4 vs. 68.2 kg), and had lower values for WC ( P = 0.003, 77.1 vs. 78.7 cm) than Saudi males. Males ( P = 0.0001) were significantly more active than females but the difference between inactive Saudi and British females was greater than that between inactive Saudi and British males. Being female was significantly ( P < 0.001) associated with lower activity levels in both the Saudi and British adolescents. Having lower frequency of fruit intake was significantly ( P < 0.001) associated with lower activity levels, whereas increased frequency of consumption of French fries/potato chips was significantly ( P = 0.008) associated with increased activity levels in Saudi adolescents. Among British adolescents, lower frequency of breakfast was ( P = 0.045) associated with lower activity levels, increased frequency of consumption of sweetened beverages was significantly ( P = 0.005) associated with higher activity levels. Higher energy drinks intake frequency was significantly ( P = 0.007) associated with higher activity levels. Conclusion The present study identifies crosscultural differences and similarities in lifestyle habits in adolescents from Britain and Saudi Arabia. Activity status (active vs. inactive) appears to play an important role in other lifestyle related behaviors, with active adolescent more likely to engage in healthy dietary behavior than their inactive peers, irrespective of country of origin. Am. J. Hum. Biol. 26:635–642, 2014. © 2014 Wiley Periodicals, Inc.