Discussion
lower sedentary behavior
In a large sample of early adolescents included in the SI! Program for Secondary Schools in Spain, four lifestyle clusters were derived from four key lifestyle behaviors (healthy diet, step counts, sleep time, and leisure screen time). Three of them (Socioeconomic differences during childhood and adolescence are relevant, since their effect in lifestyle accumulates over time, broadening the gap in health inequalities.Previous studies reported that adolescents with high parental education level are often allocated to healthier clusters (better diet quality, lower sedentary behavior, or higher physical activity levels), while adolescents with low parental education level are frequently allocated to less favorable clusters [The relationship between childhood and adolescent lifestyle patterns and health indicators has been widely described, although no consistent trends were found [It is important to note that the results of cluster analysis are intrinsically related to the study sample and are limited by its behavioral levels, representing participants with better or worse healthy lifestyle profiles. In this sense, it is noteworthy that our sample presents unhealthy lifestyle habits as a whole, similarly to previous results related to lifestyle recommendations [This study has some limitations. This cross-sectional analysis allows the establishment of associations, but not causation. Participation was voluntary, and we therefore cannot exclude selection bias and adolescents with worse CV health or unhealthier lifestyles might have been less willing to participate. In this analysis, only participants with complete information on the behaviors involved in the derived cluster solution were included, showing the excluded participants a differential sociodemographic distribution and thus resulting in a potential additional bias (Additional file Strengths of the study include the status of the SI! Program for Secondary Schools as a large, longitudinal multi-center study conducted in early adolescents who were assessed through a solid combination of direct measurements and questionnaires, all carried out by trained nutritionists and nurses. Another strength is the use of wrist-worn accelerometers [