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Kourpas E, Makrilakis K, Dafoulas G, Iotova V, Tsochev K, Dimova R, Cardon G, González-Gil EM, Moreno L, Kivelä J, Lindström J, Rurik I, Antal E, Timpel P, Schwartz P, Mavrogianni C, Manios Y, Liatis S. Factors affecting continuous participation in follow-up evaluations during a lifestyle intervention programme for type 2 diabetes prevention: The Feel4Diabetes-study. Diabet Med 2024; 41:e15368. [PMID: 38837852 DOI: 10.1111/dme.15368] [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: 01/05/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
AIMS Community- and school-based lifestyle interventions are an efficient method of preventing type 2 diabetes in vulnerable populations. Many participants, however, fail to complete the necessary follow-ups. We investigated factors affecting the continuous participation in follow-up evaluations during the Feel4Diabetes-study, a multilevel intervention programme implemented across Europe. METHODS Socioeconomic, sociodemographic and clinical factors were assessed for 2702 participants within six participating countries: Bulgaria and Hungary (low-to-middle-income countries, LMIC), Belgium and Finland (high-income countries, HIC) and Greece and Spain (high-income countries under austerity measures, HICAM). RESULTS Statistically significant differences were detected with respect to sex, control group, education level, employment status, BMI and blood pressure measurements (systolic and diastolic blood pressure). Post hoc analysis revealed significant differences within socioeconomic regions. Higher levels of education were associated with significantly lower attrition in HIC (p < 0.05) and HICAM (p < 0.001), higher employment status was associated with lower attrition in HICAM (p < 0.001) and being female was associated with lower attrition in LMIC (p < 0.001). Surprisingly, the intervention group exhibited higher-than-expected attrition in HIC (p < 0.001) and HICAM (p = 0.003), and lower attrition in LMIC (p = 0.007). When tested together in the same multivariable predictive model, all sociodemographic and socioeconomic variables along with higher BMI retained their statistical significance, while systolic and diastolic blood pressure failed to remain significant. CONCLUSIONS Key socioeconomic and sociodemographic factors along with BMI play a significant role in determining continuous participation in follow-up evaluations during school- and community-based intervention programmes.
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Affiliation(s)
- Elias Kourpas
- Department of Business Administration, Gies College of Business, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Diabetes Centre, Laiko General Hospital, Athens, Greece
| | - George Dafoulas
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Roumyana Dimova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Esther M González-Gil
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Moreno
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Jemina Kivelä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Lindström
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Imre Rurik
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Emese Antal
- Hungarian Society of Nutrition, Budapest, Hungary
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Schwartz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Diabetes Centre, Laiko General Hospital, Athens, Greece
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Basdeki ED, Karatzi K, Arnaoutis G, Makrilakis K, Liatis S, Cardon G, De Craemer M, Iotova V, Tsochev K, Tankova T, Kivelä J, Wikström K, Rurik I, Radó S, Miguel-Berges ML, Gimenez-Legarre N, Moreno-Aznar L, Manios Y. A lifestyle pattern characterised by high consumption of sweet and salty snacks, sugar sweetened beverages and sedentary time is associated with blood pressure in families at risk for type 2 diabetes mellitus in Europe. The Feel4Diabetes Study. J Hum Nutr Diet 2023; 36:1564-1575. [PMID: 36719056 DOI: 10.1111/jhn.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Individuals from families at high-risk for type 2 diabetes mellitus (T2DM) are also at high risk for hypertension (HTN) and cardiovascular disease. Studies identifying lifestyle patterns (LPs) combining dietary, physical activity or sedentary variables and examining their possible role with respect to developing blood pressure (BP) are limited. The present study aimed to examine the association of different LPs with BP levels in families at high risk for T2DM in Europe. METHODS In total, 1844 adults (31.6% males) at high-risk for T2DM across six European countries were included in this cross-sectional study using data from the baseline assessment of the Feel4Diabetes Study. BP measurements and dietary and physical activity assessments were conducted, and screen times were surveyed. LPs were revealed with principal component analysis of various data regarding diet, physical activity, screen time and smoking. RESULTS Three LPs were identified. LP3 (high consumption of sweet and salty snacks, sugar sweetened soft drinks and juices, and high amount of screen time) was positively associated with diastolic BP (B, 0.52; 95% confidence interval = 0.05-0.99) and the existence of HTN (odds ratio = 1.12; 95% confidence interval = 1.00-1.25). Participants in the highest tertile of LP3 spent mean 3 h of screen time, consumed 1.5 portions of sweet and/or salty snacks and 1 L of soft drinks on a daily basis, were associated with 12% higher risk of HTN. CONCLUSIONS Focusing on the combination of eating and lifestyle behaviours may more accurately identify, and therefore guide preventive measures tailored to the specific needs of high-risk populations.
