Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland.

Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.

Maternal and Paternal Dietary Quality and Dietary Inflammation Associations with Offspring DNA Methylation and Epigenetic Biomarkers of Aging in the Lifeways Cross-Generation Study.

BACKGROUND: Early-life nutritional exposures may contribute to offspring epigenetic modifications. However, few studies have evaluated parental dietary quality effects on offspring DNA methylation (DNAm). OBJECTIVES: We aim to fill this gap by elucidating the influence of maternal and paternal whole-diet quality and inflammatory potential on offspring DNAm in the Lifeways Cross-generation cohort. METHODS: Families (n = 1124) were recruited around 16 weeks of gestation in the Republic of Ireland between 2001 and 2003. Maternal dietary intake during the first trimester and paternal diet during the 12 previous months were assessed with an FFQ. Parental dietary inflammatory potential and quality were determined using the energy-adjusted Dietary Inflammatory Index (E-DII), the Healthy Eating Index-2015 (HEI-2015), and the maternal DASH score. DNAm in the saliva of 246 children at age nine was measured using the Illumina Infinium HumanMethylationEPIC array. DNAm-derived biomarkers of aging, the Pediatric-Buccal-Epigenetic clock and DNAm estimator of telomere length, were calculated. Parental diet associations with the DNAm concentrations of 850K Cytosine-phosphate-guanine sites (CpG sites) and with DNAm-derived biomarkers of aging were examined using an epigenome-wide association study and linear regressions, respectively. RESULTS: Maternal HEI-2015 scores were inversely associated with DNAm at CpG site (cg21840035) located near the PLEKHM1 gene, whose functions involve regulation of bone development (ß = -0.0036, per 1 point increase in the score; P = 5.6 × 10-8). Higher paternal HEI-2015 score was related to lower methylation at CpG site (cg22431767), located near cell signaling gene LUZP1 (ß = -0.0022, per 1 point increase in the score, P = 4.1 × 10-8). There were no associations with parental E-DII and DASH scores, and no evidence of major effects on biomarkers of aging. CONCLUSIONS: Parental dietary quality in the prenatal period, evaluated by the HEI-2015, may influence offspring DNAm during childhood. Further research to improve our understanding of parental nutritional programming is warranted.

Parental influences on children's dairy products consumption: a narrative review.

OBJECTIVE: To review research on the influence of parent-related factors on children's dairy products consumption. DESIGN: A search of electronic databases and a narrative synthesis of the literature were conducted. English-language articles were included if they reported data relating to parental influences on children's consumption of dairy products and if statistical significance was reported. SETTING: Studies were carried out in the USA (n 8) and in a range of countries across Europe (n 12) and Asia (n 5). PARTICIPANTS: The subjects of this research were children aged between 2 and 12 years of age, from a range of geographical locations. RESULTS: Twenty-five studies met the inclusion criteria. The studies examined children's dairy products consumption in relation to parental socio-economic status (education level and income) (n 12), home availability (n 2), home food environment (n 3), parental dairy products consumption (n 4), parent feeding practices (n 3), parents' beliefs and attitudes (n 3) and parental nutrition knowledge (n 3). Results on the association between socio-economic status and children's dairy products consumption varied; however, studies reporting a significant association generally observed a positive relationship. Fifteen studies reported children's total dairy products intake as an outcome measure, with the remaining studies reporting intake of milk or other dairy products as individual foods. CONCLUSIONS: This review identified literature exploring a range of parental factors in relation to children's dairy products intake. However, there were limited numbers of studies published within each category of modifiable factors. Further research on the parent-related determinants of dairy products consumption in children is required in order to identify potential intervention targets in this age group.

The association between alcohol intake and obesity in a sample of the Irish adult population, a cross-sectional study.

