Ci a ion: Villod es, G.C.; Padial-Ruz,
R.; Salas-Mon o o, J.-A.; Mu os, J.J.
Li es yle Beha iou s in P e-Schoole s
om Sou he n Spain—A S uc u al
Equa ion Model Acco ding o Sex and
Body Mass Index. Nu ien s 2024,16,
3582. h ps://doi.o g/10.3390/
nu16213582
Academic Edi o s: Ja ie Gómez-
Amb osi and Ahmad Alkha ib
Recei ed: 11 Sep embe 2024
Re ised: 14 Oc obe 2024
Accep ed: 21 Oc obe 2024
Published: 22 Oc obe 2024
Copy igh : © 2024 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
nu ien s
A icle
Li es yle Beha iou s in P e-Schoole s om Sou he n
Spain—A S uc u al Equa ion Model Acco ding o Sex
and Body Mass Index
G acia C is ina Villod es 1, Rosa io Padial-Ruz 1, José-An onio Salas-Mon o o 2and JoséJoaquín Mu os 1,*
1Depa men o Didac ics o Co po al Exp ession, Facul y o Educa ion, Uni e si y o G anada,
18071 G anada, Spain; gc illod es@ug .es (G.C.V.); padial@ug .es (R.P.-R.)
2Depa men o Physical Educa ion and Spo s, Facul y o Spo s Sciences, Uni e si y o G anada,
18071 G anada, Spain; salasmon o o@ug .es
*Co espondence: jjmu os@ug .es; Tel.: +34-958246350
Abs ac : Objec i es: The p esen s udy aimed o examine he ela ionship be ween sc een ime (ST),
sleep ime (SLT), physical i ness (PF), Medi e anean die (MD) adhe ence, ea ing beha iou s, and
body mass index (BMI) in a sample o p e-schoole s om G anada (Spain). In o de o add ess his
aim, an explana o y model was de eloped o examine exis ing ela ionships be ween ST, SLT, PF, MD,
p o-in ake (PRO-I) and an i-in ake (ANT-I) beha iou s, and BMI. Fu he , he p oposed s uc u al
model was examined ia mul i-g oup analysis as a unc ion o sex and BMI. Me hods: A c oss-
sec ional s udy was conduc ed wi h 653 h ee- o six-yea -old p e-schoole s a ending 18 di e en
schools in i ed o ake pa in he p esen s udy. S uc u al equa ion modelling (SEM) was employed
o analyse ela ionships be ween s udy a iables as a unc ion o sex and BMI. Resul s: SEM analysis
e ealed nega i e associa ions be ween ST and PF (p< 0.005), ST and MD adhe ence (
p< 0.0
05), ST
and SLT (p< 0.005), MD adhe ence and ANT-I beha iou s (p< 0.005), and MD adhe ence and BMI
(p= 0.033). In con as , posi i e associa ions eme ged be ween SLT and MD adhe ence (p< 0.005),
and PRO-I beha iou s and BMI (p< 0.005). SEM e ealed di e ences acco ding o sex and BMI.
Conclusions: The s udy highligh s signi ican ela ionships be ween li es yle beha iou s and physical
and die a y ou comes in p e-schoole s om sou he n Spain, wi h a ia ions based on sex and BMI.
These indings sugges he need o in e en ions aimed a educing ST and p omo ing be e sleep,
PF, and die a y habi s in o de o limi weigh - ela ed and gene al heal h isks in p e-schoole s om
sou he n Spain.
Keywo ds: sc een ime; sleep ime; physical i ness; Medi e anean die ; ea ing beha iou s; body
mass index; childhood
1. In oduc ion
Obesi y is a ch onic and complex condi ion cha ac e ised by excessi e a accumula-
ion ha can nega i ely impac heal h. I can in luence quali y o li e, including aspec s
such as sleep and mobili y. Likewise, obesi y is associa ed wi h inc eased isk o ype 2
diabe es, hea disease, and ce ain cance s, and may a ec bone heal h and ep oduc ion.
Addi ionally, childhood obesi y con e s majo isks o excess and p ema u e mo bidi y and
mo ali y in bo h sexes [
1
]. This is suppo ed by he Wo ld Heal h O ganiza ion (WHO) [
2
],
which also epo ed in 2022 ha 37 million child en unde he age o i e we e o e weigh .
In Spain, in 2020, one in h ee child en be ween wo and 17 yea s old was o e weigh ,
whils one in en was obese [
3
]. Mo eo e , he mos ecen da a ga he ed by he ALADINO
s udy in 2019 [
4
,
5
] e eal ha 23.3% o Spanish schoolchild en a e conside ed o e weigh ,
whils 17.3% a e conside ed obese. This means ha a o al o 40.6% o he child popula ion
is a ec ed by excess bodyweigh . Gi ls a e mo e likely o be o e weigh (24.7%) han boys
(21.9%), whils he p e alence o obesi y is no ably highe in boys (19.4%) han in gi ls
Nu ien s 2024,16, 3582. h ps://doi.o g/10.3390/nu16213582 h ps://www.mdpi.com/jou nal/nu ien s
Nu ien s 2024,16, 3582 2 o 20
(15.0%). When compa ed wi h o he na ions co e ed by he COSI s a egy, Spain anks
second wi h ega ds o p e alence o excess weigh and six h wi h ega ds o obesi y p e a-
lence [
6
]. Fu he , acco ding o he PASOS s udy [
7
], 33.4% o he adolescen popula ion
is o e weigh o obese. These s a is ics unde line he u gency o add essing his issue in
Spain, making i necessa y o in e ene om an ea ly age, including wi h he p e-school
popula ion, and cu bing he ise in o e weigh and obesi y du ing he school yea s and
h oughou adolescence.
Excess weigh , along wi h he ch onic non-communicable diseases associa ed wi h
i , is la gely p e en able. I is c ucial o unde s and he scale o his issue and he ac o s
ha con ibu e o i . This knowledge is essen ial o he design, implemen a ion, and
e alua ion o s a egies and in e en ions aimed a mi iga ing his p oblem [
5
]. The main
cause o childhood obesi y is ene gy imbalance in which ene gy in ake su passes ene gy
expendi u e, wi h gene ics also playing a signi ican ole ega ding p edisposi ion owa ds
weigh gain [
8
]. Ne e heless, o mos obese child en, weigh gain canno be a ibu ed o
a single gene ic o endoc ine ac o [
9
]. This sugges s ha li es yle ac o s a e he dominan
con ibu o s o he ea ly de elopmen o obesi y. A sys ema ic e iew and me a-analysis
by Poo olajal e al. [
10
] indica ed ha ac o s associa ed wi h highe childhood body mass
index (BMI) we e insu icien physical ac i i y, poo die , inadequa e sleep, and engaging
in mo e han wo hou s o sc een ime pe day.
