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Börnhorst C, Pigeot I, De Henauw S, Formisano A, Lissner L, Molnár D, Moreno LA, Tornaritis M, Veidebaum T, Vrijkotte T, Didelez V, Wolters M. The effects of hypothetical behavioral interventions on the 13-year incidence of overweight/obesity in children and adolescents. Int J Behav Nutr Phys Act 2023; 20:100. [PMID: 37620898 PMCID: PMC10463721 DOI: 10.1186/s12966-023-01501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort. METHODS Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions 'shifting' the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to 'no intervention' (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed. RESULTS The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects. CONCLUSIONS While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
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Affiliation(s)
- C Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany.
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - S De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - A Formisano
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - L Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad Y Nutrición (CIBERObn), Madrid, Spain
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia
| | - T Vrijkotte
- Department of Public and Occupational Health, Amsterdam University Medical Center (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - V Didelez
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - M Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
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Zeeb H, Schüz B, Pigeot I. Highlighting the ‘public ‘in digital public health – a critical reflection. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
What is the appropriate differentiation of digital public health versus digital health - or is there none? This is an essential question when pondering digitalisation and public health, especially with a view to the potential development of the field. Digital health seems to be a general term related to information and communication technology in health care. Putting a public health lens on this general descriptive term can be done by simply expanding it towards public health as a population science and practice field, rather than the narrow medical and health care arena. However, a more specific approach towards outlining similarities and differences will also focus on digital technologies and their challenges in the core areas of prevention and health promotion. Considering the leading public health functions, their relationship with digitalisation and their specific requirements towards digitalisation can be a valuable path to describe and discuss what digital public health is all about. We will also highlight where interfaces and interrelations with digital health need to be considered for research and practice. This contribution will aim to provide such a perspective.
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Affiliation(s)
- H Zeeb
- BIPS , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health , Bremen, Germany
- EUPHA-DH
| | - B Schüz
- BIPS , Bremen, Germany
- Institute of Public Health and Nursing Research, University of Bremen , Bremen, Germany
| | - I Pigeot
- BIPS , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health , Bremen, Germany
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Buck C, Lauria F, Eiben G, Konstabel K, Page A, Pigeot I, Ahrens W. A longitudinal study of urban moveability and physical activity in the transition phase from childhood to adolescence. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ahrens W, Siani A, Adan R, De Henauw S, Eiben G, Gwozdz W, Hebestreit A, Hunsberger M, Kaprio J, Krogh V, Lissner L, Molnár D, Moreno LA, Page A, Picó C, Reisch L, Smith RM, Tornaritis M, Veidebaum T, Williams G, Pohlabeln H, Pigeot I. Cohort Profile: The transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort. Int J Epidemiol 2017; 46:1394-1395j. [PMID: 28040744 PMCID: PMC5837508 DOI: 10.1093/ije/dyw317] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
| | - A Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - R Adan
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Kaprio
- Department of Public Health, University of Helsinki, Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - A Page
- Centre for Exercise, Nutrition & Health Sciences, University of Bristol, Bristol, UK
| | - C Picó
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics), University of the Balearic Islands (UIB) and CIBER Fisiopatología de la Obesidad y Nutrición, Palma de Mallorca, Spain
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - R M Smith
- Minerva Communications UK, Andover, UK
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia and
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
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5
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Nagy P, Intemann T, Buck C, Pigeot I, Ahrens W, Molnar D. Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study. Int J Obes (Lond) 2016; 40:1604-1605. [PMID: 27701402 PMCID: PMC5056956 DOI: 10.1038/ijo.2016.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Michels N, De Henauw S, Eiben G, Hadjigeorgiou C, Hense S, Hunsberger M, Konstabel K, Molnár D, Moreno LA, Siani A, De Bourdeaudhuij I, Pigeot I. Effect of the IDEFICS multilevel obesity prevention on children's sleep duration. Obes Rev 2015; 16 Suppl 2:68-77. [PMID: 26707017 DOI: 10.1111/obr.12327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/30/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND According to recent findings, short sleep duration is associated with overweight in children. However, primary prevention efforts aimed at achieving adequate sleep among children are scarce. Therefore, the 'Identification and prevention of Dietary-induced and lifestyle-induced health EFfects In Children and infantS' (IDEFICS) study implemented a multilevel intervention that included sleep duration as a key behavioural target. The aim of this study is to evaluate sleep duration among children participating in the IDEFICS study. METHODS The IDEFICS nocturnal sleep intervention was included as part of stress reduction educational messages aimed at parents and children. Sleep was assessed by a parental 24-h recall (only weekdays; n = 8,543) and by a diary (weekdays and weekends separately; n = 4,150). Mixed linear models tested the intervention effect on sleep duration change between baseline when children were 2-9.9 years of age (2007/2008) and follow-up (2009/2010). Logistic mix models were used to study the intervention effect on the presence of TV in the children's bedroom (one of the intervention messages; n = 8,668). Additionally, parents provided qualitative data regarding exposure to the intervention. RESULTS About 51.1% of the parents in the intervention regions reported awareness of the sleep intervention. A small intervention effect was seen on weeknight sleep duration in that the decrease in sleep duration over 2 years was smaller in the intervention (15 min) as compared with control regions (19 min) (p = 0.044). There was no overall intervention effect on weekend sleep duration or on the presence of a TV in the bedroom. A small significant time effect between baseline and follow-up was found on bedroom TV presence depending on self-reported intervention exposure (3% increase in TV presence in exposed versus 6.6% increase in non-exposed). Children without a TV in the bedroom had longer nocturnal sleep duration. DISCUSSION The sleep component of the intervention did not lead to clinically relevant changes in sleep duration. Future interventions aimed at young children's sleep duration could benefit from more specific and intense messaging than that found in the IDEFICS intervention. Future research should use objective measures of sleep duration as well as intermediate outcomes (sleep knowledge, sleep environment and sleep practices).
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Affiliation(s)
- N Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Health Sciences, Vesalius, University College Ghent, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - S Hense
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - A Siani
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
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7
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Kovács E, Hunsberger M, Reisch L, Gwozdz W, Eiben G, De Bourdeaudhuij I, Russo P, Veidebaum T, Hadjigeorgiou C, Sieri S, Moreno LA, Pigeot I, Ahrens W, Pohlabeln H, Molnár D. Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study. Obes Rev 2015; 16 Suppl 2:138-50. [PMID: 26707023 DOI: 10.1111/obr.12349] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. METHODS Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese. RESULTS Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%) CONCLUSION The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.
