1
|
Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
Collapse
Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Miguel-Berges ML, Mouratidou T, Santaliestra-Pasias A, Androutsos O, Iotova V, Galcheva S, De Craemer M, Cardon G, Koletzko B, Kulaga Z, Manios Y, Moreno LA. Longitudinal associations between diet quality, sedentary behaviours and physical activity and risk of overweight and obesity in preschool children: The ToyBox-study. Pediatr Obes 2023; 18:e13068. [PMID: 37525363 DOI: 10.1111/ijpo.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Lifestyle behaviours related to diet and physical activity are associated with increased risk of obesity and evidence suggests that associations might be stronger when a synergetic effect is examined. OBJECTIVE To examine the cross-sectional and longitudinal associations between diet, screen time (ST) and step recommendations and risk of overweight and obesity in European preschoolers participating in the ToyBox-study. METHODS In this cluster-randomized clinical trial, 718 children (51.4% boys) from six European countries participated. Parents filled out questionnaires with information on socio-demographic status, step recommendations and ST. RESULTS Longitudinal results indicate that participants having a low Diet Quality Index (DQI), not meeting ST and step recommendations at T0 and T1 had higher odds of having overweight/obesity at T1 (odds ratio [OR] = 1.116; 95% confidence interval [CI] = 1.104-2.562) than those children having a high DQI and meeting ST and step recommendations at T0 and T1. Similarly, participants having a high DQI, but not meeting ST and step recommendations at T0 and T1 had increased odds of having overweight/obesity (OR = 2.515; 95% CI = 1.171-3.021). CONCLUSIONS The proportion of participants having a low DQI, not adhering to both step and ST recommendations was very high, and it was associated with a higher probability of having overweight and obesity.
Collapse
Affiliation(s)
- María L Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Theodora Mouratidou
- Department of Nutrition and Dietetics, School of Health Sciences, Hellenic Mediterranean University, Sitia, Greece
| | - Alba Santaliestra-Pasias
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Odysseas Androutsos
- Lab of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | | | | | | | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Berthold Koletzko
- LMU-Ludwig Maximilians Universität Munich, Department Paediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
van Tetering EMA, Muskens JB, Deenik J, Pillen S, Cahn W, von Rosenstiel I, Oomen M, Rommelse NN, Staal WG, Klip H. The short and long-term effects of a lifestyle intervention in children with mental illnesses: a randomized controlled trial (Movementss study). BMC Psychiatry 2023; 23:529. [PMID: 37480007 PMCID: PMC10362712 DOI: 10.1186/s12888-023-04884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle. METHODS A total of 80 children (6-12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects. DISCUSSION This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI. TRIAL REGISTRATION trialsearch.who.int/ NL9822. Registered at November 2nd, 2021.
Collapse
Affiliation(s)
- Emilie M A van Tetering
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Jet B Muskens
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Deenik
- GGz Centraal, Department of Science, Amersfoort, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sigrid Pillen
- Kinderslaapexpert BV (Pediatric Sleep Expert Ltd), Mook, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Nanda N Rommelse
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Leiden Institution for Brain and Cognition, Leiden, The Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Jakobovich R, Berry EM, Levita A, Levin-Zamir D. Developing Healthy Lifestyle Behaviors in Early Age-An Intervention Study in Kindergartens. Nutrients 2023; 15:nu15112615. [PMID: 37299578 DOI: 10.3390/nu15112615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Childhood obesity prevention is a leading public health challenge requiring the adoption of healthy lifestyles at an early age. We examined how the kindergarten environment can promote eating sensibly, drinking water and becoming physically active. The effects of an intervention program among 42 Israeli kindergartens (1048 children, aged 4-6) whose teachers participated in a health education training program were compared to 32 kindergartens (842 children) whose teachers did not undergo this training program. An eight-month intervention program focused on knowledge/mathematical/logical/critical thinking, self-regulation/control acquisition, and sensible decision-making abilities. We hypothesized that nutrition and physical-exercise-oriented intervention programs, combining knowledge/mathematical logical thinking, would positively impact the quality of children's mid-morning snack and water consumption, their ability to express feelings following physical exercise, and the adoption of healthy lifestyles at home. The quality of mid-morning snacks and water consumption were observed in both groups pre- and post-intervention. Qualitative interviews documented children's subjective feelings following physical exercise. A significant improvement (p < 0.001) was observed in the mid-morning snacks composition and in water drinking habits in the intervention group; 80% of children offered a physiological explanation regarding energy expenditure processes following intense physical exercise. In conclusion, kindergarten interventions implemented by trained teachers can promote adoption of health behaviors necessary for obesity prevention.
Collapse
Affiliation(s)
- Ronit Jakobovich
- Department of Health Promotion, School of Public Health, Tel Aviv University, Tel Aviv 6209804, Israel
| | - Elliot M Berry
- Department of Human Nutrition and Metabolism, Braun School of Public Health, Hebrew University Hadassah Medical School, Jerusalem 9103102, Israel
| | - Asia Levita
- Faculty of Science and Technology Education, Technion, Haifa 3498838, Israel
| | - Diane Levin-Zamir
- School of Public Health, University of Haifa, Haifa 3498838, Israel
- Department of Health Education and Promotion, Clalit Health Services, School of Public Health, University of Haifa, Tel Aviv 6209804, Israel
| |
Collapse
|
5
|
González J, Vilella M, Ruiz S, Iglesia I, Clavero-Adell M, Ayerza-Casas A, Matute-Llorente A, Oros D, Casajús JA, Pueyo V, Rodriguez G, Paules C. Impact of Suspected Preterm Labor during Pregnancy on Cardiometabolic Profile and Neurodevelopment during Childhood: A Prospective Cohort Study Protocol. Diagnostics (Basel) 2023; 13:diagnostics13061101. [PMID: 36980410 PMCID: PMC10047113 DOI: 10.3390/diagnostics13061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Suspected preterm labor (SPL), defined as the presence of regular and painful uterine contractions and cervical shortening, represents a prenatal insult with potential long-term consequences. However, despite recent evidence demonstrating suboptimal neurodevelopment at 2 years in this population, it remains underestimated as a significant risk factor for neurodevelopmental disorders or other chronic diseases. The aim of this study is to assess the impact of suspected preterm labor during pregnancy on cardiometabolic profile and neurodevelopment during childhood (6–8 years). Methods and analysis: Prospective cohort study including children whose mothers suffered suspected preterm labour during pregnancy and paired controls. Neurodevelopmental, cardiovascular, and metabolic assessments will be performed at 6–8 years of age. A trained psychologist will carry out the neurodevelopment assessment including intelligence, visual perception, and behavioral assessment. Body composition and physical fitness assessment will be performed by one trained pediatrician and nurse. Finally, cardiovascular evaluation, including echocardiography and blood pressure, will be performed by two pediatric cardiologists. Data regarding perinatal and postnatal characteristics, diet, lifestyle, and weekly screen time of the child will be obtained from medical history and direct interviews with families. Primary outcome measures will include body mass index and adiposity, percentage of fat mass and total and regional lean mass, bone mineral content and density, cardiorespiratory resistance, isometric muscle strength, dynamic lower body strength, systolic and diastolic blood pressure, left ventricle (LV) systolic and diastolic function, general intelligence index, visuospatial working memory span, oculomotor control test, index of emotional, and behavioral problems.
Collapse
Affiliation(s)
- Jesús González
- Pediatrics Department, Quirónsalud Hospital Zaragoza, 50006 Zaragoza, Spain
| | - Marina Vilella
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | - Sonia Ruiz
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | - Iris Iglesia
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Marcos Clavero-Adell
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Paediatric Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ariadna Ayerza-Casas
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Paediatric Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Angel Matute-Llorente
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health and Sport Sciences (FCSD), University of Zaragoza, 22001 Huesca, Spain
- Physiopathology of Obesity and Nutrition Networking Biomedical Research Center (CIBERObn), 28029 Madrid, Spain
| | - Daniel Oros
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jose Antonio Casajús
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Physiopathology of Obesity and Nutrition Networking Biomedical Research Center (CIBERObn), 28029 Madrid, Spain
| | - Victoria Pueyo
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Ophthalmology Department, Miguel Servet University Hospital, University of Zaragoza, 50009 Zaragoza, Spain
| | - Gerardo Rodriguez
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, 50009 Zaragoza, Spain
| | - Cristina Paules
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: or ; Tel.: +34-976765700 (ext. 4908)
| |
Collapse
|
6
|
Lehto R, Vepsäläinen H, Lehtimäki AV, Lehto E, Leppänen MH, Skaffari E, Abdollahi AM, Roos E, Erkkola M, Ray C. Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation. BMC Public Health 2022; 22:2268. [PMID: 36471322 PMCID: PMC9720976 DOI: 10.1186/s12889-022-14639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/05/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09, -0.09). CONCLUSIONS Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION ISRCTN57165350 (8 January, 2015).
