Vitamin D deficiency in Bangladesh: A review of prevalence, causes and recommendations for mitigation.

Vitamin D is essential for the maintenance of calcium homeostasis and bone mineralization. Overt deficiency of vitamin D causes rickets in children and osteomalacia in adults. Vitamin D deficiency is an important public health problem worldwide. This review examines the available published data from all peer-reviewed original research articles of community and hospital-based research carried out on vitamin D status in different population groups in Bangladesh. Baseline data of intervention trials are also included. The available selected articles were in English and retrieved from 2002 to January 2022. The paper concentrates on underlying factors for increased prevalence of vitamin D deficiency in Bangladesh. Studies uniformly report very high prevalences of hypovitaminosis D among different population groups. Age and sex-specific comparisons indicate that prevalence is higher for the elderly and women. Hypovitaminosis D ranged from 21 to 75 % for infants, children, and adolescents, 38 to 100 percent for premenopausal women, 66 to 94.2 % for pregnant women, 6 to 91.3 % for adult men and 82 to 95.8 % for postmenopausal women. Important underlying factors related to this silent epidemic include dark skin colour, homebound and sedentariness, insufficient sunlight exposure, atmospheric pollution, clothing style, obesity, use of sunscreen and no supplementation. A comprehensive strategy to alleviate and control the health consequences of vitamin D deficiency is needed. This would include the creation of public awareness, refrain in sunscreen usage, exposure to sunlight, regular exercise, food fortification, and supplementation with vitamin D (bearing in mind potential differences between them and food-based sources).

Investigating the Effectiveness of an Educational Escape Game for Increasing Nutrition-Related Knowledge in Young Adolescents: A Pilot Study.

Objective: As a pilot trial under the Games of Food consortium, this study assessed the effectiveness of an educational escape game alongside a self-study method as a nutrition knowledge intervention. Furthermore, this study explored the use of an escape game as an educational tool for young adolescents. Materials and Methods: Altogether three schools participated, one from Finland and two from the UK. Baseline questionnaires assessing knowledge were administered before intervention day. Participants from each class were randomly allocated by the researchers into either the escape game condition, where participants played a nutrition education escape game with a focus on plant-based protein sources, or the self-study condition, where participants received an educational leaflet with identical content. In addition to the knowledge post-assessment, the educational escape game condition answered an enjoyment and intrinsic motivation questionnaire to evaluate the game experience. Paired t-tests were used to determine significant changes within intervention conditions and ANCOVA was used to estimate the differences in knowledge. Results: The participants were 130 children (11-14 years), divided into educational escape game (n = 68) and self-study (n = 62) conditions. Both the educational escape game (20.7 vs. 23, p < 0.001) and self-study (21.1 vs. 23.1, p = 0.002) had improved overall knowledge scores. No significant differences in gained knowledge existed between groups. Of the educational escape game participants, 60% reported the game as mostly enjoyable and 46% reported added use and value for learning. Conclusion: The educational escape game condition was comparable to the self-study method for nutrition education in adolescents. However, since the educational escape game provides an enjoyable experience that may enhance intrinsic motivation to promote learning and possible behavior change, the use of escape games for nutrition education warrant further investigation.

Life-course leisure-time physical activity trajectories in relation to health-related behaviors in adulthood: the Cardiovascular Risk in Young Finns study.