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Affiliation(s)
- Eirini D Basdeki
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Giannis Arnaoutis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- National and Kapodistrian University of Athens Medical School, First Department of Propaedeutic Medicine, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- National and Kapodistrian University of Athens Medical School, First Department of Propaedeutic Medicine, Laiko General Hospital, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Violeta Iotova
- Departemnt of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Departemnt of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology and Gerontology, Medical University of Sofia, Sofia, Bulgaria
| | - Jemina Kivelä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Wikström
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Imre Rurik
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándorné Radó
- Faculty of Health, Doctoral School of Health Science, University of Debrecen, Debrecen, Hungary
| | - María L Miguel-Berges
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de 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), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Gimenez-Legarre
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Luis Moreno-Aznar
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de 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), Instituto de Salud Carlos III, Madrid, Spain
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University of Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre(Agro-Health), Heraklion, Greece
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3
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Mourouti N, Mavrogianni C, Mouratidou T, Liatis S, Valve P, Rurik I, Torzsa P, Cardon G, Bazdarska Y, Iotova V, Moreno LA, Makrilakis K, Manios Y. The Association of Lifestyle Patterns with Prediabetes in Adults from Families at High Risk for Type 2 Diabetes in Europe: The Feel4Diabetes Study. Nutrients 2023; 15:3155. [PMID: 37513573 PMCID: PMC10386359 DOI: 10.3390/nu15143155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The increasing prevalence of prediabetes globally does not bode well for the growing epidemic of type 2 diabetes (T2D) and its complications. Yet there is a lack of studies regarding lifestyle patterns (LPs) and their association with prediabetes. The present study aimed to examine the association of different LPs with the existence of prediabetes in adults from families at high risk for T2D in Europe. In total, 2759 adults (66.3% females) from six European countries were included in this cross-sectional analysis using data from the baseline assessment of the Feel4Diabetes study. Anthropometric, sociodemographic, dietary and behavioral data were assessed, and fasting blood glucose measurements were also obtained. LPs were derived via principal component analysis. Two LPs were derived, explaining 32% of the total variation. LP 1 was characterized by breakfast consumption, high consumption of fruits and berries, vegetables and nuts and seeds, and low consumption of salty snacks and soft drinks with sugar, while LP 2 was characterized by high consumption of salty and sweet snacks, soft drinks with sugar and juice with sugar and sedentary behavior. After adjusting for various confounders, LP 2 was positively associated with the existence of prediabetes (odds ratio = 1.02, 95% CI 1.01-1.04), while LP 1 was not significantly associated with prediabetes. Understanding LPs would provide necessary evidence for planning intervention and education strategies for prediabetes and T2D.
