Gender differences in the proportion of Japanese parents meeting recommendations within 24- hour movement guidelines and associations with weight status

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Tremblay, Shigeho Tanaka This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3534444/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Canadian 24-h movement guidelines were developed to improve health of adults. Parents’ healthy behaviours are especially important because they are also role models for their children. The purpose of this study was to evaluate adherence to the three recommendations associated with health in the Canadian 24-h movement guidelines and their relationship with weight status (underweight or obesity) in Japanese parents. Methods This cross-sectional study included 425 mothers and 237 fathers who had children < 13 years of age. Weight status according to measured body mass index (BMI) was classified by < 18.5 kg/m 2 and ≥ 25 kg/m 2 as the cut-off for underweight and obesity, respectively. Meeting the 24-h movement guidelines was defined as: ≥150 min/week of moderate-to-vigorous physical activity (MVPA) (Canadian PA recommendation) or at least 60 min/day of MVPA (Japanese PA recommendation), ≤ 8 h/day of sedentary time which includes ≤ 3 hours of recreational screen time, and 7 to 9 h/night of sleep. MVPA and sedentary time were accelerometer-determined while and screen time and sleep duration were self-reported. Results The prevalence of mothers meeting all three recommendations was 30.6% using Canadian physical activity guidelines and 20.7% using Japanese physical activity guidelines, while that of fathers was 10.6% and 8.0%, respectively. Mothers not meeting the sedentary behaviour recommendation had a lower odds ratio and those not meeting Japanese PA recommendations had a higher odds ratio for underweight compared to mothers meeting the recommendations, adjusted for age and area socioeconomic status. Conclusions The screen time recommendation or Japanese PA recommendation were associated with underweight in mothers. None of the recommendations was associated with weight status in fathers. Further research is needed to understand the relationships among movement behaviours and weight status, particularly among Japanese women, whose routine behaviours may be misclassified as sedentary. physical activity sedentary behaviour sleep body weight adults Background Underweight and obesity are associated with elevated risks of adverse health outcomes [ 1 ]. There is a difference in the prevalence of obese and underweight adults among countries according to the NCD Risk Factor Collaboration [ 2 ]. The prevalence of underweight was highest in South Asia. In the 2009 and 2016 National Nutrition Surveys in Japan, the prevalence of underweight defined as body mass index (BMI) < 18.5 kg/m 2 went from 11.0–11.5% for women and from 4.4–3.9% for men; and obesity defined as BMI ≥ 25 kg/m 2 went from 20.8–22.3% for women and from 30.5–33.0% for men [ 3 ]. These results show clear gender differences in weight status and worrying increases in the prevalence of Japanese adults at risk. Underweight was especially prominent among women in their twenties at 29.0% as found in a nationwide study in 2010 [4]. This is most likely because young adult women in Japan desire thinness more than other age groups [ 5 ]. Recently, the number of low birth weight infants (＜2500 g) has increased in Japan (6.3% in 1990 vs 9.4% in 2019) [ 6 ]. In comparison to other Organization for Economic Co-operation and Development (OECD) countries, the percentages were remarkably high [ 6 ]. A previous systematic review reported that underweight women had an increased risk of having a low birth weight infant [ 7 ]. Health Japan 21 (the second term) from 2013 to 2023 established by the Minister of Health, Labour, and Welfare set reductions in percentages of underweight women in their 20s and low birth weight infants, as specific targets[ 8 ]. Twenty-four hour movement guidelines (physical activity, sedentary time, and sleep duration) for adults were developed recently in Canada [ 9 ]. Meeting the overall 24-h movement guidelines for adults aged 18–64 years was defined as: ≥150 min/week of moderate-to-vigorous physical activity (MVPA), ≤ 8 h/day of sedentary time which includes ≤ 3 hours of recreational screen time, and 7 to 9 h/night of sleep. These new guidelines recognize and acknowledge the importance and codependency of movement behaviours throughout the whole day and their interactions with each other [ 10 , 11 ]. A previous review reported that the composition of movement behaviours within a 24-h period may have important implications for health at all ages and that meeting the current 24-h movement guidelines is associated with a number of desirable health indicators in children and youth [ 12 ]. Thus, 24 movement-behaviours are important for both parents and children. In contrast to Canada, Japan has only PA guidelines for adults (≥ 60 min/day of MVPA)[ 13 , 14 ]. Many studies have shown a negative association between obesity and 24-h movement behaviour adherence in adults [ 12 ]. Most of the studies have been reported from Western countries and only a few from Asian countries [ 12 ]. In addition, a few previous studies on adults indicated that the level of physical inactivity in underweight adults was similar to obese adults [ 15 – 18 ]. In general, studies that show the association between underweight adults and 24-h movement behaviours are lacking, although there have been a few physical activity studies using self-report questionnaires for underweight adults [ 15 – 18 ]. Recently, Lee et al. [ 19 ] reported that objectively measured sitting time for underweight Korean adults was significantly longer on weekdays than among counterparts who were obese. To our knowledge, no study has assessed the relationship between underweight and 24-h movement behaviours for adults with an accelerometer for both women and men. In a previous study on Japanese preschool children, underweight, rather than excess weight, was associated with decreased physical activity [ 20 ]. For Japanese primary school children, the screen time recommendations or combinations including screen time recommendations were associated with overweight/obesity, while none of the recommendations were associated with underweight [ 21 ]. Furthermore, physical activity and sedentary behaviour research on parents has overwhelmingly focused on mothers [ 22 , 23 ]. Therefore, the purpose of the present study was to examine the differences in habitual MVPA across different weight status for Japanese mothers and fathers, using objectively evaluated physical activity with triaxial accelerometry. Accordingly. we examined the proportions of participants who met each of the MVPA for Canadian and Japanese guidelines, sedentary time, and sleep duration recommendations and combinations of these recommendations, and evaluated their relationship with weight status in Japanese mothers and fathers. Methods Participants were Japanese adults living in the Kanto area and Kyoto in Japan. We employed data from a cross-sectional study of Japanese preschool and elementary school children and parents. Flyers were distributed in the schools to invite participants to join the study and all participants and their parents gave their informed consent. All reported being in good health, without a history of conditions affecting physical activity (e.g., abnormal thyroid gland function or orthopedic disease). Pregnant women were excluded. A total of 425 mothers and 237 fathers were included in the convenience sample. The Ethical Committee of J. F. Oberlin University (Approval no: 10007; 12023) approved the study protocol. Anthropometric, MVPA, sedentary time, screen time and sleeping time measurements were collected during the school year between November 2010 and January 2015. The initial sample from 7 preschools and 14 elementary schools comprised 891 participants, among whom 225 parents were subsequently excluded because of accelerometer data not conforming with the study criteria (see below) [n = 144], accelerometer loss [n = 5], revocation of the consent [n = 38], history of conditions affecting physical activity [n = 50], or pregnant mothers [n = 2], non-Japanese [n = 3], or no questionnaire data [n = 45]. Data analysis was carried out on the remaining 662 parents. No significant difference in age or BMI in each gender was observed between the sample used in the analyses and parents excluded (106 mothers and 119 furthers) from the analyses. Weight status Height and weight are measured in increments of 0.1 cm and 0.1 kg respectively at schools or employee health checks. Height was measured without shoes. Body weight was measured without shoes, in light clothing. Net body weight was calculated as the weight of clothing subtracted from the measured body weight. Clothing for each participant included pants and a shirt corresponding to a 1.0 kg deduction. BMI was calculated as weight in kilograms divided by height in meters squared. To evaluate the prevalence of underweight and obesity, we defined a BMI of < 18.5 kg/m 2 and ≥ 25 kg/m 2 as the cut-off for underweight and obesity according to the criteria set by the Japan Society for the Study of Obesity [ 24 ]. Objective measurement of physical activity and sedentary time Habitual MVPA and sedentary time were measured with a triaxial accelerometer (Active style Pro HJA-350IT, OMRON HEALTHCARE, Kyoto, 74×46×34 mm and 60 g including batteries). Details on the accelerometer have been published elsewhere [ 25 ]. The Active style Pro was set to record in 10-sec epochs, and the value for 1-min epochs was calculated as the mean value of physical intensity in 10-sec epochs. Physical activity was monitored continuously for 6–10 days. Participants were requested to wear these devices at all times, except when dressing and bathing. Periods with over 60 minutes of consecutive zero counts were considered to be non-wearing time. A valid day was defined as having ≥ 600 min (10 hours) wear time. Participants with data from at least 2 weekdays and 1 weekend day were included in the analysis [ 26 ]. These data acceptance/reduction criteria were similar to those in other papers [ 27 ]. A macro program developed and distributed by Japan Physical Activity Research Platform ( http://paplatform.umin.jp (in Japanese)) was used for processing of the accelerometer data. Screen time and sleep duration Screen time and sleep duration were evaluated through self-report questionnaire. Time spent viewing television and videos, playing electronic games and using a personal computer in leisure time were assessed using the following two questions: 1) “How many hours of television and video movies do you usually watch? and 2) “How many hours in a single day do you usually use a personal computer or play electronic games (including television, personal computer, portable game machines, etc.)