Medical

Communication

Biosci. Biotech. Res. Comm. 10(4): 739-745 (2017)

Associations of physical activity and sedentary

behaviors with dietary behaviors among mid-

adolescent female students in the southeast of Iran

Fariba Shahraki-Sanavi

, Fatemeh Rakhshani

, Alireza Ansari-Moghaddam

* and

Mahdi Mohammadi

PhD Student Health Education & Promotion, Health Promotion Research Center, Public Health Department,

Zahedan University of Medical Science, Zahedan, Iran

Professor Health Education, Safety Promotion and Injury Prevention Research Center (SPIPRC), Shahid

Beheshti University of Medical Sciences, School of Public Health, Tehran, Iran

Professor Epidemiology,Health Promotion Research Center, Epidemiology & Biostatistics Department,

Zahedan University of Medical Sciences, Zahedan, Iran

Associate Professor in Statistic, Health Promotion Research Center, Epidemiology & Biostatistics

Department, Zahedan University of Medical Sciences, Zahedan, Iran

ABSTRACT

Given the complexity of dietary behaviors and physical activity of adolescents and its relationship to the chronic diseases

later on, the present study aimed to investigate the relationship between the physical activity and sedentary behaviors

with dietary behaviors of female high school students in the southeast of Iran. This cross-sectional study was conducted

in four public high schools in the southeast of Iran (Zahedan) on a sample of 457 female students of Tenth Grade. Infor-

mation collected using a self-reported 38-item questionnaire with the content validity ratio (CVR) of 0.79, the content

validity index (CVI) of 0.88 and the reliability () of 0.70. The data were analyzed by SPSS15 Software by linear and

logistic regression models. Physical activity and socio-economic class of students were predictors of their healthy dietary

behavior. Students who had spent much time in sedentary behaviors were more likely to consume fast foods.It is rec-

ommended to implement some combined interventions including training, consultation and environmental supports in

schools along with the focus on family intervention so as to strengthen and lengthen the effects of interventions.

KEY WORDS: PHYSICAL FITNESS, NUTRITION, TEENS

739

ARTICLE INFORMATION:

*Corresponding Author: ansaryalireza@yahoo.com

Received 2

Nov, 2017

Accepted after revision 28

Dec, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

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Online Contents Available at:

http//www.bbrc.in/

DOI: 10.21786/bbrc/10.4/20

740 ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS WITH DIETARY BEHAVIORS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Fariba Shahraki-Sanavi et al.

INTRODUCTION

Despite major plans of public health to increase the pub-

lic awareness regarding the promotion of healthy dietary

behaviors and physical activity of healthy people by

2020, these issues are still considered as major concerns

of the public health. (America’s Health Literacy: 2008)

Nowadays, non-communicable diseases have been prev-

alent in both developed and developing countries. It has

been well proven that poor dietary habits are directly

associatedwith the outbreak of some serious health

problems such as diabetes, cardiovascular diseases and

probably some types of cancers in the future life ofthe

adolescents. (Ogden et al 2012, Rao 2008).

In comparison, increased physical activity is related

to the lower blood pressure, body  tness and blood fat

regulation. It also reduces the depression and anxiety

and increases self-esteem and quality of life. On the other

hand, a decrease in the physical activity and increase in

the sedentary activitiesare signi cantly associated with

the risk of obesity, (Singh et al., Vuori 2010; Hills et al.,

2006; Andersen et al., 2011; Kantomaa et al., 2008; Motl

et al., 2004) cardiovascular health defects, (Ankoski et

al. 2011; Healy et al 2011; Henson et al. 2013) and mor-

tality. (León-Muñoz et al., 2013; Matthews et al. 2012).

Key indicator of bodily activity includes physical activ-

ity and activities with low mobility (sedentary activities),

while dietary behavior includes the diet and the number of

meals. (Jiménez-Pavón et al. 2011-Rodríguez et al., 2011).

