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Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10\u201315\u2009years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Cross-sectional study. Adolescents (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent\u00a0using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores &gt; +1SD and WHtR &gt;\u20090.5) and unhealthy behaviors (PA\u2009&lt;\u200960\u2009min\/d, ST\u2009&gt;\u2009120\u2009min\/d and PSQI scores &gt;\u20095), stratified by sex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA&lt;\u200960\u2009min\/d and ST\u2009&gt;\u2009120\u2009min\/d respectively. Girls reported higher ST (218.21 (69.01) min\/d) as compared to boys (165.3 (101.22) min\/d,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA &lt;\u200960\u2009min\/d (OR\u2009=\u20091.78, 95% CI 1.54\u20131.92, p\u2009&lt;\u20090.001) and PSQI scores &gt;\u20095 (OR\u2009=\u20092.01, 95% CI 1.78\u20132.25, p\u2009&lt;\u20090.001) predicted increased BMI. The odds of overweight\/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST\u2009&gt;\u2009120\u2009min\/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-021-12183-9","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T07:03:01Z","timestamp":1636959781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3630-2794","authenticated-orcid":false,"given":"Panchali","family":"Moitra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1472-0821","authenticated-orcid":false,"given":"Jagmeet","family":"Madan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"issue":"1","key":"12183_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12889-016-3353-x","volume":"2","author":"K Shridhar","year":"2016","unstructured":"Shridhar K, Millett C, Laverty AA, Alam D, Dias A, Williams J, et al. 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