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Affiliation(s)
- E Kovács
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.,Institute for Medical Information Processing Biometrics and Epidemiology, German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - G Eiben
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - P Russo
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - S Sieri
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, National Tumor Institute, Milan, Italy
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
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8
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Lissner L, De Bourdeaudhuij I, Konstabel K, Mårild S, Mehlig K, Molnár D, Moreno LA, Pigeot I, Siani A, Tornaritis M, Williams G. Differential outcome of the IDEFICS intervention in overweight versus non-overweight children: did we achieve 'primary' or 'secondary' prevention? Obes Rev 2015; 16 Suppl 2:119-26. [PMID: 26707021 DOI: 10.1111/obr.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to explore whether the IDEFICS intervention had a differential effect on 11,041 children's weight trajectories depending on their baseline body mass index status. METHODS Two subgroups of children are considered in the present analysis: those who were overweight or obese prior to the intervention and those who were neither overweight nor obese. RESULTS Among children in all eight countries who did not have prevalent overweight or obesity (OWOB) at baseline, 2 years later, there was no significant difference between intervention and control groups in risk of having developed OWOB. However, we observed a strong regional heterogeneity, which could be attributed to the presence of one distinctly outlying country, Belgium, where the intervention group had increased risk for becoming overweight. In contrast, among the sample of children with prevalent OWOB at baseline, we observed a significantly greater probability of normalized weight status after 2 years. In other words, a protective effect against persistent OWOB was observed in children in intervention regions compared with controls, which corresponded to an adjusted odds ratio of 0.76 (95% confidence interval: 0.58, 0.98). DISCUSSION This analysis thus provided evidence of a differential effect of the IDEFICS intervention, in which children with overweight may have benefited without having been specifically targeted. However, no overall primary preventive effect could be observed in children without initial overweight or obesity.
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Affiliation(s)
- L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - K Konstabel
- Research Centre, National Institute for Health Development, Tallinn, Estonia
| | - S Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Mehlig
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition, and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - A Siani
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - G Williams
- Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK
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Verloigne M, Ahrens W, De Henauw S, Verbestel V, Mårild S, Pigeot I, De Bourdeaudhuij I. Process evaluation of the IDEFICS school intervention: putting the evaluation of the effect on children's objectively measured physical activity and sedentary time in context. Obes Rev 2015; 16 Suppl 2:89-102. [PMID: 26707019 DOI: 10.1111/obr.12353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/09/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The first aim was to describe the intervention implementation and reception with specific regard to physical activity (PA) within Belgian schools participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) intervention. Second, we examined if a higher intervention process score in schools showed more favourable effects on children's objectively measured PA and sedentary time (ST). METHODS The IDEFICS intervention focused on improving children's health behaviour (including PA) at the community, school/kindergarten and family level. Five process evaluation questionnaires completed by school working groups, and (physical education) teachers were used for the process evaluation of four intervention modules (school working groups, healthy weeks, school environment, health-related physical education and PA). Items were summed to calculate a total intervention process score per school. Schools were subdivided into three groups (low, medium and high score). Multilevel models were used to examine if changes in PA or ST differed between schools with a low, medium or high score. In total, 333 children (54.1% girls, mean age 6.0 ± 1.5 years) from 34 intervention schools (18 pre-schools and 16 primary schools) in the town of Geraardsbergen, Belgium, provided valid accelerometer data for two weekdays and one weekend day. RESULTS Mean intervention process score (maximum value = 44) was 20.9 ± 5.8 for schools. The breakdown per module showed which components were implemented and received well and which components could have been improved. After the intervention, the decrease in light PA and increase in ST was much higher in children from primary schools with a low intervention process score, whereas the behaviours remained relatively stable in children from primary schools with a medium or high score. The change in moderate to vigorous PA did not differ significantly between schools with a low, medium or high score. CONCLUSION The IDEFICS intervention was relatively able to prevent unfavourable changes in ST and light PA in schools with a medium and high intervention process score. Further process evaluation research is needed to obtain a more profound picture of the IDEFICS intervention process.
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Affiliation(s)
- M Verloigne
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation - Flanders (FWO), Brussel, Belgium
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Health Sciences, Vesalius, University College Ghent, Ghent, Belgium
| | - V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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10
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Pigeot I, de Henauw S, Baranowski T. The IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) trial outcomes and process evaluations. Obes Rev 2015; 16 Suppl 2:2-3. [PMID: 26707011 DOI: 10.1111/obr.12328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - S de Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - T Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
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11
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De Bourdeaudhuij I, Verbestel V, De Henauw S, Maes L, Mårild S, Moreno LA, Barba G, Siani A, Kovács E, Konstabel K, Tornaritis M, Pigeot I, Ahrens W. Implementation of the IDEFICS intervention across European countries: perceptions of parents and relationship with BMI. Obes Rev 2015; 16 Suppl 2:78-88. [PMID: 26707018 DOI: 10.1111/obr.12330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary aim of the present study was to obtain insight into parents' perception of the IDEFICS intervention at the school or preschool/kindergarten and community levels and whether they received specific materials related to the intervention. The secondary aim was to analyse whether parents who reported higher levels of exposure to the IDEFICS intervention had children with more favourable changes in body mass index (BMI) z-scores between baseline and after 2 years of intervention. METHODS Process evaluation of the IDEFICS intervention investigated the implementation of the 2-year intervention in the intervention communities. Intervention group parents (n = 4,180) in seven countries (Belgium, Cyprus, Estonia, Germany, Italy, Spain and Sweden) answered questions about their exposure to the IDEFICS study. To analyse the relationship between exposure and BMI z-score, a composite score was calculated for exposure at the setting and at the community levels. RESULTS The frequency of parental exposure to the IDEFICS messages not only through the community but also through the (pre)school/kindergarten was lower than what was intended and planned. The dose received by the parents was considerably higher through the (pre)school/kindergarten settings than that through the community in all countries. Efforts by the settings or communities related to fruit and vegetable consumption (range 69% to 97%), physical activity promotion (range 67% to 91%) and drinking water (range 49% to 93%) were more visible and also realized more parental involvement than those related to TV viewing, sleep duration and spending time with the family (below 50%). Results showed no relation of parental exposure at the setting or the community level on more favourable changes in children's BMI z-scores for the total sample. Country-specific analyses for parental exposure at the setting level showed an expected positive effect in German girls and an unexpected negative effect in Italian boys. CONCLUSION Parental exposure and involvement in the IDEFICS intervention in all countries was much less than aimed for, which might be due to the diverse focus (six key messages) and high intensity and duration of the intervention. It may also be that the human resources invested in the implementation and maintenance of intervention activities by the study centres, the caretakers and the community stakeholders were not sufficient. Higher levels of parental exposure were not related to more favourable changes in BMI z-scores.