The ideal diet for teenagers includes supplying needed

calories by eating nutrient foods such as fruits, vegetables,

dairy, whole grains, and low-fat protein and limiting the

consumption of high-fat foods and beverages. Then, it is

recommended for the teenagers to have healthy diet with

eating at least  ve portions of fruits and vegetables a day

and limiting fat intake to less than thirty percent of their

energy needs, (Nelson et al., 2005) as well as having at least

sixty minutes of moderate to severe physical activity most

of the days of the week and participation of two hours or

less per day in sedentary activities, (Sanchez et al., 2007).

However, some studies reported that only 30-40% of

teenagers have at least sixty minutes of physical activity

 ve times or more per week (Larsen et al. 2004) and the

level of sedentary activities increases in their older age.

(Driskell et al., 2008).

In addition, the nutritional trends suggest that most

teenagers don’t adhere to the recommended diet of serv-

ings  ve portions of fruits and vegetables a day, con-

suming dairy products two or more times a day, and

having grains six times a daywhereas they may not eat

breakfast regularly.In comparison, they may eat fast

food two or more times a week. (Larson et al., 2008) On

the other hand, nearly a quarter of their daily calorie

is supplied by having sugary drinks, (Harrington 2008).

Data suggest that in recent years, there has not only

been a decrease in the level of Iranian teenagers’ physical

activities, but their food tastes have also had a tendency

towards the high-calorie foods and the foods lacking of

nutritional value (Kelishadi et al. 2005).

However, healthy nutrition and regular physical

activities which are parts of the health promoting behav-

iors can preventwasting of costs, causingmorbidity, and

mortality (Lee and Loke 2005). Given the importance of

healthy nutrition and physical activity to maintain and

improve the public health, the currents study aimed to

investigate the relationship between the physical activ-

ity and sedentary behaviors, and dietary behaviors of

female high school students in the southeast of Iran

(Zahedan) so as to assess the current status of the ado-

lescent behaviors; then, the results can be used for plan-

ning of health promotion interventions in schools.

MATERIAL AND METHODS

The present cross-sectional school-based study was carried

out in the South East of Iran (Zahedan) in 2015. First, 4

female state high schools were randomly selected; then, all

students in Grade 10 (n = 457) wereenrolled in the study

through a census. The objectives of the study and the way

of answering the questionnaire were explained to the par-

ticipants. The subjects were entered into the study with

observing the ethical codes and voluntary. Data collected

via a self-reported questionnaire including demographic

questions (11 items), healthy dietary behaviors (14 items),

physical activity and sedentary behaviors (7 items), thesta-

tus of the school and description of the weight (6 items).

The questionnaire has content validity ratio (CVR) of 0.79,

the content validity index (CVI) of 0.88 and the reliability

() of 0.70 that examines the students’ nutritional status

and physical activity during the week before the study. The

minimum and maximum scores for nutrition were 14 and

64, respectively; for the physical activity dimension,the

minimum, and maximum scores were 7 and 47, respec-

tively. The questionnaires did not include any identify-

ing information and the students were explained that the

information was solely analyzed in thegroup. The allocated

time to complete the questionnaire was 15-20 minutes.

After collecting the data, they were analyzedby SPSS15

Softwareusing the linear and logistic regression models.

RESULTS

The study includeda total of 457 teenage girls of 10

Grade in the 14-17 age range and majority of them were

at the birth rank of 1-3. Half of their fathers were employ-

ees and their education levels were around diploma.

Most of their mothers were housewives and majority of

them had the high school diploma as well. Table 1 dem-

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS WITH DIETARY BEHAVIORS 741

Fariba Shahraki-Sanavi et al.