Limi ing sc een ime (ST) (<1 h), adequa e sleep du a ion (SLT) (10–13 h), good physical
i ness (PF) (adequa e ca dio espi a o y capaci y, s eng h, speed/agili y and balance, and
adequa e Medi e anean die (MD) adhe ence ( ui s, ege ables, whole g ains, legumes,
nu s, oli e oil and lean p o eins, pa icula ly ish, and limi ed p ocessed oods) play a
c ucial ole in o e all quali y o li e in child en [
11
–
13
]. Fu he , highe MD adhe ence,
physical ac i i y engagemen , and good PF a e associa ed wi h a hea hy weigh s a us in
child en [14].
In con as , dec eased physical ac i i y and inc eased seden a y beha iou a e wo o
he main ac o s ha ha e con ibu ed o he ise in obesi y [
15
]. Speci ically in Spain, i
has been obse ed ha 26.3% o schoolchild en spend wo hou s o mo e wa ching TV o
using elec onic de ices du ing he week, wi h his being ue o 75.4% o schoolchild en
on weekends [
4
]. This inc ease in ST may be associa ed wi h g ea e educ ions in SLT,
wi h one in h ee child en unde i e yea s o age epo ed o ha e poo sleep quali y a
nigh [
16
]. A he same ime, only 37.1% o Spanish schoolchild en consume esh ui daily,
and jus 13.4% ea ege ables e e y day. Mo eo e , 53.9% consume pas ies, comme cial
juices, o milkshakes as pa o hei b eak as s. Also o conce n is he equen consump ion
o ce ain oods ha should only be pa o a schoolchild’s die occasionally, such as biscui s,
cakes, o pas ies, wi h 25.3% o schoolchild en epo ing ea ing such oods mo e han
ou imes a week [4].
In ligh o he ac o s discussed abo e, p e-schoole ’s ST is nega i ely associa ed wi h
hei consump ion o ege ables and ui s, and posi i ely associa ed wi h hei consump-
ion o snacks and suga y d inks [
17
]. In his sense, insu icien physical ac i i y and
excessi e ST in his popula ion ha e been ound o be linked wi h less heal hy pa e ns o
ood and be e age consump ion [
18
]. Fu he , Spanish child en aged h ee o we
l e yea
s
wi h mo e seden a y li es yle ha e also been epo ed o exhibi sho e du a ion and poo e
quali y sleep, lowe MD adhe ence, and poo e PF, wi h such child en also ha ing a less
heal hy weigh [
19
,
20
]. In his ega d, due o he ise in new echnologies, child en can
easily be a ac ed o echnological de ices, leading hem o engage in mo e seden a y
beha iou and less physical ac i i y, which in u n causes hem o miss oppo uni ies
o de eloping PF. Socially, his beha iou is o en accompanied by he consump ion o
unheal hy snacks [
17
], which can ha e a nega i e in luence on child en’s BMI and isk o
being o e weigh o obese.
Wi h ega ds o ea ing habi s, no only is i necessa y o ollow a heal hy die bu ,
also, ood p e e ences play a signi ican ole a his s age. Ea ing beha iou s a e o med
in he ea ly yea s o childhood; howe e , such beha iou s can e ol e o e ime based on
Nu ien s 2024,16, 3582 3 o 20
indi idual expe iences [
21
]. Jimeno-Ma ínez e al. [
22
] epo ed ha Spanish p e-schoole s
wi h a highe BMI epo ed highe p o-in ake (PRO-I) sco es, speci ically wi h ega ds o he
“ ood esponsi eness”, “emo ional o e ea ing”, and “enjoymen o ood” subscales. Fu he ,
highe ST and sho e SLT a e associa ed wi h poo e ea ing beha iou s such as “mindless
ea ing” o he inclina ion owa ds “ ewa d oods” [
23
,
24
]. Along he same lines, p e-
schoole s wi h highe an i-in ake (ANT-I) beha iou s epo ed lowe ish consump ion and
mo e equen ly consumed as ood [
25
], hus mo ing away om adequa e
MD adhe
ence.
Mo eo e , exis ing s udies highligh he impo ance o di e en ia ing in e en ion
ac o s as a unc ion o sex and BMI and o conside ing he sociocul u al di e ences a
play [
26
]. In his sense, wi h ega ds o sex di e ences in child en, boys gene ally spend
mo e ime playing ideo games, whils gi ls engage mo e wi h social media and passi e
en e ainmen [
27
]. Gi ls also end o ha e s ic e sleep ou ines, leading o be e sleep
quali y, whe eas boys o en use sc eens la e a nigh , esul ing in sho e and poo e
sleep [
28
]. In he case o physical i ness, boys a e mo e in ol ed in compe i i e spo s,
whils gi ls lean owa ds non-compe i i e ac i i ies such as dance, wi h his end being
la gely in luenced by social ba ie s [
29
]. Wi h ega ds o die a y habi s, gi ls ypically
choose heal hie oods and exhibi be e emo ional con ol, whe eas boys a e mo e likely
o consume unheal hy snacks [30].
Simila ly, ega ding BMI di e ences in child en, compa ed o hose wi h a heal hy
BMI, child en wi h a highe BMI end o ha e mo e ST, cha ac e ised by high ideo games
and passi e en e ainmen use [
31
]. An unheal hy BMI is also linked o sho e and poo e
quali y sleep due o inc eased ST be o e bed, whe eas child en wi h a heal hy BMI engage
in mo e egula and be e sleep [
32
]. Wi h ega ds o PF, child en wi h a heal hy BMI
a e mo e likely o engage in igo ous ac i i ies and belong o spo s clubs, whils hose
wi h an unheal hy BMI end o be mo e seden a y [
33
]. In e ms o die , child en wi h
a heal hy BMI consume mo e ui s, ege ables, and MD s aples, whils hose wi h an
unheal hy BMI a ou p ocessed oods and suga y d inks, and exhibi mo e emo ional
ea ing beha iou s [34].
In physiological e ms, posi i e co ela ions ha e been demons a ed be ween BMI
and iglyce ides (TG) and low-densi y lipop o ein choles e ol (LDL-C) om as ea ly as
h
ee yea s old [35]
. Consequen ly, BMI co ela es wi h u u e obesi y isk and me abolic
issues such as insulin esis ance and dyslipidaemia [
36
]. Fu he , p e ious s udies ha e shown
ha a BMI classi ied as o e weigh (abo e he 85 h pe cen ile) o obese (95 h pe cen ile) in ea ly
childhood is linked wi h a accumula ion, wais ci cum e ence, and adiposi y [
37
], making i
a use ul p edic o e en when body composi ion canno be di ec ly measu ed. Addi ionally,
BMI is easily measu ed, making i a use ul a iable o la ge-scale s udies. I is also especially
impo an du ing he p e-school yea s, as i can p edic u u e weigh ajec o ies [
38
] and
highligh he need o ea ly in e en ion.
