Longitudinal trends in physical activity levels and lifetime cardiovascular disease risk: insights from the ATTICA cohort study (2002-2022).

Objective: To evaluate trends in physical activity levels and their associations with demographic characteristics, health status, and lifetime cardiovascular disease (CVD) risk. Methods: A longitudinal analysis was conducted using data from 987 males and 1,001 females (45 ± 12 years old) participating in the ATTICA cohort study. Physical activity levels were assessed at baseline (2001-2002) and subsequent follow-ups (2006, 2012, and 2022). Four physical activity trajectories according to participants' physical activity tracking were defined, i.e., consistently active/inactive and changed from active/inactive. Twenty-year incidence of hypertension, hypercholesterolemia, and diabetes were evaluated in relation to physical activity trajectories; the life-table method was utilized to forecast the lifetime CVD risk (death without CVD was regarded as a competing event). Results: in total, 47% of the participants were categorized as being consistently inactive, whereas only 9% of males and 15% of females sustained physical activity levels throughout the 20-year follow-up period (p < 0.001). Participants being consistently inactive were from lower socioeconomic backgrounds (p = 0.002). Transitioning to being physically active was associated with higher education level and being married (p < 0.001). Consistently active individuals had up to 35% reduced lifetime CVD risk, and lower 20-year incidence of hypertension, and hypercholesterolemia (p < 0.01); no association was observed regarding diabetes incidence. Conclusions: Promoting and maintaining regular physical activity throughout lifespan is crucial for reducing lifetime CVD risk and related risk factors. Tailored interventions addressing demographic and socioeconomic factors may help enhance cardiovascular health outcomes.

Dietary Intake, Body Composition, and Nutritional Knowledge of Elite Handball Players.

Nutrition affects both body composition and, consequently, athletic performance. Only a few studies have assessed the nutritional behavior and knowledge of elite players. The present study aimed to assess the dietary intake, body composition, and nutritional knowledge of elite handball players. Thirty-nine handball players (age: 23.2 ± 2.7 years, weight: 88.2 ± 10.1 kg, height: 1.87 ± 0.07 m, and years of training: 13 ± 2) participated in the study. The athletes completed a set of anthropometric measurements, a 24 h food recall, and a translated edition of Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ). The average body fat percentage was 16.7 ± 3.8%, while the average fat free mass was 73.9 ± 8.5 kg. The athletes' average daily energy intake was 2606.6 ± 756 kcal, while the average daily intake for carbohydrates, proteins, and fats was 243.85 ± 107.79 g [2.8 ± 1.3 g/kg BW/d-37.2 ± 10.5% of Total Energy Intake (TEI)], 131.59 ± 53.28 g (1.51 ± 0.7 g/kg BW/d-20.3 ± 6.9% of TEI), and 117.65 ± 40.52 g (40.9 ± 9.9% of TEI), respectively. For iron, calcium, and vitamin D, the average daily intakes were 19.33 ± 10.22 mg, 1287.7 ± 676.42 mg, and 3.22 ± 3.57 mcg respectively. The average success rate on the A-NSKQ was only 38.5 ± 10.7% out of 100. Elite handball players exhibit inadequate dietary intake and sports nutrition knowledge. Nutritional education should be a primary concern towards the amelioration of their athletic performance.

Dietary habits among 177,091 Greek schoolchildren by age, sex, weight status, region, and living area. A cross-sectional study.

BACKGROUND: This study aimed to investigate the dietary habits from early childhood to adolescence among participants from all regions of the country and living areas (rural/urban) and assess potential associations between dietary habits and obesity in both sexes. METHODS: Population data were derived from a cross-sectional health survey on a representative sample of 177,091 children aged 6-18 years. Dietary habits were considered via a self-completed questionnaire (Mediterranean diet quality index for children and adolescents [KIDMED]). Trained investigators assessed the anthropometric data. RESULTS: KIDMED scores were 6.7 ± 2.4 and 6.8 ± 2.3 for boys and girls, respectively, whereas a percentage of almost 10% of the total study population had insufficient dietary habits. Dietary habits peaked around age 11 years and then gradually worsened until the end of adolescence in both sexes, with an annual trend equal to -0.28 ± 0.02 (p < 0.001) for boys and -0.31 ± 0.03 (p < 0.001) for girls. Schoolchildren who are overweight/obese presented higher percentages in all unhealthy dietary habits (e.g., skipping breakfast, going often to a fast food restaurant, and consuming a lot of sweets) than children with a normal weight (all p-values < 0.001). Dietary habits did not noteworthy differ by area of living, that is, urban versus rural, of participants in both sexes. In addition, no noticeable differences in the values of the KIDMED index were found among all regions of Greece, with the highest values in Attica and Crete in both sexes. CONCLUSIONS: Because Greek schoolchildren do not fully adopt the traditional cardio-protective Mediterranean diet, it could be helpful to provide certain recommendations, especially for adolescents, to decrease the risk for future adverse health consequences.