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Affiliation(s)
- I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - L Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - S Mårild
- Department of Pediatrics, Göteborg University, Göteborg, Sweden
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - G Barba
- Institute of Food Science, National Research Council, Avellino, Italy
| | - A Siani
- Institute of Food Science, National Research Council, Avellino, Italy
| | - E Kovács
- Department Paediatrics, University of Pécs, Pécs, Hungary
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - M Tornaritis
- Research and Education Institute for Child Health, Strovolos, Cyprus
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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12
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De Bourdeaudhuij I, Verbestel V, De Henauw S, Maes L, Huybrechts I, Mårild S, Eiben G, Moreno LA, Barba G, Kovács É, Konstabel K, Tornaritis M, Gallois K, Hebestreit A, Pigeot I. Behavioural effects of a community-oriented setting-based intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study. Obes Rev 2015; 16 Suppl 2:30-40. [PMID: 26707014 DOI: 10.1111/obr.12347] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this paper is to evaluate the behavioural effects, as reported by the parents of the participating boys and girls, of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) intervention. METHODS The effectiveness of the IDEFICS intervention was evaluated through a cluster-controlled trial in eight European countries (control and intervention communities in each country) including more than 16,000 children. The 2- to 9.9-year-old children in the intervention group were exposed to a culturally adapted intervention that aimed to prevent childhood obesity through the community, schools/kindergartens and family. Parents completed questionnaires to measure water, soft drink and fruit juice intake; fruit and vegetable intake; daily TV viewing and other sedentary behaviours; daily physical activity levels and strengthening of the parent-child relationships at baseline and follow-up (2 years later). Mixed models with an additional random effect for country were used to account for the clustered study design, and results were stratified by sex. RESULTS The pan-European analysis revealed no significant time by condition interaction effects, neither for boys nor girls, i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents (F = 0.0 to 3.3, all p > 0.05). Also very few significances were found in the country-specific analyses. Positive intervention effects were only found for sport club participation in Swedish boys, for screen time in weekends for Spanish boys and for TV viewing in Belgian girls. CONCLUSION Although no expected intervention effects as reported by the parents on diet, physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort, a few favourable intervention effects were found on specific behaviours in some individual countries. More in-depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect.
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Affiliation(s)
- I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - L Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - I Huybrechts
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - S Mårild
- Department of Pediatrics, University of Gothenburg, Göteborg, Sweden
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Göteborg, Sweden
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) research group, Universidad de Zaragoza, Zaragoza, Spain
| | - G Barba
- Institute of Food Science, National research Council, Avellino, Italy
| | - É Kovács
- Department Paediatrics, University of Pécs, Pécs, Hungary
- Institute for Medical Information Processing, Biometrics and Epidemiology and German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - M Tornaritis
- Research and Education Institute for Child Health, Strovolos, Cyprus
| | - K Gallois
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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13
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De Henauw S, Huybrechts I, De Bourdeaudhuij I, Bammann K, Barba G, Lissner L, Mårild S, Molnár D, Moreno LA, Pigeot I, Tornaritis M, Veidebaum T, Verbestel V, Ahrens W. Effects of a community-oriented obesity prevention programme on indicators of body fatness in preschool and primary school children. Main results from the IDEFICS study. Obes Rev 2015; 16 Suppl 2:16-29. [PMID: 26707013 DOI: 10.1111/obr.12346] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood obesity is a major public health concern but evidence-based approaches to tackle this epidemic sustainably are still lacking. The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. Here, we report on the effects of the IDEFICS intervention on indicators of body fatness. SUBJECTS/METHODS The intervention modules addressed the community, school and parental level, focusing on diet, physical activity and stress-related lifestyle factors. A cohort of 16,228 children aged 2-9.9 years - about 2000 per country - was equally divided over intervention and control regions. (Participating countries were Sweden, Germany, Estonia, Hungary, Cyprus, Italy, Spain and Belgium.) We compared the prevalence of overweight/obesity and mean values of body mass index z-score, per cent body fat and waist-to-height ratio over 2 years of follow-up. Mixed models adjusting for age and socioeconomic status of the parents and with an additional random effect for country accounted for the clustered study design. RESULTS The prevalence of overweight and obesity increased in both the intervention and control group from 18.0% at baseline to 22.9% at follow-up in the control group and from 19.0% to 23.6% in the intervention group. The difference in changes between control and intervention was not statistically significant. For the cohort as a whole, the changes in indicators of body fatness did not show any clinically relevant differences between the intervention and control groups. Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators. CONCLUSIONS Over the 2-year-observation period, the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole.
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Affiliation(s)
- S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Health Sciences, Vesalius, University College Ghent, Ghent, Belgium
| | - I Huybrechts
- International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France
| | - I De Bourdeaudhuij
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - K Bammann
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - G Barba
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - V Verbestel
- International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
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14
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Pigeot I, Baranowski T, De Henauw S. The IDEFICS intervention trial to prevent childhood obesity: design and study methods. Obes Rev 2015; 16 Suppl 2:4-15. [PMID: 26707012 DOI: 10.1111/obr.12345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/25/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION One of the major research dimensions of the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study involved the development, implementation and evaluation of a setting-based community-oriented intervention programme for primary prevention of childhood obesity. In this supplement of Obesity Reviews, a compilation of key results of the IDEFICS intervention is packaged in a series of complementary papers. OBJECTIVE This paper describes the overall design and methods of the IDEFICS intervention in order to facilitate a comprehensive reading of the supplement. In addition, some 'best practice' examples are described. RESULTS The IDEFICS intervention trial was conducted to assess whether the IDEFICS intervention prevented obesity in young children aged 2 to 9.9 years. The study was a non-randomized, quasi-experimental trial with one intervention matched to one control region in each of eight participating countries. The intervention was designed following the intervention mapping framework, using a socio-ecological theoretical approach. The intervention was designed to address several key obesity-related behaviours in children, parents, schools and community actors; the primary outcome was the prevalence of overweight/obesity according to the IOTF criteria based on body mass index. The aim was to achieve a reduction of overweight/obesity prevalence in the intervention regions. The intervention was delivered in school and community settings over a 2-year period. Data were collected in the intervention and control cohort regions at baseline and 2 years later. CONCLUSION This paper offers an introductory framework for a comprehensive reading of this supplement on IDEFICS intervention key results.