? (a) in a week day or (b) a weekend day. Participants were also asked: “What time do you usually go to bed?” and “What time do you usually get up?” Statistical Analysis The average number of minutes spent in sedentary behaviour (metabolic equivalents, (METs) ≤ 1.5) and MVPA (METs ≥ 3.0) for each of weekday and weekend days was calculated. For the MVPA and sedentary time data, the average weekly values were calculated as [((mean for weekdays × 5) + (mean for weekend days × 2))/7]. The proportions of participants meeting each of the weekly MVPA (≥ 150 min/week for Canadian PA guideline or ≥ 60 min/day for Japanese PA guideline (Ministry of Health, Labour and Welfare, Japan 2013; Miyachi 2015)), sedentary time (≤ 8 h/day which includes ≤ 3 hours of recreational screen time), and sleep recommendations (7 to 9 h/night) [ 9 ], and combinations of these recommendations were determined. A Mann–Whitney's U was used to compare age, body height, body weight, BMI, MVPA, sedentary time, screen time and sleep duration between mothers and fathers. Weight status was compared by the Cramer's V. Associations between meeting recommendations versus not meeting (separately or in combinations of recommendations) with underweight or obese were assessed with odds ratios obtained from polytomous logistic regression analysis adjusted for age and socioeconomic status (SES) of each school, with normal weight group as a reference. A higher odds ratio means that not meeting the recommendation is related to being underweight or obese. SES was evaluated by an average annual income within a 4 km buffer of each school, because students in public primary school come from their home within 4 km of each school [ 28 ]. SES was estimated by Zenrin Geo Intelligence Co. Ltd., using the statistical data of the Population Census in 2015 and Housing and Land Survey in 2013 by the Statistics Bureau, Ministry of Internal Affairs and Communications. All statistical analyses were conducted using IBM SPSS statistics 28.0 for Windows (IBM Co., Tokyo, Japan). Results are presented as median and interquartile range or percentage. P-value < 0.05 was taken to indicate statistical significance. Results A total of 425 mothers and 237 fathers were included in the convenience sample. Table 1 shows descriptive characteristics of the participants. In the sample, 75.4% were in the normal weight category. Age, body height, body weight, BMI and screen time for fathers were significantly higher or longer than those of mothers. Sleep duration for fathers was shorter than that of mothers. Table 1 Descriptive characteristics of participants. Mothers (n: 425) Fathers (n: 237) Mann–Whitney's U p-value Median IQR Median IQR Age (years) 40.7 37.8 - 43.9 41.6 38.3 - 45.3 43928.0 0.006 Height (cm) 158.6 155.1 - 162.5 171.0 168.5 - 175.9 3736.0 < 0.001 Weight (kg) 51.4 47.2 - 56.1 68.0 62.0 - 73.9 6967.5 < 0.001 Body mass index (kg/m 2 ) 20.2 18.9 - 21.9 23.3 21.3 - 24.9 23402.0 < 0.001 Weight status (%) (n) (%) (n) Cramer's V Obesity 6.4 27 23.2 55 0.293 < 0.001 Normal weight 76.7 326 73.0 173 Underweight 16.9 72 3.8 9 MVPA (min/day) 67.6 51.9 - 90.9 64.2 49.4 - 85.7 49020.5 0.503 Sedentary time (h/day) 7.5 6.4 - 8.6 9.4 7.8 - 10.9 46861.0 0.137 Screen time (h/day) 1.9 1.0 - 3.0 2.1 1.1 - 3.2 24443.0 < 0.001 Sleep duration (h/day) 7.0 6.0 - 7.5 6.8 6.0 - 7.5 54980.0 0.043 Abbreviations: BMI: body mass index, MVPA moderate-to-vigorous physical activity, IQR: interquartile range. Table 2 shows the proportions of the participants who met each of the MVPA, sedentary, and sleep duration recommendations, and combinations of these recommendations. The proportions were higher for mothers than for fathers in all recommendations and combinations of these recommendations. The proportions of the mothers and fathers who met of the MVPA recommendation for the Canadian guidelines were 99.8% and 98.6%, respectively. Table 2 Proportion of participants who met the MVPA, screen time, and sleep duration recommendations and combinations of these recommendations. Canadian physical activity guideline Japanese physical activity guideline MVPA ST SLEEP MVPA + ST MVPA + SLEEP ST + SLEEP MVPA + ST + SLEEP None MVPA* MVPA* + ST MVPA* + SLEEP MVPA* + ST + SLEEP None* (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Mothers 99.8 65.4 50.1 52.8 50.1 30.6 30.6 0.2 60.5 34.6 31.1 20.7 12.5 Fathers 98.6 20.3 42.9 20.3 42.4 10.6 10.6 0.9 57.8 15.2 21.9 8.0 18.1 Meeting the recommendations is defined as ≥ 150 min/week for MVPA, ≤ 8 h/day of sedentary time which includes ≤ 3 hours of recreational screen time and 7 to 9 h/night of sleep. MVPA*: meeting the recommendations in Japan is defined as ≥ 60 min/day for MVPA. MVPA and sedentary time were accelerometer-determined while and screen time and sleep duration were self-reported. MVPA: moderate-to-vigorous physical activity, ST: sedentary time and screen time, SLEEP: sleep duration. None: percentage of participants meeting none of the MVPA, ST or Sleep recommendations. Table 3 provides the odds ratios for underweight or obesity associated with not meeting versus meeting the physical activity, sedentary behaviour, and sleep duration recommendations, and combinations of these recommendations. Most mothers and fathers met the MVPA recommendation for the Canadian guideline and the number of underweight fathers was only 9; therefore, odds ratios for these variables were not analyzed. For mothers, participants not meeting the sedentary behaviour recommendation had a lower odds ratio for underweight compared to those meeting the recommendations, and participants not meeting the physical activity recommendation for Japanese had a higher odds ratio for underweight compared to those meeting the recommendation. Participants meeting neither of the sedentary behaviour recommendation and PA recommendation for Japanese had a higher odds ratio for obesity compared to those meeting both of the recommendations. None of the individual or combinations of the recommendations were associated with obesity for fathers. Table 3 Odds ratios for underweight and obesity associated with not meeting vs. meeting physical activity, sedentary behaviour, and sleep duration recommendations. Mothers n OR 95% CI P n n OR 95% CI P Not meeting the following recommendation(s) Underweight (n = 72) Normal weight (n = 326) Obesity (n = 27) PA* 37 1.89 1.12 - 3.17 0.02 118 13 1.63 0.74 - 3.59 0.23 ST 25 0.54 0.32 - 0.92 0.02 161 14 1.14 0.52 - 2.50 0.75 SLEEP 36 1.09 0.65 - 1.84 0.75 164 13 0.90 0.41 - 2.00 0.80 PA + ST* 50 1.32 0.76 - 2.30 0.32 205 23 3.59 1.21 - 10.68 0.02 MVPA + SLEEP* 55 1.68 0.92 - 3.05 0.09 218 20 1.43 0.58 - 3.50 0.44 All three recommendations* 59 1.29 0.67 - 2.51 0.45 255 23 1.71 0.57 - 5.12 0.34 Fathers Meeting the following recommendation(s) Underweight (n = 9) Normal weight (n = 173) Obesity (n = 55) PA* 67 29 1.62 0.86 - 3.04 0.13 PA 2 1 1.24 0.10 - 15.01 0.87 ST 133 47 1.63 0.70 - 3.77 0.26 SLEEP 95 31 1.01 0.55 - 1.89 0.96 PA + ST* 142 50 2.07 0.75 - 5.72 0.16 PA + SLEEP* 129 48 2.02 0.84 - 4.86 0.12 All three recommendations* 156 53 2.49 0.55 - 11.36 0.24 Associations between not meeting these recommendations versus meeting (each or combinations of recommendations) with underweight or obese were assessed with odds ratios obtained from polytomous logistic regression analysis. Models adjusted for age and SES of each school, with normal weight group as a reference. A higher odds ratio means that not meeting the recommendation tends to be underweight or obese. Meeting the recommendations is defined as ≥ 60 min/day for MVPA, ≤ 8 h/day of sedentary time which includes ≤ 3 hours of recreational screen time, and between 7 to 9 h/night for sleep duration. OR: odds ratio, CI: confidence interval, P: p-value, MVPA: moderate-to-vigorous physical activity, ST: sedentary time and screen time, SLEEP: sleep duration. Discussion The present study examined the adherence to each of the physical activity, sedentary behaviour, and sleep duration recommendations (and combinations of these recommendations) and evaluated their relationship with underweight and obesity in Japanese parents who had children ≤ 13 years of age. Almost two thirds of parents met one or more of the recommendations, but very few met all three recommendations, especially for fathers (10.6% for Canadian PA guideline, 8.0% for Japanese physical activity guideline). Nearly all mothers (99.8%) and fathers (98.6%) met the Canadian physical activity guideline while, the Japanese physical activity guideline was met by 60.5% of mothers and 57.8% of fathers. For mothers, 65.4% met the sedentary behaviour recommendation, and 60.5% met the Japanese physical activity recommendation. For fathers, approximately 57.8% met the Japanese physical activity recommendation and 42.9% met the sleep duration recommendation. Mothers not meeting the Japanese physical activity recommendation had a higher odds ratio and those not meeting the sedentary behaviour recommendation had a lower odds ratio for underweight than those who met the corresponding recommendation. Moreover, mothers not meeting the combination of the sedentary behaviour and Japanese physical activity recommendations had a lower odds ratio for obesity than participants who met both of the recommendations, although the number of obese mothers was only 4. This study is the first to examine the prevalence of 24-h movement guidelines in Japanese adults. To our knowledge, it is also the first study to examine the association of movement behaviours employing direct measures of physical activity and sedentary behaviour with weight status in Japanese adults. In the previous studies in Asian countries, Liangruenrom et al. [ 29 ] found that the prevalence of adults who met the physical activity, sedentary behaviour, sleep, and overall recommendations was 81.7%, 44.6%, 56.4%, and 21.3% in Thai adults, respectively. Kastelic et al. [ 30 ] reported 9%, 8%, 9% and 25% by using a questionnaire among Slovenian residents, respectively. Lee et al. [ 19 ] found that the proportions of adults meeting the physical activity and sleep guidelines in Korea were, 48.8% and 57.6% in women; 55.5% and 54.0% in men, respectively. However, there are limitations when making direct comparisons of results, as there are differences in methodology used to assess movement behaviours, criteria of the 24-h movement behaviour guidelines and sampling of participants. For example, the Thailand study used a 24-h time-use dairy. The overall 24-h movement behaviour guidelines in their study included meeting MVPA (defined as ≥ 150 min/week), interrupting sedentary behaviour every 2 h and sleep (7–9 h/day) recommendations. The Korean study used questionnaires to estimate daily MVPA and sedentary behaviour, and a single question for sleep duration. Their overall 24-h movement behaviour guideline included meeting MVPA (defined as ≥ 600 METs minute/week) and sleep (7–9 h/day) recommendations and not having high sitting time (≥ 9 h/day). Ferrari et al. [ 31 ] reported the prevalence of adults who met the overall recommendations (all 3 behaviours) from eight Latin American countries was 1.6%. With respect to individual movement behaviour recommendations, the proportions meeting each of the recommendations was 58.7% in men and 39.4% in women for physical activity, 21.2% and 22.7% for sedentary behaviour (collected using accelerometers), and 22.8% and 16.5% for sleep time. Their criteria of the overall 24-h movement behaviour guideline included at least 150 min/week of MVPA, ≤ 8 h/day in sedentary behaviour, and between 7 and 9 h/day of sleep. Sedentary behaviour for Japanese fathers in the present study was only similar to the Latin American study [ 31 ]. Other percentages were considerably higher in our study. However, there are also differences in methodology used to assess movement behaviours, criteria of the 24-h movement behaviour guideline and participant sampling procedures. There are several previous studies on the differences among women and men in 24-h movement behaviours. Lee et al. [ 19 ] reported that women had less unfavorable patterns of 24-h movement behaviours than men. Ferrari et al. [ 31 ] also reported that the number of guidelines being met was higher in men than women. In contrast, Liangruenrom et al. [ 29 ] found the lowest odds for meeting the 24-h guidelines