European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network.

OBJECTIVES: (1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. METHODS: This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. RESULTS: A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu). CONCLUSION: This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.

Recommended dairy intake is associated with healthy dietary habits, better physical fitness, less obesity and a healthier lifestyle profile in school age children.

This study aimed to identify the association of recommended dairy intake with several dietary habits, obesity, physical fitness (PF), physical activity (PA), screen time and sleep. Population data were derived from a health survey on a representative sample of 177 091 children aged 8-17 years. Dairy intake and dietary habits were evaluated using questionnaires (KIDMED index). Participants were characterised as 'dairy products consumers' based on whether they met current recommendations for milk or dairy consumption (e.g. if they consumed two yogurts and/or 40 g cheese and a cup of milk daily). Participants who did not consume the above-mentioned quantities were characterised as 'non-consumers.' Anthropometric and PF data were obtained by trained investigators. PA status, screen time and sleeping habits were assessed through self-completed questionnaires. Boys and girls consuming recommended dairy products were 25 % (95 % CI: 0·71, 0·79) and 43 % (95 % CI: 0·51, 0·64) less likely to have low performances in cardiorespiratory fitness tests, Participants from both sexes classified as dairy products consumers had lower odds of central obesity by 10 % (95 % CI: 0·86, 0·95), as compared with non-consumers. Moreover, recommended dairy products consumers had lower odds for insufficient sleep by 8 % (95 % CI: 0·89, 0·96) in boys and 14 % (95 % CI: 0·83-0·90) in girls, for inadequate PA levels by 15 % (95 % CI: 0·77, 0·93) in boys and 16 % (95 % CI: 0·76, 0·90) in girls and for increased screen time by 11 % (95 % CI: 0·83, 0·95) in boys and 9 % (95 % CI: 0·85, 0·97) in girls than no-consumers. In conclusion, recommended dairy intake is associated with less obesity, better PF and a healthier lifestyle profile.

Birth Weight was Favorably Associated With Physical Fitness in Childhood After Adjustment for Several Perinatal Factors.

BACKGROUND: The purpose was to examine the potential associations of birth weight and infant growth with physical fitness (PF) components in childhood. METHOD: A random sample of 5125 dyads of children aged 8-9 years and their mothers were evaluated. Telephone interviews were carried out with the use of a standardized questionnaire for the collection of maternal lifestyle factors. Mothers were asked to provide information contained in their medical booklets and pregnancy ultrasound records. Data from 5 PF tests were used to assess cardiorespiratory fitness, speed, and body strength. Linear regression analysis was applied to assess the associations between birth weight and infant growth with PF test performances and logistic regression analysis to evaluate the associations of normal weight versus low birth weight and normal versus accelerated infant growth with PF tests performance categories (low vs high/average). RESULTS: Birth weight was favorably associated with cardiorespiratory fitness (b = 0.12 stage increase per SD increase in birth weight, P = .047), lower body strength (b = 1.07, P = .037), upper body strength (b = 0.10, P = .038), and speed (b = -0.04, P = .001), and infant growth was associated with upper body strength (b = 0.21 cm increase per SD increase in infant weight gain, P < .001) after adjusting for children's body mass index and several perinatal factors. Low birth weight children had 35% increased odds for low performances in PF tests compared with their normal birth weight counterparts. CONCLUSION: Low birth weight negatively affects childhood PF, and hence, it could play an unfavorable role in the future health of the offspring.

Students Living in the Islands are Heavier and have Lower Fitness Levels Compared to their Mainland Counterparts; Results from the National Action for Children's Health (EYZHN) Program.

