Associations between the home environment and children's sweet beverage consumption at 2-year follow-up: the 'Be active, eat right' study.

BACKGROUND: This study evaluates the association between home environmental characteristics and sweet beverage consumption (i.e. beverages that contain sugar) of 7-year-old children. METHODS: The population for analysis consisted of n = 2047 parents and their children from the population-based 'Be active, eat right' study. Data on sociodemographic characteristics, parental beliefs, parenting practices and child's sweet beverage consumption were obtained by parental report with questionnaires. We performed linear and multinomial regression analyses evaluating associations between characteristics at age 5 years and (i) consumption at 7 years and (ii) consumption patterns between age 5 and 7 years with reference category 'low consumption'. RESULTS: Based on the report from their parents, 5-year-old children drank on average 3.0 (SD:1.4) sweet beverage per day. Children consumed less sweet beverages at age 7 years (beta -0.16, 95% confidence interval [CI] -0.24 to -0.09) when there were less sweet beverages available at home. The multinomial regression model showed that children with parents who discouraged sweet beverage consumption were more likely to decrease their sweet beverage consumption over the study period (odds ratio: 1.24, 95% CI 1.07 to 1.43). Moreover, when there were less sweet beverages available at home, children were less likely to increase their consumption or have a high consumption over the study period (odds ratio: 0.70, 95% CI 0.59 to 0.83 and 0.61, 95% CI 0.54 to 0.70, respectively). CONCLUSIONS: The results showed that characteristics of the home environment are associated with the consumption of sweet beverages among children. Specifically, the availability of sweet beverages at home is associated with the child's sweet beverage consumption.

Home environmental determinants of children's fruit and vegetable consumption across different SES backgrounds.

OBJECTIVE: To investigate the association between home environmental determinants of fruit and vegetable consumption with childhood overweight separately for low, medium and high social economic status (SES) families. METHOD: A cross-sectional study was carried out in 2006 among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Of these children, data were available on measured height and weight, and from a parental questionnaire, on sociodemographic characteristics and children's fruit and vegetables intake. Associations were studied using logistic regression analyses. RESULTS: Not eating the recommended amounts of vegetables daily was associated with overweight for children with a low SES background (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 0.66-2.07) and medium SES background (OR: 1.73; 95% CI: 1.20-2.49). Eating < 2 pieces of fruit daily was associated with a lower OR for overweight among children with a high SES background (OR: 0.66; 95% CI: 0.50-0.88). Determinants of eating vegetables < 7 d were: permission to take candy without asking, eating at the table < 7 d per week, eating a takeaway meal ≥ 1 d per week, eating a home cooked meal < 6 d per week and cooking together with caregiver less than 5 d per week. CONCLUSION: Interventions regarding vegetable consumption should be tailored to families with low and medium SES background. The most promising avenues for intervention seem to be (i) to prevent eating takeaway meals on a weekly basis and, (ii) to promote eating a home cooked meal at the table and (iii) to involve children in the cooking process. Interventions should support parents in making these home environmental changes.

Dutch teachers and parents about overweight prevention in pre-vocational schools.

Healthier lifestyles may contribute to prevent overweight in adolescents. Although school-based interventions show promising results, adoption and implementation by secondary schools and involvement of parents is difficult. Our study aims to gain a better understanding of the problem awareness and beliefs of school staff and parents regarding adolescents' overweight and energy balance-related behaviour, their motivation for health-promoting activities and suggested actions in the school environment. Focus group interviews were conducted with three groups of parents and three groups of school staff at three pre-vocational schools in the Netherlands. Comments concerning awareness, motivation to intervene and possible actions were analysed with the Atlas.ti program. Results showed that school staff and parents were aware of overweight as a health problem, but underestimated the prevalence and impact of overweight and unhealthy behaviour in their school. Health-related behaviour of adolescents was considered primarily the responsibility of parents, but the school staff also had a pedagogical responsibility. Parents and school staff agreed that health promotion efforts would have more impact on adolescents' behaviour, when school-based activities were supported by parents and parental efforts were supported by school health promotion. Therefore, parental efforts and school-based activities should be aligned by developing and expressing shared norms about healthy behaviour and parents should be taught how to discuss healthy dietary and physical activity behaviour with their children. To tackle peer group culture and the obese environment, parents' and school staff's efforts should be part of an integrated community approach.

Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error.

Bioelectrical impedance analysis (BIA) is a practical method to estimate percentage body fat (%BF). In this systematic review, we aimed to assess validity, responsiveness, reliability and measurement error of BIA methods in estimating %BF in children and adolescents.We searched for relevant studies in Pubmed, Embase and Cochrane through November 2012. Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies. We performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. We included 50 published studies. Mean differences between BIA and reference methods (gold standard [criterion validity] and convergent measures of body composition [convergent validity]) were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity. We found strong evidence for a good reliability, i.e. (intra-class) correlations ≥0.82. However, test-retest mean differences ranged from 7.5% to 13.4% of total %BF in the included study samples, indicating considerable measurement error. Our systematic review suggests that BIA is a practical method to estimate %BF in children and adolescents. However, validity and measurement error are not satisfactory.

Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13-year-old children.

OBJECTIVE: TV viewing and computer use is associated with childhood overweight, but it remains unclear as to how these behaviours could best be targeted. The aim of this study was to determine to what extent the association between TV viewing, computer use and overweight is explained by other determinants of overweight, to find determinants of TV viewing and computer use in the home environment and to investigate competing activities. METHOD: A cross-sectional study was carried out among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Data collection consisted of measured height, weight and waist circumference, and a parental questionnaire on socio-demographic characteristics, child's nutrition, physical activity (PA) and sedentary behaviour. Associations were studied with logistic regression analyses, for older and younger children, boys and girls separately. RESULTS: The odds ratio (OR) of being overweight was 1.70 (95% confidence interval (CI): 1.07-2.72) for viewing TV >1.5 h among 4- to 8-year-old children adjusted for all potential confounders. Computer use was not significantly associated with overweight. Determinants of TV viewing were as follows: having >2 TVs in the household (OR: 2.38; 95% CI: 1.66-3.41), a TV in the child's bedroom and not having rules on TV viewing. TV viewing and computer use were both associated with shorter sleep duration and not with less PA. CONCLUSION: Association between TV viewing and overweight is not explained by socio-demographic variables, drinking sugared drinks and eating snacks. Factors in the home environment influence children's TV viewing. Parents have a central role as they determine the number of TVs, rules and also their children's bedtime. Therefore, interventions to reduce screen time should support parents in making home environmental changes, especially when the children are young.

Association between sleep duration and overweight: the importance of parenting.

OBJECTIVE: Sleep duration has been related to overweight in children, but determinants of sleep duration are unclear. The aims were to investigate the association between sleep duration and childhood overweight adjusted for family characteristics and unhealthy behaviours, to explore determinants of sleep duration and to determine with sleep competing activities. METHOD: A cross-sectional study was carried out in 2006 among 4072 children aged 4-13 years in the city of Zwolle, The Netherlands. In these children, data were available on measured height, weight and waist circumference, and from a parental questionnaire, on socio-demographic characteristics, child's sleep duration, nutrition, physical activity and sedentary behaviour. Associations were studied in 2011 using logistic and linear regression analyses, adjusted for potential confounders. RESULTS: Short sleep duration was associated with overweight for 4-8-year-old boys (odds ratio (OR):3.10; 95% confidence interval (CI):1.15-8.40), 9-13-year-old boys (OR:4.96; 95% CI:1.35-18.16) and 9-13-year-old girls (OR:4.86; 95% CI:1.59-14.88). Among 4-8-year-old girls no statistically significant association was found. Determinants for short sleep duration were viewing television during a meal, permission to have candy without asking, not being active with their caregiver and a late bedtime. For all children, short sleep duration was strongly associated with more television viewing and computer use. CONCLUSIONS: Association between sleep duration and overweight is not explained by socio-demographic variables, drinking sugared drinks and eating snacks. Parents have a key role in stimulating optimal sleep duration. Improving parenting skills and knowledge to offer children more structure, and possibly with that, increase sleeping hours, may be promising in prevention of overweight.