Collapse
Affiliation(s)
- Reetta Lehto
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| | - Henna Vepsäläinen
- grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| | - Aku-Ville Lehtimäki
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland
| | - Elviira Lehto
- grid.7737.40000 0004 0410 2071Faculty of Social Sciences, Department of Sociology, University of Helsinki, P.O. Box, 00014 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Faculty of Educational Sciences, Department of Teacher Education, University of Helsinki, P.O. Box 9, 00014 Helsinki, Finland
| | - Marja H. Leppänen
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Essi Skaffari
- grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| | - Anna M. Abdollahi
- grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| | - Eva Roos
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Faculty of Medicine, University of Helsinki, Helsinki, Finland ,grid.8993.b0000 0004 1936 9457Department of food studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Maijaliisa Erkkola
- grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| | - Carola Ray
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
| |
Collapse
|
7
|
Tadakamadla SK, Rathore V, Mitchell AE, Johnson N, Morawska A. Protocol of a cluster randomised controlled trial evaluating the effectiveness of an online parenting intervention for promoting oral health of 2-6 years old Australian children. BMJ Open 2022; 12:e056269. [PMID: 36229155 PMCID: PMC9562284 DOI: 10.1136/bmjopen-2021-056269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dental decay is a major problem among Australian children. It can be prevented through good self-care and limiting sugar intake, but many parents/caregivers lack the skills and confidence to help their children adopt these practices. This trial will evaluate the efficacy of Healthy Habits Triple P - Oral health, a web-based online programme, in improving children's oral health-related behaviours (toothbrushing, snacking practices and dental visits) and related parenting practices, thereby preventing dental caries. METHODS AND ANALYSIS This is a cluster, parallel-group, single-blinded, randomised controlled trial of an online intervention for parents/caregivers of children aged 2-6 years. From the City of Gold Coast (Australia), 18 childcare centres will be randomly selected, with equal numbers randomised into intervention and control arms. Intervention arm parents/caregivers will receive access to a web-based parenting intervention while those in the control arm will be directed to oral health-related information published by Australian oral health agencies. After the completion of the study, the Healthy Habits Triple P - Oral health intervention will be offered to parents/caregivers in the control arm. The primary outcome of this trial is toothbrushing frequency, which will be assessed via Bluetooth supported smart toothbrushes and parent/caregiver report. Data on other outcomes: parenting practices and child behaviour during toothbrushing, consumption of sugar rich foods and parents' confidence in dealing with children's demands for sugar rich food, and dental visiting practices, will be collected through a self-administered questionnaire at baseline (before randomisation), and 6 weeks (primary endpoint), 6 months and 12 months after randomisation. Data on dental caries will be collected at baseline, 12 and 18 months post-randomisation. ETHICS AND DISSEMINATION Ethical approval has been obtained from Human Research Ethics Committees of Griffith University (2020/700) and the University of Queensland (2020002839). Findings will be submitted for publication in leading international peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12621000566831.
Collapse
Affiliation(s)
- Santosh Kumar Tadakamadla
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Vatsna Rathore
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Amy E Mitchell
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Newell Johnson
- School of Medicine and Dentistry & Menzies Health Institute Queensland, Griffith University - Gold Coast Campus, Gold Coast, Queensland, Australia
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study. Public Health Nutr 2022; 25:1552-1562. [PMID: 33843562 PMCID: PMC9991669 DOI: 10.1017/s1368980021001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. DESIGN A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children's body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used. SETTING Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). PARTICIPANTS A sample of 6268 preschoolers aged 3·5-5·5 years (51·9 % boys). RESULTS There was no intervention effect on the change in children's BMI percentile. However, parents' underestimation of their children's actual weight status, parental overweight and mothers' pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children's BMI percentile in multivariate modelling. CONCLUSIONS As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children's weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.
Collapse
|
9
|
Ferrer P, Iglesia I, Muniz-Pardos B, Miguel-Berges ML, Flores-Barrantes P, Gomez-Bruton A, Moreno LA, Rodríguez G. Is it important to achieve physical activity recommendations at early stages of life to improve bone health? Osteoporos Int 2022; 33:1017-1026. [PMID: 34905063 PMCID: PMC9007798 DOI: 10.1007/s00198-021-06256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/26/2021] [Indexed: 12/01/2022]
Abstract
UNLABELLED Research in bone health during childhood is limited and important to prevent future diseases, particularly, osteoporosis. Bone parameters using DXA and pQCT in 295 Spanish children were evaluated and we found a benefit of meeting the World Health Organization physical activity recommendations in bone composition in childhood. PURPOSE To investigate the association between physical activity (PA) and bone health in a Spanish paediatric cohort, considering the influence of meeting/not meeting the current World Health Organization (WHO) PA recommendations and to elucidate if there are differences between boys and girls. METHODS In a cohort of children born in the region of Aragon (Spain) in 2009, followed until the age of 7 years, bone parameters were assessed using dual-energy X-ray absorptiometry (DXA) (whole body scan) and peripheral quantitative computed tomography (pQCT) (tibia scanned at the 8% (distal) and 38% (diaphyseal) of the total tibia length) in 295 7-year-old children (154 boys) in the last evaluation performed between 2016 and 2017. PA was assessed using GT3X Actigraph accelerometers. RESULTS Boys had significantly higher areal bone mineral density (aBMD), higher total bone mineral content (BMC) at the diaphyseal site and higher trabecular BMC and vBMD, and higher total bone area at the distal site than girls (p<0.01 for all of them). Both boys and girls complying with the WHO PA recommendations had significantly higher trabecular BMC than their inactive counterparts. CONCLUSIONS Meeting WHO PA recommendations has a beneficial effect in bone composition in childhood both in boys and in girls.
Collapse
Affiliation(s)
- P Ferrer
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
| | - I Iglesia
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain.
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain.
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - B Muniz-Pardos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
- Facultad de Ciencias de la Salud y el Deporte, Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, España
| | - M L Miguel-Berges
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
| | - P Flores-Barrantes
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
| | - A Gomez-Bruton
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
- Facultad de Ciencias de la Salud y el Deporte, Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, España
| | - L A Moreno
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - G Rodríguez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), 50009, Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Facultad de Medicina, Departamento de Pediatría, Universidad de Zaragoza, Zaragoza, España
- Hospital Clínico Universitario "Lozano Blesa", Zaragoza, España
| |
Collapse
|
10
|
Do Children and Adolescents with Overweight or Obesity Adhere to the National Food-Based Dietary Guidelines in Greece? CHILDREN 2022; 9:children9020256. [PMID: 35204978 PMCID: PMC8870155 DOI: 10.3390/children9020256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
Childhood obesity increases the risk for metabolic disorders, but is also related to nutritional deficiencies, such as anemia and hypovitaminosis D. Although children/adolescents with overweight/obesity may have higher energy intake, their diet quality and diversity may be low. The present study aimed to evaluate the consumption of foods against the national food-based dietary guidelines in children and adolescents with overweight or obesity in Greece. Sociodemographic, anthropometric and lifestyle data were collected from a sample of 1467 children 2–18 years old (962 obese, 505 overweight, 51.2% females) in 2014–2017. The results of this study show that the consumption of dairy products, fruit, vegetables, legumes and fish by children/adolescents with overweight or obesity was lower than the national recommendations (ranging from a minimum of 39.5% for fish, to a maximum of 75.5% for cereal/potato/rice). Only the consumption of meat/poultry was found to exceed the national recommendation (estimated coverage of 131.3%). Moreover, a large proportion of participants regularly consumed various unhealthy foods/beverages. The present findings indicate that the majority of children/adolescents with overweight/obesity do not comply with the national food-based dietary guidelines in Greece. The implementation of new strategies to promote healthy diets among children/adolescents with overweight/obesity are urgently required.
Collapse
|
11
|
Usheva N, Lateva M, Galcheva S, Koletzko BV, Cardon G, De Craemer M, Androutsos O, Kotowska A, Socha P, Moreno LA, Manios Y, Iotova V. Breastfeeding and Overweight in European Preschoolers: The ToyBox Study. Nutrients 2021; 13:nu13082880. [PMID: 34445041 PMCID: PMC8401161 DOI: 10.3390/nu13082880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/04/2022] Open
Abstract
The benefits of breastfeeding (BF) include risk reduction of later overweight and obesity. We aimed to analyse the association between breastfeeding practices and overweight/obesity among preschool children participating in the ToyBox study. Data from children in the six countries, participating in the ToyBox-study (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) 7554 children/families and their age is 3.5–5.5 years, 51.9% were boys collected cross-sectionally in 2012. The questionnaires included parents’ self-reported data on their weight, height, socio-demographic status, and infant feeding practices. Measurements of preschool children’s weight and height were done by trained researchers using standard protocols and equipment. The ever breastfeeding rate in the total sample was 85.0% (n = 5777). Only 6.3% (n = 428) of the children from the general sample were exclusively breastfed (EBF) for the duration of the first six months. EBF for four to six months was significantly (p < 0.001) less likely among mothers with formal education < 12 years (adjusted Odds Ratio (OR) = 0.61; 95% Confidence interval (CI) 0.44–0.85), smoking throughout pregnancy (adjusted OR = 0.39; 95% CI 0.24–0.62), overweight before pregnancy (adjusted OR = 0.67; 95%CI 0.47–0.95) and ≤25 years old. The median duration of any breastfeeding was five months. The prevalence of exclusive formula feeding during the first five months in the general sample was about 12% (n = 830). The prevalence of overweight and obesity at preschool age was 8.0% (n = 542) and 2.8% (n = 190), respectively. The study did not identify any significant association between breastfeeding practices and obesity in childhood when adjusted for relevant confounding factors (p > 0.05). It is likely that sociodemographic and lifestyle factors associated with breastfeeding practices may have an impact on childhood obesity. The identified lower than desirable rates and duration of breastfeeding practices should prompt enhanced efforts for effective promotion, protection, and support of breastfeeding across Europe, and in particular in regions with low BF rates.
Collapse
Affiliation(s)
- Natalya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, 9002 Varna, Bulgaria
- Correspondence: ; Tel.: +359-52677164
| | - Mina Lateva
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria; (M.L.); (S.G.); (V.I.)
| | - Sonya Galcheva
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria; (M.L.); (S.G.); (V.I.)
| | - Berthold V. Koletzko
- Division of Metabolic and Nutritional Medicine, Department Paediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, 80337 Munich, Germany;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 382 21 Volos, Greece;
| | - Aneta Kotowska
- Public Health Department, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.K.); (P.S.)
| | - Piotr Socha
- Public Health Department, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.K.); (P.S.)