Few studies have examined variations in obesity by geographic location in youth and its relation with fitness levels. The present study investigated the association between geographic status (islands versus mainland), excess of body weight and fitness levels among 335.810 schoolchildren (male: 51.3%, 6-18 y, during the school year 2014-2015). Students' anthropometric parameters and fitness levels - accessed via the Euro-fit test - were measured by trained physical education teachers and evaluated according to published norms. Prevalence of overweight (23.0 Vs 21.8%) and obese (10.1 Vs 8.0%) was significantly higher for students living in the islands contrary to their mainland counterparts. A significant difference was also observed for centrally obese children (33.5 Vs 28.2%). Except for speed test .408), in all other four fitness tests, the students from the islands presented significantly lower performance (≤25th percentile of published age- and sex-specific normative values) versus their mainland counterparts. Boys and girls living in the islands had 48% and 37% increased odds of low physical fitness (as a total), respectively, compared to their mainland counterparts. Likewise, children living in islands presented increased odds of being overweight or obese by 19% and 15% in boys and girls, respectively, as compared to those living in the mainland. Increased general and abdominal adiposity have a direct negative impact on students' performance in Physical Fitness tests. Our data highlight the problem of excessive body weight that children living in rural areas, face.

Screen time and its effect on dietary habits and lifestyle among schoolchildren.

OBJECTIVE: The aim of the study was to determine the associations between recreational screen time and dietary habits and lifestyle factors in a representative sample of schoolchildren. METHODS: Observational, cross-sectional study data were derived from 177,091 children aged 8 to 17 years participating in a health survey. Recreational screen time, physical activity (PA), and sleeping hours were assessed through self-completed questionnaires. Dietary habits were evaluated via the Mediterranean Diet Quality Index for children and adolescents (KIDMED) test. Anthropometric and physical fitness (PF) estimations were obtained by trained investigators. RESULTS: Binary logistic regression comparisons between screen time levels (e.g. < 2 vs. ≥ 2 - < 3 h/d, < 2 vs. ≥ 3 - < 4 h/d and < 2 vs. ≥ 4 h/d) and dietary habits showed that the longer the screen time the increased the odds of unhealthy dietary habits such as skipping breakfast, consuming fast food frequently, and eating sweets frequently, and the decreased the odds of healthy dietary habits such as consuming a second fruit every day, consuming fresh or cooked vegetables or/and fish regularly, in both genders, after adjusting for several covariates. Furthermore, the longer the screen time the increased the odds of total and central obesity, insufficient sleep (< 8-9 h/d), and inadequate PA, and the decreased the odds of healthy PF. CONCLUSIONS: The longer the screen time the unhealthier dietary habits and lifestyle profile among schoolchildren, after adjusting for several covariates.

Associations of Maternal Prepregnancy Body Mass Index and Gestational Weight Gain With Physical Fitness in Childhood.

PURPOSE: To investigate the potential associations of maternal prepregnancy body mass index (mppBMI) and gestational weight gain (GWG) with physical fitness in children. METHODS: A random sample of 5125 children and their mothers was evaluated. The mothers provided data contained in their medical booklets and pregnancy ultrasound records. The data from 5 physical fitness tests (eg, 20-m shuttle run, 30-m sprint, vertical jump, standing long jump, and small ball throw) were used to assess children's cardiorespiratory fitness, speed, explosive power, and lower and upper body strength, respectively. RESULTS: MppBMI was inversely associated with cardiorespiratory fitness (b = -0.02), lower body strength (b = -1.01), upper body strength (b = -0.07), and speed (b = 0.04). Also, GWG was unfavorably associated with cardiorespiratory fitness (b = -0.02), lower body strength (b = -1.12), upper body strength (b = -0.03), and speed (b = 0.03), after adjusting for sex, birth weight, and children's BMI (all P values < .05). Children of mothers with an mppBMI ≥ 25 kg/m2 and excess GWG had almost 30% and 20% increased odds for low performances in physical fitness tests than those of mothers with an mppBMI < 25 kg/m2 and adequate GWG, respectively. CONCLUSIONS: Antenatal factors such as increased mppBMI and excess GWG could play an unfavorable role in the future health of the offspring.

Exclusive olive oil consumption was favorably associated with metabolic indices and lifestyle factors in schoolchildren.