Table 1. The prevalence of dietary behaviors, Physical/sedentary activities and weightrelated

Percent (95% CI)Dietary behaviors

53.08(48.47-57.69)

24.45(20.48-28.41)

6.17(3.94-8.38)

12.11(9.10-15.12)

4.19(2.33-6.03)

Student who did not eat fruit drink 100% fruit juices

drank 100% fruit juices one to three day/week

drank 100% fruit juices four to six day/week

drank 100% fruit juices one times/day

drank 100% fruit juices two or more times/day

35.90(31.47-40.33)

35.24(30.83-39.65)

9.47(6.76-12.17)

14.54(11.28-17.79)

4.85(2.86-6.82)

Student who did not drink milk

drank milk one to three day/week

drank milk four to six day/week

drank milk one times/day

drank milk two or more times/day

47.80(43.18-52.40)

10.79(7.92-13.65)

6.83(4.49-9.15)

29.07(24.88-33.26)

5.51(3.40-7.61)

Student who did not drink a can or glass of cola or other

drank a can or glass of cola or other one to three day/week

drank a can or glass of cola or other four to six day/week

drank a can or glass of cola or other one times/day

drank a can or glass of cola or other two or more times/day

90.52(87.82-93.23)

5.50(3.40-7.61)

0.66(0.08-1.40)

2.20(0.84-3.55)

1.10(0.13-2.06)

Student who did not drink a can or glass of energy/Sports drank

drank a can or glass of energy/Sports drank one to three day/week

drank a can or glass of energy/Sports drank four to six day/week

drank a can or glass of energy/Sports drank one times/day

drank a can or glass of energy/Sports drank two or more times/day

3.74(1.99-5.49)

18.72(15.12-22.32)

28.85(24.67-33.03)

48.68(44.06-53.29)

Student who did not eat fruit

ate fruit one or two day/week

ate fruit three to six day/week

ate fruit  ve to seven day/week

13.44(10.28-16.58)

40.31(35.77-44.83)

28.41(24.24-32.57)

17.84(14.30-21.37)

Student who did not eat vegetables

ate vegetables one or two day/week

ate vegetables three to six day/week

ate vegetables  ve to seven day/week

10.57(7.73-13.41)

29.52(25.30-33.72)

36.12(31.68-40.55)

23.79(19.85-27.72)

Student who did not eat beef/lamb

ate beef/lamb one or two day/week

ate beef/lamb three to six day/week

ate beef/lamb  ve to seven day/week

7.93(5.43-10.42)

34.80(30.40-39.20)

34.14(29.76-38.51)

23.13(19.23-27.02)

Student who did not eat chicken/ sh

ate chicken/ sh one or two day/week

ate chicken/ sh three to six day/week

ate chicken/ sh  ve to seven day/week

5.95(3.76-8.13)

29.74(25.51-33.95)

25.77(21.73-29.80)

38.55(34.05-43.04)

Student who did not eat dairy products

ate dairy products one or two day/week

ate dairy products three to six day/week

ate dairy products  ve to seven day/week

10.35(7.53-13.16)

24.67(20.68-28.65)

46.26(20.68-28.65)

18.72(15.12-22.32)

Student who did not eat sweets/chocolate

ate sweets/chocolate one or two day/week

ate sweets/chocolate three to six day/week

ate sweets/chocolate  ve to seven day/week

18.94(15.32-22.56)

39.21(34.69-43.71)

24.01(20.06-27.95)

17.84(14.30-21.37)

Student who did not eat nuts

ate nuts one or two day/week

ate nuts three to six day/week

ate nuts  ve to seven day/week

23.79(19.85-27.72)

18.72(15.12-22.32)

39.87(35.34-44.38)

17.62(14.10-21.13)

Student who did not eat goody

ate goody one or two days/week

ate goody three to six day/week

ate goody  ve to seven day/week

Fariba Shahraki-Sanavi et al.