were among males. Two previous studies explored Japanese physical activity recommendations by using the same accelerometer as the present study. Tanaka et al. [ 32 ] found that accumulating MVPA 60 min/day or 30 min/day in women (35.3 ± 7.4 years) and men (36.6 ± 8.1 years) were 76% or 97%, and 68% or 96%, respectively. Amagasa et al. [ 33 ] did not find significant gender differences in the proportions adhering to the 2020 WHO physical activity guidelines (≥ 150 min/week of MVPA, women: 95.8% and men: 93.1%) nor to the Japanese physical activity guidelines for health promotion 2013 (≥ 23 MET h/wk of MVPA, women: 63.2% and men: 63.0%), although their mean age was higher than that of present study (52.1 ± 7.0 years in women; 52.5 ± 7.3 years in men). The percentages of the present study were slightly lower than those of the previous Japanese studies. The inconsistency between Korean and Latin American countries studies and the present study might be attributable in part to the fact that Japanese females may spend more time than women in other countries doing activities classified as household activities. The Statistics Bureau of Japan [ 34 ] reported that compared to US and European countries, the time spent by Japanese men on childcare is extremely short. According to data from the Basic Survey of Social Life of the Ministry of Internal Affairs and Communications, Japanese men spend an average of 1 hour 23 minutes a day on housework and childcare (including 49 minutes on childcare), compared with 3 hours 12 minutes in Norway (including 73 minutes on childcare). Japanese women spend an average of 7 hour 34 minutes a day on housework and childcare (including 3 h 45 minutes on childcare), compared with 5 hours 26 minutes in Norway (including 2h 17 minutes on childcare). This gender gap has remained almost unchanged since 1996, although the women’ share of time spent on housework has been decreasing over the long term [ 35 ]. Liangruenrom et al. [ 29 ] also reported that Thai adults who were married were found to be more likely to meet the physical activity, sedentary behaviour, sleep, and overall 24-h movement guidelines compared to those who have never been married. Thai women tended to meet the sedentary behaviour, sleep, and the overall guidelines more than males. Traditional gender roles might affect Japanese mother’s MVPA and sedentary behaviour. Another reason for relatively higher MVPA in women may be that the accelerometer used in the present study can capture household activities relatively accurately [ 25 , 36 ], while most common algorithms to predict METs tend to underestimate household activities [ 37 ]. Many household activities correspond to activity of ≥ 3 METs, as reported by Ainsworth et al. [ 38 ], carpet sweeping, sweeping floors, mopping, vacuuming, carpentry, bagging grass, etc. while childcare is reported as 2.0 to 3.0 METs. Previous studies that show an association between underweight adults and physical activity are lacking, although there have been a few studies using a questionnaire for underweight adults [ 15 – 18 ]. To our knowledge, no study has assessed the relationship between underweight and 24-h movement guidelines for adults with an accelerometer. In our previous study on Japanese preschool children, underweight, rather than excess weight, was associated with decreased physical activity [ 32 ]. However, another previous study of ours showed that adherence to the 24-h movement guidelines was not associated with underweight in Japanese primary school children [ 21 ]. None of the recommendations was associated with underweight in both boys and girls. In the present study, we could not examine the association in fathers, because of the low proportion of underweight participants in the present study (3.8%) (note the percentage was similar with that of a National Survey [4]). For mothers, not meeting the Japanese physical activity recommendation was related to being more likely to be underweight. Moreover, not meeting the sedentary behaviour recommendation was related to being less likely to be underweight. Li et al. [ 39 ] found that physical fitness level was poorer among underweight Chinese college students than among their normal-weight counterparts. These findings suggest that being underweight may hinder an active lifestyle because of the lack of physical fitness or vice versa, that is, that inactive lifestyle may lead to underweight. It should be highlighted that underweight mothers may benefit from interventions aiming to increase MVPA, although the causal relationship is unknown in the present study. It should also be acknowledged that current evidence for the association between adherence to 24-h movement guidelines and underweight in adults is still understudied in Japan. Kelly et al. [ 16 ] showed that underweight individuals were significantly more inactive than adults with acceptable weight or overweight, indicating a U-shaped relationship between BMI and physical activity in England. Churilla et al. [ 18 ] also indicated that the odds of reporting physical inactivity in underweight women or men in the United States were 1.57 and 1.65, respectively, compared with women or men of desirable weight. Those odds were similar in underweight and class I obese women or men. Furthermore, Churilla et al. [ 17 ] reported that underweight, overweight, and obese BMI categories possessed higher odds of not meeting current physical activity guidelines. In contrast, relationships between underweight prevalence and lower levels of physical activity assessed by questionnaire among adults in Laos and Kenya were non-significant [ 40 , 41 ]. Moreover, sedentary behaviour was also positively associated with underweight in Afghanistan adults (adjusted relative risk ratio: 1.85, 95% CI: 1.11–3.10) [ 42 ]. Thus, the relationship between underweight and physical activity and/or sedentary behaviour are controversial, although a direct comparison with our findings is limited because of differences in methodology used to assess movement behaviour. Further research using direct measure methods such as accelerometers is needed. Previous studies have examined the relationship between adherence to 24-h movement guidelines and adiposity markers in adults [ 9 , 31 , 43 ]. These studies found that the distribution of time spent in 24-h movement behaviours was significantly associated with overweight/obesity. For example, Rollo et al. [ 43 ] reported that compared with adults meeting two or fewer recommendations, those who met all three recommendations had more favorable BMI. Ferrari et al. [ 31 ] also found that meeting physical activity and sedentary behaviour recommendations measured using the GT3X + ActiGraph (ActiGraph LLC, Pensacola, FL, USA) were related to lower adiposity markers in men from eight Latin America countries but not in women. In contrast, we found that only for mothers meeting the combination of Japanese physical activity and sedentary behaviour recommendations were related to being less likely to be obese, however the number of obese mothers was only 4. The National Health and Nutrition Survey in 2019 reported that the percentages of obesity and underweight were 29.4% and 5.1% for 30–39 year-old, 39.7% and 1.7% for 40–49 year-old men; 15.0% and 16.4%, and 16.6% and 12.9% in women, respectively [4]. The percentages of both of obese mothers and fathers in the present study were lower than those of the national survey, but the percentages of underweight were similar. The reasons why such differences between ethnicity are unclear, but much lower prevalence of obesity (6.4% in mothers and 23.2% in fathers) in our sample than those of previous studies and differences in measurement tools to assess movement behaviours may be associated the differences. For the sleep recommendation, we calculated a prevalence of sleep recommendation for Japanese adults by the Japanese National survey. The percentages of 7 to 9 h/night of sleep recommendations by self-report were 18.9% for 30–39 year-old and 15.7% for 40–49 year-old men, 21.8% and 16.6% in women, respectively in the National Health and Nutrition Survey in 2019 [4]. The prevalence in our participants was 50.1% for mothers and 42.9% for fathers, respectively. In the Japanese culture, child(ren) and parent(s) sleep together. The participants may have been able to get longer hours of sleep than Japanese without relatively younger children. However, both studies used the questionnaire. Data obtained with self-reported questionnaire may have suffered from biased responses. A comparison study of sleeping time in 33 other countries among OECD, showed the shortest time in Japan (7.4h) [ 44 ]. A systematic review and meta-analysis showed a mean 7.6 h/day of self-reported sleep duration in adults and older adults using data from 17 studies from these countries[ 45 ]. Self-report measures of sleep duration may considerably underestimate sleep time, when compared with objective measures [ 46 ]. Future research is needed to evaluate sleep time by the objective measures. This study has several limitations. First, this study employed ae cross-sectional design. Second, there was no objective measure of sleep available. Furthermore, there are no specific public health recommendations concerning 24-Hour Movement Guidelines for the Japanese population of any age. The number of obese mothers and underweight fathers were small. There are also several strengths of the present study. First, to our knowledge, this was the first study to describe the adherence to 24-hour movement guideline recommendations among Japanese adults. Second, the relatively large sample size from fathers was a strength. Third, objective measures were used to assess MVPA and sedentary time. Conclusions The purpose of the present study was to evaluate adherence to the three recommendations for physical activity, screen time, and sleep duration and to examine their relationship with weight status in Japanese mothers and fathers. Not meeting Japanese physical activity recommendations was associated with a higher odds ratio and not meeting sedentary behaviour recommendations was associated with a lower odds ratio for underweight in Japanese mothers. The present findings suggest differences in the associations between 24-h movement recommendations adherence and BMI by gender. We did not detect a significant association between meeting 24-h movement guidelines and obesity, with the reference category of meeting none of the guidelines in fathers. These findings help our understanding of 24-h movement behaviours in Japanese parents, and perhaps specifically for Japanese women for establishing evidence-informed interventions for preventing underweight. Future research is needed to gain insights into the directionality of the associations between 24-h movement guidelines adherence and underweight and obesity, and also the mechanisms explaining differences between men and women. Abbreviations BMI, body mass index; MVPA, moderate-to-vigorous physical activity; METs, metabolic equivalents; SES, socioeconomic status; SD, standard deviation. Declarations Ethics approval and consent to participate The Ethical Committee of J. F. Oberlin University approved the study protocol (No. 10007 and 12023). Written informed consent was obtained from all participants and their parents. Consent for publication Not applicable for that section. Availability of data and materials The dataset supporting the conclusions of this article are currently not available in the public domain but may be shared upon reasonable request. For further information on the data and materials used in this study, please contact the corresponding author. Competing interests Dr. Shigeho Tanaka received consigned research funds from Omron Healthcare Co., Ltd. The remaining authors declare no competing interests. Funding This work was supported by a Grant-in-Aid for Scientific Research (A) (24240092) and a Grant-in-Aid for Scientific Research (C) (24500832). The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the paper; or in the decision to submit the paper for publication. Authors' contributions CT and ST designed the study, collected and analyzed the data. CT drafted the manuscript. MT gave technical support and conceptual advice. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the participants for their cooperation in the study. We also wish to thank M.S. Maki Tanaka in Kyoto Tachibana University and the staff of the National Institute of Health and Nutrition for their help with the experiments. References Park D, Lee JH, Han S. Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA. Medicine (Baltimore). 2017;96(48):e8769. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387(10026):1377-1396. Ministry of Health, Labour and Welfare. The 2016 National Health and Nutrition Survey results. 2017. https://www.mhlw.go.jp/file/04-Houdouhappyou-10904750-Kenkoukyoku-Gantaisakukenkouzoushinka/kekkagaiyou_7.pdf. Accessed 24 October 2023, in Japanese. e-Stat. The National Health and Nutrition Survey. https://www.e-stat.go.jp/stat-search/database?page=1&layout=datalist&toukei=00450171&tstat=000001041744&cycle=7&result_back=1&tclass1val=0. Accessed 24 October 2023. Hayashi F, Takimoto H, Yoshita K, Yoshiike N. Perceived body size and desire for thinness of young Japanese women: a population-based survey. Br J Nutr. 2006;96(6):1154-1162. Cabinet Office. The 2018 Annual Report on the State of the Formation of a Gender Equal Society and Policies. 2018. http://www.gender.go.jp/about_danjo/whitepaper/h30/zentai/html/zuhyo/zuhyo01-00-30.html. Accessed 24 October 2023, in Japanese. Han Z, Mulla S, Beyene J, Liao G, McDonald SD, Knowledge Synthesis Group. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol. 2011;40(1):65-101. Ministry of Health, Labour and Welfare. Health Japan 21 (the second term), https://www.nibiohn.go.jp/eiken/kenkounippon21/en/kenkounippon21/genjouchi.html. Accessed 24 October 2023. Ross R, Chaput JP, Giangregorio LM, Janssen I, Saunders TJ, Kho ME, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45(10 Suppl 2):S57-S102. McGregor DE, Carson V, Palarea-Albaladejo J, Dall PM, Tremblay MS, Chastin SFM. Compositional Analysis of the Associations between 24-h Movement Behaviours and Health Indicators among Adults and Older Adults from the Canadian Health Measure Survey. Int J Environ Res Public Health. 2018;15(8):1779. 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Ann Hum Biol 2013;40(6):541-546. Tanaka C, Tremblay MS, Okuda M, Inoue S, Tanaka S. Proportion of Japanese primary school children meeting recommendations for 24-h movement guidelines and associations with weight status. Obes Res Clin Pract. 2020;14(3):234-240. Davison KK, Gicevic S, Aftosmes-Tobio A, Ganter C, Simon CL, Newlan S, et al. Fathers' Representation in Observational Studies on Parenting and Childhood Obesity: A Systematic Review and Content Analysis. Am J Public Health. 2016;106(11):e14-e21. Morgan PJ, Young MD, Lloyd AB, Wang ML, Eather N, Miller A, et al. Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review. Pediatrics. 2017;139(2):e20162635. The Examination Committee of Criteria for ׳Obesity Disease׳ in Japan. Japan Society for the Study of Obesity. New criteria for ׳obesity disease׳ in Japan. Circ J 2002;66: 987-992. Ohkawara K, Oshima Y, Hikihara Y, Ishikawa-Takata K, Tabata I, Tanaka S. 2011 Real-time estimation of daily physical activity intensity by a triaxial accelerometer and a gravity-removal classification algorithm. Br J Nutr. 2011;105(11):1681-1691. Mâsse LC, Fuemmeler BF, Anderson CB, Matthews CE, Trost SG, Catellier DJ, et al. Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc. 2005;37(11 Suppl):S544-S554. Migueles JH, Cadenas-Sanchez C, Ekelund U, Nyström CD, Mora-Gonzalez J, Löf M, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. 2017; 47(9): 1821-1845. Mori N, Armada F, Willcox DC. Walking to school in Japan and childhood obesity prevention: new lessons from an old policy. Am J Public Health. 2012;102(11):2068-2073. Liangruenrom N, Dumuid D, Craike M, Biddle SJH, Pedisic Z. Trends and correlates of meeting 24-hour movement guidelines: a 15-year study among 167,577 Thai adults. Int J Behav Nutr Phys Act. 2020;17(1):106. Kastelic K, Pedišić Ž, Lipovac D, Kastelic N, Chen ST, Šarabon N. Associations of meeting 24-h movement guidelines with stress and self-rated health among adults: is meeting more guidelines associated with greater benefits? BMC Public Health. 2021;21(1):929. Ferrari G, Cristi-Montero C, Drenowatz C, Kovalskys I, Gómez G, Rigotti A, et al. Meeting 24-h movement guidelines and markers of adiposity in adults from eight Latin America countries: the ELANS study. Sci Rep. 2022;12(1):11382. Tanaka C, Fujiwara Y, Sakurai R, Fukaya T, Yasunaga M, Tanaka S. Locomotive and non-locomotive activities evaluated with a triaxial accelerometer in adults and elderly individuals. Aging Clin Exp Res. 2013;25(6):637-643. Amagasa S, Inoue S, Shibata A, Ishii K, Kurosawa S, Owen N, et al. Differences in accelerometer-measured physical activity and sedentary behavior between middle-aged men and women in Japan: a compositional data analysis. J Phys Act Health. 2022;19(7):500-508. Statistics Bureau of Japan. Outline of the 2016 Survey on Time Use and Leisure Activities. Statistics Bureau of Japan. 2017. https://www.stat.go.jp/english/data/shakai/2016/gaiyo.html. Accessed 24 October 2023, in Japanese Gender Equality Bureau Cabinet Office. Time spent on housework and childcare among couples with children under the age of 6 (Per day, international comparison). 2018. https://www.gender.go.jp/about_danjo/whitepaper/h30/zentai/html/zuhyo/zuhyo01-03-08.html. Accessed 24 October 2023, in Japanese. Murakami H, Kawakami R, Nakae S, Nakata Y, Ishikawa-Takata K, Tanaka S, Miyachi M. Accuracy of wearable devices for estimating total energy expenditure: comparison with metabolic chamber and doubly labeled water method. JAMA Intern Med. 2016;176(5):702-703. Matthews CE. Calibration of accelerometer output for adults. Med Sci Sports Exerc 2005;37(11 Suppl):S512-S522. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575-1581. Li S, Cao H, Liu H, Hu Y, Liu J. Relationship between body mass index and physical fitness index in Chinese college students: Results from a cross-sectional survey. Am J Hum Biol. 2023;35(5):e23854. Pengpid S, Vonglokham M, Kounnavong S, Sychareun V, Peltzer K. The prevalence of underweight and overweight/obesity and its correlates among adults in Laos: A cross-sectional national population-based survey, 2013. Eat Weight Disord. 2020;25(2):265-273. Pengpid S, Peltzer K. The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey. Pan Afr Med J. 2020;36:338. Pengpid S, Peltzer K. Underweight and overweight/obesity among adults in Afghanistan: prevalence and correlates from a national survey in 2018. J Health Popul Nutr. 2021;40(1):25. Rollo S, Lang JJ, Roberts KC, Bang F, Carson V, Chaput JP, et al. Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey. Health Rep. 2022;33(1):16-26. OECD. How’s Life? Measuring Well-Being; OECD Publishing: Paris, France, 2011. http://dx.doi.org/10.1787/9789264121164-en. Accessed 24 October 2023. Simonelli G, Marshall NS, Grillakis A, Miller CB, Hoyos CM, Glozier N. Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration. Sleep Health. 2018;4(3):239-250. Schokman A, Bin YS, Simonelli G, Pye J, Morris R, Sumathipala A, et al. Agreement between subjective and objective measures of sleep duration in a low-middle income country setting. Sleep Health. 2018;4(6):543-550. Additional Declarations Competing interest reported. Dr. Shigeho Tanaka received consigned research funds from Omron Healthcare Co., Ltd. The remaining authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3534444","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":256132138,"identity":"194e8c88-0638-4985-849c-fd2df27a415d","order_by":0,"name":"Chiaki Tanaka","email":"data:image/png;base64,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","orcid":"","institution":"Tokyo Kasei Gakuin University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chiaki","middleName":"","lastName":"Tanaka","suffix":""},{"id":256132140,"identity":"a618d3a6-adcf-4c2f-822f-c15c51e0d32d","order_by":1,"name":"Mark S. Tremblay","email":"","orcid":"","institution":"Children’s Hospital of Eastern Ontario Research Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mark","middleName":"S.","lastName":"Tremblay","suffix":""},{"id":256132143,"identity":"ef555732-9627-4a07-a3ad-42fda9196b4f","order_by":2,"name":"Shigeho Tanaka","email":"","orcid":"","institution":"Kagawa Nutrition University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shigeho","middleName":"","lastName":"Tanaka","suffix":""}],"badges":[],"createdAt":"2023-11-01 11:29:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3534444/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3534444/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50555193,"identity":"1bcd47c8-18ad-4c53-8c4c-cff81d53177b","added_by":"auto","created_at":"2024-02-02 12:22:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":291452,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3534444/v1/f339948c-27cb-41ba-bfe3-8627ee056ff5.pdf"}],"financialInterests":"Competing interest reported. Dr. Shigeho Tanaka received consigned research funds from Omron Healthcare Co., Ltd. The remaining authors declare no competing interests.","formattedTitle":"Gender differences in the proportion of Japanese parents meeting recommendations within 24- hour movement guidelines and associations with weight status","fulltext":[{"header":"Background","content":"\u003cp\u003eUnderweight and obesity are associated with elevated risks of adverse health outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There is a difference in the prevalence of obese and underweight adults among countries according to the NCD Risk Factor Collaboration [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The prevalence of underweight was highest in South Asia. In the 2009 and 2016 National Nutrition Surveys in Japan, the prevalence of underweight defined as body mass index (BMI)\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e went from 11.0\u0026ndash;11.5% for women and from 4.4\u0026ndash;3.9% for men; and obesity defined as BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e went from 20.8\u0026ndash;22.3% for women and from 30.5\u0026ndash;33.0% for men [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These results show clear gender differences in weight status and worrying increases in the prevalence of Japanese adults at risk. Underweight was especially prominent among women in their twenties at 29.0% as found in a nationwide study in 2010 [4]. This is most likely because young adult women in Japan desire thinness more than other age groups [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recently, the number of low birth weight infants (＜2500 g) has increased in Japan (6.3% in 1990 vs 9.4% in 2019) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In comparison to other Organization for Economic Co-operation and Development (OECD) countries, the percentages were remarkably high [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A previous systematic review reported that