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Drinking Behaviour and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 176 76 Athens, Greece;
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria; (M.L.); (S.G.); (V.I.)
| | | |
Collapse
|
12
|
Compliance with the 24-Hour Movement Behavior Guidelines and Associations with Adiposity in European Preschoolers: Results from the ToyBox-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147499. [PMID: 34299954 PMCID: PMC8307342 DOI: 10.3390/ijerph18147499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 02/01/2023]
Abstract
In 2019, the World Health Organization (WHO) published 24 h movement behavior guidelines for preschoolers with recommendations for physical activity (PA), screen time (ST), and sleep. The present study investigated the proportion of preschoolers complying with these guidelines (on a total week, weekdays and weekend days), and the associations with adiposity. This cross-sectional study included 2468 preschoolers (mean age: 4.75 years; 41.9% boys) from six European countries. The associations were investigated in the total sample and in girls and boys separately. PA was objectively assessed by step counts/day. Parent-reported questionnaires provided ST and sleep duration data. Generalized estimating equations were used to analyze the association between guideline compliance and adiposity indicators, i.e., body mass index (BMI) z-score and waist to height ratio (WHR). Only 10.1% of the preschoolers complied with the 24 h movement behavior guidelines, 69.2% with the sleep duration guideline, 39.8% with the ST guideline and 32.7% with the PA guideline. No association was found between guideline compliance with all three movement behaviors and adiposity. However, associations were found for isolated weekday screen time (BMI z-scores and WHR: p = 0.04) and weekend day sleep duration (BMI z-scores and WHR: p = 0.03) guideline compliance with both lower adiposity indicators. The latter association for sleep duration was also found in girls separately (BMI z-scores: p = 0.02; WHR: p = 0.03), but not in boys. Longitudinal studies, including intervention studies, are needed to increase preschoolers’ guideline compliance and to gain more insight into the manifestation of adiposity in children and its association with 24 h movement behaviors from a young age onwards.
Collapse
|
13
|
Miguel-Berges ML, Santaliestra-Pasias AM, Mouratidou T, Flores-Barrantes P, Androutsos O, De Craemer M, Galcheva S, Koletzko B, Kulaga Z, Manios Y, Moreno LA. Parental perceptions, attitudes and knowledge on European preschool children's total screen time: the ToyBox-study. Eur J Public Health 2021; 30:105-111. [PMID: 31501880 DOI: 10.1093/eurpub/ckz151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Preschool children spend a significant proportion of their waking hours being sedentary. Parents play a critical role in developing and shaping their children's lifestyle behaviours, particularly in the early years of life. This study aims to assess parental perceptions, attitudes and knowledge of their preschool children's sedentary behaviours and the association with children's television (TV)/video/DVDs viewing and total screen time. METHODS Data were obtained from a sample of 4836 children (3.5-5.5 years), participating in the multi-centre ToyBox-study at baseline (T0) and at 1-year follow-up (T1) periods. Data on children's sedentary behaviours were collected via a standardized proxy-administered primary caregiver's questionnaire. RESULTS Regarding total screen time, 66.6% of the children at T0 and 71.8% at T1 in the control group exceeded the recommendations, whereas the proportion in the intervention group varied from 69.7% at T0 to 72.5% at T1. The odds of exceeding total screen time recommendations were significantly higher when parental perceptions towards limiting the total screen time were negative [(both T0 and T1 and in the intervention and control groups (P < 0.05)]. Similarly, the odds of exceeding TV/video/DVDs viewing recommendations were significantly higher (both T0 and T1 is observed in both groups) when parental knowledge of recommendation were absent. CONCLUSIONS Preschool children whose caregivers stated rules limiting their sedentary screen time were less likely to spend a high amount of time watching TV/video/DVDs. Interventions to increase parental practices may be a promising approach to decrease total screen time of preschool children but studies are needed to confirm this.
Collapse
Affiliation(s)
- María L Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain
| | - Alba M Santaliestra-Pasias
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain.,Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, Zaragoza, Spain
| | - Theodora Mouratidou
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Paloma Flores-Barrantes
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Berthold Koletzko
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain.,Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
14
|
Moderate-to-Vigorous Physical Activity and Body Composition in Children from the Spanish Region of Aragon. CHILDREN-BASEL 2021; 8:children8050341. [PMID: 33926063 PMCID: PMC8146711 DOI: 10.3390/children8050341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/18/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Most of the studies analyzing the effect of moderate to vigorous physical activity (MVPA) on children’s health do not contain information on early stages or do not use accurate methods. We investigated the association between PA and body composition using objective methods, perinatal data, lifestyle behaviors, and World Health Organization (WHO) physical activity (PA) recommendations. The CALINA study is a longitudinal observational cohort study of children born in Aragon (Spain) in 2009. A total of 308 7-year-old children (52.3% boys) were assessed. We used dual-energy X-ray absorptiometry (DXA) and accelerometry. Rapid weight gain until 12 months and lifestyle behaviors were considered as covariates both in the ANCOVA and linear regression models. A higher percentage of boys met the WHO PA recommendations compared to girls (69.6% vs. 40.9%, respectively; p < 0.001). There was a negative association between MVPA and subtotal fat and abdominal fat in both girls and boys. After adjusting for perinatal and lifestyle variables, we found that subtotal body fat, abdominal fat, and fat mass index (FMI) were significantly lower in those classified as active. MVPA was associated with body fat both in boys and girls. More research is needed to identify the cutoffs points of MVPA that generate benefit to boys and girls in all body composition components.
Collapse
|
15
|
Complementary Feeding and Overweight in European Preschoolers: The ToyBox-Study. Nutrients 2021; 13:nu13041199. [PMID: 33916419 PMCID: PMC8066073 DOI: 10.3390/nu13041199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Complementary feeding (CF) should start between 4–6 months of age to ensure infants’ growth but is also linked to childhood obesity. This study aimed to investigate the association of the timing of CF, breastfeeding and overweight in preschool children. Infant-feeding practices were self-reported in 2012 via a validated questionnaire by >7500 parents from six European countries participating in the ToyBox-study. The proportion of children who received breast milk and CF at 4–6 months was 51.2%. There was a positive association between timing of solid food (SF) introduction and duration of breastfeeding, as well as socioeconomic status and a negative association with smoking throughout pregnancy (p < 0.005). No significant risk to become overweight was observed among preschoolers who were introduced to SF at 1–3 months of age compared to those introduced at 4–6 months regardless of the type of milk feeding. Similarly, no significant association was observed between the early introduction of SF and risk for overweight in preschoolers who were breastfed for ≥4 months or were formula-fed. The study did not identify any significant association between the timing of introducing SF and obesity in childhood. It is likely that other factors than timing of SF introduction may have impact on childhood obesity.
Collapse
|
16
|
De Craemer M, Verbestel V, Verloigne M, Androutsos O, Moreno L, Iotova V, Koletzko B, Socha P, Manios Y, Cardon G. Combining Effect and Process Evaluation on European Preschool Children's Snacking Behavior in a Kindergarten-Based, Family-Involved Cluster Randomized Controlled Trial: The ToyBox Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197312. [PMID: 33036371 PMCID: PMC7579655 DOI: 10.3390/ijerph17197312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/14/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
This study aimed at (1) studying the effect of the standardized ToyBox intervention on European preschoolers' snacking behavior, and (2) studying whether a higher process evaluation score from teachers and parents/caregivers was associated with a more positive result for preschoolers' snack intake. A sample of 4970 preschoolers (51.4% boys, 4.74 ± 0.44 years) from six European countries provided information on snack intake with the use of a Food Frequency Questionnaire. To investigate the effect of the intervention, multilevel repeated measures analyses were executed for the total sample and the six country-specific samples. Furthermore, questionnaires to measure process evaluation were used to compute a total process evaluation score for teachers and parents/caregivers. No significant intervention effects on preschoolers' snack intake were found (all p > 0.003). In general, no different effects of the intervention on snack intake were found according to kindergarten teachers' and parents'/caregivers' process evaluation scores. The lack of effects could be due to limited intervention duration and dose. To induce larger effects on preschoolers' snack intake, a less standardized intervention which is more tailored to the local needs might be needed.
Collapse
Affiliation(s)
- Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium;
- Correspondence: ; Tel.: +32-9332-52-08
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Maïté Verloigne
- Research Foundation Flanders, 1000 Brussels, Belgium;
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, University of Thessaly, Sport Science and Dietetics, 421 00 Trikala, Greece;
| | - Luis Moreno
- Department of Physiatry and Nursing, GENUD (Growth, Exercise, Drinking Behaviour and Development), University of Zaragoza, 50001 Zaragoza, Spain;
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, 9002 Varna, Bulgaria;
| | - Berthold Koletzko
- Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, 80337 Munich, Germany;
| | - Piotr Socha
- Children’s Memorial Institute, 04-730 Warsaw, Poland;
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, 17778 Athens, Greece;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium;
| |
Collapse
|
17
|
De Craemer M, Verbestel V, Cardon G, Androutsos O, Manios Y, Chastin S. Correlates of Meeting the Physical Activity, Sedentary Behavior, and Sleep Guidelines for the Early Years among Belgian Preschool Children: The ToyBox-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197006. [PMID: 32987961 PMCID: PMC7579535 DOI: 10.3390/ijerph17197006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023]
Abstract
Physical activity, sedentary behavior, and sleep guidelines for preschool children were already established and integrated into the 24 h movement behavior guidelines in 2017. The aim of the current study was to investigate correlates of meeting or not meeting the physical activity, sedentary behavior, and sleep guidelines in Belgian preschool children. In total, 595 preschool children (53.3% boys, 46.7% girls, mean age: 4.2 years) provided complete data for the three behaviors and potentially associated correlates. Physical activity was objectively measured with accelerometers. Screen time, sleep duration, and correlates were reported by parents with the use of a questionnaire. Backward logistic regression was used to identify factors associated with meeting all guidelines for weekdays and weekend days. In the final model, older preschoolers (OR = 1.89), having a normal weight compared to being underweight (OR = 0.30), having parents that do not watch a lot of television (OR = 0.99), and having a father that attained higher education (OR = 1.91) were associated with meeting all guidelines on weekdays. For weekend days, a significant association was found for attending a sports club (OR = 1.08). Overall, only a few factors were associated with meeting the guidelines. A more comprehensive measurement of preschool children’s potential correlates of physical activity, sedentary behavior, and sleep is warranted.
