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.

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.

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.

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.

Prevalence and lifestyle determinants of central obesity in children.

PURPOSE: Central obesity is a strong risk factor for metabolic disorders and cardiometabolic diseases in children and adolescents. The aim of the present study was to evaluate the prevalence of central obesity and to determine its cross-sectional association with lifestyle habits in a sample of school-aged children in Greece. METHODS: The study sample consisted of 124,113 children (9.9 ± 1.1 years old, 51 % boys) attending the third and fifth grade of primary school. Anthropometric measurements were performed by trained physical education teachers, and central obesity was defined as waist-to-height ratio ≥0.5. Children's lifestyle habits were assessed through 7-day recall questionnaires. RESULTS: Of the participating children, 33.4 % were classified as centrally obese. Central obesity was significantly more prevalent in boys than in girls (36.0 vs. 30.7 %, P < 0.001) and was present in 95 % of obese children, as well as in a significant percentage of overweight (69.5 %) and normal-weight ones (12.0 %). Children with central obesity, compared to their non-centrally obese counterparts, reported poorer dietary habits and were less physically active. According to multiple logistic regression analysis, frequent breakfast (OR 0.72, 95 % CI 0.69-0.75) and snack consumption (OR 0.70, 95 % CI 0.67-0.74), as well as frequent participation in sedentary activities (OR 1.10, 95 % CI 1.07-1.14), were the strongest lifestyle determinants of central obesity. CONCLUSION: Strategies for the prevention of central obesity and associated comorbidities are urgently needed, for both obese and non-obese children. Our results suggest the need for a shift towards a healthier environment for our children, with emphasis on specific lifestyle habits, such as regular meal consumption and low sedentariness.

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.

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.

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.

Schoolteachers' Nutrition Knowledge, Beliefs, and Attitudes Before and After an E-Learning Program.

OBJECTIVE: Το explore teachers' nutrition knowledge, beliefs, and attitudes and to examine the effectiveness of an electronic learning (e-learning) program in teachers' nutrition knowledge. DESIGN: Cross-sectional and experimental design. SETTING: The study took place in Greece, while schoolteachers were invited by e-mail. PARTICIPANTS: Teachers of primary and secondary education, with no exclusion criteria, were enrolled in the study between March, 2015 and 2016. MAIN OUTCOME MEASURES: Schoolteachers' nutrition knowledge, beliefs, and attitudes. INTERVENTION: Teachers completed a 36-item nutrition questionnaire and then a subgroup participated in an e-learning program. After the intervention, teachers completed the same questionnaire. ANALYSIS: Principal component analysis and multivariate logistic regression were used for data analysis. RESULTS: A total of 1,094 teachers completed the questionnaire; 619 participated in the e-learning program. Teachers showed moderate nutrition knowledge scores (ie, 65% correct answers) before the intervention, whereas their attitudes regarding acting as role models and their belief in the importance of the role of nutrition were associated with 74% (odds ratio, 1.28; 95% confidence interval, 1.13-1.45) and 79% (odds ratio, 1.21; 95% confidence interval, 1.07-1.37) increased possibility of having good nutrition knowledge, respectively. The e-learning program was effective in strengthening teachers' nutrition knowledge (P < .001) and improving their beliefs and attitudes (P < .05). CONCLUSIONS AND IMPLICATIONS: Future research is needed to validate the current results, which can be used to design and implement similar educational programs to teachers as a means of creating health-promoting schools.

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.

Association of Anthropometric and Lifestyle Parameters with Fitness Levels in Greek Schoolchildren: Results from the EYZHN Program.

OBJECTIVE: The aim of the study was to evaluate physical fitness (PF) and identify its anthropometric and lifestyle determinants in a sample of Greek schoolchildren. METHODS: The study sample consisted of 335,810 schoolchildren (♂: 51.3%, 6-18 years old). Students' anthropometric parameters and PF levels-assessed via the Eurofit test battery-were measured by trained physical education teachers and evaluated according to the available norms, while their lifestyle habits were assessed through a questionnaire. RESULTS: In all applied PF tests, students' performance was negatively associated with the presence of obesity and central obesity, defined through international criteria for body mass index and waist to height ratio, respectively. According to multiple logistic regression analysis, the presence of overweight/obesity [odds ratio (OR): 4.43, 95% confidence interval (CI): 3.98-4.93], low adherence to the MD (KIDMED ≤ 3) (OR: 1.27, 95% CI: 1.09-1.48), and increased time spent in sedentary activities (>2 h per day) (OR: 1.16, 95% CI: 1.03-1.29) were positively associated with poor PF, after adjusting for age and sex. In contrast, for every 1 day increase in the weekly frequency of engagement in athletic activity, the probability of poor PF decreased by 26% (OR: 0.74, 95% CI: 0.72-0.77). In a similar model, the presence of central obesity emerged as an even stronger possible predictor of poor PF (OR: 5.20, 95% CI: 4.66-5.78), compared to the presence of general obesity. CONCLUSION: Higher general or abdominal adiposity, as well as the adoption of a low-quality diet and a sedentary lifestyle, is strongly associated with low PF levels during childhood.

Elevated total and central adiposity and low physical activity are associated with insulin resistance in children.