Childhood obesity in the Caribbean.

OBJECTIVE: To determine the prevalence of overweight among school children in Bonaire, an island in the Caribbean, and to obtain clues for prevention of overweight. METHODS: In a cross-sectional school-based study, weight and height were measured in all 4-16-year old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and nutrition. RESULTS: The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern. Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day compared to normal weight children (56%). CONCLUSION: The prevalence of overweight and obesity in children in Bonaire is high. Prevention of overweight should focus on stimulating healthy eating habits and more physical activity.

Body size and growth in 0- to 4-year-old children and the relation to body size in primary school age.

Excess weight in early life is believed to increase susceptibility to obesity, and in support of such theory, excess weight and fast weight gain in early childhood have been related to overweight later in life. The aim of this study was to review the literature on body size and growth in 0- to 4-year-old children and the association with body size at age 5-13 years. In total, 43 observational studies on body size and/or growth were included, of which 24 studies had been published in 2005 or later. Twenty-one studies considered body size at baseline, and 31 studies considered growth which all included assessment of weight gain. Eight (38%) studies on body size, and 15 (48%) on weight gain were evaluated as high-quality studies. Our results support conclusions in previous reviews of a positive association between body size and weight gain in early childhood, and subsequent body size. Body size at 5-6 months of age and later and weight gain at 0-2 years of age were consistently positively associated with high subsequent body size. Results in this review were mainly based on studies from developed Western countries, but seven studies from developing countries showed similar results to those from developed countries.

[Obscurity still exists with regard to the policy in undescended testes: early operation versus well-underpinned wait-and-see policy]. / Nog steeds onduidelijkheden over het beleid bij niet-scrotale testis: vroeg opereren versus onderbouwd afwachten.

The frequency of orchidopexy in the Netherlands is higher than the frequency of genuine undescended testes in spite of an existing consensus guideline on the subject. Evidence that orchidopexy has a positive effect on fertility or the decrease of testicular malignancy is lacking. Clinical trials are necessary to answer the question whether orchidopexy before the age of 2 years prevents malignancy or improves fertility. It is important that research that shows no results of early orchidopexy is also published. A public health approach is necessary to prevent unnecessary surgical interventions.

Health-related-quality-of-life in obese adolescents is decreased and inversely related to BMI.

AIM: To compare health related quality of life (HRQoL) of obese adolescents with normal weight controls and to explore the relation between Body Mass Index (BMI) and HRQoL. METHODS: Cross-sectional study in 31 adolescents (12-18 years), referred for obesity, in comparison with 62 age and sex matched normal weight controls. HRQoL was assessed using the PedsQL 4.0 and Child Health Questionnaire (CHQ). The main outcome measure was difference in HRQoL between obese and control subjects. RESULTS: Mean BMI (SD) in patients versus controls was 34.9 (8.8) versus 19.5 (2.2) kg/m2. In obese adolescents, lower HRQoL in three PedsQL and seven CHQ scales was found (p < 0.05). Variance in HRQoL scales explained by obesity ranged from 8% (CHQ Physical Functioning) to 28% (CHQ Global Health). BMI z-score was inversely correlated with five PedsQL and 10 CHQ scales while the percentage of scale variance explained by BMI z-score ranged from 7% (CHQ Physical summary scale) to 33% (CHQ Global Health). CONCLUSION: HRQoL in obese adolescents is less than in normal weight controls, and is partially explained by obesity-related comorbidity. Overall HRQoL was inversely associated with BMI. Hence, HRQoL is an important indicator of impact of obesity and effect of interventions, complementary to clinical variables.

Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents.

OBJECTIVE: To examine among adolescents (1) the prevalence of neck/shoulder, low back, and arm pain within different sociodemographic groups and (2) the association of neck/shoulder, low back, and arm pain with computer use, physical activity, depression, and stress. METHODS: A school-based questionnaire survey in 2002 and 2003 of neck/shoulder, low back, and arm pain, computer use, physical activity, depression, and stress. The survey was given to 3485 adolescents aged 12 to 16 years who attended secondary schools in Amsterdam, Netherlands. RESULTS: The overall prevalence of neck/shoulder, low back, and arm pain was 11.5%, 7.5%, and 3.9%, respectively. The prevalence of neck/shoulder pain was higher among girls and adolescents not living with both parents. The prevalence of low back pain also was higher among girls. Depressive symptoms were associated with neck/shoulder pain, low back pain, and arm pain. The stress experienced was associated with neck/shoulder pain and with low back pain. CONCLUSIONS: This study strengthens the findings that musculoskeletal pain is common among adolescents and is associated with depression and stress but not with computer use and physical activity.

Determinants of Dutch parents' decisions to vaccinate their child.

This study examines the factors that influence parents' decisions to have their children vaccinated under the Dutch National Immunisation Programme. A computer questionnaire was sent to 500 parents in 1999 (the response rate was 98.2%). The intention to vaccinate was most strongly determined by attitudes. The belief that vaccination is safe and the best way to protect children against infectious diseases positively influenced parents' attitudes. The idea that children receive too many vaccines simultaneously and that vaccination interferes with natural development had a negative effect on attitudes. Dutch parents believe that doctors only inform them about the benefits of vaccination and disregard possible drawbacks. Since attitudes did not appear to be the result of thorough deliberation, parents could easily be influenced by negative publicity about vaccination. Educational campaigns and practitioners' advice should provide complete information about all aspects of the question, enabling parents to make well-considered and therefore enduring decisions.

The prevalence of encopresis in a multicultural population.

BACKGROUND: Population-based studies on the prevalence of encopresis in children are scarce and generally outdated. Prevalence estimates based on clinical studies are unreliable because parents tend to be reticent to seek medical help for this problem. Professional help is necessary, however, because encopresis can lead to serious psychosocial health problems. The authors examined the prevalence of encopresis in children, the frequency of visits made to general practitioners for encopresis and the psychosocial health problems of encopretic children. METHODS: This population-based study involved 13,111 parents and their 5- to 6-year-old children and 9,780 parents and their 11- to 12-year-old children, all residents of Amsterdam, the Netherlands. RESULTS: The prevalence of encopresis was 4.1% in the 5-to-6 age group and 1.6% in the 11-to-12 age group. Encopresis was more frequent among boys and children from the very depressed areas of the city. Encopresis was less frequent among Moroccan and Turkish children. A defecation frequency of less than three per week was found in 3.8% of the 5- to 6-year-olds and 10.1% of the 11- to 12-year-olds with encopresis. Only 37.7% of the 5- to 6-year-olds and 27.4% of the 11- to 12-year-olds who had encopresis had ever been taken to see a doctor for this problem. Psychosocial problems were far more common among children with encopresis than among normal children. CONCLUSIONS: Encopresis is a common condition that is often associated with psychosocial health disorders but only a small proportion of the children with encopresis are taken to a general practitioner to discuss their problem.

Vaccination rates in a multicultural population.

