Effectiveness of a community-based multicomponent lifestyle intervention (the ADA programme) to improve the quality of life of French breast cancer survivors: protocol for a pragmatic cluster randomised trial and embedded qualitative study.

INTRODUCTION: Breast cancer survivors (BCSs) are often faced with multiple mental and physical sequelae and are at increased risk of emotional distress, degraded health-related quality of life (HRQoL), chronic pain and fatigue.Physical activity is strongly associated with improved HRQoL and survival rates; however, adherence rates to recommendations for a healthy lifestyle are seldom satisfactory among BCSs. Also, few studies have examined the effectiveness of multicomponent and personalised interventions that integrate physical activity and motivational techniques to improve the HRQoL of BCS. METHOD AND ANALYSIS: "Activité physique adaptée Doublée d'un Accompagnement d'après cancer" (ADA) is an integrated programme of physical activity enriched with a dietary and supportive care approach targeting BCS in the early post-treatment phase. The effectiveness of the ADA intervention will be evaluated using a cluster randomised controlled trial design with two arms (ADA programme vs usual care; 1:1 ratio).The ADA intervention aims to recruit 160 participants and will be implemented by Siel Bleu, a non-profit association specialised in health prevention via adapted physical activity. Measurements will be performed at baseline, 3, 6 and 12 months after the start of the intervention. The primary outcome will be participants' HRQoL, at 12 months measured by the Functional Assessment of Chronic Illness Therapy-Fatigue global score. Secondary outcome will include participants' physical, social, emotional and functional well-being. The effect of the intervention on physical activity level, motivation for physical activity, relation to food and self-efficacy will also be evaluated. ETHICS AND DISSEMINATION: The study was approved by the 'CPP Paris XI' Institutional Review Board on 5 May 2022 (Ref no.: 21.04512.000048-22004). The study's findings will be shared through various channels, including academic publications, simplified reports for wider audiences and active engagement with medical and institutional organisations as well as patients' associations. TRIAL REGISTRATION NUMBER: NCT05658341.

[Anti-fall plan for the elderly in France 2022-2024: objectives and methodology]. / Plan antichute des personnes âgées France 2022-2024 : objectifs et méthodologie1.

BACKGROUND: Falls and fall-related injuries are a major public health problem in industrialized countries. Faced with this challenge, a French national plan was launched in 2022 aiming to reduce by 20% the incidence of falls-related hospitalizations or deaths. OBJECTIVES: To describe the main pillars of the 2022-2024 French national plan against falls in older persons. Methods and assessment: The six pillars of the plan are: 1) screening and monitoring risks of falls and alert health and care workers; 2) home safety assessment and getting out safely; 3) developing technical aids for mobility and the use of assistive technologies at home; 4) appropriate physical activity, best weapon against falls; 5) tele-assistance devices for all older persons; 6) a cross-cutting pillar: Informing, raising awareness, training, and involving local actors. The plan, deployed in the 18 French regions, will provide a unique opportunity to determine the best strategies to achieve the objectives and the barriers encountered. CONCLUSIONS: The deployment of the French national plan will bring useful data for considering a long-term strategy in France and helping countries or regions wishing to implement a fall prevention plan on their territory.

Lifestyle patterns in European preschoolers: Associations with socio-demographic factors and body mass index.

BACKGROUND: Energy balance-related behaviours (EBRBs), that is, dietary intake, screen, outdoor play and sleep, tend to combine into 'lifestyle patterns', with potential synergistic influences on health. To date, studies addressing this theme mainly focused on school children and rarely accounted for sleep, with a cross-country perspective. OBJECTIVES: We aimed at comparing lifestyle patterns among preschool-aged children across Europe, their associations with socio-demographic factors and their links with body mass index (BMI). METHODS: Harmonized data on 2-5-year-olds participating in nine European birth cohorts from the EU Child Cohort Network were used (EBRBs, socio-demographics and anthropometrics). Principal component analysis and multivariable linear and logistic regressions were performed. RESULTS: The most consistent pattern identified across cohorts was defined by at least three of the following EBRBs: discretionary consumption, high screen time, low outdoor play time and low sleep duration. Consistently, children from low-income households and born to mothers with low education level had higher scores on this pattern compared to their socioeconomically advantaged counterparts. Furthermore, it was associated with higher BMI z-scores in the Spanish and Italian cohorts (ß = 0.06, 95% CI = [0.02; 0.10], both studies). CONCLUSION: These findings may be valuable in informing early multi-behavioural interventions aimed at reducing social inequalities in health at a European scale.

