Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study)

Purpose To investigate the individual and combined effect of physical activity, adherence to the Mediterranean diet, sleep quality, sleep duration, and screen time on health-related quality of life (HRQoL) in adolescents. Methods This is a cross-sectional analysis with 262 adolescents (13.9 +/- 0.3 years) from DADOS (Deporte, ADOlescencia y Salud) study. Physical activity was assessed with a wrist-worn GENEActiv triaxial accelerometer. Adherence to the Mediterranean diet was evaluated by the KIDMED questionnaire. Sleep patterns were self-reported through the Spanish version of Pittsburgh Sleep Quality Index questionnaire. Screen time was assessed through the HELENA sedentary behavior questionnaire. HRQoL was measured using the KIDSCREEN-10 questionnaire. Scores were categorized into low and high using a normative cut-off used to identify factors associated with being in a high HRQoL group. A healthy lifestyle index was created including positive scores for each individual behavior, and five categories of achievement were established (0, 1, 2, 3, >= 4). Results Sleep patterns and screen time revealed a significant individual relationship with HRQoL (p < 0.05). Adolescents achieving >= 3 positive health-related behaviors showed higher HRQoL levels compared to those fulfilling none (p < 0.05). Logistic regression analysis revealed an increased likelihood of high HRQoL according to the number of positive health-related behaviors achieved (p < 0.05). Conclusions Our results reveal higher levels of HRQoL in those adolescents achieving >= 3 health-related behaviors compared to their peers achieving none. Moreover, our findings show a cumulative effect of health-related behaviors on HRQoL. These findings underline the key role of promoting a healthy lifestyle in order to improve adolescents' health and well-being.