Project Earthrise: Proceedings of the Ninth Annual Conference of inVIVO Planetary Health.

The "Earthrise" photograph, taken on the 1968 Apollo 8 mission, became one of the most significant images of the 20th Century. It triggered a profound shift in environmental awareness and the potential for human unity-inspiring the first Earth Day in 1970. Taking inspiration from these events 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO Planetary Health. This builds on the emergent concept of planetary health, which provides a shared narrative to integrate rich and diverse approaches from all aspects of society towards shared solutions to global challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention to many other interconnected global health, environmental, social, spiritual, and economic problems that have been underappreciated or neglected for decades. This is accelerating opportunities for greater collaborative action, as many groups now focus on the necessity of a "Great Transition". While ambitious integrative efforts have never been more important, it is imperative to apply these with mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise is our contribution to this important process. This underscores the imperative for creative ecological solutions to challenges in all systems, on all scales with advancing global urbanization in the digital age-for personal, environmental, economic and societal health alike. At the same time, our agenda seeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting the inspiration of "Earthrise", we welcome diverse perspectives from across all dimensions of the arts and the sciences, to explore novel solutions and new normative values. Building on academic rigor, we seek to place greater value on imagination, kindness and mutualism as we address our greatest challenges, for the health of people, places and planet.

Impact of outdoor nature-related activities on gut microbiota, fecal serotonin, and perceived stress in preschool children: the Play&Grow randomized controlled trial.

Due to rapid urbanization, children today have fewer opportunities to interact with nature and this may result in a greater risk for developing stress and depression. Outdoor nature-related activities can enhance general well-being. However, the underlying mechanisms are not fully delineated. Here we recruited 54 preschool children to participate in a 10-week structured nature-related "Play&Grow" program. Following the intervention, children were assessed for connectedness to nature and perceived stress levels using validated questionnaires. Moreover, fecal serotonin level and gut microbiota profiles were measured by ELISA and 16S rDNA amplicon sequencing, respectively. Children were significantly more connected to nature after the intervention. Their gut microbiota altered, especially by modulating the abundance of Roseburia and the fecal-serotonin level. Moreover, we also observed a reduction in the overall perceived stress, particularly in the frequency of anger among these children. This study is the first to demonstrate the impact of nature-related activities on gut microbiota, fecal serotonin and psychosocial behaviour of preschool children. However, further mechanistic studies are needed to confirm the functional role of gut microbiota in the association between connectedness to nature and improved psychosocial behavior.

Does connectedness to nature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play&Grow randomised controlled trial in Hong Kong.

BACKGROUND: Nature-based interventions, which focus on outdoor play, mental health, and self-directed autonomous play, are becoming popular in promoting well-being. The objective of this study was to test whether connecting to nature would contribute to better feeding and eating habits in families with pre-schoolers. METHODS: 241 families with children aged two to five were randomly assigned to the Intervention (IG) and Control Groups (CG). IG received 10 sessions of a family-based programme, which included a novel Connectedness to Nature (CN) element. CG received only the government's health recommendations. The effectiveness of the intervention's primary outcomes (CN, eating/feeding behaviours) was analysed by a repeated measures structural equation model with intervention status as a causal predictor. RESULTS: 204 families (IG, n = 120; CG, n = 84) completed the measurements before and after the trial. The intervention had a medium effect on caregivers' CN (f2 = 0.16, (95%CI = 0.06, 0.30)) and a large effect on children's CN (f2 = 0.58, (95%CI = 0.36, 0.89)). In the IG, children's CN strongly predicted caregivers' feeding style (ß = 0.48 (p < .01, 95%CI = 0.14, 0.83)) and moderately, children's eating behaviours (ß = 0.21 (p = .16, 95%CI = -0.09, 0.52)). This produced a positive trend for greater vegetable consumption in the IG compared to the CG (ß = 0.20 (95%CI = 0.01, 0.39) vs. ß = -0.05, (95%CI = -0.18, 0.08)). Interestingly, the path values in the CG significantly reflected the traditional pattern, (e.g., parental feeding style strongly influenced children's eating behaviour (ß = 0.33, p = .001, 95%CI = 0.13, 0.54). CONCLUSIONS: The Play&Grow intervention positively increased caregivers' and children's CN. It also improved eating behaviors in children independent of their caregivers' feeding style. This may indicate a higher degree of autonomy in children's eating behaviour if they are exposed to nature. Further research should test the CN component in promotion of healthy eating in pre-schoolers.