Collapse
Affiliation(s)
- Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-9332-52-08
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100 Trikala, Greece;
| | - Yannis Manios
- School of Health Sciences & Education, Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece;
| | - Sebastien Chastin
- Department of Health and Community Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| |
Collapse
|
18
|
Anastasiou CA, Fappa E, Zachari K, Mavrogianni C, Van Stappen V, Kivelä J, Virtanen E, González-Gil EM, Flores-Barrantes P, Nánási A, Semánová C, Dimova R, Usheva N, Iotova V, Cardon G, Manios Y, Makrilakis K. Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study. BMC Endocr Disord 2020; 20:135. [PMID: 32164677 PMCID: PMC7066729 DOI: 10.1186/s12902-019-0469-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family's energy balance-related behaviors. METHODS Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1-2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest. RESULTS Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family's energy balance-related behaviors and their determinants was 0.659. CONCLUSION The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children's and parents' behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- and community-based interventions.
Collapse
Affiliation(s)
- Costas A. Anastasiou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelia Fappa
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Zachari
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Eeva Virtanen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Esther M. González-Gil
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Paloma Flores-Barrantes
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csilla Semánová
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Roumyana Dimova
- Department of Diabetology, Clinical, Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Natalya Usheva
- Department of Social Sciences and Public Health, Medical University of Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Clinic of Pediatric Endocrinology, Medical University of Varna, Varna, Bulgaria
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, 17 Ag. Thoma St, 11527 Athens, Greece
| | | |
Collapse
|
19
|
Androutsos O, Anastasiou C, Lambrinou CP, Mavrogianni C, Cardon G, Van Stappen V, Kivelä J, Wikström K, Moreno LA, Iotova V, Tsochev K, Chakarova N, Ungvári T, Jancso Z, Makrilakis K, Manios Y. Intra- and inter- observer reliability of anthropometric measurements and blood pressure in primary schoolchildren and adults: the Feel4Diabetes-study. BMC Endocr Disord 2020; 20:27. [PMID: 32164691 PMCID: PMC7066724 DOI: 10.1186/s12902-020-0501-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Feel4Diabetes was a large-scale, multicenter lifestyle intervention aiming to prevent type 2 diabetes among families from vulnerable population groups in six European countries (Belgium, Bulgaria, Finland, Greece, Hungary and Spain). The current study aimed to describe the process that was followed to harmonize and standardize the measurement of anthropometric (weight, height and waist circumference) and blood pressure (systolic and diastolic) indices, as well as to assess the intra- and inter- observer reliability of these measurements. METHODS A central training workshop was conducted prior to the baseline measurements of the Feel4Diabetes-intervention. One researcher from each intervention country, as well as 12 adults and 12 children (for the anthropometric measurements) and 21 adults (for the blood pressure measurements) participated in this workshop. Technical Error of Measurement (TEM) and reliability (%R) were calculated to assess the reliability of the indices which were assessed to evaluate the outcome of the Feel4Diabetes-intervention. The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872). RESULTS Intra-observer reliability was found to be higher than 99.5% for all anthropometric measurements in both children and adults. Inter-observer reliability was found to be higher than 98% regarding the anthropometric measurements, while for blood pressure measurements %R was 76.62 and 91.38% for systolic and diastolic blood pressure measurements, respectively. CONCLUSION The central training of the Fee4Diabetes-intervention ensured that the data collected for the outcome evaluation of the Feel4Diabetes-intervention in the six European countries at three different time points (baseline, follow-up 1 and follow-up 2) were valid and comparable.
Collapse
Affiliation(s)
- Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Costas Anastasiou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancso
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | | |
Collapse
|
20
|
Gibson EL, Androutsos O, Moreno L, Flores-Barrantes P, Socha P, Iotova V, Cardon G, De Bourdeaudhuij I, Koletzko B, Skripkauskaite S, Manios Y. Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children's Healthy and Unhealthy Snacking: The ToyBox Study. Nutrients 2020; 12:nu12020432. [PMID: 32046193 PMCID: PMC7071198 DOI: 10.3390/nu12020432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/25/2022] Open
Abstract
This study investigated parental influences on preschool children's healthy and unhealthy snacking in relation to child obesity in a large cross-sectional multinational sample. Parents and 3-5 year-old child dyads (n = 5185) in a kindergarten-based study provided extensive sociodemographic, dietary practice and food intake data. Parental feeding practices that were derived from questionnaires were examined for associations with child healthy and unhealthy snacking in adjusted multilevel models, including child estimated energy expenditure, parental education, and nutritional knowledge. Parental healthy and unhealthy snacking was respectively associated with their children's snacking (both p < 0.0001). Making healthy snacks available to their children was specifically associated with greater child healthy snack intake (p < 0.0001). Conversely, practices that were related to unhealthy snacking, i.e., being permissive about unhealthy snacking and acceding to child demands for unhealthy snacks, were associated with greater consumption of unhealthy snacks by children, but also less intake of healthy snacks (all p < 0.0001). Parents having more education and greater nutritional knowledge of snack food recommendations had children who ate more healthy snacks (all p < 0.0001) and fewer unhealthy snacks (p = 0.002, p < 0.0001, respectively). In the adjusted models, child obesity was not related to healthy or unhealthy snack intake in these young children. The findings support interventions that address parental practices and distinguish between healthy and unhealthy snacking to influence young children's dietary patterns.
Collapse
Affiliation(s)
- Edward Leigh Gibson
- Department of Psychology, University of Roehampton, London SW15 4JD, UK;
- Correspondence:
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Luis Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Saragossa, Spain; (L.M.); (P.F.-B.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Saragossa, Spain
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Saragossa, Spain
| | - Paloma Flores-Barrantes
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Saragossa, Spain; (L.M.); (P.F.-B.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Saragossa, Spain
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Saragossa, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (G.C.); (I.D.B.)
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (G.C.); (I.D.B.)
| | - Berthold Koletzko
- Dr von Hauner Children’s Hospital, LMU-Ludwig-Maximilians-University at Munich, D-80337 Munich, Germany;
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece;
| | | |
Collapse
|
21
|
Malden S, Reilly JJ, Gibson AM, Bardid F, Summerbell C, De Craemer M, Cardon G, Androutsos O, Manios Y, Hughes A. A feasibility cluster randomised controlled trial of a preschool obesity prevention intervention: ToyBox-Scotland. Pilot Feasibility Stud 2019; 5:128. [PMID: 31728203 PMCID: PMC6842492 DOI: 10.1186/s40814-019-0521-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background High levels of childhood obesity have been observed globally over the last three decades. Preschools are promising settings to implement obesity prevention interventions in the early years. The aim of this study was to test the feasibility of a cluster randomised controlled trial of the ToyBox-Scotland preschool obesity prevention intervention. Methods Six preschools in predominantly deprived areas of Glasgow, UK, were randomised to either the ToyBox intervention (n = 3) or usual curriculum control group (n = 3). The intervention ran for 18 weeks from March-June 2018, and consisted of practitioner-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures were intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes were body mass index (BMI) z-score, bioelectrical impedance analysis (BIA), objectively measured physical activity and sedentary time via activPAL accelerometer, and parent-reported home eating, snacking, and water consumption. Results The preschool component of the intervention was implemented with high fidelity (64%), while the home component was implemented with low fidelity (41%). A cluster-level recruitment rate of 10% was achieved, and the individual-level recruitment rate was 18% (42/233 children, mean age 4.4 years; 17 girls). The attrition rate was 14%, and compliance rates varied considerably by the outcome. Compliance was highest for BMI (86%), while 19% of the sample returned valid accelerometer data for both baseline and follow-up and the parental questionnaire response rate was 23%. Both intervention and control groups showed small increases in BMI z-scores at follow-up of 0.02 and 0.06, respectively. Both groups had small decreases in physical activity and increases in sedentary time at follow-up. Conclusions Before progression to an effectiveness trial, additional procedures should be considered to improve recruitment rates, compliance with outcome measures, and implementation of the home-based component of the ToyBox-Scotland intervention. Trial registration ISRCTN12831555.
