How energy balance-related behaviours, temperament, stress and overweight associate: a cross-sectional study of Finnish preschoolers

OBJECTIVE

This study aimed to (1) examine the clustering of energy balance-related behaviours (EBRB) and (2) investigate whether EBRB clusters, temperament and hair cortisol concentration (HCC) associate with overweight.

DESIGN

We assessed food consumption using food records, screen time (ST) using sedentary behaviour diaries, sleep consistency and temperament (negative affectivity, surgency, effortful control) using questionnaires and HCC using hair samples. Accelerometers were used to assess physical activity (PA) intensities, sleep duration and sleep efficiency. Researchers measured each child's weight and height. We used finite mixture models to identify EBRB clusters and multilevel logistic regression models to examine the associations between EBRB clusters, temperament, HCC and overweight.

SETTING

The cross-sectional DAGIS survey, data collected in 2015-2016.

PARTICIPANTS

Finnish 3-6-year-olds (n 864) recruited through preschools.

RESULTS

One-third of the participants were categorised into the cluster labelled 'Unhealthy diet, excessive screen time', characterised by unhealthy dietary choices (e.g. greater consumption of high-fat, high-sugar dairy products) and longer ST. Two-thirds were categorised into the second cluster, labelled 'Healthy diet, moderate screen time'. PA and sleep were irrelevant for clustering. Higher negative affectivity and lower effortful control associated with the 'Unhealthy diet, excessive screen time' cluster. EBRB clusters and HCC did not associate with overweight, but surgency was positively associated with overweight (OR = 1·63, 95 % CI 1·17, 2·25).

CONCLUSIONS

Of the EBRB, food consumption and ST seem to associate. As temperament associates with EBRB clusters and overweight, tailored support acknowledging the child's temperament could be profitable in maintaining a healthy weight.

Comparison of actigraphy-measured and parent-reported sleep in association with weight status among preschool children

This study compared weekday and weekend actigraphy-measured and parent-reported sleep in relation to weight status among preschool-aged children. Participants were 3-6 years old preschoolers from the cross-sectional DAGIS-study with sleep data for ≥2 weekday and ≥2 weekend nights. Parents-reported sleep onset and wake-up times were gathered alongside 24 h hip-worn actigraphy. An unsupervised Hidden-Markov Model algorithm provided actigraphy-measured night time sleep without the guidance of reported sleep times. Waist-to-height ratio and age-and-sex-specific body mass index characterised weight status. Comparison of methods were assessed with consistency in quintile divisions and Spearman correlations. Associations between sleep and weight status were assessed with adjusted regression models. Participants included 638 children (49% girls) with a mean ± SD age of 4.76 ± 0.89. On weekdays, 98%-99% of actigraphy-measured and parent-reported sleep estimates were classified in the same or adjacent quintile and were strongly correlated (rs  = 0.79-0.85, p < 0.001). On weekends, 84%-98% of actigraphy-measured and parent-reported sleep estimates were respectively classified and correlations were moderate to strong (rs  = 0.62-0.86, p < 0.001). Compared with actigraphy-measured sleep, parent-reported sleep had consistently earlier onset, later wake-up, and greater duration. Earlier actigraphy-measured weekday sleep onset and midpoint were associated with a higher body mass index (respective β-estimates: -0.63, p < 0.01 and -0.75, p < 0.01) and waist-to-height ratio (-0.004, p = 0.03 and -0.01, p = 0.02). Though the sleep estimation methods were consistent and correlated, actigraphy measures should be favoured as they are more objective and sensitive to identifying associations between sleep timing and weight status compared with parent reports.

Role of early childhood educators' demographic characteristics and perceived work environment in implementation of a preschool health promotion intervention

BACKGROUND

Research has indicated that the effectiveness of intervention programs is affected by how well these programs are implemented, but key gaps remain in our understanding of the factors that promote or inhibit implementation. This study examined how demographic characteristics and perceived work environment among early childhood educators were associated with implementation outcomes of the Increased Health and Wellbeing in Preschools (DAGIS) intervention, which was conducted as a cluster randomized trial.

METHODS

Participants included 101 educators from 32 intervention preschool classrooms. Data were analyzed at the classroom level, as the DAGIS intervention was delivered in preschool classrooms consisting of several educators instead of individual implementers. Linear regression was used to estimate the associations of educators' demographic characteristics and perceived work environment with different aspects of implementation (i.e., dose delivered; dose received - exposure; dose received - satisfaction; and perceived quality, as well as a total sum score based on these four dimensions). Municipality was controlled in the adjusted models.

RESULTS

Findings indicated that having a higher proportion of educators with a Bachelor's or Master's degree in education within the classroom was associated with higher dose received - exposure and higher total degree of implementation, and the significance of the models was unaffected by adjustment for municipality. Moreover, having a higher proportion of educators younger than 35 years within the classroom was associated with higher dose received - exposure. However, the association was non-significant when adjusted for municipality. No other educator factor (i.e., work experience in years and perceived support from coworkers, group work, and innovative climate) predicted implementation outcomes.