[Synthesis in French of the 2022 global recommendations for the management and prevention of falls in the elderly]. / Synthèse en langue française des recommandations mondiales 2022 pour la prise en charge et la prévention des chutes chez les personnes âgées.

BACKGROUND: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. OBJECTIVE: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources. RECOMMENDATIONS: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort.

BACKGROUND: Excessive screen time in infancy and childhood has been associated with consequences on children's development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time. METHODS: In 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers. RESULTS: Overall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]). CONCLUSIONS: Adherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions.

Cardiovascular Health at Age 5 Years: Distribution, Determinants, and Association With Neurodevelopment.

Background: Early childhood may represent an opportune time to commence primordial prevention of cardiovascular disease (CVD, i.e., prevention of risk factors onset), but epidemiological evidence is scarce. We aimed to examine the distribution and parental and early life determinants of ideal cardiovascular health (CVH) in children up to 5 years and to compare the level of cognitive development between children with and without ideal CVH at age 5 years. Methods: Using data from the Etude sur les déterminants pré et post natals précoces du Développement psychomoteur et de la santé de l'Enfant (EDEN) study, a French population-based mother-child cohort study, CVH was examined in children at 5 years of age based on the American Heart Association CVH metrics (ideal body mass index, physical activity, diet, blood pressure, cholesterol and glucose levels, and passive smoking, considered in sensitivity analysis only). Children were categorized as having ideal (five to six ideal metrics) or non-ideal CVH (<5 ideal metrics). Intelligence quotient (IQ) at age 5 years was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence. Results: Among the 566 children (55% boys), only 34% had ideal CVH. In fully adjusted logistic regression, boys compared to girls (OR = 1.77, 95% CI 1.13-2.78), children with intermediate (1.77, 1.05-2.98) or ideal (2.58, 1.38-4.82) behavioral CVH at age 3 years and children who spent < 30 min/day watching television (1.91, 1.09-3.34) at age 3 years were more likely to have ideal CVH at age 5 years. At age 5 years, there was a significant 2.98-point difference (95% CI 0.64-5.32) in IQ between children with and without ideal biological CVH after adjusting for confounders. Conclusion: This study highlights that only a third of children aged 5 years had ideal CVH and identified modifiable determinants of ideal CVH and is suggestive of an association between CVH and neurodevelopment at a young age.

Family-focused contextual factors associated with lifestyle patterns in young children from two mother-offspring cohorts: GUSTO and EDEN.

BACKGROUND: Integrated patterns of energy balance-related behaviours of preschool children in Asia are sparse, with few comparative analyses. PURPOSE: Using cohorts in Singapore (GUSTO) and France (EDEN), we characterized lifestyle patterns of children and investigated their associations with family-focused contextual factors. METHODS: Ten behavioural variables related to child's diet, walking, outdoor play and screen time were ascertained by parental questionnaires at age 5-6 years. Using principal component analysis, sex-specific lifestyle patterns were derived independently for 630 GUSTO and 989 EDEN children. Contextual variables were organised into distal (family socio-economics, demographics), intermediate (parental health, lifestyle habits) and proximal (parent-child interaction factors) levels of influence and analysed with hierarchical linear regression. RESULTS: Three broadly similar lifestyle patterns were identified in both cohorts: "discretionary consumption and high screen time", "fruit, vegetables, and low screen time" and "high outdoor playtime and walking". The latter two patterns showed small differences between cohorts and sexes. The "discretionary consumption and high screen time" pattern was consistently similar in both cohorts; distal associated factors were lower maternal education (EDEN boys), no younger siblings (GUSTO boys) and Malay/Indian ethnicity (GUSTO), while intermediate and proximal associated factors in both cohorts and sexes were poor maternal diets during pregnancy, parents allowing high child control over food intake, snacking between meals and having television on while eating. CONCLUSIONS: Three similar lifestyle patterns were observed among preschool children in Singapore and France. There were more common associated proximal factors than distal ones. Cohort specific family-focused contextual factors likely reflect differences in social and cultural settings. Findings will aid development of strategies to improve child health.