Measuring connectedness to nature in preschool children in an urban setting and its relation to psychological functioning.

BACKGROUND: The urban environment has been criticized for promoting 'nature-deficit' and 'child-nature disconnectedness'. Keeping in mind the importance of nature exposure and its extensive health benefits, many environmental programs around the world hope to (re)connect children with nature. To evaluate the effectiveness of such efforts, valid tools to measure Connectedness to Nature (CN) are needed but do not exist today, especially for use with pre-schoolers. METHODS: The original CN Index was modified and tested among the Parents of Preschool Children (CNI-PPC) in an urban setting (Hong Kong) for its internal consistency (n = 299) and external validity (n = 194). The 'Strength and Difficulties Questionnaire' (SDQ) was chosen for divergent and convergent analysis. Conventional recommendations for test adaptation and translation were used. RESULTS: Confirmatory factor analysis (CFA) revealed that the 16-item scale adequately captured four major dimensions: enjoyment of nature, empathy for nature, responsibility toward nature, and awareness of nature (Cronbach's α were respectively .86, .87, .75 and .80). When tested against the SDQ, a validated measure for child psychological functioning, and identification of children's problem behaviours, three CNI-PPC factors influenced the SDQ outcomes: (1) the more enjoyment of nature children displayed the less overall distress and impairment they exhibited (ß = -.64); (2) greater responsibility toward nature in children was associated with less hyperactivity (ß = -.50), fewer behavioural and peer difficulties (ß = -.62 and ß = -.65 respectively) and improved prosocial behaviour (ß = .77); (3) the more aware children were of nature, the less emotional difficulties they exhibited (ß = -.51). The variance explained was large (range R2 = .42 to .80). CONCLUSIONS: Thus, CNI-PPC factors have meaningful and substantive associations with the strengths and difficulties parents perceive in their children. This indicates that the CNI-PPC is a valid and reliable instrument to measure CN at an age when children cannot respond for themselves. Further, this simple tool can help researchers/practitioners to better understand how connectedness to nature affects child psychological functioning and wellbeing. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02715544. Registered 8 March 2016.

Physical Activity Patterns and Correlates of 9-Month-Old Chinese Infants in the Macau Population.

Objectives Many obesity-related chronic diseases originate from unhealthy childhood habits. The aim of this study was to describe 9-month-old infants' physical activity levels and patterns and to examine the correlates. Understanding these factors is necessary for improving the effectiveness of physical activity intervention programs for infants. Methods In total, 143 infant-mother dyads from Macau, SAR China, participated in this study. Physical activity (PA) was assessed by using the Actigraph GT3X+ accelerometer and the demographic variables were collected by questionnaires. Results The most important findings were that: (1) infants had more screen time during weekdays (p = .044); (2) infants and mothers were least active at 8 a.m. (both weekdays and weekends) in the morning and most active at 7 p.m. (weekdays) and 8 p.m. (weekends) in the evening; (3) infants' PA levels significantly correlated with their mothers' PA intensities during the weekends (r = .192, p = .036), especially the mothers' lower intensities in the mornings and evenings; (4) maternal BMI predicted the PA levels of the 9-month-old infants' (R2 = .06, ß = 29.188, p = .009). Conclusions for Practice Physical activity promotion programs for infants should be time-specific starting from early infancy. This study was one of the first to examine 9-month-old infants' PA levels, patterns and correlates. The results may be helpful in improving the effectiveness of future healthy lifestyle intervention programs for infants in Macau and in the region in general.

Promoting healthy eating and active playtime by connecting to nature families with preschool children: evaluation of pilot study "Play&Grow".