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Affiliation(s)
- I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - T Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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15
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Verbestel V, De Henauw S, Barba G, Eiben G, Gallois K, Hadjigeorgiou C, Konstabel K, Maes L, Mårild S, Molnár D, Moreno LA, Oja L, Pitsiladis Y, Ahrens W, Pigeot I, De Bourdeaudhuij I. Effectiveness of the IDEFICS intervention on objectively measured physical activity and sedentary time in European children. Obes Rev 2015; 16 Suppl 2:57-67. [PMID: 26707016 DOI: 10.1111/obr.12348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/25/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND This paper reports on the effectiveness of the prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) intervention on objectively measured physical activity (PA) and sedentary time (ST) in 2- to 9.9-year-old European boys and girls. METHODS The intervention was evaluated after 2 years through a non-randomized cluster-controlled trial in eight European countries (one control and one intervention community per country). All children in the intervention group received a culturally adapted childhood obesity prevention programme through the community, schools/kindergartens and family. A random sub-sample of children participating in the IDEFICS study wore an accelerometer at baseline and follow-up for at least 3 days (n = 9,184). Of this sample, 81% provided valid accelerometer data at baseline (n = 7,413; 51% boys; 6.21 ± 1.76 years; boys: 617 ± 170 cpm day(-1) ; girls 556 ± 156 cpm day(-1) ) and 3,010 children provided valid accelerometer data at baseline and during the follow-up survey 2 years later. RESULTS In boys and girls, no significant differences in PA and ST were found between intervention and control groups over 2 years. Strong temporal effects were found in the total sample of boys and girls: the percentage of time spent in light PA per day decreased by 4 percentage points in both boys and girls between baseline and follow-up (both: p < 0.001), while time spent in ST per day increased by 4 percentage points in both sexes over time (both: p < 0.001). Percentage of time spent in moderate-to-vigorous PA per day remained stable over time in boys and girls. CONCLUSION Despite the socio-ecological approach and implementation of a culturally adapted intervention in each country, no effects of the IDEFICS intervention were found on children's objectively measured PA and ST. Behavioural interventions for children may need to enhance specificity and intensity at the family level using other behaviour change techniques and more direct strategies to reach parents.
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Affiliation(s)
- V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Barba
- Unit of Epidemiology and Population Genetics, Institute of Food Science, National Research Council, Avellino, Italy
| | - G Eiben
- Department of Public Health and Community Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
| | - K Gallois
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - L Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - S Mårild
- Department of Pediatrics, The Queen Silvia Childrens' University Hospital, Göteborg University, Göteborg, Sweden
| | - D Molnár
- Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.,Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - L Oja
- National Institute for Health Development, Tallinn, Estonia
| | - Y Pitsiladis
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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16
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Tognon G, Moreno LA, Mouratidou T, Veidebaum T, Molnár D, Russo P, Siani A, Akhandaf Y, Krogh V, Tornaritis M, Börnhorst C, Hebestreit A, Pigeot I, Lissner L. Adherence to a Mediterranean-like dietary pattern in children from eight European countries. The IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S108-14. [PMID: 25219407 DOI: 10.1038/ijo.2014.141] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite documented benefits of a Mediterranean-like dietary pattern, there is a lack of knowledge about how children from different European countries compare with each other in relation to the adherence to this pattern. In response to this need, we calculated the Mediterranean diet score (MDS) in 2-9-year-old children from the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) eight-country study. SUBJECTS AND METHODS Using 24 h dietary recall data obtained during the IDEFICS study (n=7940), an MDS score was calculated based on the age- and sex-specific population median intakes of six food groups (vegetables and legumes, fruit and nuts, cereal grains and potatoes, meat products and dairy products) and the ratio of unsaturated to saturated fats. For fish and seafood, which was consumed by 10% of the population, one point was given to consumers. The percentages of children with high MDS levels (>3) were calculated and stratified by sex, age and by having at least one migrant parent or both native parents. Demographic (sex and age) and socioeconomic characteristics (parental education and income) of children showing high (>3) vs low (⩽3) MDS levels were examined. RESULTS The highest prevalence of children with MDS>3 was found among the Italian pre-school boys (55.9%) and the lowest among the Spanish school-aged girls (26.0%). Higher adherence to a Mediterranean-like dietary pattern was not associated with living in a Mediterranean country or in a highly educated or high-income family, although with some exceptions. Differences in adherence between boys and girls or age groups varied between countries without any general pattern. CONCLUSIONS With the exception of Italian pre-schoolers, similar adherence levels to a Mediterranean-like dietary pattern have been observed among European children.
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Affiliation(s)
- G Tognon
- Public Health Epidemiology Unit, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) research group, University of Zaragoza, Zaragoza, Spain
| | - T Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) research group, University of Zaragoza, Zaragoza, Spain
| | - T Veidebaum
- Department of Chronic Disease, National Institute for Health Development, Tallinn, Estonia
| | - D Molnár
- Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - P Russo
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - A Siani
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Y Akhandaf
- Department of Public Health/Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - C Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - L Lissner
- Public Health Epidemiology Unit, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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17
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Erhardt E, Foraita R, Pigeot I, Barba G, Veidebaum T, Tornaritis M, Michels N, Eiben G, Ahrens W, Moreno LA, Kovács E, Molnár D. Reference values for leptin and adiponectin in children below the age of 10 based on the IDEFICS cohort. Int J Obes (Lond) 2015; 38 Suppl 2:S32-8. [PMID: 25219410 DOI: 10.1038/ijo.2014.133] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish age- and sex-specific reference values for serum leptin and adiponectin in normal-weight 3.0-8.9-year old European children. SUBJECTS AND METHODS Blood samples for hormone analysis were taken from 1338 children of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study cohort. Only normal-weight children aged 3.0-8.9 years were included (n=539) in our analysis. Using the General Additive Model for Location Scale and Shape, age- and sex-specific percentiles were derived. The influence of under/overweight and obesity on the proposed reference curves based on normal-weight children was investigated in several sensitivity analyses using the sample without obese children (n=1015) and the whole study sample (n=1338). RESULTS There was a negative age trend of adiponectin blood levels and a positive trend of leptin levels in boys and girls. Percentiles derived for girls were generally higher than those obtained for boys. The corresponding age-specific differences of the 97th percentile ranged from -2.2 to 4.6 μg ml(-1) and from 2.2 to 4.8 ng ml(-1) for adiponectin and leptin, respectively. CONCLUSIONS According to our knowledge, these are the first reference values of leptin and adiponectin in prepubertal, normal-weight children. The presented adiponectin and leptin reference curves may allow for a more differentiated interpretation of children's hormone levels in epidemiological and clinical studies.
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Affiliation(s)
- E Erhardt
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - R Foraita
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - G Barba
- Epidemiology and Population Genetics, Institute of Food Science, National Research Council, Avellino, Italy
| | - T Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - N Michels
- Department of Public Health, University of Ghent, Ghent, Belgium
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W Ahrens
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - L A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
| | - E Kovács
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
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18
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Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, Böhmann J, Günther K, Hadjigeorgiou C, Iacoviello L, Lissner L, Veidebaum T, Pohlabeln H, Pigeot I. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S4-14. [PMID: 25376220 DOI: 10.1038/ijo.2014.130] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.