BACKGROUND: Obesity epidemic is one of the most serious public health challenges of the twenty-first century. Alcohol has been studied as a possible risk factor for obesity, but the evidence is discordant. This study examined the association between alcohol consumption and obesity in a sample of the Irish adult population. METHOD: An analytical cross-sectional study was conducted using secondary data from the 2017 Healthy Ireland Survey. The primary survey recruited patients using a two-stage probability-based technique and a face-to-face-administered questionnaire to collect data. Descriptive and comparative data were analysed to identify associations between alcohol-related variables with waist circumference (WC) and body mass index (BMI). Regression analysis was performed to examine the associations between harmful alcohol consumption (AUDIT-C score ≥ 5) (exposure variable) and obesity indicators (WC and BMI), the primary outcomes of interest. Adjustments were made for sociodemographic, health-related, and other alcohol-related variables. RESULTS: Total of 6864 participants, aged 25 and older, took part in this survey (response rate = 60.4%). Most of the participants (81.9%) were alcohol drinkers, with the majority drinking less than three times per week (76.3%); 47.7% were considered harmful drinkers (AUDIT-C score ≥ 5). After controlling for possible confounders, positive associations of harmful alcohol consumption with WC (ß = 1.72, 95% CI: 0.25, 3.19) and BMI (OR = 1.47, 95% CI: 1.10, 1.96) were observed. Binge drinking was positively associated with WC (ß = 1.71, 95% CI: 0.50, 2.91), while alcohol consumption frequency was significantly and inversely associated with BMI (OR = 0.59, 95% CI: 0.44, 0.78). CONCLUSION: Harmful alcohol consumption was associated with obesity (high BMI, large WC) after controlling for possible confounders. Frequent binge drinkers were more likely to have a large WC, while frequent alcohol consumers were less likely to have obesity. Further longitudinal studies to examine the exact association between alcohol consumption and obesity are warranted.

What are the determinants of vegetable intake among adolescents from socioeconomically disadvantaged urban areas? A systematic review of qualitative studies.

BACKGROUND: Evidence available on the determinants of vegetable intake in young populations is inconsistent. Vegetable intake is particularly low in adolescents from less-affluent backgrounds, yet no systematic review of qualitative studies investigating determinants for vegetable intake specifically has been conducted to date in this group. This systematic review aimed to identify determinants of vegetable intake in adolescents from socioeconomically disadvantaged urban areas located in very high-income countries reported in qualitative studies. METHODS: Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched until August 2022. The search strategy used combinations of synonyms for vegetable intake, adolescents, and qualitative methodologies. Main inclusion criteria were studies exploring views and experiences of motivators and barriers to vegetable intake in a sample of adolescents aged 12-18 years from socioeconomically disadvantaged urban areas in very high income countries. Study quality assessment was conducted using criteria established in a previous review. RESULTS: Sixteen studies were included out of the 984 screened citations and 63 full texts. The synthesis of findings identified the following determinants of vegetable intake: sensory attributes of vegetables; psychosocial factors (nutrition knowledge, preferences/liking, self-efficacy, motivation); lifestyle factors (cost/price, time, convenience); fast food properties (taste, cost, satiety); home environment and parental influence; friends' influence; school food environment, nutrition education and teachers' support; and availability and accessibility of vegetables in the community and community nutrition practices. Studies attained between 18 and 49 out of 61 quality points, with eleven of 16 studies reaching ≥ 40 points. One main reason for lower scores was lack of data validation. CONCLUSION: Multiple determinants of vegetable intake were identified complementing those investigated in quantitative studies. Future large scale quantitative studies should attempt to examine the relative importance of these determinants in order to guide the development of successful interventions in adolescents from socioeconomically disadvantaged backgrounds.

Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies.

OBJECTIVE: To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme. DESIGN: A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health. SETTING: Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1). PARTICIPANTS: Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings. RESULTS: Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings. CONCLUSIONS: There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

Strength of EU-level food environment policies and priority recommendations to create healthy food environments.