CONCLUSIONS

Higher educational attainment and younger age among educators at the classroom level were associated with higher scores for some of the implementation outcomes. Educators' work experience in years at the current preschool and in early childhood education, support from coworkers, group work, and innovative climate were not significantly associated with any implementation outcomes. Future research should explore ways to improve educators' implementation of interventions aimed at promoting children's health behaviors.

Associations between socioeconomic status, home food availability, parental role-modeling, and children's fruit and vegetable consumption: a mediation analysis

BACKGROUND

Recent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children's diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children's diet. This study aimed to determine the associations between family SES and children's fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations.

METHODS

Cross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children's FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level ("low", "middle", and "high") and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0.

RESULTS

The positive association between high parental educational level and children's FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51-4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10-1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35-1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 - -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children's FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06-1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40-1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations.

CONCLUSIONS

Parental educational level showed more associations with children's FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children's FV consumption. Future interventions to improve children's dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

Child temperament is associated with energy intake and its day-to-day variability among preschoolers-Results from a cross-sectional DAGIS study

BACKGROUND

Although research has linked children's temperament with weight outcomes, the associations between temperament and dietary outcomes, particularly energy intake, remain understudied. Furthermore, little is known about how temperament is associated with diet in the early childhood education and care (ECEC) context, which is an important environment for many children.

OBJECTIVES

This study examined whether temperament is associated with mean energy intake and its day-to-day variability. In addition, the associations were examined separately in the contexts of home and ECEC.

METHODS

The study used data from 505 Finnish children from a cross-sectional DAGIS study conducted in 2015-2016. Parents reported their child's temperament with a questionnaire and food consumption with a food record for two weekdays (outside daycare hours) and one weekend day. Early educators at an ECEC centre reported the child's food consumption during the daycare hours on the same weekdays as the parents kept food records at home. Associations were examined with linear regression models.

RESULTS

Children with higher surgency had a higher mean daily energy intake. When examined separately at home and in the ECEC centre, the association was found only in the ECEC centre. Children with higher negative affectivity had greater day-to-day variability in energy intake. This association, however, was not observed when examined separately at home and at the ECEC centre.

CONCLUSIONS

The results indicate that temperament may shape children's energy intake. Moreover, the role of the ECEC context in children's eating may be different depending on a child's temperamental dispositions, which warrants further research.

The role of parental congruence in pre-school children's screen time, moderated by parental education

AIM

This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship.

METHODS

A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression.

RESULTS

Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST.

CONCLUSION

Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation

BACKGROUND

Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators.

METHODS

The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms.

RESULTS

Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09).

CONCLUSIONS

Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior.

TRIAL REGISTRATION

ISRCTN57165350 (8 January, 2015).

Is parental socioeconomic status associated with irregularity of energy intake among children?

Background

The timing of eating, chrono-nutrition, is a relatively new research area, where the focus is not on only what we eat but also when we eat and of irregularity between days. Chrono-nutrition have been associated with cardiovascular risk factors among adults. Societal factors influence the chrono-nutrition, but there is limited research on how different socioeconomic factors are associated with chrono-nutrition, especially among children. The aim of this study is to examine the association between parental socioeconomic status and irregularity of children’s energy intake.

Methods

We used data from the DAGIS (Increased Health and Wellbeing in Preschools) study in years 2015-2016, in which 864 preschool children participated (age 3-6 years old). Childreńs dietary intake was measured by a 3-day food record. We included only children that had complete data from all three days and the child was at day care on two of those days and one day was a weekend day (n = 568). To calculate the irregularity score, the absolute difference between the daily energy intake and 3-day mean intake for each three days was divided by the 3-day mean energy intake, multiplied by 100 and then averaged over the 3 days; this served as a measure of irregularity of energy intake, with a low score indicating a more regular energy intake and a higher more irregular energy intake. The parents reported highest parental educational level and household income on a questionnaire. The associations were tested by general linear models on SPSS.

Results

No association was found between parental educational level or household income with irregularity of children’s energy intake.

Conclusions

There was no association between parental socioeconomic status and children’s irregularity of energy intake. Other aspects of children’s chrono-nutrition should also be tested to be able to conclude that children’s chrono-nutrition is not influenced by parental socioeconomic status.

Key messages

• We found no association between parental socioeconomic status and irregularity in children’s energy intake.

• Chrono-nutrition among children is under-examined.

Parent-child nature visits and young Finnish childreńs nature connectedness

Background

It is well-known that frequent nature visits are associated with health benefits in children. Global climate crisis and environmental challenges emphasize the need for reconnecting children to nature, as well. Young children’s nature connectedness (NC) involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature. The study examines whether there is an association between the frequency of parent-child nature visits and young children’s NC.

Methods

The study uses WEB survey data from the Finnish Empowered by Nature project. Respondents, n = 1463, were parents of children aged 2 to 7 years old. NC was assessed by 11-items derived from the NC questionnaire of Sobko et al (2018). Multinomial logistic regression analysis was used and the lowest tertile of NC was used as reference group. Analysis were adjusted for child’s age and gender, and highest education of parent.