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Affiliation(s)
- W Ahrens
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Institute of Food Sciences, Unit of Epidemiology & Population Genetics, National Research Council, Avellino, Italy
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J Böhmann
- Paediatric Clinic Delmenhorst, Delmenhorst, Germany
| | - K Günther
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - L Iacoviello
- Department of Epidemiology and Prevention, Unit of Molecular and Nutritional Epidemiology, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
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Hebestreit A, Börnhorst C, Pala V, Barba G, Eiben G, Veidebaum T, Hadjigergiou C, Molnár D, Claessens M, Fernández-Alvira JM, Pigeot I. Dietary energy density in young children across Europe. Int J Obes (Lond) 2015; 38 Suppl 2:S124-34. [PMID: 25376214 DOI: 10.1038/ijo.2014.143] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To describe energy density (ED; kcal g(-1)) of dietary intake of European children. METHODS From 16, 228 children who participated in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) baseline examination, 8551 children with 24-h dietary recalls (24-HDR), with plausible reported energy intakes and complete covariate information were included in the present analysis. ED was calculated using two methods: (1) ED including solid foods (EDF) and (2) ED including solid foods and energy-containing beverages (EDF&B). Beverage energy was calculated in kcal per day. Dietary characteristics and body mass index (BMI) z-score of children aged 2 to <6 years and 6 to <10 years were compared between children with an overall EDF below the <25th percentile, between the 25th and 75th percentile as well as above the >75th percentile. Standardised regression coefficients were estimated to assess the association between dietary characteristics, BMI z-score and ED of the diet. RESULTS Children with low EDF and EDF&B diets consumed less energy but higher quantity of food and beverages than children with high EDF and EDF&B diets. Consumption of caloric beverages decreased with increasing EDF&B of the diet owing to the relatively low ED of the beverages, in relation to solid foods. Generally, children with low EDF and EDF&B diets showed healthier food choices than peers with higher EDF and EDF&B diets. In this sample, EDF and EDF&B were not associated with BMI z-score. CONCLUSION Health promotion strategies should proclaim lower ED diets by means of foods with high water and low fat content and mainly fruit and vegetable components. Excluding caloric beverages from EDF calculation is a useful method to avoid misinterpretation of true exposure to a high energy dense diet. We recommend excluding caloric beverages from EDF calculation when investigating the effect of ED on a certain (health) outcome.
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Affiliation(s)
- A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - C Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Barba
- Epidemology & Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Sweden
| | - T Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigergiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - D Molnár
- Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - M Claessens
- Department of Public Health, Ghent University, Ghent, Belgium
| | - J M Fernández-Alvira
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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Santaliestra-Pasías AM, Mouratidou T, Reisch L, Pigeot I, Ahrens W, Mårild S, Molnár D, Siani A, Sieri S, Tornatiris M, Veidebaum T, Verbestel V, De Bourdeaudhuij I, Moreno LA. Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study. Eur J Clin Nutr 2015; 69:811-6. [DOI: 10.1038/ejcn.2015.76] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/26/2015] [Accepted: 04/15/2015] [Indexed: 01/25/2023]
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Pigeot I. The GAMLSS. An innovative approach for calculating reference values. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stallmann C, Ahrens W, Kaaks R, Pigeot I, Swart E, Jacobs S. [Individual linkage of primary data with secondary and registry data within large cohort studies - capabilities and procedural proposals]. Gesundheitswesen 2015; 77:e37-42. [PMID: 25622212 DOI: 10.1055/s-0034-1396805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Some German cohort studies have already linked secondary and registry data with primary data from interviews and medical examinations. This offers the opportunity to obtain more valid information by taking advantage of the strengths of these data synergistically and overcome their individual weaknesses at the same time. The potential and the requirements for linking secondary and registry data with primary data from cohort studies is described generally and illustrated by the example of the "German National Cohort" (GNC). The transfer and usage of secondary and registry data require that administrative and logistic efforts be made over the whole study period. In addition, rigid data protection regulations for using social data have to be observed. The particular strengths of secondary and registry data, namely their objectivity and independence from recall bias, add to the strengths of newly collected primary data and improve the assessment of morbidity endpoints, exposure history and need of patient care. Moreover, new insights on quality and on the added value of linking different data sources may be obtained.
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Affiliation(s)
- C Stallmann
- Institut für Sozialmedizin und Gesundheitsökonomie, Med. Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - W Ahrens
- BIPS Bremen, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - R Kaaks
- DKFZ Heidelberg, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg
| | - I Pigeot
- BIPS Bremen, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - E Swart
- Institut für Sozialmedizin und Gesundheitsökonomie, Med. Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - S Jacobs
- BIPS Bremen, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
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Kovács E, Siani A, Konstabel K, Hadjigeorgiou C, de Bourdeaudhuij I, Eiben G, Lissner L, Gwozdz W, Reisch L, Pala V, Moreno LA, Pigeot I, Pohlabeln H, Ahrens W, Molnár D. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study. Int J Obes (Lond) 2014; 38 Suppl 2:S144-51. [PMID: 25376216 PMCID: PMC4165864 DOI: 10.1038/ijo.2014.145] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.
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Affiliation(s)
- E Kovács
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - I de Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark
| | - V Pala
- Department of Preventive and Predictive Medicine, Epidemiology and Prevention Unit, National Tumor Institute, Milan, Italy
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
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Börnhorst C, Huybrechts I, Hebestreit A, Krogh V, De Decker A, Barba G, Moreno LA, Lissner L, Tornaritis M, Loit HM, Molnár D, Pigeot I. Usual energy and macronutrient intakes in 2-9-year-old European children. Int J Obes (Lond) 2014; 38 Suppl 2:S115-23. [PMID: 25376213 DOI: 10.1038/ijo.2014.142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Valid estimates of population intakes are essential for monitoring trends as well as for nutritional interventions, but such data are rare in young children. In particular, the problem of misreporting in dietary data is usually not accounted for. Therefore, this study aims to provide accurate estimates of intake distributions in European children. DESIGN Cross-sectional setting-based multi-centre study. SUBJECTS A total of 9560 children aged 2-9 years from eight European countries with at least one 24-h dietary recall (24-HDR). METHODS The 24-HDRs were classified in three reporting groups based on age- and sex-specific Goldberg cutoffs (underreports, plausible reports, overreports). Only plausible reports were considered in the final analysis (N=8611 children). The National Cancer Institute (NCI)-Method was applied to estimate population distributions of usual intakes correcting for the variance inflation in short-term dietary data. RESULTS The prevalence of underreporting (9.5%) was higher compared with overreporting (3.4%). Exclusion of misreports resulted in a shift of the energy and absolute macronutrient intake distributions to the right, and further led to the exclusion of extreme values, that is, mean values and lower percentiles increased, whereas upper percentiles decreased. The distributions of relative macronutrient intakes (% energy intake from fat/carbohydrates/proteins) remained almost unchanged when excluding misreports. Application of the NCI-Method resulted in markedly narrower intake distributions compared with estimates based on single 24-HDRs. Mean percentages of usual energy intake from fat, carbohydrates and proteins were 32.2, 52.1 and 15.7%, respectively, suggesting the majority of European children are complying with common macronutrient intake recommendations. In contrast, total water intake (mean: 1216.7 ml per day) lay below the recommended value for >90% of the children. CONCLUSION This study provides recent estimates of intake distributions of European children correcting for misreporting as well as for the daily variation in dietary data. These data may help to assess the adequacy of young children's diets in Europe.