BACKGROUND: Food environments impact on diets, obesity and non-communicable diseases (NCDs). Government policies are essential to create healthy food environments. This study aimed to assess the strength of European Union (EU)-level policies, and identify and prioritize actions for the EU to create healthy food environments. METHODS: The Healthy Food Environment Policy Index (Food-EPI) was applied. The Food-EPI included 26 policy and 24 infrastructure support indicators. Independent experts (n = 31) rated the strength of EU-level policies and infrastructure support for each of these indicators (on a 5-point scale, from very weak to very strong) and identified and prioritized actions to improve food environments. RESULTS: For 65% of the 26 policy indicators, EU-level policies were rated as weak and for 23% as very weak. For 63% of the 24 infrastructure support indicators, EU-level policies were rated as moderate and for 33% as weak. The experts recommended 18 policy and 19 infrastructure support actions to the EU. The Top 5 prioritized policy actions included three actions in the food composition domain (e.g. setting mandatory food composition targets), one action in the food prices domain and one action in the food promotion domain. The Top 5 prioritized infrastructure support actions included three actions in the leadership domain (e.g. developing a high-level NCDs Prevention Strategy) and two actions in the monitoring domain. CONCLUSIONS: There is large potential for the EU to strengthen its policies and infrastructure support in order to improve food environments. This study specifies priority actions for the EU to create healthy food environments.

Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme.

BACKGROUND: For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children's fruit and vegetable consumption. METHODS: We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. RESULTS: The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children's fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. CONCLUSIONS: The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.

Health surveillance indicators for diet and physical activity: what is available in European data sets for policy evaluation?

BACKGROUND: Policies targeting diet and physical activity have the potential to improve health and well-being at a population level. However, the impact of these policies in Europe is currently unknown. Based on existing data, as well as on a needs assessment, we derived a catalogue of indicators that can be employed to evaluate such policies. These indicators may also inform the further development and harmonization of surveillance systems. METHODS: Forty EU experts agreed on a list of key indicators and ranked their priority for future surveillance. We mapped these indicators onto variables provided by ongoing European surveillance systems. Using a Likert scale (well matched, somewhat matched, poorly matched, unmatched), we assessed the suitability of these variables as measures for the indicators. RESULTS: Key indicators included behaviour outcome indicators relating to diet (n = 72) and physical activity and sedentary behaviour (n = 67) as well as upstream determinants of these behaviours. It was possible to map 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators onto at least one variable in an ongoing surveillance system. CONCLUSIONS: Current monitoring and surveillance systems focus mainly on measuring 'downstream' indicators, while gaps exist in policy and environmental level data in dimensions such as inequality, funding and resources and governance.

Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations.

BACKGROUND: The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. METHODS: In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. RESULTS: In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems' use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. CONCLUSION: We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process.

Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network.

BACKGROUND: An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS: A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS: Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS: The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.

Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN).

The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.

Selection of key indicators for European policy monitoring and surveillance for dietary behaviour, physical activity and sedentary behaviour.

BACKGROUND: A pan-European approach to evaluate policy impact on health behaviour requires the employment of a consensus set of established and relevant indicators. METHODS: As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life, the Policy Evaluation Network PEN identified key indicators of health behaviours and their determinants. These key indicators are already, or have the potential to be, adopted by large European Union surveillance systems for the assessment of policy impact. The iterative selection process included consultations in two rounds via email prior to a 2-days expert workshop. The experts collated a list of dietary behaviour, physical activity and sedentary behaviour indicators for European policy monitoring in young and adult populations based on existing frameworks and literature reviews. The expert panel was composed of researchers, policy makers and representatives of major European surveillance systems and related initiatives, as well as, representatives of organisations providing monitoring data, such as the European Commission and Eurostat. RESULTS: The process provided two lists of key indicators including 37 diet 'policy' indicators and 35 indicators for dietary behaviour and their 'determinants'; as well as 32 physical activity 'policy' indicators and 35 indicators for physical activity, sedentary behaviour and their 'determinants'. CONCLUSION: A total of 139 key indicators related to the individual, the setting and the population level, and suitable for the assessment of dietary behaviour, physical activity and sedentary behaviour were prioritised by policy makers and researchers with the ultimate aim to embed policy evaluation measures in existing surveillance systems across the European Union. In a next step, data sources and suitable instruments will be identified to assess these key indicators.