BACKGROUND: Evidence on whether leisure-time physical activity (LTPA) facilitates individuals' adoption of multiple healthy behaviors remains scarce. This study investigated the associations of diverse longitudinal LTPA trajectories from childhood to adulthood with diet, screen time, smoking, binge drinking, sleep difficulties, and sleep duration in adulthood. METHODS: Data were drawn from the Cardiovascular Risk in Young Finns Study. Participants were aged 9-18 years (N = 3553; 51% females) in 1980 and 33-49 years at the latest follow-up in 2011. The LTPA trajectories were identified using a latent profile analysis. Differences in self-reported health-related behaviors across the LTPA trajectories were studied separately for women and men by using the Bolck-Croon-Hagenaars approach. Models were adjusted for age, body mass index, education level, marital status, total energy intake and previous corresponding behaviors. RESULTS: Persistently active, persistently low-active, decreasingly and increasingly active trajectories were identified in both genders and an additional inactive trajectory for women. After adjusting the models with the above-mentioned covariates, the inactive women had an unhealthier diet than the women in the other trajectories (p <  0.01; effect size (ES) > 0.50). The low-active men followed an unhealthier diet than the persistently and increasingly active men (p <  0.01; ES > 0.50). Compared to their inactive and low-active peers, smoking frequency was lower in the increasingly active women and men (p <  0.01; ES > 0.20) and persistently active men (p <  0.05; ES > 0.20). The increasingly active men reported lower screen time than the low-active (p <  0.001; ES > 0.50) and persistently active (p <  0.05; ES > 0.20) men. The increasingly and persistently active women reported fewer sleep difficulties than the inactive (p <  0.001; ES > 0.80) and low-active (p <  0.05; ES > 0.50 and > 0.80, respectively) women. Sleep duration and binge drinking were not associated with the LTPA trajectories in either gender, nor were sleep difficulties in men and screen time in women. CONCLUSIONS: Not only persistently higher LTPA but also an increasing tendency to engage in LTPA after childhood/adolescence were associated with healthier diet and lower smoking frequency in both genders, having less sleep difficulties in women and lower screen time in increasingly active men. Inactivity and low activity were associated with the accumulation of several unhealthy behaviors in adulthood. Associations were stronger in women.

The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes.

AIM: To compare the impact of two long-term weight-maintenance diets, a high protein (HP) and low glycaemic index (GI) diet versus a moderate protein (MP) and moderate GI diet, combined with either high intensity (HI) or moderate intensity physical activity (PA), on the incidence of type 2 diabetes (T2D) after rapid weight loss. MATERIALS AND METHODS: A 3-year multicentre randomized trial in eight countries using a 2 x 2 diet-by-PA factorial design was conducted. Eight-week weight reduction was followed by a 3-year randomized weight-maintenance phase. In total, 2326 adults (age 25-70 years, body mass index ≥ 25 kg/m2 ) with prediabetes were enrolled. The primary endpoint was 3-year incidence of T2D analysed by diet treatment. Secondary outcomes included glucose, insulin, HbA1c and body weight. RESULTS: The total number of T2D cases was 62 and the cumulative incidence rate was 3.1%, with no significant differences between the two diets, PA or their combination. T2D incidence was similar across intervention centres, irrespective of attrition. Significantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycaemia was lowest in HP-HI (11.9%) compared with the other three groups (20.0%-21.0%, P < .05). There were no group differences in body weight change (-11% after 8-week weight reduction; -5% after 3-year weight maintenance) or in other secondary outcomes. CONCLUSIONS: Three-year incidence of T2D was much lower than predicted and did not differ between diets, PA or their combination. Maintaining the target intakes of protein and GI over 3 years was difficult, but the overall protocol combining weight loss, healthy eating and PA was successful in markedly reducing the risk of T2D. This is an important clinically relevant outcome.

Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents.

BACKGROUND: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. METHODS: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2-18 years) from 18 different European countries. RESULTS: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age. CONCLUSIONS: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

Cycling but not walking to work or study is associated with physical fitness, body composition and clustered cardiometabolic risk in young men.