Prospective associations between dietary patterns, screen and outdoor play times at 2 years and age at adiposity rebound: The EDEN mother-child cohort.

Although an early adiposity rebound (AR) is an established risk factor for later obesity, little is known regarding its determinants, especially modifiable ones. Using data from the French EDEN mother-child cohort (1903 children born in 2003-2006), we aimed to examine the association between diet and activity-related behaviors at 2 years of age and the timing of the AR. Two-year-old children (n = 1138) with parent-reported data on their foods/drinks intake, TV/DVD watching time, outdoor playtime, and with an estimated (via growth modelling) age at AR were included in the present study. Two dietary patterns, labelled 'Nutrient-dense foods' and 'Processed and fast foods', were identified in a previous study. Multivariable linear and logistic regression models were used to assess the association between dietary patterns and activity-related behaviors and, respectively, the age at AR (continuous) and the likelihood of having a very early AR (before 3.6 years for girls and 3.8 years for boys, i.e., below the 10th percentile of sex-specific distribution). A higher score on the 'Processed and fast foods' dietary pattern was associated with a higher likelihood of having a very early AR (OR = 1.23; 95% CI: 1.00 to 1.50). No significant association was observed between the 'Nutrient-dense foods' dietary pattern, TV/DVD watching and outdoor playing times and the timing of the AR. This finding emphasizes the importance of reducing nutrient-dense and processed foods from the early years of life, and provides further support for early interventions aimed at helping parents establish healthy eating habits for their growing child from the complementary period.

Family Socioecological Correlates of Lifestyle Patterns in Early Childhood: A Cross-Sectional Study from the EDEN Mother-Child Cohort.

Energy balance-related behaviors (EBRBs), i.e., diet, sedentary behavior, physical activity, and sleep, combine into lifestyle patterns, which we aim to identify in French preschoolers and analyze their family correlates within the framework of a comprehensive socioecological model. Parental questionnaires provided information about family characteristics and children's EBRBs for 978 5-year-olds of the EDEN cohort. We used principal component analysis to derive lifestyle patterns from EBRBs and hierarchical multivariable linear regressions to assess their associations with family socio-demographics, parent health/behaviors, and parent-child interactions. Analyses were stratified by sex. Of the three lifestyle patterns identified (unhealthy, healthy, and mixed), the mixed pattern differed the most between sexes. Lower parental education, suboptimal maternal diet, TV during meals, and later bedtime were associated with higher adherence to unhealthy patterns. Children cognitively stimulated at home and boys of mothers not employed adhered more to the healthy pattern. Older siblings (for girls) and higher engagement of parents in leisure-time physical activity (for boys) were related to greater adherence to mixed patterns. The identification of various correlates from multiple socioecological levels suggests that tackling the potentially synergistic effect of lifestyle patterns on health requires addressing processes relevant to the parent-child dimension and structural barriers parents may encounter.

Clusters of diet, physical activity, television exposure and sleep habits and their association with adiposity in preschool children: the EDEN mother-child cohort.