742 ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS WITH DIETARY BEHAVIORS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

40.31(35.77-44.83)

9.47(6.76-12.17)

42.73(38.16-47.29)

7.49(5.05-9.91)

Student who did not eat fast food

ate fast food one or two days/week

ate fast food three to six day/week

ate fast food  ve to seven day/week

11.45(8.51-14.39)

53.74(49.14-58.34)

Students who did not eat breakfast

ate breakfast on all 7 days

43.69(6.20)Mean of Dietary behaviors (SD)

Percent (95% CI)Physical/sedentary activities

46.56(32.11-41.01)

41.85(37.29-46.40)

13.44(10.28-16.58)

3.96(2.16-5.76)

4.19(2.33-6.03)

Student who did not participate in at least 60 minutes of physical activity

participated in physically active at least 60 minutes/day on 1 or 2 days/week

participated in physically active at least 60 minutes/day on 3 or 4 days/week

participated in physically active at least 60 minutes/day on 5 or 6 days/week

participated in physically active at least 60 minutes/day on all 7 days

50.00(45.38-54.61)

40.97(36.42-45.50)

4.41(2.51-6.30)

1.54(0.40-2.67)

3.08(1.48-4.67)

Student who did not participate in muscle-strengthening activities

participated in muscle-strengthening activities on 1 or 2 days/week

participated in muscle-strengthening activities on 3 or 4 days/week

participated in muscle-strengthening activities on 5 or 6 days/week

participated in muscle strengthening activities on all 7 days

70.26(66.04-74.48)

21.59(17.78-25.38)

6.61(4.31-8.90)

1.54(0.40-2.67)

Student who did not go to jam

went jam on 1 or 2 days/week

went jam on 3 or 4 days/week

went jam on 5 days/week

49.34(44.72-53.95)

44.05(39.46-48.63)

6.61(4.31-8.90)

Student who did not play video or computer games or used a computer

played video or computer games or used a computer for 1 to 2 hours/day

played video or computer games or used a computer for 3 or more hours/day

9.03(6.38-11.67)

55.95(51.36-60.53)

35.02(30.61-39.42)

Student who did not watch television

Student who watched 1 to 2 hours/day of television

Student who watched 3 or more hours/day of television

38.99(34.48-43.49)

37.00(32.54-41.46)

24.01(20.06-27.95)

A student who did not use mobile (whats up, Viber, email, …)

used mobile (whats up, Viber, email, …) 1 to 2 hours/day

used mobile (whats up, Viber, email, …) 3 or more hours/day

22.49(4.84)Mean of Physical/sedentary activities (SD)

Weight-related

4.41(3.76-8.13)Student who described themselves as Obese

22.25(11.08-17.55)Student who described themselves as Overweight

53.08(48.47-57.69)Student who described themselves as Normal weight

14.32(18.40-26.08)Student who described themselves as low weight

5.95(2.51-6.30)Student who described themselves as Underweight

onstrated the prevalence of dietary behaviors, Physical/

sedentary activities and weight related variables. As can

be seen, teenagers who do not have all-natural juice

and milk twice a day or more were about 4 and 5 %,

respectively. Nearly half of them had fruits every day,

18% vegetables, 15% milk and dairy products, and 18%

nuts. In addition, nearly half of the surveyed adolescents

reported the least level of daily physical activity and

stretching exercises. The percentage of adolescents who

spend more than two hours a day for sedentary activi-

ties including working with the computer, watching

TV, using cell phones and social networks were about

35.7 and 24 %, respectively. Moreover, about 4% of stu-

dents reported to be overweight and 6% reported severe

weight loss.

The physical activity and socio-economic classeswere

predictors of the healthy nutritional behavior (Table 2).

The results (Table 3) also showed that, there is a posi-

tive signi cant relationship between the consumption of

fast foods and behaviors related to the physical activity

in the studied high school students.

