Clustering patterns of behavioural risk factors for cardiovascular diseases in Bangladeshi adolescents: a population-based study

Objectives: To examine the clustering of major behavioural risk factors for cardiovascular diseases (CVD) among adolescents in Bangladesh. Methods: Nationally representative data from the 2014 Bangladesh Global School-based Student Health Survey were analysed in 2,978 adolescents (mean age: 14.2 SD 0.99; 60.0% females). We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of the six behavioural risk factors (i.e., physical inactivity, sedentary behaviour, tobacco smoking, alcohol drinking, low fruit and vegetable intake, and overweight/obesity) to determine their clustering patterns. Poisson regression was used to examine the associations. Results: The most common single risk factor was low fruit and vegetable intake, followed by physical inactivity (87% and 59%, respectively). Overall, 18% of the adolescents had three or more risk factors, with males reporting higher prevalence than females (21% vs. 11%). The simultaneous occurrence of low fruit and vegetable intake, and physical inactivity was 30% greater in males (O/E ratio: 1.3, 95% CI: 1.2–1.4) and 20% greater in females (1.2, 1.2–1.3) than what was expected if there was no clustering. The analysis also demonstrated clustering of low fruit and vegetable, overweight/obesity, and high sedentary behaviour (2.5, 1.3–4.9), and low fruit and vegetable, overweight/obesity, and physical inactivity (1.4, 1.1–2.0) for males. Conclusions: This study fills the gap in the scientific literature by providing evidence that behavioural risk factors tend to cluster among adolescents in Bangladesh. Early prevention programs with evidence-based strategies need to target adolescents who are at a greater risk of engaging in multiple risk behaviours.