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Affiliation(s)
- C Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Huybrechts
- 1] Department of Public Health, Ghent University, Ghent, Belgium [2] Dietary Exposure Assessment Groups, International Agency for Research on Cancer, Lyon, France
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - A De Decker
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Barba
- Epidemiology and Population Genetics, Institute of Food Science, CNR, Avellino, Italy
| | - L A Moreno
- 1] GENUD (Growth, Exercise, Nutrition and Development) Research Group. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain [2] Faculty of Medicine, University of Brazil, Sao Paulo, Brazil
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - H-M Loit
- Center of Health and Behavioral Science, National Institute for Health Development, Tallinn, Estonia
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Faculty of Computer Science and Mathematics, University of Bremen, Bremen, Germany
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Pigeot I, Kraywinkel K. [Epidemiological cancer registration in Germany: an impressive research resource]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 57:5-6. [PMID: 24357165 DOI: 10.1007/s00103-013-1885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Achterstr. 30, 28359, Bremen, Deutschland,
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Börnhorst C, Bel-Serrat S, Pigeot I, Huybrechts I, Ottavaere C, Sioen I, De Henauw S, Mouratidou T, Mesana MI, Westerterp K, Bammann K, Lissner L, Eiben G, Pala V, Rayson M, Krogh V, Moreno LA. Validity of 24-h recalls in (pre-)school aged children: comparison of proxy-reported energy intakes with measured energy expenditure. Clin Nutr 2013; 33:79-84. [PMID: 23622780 DOI: 10.1016/j.clnu.2013.03.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Little is known about the validity of repeated 24-h dietary recalls (24-HDR) as a measure of total energy intake (EI) in young children. This study aimed to evaluate the validity of proxy-reported EI by comparison with total energy expenditure (TEE) measured by the doubly labeled water (DLW) technique. METHODS The agreement between EI and TEE was investigated in 36 (47.2% boys) children aged 4-10 years from Belgium and Spain using subgroup analyses and Bland-Altman plots. Low-energy-reporters (LER), adequate-energy-reporters (AER) and high-energy-reporters (HER) were defined from the ratio of EI over TEE by application of age- and sex-specific cut-off values. RESULTS There was good agreement between means of EI (1500 kcal/day) and TEE (1523 kcal/day) at group level though in single children, i.e. at the individual level, large differences were observed. Almost perfect agreement between EI and TEE was observed in thin/normal weight children (EI: 1511 kcal/day; TEE: 1513 kcal/day). Even in overweight/obese children the mean difference between EI and TEE was only -86 kcal/day. Among the participants, 28 (78%) were classified as AER, five (14%) as HER and three (8%) as LER. CONCLUSION Two proxy-reported 24-HDRs were found to be a valid instrument to assess EI on group level but not on the individual level.
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Affiliation(s)
- C Börnhorst
- BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany
| | - S Bel-Serrat
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany
| | - I Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium; Dietary Exposure Assessment Groups, International Agency for Research on Cancer, Lyon, France
| | - C Ottavaere
- Department of Public Health, Ghent University, Ghent, Belgium
| | - I Sioen
- Department of Public Health, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium; University College Ghent, Department of Nutrition and Dietetics, Faculty of Health Care "Vesalius", Ghent, Belgium
| | - T Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - M I Mesana
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - K Westerterp
- Department of Human Biology, Maastricht University, The Netherlands
| | - K Bammann
- BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany; Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - V Pala
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Rayson
- BioTel Ltd. Clifton, Clifton, Bristol, United Kingdom
| | - V Krogh
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
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Regber S, Novak M, Eiben G, Bammann K, De Henauw S, Fernández-Alvira JM, Gwozdz W, Kourides Y, Moreno LA, Molnár D, Pigeot I, Reisch L, Russo P, Veidebaum T, Borup I, Mårild S. Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study. Pediatr Obes 2013; 8:118-29. [PMID: 23001999 DOI: 10.1111/j.2047-6310.2012.00093.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/19/2012] [Accepted: 07/17/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort. DESIGN Cross-sectional multi-centre study in eight European countries. PARTICIPANTS 16,220 children, ages 2-9 years. METHODS Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception. RESULTS Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe. CONCLUSION Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.
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Affiliation(s)
- S Regber
- Nordic School of Public Health NHV, Gothenburg, Sweden.
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Bammann K, Gwozdz W, Lanfer A, Barba G, De Henauw S, Eiben G, Fernandez-Alvira JM, Kovács E, Lissner L, Moreno LA, Tornaritis M, Veidebaum T, Pigeot I. Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study. Pediatr Obes 2013; 8:1-12. [PMID: 22888012 DOI: 10.1111/j.2047-6310.2012.00075.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 05/09/2012] [Accepted: 05/21/2012] [Indexed: 11/27/2022]
Abstract
UNLABELLED What is already known about this subject Overweight and obesity can be linked to different parental socioeconomic factors already in very young children. In Western developed countries, the association of childhood overweight and obesity and parental socioeconomic status shows a negative gradient. Ambiguous results have been obtained regarding the association between socioeconomic factors and childhood overweight and obesity in different countries and over time. What this study adds European regions show heterogeneous associations between socioeconomic factors and overweight and obesity in a multi-centre study with highly standardized study protocol. The strength of association between SES and overweight and obesity varies across European regions. In our study, the SES gradient is correlated with the regional mean income and the country-specific Human development index indicating a strong influence not only of the family but also of region and country on the overweight and obesity prevalence. OBJECTIVE To assess the association between different macro- and micro-level socioeconomic factors and childhood overweight. METHODS Data from the IDEFICS baseline survey is used to investigate the cross-sectional association between socioeconomic factors, like socioeconomic status (SES), and the prevalence of childhood overweight. Differences and similarities regarding this relationship in eight European regions (located in Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden) are explored. 11 994 children (50.9% boys, 49.1% girls) and their parents were included in the analyses. RESULTS In five of the eight investigated regions (in Belgium, Estonia, Germany, Spain and Sweden), the prevalence of childhood overweight followed an inverse SES gradient. In the other three regions (in Cyprus, Hungary and Italy), no association between SES and childhood overweight was found. The SES-overweight association in a region was best explained by the country-specific human development index and the centre-specific mean income. For the investigated association between other socioeconomic factors and overweight, no clear pattern could be found in the different regions. CONCLUSION The association between socioeconomic factors and childhood overweight was shown to be heterogeneous across different European regions. Further research on nationwide European data is needed to confirm the results and to identify target groups for prevention.
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Affiliation(s)
- K Bammann
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany.
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Pigeot I, Foraita R. [Invited commentary: directed acyclic graphs - realization of a dream?]. Gesundheitswesen 2011; 73:921-2. [PMID: 22193908 DOI: 10.1055/s-0031-1291194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin, Universität Bremen, Bremen.