INTRODUCTION: Active commuting is an inexpensive and accessible form of physical activity and may be beneficial to health. The aim of this study was to investigate the association of active commuting and its subcomponents, cycling and walking, with cardiometabolic risk factors, physical fitness and body composition in young men. METHODS: Participants were 776 Finnish young (26±7 years), healthy adult men. Active commuting was measured with self-report. Waist circumference was measured and body mass index (BMI) calculated. Aerobic fitness was measured with bicycle ergometer and muscular fitness with maximal leg and bench press, sit-ups, push-ups and standing long jump. Cardiometabolic risk factors were analysed from blood samples and selected variables (glucose, insulin, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, as well as systolic and diastolic blood pressure) were further converted to z-score to form clustered cardiometabolic risk. RESULTS: A total of 24% used active commuting consisting of 10% of walkers and 14% of cyclists. After adjustments for age, smoking, time of year, leisure-time and occupational physical activities, cycling was inversely associated with the clustered cardiometabolic risk (ß=-0.11, 95% CI -0.22 to -0.01), while walking was not (ß=-0.04, 95% CI -0.16 to 0.08). However, further adjustment for waist circumference attenuated the associations to non-significant. Moreover, cycling but not walking was inversely associated with BMI, waist circumference and maximal strength, while a positive association was observed with aerobic fitness (p<0.05). CONCLUSION: This study shows that cycling to work or study has beneficial associations to clustered cardiometabolic risk, body composition and aerobic fitness in young, healthy adult men.

Cardiorespiratory and muscular fitness in young adult Finnish men between 2003 and 2015.

INTRODUCTION: Physical fitness is strongly related to health and may offer valuable information about public health. We investigated trends in physical fitness, leisure-time physical activity (LTPA), and anthropometry of young healthy adult Finnish men in representative population-based samples between 2003 and 2015. METHODS: Three independent cross-sectional samples of 18- to 35-year-old Finnish men were assessed in 2003 (n = 889), 2008 (n = 803), and 2015 (n = 690). Cardiorespiratory (VO2 max) and muscular fitness (1-minute sit-ups and push-ups), body mass, and height were measured. Self-reported LTPA was assessed. RESULTS: After adjusting for age, education, and smoking, cardiorespiratory fitness was higher in 2003 (mean: 43.5, 95%CI: 42.9-44.1 mL/kg/min) compared to 2008 (41.3, 95%CI: 40.7-41.9 mL/kg/min) and 2015 (40.6, 95%CI: 40.0-41.2 mL/kg/min) (P < .001), whereas no difference was observed between 2008 and 2015. The lowest values in muscular fitness were observed in 2003, while no clear trends were further noticed. The adjusted BMI was higher in 2008 (25.1, 95%CI: 24.9-25.4) and 2015 (25.3, 95%CI: 25.3, 95%CI: 25.0-25.6) compared to 2003 (24.5, 95%CI: 24.3-24.8) (P < .005). In 2015, a higher proportion of individuals exercised at least four times per week compared to 2003 and 2008 (P < .05). CONCLUSION: The decrease in cardiorespiratory fitness that took place between 2003 and 2008 plateaued after 2008. The plateau is in accordance with the previously observed trend of 5-10 years younger Finnish men. Moreover, muscular fitness was for the most part higher in 2008 and 2015 compared to 2003. Efforts directed to promote regular physical activity and improve physical fitness are needed.

Associations of Leisure-Time Physical Activity Trajectories with Fruit and Vegetable Consumption from Childhood to Adulthood: The Cardiovascular Risk in Young Finns Study.

A physically active lifestyle and a diet rich in vegetables and fruits have a central role in promoting health. This study examined the associations between leisure-time physical activity (LTPA) trajectories and fruit and vegetable consumption (FVC) from childhood to middle age. The data were drawn from the Cardiovascular Risk in Young Finns Study with six age cohorts. Participants were 9 to 18 years (n = 3536; 51% females) at baseline in 1980 and 33 to 48 years at the last follow-up in 2011. LTPA and FVC were self-reported. LTPA trajectories were identified using latent profile analyses, after which the mean differences in FVC across the trajectories were studied. Active, low-active, decreasingly and increasingly active trajectories were identified for both genders. An additional trajectory describing inactivity was identified for females. Those who were persistently active or increased their LTPA had higher FVC at many ages when compared to their inactive or low-active counterparts (p < 0.05). In females prior to age 42 and in males prior to age 24, FVC was higher at many ages in those with decreasing activity than in their inactive or low-active counterparts (p < 0.05). The development of LTPA and FVC from childhood to middle age seem to occur in tandem.