BACKGROUND: This pilot project aimed to evaluate the "Play&Grow" program which promotes age-appropriate dietary habits and playtime healthy routines through "connectedness to nature" experiences in Hong Kong families with young children. METHOD: Thirty-eight preschoolers (aged 33.97 ± 9.38 mo), mothers, and their domestic workers were recruited. The families attended one workshop/week for a 4-mo period, consisting of: (i) health topic; (ii) food games; (iii) nature-related outdoor activities. RESULTS: Feeding practices, particularly Promoting and Encouragement to eat (PE) and Instrumental Feeding (IF) improved after the intervention (P = 0.008 and P = 0.016, respectively). Mother's BMI, responsibility for child's meal, child's birth weight had a bearing on the improvement of PE, r2 = 0.243, F(3,33) = 3.54, P = 0.025. Domestic helper's responsibility for child's cooking and her IF practices could predict child's picky eating (r2 = 0.203, F(2,34) = 4.322, P = 0.021). Mother's responsibility for child and helper's responsibility for cooking could predict child's consumption of salty foods (r2 = 0.252, F(2,34) = 5.737, P = 0.007). Physical activity of caregivers improved after the intervention. CONCLUSION: The pilot confirmed the design, protocols, evaluation instruments, and logistics of the study. Modified "Play&Grow" intervention will be conducted in a more rigorous randomized controlled trial to determine the long-term impact on obesity prevention in Hong Kong.

A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature.

BACKGROUND: Promotion of healthy lifestyles in children focuses predominantly on proper nutrition and physical activity, elements now widely recognised as essential for a healthy life. Systematic reviews have shown that nature-related activities also enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. Recent research suggests that many young children in Hong Kong between the ages of two and four in Hong Kong are more sedentary than recommended and seldom participate in active play, placing them at risk of becoming overweight or obese. The proposed project aims to investigate whether connecting families to nature positively influences physical activity (i.e., active playtime) and healthy eating routines in children aged 2 to 4. METHODS: We recently conducted a pilot study in Hong Kong to develop a programme, Play & Grow, based on the most successful evidence-based international preschool interventions. In addition to adopting the healthy eating and physical activity elements of these interventions, this project will additionally include a third novel element of Connectedness to nature: discovering nature through games and awareness of sounds, touch, smells, and temperature. To test the effectiveness of this modified intervention, a randomised controlled trial (RCT) involving 240 families with children aged 2 to 4 will be conducted. Families and children will take part in weekly one-hour activity sessions for 10-weeks. Lifestyle-related habits will be assessed before and immediately after the 10-week intervention, with follow up testing at 6 and 12 months' post intervention. DISCUSSION: A novel measuring tool created specifically for assessing Connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RCT. The results of the RCT are intended to be used to understand which components of the intervention are most effective. The objectives of this project will be achieved over a 30-month period and will contribute to the research that examines key components of successful healthy lifestyle promotion programmes during early childhood. We predict that the inclusion of Connectedness to nature will significantly improve recognised preschool interventions. Finally, the aim of targeting family involvement will hopefully increase the sustainability of longer-term lifestyle modifications in children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02715544 . Registered 22 March 2016.

Feasibility of a Chest-worn accelerometer for physical activity measurement.

OBJECTIVES: A "proof-of-concept" study to examine the feasibility of wearing an Actigraph GT3X+ at the Chest (resembling a neck pendant) for physical activity measurement. DESIGN: A convenience sample of 45 healthy adults (23 male, mean age 20.0±4.5 years) was included in data analysis. METHODS: Participants simultaneously wore three GT3X+ accelerometers, on the Waist, Wrist, and Chest and completed 8 bouts of slow (.67, .89, 1.11m/s), average (1.33, 1.56, 1.78m/s) and fast (2.00, 2.22m/s) walking on a treadmill. Paired t-test, correlations and absolute percentage errors (APE) of accelerometer output (vector magnitude, VM) were computed for the key pairs: Waist-Wrist; and Waist-Chest. RESULTS: The Wrist-site overestimated VM to a greater extent at all speeds in comparison to the Chest. Pearson's r correlations were weaker for Waist-Wrist (<.80) in comparison to the Waist-Chest (>.85). The APE's were much lower (i.e. higher agreement) for the Chest (9.23-15.5%) compared to the Wrist (19.7-54.9%). Participants also felt the Chest-site was more acceptable than the Waist-site. CONCLUSIONS: PA measurements recorded by a Chest worn GT3X+ more closely resembled PA measurements recorded at the traditional Waist site than when compared to the Wrist site. When combined with high Chest site preference, the findings of our study suggest that the Chest is a feasible site for accelerometer wear.

