Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity.

BACKGROUND: Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used. METHODS: To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring. RESULTS: Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired. CONCLUSION: Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript.

Recommendations for obesity prevention among adolescents from disadvantaged backgrounds: a concept mapping study among scientific and professional experts.

The present study aimed to enrich the scientific evidence on obesity prevention programmes for adolescents from socio-economically disadvantaged backgrounds with practice-based experiences from both scientific and professional experts in the field of youth obesity prevention. We used the participatory method of concept mapping. Two concept mapping sessions were conducted: one with programme coordinators of national/regional obesity prevention programmes across Europe (n = 8) and one with scientists participating in European obesity prevention projects (n = 5). Five recommendations were extracted from both concept maps: (1) involve adolescents in the design and delivery of the programme, (2) invest in family/parental capacity building, (3) provide and support a healthy school food and physical activity environment, (4) regulate exposure to unhealthy messages/advertising and (5) facilitate safe and active travel. These recommendations can be used as a conceptual framework for programme development for preventing obesity in adolescents.

Downward trends in the prevalence of childhood overweight in two pilot towns taking part in the VIASANO community-based programme in Belgium: data from a national school health monitoring system.

BACKGROUND: Multilevel approaches involving environmental strategies are considered to be good practice to help reduce the prevalence of childhood overweight. OBJECTIVES: The objective of this study was to evaluate the effects of VIASANO, a community-based programme using the EPODE methodology, on the prevalence of overweight in two pilot towns in Belgium. METHODS: We analysed data from a national school health monitoring system to compare changes in the prevalence of overweight and obesity over a 3-year period (2007-2010) in children aged 3-4 and 5-6 years in the pilot towns with those of children of the same ages from the whole French-speaking community of Belgium. Heights and weights of all participants were measured by trained school nurses using a standardized method. RESULTS: The prevalence of overweight (-2.1%) and overweight + obesity (-2.4%) decreased in the pilot towns, but remained stable in the comparison population (+0.1% and +0.2%, respectively). After adjustment for lack of homogeneity between the study populations, there was a trend towards a decrease in overweight (P = 0.054) and overweight + obesity (P = 0.058) in the pilot towns compared with the general population. CONCLUSIONS: These results suggest that a community-based programme, such as VIASANO, may be a promising strategy for reducing the prevalence of childhood overweight even over a short period of time.

EPODE - A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities.

Obesity is a global epidemic: it is estimated that the majority of the world's adults will be overweight or obese by 2030. It is therefore important to reverse trends towards increasing childhood obesity by interventions at the community level. Ensemble Prévenons l'obésité Des Enfants (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multi-stakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.

Characterizing the EPODE logic model: unravelling the past and informing the future.

EPODE ('Ensemble Prévenons l'Obésité De Enfants' or 'Together let's Prevent Childhood Obesity') is a large-scale, centrally coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. Since 2004, EPODE has been implemented in over 500 communities in six countries. Although based on emergent practice and scientific knowledge, EPODE, as many community programs, lacks a logic model depicting key elements of the approach. The objective of this study is to gain insight in the dynamics and key elements of EPODE and to represent these in a schematic logic model. EPODE's process manuals and documents were collected and interviews were held with professionals involved in the planning and delivery of EPODE. Retrieved data were coded, themed and placed in a four-level logic model. With input from international experts, this model was scaled down to a concise logic model covering four critical components: political commitment, public and private partnerships, social marketing and evaluation. The EPODE logic model presented here can be used as a reference for future and follow-up research; to support future implementation of EPODE in communities; as a tool in the engagement of stakeholders; and to guide the construction of a locally tailored evaluation plan.

EPODE approach for childhood obesity prevention: methods, progress and international development.

Childhood obesity is a complex issue and needs multi-stakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. 'Ensemble Prévenons l'Obésité Des Enfants' (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input--drawing on the evidence-base--together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge.

Contribution of social marketing strategies to community-based obesity prevention programmes in children.