Effects of a High-Protein/Moderate-Carbohydrate Diet on Appetite, Gut Peptides, and Endocannabinoids-A Preview Study.

Favorable effects of a high-protein/moderate-carbohydrate (HP/MCHO) diet after weight loss on body weight management have been shown. To extend these findings, associations between perception of hunger and satiety with endocannabinoids, and with glucagon-like peptide-1 (GLP-1) and polypeptide YY (PYY) were assessed. At approximately 34 months after weight loss, 22 female and 16 male participants (mean age 64.5 ± 5.9 years; body mass index (BMI) 28.9 ± 3.9 kg/m2) completed a 48 h respiration chamber study. Participants were fed in energy balance with a HP/MCHO diet with 25%:45%:30% or a moderate-protein/high-carbohydrate (MP/HCHO) diet with 15%:55%:30% of energy from protein:carbohydrate:fat. Endocannabinoids and related compounds, relevant postprandial hormones (GLP-1, PYY), hunger, satiety, and ad libitum food intake were assessed. HP/MCHO versus MP/HCHO reduced hunger perception. The lower decremental area under the curve (dAUC) for hunger in the HP/MCHO diet (-56.6% compared to MP, p < 0.05) was associated with the higher AUC for 2-arachidonoylglycerol (2-AG) concentrations (p < 0.05). Hunger was inversely associated with PYY in the HP/MCHO group (r = -0.7, p < 0.01). Ad libitum food intake, homeostatic model assessment for insulin resistance (HOMA-IR) and incremental AUCs for gut peptides were not different between conditions. HP/MCHO versus MP/HCHO diet-induced reduction in hunger was present after 34 months weight maintenance in the post-obese state. HP/MCHO diet-induced decrease of hunger is suggested to interact with increased 2-AG and PYY concentrations.

The Impact of Nutrition Education Intervention with and Without a Mobile Phone Application on Nutrition Knowledge Among Young Endurance Athletes.

Athletes often have significant gaps in their nutrition knowledge. Thus, the aim of this study was to investigate whether young Finnish endurance athletes' nutrition knowledge and dietary intake can be improved through an education intervention with or without a mobile food application. Seventy-nine endurance athletes, 18.0 years (SD: 1.4), participated in this randomized, controlled intervention. We compared the effects of participatory nutrition education sessions alone (group EDU) to those including the use of a mobile food application (group EDU + APP) for four days after each session. Both groups attended three 90-min education sessions fortnightly. The participants completed a validated nutrition knowledge questionnaire in Weeks 0, 5, and 17, and a three-day food diary in Weeks 0 and 17. The education plan was based on the Self-Determination Theory and the concept of meaningful learning process. The EDU group's nutrition knowledge scores were: 78 (week 0), 85 (week 5), and 84 (week 17) and the EDU + APP group's 78, 86, and 85, respectively. Nutrition knowledge increased significantly (main effect of time (p < 0.001)), but we observed no significant group × time interaction (p = 0.309). The changes in dietary intakes were minor (p > 0.05). The amount of carbohydrates was below endurance athletes' recommendations throughout the intervention. The reported energy intakes were also below the estimated energy expenditures. In conclusion, nutrition knowledge improved significantly after only three education sessions and food diary feedback, but the mobile app did not improve learning further. However, the nutrition education intervention alone was not enough to change dietary intake.

International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): Contributions to Understanding the Global Obesity Epidemic.