A mo e ac i e li es yle adop ed in he i s yea s o li e o en pe sis s in o la e li e,
making he pe iod be ween h ee o six yea s o age c i ical o beginning o es ablish a
heal hy li es yle [
38
]. Despi e his, p e-schoole s ha e been less ex ensi ely s udied han
olde age g oups when i comes o he heal h impac o ce ain li es yle habi s [
39
]. This
is p ima ily due o challenges associa ed wi h assessing his popula ion and es ic ed
access o po en ial pa icipan s, pa icula ly in heal h- ela ed a eas, such as pa en al con-
ce ns a ound educa ion, pa icipa ion bu den, lack o us , gene al esea ch conce ns,
in o ma ional- and consen - ela ed challenges, and ela ional issues [
40
]. These challenges
mus , he e o e, be o e come in o de o be e examine his popula ion.
The opic add essed by he manusc ip has been widely s udied, howe e , no p e ious
s udies ha e examined he wide se o po en ial li es yle de e minan s oge he . This
includes ea ing beha iou s, wi h a ele an ques ionnai e being ecen ly adap ed o use
wi h Spanish samples [
22
], al hough i s applica ion o p e-schoole s is highly inno a i e.
Ano he ques ion o add ess is whe he ela ionships exis be ween heal hy li es yle habi s
and BMI a such ea ly ages and whe he sex plays a ole. Based on he exis ing li e a u e,
an al e na i e hypo hesis o he p esen s udy is ha , om e y ea ly ages, ela ionships
Nu ien s 2024,16, 3582 4 o 20
eme ge be ween heal hy li es yle habi s and BMI and, consequen ly, heal h. Likewise, i is
expec ed ha sex will impac his ela ionship.
Thus, he p esen s udy aimed o examine he ela ionship be ween ST, SLT, PF, and
MD adhe ence, ea ing beha iou s, and BMI in a sample o p e-schoole s om G anada,
Spain. In o de o add ess his aim, an explana o y model was de eloped o examine
exis ing ela ionships be ween ST, SLT, PF, MD, ANT-I and PRO-I, and BMI. Fu he , he
p oposed s uc u al model was examined ia mul i-g oup analysis as a unc ion o sex
and BMI.
2. Ma e ials and Me hods
2.1. Pa icipan s
A c oss-sec ional s udy was designed. A sample o 653 p e-schoole s aged h ee o
six yea s was ec ui ed o he s udy. A o al o 2250 child en om 18 schools (G anada,
Spain) we e in i ed o ake pa in he p esen s udy be ween Ap il 2023 and Ap il 2024.
Pa icipa ing schools we e selec ed h ough con enience due o hem being easy o access.
In o al, 336 gi ls (51.5%) and 317 boys (48.5%) wi h an a e age age o 4.78 yea s
±
0.93 yea s
pa icipa ed in he s udy. The main inclusion c i e ion e e ed o p e-school child en who
do no su e om ood alle gies o physical o psychia ic condi ions. In o de o add ess
his, he s a emen “obse a ions” was included a he end o he ques ionnai e, in i ing
open esponses and enabling pa en s o disclose in o ma ion ega ding any physical,
psychia ic, o die a y condi ions ha could a ec ou comes. No pa en s esponded o his
ques ion, sugges ing ha no pa icipan s ell in o his ca ego y.
2.2. P ocedu e
The ec ui men s a egy is p esen ed in Figu e 1. In o de o access he s udy a ge
popula ion o p e-school child en, 30 schools we e selec ed which had a p e-exis ing
ela ionship wi h esea che s. O hese 30 schools, di ec o s a 12 schools declined o
pa icipa e. A e ecei ing pe mission om 18 schools (n= 2250), in o med consen was
eques ed om he pa en s o legal gua dians o he child en belonging o each o he
schools. In his way, pa en s we e in o med abou he s udy aims, design, and p ocedu e.
Following he eceip o w i en in o med consen (n= 653), a ques ionnai e was sen ou o
olun a y comple ion by pa en s o legal gua dians on behal o hei child en. The Google
D i e
®
applica ion (Alphabe , Moun ain View, CA, USA) was used. E hical p inciples o
he Decla a ion o Helsinki o Medical Resea ch we e ollowed, and e hical app o al was
g an ed by he E hics Commi ee o he Uni e si y o G anada 2794/CEIH/2022.
2.3. Ins umen s
The la es e sion o he Medi e anean Die Quali y Index (KIDMED) was used o
e alua e child en’s MD adhe ence [
41
]. This comp ises a o al o 16 i ems which can ass
bina y esponses (“yes” o “no”). Fou i ems a e nega i ely amed, and so posi i e
esponses a e sco ed as
−
1. Con e sely, he emaining i ems a e posi i ely amed, wi h
a i ma i e esponses being sco ed as +1 and nega i e esponses ecei ing a sco e o 0. As
a esul , po en ial o e all inal sco es ange om −4 o 12.
PF was e alua ed using he la es Spanish edi ion o he In e na ional Fi ness Scale
(IFIS) [
42
]. This ques ionnai e comp ises i e i ems, wi h each being measu ed on a
i
e-poi
n scale anging om 1 ( e y poo ) o 5 ( e y good). I ems assess essen ial aspec s
o sel -pe cei ed i ness (1: ca dio espi a o y i ness; 2: muscula i ness; 3: speed-agili y;
4: balance; and 5: o e all PF). Indi idual sco es o each i em a e summed o p oduce an
o e all i ness sco e. An a e age sco e is calcula ed om he i e i ems o ob ain an o e all
es sco e.
The la es Spanish edi ion o he Child Ea ing Beha iou Ques ionnai e (CEBQ) was
employed o e alua e child en’s ea ing beha iou s [
22
,
43
]. This comp ises a o al o 36 i ems
ha a e a ed along a i e-poin Like scale. I ems can be g ouped in o wo dimensions,
namely, p o-in ake (PRO-I) and an i-in ake (ANT-I). PRO-I e e s o ood esponsi eness,
Nu ien s 2024,16, 3582 5 o 20
emo ional o e ea ing, enjoymen o ood, and desi e o d ink, whils ANT-I e e s o sa ie y
esponsi eness, slowness in ea ing, emo ional unde ea ing, and ood ussiness.
Nu ien s 2024, 16, x FOR PEER REVIEW 5 o 22
Figu e 1. Rec ui men s a egy.