Collapse
Affiliation(s)
- Stephen Malden
- 1Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - John J Reilly
- 1Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - Ann-Marie Gibson
- 1Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - Farid Bardid
- 2School of Education, University of Strathclyde, Glasgow, UK.,3Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Carolyn Summerbell
- 4Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Marieke De Craemer
- 3Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- 3Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- 5Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Yannis Manios
- 5Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Adrienne Hughes
- 1Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| |
Collapse
|
22
|
Mouratidou T, Mesana Graffe MI, Huybrechts I, De Decker E, De Craemer M, Androutsos O, Manios Y, Galcheva S, Lateva M, Gurzkowska B, Kułaga Z, Birnbaum J, Koletzko B, Moreno LA. Reproducibility and relative validity of a semiquantitative food frequency questionnaire in European preschoolers: The ToyBox study. Nutrition 2019; 65:60-67. [PMID: 31029924 DOI: 10.1016/j.nut.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/09/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine the reproducibility and relative validity of a semiquantitative food frequency questionnaire (FFQ) in assessing food group estimates. METHODS Food group estimates were assessed via a 37-item FFQ and a 3-d food record (FR). Pearson's correlation coefficients for log-transformed values were calculated to assess the reproducibility and Spearman's rank correlation coefficients for log-transformed values were calculated to assess the validity. Kindergartens from six European countries participated in the preparatory substudies of the ToyBox intervention study; data from preschool children 4 to 6 y of age (n = 196, reproducibility study; n = 324, validation study) were obtained. RESULTS In the reproducibility study, positive Pearson's correlation coefficients for single and aggregated food groups ranged from 0.14 for pasta and rice to 0.90 for cooked vegetables. In the validation study, the FR gave higher estimates of 40 of the 50 food items (single and aggregated) examined compared with those obtained from the FFQ. Positive crude Spearman rank correlation coefficients ranged from 0.01 for total beverages (added sugar) and rice to 0.62 for tea. Corrections for the deattenuation effect did not improve observed correlations. Quartiles and tertiles were calculated for a small number of food groups (N = 14) owing to zero consumption in the rest of the groups. CONCLUSIONS Moderately good reproducibility and low-moderate relative validity of the FFQ used in preschool children was observed. Relative validity, however, varied by food and beverage group; for some of the "key" foods/drinks targeted in the ToyBox intervention (e.g., biscuits), the validity was good. The findings should be considered in future epidemiologic and intervention studies in preschool children.
Collapse
Affiliation(s)
- Theodora Mouratidou
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain
| | - María Isabel Mesana Graffe
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain; Instituto de Investigqación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA) Avda. San Juan Bosco, 13. 50009. Zaragoza, Spain; Red de Salud Materno-infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain; Red de Salud Materno-infantil y del Desarrollo.
| | - Inge Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium; International Agency for Research on Cancer, Lyon, France
| | - Ellen De Decker
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Yanis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | | | | | | | - Julia Birnbaum
- Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Luis Alberto Moreno
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain; Instituto de Investigqación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA) Avda. San Juan Bosco, 13. 50009. Zaragoza, Spain; Red de Salud Materno-infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición
| |
Collapse
|
23
|
Miguel-Berges ML, Santaliestra-Pasias AM, Mouratidou T, De Miguel-Etayo P, Androutsos O, De Craemer M, Galcheva S, Koletzko B, Kulaga Z, Manios Y, Moreno LA, Group OBOTTS. Combined Longitudinal Effect of Physical Activity and Screen Time on Food and Beverage Consumption in European Preschool Children: The ToyBox-Study. Nutrients 2019; 11:nu11051048. [PMID: 31083368 PMCID: PMC6566350 DOI: 10.3390/nu11051048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022] Open
Abstract
Lifestyle behavioral habits such as excess screen time (ST), a lack of physical activity (PA), and high energy-dense food consumption are associated with an increased risk of children being overweight or obese. This study aimed to (1) track longitudinal adherence to PA and ST recommendations at baseline (T0) and follow-up (T1) and (2) assess the association between changes in adherence to PA and ST recommendations and food and beverage consumption at follow-up. The present study included 2321 preschool children (3.5 to 6) participating in the multicenter ToyBox-study. A lineal mixed effects model was used to examine the association between different types of food and beverages and their relationship with changes in adherence to PA and ST recommendations. Approximately half of the children (50.4%) did not meet the PA and ST recommendations at both baseline and follow-up. However, only 0.6% of the sample met both PA and ST recommendations. Preschool children who met both recommendations consumed fewer fizzy drinks, juices, sweets, desserts, and salty snacks and consumed more water, fruits and vegetables, and dairy products than did those not meeting both recommendations. In conclusion, the proportion of European preschool children adhering to both PA and ST recommendations was very low and was associated with a low consumption of energy-dense foods.
Collapse
Affiliation(s)
- María L Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain.
| | - Alba M Santaliestra-Pasias
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain.
- School of Health Science (EUCS), University of Zaragoza, C/Domingo Miral s/n, 50009 Saragossa, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 50009 Zaragoza, Spain.
| | - Theodora Mouratidou
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain.
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 50009 Zaragoza, Spain.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium.
| | - Sonya Galcheva
- Department of paediatrics. Medical University Varna, 55 Marin Drinov Str., 9002 Varna, Bulgaria.
| | - Berthold Koletzko
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, 80337 Munich, Germany.
| | - Zbigniew Kulaga
- The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain.
- School of Health Science (EUCS), University of Zaragoza, C/Domingo Miral s/n, 50009 Saragossa, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 50009 Zaragoza, Spain.
| | | |
Collapse
|
24
|
Birnbaum J, Geyer C, Kirchberg FF, Beulshausen M, Manios Y, Koletzko B. Associations of motor abilities with biological, sociodemographic, and behavioural factors in children: results from the ToyBox study. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-018-0507-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Malden S, Hughes AR, Gibson AM, Bardid F, Androutsos O, De Craemer M, Manios Y, Summerbell C, Cardon G, Reilly JJ. Adapting the ToyBox obesity prevention intervention for use in Scottish preschools: protocol for a feasibility cluster randomised controlled trial. BMJ Open 2018; 8:e023707. [PMID: 30368450 PMCID: PMC6224766 DOI: 10.1136/bmjopen-2018-023707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION There is an increasing need for the adoption of effective preschool obesity prevention interventions to combat the high levels of early-childhood obesity in the UK. This study will examine the feasibility and acceptability of the adapted version of the ToyBox intervention-a preschool obesity prevention programme-for use in Scotland (ToyBox-Scotland). This will inform the design of a full-scale cluster randomised controlled trial (RCT). METHODS AND ANALYSIS The ToyBox-Scotland intervention will be evaluated using a feasibility cluster RCT, which involves children aged 3-5 years at six preschools in Glasgow, three randomly assigned to the intervention group and three to the usual-care control group. The original ToyBox intervention was adapted for the Scottish context using a coproduction approach. Within the 18-week intervention, physical activity and sedentary behaviour will be targeted in the preschool through environmental changes to the classroom, physical activity sessions and movement breaks. Parents will receive home activity packs every 3 weeks containing sticker incentives and interactive parent-child games that target sedentary behaviour, physical activity, eating/snacking and water consumption. As this is a feasibility study, parameters such as recruitment rates, attrition rates and SDs of outcome measures will be obtained which will inform a power calculation for a future RCT. Additional variables to be assessed include accelerometer-measured physical activity, sedentary behaviour and sleep, body mass index, home screen time, eating/snacking and water consumption. Outcomes will be assessed at baseline and 14-17 weeks later. Intervention fidelity will be assessed using questionnaires and interviews with parents and practitioners, observation and session delivery records. ETHICS AND DISSEMINATION This study was granted ethical approval by the University of Strathclyde's School of Psychological Sciences and Health Ethics Committee. Results will be disseminated through publication in peer-reviewed journals, presentation at conferences and in lay summaries provided to participants. TRIAL REGISTRATION NUMBER ISRCTN12831555.
Collapse
Affiliation(s)
- Stephen Malden
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Adrienne R Hughes
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ann-Marie Gibson
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Farid Bardid
- School of Education, University of Strathclyde, Glasgow, UK
- Department of Movement and Sports Sciences, Ghent University, Ghent, UK
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, UK
| | - John J Reilly
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| |
Collapse
|
26
|
Määttä S, Vepsäläinen H, Lehto R, Erkkola M, Roos E, Ray C. Reproducibility of Preschool Personnel and Guardian Reports on Energy Balance-Related Behaviors and Their Correlates in Finnish Preschool Children. CHILDREN-BASEL 2018; 5:children5110144. [PMID: 30360523 PMCID: PMC6262525 DOI: 10.3390/children5110144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023]
Abstract
Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a screen time diary, and (c) a food frequency questionnaire (FFQ) reported by a guardian. A sample of guardians having preschool-aged children (N = 69) and preschool personnel (N = 61) completed questionnaires twice within a five-week time interval during April–May 2018 in Finland. Intra-class correlations (ICC), kappas, and percentage agreement were calculated to test the test-retest-reproducibility. The guardian questionnaire for correlates of the children’s EBRBs demonstrated mainly moderate to good reproducibility whereas the preschool personnel questionnaire of preschool correlates for children’s EBRBs was mostly good. The reproducibility of the screen time diary was good and FFQ food items showed mostly moderate reproducibility. The reproducibility of the FFQ foods items for vegetables, fruit, and berries was slightly better for the amount consumed than for the frequency of consumption. To conclude, all the instruments are acceptable for use in future studies.
Collapse
Affiliation(s)
- Suvi Määttä
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
| | - Reetta Lehto
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
| | - Eva Roos
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
- Department of Public Health, Clinicum, University of Helsinki, 00014 Helsinki, Finland.
| | - Carola Ray
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
| |
Collapse
|
27
|
A school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study. Public Health Nutr 2018; 21:3281-3290. [PMID: 30207513 DOI: 10.1017/s1368980018002136] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample. DESIGN School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016-2018 and included: (i) the 'all-families' component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the 'high-risk families' component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016-2017) and a text-messaging intervention (2017-2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention. SETTING Primary schools and municipalities in six European countries. SUBJECTS Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain). RESULTS The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 'all families' and 2230 'high-risk families' were measured at baseline. CONCLUSIONS The Feel4Diabetes-intervention is expected to provide evidence-based results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.