BACKGROUND: Despite the growing interest in the relation between adiposity in children and different lifestyle clusters, few studies used a longitudinal design to examine a large range of behaviors in various contexts, in particular eating- and sleep-related routines, and few studies have examined these factors in young children. The objectives of this study were to identify clusters of boys and girls based on diet, sleep and activity-related behaviors and their family environment at 2 and 5 years of age, and to assess whether the clusters identified varied across maternal education levels and were associated with body fat at age 5. METHODS: At 2 and 5 years, respectively, 1436 and 1195 parents from the EDEN mother-child cohort completed a questionnaire including behavioral data. A latent class analysis aimed to uncover gender-specific behavioral clusters. Body fat percentage was estimated by anthropometric and bioelectrical impedance measurements. Association between cluster membership and body fat was assessed with mutivariable linear regression models. RESULTS: At 2 years, two clusters emerged that were essentially characterized by opposite eating habits. At 5 years, TV exposure was the most distinguishing feature, but the numbers and types of clusters differed by gender. An association between cluster membership and body fat was found only in girls at 5 years of age, with girls in the cluster defined by very high TV exposure and unfavorable mealtime habits (despite high outdoor playing and walking time) having the highest body fat. Girls whose mother had low educational attainment were more likely to be in this high-risk cluster. Girls who were on a cluster evolution path corresponding to the highest TV viewing time and the least favorable mealtime habits from 2 to 5 years of age had higher body fat at 5 years. CONCLUSIONS: Efforts to decrease TV time and improve mealtime routines may hold promise for preventing overweight in young children, especially girls growing up in disadvantaged families. These preventive efforts should start as early in life as possible, ideally before the age of two, and should be sustained over the preschool years.

Domain-specific physical activity and sedentary behavior during pregnancy and postpartum depression risk in the French EDEN and ELFE cohorts.

The potential beneficial effects of physical activity during pregnancy on postpartum depressive symptoms (PPD) remain inconclusive. Using data from two prospective French birth cohorts, we aimed to examine the relationship between domain-specific physical activity (including leisure-time sedentary behavior) in pregnancy and the occurrence of PPD. Participants of the ELFE cohort (n = 15,538) completed the Pregnancy Physical Activity Questionnaire (PPAQ), which assesses the following physical activity/sedentary behavior domains: household/caregiving, occupational, sports/exercise, transportation and leisure-time sedentary behavior during the third pregnancy trimester. In the EDEN cohort (n = 1745) women completed the Baecke Questionnaire (BQ) measuring occupational, sports/exercise, and leisure-time activity during the first trimester of pregnancy. Depressive symptoms in the first postpartum year were measured using the Edinburgh Postnatal Depression Scale in both cohorts. Associations of physical activity/sedentary behavior with PPD symptoms were determined by logistic regression analysis, with adjustment on potential confounding factors. In the adjusted models, higher levels of household/caregiving activities (OR = 1.10 (95% CI 1.01-1.19)) and leisure-time sedentary behavior (OR = 1.16 (95% CI 1.06-1.23)), in the third pregnancy trimester were associated with an increased odds of PPD. No significant associations were found for physical activity domains during the first pregnancy trimester. Higher levels of household and caregiving activities and leisure-time sedentary behavior in the last trimester of pregnancy appear to increase the likelihood of postpartum depression. Purpose and context should be taken into account when encouraging physical activity as a strategy to help prevent postpartum mental health problems from pregnancy onwards. Reducing sedentary behavior could be a complementary strategy.

Cord-blood vitamin D level and night sleep duration in preschoolers in the EDEN mother-child birth cohort.

OBJECTIVE: Deficiency in 25-hydroxyvitamin D (25OHD) has been associated with sleep disorders in adults. Only three cross-sectional studies were performed in children; which showed an association between 25OHD deficiency and both obstructive sleep apnea syndrome and primary snoring. No longitudinal study has been performed in children from the general population. We analyzed the association between cord-blood vitamin D levels at birth and night-sleep duration trajectories for children between 2 and 5-6 years old in a non-clinical cohort. METHOD: We included 264 children from the French EDEN mother-child birth-cohort with cord-blood 25OHD level determined by radio-immunoassay at birth, and night-sleep trajectories for children between 2 and 5-6 years old obtained by the group-based trajectory modeling method. Associations between 25OHD and sleep trajectories were assessed by multinomial logistic regression adjusted for maternal and child characteristics. RESULTS: The trajectories short sleep (<10h30/night), medium-low sleep (10h30-11h00/night), medium-high sleep (≈11h30/night), long sleep (≥11h30/night) and changing sleep (decreased from ≥11h30 to 10h30-11h00/night) represented 5%, 46%, 37%, 4% and 8% of the children, respectively. The mean 25OHD level was 19 ng/ml (SD = 11, range 3-63). It was 12 (SD = 7), 20 (SD = 11), 19 (SD = 10), 14 (SD = 7) and 16 (SD = 8) ng/ml for children with short, medium-low, medium-high, long and changing sleep trajectories, respectively. On adjusted analysis, for each 1-ng/ml decrease in 25OHD level, the odds of belonging to the short sleep versus medium-high sleep trajectory was increased (odds ratio = 1.12, 95% confidence interval [1.01-1.25]). We found no other significant association between 25OHD level and other trajectories. CONCLUSION: A low 25OHD level at birth may be associated with an increased probability of being a persistent short sleeper in preschool years. These results need confirmation.