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Affiliation(s)
- Niki Mourouti
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300 Sitia, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Theodora Mouratidou
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300 Sitia, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Päivi Valve
- Department of Public Health and Welfare, Finnish Institute of Health and Welfare, FI-00271 Helsinki, Finland
| | - Imre Rurik
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yulia Bazdarska
- Department of Pediatrics, Medical University Varna, 9002 Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, 9002 Varna, Bulgaria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Yannis Manios
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
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4
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Vitoratou DI, Mavrogianni C, Karatzi K, Cardon G, Iotova V, Tsochev K, Lindström J, Wikström K, González-Gil EM, Moreno L, Rurik I, Radó AI, Tankova T, Liatis S, Makrilakis K, Manios Y. Do parental risk factors for type 2 diabetes predict offspring risk of overweight and obesity? The Feel4Diabetes study. Nutrition 2023; 107:111900. [PMID: 36527889 DOI: 10.1016/j.nut.2022.111900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The prevention of children being overweight/obese is of utmost importance. Parental characteristics play a pivotal role in shaping offspring weight status. This study aimed to examine associations between parental obesity and children's overweight/obesity status, and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity status. METHODS Logistic regression and receiver operating characteristic (ROC) analyses were conducted, using cross-sectional data from a European cohort of 20 151 adults (10 967 mothers; 9184 fathers) and children (n = 10 967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children, and overweight/obesity was defined according to the International Obesity Task Force criteria. Parents' T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC). RESULTS After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal (adjusted odds ratio [aOR]: 2.64; 95% confidence interval [CI], 2.18-3.20) and parental (aOR: 3.21; 95% CI, 2.65-3.91) obesity, maternal (aOR: 1.46; 95% CI, 1.23-1.74) and parental (aOR: 1.59; 95% CI, 1.32-1.92) high waist circumference, as well as maternal (aOR: 1.60; 95% CI, 1.27-2.01) and parental (aOR: 1.87; 95% CI, 1.58-2.21) high FINDRISC score, were associated with child overweight/obesity status. Maternal (area under the curve- ROC: 0.638; 95% CI, 0.628-0.647) and paternal body mass index (BMI; area under the curve-ROC: 0.632; 95% CI, 0.622-0.642) were the most accurate in predicting child overweight/obesity status. CONCLUSIONS Among parental risk factors for T2D, maternal/parental overweight/obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, and might be useful for the early identification of children at risk of being overweight/obese rather than other T2D factors.
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Affiliation(s)
- Dimitra-Irinna Vitoratou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esther M González-Gil
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research, Universidad de Granada, Granada, Spain; Growth, Exercise, Nutrition and Development Research Group, School of Health Science, University of Zaragoza, Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Moreno
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research, Universidad de Granada, Granada, Spain
| | - Imre Rurik
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Anette Is Radó
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Stavros Liatis
- University of Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- University of Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece.
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5
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E B, K K, C M, Tsochev K, González-Gil EM, S R, J K, K W, G C, I R, S L, Tankova T, Iotova V, Moreno LA, K M, Y M, C T. Association of diet quality with glycemia, insulinemia, and insulin resistance in families at high risk for type 2 diabetes mellitus in Europe: Feel4 Diabetes Study. Nutrition 2023; 105:111805. [PMID: 36335874 DOI: 10.1016/j.nut.2022.111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/08/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the association of diet quality with fasting glycemia, insulinemia, and insulin resistance in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM) from six European countries, taking into account their socioeconomic status (SES). METHODS Baseline data from non-diabetic adults from the Feel4 Diabetes study were used and diet was assessed by the Healthy Diet Score (HDS). Insulin resistance (IR) was determined by homeostasis model assessment of IR (HOMA-IR). Sociodemographic and lifestyle characteristics were assessed through standardized questionnaires. Multiple linear regressions were adjusted for many confounders, in the total sample and by SES category. RESULTS In 1980 adults, the third tertile of diet quality was inversely associated with insulin levels (-1.48; 95% confidence interval [CI], -2.34 to 0.62), and HOMA-IR (-0.33; 95% CI, -0.57 to 0.09), yet with no statistically significant results for glucose levels. In the SES subgroup analysis, in the high SES group, both second and third diet score tertiles were inversely associated with insulin levels (-1.81; 95% CI, -2.66 to 0.95) and HOMA-IR values (-0.45; 95% CI -0.69 to 0.21), independent of age, sex, smoking and body mass index. No such associations were observed for glucose levels in the high SES group and for all indices in the low SES group. CONCLUSION In adults from families at high risk for T2DM, higher diet quality was negatively associated with fasting insulin levels and IR, only in the high SES group and not in the low SES group. Future larger studies may be able to explore further this association, as well as the potential factors that mitigate its strength in the low SES groups.