Collapse
|
28
|
Manios Y, Androutsos O, Katsarou C, Vampouli EA, Kulaga Z, Gurzkowska B, Iotova V, Usheva N, Cardon G, Koletzko B, Moreno LA, De Bourdeaudhuij I. Prevalence and sociodemographic correlates of overweight and obesity in a large Pan-European cohort of preschool children and their families: the ToyBox study. Nutrition 2018; 55-56:192-198. [PMID: 30121021 DOI: 10.1016/j.nut.2018.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/26/2018] [Accepted: 05/04/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Health inequalities are observed among different regions and socioeconomic groups. The present study aimed to record the prevalence of overweight and obesityamong preschoolers across six European countries in relation to sociodemographic and family factors. METHODS A total of 7554 preschool-aged children and their parents participated in the ToyBox-study. Children's weight and height were measured and parents self-reported their weight, height, and family sociodemographic data using questionnaires. Data were obtained in May and June 2012. RESULTS The prevalence of overweight and obesity ranged from 10.0% in Germany to 20.6% in Greece and was found to be higher in children from low socioeconomic status (SES) families as well as children with two overweight or obese parents. Children from low-SES families and children with overweight or obese parents were more likely to be overweight or obese compared with their peers from medium- or high-SES families or those with normal-weight parents, respectively. CONCLUSIONS In a large sample of European preschoolers, the prevalence of overweight and obesity was found to be higher in Southern and Eastern European countries compared with Central and Northern European countries. Higher prevalence was recorded among low-SES families and in children with overweight or obese parents, which indicates that these areas and vulnerable groups need to be prioritized to close the gap in health and social inequalities and provide more effective prevention of early childhood obesity.
Collapse
Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - Christina Katsarou
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - Eleni Anna Vampouli
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | | | | | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Natalya Usheva
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Berthold Koletzko
- Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Luis A Moreno
- Growth, Exercise, NUtrition and Development Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | | |
Collapse
|
29
|
Ring-Dimitriou S, Freudenthaler T, Aistleitner V, Horvath G, Stallinger J, Dimitriou M, Ardelt-Gattinger E, Weghuber D. SALTO - Study Protocol and Rationale of a Community-Oriented Obesity Prevention Program in the Kindergarten. Obes Facts 2018; 11:234-246. [PMID: 29961050 PMCID: PMC6103335 DOI: 10.1159/000481139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of early childhood overweight and obesity in Austria has reached average European levels of 20% in boys and 18% in girls. The rationale and study protocol of SALTO, Salzburg Together against Obesity will be presented, which is aimed to assist adults in increasing the rate of 4- to 6-year-old children with a healthy body weight. METHODS A controlled longitudinal sequential study design consisting of 14 intervention (IK) and 8 control (CK) kindergarten was used to investigate the effect of actions tailored for teachers and parents on BMI among 4- to 6-year-old children. The study launched in November 2014 was approved by the ethics committee of the University of Salzburg. RESULTS 681 children, 181 parents (119 mothers, 62 fathers) and 30 teachers were investigated until October 2016. Preliminary analyses revealed that more boys (19%) and fathers (60% IK, 43% CK) were overweight and obese than girls (16%) and mothers (19% IK, 20% CK). CONCLUSION The challenges faced by the SALTO staff in the implementation of health-promoting actions in the kindergarten are manifold. The Community-Oriented Core Setting (COCS) intervention approach will show whether the actions will reduce the percentage of obesity and be sustainable in the long term.
Collapse
Affiliation(s)
- Susanne Ring-Dimitriou
- Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria
- *Assoc. Prof. Dr. Dr. Susanne Ring-Dimitriou, Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria, Schlossallee 49, 5400 Hallein, Austria,
| | - Thomas Freudenthaler
- Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria
| | - Verena Aistleitner
- Salzburg Together against Obesity-SALTO, Project Management, Salzburg, Austria
| | - Gertrude Horvath
- Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria
| | - Julia Stallinger
- Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria
| | - Minas Dimitriou
- Department of Sports Science and Kinesiology, Paris Lodron University, Salzburg, Austria
| | | | - Daniel Weghuber
- Department of Paediatrics and Obesity Research Unit Salzburg, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
30
|
Clustering of energy balance-related behaviours and parental education in European preschool children: the ToyBox study. Br J Nutr 2017; 118:1089-1096. [DOI: 10.1017/s0007114517003129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractEnergy balance-related behaviours (EBRB) are established in childhood and seem to persist through to adulthood. A lower parental educational level was associated with unhealthy behavioural patterns. The aim of the study is to identify clusters of EBRB and examine their association with preschool children’s BMI and maternal, paternal and parental education. A subsample of the ToyBox study (n 5387) conducted in six European countries was used. Six behavioural clusters (‘healthy diet and low activity’, ‘active’, ‘healthy lifestyle’, ‘high water and screen time; low fruits and vegetables (F&V) and physical activity (PA)’, ‘unhealthy lifestyle’ and ‘high F&V consumers’) emerged. The healthiest group characterised by high water and F&V consumption and high PA z scores (‘healthy lifestyle’) was more prevalent among preschool children with at least one medium- or higher-educated parent and showed markedly healthier trends for all the included EBRB. In the opposite, the ‘unhealthy lifestyle’ cluster (characterised by high soft drinks and screen time z scores, and low water, F&V and PA z scores) was more prevalent among children with lower parental, paternal and maternal education levels. OR identified that children with lower maternal, paternal and parental education levels were less likely to be allocated in the ‘healthy lifestyle’ cluster and more likely to be allocated in the ‘unhealthy lifestyle’ cluster. The ‘unhealthy lifestyle’ cluster was more prevalent among children with parents in lower parental educational levels and children who were obese. Therefore, parental educational level is one of the key factors that should be considered when developing childhood obesity prevention interventions.
Collapse
|
31
|
Androutsos O, Moschonis G, Ierodiakonou D, Karatzi K, De Bourdeaudhuij I, Iotova V, Zych K, Moreno LA, Koletzko B, Manios Y. Perinatal and lifestyle factors mediate the association between maternal education and preschool children's weight status: the ToyBox study. Nutrition 2017; 48:6-12. [PMID: 29469021 DOI: 10.1016/j.nut.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study aimed to explore the associations among perinatal, sociodemographic, and behavioral factors and preschool overweight/obesity. METHODS Data were collected from 7541 European preschoolers in May/June 2012. Children's anthropometrics were measured, and parents self-reported all other data via questionnaires. Level of statistical significance was set at P ≤ 0.05. RESULTS Certain perinatal factors (i.e., maternal prepregnancy overweight/obesity, maternal excess gestational weight gain, excess birth weight, and "rapid growth velocity"), children's energy balance-related behaviors (i.e., high sugar-sweetened beverage consumption, increased screen time, reduced active-play time), family sociodemographic characteristics (i.e., Eastern or Southern Europe, low maternal and paternal education), and parental overweight/obesity were identified as correlates of preschoolers' overweight/obesity. Furthermore, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time mediated by 21.2%, 12.5%, and 5.7%, respectively, the association between maternal education and preschoolers' body mass index. CONCLUSION This study highlighted positive associations of preschooler's overweight/obesity with excess maternal prepregnancy and gestational weight gain, excess birth weight and "rapid growth velocity," Southern or Eastern European region, and parental overweight/obesity. Moreover, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time partially mediated the association between maternal education and preschoolers' body mass index. The findings of the present study may support childhood obesity prevention initiatives, because vulnerable population groups and most specifically low-educated families should be prioritized. Among other fields, these intervention initiatives should also focus on the importance of normal prepregnancy maternal weight status, normal growth velocity during infancy, and retaining preschool children's screen time within recommendations.
Collapse
Affiliation(s)
- Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - George Moschonis
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Melbourne, Australia
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Kalliopi Karatzi
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | | | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Kamila Zych
- The Children's Memorial Health Institute, Warsaw, Poland
| | - Luis A Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
| |
Collapse
|
32
|
Pinket AS, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, Van Lippevelde W. Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients 2017; 9:E479. [PMID: 28489048 PMCID: PMC5452209 DOI: 10.3390/nu9050479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to examine whether a multibehavioural intervention with a focus on specific energy balance-related behaviours can affect total diet quality and its four subcomponents in European preschoolers and to investigate if these intervention effects differed by socioeconomic status (SES). Parents/caregivers of 3.5 to 5.5 year-olds (n = 4968) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics and a food frequency questionnaire on their preschoolers' diet. To assess intervention effects and differences by SES, multilevel repeated measures analyses were conducted. In contrast to no significant difference in total diet quality, in both the intervention and control group, the dietary quality and dietary equilibrium increased, with a larger increase in the intervention group (mean difference quality: +3.4%; mean difference equilibrium: +0.9%) compared to the control group (quality: +1.5%; equilibrium: +0.2%). SES was not a significant moderator for intervention effects on total diet quality, nor for the four subcomponents. This study indicates that multibehavioural interventions with a focus on specific energy balance-related behaviours in preschoolers not only affect those targeted behaviours, but can also have more generalized effects. The ToyBox-intervention effects were similar for both lower and high SES preschoolers.
Collapse
Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC/WHO), 69000 Lyon, France.
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, 1000 Brussels, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, 80337 München, Germany.
| | - Luis A Moreno
- GENUD Research Group, University of Zaragoza, 50009 Zaragoza, Spain.
| | - Piotr Socha
- The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | | |
Collapse
|
33
|
A systematic review of methods to assess intake of sugar-sweetened beverages among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study. Public Health Nutr 2016; 20:578-597. [PMID: 27766999 DOI: 10.1017/s1368980016002639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research indicates that intake of sugar-sweetened beverages (SSB) may be associated with negative health consequences. However, differences between assessment methods can affect the comparability of intake data across studies. The current review aimed to identify methods used to assess SSB intake among children and adults in pan-European studies and to inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies. DESIGN A literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed SSB consumption were included in the review. SETTING Studies involving two or more European countries were included in the review. SUBJECTS Healthy, free-living children and adults. RESULTS The review identified twenty-three pan-European studies which assessed intake of SSB. The FFQ was the most commonly used (n 24), followed by the 24 h recall (n 6) and diet records (n 1). There were several differences between the identified FFQ, including the definition of SSB used. In total, seven instruments that were tested for validity were selected as potentially suitable to assess SSB intake among adults (n 1), adolescents (n 3) and children (n 3). CONCLUSIONS The current review highlights the need for instruments to use an agreed definition of SSB. Methods that were tested for validity and used in pan-European populations encompassing a range of countries were identified. These methods should be considered for use by future studies focused on evaluating consumption of SSB.