Breastfeeding practices and policies in WHO European Region Member States.

OBJECTIVE: To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region. DESIGN: National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution. SETTING: WHO European Member States. RESULTS: Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries. CONCLUSIONS: Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.

Obesogenic dietary intake in families with 1-year-old infants at high and low obesity risk based on parental weight status: baseline data from a longitudinal intervention (Early STOPP).

PURPOSE: To compare dietary intake in 1-year-old infants and their parents between families with high and low obesity risk, and to explore associations between infant dietary intake and relative weight. METHODS: Baseline analyses of 1-year-old infants (n = 193) and their parents participating in a longitudinal obesity intervention (Early STOPP) were carried out. Dietary intake and diet quality indicators were compared between high- and low-risk families, where obesity risk was based on parental weight status. The odds for high diet quality in relation to parental diet quality were determined. Associations between measured infant relative weight and dietary intake were examined adjusting for obesity risk, socio-demographics, and infant feeding. RESULTS: Infant dietary intake did not differ between high- and low-risk families. The parents in high-risk families consumed soft drinks, French fries, and low-fat spread more frequently, and fish and fruits less frequently (p < 0.05) compared to parents in low-risk families. Paternal intake of vegetables and fish increased the odds for children being consumers of vegetables (OR 1.7; 95 % CI 1.0-2.9) and fish, respectively (OR 2.5; 95 % CI 1.4-4.4). Infant relative weight was weakly associated with a high intake of milk cereal drink (r = 0.15; p < 0.05), but not with any other aspect of dietary intake, obesity risk, or early feeding patterns. CONCLUSIONS: At the age of one, dietary intake in infants is not associated with family obesity risk, nor with parental obesogenic food intake. Milk cereal drink consumption but no other infant dietary marker reflects relative weight at this young age.

Men in Macau SAR have higher prevalence in metabolic syndrome and among related metabolic components: a cross-sectional Macau Health Survey.

BACKGROUND: Macau has recently experienced expansive socioeconomic growth, leading to lifestyle changes that could have contributed to the development of certain diseases. Little information exists on the prevalence of metabolic syndrome (MetS) and associated risk factors. This information is important, since the management of MetS is tightly connected with prevention of cardiovascular diseases in the population. METHODS: This study is based on the cross-sectional Macau Health Survey 2006. Information on anthropometry, physical measurements, socio-demographics, laboratory tests and life-style habits was collected by trained health professionals from a random sub-population sample, aged 18-44 (32.6 ± 8.3). Body Mass Index (BMI) cut-offs were based on WHO criteria for Asian population. The prevalence of MetS, as defined by the International Diabetes Federation was calculated and the associated lifestyle factors were analysed. RESULTS: Among Macau's adults (n = 1592), the age-adjusted prevalence of MetS was over two times higher in men (10.5%) than in woman (3.7%), (p <0.01). 15.8% were overweight (BMI ≥23 < 25) and 18.8% were obese (BMI ≥25). Man had significantly higher risk profile in almost all components of MetS (p <0.001), except the waist circumference and HDL. BMI, age and education were significantly related to MetS in both genders (p <0.001). CONCLUSIONS: We found significant gender differences in MetS among the 18-44 year old population of Macau, which should be addressed separately in the gender-specific preventive strategies.

Dramatic escalation in metabolic syndrome and cardiovascular risk in a Chinese population experiencing rapid economic development.