AIMS: To establish whether there are social or cultural groups of children in Amsterdam with relatively low vaccination coverage for diphtheria, pertussis, tetanus, and poliomyelitis (DPTP), and for measles, mumps, and rubella (MMR). METHODS: All of the 57,382 children aged between 5 and 12 years and living in Amsterdam on 1 January 2003 were analysed with respect to vaccination and sociodemographic data collected routinely by the Department of Child Health Care. The State Vaccination Programme (SVP) guidelines were adhered to in order to determine vaccination status. RESULTS: The overall respective DPTP and MMR vaccination rates were 93.0% and 93.9%. No great differences in vaccination levels were found between depressed and affluent areas or between the children of Dutch and non-Dutch mothers. However, foreign children who had been born abroad (Surinam, Morocco, Turkey) were most likely not to have been fully vaccinated. Children who attended anthroposophical schools were also found to be considerably less frequently fully immunised than those at other types of schools. CONCLUSIONS: Vaccination coverage for children domiciled in Amsterdam was very high. Nevertheless, there are groups where the vaccination level is relatively low and social contact is high.

[Overweight and obesity in children and adolescents and preventative measures]. / Overgewicht en obesitas bij kinderen en adolescenten en preventieve maatregelen.

The prevalence of overweight and obesity in children is increasing rapidly. This is alarming because obesity is associated with severe chronic diseases, such as type 2 diabetes mellitus. Obesity at young age is related to obesity at adult age. Consequently, the prevention of overweight from childhood onwards is an important issue. Apart from diabetes mellitus type 2 there is an increased risk of orthopaedic complications, respiratory problems, fertility problems, cardiovascular diseases and psychosocial consequences in the form of a negative self-image, emotional and behavioural problems and depression. Environmental and behavioural factors are regarded as the most important causes of the rapid increase in the prevalence of overweight and as the most important starting points for prevention. Most prevention programmes are still in the initial stages. Prevention programmes aimed at stimulating breast feeding and daily physical activity (playing outside) and the restriction of sweetened drinks and watching TV are very promising. With such preventive measures the involvement of both the school and the parents is important.

[Television watching and some eating habits of 6-14-year-old children in Amsterdam, the Netherlands; a cross-sectional study]. / Televisiekijken en enkele eetgewoonten bij Amsterdamse 6-14-jarigen; een transversaal onderzoek.

OBJECTIVE: To describe the time spent by children between the ages of 6-14 years watching television during a weekday and to examine associated factors. DESIGN: Cross-sectional questionnaire study. METHOD: Data were collected during a vaccination campaign against meningococci C in Amsterdam in September 2002. From a sample of 2910 parents of 6-14-year-old children 1775 agreed to participate in the study. Socio-demographic characteristics and data on television viewing the previous day, the presence of a television in the child's bedroom and on eating habits were collected by short interviews. RESULTS: In total 1587 children were included in the analyses, 805 boys and 782 girls. In total 40.1% of the boys and 36.5% of the girls had watched television for > or = 2 h during the previous day. Among the children < or = 10 years 28.7% had a television in their bedroom, among children > 10 years this was 45.7%. Age (> 10 years), ethnicity (notably Surinam origin) and having a television in the bedroom was related to spending more time watching television. Having parents with a high socioeconomic status (SES) was associated with less television viewing than having parents with a lower SES. Children who had not eaten fresh fruit or who had visited a snackbar the previous day had been watching television for > or = 2 h more often than children who had eaten fresh fruit (p < 0.001) or who had not visited a snackbar (p < 0.05). CONCLUSION: Children spent a lot of time watching television. In view of the relation between television viewing and overweight this is an alarming development. Possibilities for the prevention of overweight by reducing television viewing must be investigated.

[The incidence and initial symptoms of diabetes mellitus type 1 in 0-14-year-olds in the Netherlands, 1996-1999]. / De incidentie en de eerste symptomen van diabetes mellitus type 1 bij 0-14-jarigen in Nederland, 1996-1999.