2.3. Ins umen s
The la es e sion o he Medi e anean Die Quali y Index (KIDMED) was used o
e alua e child en’s MD adhe ence [41]. This comp ises a o al o 16 i ems which can ass
bina y esponses (“yes” o “no”). Fou i ems a e nega i ely amed, and so posi i e e-
sponses a e sco ed as −1. Con e sely, he emaining i ems a e posi i ely amed, wi h
affi ma i e esponses being sco ed as +1 and nega i e esponses ecei ing a sco e o 0. As
a esul , po en ial o e all inal sco es ange om −4 o 12.
PF was e alua ed using he la es Spanish edi ion o he In e na ional Fi ness Scale
(IFIS) [42]. This ques ionnai e comp ises i e i ems, wi h each being measu ed on a
i e-poin scale anging om 1 ( e y poo ) o 5 ( e y good). I ems assess essen ial aspec s
o sel -pe cei ed i ness (1: ca dio espi a o y i ness; 2: muscula i ness; 3: speed-agili y;
4: balance; and 5: o e all PF). Indi idual sco es o each i em a e summed o p oduce an
o e all i ness sco e. An a e age sco e is calcula ed om he i e i ems o ob ain an o e -
all es sco e.
The la es Spanish edi ion o he Child Ea ing Beha iou Ques ionnai e (CEBQ) was
employed o e alua e child en’s ea ing beha iou s [22,43]. This comp ises a o al o 36
i ems ha a e a ed along a i e-poin Like scale. I ems can be g ouped in o wo di-
mensions, namely, p o-in ake (PRO-I) and an i-in ake (ANT-I). PRO-I e e s o ood e-
sponsi eness, emo ional o e ea ing, enjoymen o ood, and desi e o d ink, whils ANT-I
e e s o sa ie y esponsi eness, slowness in ea ing, emo ional unde ea ing, and ood
ussiness.
Sociodemog aphic da a we e collec ed h ough an ad hoc ques ionnai e. Pa en s
epo ed hei child en’s sex, da e o bi h, heigh , and weigh . BMI was hen calcula ed
Figu e 1. Rec ui men s a egy.
Sociodemog aphic da a we e collec ed h ough an ad hoc ques ionnai e. Pa en s
epo ed hei child en’s sex, da e o bi h, heigh , and weigh . BMI was hen calcula ed
om heigh and weigh (BMI = weigh [kg]/(heigh [m])
2
). Age and sex s anda dized clas-
si ica ions o heal hy weigh , o e weigh , and obese we e calcula ed in line wi h anking
pe cen iles ou lined by Sob adillo e al. [
44
]. O e weigh and obese g oups we e combined
due o he low pe cen age o child en epo ing being o e weigh (4.9%) and obese (6.3%).
Child en’s pa en s epo ed he numbe o hou s o nigh ly sleep on weekdays and week-
ends. Simila ly, wo i ems we e added o examine he numbe o hou s spen daily solely
engaged in sc een-based leisu e ac i i ies (wa ching ele ision, playing ideo games, using
a mobile phone, using a compu e , e c.) on weekdays and weekends. Hou s spen in on
o he sc een in in-pe son o online classes we e no conside ed. O e all summa y sco es
we e calcula ed om he mean numbe o hou s epo ed o e he se en days examined.
2.4. S a is ical Analysis
Ca ego ical da a such as sex and BMI a e ep esen ed as pe cen ages. Mean and s an-
da d de ia ions a e epo ed o all quan i a i e a iables. No mali y o he da a was es ed
using he Kolmo o –Smi no es . A e e i ying ha da a we e no no mally dis ibu ed,
he da a we e analysed using he Mann–Whi ney U es o compa e w
o inde
penden
g oups. Associa ions be ween quan i a i e a iables we e examined acco ding o Spea -

Nu ien s 2024,16, 3582 6 o 20
man co ela ions (p< 0.05). All s a is ical analyses we e pe o med using e sion 25 o
IBM-SPSS
®
o Windows. Then, s uc u al equa ion modelling (SEM) was pe o med using
IBM AMOS
®
24.0 so wa e. SEM acili a es he es ablishmen o connec ions be ween a i-
ables speci ied in a heo e ical model (Figu e 2). The model cons uc ed in he p esen s udy
comp ised se en obse ed a iables. O hese, i e we e endogenous (PF, MD, ANT-I and
PRO-I and IMC) and wo we e exogenous a iables (ST and SLT). Endogenous a iables a e
ep esen ed wi hin he de eloped model alongside hei associa ed e o e ms, which a e
illus a ed wi h a ci cle, whils exogenous a iables do no ha e associa ed e o e ms and
a e depic ed ia wo-way a ows. SEM was employed o de e mine exis ing ela ionships
be ween he a iables included in he heo e ical model as a unc ion o sex (boy/gi l) and
BMI (heal hy weigh /o e weigh /obese).
Nu ien s 2024, 16, x FOR PEER REVIEW 6 o 22
om heigh and weigh (BMI = weigh [kg]/(heigh [m])
2
). Age and sex s anda dized
classi ica ions o heal hy weigh , o e weigh , and obese we e calcula ed in line wi h
anking pe cen iles ou lined by Sob adillo e al. [44]. O e weigh and obese g oups we e
combined due o he low pe cen age o child en epo ing being o e weigh (4.9%) and
obese (6.3%). Child en’s pa en s epo ed he numbe o hou s o nigh ly sleep on
weekdays and weekends. Simila ly, wo i ems we e added o examine he numbe o
hou s spen daily solely engaged in sc een-based leisu e ac i i ies (wa ching ele ision,
playing ideo games, using a mobile phone, using a compu e , e c.) on weekdays and
weekends. Hou s spen in on o he sc een in in-pe son o online classes we e no con-
side ed. O e all summa y sco es we e calcula ed om he mean numbe o hou s e-
po ed o e he se en days examined.
2.4. S a is ical Analysis
Ca ego ical da a such as sex and BMI a e ep esen ed as pe cen ages. Mean and
s anda d de ia ions a e epo ed o all quan i a i e a iables. No mali y o he da a was
es ed using he Kolmo o –Smi no es . A e e i ying ha da a we e no no mally
dis ibu ed, he da a we e analysed using he Mann–Whi ney U es o compa e wo in-
dependen g oups. Associa ions be ween quan i a i e a iables we e examined acco d-
ing o Spea man co ela ions (p < 0.05). All s a is ical analyses we e pe o med using
e sion 25 o IBM-SPSS
®
o Windows. Then, s uc u al equa ion modelling (SEM) was
pe o med using IBM AMOS
®
24.0 so wa e. SEM acili a es he es ablishmen o con-
nec ions be ween a iables speci ied in a heo e ical model (Figu e 2). The model con-
s uc ed in he p esen s udy comp ised se en obse ed a iables. O hese, i e we e
endogenous (PF, MD, ANT-I and PRO-I and IMC) and wo we e exogenous a iables (ST
and SLT). Endogenous a iables a e ep esen ed wi hin he de eloped model alongside
hei associa ed e o e ms, which a e illus a ed wi h a ci cle, whils exogenous a ia-
bles do no ha e associa ed e o e ms and a e depic ed ia wo-way a ows. SEM was
employed o de e mine exis ing ela ionships be ween he a iables included in he he-
o e ical model as a unc ion o sex (boy/gi l) and BMI (heal hy weigh /o e weigh /obese).