Understanding disadvantaged adolescents' perception of health literacy through a systematic development of peer vignettes.

BACKGROUND: Adolescence represents a crucial phase of life where health behaviours, attitudes and social determinants can have lasting impacts on health quality across the life course. Unhealthy behaviour in young people is generally more common in low socioeconomic groups. Nevertheless, all adolescents should have a fair opportunity to attain their full health potential. Health literacy is positioned as a potential mediating factor to improve health, but research regarding health literacy in adolescents and socially disadvantaged populations is limited. As part of Phase one of the Ophelia (OPtimising HEalth LIterAcy) framework, The purpose of this study was to explore the perceptions of socially disadvantaged Irish adolescents in relation to health literacy and related behaviours, and utilise this data to develop relevant vignettes. METHODS: A convergent mixed method design was used to co-create the vignettes. Questionnaires were completed by 962 adolescents (males n = 553, females n = 409, Mean age = 13.97 ± 0.96 years) from five participating disadvantaged schools in Leinster, Ireland. Focus groups were also conducted in each school (n = 31). Results were synthesised using cluster and thematic analysis, to develop nine vignettes that represented typical male and female subgroups across the schools with varying health literacy profiles. These vignettes were then validated through triangular consensus with students, teachers, and researchers. DISCUSSION: The co-creation process was a participatory methodology which promoted the engagement and autonomy of the young people involved in the project. The vignettes themselves provide an authentic and tangible description of the health issues and health literacy profiles of adolescents in this context. Application of these vignettes in workshops involving students and teachers, will enable meaningful engagement in the discussion of health literacy and health-related behaviours in Irish young people, and the potential co-designing of strategies to address health literacy in youth. CONCLUSION: As guided by the Ophelia framework, the use of authentic, interactive and participatory research methods, such as the co-creation of vignettes, is particularly important in groups that are underserved by traditional research methods. The approach used in this study could be adapted to other contexts to represent and understand stakeholders' perceptions of health, with a view to explore, and ultimately improve, health literacy.

Waist circumference-to-height ratio and body mass index for obesity classification in Irish children.

AIM: Waist circumference-to-height ratio (WHt) has been proposed as an alternative measure to BMI due to its focus on central weight distribution and its basic threshold for increased cardiometabolic risk. This study aimed to compare prevalence of overweight including obesity using BMI and WHt, and assess 10-year trends of WHt prevalence, in a representative sample of Irish children. METHODS: Children measured during rounds 2-5 of the Childhood Obesity Surveillance Initiative (n = 20037) were classified as healthy weight or overweight including obesity (International Obesity Task Force age and sex BMI cut-offs), and low or high WHt (WHt ≥ 0.5). Differences in prevalence of BMI and WHt classifications were determined for round five in younger (<9 years) and older (≥9 years) children. The prevalence of high WHt was assessed across rounds. RESULTS: Differences in prevalence between overweight including obesity and high WHt were apparent in younger (BMI: 16.7%, WHt: 8.9%; p < .001) and older (BMI: 21.3%, WHt: 12.1%; p < .001) children. An inverse trend for prevalence of high WHt was identified across rounds (p < .001). CONCLUSION: BMI overestimates overweight including obesity prevalence compared to WHt. Given its ease of use, consideration of the WHt as an additional measure in childhood surveillance and screening is warranted.

Teachers' perspectives on the barriers to healthy lifestyle behaviors among adolescent girls of disadvantaged backgrounds in Ireland: A qualitative study.