Changes in children's television and computer time according to parental education, parental income and ethnicity: A 6-year longitudinal EYHS study.

OBJECTIVES: To investigate changes in children's television and computer time according to three socio-economic status (SES) indicators. DESIGN: Prospective cohort study. METHODS: Data were drawn from the European Youth Heart Study and included longitudinal data collected in 1997 and 2003 in Denmark. Television and computer time were self-reported by children. Parental education, income and ethnicity were parent-reported. Baseline data were available for 549 children (47.0% boys, 9.6 years). Generalized linear mixed models analyzed whether changes in television and computer time from baseline to follow-up differed according to the SES-indicators. RESULT: TV viewing time increased with 25% over time (ExpB = 1.25, 95% CI = 1.04-1.50). At both time points, children with two higher educated parents viewed 25% less hours of television than children with no higher educated parents (ExpB = 0.75, 95% CI = 0.60-0.94) and one higher educated parent (ExpB = 0.75, 95%CI = 0.59-0.97). Among children with no higher educated parents the odds of being in a higher category of computer time increased with 80% over time (OR = 1.80, 95% CI = 1.24-2.60). Among children with two higher educated parents the odds of being in a higher category of computer time decreased with 45% over time (OR = 0.55, 95% CI = 0.32-0.94). The association with ethnicity showed that white children had 42% lower odds (OR = 0.58; 95% CI = 0.34-1.00) of being in a higher category of computer time than non-white children. No significant associations were found for parental income. CONCLUSIONS: The most important SES measure of screen-based behaviors in children was parental education. Ethnicity was only associated with computer time. Financial resources were less relevant for changes in television viewing and computer use.

Data on Determinants Are Needed to Curb the Sedentary Epidemic in Europe. Lessons Learnt from the DEDIPAC European Knowledge Hub.

Societal and technological changes have resulted in sitting being the dominant posture during most activities of daily living, such as learning, working, travelling and leisure time. Too much time spent in seated activities, referred to as sedentary behaviour, is a novel concern for public health as it is one of the key lifestyle causes of poor health. The European DEDIPAC (Determinants of Diet and Physical Activity) Knowledge Hub coordinated the work of 35 institutions across 12 European member states to investigate the determinants of sedentary behaviour. DEDIPAC reviewed current evidence, set a theoretical framework and harmonised the available epidemiological data. The main results are summarised. The conclusion is that there is a dire lack of data that is exploitable across Europe to inform policy and intervention. There is an urgent need to develop international data collection compliant with FAIR (Findable, Accessible, Interoperable, Re-usable) and standardised surveillance systems for sedentary behaviour.

A systematic review of determinants of sedentary behaviour in youth: a DEDIPAC-study.

Sedentary behaviour (SB) has emerged as a potential risk factor for metabolic health in youth. Knowledge on the determinants of SB in youth is necessary to inform future intervention development to reduce SB. A systematic review was conducted to identify predictors and determinants of SB in youth. Pubmed, Embase, CINAHL, PsycINFO and Web of Science were searched, limiting to articles in English, published between January 2000 and May 2014. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour, (b) determinants, (c) types of sedentary behaviours, (d) types of determinants. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Cross-sectional studies were excluded. The analysis was guided by the socio-ecological model. 37 studies were selected out of 2654 identified papers from the systematic literature search. Most studies were conducted in Europe (n = 13), USA (n = 11), and Australia (n = 10). The study quality, using the Qualsyst tool, was high with a median of 82% (IQR: 74-91%). Multiple potential determinants were studied in only one or two studies. Determinants were found at the individual, interpersonal, environmental and policy level but few studies examined a comprehensive set of factors at different levels of influences. Evidence was found for age being positively associated with total SB, and weight status and baseline assessment of screen time being positively associated with screen time (at follow-up). A higher playground density and a higher availability of play and sports equipment at school were consistently related to an increased total SB, although these consistent findings come from single studies. Evidence was also reported for the presence of safe places to cross roads and lengthening morning and lunch breaks being associated with less total SB. Future interventions to decrease SB levels should especially target children with overweight or obesity and should start at a young age. However, since the relationship of many determinants with SB remains inconsistent, there is still a need for more longitudinal research on determinants of SB in youth.