The purpose of this review is to summarize the scientific contributions of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) in extending our understanding about obesity in children from around the world. ISCOLE was a multi-national study of 9 to 11 year-old children from sites in 12 countries from all inhabited continents. The primary purpose was to investigate relationships between lifestyle behaviors and obesity, and the influence of higher-order characteristics such as behavioral settings, and physical, social and policy environments. ISCOLE has made several advances in scientific methodology related to the assessment of physical activity, dietary behavior, sleep and the neighborhood and school environments. Furthermore, ISCOLE has provided important evidence on (1) epidemiological transitions in obesity and related behaviors, (2) correlates of obesity and lifestyle behaviors at the individual, neighborhood and school levels, and (3) 24-h movement behaviors in relation to novel analytical techniques. A key feature of ISCOLE was the development of a platform for international training, data entry, and data quality for multi-country studies. Finally, ISCOLE represents a transparent model for future public-private research partnerships across low, middle and high-income countries.

Emotional Eating, Health Behaviours, and Obesity in Children: A 12-Country Cross-Sectional Study.

Eating in response to negative emotions (emotional eating, EE) may predispose an individual to obesity. Yet, it is not well known how EE in children is associated with body mass index (BMI) and health behaviours (i.e., diet, physical activity, sleep, and TV-viewing). In the present study, we examined these associations in a cross-sectional sample of 5426 (54% girls) 9⁻11-year-old children from 12 countries and five continents. EE, food consumption, and TV-viewing were measured using self-administered questionnaires, and physical activity and nocturnal sleep duration were measured with accelerometers. BMI was calculated using measured weights and heights. EE factor scores were computed using confirmatory factor analysis, and dietary patterns were identified using principal components analysis. The associations of EE with health behaviours and BMI z-scores were analyzed using multilevel models including age, gender, and household income as covariates. EE was positively and consistently (across 12 study sites) associated with an unhealthy dietary pattern (ß = 0.29, SE = 0.02, p < 0.0001), suggesting that the association is not restricted to Western countries. Positive associations between EE and physical activity and TV viewing were not consistent across sites. Results tended to be similar in boys and girls. EE was unrelated to BMI in this sample, but prospective studies are needed to determine whether higher EE in children predicts the development of undesirable dietary patterns and obesity over time.

Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries.

BACKGROUND: Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. METHODS: This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. RESULTS: Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. CONCLUSIONS: In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. TRIAL REGISTRATION: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

Diet Macronutrient Composition, Physical Activity, and Body Composition in Soldiers During 6 Months Deployment.

INTRODUCTION: Optimal diet together with good physical fitness maintains readiness and military performance during longer deployments. The purpose of this study was to describe changes in dietary macronutrient and energy intake, total physical activity and body composition during a 6-month deployment in South Lebanon. Furthermore, associations of diet macronutrient intake and physical activity on body composition were also studied. MATERIALS AND METHODS: Forty male soldiers kept a 3-day food diary and their body composition was measured via bioimpedance and ultrasonography. Total physical activity was evaluated by accelerometers in a subgroup of participants. Measurements were conducted in the PRE-, MID-, and POST-deployment. RESULTS: Mean carbohydrate intakes were 39.5-42.6 E%, protein intakes 18.7-22.3 E%, and fat intakes 34.9-35.7 E%. Daily energy intake remained stable (10.1-10.3 MJ/D). Total physical activity was decreased during deployment (e.g., step count from 9,835 ± 2,743 to 8,388 ± 2,875 steps/day, p = 0.007). Skeletal muscle mass and subcutaneous fat increased by 1.3% (p = 0.019) and 1.9% (p = 0.006), respectively. Energy and fat intake associated positively with body mass and skeletal muscle mass (r = 0.31-0.48, p < 0.05-0.001). CONCLUSIONS: Carbohydrate intakes and physical activity were low, compared with the general recommendations. Protein intakes were relatively high. Skeletal muscle mass and subcutaneous fat increased. Suboptimal diet together with low level of physical activity may have a negative impact on body composition, physical performance, and cardiometabolic health. Consequently, soldiers should be encouraged to consume more fiber-rich carbohydrates and less saturated fatty acids as well as maintain a high level of physical fitness to sustain military readiness during long-term deployments.