BACKGROUND AND AIM: Olive oil consumption has been suggested to favorably impact children's health. The present study aimed to identify possible associations between exclusive olive oil consumption and metabolic indices and lifestyle factors. METHODS AND RESULTS: Cross-sectional, observational study. Population data derived from a health survey on a sample of 177 091 children aged 8-17 years. Olive oil consumption and dietary habits were evaluated using questionnaires (KIDMED index). Anthropometric and physical fitness measurements were obtained by trained investigators. Physical activity (PA) status, screen time and sleeping habits were assessed through self-completed questionnaires. Exclusive olive oil consumption decreased the odds of obesity and increased the odds of healthy cardiorespiratory fitness (CRF) by 15% (95% confidence interval (CI): 0.75-0.95) and 13% (95% CI: 1.04-1.22), respectively, after adjusting for several covariates. Moreover, exclusive olive oil consumption was associated with increased odds of having sufficient dietary habits (average/optimal adherence to the Mediterranean Diet) by almost four times (95% CI: 3.65-4.45) and decreased odds of insufficient sleep (<8-9 h/d) and increased screen time (>2 h/d) by 20% (95% CI: 0.73-0.87) and 40% (95% CI: 0.48-0.72), respectively. CONCLUSIONS: Exclusive olive oil consumption was associated with metabolic indices such as obesity and CRF and a healthy lifestyle profile. The exclusive consumption of olive oil as part of a balanced MD does seem to provide favorable health benefits and should be further promoted.

High and moderate adherence to Mediterranean lifestyle is inversely associated with overweight, general and abdominal obesity in children and adolescents: The MediLIFE-index.

Several lifestyle factors, such as diet and exercise, have been linked to pediatric obesity. However, relatively few studies have considered them simultaneously, as a pattern. To investigate the associations between students' lifestyle and overweight, general, and abdominal obesity, an a priori Mediterranean lifestyle index (ie, MediLIFE-index) was created. We hypothesized that students' characteristics and their probability to be overweight or obese would be lower towards a better adherence to a Mediterranean lifestyle pattern. This study included 174 209 students aged 6 to 18 years from all geographical regions of Greece who participated in the 2014-2015 EYZHN study. The total range of MediLIFE-index was 0-8 (higher values indicating greater adherence to the Mediterranean lifestyle). Index values were thereafter divided into three groups according to its tertiles (a) 'non-adherent'; (b) 'moderately adherent'; and (c) "highly adherent" to the Mediterranean lifestyle. The mean ±â€¯standard deviation of the MediLIFE-index was 5.1 ±â€¯1.6. Students with higher scores had lower BMI and waist circumference (all P < .001). Those who were "highly adherent" compared to those who were "non-adherent" were associated with lower likelihood of being overweight, obese or abdominal obese, by 6% (OR 0.94, 95% CI 0.92, 0.98), 30% (OR 0.70, 95% CI 0.67, 0.75) and 20% (OR 0.80, 95% CI 0.77, 0.83), respectively. The optimal discriminating value of the index for overweight was 4.5 (78% sensitivity and 80% specificity), while for obese/abdominal obese was 3.5 (82% sensitivity and 85% specificity). A useful tool was developed in order to identify children and adolescents with increased odds of being overweight, obese, or abdominal obese based on their lifestyle.

Concomitant Associations between Lifestyle Characteristics and Physical Activity Status in Children and Adolescents.

BACKGROUND: To examine the concomitant associations between physical activities (PA) and lifestyle factors in a representative sample of children and adolescents. STUDY DESIGN: Cross-sectional, observational study. METHODS: Population data were derived from a school-based health survey carried out in 2015 on 177,091 (51% boys) Greek children aged 8 to 17 yr old. PA, sedentary activities and sleeping habits were assessed through self-completed questionnaires. Dietary habits were evaluated using the Mediterranean Diet Quality Index for children and adolescents. Anthropometric and physical fitness measurements were obtained by trained investigators. Logistic regression models were estimated and adjusted for relevant covariates. RESULTS: More boys as compared to girls (65.1% vs. 50.7%, P<0.001) and children than adolescents (59.8% vs. 52.8%, P<0.001) met the recommendations for PA. Frequent fast food consumption and skipping breakfast were associated with inadequate PA levels. In the whole population, sufficient dietary habits, sufficient (>8-9 h/d) sleeping and accepted screen time increased the participant's odds of adequate PA levels by 38% (95% CI: 1.32, 1.44), 5% (95% CI: 1.01, 1.09) and 21% (95% CI: 1.16, 1.26), respectively, while, overweight/obese and central obesity decreased the odds of adequate PA levels by 7% and 5%, respectively, after adjusting for several covariates. Participants with combination of healthy aerobic fitness/dietary habits/screen time had 60% increased odds for adequate PA levels than those with unhealthy choices. CONCLUSION: Healthy aerobic fitness, dietary habits and screen time were strongly associated with PA status among children. The results support the development of interventions to help children adopt a healthy lifestyle.