Results

Children with moderate (1-2 times a week in previous month) or high (3 times a week or more) frequency of parent-child nature visits were more likely to have strong than weak NC compared to children with low frequency (less than once a week) of adult-child nature visits. Odds ratios (OR) in adjusted models were: moderate frequency 1.67 (1.21- 2.32), and high frequency 2.31 (1.67-3.18). The odds of having medium NC compared to weak NC were more likely in moderate frequency compared to low frequency of parent-child nature visits in the adjusted model (OR 1.46; 1.07-2.00).

Conclusions

The results highlight the importance of parents visiting nature frequently with their children during early childhood. It promotes young children’s NC and may further contribute to raising environmentally responsible children.

Key messages

• More frequent parent-child visits promote young children’s nature connectedness which involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature.

• A strong nature connectedness among children is highly relevant, as it may contribute to raise environmentally responsible children.

Implementation, home mediators and children’s sugary drink consumption - results from DAGIS study

Background and objectives

The effectiveness of a health behavior intervention can depend on the extent to which the intervention is implemented; higher degree of implementation (DOI) might associate with larger intervention effects. This study examined whether the parental DOI of an health behavior intervention had an effect on children's consumption of sugar-sweetened beverages (SSB) and was the effect mediated by home factors.

Methods

the DAGIS preschool intervention was conducted in 2017-2018 in Finland among 3-6-year-olds with valid data from 476 children. At baseline and follow-up parents reported 1) children's SSB consumption in a semi-quantified food frequency questionnaire, 2) availability of SSB at home, parental role modelling of drinking SSB, and norm (parental view on the suitable amount of SSB for children), and 3) DOI: a dichotomized sum variable on several aspects of parental program implementation. In the analyses, high and low DOI were compared to control group. Mediation analysis of the effect of DOI on the change in children's SSB consumption via change in availability, role modelling and norm was conducted with R statistical software.

Results

High DOI was associated with reduced consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No mediated effects were found. All studied mediators impacted the change in SSB consumption, but the DOI had no effect on the change in mediators.

Conclusions

Intervention effect on the consumption of SSB was only found in the high DOI group, which supports the importance of assessing intervention implementation. Since the found effect was not mediated by the studied mediators, other possible mediators should be examined, as understanding intervention mediators is crucial in developing successful interventions.

Key messages

Preschool children’s temperament and its associations with energy intake

Background and objectives

Child's temperament dimensions have been linked with different weight outcomes as well as dietary factors such as consumption of fruit and vegetables, sugar-rich foods and drinks and an overall dietary quality. Links between temperament dimensions and energy intake, however, remain under-examined. This study expands the literature by investigating associations between child's temperament dimensions and energy intake.

Methods

Altogether 505 Finnish children aged 3-6 years provided data for the analyses. The data is a part of the DAGIS (Increased Health and Wellbeing in Preschools) study conducted in 2015-2016. Child's energy intake was measured with 3-day food records. To be included, children had to 1) have food record for two preschool days and one weekend day and 2) to have consumed both lunch and an afternoon snack in the preschool on the two preschool days. The very short form of Children's Behavior Questionnaire was used to measure child's temperament dimensions. Concurrent associations between three temperament dimensions (surgency, negative affectivity, and effortful control) and energy intake were examined using linear regression models adjusted for child's age, sex, mother's highest education, and moderate-to-vigorous physical activity.

Results

Surgency, temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake. Effortful control or negative affectivity were not associated with energy intake.

Conclusions

The findings imply that temperamental surgency may be one relevant determinant of energy intake among preschool children. The result is in line with previous studies linking child's surgency as well as its specific facets, such as impulsivity, with weight outcomes and food approach behaviors. Considering child's individual temperament dimensions when counselling families in eating issues could be beneficial.

Key messages

• Surgency, a temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake.

• When promoting children’s balanced eating, tailored support for parents acknowledging child’s temperament could be beneficial.

Psychometric properties of the item-reduced version of the comprehensive general parenting questionnaire for caregivers of preschoolers in a Finnish context

Introduction

Many instruments for assessing general parenting have been reported as burdensome and are thus seldom used in studies exploring children’s energy balance-related behaviors or weight. This study evaluates the factorial structure of the item-reduced version of the Comprehensive General Parenting Questionnaire (CGPQ), which assesses five constructs of general parenting.

Methods

The study uses data from two cross-sectional studies: Study 1 in 2014 (n = 173) and Study 2 in 2015–16 (n = 805). Parents of children aged three to six answered the CGPQ; in Study 1 the 69-item version, and in Study 2 the 29-item version. The reduction was based on the results of the confirmatory factor analyses (CFA) in Study 1. In both datasets, internal consistency, as Cronbach’s alphas and intraclass correlations between the items of each construct, was tested. A combined assessment of the CFA and items response theory evaluated the construct validity and the item importance for the 29-item version, and a further the reduced 22-item version.

Results

In Study 1, the highest Cronbach’s alphas were shown for the five constructs in the 69-item version. A higher intraclass correlation was found between the constructs in the 69- and 29-item versions, than between the 69- and the 22-item version. However, a high concordance was found between the constructs in the 29- and 22-item versions in both Study 1 and in Study 2 (0.76–1.00). Testing the goodness-of-fit of the CFA models revealed that the 22-item model fulfilled all the criteria, showing that it had a better factorial structure than the 29-item model. Standard estimations ranged from 0.20 to 0.76 in the 22-item version.