DISCUSSION

The  ndings of the present study illustrated that the

majority of the studied adolescents do not have daily

all-natural juiceand less than a quarter of them do not

eat, milk. Almost half of them have daily breakfast,

fruits and less than a quarter of them eatonce or more

Fariba Shahraki-Sanavi et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS WITH DIETARY BEHAVIORS 743

Table 2. Linear Regression Test for the Prediction of Healthy Dietary Behaviors of the Studied Adolescents

Dietary

Independent

Variable

Unstandardized

Coef cients

Standardized

Coef cients

t P value

B Std.Error Beta

Physical/sedentary activities 0.33 0.05 0.26 5.84 0.001

Family Economy

0.99 0.38 0.11 2.56 0.01

Table 3. Binary Logistic Regression for ate fast food with Sedentary-related behaviors

Fast food OR (95% CI)Sedentary Behavior

Reference

0.63(0.43-0.94)*

Watched TV ≥2 hours per day

Yes

Reference

0.55(0.36-0.84)**

Used mobile (whats up, Viber, email, …) ≥2 hours per day

Yes

Reference

0.54(0.28-1.03)*

Played video or computer games or used a computer for something other than school

work≥2 hours on an average school day

Yes

Ate at least one meal or snack at a fast food restaurant ≥1 day/week

*p<0.05

**p<0.01

 zzy sugary drinks daily. Half of them do the least level

of physical activity and stretching exercises and almost

a third of them are engaged in sedentary activities. A

quarter of them were overweight or obese. A statisti-

cal signi cant relationship was observed between the

unhealthy nutrition and physical activity behavior and

socio-economic classes of the student and between the

fast food consumption and sedentary behaviors.

The results indicate that the removal of breakfast

meal among the students ranged from 1.7 to 30% and

having daily breakfast reported to be 31-33%.The results

also suggest the high level of not having breakfast in

female students and its growing prevalence rate with

the low socio-economic status and higher ages. Students

who eat breakfast regularly, have healthier food choices

and adolescents who go to school without having break-

fast, their typical foods are chips, popcorn and sugary

drinks. In this regard, the results of the present study are

consistent with the previous ones.

Regarding the consumption of milk and dairy prod-

ucts at least 1-3 times a day, the consumption level has

been reported to be 2-25.1% and lack of consumption of

the same group reported to be 14.8 – 22.4 % ; however,

it has been reported that 98% of Swedish adolescents

use milk and its products at least once a day. Similar

to previous studies, the subjects in the present study,

despite the daily distribution of milk in schools, use milk

and dairy products at the lower level.

With respect to the consumption of fruits and veg-

etables, the results of previous studies indicate that 11.5

– 68.2 % of adolescents in different countries have daily

natural juices and fruits, and 11.6 – 58% of them eat

fruits and vegetables at least once or more a day. In a

study in Iran, the mean frequency of the consumption of

fruits and vegetables among the students were 1.2 and

1.1 times a day, respectively. In the present study, the

consumption of natural juices was at the lower level, but

due to the availability of fruits in Iran, almost half of the

students have daily fruit consumption. However, like the

previous studies, the consumption level of vegetables

was at the lower level.

In the present study, the consumption of red and

white meat was observed only in one quarter of the stu-

dents. While the consumption level of red meat among

the adolescents of Syrian and Swedish has been reported

equal to 62% and 82 % a day, respectively.According

to other studies, high-protein diets containing red meat

would also be resulted in weight control.

The results of studies re ect lower consumption of

fruits, vegetables,  sh, dairy products and eggs among

adolescents; they also get more unhealthy foods like

French fries, burgers, sugary drinks and a variety of

jellies. Due to containing high sugar and energy, sodas

cause to overweight and reduced consumption level of

fruits, vegetables and dairy products. However, this rela-

tionship has not been seen in some studies. In the pre-

Fariba Shahraki-Sanavi et al.

744 ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS WITH DIETARY BEHAVIORS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

sent study, half of the students had  zzy sugary drinks

more than twice a day.

