Meta-Datasets
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This study aimed to evaluate adherence to the 24-hour movement guidelines among toddlers, preschoolers, children, and adolescents, and to investigate the association between guideline adherence and cardiometabolic risk factors (CMRFs).
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A comprehensive systematic literature search was conducted in four major electronic databases: PubMed, EMBASE, The Cochrane Library, and Web of Science. The search period was restricted to studies published from January 2016 onwards, corresponding to the initial publication date of the 24-hour Movement Guidelines. The final search was performed on July 2, 2024. The search strategy incorporated key terms including "physical activity," "sedentary behavior," "sleep," "24-hour Movement Guidelines," "cardiometabolic risk," and their relevant variants. The complete search strategy for each database is detailed in Appendix 2. Studies were included if they met the following criteria: participants were healthy individuals aged 1-17 years, including toddlers (1-2 years), preschoolers (3-4 years), children (5-12 years), and youths (13-17 years); reported adherence to 24-hour movement guidelines and associated movement behaviors (PA, SB, and sleep); examined CMRFs including glucose metabolism (glucose, insulin), lipid metabolism(TG, HDL-C), body Size and Composition (BMI, WC), and cardiovascular Physiology (SBP, DBP); and were observational studies (prospective cohort or cross-sectional studies) published in English. Studies were excluded if they involved participants with pre-existing diseases or aged >17 years, were non-English language publications, or were conference abstracts, proceedings, or studies without accessible full texts. The exposure categories were analyzed in seven combinations: individual components (PA, SB, sleep) and their various combinations (PA+SB, PA+Sleep, Sleep+SB, PA+SB+Sleep). CMRFs were categorized into four domains following the GRADE framework: body Size and Composition(overweight/obesity, WC), lipid metabolism (TG, HDL-C), glucose metabolism (glucose, insulin), and cardiovascular Physiology (SBP, DBP). In this study, adherence to the 24-hour movement guidelines served as the exposure variable, while CMRFs were the outcome indicators. The ORs from each study were extracted to estimate the association between guideline adherence and CMRFs. If an OR was not provided, the β-value was converted to an OR using the formula [OR=e^β; OR lower=e^β(lower); OR upper=e^β(upper)]. Routine meta-analyses were performed using the "meta" package in R (version 4.3.3). Pooled ORs and 95% CIs were calculated using fixed- or random-effects models, depending on the heterogeneity between studies (I² <50% for fixed-effects and I² ≥50% for random-effects models). Subgroup analyses were conducted by guideline combinations (PA, SB, SLEEP, PA+SB, PA+SLEEP, SB+SLEEP, PA+SB+SLEEP), age groups (toddlers, preschoolers, children, youths), geographic regions (Africa, Asia, Europe, North America, Oceania, South America), and gender to investigate heterogeneity sources and assess interactions between factors and CMRFs. Publication bias was evaluated using funnel plots and the Egger test.