The aim of this study was 2-fold: (1) to examine insulin resistance, blood lipid levels, and inflammatory markers in 9- to 11.5-year-old obese and lean children and (2) to identify factors that influence insulin resistance in this cohort of youths. Body mass index, skinfold thickness, waist circumference, physical activity (4-day triaxial accelerometer), cardiorespiratory fitness (submaximal bicycle ergometer test), and dietary intake (3-day food records) were evaluated in 27 obese and 27 lean boys and girls. Fasting blood samples were analyzed for insulin, glucose, lipids and lipoproteins, C-reactive protein (CRP), interleukin 6, soluble intercellular adhesion molecule, and soluble vascular cell adhesion molecule. Homeostasis model assessment (HOMA) was used to evaluate insulin resistance (HOMA-IR). Obese children presented higher HOMA-IR, CRP, and blood lipid levels (all P < .01) compared with lean children. Total body fat and waist circumference were positively associated with fasting insulin (r > or = 0.51), HOMA-IR (r > or = 0.56), CRP (r > or = 0.51), and blood triacylglycerol (r > or = 0.38), and were inversely correlated with high-density lipoprotein cholesterol (r > or = -0.39; all P < .01). Cardiorespiratory fitness was inversely associated with HOMA-IR (r = -0.24; P < .05), but this association disappeared when adjusted for age, sex, and fat mass. Waist circumference and total daily physical activity explained 49% of the variance in HOMA-IR in these children. In conclusion, these findings suggest that total and central adiposity are positively associated and physical activity is negatively associated with insulin resistance in children. Interventions to improve glucose metabolism in youth should target at reducing total body and abdominal fat and increasing physical activity. The lack of association between inflammatory markers and HOMA-IR suggests that obesity may precede the elevation of these markers in the evolution of insulin resistance in youth.

Physical fitness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method.

The aim of the this study was to establish age- and gender-specific physical fitness normative values and to compare percentiles and Z scores values in a large, nationwide sample of Greek children aged 6-18 years. From March 2014 to May 2014, a total of 424,328 boys and girls aged 6-18 years who attended school in Greece were enrolled. The studied sample was representative, in terms of age-sex distribution and geographical region. Physical fitness tests (i.e. 20 m shuttle run test (SRT), standing long jump, sit and reach, sit-ups, and 10 × 5 m SRT) were performed and used to calculate normative values, using the percentiles of the empirical distributions and the lambda, mu, and sigma statistical method. Normative values were presented as tabulated percentiles for five health-related fitness tests based on a large data set comprising 424,328 test performances. Boys typically scored higher than girls on cardiovascular endurance, muscular strength, muscular endurance, and speed/agility, but lower on flexibility (all p values <0.001). Older boys and girls had better performances than younger ones (p < 0.001). Physical fitness tests' performances tended to peak at around the age of 15 years in both sexes. The presented population-based data are the most up-to-date sex- and age-values for the health-related fitness of children and adolescents in Greece and can be used as standard values for fitness screening and surveillance systems and for comparisons among the same health-related fitness scores of children from other countries similar to Greece. Schools need to make efforts to improve the fitness level of the schoolchildren through the physical education curriculum to prevent cardiovascular risk.

Inverse but independent trends in obesity and fitness levels among Greek children: a time-series analysis from 1997 to 2007.

OBJECTIVE: We examined secular trends in physical fitness and BMI status in 8- to 9-year-old Greek children during an 11-year period (1997-2007). METHODS: Population data derived from a yearly health survey performed in over 85% of Greek schools. Anthropometric measurements and physical fitness tests from 651,582 children were analyzed. The gender- and age-specific BMI cut-off points by the International Obesity Task Force were used to define overweight/obesity. RESULTS: Aerobic performance decreased by 4.9% (p < 0.001) for boys and 4.4% (p < 0.001) for girls between 1997 and 2007 while obesity increased by approximately 50% in both genders (p < 0.001). Time-series analyses revealed that the increasing trends in obesity were independent of the reduction in fitness levels. An increase from 21% in 1997 to 48.2% in 2007 was observed in the prevalence of the low quartile of aerobic performance for girls (p < 0.001) and from 25.7% in 1997 to 38.7% in 2007 (p < 0.001) for boys. Approximately 80% and 85% of obese boys and girls, respectively, failed to pass the low quartile of all aerobic tests in 2007. CONCLUSIONS: Inverse but independent trends in obesity and fitness levels were observed among Greek children during an 11-year period (1997-2007), a fact that predisposes our children to serious health risks as they grow older.

Short-term predictors of abdominal obesity in children.

BACKGROUND: The aim of this study was to examine the short-term tracking of abdominal adiposity in children. METHODS: A total of 918 children (477 boys) aged 6-12 years at baseline were followed-up for 2 years. Central obesity was assessed by waist circumference (WaistC), whereas body fat distribution by waist-to-hip ratio. Maturity was assessed by the Khamis-Roche method. Parental fatness and children's cardiorespiratory fitness (CRF) were also evaluated. Multiple and logistic regressions were employed to identify the predictors of BMI and WaistC. RESULTS: Tracking of body fatness and body fat distribution was high (r = 0.69-0.86, P < 0.01). More boys remained obese than girls (P < 0.05), whereas a greater percentage of boys moved to a higher quartile of WaistC after the 2-year follow-up (22.0 vs 14.1%, P < 0.01). Sex, child's maturity and WaistC at baseline, CRF, and maternal BMI explained 76% of the variability in BMI and WaistC at the follow-up (n = 290). Children with high WaistC at baseline and low CRF presented 1.9- and 4.3-fold increased risk of remaining in the upper quartile of WaistC at the follow-up (P < 0.01; n = 552). CONCLUSION: Youth with increased WaistC at baseline and low CRF presented an increased chance of maintaining central obesity at the follow-up. More boys than girls moved into a higher quartile of abdominal obesity during the 2-year follow-up period and this should be taken into account in designing programmes for childhood obesity.