Figu e 2. S uc u al equa ion model. No e: ST: sc een ime; SLT: sleep ime; PF: physical i ness; MD:
Medi e anean die ; ANT-I: an i-in ake; PRO-I: p o-in ake; BMI: body mass index; E1–E5: e o e ms.
In o de o de e mine he ex en o which he s uc u al equa ion model (SEM) aligns
wi h he obse ed da a, se e al indices we e u ilized o assess model adequacy. Model
i should p ima ily be e alua ed acco ding o chi-squa e, wi h a non-signi ican p- alue
sugges ing good i . Howe e , By ne [
45
] a gues ha his s a is ic can be hea ily impac ed
by sample size and so addi ional i indices should also be conside ed. To his end, compa -
a i e i (CFI), inc emen al i (IFI), no malized i (NFI), and Tucke –Lewis (TLI) indices
we e calcula ed. Fo model i o be deemed accep able, hese indices should e lec alues
highe han 0.90, wi h alues abo e 0.95 indica ing excellen i . Fu he mo e, oo mean
squa e e o o app oxima ion (RMSEA) was es ima ed, wi h alues below 0.08 e lec ing
accep able i and alues below 0.05 sugges ing excellen i .
Jus i ica ion o Model Speci ica ion and Goodness o Fi Indices
The i s s uc u al equa ion model was buil based on esea ch p esen ed abo e.
ST and SLT ha e been iden i ied as key ac o s in luencing physical heal h and ea ing
beha iou s. Inc eased ST, along wi h inadequa e sleep, has been ound o be associa ed
wi h g ea e physical inac i i y, lowe adhe ence o heal hy die s such as he MD, and less
Nu ien s 2024,16, 3582 7 o 20
heal hy ea ing beha iou s [
19
,
20
]. Fo his eason, ST and SLT a e en e ed in he i s le el
o he model.
PF has been posi i ely linked o g ea e MD adhe ence, due o he ela ionship be ween
egula physical ac i i y and inc eased awa eness o he impo ance o p ope nu i ion
o physical pe o mance and o e all heal h. This aligns wi h s udies ha highligh ha
physically ac i e indi iduals end o ollow heal hie die a y pa e ns [
18
]. Fo his eason,
PF, MD adhe ence, and ea ing beha iou s a e included a he second le el o he model in
o de o es ablish he in luence o PF on MD adhe ence and, in u n, ea ing beha iou s.
Finally, e idence sugges s ha adequa e MD adhe ence, cha ac e ized by a balanced
in ake o ui s, ege ables, legumes, and heal hy a s, has a posi i e impac on bo h
ea ing beha iou s and he main enance o a heal hy BMI, wi h die being one o he main
de e minan s o BMI [8].
Following speci ica ion o he model, di ec ions o associa ion be ween a iables
we e de e mined in acco dance wi h he Spea man co ela ion analysis. Following his,
ini ial model i was examined. Ul ima ely, model i was e ined un il accep able o
excellen alues we e achie ed o CFI, IFI, NFI, and TLI. These indices we e selec ed due
o hei abili y o p o ide comp ehensi e assessmen o model i . These indices a e widely
ecognised in SEM li e a u e as obus me ics ha help o o e come he limi a ions o he
chi-squa e s a is ic [45].
3. Resul s
Table 1p esen s he desc ip i e cha ac e is ics o he s udy sample. Wi h ega ds o
sex, boys epo ed less SLT (10.29
±
0.61 s. 10.41
±
0.70; p= 0.011) and sco ed lowe
o ANT-I (2.86
±
0.56 s. 2.94
±
0.53; p= 0.019) and sa ie y esponsi eness (2.75
±
0.69
s. 2.8
8±0.6
4; p= 0.004) han gi ls. No u he sex di e ences we e obse ed o he
emaining s udy pa ame e s. Wi h ega ds o BMI, ela i e o o e weigh o obese child en,
child en wi h a heal hy body weigh epo ed highe sco es o o e all PF (4.30
±
0.64 s.
4.14
±
0.65; p= 0.045) and ca dio ascula i ness (4.08
±
0.75 s. 3.82
±
0.71; p= 0.003) and
lowe sco es o PRO-I (2.48
±
0.53 s. 2.74
±
0.68; p= 0.003) and all o i s subdimensions
excep desi e o d ink. Fu he , child en wi h a heal hy body weigh epo ed highe sco es
o ANT-I (2.92
±
0.56 s. 2.77
±
0.53; p= 0.023) and sa ie y esponsi eness (2.84
±
0.67 s.
2.66 ±0.67; p= 0.037) han o e weigh o obese child en.
Table 2p esen s co ela ion coe icien s p oduced be ween s udy a iables. ST was
posi i ely associa ed wi h ANT-I ( = 0.144; p< 0.01) and in e sely associa ed wi h SLT
(
= −0.21
9; p< 0.01), o e all PF ( =
−
0.152; p< 0.01), and MD adhe ence ( =
−
0.262;
p< 0.0
1). In con as , SLT was posi i ely associa ed wi h o e all PF ( = 0.093; p< 0.05)
and MD adhe ence ( = 0.235; p< 0.01), and in e sely associa ed wi h ANT-I ( =
−
0.106;
p< 0.0
1). Fu he , highe o e all PF was posi i ely associa ed wi h MD adhe ence (
= 0.113
;
p<. 05) and nega i ely associa ed wi h ANT-I ( =
−
0.160; p< 0.01). A he same ime, MD
adhe ence was in e sely associa ed wi h ANT-I ( =
−
0.287; p< 0.01), wi h he la e also
being in e sely associa ed wi h PRO-I ( = −0.403; p< 0.01).
Gi en ha a numbe o signi ican di e ences eme ged acco ding o sex and BMI, an-
o he SEM was cons uc ed o be e unde s and he ela ionship be ween s udy a iables.
This SEM showed good i indices o he mul i-g oup analysis. The chi-squa e
ou come was signi ican (
χ2
= 16.9; d = 7; p= 0.018), meaning ha his index does no
suppo he goodness o i o he model. None heless, acco ding o Ma sh [
46
], his index
canno be in e p e ed in a s anda dised way due o i s sensi i i y o sample size. Thus,
o he s anda dised i indices we e used ha a e less sensi i e o sample size [
47
]. In his
way, NFI and TLI alues we e accep able, being 0.948 and 0.902, espec i ely. IFI and CFI
alues we e excellen , being 0.969 and 0.967, espec i ely. A he same ime, he RMSEA
alue was also excellen , being 0.047.
