Obesity is a key health issue in children[1]. Over the past five decades, there has been a global annual increase in body mass index (BMI) of 0.32 kg/m2 for males and 0.40 kg/m2 for females [2]. A global survey from 1975 to 2016 reported a significant increase in obesity, with the number of females increasing from 5 million to 50 million and males from 6 million to 74 million [2]. In East Asia, the prevalence of obesity has notably outpaced other regions, with China and India reporting the highest number of obese children globally in 2015 [3]. Moreover, the incidence of overweight and obesity among school-aged children in China rose from 15.5 % in 2010 to 29.4 % in 2022 [4]. These alarming trends highlight the need to address unhealthy eating habits, which are major contributors to obesity in this demographic, including behaviours such as eating while watching screen, skipping breakfast, and consuming excessive sugar [1]. Conversely, healthy eating habits are associated with enhanced academic performance, cognitive function, and executive functioning in children and adolescents [[5], [6], [7]]. Given the crucial role of childhood in establishing lifelong healthy lifestyles, effective strategies to promote these habits are imperative [8]. Dietary guidelines recommending daily consumption of breakfast, fruits, and vegetables are essential for optimal health outcomes [9].

Adherence to guidelines for physical activity, screen time, and sleep has been demonstrated to be effective in preventing obesity in children [10]. Insufficient physical activity and sleep, coupled with excessive screen time, adversely affect eating habits and contribute to obesity [11]. While numerous studies have investigated the independent relationships of physical activity [12], sedentary behaviour [13,14], and sleep [15,16] with eating habits, research examining the combined impacts of these movement behaviours is currently limited. For example, physical activity exhibits a J-shaped relationship with energy intake, where low physical activity levels are linked to unhealthy dietary patterns [12]. Similarly, excessive screen time is associated with decreased energy expenditure and increased dietary intake in children and adolescents [17]. Sleep deprivation also influences appetite regulation, reduces physical activity levels, and ultimately contributes to weight gain in children and adolescents [16]. Recent evidence highlights the need to consider all movement behaviours within a 24-h period, as they collectively influence health outcomes in children [[18], [19], [20]]. Moreover, these studies are predominantly based on Western populations, leaving a gap in understanding the cultural and regional differences, particularly in Chinese children. Therefore, research should adopt a holistic approach to understanding the 24-h continuum and its impact on health outcomes [19].

Despite a growing body of evidence supporting the benefits of adequate physical activity, sufficient sleep duration, and limited screen time, few studies have investigated their combined influence on eating habits in Chinese children and adolescents. A review summarized the positive impacts of adherence to 24-h movement guidelines on various health indicators, yet only one study examined dietary patterns [21]. This review study highlighted a positive association between meeting more movement behaviour recommendations and healthier dietary patterns among children but it did include a very limited number of Chinese children [11]. Given the rising prevalence of obesity in China and the limited research in this area, exploring the relationship between adherence to 24-h movement guidelines and eating habits is both timely and necessary, which can help inform further research and practice in obesity prevention among child population.

This cross-sectional study aimed to investigate the relationship between adherence to 24-h movement guidelines and eating habits in a sample of Chinese children.