underweight women had an increased risk of having a low birth weight infant [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Health Japan 21 (the second term) from 2013 to 2023 established by the Minister of Health, Labour, and Welfare set reductions in percentages of underweight women in their 20s and low birth weight infants, as specific targets[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwenty-four hour movement guidelines (physical activity, sedentary time, and sleep duration) for adults were developed recently in Canada [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Meeting the overall 24-h movement guidelines for adults aged 18\u0026ndash;64 years was defined as: \u0026ge;150 min/week of moderate-to-vigorous physical activity (MVPA), \u0026le;\u0026thinsp;8 h/day of sedentary time which includes\u0026thinsp;\u0026le;\u0026thinsp;3 hours of recreational screen time, and 7 to 9 h/night of sleep. These new guidelines recognize and acknowledge the importance and codependency of movement behaviours throughout the whole day and their interactions with each other [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A previous review reported that the composition of movement behaviours within a 24-h period may have important implications for health at all ages and that meeting the current 24-h movement guidelines is associated with a number of desirable health indicators in children and youth [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, 24 movement-behaviours are important for both parents and children. In contrast to Canada, Japan has only PA guidelines for adults (\u0026ge;\u0026thinsp;60 min/day of MVPA)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany studies have shown a negative association between obesity and 24-h movement behaviour adherence in adults [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Most of the studies have been reported from Western countries and only a few from Asian countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, a few previous studies on adults indicated that the level of physical inactivity in underweight adults was similar to obese adults [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In general, studies that show the association between underweight adults and 24-h movement behaviours are lacking, although there have been a few physical activity studies using self-report questionnaires for underweight adults [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Recently, Lee et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported that objectively measured sitting time for underweight Korean adults was significantly longer on weekdays than among counterparts who were obese. To our knowledge, no study has assessed the relationship between underweight and 24-h movement behaviours for adults with an accelerometer for both women and men. In a previous study on Japanese preschool children, underweight, rather than excess weight, was associated with decreased physical activity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For Japanese primary school children, the screen time recommendations or combinations including screen time recommendations were associated with overweight/obesity, while none of the recommendations were associated with underweight [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, physical activity and sedentary behaviour research on parents has overwhelmingly focused on mothers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Therefore, the purpose of the present study was to examine the differences in habitual MVPA across different weight status for Japanese mothers and fathers, using objectively evaluated physical activity with triaxial accelerometry. Accordingly. we examined the proportions of participants who met each of the MVPA for Canadian and Japanese guidelines, sedentary time, and sleep duration recommendations and combinations of these recommendations, and evaluated their relationship with weight status in Japanese mothers and fathers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants were Japanese adults living in the Kanto area and Kyoto in Japan. We employed data from a cross-sectional study of Japanese preschool and elementary school children and parents. Flyers were distributed in the schools to invite participants to join the study and all participants and their parents gave their informed consent. All reported being in good health, without a history of conditions affecting physical activity (e.g., abnormal thyroid gland function or orthopedic disease). Pregnant women were excluded. A total of 425 mothers and 237 fathers were included in the convenience sample. The Ethical Committee of J. F. Oberlin University (Approval no: 10007; 12023) approved the study protocol. Anthropometric, MVPA, sedentary time, screen time and sleeping time measurements were collected during the school year between November 2010 and January 2015. The initial sample from 7 preschools and 14 elementary schools comprised 891 participants, among whom 225 parents were subsequently excluded because of accelerometer data not conforming with the study criteria (see below) [n\u0026thinsp;=\u0026thinsp;144], accelerometer loss [n\u0026thinsp;=\u0026thinsp;5], revocation of the consent [n\u0026thinsp;=\u0026thinsp;38], history of conditions affecting physical activity [n\u0026thinsp;=\u0026thinsp;50], or pregnant mothers [n\u0026thinsp;=\u0026thinsp;2], non-Japanese [n\u0026thinsp;=\u0026thinsp;3], or no questionnaire data [n\u0026thinsp;=\u0026thinsp;45]. Data analysis was carried out on the remaining 662 parents. No significant difference in age or BMI in each gender was observed between the sample used in the analyses and parents excluded (106 mothers and 119 furthers) from the analyses.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eWeight status\u003c/h2\u003e \u003cp\u003eHeight and weight are measured in increments of 0.1 cm and 0.1 kg respectively at schools or employee health checks. Height was measured without shoes. Body weight was measured without shoes, in light clothing. Net body weight was calculated as the weight of clothing subtracted from the measured body weight. Clothing for each participant included pants and a shirt corresponding to a 1.0 kg deduction. BMI was calculated as weight in kilograms divided by height in meters squared. To evaluate the prevalence of underweight and obesity, we defined a BMI of \u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e and \u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e as the cut-off for underweight and obesity according to the criteria set by the Japan Society for the Study of Obesity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eObjective measurement of physical activity and sedentary time\u003c/h2\u003e \u003cp\u003eHabitual MVPA and sedentary time were measured with a triaxial accelerometer (Active style Pro HJA-350IT, OMRON HEALTHCARE, Kyoto, 74\u0026times;46\u0026times;34 mm and 60 g including batteries). Details on the accelerometer have been published elsewhere [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The Active style Pro was set to record in 10-sec epochs, and the value for 1-min epochs was calculated as the mean value of physical intensity in 10-sec epochs. Physical activity was monitored continuously for 6\u0026ndash;10 days. Participants were requested to wear these devices at all times, except when dressing and bathing. Periods with over 60 minutes of consecutive zero counts were considered to be non-wearing time. A valid day was defined as having\u0026thinsp;\u0026ge;\u0026thinsp;600 min (10 hours) wear time. Participants with data from at least 2 weekdays and 1 weekend day were included in the analysis [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These data acceptance/reduction criteria were similar to those in other papers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A macro program developed and distributed by Japan Physical Activity Research Platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://paplatform.umin.jp\u003c/span\u003e\u003cspan address=\"http://paplatform.umin.jp\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (in Japanese)) was used for processing of the accelerometer data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eScreen time and sleep duration\u003c/h2\u003e \u003cp\u003eScreen time and sleep duration were evaluated through self-report questionnaire. Time spent viewing television and videos, playing electronic games and using a personal computer in leisure time were assessed using the following two questions: 1) \u0026ldquo;How many hours of television and video movies do you usually watch? and 2) \u0026ldquo;How many hours in a single day do you usually use a personal computer or play electronic games (including television, personal computer, portable game machines, etc.)? (a) in a week day or (b) a weekend day. Participants were also asked: \u0026ldquo;What time do you usually go to bed?\u0026rdquo; and \u0026ldquo;What time do you usually get up?\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe average number of minutes spent in sedentary behaviour (metabolic equivalents, (METs)\u0026thinsp;\u0026le;\u0026thinsp;1.5) and MVPA (METs\u0026thinsp;\u0026ge;\u0026thinsp;3.0) for each of weekday and weekend days was calculated. For the MVPA and sedentary time data, the average weekly values were calculated as [((mean for weekdays \u0026times; 5) + (mean for weekend days \u0026times; 2))/7]. The proportions of participants meeting each of the weekly MVPA (\u0026ge;\u0026thinsp;150 min/week for Canadian PA guideline or \u0026ge;\u0026thinsp;60 min/day for Japanese PA guideline (Ministry of Health, Labour and Welfare, Japan 2013; Miyachi 2015)), sedentary time (\u0026le;\u0026thinsp;8 h/day which includes\u0026thinsp;\u0026le;\u0026thinsp;3 hours of recreational screen time), and sleep recommendations (7 to 9 h/night) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and combinations of these recommendations were determined. A Mann\u0026ndash;Whitney's U was used to compare age, body height, body weight, BMI, MVPA, sedentary time, screen time and sleep duration between mothers and fathers. Weight status was compared by the Cramer's V. Associations between meeting recommendations versus not meeting (separately or in combinations of recommendations) with underweight or obese were assessed with odds ratios obtained from polytomous logistic regression analysis adjusted for age and socioeconomic status (SES) of each school, with normal weight group as a reference. A higher odds ratio means that not meeting the recommendation is related to being underweight or obese. SES was evaluated by an average annual income within a 4 km buffer of each school, because students in public primary school come from their home within 4 km of each school [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. SES was estimated by Zenrin Geo Intelligence Co. Ltd., using the statistical data of the Population Census in 2015 and Housing and Land Survey in 2013 by the Statistics Bureau, Ministry of Internal Affairs and Communications. All statistical analyses were conducted using IBM SPSS statistics 28.0 for Windows (IBM Co., Tokyo, Japan). Results are presented as median and interquartile range or percentage. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 425 mothers and 237 fathers were included in the convenience sample. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows descriptive characteristics of the participants. In the sample, 75.4% were in the normal weight category. Age, body height, body weight, BMI and screen time for fathers were significantly higher or longer than those of mothers. Sleep duration for fathers was shorter than that of mothers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMothers (n: 425)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eFathers (n: 237)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMann\u0026ndash;Whitney's U\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e43928.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e162.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e171.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e168.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e175.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3736.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e73.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6967.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23402.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCramer's V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVPA (min/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e49020.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time (h/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e46861.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreen time (h/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24443.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep duration (h/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e54980.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eAbbreviations: BMI: body mass index, MVPA moderate-to-vigorous physical activity, IQR: interquartile range.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the proportions of the participants who met each of the MVPA, sedentary, and sleep duration recommendations, and combinations of these recommendations. The proportions were higher for mothers than for fathers in all recommendations and combinations of these recommendations. The proportions of the mothers and fathers who met of the MVPA recommendation for the Canadian guidelines were 99.8% and 98.6%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportion of participants who met the MVPA, screen time, and sleep duration recommendations and combinations of these recommendations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eCanadian physical activity guideline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c14\" namest=\"c10\"\u003e \u003cp\u003eJapanese physical activity guideline\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMVPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMVPA\u0026thinsp;+\u0026thinsp;ST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMVPA\u0026thinsp;+\u0026thinsp;SLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eST\u0026thinsp;+\u0026thinsp;SLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMVPA\u0026thinsp;+\u0026thinsp;ST\u0026thinsp;+\u0026thinsp;SLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMVPA*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eMVPA* + ST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMVPA* + SLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eMVPA* + ST\u0026thinsp;+\u0026thinsp;SLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNone*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eMeeting the recommendations is defined as \u0026ge;\u0026thinsp;150 min/week for MVPA, \u0026le;\u0026thinsp;8 h/day of sedentary time which includes\u0026thinsp;\u0026le;\u0026thinsp;3 hours of recreational screen time and 7 to 9 h/night of sleep. MVPA*: meeting the recommendations in Japan is defined as \u0026ge;\u0026thinsp;60 min/day for MVPA. MVPA and sedentary time were accelerometer-determined while and screen time and sleep duration were self-reported. MVPA: moderate-to-vigorous physical activity, ST: sedentary time and screen time, SLEEP: sleep duration. None: percentage of participants meeting none of the MVPA, ST or Sleep recommendations.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides the odds ratios for underweight or obesity associated with not meeting versus meeting the physical activity, sedentary behaviour, and sleep duration recommendations, and combinations of these recommendations. Most mothers and fathers met the MVPA recommendation for the Canadian guideline and the number of underweight fathers was only 9; therefore, odds ratios for these variables were not analyzed. For mothers, participants not meeting the sedentary behaviour recommendation had a lower odds ratio for underweight compared to those meeting the recommendations, and participants not meeting the physical activity recommendation for Japanese had a higher odds ratio for underweight compared to those meeting the recommendation. Participants meeting neither of the sedentary behaviour recommendation and PA recommendation for Japanese had a higher odds ratio for obesity compared to those meeting both of the recommendations. None of the individual or combinations of the recommendations were associated with obesity for fathers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds ratios for underweight and obesity associated with not meeting vs. meeting physical activity, sedentary behaviour, and sleep duration recommendations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMothers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot meeting the following recommendation(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNormal weight (n\u0026thinsp;=\u0026thinsp;326)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eObesity (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u0026thinsp;+\u0026thinsp;ST*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVPA\u0026thinsp;+\u0026thinsp;SLEEP*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll three recommendations*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeeting the following recommendation(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNormal weight (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eObesity (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e15.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLEEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u0026thinsp;+\u0026thinsp;ST*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u0026thinsp;+\u0026thinsp;SLEEP*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll three recommendations*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e11.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eAssociations between not meeting these recommendations versus meeting (each or combinations of recommendations) with underweight or obese were assessed with odds ratios obtained from polytomous logistic regression analysis. Models adjusted for age and SES of each school, with normal weight group as a reference. A higher odds ratio means that not meeting the recommendation tends to be underweight or obese. Meeting the recommendations is defined as \u0026ge;\u0026thinsp;60 min/day for MVPA, \u0026le;\u0026thinsp;8 h/day of sedentary time which includes\u0026thinsp;\u0026le;\u0026thinsp;3 hours of recreational screen time, and between 7 to 9 h/night for sleep duration. OR: odds ratio, CI: confidence interval, P: p-value, MVPA: moderate-to-vigorous physical activity, ST: sedentary time and screen time, SLEEP: sleep duration.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study examined the adherence to each of the physical activity, sedentary behaviour, and sleep duration recommendations (and combinations of these recommendations) and evaluated their relationship with underweight and obesity in Japanese parents who had children\u0026thinsp;\u0026le;\u0026thinsp;13 years of age. Almost two thirds of parents met one or more of the recommendations, but very few met all three recommendations, especially for fathers (10.6% for Canadian PA guideline, 8.0% for Japanese physical activity guideline). Nearly all mothers (99.8%) and fathers (98.6%) met the Canadian physical activity guideline while, the Japanese physical activity guideline was met by 60.5% of mothers and 57.8% of fathers. For mothers, 65.4% met the sedentary behaviour recommendation, and 60.5% met the Japanese physical activity recommendation. For fathers, approximately 57.8% met the Japanese physical activity recommendation and 42.9% met the sleep duration recommendation. Mothers not meeting the Japanese physical activity recommendation had a higher odds ratio and those not meeting the sedentary behaviour recommendation had a lower odds ratio for underweight than those who met the corresponding recommendation. Moreover, mothers not meeting the combination of the sedentary behaviour and Japanese physical activity recommendations had a lower odds ratio for obesity than participants who met both of the recommendations, although the number of obese mothers was only 4.\u003c/p\u003e \u003cp\u003e This study is the first to examine the prevalence of 24-h movement guidelines in Japanese adults. To our knowledge, it is also the first study to examine the association of movement behaviours employing direct measures of physical activity and sedentary behaviour with weight status in Japanese adults. In the previous studies in Asian countries, Liangruenrom et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e] found that the prevalence of adults who met the physical activity, sedentary behaviour, sleep, and overall recommendations was 81.7%, 44.6%, 56.4%, and 21.3% in Thai adults, respectively. Kastelic et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e] reported 9%, 8%, 9% and 25% by using a questionnaire among Slovenian residents, respectively. Lee et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e] found that the proportions of adults meeting the physical activity and sleep guidelines in Korea were, 48.8% and 57.6% in women; 55.5% and 54.0% in men, respectively. However, there are limitations when making direct comparisons of results, as there are differences in methodology used to assess movement behaviours, criteria of the 24-h movement behaviour guidelines and sampling of participants. For example, the Thailand study used a 24-h time-use dairy. The overall 24-h movement behaviour guidelines in their study included meeting MVPA (defined as \u0026ge;\u0026thinsp;150 min/week), interrupting sedentary behaviour every 2 h and sleep (7\u0026ndash;9 h/day) recommendations. The Korean study used questionnaires to estimate daily MVPA and sedentary behaviour, and a single question for sleep duration. Their overall 24-h movement behaviour guideline included meeting MVPA (defined as \u0026ge;\u0026thinsp;600 METs minute/week) and sleep (7\u0026ndash;9 h/day) recommendations and not having high sitting time (\u0026ge;\u0026thinsp;9 h/day). Ferrari et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] reported the prevalence of adults who met the overall recommendations (all 3 behaviours) from eight Latin American countries was 1.6%. With respect to individual movement behaviour recommendations, the proportions meeting each of the recommendations was 58.7% in men and 39.4% in women for physical activity, 21.2% and 22.7% for sedentary behaviour (collected using accelerometers), and 22.8% and 16.5% for sleep time. Their criteria of the overall 24-h movement behaviour guideline included at least 150 min/week of MVPA, \u0026le; 8 h/day in sedentary behaviour, and between 7 and 9 h/day of sleep. Sedentary behaviour for Japanese fathers in the present study was only similar to the Latin American study [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Other percentages were considerably higher in our study. However, there are also differences in methodology used to assess movement behaviours, criteria of the 24-h movement behaviour guideline and participant sampling procedures.