BACKGROUND: Metabolic syndrome (MetSyn) increases the incidence of cardiovascular disease. Information on changes in prevalence of MetSyn in developing countries is limited. This study aims to compare MetSyn prevalence and its associated vascular risk over the period between 2002 and 2010 in a population which has had the world's fastest economic development over the past three decades. METHODS: Two health surveys were conducted by using the multistage cluster random sampling method in a Chinese population of 85 million in southern China. The participants received a full medical check-up, including measurement of blood pressure (BP), obesity indices, fasting lipids and glucose levels. Data describing socio-economic status and lifestyle factors were also collected through interview. Metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. RESULTS: A total of 3,561 participants from Survey 2010 were included in the data analysis. Women had a significantly higher prevalence of MetSyn than men. Comparison between the two surveys shows that age-standardized prevalence of MetSyn increased fourfold (from 5.4% in 2002 to 21.3% in 2010) in those ≧ 20 years. Among the MetSyn components, prevalence of hyperglycaemia has increased most (from 9.1% to 53.1%). The age-standardized prevalence of central obesity, hypertension, hypertriglyceridaemia and low HDL-cholesterol increased from 13.5% to 25.4%, from 23.6% to 40.8%, from 12.1% to 17.4% and from 32.1% to 71.1%, respectively. Differences between rural and urban residents in the prevalence in MetSyn and its components narrowed in 2010. CONCLUSIONS: Cardiovascular risk escalated dramatically in this population between 2002 and 2010. The escalation may relate to the rapid economic development, which led to accelerating changes in nutrition, lifestyle, and socio-economic status. Our findings suggest that health transition in rapidly developing second- and third-world countries may be much faster than what has been observed in Western countries.

Higher maternal education is associated with favourable growth of young children in different countries.

BACKGROUND: Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life. METHODS: We compared growth data of 4-year-old to 6-year-old children born 1997-2002 in UK (n=15,168), Sweden (n=6749) and rural China (n=10,327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<-2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII). RESULTS: Mean SDS height, weight and BMI in the UK (-0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (-0.98, -0.82, -0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: -25.8% and -12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: -3.3%) and Sweden (-2.8%), but not in China (+0.3%). CONCLUSIONS: Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings.

Eating behaviour patterns in Chinese children aged 12-18 months and association with relative weight--factorial validation of the Children's Eating Behaviour Questionnaire.

BACKGROUND: Eating behaviours have been suggested relating to obesity development. The Children's Eating Behaviour Questionnaire (CEBQ) is a parent-report measure constructed to assess multiple dimensions of eating behavior for children. This study aimed to test the validity of the Chinese version of Children's Eating Behaviour Questionnaire (CEBQ) in Chinese children aged 12-18 months. We examined factor structure and the reliability of the Chinese version of the CEBQ, the associations between children's eating behaviours and children's weight (BMI SDS) were assessed. METHODS: 219 questionnaires were filled out by the caregivers, approached in community health care centers in two cities in China. BMI of each child was calculated and converted to BMI SDS. Factor validation (Principal Component Analysis, exploratory factor analysis) on all CEBQ items was performed and gender difference in eating behaviours was examined. Correlations between eating behaviours and the child's BMI SDS were analyzed by linear regression analysis controlling for gender, parental combined weight, and education. RESULTS: The factor analysis revealed a seven-factor solution, with factor 'food responsiveness' (FR) split into two. 'Satiety responsiveness' (SR) and 'Enjoyment of food' (EF) factors were not detected. Interestingly, boys scored higher than girls in the FR scales, whereas girls had a higher score in 'food fussiness' (FF) scale. CONCLUSIONS: We conclude that although a valuable psychometric instrument, CEBQ might be affected by age and cultural differences. Therefore, adjusting it in order to fit the Chinese population was suggested. We did not find an association between eating behaviours and children's BMI SDS, when it was controlled for gender and parental weight.

Microbiota in the oral subgingival biofilm is associated with obesity in adolescence.