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Affiliation(s)
- Botsi E
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
| | - Karatzi K
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Mavrogianni C
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Esther M González-Gil
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research (CIBM), Universidad de Granada, Granada, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Growth, Exercise, Nutrition and Development Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - Radó S
- Faculty of Health Doctoral School of Health Science, University of Debrecen
| | - Kivelä J
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Wikström K
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Cardon G
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Rurik I
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen
| | - Liatis S
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - Makrillakis K
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Manios Y
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece (Agro-Health)
| | - Tsigos C
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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6
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Diamantis DV, Karatzi K, Kantaras P, Liatis S, Iotova V, Bazdraska Y, Tankova T, Cardon G, Wikström K, Rurik I, Antal E, Ayala-Marín AM, Legarre NG, Makrilakis K, Manios Y. Prevalence and Socioeconomic Correlates of Adult Obesity in Europe: The Feel4Diabetes Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12572. [PMID: 36231871 PMCID: PMC9566241 DOI: 10.3390/ijerph191912572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
To effectively tackle obesity, it is necessary to identify all specific socioeconomic factors which contribute to its development. We aimed to highlight the prevalence of adult overweight/obesity in European countries and investigate the association of various socioeconomic factors and their accumulative effect on overweight/obesity status. Cross-sectional data from the Feel4Diabetes study for 24,562 adults residing in low socioeconomic areas were collected, representing Belgium, Finland, Greece, Spain, Bulgaria, and Hungary. Socioeconomic Burden Score (SEBS) was created, accounting for unemployment, financial insecurity, and education ≤ 12 years. Data were analyzed using analysis of variance and logistic regression. In total, 19,063 adults with complete data were included (34.5% overweight and 15.8% obese). The highest overweight/obesity rates occurred in Greece (37.5%/17.8%) and Hungary (35.4%/19.7%). After adjusting for confounders, age of <45 years and female sex were inversely associated with overweight/obesity, while low educational level (≤12 years), unemployment, and financial insecurity were positively associated. The increase in SEBS (clustering of socioeconomic disadvantages) was associated with increased overweight/obesity likelihood. This association of SEBS scores with overweight/obesity was evident for males and females across all examined countries, excluding males in low-income countries (Bulgaria and Hungary), where the highest SEBS score was inversely associated with overweight/obesity. The clustering burden of socioeconomic disadvantages on overweight/obesity was found to be influenced by the countries' economic state and sex.
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Affiliation(s)
- Dimitrios V. Diamantis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life, Department of Food Science & Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
| | - Paris Kantaras
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Stavros Liatis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, 9010 Varna, Bulgaria
| | - Yulia Bazdraska
- Department of Paediatrics, Medical University of Varna, 9010 Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology and Gerontology, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium
| | - Katja Wikström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Imre Rurik
- Department of Family Medicine Hungarian Society of Nutrition, Semmelweis University, 1085 Budapest, Hungary
| | - Emese Antal
- Hungarian Society of Nutrition, 1088 Budapest, Hungary
| | - Alelí M. Ayala-Marín
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50013 Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain
| | - Natalia Giménez Legarre
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50013 Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), 50009 Zaragoza, Spain
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410 Heraklion, Greece
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7
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De Craemer M, Van Stappen V, Brondeel R, Iotova V, Chakarova N, Rurik I, Lindström J, Kivelä J, Moreno LA, Mavrogianni C, Manios Y, Cardon G. Self-reported lifestyle behaviours in families with an increased risk for type 2 diabetes across six European countries: a cross-sectional analysis from the Feel4Diabetes-study. BMC Endocr Disord 2022; 22:213. [PMID: 36002885 PMCID: PMC9404668 DOI: 10.1186/s12902-022-01115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria). METHODS Parents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire (eight items questioning age, Body Mass Index, waist circumference, PA, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families' lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status. RESULTS Most Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries. CONCLUSIONS Countries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.
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Affiliation(s)
- Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium.