Though adolescence is a particularly sensitive period regarding the development of long-lasting health-related attitudes and behaviors, little research has examined the factors which influence their engagement in such behaviors. Adolescent females are particularly sensitive to suffer from overweight and obesity. It is also a time that can impact the health patterns of future generations due to the influence of preconception maternal factors on the health of their offspring. Furthermore, much research has identified a strong socioeconomic gradient in obesity in Ireland, with individuals from low socioeconomic backgrounds being particularly likely to develop unhealthy habits. The current study aimed to develop an understanding of the factors which influence the health-related behaviors of adolescent girls of low-socioeconomic status in Ireland, an underrepresented yet particularly sensitive cohort. Semi-structured interviews were conducted with nine teachers from disadvantaged schools in Dublin and were examined using a thematic analytic approach. Nine themes were identified: lack of interest and knowledge, lack of self-confidence, the dual role of modern technology, behaviors of significant others, need for good role models, availability of convenience foods, inadequate existing approaches and initiatives, lack of resources to promote a healthy lifestyle, and living difficulties at home and in the community. Findings suggested ways for intervening at personal, interpersonal, organizational and community levels. In conclusion, a range of practical changes are required in the home, school, and community environments in order to improve the health of these individuals, and ultimately to improve the health of future generations.

Associations between a maternal healthy lifestyle score and adverse offspring birth outcomes and childhood obesity in the Lifeways Cross-Generation Cohort Study.

BACKGROUND/OBJECTIVES: Maternal adherence to healthy lifestyle behaviors during pregnancy has been associated with reduced risk of obesity in the offspring. Our objective is to examine associations between a composite healthy lifestyle score (HLS) in expectant mothers and adverse offspring birth outcomes and childhood obesity. SUBJECTS/METHODS: The Lifeways Study comprises 665 mother-child pairs. A composite HLS (scored 0-5) based on high dietary quality (top 40% of the Healthy Eating Index (HEI)-2015), moderate to vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5-24.9 kg/m2), never smoker, and no/moderate alcohol intake was calculated. Birth outcomes were abstracted from hospital records. Offspring waist circumference (WC) and BMI was determined at age 5 and 9. Logistic regression tested HLS associations with offspring outcomes. RESULTS: Offspring birth weight, length, and head circumference were positively associated with the maternal HLS (p < 0.001), whereas child BMI and incidence of overweight/obesity at age 5 and 9 were negatively associated (p < 0.05). In multivariable models, a lower maternal HLS was associated with increased risk of low birth weight (LBW) (P trend = 0.04) and lower likelihood of macrosomia (P trend = 0.03). Examined individually, poor maternal dietary quality, smoking, and alcohol intake were associated with higher risk of LBW (p < 0.04). Likelihood of macrosomia and combined overweight/obesity at age 5 and 9 years were greater among mothers with a pre-pregnancy BMI in the range with obesity (p < 0.04). Smoking during pregnancy was also linked to greater risk of childhood overweight/obesity (OR:1.91, 95% CI:1.01-3.61, p = 0.04 at age 5 and OR: 2.14, 95% CI:1.01-4.11, p = 0.03 at age 9). CONCLUSIONS: Our findings suggest that maternal adherence to a healthy lifestyle during pregnancy, in particular having a good quality diet, not smoking, and no/low alcohol intake in combination with a healthy pre-pregnancy BMI, is associated with reduced risk of adverse offspring birth outcomes and childhood obesity.

Developing a national undergraduate standardized curriculum for future healthcare professionals on "Making Every Contact Count" for chronic disease prevention in the Republic of Ireland.