Nu ien s 2024,16, 3582 8 o 20
Table 1. Desc ip i e cha ac e is ics o he s udy sample acco ding o sex and BMI.
Sex BMI
O e all
(n= 653)
Male
(n= 317)
Female
(n= 336) p
Heal hy
Weigh
(n= 580)
O e weigh /
Obese
(n= 73)
p
Age (yea s) 4.78 ±0.93 4.78 ±0.97 4.78 ±0.90 0.892 4.76 ±0.93 4.92 ±0.92 0.210
BMI (kg/m2)15.53 ±2.09 15.52 ±1.92 15.53 ±2.23 0.691
ST (hou s) 1.78 ±1.07 1.81 ±1.11 1.75 ±1.02 0.604 1.76 ±1.06 1.94 ±1.12 0.271
SLT (hou s) 10.35 ±0.66 10.29 ±0.61 10.41 ±0.70 0.011 10.37 ±0.64 10.19 ±0.74 0.147
MD adhe ence 7.17 ±2.03 7.18 ±2.09 7.16 ±1.97 0.999 7.21 ±2.02 6.79 ±2.05 0.115
O e all PF 4.11 ±0.57 4.14 ±0.59 4.08 ±0.55 0.104 4.12 ±0.57 4.01 ±0.55 0.069
GPF 4.28 ±0.65 4.30 ±0.067 4.26 ±0.62 0.267 4.30 ±0.64 4.14 ±0.65 0.045
CF 4.05 ±0.75 4.09 ±0.76 4.02 ±0.74 0.203 4.08 ±0.75 3.82 ±0.71 0.003
MS 4.02 ±0.70 4.06 ±0.71 3.99 ±0.69 0.223 4.03 ±0.69 4.01 ±0.75 0.902
SA 4.12 ±0.72 4.17 ±0.72 4.07 ±0.73 0.074 4.13 ±0.74 4.05 ±0.62 0.237
B 4.07 ±0.71 4.08 ±0.74 4.07 ±0.69 0.765 4.08 ±0.72 4.05 ±0.62 0.495
PRO-I 2.51 ±0.56 2.50 ±0.56 2.51 ±0.56 0.998 2.48 ±0.53 2.74 ±0.68 0.003
FR 2.22 ±0.84 2.17 ±0.80 2.27 ±0.87 0.258 2.18 ±0.80 2.54 ±1.06 0.008
EO 1.76 ±0.64 1.74 ±0.65 1.78 ±0.64 0.442 1.73 ±0.62 1.97 ±0.77 0.015
EF 3.59 ±0.80 3.60 ±0.82 3.58 ±0.78 0.407 3.56 ±0.80 3.83 ±0.74 0.006
DD 2.46 ±0.87 2.48 ±0.91 2.43 ±0.84 0.560 2.44 ±0.86 2.61 ±0.96 0.223
ANT-I 2.90 ±0.55 2.86 ±0.56 2.94 ±0.53 0.019 2.92 ±0.56 2.77 ±0.53 0.023
SR 2.82 ±0.67 2.75 ±0.69 2.88 ±0.64 0.004 2.84 ±0.67 2.66 ±0.67 0.037
SE 3.08 ±0.79 3.02 ±0.81 3.13 ±0.77 0.050 3.10 ±0.79 2.92 ±0.71 0.093
EU 2.96 ±0.60 2.94 ±0.60 2.98 ±0.60 0.429 2.98 ±0.59 2.86 ±0.61 0.129
FF 2.76 ±0.84 2.73 ±0.86 2.80 ±0.81 0.193 2.78 ±0.84 2.65 ±0.81 0.211
No e: BMI: body mass index; ST: sc een ime; SLT: sleep ime; MD: Medi e anean die ; PF: physical i ness; GPF:
gene al physical i ness; CF: ca dio espi a o y i ness; MS: muscula s eng h; SA: speed/agili y; B: balance; PRO-I:
p o-in ake; FR: ood esponsi eness; EO: emo ional o e ea ing; EF: enjoymen o ood; DD: desi e o d ink; ANT-I:
an i-in ake; SR: sa ie y esponsi eness; SE: slowness in ea ing; EU: emo ional unde ea ing; FF: ood ussiness.
Table 2. Co ela ion coe icien s p oduced be ween s udy a iables adjus ed o sex.
BMI ST SLT O e all PF MD ANT-I
ST 0.074
SLT −0.053 −0.219 **
O e all PF −0.025 −0.152 ** 0.093 *
MD −0.062 −0.262 ** 0.235 ** 0.113 *
ANT-I −0.105 ** 0.144 ** −0.106 ** −0.160 ** −0.287 **
PRO-I 0.178 ** 0.002 0.015 0.067 0.039 −0.403 **
No e: * p < 0.05; ** p< 0.01. BMI: body mass index; ST: sc een ime; SLT: sleep ime du a ion; PF: physical i ness;
MD: Medi e anean die ; ANT-I: an i-in ake; PRO-I: p o-in ake.
Table 3and Figu e 3p esen eg ession weigh s and s anda dised eg ession weigh s
pe aining o he SEM cons uc ed o he o e all sample. Ou comes demons a e ha
associa ions exis be ween ST, SLT, PF, MD, ANT-I, and PRO-I and BMI. Nega i e ela ion-
ships we e obse ed be ween ST and PF (b =
−
0.137; p< 0.005), ST and MD adhe ence
(
b = −0.21
2; p< 0.005), ST and SLT (b =
−
0.221; p< 0.005), MD adhe ence and ANT-I
(
b = −0.24
2; p< 0.005), ANT-I and PRO-I (b =
−
0.407; p< 0.005), and MD adhe ence and
BMI (b =
−
0.085; p= 0.033). In con as , posi i e ela ionships we e ound be ween SLT
and MD adhe ence (b = 0.181; p< 0.005), and PRO-I and BMI (b = 0.152; p< 0.005).
Table 4and Figu e 4p esen eg ession weigh s and s anda dised eg ession weigh s
pe aining o he SEM de eloped o gi ls. The chi-squa e s a is ic was non-signi ican
(
χ2= 3.6
;d = 7; p= 0.821), meaning ha , on his occasion, he model could be concluded o
exhibi good i . The model could also be concluded o be homogeneous. Fu he mo e, NFI,
IFI, TLI, and CFI alues we e excellen , being 0.980, 1.019, 1.063, and 1.000, espec i ely. A
he same ime, he RMSEA alue was also excellen , being 0.000. This shows ha he SEM
cons uc ed closely aligns wi h he empi ical da a collec ed, indica ing an excellen i . In
Nu ien s 2024,16, 3582 9 o 20
his case, nega i e ela ionships we e obse ed be ween ST and PF (b =
−
0.147;
p= 0.00
7),
ST and MD adhe ence (b =
−
0.259; p< 0.005), ST and SLT (b =
−
0.210; p< 0.005), MD
adhe ence and ANT-I (b =
−
0.175; p= 0.002), ANT-I and PRO-I (b =
−
0.424; p< 0.005) ),
and MD adhe ence and BMI (b =
−
0.114; p= 0.036). In con as , posi i e ela ionships
we e ound be ween SLT and PF (b = 0.137; p= 0.012), SLT and MD adhe ence (b = 0.196;
p< 0.005), and PRO-I and BMI (b = 0.174; p= 0.003).