The prevalence of watching TV more than 2 hours a day

among the American students showed a signi cant reduc-

tion from 43% in 1999 to 32% in 2013 and an increase

to 43.3% in 2015. There has also been an increase in the

time allocated to using computer and playing video games

from 22% in 2003 to 43% in 2015. In comparison, Iranian

female adolescents were similar to American teenagers in

this regard; however, the prevalence of reduction in the

physical activity and sedentary behaviors in Jordanian

adolescents was reported to be at higher level; and in

European adolescents, the results showed that only 18%

of them have consistently healthy behaviors and 21% of

them had consistently unhealthy behaviors.The percentage

of watching TV in the studied adolescents was similar to

the results of above-mentioned studies, but the time spent

on computer games was lower in this population.

The results indicate that nearly one- third of adoles-

cents had daily fast food and nearly a quarter of them

eat fast food more than three times a week; in the fami-

lies with high income and residents of the North of the

city, the level of fast food consumption was high. The

results indicate that one of the factors in uencing the

food choices in adolescents is their socio-economic sta-

tus. On the other hand, consumption of fast foods and a

sedentary life style are among the factors of overweight

in adolescents.Like the previous studies, fast consump-

tion level was high. Furthermore, a signi cant relation-

ship was observed between the socio-economic status of

students and their orientation to unhealthy nutrition. In

general, the role of the family’s economic status on food

choices can be justi ed due to the increased purchasing

power and access to a variety of foods.

The prevalence of overweight in female Asian teens

was reported 6.2 – 18.9 % and the obesity 1.8 – 4.7 %;

the overweight in adolescents of Spain, Mexico, Ecua-

dor, Jordan, Taiwan, the U.S, and New Zealand has been

reported to be 8.3 – 26.6 % and the obesity 3.9 – 18%.

The results showed that the prevalence of overweight or

obesity among the Filipino teens has had a reduction

from 11.4 % in 2003 to 9.4% in 2011. Similar descrip-

tion of weight with Asian teens has been reported in the

present study by our participants.

The results demonstrated a relationship between the

sedentary behaviors and less healthy diet. The adoles-

cents who watch TV more than 5 hours a day and don’t

exercise are more likely to consume fast foods.The pre-

sent study also showedthat adolescents with more sed-

entary activities have more chances to use fast foods.

Said the reasons for this might be the fact that adoles-

cents who watch TV more and have less physical activ-

ity are more inclined to the advertised foods and they

normally eat more food while watching TV.

According to the results and since the health promo-

tion of this age range can be effective in the preven-

tion of non-communicable diseases in the developing

countries, it’s recommended to establish the necessary

measures to comply with the principles of healthy life-

style habits, because subsequent attempts to change

the established habits will be very dif cult and perhaps

impossible. On the other hand, given the importance of

the family in Iran and due to the emotional and  nan-

cial dependency of adolescents to families in this age

range, the strong impact of family support on physi-

cal activity and dietary behaviors of students is logical.

Therefore, designing training programs with an empha-

sis on the central role of the family can be effective in

the promotion of healthy dietary behaviors and doing

physical activities in this age group. Therefore, it’s also

necessary to design and implement interventions based

on behavior change for adolescents in the schools.

LIMITATION

Students participated in this study were limited to the pub-

lic schools and grade 10, therefore, are not representative

of all adolescents in this age group. In addition, the data

collected are based on a self-administered questionnaire.

ACKNOWLEDGMENTS

This article was part of the Ph.D. dissertation. The Study

was funded by Zahedan University of medical science

with grant number 2772 and ethical number IR.ZAUMS.

REC.1394.251. Therefore, authors would like to express

their gratitude to the Zahedan University of Medical Sci-

ences, the Health Promotion Research Center, the District

Department of Education and the school heads, teachers

and students who helped conduct this study.

CONFLICT OF INTEREST

The authors declare that they have no con ict of interest.

AUTHORS CONTRIBUTIONS

The overall implementation of study design, data man-

agement and analysis and manuscript preparation were

the results of join efforts by multiple individuals who are

listed as coauthors of this paper. All authors read and

approved the  nal manuscript.

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