Exclusive Breastfeeding Is Favorably Associated with Physical Fitness in Children.

Objective: To examine the potential association between exclusive breastfeeding and its duration on physical fitness (PF) components during childhood. Materials and Methods: A random sample of 5,125 dyads children and their mothers was evaluated. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of maternal lifestyle factors (e.g., breastfeeding and its duration, etc.). Data from five PF tests (e.g., vertical jump, standing long jump, small ball throw, 30-m sprint, and 20-m shuttle run) were used to assess lower and upper body strength, speed, and cardiorespiratory fitness (CRF). Linear and logistic regression models were estimated and adjusted for children's body mass index (BMI) and birth weight, and parental factors (prepregnancy BMI, gestational weight gain, gestational age, pregnancy in vitro, parity before, and educational level). Results: Among boys, exclusive breastfeeding was favorably associated with CRF (b = 0.07), lower body strength (b = 0.41), upper body strength (b = 0.10), and speed (b = -0.11). Also, among girls, we found a favorable association between exclusive breastfeeding and CRF (b = 0.07), lower body strength (b = 0.47), upper body strength (b = 0.10), and speed (b = -0.11). All of the associations remained significant after adjusting for several potential confounders. With the exception of speed test in girls, children who were exclusively breastfed ≥6 months had 10-40% increased odds for average/high performances in PF tests in comparison with those who were breastfed <1 month. Conclusions: Exclusive breastfeeding ≥6 months had a favorable influence on PF test performances in childhood. It seems that exclusive breastfeeding could play a significant role in children's future health.

Breakfast skipping in Greek schoolchildren connected to an unhealthy lifestyle profile. Results from the National Action for Children's Health program.

AIM: The aim of the present study was to examine prevalence and correlates of skipping breakfast in a representative sample of children and adolescents. METHODS: Cross-sectional, observational study. Population data derived from a school-based health survey carried out in 2015 on 177 091 Greek children aged 8-17 years. Trained investigators performed all anthropometric evaluations. Breakfast skipping and adherence to the Mediterranean diet (MD) was assessed through the Mediterranean Diet Quality Index for children and adolescents. Physical activity status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. RESULTS: Almost one in four (22.4% of boys, 23.1% of girls) schoolchildren skipped breakfast. Participants' characteristics associated with skipping breakfast were being female, being older, being overweight/obese, poorer diet, inadequate physical activity levels, insufficient sleep and increased screen time. Regression models adjusted for several potential confounders demonstrated that poor dietary habits, insufficient sleeping status (<8-9 hours per day), and increased screen time (>2 hours per day), increased the odds for skipping breakfast by almost 80% (95% CI: 1.78-1.82), 23% (95% CI: 1.20-1.26) and 22.5% (95% CI: 1.19-1.26), respectively. CONCLUSIONS: Skipping breakfast was common among schoolchildren. Participants who skipped breakfast tended to have an unhealthy lifestyle profile. Policies designed to increase breakfast consumption should target schoolchildren with unhealthy lifestyle profiles.

Association of cardiorespiratory fitness levels with dietary habits and lifestyle factors in schoolchildren.