OBJECTIVES: To review child and adolescent obesity prevention programmes to determine whether they have included the Social Marketing Benchmark Criteria (BC). In addition, we analysed whether there was a relationship between the presence of the criteria and the effectiveness of the programme. METHODS: Interventions had to be aimed at preventing obesity through behaviour changes relating to diet, physical activity, lifestyle and social support, separately or in combination. A total of 41 interventions were identified in PubMed and Embase that fulfilled the inclusion criteria. RESULTS: The more recent the studies, the greater the number of the BC that seem to have been used. However, regarding behaviour changes, we found the most effective period to be 1997-2002, with 100% of the interventions resulting in behaviour changes (9/9). In addition, almost all interventions resulted in improvements in body composition variables: 5 of 6 for body mass index or overweight/obesity prevalence and 6 of 6 for skin-folds. CONCLUSIONS: The presence of a higher number of BC does not assure higher effectiveness. Further research is required in this field. At the moment, studies aimed at preventing obesity in children and adolescents have not included social marketing aspects in their interventions in a comprehensive manner.

Reproducibility and relative validity of a food-frequency questionnaire among French adults and adolescents.

OBJECTIVE: Our aim was to evaluate the reproducibility of a food-frequency questionnaire (FFQ) developed in a French population, and its validity against four 24-h dietary recalls (24-HRs). METHODS: A total of 57 adults (aged 18-63), 17 adolescents (aged 14-18) and 20 children (aged 10-14) completed four 24-HRs (one per season) and two FFQs over a 1-year interval. Reproducibility of the FFQ was estimated by intraclass correlation coefficients (ICCs). The validity of FFQ was assessed by comparison with the four 24-HRs. RESULTS: For most nutrients, the first FFQ measurements gave higher mean values than the second FFQ. The ICCs for nutrients ranged from 0.39 for total protein to 0.83 for alcohol. The ICCs were higher for food items consumed daily such as milk (0.80) or sugars and confectionery (0.65), and lower for rarely eaten food such as inner organs (0.11). Nutrient intakes as assessed by FFQs were higher than those from the 24-HRs, except for alcohol. The de-attenuated Pearson's correlation coefficient for nutrients varied from 0.25 (dietary fiber) to 0.90 (alcohol), but the adjustment for energy did not improve these coefficients. When nutrient intakes were categorized into quintiles, FFQ and 24-HRs produced agreement rates (same or adjacent quintile) between 55% (for PUFA) and 95% (for alcohol), while misclassification to an extreme quintile was rare (<5%). CONCLUSION: The FFQ developed for the FLVS II Study can be used to classify adults or adolescents according to their nutrients and food intakes over a 1-year period.

High plasma leptin predicts an increase in subcutaneous adiposity in children and adults.

OBJECTIVE: To investigate the hypothesis that plasma leptin may predict adiposity changes. DESIGN: A population-based cohort study. SETTING: Fleurbaix and Laventie, in the north of France. SUBJECTS: In all, 1175 subjects participated, of whom 946 completed measurements at baseline (1999) and follow-up (2001). After excluding 64 subjects obese at baseline, 882 subjects (478 adults, 404 children 8 years and over) were included in the analysis. INTERVENTIONS: We measured plasma leptin concentrations at baseline and various adiposity parameters at baseline and follow-up. Partial correlation coefficients (r(p)) between baseline plasma leptin and each adiposity indicator at follow-up were calculated with adjustment for baseline age, pubertal stage, adiposity and familial correlations between siblings. RESULTS: Changes in body mass index and percentage body fat were not related to baseline plasma leptin. High baseline plasma leptin predicted an increase (r(p) (P-value)) in the sum of the four skinfolds (0.18 (<0.0001)), the waist circumference (0.16 (0.0003)) and the waist-to-hip ratio (0.29 (<0.0001)) in adults only, and in the hip circumference in adults (0.20 (<0.0001)) and children (0.22 (<0.0001)). After adjustment for a set of four adiposity variables at baseline (percentage body fat, skinfolds, waist and hip circumferences), baseline plasma leptin predicted only changes in the sum of the four skinfolds in adults (0.15 (0.001)), with similar tendency although not significant in children (0.08 (0.13)). CONCLUSIONS: A high leptin relative to baseline fat mass predicts fat mass gain over time, mainly in the subcutaneous location.