Pessimism, diet, and the ability to improve dietary habits: a three-year follow-up study among middle-aged and older Finnish men and women.

BACKGROUND: Dietary habits have a great influence on physiological health. Even though this fact is generally recognized, people do not eat as healthily as they know they should. The factors that support a healthy diet, on the other hand, are not well known. It is supposed that there is a link between personal traits and dietary habits. Personal traits may also partially explain why some people manage to make healthy dietary changes while some fail to do so or are not able to try to make changes even when they desire to do so. There is some information suggesting that dispositional optimism plays a role in succeeding in improving dietary habits. The aim of this study was to determine the role of optimism and pessimism in the process of dietary changes. METHODS: Dispositional optimism and pessimism were determined using the revised Life Orientation Test in 2815 individuals (aged 52-76 years) participating in the GOAL study in the region of Lahti, Finland. The dietary habits of the study subjects were analysed. After 3 years, the subjects' dietary habits and their possible improvements were registered. The associations between dispositional optimism and pessimism, dietary habits at baseline, and possible changes in dietary habits during the follow-up were studied with logistic regression. We also studied if the dietary habits or certain lifestyle factors (e.g. physical exercising and smoking) at baseline predicted success in improving the diet. RESULTS: Pessimism seemed to correlate clearly negatively with the healthiness of the dietary habits at baseline - i.e. the higher the level of pessimism, the unhealthier the diet. Optimism also showed a correlation with dietary habits at baseline, although to a lesser extent. Those who managed to improve their dietary habits during follow-up or regarded their dietary habits as healthy enough even without a change were less pessimistic at baseline than those who failed in their attempts to improve their diet or did not even try, even when they recognized the need for a change. CONCLUSIONS: Pessimistic people are more likely to eat an unhealthy diet than others. Pessimism reduces independently the possibilities to improve dietary patterns.

Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity.

UNLABELLED: We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. TRIAL REGISTRATION: Clinical Trials NCT00893646.

Relationship between lifestyle behaviors and obesity in children ages 9-11: Results from a 12-country study.

OBJECTIVE: The aim was to assess associations between lifestyle behaviors and obesity in a multinational study of children from 12 countries representing a wide range of human development. METHODS: The sample included 6,025 children 9-11 years of age. Behavioral risk factors included nocturnal sleep duration, moderate to vigorous physical activity (MVPA), television viewing (TV time), and healthy and unhealthy diet pattern scores. Multilevel analyses were used to obtain odds ratios for obesity expressed per standard deviation of each behavioral risk factor. RESULTS: The odds ratios (95% confidence intervals) for obesity from multilevel, multivariable models were 0.79 (0.71-0.90) for nocturnal sleep duration, 0.52 (0.45-0.60) for MVPA, 1.15 (1.05-1.27) for TV time, 1.08 (0.96-1.20) for healthy diet score, and 0.93 (0.83-1.04) for unhealthy diet score in boys and 0.71 (0.63-0.80) for nocturnal sleep duration, 0.43 (0.35-0.53) for MVPA, 1.07 (0.96-1.19) for TV time, 1.05 (0.93-1.19) for healthy diet score, and 0.96 (0.82-1.11) for unhealthy diet score in girls. CONCLUSIONS: Behavioral risk factors are important correlates of obesity in children, particularly low MVPA, short sleep duration, and high TV viewing.

A model for presenting accelerometer paradata in large studies: ISCOLE.