This study examined the association between cardiorespiratory fitness (CRF) levels and lifestyle factors in a representative sample of Greek schoolchildren. In 2015, a health survey was carried out in 177 091 participants 8-17 years of age. Dietary habits, sleeping hours, physical activity (PA), and sedentary activities were assessed through self-completed questionnaires. CRF was evaluated with a 20-m shuttle run test. Insufficient dietary habits were greater in boys and girls classified as having low CRF than in their peers with healthy CRF. Skipping breakfast (odds ratio (OR), 0.82; 95% confidence interval (CI) 0.79-0.85), fast food consumption (OR, 0.70; 95% CI 0.68-0.72), and regular sweet intake (OR, 0.79; 95% CI 0.76-0.82) decreased the odds of having a healthy CRF level. An increase in age by 1 year (OR, 0.71; 95% CI, 0.70-0.72), overweight/obesity (OR, 0.30; 95% CI 0.29-0.31), and insufficient sleep duration (OR, 0.74; 95% CI 0.72-0.76) decreased the odds of a healthy CRF level, whereas sufficient dietary habits and adequate PA levels increased a participant's odds of having a healthy CRF level, by 48% and 40%, respectively. Although the mechanisms via which CRF may be influenced by dietary habits remain unclear, health policy-makers should consider opportunities for improving both CRF and dietary habits.

Validity and Reliability of the New Portable Metabolic Analyzer PNOE.

Assessment of the oxygen and carbon dioxide content of expired air during exercise is critical for determining cardiorespiratory status. The purpose of this study was to compare the new portable metabolic analyzer PNOE with COSMED - Quark CPET, a previously validated stationary metabolic cart. Methods: A total of 22 subjects (17 male and 5 female) aged 32.3 ± 11.1 years took part in the study. Breath by breath gas exchange was measured by both devices during a four-stage incremental protocol on a cycle ergometer. On a separate day, 10 participants repeated the trial to assess the reliability of the PNOE metabolic cart. Results: Strong correlations were obtained in VO2 (r = 0.98, p < 0.001), VCO2 (r = 0.98, p < 0.001), VE (r = 0.98, p < 0.001), and RQ (r = 0.91, p < 0.001), between the two devices. Bland-Altman plots revealed a mean difference of 34.0 ± 118 ml/min and 36.4 ± 110 ml/min in VO2 and VCO2 analysis, respectively. There were no significant differences in VO2, VCO2, VE, or RQ between the two devices. Intraclass correlation coefficient was high between the two trials for VO2 (r = 0.98, p < 0.001), VCO2 (r = 0.98, p < 0.001), VE (r = 0.99, p < 0.001), and RQ (r = 0.93, p < 0.001). Conclusions: Our data indicate that the portable metabolic cart PNOE can accurately determine respiratory gases over a wide range of exercise intensities, in healthy individuals, in a controlled laboratory setting.

Association of Exclusive Breastfeeding with Risk of Obesity in Childhood and Early Adulthood.

OBJECTIVE: To explore the effects of exclusive breastfeeding and its duration on the development of childhood and early adulthood obesity. MATERIALS AND METHODS: A random sample of 5,125 dyad children and their mothers was extracted from a national database. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of maternal lifestyle factors (e.g., breastfeeding). The body mass index was determined based on International Obesity Task Force criteria. Body weight and height of the offspring at the age of 8 was calculated from measurements derived from the national database, while the corresponding body measurements at early adulthood were self-reported. RESULTS: Mothers who had breastfed or exclusively breastfed ≥6 months were 22.4% and 15.2%, respectively. Exclusive breastfeeding ≥6 months (versus never) was associated with a lower risk of overweight in childhood (8 years old; odds ratio [OR] = 0.89; 95% confidence interval [95% CI], 0.82-0.96) and adolescence/adulthood (15-25 years old; OR = 0.83; 95% CI, 0.68-0.97). Also, exclusive breastfeeding ≥6 months (versus never) was associated with a decreased risk of childhood and adolescence obesity by 30% (95% CI, 0.54-0.91) and 38% (95% CI, 0.40-0.83), respectively. CONCLUSIONS: Exclusive breastfeeding had a favorable influence on offspring's overweight and obesity not only in childhood but also in adolescence/adulthood.

Insufficient Sleep Duration Is Associated With Dietary Habits, Screen Time, and Obesity in Children.