To test the hypothesis whether microbiota in oral biofilm is linked with obesity in adolescents we designed this cross-sectional study. Obese adolescents (n = 29) with a mean age of 14.7 years and normal weight subjects (n = 58) matched by age and gender were examined with respect to visible plaque index (VPI%) and gingival inflammation (bleeding on probing (BOP%)). Stimulated saliva was collected. They answered a questionnaire concerning medical history, medication, oral hygiene habits, smoking habits, and sociodemographic background. Microbiological samples taken from the gingival crevice was analyzed by checkerboard DNA-DNA hybridization technique. The sum of bacterial cells in subgingival biofilm was significantly associated with obesity (P < 0.001). The link between sum of bacterial cells and obesity was not confounded by any of the studied variables (chronic disease, medication, VPI%, BOP%, flow rate of whole saliva, or meal frequency). Totally 23 bacterial species were present in approximately threefold higher amounts, on average, in obese subjects compared with normal weight controls. Of the Proteobacteria phylum, Campylobacter rectus and Neisseria mucosa were present in sixfold higher amounts among obese subjects. The association between obesity and sum of bacterial cells in oral subgingival biofilm indicates a possible link between oral microbiota and obesity in adolescents.

Obesity related eating behaviour patterns in Swedish preschool children and association with age, gender, relative weight and parental weight--factorial validation of the Children's Eating Behaviour Questionnaire.

BACKGROUND: The Children's Eating Behaviour Questionnaire (CEBQ) is a multi-dimensional, parent-reported questionnaire measuring children's eating behaviours related to obesity risk, i.e. 'enjoyment of food', 'food responsiveness', 'slowness in eating' and 'satiety responsiveness'. It has not previously been validated in a Swedish population, neither on children under the age of 2 years. In the present study we examined the factor structure and the reliability of the Swedish version of the CEBQ, for use in an obesity intervention programme targeting preschool children 1-6 years. Further, the associations between eating behaviours and children's age, gender and relative weight (BMI SDS) and parental weight were investigated. METHODS: Parents to 174 children aged 1-6 years (50% girls, mean age 3.8 years), recruited from five kindergartens in Stockholm, completed the Swedish version of the CEBQ. Data on children's weight and height, parental weight, height and educational level was collected. Children's relative weight was calculated for a subpopulation (mean BMI SDS -0.4, n = 47). Factorial validation (Principal Component Analysis) on all CEBQ items was performed. Differences in eating behaviours by age, gender and parental weight were examined. Correlations between eating behaviours and the child's BMI SDS were analysed controlling for age, gender, parental weight and education in linear regression analyses. RESULTS: The factor analysis revealed a seven factor solution with good psychometric properties, similar to the original structure. The behaviour scales 'overeating'/'food responsiveness', 'enjoyment of food' and 'emotional undereating' decreased with age and 'food fussiness' increased with age. Eating behaviours did not differ between girls and boys. The children's relative weight was not related to any of the eating behaviours when controlling for age, gender, parental weight and education, and only associated with parental weight status. CONCLUSIONS: Our results support the use of the CEBQ as a psychometric instrument for assessing children's eating behaviours in Swedish children aged 1-6 years. Measuring obesity related eating behaviours in longitudinal and interventional studies would offer opportunities for studying causal effects of eating behaviours in the development of obesity in children.

A randomised controlled trial for overweight and obese parents to prevent childhood obesity--Early STOPP (STockholm Obesity Prevention Program).

BACKGROUND: Overweight and obesity have a dramatic negative impact on children's health not only during the childhood but also throughout the adult life. Preventing the development of obesity in children is therefore a world-wide health priority. There is an obvious urge for sustainable and evidenced-based interventions that are suitable for families with young children, especially for families with overweight or obese parents. We have developed a prevention program, Early STOPP, combating multiple obesity-promoting behaviors such unbalanced diet, physical inactivity and disturbed sleeping patterns. We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents. This protocol outlines methods for the recruitment phase of the study. DESIGN AND METHODS: This randomized controlled trial (RCT) targets overweight and/or obese parents with infants, recruited from the Child Health Care Centers (CHCC) within the Stockholm area. The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach (dietitian, physiotherapist or a nurse). The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC, which include advices on healthy food choices and eating patterns, increasing physical activity/reducing sedentary behavior and regulating sleeping patterns. DISCUSSION: The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population, defining a feasible, theory-based intervention and assessing multiple measurements to validate and interpret the program effectiveness. The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge, this longitudinal RCT is the first attempt to demonstrate whether an early, long-term, targeted health promotion program focusing on healthy eating, physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective. If proven so, Early STOPP may protect children from the development of overweight and obesity. TRIAL REGISTRATION: The protocol for this study is registered with the clinical trials registry clinicaltrials.gov, ID: ES-2010).