\u003c/p\u003e \u003cp\u003eThere are several previous studies on the differences among women and men in 24-h movement behaviours. Lee et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported that women had less unfavorable patterns of 24-h movement behaviours than men. Ferrari et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] also reported that the number of guidelines being met was higher in men than women. In contrast, Liangruenrom et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e] found the lowest odds for meeting the 24-h guidelines were among males. Two previous studies explored Japanese physical activity recommendations by using the same accelerometer as the present study. Tanaka et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e] found that accumulating MVPA 60 min/day or 30 min/day in women (35.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 years) and men (36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 years) were 76% or 97%, and 68% or 96%, respectively. Amagasa et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e] did not find significant gender differences in the proportions adhering to the 2020 WHO physical activity guidelines (\u0026ge;\u0026thinsp;150 min/week of MVPA, women: 95.8% and men: 93.1%) nor to the Japanese physical activity guidelines for health promotion 2013 (\u0026ge;\u0026thinsp;23 MET h/wk of MVPA, women: 63.2% and men: 63.0%), although their mean age was higher than that of present study (52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0 years in women; 52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3 years in men). The percentages of the present study were slightly lower than those of the previous Japanese studies.\u003c/p\u003e \u003cp\u003eThe inconsistency between Korean and Latin American countries studies and the present study might be attributable in part to the fact that Japanese females may spend more time than women in other countries doing activities classified as household activities. The Statistics Bureau of Japan [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported that compared to US and European countries, the time spent by Japanese men on childcare is extremely short. According to data from the Basic Survey of Social Life of the Ministry of Internal Affairs and Communications, Japanese men spend an average of 1 hour 23 minutes a day on housework and childcare (including 49 minutes on childcare), compared with 3 hours 12 minutes in Norway (including 73 minutes on childcare). Japanese women spend an average of 7 hour 34 minutes a day on housework and childcare (including 3 h 45 minutes on childcare), compared with 5 hours 26 minutes in Norway (including 2h 17 minutes on childcare). This gender gap has remained almost unchanged since 1996, although the women\u0026rsquo; share of time spent on housework has been decreasing over the long term [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Liangruenrom et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e] also reported that Thai adults who were married were found to be more likely to meet the physical activity, sedentary behaviour, sleep, and overall 24-h movement guidelines compared to those who have never been married. Thai women tended to meet the sedentary behaviour, sleep, and the overall guidelines more than males. Traditional gender roles might affect Japanese mother\u0026rsquo;s MVPA and sedentary behaviour. Another reason for relatively higher MVPA in women may be that the accelerometer used in the present study can capture household activities relatively accurately [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e], while most common algorithms to predict METs tend to underestimate household activities [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Many household activities correspond to activity of \u0026ge;\u0026thinsp;3 METs, as reported by Ainsworth et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e], carpet sweeping, sweeping floors, mopping, vacuuming, carpentry, bagging grass, etc. while childcare is reported as 2.0 to 3.0 METs.\u003c/p\u003e \u003cp\u003ePrevious studies that show an association between underweight adults and physical activity are lacking, although there have been a few studies using a questionnaire for underweight adults [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. To our knowledge, no study has assessed the relationship between underweight and 24-h movement guidelines for adults with an accelerometer. In our previous study on Japanese preschool children, underweight, rather than excess weight, was associated with decreased physical activity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, another previous study of ours showed that adherence to the 24-h movement guidelines was not associated with underweight in Japanese primary school children [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. None of the recommendations was associated with underweight in both boys and girls. In the present study, we could not examine the association in fathers, because of the low proportion of underweight participants in the present study (3.8%) (note the percentage was similar with that of a National Survey [4]). For mothers, not meeting the Japanese physical activity recommendation was related to being more likely to be underweight. Moreover, not meeting the sedentary behaviour recommendation was related to being less likely to be underweight. Li et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e] found that physical fitness level was poorer among underweight Chinese college students than among their normal-weight counterparts. These findings suggest that being underweight may hinder an active lifestyle because of the lack of physical fitness or vice versa, that is, that inactive lifestyle may lead to underweight. It should be highlighted that underweight mothers may benefit from interventions aiming to increase MVPA, although the causal relationship is unknown in the present study. It should also be acknowledged that current evidence for the association between adherence to 24-h movement guidelines and underweight in adults is still understudied in Japan. Kelly et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e] showed that underweight individuals were significantly more inactive than adults with acceptable weight or overweight, indicating a U-shaped relationship between BMI and physical activity in England. Churilla et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e] also indicated that the odds of reporting physical inactivity in underweight women or men in the United States were 1.57 and 1.65, respectively, compared with women or men of desirable weight. Those odds were similar in underweight and class I obese women or men. Furthermore, Churilla et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported that underweight, overweight, and obese BMI categories possessed higher odds of not meeting current physical activity guidelines. In contrast, relationships between underweight prevalence and lower levels of physical activity assessed by questionnaire among adults in Laos and Kenya were non-significant [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Moreover, sedentary behaviour was also positively associated with underweight in Afghanistan adults (adjusted relative risk ratio: 1.85, 95% CI: 1.11\u0026ndash;3.10) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Thus, the relationship between underweight and physical activity and/or sedentary behaviour are controversial, although a direct comparison with our findings is limited because of differences in methodology used to assess movement behaviour. Further research using direct measure methods such as accelerometers is needed.\u003c/p\u003e \u003cp\u003ePrevious studies have examined the relationship between adherence to 24-h movement guidelines and adiposity markers in adults [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These studies found that the distribution of time spent in 24-h movement behaviours was significantly associated with overweight/obesity. For example, Rollo et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e] reported that compared with adults meeting two or fewer recommendations, those who met all three recommendations had more favorable BMI. Ferrari et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] also found that meeting physical activity and sedentary behaviour recommendations measured using the GT3X\u0026thinsp;+\u0026thinsp;ActiGraph (ActiGraph LLC, Pensacola, FL, USA) were related to lower adiposity markers in men from eight Latin America countries but not in women. In contrast, we found that only for mothers meeting the combination of Japanese physical activity and sedentary behaviour recommendations were related to being less likely to be obese, however the number of obese mothers was only 4. The National Health and Nutrition Survey in 2019 reported that the percentages of obesity and underweight were 29.4% and 5.1% for 30\u0026ndash;39 year-old, 39.7% and 1.7% for 40\u0026ndash;49 year-old men; 15.0% and 16.4%, and 16.6% and 12.9% in women, respectively [4]. The percentages of both of obese mothers and fathers in the present study were lower than those of the national survey, but the percentages of underweight were similar. The reasons why such differences between ethnicity are unclear, but much lower prevalence of obesity (6.4% in mothers and 23.2% in fathers) in our sample than those of previous studies and differences in measurement tools to assess movement behaviours may be associated the differences.\u003c/p\u003e \u003cp\u003eFor the sleep recommendation, we calculated a prevalence of sleep recommendation for Japanese adults by the Japanese National survey. The percentages of 7 to 9 h/night of sleep recommendations by self-report were 18.9% for 30\u0026ndash;39 year-old and 15.7% for 40\u0026ndash;49 year-old men, 21.8% and 16.6% in women, respectively in the National Health and Nutrition Survey in 2019 [4]. The prevalence in our participants was 50.1% for mothers and 42.9% for fathers, respectively. In the Japanese culture, child(ren) and parent(s) sleep together. The participants may have been able to get longer hours of sleep than Japanese without relatively younger children. However, both studies used the questionnaire. Data obtained with self-reported questionnaire may have suffered from biased responses. A comparison study of sleeping time in 33 other countries among OECD, showed the shortest time in Japan (7.4h) [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. A systematic review and meta-analysis showed a mean 7.6 h/day of self-reported sleep duration in adults and older adults using data from 17 studies from these countries[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Self-report measures of sleep duration may considerably underestimate sleep time, when compared with objective measures [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Future research is needed to evaluate sleep time by the objective measures.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this study employed ae cross-sectional design. Second, there was no objective measure of sleep available. Furthermore, there are no specific public health recommendations concerning 24-Hour Movement Guidelines for the Japanese population of any age. The number of obese mothers and underweight fathers were small. There are also several strengths of the present study. First, to our knowledge, this was the first study to describe the adherence to 24-hour movement guideline recommendations among Japanese adults. Second, the relatively large sample size from fathers was a strength. Third, objective measures were used to assess MVPA and sedentary time.