Growth curves of anthropometric indices in a general population of French children and comparison with reference data.

BACKGROUND: The description of growth patterns of the different anthropometric measurements mainly used in epidemiological studies is useful to better understand the development of obesity in children and its consequences. OBJECTIVE: Our aim was to establish growth curves of anthropometric indices in a general population of French children born during the 1980s and to compare them with the French reference curves based on children born in the 1950s. DESIGN: As part of the Fleurbaix Laventie Ville Santé Studies I and II (FLVS), 441 girls and 467 boys were examined at least twice between 1993 and 2001. Height, weight and four skinfold thicknesses were measured. Body mass index (BMI), sum of peripheral and truncal skinfolds and truncal-to-peripheral ratio were calculated. Mean growth curves from ages 5 to 17 years were assessed for these indices, calculating means and 95% confidence interval per 1 year age group and by gender. RESULTS: Trajectories with age differed importantly according to the index considered; BMI was the one with the smallest difference between genders and the most linear shape with age. From the age of 5 years and after, the FLVS children were on average taller and had a higher subcutaneous adiposity than children born 30 years earlier. Truncal-to-peripheral ratio was higher in our population; this difference became more marked with puberty in girls. DISCUSSION: This study suggests the existence of a secular trend towards a precocious accelerated growth, and a more truncal adiposity distribution, especially in girls. It is a disquieting trend considering its expected consequences on adult health.

Reliability of bioimpedance analysis compared with other adiposity measurements in children: the FLVS II Study.

OBJECTIVE: To evaluate the reproducibility of the measurement of% body fat by bipedal biometrical impedance analysis (BIA) compared with anthropometric measurements of adiposity in children and the correlations between these methods in children and adults. METHODS: A cross-sectional study in a total of 1080 adults and children enrolled in 1999 in the Fleurbaix-Laventie Ville Santé II (FLVS II) population-based study in northern France. The reproducibility of anthropometrical and BIA methods was determined by a nested analysis of variance of repeated measurements by 2 investigators and a bipedal BIA device (Tanita TBF 310) in 64 pupils of two 5th grade classes. The correlation of BIA and anthropometric adiposity measurements with the unknown relative fat mass or volume of the body estimated by a latent adiposity variable (LAV) was established by the triads' method in 1080 subjects of the FLVS II cohort. RESULTS: The reproducibility was similar for the sum of skinfolds, waist circumference and BIA% fat measurements (intraclass correlation coefficients: 0.979-0.992). Correlation coefficient between BIA body fat% and the LAV was higher than 0.86 in all sex and Tanner stage related groups, and similar in children and adults, except in pubertal boys (0.76). CONCLUSION: With a high level of reproducibility, foot-to-foot BIA analysis provides a valuable measurement of total% fat for epidemiologic studies in children. However further studies are needed before extrapolating these results to overweight children.

Changes in physical activity explain paradoxical relationship between baseline physical activity and adiposity changes in adolescent girls: the FLVS II study.

OBJECTIVE: To investigate in adolescents relationships between habitual physical activity (PA) and changes in several indicators of adiposity. DESIGN: Longitudinal population-based study. The Fleurbaix-Laventie Ville Sante II (FLVS II) study in Northern France. SUBJECTS: A total of 222 boys and 214 girls aged 8-18 y, not obese at inclusion. MEASUREMENTS: PA (Modifiable Activity Questionnaire) and adiposity (body mass index (kg/m2), percent body fat by bioimpedance analysis, sum of four skinfolds, waist circumference) were assessed in 1999 and 2001. Adiposity indicators adjusted for age and pubertal stage were compared between groups of baseline PA and between groups of PA changes, separately by sex. RESULTS: At baseline, PA was not associated with adiposity indicators in both sexes. In girls only, being in the group with the highest age-relative level of moderate PA at baseline predicted the highest adiposity gain from baseline to follow-up, for all indicators. After adjustment for baseline values, all adiposity indicators were higher at follow-up in girls who had decreased their relative level of moderate PA during follow-up. In boys, changes in adiposity during follow-up were not significantly different across groups of PA changes. However, the sum of skinfolds at follow-up, adjusted for baseline value, tended to be higher in those who decreased their vigorous PA level and lower in those who increased it. CONCLUSION: In adolescent girls, a decrease in PA rather than inactivity per se may result in increased adiposity over time.