| | - Vicky Van Stappen
- Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium
| | | | - Violeta Iotova
- Clinic of Paediatric Endocrinology, Medical University Varna, 9002, Varna, Bulgaria
| | - Nevena Chakarova
- Clinical Center of Endocrinology, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Imre Rurik
- Debreceni Egyetem (UoD), University of Debrecen, 4002, Debrecen, Hungary
| | - Jaana Lindström
- Finnish Institute for Health and Welfare, 00271, Helsinki, Finland
| | - Jemina Kivelä
- Finnish Institute for Health and Welfare, 00271, Helsinki, Finland
| | - Luis Alberto Moreno
- Growth, Exercise, Nutrition and Development (GENUD), University of Zaragoza, 50009, Saragossa, Spain
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, 176 76, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, 176 76, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Greet Cardon
- Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium
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8
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Apergi K, Karatzi K, Reppas K, Karaglani E, Usheva N, Giménez-Legarre N, Moreno LA, Dimova R, Antal E, Jemina K, Cardon G, Iotova V, Manios Y, Makrilakis K. Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study. Eur J Clin Nutr 2022; 76:1600-1610. [PMID: 35614208 DOI: 10.1038/s41430-022-01160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to investigate the association of breakfast consumption frequency (BCF) with glycemic control indices in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM), exploring the role of sex and socioeconomic status (SES). METHODS In 2370 adults (40.8 ± 5.6 years) from 6 European countries, sociodemographic, lifestyle, anthropometric and biochemical characteristics were assessed through standardized procedures. Multivariable regression models were used to examine the association between fasting glucose (FG), fasting insulin (FI), and insulin resistance (HOMA-IR) (dependent variables) with BCF (independent variable) controlling for multiple possible confounders. RESULTS A linear association of BCF with FG (β = -0.557, 95% CI (-0.834, -0.280)) and a quadratic association with FI and HOMA-IR with the highest point of curve observed at BCF = 2.989 (times/week) and at BCF = 2.746, respectively, independent of the used covariates. In males and in participants of high SES, BCF was linearly and inversely associated with FG, while with FI and HOMA-IR there was an association with BCF in quadratic function. In females, BCF was linearly and inversely associated with FG and HOMA-IR, and there was a quadratic association with FI. In low SES there was only a linear association with FG, yet with no statistically significant findings for FI and HOMA-IR. CONCLUSIONS Regular breakfast consumption, especially >3 times/week is associated with improved indices of glycemic control. This association was diminished in low SES participants in the presence of the used covariates.
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Affiliation(s)
- Kiriaki Apergi
- Medical School, National and Kapodistrian University, Athens, Greece.
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life Department Of Food Science & Human Nutrition School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
| | - Kyriakos Reppas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Natalya Usheva
- Department of Social Medicine and Health Care, Medical University of Varna, Varna, Bulgaria
| | - Natalia Giménez-Legarre
- Growth, Exercise, Nutrition and Development Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Instituto de InvestigAICón Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Instituto de InvestigAICón Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Centro de InvestigAICón Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Roumyana Dimova
- Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Emese Antal
- Hungarian Society of Nutrition, Budapest, Hungary
| | - Kivelä Jemina
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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9
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Cross-Sectional Associations Between Mothers and Children's Breakfast Routine-The Feel4Diabetes-Study. Nutrients 2021; 13:nu13030720. [PMID: 33668380 PMCID: PMC7996176 DOI: 10.3390/nu13030720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022] Open
Abstract
Positive influences of family members have been associated with a high probability of children’s daily breakfast consumption. Therefore, the aim of this study was to scrutinize the association of breakfast routines between mothers and their children. The baseline data of the Feel4Diabetes-study was obtained in 9760 children (49.05% boys)–mother pairs in six European countries. A parental self-reported questionnaire gauging the frequency of breakfast consumption and of breakfast´ foods and beverages consumption was used. Agreement in routines of mothers and their children’s breakfast consumption was analyzed in sex-specific crosstabs. The relationship of breakfast routine and food groups’ consumption between mothers and their children was assessed with analysis of covariance. The highest proportion of children who always consumed breakfast were those whose mothers always consumed it. Children consuming breakfast regularly had a higher intake of milk or unsweetened dairy products and all kind of cereal products (low fiber and whole-grain) than occasional breakfast consumers (p < 0.05). The strong similarity between mothers and children suggests a transfer of breakfast routine from mothers to their children, as a high proportion of children who usually consume breakfast were from mothers also consuming breakfast. All breakfast foods and beverages consumption frequencies were similar between children and their mothers.
