1 YCARE (Youth/Child and Cardiovascular Risk and Environmental) Research Group, Facultad de Medicina de la Universidad de Sao Paulo, Brazil; 2 Faculty of Health Sciences of the University of Zaragoza, GENUD (Growth, Exercise, Nutrition and Development) Research Group, Spain; 3 National Center for Cardiovascular Research Carlos III, Spain; 4 Unité Inserm U995 & Université Lille 2, France; 5 Preventive Medicine & Nutrition Unit, University of Crete School of Medicine, Greece; 6 Department of Paediatrics. Medical Faculty - University of Pécs, Hungary; 7 Department of Public Health, Ghent University, Belgium; 8 Department of Nutrition and Dietetics, Harokopio University, Greece.
Background: Several lifestyle behaviors (fruits and vegetables consumption, sugar-sweetened beverages, physical activity, screen time and sleep duration) are associated with cardiovascular health outcomes in adolescents. Objetives: To identify clustered lifestyle behaviors among Brazilian and European adolescents, and to examine their association with systolic (SBP) and diastolic (DBP) blood pressure levels. Methods: Participants from two cross-sectional studies, one conducted in Europe (n = 1,252; HELENA study) and the other in Brazil (n = 682; BRACAH study), were selected by complex sampling. SBP and DBP (outcomes), clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of soft drinks, sleep duration, screen time and physical activity), and potential confounders were analyzed. Associations were examined by multilevel linear regression. Results: We identified four clusters in girls and three in boys, but the clusters are different in Brazil and Europe. The Healthy Eating cluster was negatively associated with DBP in European girls β -2.46 (-4.62; -0.30) and SBP in Brazilian boys β -2.79 (-3.10; -0.15). However, Unhealthy Eating cluster was associated with increased SBP in European girls β 4.54 (1.29; 7.79) and Brazilian boys β 4.10 (0.80; 7.40). Conclusions: The Healthy Eating patterns are associated with lower blood pressure, while the patterns of Unhealthy Eating, may increase the levels of SBP in adolescents. The clusters characterized by physical activity / sedentary lifestyle are not associated with blood pressure.