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De Henauw S, Verbestel V, Mårild S, Barba G, Bammann K, Eiben G, Hebestreit A, Iacoviello L, Gallois K, Konstabel K, Kovács E, Lissner L, Maes L, Molnár D, Moreno LA, Reisch L, Siani A, Tornaritis M, Williams G, Ahrens W, De Bourdeaudhuij I, Pigeot I. The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe? Int J Obes (Lond) 2011; 35 Suppl 1:S16-23. [PMID: 21483418 DOI: 10.1038/ijo.2011.31] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES The European Union-as well as other parts of the world-faces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2-10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus. MATERIALS AND METHODS The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted. RESULTS So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programme's duration was 2 years, but a longer-term follow-up programme is under development. CONCLUSIONS This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.
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Affiliation(s)
- S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, University Hospital, Ghent University, Belgium.
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Hebestreit A, Keimer K, Hassel H, Pigeot I. Entwicklung und Evaluation der IDEFICS Intervention. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pigeot I, Buck C, Herrmann D, Ahrens W. Übergewicht und Adipositas bei Kindern und Jugendlichen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:653-65. [DOI: 10.1007/s00103-010-1082-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Behrens T, Pigeot I, Ahrens W. [Epidemiological and statistical methods of risk assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 52:1151-60. [PMID: 20012566 DOI: 10.1007/s00103-009-0971-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Risk assessment offers a variety of methods which comprise different risk concepts to assess population-based or individual risks. A central epidemiological measure of risk is incidence which is used to derive the relative risk as the ratio between the incidence among subjects exposed and the incidence among subjects unexposed to a certain risk factor. The excess risk quantifies the risk of an exposed population that exceeds the background risk of a non-exposed population. In environmental epidemiology the latter is frequently based on a constant exposure dose over a certain period and is expressed as unit risk. Since the application of different risk concepts depends on the respective study type, we first discuss the different epidemiological study designs. Next, methods to derive the different risk concepts are evaluated and the corresponding statistical measures are presented. Finally, an example illustrates the application of the discussed concepts for individual risk assessment.
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Affiliation(s)
- T Behrens
- Bremer Institut für Präventionsforschung und Sozialmedizin (BIPS), Universität Bremen, Linzer Str. 10, 28359, Bremen, Deutschland.
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Ahrens W, Bammann K, Pigeot I. Evidenzbasierung von Primärprävention am Beispiel einer Interventionsstudie zum kindlichen Übergewicht. Präv Gesundheitsf 2008. [DOI: 10.1007/s11553-008-0139-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Affiliation(s)
- U. Gather
- Department of Statistics, University of Dortmund, Vogelpothsweg 87, D‐44221 Dortmund, Federal Republic of Germany,
| | - J. Pawlitschko
- Department of Statistics, University of Dortmund, Vogelpothsweg 87, D‐44221 Dortmund, Federal Republic of Germany,
| | - I. Pigeot
- Institute of Statistics, University of München, Ludwigstr. 33, D‐80539 München, Federal Republic of Germany
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Giersiepen K, Pohlabeln H, Egidi G, Pigeot I. Die ICD-Kodierqualität für Diagnosen in der ambulanten Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1028-38. [PMID: 17676417 DOI: 10.1007/s00103-007-0297-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ICD-coding quality for outpatients' diagnoses by German physicians was analysed in a sample of five million members of the German Statutary Health Insurance System. New federal legislation coming into effect in 2009 for the reimbursement of physicians is based on patients' morbidity risks and thus on the quality of a provider's ICD coding. A sample of physicians' billing data for 2001-2003 containing ICD codes for patients' morbidity and the billed services was linked with outpatients' prescription data for the time period 2002- 2003. As in 2001-2003 information on the certainty of diagnosis was not yet mandatory, only 7.4% of all diagnoses were labelled as either "suspected diagnosis", "excluded diagnosis" or "history of diagnosis", hampering coding validity measurements. Chronic disease persisted in the time window analysed showing only minor successive prevalence decreases after an initial dip of at least 6% in the calendar term following the index term. The immediate decrease following the initial term may be due to initially suspected disease not confirmed until the work up at subsequent visits is completed. The slight downward slope after six months may indicate minor undercoding of chronic diagnoses. Few acute diagnoses persisted for longer than two calendar terms making it unlikely that acute diagnoses were erroneously maintained for repetitive reimbursement. Undercoding of diagnosis was abundant in patients receiving insulin prescriptions, as a diagnosis of diabetes was often missing. Numerous drugs prescribed could not be associated with a corresponding diagnosis coded by physicians. We suggest that before reimbursements to physicians are based on ICD-coded morbidity, a re-analysis of the data should be performed containing information on diagnosis certainty (mandatory since 2004) and the recently updated catalogue on fees for medical procedures provided "Einheitlicher Bewertungsmassstab" (EBM).
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Affiliation(s)
- K Giersiepen
- Bremer Institut für Präventionsforschung und Sozialmedizin, Bremen, Germany.
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Pigeot I, Ahrens W, Foraita R, Jahn I, Pohlabeln H. Ausgewählte methodische Probleme evidenzbasierter Prävention. Präv Gesundheitsf 2006. [DOI: 10.1007/s11553-006-0036-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bammann K, Wawro N, Pigeot I. Genforschung: Chance oder Risiko für die Gesundheit? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:961-2. [PMID: 17028829 DOI: 10.1007/s00103-006-0054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The use of large databases has a high potential for future epidemiological research. Databases consisting of primary data as well as routine data that are mainly collected for administrative purposes will be of interest. This paper presents some large databases and some that are most relevant for epidemiological research, respectively, and shows how they might be exploited for research purposes. To make better use of large databases there are new requirements and challenges that we have to face regarding appropriate methods for their analysis. Some examples of such methods are given. An example of pharmaco-epidemiology illustrates linkage of several administrative databases and specific problems that have to be solved in this context. Finally, future challenges are discussed that have to be overcome on the way towards establishment, maintenance and analysis of large databases, especially regarding data protection, data quality and regular updates.
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Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin (BIPS), Linzer Strsse 10, 28359 Bremen.