Anthropometric relationships between parents and children throughout childhood: the Fleurbaix-Laventie Ville Santé Study.

BACKGROUND: The study of parent-child anthropometric relationships and their evolution over time may help to better understand familial risk factors for childhood obesity. METHODS: In a population-based cohort of 124 nuclear families (Fleurbaix-Laventie Ville Santé Study (FLVS) I and II), various anthropometric parameters were measured in both parents and their children, first when the children were prepubescent and again at the end of puberty. Troncular adiposity repartition was estimated by calculating troncular to peripheral skinfolds ratio and waist-to-hip circumferences ratio. Birth and infancy heights and weights were also obtained from the children's health booklets. Parent-child correlations were estimated in infancy, before and at the end of the child's puberty. A prospective analysis was performed to predict the changes in the children's measurements over puberty according to their parents' corresponding baseline values. RESULTS: BMI and weight correlations at birth were high (>0.30) with the mother and low (<0.10) with the father, then they converged to an intermediate level at 2 y and remained between 0.2 and 0.3 thereafter. Correlations for waist circumference were already present at the prepubertal period and persisted on the same level at the postpubertal period, whereas correlations for subcutaneous adiposity - measured by four skinfolds - and for adiposity distribution - measured by ratios - were higher at the postpubertal period. Moreover, the prospective approach showed that mother's BMI predicted the evolution of her children's BMI over puberty, whereas this relationship was observed more specifically with the father concerning adiposity distribution parameters. CONCLUSION: Maternal adiposity may act early in life on the adiposity of the child. Maternal and paternal adiposities seem to have quite distinct effects at two key periods of the child's adiposity development such as the prenatal and pubertal periods.

Relationships between physical activity and plasma leptin levels in healthy children: the Fleurbaix-Laventie Ville Santé II Study.

OBJECTIVE: To study the relationships between physical activity and plasma leptin levels in children from a population-based study, taking into account puberty stages. DESIGN: Subjects were part of the Fleurbaix-Laventie Ville Santé (FLVS) II Study, a longitudinal study on the determinants of weight gain in children and their parents. At baseline examination, 253 girls and 257 boys aged 8-18 y were examined. MEASUREMENTS: : Height and weight were measured, adiposity was assessed by the sum of four skinfold thicknesses (SSK). Pubertal stage was assigned according to Tanner. Leisure-time physical activity (LTPA) was assessed by the Modifiable Activity Questionnaire and ambulatory activity by pedometer recording over a week. A fasting blood sample was obtained to determine plasma leptin and insulin levels. RESULTS: Plasma leptin was higher in girls compared to boys (8.3 (1.6-36.5) ng/ml vs 2.2 (0.1-15.3) ng/ml, P<0.001). Multivariate analyses were performed with leptin as dependent variable, and number of steps by day, Tanner stage, insulin and SSK as independent variables. In girls, leptin was negatively correlated to number of steps/day (P<0.001) and positively to SSK (P<0.001) and insulinemia (P<0.001). In boys, leptin was correlated to insulinemia (P<0.001), SSK (P<0.001), Tanner stage (P<.0001), but not to physical activity. CONCLUSION: Physical activity is negatively related to leptin levels in girls only and this association is independent of fasting plasma insulin. In children, fasting insulinemia remains associated with leptin levels after taking into account adiposity, physical activity and Tanner stage.

Time trend in height, weight, and obesity prevalence in school children from Northern France, 1992-2000.