Conclusion

The reduced 22- and 29-item versions of the 69-item CGPQ showed good model fit, the 22-item version the better of the two. These short versions can be used to assess general parenting without overburdening the respondents.

Computational hyperspectral light-sheet microscopy

We describe a computational light-sheet microscope designed for hyperspectral acquisition at high spectral resolution. The fluorescence light emitted from the full field-of-view is focused along the entrance slit of an imaging spectrometer using a cylindrical lens. To acquire the spatial dimension orthogonal to the slit of the spectrometer, we propose to illuminate the specimen with a sequence of structured light patterns and to solve the image reconstruction problem. Beam shaping is obtained simply using a digital micromirror device in conjunction with a traditional selective plane illumination microscopy setup. We demonstrate the feasibility of this method and report the first results in vivo in hydra specimens labeled using two fluorophores.

A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial

Background

Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce.

Objective

This paper describes the development of the Mole’s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years.

Methods

A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children’s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children’s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up.

Results

A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52).

Conclusions

The Mole’s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments.

Trial Registration

ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283

Associations between hair and salivary cortisol, salivary alpha-amylase, and temperament dimensions among 3-6-year-olds

Associations between hair cortisol concentration (HCC), diurnal salivary cortisol (sCort) and alpha-amylase (sAA), and temperament dimensions were examined among 3-6-year-old Finnish children (n = 833). Children's hair samples were collected at preschool, while parents collected five saliva samples from children during one weekend day and completed a questionnaire assessing child's temperament dimensions i.e. surgency, negative affectivity, and effortful control (HCC, n = 677; AUCg of sAA, n = 380; AUCg of sCort, n = 302; temperament dimensions, n = 751). In linear regression analysis, diurnal sCort associated positively with HCC, the association persisting after adjustments (β 0.31, 95% CI 0.20-0.42). In logistic regression analysis, increasing scores in effortful control associated with higher likelihood of having high HCC (OR 1.47, 95% CI 1.07-2.03), the association slightly attenuating to non-significant after adjustments. Otherwise, no clear indication for associations between temperament and stress-related biomarkers were found.

Temperament, physical activity and sedentary time in preschoolers - the DAGIS study

Background

Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children.

Methods

Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children’s Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied.

Results

Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = − 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = − 3.63, p < 0.001), VPA (B = − 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation.

Conclusion

Children’s temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control.

Does temperament make children differently susceptible to their home physical food environment? A cross-sectional DAGIS study on 3-6 year old Finnish children's food consumption

Consistently linked with children's food consumption are food availability and accessibility. However, less is known about potential individual differences among young children in their susceptibility to home food environments. The purpose of the study was to examine whether the association between home food availability and accessibility of sugar-rich foods and drinks (SFD) or fruits and vegetables (FV) and children's consumption of these foods differ according to their temperament. The study used two cross-sectional datasets collected as part of the Increased Health and Wellbeing in Preschools (DAGIS) study: 1) a cross-sectional data of 864 children aged 3-6 years old collected between fall 2015 and spring 2016, and 2) an intervention baseline data of 802 children aged 3-6 collected in fall 2017. Parents reported their children's temperament, consumption of FV and SFD, and home availability and accessibility of SFD and FV. Examination of whether associations between home availability and accessibility of FV and their consumption differ according to children's temperament involved using linear regression models. Similar models were used to examine association between home availability and accessibility of SFD and their consumption, and the moderating role of temperament. The association between home accessibility of SFD and their consumption frequency was dependent on the level of children's negative affectivity. More frequent consumption of SFD was observed with higher home accessibility of SFD. The association was stronger in children with higher scores in negative affectivity. No other interactions were found. Children with higher negative affectivity are possibly more vulnerable to food cues in the home environment than children with lower negative affectivity. Consideration of children's individual characteristics is necessary in supporting their healthy eating.

Are associations between home environment and preschool children's sedentary time influenced by parental educational level in a cross-sectional survey?

Background

Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children’s SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3–6-year-old children, and to examine how home environment associates with children’s SED, and whether PEL modifies these associations.

Methods

A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015–2016 in Finland. The parents (n = 809) filled in questionnaires assessing PEL, and the home physical and social environment related to children’s SED. Children’s SED was measured with accelerometers, which the children (n = 745) wore for 1 week.

Results

High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child’s screen time, and satisfaction about the child’s screen time associated with children’s lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance.

Conclusions

Future interventions aiming to decrease SED should pay attention to relevant factors in children’s sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

STUDY OBJECTIVES

To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.

METHODS

The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.

RESULTS

An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.

CONCLUSIONS

Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group.