Table 3. Reg ession weigh s o he o e all sample.
Associa ion Be ween
Va iables
RW SRW
Es ima ion SE CR pEs ima ion
PF ←ST −0.073 0.021 −3.466 *** −0.137
PF ←SLT 0.050 0.034 1.451 0.147 0.058
MD ←SLT 0.559 0.117 4.764 *** 0.181
MD ←PF 0.233 0.133 1.750 0.080 0.066
MD ←ST −0.403 0.073 −5.537 *** −0.212
ANT-I ←ST 0.032 0.020 1.554 0.120 0.062
ANT-I ←SLT −0.012 0.033 −0.379 0.705 −0.015
ANT-I ←MD −0.066 0.011 −6.088 *** −0.242
PRO-I ←ANT-I −0.415 0.038 −10.924 *** −0.407
PRO-I ←MD −0.020 0.010 −1.941 0.052 −0.072
BMI ←ANT-I −0.264 0.165 −1.606 0.108 −0.069
BMI ←PRO-I 0.566 0.156 3.632 *** 0.152
BMI ←MD −0.088 0.041 −2.130 0.033 −0.085
SLT ↔ST −0.155 0.028 −5.508 *** −0.221
No e: PF: physical i ness; ST: sc een ime; SLT: sleep ime; MD: Medi e anean die ; ANT-I: an i-in ake; PRO-I:
p o-in ake; BMI: body mass index; RW: eg ession weigh ; SRW: s anda dised eg ession weigh ;
←
: di ec ional
ela ionships be ween a iables; ↔: co ela ion be ween wo a iables. *** p < 0.005.
Nu ien s 2024, 16, x FOR PEER REVIEW 10 o 22
Figu e 3. S uc u al equa ion model o he o e all sample. No e: ST: sc een ime; SLT: sleep ime;
PF: physical i ness; MD: Medi e anean die ; ANT-I: an i-in ake; PRO-I: p o-in ake; BMI: body
mass index; E1–E5: e o e ms.
Table 4 and Figu e 4 p esen eg ession weigh s and s anda dised eg ession
weigh s pe aining o he SEM de eloped o gi ls. The chi-squa e s a is ic was
non-signi ican (χ2 = 3.6; d = 7; p = 0.821), meaning ha , on his occasion, he model could
be concluded o exhibi good i . The model could also be concluded o be homogeneous.
Fu he mo e, NFI, IFI, TLI, and CFI alues we e excellen , being 0.980, 1.019, 1.063, and
1.000, espec i ely. A he same ime, he RMSEA alue was also excellen , being 0.000.
This shows ha he SEM cons uc ed closely aligns wi h he empi ical da a collec ed, in-
dica ing an excellen i . In his case, nega i e ela ionships we e obse ed be ween ST
and PF (b = −0.147; p = 0.007), ST and MD adhe ence (b = −0.259; p < 0.005), ST and SLT (b =
−0.210; p < 0.005), MD adhe ence and ANT-I (b = −0.175; p = 0.002), ANT-I and PRO-I (b =
−0.424; p < 0.005) ), and MD adhe ence and BMI (b = −0.114; p = 0.036). In con as , posi i e
ela ionships we e ound be ween SLT and PF (b = 0.137; p = 0.012), SLT and MD adhe -
ence (b = 0.196; p < 0.005), and PRO-I and BMI (b = 0.174; p = 0.003).
Table 4. Reg ession weigh s p oduced by he SEM de eloped o gi ls.
Associa ion Be ween
Va iables
RW SRW
Es ima ion SE CR p Es ima ion
PF ← ST −0.079 0.029 −2.693 0.007 −0.147
PF ← SLT 0.109 0.043 2.523 0.012 0.137
MD ← SLT 0.553 0.149 3.716 *** 0.196
MD ← PF 0.034 0.186 0.185 0.853 0.010
MD ← ST −0.497 0.101 −4.908 *** −0.259
ANT-I ← ST 0.011 0.029 0.395 0.693 0.022
Figu e 3. S uc u al equa ion model o he o e all sample. No e: ST: sc een ime; SLT: sleep ime;
PF: physical i ness; MD: Medi e anean die ; ANT-I: an i-in ake; PRO-I: p o-in ake; BMI: body mass
index; E1–E5: e o e ms.
Nu ien s 2024,16, 3582 16 o 20
in heal h-enhancing physical ac i i y (37.5% s. 18.2%, p< 0.001). In o de o ensu e ha
p eschool gi ls engage in physical ac i i y a le els compa able o boys, i is i al o c ea e
an inclusi e en i onmen ha coun e s cul u al p essu es [
60
]. This can be achie ed by
p omo ing posi i e ole models, emphasising un o e compe i ion, and o e ing p og ams
ailo ed o gi ls’ in e es s, such as dance o coope a i e games [
65
]. In ol ing pa en s can
ein o ce posi i e a i udes owa ds physical ac i i y [
66
]. Mo eo e , a p omising app oach
is o p omo e posi i e pee ela ionships and social suppo om iendship g oups in he
PA se ing [
67
]. C ea ing sa e and suppo i e en i onmen s o gi ls o engage in play can
enable hem o enjoy he heal h bene i s o physical ac i i y in he same way ha boys do.
Finally, he use o mul i-g oup analysis based on sex and BMI adds nuance o he
indings, whils he inno a i e me hodology in eg a es a ious li es yle de e minan s, con-
ibu ing aluable insigh s o u u e esea ch and in e en ions ailo ed owa ds Spanish
p e-schoole s. Addi ionally, he p ac ical implica ions o p esen indings a e a ied and
ha e applica ions o heal h, educa ion, and li es yle in e en ions. Schools should be
he p ima y enues o such in e en ions, as hey a e ideal en i onmen s o encou age
s uden s and amilies o os e heal hy habi s. Indeed, heal hy habi s lea ned a school can
la e be implemen ed a home and o en pe sis o e ime [68].
Limi a ions, S eng hs and Fu u e Pe spec i es
P esen indings should be conside ed in ligh o a numbe o limi a ions.
