Urban-rural differences in BMI status, 24-hour movement guideline compliance, executive functions, and motor skills in preschool children: a cross-sectional study.

Background: Early childhood is a critical developmental period during which weight status, 24-hour movement behaviors (MB), executive functions (EF), and motor skills (MS) interact to influence long-term health and development. However, few studies have simultaneously examined these domains among preschool children in North African countries, particularly considering urban-rural differences. Therefore, this study investigated urban-rural differences in body mass index (BMI) categories, 24-hour MB, EF, and MS among Tunisian preschool children. Methods: A cross-sectional observational study was conducted in Tunisian preschool children. The sample included 112 children, of whom 74 were from urban areas and 38 from rural areas (50 boys and 62 girls), aged 4-5 years (mean age: 4.10 ± 0.58 years). BMI categories were defined according to World Health Organization (WHO) standards. Anthropometric measurements were used to calculate BMI-for-age z-scores and classify children as below normal, normal, or above normal. Twenty-four-hour MB, including physical activity (PA), sedentary behavior (SB), and sleep, were objectively assessed using accelerometers over five consecutive days. EF (inhibition and working memory) were assessed using standardized cognitive tests. Gross MS were evaluated using the Supine Timed Up and Go, One-Leg Standing Balance, Hand Grip Dynamometer, and Standing Long Jump tests, while fine MS were assessed using the 9-Hole Pegboard Test. Results: Significant differences between BMI categories were found for most anthropometric variables. Children with BMI above normal showed higher body weight and BMI-for-age z-scores. No significant differences were observed for accelerometer-derived MB, EF, or MS. However, BMI categories were associated with adherence to some 24-hour movement recommendations. While 76.4% met physical activity guidelines and 81.3% met sleep recommendations, only 18% adhered to all integrated guidelines. Conclusions: These findings suggest associations between BMI categories and anthropometric differences, while no clear associations were observed with variations in MB, EF, or motor competence. Urban-rural differences in adherence to some movement recommendations suggest a potential role of environmental context in children's daily behaviors. Given the cross-sectional and observational design, results should be interpreted with caution. Larger longitudinal studies are needed to clarify the complex interactions between weight status, MB, cognitive development, and MS in early childhood.