Collapse
|
34
|
Pinket AS, De Craemer M, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, Van Lippevelde W. Can Parenting Practices Explain the Differences in Beverage Intake According to Socio-Economic Status: The Toybox-Study. Nutrients 2016; 8:nu8100591. [PMID: 27669290 PMCID: PMC5083979 DOI: 10.3390/nu8100591] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
Previous research indicated that preschoolers of lower socioeconomic status (SES) consume less healthy beverages than high SES preschoolers. The purpose of this study is to investigate the mediating role of parenting practices in the relationship between SES and plain water, soft drink and prepacked fruit juice (FJ) consumption in European preschoolers. Parents/caregivers of 3.5 to 5.5 years old (n = 6776) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics, parenting practices and a food frequency questionnaire. Availability of sugared beverages and plain water, permissiveness towards sugared beverages and lack of self-efficacy showed a mediating effect on SES-differences in all three beverages. Rewarding with sugared beverages significantly mediated SES-differences for both plain water and prepacked FJ. Encouragement to drink plain water and awareness significantly mediated SES-differences for, respectively, plain water and prepacked FJ consumption. Avoiding negative modelling did not mediate any associations. Overall, lower SES preschoolers were more likely to be confronted with lower levels of favourable and higher levels of unfavourable parenting practices, which may lead to higher sugared beverage and lower plain water consumption. The current study highlights the importance of parenting practices in explaining the relation between SES and both healthy and unhealthy beverage consumption.
Collapse
Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Ghent 9000, Belgium.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium.
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent 9000, Belgium.
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels 1000, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece.
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, München 80337, Germany.
| | - Luis A Moreno
- GENUD Research Group, University of Zaragoza, Zaragoza 50009, Spain.
| | - Piotr Socha
- The Children's Memorial Health Institute, Warsaw 04-730, Poland.
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna 9002, Bulgaria.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece.
| | | |
Collapse
|
35
|
A systematic review of methods to assess intake of fruits and vegetables among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study. Public Health Nutr 2016; 20:417-448. [DOI: 10.1017/s1368980016002366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveEvidence suggests that health benefits are associated with consuming recommended amounts of fruits and vegetables (F&V), yet standardised assessment methods to measure F&V intake are lacking. The current review aims to identify methods to assess F&V intake among children and adults in pan-European studies and inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies.DesignA literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed F&V intake were included in the review.SettingStudies involving two or more European countries were included in the review.SubjectsHealthy, free-living children or adults.ResultsThe review identified fifty-one pan-European studies which assessed F&V intake. The FFQ was the most commonly used (n42), followed by 24 h recall (n11) and diet records/diet history (n7). Differences existed between the identified methods; for example, the number of F&V items on the FFQ and whether potatoes/legumes were classified as vegetables. In total, eight validated instruments were identified which assessed F&V intake among adults, adolescents or children.ConclusionsThe current review indicates that an agreed classification of F&V is needed in order to standardise intake data more effectively between European countries. Validated methods used in pan-European populations encompassing a range of European regions were identified. These methods should be considered for use by future studies focused on evaluating intake of F&V.
Collapse
|
36
|
Pinket AS, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno L, Socha P, Iotova V, Manios Y, Van Lippevelde W. Diet quality in European pre-schoolers: evaluation based on diet quality indices and association with gender, socio-economic status and overweight, the ToyBox-study. Public Health Nutr 2016; 19:2441-50. [PMID: 27087125 PMCID: PMC10270831 DOI: 10.1017/s1368980016000604] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/19/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study diet quality among pre-schoolers using the Diet Quality Index (DQI) and to investigate differences according to gender, socio-economic status (SES) and overweight/obesity status. DESIGN Kindergarten-based cross-sectional survey within the ToyBox-study. A standardized protocol was used and parents/caregivers self-reported sociodemographic data and a semi-quantitative FFQ. A total DQI and its four subcomponents (diversity, quality, equilibrium and meal index) were calculated based on this FFQ. High total DQI scores indicate better diet quality than low scores. Results of the total DQI and the subcomponents were reported as percentages of maximum scores (100 %). SETTING Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). SUBJECTS European pre-schoolers (aged 3·5-5·5 years) and their parents/caregivers (n 7063). RESULTS The mean total DQI score was 68·3 %. Mean scores of the subcomponents were 61·7 % for diversity, 56·5 % for quality, 65·4 % for equilibrium and 89·7 % for the meal index. Pre-schoolers of lower-SES backgrounds had lower scores on the total DQI and all its subcomponents. No clear differences were found by gender and overweight status. Results differed slightly according to country. CONCLUSIONS Pre-schoolers scored low on the total DQI and especially on dietary quality, as energy-dense, low-nutritious food items were more often consumed than highly nutritious food items. Furthermore, already in pre-schoolers lower-SES mothers were less likely to provide a good diet quality and this was consistent for all four subcomponents of the total DQI. Food intake in pre-schoolers should be enhanced, especially in pre-schoolers of lower-SES backgrounds.
Collapse
Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Inge Huybrechts
- Dietary Exposure Assessment Group (DEX), International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Berthold Koletzko
- Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Luis Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, Warsaw, Poland
| | - Violeta Iotova
- Department of Pediatrics and Medical Genetics, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
| |
Collapse
|
37
|
Miguel-Berges ML, Santaliestra-Pasias AM, Mouratidou T, Androutsos O, de Craemer M, Pinket AS, Birnbaum J, Koletzko B, Iotova V, Usheva N, Kulaga Z, Gozdz M, Manios Y, Moreno LA. Associations between food and beverage consumption and different types of sedentary behaviours in European preschoolers: the ToyBox-study. Eur J Nutr 2016; 56:1939-1951. [PMID: 27312566 DOI: 10.1007/s00394-016-1236-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the association between food and beverage consumption and time spent in different sedentary behaviours such as watching TV and DVDs, playing computer/video games and quiet play/activities in preschoolers. METHODS A sample of 6431 (51.8 % males) European preschoolers aged 3.5-5.5 years from six survey centres was included in the data analyses. Data on dietary habits and sedentary behaviours [watching TV, playing computer and quiet play (both during weekdays and weekend days)] were collected via standardized proxy-administered questionnaires. One-way analysis of covariance and general linear model (adjusted for sex, maternal education, body mass index and centre) were conducted. RESULTS The results of the generalized linear model showed that the more strong associations in both males and females who were watching TV for > 1 h/day during weekdays were positively associated with increased consumption of fizzy drinks (β = 0.136 for males and β = 0.156 for females), fresh and packed juices (β = 0.069, β = 0.089), sweetened milk (β = 0.119, β = 0.078), cakes and biscuits (β = 0.116, β = 0.145), chocolate (β = 0.052, β = 0.090), sugar-based desserts and pastries (β = 0.234, β = 0.250), salty snacks (β = 0.067, β = 0.056), meat/poultry/processed meat (β = 0.067, β = 0.090) and potatoes (β = 0.071, β = 0.067), and negative associations were observed for the consumption of fruits (β = -0.057, β = -0.099), vegetables (β = -0.056, β = -0.082) and fish (β = -0.013, β = -0.013). During weekend days, results were comparable. CONCLUSIONS In European preschoolers, sedentary behaviours were associated with consumption of energy-dense foods and fizzy drinks. The present findings will contribute to improve the strategies to prevent overweight, obesity and nutrition-related chronic diseases from early childhood.
Collapse
Affiliation(s)
- María L Miguel-Berges
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain. .,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain.
| | - Alba M Santaliestra-Pasias
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
| | - Theodora Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marieke de Craemer
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - An-Sofie Pinket
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Julia Birnbaum
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Violeta Iotova
- Medical University Varna, 55 Marin Drinov Str., 9002, Varna, Bulgaria
| | - Natalia Usheva
- Medical University Varna, 55 Marin Drinov Str., 9002, Varna, Bulgaria
| | | | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,School of Health Science (EUCS), University of Zaragoza, C/Domingo Miral s/n, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
| | | |
Collapse
|
38
|
Pinket AS, Van Lippevelde W, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, De Craemer M. Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study. PLoS One 2016; 11:e0152928. [PMID: 27064274 PMCID: PMC4827861 DOI: 10.1371/journal.pone.0152928] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/20/2016] [Indexed: 12/14/2022] Open
Abstract
Background Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers. Method A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed. Results Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores. Conclusion The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.
Collapse
Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Ghent, Belgium
- * E-mail:
| | | | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children’s Hospital, München, Germany
| | - Luis A. Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, Warsaw, Poland
| | - Violeta Iotova
- Dept. of pediatrics and medical Genetics, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | | |
Collapse
|
39
|
Birnbaum J, Geyer C, Kirchberg F, Manios Y, Koletzko B. Effects of a kindergarten-based, family-involved intervention on motor performance ability in 3- to 6-year-old children: the ToyBox-study. J Sports Sci 2016; 35:377-384. [DOI: 10.1080/02640414.2016.1166390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Cardon G, De Bourdeaudhuij I, Iotova V, Latomme J, Socha P, Koletzko B, Moreno L, Manios Y, Androutsos O, De Craemer M. Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study. PLoS One 2016; 11:e0150580. [PMID: 26950063 PMCID: PMC4780703 DOI: 10.1371/journal.pone.0150580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/15/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.