One such limi a ion pe ains o he c oss-sec ional s udy design employed, which
limi s he abili y make conclusions ega ding causal ela ionships. In u u e esea ch,
longi udinal s udies should be conside ed o analyse he e olu ion o ou comes.
Mo eo e , he s udy’s eliance on sel - epo ed da a o a ious a iables inc eases
he isk o measu emen e o . Howe e , since bo h he KIDMED o child en and he
CEBQ ha e consis en ly demons a ed s ong alidi y and eliabili y in simila samples,
his issue is unlikely o ha e subs an ially in luenced indings. Simila ly, BMI has known
limi a ions as a s and-alone measu e, as i does no accoun o a pe cen age o bone
densi y; howe e , i emains a p ac ical ool o assessing obesi y isk in young child en [
37
].
Speci ically, a ecen c oss-sec ional s udy conduc ed by Desca pen ie e al. [
69
] obse ed
ha associa ions be ween unheal hy li es yle pa e ns and BMI may di e depending on
he popula ion, wi h posi i e ela ionships only being obse ed in Spanish and I alian
p e-school coho s. This sugges s ha BMI may be a good indica o in he con ex o he
p esen s udy.
The non- andom app oach o sample selec ion should also be conside ed. Despi e
his limi a ion, a la ge numbe o pa icipan s we e ec ui ed om 18 public and p i a e
schools in he p o ince o G anada. The la ge sample size o a di icul o ob ain popula ion
ec ui ed by he p esen s udy p o ides es ima es ha be e app oxima e popula ion
pa ame e s [
70
]. In o de o boos ec ui men , alongside p o ision o an in o ma ion le e
p io o eques ing consen , pe sonal con ac de ails o he p incipal in es iga o we e
p o ided o pa icipan s. This enabled pa en s o eques addi ional in o ma ion p io
o s udy s a , helped o os e us in esea che s, and p omo ed pa en al mo i a ion o
pa icipa e. In addi ion, pa icipan s we e in o med h oughou he s udy p ocess ha hey
could wi hd aw om he s udy a any ime. These measu es we e es ablished ollowing
sugges ions made by Sammons e al. [
71
] o mo i a ing pa en s o consen o pa icipa ion.
Ano he limi a ion is ha he pa en s o pa icipa ing p e-schoole s wi hheld hei
consen o socioeconomic s a us da a o be accessed. Fu u e esea ch can/should in es-
iga e he in luence o pa en s’ heal hy habi s on hei child en, whils conside ing o he
sociocul u al ac o s such as he amily’s educa ion o socioeconomic s a us, as hese appea
o be key ac o s when i comes o p omo ing heal hy habi s in p e-school-aged child en.
Al hough many po en ial co ounde s we e con olled o , some physiological and gene ic
ac o s may ha e s ill con ounded es ima ions. In addi ion, i would be in e es ing o
u u e esea ch o e alua e o he a iables ha may be ela ed o heal hy li es yles such as
cogni i e pe o mance, men al heal h, and gene al well-being.

Nu ien s 2024,16, 3582 17 o 20
Fu he mo e, i mus be acknowledged ha , o he bes o he au ho s’ knowledge, he
p esen s udy ep esen s one o e y ew s udies a ailable ha conduc in eg a i e analysis
o a ious heal hy li es yle de e minan s in child en unde six yea s o age. Thus, u he
scien i ic esea ch is equi ed a his s age.
5. Conclusions
P e-schoole s om sou he n Spain wi h lowe ST end o ha e highe PF, MD ad-
he ence, and SLT. Likewise, p e-schoole s who epo adequa e MD adhe ence exhibi
mo e SLT, ewe PRO-I and ANT-I beha iou s, and a lowe BMI. Wi h ega ds o he la e ,
child en wi h a highe BMI exhibi mo e PRO-I beha iou s. Rela ionships be ween hese
ac o s a e clea e in gi ls and p e-schoole s who a e o e weigh o obese, indica ing ha
bo h sex and weigh s a us play a ole in hese in e ac ions.
In o de o imp o e PF in o e weigh o obese child en, in e en ions should ocus on
educing ST. As indica ed by he co ela ions ound in he p esen s udy, such in e en ions
a e c ucial gi en ha good PF is likely o lead o be e MD adhe ence in p e-schoole s.
This, in u n, will b ing abou educ ions in BMI and educe he isk o being o e weigh o
obese. Speci ically in he case o gi ls, i is sugges ed ha in e en ions ocus on educing
ST and inc easing SLT as a means o imp o ing bo h PF and MD adhe ence. Whils his
s a egy is also likely o be bene icial o boys, he p omo ion o MD adhe ence by a ge ing
PF will likely p oduce be e ou comes.
Au ho Con ibu ions: Concep ualiza ion, G.C.V. and J.J.M.; me hodology, G.C.V. and J.J.M.; so -
wa e, G.C.V. and J.J.M.; alida ion, G.C.V., R.P.-R., J.-A.S.-M. and J.J.M.; o mal analysis, G.C.V. and
J.J.M.; in es iga ion, G.C.V., R.P.-R., J.-A.S.-M. and J.J.M.; esou ces, J.J.M.; da a cu a ion, G.C.V. and
J.J.M.; w i ing—o iginal d a p epa a ion, G.C.V.; w i ing— e iew and edi ing, G.C.V. and J.J.M.;
isualiza ion, G.C.V., R.P.-R., J.-A.S.-M. and J.J.M.; supe ision, J.J.M.; p ojec adminis a ion, G.C.V.
and J.J.M.; unding acquisi ion, G.C.V. and J.J.M. All au ho s ha e ead and ag eed o he published
e sion o he manusc ip .
Funding: This wo k was suppo ed by he Spanish “Minis e io de Uni e sidades” ia he p edoc o al
g an “Fo mación de P o eso ado Uni e si a io” awa ded o G acia C is ina Villod es (FPU20/02739).
Ins i u ional Re iew Boa d S a emen : This s udy was conduc ed acco ding o he guidelines laid
ou in he Decla a ion o Helsinki and all p ocedu es in ol ing esea ch s udy pa icipan s we e
app o ed by he E hics Commi ee o he Uni e si y o G anada, Spain (2794/CEIH/2022, da e o
app o al: 28 Ap il 2022).
In o med Consen S a emen : In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen : Da a a e a ailable om he au ho s on eques . Da a a e no publicly
a ailable due o p i acy easons.
Acknowledgmen s: The au ho s would like o hank all s uden s and hei amilies o hei pa ici-
pa ion in his s udy. The au ho s also wish o hank he s a a he schools o hei con ibu ions
du ing da a collec ion. The au ho s would like o especially hank Emily Knox o he assis ance in
e iewing he English e sion.
Con lic s o In e es : The au ho s decla e no con lic s o in e es .
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