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe purpose of the present study was to evaluate adherence to the three recommendations for physical activity, screen time, and sleep duration and to examine their relationship with weight status in Japanese mothers and fathers. Not meeting Japanese physical activity recommendations was associated with a higher odds ratio and not meeting sedentary behaviour recommendations was associated with a lower odds ratio for underweight in Japanese mothers. The present findings suggest differences in the associations between 24-h movement recommendations adherence and BMI by gender. We did not detect a significant association between meeting 24-h movement guidelines and obesity, with the reference category of meeting none of the guidelines in fathers. These findings help our understanding of 24-h movement behaviours in Japanese parents, and perhaps specifically for Japanese women for establishing evidence-informed interventions for preventing underweight. Future research is needed to gain insights into the directionality of the associations between 24-h movement guidelines adherence and underweight and obesity, and also the mechanisms explaining differences between men and women.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI, body mass index; MVPA, moderate-to-vigorous physical activity; METs, metabolic equivalents; SES, socioeconomic status; SD, standard deviation.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe Ethical Committee of J. F. Oberlin University approved the study protocol (No. 10007 and 12023). Written informed consent was obtained from all participants and their parents.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable for that section.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Availability of data and materials\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article are currently not available in the public domain but may be shared upon reasonable request. For further information on the data and materials used in this study, please contact the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Competing interests\u003c/p\u003e\n\u003cp\u003eDr. Shigeho Tanaka received consigned research funds from Omron Healthcare Co., Ltd. The remaining authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Funding\u003c/p\u003e\n\u003cp\u003eThis work was supported by a Grant-in-Aid for Scientific Research (A) (24240092) and a Grant-in-Aid for Scientific Research (C) (24500832).\u0026nbsp;The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the paper; or in the decision to submit the paper for publication.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Authors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eCT and ST designed the study, collected and analyzed the data. CT drafted the manuscript. MT gave technical support and conceptual advice. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Acknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants for their cooperation in the study. We also wish to thank M.S. Maki Tanaka in Kyoto Tachibana University and the staff of the National Institute of Health and Nutrition for their help with the experiments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePark D, Lee JH, Han S. Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA. Medicine (Baltimore). 2017;96(48):e8769. \u003c/li\u003e\n\u003cli\u003eNCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19\u0026middot;2 million participants. Lancet. 2016;387(10026):1377-1396. \u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. The 2016 National Health and Nutrition Survey results. 2017. https://www.mhlw.go.jp/file/04-Houdouhappyou-10904750-Kenkoukyoku-Gantaisakukenkouzoushinka/kekkagaiyou_7.pdf. 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Circ J 2002;66: 987-992.\u003c/li\u003e\n\u003cli\u003eOhkawara K, Oshima Y, Hikihara Y, Ishikawa-Takata K, Tabata I, Tanaka S. 2011 Real-time estimation of daily physical activity intensity by a triaxial accelerometer and a gravity-removal classification algorithm. Br J Nutr. 2011;105(11):1681-1691. \u003c/li\u003e\n\u003cli\u003eM\u0026acirc;sse LC, Fuemmeler BF, Anderson CB, Matthews CE, Trost SG, Catellier DJ, et al. Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc. 2005;37(11 Suppl):S544-S554.\u003c/li\u003e\n\u003cli\u003eMigueles JH, Cadenas-Sanchez C, Ekelund U, Nystr\u0026ouml;m CD, Mora-Gonzalez J, L\u0026ouml;f M, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. 2017; 47(9): 1821-1845. \u003c/li\u003e\n\u003cli\u003eMori N, Armada F, Willcox DC. Walking to school in Japan and childhood obesity prevention: new lessons from an old policy. Am J Public Health. 2012;102(11):2068-2073. \u003c/li\u003e\n\u003cli\u003eLiangruenrom N, Dumuid D, Craike M, Biddle SJH, Pedisic Z. Trends and correlates of meeting 24-hour movement guidelines: a 15-year study among 167,577 Thai adults. Int J Behav Nutr Phys Act. 2020;17(1):106.\u003c/li\u003e\n\u003cli\u003eKastelic K, Pedi\u0026scaron;ić Ž, Lipovac D, Kastelic N, Chen ST, \u0026Scaron;arabon N. Associations of meeting 24-h movement guidelines with stress and self-rated health among adults: is meeting more guidelines associated with greater benefits? BMC Public Health. 2021;21(1):929. \u003c/li\u003e\n\u003cli\u003eFerrari G, Cristi-Montero C, Drenowatz C, Kovalskys I, G\u0026oacute;mez G, Rigotti A, et al. Meeting 24-h movement guidelines and markers of adiposity in adults from eight Latin America countries: the ELANS study. Sci Rep. 2022;12(1):11382.\u003c/li\u003e\n\u003cli\u003eTanaka C, Fujiwara Y, Sakurai R, Fukaya T, Yasunaga M, Tanaka S. Locomotive and non-locomotive activities evaluated with a triaxial accelerometer in adults and elderly individuals. Aging Clin Exp Res. 2013;25(6):637-643.\u003c/li\u003e\n\u003cli\u003eAmagasa S, Inoue S, Shibata A, Ishii K, Kurosawa S, Owen N, et al. Differences in accelerometer-measured physical activity and sedentary behavior between middle-aged men and women in Japan: a compositional data analysis. J Phys Act Health. 2022;19(7):500-508. \u003c/li\u003e\n\u003cli\u003eStatistics Bureau of Japan. Outline of the 2016 Survey on Time Use and Leisure Activities. Statistics Bureau of Japan. 2017. https://www.stat.go.jp/english/data/shakai/2016/gaiyo.html. Accessed 24 October 2023, in Japanese \u003c/li\u003e\n\u003cli\u003eGender Equality Bureau Cabinet Office. Time spent on housework and childcare among couples with children under the age of 6 (Per day, international comparison). 2018. https://www.gender.go.jp/about_danjo/whitepaper/h30/zentai/html/zuhyo/zuhyo01-03-08.html. Accessed 24 October 2023, in Japanese. \u003c/li\u003e\n\u003cli\u003eMurakami H, Kawakami R, Nakae S, Nakata Y, Ishikawa-Takata K, Tanaka S, Miyachi M. Accuracy of wearable devices for estimating total energy expenditure: comparison with metabolic chamber and doubly labeled water method. JAMA Intern Med. 2016;176(5):702-703.\u003c/li\u003e\n\u003cli\u003eMatthews CE. Calibration of accelerometer output for adults. Med Sci Sports Exerc 2005;37(11 Suppl):S512-S522. \u003c/li\u003e\n\u003cli\u003eAinsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. Compendium of Physical Activities: a second update of codes and MET values. 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J Health Popul Nutr. 2021;40(1):25. \u003c/li\u003e\n\u003cli\u003eRollo S, Lang JJ, Roberts KC, Bang F, Carson V, Chaput JP, et al. Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey. Health Rep. 2022;33(1):16-26.\u003c/li\u003e\n\u003cli\u003eOECD. How\u0026rsquo;s Life? Measuring Well-Being; OECD Publishing: Paris, France, 2011. http://dx.doi.org/10.1787/9789264121164-en. Accessed 24 October 2023. \u003c/li\u003e\n\u003cli\u003eSimonelli G, Marshall NS, Grillakis A, Miller CB, Hoyos CM, Glozier N. Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration. Sleep Health. 2018;4(3):239-250. \u003c/li\u003e\n\u003cli\u003eSchokman A, Bin YS, Simonelli G, Pye J, Morris R, Sumathipala A, et al. Agreement between subjective and objective measures of sleep duration in a low-middle income country setting. Sleep Health. 2018;4(6):543-550. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"physical activity, sedentary behaviour, sleep, body weight, adults","lastPublishedDoi":"10.21203/rs.3.rs-3534444/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3534444/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Canadian 24-h movement guidelines were developed to improve health of adults. Parents\u0026rsquo; healthy behaviours are especially important because they are also role models for their children. The purpose of this study was to evaluate adherence to the three recommendations associated with health in the Canadian 24-h movement guidelines and their relationship with weight status (underweight or obesity) in Japanese parents.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included 425 mothers and 237 fathers who had children\u0026thinsp;\u0026lt;\u0026thinsp;13 years of age. Weight status according to measured body mass index (BMI) was classified by \u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e and \u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e as the cut-off for underweight and obesity, respectively. Meeting the 24-h movement guidelines was defined as: \u0026ge;150 min/week of moderate-to-vigorous physical activity (MVPA) (Canadian PA recommendation) or at least 60 min/day of MVPA (Japanese PA recommendation), \u0026le;\u0026thinsp;8 h/day of sedentary time which includes\u0026thinsp;\u0026le;\u0026thinsp;3 hours of recreational screen time, and 7 to 9 h/night of sleep. MVPA and sedentary time were accelerometer-determined while and screen time and sleep duration were self-reported.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The prevalence of mothers meeting all three recommendations was 30.6% using Canadian physical activity guidelines and 20.7% using Japanese physical activity guidelines, while that of fathers was 10.6% and 8.0%, respectively. Mothers not meeting the sedentary behaviour recommendation had a lower odds ratio and those not meeting Japanese PA recommendations had a higher odds ratio for underweight compared to mothers meeting the recommendations, adjusted for age and area socioeconomic status.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe screen time recommendation or Japanese PA recommendation were associated with underweight in mothers. None of the recommendations was associated with weight status in fathers. Further research is needed to understand the relationships among movement behaviours and weight status, particularly among Japanese women, whose routine behaviours may be misclassified as sedentary.\u003c/p\u003e","manuscriptTitle":"Gender differences in the proportion of Japanese parents meeting recommendations within 24- hour movement guidelines and associations with weight status","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-12-05 11:36:26","doi":"10.21203/rs.3.rs-3534444/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"68e6ac68-30f0-4627-9bb0-caf9f54173de","owner":[],"postedDate":"December 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-02T12:14:47+00:00","versionOfRecord":[],"versionCreatedAt":"2023-12-05 11:36:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3534444","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3534444","identity":"rs-3534444","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}