Collapse
Affiliation(s)
| | | | | | | | - Piotr Socha
- Children’s Memorial Health Institute, Warsaw, Poland
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children’s Hospital, Munich, Germany
| | | | - Yannis Manios
- Harokopio University, School of Health Science & Education, Department of Nutrition-Dietetics, Athens, Greece
| | - Odysseas Androutsos
- Harokopio University, School of Health Science & Education, Department of Nutrition-Dietetics, Athens, Greece
| | | | | |
Collapse
|
41
|
Water intake and beverage consumption of pre-schoolers from six European countries and associations with socio-economic status: the ToyBox-study. Public Health Nutr 2015; 19:2315-25. [PMID: 26680732 DOI: 10.1017/s1368980015003559] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the quantity and quality of water intake from beverages among pre-schoolers and investigate associations with gender and socio-economic status (SES). DESIGN Kindergarten-based cross-sectional survey within the large-scale European ToyBox-study. A standardized protocol was used and parents/caregivers filled in sociodemographic data and a semi-quantitative FFQ. SETTING Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). SUBJECTS European pre-schoolers (aged 3·5-5·5 years) and their parents/caregivers (n 7051). RESULTS Mean water intake was 1051 ml/d; plain water, 547 ml/d; plain milk, 241 ml/d; other fruit juice, 104 ml/d; pure fruit juice, 59 ml/d; soft drinks, 55 ml/d; tea, 45 ml/d; sugared and chocolate milk, 37 ml/d; smoothies, 15 ml/d; and light soft drinks, 6 ml/d. Boys had a higher water intake than girls due to a higher consumption of plain water, but more importantly to the consumption of beverages of less quality. Lower-SES pre-schoolers scored better on quantity than high-SES pre-schoolers, but as a consequence of consumption of sugared beverages. Nevertheless, the associations differed by country. CONCLUSIONS The water intake from beverages did not meet the European Food Safety Authority standard of 1280 ml/d; especially in Western European countries water intake from beverages was low. The most important water sources were plain water, milk and fruit juices. Interventions aiming at a proper and sufficient water intake should focus on both quantity and quality. Messages about water and water sources should be clear for everyone and interventions should be sufficiently tailored.
Collapse
|
42
|
Saloheimo T, González SA, Erkkola M, Milauskas DM, Meisel JD, Champagne CM, Tudor-Locke C, Sarmiento O, Katzmarzyk PT, Fogelholm M. The reliability and validity of a short food frequency questionnaire among 9-11-year olds: a multinational study on three middle-income and high-income countries. INTERNATIONAL JOURNAL OF OBESITY SUPPLEMENTS 2015; 5:S22-8. [PMID: 27152180 PMCID: PMC4850616 DOI: 10.1038/ijosup.2015.15] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The main aim of this study was to assess the reliability and validity of a food frequency questionnaire with 23 food groups (I-FFQ) among a sample of 9-11-year-old children from three different countries that differ on economical development and income distribution, and to assess differences between country sites. Furthermore, we assessed factors associated with I-FFQ's performance. METHODS This was an ancillary study of the International Study of Childhood Obesity, Lifestyle and the Environment. Reliability (n=321) and validity (n=282) components of this study had the same participants. Participation rates were 95% and 70%, respectively. Participants completed two I-FFQs with a mean interval of 4.9 weeks to assess reliability. A 3-day pre-coded food diary (PFD) was used as the reference method in the validity analyses. Wilcoxon signed-rank tests, intraclass correlation coefficients and cross-classifications were used to assess the reliability of I-FFQ. Spearman correlation coefficients, percentage difference and cross-classifications were used to assess the validity of I-FFQ. A logistic regression model was used to assess the relation of selected variables with the estimate of validity. Analyses based on information in the PFDs were performed to assess how participants interpreted food groups. RESULTS Reliability correlation coefficients ranged from 0.37 to 0.78 and gross misclassification for all food groups was <5%. Validity correlation coefficients were below 0.5 for 22/23 food groups, and they differed among country sites. For validity, gross misclassification was <5% for 22/23 food groups. Over- or underestimation did not appear for 19/23 food groups. Logistic regression showed that country of participation and parental education were associated (P⩽0.05) with the validity of I-FFQ. Analyses of children's interpretation of food groups suggested that the meaning of most food groups was understood by the children. CONCLUSION I-FFQ is a moderately reliable method and its validity ranged from low to moderate, depending on food group and country site.
Collapse
Affiliation(s)
- T Saloheimo
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - S A González
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - M Erkkola
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - D M Milauskas
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, USA
| | - J D Meisel
- Department of Industrial Engineering, Faculty of Engineering, Universidad de los Andes, CeiBA Complex Systems Research Center, Bogotá, Colombia
| | - C M Champagne
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, USA
| | - C Tudor-Locke
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, USA
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, USA
| | - O Sarmiento
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - P T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, USA
| | - M Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| |
Collapse
|
43
|
Manios Y, Androutsos O, Katsarou C, Iotova V, Socha P, Geyer C, Moreno L, Koletzko B, De Bourdeaudhuij I. Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:5-13. [PMID: 25047374 DOI: 10.1111/obr.12175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children's key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012-2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.
Collapse
Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Duvinage K, Ibrügger S, Kreichauf S, Wildgruber A, De Craemer M, De Decker E, Androutsos O, Lateva M, Iotova V, Socha P, Zych K, Mouratidou T, Mesana Graffe MI, Manios Y, Koletzko B. Developing the intervention material to increase physical activity levels of European preschool children: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:27-39. [PMID: 25047376 DOI: 10.1111/obr.12176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 01/11/2023]
Abstract
Early childhood is an important period for adopting positive health-related behaviours. More than 95% of European preschool children attend kindergartens, making these settings ideal for the implementation of health promotion interventions. The ToyBox-intervention addressed preschool children, their parents/caregivers and teachers. The aim of the intervention was to improve four energy balance-related behaviours (i.e. healthy snacking, water consumption, physical activity and sedentary behaviour) by implementing a kindergarten-based, family-involved intervention in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). The intervention material was developed following the intervention mapping protocol, taking into account local and cultural differences among the intervention countries. The present paper focuses on the development of the physical activity component of the intervention. Parental involvement was addressed by providing parents/caregivers with two newsletters, two tip cards and a poster. Teachers received a handbook with guidance on environmental changes in the classroom, 26 physical education sessions and suggestions for fun, interactive classroom activities aiming at total class participation to increase preschoolers' physical activity levels. The ToyBox-intervention material was distributed according to a standard time frame. Teachers received their material prior to the start of the intervention and parents/caregivers received their material during the intervention when each energy balance-related behaviour was implemented.
Collapse
Affiliation(s)
- K Duvinage
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, München, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
González-Gil EM, Mouratidou T, Cardon G, Androutsos O, De Bourdeaudhuij I, Góźdź M, Usheva N, Birnbaum J, Manios Y, Moreno LA. Reliability of primary caregivers reports on lifestyle behaviours of European pre-school children: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:61-6. [PMID: 25047380 DOI: 10.1111/obr.12184] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
Reliable assessments of health-related behaviours are necessary for accurate evaluation on the efficiency of public health interventions. The aim of the current study was to examine the reliability of a self-administered primary caregivers questionnaire (PCQ) used in the ToyBox-intervention. The questionnaire consisted of six sections addressing sociodemographic and perinatal factors, water and beverages consumption, physical activity, snacking and sedentary behaviours. Parents/caregivers from six countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) were asked to complete the questionnaire twice within a 2-week interval. A total of 93 questionnaires were collected. Test-retest reliability was assessed using intra-class correlation coefficient (ICC). Reliability of the six questionnaire sections was assessed. A stronger agreement was observed in the questions addressing sociodemographic and perinatal factors as opposed to questions addressing behaviours. Findings showed that 92% of the ToyBox PCQ had a moderate-to-excellent test-retest reliability (defined as ICC values from 0.41 to 1) and less than 8% poor test-retest reliability (ICC < 0.40). Out of the total ICC values, 67% showed good-to-excellent reliability (ICC from 0.61 to 1). We conclude that the PCQ is a reliable tool to assess sociodemographic characteristics, perinatal factors and lifestyle behaviours of pre-school children and their families participating in the ToyBox-intervention.
Collapse
Affiliation(s)
- E M González-Gil
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
De Miguel-Etayo P, Mesana MI, Cardon G, De Bourdeaudhuij I, Góźdź M, Socha P, Lateva M, Iotova V, Koletzko BV, Duvinage K, Androutsos O, Manios Y, Moreno LA. Reliability of anthropometric measurements in European preschool children: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:67-73. [PMID: 25047381 DOI: 10.1111/obr.12181] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 11/26/2022]
Abstract
The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.
Collapse
Affiliation(s)
- P De Miguel-Etayo
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Department of Physiatry and Nursing. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Department of Paediatrics. Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Manios Y. Methodological procedures followed in a kindergarten-based, family-involved intervention implemented in six European countries to prevent obesity in early childhood: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:1-4. [PMID: 25047373 DOI: 10.1111/obr.12178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | |
Collapse
|
48
|
De Craemer M, De Decker E, De Bourdeaudhuij I, Verloigne M, Duvinage K, Koletzko B, Ibrügger S, Kreichauf S, Grammatikaki E, Moreno L, Iotova V, Socha P, Szott K, Manios Y, Cardon G. Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:14-26. [PMID: 25047375 DOI: 10.1111/obr.12180] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers.
Collapse
Affiliation(s)
- M De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|