Do stressed children have a lot on their plates? A cross-sectional study of long-term stress and diet among Finnish preschoolers

We examined the association between hair cortisol concentration (HCC) - an indicator of long-term stress - and diet among preschoolers in a cross-sectional design. The participants were 597 Finnish 3-6-year-olds, and the data were collected in 2015-16. We used 4-cm hair samples to analyze HCC during the past four months. Food consumption was assessed using a food frequency questionnaire, and we used consumption frequencies of selected food groups as well as data-driven dietary pattern scores in the analyses. The parents of the participating children reported their educational level and family income. The researchers measured the children's weight and height. We examined the associations between HCC and diet using multilevel linear mixed models adjusted for age, gender, the highest education in the family, household relative income, and child BMI. Higher HCCs were associated with less frequent consumption of fruit and berries (B estimate -1.17, 95% CI -2.29, -0.05) and lower scores in a health-conscious dietary pattern (B estimate -0.38, 95% CI -0.61, -0,14). Higher HCCs were also associated with more frequent consumption of sugary beverages (B estimate 1.30, 95% CI 0.06, 2.54) in a model adjusted for age, gender and highest education in the family, but the association attenuated after further adjustments. Our results are parallel with previous studies that show a link between stress and unhealthy diet. In the future, longitudinal studies are needed to establish a causal relationship between stress and diet among children.

Analysis of the fecal microbiome in Kemp’s ridley sea turtles Lepidochelys kempii undergoing rehabilitation

The impact of the intestinal and fecal microbiome on animal health has received considerable attention in recent years and has direct implications for the veterinary and wildlife rehabilitation fields. To examine the effects of rehabilitation on the microbiome in Kemp’s ridley sea turtlesLepidochelys kempii, fecal samples from 30 incidentally captured juveniles were collected during rehabilitation. Samples were analyzed to determine alpha- (α) and beta- (β) diversity as well as the taxonomic abundance of the fecal microbiota during rehabilitation and in response to treatment with antibiotics. The fecal microbial communities of animals housed in rehabilitation for a ‘short-term’ stay (samples collected 0-9 d post-capture) were compared with ‘long-term’ (samples collected 10+ d post-capture) and ‘treated’ groups (samples collected from turtles that had received antibiotic medication). Results of this study indicate that the most dominant phylum in fecal samples wasBacteroidetes(relative abundance, 45.44 ± 5.92% [SD]), followed byFirmicutes(26.62 ± 1.58%),Fusobacteria(19.49 ± 9.07%), andProteobacteria(7.39 ± 1.84%). Similarly, at the family level,Fusobacteriaceae(28.36 ± 17.75%),Tannerellaceae(15.41 ± 10.50%),Bacteroidaceae(14.58 ± 8.48%), andRuminococcaceae(11.49 ± 3.47%) were the most abundant. Our results indicated that both antibiotic-treated and long-term rehabilitated turtles demonstrated a significant decrease in β-diversity when compared to short-term rehabilitated turtles. Our results likewise showed that the length of time turtles spent in rehabilitation was negatively correlated with α- and β-diversity. This study demonstrates the importance of a judicious use of antibiotics during the rehabilitation process and emphasizes the importance of limiting the length of hospital stays for sick and injured sea turtles as much as possible.

Preschool group practices and preschool children's sedentary time: a cross-sectional study in Finland

OBJECTIVES

Preschool is an important setting for regulating sedentary time (ST). The preschool day in Finland follows daily structures by having morning and afternoon slots for group-based activities that can encourage children for movement (eg, free play and outdoor time) or be still (eg, teacher-led sessions and sitting-based circles). This study aims to explore if the weekly routines in preschool and if more frequent visits in places encouraging physical activity (PA) are associated with children's ST during preschool hours.

DESIGN

Cross-sectional DAGIS (Increased Health and Wellbeing in Preschools) study in the years 2015 and 2016.

SETTING

In Finland.

PARTICIPANTS

864 children (48% girls, 4.7 years) from 159 preschool groups in 66 preschools OUTCOME MEASURES: A total of 778 children wore required lengths of time (at least 240 min per preschool day, at least 2 days) the accelerometer during preschool hours. Each preschool group reported their weekly schedule during the week, and one early educator completed a questionnaire covering practices. The following five measures related to weekly structures were formed; times of outdoors (times per day), teacher-led sessions (times per day), free play (low, middle or high), organised PA lessons (no lessons at all/others) and mixed activities (no lessons at all/others), and the following five measures about the frequencies of visits in places encouraging PA; nature trips (times per week), play parks (times per week), neighbourhood sport facilities (no visits at all/others), visits to gym or other indoor facility (no visits at all/others) and field trips to neighbourhoods (times per week). Multilevel linear regression analyses were conducted to measure the associations.

RESULTS

Of all the tested associations, only more frequently conducted nature trips were associated with lower children's ST during preschool hours (β=-1.026; 95% CI -1.804 to -0.248).

CONCLUSION

Frequent nature trips in preschools may be important due to its association with lower preschool children's ST.

Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers' energy balance-related behaviours and self-regulation skills

Background

Preschoolers’ energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers’ EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children’s socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework.

Methods

The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan.

Results

The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children’s EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017–May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families.

Conclusion

A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them.

Trial registration

ISRCTN57165350 (Prospectively registered January the 8th, 2015).

Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study

Background

Recent 24-h movement guidelines for the early years established recommendations for physical activity (PA), screen time (ST), and sleep. To date, few studies have focused on compliance with meeting the guidelines and their associations with health outcomes. Thus, we aimed to investigate: 1) compliance with the 24-h movement guidelines, and 2) associations between compliance and anthropometry in Finnish preschoolers.