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Ahrens W, Bammann K, de Henauw S, Halford J, Palou A, Pigeot I, Siani A, Sjöström M. Understanding and preventing childhood obesity and related disorders--IDEFICS: a European multilevel epidemiological approach. Nutr Metab Cardiovasc Dis 2006; 16:302-308. [PMID: 16679223 DOI: 10.1016/j.numecd.2006.01.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 01/27/2006] [Indexed: 11/21/2022]
Abstract
The environment of children has drastically changed in Europe during the last decades as reflected in unhealthy dietary habits and sedentary lifestyle. Nutrition obviously plays a part in the development of overweight in childhood. However, dietary factors and physical activity are also involved in the development of metabolic syndrome, type II diabetes, cardiovascular diseases, osteoporosis, and postural deformities like scoliosis, effects related in part to excessive weight gain. To stop the resulting epidemic of diet- and lifestyle-induced morbidity, efficient evidence-based approaches are needed. These issues are the focus of IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants), a five-year project proposed under the sixth EU framework. The IDEFICS consortium comprises 25 research centres and SMEs across Europe. The planned prospective study will identify risk profile inventories for children susceptible to any of these disorders with emphasis on obesity and its co-morbid conditions. Genetic and non-genetic factors, psychosocial factors and social settings will be considered. The project will devise tailored prevention strategies that are effective, easy to implement and that account for the needs of different social groups. Population-based studies will investigate the impact of sensory perception and provide results concerning internal and external triggers of food choices and children's consumer behaviour. The ethical implications of a "right not to know" of genetic factors will be addressed. We will propose knowledge-based guidelines on dietary and lifestyle activities for health promotion and disease prevention in children for health professionals, stakeholders and consumers.
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Affiliation(s)
- W Ahrens
- Division of Epidemiological Methods and Etiologic Research, Bremen Institute for Prevention Research and Social Medicine (BIPS), University of Bremen, Linzer Strasse 10, D-28359 Bremen, Germany.
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Abstract
Approval of a drug on the market is typically considered as the successful endpoint of a long development phase. This often leads to reduced interest in further research for the indication approved, while in contrast the patient's as well as physician's interest in further research increases. This paper discusses the main areas of effectiveness, safety and post-marketing practice regarding sensible study types for the specific area and the potential gain of knowledge.
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Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin, Linzer Strasse 8, Bremen.
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Röhmel J, Hauschke D, Koch A, Pigeot I. Biometrische Verfahren zum Wirksamkeitsnachweis im Zulassungsverfahren. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2005; 48:562-71. [PMID: 15887067 DOI: 10.1007/s00103-005-1042-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The increasing number of approved efficacious therapies for various indications raises the question of whether the inclusion of a placebo group is still justified. In addition, pharmaceutical companies and regulatory agencies acknowledge that it may be sufficient to prove that a new therapy is comparable to an approved reference therapy regarding efficacy and safety in some situations. This becomes especially striking for the approval to market a generic drug. Another, perhaps even more important example is the increasing resistance of bacteria which calls for new antibiotics based on new therapeutic principles without having the claim for better efficacy. In these situations, a comparable efficacy would constitute progress. In the present paper, we discuss the numerous methodological challenges and approaches to overcome these problems that occur when it is not possible or even not wanted to use the classic approach of a randomized placebo-controlled superiority trial. Here, the field of medical biometry, which has proved in the last 25 years to be an integral part of the development of new drugs, demonstrates its suitability as a flexible and scientifically based means to fulfil the requirements resulting from clinical practice. Starting from the fact that statistical methods are not able to prove "equality" of two treatments, "shifted" hypotheses are considered and their importance for the different study designs is discussed. We show how the classic hypotheses known from placebo-controlled clinical trials can be embedded in this concept. The implications of this approach for the analysis and interpretation of study results is further discussed. The relevant guidelines of the European and US regulatory agencies are taken into account.
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Pigeot I, Ahrens W. Datenbanken als Grundlage f�r Monitoring-Systeme in der Arzneimittelsicherheit. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:513-7. [PMID: 15221098 DOI: 10.1007/s00103-004-0834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical trials only allow for a limited assessment of adverse drug reactions (ADRs) due to their restricted number of patients, their short duration, and their narrow inclusion criteria. To assess potential ADRs in the population actually treated after drug approval, different systems for signal generation such as spontaneous reporting systems have been established and are required by drug laws in many countries. As of today epidemiological methods for signal confirmation for rare adverse events or events with long induction periods use record linkage databases such as the United Health Care (Ingenix) in the USA or the practice databases such as the General Practice Research Database in Great Britain. However, this approach also has its limitations. This type of database will be presented in this paper. In addition, databases operated by German public health insurance will be described. The topic of linking different data sources in Germany to support pharmaco-vigilance activities will be addressed.
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Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin, Bremen.
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Pohlabeln H, Strube H, Bosche H, Pigeot I. M�hre statt Big Mac, Apfel statt Schokoriegel, Vollkornbrot statt Pizza? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:211-2. [PMID: 15205787 DOI: 10.1007/s00103-004-0802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Pigeot I, Bosche H, Pohlabeln H. Programme der Prim�rpr�vention von Adipositas und �bergewicht im Kindesalter. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:256-65. [PMID: 15205795 DOI: 10.1007/s00103-003-0792-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The prevalence of obesity and overweight in childhood and among adolescents is dramatically increasing worldwide with high impact on their self-esteem and on their health as adults. Therefore, effective programs for primary prevention are urgently required. The focus of these programs should not only be on nutrition but also account for the complete sociocultural environment of the child. This paper will describe some of the more important programs on the one hand and present an exemplary concept for a scientifically observed program for prevention of obesity in preschool children on the other hand. The discussion will be completed by a short overview of programs for secondary prevention. In summary, it can be concluded that no sufficiently evaluated programs for primary prevention of obesity in childhood currently exist in Germany.
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Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin, Bremen.
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Gather U, Köhne S, Pigeot I. Jackknife estimators of a relative risk in 2×2 and 2×2×
K
contingency tables. STAT NEERL 2001. [DOI: 10.1111/1467-9574.00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- U. Gather
- Department of Statistics, University of Dortmund, Germany,
| | | | - I. Pigeot
- Institute of Statistics, University of Munich, München, Germany
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Morik K, Pigeot I, Robers U. CORA--a knowledge-based system for the analysis of case-control studies. Comput Methods Programs Biomed 1999; 58:35-50. [PMID: 10195645 DOI: 10.1016/s0169-2607(98)00065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Carrying out a statistical analysis, the researcher is concerned with the problem of choosing an appropriate statistical technique from a large number of competing methods. Most common statistical software offer different methods for analysing the data without giving any support regarding the adequacy of a method for a particular data set. This paper outlines the main features of the computer system CORA which provides a statistical analysis of stratified contingency tables and additionally supports the researcher at the different steps of this analysis. Here, the support given by the system consists of two different aspects. On the one hand, the help system of CORA contains general information on the implemented statistical methods which can be obtained on request. On the other hand, an advice tool recommends an adequate statistical method which depends on the actual empirical case-control data to be analysed. To build up the advice tool, a set of rules being discovered by machine learning from simulation studies is integrated into the system CORA.
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Affiliation(s)
- K Morik
- Department of Computer Science VIII, University of Dortmund, Germany
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Pigeot I, Strugholtz H. Jackknifing the Mantel-Haenszel Estimator in Sparse Contingency Tables. AUST NZ J STAT 1998. [DOI: 10.1111/1467-842x.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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