OBJECTIVE: The aim of this study was to evaluate the changes in height, weight and in the prevalence of overweight and obesity between 1992 and 2000 in children living in two towns of northern France. METHODS: Two cross-sectional studies were performed in every pre-school (last section) and primary schools of the two towns in 1992 (383 girls and 421 boys enrolled) and 2000 (296 girls and 305 boys). Children were 5 to 12 year old in both studies. MEASUREMENTS: Body height and weight were measured, and BMI was calculated (weight/height(2)). Prevalence of overweight and obesity was determined according to the gender- and age- specific cut-offs of the new international reference (IOTF). We also used the 90(th) and the 97(th) percentiles of the French reference gender- and age-specific BMI curves to define two grades of overweight. RESULTS: After adjustment for age, boys were on average 1.5 cm taller in 2000 than in 1992 (p<0.001), and the same trend was observed in girls (+ 0.9 cm, p<0.075). Height-adjusted or age-adjusted weight and BMI were significantly higher in 2000 than in 1992. In girls, obesity defined by IOTF criteria increased from 1.6 to 4.4% (p<0.03) and overweight from 14.1 to 18.6% (p<0.11). In boys, the change in prevalences was significant only when the less stringent criteria (i.e. the 90(th) percentile of French references) was used (13.8% in 1992 vs 20% in 2000, p=0.03). CONCLUSION: Over an 8 years period, there was an increase in height and BMI in both boys and girls. These results show that the increase in the prevalence of obesity is accompanied by a global trend of accelerated growth.

[Dietary intake assessments: for who? why?]. / Les enquêtes alimentaires: pour qui? Pourquoi?

The use of dietary intake assessment and questionnaires in clinical practice is largely debated, particularly for obese patients. The time needed to carry out them is very long, and the results are little or not at all workable due to the underreporting which may represent up to 50% of intakes for some patients. The usual methods and tools to evaluate dietary intakes are presented, they should not be used to calculate energy intake, but they permit to initiate a dialogue with the patient on his/her dietary pattern. The analysis of the dietary pattern is the first step in diet prescription and is essential to weight management and follow-up. This analysis must consider 3 important components: type of food usually eaten and preferred, the circumstances and environment of food intakes and meals, possible disorders of eating behaviour. Some results on food consumption in adults and children from the Fleurbaix Laventie Ville Santé Study are presented.

Gender differences in the relation between food cravings and mood in an adult community: Results from the fleurbaix laventie ville santé study.

OBJECTIVE: The aim of this survey was to study food cravings and its indulgence in community adults (538 women and 506 men) and to compare nutritional parameters, weight preoccupations, and weight history between cravers and noncravers. METHOD: Cravers experienced a strong urge to eat specific foods more than once a week during the past 6 months. Food intake was estimated by a 3-day food record. RESULTS: 28% of women and 13% of men were food cravers. Cravers, especially women, were more frequently concerned about their weight than noncravers. Energy intake during snacks was higher in cravers. Less than 40% of cravers reported being hungry when they experienced cravings. Women cravers indulged their cravings as often as men. They reported more frequently negative feelings, whereas men reported more frequently positive feelings. DISCUSSION: This study shows that food craving episodes are strongly associated with mood but in a different way in women and men.

Macronutrient energy intake and adiposity in non obese prepubertal children aged 5-11 y (the Fleurbaix Laventie Ville Santé Study).