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10
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Karatzi K, Moschonis G, Botsi E, Liatis S, Tsochev K, De Miguel-Etayo P, Kivelä J, Wikström K, Dimova R, Antal E, Lamiquiz-Moneo I, Rurik I, Cardon G, Iotova V, Makrilakis K, Manios Y. Lipidemic Profile Changes over a Two-Year Intervention Period: Who Benefited Most from the Feel4Diabetes Program? Nutrients 2020; 12:E3736. [PMID: 33291645 PMCID: PMC7761911 DOI: 10.3390/nu12123736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
Identification of participants' characteristics who benefited most from large community-based intervention studies may guide future prevention initiatives in order to maximize their effectiveness. The current study aimed to examine the socio-demographic, anthropometric, and behavioral characteristics, as well as the health and eating perceptions of those who improved their lipidemic profile, in the Feel4Diabetes early screening and prevention program. In the present analyses, 1773 adults from families at high risk for developing type 2 diabetes mellitus (T2DM) were enrolled, receiving either the standard care or the more intensive intervention, and 33.3-55.2% of them improved one or more of their lipidemic indices by >5%. Women, people living in Southeastern Europe, coming from two-parent families, having higher financial security, educational level and better diet quality were associated with a 27-64% higher likelihood for benefiting from the program regarding one or more of their lipidemic profile indices. Participants who were overweight or obese (especially with central obesity), employed, with prolonged sedentary behavior, prone to emotional eating and perceiving their weight status as lower than their actual weight were 24-43% less likely to have benefited. These findings should guide future interventions, prioritizing regions in greater need, and being tailor-made to specific population characteristics in order to further improve their effectiveness.
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Affiliation(s)
- Kalliopi Karatzi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
| | - George Moschonis
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Eirini Botsi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
| | - Stavros Liatis
- National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.L.); (K.M.)
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, 9002 Varna, Bulgaria; (K.T.); (V.I.)
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jemina Kivelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (J.K.); (K.W.)
| | - Katja Wikström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (J.K.); (K.W.)
| | - Roumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 1431 Sofia, Bulgaria;
| | - Emese Antal
- Hungarian Society of Nutrition, 1088 Budapest, Hungary; (E.A.); (I.R.)
| | - Itziar Lamiquiz-Moneo
- Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Imre Rurik
- Hungarian Society of Nutrition, 1088 Budapest, Hungary; (E.A.); (I.R.)
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium;
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, 9002 Varna, Bulgaria; (K.T.); (V.I.)
| | - Konstantinos Makrilakis
- National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.L.); (K.M.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
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Socio-Demographic Characteristics and Body Weight Perceptions of Study Participants Benefitting Most from the Feel4Diabetes Program Based on Their Anthropometric and Glycaemic Profile Changes. Nutrients 2020; 12:nu12103117. [PMID: 33065990 PMCID: PMC7601567 DOI: 10.3390/nu12103117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39–3.67, p < 0.001) and Eastern Europe (OR 1.55–2.47, p < 0.05), received more intensive intervention (OR 1.53–1.90, p = 0.002) and were younger (<40 years old) adults (OR 1.48–1.51, p < 0.05). Furthermore, individuals with tertiary education (OR 2.06, p < 0.001), who were unemployed (OR 1.62–1.68, p < 0.05) and perceived their body weight to be higher than normal (OR 1.58–3.00, p < 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024). These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations.
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12
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Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1 st Year Results of the Feel4Diabetes-Study. Nutrients 2020; 12:nu12071949. [PMID: 32629949 PMCID: PMC7399917 DOI: 10.3390/nu12071949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 01/06/2023] Open
Abstract
The Feel4Diabetes intervention was a school and community-based intervention aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease. The current study aims to present the results on lifestyle behaviors obtained from parents during the first year of the Feel4Diabetes intervention. This multicomponent intervention had a cluster randomized design and was implemented in Belgium, Bulgaria, Finland, Greece, Hungary and Spain over two years (2016-2018). Standardized protocols and procedures were used by the participating centers in all countries to collect data on parents' lifestyle behaviors (diet, physical activity, sedentary behavior). The Feel4Diabetes intervention was registered at clinicaltrials.gov (registration number: NCT02393872). In total, 2110 high-risk parents participated in the baseline and 12-month follow-up examination measurements. Participants allocated to the intervention group reduced their daily consumption of sugary drinks (p = 0.037) and sweets (p = 0.031) and their daily screen time (p = 0.032), compared with the control group. In addition, participants in the intervention group in Greece and Spain increased their consumption of breakfast (p = 0.034) and fruits (p = 0.029), while in Belgium and Finland they increased their water intake (p = 0.024). These findings indicate that the first year of the Feel4Diabetes intervention resulted in the improvement of certain lifestyle behaviors in parents from high-risk families.
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