This report describes the development of the first national undergraduate interprofessional standardized curriculum in chronic disease prevention for healthcare professionals in the Republic of Ireland. This project brought together for the first time all higher education institutions nationwide in a novel collaboration with the national health service i.e. the Health Service Executive (HSE), to develop a standardized national curriculum for undergraduate health care professions. The curriculum sits within the framework of Making Every Contact Count, the goal of which is to re-orientate health services to embed the ethos of prevention through lifestyle behavior change as part of the routine care of health professionals. The core focus of Making Every Contact Count is chronic disease prevention, targeting four main lifestyle risk factors for chronic disease; tobacco use, alcohol consumption, physical inactivity and unhealthy eating. Making Every Contact Count is a key component of Healthy Ireland, the Irish national framework for health and wellbeing. The aim of the curriculum is to prepare newly qualified health professionals with the skills needed to support patients to achieve lifestyle behavior change delivered as part of routine clinical care.

Maternal Dietary Glycemic and Insulinemic Indexes Are Not Associated with Birth Outcomes or Childhood Adiposity at 5 Years of Age in an Irish Cohort Study.

BACKGROUND: High maternal dietary glycemic index (GI) and glycemic load (GL) may be associated with adverse offspring birth and postnatal adiposity outcomes through metabolic programming, but the evidence thus far, mainly from studies conducted in high-risk pregnant populations, has been inconclusive. No study has examined the influence of maternal insulin demand [measured by food insulinemic index (II) and insulinemic load (IL)] on offspring outcomes. OBJECTIVES: We investigated associations between maternal GI, GL, II, and IL and offspring birth outcomes and postnatal adiposity in a general pregnant population. METHODS: The study was based on data from 842 mother-child pairs from the Lifeways prospective cohort study in Ireland. Through the use of standard methodology, maternal GI, GL, II, and IL were derived from dietary information obtained via a validated food-frequency questionnaire in early pregnancy (12-16 wk). Birth outcomes were abstracted from hospital records. At 5-y follow-up, children's body mass index (BMI) and waist circumference were measured. Associations were assessed through the use of multivariable-adjusted regression analysis. RESULTS: Mothers had a mean ± SD age of 30.3 ± 5.7 y and a mean BMI (kg/m2) of 23.9 ± 4.2. The mean ± SD for dietary glycemic and insulinemic indexes were: GI = 58.9 ± 4.4; GL = 152 ± 49; II = 57.4 ± 14.5; IL = 673 ± 267. After adjustment for confounders, no consistent associations were observed between maternal GI, GL, II, and IL and birth outcomes including birth weight, macrosomia, gestational age, and postterm births. Similarly, no association was observed with BMI and waist circumference z scores and childhood obesity (general and central) at 5-y follow-up. There was no evidence of a nonlinear relation between the studied indexes and outcomes. CONCLUSIONS: We observed no clear relation between maternal GI, GL, II, and IL and offspring birth outcomes and childhood obesity in a general pregnant population.

How do adults define the treats they give to children? A thematic analysis.

One in four children on the Island of Ireland are overweight or obese. The consumption of energy-dense, nutrient-poor foods such as snacks, contribute to one fifth of children's calorie intake. However the snack food literature has failed to draw firm conclusions between snack food intake and obesity. Within this literature, the word snack and treat are used interchangeably, inconsistently and in differing contexts, which may explain the poor link between snacks or extra foods, and overweight or obesity. There is currently no academic definition of the word 'treat' relevant to an Irish population. Defining how adults perceive the treats they give children is of particular importance in the context of children's diets, and may provide insight into the relative contribution of treats to energy intakes. With ten focus groups of adult caregivers of children, across the Island of Ireland, this study aimed to investigate treat giving behaviour. This research highlights a paradoxical definition of treats: a treat was identified as an energy-dense food that gave pleasure, was deserved and believed to be infrequent; participants perceived this to be the true definition of treats which was coined "real treats". However, in reality, treats were given and consumed frequently, downgrading the status of these treats to "regular treats" which reflected their real-life use. Developing the definition of treats for an adult population, may enhance our understanding of why adults give food treats to children, the role this has on the development of eating habits, the design of interventions and communication strategies to reduce the consumption of non-nutritive foods, labelled by adults as treats.