The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults.

STUDY QUESTION: Are fall prevention exercise interventions for older people living in the community effective in preventing different types of fall related injuries? SUMMARY ANSWER: Exercise programmes designed to prevent falls in older adults seem also to prevent injuries caused by falls, including the most severe injuries. Such programmes also reduce the rate of falls leading to medical care.

Multidimensionality of the relationship between social status and dietary patterns in early childhood: longitudinal results from the French EDEN mother-child cohort.

BACKGROUND: The association between socioeconomic position and diet in early childhood has mainly been addressed based on maternal education and household income. We aimed to assess the influence of a variety of social factors from different socio-ecological levels (parents, household and child-care) on multi-time point dietary patterns identified from 2 to 5 y. METHOD: This study included 974 children from the French EDEN mother-child cohort. Two multi-time point dietary patterns were derived in a previous study: they correspond to consistent exposures to either core- or non-core foods across 2, 3 and 5 y and were labelled "Guidelines" and "Processed, fast-foods". The associations of various social factors collected during pregnancy (age, education level) or at 2-y follow-up (mother's single status, occupation, work commitments, household financial disadvantage, presence of older siblings and child-care arrangements) with each of the two dietary patterns, were assessed by multivariable linear regression analysis. RESULTS: The adherence to a diet close to "Guidelines" was positively and independently associated with both maternal and paternal education levels. The adherence to a diet consistently composed of processed and fast-foods was essentially linked with maternal variables (younger age and lower education level), household financial disadvantage, the presence of older sibling (s) and being cared for at home by someone other than the mother. CONCLUSIONS: Multiple social factors operating at different levels (parents, household, and child-care) were found to be associated with the diet of young children. Different independent predictors were found for each of the two longitudinal dietary patterns, suggesting distinct pathways of influence. Our findings further suggest that interventions promoting healthier dietary choices for young children should involve both parents and take into account not only household financial disadvantage but also maternal age, family size and options for child-care.

Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial.

OBJECTIVE: To assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community. DESIGN: Pragmatic multicentre, two arm, parallel group, randomised controlled trial. SETTING: 20 study sites in 16 medium to large cities throughout France. PARTICIPANTS: 706 women aged 75-85, living in their own home, and with diminished balance and gait capacities, randomly allocated to the experimental intervention group (exercise programme, n=352) or the control group (no intervention, n=354). INTERVENTION: Weekly supervised group sessions of progressive balance training offered in community based premises for two years, supplemented by individually prescribed home exercises. OUTCOME MEASURES: A geriatrician blinded to group assignment classified falls into one of three categories (no consequence, moderate, severe) based on physical damage and medical care. The primary outcome was the rate of injurious falls (moderate and severe). The two groups were compared for rates of injurious falls with a "shared frailty" model. Other outcomes included the rates of all falls, physical functional capacities (balance and motor function test results), fear of falling (FES-I), physical activity level, and perceived health related quality of life (SF-36). Analysis was by intention to treat. RESULTS: There were 305 injurious falls in the intervention group and 397 in the control group (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). The difference in severe injuries (68 in intervention group v 87 in control group) was of the same order of magnitude (0.83, 0.60 to 1.16). At two years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. Among women who started the intervention (n=294), the median number of group sessions attended was 53 (interquartile range 16-71). Five injurious falls related to the intervention were recorded. CONCLUSION: A two year progressive balance retraining programme combining weekly group and individual sessions was effective in reducing injurious falls and in improving measured and perceived physical function in women aged 75-85 at risk of falling.Trial registration ClinicalTrials.gov (NCT00545350).