BACKGROUND: We present a model for reporting accelerometer paradata (process-related data produced from survey administration) collected in the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE), a multi-national investigation of >7000 children (averaging 10.5 years of age) sampled from 12 different developed and developing countries and five continents. METHODS: ISCOLE employed a 24-hr waist worn 7-day protocol using the ActiGraph GT3X+. Checklists, flow charts, and systematic data queries documented accelerometer paradata from enrollment to data collection and treatment. Paradata included counts of consented and eligible participants, accelerometers distributed for initial and additional monitoring (site specific decisions in the face of initial monitoring failure), inadequate data (e.g., lost/malfunction, insufficient wear time), and averages for waking wear time, valid days of data, participants with valid data (≥4 valid days of data, including 1 weekend day), and minutes with implausibly high values (≥20,000 activity counts/min). RESULTS: Of 7806 consented participants, 7372 were deemed eligible to participate, 7314 accelerometers were distributed for initial monitoring and another 106 for additional monitoring. 414 accelerometer data files were inadequate (primarily due to insufficient wear time). Only 29 accelerometers were lost during the implementation of ISCOLE worldwide. The final locked data file consisted of 6553 participant files (90.0% relative to number of participants who completed monitoring) with valid waking wear time, averaging 6.5 valid days and 888.4 minutes/day (14.8 hours). We documented 4762 minutes with implausibly high activity count values from 695 unique participants (9.4% of eligible participants and <0.01% of all minutes). CONCLUSIONS: Detailed accelerometer paradata is useful for standardizing communication, facilitating study management, improving the representative qualities of surveys, tracking study endpoint attainment, comparing studies, and ultimately anticipating and controlling costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01722500.

Improving wear time compliance with a 24-hour waist-worn accelerometer protocol in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

BACKGROUND: We compared 24-hour waist-worn accelerometer wear time characteristics of 9-11 year old children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) to similarly aged U.S. children providing waking-hours waist-worn accelerometer data in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). METHODS: Valid cases were defined as having ≥4 days with ≥10 hours of waking wear time in a 24-hour period, including one weekend day. Previously published algorithms for extracting total sleep episode time from 24-hour accelerometer data and for identifying wear time (in both the 24-hour and waking-hours protocols) were applied. The number of valid days obtained and a ratio (percent) of valid cases to the number of participants originally wearing an accelerometer were computed for both ISCOLE and NHANES. Given the two surveys' discrepant sampling designs, wear time (minutes/day, hours/day) from U.S. ISCOLE was compared to NHANES using a meta-analytic approach. Wear time for the 11 additional countries participating in ISCOLE were graphically compared with NHANES. RESULTS: 491 U.S. ISCOLE children (9.92±0.03 years of age [M±SE]) and 586 NHANES children (10.43 ± 0.04 years of age) were deemed valid cases. The ratio of valid cases to the number of participants originally wearing an accelerometer was 76.7% in U.S. ISCOLE and 62.6% in NHANES. Wear time averaged 1357.0 ± 4.2 minutes per 24-hour day in ISCOLE. Waking wear time was 884.4 ± 2.2 minutes/day for U.S. ISCOLE children and 822.6 ± 4.3 minutes/day in NHANES children (difference = 61.8 minutes/day, p < 0.001). Wear time characteristics were consistently higher in all ISCOLE study sites compared to the NHANES protocol. CONCLUSIONS: A 24-hour waist-worn accelerometry protocol implemented in U.S. children produced 22.6 out of 24 hours of possible wear time, and 61.8 more minutes/day of waking wear time than a similarly implemented and processed waking wear time waist-worn accelerometry protocol. Consistent results were obtained internationally. The 24-hour protocol may produce an important increase in wear time compliance that also provides an opportunity to study the total sleep episode time separate and distinct from physical activity and sedentary time detected during waking-hours. TRIAL REGISTRATION: ClinicalTrials.gov NCT01722500 .

Longitudinal changes in functional capacity: effects of socio-economic position among ageing adults.

INTRODUCTION: Health and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socio-economic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes. METHODS: This longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926-1930, 1936-40, 1946-50) who took part in clinical check-ups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socio-economic position. Repeated-measures ANOVA was used as a main method of analysis. RESULTS: Physical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socio-economic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socio-economic position remained the same or even narrowed independent of health behaviours. CONCLUSION: Socio-economic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.