Individual and family environmental correlates of television and computer time in 10- to 12-year-old European children: the ENERGY-project.

BACKGROUND: The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway). METHODS: Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child-parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age. RESULTS AND DISCUSSION: In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway. CONCLUSIONS: Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children's individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country.

Evaluation of the UP4FUN intervention: a cluster randomized trial to reduce and break up sitting time in European 10-12-year-old children.

BACKGROUND: The UP4FUN intervention is a family-involved school-based intervention aiming at reducing and breaking up sitting time at home (with special emphasis on screen time), and breaking up sitting time in school among 10-12 year olds in Europe. The purpose of the present paper was to evaluate its short term effects. METHODOLOGY/PRINCIPAL FINDINGS: A total of 3147 pupils from Belgium, Germany, Greece, Hungary and Norway participated in a school-randomized controlled trial. The intervention included 1-2 school lessons per week for a period of six weeks, along with assignments for the children and their parents. Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry. The effect of the intervention on these behaviors was evaluated by multilevel regression analyses. All analyses were adjusted for baseline values and gender. Significance level was p≤0.01. No significant intervention effects were observed, neither for self-reported TV/DVD or computer/game console time, nor for accelerometer-assessed total sedentary time and number of breaks in sitting time. The intervention group, however, reported more positive attitudes towards (ß = 0.25 (95% CI 0.11, 0.38)) and preferences/liking for (ß = 0.20 (95% CI 0.08, 0.32)) breaking up sitting time than the control group. CONCLUSIONS/SIGNIFICANCE: No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed, but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group. Overall, these results do not warrant wider dissemination of the present UP4FUN intervention. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Registry ISRCTN34562078.

The role of family-related factors in the effects of the UP4FUN school-based family-focused intervention targeting screen time in 10- to 12-year-old children: the ENERGY project.

BACKGROUND: Screen-related behaviours are highly prevalent in schoolchildren. Considering the adverse health effects and the relation of obesity and screen time in childhood, efforts to affect screen use in children are warranted. Parents have been identified as an important influence on children's screen time and therefore should be involved in prevention programmes. The aim was to examine the mediating role of family-related factors on the effects of the school-based family-focused UP4FUN intervention aimed at screen time in 10- to 12-year-old European children (n child-parent dyads = 1940). METHODS: A randomised controlled trial was conducted to test the six-week UP4FUN intervention in 10- to 12-year-old children and one of their parents in five European countries in 2011 (n child-parent dyads = 1940). Self-reported data of children were used to assess their TV and computer/game console time per day, and parents reported their physical activity, screen time and family-related factors associated with screen behaviours (availability, permissiveness, monitoring, negotiation, rules, avoiding negative role modeling, and frequency of physically active family excursions). Mediation analyses were performed using multi-level regression analyses (child-school-country). RESULTS: Almost all TV-specific and half of the computer-specific family-related factors were associated with children's screen time. However, the measured family-related factors did not mediate intervention effects on children's TV and computer/game console use, because the intervention was not successful in changing these family-related factors. CONCLUSION: Future screen-related interventions should aim to effectively target the home environment and parents' practices related to children's use of TV and computers to decrease children's screen time. TRIAL REGISTRATION: The study is registered in the International Standard Randomised Controlled Trial Number Register (registration number: ISRCTN34562078).

Meat supplementation increases arm muscle area in Kenyan schoolchildren.

The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled feeding intervention study was designed with three isoenergetic feeding interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0.05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.

Body fat percentiles for German children and adolescents.

OBJECTIVE: The aim of this study was to define body fat percentiles for German children and adolescents aged 3-16 years using the largest German database. METHODS: The study population included 11,632 girls and 11,604 boys. Data were pooled from: i) Kiel Obesity Prevention Study (KOPS), acquisition period: 1996-2008, n = 12,237; ii) 'Better diet. More exercise. KINDERLEICHT-REGIONS', acquisition period: 2007, n = 9,405; and iii) examination of Jena schoolchildren, acquisition period: 2005, n = 1,594. Body fat mass was measured by bioelectrical impedance analysis using a population-specific algorithm. Data were weighted to achieve a representative sample for Germany. Percentile curves were constructed by the LMS method and proved by Worm plots and Q-statistic. RESULTS: In both genders, the higher body fat percentile curves sloped downwards to age 7 years, whereas the lower percentiles declined up to 8.5 years. Thereafter fat mass remained nearly constant with age in boys and increased in girls. The 10th percentile achieved a minimum of 10-11% body fat in both genders, whereas the 90th percentile curve fluctuated between 29 and 44% in boys or 30-43% in girls. The association between fat mass and blood pressure was too weak to define disease-related cut-offs. CONCLUSION: These body fat percentiles are suitable reference values for German children and adolescents.

Designing snacks to address micronutrient deficiencies in rural Kenyan schoolchildren.

Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy.

Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children.

A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githeri as a midmorning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milk and Control groups (P < 0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat- vs. milk- vs. plant-based snacks on functional outcomes in children.

The potential of increased meat intake to improve iron nutrition in rural Kenyan schoolchildren.

Schoolchildren in developing countries often have inadequate intakes of iron, due primarily to poor bioavailability. Increasing meat in the diet could improve both the amount of iron consumed and its availability. The effect of increases in intakes of meat and ascorbic acid on absorbed iron was investigated by theoretically modifying the habitual diet of rural Kenyan schoolchildren. The projected changes in the amount of absorbed iron and prevalence of inadequate iron intakes were calculated for 78 children (6-9 years of age). The prevalence of inadequate iron intakes decreased from 77% to 54% through the theoretical addition of 50 g beef or 100 mg ascorbic acid and to 23% through the addition of both to dinner each day. To reduce the prevalence of inadequate iron intake to 5%, the addition of 100 g meat plus 150 mg ascorbic acid would be necessary. The combined addition of meat and ascorbic acid to a meal has the potential to reduce the projected prevalence of inadequate iron intakes among these schoolchildren.

Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children.

Observational studies have shown that children in developing countries consuming diets containing high amounts of bioavailable nutrients, such as those found in animal-source foods, grow better. The present study investigated which specific nutrients from the diet of Kenyan school children predicted their growth. The children (n 544, median age 7 years) participated in a 2-year long food supplementation study with animal-source foods. Height gain during the intervention period was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Weight gain was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Gain in mid-upper-arm muscle area was positively predicted by average daily intakes of energy from animal-source foods and vitamin B12. Gain in mid-upper-arm fat area was positively predicted by average daily intakes of energy from animal-source foods. Gain in subscapular skinfold thickness was not predicted by any of the nutrient intakes. Negative predictors of growth were total energy and nutrients that are contained in high amounts in plant foods. The study shows that growth was positively predicted by energy and nutrients that are provided in high amounts and in a bioavailable form in meat and milk, and their inclusion into the diets of children in developing countries should be part of all food-based programmes in order to improve micronutrient status and growth.

School snacks containing animal source foods improve dietary quality for children in rural Kenya.

Provision of a snack at school could help alleviate the micronutrient malnutrition that is common among schoolchildren in developing countries. The Child Nutrition Project was designed to compare the efficacy of three school snacks in improving growth and cognitive function of children in rural Kenya. The snacks provided approximately 20% of the children's energy requirement, and were composed of equicaloric portions of githeri (a vegetable stew) alone (Energy group), githeri plus milk (Milk group) or githeri plus meat (Meat group). A fourth group of children served as Controls. When nutrient intakes from three, 24-h dietary recalls collected before feeding were compared to three, 24-h recalls conducted after feeding began, intakes of vitamin B-12, riboflavin, vitamin A and calcium increased more in the Milk group than in the Control group, whereas intakes of vitamin B-12, vitamin A, calcium, available iron and available zinc increased more than those of Controls for children in the Meat group. At most of the time points examined, total energy intake increased more for the Meat group than for the other two feeding groups, because the additional energy provided by the Milk and Energy snacks was partially balanced by a decrease in the energy content of foods consumed at home. This decrease did not occur to the same extent for the Meat group, so both dietary quantity and dietary quality improved. For the Milk group, only dietary quality improved. For the Energy group, there were no significant changes in the total day's diet compared to the Control group.

Food supplements have a positive impact on weight gain and the addition of animal source foods increases lean body mass of Kenyan schoolchildren.

Observational studies of dietary patterns and growth and studies with milk supplementation have shown that children consuming diets containing animal source foods grow better. This study evaluates the growth of 544 Kenyan schoolchildren (median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy supplement (approximately 1255 kJ) compared to a control group without a supplement. Multivariate analyses controlled for covariates compared gain in weight, height, weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), mid-upper-arm circumference, triceps and subscapular skinfolds, mid-upper-arm muscle and mid-upper-arm fat area. Children in each of the supplementation groups gained approximately 0.4 kg (10%) more weight than children in the Control group. Children in the Meat, Milk and Energy groups gained 0.33, 0.19 and 0.27 cm more, respectively, in mid-upper-arm circumference than children in the Control group. Children who received the Meat supplement gained 30-80% more mid-upper-arm muscle area than children in the other groups, and children who received the milk supplement gained 40% more mid-upper-arm muscle area than children who did not receive a supplement. No statistically significant overall effects of supplementation were found on height, HAZ, WHZ or measures of body fat. A positive effect of the milk supplement on height gain could be seen in the subgroup of children with a lower baseline HAZ (< or = -1.4). The results indicate that food supplements had a positive impact on weight gain in the study children and that the addition of meat increased their lean body mass.