OBJECTIVE: To investigate associations between adiposity indices and food intake in nonobese prepubertal free-living children. SUBJECTS: Five-hundred and one children, 280 boys and 221 girls aged 5-11 y in two little towns in northern France. DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: Height and weight, four skinfolds (biceps, triceps, subscapular, suprailiac), waist and hip girths, were measured. Sum of skinfolds (SSF), body mass index (BMI), and relative weight (RW) were calculated. Energy intake (EI), percentage of energy intake ascribed to carbohydrates (%EIC), complex carbohydrates (%EICC), fats (%EIF), saturated fats (%EISF) and proteins (%EIP) were assessed by a single 24 h record. Basal metabolic rate (BMRI was estimated according to Schofield's equations. Obese (RW > or = 120%), and underreporting children according to Goldberg's and Black's equations were excluded. RESULTS: In multiple linear regressions analyses performed with hierarchical mixed models, adiposity indices were significantly and inversely associated in girls with %EIC (all P-values < 0.02), and positively with %EIF (all P-values < 0.05, waist girth and BMI excepted). Similar but non-significant trends were observed in boys. The relationships were not linear, and thresholds close to current dietary recommendations were highlighted. When %EIF was low, a lower percentage of energy intake ascribed to %EISF was associated with thinness. These associations remained after the exclusion of children who had an EI/BMR > or = 1.50. CONCLUSIONS: In nonobese prepubertal children aged 5-11 y, a high %EIC, close to dietary recommendations (> or = 55%), was associated with thinness. A high %EIF, over the upper dietary recommendation (< or = 35%), was associated with a greater adiposity thickness. There was no further increase in adiposity beyond this threshold. Reasons for the absence of a linear relationship pattern between adiposity and macronutrient intake remain to be determined.

[Nutritional information for children to modify the food habits of the whole family]. / L'information nutritionnelle des enfants pour modifier les habitudes alimentaires de toute la famille.

The prevention of weight gain and cardiovascular diseases is probably easier, less expensive and more effective than treating these diseases after they have fully developed. The hypothesis of a prospective intervention study in northern France, the "Fleurbaix Laventie Ville Santé Study" is that nutritional education of children aged 6-12 years at school may not only improve their nutritional knowledge but also influence the dietary habits of the family. We have conducted an information program in school for these children and made an evaluation of the educational program used in this study and the modification of the dietary habits. The first results indicate a better nutritional knowledge in children of Fleurbaix and Laventie versus control children. The families have better dietary habits consuming less fat, more carbohydrates. In women the BMI is less important in Fleurbaix and Laventie compared with the control subjects. This study is on going with a 10 year-follow up taking into account the spontaneous evolution in a control town.

Infant-feeding patterns are related to blood cholesterol concentration in prepubertal children aged 5-11 y: the Fleurbaix-Laventie Ville Santé study.

OBJECTIVE: Several studies, mainly in animals, but also in humans, have shown that diet in infancy is associated with differences in blood cholesterol concentrations later in life. The objective was to examine this relationship in children aged 5-11 y after taking into account their current diet and parental hypercholesterolemia. SETTING AND SUBJECTS: 251 prepubertal boys and 223 prepubertal girls enrolled in the schools in two little towns in northern France. DESIGN AND METHODS: Cross-sectional evaluation including measurements of cholesterol concentrations on capillary blood and a single weekday food intake record. Infant feeding patterns were obtained by questionnaire given to the mothers. RESULTS: 50% of the children had been breast-fed for a median duration of less than 2 months. Cow's milk was introduced in the diet as whole milk for 33% of the children. After adjustment for age, height, and sibship, capillary cholesterol concentration was lower in boys who had been breast fed (geometric mean: 4.4, 95% confidence interval of the mean: 4.2-4.6 mmol/L) than in those fed with formula (4.7, 4.5-4.8 mmol/L, P<0.03). In girls, breastfeeding had no significant effect on blood cholesterol concentration, which was associated with the type of cow's milk given in infancy: whole milk: 4.9 mmol/L (4.7-5. 2); totally or partially skimmed milk: 4.5 mmol/L (4.2-4.6), P<0.008. The current saturated fat and cholesterol intakes and parental hypercyholesterolemia were associated with current blood cholesterol concentration in children, but did not modify its relationship with infant feeding patterns. CONCLUSION: Results of the present study suggest that diet in infancy may have longstanding effect on lipid metabolism. SPONSORSHIP: The study was supported by funds from Eridania Béghin-Say, Groupe Fournier, Lesieur and Nestlé France, Roche Diagnostic and of the MGEN (Mutuelle Générale de l'Education Nationale, contract INSERM-MGEN #9158) and a grant from the Association de Langue Française pour l'Etude du Diabète et du Métabolisme (ALFEDIAM). European Journal of Clinical Nutrition (2000) 54, 114-119