OBJECTIVE: To determine the incidence and characteristics of type-1 diabetes mellitus (DM) in children aged 0-14 years during the period 1996-1999 and to compare this with previous measurements of the incidence. DESIGN: Descriptive. METHOD: Data were collected via reports from all practicing paediatricians to the Dutch Paediatric Surveillance Unit and a questionnaire among members of the Dutch Diabetes Association. The incidence was calculated by the capture-recapture method, and the characteristics and symptoms of the children were determined from the questionnaires. RESULTS: The incidence of DM type 1 among 0-14-year-olds increased to 18.6/100,000/year (95% CI: 17.7-19.4) compared to 11.1/100,000/year (10.5-11.7) in 1978-1980. The increase was highest in the youngest age group, 0-4 years. DM type 1 was diagnosed at an average age of 7.6 years (7.4-7.9) and in 1988-1990 at 9.2 years (9.0-9.5). The boy-girl ratio also increased. Children with a mother from Surinam, Turkey or The Netherlands Antilles had lower risk of DM type 1 while a higher risk was calculated for children from Moroccan and Somali mothers. In comparison with 1993-1994, there were less frequent lethargy or dehydration; lower average serum-glucose values, a better blood pH and less frequent ketonuria at the time of diagnosis. Treatment on an outpatient basis had increased. However, over the time span 1993-1999, Moroccan children (n = 108) showed dehydration, ketonuria and low blood-pH values more frequently than children of Dutch parents (n = 1825) and their hospital admission lasted longer. CONCLUSION: The incidence of DM type 1 had increased and the disease manifested itself at a younger age. The clinical condition at time of diagnosis, however, was better. The incidence and clinical characteristics differed between children of different ethnic origin.

Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years.

BACKGROUND: On the question of how to counsel adolescents with irregular menstrual cycles or oligomenorrhoea, no clear answer has been given. Adolescents with oligomenorrhoea especially show endocrine abnormalities and may be at risk for ovulatory dysfunction and the polycystic ovary syndrome in adulthood. METHODS: We followed a cohort of adolescents to document changes in menstrual cycle pattern between ages 15 and 18 years in the general population. RESULTS: Two per cent (2/128) of adolescents with regular menstrual cycles developed oligomenorrhoea, and 12% (17/148) of those with irregular menstrual cycles did so. Fifty-one per cent (34/67) of the oligomenorrhoeic adolescents remained oligomenorrhoeic. Increase in body mass index (BMI), concentration of LH, androstenedione or testosterone, and polycystic ovaries (PCO) were associated with persistence of oligomenorrhoea. In multivariate analysis only a normal to high BMI (>19.6 kg/m(2)) consistently contributed significantly to predict persistent oligomenorrhoea. Glucose:insulin ratio as a marker for insulin resistance was not associated with an increased risk for oligomenorrhoea. CONCLUSIONS: Oligomenorrhoea at age 18 years is better predicted by menstrual cycle pattern at age 15 years than by LH or androgen concentrations or PCO at this age. Not only obese, but also normal weight oligomenorrhoeic, adolescents have a high risk of remaining oligomenorrhoeic.

[Insulin resistance and diabetes type 2 in overweight children]. / Insulineresistentie en diabetes mellitus type 2 bij kinderen met overgewicht.

The prevalence of overweight and obesity in children is increasing significantly. This increase is attended by an increase in diabetes type 2 in children and adolescents. The most important risk factor for the rise of insulin resistance amongst young people is overweight. The diagnostic criteria for diabetes mellitus in young people are: (a) symptoms of diabetes mellitus and a random plasma-glucose concentration of > or = 11.1 mmol/l, or (b) fasting plasma-glucose concentration of > or = 7.0 mmol/l, or (c) 2-hour plasma-glucose levels following an oral glucose-tolerance test > or = 11.1 mmol/l. Treatment involves lowering the glucose concentration by changes in lifestyle such as more physical exercise and dieting. In the US, metformin is registered for use in young people. Insulin is indicated in cases of serious hyperglycaemia or diabetic ketoacidosis. Early detection is very useful in obese children with two additional risk factors: diabetes type 2 in first- and second-degree relatives, members of certain ethnic groups or indications of insulin resistance.