Methods

We utilized DAGIS survey data that were collected in 2015–2016 (N = 864). PA was assessed 24 h/day over 7 days using a waist-worn ActiGraph wGT3X-BT accelerometer. ST and sleep were reported by the parents during the same 7 days. Anthropometry was assessed using body mass index (BMI, kg/m²) and waist circumference (WC, cm). Children were classified as meeting the guidelines if they averaged ≥180 min/day of PA, which consisted of ≥60 min of moderate-to-vigorous intensity; ≤60 min/day of ST; and 10–13 h/day of sleep. In total, 778 children (51% boys, mean age: 4.7 ± 0.9 years) were included in the study. The compliance with meeting the 24-h movement guidelines was calculated for each behavior separately and in combinations. Adjusted linear regression analyses were applied to examine associations of compliance with BMI and WC.

Results

Children were physically active on average 390 (±46.2) min/day and spent 86 (±25.5) min/day in moderate-to-vigorous PA. They spent 76 (±37.4) min/day on ST and had on average 10:21 (±0:33) h:min/day of sleep. The compliance rate in meeting all three movement guidelines overall was 24%. The highest compliance rate was found for PA (85%), followed by sleep (76%) and ST (35%). Meeting guidelines separately for PA or sleep, or for both, were associated with lower WC (PA: B = -1.37, p < 0.001; Sleep: B = -0.72, p = 0.009; PA + Sleep: B = -1.03, p < 0.001). In addition, meeting guidelines for sleep or for both PA and sleep were associated with lower BMI (Sleep: B = -0.26, p = 0.027; PA + Sleep: B = -0.30, p = 0.007). There were no significant associations found regarding ST.

Conclusions

Meeting recommendations for PA and sleep may have an important role in supporting a healthy weight status in young children. However, there is still a need to improve compliance with the 24-h movement guidelines, especially for ST.

Determination of Glucosamine in Raw Materials and Dietary Supplements Containing Glucosamine Sulfate and/or Glucosamine Hydrochloride by High-Performance Liquid Chromatography with FMOC-Su Derivatization: Collaborative Study

A collaborative study was conducted for determination of glucosamine in raw materials and dietary supplements containing glucosamine sulfate and/or glucosamine hydrochloride by high-performance liquid chromatography (HPLC) with N-(9-fluorenyl-methoxycarbonyloxy) succinimide (FMOC-Su) derivatization. Thirteen blind materials, one pair of which were duplicates, were tested by 12 collaborating laboratories. The test samples consisted of various commercial products, including tablets, capsules, drink mix, and liquids as well as raw materials, blanks, and those for spike recovery analyses. The tests with blank products and products spiked with glucosamine showed good specificity of the method. The average recoveries at spike levels of 100 and 150% of the declared amount were 99.0% with a relative standard deviation (RSD) of 2.1%, and 101% with an RSD of 2.3%, respectively. The test results between laboratories on each commercial product were reproducible with RSD values of no more than 4.0%, and the results were repeatable in the same laboratory with an average RSD of 0.7%. HorRat values ranged from 0.5 to 1.7 on both tests of spike recovery and reproducibility between laboratories on commercial products. The average determination coefficient of the calibration curves from the laboratories was 0.9995 with an RSD of 0.03%. All of the 12 collaborating laboratories succeeded in the study and none of their reported test results were outliers, partly indicating the robustness of the method. It is recommended that the method be accepted by AOAC INTERNATIONAL as Official First Action.

Laboratory evaluation of secondary causes of bone loss in Veterans with spinal cord injury and disorders

An electronic health record (eHR) review of Veterans with a spinal cord injury and disorder (SCI/D) was conducted to understand the extent to which Veterans Affairs (VA) providers pursue workups for secondary causes of osteoporosis in this population. Laboratory tests for secondary causes were ordered in only one-third of Veterans, with secondary causes identified in two-thirds of those tested, most frequently, hypogonadism and hypovitaminosis D.

PURPOSE

To identify workups for secondary causes of osteoporosis in SCI/D and the extent to which subspecialty consultations are sought.

METHODS

A total of 3018 prescriptions for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, teriparatide) among 2675 Veterans were identified in fiscal years 2005-2015 from VA administrative databases. Approximately 10% of these prescriptions were selected for eHR review.

RESULTS

eHR records of 187 Veterans with a SCI/D who had received pharmacological treatment for osteoporosis were reviewed. Workups for secondary causes of osteoporosis were performed in 31.5% of Veterans (n = 59) with approximately 64.4% of those tested (n = 38) having at least one abnormality. Hypogonadism (52.0% of those tested) and hypovitaminosis D (50.0% of those tested) were the most common secondary causes of osteoporosis identified in this population. Approximately 10% of primary care and SCI providers consulted subspecialists for further evaluation and treatment of osteoporosis. Endocrinologists more frequently performed a workup for secondary causes of osteoporosis compared to other provider specialties.

CONCLUSIONS

Screening for secondary causes of osteoporosis, particularly for hypogonadism and hypovitaminosis D, should be considered in patients with a SCI/D.