Neonatal sepsis, antibiotic therapy and later risk of asthma and allergy.

Neonatal sepsis and early antibiotic therapy affect bacterial colonisation and immune activation after birth. This could have implications for later risk of allergy and asthma. Using a validated questionnaire (International Study of Asthma and Allergies in Children, ISAAC), we screened for asthma and allergy in three cohorts (total n = 834; median age 12, range 7-23 years) with different perinatal exposures as regards infection and antibiotics. Asthma, but not hay fever, was more prevalent after neonatal sepsis with adjusted odds ratio (OR) 1.63 [95% confidence interval (CI) 1.04, 2.56] and early antibiotic therapy (OR 1.48 [0.93, 2.35]) as compared with a control group. There was a trend towards increased atopic eczema after neonatal sepsis (OR = 1.39 [CI = 0.98, 1.98]). We conclude that neonatal sepsis is associated with an increased risk for later development of asthma. Early antibiotic exposure may contribute to this association.

Dietary nitrate in Japanese traditional foods lowers diastolic blood pressure in healthy volunteers.

BACKGROUND: Japanese longevity is the highest in the world. This is partly explained by low occurrence of cardiovascular diseases, which in turn is attributed to the Japanese traditional diet (JTD). Recent research demonstrates that nitric oxide (NO), a key regulator of vascular integrity, can be generated from nitrate (NO(3)(-)), abundantly found in vegetables. It can reduce blood pressure (BP) via its serial reduction to nitrite (NO(2)(-)) and to bioactive NO. Interestingly, JTD is extremely rich in nitrate and the daily consumption is higher than in any other known diet. OBJECTIVE AND DESIGN: In a randomized, cross-over trial we examined the effect of a 10-day period of JTD on blood pressure in 25 healthy volunteers. Traditional Japanese vegetables were encouraged to be consumed and avoided during the control period. Daily nitrate intake was calculated. RESULTS: Nitrate naturally provided by the JTD was 18.8 mg/kg/bw/day, exceeding the Acceptable Daily Intake by five times (ADI, 3.7 mg/kg/bw). Plasma and salivary levels of nitrate and nitrite were higher at the end of the JTD period. Diastolic BP decreased on average 4.5 mmHg during JTD compared to the control diet (P=0.0066) while systolic BP was not affected. This effect was evident in normotensive subjects and similar to that seen in the recent studies. CONCLUSIONS: An ordinary nitrate rich diet may positively affect blood pressure. Our findings further support the importance of the role of dietary nitrate on BP regulation suggesting one possible explanation of healthy aspects of traditional Japanese food.

Intestinal hydrogen and nitric oxide gases in preterm infants--effects of antibiotic therapy.

OBJECTIVE: Measurements of hydrogen (H(2)) and nitric oxide (NO) levels in intestinal gas have recently been shown to be useful to monitor bacterial colonization in healthy term newborn infants. The significance of preterm birth and antibiotic therapy for intestinal gas production is not known and was the subject of this study. METHODS: A minimally invasive tonometric technique was used for repeated measurements (44 samples) of luminal colonic H(2) and NO in 23 preterm infants with gestational age 27-35 weeks, birth weight 1,170-2,996 g and postnatal age 2-31 days. RESULTS: The measuring procedure was well tolerated in all infants. Intestinal H(2) was 300 (4-1,990) ppm and NO was 34 (11-82) ppb. Intestinal H(2) and NO increased during the first week (p < 0.05) to average levels that in the case of H(2), exceeded those of healthy, term infants. In preterm infants treated with antibiotics (n = 12), H(2) and NO levels were significantly lower than in those without such therapy (p < 0.05). CONCLUSION: These observations suggest that intestinal measurements of H(2) and NO may be used to monitor birth-related bacterial colonization in relation to postnatal age, maturation and antibiotic therapy. In preterm infants, gaseous distension of the gut is common and may signal bacterial overgrowth. The potential role of intestinal gas measurements as a diagnostic tool for intestinal disorders remains to be clarified.