STUDY OBJECTIVES: To examine sleep duration and the association between insufficient sleep duration and life- style factors in a representative sample of Greek children and adolescents. METHODS: Population data derived from a school-based health survey carried out in spring 2015 on 177,091 children (51% male) aged 8 to 17 years (participation rate was approximately 40% of the total population). Dietary habits, sleeping hours (weekdays and weekend), physical activity status, and sedentary activities were assessed through electronic questionnaires completed at school with assistance of teachers. Anthropometric and physical fitness measurements were obtained by physical education teachers. RESULTS: A greater proportion of males than females (42.3% versus 37.3%, P < .001) and of children compared with adolescents (42.1% versus 32.8%, P < .001) reported insufficient sleep duration. Insufficient sleep duration was associated with unhealthy dietary habits such as skipping breakfast (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.25-1.35), fast-food consumption (OR 1.35, 95% CI 1.29-1.41), and consuming sweets regularly (OR 1.32, 95% CI 1.25-1.39). Insufficient sleep duration was found to be associated with insufficient dietary habits (OR 0.59, 95% CI 0.54-0.64), increased screen time (OR 1.26, 95% CI 1.21-1.31), and being overweight/obese (OR 1.21, 95% CI 1.17-1.25), after adjusting for several covariates. CONCLUSIONS: Insufficient sleep duration was associated with an unhealthy lifestyle profile among children and adolescents in this study. Results support the development of interventions to help students improve sleep duration.

Association between fast-food consumption and lifestyle characteristics in Greek children and adolescents; results from the EYZHN (National Action for Children's Health) programme.

OBJECTIVE: To examine the prevalence of fast-food consumption and the association between fast food and lifestyle factors in a representative sample of children and adolescents. DESIGN: Cross-sectional, observational study. Fast-food consumption and dietary habits were evaluated using questionnaires (KIDMED index). Anthropometric and physical fitness measurements were obtained by trained investigators. Physical activity (PA) status, sedentary activities and sleeping habits were assessed through self-completed questionnaires. SETTING: Greece. SUBJECTS: Population data derived from a school-based health survey (EYZHN programme) carried out in 2015 on 177 091 (51 % boys) children aged 8-17 years. RESULTS: A greater proportion of boys v. girls (23·3 v. 15·7 %, P1 time/week. Frequent fast-food consumption was strongly correlated with unhealthy dietary habits such as skipping breakfast and consuming sweets/candy regularly. Adjusting for several covariates, insufficient dietary habits, insufficient (<8-9 h/d) sleep, inadequate PA levels and increased screen time increased the odds (95 % CI) of being a frequent fast-food consumer by 77 % (0·218, 0·234), 30 % (1·270, 1·338), 94 % (1·887, 1·995) and 32 % (1·287, 1·357), respectively. Being overweight/obese or centrally obese did not correlate with frequency of fast-food consumption. CONCLUSIONS: Frequent fast-food consumption was associated with an unhealthy lifestyle profile among children and adolescents. The findings support the development of interventions to help children adopt healthier dietary habits.

Poor dietary habits in Greek schoolchildren are strongly associated with screen time: results from the EYZHN (National Action for Children's Health) Program.

BACKGROUND/OBJECTIVES: To investigate adherence to the Mediterranean diet (MD) and the relationship between MD and lifestyle factors in a representative sample of Greek school children. SUBJECTS/METHODS: The data derived from 232,401 (51% boys) children aged 8 to 17 years old who participated in a health survey (2015). Physical fitness (PF) and anthropometric estimations were obtained by trained investigators. Physical activity (PA) status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. Mediterranean diet was evaluated via KIDMED test. RESULTS: Forty percent of participants presented an optimal adherence to MD (≥8), while one to ten incorporated a low adherence to MD (≤3), in both genders. Participants with optimal adherence to MD presented a more favourable status in anthropometric and lifestyle characteristics. Adjusting for several potential confounders, increased screen time (<2 h/d) augmented odds of low adherence by 135% (95% CI: 2.216-2.491) and 150% (95% CI: 2.346-2.687), in boys and girls, respectively. For each 1-year enlarge in the age of children the odds of low adherence to MD enlarged by almost 11% (95%CI: 1.101-1.138) in both genders, while, boys had almost 6% increased probabilities to the low adherence (95%CI: 1.039, 1.102) than girls. Furthermore, insufficient sleeping hours (>2 h/d) and inadequate PA status were connected to higher odds of low adherence to MD. CONCLUSIONS: Support a modest adherence to the MD and an enhancement considered necessary to adjust dietary intake to current guidelines. However, screen time presented a strong association with low adherence to MD.