Children’s food intake in relation to preschool-level facilitators and barriers of healthy nutrition

Background

Childcare is an important setting for young children’s food consumption as, in Finland, most children eat three meals a day in childcare. Thus, it is important to recognize determinants of children’s dietary intake in childcare. The aim of this study was to examine food-related factors at preschool and manager-level and their association with children’s fruit, vegetable and fibre intake at preschool.

Methods

The study was a part of the cross-sectional DAGIS survey conducted in 2015-2016. It aimed to examine 3-6-year-old preschoolers’ energy balance-related behaviors in Finland. Preschool managers from 58 preschools filled in a questionnaire on food and nutrition related factors at preschool such as kitchen type, food policies, food education, the manager’s possibilities to impact fruit and vegetable supply and cooperation challenges with the catering service. Preschool personnel kept food record for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender and municipality as confounders, preschool-level factors as independent variables and children’s vegetable (g/day) and fruit (yes vs. no) consumption, and fibre intake (g/MJ) as outcome variables.

Results

Having many written food policies in the preschool was associated with higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least 2 out of 3 different cooperation challenges with the catering service was associated with higher intake of fibre (0.03) and lower odds of eating fruits (p = 0.01).

Conclusions

Written food policies and manager-reported challenges with the catering service were associated with children’s vegetable, fruit and fiber intake at preschool. Factors that are relatively distal from the meal situations may impact children’s food intake at preschool and should be taken into account when promoting healthy food intake at preschool, but more studies are needed.

Key messages

Written food policies and good cooperation between the preschool and catering services may be of benefit to children’s healthy food intake at preschool. The relation between preschool and manager-level factors and children’s food intake are very little studied, and thus more studies are needed before conclusions can be made.

Fruit, Vegetable, and Fibre Intake among Finnish Preschoolers in Relation to Preschool-Level Facilitators and Barriers to Healthy Nutrition

Preschool is a major factor affecting food consumption among young children in Finland, given that most preschoolers eat three meals a day in that setting. Thus, it is important to recognise the determinants of dietary intake at preschool. The aim of this study was to examine food-related factors at the preschool and manager level, and their association with the dietary intake of children in childcare. The study was a part of the cross-sectional DAGIS survey conducted in 2015 to 2016 in Finland. The managers of 58 preschools filled in a questionnaire related to food and nutrition at their preschools. Preschool personnel kept food records for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender, and municipality as covariates, preschool-level factors as independent variables, and children's vegetable (g/day) and fruit (yes vs. no) consumption and fibre intake (g/MJ) as outcome variables. Having many written food policies in the preschool was associated with a higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least two out of three cooperation-related challenges with the catering service was associated with a higher intake of fibre (p = 0.03) and lower odds of eating fruit (p = 0.01). Factors that are relatively distal from meal situations may have an effect, and should be taken into account in the promotion of healthy eating at preschool, but more studies are needed.

Key Messages in an Early Childhood Obesity Prevention Intervention: Are They Recalled and Do They Impact Children's Behaviour?

Knowledge of the impact of health messages as an intervention strategy is sparse. The aim of this study was to explore recall and use of health behaviour messages among mothers, and whether recall is associated with child health behaviours. Intervention group data from the 15 months Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) were used (n = 127, children 4 months at commencement). Mothers recalled (unprompted then prompted) at 2 and 3.5 years post-intervention six key messages used in the program, and reported whether they had used them. Children's food intake was measured by three days of 24-h recall; physical activity by accelerometers; and television viewing by parent report. Unprompted recall ranged between 1-56% across messages and follow-up points, and 37-90% for prompted recall. The most commonly recalled messages "tap into water", "parents provide, kids decide" and "color every meal with fruit and veg" were also most commonly used. There were few associations between recall and children's health behaviours. Given the association between recall and reported use, it is important to plan messages so they resonate well with the target group and its needs. Messages should be used as one of multiple strategies within health promotion programs.

Neighborhood Socioeconomic Status and Feeding Practices in Finnish preschools

Aims: Certain feeding practices, such as role modeling healthy eating and encouragement are recommended to be used in preschools. Little is known about whether preschool characteristics are associated with the use of these feeding practices. Our aim was to examine whether the socioeconomic status (SES) of the preschool neighborhood is associated with the feeding practices in preschools. Methods: This study was part of the cross-sectional DAGIS study. We studied 66 municipal preschools and 378 early childhood educators (ECEs). Preschool neighborhood SES was assessed with map grid data. Feeding practices were assessed by questionnaires and lunchtime observation. Associations between preschool neighborhood SES and feeding practices were tested with logistic regression analyses adjusted for ECEs' educational level and municipal policies on ECEs' lunch prices, and on birthday foods. Results: The crude model showed that in high-SES neighborhood preschools ECEs were more likely to eat the same lunch as the children (OR 2.46, 95% CI 1.42-4.24) and to reward children with other food for eating vegetables (OR 2.48, 95% CI 1.40-4.41). Furthermore, in high-SES preschools it was less likely that birthday foods outside of the normal menu were available on birthdays (OR 0.29, 95% CI 0.12-0.71). In the adjusted model, rewarding with other food remained associated with preschool neighborhood SES (OR 2.13, 95% CI 1.12-4.07). Conclusions: After adjustments, preschool neighborhood SES was mostly unassociated with the feeding practices in preschools. Municipal policies may have a significant impact on feeding practices and ultimately on young children's food intake in Finland where most children attend municipal preschools.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Reproducibility of Preschool Personnel and Guardian Reports on Energy Balance-Related Behaviors and Their Correlates in Finnish Preschool Children

Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a screen time diary, and (c) a food frequency questionnaire (FFQ) reported by a guardian. A sample of guardians having preschool-aged children (N = 69) and preschool personnel (N = 61) completed questionnaires twice within a five-week time interval during April–May 2018 in Finland. Intra-class correlations (ICC), kappas, and percentage agreement were calculated to test the test-retest-reproducibility. The guardian questionnaire for correlates of the children’s EBRBs demonstrated mainly moderate to good reproducibility whereas the preschool personnel questionnaire of preschool correlates for children’s EBRBs was mostly good. The reproducibility of the screen time diary was good and FFQ food items showed mostly moderate reproducibility. The reproducibility of the FFQ foods items for vegetables, fruit, and berries was slightly better for the amount consumed than for the frequency of consumption. To conclude, all the instruments are acceptable for use in future studies.

Increased Health and Wellbeing in Preschools (DAGIS) Study-Differences in Children's Energy Balance-Related Behaviors (EBRBs) and in Long-Term Stress by Parental Educational Level

This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children's energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015⁻2016 in 66 Finnish preschools in eight municipalities involving 864 children (3⁻6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children's EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children's long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children's physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children's EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB.

Like parent, like child? Dietary resemblance in families

BACKGROUND

Studies investigating dietary resemblance between parents and their children have gained mixed results, and the resemblance seems to vary across nutrients, foods, dietary-assessment tools used, and parent-child pairs. We investigated parent-child dietary resemblance using a novel approach in applying statistical analysis, which allowed the comparison of 'whole-diet' between parents and their children. Additionally, we sought to establish whether sociodemographic factors or family meals were associated with dietary resemblance and whether parent-child dietary resemblance was dependent on the parent providing food consumption data on behalf of the child (father or mother, "the respondent").

METHODS

The DAGIS study investigated health behaviors among Finnish preschoolers using a cross-sectional design. One parent filled in a food frequency questionnaire (FFQ) measuring the child's food consumption outside preschool hours during the last week. In addition, we instructed both parents or legal guardians, should the child have two, to fill in a similar FFQ regarding their own food use. Parents also reported their educational level, the number of children living in the same household, and the number of family meals. As a measure of dietary resemblance between a parent and a child, we computed Spearman correlations ranging mostly from no resemblance (0) to complete resemblance (+ 1) between parent-child pairs over the 'whole-diet' (excluding preschool hours). These resemblance measures were further investigated using linear mixed models.

RESULTS

We obtained 665 father-child and 798 mother-child resemblance measures. Mother-child resemblance was on average 0.57 and stronger than father-child resemblance (0.50, p < 0.0001), which was explained by a parent-respondent interaction: the diet of the child resembled more the diet of the parent who provided food consumption data for the child. In univariate models, father- and mother-reported number of family meals were positively associated with father-child and mother-child resemblances. Mother-reported number of family meals was positively associated with mother-child resemblance in a full model.

CONCLUSIONS

The diet of the child seems to resemble more the diet of the parent responsible for the reporting of food consumption. Studies should report who provided the food consumption data for the child and take this into account in analyses, since reporter-bias can influence the results.

The mediating role of the home environment in relation to parental educational level and preschool children's screen time: a cross-sectional study

Background

Previous studies suggest that preschoolers from low socioeconomic backgrounds engage in more screen time. Still, the factors in the social and physical home environment driving these differences in preschool children’s screen time are poorly understood. This study examines potential home environment mediators in the associations between parental educational level and preschoolers’ screen time.

Methods

A total of 864 children aged 3–6 years and their parents participated in a cross-sectional DAGIS study in 2015–2016. Parents recorded their children’s screen time in a diary (N = 823). For the analyses, the daily average screen time at home was calculated. Parental questionnaires (N = 808) assessed educational level and eight social and physical environment factors in the home (i.e., descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, parental attitude toward societal pressures for children’s screen time, access to screens at home, parental self-efficacy for limiting children’s screen time, satisfaction of children’s screen time, and rules for limiting children’s screen time). Parental education was grouped into low, middle, and high education. The associations were tested by conducting mediation analyses adjusted by season and children’s sex and age. The significant mediators in the single-mediator models were included in the final multiple-mediator models.

Results

Of the potential eight mediators, the following four had a significant indirect association: descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, and parental attitude toward societal pressures for children’s screen time. Parents with high education had lower descriptive norm and used fewer screens in front of children compared to parents with middle or low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level. Parents with high education placed greater importance on limiting children’s screen time and felt less societal pressures about children’s screen time compared to parents with low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level.

Conclusions

Our study recognized multiple modifiable mediators in the associations between parental education and preschool children’s screen time. When aiming to diminish socioeconomic status differences in preschool children’s screen time, the focus should be on parental role models, attitudes, and norm related to children’s screen time.